ArticleBMC infectious diseases2025
Role of the alpha-1 antitrypsin in the progression and severity of COVID-19 infection among Saudi patients.
Article in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAlpha-1 antitrypsin (A1AT) is involved in pathophysiology of severe COVID-19, including thrombosis expansion. A1AT has anti-inflammatory, tissue-protective, and anticoagulant capabilities. We aimed to screen frequencies of A1AT gene polymorphism among COVID-19 Saudi patients and its relation to severity.
methodsThrough cross-sectional study, we examined 100 COVID-19 Saudi patients to explore possible correlation between A1AT/interleukin 6 (IL-6) ratio and COVID-19 severity. The COVID-19 patients grouped as severe (31 patients) and non-severe (69 patients) cases. A1AT gene polymorphism was conducted using the PCR technique amplification-refractory mutation system (ARMS) and ELISA.
resultsA1AT, IL-6, and vitamin D (VIT-D) showed extreme statistical significance among COVID-19 patients (severe, mild, and asymptomatic). The prevalence of A1AT gene mutation was higher among COVID-19 cases compared with non-mutated patients (56% vs. 44%). Moreover, serum A1AT levels were declined while serum IL-6 levels were above the reference range and highly significant among mutated cases compared with non-mutated cases. Also, IL-6/A1AT ratio in severe COVID-19 patients (mean 1.4) was significantly higher compared with asymptomatic or moderate patients (0.16, 0.21; respectively). All COVID-19 patients have severed deficiency of VIT-D level significant among mutated and non-mutated cases (p < 0.04 and p < 0.03; respectively). The frequency of MM (wild type) was substantially high among asymptomatic cases compared with severe cases (67.2% vs.16.1%). Heterozygous MS + MZ genotypes showed lower frequency among asymptomatic cases compared with severe and mild cases (27.6% vs. 48.4% and 72.7%; respectively). On the other hand, the more severe forms of SS + ZZ + SZ genotypes were all relatively rare with lower frequency among asymptomatic compared with mild and severe COVID-19 cases (5.2%, 27.3% and 35.5%; respectively). Interestingly, homozygous SS genotype elicited higher frequency among severe cases compared with mild or asymptomatic cases (22.6% vs. 0% and 5.2%). The more severe forms homozygous ZZ genotype vanished among asymptomatic and mild cases. This extensively illuminated that, severe COVID-19 patients have diminished A1AT response towards inflammation.
conclusionTwo haplotypes (S) and (Z) alleles of A1AT have higher frequency and were clearly recognized among severe COVID-19 cases suggesting that SS and ZZ genotypes may be associated with an increased risk, while MM genotype may be protective against severe COVID-19 infection. IL-6 and ATT levels can be used as predictor for severity of COVID-19. In addition, the increased potential involvement of these serum parameters in controlling viral entry in vivo but its weakness to be used as diagnostic parameter.
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