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α-1 Antitripsin Eksikliğinde Epigenetik ve Beslenme

Year 2024, Issue: 22, 354 - 369, 30.04.2024

Rümeysa Özçalkap İçöz Nihal Büyükuslu

https://doi.org/10.38079/igusabder.1340587

Abstract

α-1-proteinaz inhibitörü (PI) olarak da bilinen α-1 antitripsin (AAT), dolaşımdaki en bol serin proteaz inhibitörüdür (serpin) ve serpin süper ailesinin prototipik üyesidir. AAT, tripsin yerine birincil olarak nötrofil elastazını (NE) inhibe eder. AAT kodlayan gen üzerinde de meydana gelen mutasyonlar sonucunda AAT eksikliği (AATD) meydana gelmektedir. AATD'li hastalar amfizem, Kronik obstrüktif akciğer hastalığı (KOAH), karaciğer yetmezliği ve daha az yaygın olarak sistemik anti-nötrofil sitoplazmik antikor (ANCA)-pozitif vaskülit ve nekrotizan pannikülite karşı hassastır. Tek nükleotid polimorfizmleri (TNP'ler), DNA metilasyonu, değiştirilmiş mikroRNA (miRNA) ekspresyonu ve SERPINA1 geni mRNA izoformları dahil olmak üzere çok sayıda epigenetik faktörün AATD'nin klinik görünümü üzerinde bilinen veya olası doğrudan etkileri vardır. Beslenme şekli epigenetik mekanizmaları etkilemektedir. Dolayısıyla AATD’ye bağlı gelişen solunum yolu ve karaciğer hastalıklarının progrozunu beslenme stratejileriyle değiştirmek mümkün olabilir.

Keywords

α-1 antitipsin epigenetik KOAH karaciğer yetmezliği

References

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  • 2. Janciauskiene SM, Bals R, Koczulla R, Vogelmeier C, Köhnlein T, Welte T. The discovery of α1-antitrypsin and its role in health and disease. Respiratory Medicine. 2011;105(8):1129–1139.
  • 3. Darlington GJ, Astrin KH, Muirhead SP, Desnick RJ, Smith M. Assignment of human alpha 1-antitrypsin to chromosome 14 by somatic cell hybrid analysis. Proceedings of the National Academy of Sciences of the United States of America. 1982;79(3):870–873.
  • 4. DeMeo DL, Silverman EK. Alpha1-antitrypsin deficiency 2: genetic aspects of alpha(1)-antitrypsin deficiency: phenotypes and genetic modifiers of emphysema risk. Thorax. 2004;59(3):259–264.
  • 5. American Thoracic Society, European Respiratory Society. American Thoracic Society/European Respiratory Society statement: standards for the diagnosis and management of individuals with alpha-1 antitrypsin deficiency. American Journal of Respiratory And Critical Care Medicine. 2003;168(7):818–900.
  • 6. Clemmensen SN, Jacobsen LC, Rørvig S, et al. Alpha-1-antitrypsin is produced by human neutrophil granulocytes and their precursors and liberated during granule exocytosis. European Journal of Haematology. 2011;86(6):517–530.
  • 7. Huntington JA, Read RJ, Carrell RW. Structure of a serpin-protease complex shows inhibition by deformation. Nature. 2000;407(6806):923–926.
  • 8. Beatty K, Bieth J, Travis J. Kinetics of association of serine proteinases with native and oxidized alpha-1-proteinase inhibitor and alpha-1-antichymotrypsin. The Journal of Biological Chemistry. 1980;255(9):3931–3934.
  • 9. Korkmaz B, Horwitz MS, Jenne DE, Gauthier F. Neutrophil elastase, proteinase 3, and cathepsin G as therapeutic targets in human diseases. Pharmacological Reviews. 2010;62(4):726–759.
  • 10. Silverman EK, Sandhaus RA. Clinical practice. Alpha1-antitrypsin deficiency. The New England Journal of Medicine. 2009;360(26):2749–2757.
  • 11. Dafforn TR, Mahadeva R, Elliott PR, Sivasothy P, Lomas DA. A kinetic mechanism for the polymerization of alpha1-antitrypsin. The Journal of Biological Chemistry. 1999;274(14):9548–9555.
  • 12. Sivasothy P, Dafforn TR, Gettins PG, Lomas DA. Pathogenic alpha 1-antitrypsin polymers are formed by reactive loop-beta-sheet A linkage. The Journal of Biological Chemistry. 2000;275(43):33663–33668.
  • 13. Lomas DA. Loop-sheet polymerization: the structural basis of Z alpha 1-antitrypsin accumulation in the liver. Clinical Science. 1994;86(5):489–495.
  • 14. Jezela-Stanek A, Chorostowska-Wynimko J. SERPINA1 and more? A putative genetic contributor to pulmonary dysfunction in alpha-1 antitrypsin deficiency. Journal of Clinical Medicine. 2023;12(5):1708.
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  • 16. Rodriguez F, de la Roza C, Jardi R, Schaper M, Vidal R, Miravitlles M. Glutathione S-transferase P1 and lung function in patients with alpha1-antitrypsin deficiency and COPD. Chest. 2005;127(5):1537–1543.
  • 17. Mattei AL, Bailly N, Meissner A. DNA methylation: a historical perspective. Trends In Genetics: TIG. 2022;38(7):676–707.
  • 18. Qiu W, Baccarelli A, Carey VJ, el al. Variable DNA methylation is associated with chronic obstructive pulmonary disease and lung function. American Journal of Respiratory and Critical Care Medicine. 2012;185(4):373–381.
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  • 23. McElvaney OJ, Carroll TP, Franciosi AN, et al. Consequences of abrupt cessation of alpha1-antitrypsin replacement therapy. The New England Journal of Medicine. 2020;382(15):1478–1480.
  • 24. Spratt JR, Brown RZ, Rudser K, et al. Greater survival despite increased complication rates following lung transplant for alpha-1-antitrypsin deficiency compared to chronic obstructive pulmonary disease. Journal of Thoracic Disease. 2019;11(4):1130–1144.
  • 25. Chorostowska-Wynimko J, Barrecheguren M, Ferrarotti I, Greulich T, Sandhaus RA, Campos M. New patient-centric approaches to the management of alpha-1 antitrypsin deficiency. International Journal of Chronic Obstructive Pulmonary Disease. 2020;15:345–355.
  • 26. Attaway A, Majumdar U, Sandhaus RA, Nowacki AS, Stoller JK. An analysis of the degree of concordance among international guidelines regarding alpha-1 antitrypsin deficiency. International Journal Of Chronic Obstructive Pulmonary Disease. 2019;14:2089–2101.
  • 27. Edgar RG, Patel M, Bayliss S, Crossley D, Sapey E, Turner AM. Treatment of lung disease in alpha-1 antitrypsin deficiency: a systematic review. International Journal of Chronic Obstructive Pulmonary Disease. 2017;12:1295–1308.
  • 28. McElvaney OF, Fraughen DD, McElvaney OJ, Carroll TP, McElvaney NG. Alpha-1 antitrypsin deficiency: current therapy and emerging targets. Expert Rev Respir Med. 2023;17(3):191-202.
  • 29. Miravitlles M, Dirksen A, Ferrarotti I, et al. European Respiratory Society statement: diagnosis and treatment of pulmonary disease in α1-antitrypsin deficiency. The European Respiratory Journal. 2017;50(5):1700610.
  • 30. Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 1999;160(6):1856–1861.
  • 31. Schols AM, Slangen J, Volovics L, Wouters EF. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 1998;157(6 Pt 1):1791–1797.
  • 32. Lainscak M, von Haehling S, Doehner W, et al. Body mass index and prognosis in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Journal of Cachexia, Sarcopenia and Muscle. 2011;2(2):81–86.
  • 33. Ora J, Laveneziana P, Wadell K, Preston M, Webb KA, O'Donnell DE. Effect of obesity on respiratory mechanics during rest and exercise in COPD. Journal of Applied Physiology. 2011;111(1):10–19.
  • 34. Schols AM, Broekhuizen R, Weling-Scheepers CA, Wouters EF. Body composition and mortality in chronic obstructive pulmonary disease. The American Journal of Clinical Nutrition. 2005;82(1):53–59.
  • 35. de Serres FJ, Blanco I. Prevalence of α1-antitrypsin deficiency alleles PI*S and PI*Z worldwide and effective screening for each of the five phenotypic classes PI*MS, PI*MZ, PI*SS, PI*SZ, and PI*ZZ: a comprehensive review. Ther Adv Respir Dis. 2012;6(5):277-295.
  • 36. Wang L, Marek GW, Hlady RA, et al. Alpha-1 Antitrypsin deficiency liver disease, mutational homogeneity modulated by epigenetic heterogeneity with links to obesity. Hepatology. 2019;70(1):51-66.
  • 37. Patel D, McAllister SL, Teckman JH. Alpha-1 antitrypsin deficiency liver disease. Transl Gastroenterol Hepatol. 2021;6:23.
  • 38. Rahaghi F, Omert L, Clark V, Sandhaus RA. Managing the Alpha-1 patient in the ICU: Adapting broad critical care strategies in AATD. J Crit Care. 2019;54:212-219.
  • 39. Seersholm N. Body mass index and mortality in patients with severe alpha 1-antitrypsin deficiency. Respir Med. 1997;91(2):77-82.
  • 40. Piitulainen E, Areberg J, Lindén M, Eriksson S, Mattsson S, Wollmer P. Nutritional status and muscle strength in patients with emphysema and severe alpha(1)-antitrypsin deficiency. Chest. 2002;122(4):1240-1246.
  • 41. Hutchison DC, Cooper D; British Thoracic Society. Alpha-1-antitrypsin deficiency: smoking, decline in lung function and implications for therapeutic trials. Respir Med. 2002;96:872–880.
  • 42. Rawal G, Yadav S. Nutrition in chronic obstructive pulmonary disease: a review. J Transl Int Med. 2015;3:151–154.
  • 43. Iyer AS, Dransfield MT.The “obesity paradox” in chronic obstructive pulmonary disease: can it be resolved? Ann Am Thorac Soc. 2018;15:158–159.
  • 44. Hanson C, Rutten EP, Wouters EFM, et al. Influence of diet and obesity on COPD development and outcomes. Int J Chron Obstruct Pulmon Dis. 2014;9:723–733.
  • 45. Fuller-Thomson E, Howden KEN, Fuller-Thomson LR, et al. A strong graded relationship between level of obesity and COPD: findings from a national population-based study of lifelong nonsmokers. J Obes. 2018;2018:6149263.
  • 46. Galesanu RG, Bernard S, Marquis K, et al. Obesity in chronic obstructive pulmonary disease: is fatter really better? Can Respir J. 2014;21:297–301.
  • 47. McDonald V, Gibson P, Scott H, et al. Obesity in COPD, how should it be managed?- the effect of weight loss and resistance training in obese COPD patients. Eur Respir J. 2014;44:P3035.
  • 48. Mete B, Pehlivan E, Gülbaş G, Günen H. Prevalence of malnutrition in COPD and its relationship with the parameters related to disease severity. Int J Chron Obstruct Pulmon Dis. 2018;13:3307-3312.
  • 49. Vermeeren MA, Creutzberg EC, Schols AM, et al. Prevalence of nutritional depletion in a large out-patient population of patients with COPD. Respir Med. 2006;100(8):1349-1355.
  • 50. Engelen MP, Schols AM, Lamers RJ, Wouters EF. Different patterns of chronic tissue wasting among patients with chronic obstructive pulmonary disease. Clin Nutr. 1999;18(5):275-280.
  • 51. Bolton CE, Ionescu AA, Shiels KM, et al. Associated loss of fat-free mass and bone mineral density in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;170(12):1286-1293.
  • 52. Schols AM, Ferreira IM, Franssen FM, et al. Nutritional assessment and therapy in COPD: a European Respiratory Society statement. Eur Respir J. 2014;44(6):1504-1520.
  • 53. Lehouck A, Boonen S, Decramer M, Janssens W. COPD, bone metabolism, and osteoporosis. Chest. 2011;139(3):648-657.
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Epigenetics and Nutrition in α-1 Antitrypsin Deficiency

Year 2024, Issue: 22, 354 - 369, 30.04.2024

Rümeysa Özçalkap İçöz Nihal Büyükuslu

https://doi.org/10.38079/igusabder.1340587

Abstract

Alpha-1 proteinase inhibitor (PI), also known as alpha-1 antitrypsin (AAT), is the most abundant circulating serine protease inhibitor (serpin) and the prototypical member of the serpin superfamily. AAT primarily inhibits neutrophil elastase (NE) instead of trypsin. Mutations occurring in the gene encoding AAT lead to AAT deficiency (AATD). Patients with AATD are susceptible to emphysema, COPD, liver failure, and less commonly, systemic anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis and necrotizing panniculitis. Single nucleotide polymorphisms (SNPs), DNA methylation, altered microRNA (miRNA) expression, and various epigenetic factors, including mRNA isoforms of the SERPINA1 gene, have known or potential direct effects on the clinical manifestation of AATD. Dietary patterns
influence epigenetic mechanisms. Therefore, it may be possible to modify the progression of respiratory and liver diseases associated with AATD through nutritional strategies.

Keywords

α-1 antitrypsin epigenetic COPD liver failure

References

  • 1. Stoller JK, Aboussouan LS. Alpha1-antitrypsin deficiency. Lancet. 2005;365(9478):2225–2236.
  • 2. Janciauskiene SM, Bals R, Koczulla R, Vogelmeier C, Köhnlein T, Welte T. The discovery of α1-antitrypsin and its role in health and disease. Respiratory Medicine. 2011;105(8):1129–1139.
  • 3. Darlington GJ, Astrin KH, Muirhead SP, Desnick RJ, Smith M. Assignment of human alpha 1-antitrypsin to chromosome 14 by somatic cell hybrid analysis. Proceedings of the National Academy of Sciences of the United States of America. 1982;79(3):870–873.
  • 4. DeMeo DL, Silverman EK. Alpha1-antitrypsin deficiency 2: genetic aspects of alpha(1)-antitrypsin deficiency: phenotypes and genetic modifiers of emphysema risk. Thorax. 2004;59(3):259–264.
  • 5. American Thoracic Society, European Respiratory Society. American Thoracic Society/European Respiratory Society statement: standards for the diagnosis and management of individuals with alpha-1 antitrypsin deficiency. American Journal of Respiratory And Critical Care Medicine. 2003;168(7):818–900.
  • 6. Clemmensen SN, Jacobsen LC, Rørvig S, et al. Alpha-1-antitrypsin is produced by human neutrophil granulocytes and their precursors and liberated during granule exocytosis. European Journal of Haematology. 2011;86(6):517–530.
  • 7. Huntington JA, Read RJ, Carrell RW. Structure of a serpin-protease complex shows inhibition by deformation. Nature. 2000;407(6806):923–926.
  • 8. Beatty K, Bieth J, Travis J. Kinetics of association of serine proteinases with native and oxidized alpha-1-proteinase inhibitor and alpha-1-antichymotrypsin. The Journal of Biological Chemistry. 1980;255(9):3931–3934.
  • 9. Korkmaz B, Horwitz MS, Jenne DE, Gauthier F. Neutrophil elastase, proteinase 3, and cathepsin G as therapeutic targets in human diseases. Pharmacological Reviews. 2010;62(4):726–759.
  • 10. Silverman EK, Sandhaus RA. Clinical practice. Alpha1-antitrypsin deficiency. The New England Journal of Medicine. 2009;360(26):2749–2757.
  • 11. Dafforn TR, Mahadeva R, Elliott PR, Sivasothy P, Lomas DA. A kinetic mechanism for the polymerization of alpha1-antitrypsin. The Journal of Biological Chemistry. 1999;274(14):9548–9555.
  • 12. Sivasothy P, Dafforn TR, Gettins PG, Lomas DA. Pathogenic alpha 1-antitrypsin polymers are formed by reactive loop-beta-sheet A linkage. The Journal of Biological Chemistry. 2000;275(43):33663–33668.
  • 13. Lomas DA. Loop-sheet polymerization: the structural basis of Z alpha 1-antitrypsin accumulation in the liver. Clinical Science. 1994;86(5):489–495.
  • 14. Jezela-Stanek A, Chorostowska-Wynimko J. SERPINA1 and more? A putative genetic contributor to pulmonary dysfunction in alpha-1 antitrypsin deficiency. Journal of Clinical Medicine. 2023;12(5):1708.
  • 15. Novoradovsky A, Brantly ML, Waclawiw MA, et al. Endothelial nitric oxide synthase as a potential susceptibility gene in the pathogenesis of emphysema in alpha1-antitrypsin deficiency. American Journal of Respiratory Cell and Molecular Biology. 1999;20(3):441–447.
  • 16. Rodriguez F, de la Roza C, Jardi R, Schaper M, Vidal R, Miravitlles M. Glutathione S-transferase P1 and lung function in patients with alpha1-antitrypsin deficiency and COPD. Chest. 2005;127(5):1537–1543.
  • 17. Mattei AL, Bailly N, Meissner A. DNA methylation: a historical perspective. Trends In Genetics: TIG. 2022;38(7):676–707.
  • 18. Qiu W, Baccarelli A, Carey VJ, el al. Variable DNA methylation is associated with chronic obstructive pulmonary disease and lung function. American Journal of Respiratory and Critical Care Medicine. 2012;185(4):373–381.
  • 19. Stoller JK, Hupertz V, Aboussouan LS. Alpha-1 Antitrypsin Deficiency. 2006 Oct 27 [Updated 2023 Jun 1]. In: Adam MP, Mirzaa GM, Pagon RA, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1519/
  • 20. Sandhaus RA, Turino G, Brantly ML, et al. The diagnosis and management of alpha-1 antitrypsin deficiency in the adult. Chronic Obstructive Pulmonary Diseases. 2016;3(3):668–682.
  • 21. Bossé Y, Lamontagne M, Gaudreault N, et al. Early-onset emphysema in a large French-Canadian family: a genetic investigation. The Lancet Respiratory Medicine. 2019;7(5):427–436.
  • 22. Corda L, Bertella E, La Piana GE, Boni E, Redolfi S, Tantucci C. Inhaled corticosteroids as additional treatment in alpha-1-antitrypsin-deficiency-related COPD. Respiration; İnternational Review of Thoracic Diseases. 2008;76(1):61–68.
  • 23. McElvaney OJ, Carroll TP, Franciosi AN, et al. Consequences of abrupt cessation of alpha1-antitrypsin replacement therapy. The New England Journal of Medicine. 2020;382(15):1478–1480.
  • 24. Spratt JR, Brown RZ, Rudser K, et al. Greater survival despite increased complication rates following lung transplant for alpha-1-antitrypsin deficiency compared to chronic obstructive pulmonary disease. Journal of Thoracic Disease. 2019;11(4):1130–1144.
  • 25. Chorostowska-Wynimko J, Barrecheguren M, Ferrarotti I, Greulich T, Sandhaus RA, Campos M. New patient-centric approaches to the management of alpha-1 antitrypsin deficiency. International Journal of Chronic Obstructive Pulmonary Disease. 2020;15:345–355.
  • 26. Attaway A, Majumdar U, Sandhaus RA, Nowacki AS, Stoller JK. An analysis of the degree of concordance among international guidelines regarding alpha-1 antitrypsin deficiency. International Journal Of Chronic Obstructive Pulmonary Disease. 2019;14:2089–2101.
  • 27. Edgar RG, Patel M, Bayliss S, Crossley D, Sapey E, Turner AM. Treatment of lung disease in alpha-1 antitrypsin deficiency: a systematic review. International Journal of Chronic Obstructive Pulmonary Disease. 2017;12:1295–1308.
  • 28. McElvaney OF, Fraughen DD, McElvaney OJ, Carroll TP, McElvaney NG. Alpha-1 antitrypsin deficiency: current therapy and emerging targets. Expert Rev Respir Med. 2023;17(3):191-202.
  • 29. Miravitlles M, Dirksen A, Ferrarotti I, et al. European Respiratory Society statement: diagnosis and treatment of pulmonary disease in α1-antitrypsin deficiency. The European Respiratory Journal. 2017;50(5):1700610.
  • 30. Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 1999;160(6):1856–1861.
  • 31. Schols AM, Slangen J, Volovics L, Wouters EF. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 1998;157(6 Pt 1):1791–1797.
  • 32. Lainscak M, von Haehling S, Doehner W, et al. Body mass index and prognosis in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Journal of Cachexia, Sarcopenia and Muscle. 2011;2(2):81–86.
  • 33. Ora J, Laveneziana P, Wadell K, Preston M, Webb KA, O'Donnell DE. Effect of obesity on respiratory mechanics during rest and exercise in COPD. Journal of Applied Physiology. 2011;111(1):10–19.
  • 34. Schols AM, Broekhuizen R, Weling-Scheepers CA, Wouters EF. Body composition and mortality in chronic obstructive pulmonary disease. The American Journal of Clinical Nutrition. 2005;82(1):53–59.
  • 35. de Serres FJ, Blanco I. Prevalence of α1-antitrypsin deficiency alleles PI*S and PI*Z worldwide and effective screening for each of the five phenotypic classes PI*MS, PI*MZ, PI*SS, PI*SZ, and PI*ZZ: a comprehensive review. Ther Adv Respir Dis. 2012;6(5):277-295.
  • 36. Wang L, Marek GW, Hlady RA, et al. Alpha-1 Antitrypsin deficiency liver disease, mutational homogeneity modulated by epigenetic heterogeneity with links to obesity. Hepatology. 2019;70(1):51-66.
  • 37. Patel D, McAllister SL, Teckman JH. Alpha-1 antitrypsin deficiency liver disease. Transl Gastroenterol Hepatol. 2021;6:23.
  • 38. Rahaghi F, Omert L, Clark V, Sandhaus RA. Managing the Alpha-1 patient in the ICU: Adapting broad critical care strategies in AATD. J Crit Care. 2019;54:212-219.
  • 39. Seersholm N. Body mass index and mortality in patients with severe alpha 1-antitrypsin deficiency. Respir Med. 1997;91(2):77-82.
  • 40. Piitulainen E, Areberg J, Lindén M, Eriksson S, Mattsson S, Wollmer P. Nutritional status and muscle strength in patients with emphysema and severe alpha(1)-antitrypsin deficiency. Chest. 2002;122(4):1240-1246.
  • 41. Hutchison DC, Cooper D; British Thoracic Society. Alpha-1-antitrypsin deficiency: smoking, decline in lung function and implications for therapeutic trials. Respir Med. 2002;96:872–880.
  • 42. Rawal G, Yadav S. Nutrition in chronic obstructive pulmonary disease: a review. J Transl Int Med. 2015;3:151–154.
  • 43. Iyer AS, Dransfield MT.The “obesity paradox” in chronic obstructive pulmonary disease: can it be resolved? Ann Am Thorac Soc. 2018;15:158–159.
  • 44. Hanson C, Rutten EP, Wouters EFM, et al. Influence of diet and obesity on COPD development and outcomes. Int J Chron Obstruct Pulmon Dis. 2014;9:723–733.
  • 45. Fuller-Thomson E, Howden KEN, Fuller-Thomson LR, et al. A strong graded relationship between level of obesity and COPD: findings from a national population-based study of lifelong nonsmokers. J Obes. 2018;2018:6149263.
  • 46. Galesanu RG, Bernard S, Marquis K, et al. Obesity in chronic obstructive pulmonary disease: is fatter really better? Can Respir J. 2014;21:297–301.
  • 47. McDonald V, Gibson P, Scott H, et al. Obesity in COPD, how should it be managed?- the effect of weight loss and resistance training in obese COPD patients. Eur Respir J. 2014;44:P3035.
  • 48. Mete B, Pehlivan E, Gülbaş G, Günen H. Prevalence of malnutrition in COPD and its relationship with the parameters related to disease severity. Int J Chron Obstruct Pulmon Dis. 2018;13:3307-3312.
  • 49. Vermeeren MA, Creutzberg EC, Schols AM, et al. Prevalence of nutritional depletion in a large out-patient population of patients with COPD. Respir Med. 2006;100(8):1349-1355.
  • 50. Engelen MP, Schols AM, Lamers RJ, Wouters EF. Different patterns of chronic tissue wasting among patients with chronic obstructive pulmonary disease. Clin Nutr. 1999;18(5):275-280.
  • 51. Bolton CE, Ionescu AA, Shiels KM, et al. Associated loss of fat-free mass and bone mineral density in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;170(12):1286-1293.
  • 52. Schols AM, Ferreira IM, Franssen FM, et al. Nutritional assessment and therapy in COPD: a European Respiratory Society statement. Eur Respir J. 2014;44(6):1504-1520.
  • 53. Lehouck A, Boonen S, Decramer M, Janssens W. COPD, bone metabolism, and osteoporosis. Chest. 2011;139(3):648-657.
  • 54. Graat-Verboom L, Wouters EF, Smeenk FW, van den Borne BE, Lunde R, Spruit MA. Current status of research on osteoporosis in COPD: a systematic review. Eur Respir J. 2009;34(1):209-218.
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There are 65 citations in total.

Details

Primary Language Turkish
Subjects Nutritional Science, Nutrigenomics and Personalised Nutrition, Clinical Nutrition, Nutrition and Dietetics (Other)
Journal Section Articles
Authors

Rümeysa Özçalkap İçöz 0000-0002-8006-0411

Nihal Büyükuslu 0000-0003-1420-0989

Early Pub Date April 27, 2024
Publication Date April 30, 2024
Acceptance Date February 29, 2024
Published in Issue Year 2024 Issue: 22

Cite

JAMA Özçalkap İçöz R, Büyükuslu N. α-1 Antitripsin Eksikliğinde Epigenetik ve Beslenme. IGUSABDER. 2024;:354–369.
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