“…In the most common and severe Z α 1 AT variant, the replacement of glutamic acid 342 with a lysine residue causes the mutant protein to undergo an aberrant conformational transition, which favours the formation of polymers that tangle within the endoplasmic reticulum (ER) as periodic acid-Shiff-positive, diastase-resistant inclusions (Lomas, et al, 1992). The retention of Z α 1 AT within the hepatocytes results in a lack of circulating plasma α 1 AT and a gradual intracellular protein accumulation, which gives rise to progressive liver damage, with possible evolution to cirrhosis and hepatocellular carcinoma (Janciauskiene, et al, 2004). The significance of this pathological α 1 AT polymerization was underscored by the finding of two other deficiency variants, S iiyama (Ser52Phe) and M malton (Phe52del) which, similarly to Z, form polymers in vivo and are associated with hepatic inclusions and severe plasma deficiency (Lomas, et al, 1993;Lomas, et al, 1995).…”