Abstract
•Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder and model for misfolding protein diseases.•AATD polymorphism leads to essential metal ions (iron, copper and zinc) dyshomeostasis, but there are no biochemical models of Alpha-1 antitrypsin (AAT) metal coordination and possible implications.•Metal dyshomeostasis as well as metal/peptide and metal/protein interactions are correlated with misfolding protein pathologies as Type 2 Diabetes Mellitus (T2DM) and neurodegeneration (dementia, Alzheimer’s disease (AD), Parkinson’s Disease (PD), prion diseases).•Conformational diseases are not distinct pathologies, but the same pathological state that is correlated with AAT polymorphism, and develop in different tissues at different stages of life.
Conformational diseases are caused by the aggregation of misfolded proteins. The risk for such pathologies develops years before clinical symptoms appear, and is higher in people with alpha-1 antitrypsin (AAT) polymorphisms. Thousands of people with alpha-1 antitrypsin deficiency (AATD) are underdiagnosed. Enemy-aggregating proteins may reside in these underdiagnosed AATD patients for many years before a pathology for AATD fully develops. In this perspective review, we hypothesize that the AAT protein could exert a new and previously unconsidered biological effect as an endogenous metal ion chelator that plays a significant role in essential metal ion homeostasis. In this respect, AAT polymorphism may cause an imbalance of metal ions, which could be correlated with the aggregation of amylin, tau, amyloid beta, and alpha synuclein proteins in type 2 diabetes mellitus (T2DM), Alzheimer’s and Parkinson’s diseases, respectively.