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What do they mean when they say Alpha-1 may be a co-factor?

The investigators found that MZ carriers had significantly higher liver enzymes and evidence of liver cirrhosis than non-carriers. A possible mechanism for this observation was offered by David Lomas, MD, PhD, from the University of London, U.K. He reported that the MZ protein can form polymers by showing that a single copy of the Z allele is sufficient to form polymers within liver cells and may act as a co-factor in driving liver disease in MZ carriers.

Alpha-1-To-One, Winter 2018 – Alpha-1 Foundation

There are strong arguments to consider heterozygous A1AT deficiency as an important co-factor in the aetiology of chronic liver disease. Studies have shown that A1AT heterozygosity can be considered a modifier for hepatitis C virus, end-stage liver disease, cirrhosis and hepatocellular carcinoma. The accumulation of A1AT in the hepatocytes occurs more profoundly in a diseased liver, and as a consequence it affects the natural course of the liver disease.

The Netherlands Journal of Medicine