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Your Alpha-1 genotype is ZNull/rare. This result means that you have, or are suspected to have, a rare form of AATD. This is an important finding that may require further testing. The Z mutation is a deficiency allele (version of the gene) that reduces the quantity of alpha-1 antitrypsin (AAT) in the blood. The Z mutation is risk-raising for lung and liver disease, and the degree of risk depends on your other Alpha-1 gene and your AAT level. Your other Alpha-1 gene has, or is suspected to have, a null or rare mutation. “Null” mutations in the Alpha-1 gene make no alpha-1 antitrypsin (AAT), and “rare” mutations make altered forms of AAT that may reduce the quantity of AAT in the blood.

There are over 100 different rare and null mutations for Alpha-1. Examples include Plowell, QOcincinnati, and many others. If you know which rare or null mutation you have (usually from results of advanced testing), more information about that specific mutation may be available. Call the genetic counselor for details.

The University of Florida Alpha-1 Foundation DNA and Tissue Bank offers testing to clarify suspected rare/null mutations through a research program. If you think you have a rare or null mutation, but do not know which one, you may enroll in this program. You will be sent a kit with a consent form, empty blood tubes and instructions for collecting a blood sample. You will receive results of this test from the DNA and Tissue Bank. To request this more comprehensive blood tube test, contact the DNA and Tissue Bank at their toll free number: 1-855-476-1227, Option 1.

Individuals with confirmed ZNull/rare genotypes have AATD and increased risks for Alpha-1 lung disease similar to ZZ individuals. Some, but not all, individuals with these genotypes have increased risks for liver disease. We recommend that you follow-up with a physician to discuss personalized screening or management recommendations. A list of Alpha-1 specialists can be found at

Relatives of someone with the Znull/rare genotype are at increased risk to also have abnormal alpha-1 genes and should be offered testing. Contact the genetic counselor with testing questions and to coordinate advanced testing for rare and null mutations. Reproductive partners of people with abnormal alpha-1 genes should also be offered testing to assess risk to children.

Alpha-1 at MUSC – Genetic Counseling