Z alpha-1 antitrypsin (AAT) deficiency is a genetic disease associated with accumulation of misfolded AAT in the endoplasmic reticulum (ER) of hepatocytes. ZAAT-expressing cells display ER stress responses including nuclear factor kappaB activation and apoptosis. Using an in vitro model of ZAAT ER accumulation, we investigated the mechanism of ZAATmediated ER-induced apoptosis and evaluated methods to inhibit this process. Here we demonstrate that expression of ZAAT, but not normal MAAT, in HEK293 cells leads to cleavage and activation of caspase-4 and induces apoptosis that is characterized by activation of caspase-3 and caspase-7 and DNA fragmentation. Similar effects are also induced using the ER agonist thapsigargin. A caspase-4 -specific short interfering RNA (siRNA) does not impair ZAAT-induced caspase-3/7 activation or cell death in these cells. However, inhibition studies performed using tauroursodeoxycholic acid (TUDCA) demonstrate its ability to inhibit caspase-4 and caspase-3/7 activation, mitochondrial cytochrome c release, and caspase
496-503.)A lpha 1-Antitrypsin (AAT 1 ) deficiency is a conformational liver disorder also associated with earlyonset emphysema. The mutant "Z" form (ZAAT) occurs in more than 95% of all individuals with AAT deficiency 1 and is characterized by accumulation of misfolded ZAAT within hepatocytes and cholangiocytes. The ZAAT protein differs from the normal "M" variant by a single amino acid substitution (Glu3423 Lys). 2 This affects the secondary structure of AAT, causing aberrant protein folding and accumulation of ZAAT polymers in the endoplasmic reticulum (ER). 3 The Z allele in particular is associated with liver disease, with homozygous neonates developing hepatitis and cholestasis in approximately 10% of cases. A further subset of these children require liver transplantation to correct the irreversible liver damage. 4,5 Cirrhosis in ZAAT-deficient adults can occur without preceding history of childhood liver disease. 6,7 ER accumulation of ZAAT is known to induce ER stress 8 and activate a number of intracellular signaling pathways. 9 Three major ER stress response pathways include the ER overload response, which is characterized by nuclear factor kappa B activation, the unfolded protein response that involves upregulation of chaperones, foldases and degradation factors, and apoptosis. Model systems and in vivo studies have demonstrated that ZAAT Abbreviations: AAT, ER, endoplasmic reticulum; RT, reverse transcription; siRNA, short interfering RNA; TUDCA, tauroursodeoxycholic acid; TUNEL, ZAAT, From the