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The interaction between AAT and the expression of endogenous antioxidant enzymes such as catalases and superoxide dismutase (SOD) has been known and studied for some time ( Recent studies have demonstrated that patients with PI ZZ genotype exhibit reduced expression of catalase and glutathione reductase, indicating an indirect role of alpha-1 antitrypsin (A1AT) in modulating reactive oxygen species (ROS) and reactive nitrogen species (RNS) levels