Luckily, since a few years, as there is a growing interest in AATD, rarer variants are more often identified [1, 13] and, among them, some are polymerogenic and can be associated with a mildly or severely decreased concentration of A1AT that may lead to emphysema and/or liver disease: Pi Queen’s (Lys154Asn), Pi Pbrescia (Gly225Arg), Pi Mpisa (lys259Ile), Pi King’s (His334Asp), Pi Etaurisano (Lys368Glu), Pi Yorzinuovi (Pro391His), Pi Wurzburg (Pro369Ser) and Pi Mheerlen (Pro369Leu). This evidence concerns the gene SERPINA1 and pulmonary emphysema.