Hepatic accumulation of AAT PI-Z leads not only to ER stress and subsequent liver disease but also to a deficiency in circulating and pulmonary AAT, which ultimately leads to lung disease (Teckman et al., 1996; Silverman and Sandhaus, 2009; Manne and Kowdley, 2020; Narayanan and Mistry, 2020; Patel et al., 2021). The gene discussed is SERPINA1; the disease is lung disorder.