The Alpha One International Registry is a scientific foundation established to comply with a World Health Organization recommendation to develop a multinational registry of alpha1-antitrypsin deficiency, with the aim of creating a common database of subjects recognised in a standardised way. A commitment of the Alpha One International Registry members, belonging to 15 national registries, is to meet every 2 yrs in an open scientific conference to provide a scientific and clinical update on the deficiency. The second Alpha One International Registry meeting was held in Rapallo (Genoa, Italy) on September 27th-28th, 2001, and 26 speakers provided an exhaustive overview of all aspects of alpha1-antitrypsin deficiency, including epidemiology, genetics, biochemistry, associated conditions, established and novel therapeutic options, and markers of efficacy. In the framework of a rare and often under-recognised condition, this meeting is likely to be central to improving understanding and increasing awareness of alpha1-antitrypsin deficiency.