I've never asked David Tzur that and even if I did, well, he is known for his hush hush attitude. I think that based on current understanding, and confirmed by the FDA' CBER Blood Products Advisory Committee in 1998, augmentation therapy using normal dosing regimen of IV AAT of 60 mg/kg given every week, restore serum levels above the so-called "protective" threshold of 0.5 g/l (~11 µM). This treatment correlated with a reduced level of disease progression.
It is also estimated like you've heard, that only a small fraction of the dose reaches the target tissue.
As for the inhaled treatment, there are several variables like breathing patterns, deposition mode and compliance, which are hard to control. Also, efficacy has not been determined yet but Kamada did look at other inhaled AAT trials and the dose that has been used there.
It is believed that for effective treatment with inhaled AAT, the highest possible fraction of the aerosolised drug must reach the target region, and since it is technically feasible to deliver several fold larger doses of AAT within an adequate inhalation time, they use relatively large AAT amounts.
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