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Moura J, Pinto C, Freixo P, Alves H, Ramos C, Santos Silva E, Nery F, Gandara J, Lopes V, Ferreira S, Presa J, Ferreira JM, Miranda HP, Magalhães M. Correlation between neuroimaging, neurological phenotype, and functional outcomes in Wilson's disease. Neurol Sci 2024; 45:3201-3208. [PMID: 38291197 DOI: 10.1007/s10072-024-07371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/27/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Wilson's disease (WD) is associated with a variety of movement disorders and progressive neurological dysfunction. The aim of this study was to correlate baseline brain magnetic resonance imaging (MRI) features with clinical phenotype and long-term outcomes in chronically treated WD patients. METHODS Patients were retrospectively selected from an institutional database. Two experienced neuroradiologists reviewed baseline brain MRI. Functional assessment was performed using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) scale, and disease severity was classified using the Global Assessment Scale for Wilson's Disease (GASWD). RESULTS Of 27 patients selected, 14 were female (51.9%), with a mean (standard deviation [SD]) age at onset of 19.5 (7.1) years. Neurological symptoms developed in 22 patients (81.5%), with hyperkinetic symptoms being the most common (70.4%). Baseline brain MRI showed abnormal findings in 18 cases (66.7%), including T2 hyperintensities in 59.3% and atrophy in 29.6%. After a mean (SD) follow-up of 20.9 (11.0) years, WD patients had a mean score of 19.2 (10.2) on WHODAS 2.0 and 6.4 (5.7) on GASWD. The presence of hyperkinetic symptoms correlated with putaminal T2 hyperintensities (p = 0.003), putaminal T2 hypointensities (p = 0.009), and mesencephalic T2 hyperintensities (p = 0.009). Increased functional disability was associated with brain atrophy (p = 0.007), diffusion abnormalities (p = 0.013), and burden of T2 hyperintensities (p = 0.002). A stepwise regression model identified atrophy as a predictor of increased WHODAS 2.0 (p = 0.023) and GASWD (p = 0.007) scores. CONCLUSIONS Atrophy and, to a lesser extent, deep T2 hyperintensity are associated with functional disability and disease severity in long-term follow-up of WD patients.
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Affiliation(s)
- João Moura
- Department of Neurology, Centro Hospitalar Universitário de Santo António, Largo Do Professor Abel Salazar, 4099-001, Porto, Portugal.
| | - Catarina Pinto
- Department of Neuroradiology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Pedro Freixo
- Department of Physical and Rehabilitation Medicine, Unidade Local de Saúde de Matosinhos, Porto, Portugal
| | - Helder Alves
- Porto Institute of Social Work (ISSSP), Porto, Portugal
- INESC TEC, Porto, Portugal
| | - Cristina Ramos
- Department of Neuroradiology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Ermelinda Santos Silva
- Department of Paediatric Gastrenterology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Filipe Nery
- Department of Hepatic and Pancreatic Transplantation, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Judit Gandara
- Department of Hepatic and Pancreatic Transplantation, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Vitor Lopes
- Department of Hepatic and Pancreatic Transplantation, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Sofia Ferreira
- Department of Hepatic and Pancreatic Transplantation, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - José Presa
- Liver Unit, Department of Medicine, Centro Hospitalar de Trás-Os-Montes E Alto Douro, Porto, Portugal
| | - José Manuel Ferreira
- Department of Gastrenterology, Centro Hospitalar de Trás-Os-Montes E Alto Douro, Porto, Portugal
| | - Helena Pessegueiro Miranda
- Department of Hepatic and Pancreatic Transplantation, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Marina Magalhães
- Department of Neurology, Centro Hospitalar Universitário de Santo António, Largo Do Professor Abel Salazar, 4099-001, Porto, Portugal
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Su D, Zhang Z, Zhang Z, Zheng S, Yao T, Dong Y, Zhu W, Wei N, Suo Y, Liu X, Zhao H, Wang Z, Ma H, Li W, Zhou J, Lam JST, Wu T, Dusek P, Stoessl AJ, Wang X, Jing J, Feng T. Distinctive Pattern of Metal Deposition in Neurologic Wilson Disease: Insights From 7T Susceptibility-Weighted Imaging. Neurology 2024; 102:e209478. [PMID: 38830145 DOI: 10.1212/wnl.0000000000209478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Noninvasive and accurate biomarkers of neurologic Wilson disease (NWD), a rare inherited disorder, could reduce diagnostic error or delay. Excessive subcortical metal deposition seen on susceptibility imaging has suggested a characteristic pattern in NWD. With submillimeter spatial resolution and increased contrast, 7T susceptibility-weighted imaging (SWI) may enable better visualization of metal deposition in NWD. In this study, we sought to identify a distinctive metal deposition pattern in NWD using 7T SWI and investigate its diagnostic value and underlying pathophysiologic mechanism. METHODS Patients with WD, healthy participants with monoallelic ATP7B variant(s) on a single chromosome, and health controls (HCs) were recruited. NWD and non-NWD (nNWD) were defined according to the presence or absence of neurologic symptoms during investigation. Patients with other diseases with comparable clinical or imaging manifestations, including early-onset Parkinson disease (EOPD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and neurodegeneration with brain iron accumulation (NBIA), were additionally recruited and assessed for exploratory comparative analysis. All participants underwent 7T T1, T2, and high-resolution SWI scanning. Quantitative susceptibility mapping and principal component analysis were performed to illustrate metal distribution. RESULTS We identified a linear signal intensity change consisting of a hyperintense strip at the lateral border of the globus pallidus in patients with NWD. We termed this feature "hyperintense globus pallidus rim sign." This feature was detected in 38 of 41 patients with NWD and was negative in all 31 nNWD patients, 15 patients with EOPD, 30 patients with MSA, 15 patients with PSP, and 12 patients with NBIA; 22 monoallelic ATP7B variant carriers; and 41 HC. Its sensitivity to differentiate between NWD and HC was 92.7%, and specificity was 100%. Severity of the hyperintense globus pallidus rim sign measured by a semiquantitative scale was positively correlated with neurologic severity (ρ = 0.682, 95% CI 0.467-0.821, p < 0.001). Patients with NWD showed increased susceptibility in the lenticular nucleus with high regional weights in the lateral globus pallidus and medial putamen. DISCUSSION The hyperintense globus pallidus rim sign showed high sensitivity and excellent specificity for diagnosis and differential diagnosis of NWD. It is related to a special metal deposition pattern in the lenticular nucleus in NWD and can be considered as a novel neuroimaging biomarker of NWD. CLASSIFICATION OF EVIDENCE The study provides Class II evidence that the hyperintense globus pallidus rim sign on 7T SWI MRI can accurately diagnose neurologic WD.
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Affiliation(s)
- Dongning Su
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Zhijin Zhang
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Zhe Zhang
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Sujun Zheng
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Tingyan Yao
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Yi Dong
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Wanlin Zhu
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Ning Wei
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Yue Suo
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Xinyao Liu
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Huiqing Zhao
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Zhan Wang
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Huizi Ma
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Wei Li
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Junhong Zhou
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Joyce S T Lam
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Tao Wu
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Petr Dusek
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - A Jon Stoessl
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Xiaoping Wang
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Jing Jing
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Tao Feng
- From the Department of Neurology (D.S., Zhijin Zhang, H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (D.S., Zhijin Zhang, Zhe Zhang, W.Z., N.W., Y.S., X.L., H.Z., Z.W., H.M., W.L., T.W., J.J., T.F.); Tiantan Neuroimaging Center of Excellence (Zhe Zhang, W.Z., N.W., Y.S., X.L., J.J.), and Department of Hepatology (S.Z.), Beijing Youan Hospital, Capital Medical University; Department of Neurology (T.Y.), Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders; Senior Department of Hepatology (Y.D.), the Fifth Medical Center of PLA General Hospital, Beijing, China; Hinda and Arthur Marcus Institute for Aging Research (J.Z.), Hebrew SeniorLife, Roslindale; Harvard Medical School (J.Z.), Boston, MA; Pacific Parkinson's Research Centre (J.S.T.L., A.J.S.), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology and Centre of Clinical Neuroscience (P.D.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Division of Neurology (A.J.S.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Department of Neurology (X.W.), Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
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3
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Wang Z, You Z. Assessment of sleep disturbance in patients with Wilson's disease. BMC Psychiatry 2024; 24:205. [PMID: 38481200 PMCID: PMC10938750 DOI: 10.1186/s12888-024-05493-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/01/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Wilson's disease (WD) is frequently manifested with anxiety, depression and sleep disturbance; this investigation aimed to elucidate these manifestations and identify the influencing factors of sleep disturbance. METHODS Sleep disturbance, anxiety and depression were compared in 42 WD and 40 age- and gender-matched healthy individuals. 27 individuals indicated a neurological form of the disease (NV), and 15 had a non-neurological variant (NNV). RESULTS This investigation revealed that the Parkinson's disease sleep scale (PDSS) score of WD individuals was lower, whereas their Epworth Sleepiness Scale (ESS), Pittsburgh sleep quality index (PSQI), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD) scores were higher than the healthy individuals (p < 0.05). Furthermore, the WD subjects had markedly increased prevalence of poor sleep quality, anxiety, and depression than healthy individuals (p < 0.05). Subgroup analysis showed that NV subjects had significantly higher scores on the UWDRS, PSQI, HAMA, and HAMD scales than those in the NV group, as well as higher rates of EDS, anxiety, and depression (p < 0.05). In patients with sleep disturbance, we identified UWDRS, neurological variant, and depression as associated factors. The linear regression model demonstrated depression as the dominant risk factor. CONCLUSIONS Depression is highly correlated with and is a determinant of sleep disturbance in WD patients.
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Affiliation(s)
- Zhengyang Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Department of Neurology, Taizhou Clinical Medical School of Nanjing Medical University, Jiangsu Taizhou People's Hospital, 225300, Taizhou, China.
| | - ZhiFei You
- Department of Neurology, Taizhou Clinical Medical School of Nanjing Medical University, Jiangsu Taizhou People's Hospital, 225300, Taizhou, China.
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4
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Hao W, Yang W, Yang Y, Cheng T, Wei T, Tang L, Qian N, Yang Y, Li X, Jiang H, Wang M. Identification of lncRNA-miRNA-mRNA Networks in the Lenticular Nucleus Region of the Brain Contributes to Hepatolenticular Degeneration Pathogenesis and Therapy. Mol Neurobiol 2024; 61:1673-1686. [PMID: 37759104 PMCID: PMC10896925 DOI: 10.1007/s12035-023-03631-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Long non-coding RNAs (lncRNAs) are a recently discovered group of non-coding RNAs that play a crucial role in the regulation of various human diseases, especially in the study of nervous system diseases which has garnered significant attention. However, there is limited knowledge on the identification and function of lncRNAs in hepatolenticular degeneration (HLD). The objective of this study was to identify novel lncRNAs and determine their involvement in the networks associated with HLD. We conducted a comprehensive analysis of RNA sequencing (RNA-seq) data, reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and computational biology to identify novel lncRNAs and explore their potential mechanisms in HLD. We identified 212 differently expressed lncRNAs, with 98 upregulated and 114 downregulated. Additionally, 32 differently expressed mRNAs were found, with 15 upregulated and 17 downregulated. We obtained a total of 1131 pairs of co-expressed lncRNAs and mRNAs by Pearson correlation test and prediction and annotation of the lncRNA-targeted miRNA-mRNA network. The differential lncRNAs identified in this study were found to be involved in various biological functions and signaling pathways. These include translational initiation, motor learning, locomotors behavior, dioxygenase activity, integral component of postsynaptic membrane, neuroactive ligand-receptor interaction, nuclear factor-kappa B (NF-κB) signaling pathway, cholinergic synapse, sphingolipid signaling pathway, and Parkinson's disease signaling pathway, as revealed by the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. Six lncRNAs, including XR_001782921.1 (P < 0.01), XR_ 001780581.1 (P < 0.01), ENSMUST_00000207119 (P < 0.01), XR_865512.2 (P < 0.01), TCONS_00005916 (P < 0.01), and TCONS_00020683 (P < 0.01), showed significant differences in expression levels between the model group and normal group by RT-qPCR. Among these, four lncRNAs (TCONS_00020683, XR_865512.2, XR_001780581.1, and ENSMUST00000207119) displayed a high degree of conservation. This study provides a unique perspective for the pathogenesis and therapy of HLD by constructing the lncRNA-miRNA-mRNA network. This insight provides a foundation for future exploration in this field.
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Affiliation(s)
- Wenjie Hao
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
- Center for Xin'an Medicine and Modernization of Traditional Chinese Medicine of IHM, Anhui University of Chinese Medicine, Hefei, China
- Key Laboratory of Xin'an Medicine of the Ministry of Education, Anhui University of Chinese Medicine, Hefei, China
| | - Wenming Yang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China.
- Center for Xin'an Medicine and Modernization of Traditional Chinese Medicine of IHM, Anhui University of Chinese Medicine, Hefei, China.
- Key Laboratory of Xin'an Medicine of the Ministry of Education, Anhui University of Chinese Medicine, Hefei, China.
| | - Yue Yang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Ting Cheng
- Department of Graduate, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Taohua Wei
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
- Center for Xin'an Medicine and Modernization of Traditional Chinese Medicine of IHM, Anhui University of Chinese Medicine, Hefei, China
| | - Lulu Tang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
- Center for Xin'an Medicine and Modernization of Traditional Chinese Medicine of IHM, Anhui University of Chinese Medicine, Hefei, China
| | - Nannan Qian
- Key Laboratory of Xin'an Medicine of the Ministry of Education, Anhui University of Chinese Medicine, Hefei, China
| | - Yulong Yang
- Key Laboratory of Xin'an Medicine of the Ministry of Education, Anhui University of Chinese Medicine, Hefei, China
| | - Xiang Li
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Hailin Jiang
- Center for Xin'an Medicine and Modernization of Traditional Chinese Medicine of IHM, Anhui University of Chinese Medicine, Hefei, China
| | - Meixia Wang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
- Center for Xin'an Medicine and Modernization of Traditional Chinese Medicine of IHM, Anhui University of Chinese Medicine, Hefei, China
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5
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Maroofian R, Kaiyrzhanov R, Cali E, Zamani M, Zaki MS, Ferla M, Tortora D, Sadeghian S, Saadi SM, Abdullah U, Karimiani EG, Efthymiou S, Yeşil G, Alavi S, Al Shamsi AM, Tajsharghi H, Abdel-Hamid MS, Saadi NW, Al Mutairi F, Alabdi L, Beetz C, Ali Z, Toosi MB, Rudnik-Schöneborn S, Babaei M, Isohanni P, Muhammad J, Khan S, Al Shalan M, Hickey SE, Marom D, Elhanan E, Kurian MA, Marafi D, Saberi A, Hamid M, Spaull R, Meng L, Lalani S, Maqbool S, Rahman F, Seeger J, Palculict TB, Lau T, Murphy D, Mencacci NE, Steindl K, Begemann A, Rauch A, Akbas S, Aslanger AD, Salpietro V, Yousaf H, Ben-Shachar S, Ejeskär K, Al Aqeel AI, High FA, Armstrong-Javors AE, Zahraei SM, Seifi T, Zeighami J, Shariati G, Sedaghat A, Asl SN, Shahrooei M, Zifarelli G, Burglen L, Ravelli C, Zschocke J, Schatz UA, Ghavideldarestani M, Kamel WA, Van Esch H, Hackenberg A, Taylor JC, Al-Gazali L, Bauer P, Gleeson JJ, Alkuraya FS, Lupski JR, Galehdari H, Azizimalamiri R, Chung WK, Baig SM, Houlden H, Severino M. Biallelic MED27 variants lead to variable ponto-cerebello-lental degeneration with movement disorders. Brain 2023; 146:5031-5043. [PMID: 37517035 PMCID: PMC10690011 DOI: 10.1093/brain/awad257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
MED27 is a subunit of the Mediator multiprotein complex, which is involved in transcriptional regulation. Biallelic MED27 variants have recently been suggested to be responsible for an autosomal recessive neurodevelopmental disorder with spasticity, cataracts and cerebellar hypoplasia. We further delineate the clinical phenotype of MED27-related disease by characterizing the clinical and radiological features of 57 affected individuals from 30 unrelated families with biallelic MED27 variants. Using exome sequencing and extensive international genetic data sharing, 39 unpublished affected individuals from 18 independent families with biallelic missense variants in MED27 have been identified (29 females, mean age at last follow-up 17 ± 12.4 years, range 0.1-45). Follow-up and hitherto unreported clinical features were obtained from the published 12 families. Brain MRI scans from 34 cases were reviewed. MED27-related disease manifests as a broad phenotypic continuum ranging from developmental and epileptic-dyskinetic encephalopathy to variable neurodevelopmental disorder with movement abnormalities. It is characterized by mild to profound global developmental delay/intellectual disability (100%), bilateral cataracts (89%), infantile hypotonia (74%), microcephaly (62%), gait ataxia (63%), dystonia (61%), variably combined with epilepsy (50%), limb spasticity (51%), facial dysmorphism (38%) and death before reaching adulthood (16%). Brain MRI revealed cerebellar atrophy (100%), white matter volume loss (76.4%), pontine hypoplasia (47.2%) and basal ganglia atrophy with signal alterations (44.4%). Previously unreported 39 affected individuals had seven homozygous pathogenic missense MED27 variants, five of which were recurrent. An emerging genotype-phenotype correlation was observed. This study provides a comprehensive clinical-radiological description of MED27-related disease, establishes genotype-phenotype and clinical-radiological correlations and suggests a differential diagnosis with syndromes of cerebello-lental neurodegeneration and other subtypes of 'neuro-MEDopathies'.
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Affiliation(s)
- Reza Maroofian
- Department of Neuromuscular Diseases, University College London, Queen Square, Institute of Neurology, London WC1N 3BG, UK
| | - Rauan Kaiyrzhanov
- Department of Neuromuscular Diseases, University College London, Queen Square, Institute of Neurology, London WC1N 3BG, UK
| | - Elisa Cali
- Department of Neuromuscular Diseases, University College London, Queen Square, Institute of Neurology, London WC1N 3BG, UK
| | - Mina Zamani
- Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran
- Narges Medical Genetics and Prenatal Diagnosis Laboratory, Kianpars, Ahvaz, Iran
- Ati Mehr Kasra Genetics Institute, Kianpars, Ahvaz, Iran
| | - Maha S Zaki
- Clinical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Cairo 12622, Egypt
| | - Matteo Ferla
- Wellcome Centre for Human Genetics, University of Oxford and Oxford NIHR Biomedical Research Centre, Oxford, OX3 7BN UK
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Saeid Sadeghian
- Department of Pediatric Neurology, Golestan Medical, Educational, and Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saadia Maryam Saadi
- Human Molecular Genetics Laboratory, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE) College, PIEAS, 44000 Faisalabad, Pakistan
| | - Uzma Abdullah
- University Institute of Biochemistry and Biotechnology, PMAS Arid Agriculture University, 46300 Rawalpindi, Pakistan
| | - Ehsan Ghayoor Karimiani
- Department of Medical Genetics, Next Generation Genetic Polyclinic, Mashhad, Iran
- Molecular and Clinical Sciences Institute, St. George’s, University of London, London SW17 0RE, UK
- Innovative Medical Research Center, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Stephanie Efthymiou
- Department of Neuromuscular Diseases, University College London, Queen Square, Institute of Neurology, London WC1N 3BG, UK
| | - Gözde Yeşil
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, Turkey
| | - Shahryar Alavi
- Department of Neuromuscular Diseases, University College London, Queen Square, Institute of Neurology, London WC1N 3BG, UK
| | - Aisha M Al Shamsi
- Genetic Division, Pediatrics Department, Tawam Hospital, Al Ain, UAE
| | - Homa Tajsharghi
- School of Health Science, Division Biomedicine and Translational Medicine, University of Skovde, SE-541 28 Skovde, Sweden
| | - Mohamed S Abdel-Hamid
- Medical Molecular Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, 12622 Cairo, Egypt
| | - Nebal Waill Saadi
- College of Medicine, University of Baghdad, 10071 Baghdad, Iraq
- Children Welfare Teaching Hospital, 10071 Baghdad, Iraq
| | - Fuad Al Mutairi
- Genetics and Precision Medicine department, King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, 22384 Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, 22384 Riyadh, Saudi Arabia
| | - Lama Alabdi
- Department of Zoology, College of Science, King Saud University, 11421 Riyadh, Saudi Arabia
- Department of Translational Genomics, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Center, 12713 Riyadh, Saudi Arabia
| | | | - Zafar Ali
- Department of Cellular and Molecular Medicine, WJC PANUM, University of Copenhagen, DK-1165 Copenhagen, Denmark
- Centre for Biotechnology and Microbiology, University of Swat, Swat 19120, Pakistan
| | - Mehran Beiraghi Toosi
- Pediatric Neurology Department Pediatric Ward Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Meisam Babaei
- Department of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Pirjo Isohanni
- Research Programs Unit, Stem Cells and Metabolism, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Department of Child Neurology, Children’s Hospital, Paediatric Research Center, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
| | - Jameel Muhammad
- Human Molecular Genetics Laboratory, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE) College, PIEAS, 44000 Faisalabad, Pakistan
- Centre for Regenerative Medicine and Stem Cell Research, Juma Building, Aga Khan University, Karachi 74800, Pakistan
| | - Sheraz Khan
- Human Molecular Genetics Laboratory, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE) College, PIEAS, 44000 Faisalabad, Pakistan
| | - Maha Al Shalan
- Genetics and Precision Medicine department, King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, 22384 Riyadh, Saudi Arabia
| | - Scott E Hickey
- Division of Genetic & Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Daphna Marom
- Genetics Institute and Genomic Center, Tel Aviv Sourasky Medical Center, and Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Emil Elhanan
- Nephro-Genetic Clinic, Nephrology Department and Genetics Institute, Tel Aviv Medical Center, Tel Aviv 64239, Israel
| | - Manju A Kurian
- Molecular Neurosciences, Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Department of Neurology, Great Ormond Street Hospital, London WC1N 1EH, UK
| | - Dana Marafi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Safat 13110, Kuwait
| | - Alihossein Saberi
- Narges Medical Genetics and Prenatal Diagnosis Laboratory, Kianpars, Ahvaz, Iran
- Department of Medical Genetics, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Hamid
- Department of Molecular Medicine, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Robert Spaull
- Nephro-Genetic Clinic, Nephrology Department and Genetics Institute, Tel Aviv Medical Center, Tel Aviv 64239, Israel
- Molecular Neurosciences, Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Linyan Meng
- Department of Neurology, Great Ormond Street Hospital, London WC1N 1EH, UK
| | - Seema Lalani
- Department of Neurology, Great Ormond Street Hospital, London WC1N 1EH, UK
| | - Shazia Maqbool
- Developmental-Behavioural Paediatrics Department, University of Child Health Sciences & The Children’s Hospital, 54000 Lahore, Pakistan
| | - Fatima Rahman
- Developmental-Behavioural Paediatrics Department, University of Child Health Sciences & The Children’s Hospital, 54000 Lahore, Pakistan
| | - Jürgen Seeger
- Center for Social Pediatrics and Epilepsy Outpatient Clinic Frankfurt Mitte, 60316 Frankfurt am Main, Germany
| | | | - Tracy Lau
- Department of Neuromuscular Diseases, University College London, Queen Square, Institute of Neurology, London WC1N 3BG, UK
| | - David Murphy
- Department of Neuromuscular Diseases, University College London, Queen Square, Institute of Neurology, London WC1N 3BG, UK
| | - Niccolo Emanuele Mencacci
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Katharina Steindl
- Institute of Medical Genetics, University of Zurich, 8952 Schlieren, Switzerland
| | - Anais Begemann
- Institute of Medical Genetics, University of Zurich, 8952 Schlieren, Switzerland
| | - Anita Rauch
- Institute of Medical Genetics, University of Zurich, 8952 Schlieren, Switzerland
| | - Sinan Akbas
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, Turkey
| | - Ayça Dilruba Aslanger
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, Turkey
| | - Vincenzo Salpietro
- Department of Neuromuscular Diseases, University College London, Queen Square, Institute of Neurology, London WC1N 3BG, UK
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, 67100 L’Aquila, Italy
| | - Hammad Yousaf
- Human Molecular Genetics Laboratory, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE) College, PIEAS, 44000 Faisalabad, Pakistan
| | - Shay Ben-Shachar
- Clalit Research Institute, Clalit Health Services, 6578898 Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katarina Ejeskär
- School of Health Science, Division Biomedicine and Translational Medicine, University of Skovde, SE-541 28 Skovde, Sweden
| | - Aida I Al Aqeel
- Department of Pediatrics, Prince Sultan Military Medical City, 12233 Riyadh, Saudi Arabia
- American University of Beirut, 1107 2020 Beirut, Lebanon
- Alfaisal University, 11533 Riyadh, Saudi Arabia
| | - Frances A High
- Division of Medical Genetics, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Amy E Armstrong-Javors
- Harvard Medical School, Boston, MA 02115, USA
- Department of Pediatric Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Tahereh Seifi
- Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran
- Narges Medical Genetics and Prenatal Diagnosis Laboratory, Kianpars, Ahvaz, Iran
| | - Jawaher Zeighami
- Narges Medical Genetics and Prenatal Diagnosis Laboratory, Kianpars, Ahvaz, Iran
- Ati Mehr Kasra Genetics Institute, Kianpars, Ahvaz, Iran
| | - Gholamreza Shariati
- Narges Medical Genetics and Prenatal Diagnosis Laboratory, Kianpars, Ahvaz, Iran
- Department of Medical Genetics, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Sedaghat
- Narges Medical Genetics and Prenatal Diagnosis Laboratory, Kianpars, Ahvaz, Iran
- Diabetes Research center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Samaneh Noroozi Asl
- Department of Pediatrics Endocrinology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohmmad Shahrooei
- Specialized Immunology Laboratory of Dr Shahrooei, Sina Medical Complex, Ahvaz, Iran
- Department of Microbiology and Immunology, Clinical and Diagnostic Immunology, KU Leuven, 3000 Leuven, Belgium
| | | | - Lydie Burglen
- Cerebellar Malformations and Congenital diseases Reference Center and Neurogenetics Lab, Department of Genetics, Armand Trousseau Hospital, AP-HP Sorbonne Université, 75006 Paris, France
- Developmental Brain Disorders Laboratory, Imagine Institute, INSERM UMR 1163, 75015 Paris, France
| | - Claudia Ravelli
- Pediatric Neurology Department, Movement Disorders Center, Armand Trousseau Hospital, AP-HP Sorbonne Université, 75006 Paris, France
| | - Johannes Zschocke
- Institute of Human Genetics, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Ulrich A Schatz
- Institute of Human Genetics, Medical University Innsbruck, 6020 Innsbruck, Austria
- Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität Munich, 81675 Munich, Germany
| | | | - Walaa A Kamel
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Neurology, Faculty of Medicine, Beni-Suef University, 62521 Beni Suef, Egypt
| | - Hilde Van Esch
- Center for Human Genetics, University Hospitals Leuven, 3000 Leuven, Belgium
- Laboratory for the Genetics of Cognition, Department of Human Genetics, KU Leuven–University of Leuven, 3000 Leuven, Belgium
| | - Annette Hackenberg
- Department of Pediatric Neurology, University Children's Hospital Zürich, University of Zürich, 8032 Zürich, Switzerland
| | - Jenny C Taylor
- Wellcome Centre for Human Genetics, University of Oxford and Oxford NIHR Biomedical Research Centre, Oxford, OX3 7BN UK
| | - Lihadh Al-Gazali
- Departments of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | | | - Joseph J Gleeson
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92025, USA
| | - Fowzan Sami Alkuraya
- Department of Translational Genomics, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - James R Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Hospital, Houston, TX 77030, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Hamid Galehdari
- Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran
- Ati Mehr Kasra Genetics Institute, Kianpars, Ahvaz, Iran
| | - Reza Azizimalamiri
- Department of Pediatric Neurology, Golestan Medical, Educational, and Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Wendy K Chung
- Boston Children’s Hospital and Harvard Medical School Boston, MA 02115, USA
| | - Shahid Mahmood Baig
- Human Molecular Genetics Laboratory, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE) College, PIEAS, 44000 Faisalabad, Pakistan
- Department of Biological and Biomedical Sciences, Aga Khan University, 74800 Karachi, Pakistan
| | - Henry Houlden
- Department of Neuromuscular Diseases, University College London, Queen Square, Institute of Neurology, London WC1N 3BG, UK
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Wang G, Jin P, Ma X, Hong X, Zhang L, Lin K, Wen X, Bai X, Han Y. Cognitive and gait in Wilson's disease: a cognitive and motor dual-task study. Front Neurol 2023; 14:1243122. [PMID: 37719756 PMCID: PMC10501853 DOI: 10.3389/fneur.2023.1243122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Background Cognitive and motor dual-tasks play important roles in daily life. Dual-task interference impacting gait performance has been observed not only in healthy subjects but also in subjects with neurological disorders. Approximately 44-75% of Wilson's disease (WD) patients have gait disturbance. According to our earlier research, 59.7% of WD patients have cognitive impairment. However, there are few studies on how cognition affects the gait in WD. Therefore, this study aims to explore the influence of cognitive impairment on gait and its neural mechanism in WD patients and to provide evidence for the clinical intervention of gait disturbance. Methods We recruited 63 patients who were divided into two groups based on their scores on the Addenbrooke's cognitive examination III (ACE-III) scale: a non-cognitive impairment group and a cognitive impairment group. In addition to performing the timed up and go (TUG) single task and the cognitive and motor dual-task digital calculation and animal naming tests, the Tinetti Balance and Gait Assessment (POMA), Berg Balance Scale (BBS), and brain MRI severity scale of WD (bMRIsc-WD) were evaluated. The dual-task cost (DTC) was also computed. Between the two groups, the results of the enhanced POMA, BBS, and bMRIsc-WD scales, as well as gait performance measures such as TUG step size, pace speed, pace frequency, and DTC value, were compared. Results (1) Among the 63 patients with WD, 30 (47.6%) patients had gait disturbance, and the single task TUG time was more than 10 s. A total of 43 patients had cognitive impairment, the incidence rate is 44.4%. Furthermore, 28 (44.4%) patients had cognitive impairment, 39 (61.9%) patients had abnormal brain MRI. (2) The Tinetti gait balance scale and Berg balance scale scores of patients with cognitive impairment were lower than those of patients without cognitive impairment (p < 0.05), and the pace, step size, and pace frequency in the single task TUG were slower than those of patients without cognitive impairment (p < 0.05). There was no change in the pace frequency between the dual-task TUG and the non-cognitive impairment group, but the pace speed and step size in the dual-task TUG were smaller than non-cognitive impairment group (p < 0.05). There was no difference in DTC values between cognitive impairment group and non-cognitive impairment group when performing dt-TUG number calculation and animal naming respectively (p > 0.05). However, regardless of cognitive impairment or not, the DTC2 values of number calculation tasks is higher than DTC1 of animal naming tasks in dt-TUG (p < 0.05). (3) Pace speed and step size were related to the total cognitive score, memory, language fluency, language understanding, and visual space factor score of the ACE-III (p < 0.05), and step frequency was correlated with memory and language comprehension factors (p < 0.05). There was no correlation between the attention factor scores of the ACE-III and TUG gait parameters of different tasks (p > 0.05). Brain atrophy, the thalamus, caudate nucleus, and cerebellum were correlated with cognitive impairment (p < 0.05), the lenticular nucleus was related to the step size, brain atrophy was related to the pace speed, and the thalamus, caudate nucleus, and midbrain were involved in step frequency in WD patients (p < 0.05). Conclusion WD patients had a high incidence of cognitive impairment and gait disorder, the pace speed and step size can reflect the cognitive impairment of WD patients, cognitive impairment affects the gait disorder of WD patients, and the different cognitive and motor dual-tasks were involved in affecting gait parameters. The joint participation of cognitive impairment and lesion brain area may be the principal neural mechanism of gait abnormality in WD patients.
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Affiliation(s)
- Gongqiang Wang
- Institute of Neurology, Anhui University of Traditional Chinese Medicine, Hefei, China
- Affiliated Hospital of Institute of Neurology, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Ping Jin
- Affiliated Hospital of Institute of Neurology, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Xinfeng Ma
- Affiliated Hospital of Institute of Neurology, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Xia Hong
- Graduate School of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Long Zhang
- Affiliated Hospital of Institute of Neurology, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Kang Lin
- Affiliated Hospital of Institute of Neurology, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Xiao Wen
- Graduate School of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Xue Bai
- Graduate School of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Yongzhu Han
- Institute of Neurology, Anhui University of Traditional Chinese Medicine, Hefei, China
- Affiliated Hospital of Institute of Neurology, Anhui University of Traditional Chinese Medicine, Hefei, China
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Wang SJ, Geng H, Cheng SR, Xu CC, Zhang RQ, Wang Y, Wu T, Li B, Wang T, Han YS, Ding ZH, Sun YN, Wang X, Han YZ, Cheng N. A weighted cranial diffusion-weighted imaging scale for Wilson's disease. Front Neurosci 2023; 17:1186053. [PMID: 37650098 PMCID: PMC10463731 DOI: 10.3389/fnins.2023.1186053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
Objectives Cranial magnetic resonance imaging (MRI) could be a crucial tool for the assessment for neurological symptoms in patients with Wilson's disease (WD). Diffusion-weighted imaging (DWI) hyperintensity reflects the acute brain injuries, which mainly occur in specific brain regions. Therefore, this study aimed to develop a weighted cranial DWI scale for patients with WD, with special focus on specific brain regions. Materials and methods In total, 123 patients with WD were enrolled, 118 of whom underwent 1.5 T-MRI on admission. The imaging score was calculated as described previously and depended on the following sequences: one point was acquired when abnormal intensity occurred in the T1, T2, and fluid-attenuation inversion recovery sequences, and two points were acquired when DWI hyperintensity were found. Consensus weighting was conducted based on the symptoms and response to treatment. Results Intra-rater agreement were good (r = 0.855 [0.798-0.897], p < 0.0001). DWI hyperintensity in the putamen was a high-risk factor for deterioration during de-copper therapy (OR = 8.656, p < 0.05). The high-risk factors for readmission for intravenous de-copper therapies were DWI hyperintensity in the midbrain (OR = 3.818, p < 0.05) and the corpus callosum (OR = 2.654, p < 0.05). Both scoring systems had positive correlation with UWDRS scale (original semi-quantitative scoring system, r = 0.35, p < 0.001; consensus semi-quantitative scoring system, r = 0.351, p < 0.001.). Compared to the original scoring system, the consensus scoring system had higher correlations with the occurrence of deterioration (OR = 1.052, 95%CI [1.003, 1.0103], p < 0.05) and readmission for intravenous de-copper therapy (OR = 1.043, 95%CI [1.001, 1.086], p < 0.05). Conclusion The predictive performance of the consensus semi-quantitative scoring system for cranial MRI was improved to guide medication, healthcare management, and prognosis prediction in patients with WD. For every point increase in the neuroimaging score, the risk of exacerbations during treatment increased by 5.2%, and the risk of readmission to the hospital within 6 months increased by 4.3%.
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Affiliation(s)
- Shi-jing Wang
- Graduate School, Anhui University of Chinese Medicine, Hefei, China
- Hospital Affiliated to the Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Hao Geng
- Institute of Intelligent Machines, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hefei, China
- Department of Biophysics, University of Science and Technology of China, Hefei, China
| | - Si-rui Cheng
- Department of Economics, Nankai University, Tainjin, China
| | - Chen-chen Xu
- Hospital Affiliated to the Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Rui-qi Zhang
- Institute of Intelligent Machines, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hefei, China
- Department of Biophysics, University of Science and Technology of China, Hefei, China
| | - Yu Wang
- Institute of Intelligent Machines, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hefei, China
- Department of Biophysics, University of Science and Technology of China, Hefei, China
| | - Tong Wu
- Graduate School, Anhui University of Chinese Medicine, Hefei, China
| | - Bo Li
- Hospital Affiliated to the Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Tao Wang
- Institute of Intelligent Machines, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Yong-sheng Han
- Hospital Affiliated to the Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Zeng-hui Ding
- Institute of Intelligent Machines, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Yi-ning Sun
- Institute of Intelligent Machines, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Xun Wang
- Graduate School, Anhui University of Chinese Medicine, Hefei, China
- Hospital Affiliated to the Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Yong-zhu Han
- Graduate School, Anhui University of Chinese Medicine, Hefei, China
- Hospital Affiliated to the Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Nan Cheng
- Graduate School, Anhui University of Chinese Medicine, Hefei, China
- Hospital Affiliated to the Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
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Litwin T, Dusek P, Antos A, Członkowska A, Bembenek J. Tackling the neurological manifestations in Wilson's disease - currently available treatment options. Expert Rev Neurother 2023; 23:1249-1259. [PMID: 37842984 DOI: 10.1080/14737175.2023.2268841] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Wilson's disease (WD) is a potentially treatable, inherited disorder resulting from impaired copper metabolism. Pathological copper accumulation causes a range of symptoms, most commonly hepatic and a wide spectrum of neurological symptoms including tremor, dystonia, chorea, parkinsonism, dysphagia, dysarthria, gait and posture disturbances. To reduce copper overload, anti-copper drugs are used that improve liver function and neurological symptoms in up to 85% of patients. However, in some WD patients, treatment introduction leads to neurological deterioration, and in others, neurological symptoms persist with no improvement or improvement only after several years of treatment, severely affecting the patient's quality of life. AREAS COVERED This review appraises the evidence on various pharmacological and non-pharmacological therapies, neurosurgical procedures and liver transplantation for the management of neurological WD symptoms. The authors also discuss the neurological symptoms of WD, causes of deterioration and present symptomatic treatment options. EXPERT OPINION Based on case and series reports, current recommendations and expert opinion, WD treatment is focused mainly on drugs leading to negative copper body metabolism (chelators or zinc salts) and copper-restricted diet. Treatment of WD neurological symptoms should follow general recommendations of symptomatic treatment. Patients should be always considered individually, especially in the case of severe, disabling neurological symptoms.
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Affiliation(s)
- Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Petr Dusek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Agnieszka Antos
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Jan Bembenek
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
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Huang Z, Yang J, Chen D, Zhou X, Xiao X, Wang J, Wang M, Zhao J, Chu J. Metal deposits associated with brain atrophy in the deep gray matter nucleus in Wilson's disease. Cereb Cortex 2023:bhad182. [PMID: 37365842 DOI: 10.1093/cercor/bhad182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/03/2023] [Indexed: 06/28/2023] Open
Abstract
Regional atrophy and metal deposition are typical manifestations in Wilson's disease, but their relationship has not been systematically investigated. We aim to investigate the association of regional brain atrophy and metal deposition in the deep gray matter nucleus at MRI in Wilson's disease. We acquired the structural and susceptibility mapping and performed a cross-sectional comparison of volume and susceptibility in deep gray matter nucleus. The most extensive and severe atrophy was detected in brain regions in neuro-Wilson's disease, as well as the most widespread and heaviest metal deposits. Metal deposits were significantly negatively correlated with volume in the bilateral thalamus, caudate, and putamen. None of correlation was found between the clinical score with volume or susceptibility in the focused regions. In the 1-year follow-up analysis, the volume of right thalamus, globus pallidus, and brainstem and the susceptibility of the left caudate have decreased significantly as the symptom improvement. In Wilson's disease, phenotypes have varied scope and extend of volumetric atrophy and metal deposits. This study is expected to take the lead in revealing that in neuro-Wilson's disease, greater regional atrophy associated with heavier metal deposits in Wilson's disease. Moreover, after 1-year treatment, the imaging data have changed as the patient's condition improvement.
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Affiliation(s)
- Zihuan Huang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Jie Yang
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen 518000, Guangdong Province, China
| | - Dingbang Chen
- Department of Neurology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Xiangxue Zhou
- Department of Neurology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Xia Xiao
- Department of Neurology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Junqiao Wang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Mengzhu Wang
- Department of MR Scientific Marketing, Siemens Healthineers, Guangzhou 510120, Guangdong Province, China
| | - Jing Zhao
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Jianping Chu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
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Antos A, Członkowska A, Bembenek J, Skowronska M, Kurkowska-Jastrzębska I, Litwin T. Blood Based Biomarkers of Central Nervous System Involvement in Wilson's Disease. Diagnostics (Basel) 2023; 13:diagnostics13091554. [PMID: 37174946 PMCID: PMC10177361 DOI: 10.3390/diagnostics13091554] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/15/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Wilson's disease (WD) is an inherited disorder of copper metabolism with clinical symptoms related to pathological copper accumulation, which are mainly hepatic and/or neuropsychiatric. The disease is potentially treatable with pharmacological agents (chelators or zinc salts). As such, key factors for a favorable treatment outcome are early diagnosis and anti-copper treatment initiation as well as appropriate treatment monitoring for safety and efficacy. Despite the generally favorable outcome in most treated patients, almost 10% of the general population of WD patients and about 25% of patients in the group with initial neurological phenotype of disease experience early neurological deterioration. In almost 50% of patients with neurological symptoms, the symptoms persist. A search for new treatment modalities (e.g., gene therapy, molybdenum salts) aims to prevent early neurological deterioration as well as improve treatment outcomes. In addition to evaluating the clinical signs and symptoms of the disease, serum biomarkers for diagnosis and treatment monitoring are very important for WD management. Sensitive serum biomarkers of copper metabolism and liver injury are well described. However, there is a need to establish blood-based biomarkers of central nervous system (CNS) injury to help identify patients at risk of early neurological deterioration and aid in their monitoring. Based on the available literature and studies of WD patients, the authors reviewed serum biomarkers of CNS involvement in WD, as well as their potential clinical significance.
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Affiliation(s)
- Agnieszka Antos
- Second Department of Neurology, Institute of Psychiatry and Neurology, 9 Sobieskiego Str., 02-957 Warsaw, Poland
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, 9 Sobieskiego Str., 02-957 Warsaw, Poland
| | - Jan Bembenek
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland
| | - Marta Skowronska
- Second Department of Neurology, Institute of Psychiatry and Neurology, 9 Sobieskiego Str., 02-957 Warsaw, Poland
| | - Iwona Kurkowska-Jastrzębska
- Second Department of Neurology, Institute of Psychiatry and Neurology, 9 Sobieskiego Str., 02-957 Warsaw, Poland
| | - Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, 9 Sobieskiego Str., 02-957 Warsaw, Poland
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Wang Y, Xuan H, Zhao T, Li X, Li S, Hu W. A study of linear measurement and clinical correlation of brain atrophy in Wilson's disease. Front Hum Neurosci 2023; 17:1142082. [PMID: 37056963 PMCID: PMC10086176 DOI: 10.3389/fnhum.2023.1142082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/14/2023] [Indexed: 03/30/2023] Open
Abstract
Background The aim of this study was to explore the clinical relevance of linear measures of Wilson's disease (WD). Methods Relative values of brain atrophy in 30 patients with WD and 30 healthy volunteers were measured and compared using a manual measurement method. Linear measurement indicators of brain atrophy in patients with and without mental disorders were also compared. In addition, correlations of patients' age, disease duration, and Unified Wilson's Disease Rating Scale (UWDRS) scores with brain atrophy indicators were determined. Results The results showed that the e-value, Huckman number, Evans index, and lateral ventricular body index were higher in the WD group compared with the control group. The age of patients with WD was negatively correlated with the k-value and significantly positively correlated with the brainstem index. WD duration was prominently positively correlated with the d-value and negatively correlated with the j-value. In addition, neurological function scores were significantly positively correlated with the c-value, e-value, caudate nucleus index, Huckman number, Evans index, and lateral ventricular body index. By contrast, patients with psychiatric symptoms had a higher a-value and fourth ventricular index than those without psychiatric symptoms. Conclusion Therefore, it can be concluded that patients with WD and those with psychiatric symptoms have more severe brain atrophy compared to normal subjects. The patient's age, disease duration, and neurological function scores were positively correlated with the severity of brain atrophy.
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Affiliation(s)
- Yun Wang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hongxia Xuan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Hongda Hospital, Jiamusi University, Jiamusi, China
| | - Tun Zhao
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaodong Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shujuan Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Nilles C, Obadia MA, Sobesky R, Dumortier J, Guillaud O, Laurencin C, Moreau C, Vanlemmens C, Ory-Magne F, de Ledinghen V, Bardou-Jacquet E, Fluchère F, Collet C, Oussedik-Djebrani N, Woimant F, Poujois A. Diagnosis and Outcomes of Late-Onset Wilson's Disease: A National Registry-Based Study. Mov Disord 2023; 38:321-332. [PMID: 36573661 DOI: 10.1002/mds.29292] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Wilson's disease (WD) is usually diagnosed in children and young adults; limited data exist on late-onset forms. OBJECTIVE The aim was to characterize the clinical and paraclinical presentations, therapeutic management, and outcomes in patients with late-onset WD. METHODS Patients diagnosed with WD after age 40 years were identified from the French Wilson's Disease Registry (FWDR). Clinical, laboratory, and imaging findings and treatment were reported at diagnosis and last follow-up. RESULTS Forty-five patients were identified (median age: 49, range: 40-64) and placed in three groups according to their clinical presentation: neurological (n = 20, median diagnostic delay: 20 months), hepatic (n = 13, diagnostic delay: 12 months), and family screening (n = 12), all confirmed genetically. Six neurological patients had an atypical presentation (1 torticollis, 2 writer's cramps, 2 functional movement disorders, and 1 isolated dysarthria), without T2/fluid-attenuated inversion recovery brain magnetic resonance imaging (MRI) hyperintensities; 5 of 6 had no Kayser-Fleischer ring (KFR); 5 of 6 had liver involvement. In the neurological group, 84% of patients improved clinically, and 1 developed copper deficiency. In the hepatic group, 77% had cirrhosis; 6 patients required liver transplantation. In the screened group, 43% had mild liver involvement; 3 were not treated and remained stable; 24-h urinary copper excretion was normal in 33% of patients at diagnosis. CONCLUSIONS In the FWDR, late-onset forms of WD affect 8% of patients, mostly with neurological presentations. Thirty percent of the neurological forms were atypical (isolated long-lasting symptoms, inconspicuous brain MRI, no KFR). With personalized treatment, prognosis was good. This study emphasized that WD should be suspected at any age and even in cases of atypical presentation. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Christelle Nilles
- Department of Neurology, Rothschild Foundation Hospital, Paris, France.,National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France
| | - Mickael Alexandre Obadia
- Department of Neurology, Rothschild Foundation Hospital, Paris, France.,National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France
| | - Rodolphe Sobesky
- Centre Hépato-Biliaire, AP-HP, DHU Hepatinov, INSERM UMR-S 1193, Hôpital Paul Brousse, Villejuif, France
| | - Jérôme Dumortier
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France.,Department of Hepatologie-Gastroenterologie, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Olivier Guillaud
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France.,Service d'explorations fonctionnelles digestives, CHU Lyon, Lyon, France
| | - Chloé Laurencin
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France.,Service de Neurologie HFME-GHE, Bron Cedex, France
| | - Caroline Moreau
- Service de neurologie et pathologies du mouvement, INSERM UMR, CHU Lille, Lille, France
| | - Claire Vanlemmens
- Service d'Hépatologie et soins intensifs digestifs, CHU Besançon, Hôpital Jean Minjoz, Besançon, France
| | - Fabienne Ory-Magne
- Service de Neurologie, Neurology Department, CHU Toulouse, Hôpital Purpan, Toulouse, France
| | - Victor de Ledinghen
- Service d'Hépatologie-Gastroentérologie, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac & INSERM U1312, Université de Bordeaux, Bordeaux, France
| | | | - Frederique Fluchère
- Service de Neurologie, Neurology Department, CHU Marseille, Hôpital de la Timone, Marseille, France
| | - Corinne Collet
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France.,Département de Génétique, Hôpital Robert Debré AP-HP, Paris, France
| | - Nouzha Oussedik-Djebrani
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France.,Laboratoire de Toxicologie Biologique, Hôpital Lariboisière AP-HP, Paris, France
| | - France Woimant
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France
| | - Aurélia Poujois
- Department of Neurology, Rothschild Foundation Hospital, Paris, France.,National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France
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13
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Rędzia-Ogrodnik B, Członkowska A, Antos A, Bembenek J, Kurkowska-Jastrzębska I, Przybyłkowski A, Skowrońska M, Smoliński Ł, Litwin T. Pathognomonic neuroradiological signs in Wilson's disease - Truth or myth? Parkinsonism Relat Disord 2023; 107:105247. [PMID: 36543734 DOI: 10.1016/j.parkreldis.2022.105247] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Wilson's disease (WD) is a treatable genetic disorder caused by impaired copper metabolism. Early diagnosis and correct anti-copper treatment are crucial for therapeutic success. Brain magnetic resonance imaging (MRI) is used both for diagnosis and treatment monitoring. Several neuroradiological signs have been proposed to be pathognomonic for WD; however, their frequency and significance are not established. The frequency and significance of these brain MRI signs were analyzed in a large cohort of WD patients. METHODS We retrospectively analyzed 100 newly diagnosed, treatment-naive WD patients. Brain MRI was performed and the frequency of typical MRI changes was analyzed with demographic, clinical and laboratory characteristics of WD. RESULTS Potentially pathognomonic brain MRI signs for WD occurred in 24% patients and in 43% (24/55) patients with neurological WD. Signs detected included the "face of the giant panda" in 15% of all patients (27.3% of neurological cases), "miniature panda" in 12% (21.8% of neurological cases), "split thalamus" in 7% (12.7% of neurological cases), and "bright claustrum" and "whorl" signs in 1 patients each. Signs were observed only in patients with neurological symptoms and were significantly associated with early age of onset/diagnosis, more severe neurological presentation and lower ceruloplasmin level (all p < 0.05). CONCLUSIONS Potentially brain MRI pathognomonic signs occurred relatively rarely across all patients, most often in patients with early onset and severe neurological symptoms, and this knowledge may improve WD diagnosis. However, as these signs are also found in brain MRI in other disorders, they may not be truly pathognomonic of WD.
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Affiliation(s)
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Agnieszka Antos
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Jan Bembenek
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Adam Przybyłkowski
- Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, Poland
| | - Marta Skowrońska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Łukasz Smoliński
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
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14
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Guillaud O, Dumortier J, Couchonnal-Bedoya E, Ruiz M. Wilson Disease and Alpha1-Antitrypsin Deficiency: A Review of Non-Invasive Diagnostic Tests. Diagnostics (Basel) 2023; 13:diagnostics13020256. [PMID: 36673066 PMCID: PMC9857715 DOI: 10.3390/diagnostics13020256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
Wilson disease and alpha1-antitrypsin deficiency are two rare genetic diseases that may impact predominantly the liver and/or the brain, and the liver and/or the lung, respectively. The early diagnosis of these diseases is important in order to initiate a specific treatment, when available, ideally before irreversible organ damage, but also to initiate family screening. This review focuses on the non-invasive diagnostic tests available for clinicians in both diseases. These tests are crucial at diagnosis to reduce the potential diagnostic delay and assess organ involvement. They also play a pivotal role during follow-up to monitor disease progression and evaluate treatment efficacy of current or emerging therapies.
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Affiliation(s)
- Olivier Guillaud
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence pour la Maladie de Wilson, 69500 Bron, France
- Ramsay Générale de Santé, Clinique de la Sauvegarde, 69009 Lyon, France
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, 69003 Lyon, France
- Correspondence: ; Tel.: +33-4-72-11-95-19
| | - Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence pour la Maladie de Wilson, 69500 Bron, France
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, 69003 Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, 69003 Lyon, France
| | - Eduardo Couchonnal-Bedoya
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence pour la Maladie de Wilson, 69500 Bron, France
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d’Hépatogastroentérologie et Nutrition Pédiatrique, 69500 Bron, France
| | - Mathias Ruiz
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d’Hépatogastroentérologie et Nutrition Pédiatrique, 69500 Bron, France
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence pour l’Atrésie des Voies Biliaires et les Cholestases Génétiques, 69500 Bron, France
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15
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Jing XZ, Li GY, Wu YP, Yuan XZ, Luo XG, Chen JL, Taximaimaiti R, Wang XP, Li JQ. Free water imaging as a novel biomarker in Wilson's disease: A cross-sectional study. Parkinsonism Relat Disord 2023; 106:105234. [PMID: 36481719 DOI: 10.1016/j.parkreldis.2022.105234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The bi-tensor free water imaging may provide more specific information in detecting microstructural brain tissue alterations than conventional single tensor diffusion tensor imaging. The study aimed to investigate microstructural changes in deep gray matter (DGM) nuclei of Wilson's disease (WD) using a bi-tensor free water imaging and whether the findings correlate with the neurological impairment in WD patients. METHODS The study included 29 WD patients and 25 controls. Free water and free water corrected fractional anisotropy (FAT) in DGM nuclei of WD patients were calculated. The correlations of free water and FAT with the Unified WD Rating Scale (UWDRS) neurological subscale of WD patients were performed. RESULTS Free water and FAT values were significantly increased in multiple DGM nuclei of neurological WD patients compared to controls. WD patients with normal appearing on conventional MRI also had significantly higher free water and FAT values in multiple DGM nuclei than controls. Positive correlations were noted between the UWDRS neurological subscores and free water values of the putamen and pontine tegmentum as well as FAT values of the dentate nucleus, red nucleus, and globus pallidus. In addition, the measured free water and FAT values of specific structures also showed a positive correlation with specific clinical symptoms in neurological WD patients, such as dysarthria, parkinsonian signs, tremor, dystonia, and ataxia. CONCLUSIONS Free water imaging detects microstructural changes in both normal and abnormal appearing DGM nuclei of WD patients. Free water imaging indices were correlated with the severity of neurological impairment in WD patients.
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Affiliation(s)
- Xiao-Zhong Jing
- Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Gai-Ying Li
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China.
| | - Yu-Peng Wu
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China.
| | - Xiang-Zhen Yuan
- Department of Neurology, Weifang People's Hospital, Weifang, Shandong, China.
| | - Xing-Guang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Jia-Lin Chen
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China.
| | - Reyisha Taximaimaiti
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xiao-Ping Wang
- Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jian-Qi Li
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China.
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16
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Su D, Zhang Z, Zhang Z, Gan Y, Zhang Y, Liu X, Bi J, Ma L, Zhao H, Wang X, Wang Z, Ma H, Sifat S, Zhou J, Li W, Wu T, Jing J, Feng T. Microstructural and functional impairment of the basal ganglia in Wilson's disease: a multimodal neuroimaging study. Front Neurosci 2023; 17:1146644. [PMID: 37152597 PMCID: PMC10157043 DOI: 10.3389/fnins.2023.1146644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
Objectives Magnetic susceptibility changes in brain MRI of Wilson's disease (WD) patients have been described in subcortical nuclei especially the basal ganglia. The objectives of this study were to investigate its relationship with other microstructural and functional alterations of the subcortical nuclei and the diagnostic utility of these MRI-related metrics. Methods A total of 22 WD patients and 20 healthy controls (HCs) underwent 3.0T multimodal MRI scanning. Susceptibility, volume, diffusion microstructural indices and whole-brain functional connectivity of the putamen (PU), globus pallidus (GP), caudate nucleus (CN), and thalamus (TH) were analyzed. Receiver operating curve (ROC) was applied to evaluate the diagnostic value of the imaging data. Correlation analysis was performed to explore the connection between susceptibility change and microstructure and functional impairment of WD and screen for neuroimaging biomarkers of disease severity. Results Wilson's disease patients demonstrated increased susceptibility in the PU, GP, and TH, and widespread atrophy and microstructural impairments in the PU, GP, CN, and TH. Functional connectivity decreased within the basal ganglia and increased between the PU and cortex. The ROC model showed higher diagnostic value of isotropic volume fraction (ISOVF, in the neurite orientation dispersion and density imaging model) compared with susceptibility. Severity of neurological symptoms was correlated with volume and ISOVF. Susceptibility was positively correlated with ISOVF in GP. Conclusion Microstructural impairment of the basal ganglia is related to excessive metal accumulation in WD. Brain atrophy and microstructural impairments are useful neuroimaging biomarkers for the neurological impairment of WD.
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Affiliation(s)
- Dongning Su
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhijin Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhe Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yawen Gan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yingkui Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinyao Liu
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jingfeng Bi
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lingyan Ma
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huiqing Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuemei Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huizi Ma
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shairy Sifat
- Djavad Mowafaghian Centre for Brain Health, Pacific Parkinson’s Research Centre, University of British Columbia and Vancouver Coastal Health, Vancouver, BC, Canada
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Wei Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tao Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jing Jing,
| | - Tao Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Tao Feng,
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17
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Diao SP, Lǚ CX, Huang YQ, Zhou ZH, Liu AQ, Hong MF. Linear structural features of Wilson's disease and its correlation with neurological symptoms. Medicine (Baltimore) 2022; 101:e31386. [PMID: 36550817 PMCID: PMC9771331 DOI: 10.1097/md.0000000000031386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To measure the linear structure of the brain in patients with Wilson's disease (WD) and analyze its correlation with neurological symptoms. A total of 174 patients diagnosed with WD were enrolled. According to the type of clinical presentation, the patients with WD were divided into two groups: neurological (NWD) and hepatic (HWD). Sixty healthy volunteers were assigned to a control group. All patients with WD and healthy controls underwent brain magnetic resonance imaging (MRI). The severity of the neurological symptoms was assessed using the Burke Fahn Marsden Movement subscale (BFM-M). Linear brain measurements were performed using T1-weighted MRI scans of all the patients, and the correlation between these linear indices and BFM-M score was investigated. The Huckman index, third ventricle width, and sulcus width of the NWD group were significantly higher than those of the HWD and control groups (P < .05). The frontal horn index, ventricular index, and lateral ventricular body width index of the NWD group were significantly lower than those of the HWD and control groups (P < .05). The Huckman index and third ventricle width of the HWD group were higher than those of the control group (P < .05), whereas the body width index of the lateral ventricle was lower than that of the control group (P < .05). The BFM-M score correlated with the Huckman index (r = 0.29, P < .05), third ventricle width (r = 0.426, P < .001), and lateral ventricular body width index (r = -0.19, P < .05). This study demonstrated significant changes in the linear structure of patients with WD. Linear brain measurement analysis could be used as a potential method to assess the severity of neurological symptoms in WD.
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Affiliation(s)
- Sheng-Peng Diao
- Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Neurology, College of Clinical Medicine, The First Affiliated Hospital, Guangdong Pharmaceutical University, Guangzhou, China
| | - Chun-Xiao Lǚ
- Department of Neurology, College of Clinical Medicine, The First Affiliated Hospital, Guangdong Pharmaceutical University, Guangzhou, China
| | - Ye-Qing Huang
- Department of Neurology, College of Clinical Medicine, The First Affiliated Hospital, Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhi-Hua Zhou
- Department of Neurology, College of Clinical Medicine, The First Affiliated Hospital, Guangdong Pharmaceutical University, Guangzhou, China
| | - Ai-Qun Liu
- Department of Neurology, College of Clinical Medicine, The First Affiliated Hospital, Guangdong Pharmaceutical University, Guangzhou, China
| | - Ming-Fan Hong
- Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Neurology, College of Clinical Medicine, The First Affiliated Hospital, Guangdong Pharmaceutical University, Guangzhou, China
- *Correspondence: Ming-Fan Hong, Department of Neurology, The First Affiliated Hospital, Jinan University, 613 Huangpu Road West, Tianhe, Guangzhou, Guangdong 510630, China (e-mail: )
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18
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Smolinski L, Ziemssen T, Akgun K, Antos A, Skowrońska M, Kurkowska-Jastrzębska I, Członkowska A, Litwin T. Brain Atrophy Is Substantially Accelerated in Neurological Wilson's Disease: A Longitudinal Study. Mov Disord 2022; 37:2446-2451. [PMID: 36165286 DOI: 10.1002/mds.29229] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although brain atrophy is common in neurological Wilson's disease, longitudinal studies are lacking. OBJECTIVE The objective of this study was to measure longitudinal brain atrophy rate and to relate it to the change in neurological impairment in Wilson's disease. METHODS We included patients with brain imaging done at diagnosis and at least 12 months later. The atrophy rate was measured as percentage change in ventricular volume, whereas the change in neurological impairment was scored on the Unified Wilson's Disease Rating Scale. RESULTS Of 57 patients, 36 had neurological presentation, 17 had hepatic presentation, and 4 were presymptomatic. The annualized atrophy rate was significantly greater in patients with the neurological presentation than in other patients (P = 0.001). In the neurological presentation, the atrophy rate correlated with the change in impairment (rho = 0.39, P = 0.018) and was significantly greater in those with worsening after diagnosis than in those without worsening (P < 0.001). CONCLUSIONS Brain atrophy rate appears as a promising marker of neurodegeneration in Wilson's disease. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Lukasz Smolinski
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl Gustav Carus & Dresden University of Technology, Dresden, Germany
| | - Katja Akgun
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl Gustav Carus & Dresden University of Technology, Dresden, Germany
| | - Agnieszka Antos
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Marta Skowrońska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
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Brain microstructural abnormalities in patients with Wilson’s disease: A systematic review of diffusion tenor imaging studies. Brain Imaging Behav 2022; 16:2809-2840. [DOI: 10.1007/s11682-022-00733-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
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20
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Pinto C, Malaquias MJ, Miranda HP, Temudo T, Silva E, Ramos C, Magalhães M. Brain MRI in the Decision for Liver Transplantation in Pediatric Neurological Wilson's Disease. Mov Disord Clin Pract 2022; 9:941-948. [PMID: 36247905 PMCID: PMC9547145 DOI: 10.1002/mdc3.13547] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 06/06/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Neurological Wilson's disease (WD) presentation in the pediatric population is rare, and liver transplantation (LT) in these patients remains controversial. The aim of the present study was to assess the role of brain magnetic resonance imaging (MRI) in predicting reversion of brain lesions and neurological outcomes in pediatric WD patients after LT. Methods Patients with confirmed WD (Leipzig score ≥4), disease onset in pediatric age (<18 years), neurological involvement, and submitted to LT were selected. Clinical records and pre- and post-LT brain MRI were evaluated. Results Six patients met the pre-defined inclusion criteria, one of whom died shortly after LT and was excluded. The indication for LT was end-stage liver disease in two patients and neurological worsening despite optimized treatment in three patients. After LT, the neurological picture progressively improved in all patients. Pre-LT brain MRI showed T1-weighted hyperintensities in four patients, which quickly resolved afterward. T2-weighted hyperintensities were observed in four patients before LT, completely resolving in one patient, stabilizing in two, and improving in one after LT. A direct correlation could not be found between clinical and neuroradiological improvement. Progressive clinical improvement was observed even in patients with irreversible brain MRI changes. Conversely, some patients with normal MRI had only slight neurological improvement. Conclusions The pattern of T2-weighted hyperintensities after LT was unpredictable and did not correlate with neurological outcomes, suggesting that these changes may not entail irreversible clinical damage. Therefore, brain MRI does not seem to have prognostic value for assessing clinical response to LT.
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Affiliation(s)
- Catarina Pinto
- Neuroradiology DepartmentCentro Hospitalar Universitário do PortoPortoPortugal
| | | | | | - Teresa Temudo
- Neuropediatric Unit, Centro Materno‐Infantil do NorteCentro Hospitalar Universitário do PortoPortoPortugal
| | - Ermelinda Silva
- Pediatric Gastroenterology Unit, Centro Materno‐Infantil do NorteCentro Hospitalar Universitário do PortoPortoPortugal
| | - Cristina Ramos
- Neuroradiology DepartmentCentro Hospitalar Universitário do PortoPortoPortugal
| | - Marina Magalhães
- Neurology DepartmentCentro Hospitalar Universitário do PortoPortoPortugal
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Ziemssen T, Smolinski L, Członkowska A, Akgun K, Antos A, Bembenek J, Kurkowska-Jastrzębska I, Przybyłkowski A, Skowrońska M, Redzia-Ogrodnik B, Litwin T. Serum neurofilament light chain and initial severity of neurological disease predict the early neurological deterioration in Wilson's disease. Acta Neurol Belg 2022:10.1007/s13760-022-02091-z. [PMID: 36098934 PMCID: PMC9469052 DOI: 10.1007/s13760-022-02091-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/01/2022] [Indexed: 12/03/2022]
Abstract
Background In Wilson’s disease (WD), early neurological deterioration after treatment initiation is associated with poor outcomes; however, data on this phenomenon are limited. Our study analysed the frequency and risk factors of early neurological deterioration in WD. Methods Early neurological deterioration, within 6 months from diagnosis, was defined based on the Unified Wilson’s Disease Rating Scale (UWDRS): any increase in part II or an increase of ≥ 4 in part III. In total, 61 newly diagnosed WD patients were included. UWDRS scores, brain magnetic resonance imaging (MRI) scores, copper metabolism parameters, treatment type and serum neuro-filament light chain (sNfL) concentrations at diagnosis were analysed as potential risk factors of early deterioration. Results Early neurological deterioration was observed in 16.3% of all WD patients; all cases of worsening occurred in the neurological phenotype (27.7%). Higher scores were seen in those who deteriorated compared with those who did not for UWDRS part II (4.3 ± 5.0 vs 2.0 ± 5.9; p < 0.05), UWDRS part III (21.5 ± 14.1 vs 9.3 ± 16.4; p < 0.01) and MRI-assessed chronic damage (3.2 ± 1.6 vs 1.4 ± 2.2; p = 0.006); all these variables indicated the initial severity of neurological disease. Pre-treatment sNfL concentrations were significantly higher in patients who deteriorated compared with those who did not (33.2 ± 23.5 vs 27.6 ± 62.7 pg/mL; p < 0.01). In univariate logistic regression amongst all patients, chronic damage MRI scores, UWDRS part III scores and sNfL concentrations predicated early deterioration. In the neurological WD, only sNFL were a significant predictor. In bivariate logistic regression amongst all patients, sNfL remained the only significant predictor of deterioration when corrected for MRI scores. Conclusion sNfL concentrations are a promising biomarker of the risk of early neurological deterioration in WD.
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Affiliation(s)
- Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl Gustav Carus and Dresden University of Technology, Dresden, Germany
| | - Lukasz Smolinski
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Katja Akgun
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl Gustav Carus and Dresden University of Technology, Dresden, Germany
| | - Agnieszka Antos
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Jan Bembenek
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Iwona Kurkowska-Jastrzębska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Adam Przybyłkowski
- Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marta Skowrońska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | | | - Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland.
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22
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Rędzia-Ogrodnik B, Członkowska A, Bembenek J, Antos A, Kurkowska-Jastrzębska I, Skowrońska M, Smoliński Ł, Litwin T. Brain magnetic resonance imaging and severity of neurological disease in Wilson's disease - the neuroradiological correlations. Neurol Sci 2022; 43:4405-4412. [PMID: 35275318 DOI: 10.1007/s10072-022-06001-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Wilson's disease (WD) is a genetic disorder with pathological copper accumulation and associated clinical symptoms in various organs, particularly the liver and brain. Neurological disease is assessed with the clinical Unified Wilson's Disease Rating Scale (UWDRS). There is a lack of quantitative objective markers evaluating brain involvement. Recently, a semiquantitative brain magnetic resonance imaging (MRI) scale has been proposed, which combines acute toxicity and chronic damage measures into a total score. The relationship between MRI brain pathology and the MRI scale with disease form and neurological severity was studied in a large cohort. METHODS We retrospectively assessed 100 newly diagnosed treatment-naïve patients with WD with respect to brain MRI pathology and MRI scores (acute toxicity, chronic damage, and total) and analyzed the relationship with disease form and UWDRS part II (functional impairment) and part III (neurological deficits) scores. RESULTS Most patients had the neurological form of WD (55%) followed by hepatic (31%) and presymptomatic (14%). MRI examination revealed WD-typical abnormalities in 56% of patients, with higher pathology rates in neurological cases (83%) than in hepatic (29%) and presymptomatic (7%) cases. UWDRS part II and III scores correlated with the MRI acute toxicity score (r = 0.55 and 0.55, respectively), chronic damage score (r = 0.39 and 0.45), and total score (0.45 and 0.52) (all P < 0.01). CONCLUSIONS Brain MRI changes may be present even in patients without neurological symptoms, although not frequently. The semiquantitative MRI scale correlated with the UWDRS and appears to be a complementary tool for severity of brain injury assessment in WD patients.
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Affiliation(s)
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Jan Bembenek
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Agnieszka Antos
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Iwona Kurkowska-Jastrzębska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Marta Skowrońska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Łukasz Smoliński
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland.
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23
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Jing XZ, Yuan XZ, Li GY, Chen JL, Wu R, Yang LL, Zhang SY, Wang XP, Li JQ. Increased Magnetic Susceptibility in the Deep Gray Matter Nuclei of Wilson's Disease: Have We Been Ignoring Atrophy? Front Neurosci 2022; 16:794375. [PMID: 35720701 PMCID: PMC9198485 DOI: 10.3389/fnins.2022.794375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Histopathological studies in Wilson's disease (WD) have revealed increased copper and iron concentrations in the deep gray matter nuclei. However, the commonly used mean bulk susceptibility only reflects the regional metal concentration rather than the total metal content, and regional atrophy may affect the assessment of mean bulk susceptibility. Our study aimed to quantitatively assess the changes of metal concentration and total metal content in deep gray matter nuclei by quantitative susceptibility mapping to distinguish patients with neurological and hepatic WD from healthy controls. Methods Quantitative susceptibility maps were obtained from 20 patients with neurological WD, 10 patients with hepatic WD, and 25 healthy controls on a 3T magnetic resonance imaging system. Mean bulk susceptibility, volumes, and total susceptibility of deep gray matter nuclei in different groups were compared using a linear regression model. The area under the curve (AUC) was calculated by receiver characteristic curve to analyze the diagnostic capability of mean bulk susceptibility and total susceptibility. Results Mean bulk susceptibility and total susceptibility of multiple deep gray matter nuclei in patients with WD were higher than those in healthy controls. Compared with patients with hepatic WD, patients with neurological WD had higher mean bulk susceptibility but similar total susceptibility in the head of the caudate nuclei, globus pallidus, and putamen. Mean bulk susceptibility of putamen demonstrated the best diagnostic capability for patients with neurological WD, the AUC was 1, and the sensitivity and specificity were all equal to 1. Total susceptibility of pontine tegmentum was most significant for the diagnosis of patients with hepatic WD, the AUC was 0.848, and the sensitivity and specificity were 0.7 and 0.96, respectively. Conclusion Brain atrophy may affect the assessment of mean bulk susceptibility in the deep gray matter nuclei of patients with WD, and total susceptibility should be an additional metric for total metal content assessment. Mean bulk susceptibility and total susceptibility of deep gray matter nuclei may be helpful for the early diagnosis of WD.
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Affiliation(s)
- Xiao-Zhong Jing
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang-Zhen Yuan
- Department of Neurology, Weifang People's Hospital, Weifang, China
| | - Gai-Ying Li
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Jia-Lin Chen
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Rong Wu
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling-Li Yang
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu-Yun Zhang
- Department of Neurology, Weifang People's Hospital, Weifang, China
| | - Xiao-Ping Wang
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Qi Li
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
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24
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Shribman S, Marjot T, Sharif A, Vimalesvaran S, Ala A, Alexander G, Dhawan A, Dooley J, Gillett GT, Kelly D, McNeill A, Warner TT, Wheater V, Griffiths W, Bandmann O. Investigation and management of Wilson's disease: a practical guide from the British Association for the Study of the Liver. Lancet Gastroenterol Hepatol 2022; 7:560-575. [PMID: 35429442 DOI: 10.1016/s2468-1253(22)00004-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 02/07/2023]
Abstract
Wilson's disease is an autosomal-recessive disorder of copper metabolism with hepatic, neurological, psychiatric, ophthalmological, haematological, renal, and rheumatological manifestations. Making a diagnosis can be challenging given that no single test can confirm or exclude the disease, and diagnostic delays are common. Treatment protocols vary and adverse effects, including paradoxical neurological worsening, can occur. In this Review, we provide a practical guide to the diagnosis of Wilson's disease. We include recommendations on indications for testing, how to interpret results, and when additional investigations are required. We also cover treatment initiation, ideally under the guidance of a specialist centre for Wilson's disease, and the principles behind long-term management. This guidance was developed by a multidisciplinary group of Wilson's disease experts formed through the British Association for the Study of the Liver. The guidance has been endorsed by the British Society of Gastroenterology and approved by the Association of British Neurologists.
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Affiliation(s)
- Samuel Shribman
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK
| | - Thomas Marjot
- Oxford Liver Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Abubakar Sharif
- Liver Unit, Birmingham Women and Children's Hospital, Birmingham, UK
| | - Sunitha Vimalesvaran
- Paediatric Liver, GI and Nutrition Centre and Mowat Labs, King's College Hospital, Denmark Hill, London, UK
| | - Aftab Ala
- Department of Gastroenterology and Hepatology, Royal Surrey NHS Foundation Trust, Guildford; Institute of Liver Studies, King's College Hospital, London, UK
| | - Graeme Alexander
- University College London Institute of Liver and Digestive Health, London, UK
| | - Anil Dhawan
- Paediatric Liver, GI and Nutrition Centre and Mowat Labs, King's College Hospital, Denmark Hill, London, UK
| | - James Dooley
- University College London Institute of Liver and Digestive Health, London, UK
| | - Godfrey T Gillett
- Laboratory Medicine, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Deirdre Kelly
- Liver Unit, Birmingham Women and Children's Hospital, Birmingham, UK
| | | | - Thomas T Warner
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK
| | | | | | - Oliver Bandmann
- Sheffield Institute for Translational Neuroscience (SITraN), Department of Neuroscience, University of Sheffield, UK.
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25
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Wang RM, Xu WQ, Zheng ZW, Yang GM, Zhang MY, Ke HZ, Xia N, Dong Y, Wu ZY. Serum Neurofilament Light Chain in Wilson's Disease: A Promising Indicator but Unparallel to Real-Time Treatment Response. Mov Disord 2022; 37:1531-1535. [PMID: 35507442 DOI: 10.1002/mds.29039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/01/2022] [Accepted: 04/11/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Wilson's disease (WD) currently lacks a promising indicator that could reflect neurological impairment and monitor treatment outcome. We aimed to investigate whether serum neurofilament light chain (sNfL) functions as a candidate for disease assessment and treatment monitoring of WD. METHODS We assessed preclinical and manifested WD patients' sNfL levels compared to controls and analyzed the differences between patients with various clinical symptoms. We then explored the correlation between clinical scales and sNfL levels. And repeated measurements were performed in 34 patients before and after treatment. RESULTS WD patients with neurological involvement had significantly higher sNfL levels than both hepatic patients and controls. Positive correlations were found between Unified Wilson's Disease Rating Scale scores and sNfL and between semiquantitative magnetic resonance imaging scales and sNfL levels in WD patients. However, in the treatment follow-up analysis, the trend of sNfL before and after treatment disaccorded with clinical response. CONCLUSION These findings suggest that sNfL levels can be an ideal indicator for the severity of neurological involvement but fail to evaluate change in disease condition after treatment. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rou-Min Wang
- Department of Neurology and Department of Medical Genetics in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Wan-Qing Xu
- Department of Neurology and Department of Medical Genetics in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Zi-Wei Zheng
- Department of Neurology and Department of Medical Genetics in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Guo-Min Yang
- Department of Neurology and Department of Medical Genetics in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Mei-Yan Zhang
- Department of Neurology and Department of Medical Genetics in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Hua-Zhen Ke
- Department of Neurology and Department of Medical Genetics in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Nan Xia
- Department of Neurology and Department of Medical Genetics in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Dong
- Department of Neurology and Department of Medical Genetics in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhi-Ying Wu
- Department of Neurology and Department of Medical Genetics in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China.,NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Research and Brain-Machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China
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26
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Hou H, Chen D, Liu J, Feng L, Zhang J, Liang X, Xu Y, Li X. Clinical and Genetic Analysis in Neurological Wilson’s Disease Patients With Neurological Worsening Following Chelator Therapy. Front Genet 2022; 13:875694. [PMID: 35444691 PMCID: PMC9013891 DOI: 10.3389/fgene.2022.875694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/21/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives: None of the previous studies have focused on the genetic effect on neurological worsening in neurological Wilson’s disease (WD) patients following chelator therapy. We aimed to evaluate the clinical and genetic role in the occurrence of neurological worsening. Methods: We retrospectively reviewed the medical records of neurological WD patients who received initial chelator therapy and genetic test. Clinical, laboratory, and genetic data were collected. The genotype was classified into two types: 1) severe mutation genotype: patients who carried at least one of the following three types of mutations: frameshift mutation, splicing mutation, or nonsense mutation; 2) non-severe mutation genotype: patients who only carried missense mutations. Then, the clinical features and genotype of the patients with and without neurological worsening were investigated. Results: Forty-seven neurological WD patients were identified with a median age at onset of 16.17 years (range 7.75–47 years) and 35 (74.5%) males. The mean interval from onset to diagnosis was 0.6 years (range: 0.5 months-6.25 years). Neurological deterioration was observed in 29 patients (61.7%) and the other 18 patients (38.3%) were stable or improved during anti-copper treatment. The neurological worsening was completely irreversible in 6 cases (20.7%) and partially irreversible in 16 cases (55.2%). The common deteriorated symptoms were as follows: rigidity in 20 cases (69%), speech difficulties in 20 cases (69%)), walking difficulties in 13 cases (44.8%), dysphagia in 9 cases (31%), and salivation in 9 cases (31%). The patients with neurological worsening had significantly younger age (p = 0.028), shorter delayed diagnosis time (p = 0.011), higher rate of dystonia (p = 0.003), and severe mutation genotype (p = 0.036), compared to those without neurological worsening. Conclusion: We found that younger age of onset, the presence of dystonia, and genotype with severe mutations may be predictive of neurological worsening in the neurological WD patients that received chelator therapy. For those patients, chelator therapy should be given with caution and needs closer observation during follow-up.
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Affiliation(s)
- Haiman Hou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dingbang Chen
- Department of Neurology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Junxiu Liu
- The First People’s Hospital of Zhongshan City, Zhongshan, China
| | - Li Feng
- Department of Neurology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiwei Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiuling Liang
- Department of Neurology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Yuming Xu, ; Xunhua Li,
| | - Xunhua Li
- Department of Neurology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- *Correspondence: Yuming Xu, ; Xunhua Li,
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27
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Shribman S, Bocchetta M, Sudre CH, Acosta-Cabronero J, Burrows M, Cook P, Thomas DL, Gillett GT, Tsochatzis EA, Bandmann O, Rohrer JD, Warner TT. Neuroimaging correlates of brain injury in Wilson's disease: a multimodal, whole-brain MRI study. Brain 2022; 145:263-275. [PMID: 34289020 PMCID: PMC8967100 DOI: 10.1093/brain/awab274] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/25/2021] [Accepted: 07/04/2021] [Indexed: 11/23/2022] Open
Abstract
Wilson's disease is an autosomal-recessive disorder of copper metabolism with neurological and hepatic presentations. Chelation therapy is used to 'de-copper' patients but neurological outcomes remain unpredictable. A range of neuroimaging abnormalities have been described and may provide insights into disease mechanisms, in addition to prognostic and monitoring biomarkers. Previous quantitative MRI analyses have focused on specific sequences or regions of interest, often stratifying chronically treated patients according to persisting symptoms as opposed to initial presentation. In this cross-sectional study, we performed a combination of unbiased, whole-brain analyses on T1-weighted, fluid-attenuated inversion recovery, diffusion-weighted and susceptibility-weighted imaging data from 40 prospectively recruited patients with Wilson's disease (age range 16-68). We compared patients with neurological (n = 23) and hepatic (n = 17) presentations to determine the neuroradiological sequelae of the initial brain injury. We also subcategorized patients according to recent neurological status, classifying those with neurological presentations or deterioration in the preceding 6 months as having 'active' disease. This allowed us to compare patients with active (n = 5) and stable (n = 35) disease and identify imaging correlates for persistent neurological deficits and copper indices in chronically treated, stable patients. Using a combination of voxel-based morphometry and region-of-interest volumetric analyses, we demonstrate that grey matter volumes are lower in the basal ganglia, thalamus, brainstem, cerebellum, anterior insula and orbitofrontal cortex when comparing patients with neurological and hepatic presentations. In chronically treated, stable patients, the severity of neurological deficits correlated with grey matter volumes in similar, predominantly subcortical regions. In contrast, the severity of neurological deficits did not correlate with the volume of white matter hyperintensities, calculated using an automated lesion segmentation algorithm. Using tract-based spatial statistics, increasing neurological severity in chronically treated patients was associated with decreasing axial diffusivity in white matter tracts whereas increasing serum non-caeruloplasmin-bound ('free') copper and active disease were associated with distinct patterns of increasing mean, axial and radial diffusivity. Whole-brain quantitative susceptibility mapping identified increased iron deposition in the putamen, cingulate and medial frontal cortices of patients with neurological presentations relative to those with hepatic presentations and neurological severity was associated with iron deposition in widespread cortical regions in chronically treated patients. Our data indicate that composite measures of subcortical atrophy provide useful prognostic biomarkers, whereas abnormal mean, axial and radial diffusivity are promising monitoring biomarkers. Finally, deposition of brain iron in response to copper accumulation may directly contribute to neurodegeneration in Wilson's disease.
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Affiliation(s)
- Samuel Shribman
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
| | - Martina Bocchetta
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
| | - Carole H Sudre
- MRC Unit for Lifelong Health and Ageing, University College London, London WC1E 7HB, UK
- Centre for Medical Image Computing, University College London, London WC1V 6LJ, UK
- Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK
| | | | - Maggie Burrows
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
| | - Paul Cook
- Department of Clinical Biochemistry, Southampton General Hospital, Southampton SO16 6YD, UK
| | - David L Thomas
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
| | - Godfrey T Gillett
- Department of Clinical Chemistry, Northern General Hospital, Sheffield S5 7AU, UK
| | - Emmanuel A Tsochatzis
- UCL Institute of Liver and Digestive Health and Royal Free Hospital, London NW3 2PF, UK
| | - Oliver Bandmann
- Sheffield Institute of Translational Neuroscience, Sheffield S10 2HQ, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
| | - Thomas T Warner
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
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28
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Ziemssen T, Akgun K, Członkowska A, Antos A, Bembenek J, Kurkowska-Jastrzębska I, Przybyłkowski A, Skowrońska M, Smolinski L, Litwin T. Serum Neurofilament Light Chain as a Biomarker of Brain Injury in Wilson's Disease: Clinical and Neuroradiological Correlations. Mov Disord 2022; 37:1074-1079. [PMID: 35114010 DOI: 10.1002/mds.28946] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Clinical scales and neuroimaging are used to monitor nervous system injury in Wilson's disease, while data on serum markers are scarce. OBJECTIVE To investigate whether serum concentrations of neurofilament light chain (sNfL) correlate with brain injury in Wilson's disease patients. METHODS In 61 treatment-naïve patients, the Unified Wilson's Disease Rating Scale and a validated semiquantitative brain magnetic resonance imaging scale were compared with concentrations of sNfL. RESULTS Concentrations of sNfL were significantly higher in patients with neurological disease compared with patients presenting with other forms (39.7 ± 73.4 pg/mL vs. 13.3 ± 9.2 pg/mL; P < 0.01). Moreover, the sNfL concentration positively correlated with neurological severity scores and with acute and chronic brain damage based on the neuroimaging scale. CONCLUSIONS Neurofilament light chain concentrations may be used as a marker of brain injury in Wilson's disease, in addition to the clinical and neuroimaging disease severity scales. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl Gustav Carus & Dresden University of Technology, Dresden, Germany
| | - Katja Akgun
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl Gustav Carus & Dresden University of Technology, Dresden, Germany
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Agnieszka Antos
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Jan Bembenek
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Adam Przybyłkowski
- Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marta Skowrońska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Lukasz Smolinski
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
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29
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Yu M, Ren L, Zheng M, Hong M, Wei Z. Delayed Diagnosis of Wilson's Disease Report From 179 Newly Diagnosed Cases in China. Front Neurol 2022; 13:884840. [PMID: 35865642 PMCID: PMC9294220 DOI: 10.3389/fneur.2022.884840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the initial symptom and the cause of the misdiagnosis of Wilson's Disease (WD) so as to enhance awareness of this condition and reduce diagnostic errors. METHODS The clinical data of 179 patients with the confirmed diagnosis of WD who were hospitalized in the First Affiliated Hospital of Guangdong Pharmaceutical University from October 2014 to September 2021 were analyzed. Those patients who had attended two or more hospitals, had been misdiagnosed as other diseases, or failed to get a clear diagnosis for 3 months and over before hospitalization were included in the group of clinical misdiagnosis or the group without a definite diagnosis. RESULTS One hundred twenty-nine cases (72.1%) were misdiagnosed, 39 cases (21.8%) failed to be diagnosed as a specific disease, and only 11 cases (6.2%) had been diagnosed as WD within 3 months at the early stage of the disease. WD was easily masqueraded as a variety of diseases, including all types of hepatitis, cirrhosis, splenomegaly, hepatomegaly, encephalitis, encephalopathy, peripheral neuropathy, psychosis, osteoarthrosis, nephrosis, anemia, and other illnesses. CONCLUSION Wilson's Disease is prone to long-term misdiagnosis or unclear diagnosis. Early diagnosis and treatment are the most important determinations of the prognosis. Therefore, when facing patients with doubtful WD, it is valued to perform Kayser-Fleischer ring, copper metabolism, imaging examination, genetic tests, and radioactive copper test if necessary.
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Wilson's Disease: An Update on the Diagnostic Workup and Management. J Clin Med 2021; 10:jcm10215097. [PMID: 34768617 PMCID: PMC8584493 DOI: 10.3390/jcm10215097] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/18/2021] [Accepted: 10/27/2021] [Indexed: 02/08/2023] Open
Abstract
Wilson's disease (WD) is a rare autosomal recessive disorder of hepatocellular copper deposition. The diagnostic approach to patients with WD may be challenging and is based on a complex set of clinical findings that derive from patient history, physical examination, as well as laboratory and imaging testing. No single examination can unequivocally confirm or exclude the disease. Timely identification of signs and symptoms using novel biomarkers and modern diagnostic tools may help to reduce treatment delays and improve patient prognosis. The proper way of approaching WD management includes, firstly, early diagnosis and prompt treatment introduction; secondly, careful and lifelong monitoring of patient compliance and strict adherence to the treatment; and, last but not least, screening for adverse effects and evaluation of treatment efficacy. Liver transplantation is performed in about 5% of WD patients who present with acute liver failure at first disease presentation or with signs of decompensation in the course of liver cirrhosis. Increasing awareness of this rare inherited disease among health professionals, emphasizing their training to consider early signs and symptoms of the illness, and strict monitoring are vital strategies for the patient safety and efficacy of WD therapy.
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Blink reflex in newly diagnosed and treated patients with Wilson's disease. J Neural Transm (Vienna) 2021; 128:1873-1880. [PMID: 34669020 PMCID: PMC8571127 DOI: 10.1007/s00702-021-02432-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/14/2021] [Indexed: 01/02/2023]
Abstract
Abnormal blink reflex (BR) results mainly from the dysfunction of reticular brainstem pathways and is one of the features of degenerative brain disorders. We aimed to investigate whether patients with Wilson’s disease (WD) have abnormal BR. This was a prospective, observational, single-center study. BR was assessed in accordance with generally accepted standards in 44 newly diagnosed treatment-naïve and 66 treated patients with WD. Any abnormal parameters in BR were observed in 45.5% treatment-naïve patients and 37.9% treated patients (p = 0.429). We also did not observe significant differences in BR parameters and frequency of abnormal findings between treated and treatment naïve patients. Abnormal findings in any of the BR parameters were more frequent in patients with neurological vs. non-neurological presentation (57.5 vs. 28.6%, p = 0.002), present vs. absent Kayser–Fleischer ring (73 vs. 21.5%, p < 0.001), and typical vs. no typical WD abnormalities in brain MRI (50% vs. 24.4%, p = 0.009). In addition, longer median R1 and R2 latencies, both ipsilateral and contralateral, were significantly more frequent in neurological than non-neurological WD patients, those with Kayser–Fleischer rings, and those with abnormal MRI findings typical of WD. Our results confirm frequent BR abnormalities in WD, which may be explained by the pathological influence of copper deposits in the circuit linking the basal ganglia, cerebellum and brainstem.
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Socha P, Czlonkowska A, Janczyk W, Litwin T. Wilson's disease- management and long term outcomes. Best Pract Res Clin Gastroenterol 2021; 56-57:101768. [PMID: 35331405 DOI: 10.1016/j.bpg.2021.101768] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/01/2021] [Accepted: 10/08/2021] [Indexed: 01/31/2023]
Abstract
Wilson's disease (WD) is an autosomal recessive genetic disorder of copper metabolism leading to liver or brain injury due to accumulation of copper. Diagnosis is based on: clinical features, biochemical tests including plasma ceruloplasmin concentration, 24h urinary copper excretion, copper content in the liver, and molecular analysis. Pharmacological therapy comprises chelating agents (penicillamine, trientine) and zinc salts which seem to be very effective. Still, poor compliance is a major problem. Adolescents and patients with psychiatric disorders usually have problems with adherence to treatment. As transition is a vulnerable period transition ''training'' should start before the planned transfer, preferably already in early adolescence in cooperation between adult and pediatric clinics. Response to treatment is assessed based on physical examination, normal liver function tests and monitoring of copper metabolism markers. Liver transplantation has a well-defined role in Wilsonian acute hepatic failure according to the prognostic score. The long-term survival in WD patients seems to be very similar as for the general population if disease is early diagnosed and correctly treated. WD patients with a longer delay from diagnosis to therapy and who present with neurological and psychiatric symptoms have worse quality of life.
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Affiliation(s)
- Piotr Socha
- The Children's Memorial Health Institute, Warsaw, Poland.
| | | | | | - Tomasz Litwin
- Institute of Psychiatry and Neurology, Warsaw, Poland
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Shribman S, Poujois A, Bandmann O, Czlonkowska A, Warner TT. Wilson's disease: update on pathogenesis, biomarkers and treatments. J Neurol Neurosurg Psychiatry 2021; 92:1053-1061. [PMID: 34341141 DOI: 10.1136/jnnp-2021-326123] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/08/2021] [Indexed: 12/22/2022]
Abstract
Wilson's disease is an autosomal-recessive disorder of copper metabolism caused by mutations in ATP7B and associated with neurological, psychiatric, ophthalmological and hepatic manifestations. Decoppering treatments are used to prevent disease progression and reduce symptoms, but neurological outcomes remain mixed. In this article, we review the current understanding of pathogenesis, biomarkers and treatments for Wilson's disease from the neurological perspective, with a focus on recent advances. The genetic and molecular mechanisms associated with ATP7B dysfunction have been well characterised, but despite extensive efforts to identify genotype-phenotype correlations, the reason why only some patients develop neurological or psychiatric features remains unclear. We discuss pathological processes through which copper accumulation leads to neurodegeneration, such as mitochondrial dysfunction, the role of brain iron metabolism and the broader concept of selective neuronal vulnerability in Wilson's disease. Delayed diagnoses continue to be a major problem for patients with neurological presentations. We highlight limitations in our current approach to making a diagnosis and novel diagnostic biomarkers, including the potential for newborn screening programmes. We describe recent progress in developing imaging and wet (fluid) biomarkers for neurological involvement, including findings from quantitative MRI and other neuroimaging studies, and the development of a semiquantitative scoring system for assessing radiological severity. Finally, we cover the use of established and novel chelating agents, paradoxical neurological worsening, and progress developing targeted molecular and gene therapy for Wilson's disease, before discussing future directions for translational research.
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Affiliation(s)
- Samuel Shribman
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK
| | - Aurelia Poujois
- Department of Neurology, National Reference Centre for Wilson's Disease, Rothschild Foundation Hospital, Paris, France
| | - Oliver Bandmann
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, Sheffield, UK
| | - Anna Czlonkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Thomas T Warner
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK
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Sánchez-Monteagudo A, Ripollés E, Berenguer M, Espinós C. Wilson's Disease: Facing the Challenge of Diagnosing a Rare Disease. Biomedicines 2021; 9:1100. [PMID: 34572285 PMCID: PMC8471362 DOI: 10.3390/biomedicines9091100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
Wilson disease (WD) is a rare disorder caused by mutations in ATP7B, which leads to the defective biliary excretion of copper. The subsequent gradual accumulation of copper in different organs produces an extremely variable clinical picture, which comprises hepatic, neurological psychiatric, ophthalmological, and other disturbances. WD has a specific treatment, so that early diagnosis is crucial to avoid disease progression and its devastating consequences. The clinical diagnosis is based on the Leipzig score, which considers clinical, histological, biochemical, and genetic data. However, even patients with an initial WD diagnosis based on a high Leipzig score may harbor other conditions that mimic the WD's phenotype (Wilson-like). Many patients are diagnosed using current available methods, but others remain in an uncertain area because of bordering ceruloplasmin levels, inconclusive genetic findings and unclear phenotypes. Currently, the available biomarkers for WD are ceruloplasmin and copper in the liver or in 24 h urine, but they are not solid enough. Therefore, the characterization of biomarkers that allow us to anticipate the evolution of the disease and the monitoring of new drugs is essential to improve its diagnosis and prognosis.
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Affiliation(s)
- Ana Sánchez-Monteagudo
- Rare Neurodegenerative Diseases Laboratory, Centro de Investigación Príncipe Felipe (CIPF), 46012 Valencia, Spain; (A.S.-M.); (E.R.)
- Joint Unit on Rare Diseases CIPF-IIS La Fe, 46012 Valencia, Spain;
| | - Edna Ripollés
- Rare Neurodegenerative Diseases Laboratory, Centro de Investigación Príncipe Felipe (CIPF), 46012 Valencia, Spain; (A.S.-M.); (E.R.)
- Joint Unit on Rare Diseases CIPF-IIS La Fe, 46012 Valencia, Spain;
| | - Marina Berenguer
- Joint Unit on Rare Diseases CIPF-IIS La Fe, 46012 Valencia, Spain;
- Hepatology-Liver Transplantation Unit, Digestive Medicine Service, IIS La Fe and CIBER-EHD, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- Department of Medicine, Universitat de València, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Carmen Espinós
- Rare Neurodegenerative Diseases Laboratory, Centro de Investigación Príncipe Felipe (CIPF), 46012 Valencia, Spain; (A.S.-M.); (E.R.)
- Joint Unit on Rare Diseases CIPF-IIS La Fe, 46012 Valencia, Spain;
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Du J, Bydder GM. Brain Atrophy Is a Better Biomarker than Susceptibility for Evaluating Clinical Severity in Wilson Disease. Radiology 2021; 299:673-674. [PMID: 33759583 DOI: 10.1148/radiol.2021210106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jiang Du
- From the Department of Radiology, University of California San Diego, 408 Dickinson St, San Diego, CA 92103-8226
| | - Graeme M Bydder
- From the Department of Radiology, University of California San Diego, 408 Dickinson St, San Diego, CA 92103-8226
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Dusek P, Lescinskij A, Ruzicka F, Acosta-Cabronero J, Bruha R, Sieger T, Hajek M, Dezortova M. Associations of Brain Atrophy and Cerebral Iron Accumulation at MRI with Clinical Severity in Wilson Disease. Radiology 2021; 299:662-672. [PMID: 33754827 DOI: 10.1148/radiol.2021202846] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Abnormal findings at brain MRI in patients with neurologic Wilson disease (WD) are characterized by signal intensity changes and cerebral atrophy. T2 signal hypointensities and atrophy are largely irreversible with treatment; their relationship with permanent disability has not been systematically investigated. Purpose To investigate associations of regional brain atrophy and iron accumulation at MRI with clinical severity in participants with neurologic WD who are undergoing long-term anti-copper treatment. Materials and Methods Participants with WD and controls were compared in a prospective study performed from 2015 to 2019. MRI at 3.0 T included three-dimensional T1-weighted and six-echo multigradient-echo pulse sequences for morphometry and quantitative susceptibility mapping, respectively. Neurologic severity was assessed with the Unified WD Rating Scale (UWDRS). Automated multi-atlas segmentation pipeline with dual contrast (susceptibility and T1) was used for the calculation of volumes and mean susceptibilities in deep gray matter nuclei. Additionally, whole-brain analysis using deformation and surface-based morphometry was performed. Least absolute shrinkage and selection operator regression was used to assess the association of regional volumes and susceptibilities with the UWDRS score. Results Twenty-nine participants with WD (mean age, 47 years ± 9 [standard deviation]; 15 women) and 26 controls (mean age, 45 years ± 12; 14 women) were evaluated. Whole-brain analysis demonstrated atrophy of the deep gray matter nuclei, brainstem, internal capsule, motor cortex and corticospinal pathway, and visual cortex and optic radiation in participants with WD (P < .05 at voxel level, corrected for family-wise error). The UWDRS score was negatively correlated with volumes of putamen (r = -0.63, P < .001), red nucleus (r = -0.58, P = .001), globus pallidus (r = -0.53, P = .003), and substantia nigra (r = -0.50, P = .006) but not with susceptibilities. Only the putaminal volume was identified as a stable factor associated with the UWDRS score (R2 = 0.38, P < .001) using least absolute shrinkage and selection operator regression. Conclusion Individuals with Wilson disease (WD) had widespread brain atrophy most pronounced in the central structures. The putaminal volume was associated with the Unified WD Rating Scale score and can be used as a surrogate imaging marker of clinical severity. © RSNA, 2021 Supplemental material is available for this article. See also the editorial by Du and Bydder in this issue.
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Affiliation(s)
- Petr Dusek
- From the Department of Radiology (P.D., A.L.), Department of Neurology and Centre of Clinical Neuroscience (P.D., F.R.) and Fourth Department of Internal Medicine (R.B.), First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00, Prague 2, Czech Republic; Tenoke, Cambridge, England (J.A.C.); Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic (T.S.); and Magnetic Resonance Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (M.H., M.D.)
| | - Artem Lescinskij
- From the Department of Radiology (P.D., A.L.), Department of Neurology and Centre of Clinical Neuroscience (P.D., F.R.) and Fourth Department of Internal Medicine (R.B.), First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00, Prague 2, Czech Republic; Tenoke, Cambridge, England (J.A.C.); Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic (T.S.); and Magnetic Resonance Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (M.H., M.D.)
| | - Filip Ruzicka
- From the Department of Radiology (P.D., A.L.), Department of Neurology and Centre of Clinical Neuroscience (P.D., F.R.) and Fourth Department of Internal Medicine (R.B.), First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00, Prague 2, Czech Republic; Tenoke, Cambridge, England (J.A.C.); Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic (T.S.); and Magnetic Resonance Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (M.H., M.D.)
| | - Julio Acosta-Cabronero
- From the Department of Radiology (P.D., A.L.), Department of Neurology and Centre of Clinical Neuroscience (P.D., F.R.) and Fourth Department of Internal Medicine (R.B.), First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00, Prague 2, Czech Republic; Tenoke, Cambridge, England (J.A.C.); Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic (T.S.); and Magnetic Resonance Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (M.H., M.D.)
| | - Radan Bruha
- From the Department of Radiology (P.D., A.L.), Department of Neurology and Centre of Clinical Neuroscience (P.D., F.R.) and Fourth Department of Internal Medicine (R.B.), First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00, Prague 2, Czech Republic; Tenoke, Cambridge, England (J.A.C.); Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic (T.S.); and Magnetic Resonance Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (M.H., M.D.)
| | - Tomas Sieger
- From the Department of Radiology (P.D., A.L.), Department of Neurology and Centre of Clinical Neuroscience (P.D., F.R.) and Fourth Department of Internal Medicine (R.B.), First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00, Prague 2, Czech Republic; Tenoke, Cambridge, England (J.A.C.); Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic (T.S.); and Magnetic Resonance Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (M.H., M.D.)
| | - Milan Hajek
- From the Department of Radiology (P.D., A.L.), Department of Neurology and Centre of Clinical Neuroscience (P.D., F.R.) and Fourth Department of Internal Medicine (R.B.), First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00, Prague 2, Czech Republic; Tenoke, Cambridge, England (J.A.C.); Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic (T.S.); and Magnetic Resonance Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (M.H., M.D.)
| | - Monika Dezortova
- From the Department of Radiology (P.D., A.L.), Department of Neurology and Centre of Clinical Neuroscience (P.D., F.R.) and Fourth Department of Internal Medicine (R.B.), First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00, Prague 2, Czech Republic; Tenoke, Cambridge, England (J.A.C.); Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic (T.S.); and Magnetic Resonance Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (M.H., M.D.)
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Lin J, Zheng Y, Liu Y, Lin Y, Wang Q, Lin XH, Zhu W, Lin WH, Wang N, Chen WJ, Fu Y. Higher Concentration of Plasma Glial Fibrillary Acidic Protein in Wilson Disease Patients with Neurological Manifestations. Mov Disord 2021; 36:1446-1450. [PMID: 33502774 PMCID: PMC8248415 DOI: 10.1002/mds.28509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 12/21/2022] Open
Abstract
Background Wilson disease is a rare, disabling, neurological genetic disease. Biomarkers of brain damage are less well developed. Objective The aim of this study was to evaluate the utility of plasma glial fibrillary acidic protein as a biomarker for neurological involvement in patients with Wilson disease. Methods This prospective cross‐observational study compared plasma glial fibrillary acidic protein concentration among different subtypes of patients with Wilson disease and healthy control subjects. Plasma glial fibrillary acidic protein levels were measured in 94 patients and 25 healthy control subjects. Patients were divided into two subtypes: patients with neurological manifestations (n = 74) or hepatic manifestations (n = 20). Results Median levels of plasma glial fibrillary acidic protein were significantly elevated in patients with neurological manifestations (143.87 pg/mL) compared with those with hepatic manifestations (107.50 pg/mL) and healthy control subjects (86.85 pg/mL). Receiver operating characteristic curve revealed that a plasma glial fibrillary acidic protein cutoff value of 128.8 pg/mL provides sufficient sensitivity (80.0%) and specificity (63.5%) to differentiate patients with neurological manifestations from those with hepatic manifestations. Conclusions Plasma glial fibrillary acidic protein may serve as a biomarker for distinguishing different subtypes of Wilson disease. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Jie Lin
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Yexiang Zheng
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Ying Liu
- Department of Radiology of First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yi Lin
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Qiqi Wang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Xiao-Hong Lin
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Wenli Zhu
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Wei-Hong Lin
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Ning Wang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Wan-Jin Chen
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Ying Fu
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
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Yuan XZ, Yang RM, Wang XP. Management Perspective of Wilson's Disease: Early Diagnosis and Individualized Therapy. Curr Neuropharmacol 2021; 19:465-485. [PMID: 32351182 PMCID: PMC8206458 DOI: 10.2174/1570159x18666200429233517] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 02/05/2023] Open
Abstract
Wilson's disease (WD) is an inherited disease caused by mutations in ATP7B and is characterized by the pathological accumulation of copper in the liver and brain. Common clinical manifestations of WD include a wide range of liver disease and neurological symptoms. In some patients, psychiatric symptoms may be the only manifestation at the time of diagnosis. The clinical features of WD are highly variable and can mimic any disease of internal medicine. Therefore, for unexplained medical diseases, the possibility of WD should not be ignored. Early diagnosis and treatment can improve the prognosis of WD patients and reduce disability and early death. Gene sequencing is becoming a valuable method to diagnose WD, and if possible, all WD patients and their siblings should be genetically sequenced. Copper chelators including D-penicillamine, trientine, and dimercaptosuccinic acid can significantly improve the liver injury and symptoms of WD patients but may have a limited effect on neurological symptoms. Zinc salts may be more appropriate for the treatment of asymptomatic patients or for the maintenance treatment of symptomatic patients. High-quality clinical trials for the drug treatment of WD are still lacking, therefore, individualized treatment options for patients are recommended. Individualized treatment can be determined based on the clinical features of the WD patients, efficacy and adverse effects of the drugs, and the experience of the physician. Liver transplantation is the only effective method to save patients with acute liver failure or with severe liver disease who fail drug treatment.
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Affiliation(s)
| | | | - Xiao-Ping Wang
- Address correspondence to this author at the Department of Neurology, TongRen Hospital, Shanghai Jiao Tong University School of Medicine, No.1111 Xianxia Road, 200336, Shanghai, China; Tel: +86-021-52039999-72223; Fax: +86-021-52039999-72223; E-mail:
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Tinaz S, Arora J, Nalamada K, Vives-Rodriguez A, Sezgin M, Robakis D, Patel A, Constable RT, Schilsky ML. Structural and functional brain changes in hepatic and neurological Wilson disease. Brain Imaging Behav 2020; 15:2269-2282. [PMID: 33244627 DOI: 10.1007/s11682-020-00420-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/14/2022]
Abstract
Wilson disease (WD) can manifest with hepatic or neuropsychiatric symptoms. Our understanding of the in vivo brain changes in WD, particularly in the hepatic phenotype, is limited. Thirty subjects with WD and 30 age- and gender-matched controls participated. WD group underwent neuropsychiatric assessment. Unified WD Rating Scale neurological exam scores were used to determine neurological (WDN, score > 0) and hepatic-only (WDH, score 0) subgroups. All subjects underwent 3 Tesla anatomical and resting-state functional MRI. Diffusion tensor imaging (DTI) and susceptibility-weighted imaging (SWI) were performed only in the WD group. Volumetric, DTI, and functional connectivity analyses were performed to determine between-group differences. WDN and WDH groups were matched in demographic and psychiatric profiles. The entire WD group compared to controls showed significant thinning in the bilateral superior frontal cortex. The WDN group compared to control and WDH groups showed prominent structural brain changes including significant striatal and thalamic atrophy, more subcortical hypointense lesions on SWI, and diminished white matter integrity in the bilateral anterior corona radiata and corpus callosum. However, the WDH group also showed significant white matter volume loss compared to controls. The functional connectivity between the frontostriatal nodes was significantly reduced in the WDN group, whereas that of the hippocampus was significantly increased in the WDH group compared to controls. In summary, structural and functional brain changes were present even in neurologically non-manifesting WD patients in this cross-sectional study. Longitudinal brain MRI scans may be useful as biomarkers for prognostication and optimization of treatment strategies in WD.
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Affiliation(s)
- Sule Tinaz
- Department of Neurology, Yale University School of Medicine, 15 York St, LCI Suite 710, New Haven, CT, 06510, USA. .,Clinical Neurosciences Imaging Center, Yale University School of Medicine, New Haven, CT, USA.
| | - Jagriti Arora
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Keerthana Nalamada
- Department of Neurology, Yale University School of Medicine, 15 York St, LCI Suite 710, New Haven, CT, 06510, USA
| | - Ana Vives-Rodriguez
- Department of Neurology, Yale University School of Medicine, 15 York St, LCI Suite 710, New Haven, CT, 06510, USA
| | - Mine Sezgin
- Department of Neurology, Yale University School of Medicine, 15 York St, LCI Suite 710, New Haven, CT, 06510, USA.,Istanbul Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkey
| | - Daphne Robakis
- Department of Neurology, Yale University School of Medicine, 15 York St, LCI Suite 710, New Haven, CT, 06510, USA.,Department of Neurology, State University of New York Downstate College of Medicine, Brooklyn, NY, USA
| | - Amar Patel
- Department of Neurology, Yale University School of Medicine, 15 York St, LCI Suite 710, New Haven, CT, 06510, USA
| | - R Todd Constable
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Michael L Schilsky
- Departments of Medicine and Surgery, Sections of Digestive Diseases and Transplant and Immunology, Yale University School of Medicine, New Haven, CT, USA
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Yuan XZ, Li GY, Chen JL, Li JQ, Wang XP. Paramagnetic Metal Accumulation in the Deep Gray Matter Nuclei Is Associated With Neurodegeneration in Wilson's Disease. Front Neurosci 2020; 14:573633. [PMID: 33041766 PMCID: PMC7525019 DOI: 10.3389/fnins.2020.573633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/27/2020] [Indexed: 02/05/2023] Open
Abstract
Background Neuropathological studies have revealed copper and iron accumulation in the deep gray matter (DGM) nuclei of patients with Wilson’s disease (WD). However, the association between metal accumulation and neurodegeneration in WD has not been well studied in vivo. The study was aimed to investigate whether metal accumulation in the DGM was associated with the structural and functional changes of DGM in neurological WD patients. Methods Seventeen neurological WD patients and 20 healthy controls were recruited for the study. Mean bulk susceptibility values and volumes of DGM were obtained from quantitative susceptibility mapping (QSM). Regions of interest including the head of the caudate nucleus, globus pallidus, putamen, thalamus, substantia nigra, red nucleus, and dentate nucleus were manually segmented. The susceptibility values and volumes of DGM in different groups were compared using a linear regression model. Correlations between susceptibility values and volumes of DGM and Unified Wilson’s Disease Rating Scale (UWDRS) neurological subscores were investigated. Results The susceptibility values of all examined DGM in WD patients were higher than those in healthy controls (P < 0.05). Volume reductions were observed in the head of the caudate nucleus, globus pallidus, putamen, thalamus, and substantia nigra of WD patients (P < 0.001). Susceptibility values were negatively correlated with the volumes of the head of the caudate nucleus (rp = −0.657, P = 0.037), putamen (rp = −0.667, P = 0.037), and thalamus (rp = −0.613, P = 0.046) in WD patients. UWDRS neurological subscores were positively correlated with the susceptibility values of all examined DGM. The susceptibility values of putamen, head of the caudate nucleus, and dentate nucleus could well predict UWDRS neurological subscores. Conclusion Our study provided in vivo evidence that paramagnetic metal accumulation in the DGM was associated with DGM atrophy and neurological impairment. The susceptibility of DGM could be used as a biomarker to assess the severity of neurodegeneration in WD.
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Affiliation(s)
- Xiang-Zhen Yuan
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gai-Ying Li
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Jia-Lin Chen
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Jian-Qi Li
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Xiao-Ping Wang
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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