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Tian L, Wu M, Zhao C, Wen Y, Chen J, Dong T. Gandouling induces GSK3β promoter methylation to improve cognitive impairment in Wilson's disease. JOURNAL OF ETHNOPHARMACOLOGY 2024:118493. [PMID: 38925320 DOI: 10.1016/j.jep.2024.118493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/06/2024] [Accepted: 06/23/2024] [Indexed: 06/28/2024]
Abstract
ETHNOPHARMACOLOGIC SIGNIFICANCE Cognitive impairment is a serious clinical manifestation of Wilson's disease (WD) in the nervous system. Gandouling (GDL) is a hospital preparation of the First Affiliated Hospital of Anhui University of Chinese Medicine. Previous studies have found that GDL has an ameliorative effect on cognitive impairment in WD. AIM OF THE STUDY We aimed to explore the molecular-level regulatory mechanisms underlying cognitive impairment in WD, and provide evidence supporting GDL as a promising candidate drug for the treatment of cognitive impairment in WD. We found that GSK3β was significantly up-regulated in the brain tissue of C3He-Atp7Btx-J/J (tx-j) mice in the WD gene mutant model, and the monomer components of GDL could combine well with GSK3β. Therefore, in this work, we used Behavioral tests, Hematoxylin and eosin (H&E), Nissl and TUNEL staining, Ultrastructural morphological observation by Transmission electron microscopy (TEM), bisulfite sequencing (BSP), RT-qPCR, Western blot, immunofluorescence, network pharmacology, molecular docking, and related methods to study the effects of GDL in tx-j mice and HT22 cell to clarify the effect of GDL on cognitive impairment in WD. RESULTS In this study, MWM, NOR, H&E, Nissl TUNEL and TEM results showed that GDL could promote the repair of learning and memory function, improve the morphological damage to hippocampal neurons, and maintain mitochondria integrity. In the HT22 cell experiment, the CCK-8 method showed that GDL increased the viability of copper-overloaded cell models. The study found that GSK3β may be a target of GDL for the treatment of WD cognitive impairment through network pharmacology. Western blot and qRT-PCR results confirmed that GDL significantly increased the expression of proteins and mRNA in DNMT1, Nrf2, and HO-1. BSP showed that GSK3β promoter methylation was lower in the Wilson group than in the control group, and the promoter methylation of GSK3β was further reduced after intraperitoneal injection with decitabine, and GDL could ameliorate this pathology. CONCLUSION GDL demonstrates a protective role by inducing GSK3β promoter methylatio, activating the Nrf2/GSK3β signaling pathway in WD.
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Affiliation(s)
- Liwei Tian
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, China
| | - Mingcai Wu
- Wannan Medical College, Wuhu 241000, China
| | - Chenling Zhao
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, China
| | - Yuya Wen
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, China
| | - Jie Chen
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, China
| | - Ting Dong
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, China; Key Laboratory of Xin'an Medicine Ministry of Education, Hefei, Anhui, 230031, China.
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Vlasnik J, Cambron-Mellott MJ, Costantino H, Kunjappu M. Burden of Wilson Disease among patients and care partners in the United States: results from a cross-sectional survey. Curr Med Res Opin 2024; 40:863-876. [PMID: 38571385 DOI: 10.1080/03007995.2024.2337684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE This study assessed the burden of Wilson Disease (WD) among patients and care partners (WD-CPs) in the US and compared it to a US general population of adults (GPs) and care partners (GP-CPs). METHODS This cross-sectional, self-reported survey included patients with WD and WD-CPs aged ≥18 years recruited through the Wilson Disease Association (WDA), while data for GPs and GP-CPs were obtained from the 2022 National Health and Wellness Survey. GPs and GP-CPs were propensity score matched (3:1) with WD patients and WD-CPs for demographics and health characteristics. Bivariate analysis evaluated differences in comorbidity burden and health-related outcomes of the WD cohorts compared to matched GP cohorts. RESULTS Thirty-seven patients with WD and 53 WD-CPs completed the survey. Most patients reported some treatment burden (73.3%), experienced sleep problems (60%), and visited a healthcare provider (HCP) in the past 6 months (91.9%). Compared with matched GPs, patients with WD had a significantly higher mortality risk (p < .001) and reported greater rates of chronic liver disease, cirrhosis (both, p < .001), migraines (p = .032), non-alcoholic steatohepatitis (p = .004), sleep problems (p = .009) and HCP visits (p = .002). Most WD-CPs (75.5%) reported high burden of caring (mean ZBI-12 score, 26.5) and more negative impact on esteem than GP-CPs. CONCLUSION This study highlights the burden of WD experienced by patients and WD-CPs, with patients experiencing high treatment burden, comorbidity burden and healthcare resource utilization, and WD-CPs experiencing high impact of caring, including impact on employment and self-esteem.
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Affiliation(s)
- Jon Vlasnik
- Alexion Pharmaceuticals Inc, AstraZeneca Rare Disease, Boston, MA, USA
| | | | | | - Mary Kunjappu
- Alexion Pharmaceuticals Inc, AstraZeneca Rare Disease, Boston, MA, USA
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Mariño Z, Berenguer M, Peña-Quintana L, Olveira A, Miralpeix A, Sastre I, Reyes-Domínguez A, Castillo P, García-Solà C, Bono A, Romero M, Pérez-Sádaba FJ, Aceituno S, Anguera A. Health-Related Quality of Life in Patients Living with Wilson Disease in Spain: A Cross-Sectional Observational Study. J Clin Med 2023; 12:4823. [PMID: 37510937 PMCID: PMC10381913 DOI: 10.3390/jcm12144823] [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: 06/28/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Wilson disease (WD) is a rare copper metabolism disorder caused by mutations in the ATP7B gene. It usually affects young individuals and can produce hepatic and/or neurological involvement, potentially affecting health-related quality of life (HRQoL). We assessed HRQoL in a cohort of Spanish patients with WD and evaluated disease impact on several domains of patients' lives, treatment adherence, drug preference and satisfaction, and healthcare resource utilisation in a cross-sectional, retrospective, multicentric, observational study. A total of 102 patients were included: 81.4% presented isolated liver involvement (group H) and 18.6% presented neurological or mixed involvement (group EH). Up to 30% of patients reported a deteriorated emotional status with anxiety and depression, which was greater in the EH subgroup; the use of neuropsychiatric drugs was high. Over 70% of the patients were satisfied with their current treatment but complained about taking too many pills, stating they would consider switching to another more patient-friendly treatment if available. The Simplified Medication Adherence Questionnaire revealed only 22.5% of patients were fully adherent to therapy, suggesting that alternative therapies are needed. This real-world study, even though is highly enriched with hepatic patients and mild disease, shows that WD impacts patients' HRQoL, especially in the emotional domain.
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Affiliation(s)
- Zoe Mariño
- Liver Unit, Hospital Clínic Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), European Reference Networks (ERN)-RARE Liver, University of Barcelona, 08007 Barcelona, Spain
| | - Marina Berenguer
- Department of Gastroenterology and Hepatology, Hospital Universitari i Politècnic La Fe, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Investigación Sanitaria (IIS La Fe), 46026 Valencia, Spain
| | - Luis Peña-Quintana
- Pediatric Gastroenterology, Hepatoloy and Nutrition Unit, Complejo Hospitalario Universitario Insular Materno-Infantil, 35016 Las Palmas de Gran Canaria, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, University of Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain
| | - Antonio Olveira
- Department of Gastroenterology, Hospital La Paz, 28046 Madrid, Spain
| | - Anna Miralpeix
- Liver Unit, Hospital Clínic Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), European Reference Networks (ERN)-RARE Liver, University of Barcelona, 08007 Barcelona, Spain
| | - Isabel Sastre
- Department of Gastroenterology and Hepatology, Hospital Universitari i Politècnic La Fe, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Investigación Sanitaria (IIS La Fe), 46026 Valencia, Spain
| | - Ana Reyes-Domínguez
- Pediatric Gastroenterology, Hepatoloy and Nutrition Unit, Complejo Hospitalario Universitario Insular Materno-Infantil, 35016 Las Palmas de Gran Canaria, Spain
| | - Pilar Castillo
- Department of Gastroenterology, Hospital La Paz, 28046 Madrid, Spain
| | - Clàudia García-Solà
- Liver Unit, Hospital Clínic Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), European Reference Networks (ERN)-RARE Liver, University of Barcelona, 08007 Barcelona, Spain
| | - Ariadna Bono
- Department of Gastroenterology and Hepatology, Hospital Universitari i Politècnic La Fe, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Investigación Sanitaria (IIS La Fe), 46026 Valencia, Spain
| | - Miriam Romero
- Department of Gastroenterology, Hospital La Paz, 28046 Madrid, Spain
| | | | | | - Anna Anguera
- Medical Department, Alexion, AstraZeneca Rare Diseases, 08028 Barcelona, Spain
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Chevalier K, Rahli D, de Veyrac L, Guillaume J, Obadia MA, Poujois A. Quality of life and depression in Wilson's disease: a large prospective cross-sectional study. Orphanet J Rare Dis 2023; 18:168. [PMID: 37386576 DOI: 10.1186/s13023-023-02777-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/18/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Wilson's disease (WD) is an autosomal recessive genetic disorder due to a mutation of the ATP7B gene, resulting in impaired hepatic copper excretion and accumulation in various tissues. Lifelong decoppering treatments are the keystone of the treatment. These treatments can prevent, stabilize, or reverse the symptoms making WD a chronic disease. Quality of life (QoL) is one of the best outcome measures of any therapeutic intervention in chronic diseases but has not been evaluated in large cohorts of WD patients. METHOD To better evaluate the QoL in WD and the correlation with different clinical or demographic factors we have performed a prospective cross-sectional study. RESULTS Two hundred fifty-seven patients (53.3% men, mean age of 39.3 years and median disease duration of 18.8 years) were included between 1st January 2021 and 31st December 2021. Hepatoneurological form of the disease and depression were significantly correlated with low QoL (p < 0.001 for both). However, the patients' quality of life was similar to that of the general population, and only 29 patients (11.3%) had moderate to severe depression. CONCLUSIONS Neurological patients should be closely monitored to prevent and treat symptoms of depression that impact their quality of life.
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Affiliation(s)
- Kevin Chevalier
- Department of Neurology, Adolphe de Rothschild Foundation Hospital, Paris, France
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Adolphe de Rothschild Foundation Hospital, 29 Rue Manin, 75019, Paris, France
| | - Djamila Rahli
- Department of Neurology, Adolphe de Rothschild Foundation Hospital, Paris, France
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Adolphe de Rothschild Foundation Hospital, 29 Rue Manin, 75019, Paris, France
| | - Louise de Veyrac
- Department of Neurology, Adolphe de Rothschild Foundation Hospital, Paris, France
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Adolphe de Rothschild Foundation Hospital, 29 Rue Manin, 75019, Paris, France
| | - Jessica Guillaume
- Clinical Research Department, Adolphe de Rothschild Foundation Hospital, Paris, France
| | - Michaël Alexandre Obadia
- Department of Neurology, Adolphe de Rothschild Foundation Hospital, Paris, France
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Adolphe de Rothschild Foundation Hospital, 29 Rue Manin, 75019, Paris, France
| | - Aurélia Poujois
- Department of Neurology, Adolphe de Rothschild Foundation Hospital, Paris, France.
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Adolphe de Rothschild Foundation Hospital, 29 Rue Manin, 75019, Paris, France.
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Hongrong W, Qingqi L, Rong G, Shuangyang T, Kaifang Z, Jianfeng Z. BMI Modifies the Association Between Depression Symptoms and Serum Copper Levels. Biol Trace Elem Res 2022:10.1007/s12011-022-03505-y. [PMID: 36437432 DOI: 10.1007/s12011-022-03505-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
Depression is one of the most common mental disorders which dramatically threatens public health and wellness. Copper has been known to be involved in many biological processes that could help explaining the occurrence of depression. However, studies focusing on its effect have yielded mixed results. The present study aims to evaluate the association between serum copper levels and depression symptoms. It also investigates the effect of modification of BMI (body mass index) on depression symptoms. A total of 5419 US adults aged 20 years or older from the National Health and Nutrition Examination Survey (NHANES) 2011-2016 participated in the cross-sectional study. Logistic regression models were applied using depression levels as the outcome and serum cooper/selenium/zinc categories as the main predictor, with the adjustments of gender, age, marital status, race, education, family income level, alcohol drinking, cigarette smoking, diabetes, pressure, stroke, and BMI. The interaction terms for copper levels and other covariates were further incorporated into the model to assess their roles in predicting depression symptoms. The prevalence of depression symptoms was significantly higher in samples with a high copper level. Among the levels of serum copper, selenium, and zinc, only the association between depression symptoms and serum copper levels was observed to be significant in the unadjusted model (P = 0.002). Individuals with a high copper level (114-134 μg/dL) and a very high copper level (≥ 134 μg/dL) had 1.85 (95% CI 1.24, 2.77)- and 1.72 (95% CI 1.21, 2.44)-fold higher odds ratio of depression symptoms, respectively, compared to those with a normal serum copper level. Although the association was not significant in the adjusted models, in which confounders were added, the interaction of copper level, including high and very high copper levels, and obesity (BMI ≥ 30 kg/m2) exhibited significantly higher odds ratio (4.12 (95% CI 1.38, 12.27) and 4.53 (95% CI 1.87, 10.96)) of having depression symptoms. The concentration of serum copper was positively associated with the prevalence of depression symptoms. Obesity exacerbated the risk of having depression symptoms in people with high serum copper levels.
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Affiliation(s)
- Wu Hongrong
- Institute of Pathogenic Biology, Hengyang Medical School, University of South China, Hengyang, People's Republic of China
| | - Li Qingqi
- Institute of Neuroscience, Hengyang Medical School, University of South China, 421001, Hengyang, People's Republic of China
| | - Gao Rong
- Department of Physiology, Hengyang Medical School, University of South China, Hengyang, People's Republic of China
| | - Tang Shuangyang
- Institute of Pathogenic Biology, Hengyang Medical School, University of South China, Hengyang, People's Republic of China
| | - Zhang Kaifang
- Department of Physiology, Hengyang Medical School, University of South China, Hengyang, People's Republic of China
| | - Zhao Jianfeng
- Institute of Neuroscience, Hengyang Medical School, University of South China, 421001, Hengyang, People's Republic of China.
- Department of Physiology, Hengyang Medical School, University of South China, Hengyang, People's Republic of China.
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Garrido I, Marques M, Liberal R, Cardoso H, Lopes S, Macedo G. Wilson disease in Northern Portugal: a long-term follow-up study. Orphanet J Rare Dis 2022; 17:82. [PMID: 35197085 PMCID: PMC8867740 DOI: 10.1186/s13023-022-02245-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/13/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Wilson disease is an autosomal recessive disease of liver copper metabolism with predominant hepatic and neurological manifestations. Long-term data on the clinical follow-up and treatment efficacy are limited due to the low frequency of the disease. We evaluated a large cohort of Wilson disease patients from Northern Portugal during a 20-year follow-up period. Methods Twenty-four patients, diagnosed from 1975 to 2020 in a tertiary care center in Portugal, were retrospectively evaluated according to their clinical presentation, therapies and outcomes. Results Most of the patients were males (54%), with a median age at diagnosis of 19 years old (interquartile range 15–25). The main manifestations of Wilson disease were hepatic (71%) and neurological (25%). Family history was positive in 5 (21%) patients. Four patients (17%) presented with acute liver failure and fifteen (63%) individuals had cirrhosis at diagnosis. Penicillamine therapy was used by 11 (46%) patients, while trientine and zinc were given to 8 (33%) and 1 (4%) patient, respectively. Ten (42%) individuals underwent liver transplantation. The majority of patients (83%) had stable disease or improved outcomes during follow-up. Conclusion This is the largest cohort of adult patients with Wilson disease reported in Northern Portugal. We show that Wilson disease has favorable outcomes with long overall survival, assuming adherence to therapy and lack of other insults to their liver.
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Affiliation(s)
- Isabel Garrido
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. .,World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal.
| | - Margarida Marques
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
| | - Rodrigo Liberal
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
| | - Hélder Cardoso
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
| | - Susana Lopes
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
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