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Locatelli M, Farina C. Role of copper in central nervous system physiology and pathology. Neural Regen Res 2025; 20:1058-1068. [PMID: 38989937 DOI: 10.4103/nrr.nrr-d-24-00110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/23/2024] [Indexed: 07/12/2024] Open
Abstract
Copper is a transition metal and an essential element for the organism, as alterations in its homeostasis leading to metal accumulation or deficiency have pathological effects in several organs, including the central nervous system. Central copper dysregulations have been evidenced in two genetic disorders characterized by mutations in the copper-ATPases ATP7A and ATP7B, Menkes disease and Wilson's disease, respectively, and also in multifactorial neurological disorders such as Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis. This review summarizes current knowledge about the role of copper in central nervous system physiology and pathology, reports about unbalances in copper levels and/or distribution under disease, describes relevant animal models for human disorders where copper metabolism genes are dysregulated, and discusses relevant therapeutic approaches modulating copper availability. Overall, alterations in copper metabolism may contribute to the etiology of central nervous system disorders and represent relevant therapeutic targets to restore tissue homeostasis.
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Affiliation(s)
- Martina Locatelli
- Institute of Experimental Neurology, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Cinthia Farina
- Institute of Experimental Neurology, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
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2
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Xiong X, Gao C, Meng X, Liu A, Gong X, Sun Y. Research progress in stem cell therapy for Wilson disease. Regen Ther 2024; 27:73-82. [PMID: 38525238 PMCID: PMC10959646 DOI: 10.1016/j.reth.2024.03.005] [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: 12/25/2023] [Revised: 02/27/2024] [Accepted: 03/09/2024] [Indexed: 03/26/2024] Open
Abstract
Wilson disease (WD), also known as hepatolenticular degeneration, is an autosomal recessive disorder characterized by disorganized copper metabolism caused by mutations in the ATP7B gene. Currently, the main treatment options for WD involve medications such as d-penicillamine, trientine hydrochloride, zinc acetate, and liver transplantation. However, there are challenges that encompass issues of poor compliance, adverse effects, and limited availability of liver sources that persist. Stem cell therapy for WD is currently a promising area of research. Due to the advancement in stem cell directed differentiation technology in vitro and the availability of sufficient stem cell donors, it is expected to be a potential treatment option for the permanent correction of abnormal copper metabolism. This article discusses the research progress of stem cell therapy for WD from various sources, as well as the challenges and future prospects of the clinical application of stem cell therapy for WD.
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Affiliation(s)
- Xianlang Xiong
- Hospital of Hunan Guangxiu, Hunan Normal University, Changsha, 410205, China
- National Engineering and Research Center of Human Stem Cells, Changsha, 410205, China
| | - Ce Gao
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China
- National Engineering and Research Center of Human Stem Cells, Changsha, 410205, China
| | - Xiangying Meng
- Hospital of Hunan Guangxiu, Hunan Normal University, Changsha, 410205, China
- National Engineering and Research Center of Human Stem Cells, Changsha, 410205, China
| | - Aihui Liu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China
- National Engineering and Research Center of Human Stem Cells, Changsha, 410205, China
| | - Xin Gong
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China
- National Engineering and Research Center of Human Stem Cells, Changsha, 410205, China
| | - Yi Sun
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China
- Hospital of Hunan Guangxiu, Hunan Normal University, Changsha, 410205, China
- National Engineering and Research Center of Human Stem Cells, Changsha, 410205, China
- Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, Changsha, 410008, China
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3
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Harrington CF, Carpenter G, Coverdale JPC, Douglas L, Mills C, Willis K, Schilsky ML. Accurate non-ceruloplasmin bound copper: a new biomarker for the assessment and monitoring of Wilson disease patients using HPLC coupled to ICP-MS/MS. Clin Chem Lab Med 2024; 0:cclm-2024-0213. [PMID: 39072400 DOI: 10.1515/cclm-2024-0213] [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: 02/13/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES Assessment of Wilson disease is complicated, with neither ceruloplasmin, nor serum or urine copper, being reliable. Two new indices, accurate non-ceruloplasmin copper (ANCC) and relative ANCC were developed and applied to a cohort of 71 patients, as part of a Wilson Disease Registry Study. METHODS Elemental copper-protein speciation was developed for holo-ceruloplasmin quantitation using strong anion exchange chromatography coupled to triple quadrupole inductively coupled plasma mass spectrometry. The serum proteins were separated using gradient elution and measured at m/z 63 (63Cu+) and 48 (32S16O+) using oxygen reaction mode and Cu-EDTA as calibration standard. The ANCC was calculated by subtraction of the ceruloplasmin bound copper from the total serum copper and the RelANCC was the percentage of total copper present as the ANCC. RESULTS The accuracy of the holo-ceruloplasmin measurement was established using two certified reference materials, giving a mean recovery of 94.2 %. Regression analysis between the sum of the copper containing species and total copper concentration in the patient samples was acceptable (slope=0.964, intercept=0, r=0.987) and a difference plot, gave a mean difference for copper of 0.38 μmol/L. Intra-day precision for holo-ceruloplasmin at serum copper concentrations of 0.48 and 3.20 μmol/L were 5.2 and 5.6 % CV and the intermediate precision at concentrations of 0.80 and 5.99 μmol/L were 6.4 and 6.4 % CV, respectively. The limit of detection (LOD) and lower limit of quantification (LLOQ) for holo-ceruloplasmin were 0.08 and 0.27 μmol/L as copper, respectively. CONCLUSIONS ANCC and Relative ANCC are important new diagnostic and monitoring biomarker indices for Wilson disease (WD).
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Affiliation(s)
- Chris F Harrington
- Supra-Regional Assay Service (SAS), Trace Element Laboratory, Guildford, Surrey, UK
- Department of Clinical Biochemistry, Royal Surrey NHS Foundation Trust, Guildford, Surrey, UK
| | - Geoff Carpenter
- Supra-Regional Assay Service (SAS), Trace Element Laboratory, Guildford, Surrey, UK
- Department of Clinical Biochemistry, Royal Surrey NHS Foundation Trust, Guildford, Surrey, UK
| | - James P C Coverdale
- Supra-Regional Assay Service (SAS), Trace Element Laboratory, Guildford, Surrey, UK
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK
| | - Leisa Douglas
- Supra-Regional Assay Service (SAS), Trace Element Laboratory, Guildford, Surrey, UK
- Department of Clinical Biochemistry, Royal Surrey NHS Foundation Trust, Guildford, Surrey, UK
| | - Craig Mills
- Supra-Regional Assay Service (SAS), Trace Element Laboratory, Guildford, Surrey, UK
- Department of Clinical Biochemistry, Royal Surrey NHS Foundation Trust, Guildford, Surrey, UK
| | - Karl Willis
- Supra-Regional Assay Service (SAS), Trace Element Laboratory, Guildford, Surrey, UK
- Department of Clinical Biochemistry, Royal Surrey NHS Foundation Trust, Guildford, Surrey, UK
| | - Michael L Schilsky
- Departments of Medicine and Surgery, Yale University Medical Center, New Haven, CT, USA
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Kumar N, Mishra R, Rohatgi A, Bargali A. Neurological Wilson's disease without hepatic involvement in an adolescent female. BMJ Case Rep 2024; 17:e259598. [PMID: 39074939 DOI: 10.1136/bcr-2023-259598] [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] [Indexed: 07/31/2024] Open
Abstract
A female adolescent presented with a 9 month history of progressive involuntary movements, initially manifesting as finger tremors and evolving into flinging motions of the extremities, resulting in an inability to walk over the last 4 months. Concurrently, she developed dysarthria. Neurologically, she exhibited normal power, rigidity and brisk deep tendon reflexes, with a downgoing plantar reflex. Contrast-enhanced MRI revealed hyperintensity in bilateral caudate lobes, basal ganglia and pons, indicative of Wilson's disease. Liver function tests and ultrasound were normal while Kayser-Fleischer rings were confirmed by slit lamp examination. Serum ceruloplasmin was low, 24-hour urine copper was elevated (125.5 mcg) and whole exome sequencing identified a heterozygous ATP7B mutation, confirming the diagnosis. Isolated neurological involvement without hepatic involvement is an extremely rare presentation and needs clinical expertise to delineate Wilson's disease as a possible aetiology.
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Affiliation(s)
- Naresh Kumar
- Medicine, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Rashmi Mishra
- Medicine, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Anurag Rohatgi
- Medicine, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Arun Bargali
- Medicine, Maulana Azad Medical College, New Delhi, Delhi, India
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Vinayagamoorthy V, Srivastava A, Anuja AK, Agarwal V, Marak R, Sarma MS, Poddar U, Yachha SK. Biomarker for Infection in Children with Decompensated Chronic Liver Disease: Neutrophilic CD64 or Procalcitonin? Clin Res Hepatol Gastroenterol 2024:102432. [PMID: 39074717 DOI: 10.1016/j.clinre.2024.102432] [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: 11/16/2023] [Revised: 07/10/2024] [Accepted: 07/24/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE Biomarkers with high accuracy for identification of infection in decompensated chronic liver disease (DCLD) are urgently needed. We compared the accuracy of neutrophilic cluster of differentiation 64 (nCD64) with procalcitonin for diagnosis of bacterial infection in children with DCLD. METHODS Consecutive children admitted with DCLD were enrolled prospectively. nCD64 was assessed by flow cytometry and expressed in percentage. nCD64, procalcitonin and hemogram were measured at admission and 7-14 days after treatment in those with infection. Complete work-up for infection was done. Presence, site and severity of infection was classified as per guidelines. RESULTS 107 children [64 boys, age 97(18-168) months] were enrolled. 78(72.9%) had infection, 26(24%) had severe sepsis and 60(56%) had systemic inflammatory response syndrome. The commonest site of infection was ascitic fluid (n=37), followed by pneumonia (n=24), urinary tract (n=15), bacteraemia (n=10), cholangitis (n=8) and cellulitis (n=3). nCD64 (cut-off-51%, AUC-0.82) had a higher sensitivity (79.5%) and specificity (82.8%) than procalcitonin (cut-off ≥0.58ng/mL, AUC-0.74, sensitivity-76.9% and specificity-62.1%) for diagnosis of infection. nCD64 and procalcitonin correlated with infection severity, being highest in children with severe sepsis [88(71-97) %and 1.98(0.83-10.36) ng/mL], than in infection alone [72(45-84) % and 1.09(0.45-2.07) ng/mL], and no-infection [36(20.2-48) % and 0.42(0.19-1.08) ng/mL]. There was no difference in diagnostic utility of procalcitonin or nCD64 with different sites of infection. Elevation of all 3 parameters (nCD64, PCT and total leukocyte count) was uncommon but highly specific for presence of infection. CONCLUSION nCD64 identifies infection better than procalcitonin and correlates well with infection severity in children with DCLD.
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Affiliation(s)
- Vignesh Vinayagamoorthy
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Anshu Srivastava
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India.
| | - Anamika Kumari Anuja
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Vikas Agarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Rungmei Marak
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Moinak Sen Sarma
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Ujjal Poddar
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Surender Kumar Yachha
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
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Sánchez-Monteagudo A, Ripollés E, Murillo O, Domènech S, Álvarez-Sauco M, Girona E, Sastre-Bataller I, Bono A, García-Villarreal L, Tugores A, García-García F, González-Aseguinolaza G, Berenguer M, Espinós C. Profile of plasma microRNAs as a potential biomarker of Wilson's disease. J Gastroenterol 2024:10.1007/s00535-024-02135-6. [PMID: 39060521 DOI: 10.1007/s00535-024-02135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Wilson's disease (WD) is a rare condition resulting from autosomal recessive mutations in ATP7B, a copper transporter, manifesting with hepatic, neurological, and psychiatric symptoms. Timely diagnosis and appropriate treatment yield a positive prognosis, while delayed identification and/or insufficient therapy lead to a poor outcome. Our aim was to establish a prognostic method for WD by characterising biomarkers based on circulating microRNAs. METHODS We conducted investigations across three cohorts: discovery, validation (comprising unrelated patients), and follow-up (revisiting the discovery cohort 3 years later). All groups were compared to age- and gender-matched controls. Plasma microRNAs were analysed via RNA sequencing in the discovery cohort and subsequently validated using quantitative PCR in all three cohorts. To assess disease progression, we examined the microRNA profile in Atp7b-/- mice, analysing serum samples from 6 to 44 weeks of age and liver samples at three time points: 20, 30, and 40 weeks of age. RESULTS In patients, elevated levels of the signature microRNAs (miR-122-5p, miR-192-5p, and miR-885-5p) correlated with serum activities of aspartate transaminase, alanine aminotransferase and gamma-glutamyl transferase. In Atp7b-/- mice, levels of miR-122-5p and miR-192-5p (miR-885-5p lacking a murine orthologue) increased from 12 weeks of age in serum, while exhibiting fluctuations in the liver, possibly attributable to hepatocyte regenerative capacity post-injury and the release of hepatic microRNAs into the bloodstream. CONCLUSIONS The upregulation of the signature miR-122-5p, miR-192-5p, and miR-885-5p in patients and their correlation with liver disease progression in WD mice support their potential as biomarkers of WD.
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Affiliation(s)
- Ana Sánchez-Monteagudo
- Unit of Rare Neurodegenerative Diseases, Valencia Biomedical Research Foundation-Centro de Investigación Príncipe Felipe (CIPF), Calle Eduardo Primo Yúfera No. 13, 46012, Valencia, Spain
| | - Edna Ripollés
- Unit of Rare Neurodegenerative Diseases, Valencia Biomedical Research Foundation-Centro de Investigación Príncipe Felipe (CIPF), Calle Eduardo Primo Yúfera No. 13, 46012, Valencia, Spain
- Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain
| | - Oihana Murillo
- DNA@RNA Medicine Division, Centro de Investigación Médica Aplicada (CIMA), University of Navarra, Pamplona, Spain
| | - Sofia Domènech
- Unit of Rare Neurodegenerative Diseases, Valencia Biomedical Research Foundation-Centro de Investigación Príncipe Felipe (CIPF), Calle Eduardo Primo Yúfera No. 13, 46012, Valencia, Spain
- Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain
| | - María Álvarez-Sauco
- Department of Neurology, Hospital General Universitari d'Elx, Alicante, Spain
| | - Eva Girona
- Department of Internal Medicine, Hospital General Universitari d'Elx, Alicante, Spain
| | - Isabel Sastre-Bataller
- Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain
- Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ariadna Bono
- Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain
- Hepatology-Liver Transplantation Unit, Digestive Medicine Service, IIS La Fe and CIBER-EHD, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Luis García-Villarreal
- Research Unit, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Antonio Tugores
- Research Unit, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Francisco García-García
- Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain
- Unit of Bioinformatics and Biostatistics, Valencia Biomedical Research Foundation-Centro de Investigación Príncipe Felipe (CIPF), Valencia, Spain
| | - Gloria González-Aseguinolaza
- DNA@RNA Medicine Division, Centro de Investigación Médica Aplicada (CIMA), University of Navarra, Pamplona, Spain
- Vivet Therapeutics S.L., Pamplona, Spain
| | - Marina Berenguer
- Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain
- Hepatology-Liver Transplantation Unit, Digestive Medicine Service, IIS La Fe and CIBER-EHD, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Carmen Espinós
- Unit of Rare Neurodegenerative Diseases, Valencia Biomedical Research Foundation-Centro de Investigación Príncipe Felipe (CIPF), Calle Eduardo Primo Yúfera No. 13, 46012, Valencia, Spain.
- Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain.
- Biotechnology Department, Universitat Politècnica de València, Valencia, Spain.
- Rare Diseases Networking Biomedical Research Centre (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
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Litwin T, Rędzia-Ogrodnik B, Antos A, Przybyłkowski A, Członkowska A, Bembenek JP. Brain Magnetic Resonance Imaging in Wilson's Disease-Significance and Practical Aspects-A Narrative Review. Brain Sci 2024; 14:727. [PMID: 39061467 PMCID: PMC11274939 DOI: 10.3390/brainsci14070727] [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: 06/28/2024] [Revised: 07/10/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
Wilson's disease (WD) is a genetic disorder of copper metabolism with pathological copper accumulation in many organs, resulting in clinical symptoms, mostly hepatic and neuropsychiatric. As copper accumulates in the brain during WD, and almost 50% of WD patients at diagnosis present with neurological symptoms, neuroimaging studies (especially brain magnetic resonance imaging (MRI)) are part of WD diagnosis. The classical sequences (T1, T2, and fluid-attenuated inversion recovery) were used to describe brain MRI; however, with the development of neuroradiology, several papers proposed the use of new MRI sequences and techniques like susceptibility-weighted images, T2*, diffusion MRI, tractography, volumetric assessment and post-processing brain MRI analysis of paramagnetic accumulation-quantitative susceptibility mapping. Based on these neuroradiological data in WD, currently, brain MRI semiquantitative scale and the pathognomonic neuroradiological brain MRI signs in WD were proposed. Further, the volumetric studies and brain iron accumulation MRI analysis suggested brain atrophy and iron accumulation as biomarkers of neurological WD disease severity. All these results highlight the significance of brain MRI examinations in WD. Due to the extreme progress of these studies, based on the available literature, the authors present the current state of knowledge about the significance, practical aspects, and future directions of brain MRI in WD.
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Affiliation(s)
- Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland; (B.R.-O.); (A.A.); (A.C.)
| | - Barbara Rędzia-Ogrodnik
- Second Department of Neurology, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland; (B.R.-O.); (A.A.); (A.C.)
| | - Agnieszka Antos
- Second Department of Neurology, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland; (B.R.-O.); (A.A.); (A.C.)
| | - Adam Przybyłkowski
- Department of Gastroenterology, Medical University, Warsaw 02-097, Poland;
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland; (B.R.-O.); (A.A.); (A.C.)
| | - Jan Paweł Bembenek
- Department of Neurophysiology, Institute Psychiatry and Neurology, 02-957 Warsaw, Poland;
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Fontes A, Jauch AT, Sailer J, Engler J, Azul AM, Zischka H. Metabolic Derangement of Essential Transition Metals and Potential Antioxidant Therapies. Int J Mol Sci 2024; 25:7880. [PMID: 39063122 PMCID: PMC11277342 DOI: 10.3390/ijms25147880] [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: 05/19/2024] [Revised: 07/08/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Essential transition metals have key roles in oxygen transport, neurotransmitter synthesis, nucleic acid repair, cellular structure maintenance and stability, oxidative phosphorylation, and metabolism. The balance between metal deficiency and excess is typically ensured by several extracellular and intracellular mechanisms involved in uptake, distribution, and excretion. However, provoked by either intrinsic or extrinsic factors, excess iron, zinc, copper, or manganese can lead to cellular damage upon chronic or acute exposure, frequently attributed to oxidative stress. Intracellularly, mitochondria are the organelles that require the tightest control concerning reactive oxygen species production, which inevitably leaves them to be one of the most vulnerable targets of metal toxicity. Current therapies to counteract metal overload are focused on chelators, which often cause secondary effects decreasing patients' quality of life. New therapeutic options based on synthetic or natural antioxidants have proven positive effects against metal intoxication. In this review, we briefly address the cellular metabolism of transition metals, consequences of their overload, and current therapies, followed by their potential role in inducing oxidative stress and remedies thereof.
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Affiliation(s)
- Adriana Fontes
- Institute of Molecular Toxicology and Pharmacology, Helmholtz Center Munich, German Research Center for Environmental Health, D-85764 Neuherberg, Germany;
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal
| | - Adrian T. Jauch
- School of Medicine and Health, Institute of Toxicology and Environmental Hygiene, Technical University Munich, D-80802 Munich, Germany
| | - Judith Sailer
- School of Medicine and Health, Institute of Toxicology and Environmental Hygiene, Technical University Munich, D-80802 Munich, Germany
| | - Jonas Engler
- School of Medicine and Health, Institute of Toxicology and Environmental Hygiene, Technical University Munich, D-80802 Munich, Germany
| | - Anabela Marisa Azul
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal
- IIIUC-Institute for Interdisciplinary Research, University of Coimbra, 3030-789 Coimbra, Portugal
| | - Hans Zischka
- Institute of Molecular Toxicology and Pharmacology, Helmholtz Center Munich, German Research Center for Environmental Health, D-85764 Neuherberg, Germany;
- School of Medicine and Health, Institute of Toxicology and Environmental Hygiene, Technical University Munich, D-80802 Munich, Germany
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9
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Choi W, Cha S, Kim K. Navigating the CRISPR/Cas Landscape for Enhanced Diagnosis and Treatment of Wilson's Disease. Cells 2024; 13:1214. [PMID: 39056796 PMCID: PMC11274827 DOI: 10.3390/cells13141214] [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: 05/27/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
The clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein (Cas) system continues to evolve, thereby enabling more precise detection and repair of mutagenesis. The development of CRISPR/Cas-based diagnosis holds promise for high-throughput, cost-effective, and portable nucleic acid screening and genetic disease diagnosis. In addition, advancements in transportation strategies such as adeno-associated virus (AAV), lentiviral vectors, nanoparticles, and virus-like vectors (VLPs) offer synergistic insights for gene therapeutics in vivo. Wilson's disease (WD), a copper metabolism disorder, is primarily caused by mutations in the ATPase copper transporting beta (ATP7B) gene. The condition is associated with the accumulation of copper in the body, leading to irreversible damage to various organs, including the liver, nervous system, kidneys, and eyes. However, the heterogeneous nature and individualized presentation of physical and neurological symptoms in WD patients pose significant challenges to accurate diagnosis. Furthermore, patients must consume copper-chelating medication throughout their lifetime. Herein, we provide a detailed description of WD and review the application of novel CRISPR-based strategies for its diagnosis and treatment, along with the challenges that need to be overcome.
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Affiliation(s)
- Woong Choi
- Department of Physiology, Korea University College of Medicine, Seoul 02841, Republic of Korea;
| | - Seongkwang Cha
- Department of Physiology, Korea University College of Medicine, Seoul 02841, Republic of Korea;
- Neuroscience Research Institute, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Kyoungmi Kim
- Department of Physiology, Korea University College of Medicine, Seoul 02841, Republic of Korea;
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Republic of Korea
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10
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Lee EJ, Woo MH, Moon JS, Ko JS. Efficacy and safety of D-penicillamine, trientine, and zinc in pediatric Wilson disease patients. Orphanet J Rare Dis 2024; 19:261. [PMID: 38982450 PMCID: PMC11234817 DOI: 10.1186/s13023-024-03271-1] [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: 10/29/2023] [Accepted: 07/01/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVES Wilson disease (WD) is a rare genetic disease affecting copper metabolism and the biliary tract's copper excretion. Lifelong medication is necessary to prevent liver failure, neurological complications, and death. Although D-penicillamine (DPA), trientine, and zinc are used to treat WD, there is limited research on the long-term outcomes of these drugs, especially in children. This study aimed to evaluate the efficacy and safety of DPA, trientine, and zinc in patients diagnosed with WD during childhood. METHODS Ninety out of 92 patients were included in the analysis, excluding two patients who underwent liver transplantation without drug treatment due to an acute liver failure diagnosis. Treatment outcomes and reasons for discontinuation of therapy in 148 treatment blocks (37 DPA, 50 trientine, and 61 zinc) were analyzed using Kaplan-Meier analysis. RESULTS The median age at diagnosis was 8.3 years. There was a statistically significant difference in drug changes due to treatment ineffectiveness among the three drugs: trientine (22/50, 44%), zinc (15/61, 25%), and DPA (2/37, 5%) (all p < 0.05). Regarding drug changes due to adverse effects, the rate was the highest for DPA, followed by zinc and trientine. There were significant differences between DPA and zinc, zinc and trientine (all p < 0.05), but no significant difference was observed between DPA and zinc (p = 0.22). CONCLUSIONS In pediatric WD, DPA, zinc, and trientine have therapeutic effects in that order. However, DPA and zinc are associated with more adverse effects compared to trientine.
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Affiliation(s)
- Eun Joo Lee
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Hyung Woo
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Sung Ko
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
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11
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Beaudin M, Dupre N, Manto M. The importance of synthetic pharmacotherapy for recessive cerebellar ataxias. Expert Rev Neurother 2024:1-16. [PMID: 38980086 DOI: 10.1080/14737175.2024.2376840] [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: 04/19/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION The last decade has witnessed major breakthroughs in identifying novel genetic causes of hereditary ataxias, deepening our understanding of disease mechanisms, and developing therapies for these debilitating disorders. AREAS COVERED This article reviews the currently approved and most promising candidate pharmacotherapies in relation to the known disease mechanisms of the most prevalent autosomal recessive ataxias. Omaveloxolone is an Nrf2 activator that increases antioxidant defense and was recently approved for treatment of Friedreich ataxia. Its therapeutic effect is modest, and further research is needed to find synergistic treatments that would halt or reverse disease progression. Promising approaches include upregulation of frataxin expression by epigenetic mechanisms, direct protein replacement, and gene replacement therapy. For ataxia-telangiectasia, promising approaches include splice-switching antisense oligonucleotides and small molecules targeting oxidative stress, inflammation, and mitochondrial function. Rare recessive ataxias for which disease-modifying therapies exist are also reviewed, emphasizing recently approved therapies. Evidence supporting the use of riluzole and acetyl-leucine in recessive ataxias is discussed. EXPERT OPINION Advances in genetic therapies for other neurogenetic conditions have paved the way to implement feasible approaches with potential dramatic benefits. Particularly, as we develop effective treatments for these conditions, we may need to combine therapies, consider newborn testing for pre-symptomatic treatment, and optimize non-pharmacological approaches.
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Affiliation(s)
- Marie Beaudin
- Department of Neurology and Neurological Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Nicolas Dupre
- Neuroscience axis, CHU de Québec-Université Laval, Québec, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Mario Manto
- Service des Neurosciences, Université de Mons, Mons, Belgique
- Unité des Ataxies Cérébelleuses, Service de Neurologie, CHU-Charleroi, Charleroi, Belgique
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12
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Fontes A, Pierson H, Bierła JB, Eberhagen C, Kinschel J, Akdogan B, Rieder T, Sailer J, Reinold Q, Cielecka-Kuszyk J, Szymańska S, Neff F, Steiger K, Seelbach O, Zibert A, Schmidt HH, Hauck SM, von Toerne C, Michalke B, Semrau JD, DiSpirito AM, Ramalho-Santos J, Kroemer G, Polishchuk R, Azul AM, DiSpirito A, Socha P, Lutsenko S, Zischka H. Copper impairs the intestinal barrier integrity in Wilson disease. Metabolism 2024; 158:155973. [PMID: 38986805 DOI: 10.1016/j.metabol.2024.155973] [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: 02/17/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/12/2024]
Abstract
In Wilson disease (WD), liver copper (Cu) excess, caused by mutations in the ATPase Cu transporting beta (ATP7B), has been extensively studied. In contrast, in the gastrointestinal tract, responsible for dietary Cu uptake, ATP7B malfunction is poorly explored. We therefore investigated gut biopsies from WD patients and compared intestines from two rodent WD models and from human ATP7B knock-out intestinal cells to their respective wild-type controls. We observed gastrointestinal (GI) inflammation in patients, rats and mice lacking ATP7B. Mitochondrial alterations and increased intestinal leakage were observed in WD rats, Atp7b-/- mice and human ATP7B KO Caco-2 cells. Proteome analyses of intestinal WD homogenates revealed profound alterations of energy and lipid metabolism. The intestinal damage in WD animals and human ATP7B KO cells did not correlate with absolute Cu elevations, but likely reflects intracellular Cu mislocalization. Importantly, Cu depletion by the high-affinity Cu chelator methanobactin (MB) restored enterocyte mitochondria, epithelial integrity, and resolved gut inflammation in WD rats and human WD enterocytes, plausibly via autophagy-related mechanisms. Thus, we report here before largely unrecognized intestinal damage in WD, occurring early on and comprising metabolic and structural tissue damage, mitochondrial dysfunction, and compromised intestinal barrier integrity and inflammation, that can be resolved by high-affinity Cu chelation treatment.
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Affiliation(s)
- Adriana Fontes
- Institute of Molecular Toxicology and Pharmacology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany; CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; DCV-Department of Life Sciences, Faculty of Sciences and Technology of the University of Coimbra, Coimbra, Portugal
| | - Hannah Pierson
- Department of Physiology, Johns Hopkins Medical Institutes, Baltimore, MD, USA
| | - Joanna B Bierła
- Department of Pathomorphology, Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Carola Eberhagen
- Institute of Molecular Toxicology and Pharmacology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - Jennifer Kinschel
- Technical University Munich, Institute of Toxicology and Environmental Hygiene, Munich, Germany
| | - Banu Akdogan
- Institute of Molecular Toxicology and Pharmacology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - Tamara Rieder
- Technical University Munich, Institute of Toxicology and Environmental Hygiene, Munich, Germany
| | - Judith Sailer
- Technical University Munich, Institute of Toxicology and Environmental Hygiene, Munich, Germany
| | - Quirin Reinold
- Technical University Munich, Institute of Toxicology and Environmental Hygiene, Munich, Germany
| | - Joanna Cielecka-Kuszyk
- Department of Pathomorphology, Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Sylwia Szymańska
- Department of Pathomorphology, Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | | | - Katja Steiger
- Comparative Experimental Pathology Department, Institute for General Pathology and Pathological Anatomy, Technical University of Munich (TUM), Germany
| | - Olga Seelbach
- Comparative Experimental Pathology Department, Institute for General Pathology and Pathological Anatomy, Technical University of Munich (TUM), Germany
| | - Andree Zibert
- Medizinische Klinik B für Gastroenterologie und Hepatologie, Universitätsklinikum Münster, Münster, Germany
| | - Hartmut H Schmidt
- Medizinische Klinik B für Gastroenterologie und Hepatologie, Universitätsklinikum Münster, Münster, Germany
| | - Stefanie M Hauck
- Research Unit Protein Science, Helmholtz Center Munich, German Research Center for Environmental Health GmbH, Munich, Germany
| | - Christine von Toerne
- Research Unit Protein Science, Helmholtz Center Munich, German Research Center for Environmental Health GmbH, Munich, Germany
| | - Bernhard Michalke
- Research Unit Analytical BioGeoChemistry, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - Jeremy D Semrau
- Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, MI, 48109-2125, USA
| | - Ana M DiSpirito
- Roy J. Carver Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, USA
| | - João Ramalho-Santos
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; DCV-Department of Life Sciences, Faculty of Sciences and Technology of the University of Coimbra, Coimbra, Portugal; CIBB-Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Guido Kroemer
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université Paris Cité, Sorbonne Université, Inserm U1138, Institut Universitaire de France, Paris, France; Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France; Institut du Cancer Paris CARPEM, Department of Biology, Hôpital Européen Georges Pompidou, AP-, HP, Paris, France
| | - Roman Polishchuk
- Telethon Institute of Genetics and Medicine, 80078 Pozzuoli, Italy
| | - Anabela Marisa Azul
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; CIBB-Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal; IIIUC-Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
| | - Alan DiSpirito
- Roy J. Carver Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, USA
| | - Piotr Socha
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Svetlana Lutsenko
- Department of Physiology, Johns Hopkins Medical Institutes, Baltimore, MD, USA
| | - Hans Zischka
- Institute of Molecular Toxicology and Pharmacology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany; Technical University Munich, Institute of Toxicology and Environmental Hygiene, Munich, Germany.
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13
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Lee DU, Harmacinski A, Bahadur A, Lee KJ, Chou H, Shaik MR, Chou H, Fan GH, Kwon J, Ponder R, Chang K, Lee K, Lominadze Z. The cost implications of Wilson disease among hospitalized patients: analysis of USA hospitals. Eur J Gastroenterol Hepatol 2024; 36:929-940. [PMID: 38652529 PMCID: PMC11147697 DOI: 10.1097/meg.0000000000002777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND AIM In this study, we used a national cohort of patients with Wilson's disease (WD) to investigate the admissions, mortality rates, and costs over the captured period to assess specific subpopulations at higher burden. METHODS Patients with WD were selected using 2016-2019 National Inpatient Sample (NIS). The weighted estimates and patient data were stratified using demographics and medical characteristics. Regression curves were graphed to derive goodness-of-fit for each trend from which R2 and P values were calculated. RESULTS Annual total admissions per 100 000 hospitalizations due to WD were 1075, 1180, 1140, and 1330 ( R2 = 0.75; P = 0.13) from 2016 to 2019. Within the demographics, there was an increase in admissions among patients greater than 65 years of age ( R2 = 0.90; P = 0.05) and White patients ( R2 = 0.97; P = 0.02). Assessing WD-related mortality rates, there was an increase in the mortality rate among those in the first quartile of income ( R2 = 1.00; P < 0.001). The total cost for WD-related hospitalizations was $20.90, $27.23, $24.20, and $27.25 million US dollars for the years 2016, 2017, 2018, and 2019, respectively ( R2 = 0.47; P = 0.32). There was an increasing total cost trend for Asian or Pacific Islander patients ( R2 = 0.90; P = 0.05). Interestingly, patients with cirrhosis demonstrated a decreased trend in the total costs ( R2 = 0.97; P = 0.02). CONCLUSION Our study demonstrated that certain ethnicity groups, income classes and comorbidities had increased admissions or costs among patients admitted with WD.
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Affiliation(s)
- David Uihwan Lee
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD 21201, USA
| | - Ashton Harmacinski
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD 21201, USA
| | - Aneesh Bahadur
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Ki Jung Lee
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Hannah Chou
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Mohammed Rifat Shaik
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD 21201, USA
| | - Harrison Chou
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Gregory Hongyuan Fan
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Jean Kwon
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Reid Ponder
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Kevin Chang
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - KeeSeok Lee
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Zurabi Lominadze
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD 21201, USA
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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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15
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Burghart L, Ferenci P, Petrenko O, Mandorfer M, Schwarz M, Gschwantler M, Trauner M, Reiberger T, Stättermayer AF. Portal hypertension and its prognostic implications in patients with Wilson's disease. Aliment Pharmacol Ther 2024; 60:257-266. [PMID: 38798050 DOI: 10.1111/apt.18060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/20/2023] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND AND AIMS Wilson's disease may progress to cirrhosis and clinically significant portal hypertension (CSPH). We aimed to assess the prevalence and prognostic impact of CSPH-related features on hepatic decompensation and transplant-free survival in patients with Wilson's disease. METHODS AND RESULTS About 137 patients with Wilson's disease (Leipzig score ≥4), followed for a median observation period of 9.0 (3.9-17.7) years at the Vienna General Hospital, were included in this retrospective study. Overall, 49 (35.8%) developed features of CSPH: 14 (10.2%) varices, 40 (29.2%) splenomegaly, 20 (14.6%) ascites, 18 (13.1%) hepatic encephalopathy and 3 (2.2%) experienced acute variceal bleeding. Overall, 8 (5.8%) patients died, including three deaths caused by CSPH-related complications. Within 10 years, compensated patients with features of CSPH developed more decompensation events (8.3% vs. 1.5% in patients without CSPH, p = 0.3) and had worse transplant-free-survival (91.7% vs. 98.6%), which further declined in patients with hepatic decompensation (26.7%, log-rank: p < 0.0001). Patients with liver stiffness <15 kPa and normal platelets (≥150 G/L) were less likely to decompensate within 10 years (2.6% vs. 8.4%, p = 0.002) and had a better 10-year transplant-free-survival (97.7% vs. 83.9%, p = 0.006). CONCLUSIONS Patients with Wilson's disease developing features of CSPH are at an increased risk for hepatic decompensation and liver-related mortality, warranting for regular screening and timely initiation of effective CSPH-directed treatments.
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Affiliation(s)
- Lukas Burghart
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Laboratory, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network for Rare Hepatological Diseases (ERN RARE-LIVER), Medical University Vienna, Vienna, Austria
- Department of Internal Medicine IV, Wilhelminenspital, Vienna, Austria
- Sigmund Freud University, Vienna, Austria
| | - Peter Ferenci
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Oleksandr Petrenko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Laboratory, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network for Rare Hepatological Diseases (ERN RARE-LIVER), Medical University Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases (LBI-RUD), Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Laboratory, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network for Rare Hepatological Diseases (ERN RARE-LIVER), Medical University Vienna, Vienna, Austria
| | - Michael Schwarz
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Laboratory, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Gschwantler
- Department of Internal Medicine IV, Wilhelminenspital, Vienna, Austria
- Sigmund Freud University, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network for Rare Hepatological Diseases (ERN RARE-LIVER), Medical University Vienna, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Laboratory, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network for Rare Hepatological Diseases (ERN RARE-LIVER), Medical University Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases (LBI-RUD), Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Albert Friedrich Stättermayer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Laboratory, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network for Rare Hepatological Diseases (ERN RARE-LIVER), Medical University Vienna, Vienna, Austria
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16
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Gale J, Aizenman E. The physiological and pathophysiological roles of copper in the nervous system. Eur J Neurosci 2024; 60:3505-3543. [PMID: 38747014 DOI: 10.1111/ejn.16370] [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: 11/12/2023] [Revised: 02/28/2024] [Accepted: 04/10/2024] [Indexed: 07/06/2024]
Abstract
Copper is a critical trace element in biological systems due the vast number of essential enzymes that require the metal as a cofactor, including cytochrome c oxidase, superoxide dismutase and dopamine-β-hydroxylase. Due its key role in oxidative metabolism, antioxidant defence and neurotransmitter synthesis, copper is particularly important for neuronal development and proper neuronal function. Moreover, increasing evidence suggests that copper also serves important functions in synaptic and network activity, the regulation of circadian rhythms, and arousal. However, it is important to note that because of copper's ability to redox cycle and generate reactive species, cellular levels of the metal must be tightly regulated to meet cellular needs while avoiding copper-induced oxidative stress. Therefore, it is essential that the intricate system of copper transporters, exporters, copper chaperones and copper trafficking proteins function properly and in coordinate fashion. Indeed, disorders of copper metabolism such as Menkes disease and Wilson disease, as well as diseases linked to dysfunction of copper-requiring enzymes, such as SOD1-linked amyotrophic lateral sclerosis, demonstrate the dramatic neurological consequences of altered copper homeostasis. In this review, we explore the physiological importance of copper in the nervous system as well as pathologies related to improper copper handling.
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Affiliation(s)
- Jenna Gale
- Department of Neurobiology and Pittsburgh Institute for Neurodegenerative Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Elias Aizenman
- Department of Neurobiology and Pittsburgh Institute for Neurodegenerative Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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17
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Hegarty R, Thompson RJ. Genetic aetiologies of acute liver failure. J Inherit Metab Dis 2024; 47:582-597. [PMID: 38499319 DOI: 10.1002/jimd.12733] [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: 12/01/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
Acute liver failure (ALF) is a rare, rapidly evolving, clinical syndrome with devastating consequences where definitive treatment is by emergency liver transplantation. Establishing a diagnosis can be challenging and, historically, the cause of ALF was unidentified in up to half of children. However, recent technological and clinical advances in genomic medicine have led to an increasing proportion being diagnosed with monogenic aetiologies of ALF. The conditions encountered include a diverse group of inherited metabolic disorders each with prognostic and treatment implications. Often these disorders are clinically indistinguishable and may even mimic disorders of immune regulation or red cell disorders. Rapid genomic sequencing for children with ALF is, therefore, a key component in the diagnostic work up today. This review focuses on the monogenic aetiologies of ALF.
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Affiliation(s)
- Robert Hegarty
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
- Institute of Liver Studies, King's College London, London, UK
| | - Richard J Thompson
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
- Institute of Liver Studies, King's College London, London, UK
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Sailer J, Nagel J, Akdogan B, Jauch AT, Engler J, Knolle PA, Zischka H. Deadly excess copper. Redox Biol 2024; 75:103256. [PMID: 38959622 PMCID: PMC11269798 DOI: 10.1016/j.redox.2024.103256] [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: 04/27/2024] [Revised: 06/13/2024] [Accepted: 06/23/2024] [Indexed: 07/05/2024] Open
Abstract
Higher eukaryotes' life is impossible without copper redox activity and, literally, every breath we take biochemically demonstrates this. However, this dependence comes at a considerable price to ensure target-oriented copper action. Thereto its uptake, distribution but also excretion are executed by specialized proteins with high affinity for the transition metal. Consequently, malfunction of copper enzymes/transporters, as is the case in hereditary Wilson disease that affects the intracellular copper transporter ATP7B, comes with serious cellular damage. One hallmark of this disease is the progressive copper accumulation, primarily in liver but also brain that becomes deadly if left untreated. Such excess copper toxicity may also result from accidental ingestion or attempted suicide. Recent research has shed new light into the cell-toxic mechanisms and primarily affected intracellular targets and processes of such excess copper that may even be exploited with respect to cancer therapy. Moreover, new therapies are currently under development to fight against deadly toxic copper.
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Affiliation(s)
- Judith Sailer
- Institute of Toxicology and Environmental Hygiene, Technical University Munich, School of Medicine and Health, Munich, Germany
| | - Judith Nagel
- Institute of Toxicology and Environmental Hygiene, Technical University Munich, School of Medicine and Health, Munich, Germany
| | - Banu Akdogan
- Institute of Molecular Toxicology and Pharmacology, Helmholtz Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - Adrian T Jauch
- Institute of Toxicology and Environmental Hygiene, Technical University Munich, School of Medicine and Health, Munich, Germany
| | - Jonas Engler
- Institute of Toxicology and Environmental Hygiene, Technical University Munich, School of Medicine and Health, Munich, Germany
| | - Percy A Knolle
- Institute of Molecular Immunology and Experimental Oncology, Technical University Munich, School of Medicine and Health, Munich, Germany
| | - Hans Zischka
- Institute of Toxicology and Environmental Hygiene, Technical University Munich, School of Medicine and Health, Munich, Germany; Institute of Molecular Toxicology and Pharmacology, Helmholtz Munich, German Research Center for Environmental Health, Neuherberg, Germany.
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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 PMCID: PMC11244749 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] [Received: 11/20/2023] [Accepted: 03/11/2024] [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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20
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Yang Y, Wang GA, Fang S, Li X, Ding Y, Song Y, He W, Rao Z, Diao K, Zhu X, Yang W. Decoding Wilson disease: a machine learning approach to predict neurological symptoms. Front Neurol 2024; 15:1418474. [PMID: 38966086 PMCID: PMC11223572 DOI: 10.3389/fneur.2024.1418474] [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: 04/16/2024] [Accepted: 05/28/2024] [Indexed: 07/06/2024] Open
Abstract
Objectives Wilson disease (WD) is a rare autosomal recessive disorder caused by a mutation in the ATP7B gene. Neurological symptoms are one of the most common symptoms of WD. This study aims to construct a model that can predict the occurrence of neurological symptoms by combining clinical multidimensional indicators with machine learning methods. Methods The study population consisted of WD patients who received treatment at the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from July 2021 to September 2023 and had a Leipzig score ≥ 4 points. Indicators such as general clinical information, imaging, blood and urine tests, and clinical scale measurements were collected from patients, and machine learning methods were employed to construct a prediction model for neurological symptoms. Additionally, the SHAP method was utilized to analyze clinical information to determine which indicators are associated with neurological symptoms. Results In this study, 185 patients with WD (of whom 163 had neurological symptoms) were analyzed. It was found that using the eXtreme Gradient Boosting (XGB) to predict achieved good performance, with an MCC value of 0.556, ACC value of 0.929, AUROC value of 0.835, and AUPRC value of 0.975. Brainstem damage, blood creatinine (Cr), age, indirect bilirubin (IBIL), and ceruloplasmin (CP) were the top five important predictors. Meanwhile, the presence of brainstem damage and the higher the values of Cr, Age, and IBIL, the more likely neurological symptoms were to occur, while the lower the CP value, the more likely neurological symptoms were to occur. Conclusions To sum up, the prediction model constructed using machine learning methods to predict WD cirrhosis has high accuracy. The most important indicators in the prediction model were brainstem damage, Cr, age, IBIL, and CP. It provides assistance for clinical decision-making.
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Affiliation(s)
- Yulong Yang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China
| | - Gang-Ao Wang
- School of Information and Artificial Intelligence, Anhui Agricultural University, Hefei, Anhui, China
| | - Shuzhen Fang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China
| | - Xiang Li
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China
| | - Yufeng Ding
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China
| | - Yuqi Song
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China
| | - Wei He
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China
| | - Zhihong Rao
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China
| | - Ke Diao
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China
| | - Xiaolei Zhu
- School of Information and Artificial Intelligence, Anhui Agricultural University, Hefei, Anhui, China
| | - Wenming Yang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China
- Center for Xin'an Medicine and Modernization of Traditional Chinese Medicine, Institute of Health and Medicine Hefei Comprehensive National Science Center, Hefei, Anhui, China
- Key Laboratory of Xin'An Medicine, Ministry of Education, Hefei, Anhui, China
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21
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Ferrarese A, Cazzagon N, Burra P. Liver transplantation for Wilson disease: Current knowledge and future perspectives. Liver Transpl 2024:01445473-990000000-00405. [PMID: 38899966 DOI: 10.1097/lvt.0000000000000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
Liver transplantation currently represents a therapeutic option for patients with Wilson disease presenting with end-stage liver disease or acute liver failure. Indeed, it has been associated with excellent postoperative survival curves in view of young age at transplant and absence of recurrence. Attention has shifted over the past decades to a wise expansion of indications for liver transplantation. Evidence has emerged supporting the transplantation of carefully selected patients with primarily neuropsychiatric symptoms and compensated cirrhosis. The rationale behind this approach is the potential for surgery to improve copper homeostasis and consequently ameliorate neuropsychiatric symptoms. However, several questions remain unanswered, such as how to establish thresholds for assessing pretransplant neuropsychiatric impairment, how to standardize preoperative neurological assessments, and how to define postoperative outcomes for patients meeting these specific criteria. Furthermore, a disease-specific approach will be proposed both for the liver transplant evaluation of candidates with Wilson disease and for patient care during the transplant waiting period, highlighting the peculiarities of this systemic disease.
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Affiliation(s)
- Alberto Ferrarese
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Nora Cazzagon
- Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
- Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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22
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Teschke R. Copper, Iron, Cadmium, and Arsenic, All Generated in the Universe: Elucidating Their Environmental Impact Risk on Human Health Including Clinical Liver Injury. Int J Mol Sci 2024; 25:6662. [PMID: 38928368 PMCID: PMC11203474 DOI: 10.3390/ijms25126662] [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: 05/27/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Humans are continuously exposed to various heavy metals including copper, iron, cadmium, and arsenic, which were specifically selected for the current analysis because they are among the most frequently encountered environmental mankind and industrial pollutants potentially causing human health hazards and liver injury. So far, these issues were poorly assessed and remained a matter of debate, also due to inconsistent results. The aim of the actual report is to thoroughly analyze the positive as well as negative effects of these four heavy metals on human health. Copper and iron are correctly viewed as pollutant elements essential for maintaining human health because they are part of important enzymes and metabolic pathways. Healthy individuals are prepared through various genetically based mechanisms to maintain cellular copper and iron homeostasis, thereby circumventing or reducing hazardous liver and organ injury due to excessive amounts of these metals continuously entering the human body. In a few humans with gene aberration, however, liver and organ injury may develop because excessively accumulated copper can lead to Wilson disease and substantial iron deposition to hemochromatosis. At the molecular level, toxicities of some heavy metals are traced back to the Haber Weiss and Fenton reactions involving reactive oxygen species formed in the course of oxidative stress. On the other hand, cellular homeostasis for cadmium and arsenic cannot be provided, causing their life-long excessive deposition in the liver and other organs. Consequently, cadmium and arsenic represent health hazards leading to higher disability-adjusted life years and increased mortality rates due to cancer and non-cancer diseases. For unknown reasons, however, liver injury in humans exposed to cadmium and arsenic is rarely observed. In sum, copper and iron are good for the human health of most individuals except for those with Wilson disease or hemochromatosis at risk of liver injury through radical formation, while cadmium and arsenic lack any beneficial effects but rather are potentially hazardous to human health with a focus on increased disability potential and risk for cancer. Primary efforts should focus on reducing the industrial emission of hazardous heavy metals.
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Affiliation(s)
- Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, 63450 Hanau, Germany; ; Tel.: +49-6181/21859; Fax: +49-6181/2964211
- Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/Main, 60590 Hanau, Germany
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23
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Bracciamà E, Sapuppo A, Rapisarda L, Siciliano E, Caciotti A, Morrone A, Ruggieri M, Cantarella G, Bernardini R, Bertino G. Obesity as a Confounding Factor in the Diagnosis of Wilson's Disease: Case Report of Two Siblings with the Same Genotype but Different Clinical Courses. Curr Issues Mol Biol 2024; 46:6112-6120. [PMID: 38921036 PMCID: PMC11202942 DOI: 10.3390/cimb46060365] [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: 04/21/2024] [Revised: 05/27/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024] Open
Abstract
Wilson's disease (WD) is a biallelic disease-causing variant in the ATP7B gene on chromosome 13q14.3 that results in copper accumulation in many organs, particularly the liver and brain. The phenotypic spectrum is wide and symptoms at onset can be heterogeneous. We describe two Sicilian siblings, a young man and his elder sister, both compound heterozygous for the variants c.1286-2A>G and c.2668G>A (p.Val890Met) in the ATB7B gene. The male patient presented with liver cirrhosis, which quickly progressed to end-stage liver disease (Child-Pugh score = C10), while his sister had moderate steatotic liver disease (SLD). Our findings highlight that SLD may not always be related to obesity in overweight patients, especially when there are other potential risk factors such as a family history of chronic liver disease, or the persistence of high transaminase despite the adoption of adequate dietary and pharmacological intervention. Screening for conditions such as WD could identify patients at risk of developing SLD and avoid delays in diagnosis. Phenotypic variability in WD is considerable; therefore, further studies are needed to identify which WD patients have a greater risk of developing SLD and determine factors that can predict the severity of the disease.
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Affiliation(s)
- Emanuele Bracciamà
- Hepatology Unit, Department of Clinical and Experimental Medicine, Policlinico “G. Rodolico—San Marco” Hospital, University of Catania, 95123 Catania, Italy; (E.B.); (E.S.); (G.B.)
| | - Annamaria Sapuppo
- Pediatric Clinic, Department of Clinical and Experimental Medicine, Policlinico “G. Rodolico—San Marco” Hospital, University of Catania, 95123 Catania, Italy;
| | - Laura Rapisarda
- Department Biomedical and Biotechnological Sciences (BIOMETC), Section of Pharmacology, University of Catania, 95123 Catania, Italy (G.C.); (R.B.)
- Clinical Toxicology Unit, Policlinico “G. Rodolico-San Marco” Hospital, 95123 Catania, Italy
| | - Enrico Siciliano
- Hepatology Unit, Department of Clinical and Experimental Medicine, Policlinico “G. Rodolico—San Marco” Hospital, University of Catania, 95123 Catania, Italy; (E.B.); (E.S.); (G.B.)
| | - Anna Caciotti
- Laboratory of Molecular Biology of Neurometabolic Diseases, Neuroscience Department, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (A.C.); (A.M.)
| | - Amelia Morrone
- Laboratory of Molecular Biology of Neurometabolic Diseases, Neuroscience Department, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (A.C.); (A.M.)
- Department of NEUROFARBA, University of Florence, 50121 Florence, Italy
| | - Martino Ruggieri
- Pediatric Clinic, Department of Clinical and Experimental Medicine, Policlinico “G. Rodolico—San Marco” Hospital, University of Catania, 95123 Catania, Italy;
| | - Giuseppina Cantarella
- Department Biomedical and Biotechnological Sciences (BIOMETC), Section of Pharmacology, University of Catania, 95123 Catania, Italy (G.C.); (R.B.)
| | - Renato Bernardini
- Department Biomedical and Biotechnological Sciences (BIOMETC), Section of Pharmacology, University of Catania, 95123 Catania, Italy (G.C.); (R.B.)
- Clinical Toxicology Unit, Policlinico “G. Rodolico-San Marco” Hospital, 95123 Catania, Italy
| | - Gaetano Bertino
- Hepatology Unit, Department of Clinical and Experimental Medicine, Policlinico “G. Rodolico—San Marco” Hospital, University of Catania, 95123 Catania, Italy; (E.B.); (E.S.); (G.B.)
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24
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Jin S, Sun Z, Fang X, Yang W. Characterization of renal damage in Wilson's disease-Detailed analysis of 20 Chinese cases. Med Clin (Barc) 2024:S0025-7753(24)00134-9. [PMID: 38890098 DOI: 10.1016/j.medcli.2024.02.004] [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: 11/21/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE Copper metabolism disorder disease is thought to contribute to renal symptoms in Wilson's disease (WD). Nonetheless, there remains limited knowledge regarding the precise characteristics of renal damage in individuals with Wilson's disease, encompassing clinical presentations, biochemical indicators, imaging findings, and renal histopathological alterations. METHODS In this study, 20 patients diagnosed with Wilson's disease and renal involvement were enrolled in our hospital. These patients met the validated European criteria for Wilson's disease, and those with primary kidney disease or secondary renal damage caused by other underlying conditions were excluded. The baseline data of patients were collected. Various biochemical and hematological parameters were monitored. Biochemical examinations were measured using an automatic biochemistry analyzer, blood routines were tested by flow cytometry analysis, 24-h urine copper was tested by atomic absorption spectrophotometer. Besides, CER was measured by turbidimetric immunoassay with a Hitachi 7020 automatic biochemical analyzer (the intraplate and interplate coefficients of variation were 2.7% and 5.13% respectively). Copper oxidase was tested by colorimetric method using p-phenylenediamine hydrochloride (the intraplate and interplate coefficients of variation were both <10%). Diagnostic criteria for Wilson's disease and kidney damage were established based on the European Association for the Study of the Liver (EASL) and CKD Epidemiology Collaboration guidelines, respectively. Statistical analysis was carried out using t-tests and χ2 tests in SPSS 22.0 software. Significant differences were considered when P<0.05. RESULTS In those patients with Wilson's disease-related renal damage, edema, gross hematuria, oliguria, and lumbar pain were present in most patients. Microscopic haematuria and proteinuria were also observed in 19 patients. Compared to patients without renal involvement, those with renal complications exhibited a significant increase in white blood cell (WBC) and neutrophil counts (P<0.05). Additionally, patients with renal damage showed a noteworthy rise in both diastolic and systolic blood pressure, along with a significant reduction in hemoglobin levels (P<0.05). Color Doppler ultrasound results revealed diffuse lesions in both kidneys in 12 patients, renal cysts were identified in 5 patients, and 2 patients exhibited abnormal renal blood flow signals. Meanwhile, varying degrees of IgA, IgM, IgG-based immunoglobulins, complement C3 and C1q deposition in the glomerular mesangial area were detected by immunofluorescence. Furthermore, renal puncture biopsy results revealed a spectrum of findings, including minimal change nephrosis in 1 case, IgA nephropathy in 3 cases, atypical membranous proliferative nephropathy in 2 cases, and focal segmental glomerulosclerosis in 1 case. CONCLUSION This study comprehensively elucidates the distinct attributes of renal damage related to Wilson's disease, while also speculating that renal dysfunction in Wilson's disease could be linked to immune complex deposition. Depending on the underlying pathogenesis, kidney injury associated with Wilson's disease can be classified as primary or secondary. To slow down the progression of renal impairment, it is essential to undergo a renal biopsy pathological examination as early as possible to clarify the type of impairment and take the appropriate treatment.
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Affiliation(s)
- Shan Jin
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Zhengzhe Sun
- The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Xiang Fang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.
| | - Wenming Yang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
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25
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Abbassi N, Bourrahouat A, Bedoya EC, Pagan C, Qabli ME, Maidoumi S, Belmalih A, Guillaud O, Kissani N, Abkari A, Chahid I, Rafai MA, Mouane N, Kriouile Y, Aidi S, Hida M, Idrissi ML, Belahsen MF, Abkari ME, Rkain M, Ismaili Z, Sedki A, Bost M, Aboussair N, Lachaux A. Phenotype and molecular characterization of Wilson's disease in Morocco. Clin Res Hepatol Gastroenterol 2024; 48:102335. [PMID: 38588792 DOI: 10.1016/j.clinre.2024.102335] [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: 08/01/2022] [Revised: 01/29/2024] [Accepted: 03/29/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND STUDY AIMS In Morocco the prevalence of Wilson disease (WD) and the spectrum of mutations are not known. The aim of the present study was to estimate the prevalence of WD in Morocco, to evaluate the phenotype among a large cohort of WD patients, and to characterize ATP7B variants in a subgroup of WD patients. PATIENTS AND METHODS We collected data from 226 patients admitted to five university hospital centers in Morocco between 2008 and 2020. The diagnosis was based on clinical manifestations, function tests and biochemical parameters. The genotype was characterized in 18 families diagnosed at the University Hospital Center of Marrakesh, by next generation sequencing. RESULTS The mean annual prevalence in Morocco was 3.88 per 100,000 and the allele frequency was 0.15 %. Among the 226 patients included (121 males and 105 females), 196 were referred for a hepatic or neurological involvement and 30 were asymptomatic. The mean age at diagnosis was 13 ± 5.1 years (range: 5 - 42 years). Consanguinity was found in 63.3 % of patients. The mean duration of illness was 2.8 ± 1.9 years. Kayser-Fleischer rings were found in 131 (67.9 %) of 193 patients. Among the 196 symptomatic patients, 141/159 (88.7 %) had low serum ceruloplasmin (<0.2 g/L) and a high 24-hours urinary copper (>100 μg/day) was found in 173/182 (95.1 %) patients. The initial treatment was D-penicillamine in 207 patients, zinc acetate in five, zinc sulfate in five, and nine patients were not treated; 60/207 (29 %) patients have stopped treatment. A total of 72 patients died; the mortality rate was 31.9 %. Eight different ATP7B variants were identified among the 18 patients studied, of which two were novel (p.Cys1104Arg and p.Gln1277Hisfs*52), and six previously published (p.Gln289Ter, p.Cys305Ter, p.Thr1232Pro, p.Lys1020Arg, p.Glu583ArgfsTer25 and c.51+4A>T). All informative patients were homozygous for the disease-causing mutation. CONCLUSION In Morocco, a high prevalence due to consanguinity and a high mortality rate due to the difficulty of diagnosis and lack of treatment were observed in WD patients. NGS sequencing identified new ATP7B variants in WD patients from Morocco.
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Affiliation(s)
- Nadia Abbassi
- Université Cadi Ayyad, Faculté des Sciences Semlalia, LHEAC, 40000, Marrakech, Morocco; Université Claude Bernard Lyon 1, INSERM-U1060, INRA, INSA, Laboratoire CarMeN, 69500, Lyon, France.
| | - Aicha Bourrahouat
- Université Cadi Ayyad, Faculté de Médecine et de pharmacie, Laboratoire de recherche de l'enfance, la santé et le développement, 40000, Marrakech, Morocco; CHU Mohammed VI de Marrakech, Hôpital Mère-Enfant, Service de Pédiatrie, 40080, Marrakech, Morocco
| | - Eduardo Couchonnal Bedoya
- HCL, Centre de référence de la maladie de Wilson, 69500, Lyon, France; HCL, Hôpital Mère-Femme-Enfant, Unité de Gastroentrologie, Hépatologie et Nutrition, 69500, Lyon, France
| | - Cécile Pagan
- HCL, Centre de Biochimie et Biologie Moléculaire, LBMMS, 69500, Lyon, France
| | - Meriem El Qabli
- Université Cadi Ayyad, Faculté de Médecine et de pharmacie, Laboratoire de recherche de l'enfance, la santé et le développement, 40000, Marrakech, Morocco
| | - Sana Maidoumi
- Université Cadi Ayyad, Faculté des Sciences Semlalia, LHEAC, 40000, Marrakech, Morocco
| | | | - Olivier Guillaud
- HCL, Hôpital Mère-Femme-Enfant, Unité de Gastroentrologie, Hépatologie et Nutrition, 69500, Lyon, France
| | - Najib Kissani
- CHU Mohammed VI de Marrakech, Hôpital Arrazi, Service de Neurologie, 40080, Marrakech, Morocco
| | - Abdelhak Abkari
- CHU Ibn Rochd de Casablanca, Hôpital Mère-Enfant, Service de Gastro-Pédiatrie, 20360, Casablanca, Morocco
| | - Imane Chahid
- CHU Ibn Rochd de Casablanca, Hôpital Mère-Enfant, Service de Gastro-Pédiatrie, 20360, Casablanca, Morocco
| | - Mohammed Abdoh Rafai
- CHU Ibn Rochd de Casablanca, Service de Neurologie adulte, 20360, Casablanca, Morocco
| | - Nezha Mouane
- CHU Ibn Sina de Rabat, Hôpital Mère-Enfant, Service de Gastro-Pédiatrie, 10100, Rabat, Morocco
| | - Yamna Kriouile
- CHU Ibn Sina de Rabat, Hôpital Mère-Enfant, Service de Gastro-Pédiatrie, 10100, Rabat, Morocco
| | - Saadia Aidi
- CHU Ibn Sina de Rabat, Service de Neurologie adulte, 10100 Rabat, Morocco
| | - Moustpha Hida
- CHU Hassan II de Fès, Hôpital Mère-Enfant, Service de Pédiatrie, 30050 Fès, Morocco
| | | | | | - Mohammed El Abkari
- CHU Hassan II de Fès, Service de Gastroenterologie et Hépatologie adulte, 30050 Fès, Morocco
| | - Maria Rkain
- CHU Mohammed VI d'Oujda, Hôpital Mère-Enfant, Service de Pédiatrie, 60049 Oujda, Morocco
| | - Zahi Ismaili
- CHU Mohammed VI d'Oujda, Service de Gastroenterologie et Hépatologie adulte, 60049, Oujda, Morocco
| | - Azeddine Sedki
- Université Cadi Ayyad, Faculté des Sciences Semlalia, LHEAC, 40000, Marrakech, Morocco
| | - Muriel Bost
- HCL, Centre de référence de la maladie de Wilson, 69500, Lyon, France; HCL, Centre de Biochimie et Biologie Moléculaire, LBMMS, 69500, Lyon, France
| | - Nisrine Aboussair
- Université Cadi Ayyad, Faculté de Médecine et de pharmacie, Laboratoire de recherche de l'enfance, la santé et le développement, 40000, Marrakech, Morocco; CHU Mohammed VI de Marrakech, Centre de recherche clinique, Service de Génétique, 40080, Marrakech, Morocco
| | - Alain Lachaux
- HCL, Centre de référence de la maladie de Wilson, 69500, Lyon, France; HCL, Hôpital Mère-Femme-Enfant, Unité de Gastroentrologie, Hépatologie et Nutrition, 69500, Lyon, France; Université Claude Bernard Lyon 1, CIRI-INSERM-U1111, CNRS UMR5308, 69100, Lyon, France
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Kirk FT, Munk DE, Swenson ES, Quicquaro AM, Vendelbo MH, Schilsky ML, Ott P, Sandahl TD. Effects of trientine and penicillamine on intestinal copper uptake: A mechanistic 64 Cu PET/CT study in healthy humans. Hepatology 2024; 79:1065-1074. [PMID: 38088886 PMCID: PMC11019997 DOI: 10.1097/hep.0000000000000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/17/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND AIMS Trientine (TRI) and D-penicillamine (PEN) are used to treat copper overload in Wilson disease. Their main mode of action is thought to be through the facilitation of urinary copper excretion. In a recent study, TRI was noninferior to PEN despite lower 24-hour urinary copper excretion than PEN. We tested whether TRI and/or PEN also inhibit intestinal copper absorption. APPROACH AND RESULTS Sixteen healthy volunteers were examined with positron emission tomography (PET)/CT 1 and 15 hours after an oral Copper-64 ( 64 Cu) dose. They then received 7 days of either PEN or TRI (trientine tetrahydrochloride), after which the 64 Cu PET/CT scans were repeated. Venous blood samples were also collected. Pretreatment to posttreatment changes of the hepatic 64 Cu uptake reflect the effect of drugs on intestinal absorption. 64 Cu activity was normalized to dose and body weight and expressed as the mean standard uptake value. TRI (n=8) reduced hepatic 64 Cu activity 1 hour after 64 Cu dose from 6.17 (4.73) to 1.47 (2.97) standard uptake value, p <0.02, and after 15 hours from 14.24 (3.09) to 6.19 (3.43), p <0.02, indicating strong inhibition of intestinal 64 Cu absorption. PEN (n=8) slightly reduced hepatic standard uptake value at 15 hours, from 16.30 (5.63) to 12.17 (1.44), p <0.04. CONCLUSIONS In this mechanistic study, we show that TRI inhibits intestinal copper absorption, in addition to its cupriuretic effect. In contrast, PEN has modest effects on the intestinal copper absorption. This may explain why TRI and PEN are equally effective although urinary copper excretion is lower with TRI. The study questions whether the same therapeutic targets for 24-hour urinary excretion apply to both drugs.
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Affiliation(s)
- Frederik Teicher Kirk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Ditte Emilie Munk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Mikkel Holm Vendelbo
- Department of Nuclear Medicine & PET-center, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Michael L. Schilsky
- Department of Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Surgery, Section of Transplant and Immunology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Peter Ott
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Deguti MM, Araujo FC, Terrabuio DRB, Araujo TF, Barbosa ER, Porta G, Cançado ELR. Wilson disease: the diagnostic challenge and treatment outcomes in a series of 262 cases. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-9. [PMID: 38811021 DOI: 10.1055/s-0044-1786855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Wilson disease (WD) is an autosomal recessive disorder that leads to organ toxicity due to copper overload. Early diagnosis is complicated by the rarity and diversity of manifestations. OBJECTIVE To describe the diagnostic features and response to treatment in our cohort of WD patients. METHODS This was a retrospective analysis of 262 WD patients stratified by clinical presentation, complementary exams, ATP7B genotyping, and response to treatment. RESULTS Symptoms occurred at an average age of 17.4 (7-49) years, and patients were followed up for an average of 9.6 (0-45) years. Patients presented mainly with hepatic (36.3%), neurologic (34.7%), and neuropsychiatric (8.3%) forms. Other presentations were hematologic, renal, or musculoskeletal, and 16.8% of the patients were asymptomatic. Kayser-Fleischer rings occurred in 78.3% of the patients, hypoceruloplasminemia in 98.3%, and elevated cupruria/24h in 73.0%, with an increase after D-penicillamine in 54.0%. Mutations of the ATP7B gene were detected in 84.4% of alleles. Brain magnetic resonance imaging showed abnormalities in the basal ganglia in 77.7% of patients. D-penicillamine was the first choice in 93.6% of the 245 patients, and 21.1% of these patients were switched due to adverse effects. The second-line therapies were zinc and trientine. The therapeutic response did not differ significantly between the drugs (p = 0.2). Nine patients underwent liver transplantation and 82 died. CONCLUSION Wilson disease is diagnosed at a late stage, and therapeutic options are limited. In people under 40 years of age with compatible manifestations, WD could be considered earlier in the differential diagnosis. There is a need to include ATP7B genotyping and therapeutic alternatives in clinical practice.
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Affiliation(s)
- Marta Mitiko Deguti
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, São Paulo SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Gastroenterologia e Hepatologia, São Paulo SP, Brazil
| | - Fabiana Cordeiro Araujo
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, São Paulo SP, Brazil
| | | | - Thiago Ferreira Araujo
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Gastroenterologia e Hepatologia, São Paulo SP, Brazil
| | - Egberto Reis Barbosa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Gilda Porta
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, São Paulo SP, Brazil
| | - Eduardo Luiz Rachid Cançado
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, São Paulo SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Gastroenterologia e Hepatologia, São Paulo SP, Brazil
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Panda K, Lal BB, Sood V, Khanna R, Alam S. Relapse following withdrawal of D-penicillamine from combination (D-penicillamine + zinc) therapy in hepatic Wilson disease. J Pediatr Gastroenterol Nutr 2024; 78:1017-1026. [PMID: 38695602 DOI: 10.1002/jpn3.12128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/11/2023] [Accepted: 12/24/2023] [Indexed: 06/16/2024]
Abstract
OBJECTIVES Long-term D-penicillamine (D-pen) therapy in Wilson disease (WD) has numerous adverse effects which advocates its withdrawal, but with an inherent risk of relapse. This prospective observational study was conducted with the objective of evaluating incidence of relapse following withdrawal of D-pen from combination (D-pen + zinc) therapy in maintenance phase of previously symptomatic hepatic WD. METHODS Hepatic WD patients <18 years of age and on combination therapy for >2 years with 6 months of biochemical remission were included. Biochemical remission was defined as achievement of (i) aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤1.5 times upper limit of normal (ULN), (ii) serum albumin >3.5 g/dL, international normalized ratio (INR) <1.5 and (iii) 24-h urinary copper excretion (UCE) <500 mcg/day, nonceruloplasmin-bound-copper (NCC) <15 mcg/dL. After D-pen withdrawal, monthly liver function test (LFT) and INR and 3 monthly UCE and NCC were done till 1 year or relapse (elevation of AST/ALT/both >2 times ULN or total bilirubin >2 mg/dL), whichever occurred earlier. RESULTS Forty-five patients enrolled with median combination therapy duration of 36 months. Sixty percent of them had their index presentation as decompensated cirrhosis. Fourteen patients (31.8%) relapsed (cumulative incidence: 4 at 3 months, 11 at 6 months, and 14 at 12 months after D-pen discontinuation). All relapsers had index presentation as decompensated cirrhosis. On Cox-regression, ALT at D-pen withdrawal was an independent predictor of relapse (hazard ratio [HR]: 1.077, 95% confidence interval [CI]: 1.014-1.145, p = 0.017) with area under the receiver operating characteristic (AUROC) of 0.860. ALT ≥40 U/L predicted risk of relapse with 85.7% sensitivity, 70.9% specificity. CONCLUSION Incidence of relapse after withdrawal of D-pen from combination therapy is 31.8% in hepatic WD. ALT ≥40 U/L, at the time of D-pen stoppage, predicts future relapse.
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Affiliation(s)
- Kalpana Panda
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Bikrant B Lal
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vikrant Sood
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rajeev Khanna
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Seema Alam
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Teschke R, Eickhoff A. Wilson Disease: Copper-Mediated Cuproptosis, Iron-Related Ferroptosis, and Clinical Highlights, with Comprehensive and Critical Analysis Update. Int J Mol Sci 2024; 25:4753. [PMID: 38731973 PMCID: PMC11084815 DOI: 10.3390/ijms25094753] [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: 03/06/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
Wilson disease is a genetic disorder of the liver characterized by excess accumulation of copper, which is found ubiquitously on earth and normally enters the human body in small amounts via the food chain. Many interesting disease details were published on the mechanistic steps, such as the generation of reactive oxygen species (ROS) and cuproptosis causing a copper dependent cell death. In the liver of patients with Wilson disease, also, increased iron deposits were found that may lead to iron-related ferroptosis responsible for phospholipid peroxidation within membranes of subcellular organelles. All topics are covered in this review article, in addition to the diagnostic and therapeutic issues of Wilson disease. Excess Cu2+ primarily leads to the generation of reactive oxygen species (ROS), as evidenced by early experimental studies exemplified with the detection of hydroxyl radical formation using the electron spin resonance (ESR) spin-trapping method. The generation of ROS products follows the principles of the Haber-Weiss reaction and the subsequent Fenton reaction leading to copper-related cuproptosis, and is thereby closely connected with ROS. Copper accumulation in the liver is due to impaired biliary excretion of copper caused by the inheritable malfunctioning or missing ATP7B protein. As a result, disturbed cellular homeostasis of copper prevails within the liver. Released from the liver cells due to limited storage capacity, the toxic copper enters the circulation and arrives at other organs, causing local accumulation and cell injury. This explains why copper injures not only the liver, but also the brain, kidneys, eyes, heart, muscles, and bones, explaining the multifaceted clinical features of Wilson disease. Among these are depression, psychosis, dysarthria, ataxia, writing problems, dysphagia, renal tubular dysfunction, Kayser-Fleischer corneal rings, cardiomyopathy, cardiac arrhythmias, rhabdomyolysis, osteoporosis, osteomalacia, arthritis, and arthralgia. In addition, Coombs-negative hemolytic anemia is a key feature of Wilson disease with undetectable serum haptoglobin. The modified Leipzig Scoring System helps diagnose Wilson disease. Patients with Wilson disease are well-treated first-line with copper chelators like D-penicillamine that facilitate the removal of circulating copper bound to albumin and increase in urinary copper excretion. Early chelation therapy improves prognosis. Liver transplantation is an option viewed as ultima ratio in end-stage liver disease with untreatable complications or acute liver failure. Liver transplantation finally may thus be a life-saving approach and curative treatment of the disease by replacing the hepatic gene mutation. In conclusion, Wilson disease is a multifaceted genetic disease representing a molecular and clinical challenge.
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Affiliation(s)
- Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, D-63450 Hanau, Germany;
- Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt, D-60590 Frankfurt, Germany
| | - Axel Eickhoff
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, D-63450 Hanau, Germany;
- Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt, D-60590 Frankfurt, Germany
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Li Y, Wang JP, Zhu X. Construction of a nomogram for predicting compensated cirrhosis with Wilson's disease based on non-invasive indicators. BMC Med Imaging 2024; 24:90. [PMID: 38627672 PMCID: PMC11020316 DOI: 10.1186/s12880-024-01265-w] [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: 09/21/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Wilson's disease (WD) often leads to liver fibrosis and cirrhosis, and early diagnosis of WD cirrhosis is essential. Currently, there are few non-invasive prediction models for WD cirrhosis. The purpose of this study is to non-invasively predict the occurrence risk of compensated WD cirrhosis based on ultrasound imaging features and clinical characteristics. METHODS A retrospective analysis of the clinical characteristics and ultrasound examination data of 102 WD patients from November 2018 to November 2020 was conducted. According to the staging system for WD liver involvement, the patients were divided into a cirrhosis group (n = 43) and a non-cirrhosis group (n = 59). Multivariable logistic regression analysis was used to identify independent influencing factors for WD cirrhosis. A nomogram for predicting WD cirrhosis was constructed using R analysis software, and validation of the model's discrimination, calibration, and clinical applicability was completed. Due to the low incidence of WD and the small sample size, bootstrap internal sampling with 500 iterations was adopted for validation to prevent overfitting of the model. RESULTS Acoustic Radiation Force Impulse (ARFI), portal vein diameter (PVD), and serum albumin (ALB) are independent factors affecting WD cirrhosis. A nomogram for WD cirrhosis was constructed based on these factors. The area under the ROC curve (AUC) of the model's predictive ability is 0.927 (95% CI: 0.88-0.978). As demonstrated by 500 Bootstrap internal sampling validations, the model has high discrimination and calibration. Clinical decision curve analysis shows that the model has high clinical practical value. ROC curve analysis of the model's rationality indicates that the model's AUC is greater than the AUC of using ALB, ARFI, and PVD alone. CONCLUSION The nomogram model constructed based on ARFI, PVD, and ALB can serve as a non-invasive tool to effectively predict the risk of developing WD cirrhosis.
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Affiliation(s)
- Yan Li
- Department of Ultrasound, The first affiliated hospital of Anhui University of Traditional Chinese Medicine, MeiShan Road, 230031, Anhui, P.R. China.
| | - Jing Ping Wang
- Department of Ultrasound, The first affiliated hospital of Anhui University of Traditional Chinese Medicine, MeiShan Road, 230031, Anhui, P.R. China
| | - Xiaoli Zhu
- Department of Intervention, The First Affiliated Hospital of Soochow University, 899, The Pinghai Road, 215006, Jiangsu, P.R. China
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Yang Z, Li Q, Liu S, Zong Z, Yu L, Sun S. Systemic lupus erythematosus combined with Wilson's disease: a case report and literature review. BMC Pediatr 2024; 24:253. [PMID: 38622515 PMCID: PMC11017530 DOI: 10.1186/s12887-024-04713-2] [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: 11/18/2023] [Accepted: 03/18/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) and Wilson's disease (WD) are both systemic diseases that can affect multiple organs in the body. The coexistence of SLE and WD is rarely encountered in clinical practice, making it challenging to diagnose. CASE REPORT We present the case of a 9-year-old girl who initially presented with proteinuria, haematuria, pancytopenia, hypocomplementemia, and positivity for multiple autoantibodies. She was diagnosed with SLE, and her blood biochemistry showed elevated liver enzymes at the time of diagnosis. Despite effective control of her symptoms, her liver enzymes remained elevated during regular follow-up. Laboratory tests revealed decreased serum copper and ceruloplasmin levels, along with elevated urinary copper. Liver biopsy revealed chronic active hepatitis, moderate inflammation, moderate-severe fibrosis, and a trend towards local cirrhosis. Genetic sequencing revealed compound heterozygous mutations in the ATP7B gene, confirming the diagnosis of SLE with WD. The girl received treatment with a high-zinc/low-copper diet, but her liver function did not improve. Upon recommendation following multidisciplinary consultation, she underwent liver transplantation. Unfortunately, she passed away on the fourth day after the surgery. CONCLUSIONS SLE and WD are diseases that involve multiple systems and organs in the body, and SLE complicated with WD is rarely encountered in the clinic; therefore, it is easy to misdiagnose. Because penicillamine can induce lupus, it is not recommended. Liver transplantation is indicated for patients with liver disease who do not respond to medical treatment with WD. However, further research is needed to determine the optimal timing of liver transplantation for patients with SLE complicated with WD.
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Affiliation(s)
- Zhenle Yang
- Department of Pediatric Nephrology and Rheumatism and Immunology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, Jinan, 250021, P. R. China
- Department of Pediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, P. R. China
| | - Qian Li
- Department of Pediatric Nephrology and Rheumatism and Immunology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, Jinan, 250021, P. R. China
- Department of Pediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, P. R. China
| | - Suwen Liu
- Department of Pediatric Nephrology and Rheumatism and Immunology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, Jinan, 250021, P. R. China
- Department of Pediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, P. R. China
| | - Zihan Zong
- Department of Pediatric Nephrology and Rheumatism and Immunology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, Jinan, 250021, P. R. China
- Department of Pediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, P. R. China
| | - Lichun Yu
- Department of Pediatric Nephrology and Rheumatism and Immunology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, Jinan, 250021, P. R. China
- Department of Pediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, P. R. China
| | - Shuzhen Sun
- Department of Pediatric Nephrology and Rheumatism and Immunology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, Jinan, 250021, P. R. China.
- Department of Pediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, P. R. China.
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Chen H, Wang X, Zhang J, Xie D. Effect of high-frequency repetitive transcranial magnetic stimulation on cognitive impairment in WD patients based on inverse probability weighting of propensity scores. Front Neurosci 2024; 18:1375234. [PMID: 38660222 PMCID: PMC11039870 DOI: 10.3389/fnins.2024.1375234] [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: 01/23/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Background Hepatolenticular degeneration [Wilson disease (WD)] is an autosomal recessive metabolic disease characterized by copper metabolism disorder. Cognitive impairment is a key neuropsychiatric symptom of WD. At present, there is no effective treatment for WD-related cognitive impairment. Methods In this study, high-frequency repetitive transcranial magnetic stimulation (rTMS) was used to treat WD-related cognitive impairment, and inverse probability weighting of propensity scores was used to correct for confounding factors. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Auditory Verbal Learning Test (AVLT), Boston Naming Test (BNT), Clock Drawing Test (CDT) and Trail Making Test (TMT) were used to evaluate overall cognition and specific cognitive domains. Results The MMSE, MoCA and CDT scores after treatment were significantly different from those before treatment (MMSE: before adjustment: OR = 1.404, 95% CI: 1.271-1.537; after adjustment: OR = 1.381, 95% CI: 1.265-1.497, p < 0.001; MoCA: before adjustment: OR = 1.306, 95% CI: 1.122-1.490; after adjustment: OR = 1.286, 95% CI: 1.104; AVLT: OR = 1.161, 95% CI: 1.074-1.248; after adjustment: OR = 1.145, 95% CI: 1.068-1.222, p < 0.05; CDT: OR = 1.524, 95% CI: 1.303-1.745; after adjustment: OR = 1.518, 95% CI: 1.294-1.742, p < 0.001). The BNT and TMT scores after adjustment were not significantly different from those before adjustment (BNT: before adjustment: OR = 1.048, 95% CI: 0.877-1.219; after adjustment: OR = 1.026, 95% CI: 0.863-1.189, p > 0.05; TMT: before adjustment: OR = 0.816, 95% CI: 1.122-1.490; after adjustment: OR = 0.791, 95% CI: 0.406-1.176, p > 0.05). Conclusion High-frequency rTMS can effectively improve cognitive impairment, especially memory and visuospatial ability, in WD patients. The incidence of side effects is low, and the safety is good.
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Affiliation(s)
- Hong Chen
- The First Clinical Mdical College of Anhui University of Chinese Medicine, Hefei, China
| | - Xie Wang
- The First Clinical Mdical College of Anhui University of Chinese Medicine, Hefei, China
| | - Juan Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Daojun Xie
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
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Kirk FT, Munk DE, Swenson ES, Quicquaro AM, Vendelbo MH, Larsen A, Schilsky ML, Ott P, Sandahl TD. Effects of tetrathiomolybdate on copper metabolism in healthy volunteers and in patients with Wilson disease. J Hepatol 2024; 80:586-595. [PMID: 38081365 DOI: 10.1016/j.jhep.2023.11.023] [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: 09/06/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND & AIMS In Wilson disease (WD), copper accumulates in the liver and brain causing disease. Bis-choline tetrathiomolybdate (TTM) is a potent copper chelator that may be associated with a lower risk of inducing paradoxical neurological worsening than conventional therapy for neurologic WD. To better understand the mode of action of TTM, we investigated its effects on copper absorption and biliary excretion. METHODS In a double-blind randomized setting, hepatic 64Cu activity was examined after orally administered 64Cu by PET/CT in 16 healthy volunteers before and after seven days of TTM treatment (15 mg/d) or placebo. Oral 64Cu was administered one hour after the final TTM dose. Changes in hepatic 64Cu activity reflected changes in intestinal 64Cu uptake. Additionally, in four patients with WD, the distribution of 64Cu in venous blood, liver, gallbladder, kidney, and brain was followed after i.v. 64Cu dosing for up to 68 hours before and after seven days of TTM (15 mg/day), using PET/MRI. Increased gallbladder 64Cu activity was taken as evidence of increased biliary 64Cu excretion. RESULTS In healthy volunteers, TTM reduced intestinal 64Cu uptake by 82% 15 hours after the oral 64Cu dose. In patients with WD, gallbladder 64Cu activity was negligible before and after TTM, while TTM effectively retained 64Cu in the blood, significantly reduced hepatic 64Cu activity at all time-points and significantly reduced cerebral 64Cu activity two hours after the intravenous 64Cu dose. CONCLUSIONS While we did not show an increase in biliary excretion of 64Cu following TTM administration, we demonstrated that TTM effectively inhibited most intestinal 64Cu uptake and retained 64Cu in the blood stream, limiting the exposure of organs like the liver and brain to 64Cu. IMPACT AND IMPLICATIONS Bis-choline tetrathiomolybdate (TTM) is an investigational copper chelator being developed for the treatment of Wilson disease. In animal models of Wilson disease, TTM has been shown to facilitate biliary copper excretion. In the present human study, TTM surprisingly did not facilitate biliary copper excretion but instead reduced intestinal copper uptake to a clinically significant degree. Our study builds on our understanding of human copper metabolism and the mechanism of action of TTM.
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Affiliation(s)
- Frederik Teicher Kirk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
| | - Ditte Emilie Munk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Mikkel Holm Vendelbo
- Department of Nuclear Medicine & PET-center, Aarhus University Hospital, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Agnete Larsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Michael L Schilsky
- Department of Medicine, Section of Digestive Diseases, and Department of Surgery, Section of Transplant and Immunology, Yale School of Medicine, New Haven, CT, USA
| | - Peter Ott
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Kitahata S, Michitaka K, Kinebuchi M, Matsuura A, Hiraoka A, Ohama H, Yanagihara E, Saneto H, Izumoto H, Kawamura T, Kuroda T, Tada F, Miyata H, Ninomiya T, Hiasa Y. Renal Cell Carcinoma and Hepatocellular Carcinoma in a Patient with Wilson's Disease. Intern Med 2024; 63:963-968. [PMID: 37612087 PMCID: PMC11045387 DOI: 10.2169/internalmedicine.2056-23] [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: 04/03/2023] [Accepted: 07/06/2023] [Indexed: 08/25/2023] Open
Abstract
No reports of renal cancer in patients with Wilson's disease (WD) exist. We herein report a 37-year-old Japanese man diagnosed with WD who had been treated with d-penicillamine 9 years prior. Hepatocellular carcinoma had been diagnosed at 36 years old and treated with radiofrequency ablation therapy. One year later, renal cancer and recurrent hepatocellular carcinoma had developed. The hepatocellular carcinoma was treated after renal cancer surgical resection of a clear-cell-type renal cell carcinoma, with iron, rather than copper, deposited on the renal cancer cells. This patient harbored a novel mutation, p. Leu1395Terfs in ATP7B.
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Affiliation(s)
- Shogo Kitahata
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan
| | - Kojiro Michitaka
- Department of Internal Medicine, Saiseikai Imabari Dai2 Hospital, Japan
| | - Miyuki Kinebuchi
- First Department of Pathology, Sapporo Medical University, Japan
| | | | - Atsushi Hiraoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan
| | - Hideko Ohama
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan
| | - Emi Yanagihara
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan
| | - Hironobu Saneto
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan
| | - Hirofumi Izumoto
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan
| | - Tomoe Kawamura
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan
| | - Taira Kuroda
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan
| | - Fujimasa Tada
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan
| | - Hideki Miyata
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan
| | | | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
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Wang C, Wang R, Zhao L, Wang S, Liu Y, Zhao J, Dong Y, Liu L, Wei P, Wu ZY, Yi T. Constructing "smart" chelators by using an activatable prochelator strategy for the treatment of Wilson's disease. Redox Biol 2024; 70:103076. [PMID: 38340635 PMCID: PMC10869257 DOI: 10.1016/j.redox.2024.103076] [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: 01/08/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024] Open
Abstract
Wilson's disease (WD) is a genetic disorder that primarily leads to the pathological accumulation of copper (Cu) in the liver, causing an abnormal increase in reactive oxygen species (ROS). The prevailing clinical therapy for WD involves lifelong use of Cu chelation drugs to facilitate Cu excretion in patients. However, most available drugs exert severely side-effects due to their non-specific excretion of Cu, unsuitable for long-term use. In this study, we construct a prochelator that enables precise and controlled delivery of Cu chelator drugs to the liver in WD model, circumventing toxic side effects on other organs and normal tissues. This innovative prochelator rapidly releases the chelator and the fluorescent molecule methylene blue (MB) upon activation by ROS highly expressed in the liver of WD. The released chelator coordinates with Cu, efficiently aiding in Cu removal from the body and effectively inhibiting the pathological progression of WD.
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Affiliation(s)
- Chengcheng Wang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry and Chemical Engineering, Donghua University, Shanghai, 201620, China
| | - Roumin Wang
- Department of Neurology and Department of Medical Genetics in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, 310000, China
| | - Lingzhou Zhao
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Shasha Wang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry and Chemical Engineering, Donghua University, Shanghai, 201620, China
| | - Yan Liu
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry and Chemical Engineering, Donghua University, Shanghai, 201620, China
| | - Jinhua Zhao
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yi Dong
- Department of Neurology and Department of Medical Genetics in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, 310000, China
| | - Lingyan Liu
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry and Chemical Engineering, Donghua University, Shanghai, 201620, China
| | - Peng Wei
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry and Chemical Engineering, Donghua University, Shanghai, 201620, China.
| | - Zhi-Ying Wu
- Department of Neurology and Department of Medical Genetics in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, 310000, China.
| | - Tao Yi
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry and Chemical Engineering, Donghua University, Shanghai, 201620, China.
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Joshi D, Nayagam J, Clay L, Yerlett J, Claridge L, Day J, Ferguson J, Mckie P, Vara R, Pargeter H, Lockyer R, Jones R, Heneghan M, Samyn M. UK guideline on the transition and management of childhood liver diseases in adulthood. Aliment Pharmacol Ther 2024; 59:812-842. [PMID: 38385884 DOI: 10.1111/apt.17904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/15/2023] [Accepted: 02/03/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Improved outcomes of liver disease in childhood and young adulthood have resulted in an increasing number of young adults (YA) entering adult liver services. The adult hepatologist therefore requires a working knowledge in diseases that arise almost exclusively in children and their complications in adulthood. AIMS To provide adult hepatologists with succinct guidelines on aspects of transitional care in YA relevant to key disease aetiologies encountered in clinical practice. METHODS A systematic literature search was undertaken using the Pubmed, Medline, Web of Knowledge and Cochrane database from 1980 to 2023. MeSH search terms relating to liver diseases ('cholestatic liver diseases', 'biliary atresia', 'metabolic', 'paediatric liver diseases', 'autoimmune liver diseases'), transition to adult care ('transition services', 'young adult services') and adolescent care were used. The quality of evidence and the grading of recommendations were appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS These guidelines deal with the transition of YA and address key aetiologies for the adult hepatologist under the following headings: (1) Models and provision of care; (2) screening and management of mental health disorders; (3) aetiologies; (4) timing and role of liver transplantation; and (5) sexual health and fertility. CONCLUSIONS These are the first nationally developed guidelines on the transition and management of childhood liver diseases in adulthood. They provide a framework upon which to base clinical care, which we envisage will lead to improved outcomes for YA with chronic liver disease.
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Affiliation(s)
- Deepak Joshi
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Jeremy Nayagam
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Lisa Clay
- Paediatric Liver, GI and Nutrition service, King's College Hospital NHS Foundation Trust, London, UK
| | - Jenny Yerlett
- Paediatric Liver, GI and Nutrition service, King's College Hospital NHS Foundation Trust, London, UK
| | - Lee Claridge
- Leeds Liver Unit, St James's University Hospital, Leeds, UK
| | - Jemma Day
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Ferguson
- National Institute for Health Research, Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Paul Mckie
- Department of Social Work, King's College Hospital NHS Foundation Trust, London, UK
| | - Roshni Vara
- Paediatric Liver, GI and Nutrition service, King's College Hospital NHS Foundation Trust, London, UK
- Evelina London Children's Hospital, London, UK
| | | | | | - Rebecca Jones
- Leeds Liver Unit, St James's University Hospital, Leeds, UK
| | - Michael Heneghan
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Marianne Samyn
- Paediatric Liver, GI and Nutrition service, King's College Hospital NHS Foundation Trust, London, UK
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Jang ES, Choi HY, Ki M, Kim BH, Kim KA, Jeong SH. Prevalence, Incidence, and Treatment Pattern of Wilson's Disease Using National Health Insurance Data From 2010-2020, Korea. J Korean Med Sci 2024; 39:e115. [PMID: 38565173 PMCID: PMC10985507 DOI: 10.3346/jkms.2024.39.e115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Wilson's disease (WD) is an autosomal recessive disorder in which copper (Cu) accumulates in organs, particularly in the liver and central nervous system. This study aimed to investigate the prevalence, incidence, and treatment patterns of WD patients in Korea. METHODS National Health Insurance System (NHIS) claims data from 2010 to 2020 were analyzed. patients with WD as a primary or additional diagnosis at least once were identified using the International Classification of Diseases (ICD)-10 disease code E83.0 and a record for a registration program for rare intractable diseases in Korea. RESULTS The average age- and sex-adjusted prevalence and incidence of WD between 2010 and 2020 were 3.06/100,000 and 0.11/100,000, respectively. The mean age of the patients with newly diagnosed WD was 21.0 ± 15.9 years. Among the 622 WD incident cases during the study period, 19.3% of the patients had liver cirrhosis and 9.2% had received liver transplantation. Psychological and neurological diseases were present in 40.7% and 48.1% of the patients, respectively. Regarding the diagnosis of WD, liver biopsy was performed in only 51.6% of new cases. D-penicillamine, trientine, or zinc were prescribed in 81.5% of the incident cases, and the treatment uptake rates decreased with increasing age. CONCLUSION The prevalence of WD in Korea is 3.06/100,000 and approximately 1,800 patients use medical services annually. A significant proportion of patients are diagnosed at the cirrhotic stage and not treated with Cu-chelating therapeutics, suggesting the need for early diagnosis and adequate treatment to improve prognosis.
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Affiliation(s)
- Eun Sun Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hwa Young Choi
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Moran Ki
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Bo Hyun Kim
- Center for Liver and Pancreatobiliary Cancer, Division of Gastroenterology, National Cancer Center, Goyang, Korea
| | - Kyung-Ah Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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38
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Patil L, Mehta G, Aggarwal A. Elderly-onset severe parkinsonism in Wilson disease: Expert commentary. Parkinsonism Relat Disord 2024:106945. [PMID: 38565478 DOI: 10.1016/j.parkreldis.2024.106945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Laxmi Patil
- Wilson Disease Clinic and Movement Disorders Clinic, Center for Neurosciences, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, India.
| | - Gaurav Mehta
- Wilson Disease Clinic, Center for Hepatology and Liver Transplant, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, India.
| | - Annu Aggarwal
- Wilson Disease Clinic and Movement Disorders Clinic, Center for Neurosciences, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, India.
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39
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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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40
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Berger MM, Shenkin A, Dizdar OS, Amrein K, Augsburger M, Biesalski HK, Bischoff SC, Casaer MP, Gundogan K, Lepp HL, de Man AME, Muscogiuri G, Pietka M, Pironi L, Rezzi S, Schweinlin A, Cuerda C. ESPEN practical short micronutrient guideline. Clin Nutr 2024; 43:825-857. [PMID: 38350290 DOI: 10.1016/j.clnu.2024.01.030] [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: 01/10/2024] [Accepted: 01/27/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Trace elements and vitamins, named together micronutrients (MNs), are essential for human metabolism. The importance of MNs in common pathologies is recognized by recent research, with deficiencies significantly impacting the outcome. OBJECTIVE This short version of the guideline aims to provide practical recommendations for clinical practice. METHODS An extensive search of the literature was conducted in the databases Medline, PubMed, Cochrane, Google Scholar, and CINAHL for the initial guideline. The search focused on physiological data, historical evidence (for papers published before PubMed release in 1996), and observational and/or randomized trials. For each MN, the main functions, optimal analytical methods, impact of inflammation, potential toxicity, and provision during enteral or parenteral nutrition were addressed. The SOP wording was applied for strength of recommendations. RESULTS The limited number of interventional trials prevented meta-analysis and led to a low level of evidence for most recommendations. The recommendations underwent a consensus process, which resulted in a percentage of agreement (%): strong consensus required of >90 % of votes. Altogether the guideline proposes 3 general recommendations and specific recommendations for the 26 MNs. Monitoring and management strategies are proposed. CONCLUSION This short version of the MN guideline should facilitate handling of the MNs in at-risk diseases, whilst offering practical advice on MN provision and monitoring during nutritional support.
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Affiliation(s)
- Mette M Berger
- Faculty of Biology & Medicine, Lausanne University, Lausanne, Switzerland.
| | - Alan Shenkin
- Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - Oguzhan Sıtkı Dizdar
- Department of Internal Medicine and Clinical Nutrition Unit, University of Health Sciences Kayseri City Training and Research Hospital, Kayseri, Turkey.
| | - Karin Amrein
- Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Diabetology, Austria.
| | - Marc Augsburger
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne University Hospital and University of Lausanne, Geneva University Hospital and University of Geneva, Lausanne-Geneva, Switzerland.
| | | | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Michael P Casaer
- KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, Leuven, Belgium.
| | - Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey.
| | | | - Angélique M E de Man
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Cardiovascular Science (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università di Napoli (Federico II), Naples, Italy; United Nations Educational, Scientific and Cultural Organization (UNESCO) Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy.
| | - Magdalena Pietka
- Pharmacy Department, Stanley Dudrick's Memorial Hospital, Skawina, Poland.
| | - Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy.
| | - Serge Rezzi
- Swiss Nutrition and Health Foundation, Epalinges, Switzerland.
| | - Anna Schweinlin
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Albostani A, Warda H, Alhashemi F, Rajabieh M, Abdulrazzak M, Kanjo M. Wilson's disease causing acute-onset of optic neuropathy in a child: a case report and literature review. Ann Med Surg (Lond) 2024; 86:1753-1757. [PMID: 38463061 PMCID: PMC10923332 DOI: 10.1097/ms9.0000000000001770] [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: 12/29/2023] [Accepted: 01/19/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance Wilson disease (WD) is a rare genetic disorder with a wide range of clinical manifestations, including hepatic, neurologic, and psychiatric symptoms. To date, there have been five cases (including our case) representing optic neuropathy caused by WD. Case presentation A 15-year-old female presented to the emergency department with neurological symptoms. The patient exhibited confusion but maintained stable vital signs, and physical examinations were all normal. Abdominal ultrasound and axial brain computed tomography (CT) scan were both normal. The patient's neurological condition and laboratory test results suggested diagnoses of WD. After 2 days, the patient experienced sudden bilateral blindness. The patient's condition deteriorated rapidly, and was subsequently referred to the ICU. Clinical discussion The incidence of the disease varies by ethnicity, with a higher prevalence in Eastern Asian populations. Diagnosis can be challenging due to the diverse presentation of symptoms, but it is important to consider WD as a differential diagnosis in patients presenting with acute hepatitis and/or neurologic abnormalities. Conclusion Healthcare professionals should be educated about the diverse clinical manifestations of WD to help in early recognition and diagnosis of the disease.
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Affiliation(s)
| | - Hamza Warda
- Faculty of Medicine, Al-Baath University, Homs, Syria
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42
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Tornabene D, Bini P, Gastaldi M, Vegezzi E, Asteggiano C, Marchioni E, Diamanti L. Neurological complications due to copper deficiency in the context of Wilson disease treatment: a case report with long-term follow-up and review of the literature. Neurol Sci 2024; 45:987-996. [PMID: 37851293 PMCID: PMC10858109 DOI: 10.1007/s10072-023-07126-8] [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: 07/07/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023]
Abstract
The objective is to investigate the presentation, complications, management, and outcomes of copper deficiency-induced neurological pathologies due to Wilson disease (WD) overtreatment. We examined the case of a WD patient who developed a low thoracic dorsal myelopathy due to chronic hypocupremia from excessive zinc therapy. A comprehensive literature review was conducted to identify similar cases. Ten additional cases of neurological pathology resulting from copper deficiency in the context of WD over-treatment were identified, all occurring during therapy with zinc salts. Myelopathy and peripheral neuropathy were the most common complications, while two additional groups reported leukoencephalopathy. Early cytopenia was often associated with copper deficiency-related neurological pathology appearing early in the context of copper deficiency. WD patients undergoing treatment, especially with zinc salts, should be closely monitored to prevent over-treatment and the consequent copper deficiency. Regular complete blood counts could provide early detection of copper deficiency, avoiding irreversible neurological damage. Swift recognition of new neurological signs not consistent with WD and timely discontinuation of the decoppering therapy are critical for improving outcomes. The optimal management, including the potential benefit of copper supplementation in patients with WD and subsequent therapy adjustments, remains unclear and necessitates further investigation. Despite the general poor functional neurological outcomes, there were some exceptions that warrant further exploration.
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Affiliation(s)
- Danilo Tornabene
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
- IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Paola Bini
- IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Matteo Gastaldi
- IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Elisa Vegezzi
- IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Carlo Asteggiano
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | | | - Luca Diamanti
- IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
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Ban XX, Wan H, Wan XX, Tan YT, Hu XM, Ban HX, Chen XY, Huang K, Zhang Q, Xiong K. Copper Metabolism and Cuproptosis: Molecular Mechanisms and Therapeutic Perspectives in Neurodegenerative Diseases. Curr Med Sci 2024; 44:28-50. [PMID: 38336987 DOI: 10.1007/s11596-024-2832-z] [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: 11/24/2023] [Accepted: 12/17/2023] [Indexed: 02/12/2024]
Abstract
Copper is an essential trace element, and plays a vital role in numerous physiological processes within the human body. During normal metabolism, the human body maintains copper homeostasis. Copper deficiency or excess can adversely affect cellular function. Therefore, copper homeostasis is stringently regulated. Recent studies suggest that copper can trigger a specific form of cell death, namely, cuproptosis, which is triggered by excessive levels of intracellular copper. Cuproptosis induces the aggregation of mitochondrial lipoylated proteins, and the loss of iron-sulfur cluster proteins. In neurodegenerative diseases, the pathogenesis and progression of neurological disorders are linked to copper homeostasis. This review summarizes the advances in copper homeostasis and cuproptosis in the nervous system and neurodegenerative diseases. This offers research perspectives that provide new insights into the targeted treatment of neurodegenerative diseases based on cuproptosis.
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Affiliation(s)
- Xiao-Xia Ban
- Department of Human Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, 430013, China
| | - Hao Wan
- Department of Human Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, 430013, China
| | - Xin-Xing Wan
- Department of Endocrinology, Third Xiangya Hospital, Central South University, Changsha, 430013, China
| | - Ya-Ting Tan
- Department of Human Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, 430013, China
| | - Xi-Min Hu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 430013, China
| | - Hong-Xia Ban
- Affiliated Hospital, Inner Mongolia Medical University, Hohhot, 010050, China
| | - Xin-Yu Chen
- Department of Human Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, 430013, China
| | - Kun Huang
- Department of Human Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, 430013, China
| | - Qi Zhang
- Department of Human Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, 430013, China.
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, 571199, China.
| | - Kun Xiong
- Department of Human Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, 430013, China.
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, 571199, China.
- Hunan Key Laboratory of Ophthalmology, Changsha, 430013, China.
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Sawant R, Chaudhari P, Hamdulay KF, Kumar S, Acharya S. Beyond the Norm: Unusual Coexistence of Wilson's Disease and Hypoparathyroidism. Cureus 2024; 16:e54516. [PMID: 38516426 PMCID: PMC10955449 DOI: 10.7759/cureus.54516] [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: 01/18/2024] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
Wilson's disease (WD) encompasses diverse clinical symptoms involving the liver, nervous system, and kidneys. The fundamental cause of this condition is the build-up of copper in organs, mainly the hepatic and brain parenchyma. Here, we are reporting the hospital presentation of a male patient in his 20s who had been experiencing severe irritability, abdominal pain, distension, and yellowish discoloration of the skin for the previous 75 days. Upon examination of blood pressure, a refractory carpopedal spasm was found in him. In addition to Kayser-Fleischer (KF) rings in his cornea, he exhibited elevated 24-hour urine copper and serum ceruloplasmin (CP). He was diagnosed as a case of WD with a rare association of hypoparathyroidism.
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Affiliation(s)
- Rucha Sawant
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DMIHER), Wardha, IND
| | - Pranav Chaudhari
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DMIHER), Wardha, IND
| | - Khadija F Hamdulay
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DMIHER), Wardha, IND
| | - Sunil Kumar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DMIHER), Wardha, IND
| | - Sourya Acharya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DMIHER), Wardha, IND
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Deng W, Zhang J, Jia Z, Pan Z, Wang Z, Xu H, Zhong L, Yu Y, Zhao R, Li X. Myocardial involvement characteristics by cardiac MR imaging in neurological and non-neurological Wilson disease patients. Insights Imaging 2024; 15:24. [PMID: 38270718 PMCID: PMC10810766 DOI: 10.1186/s13244-023-01583-7] [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: 08/02/2023] [Accepted: 11/29/2023] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVES To explore the characteristics of myocardial involvement in Wilson Disease (WD) patients by cardiac magnetic resonance (CMR). METHODS We prospectively included WD patients and age- and sex-matched healthy population. We applied CMR to analyze cardiac function, strain, T1 maps, T2 maps, extracellular volume fraction (ECV) maps, and LGE images. Subgroup analyzes were performed for patients with WD with predominantly neurologic manifestations (WD-neuro +) or only hepatic manifestations (WD-neuro -). RESULTS Forty-one WD patients (age 27.9 ± 8.0 years) and 40 healthy controls (age 25.4 ± 2.9 years) were included in this study. Compared to controls, the T1, T2, and ECV values were significantly increased in the WD group (T1 1085.1 ± 39.1 vs. 1046.5 ± 33.1 ms, T2 54.2 ± 3.3 ms vs. 51.5 ± 2.6 ms, ECV 31.8 ± 3.6% vs. 24.3 ± 3.7%) (all p < 0.001). LGE analysis revealed that LGE in WD patients was predominantly localized to the right ventricular insertion point and interventricular septum. Furthermore, the WD-neuro + group showed more severe myocardial damage compared to WD-neuro - group. The Unified Wilson Disease Rating Scale score was significantly correlated with ECV (Pearson's r = 0.64, p < 0.001). CONCLUSIONS CMR could detect early myocardial involvement in WD patients without overt cardiac function dysfunction. Furthermore, characteristics of myocardial involvement were different between WD-neuro + and WD-neuro - , and myocardial involvement might be more severe in WD-neuro + patients. CRITICAL RELEVANCE STATEMENT Cardiac magnetic resonance enables early detection of myocardial involvement in Wilson disease patients, contributing to the understanding of distinct myocardial characteristics in different subgroups and potentially aiding in the assessment of disease severity. KEY POINTS • CMR detects WD myocardial involvement with increased T1, T2, ECV. • WD-neuro + patients show more severe myocardial damage and correlation with ECV. • Differences of myocardial characteristics exist between WD-neuro + and WD-neuro - patients.
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Affiliation(s)
- Wei Deng
- Department of Radiology, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China
| | - Jie Zhang
- Department of Neurology, Institute of Neurology, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Zhuoran Jia
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China
| | - Zixiang Pan
- Department of Radiology, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China
| | - Zhen Wang
- Department of Radiology, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China
| | - Huimin Xu
- Department of Radiology, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China
| | - Liang Zhong
- Duke NUS Medical School, National Heart Centre Singapore, National University of Singapore, Singapore, Singapore
| | - Yongqiang Yu
- Department of Radiology, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China.
| | - Ren Zhao
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China.
| | - Xiaohu Li
- Department of Radiology, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China.
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46
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Tang S, Liang C, Yu H, Hou W, Hu Z, Chen X, Duan Z, Zheng S. The potential serum sphingolipid biomarkers for distinguishing Wilson disease. Clin Chim Acta 2024; 553:117740. [PMID: 38145643 DOI: 10.1016/j.cca.2023.117740] [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: 11/19/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND The diagnosis of Wilson's disease (WD) remains a challenging endeavor in clinical practice. Serum sphingolipids play a significant role in the development of liver disease. In this study, we examined the serum sphingolipid profile in patients with WD and explored the potential diagnostic utility of serum sphingolipid metabolites. These metabolites may aid in distinguishing WD patients from healthy controls and identifying those with a risk of cirrhosis. METHODS This study consecutively enrolled 26 WD patients and 88 healthy controls. We utilized high-performance liquid chromatography-tandem mass spectrometry to analyze a panel of 88 serum sphingolipid metabolites. The data were analyzed by multivariate statistical methods. RESULTS Among the 88 sphingolipids metabolites analyzed, 17 sphingolipids were observed significant differences between WD and HC groups (all P < 0.05). Notably, five sphingolipids, namely S1P (d18:1), Cer (d18:2/21:0), SM41:2, sph(d18:1), and Cer (d18:2/22:0), each with an AUC exceeding 0.9, emerged as potential biomarkers for WD. Additionally, in the comparison between WD patients with and without cirrhosis, 24 sphingolipid metabolites exhibited significant differences (all P < 0.05). We identified Cer(d18:1/20:0), Cer(d18:2/22:0), Cer(d18:2/24:0), Cer(d18:2/20:0), and Cer(d18:2/18:0), each with an AUC exceeding 0.9, as potential serological markers for WD patients with cirrhosis. CONCLUSION For enhanced clinical applicability, we propose considering Cer (d18:2/22:0) as a predictive marker applicable to both WD patients and their susceptibility to cirrhosis. This particular ceramide has exhibited strong diagnostic and predictive performance. These findings have the potential to facilitate non-invasive WD diagnosis.
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Affiliation(s)
- Shan Tang
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Chen Liang
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Haitian Yu
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wei Hou
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhongjie Hu
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xinyue Chen
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhongping Duan
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Sujun Zheng
- Beijing Youan Hospital, Capital Medical University, Beijing, China.
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47
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Delle Cave V, Di Dato F, Iorio R. Wilson's Disease with Acute Hepatic Onset: How to Diagnose and Treat It. CHILDREN (BASEL, SWITZERLAND) 2024; 11:68. [PMID: 38255382 PMCID: PMC10814100 DOI: 10.3390/children11010068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/19/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
Wilson's disease (WD) with acute onset poses a diagnostic challenge because it is clinically indistinguishable from other acute liver diseases. In addition, serum ceruloplasmin and urinary copper excretion, the first-line diagnostic tools for WD, can show false positive results in the case of acute liver failure, and the diagnostic role of genetic analysis is limited by the time required to perform it. In the case of fulminant onset, there is a clear indication of liver transplantation. "New Wilson Index" is frequently used to discriminate between patients who need liver transplantation versus those who can be successfully managed by medical treatment, but its reliability remains controversial. Timely referral of patients with acute liver failure due to WD may be a key factor in improving patient survival. Although liver transplant very often represents the only chance for such patients, maximum effort should be made to promote survival with a native liver. The management of these aspects of WD is still a matter of debate and will be the subject of this review.
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Affiliation(s)
| | | | - Raffaele Iorio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, 80131 Naples, Italy; (V.D.C.); (F.D.D.)
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48
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Fatemi R, Movassagh-koolankuh S, Mosadeghi N. Simultaneous Occurrence of Wilson's Disease, Autoimmune Hepatitis, and Hereditary Hemochromatosis: A Diagnostic Challenge. Middle East J Dig Dis 2024; 16:64-68. [PMID: 39050104 PMCID: PMC11264828 DOI: 10.34172/mejdd.2024.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/22/2023] [Indexed: 07/27/2024] Open
Abstract
This is not surprising to detect iron overload in chronic liver diseases and end-stage liver diseases since Kupffer cells scavenge necrotic hepatocytes during the course of liver damage, leading to an increased serum iron level and transferrin saturation compatible with iron overload even in the absence of a genetic mutation suggestive of hereditary hemochromatosis. Therewith, a relative association has been found between some sorts of chronic liver diseases like non-alcoholic steatohepatitis and hepatitis C with human homeostatic iron regulator protein (HFE: High Fe2+) gene mutations. Moreover, impairment of ceruloplasmin ferroxidase activity in the course of Wilson's disease (WD), leading to the accumulation of ferrous ions just like what is expected in aceruloplasminemia, is another known reason for iron overload accompanied by chronic liver disease. Of chronic liver diseases, autoimmune hepatitis (AIH), and cholestatic liver diseases are less related to iron overload. Accordingly, the coexistence of WD, AIH, and hereditary hemochromatosis when there exist clinical features, laboratory tests, genetic confirmation, and histological evaluations indicative of the three mentioned diseases is exceedingly rare. Here, we present a 55-year-old man referred with progressive generalized icterus accompanied by loss of appetite and significant weight loss. The presented case was not an appropriate candidate for liver biopsy due to recent coronary angioplasty and the urgent need for dual antiplatelet therapy. However, medical follow-ups were highly suggestive of concomitant WD, hereditary hemochromatosis, and AIH. The attempts failed for the treatment of hereditary hemochromatosis and WD with chelating agents until the completion of the course of treatment with immunosuppressants targeting components of the AIH-related immune system.
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Affiliation(s)
- Reza Fatemi
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahryar Movassagh-koolankuh
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Mosadeghi
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Asano T, Yoshikawa S, Matsumoto K, Kashima H, Koito Y, Miura T, Takahashi Y, Tsuboi R, Ishii T, Otake H, Uehara T, Sekine M, Matsumoto S, Asabe S, Miyatani H, Mashima H. Late-onset Wilson Disease in a Patient Followed-up for Nonalcoholic Fatty Liver Disease. Intern Med 2024; 63:71-75. [PMID: 37121747 PMCID: PMC10824639 DOI: 10.2169/internalmedicine.1789-23] [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: 02/12/2023] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
A 73-year-old woman was referred to our hospital for persistent liver dysfunction. When the patient was 45 years old, her youngest sister had been diagnosed with Wilson disease (WD). The patient therefore underwent several family screening tests, all of which were unremarkable. She had an annual medical checkup and was diagnosed with liver dysfunction and fatty liver at 68 years old. A liver biopsy and genetic testing were performed, and she was diagnosed with WD; chelation therapy was then initiated. In patients with hepatic disorders and a family history of WD, multiple medical examinations should be conducted, as the development of WD is possible regardless of age.
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Affiliation(s)
- Takeharu Asano
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Shuhei Yoshikawa
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Keita Matsumoto
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Hitomi Kashima
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Yudai Koito
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Takaya Miura
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Yuko Takahashi
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Rumiko Tsuboi
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Takehiro Ishii
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Haruka Otake
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Takeshi Uehara
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Masanari Sekine
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Satohiro Matsumoto
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Shinichi Asabe
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Hiroyuki Miyatani
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Hirosato Mashima
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
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50
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Dooley JS. The history of Wilson disease. Clin Liver Dis (Hoboken) 2024; 23:e0238. [PMID: 38974753 PMCID: PMC11227348 DOI: 10.1097/cld.0000000000000238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/07/2024] [Indexed: 07/09/2024] Open
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