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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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Gromadzka G, Grycan M, Przybyłkowski AM. Monitoring of Copper in Wilson Disease. Diagnostics (Basel) 2023; 13:diagnostics13111830. [PMID: 37296680 DOI: 10.3390/diagnostics13111830] [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: 04/06/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Introduction: Wilson's disease (WND) is an autosomal recessive disorder of copper (Cu) metabolism. Many tools are available to diagnose and monitor the clinical course of WND. Laboratory tests to determine disorders of Cu metabolism are of significant diagnostic importance. (2) Methods: A systematic review of the literature in the PubMed, Science Direct, and Wiley Online Library databases was conducted. (Results): For many years, Cu metabolism in WND was assessed with serum ceruloplasmin (CP) concentration, radioactive Cu test, total serum Cu concentration, urinary copper excretion, and Cu content in the liver. The results of these studies are not always unambiguous and easy to interpret. New methods have been developed to calculate non-CP Cu (NCC) directly. New parameters, such as relative Cu exchange (REC), reflecting the ratio of CuEXC to total serum Cu, as well as relative Cu exchange (REC), reflecting the ratio of CuEXC to total serum Cu, have been shown to be an accurate tool for the diagnosis of WND. Recently, a direct and fast LC-ICP-MS method for the study of CuEXC was presented. A new method to assess Cu metabolism during treatment with ALXN1840 (bis-choline tetrathiomolybdate [TTM]) has been developed. The assay enables the bioanalysis of CP and different types of Cu, including CP-Cu, direct NCC (dNCC), and labile bound copper (LBC) in human plasma. Conclusions: A few diagnostic and monitoring tools are available for patients with WND. While many patients are diagnosed and adequately assessed with currently available methods, diagnosis and monitoring is a real challenge in a group of patients who are stuck with borderline results, ambiguous genetic findings, and unclear clinical phenotypes. Technological progress and the characterization of new diagnostic parameters, including those related to Cu metabolism, may provide confidence in the more accurate diagnosis of WND in the future.
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Affiliation(s)
- Grażyna Gromadzka
- Medical Faculty, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Wóycickiego Street 1/3, 01-938 Warsaw, Poland
| | - Marta Grycan
- Students Research Club, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
| | - Adam M Przybyłkowski
- Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
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Lucena-Valera A, Ruz-Zafra P, Ampuero J. [Wilson's disease: overview]. Med Clin (Barc) 2023; 160:261-267. [PMID: 36697289 DOI: 10.1016/j.medcli.2022.12.016] [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: 10/16/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/25/2023]
Abstract
Wilson's disease (WD) is an uncommon hereditary disorder caused by a deficiency in the ATP7B transporter. The protein codified by this gene facilitates the incorporation of the copper into ceruloplasmin. Therefore, WD accumulates copper primary in the liver and secondary in other organs, such as the central nervous system. It represents a wide spectrum of disease, ranging from being asymptomatic in some patients to promote an acute liver failure in others. The diagnosis requires a combination of clinical signs and symptoms, as well as some diagnostic tests such as the measurement of serum ceruloplasmin, the urinary excretion of copper, the liver biopsy or the genetic testing. The treatment must be maintained lifelong and includes some drugs such as chelating agents (penicillamine and trientine) and inhibitors of the copper absorption (zinc salts). Lastly, the liver transplant should be an option for patients with end-stage liver disease.
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Affiliation(s)
- Ana Lucena-Valera
- Departamento de Enfermedades Digestivas, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Pilar Ruz-Zafra
- Departamento de Enfermedades Digestivas, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Javier Ampuero
- Departamento de Enfermedades Digestivas, Hospital Universitario Virgen del Rocío, Sevilla, España; Instituto de Biomedicina de Sevilla (IBiS), Sevilla, España; Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España.
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Guillaud O, Woimant F, Couchonnal E, Dumortier J, Laurencin C, Lion-François L, Belmalih A, Bost M, Morvan E, Oussedik-Djebrani N, Lachaux A, Poujois A. Maintenance therapy simplification using a single daily dose: A preliminary real-life feasibility study in patients with Wilson disease. Clin Res Hepatol Gastroenterol 2022; 46:101978. [PMID: 35714901 DOI: 10.1016/j.clinre.2022.101978] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Single daily dose (SDD) is a good way to improve adherence by simplifying treatment. Efficacy data concerning patients with Wilson disease (WD) taking an SDD are lacking. AIM To report the effectiveness of the use of SDD for the treatment of WD. METHODS This retrospective study included WD patients followed in the French National Network who received an SDD in maintenance phase. The treatment failure was defined as a composite criterion with the occurrence of at least one of the following criterion: death, transplantation, increase of transaminases >2xULN, hepatic decompensation, neurological aggravation, severe side effects related to treatment, and/or discontinuation of treatment. RESULTS A total of 26 patients received an SDD (D-penicillamine=13, trientine=8, zinc=5) after a median interval of 152 months after diagnosis. After one year, two patients had treatment failure: transaminitis in one, continuation of neurological deterioration in the other related to a poor compliance. After a median duration of 41 months on SDD, 3 other patients had treatment failure (transaminitis=2, treatment discontinuation=1). There was no death, no liver transplantation, no hepatic decompensation, and no severe side effects related to treatment during the follow-up. Moreover, transaminases and serum exchangeable copper were not significantly different 1 year post-switch and at last follow-up compared to baseline. CONCLUSIONS Maintenance therapy simplification through the use of an SDD could be considered in some WD patients. In this pilot study, SDD was effective in 21/26 patients (81%) without any concern regarding safety.
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Affiliation(s)
- Olivier Guillaud
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence Pour la Maladie de Wilson, Bron, Hôpital Edouard Herriot, Lyon Cedex 03 69437, France; Ramsay Générale de Santé, Clinique de la Sauvegarde, Lyon, France.
| | - France Woimant
- APHP, Hôpital Lariboisière, Centre National de Référence Pour la Maladie de Wilson, Paris, France
| | - Eduardo Couchonnal
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence Pour la Maladie de Wilson, Bron, Hôpital Edouard Herriot, Lyon Cedex 03 69437, France
| | - Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence Pour la Maladie de Wilson, Bron, Hôpital Edouard Herriot, Lyon Cedex 03 69437, France; Université Claude Bernard Lyon1, Lyon, France
| | - Chloe Laurencin
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence Pour la Maladie de Wilson, Bron, Hôpital Edouard Herriot, Lyon Cedex 03 69437, France
| | - Laurence Lion-François
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence Pour la Maladie de Wilson, Bron, Hôpital Edouard Herriot, Lyon Cedex 03 69437, France
| | - Abdelouahed Belmalih
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence Pour la Maladie de Wilson, Bron, Hôpital Edouard Herriot, Lyon Cedex 03 69437, France
| | - Muriel Bost
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence Pour la Maladie de Wilson, Bron, Hôpital Edouard Herriot, Lyon Cedex 03 69437, France
| | - Erwan Morvan
- Hôpital Fondation Adolphe de Rothschild, Centre National de Référence Pour la Maladie de Wilson, Paris, France
| | - Nouzha Oussedik-Djebrani
- APHP, Hôpital Lariboisière, Centre National de Référence Pour la Maladie de Wilson, Paris, France
| | - Alain Lachaux
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence Pour la Maladie de Wilson, Bron, Hôpital Edouard Herriot, Lyon Cedex 03 69437, France; Université Claude Bernard Lyon1, Lyon, France
| | - Aurélia Poujois
- Hôpital Fondation Adolphe de Rothschild, Centre National de Référence Pour la Maladie de Wilson, Paris, France
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Ott P, Ala A, Askari FK, Czlonkowska A, Hilgers R, Poujois A, Roberts EA, Sandahl TD, Weiss KH, Ferenci P, Schilsky ML. Designing Clinical Trials in Wilson's Disease. Hepatology 2021; 74:3460-3471. [PMID: 34320232 PMCID: PMC9291486 DOI: 10.1002/hep.32074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/29/2021] [Accepted: 07/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Wilson's disease (WD) is an autosomal-recessive disorder caused by ATP7B gene mutations leading to pathological accumulation of copper in the liver and brain. Adoption of initial treatments for WD was based on empirical observations. These therapies are effective, but there are still unmet needs for which treatment modalities are being developed. An increase of therapeutical trials is anticipated. APPROACH AND RESULTS The first Wilson Disease Aarhus Symposium (May 2019) included a workshop on randomized clinical trial design. The authors of the article were organizers or presented during this workshop, and this article presents their consensus on the design of clinical trials for WD, addressing trial population, treatment comparators, inclusion and exclusion criteria, and treatment endpoints. To achieve adequate recruitment of patients with this rare disorder, the study groups should include all clinical phenotypes and treatment-experienced as well as treatment-naïve patients. CONCLUSIONS The primary study endpoint should be clinical or a composite endpoint until appropriate surrogate endpoints are validated. Standardization of clinical trials will permit pooling of data and allow for better treatment comparisons, as well as reduce the future numbers of patients needed per trial.
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Affiliation(s)
- Peter Ott
- Department of Hepatology and GastroenterologyAarhus UniversityAarhusDenmark
| | - Aftab Ala
- Department of Gastroenterology and HepatologyThe Royal Surrey NHS Foundation TrustGuildfordUnited Kingdom,Department of Clinical and Experimental MedicineUniversity of SurreyGuildfordUnited Kingdom,Institute of Liver StudiesKing’s College HospitalLondonUnited Kingdom
| | | | - Anna Czlonkowska
- Second Department of NeurologyInstitute of Psychiatry and NeurologyWarsawPoland
| | | | - Aurélia Poujois
- Neurology Department and National Reference Centre for Wilson’s DiseaseRothschild Foundation HospitalParisFrance
| | - Eve A. Roberts
- Departments of Paediatrics, Medicine, and Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
| | | | - Karl Heinz Weiss
- Salem Medical CenterHeidelbergGermany,Department of Internal MedicineIV at University Hospital HeidelbergHeidelbergGermany
| | - Peter Ferenci
- Department of Gastroenterology and HepatologyMedical University of ViennaViennaAustria
| | - Michael L. Schilsky
- Departments of Medicine and SurgeryYale University Medical CenterNew HavenCTUSA
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Seetharaman J, Sarma MS. Chelation therapy in liver diseases of childhood: Current status and response. World J Hepatol 2021; 13:1552-1567. [PMID: 34904029 PMCID: PMC8637676 DOI: 10.4254/wjh.v13.i11.1552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/07/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
Chelation is the mainstay of therapy in certain pediatric liver diseases. Copper and iron related disorders require chelation. Wilson’s disease (WD), one of the common causes of cirrhosis in children is treated primarily with copper chelating agents like D-penicillamine and trientine. D-Penicillamine though widely used due its high efficacy in hepatic WD is fraught with frequent adverse effects resulting discontinuation. Trientine, an alternative drug has comparable efficacy in hepatic WD but has lower frequency of adverse effects. The role of ammonium tetra-thiomolybdate is presently experimental in hepatic WD. Indian childhood cirrhosis is related to excessive copper ingestion, rarely seen in present era. D-Penicillamine is effective in the early part of this disease with reversal of clinical status. Iron chelators are commonly used in secondary hemochromatosis of liver in hemolytic anemias. There are strict chelation protocols during bone marrow transplant. The role of iron chelation in neonatal hemochromatosis is presently not in vogue due to its poor efficacy and availability of other modalities of therapy. Hereditary hemochromatosis is rare in children and the use of iron chelators in this condition is limited.
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Affiliation(s)
- Jayendra Seetharaman
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
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7
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Lucena-Valera A, Perez-Palacios D, Muñoz-Hernandez R, Romero-Gómez M, Ampuero J. Wilson's disease: Revisiting an old friend. World J Hepatol 2021; 13:634-649. [PMID: 34239699 PMCID: PMC8239488 DOI: 10.4254/wjh.v13.i6.634] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/21/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023] Open
Abstract
Wilson's disease (WD) is a rare condition caused by copper accumulation primarily in the liver and secondly in other organs, such as the central nervous system. It is a hereditary autosomal recessive disease caused by a deficiency in the ATP7B transporter. This protein facilitates the incorporation of copper into ceruloplasmin. More than 800 mutations associated with WD have been described. The onset of the disease frequently includes manifestations related to the liver (as chronic liver disease or acute liver failure) and neurological symptoms, although it can sometimes be asymptomatic. Despite it being more frequent in young people, WD has been described in all life stages. Due to its fatal prognosis, WD should be suspected in all patients with unexplained biochemical liver abnormalities or neurological or psychiatric symptoms. The diagnosis is established with a combination of clinical signs and tests, including the measurement of ceruloplasmin, urinary copper excretion, copper quantification in liver biopsy, or genetic assessment. The pharmacological therapies include chelating drugs, such as D-penicillamine or trientine, and zinc salts, which are able to change the natural history of the disease, increasing the survival of these patients. In some cases of end-stage liver disease or acute liver failure, liver transplantation must be an option to increase survival. In this narrative review, we offer an overview of WD, focusing on the importance of clinical suspicion, the correct diagnosis, and treatment.
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Affiliation(s)
- Ana Lucena-Valera
- Department of Gastroenterology, Hospital Universitario Virgen del Rocio, Sevilla 41013, Spain
| | - Domingo Perez-Palacios
- Department of Gastroenterology, Hospital Universitario Virgen del Rocio, Sevilla 41013, Spain
| | - Rocio Muñoz-Hernandez
- SeLiver Group, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España
| | - Manuel Romero-Gómez
- Department of Unit of Digestive Diseases, Hospital Universitario Virgen del Rocio, Sevilla 41014, Spain
| | - Javier Ampuero
- Department of Unit of Digestive Diseases, Hospital Universitario Virgen del Rocio, Sevilla 41014, Spain.
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Daymond R, Curtis SL, Mishra V, Roberts NB. Assay in serum of exchangeable copper and total copper using inductively coupled plasma mass spectrometry (ICP-MS): development, optimisation and evaluation of a routine procedure. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 80:630-639. [PMID: 32955383 DOI: 10.1080/00365513.2020.1821397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The assay in serum of non-caeruloplasmin copper, as exchangeable copper after complexation with EDTA (ExCu) and total copper has been evaluated and compared in patients with varying c-reactive protein(CRP). Measurement of ExCu and total copper, range 0.2-47.2 µmol/L, was developed using ICP-MS. The chelating agents EDTA and TEPA were compared over 0.0-10 g/L after incubation with serum for 60 mins followed by ultrafiltration with Amicon 10 kDa filter. The assay for ExCu was optimised with EDTA 3 g/L (8.1 mmol/L) maintained at pH 7.0-8.0 before ultrafiltration. TEPA was not as selective in chelation of copper. Patients n = 82 were studied in relation to changes in inflammatory marker CRP and a group of patients n = 37 with normal CRP. The ExCu assay gave excellent recoveries (94-102 % but poor recovery for free uncomplexed copper), good repeatability, limit of quantitation 0.19 µmol/l with a provisional reference range 0.48 to 1.63 µmol/L (n = 37 patients). The range for relative exchangeable copper (exchangeable copper divided by total serum copper) was 2.49 to 9.96 %. ExCu was elevated in conditions with increased CRP greater than 100 mg/L suggesting an effect of inflammation on the free copper fraction. A reliable and reproducible assay for ExCu and total copper has been developed. The upregulated inflammatory state increases the ExCu suggesting excess free copper.
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Affiliation(s)
- Richard Daymond
- Department of Clinical Biochemistry, Liverpool Clinical Laboratories, The Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK
| | - Sarah L Curtis
- Department of Clinical Biochemistry, Liverpool Clinical Laboratories, The Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK
| | - Vinita Mishra
- Department of Clinical Biochemistry, Liverpool Clinical Laboratories, The Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK
| | - Norman B Roberts
- Department of Clinical Biochemistry, Liverpool Clinical Laboratories, The Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK
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Woimant F, Djebrani-Oussedik N, Poujois A. New tools for Wilson's disease diagnosis: exchangeable copper fraction. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S70. [PMID: 31179307 DOI: 10.21037/atm.2019.03.02] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Wilson's disease (WD) biochemical markers continue to evolve. Classical tests [serum copper, serum ceruloplasmin (Cp), urinary copper] have their own limits, and they are often insufficient to diagnose or exclude WD. So, calculated estimation of copper that is not bound to Cp has been proposed, but it is flawed. Therefore, we focused our research on a direct measurement of serum copper labile fraction. Exchangeable copper (CuEXC) offers a correct view of the free copper overload. It provides information on the spread and severity of WD. Relative exchangeable copper (REC) (percentage of exchangeable to total serum copper) that appreciates the toxic fraction of copper in blood is an excellent biomarker for WD diagnosis. These two tests are reliable and non-invasive. They give rapid answers for an appropriate diagnosis and make possible to start the treatment quickly without waiting for the result of the genetic tests. As early diagnosis and treatment are the keystones of successful management of patients with WD, different teams have already applied these tests in a routine framework to a large number of patients.
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Affiliation(s)
- France Woimant
- National Reference Centre for Wilson's Disease, AP-HP, Lariboisière University Hospital, Paris, France.,Neurology Department, AP-HP, Lariboisière University Hospital, Paris, France
| | - Nouzha Djebrani-Oussedik
- National Reference Centre for Wilson's Disease, AP-HP, Lariboisière University Hospital, Paris, France.,Toxicology Laboratory, AP-HP, Lariboisière University Hospital, Paris, France
| | - Aurélia Poujois
- National Reference Centre for Wilson's Disease, AP-HP, Lariboisière University Hospital, Paris, France.,Neurology Department, AP-HP, Lariboisière University Hospital, Paris, France
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10
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Answer to challenging issues in the management of Wilson's disease. Clin Res Hepatol Gastroenterol 2019; 43:e7-e8. [PMID: 30166252 DOI: 10.1016/j.clinre.2018.07.006] [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: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 02/04/2023]
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Heissat S, Harel A, Um K, Brunet AS, Hervieu V, Guillaud O, Dumortier J, Lachaux A, Mintz E, Bost M. Evaluation of the accuracy of exchangeable copper and relative exchangeable copper (REC) in a mouse model of Wilson's disease. J Trace Elem Med Biol 2018; 50:652-657. [PMID: 30269758 DOI: 10.1016/j.jtemb.2018.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/09/2018] [Accepted: 06/15/2018] [Indexed: 12/12/2022]
Abstract
Wilson's disease (WD) is caused by mutations in the ATP7B gene responsible for a toxic copper overload mainly in the liver and the central nervous system. Phenotypic heterogeneity may challenge the diagnostic confirmation. Exchangeable copper (CuEXC) has recently been proposed as a new marker of WD, and its ratio to the total serum copper (Cus), Relative Exchangeable Copper (REC = CuEXC/Cus), as a diagnostic marker. This study aimed to investigate whether this could be confirmed in Atp7b-/- mice, an engineered WD animal model. Atp7b-/- (n = 137) and wild type (WT; n = 101) mice were investigated under the same conditions at 6-8, 20, 39, or 50 weeks of age. Twenty-four Atp7b-/- mice received D-penicillamine treatment from 39 to 50 weeks of age. Serum and liver [histology and intrahepatic copper (IHCu)] data were evaluated. In the WT group, all serum and liver data were normal. Atp7b-/- livers developed a chronic injury from isolated moderate inflammation (6-8 weeks: 16/33 = 48%) to inflammatory fibrosis with cirrhosis (50 weeks: 25/25 = 100% and 16/25 = 64% respectively). Cus and CuEXC increased until week 39, whereas IHCu and REC were stable with increasing age and much higher than in WT mice (mean ± SD: 669 ± 269 vs. 13 ± 3 μg/g dry liver and 39 ± 12 vs. 11 ± 3%, respectively). A threshold value of 20% for REC provided a diagnostic sensitivity and specificity of 100%, regardless of sex, age, or the use of D-penicillamine. Eleven weeks of 100 mg/kg D-penicillamine reduced liver fibrosis (p = 0.001), IHCu (p = 0.026) and CuEXC (p = 0.175). In conclusion, this study confirms REC as a WD diagnostic marker in a mouse model of chronic liver disease caused by copper overload. Further studies are needed to assess the usefulness of CuEXC to monitor the evolution of WD, particularly during treatment.
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Affiliation(s)
- Sophie Heissat
- Hépatologie gastroentérologie et nutrition pédiatrique, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, F-69500 Bron, France; Centre de référence national pour la maladie de Wilson, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, F-69500 Bron, France.
| | - Amélie Harel
- Univ Grenoble Alpes, BIG-LCBM, F-38000 Grenoble, France; CNRS, BIG-LCBM, F-38000 Grenoble, France; CEA, BIG-LCBM-BIOMET, F-38000 Grenoble, France
| | - Khémary Um
- Univ Grenoble Alpes, BIG-LCBM, F-38000 Grenoble, France; CNRS, BIG-LCBM, F-38000 Grenoble, France; CEA, BIG-LCBM-BIOMET, F-38000 Grenoble, France
| | - Anne-Sophie Brunet
- Hépatologie gastroentérologie et nutrition pédiatrique, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, F-69500 Bron, France; Centre de référence national pour la maladie de Wilson, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, F-69500 Bron, France
| | - Valérie Hervieu
- Service central d'anatomie et cytologie pathologiques, Hospices Civils de Lyon, Hôpital Edouard Herriot, F-69003 Lyon (moved to Centre de Biologie et Pathologie Est, F-69677 Bron since september 2017), France
| | - Olivier Guillaud
- Centre de référence national pour la maladie de Wilson, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, F-69500 Bron, France
| | - Jerome Dumortier
- Centre de référence national pour la maladie de Wilson, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, F-69500 Bron, France
| | - Alain Lachaux
- Hépatologie gastroentérologie et nutrition pédiatrique, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, F-69500 Bron, France; Centre de référence national pour la maladie de Wilson, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, F-69500 Bron, France
| | - Elisabeth Mintz
- Univ Grenoble Alpes, BIG-LCBM, F-38000 Grenoble, France; CNRS, BIG-LCBM, F-38000 Grenoble, France; CEA, BIG-LCBM-BIOMET, F-38000 Grenoble, France
| | - Muriel Bost
- Centre de référence national pour la maladie de Wilson, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, F-69500 Bron, France; Laboratoire d'Analyse de Trace, Biochimie et biologie moléculaire, Hospices Civils de Lyon, Hôpital Edouard Herriot, F-69003 Lyon (moved to Centre de Biologie et d'AnatomoPathologie Sud, F-69495 Pierre-Bénite since september 2016), France
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Reed E, Lutsenko S, Bandmann O. Animal models of Wilson disease. J Neurochem 2018; 146:356-373. [PMID: 29473169 PMCID: PMC6107386 DOI: 10.1111/jnc.14323] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 02/04/2018] [Accepted: 02/12/2018] [Indexed: 02/06/2023]
Abstract
Wilson disease (WD) is an autosomal recessive disorder of copper metabolism manifesting with hepatic, neurological and psychiatric symptoms. The limitations of the currently available therapy for WD (particularly in the management of neuropsychiatric disease), together with our limited understanding of key aspects of this illness (e.g. neurological vs. hepatic presentation) justify the ongoing need to study WD in suitable animal models. Four animal models of WD have been established: the Long-Evans Cinnamon rat, the toxic-milk mouse, the Atp7b knockout mouse and the Labrador retriever. The existing models of WD all show good similarity to human hepatic WD and have been helpful in developing an improved understanding of the human disease. As mammals, the mouse, rat and canine models also benefit from high homology to the human genome. However, important differences exist between these mammalian models and human disease, particularly the absence of a convincing neurological phenotype. This review will first provide an overview of our current knowledge of the orthologous genes encoding ATP7B and the closely related ATP7A protein in C. elegans, Drosophila and zebrafish (Danio rerio) and then summarise key characteristics of rodent and larger mammalian models of ATP7B-deficiency.
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Affiliation(s)
- Emily Reed
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Baltimore, USA
| | | | - Oliver Bandmann
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Baltimore, USA
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13
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Lauwens S, Costas-Rodríguez M, Delanghe J, Van Vlierberghe H, Vanhaecke F. Quantification and isotopic analysis of bulk and of exchangeable and ultrafiltrable serum copper in healthy and alcoholic cirrhosis subjects. Talanta 2018; 189:332-338. [PMID: 30086927 DOI: 10.1016/j.talanta.2018.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/01/2018] [Accepted: 07/05/2018] [Indexed: 02/07/2023]
Abstract
Information on the Cu speciation in blood serum can be valuable for a better understanding of the metabolism of this essential transition metal, but Cu speciation analysis and, to an even larger extent, compound-specific high-precision Cu isotopic analysis are challenging. In this work, quantification and isotopic analysis of Cu were carried out in bulk serum and in both its exchangeable + ultrafiltrable (EXCH + UF) Cu fraction and its non-exchangeable + non-ultrafiltrable (NEXCH + NUF) fraction using quadrupole and multi-collector ICP-mass spectrometry, respectively. The EXCH + UF serum Cu represents the labile Cu pool, i.e. Cu loosely bound to proteins, such as albumin, alpha-2 macroglobulin and other low molecular weight compounds, while the NEXCH + NUF serum Cu contains the Cu firmly bound to ceruloplasmin (Cp). The method was evaluated using human, goat and fetal bovine serum and applied to serum samples from assumed healthy subjects and from patients with alcoholic liver cirrhosis (AC). The healthy subjects showed an isotopic composition of EXCH + UF serum Cu heavier (by on average + 0.4‰) than that of their total serum Cu. In general, patients with AC showed higher EXCH + UF serum Cu concentrations and significantly lower δ65CuEXCH+UF and δ65Cuserum values than did healthy subjects. Within the AC population, δ65CuEXCH+UF values were comparable to or lower than the corresponding δ65Cuserum values, potentially reflecting the extent of labile Cu deregulation. As to be expected, the NEXCH + NUF serum Cu isotopic composition was similar to that of the total serum Cu, as most of the serum Cu is firmly bound to Cp.
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Affiliation(s)
- Sara Lauwens
- Ghent University, Department of Chemistry, Atomic and Mass Spectrometry (A&MS) Research Unit, Campus Sterre, Krijgslaan 281-S12, 9000 Ghent, Belgium
| | - Marta Costas-Rodríguez
- Ghent University, Department of Chemistry, Atomic and Mass Spectrometry (A&MS) Research Unit, Campus Sterre, Krijgslaan 281-S12, 9000 Ghent, Belgium
| | - Joris Delanghe
- Ghent University, Department of Clinical Chemistry, Microbiology and Immunology, Campus UZ Gent, De Pintelaan 185-P8, 9000 Ghent, Belgium
| | - Hans Van Vlierberghe
- Ghent University Hospital, Department of Gastroenterology and Hepatology, Campus UZ Gent, De Pintelaan 185-1K12IE, 9000 Ghent, Belgium
| | - Frank Vanhaecke
- Ghent University, Department of Chemistry, Atomic and Mass Spectrometry (A&MS) Research Unit, Campus Sterre, Krijgslaan 281-S12, 9000 Ghent, Belgium.
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14
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Guillaud O, Brunet AS, Mallet I, Dumortier J, Pelosse M, Heissat S, Rivet C, Lachaux A, Bost M. Relative exchangeable copper: A valuable tool for the diagnosis of Wilson disease. Liver Int 2018; 38:350-357. [PMID: 28719006 DOI: 10.1111/liv.13520] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 07/13/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Measuring of the relative exchangeable copper seems to be a promising tool for the diagnosis of Wilson disease. The aim of our study is to determine the performance of REC for the diagnosis of Wilson disease in a population of patients with chronic liver diseases. METHODS Measuring of exchangeable serum copper levels and relative exchangeable copper was performed in a group of Wilson disease patients at diagnosis or at clinical deterioration because of non-compliance (group 1, n=9), a group of stable WD patients (group 2, n=40), and two groups of patients (adult and paediatric) followed for non-Wilsonian liver diseases (group 3, n=103 and group 4, n=49 respectively). RESULTS Exchangeable serum copper (N: 0.6-1.1 μmol/L) was significantly higher in group 1 (mean 2.2±0.7 μmol/L) compared to the other three groups: group 2=0.9±0.4 μmol/L, group 3=1.2±0.4 μmol/L, group 4=1.1±0.3 μmol/L (P<0.05). Relative exchangeable copper was significantly higher in Wilson disease patients group 1 and 2 (mean 52.6% and 43.8%) compared to patients suffering from other liver diseases (mean 7.1% and 5.9%) (P<0.05). CONCLUSIONS Our study confirms that the determination of relative exchangeable copper is a highly valuable tool for the diagnosis of Wilson disease.
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Affiliation(s)
- Olivier Guillaud
- French National Reference Center for Wilson Disease, Femme Mère Enfant Hospital, Hospices civils de Lyon, Bron, France.,Department of Hepatogastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Anne-Sophie Brunet
- French National Reference Center for Wilson Disease, Femme Mère Enfant Hospital, Hospices civils de Lyon, Bron, France.,Department of Pediatric Hepatogastroenterology and Nutrition, Femme mère enfant Hospital, Hospices Civils de Lyon, Bron, France
| | - Isabelle Mallet
- French National Reference Center for Wilson Disease, Femme Mère Enfant Hospital, Hospices civils de Lyon, Bron, France.,Department of Biochemistry and Molecular biology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Dumortier
- French National Reference Center for Wilson Disease, Femme Mère Enfant Hospital, Hospices civils de Lyon, Bron, France.,Department of Hepatogastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Martine Pelosse
- French National Reference Center for Wilson Disease, Femme Mère Enfant Hospital, Hospices civils de Lyon, Bron, France.,Department of Pediatric Hepatogastroenterology and Nutrition, Femme mère enfant Hospital, Hospices Civils de Lyon, Bron, France
| | - Sophie Heissat
- French National Reference Center for Wilson Disease, Femme Mère Enfant Hospital, Hospices civils de Lyon, Bron, France.,Department of Pediatric Hepatogastroenterology and Nutrition, Femme mère enfant Hospital, Hospices Civils de Lyon, Bron, France
| | - Christine Rivet
- French National Reference Center for Wilson Disease, Femme Mère Enfant Hospital, Hospices civils de Lyon, Bron, France.,Department of Pediatric Hepatogastroenterology and Nutrition, Femme mère enfant Hospital, Hospices Civils de Lyon, Bron, France
| | - Alain Lachaux
- French National Reference Center for Wilson Disease, Femme Mère Enfant Hospital, Hospices civils de Lyon, Bron, France.,Department of Pediatric Hepatogastroenterology and Nutrition, Femme mère enfant Hospital, Hospices Civils de Lyon, Bron, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Muriel Bost
- French National Reference Center for Wilson Disease, Femme Mère Enfant Hospital, Hospices civils de Lyon, Bron, France.,Department of Biochemistry and Molecular biology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.,Department of Molecular Genetics and Genetic Diseases of Metabolism, Department of Biology and Pathology, Hospices Civils de Lyon, Bron, France
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15
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Abstract
Clinical presentation of Wilson disease can vary widely; therefore diagnosis is not always straightforward. Wilson disease is not just a disease of children and young adults, but may present at any age. The key features of Wilson disease are liver disease and cirrhosis, neuropsychiatric disturbances, Kayser-Fleischer rings, and acute episodes of hemolysis, often in association with acute liver failure. Diagnosis is particularly difficult in children and in adults presenting with active liver disease. None of the available laboratory tests is perfect and may not be specific for Wilson disease. A detailed neurologic examination is required for all cases. Neuroimaging and electrophysiologic methods are helpful. To overcome the diagnostic challenge, several clinical signs (Kayser-Fleischer rings, neurologic symptoms) and laboratory features (copper in serum, urine, liver; serum ceruloplasmin; genetic testing) are scored 0 (absent) to 2 (present) and the Leipzig score is calculated. If the score is ≥4, the diagnosis of Wilson disease is very likely. For asymptomatic siblings of index patients, mutation analysis is the most reliable approach.
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16
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Poujois A, Trocello JM, Djebrani-Oussedik N, Poupon J, Collet C, Girardot-Tinant N, Sobesky R, Habès D, Debray D, Vanlemmens C, Fluchère F, Ory-Magne F, Labreuche J, Preda C, Woimant F. Exchangeable copper: a reflection of the neurological severity in Wilson's disease. Eur J Neurol 2016; 24:154-160. [PMID: 27739240 DOI: 10.1111/ene.13171] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/29/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE The severity of Wilson's disease (WD) is linked to free copper accumulating in the liver and brain. Exchangeable copper (CuEXC) is a new technique to determine plasmatic copper and is useful in the diagnosis of WD. It is hypothesized that it may also enable a good evaluation of extra-hepatic involvement and its severity. METHODS Forty-eight newly diagnosed WD patients were prospectively evaluated using hepatic, neurological, ophthalmological and brain magnetic resonance imaging (MRI) scores. Three phenotypic presentations were distinguished: pre-symptomatic, hepatic and extra-hepatic. CuEXC was determined in addition to standard copper assays before decoppering therapy. Correlations between biological parameters and the different scores were determined and compared in the hepatic and extra-hepatic groups. RESULTS Extra-hepatic patients had significantly higher CuEXC values than those with the hepatic form (P < 0.0001). The overall ability of CuEXC to separate the two forms was satisfactory, with an area under the curve of 0.883 (95% confidence interval 0.771-0.996) and an optimal threshold for extra-hepatic diagnosis of 2.08 μmol/l (sensitivity 85.7%; specificity 94.1%). In extra-hepatic patients, CuEXC was the only biological marker to be positively correlated with the Unified Wilson Disease Rating Score (r = 0.45, P = 0.016), the Kayser-Fleischer ring score (r = 0.46, P = 0.014) and the brain MRI score (r = 0.38, P = 0.048), but it was not correlated with the hepatic score. CONCLUSIONS Exchangeable copper determination is useful when diagnosing WD as a value >2.08 μmol/l is indicative of the severity of the extra-hepatic involvement. In the case of purely hepatic presentation, atypical or mild neurological signs, it should encourage physicians to search for lesions in the brain and eyes.
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Affiliation(s)
- A Poujois
- National Reference Centre for Wilson's Disease, AP-HP, Lariboisière Hospital, Paris, France.,Neurology Department, AP-HP, Lariboisière Hospital, Paris, France
| | - J-M Trocello
- National Reference Centre for Wilson's Disease, AP-HP, Lariboisière Hospital, Paris, France.,Neurology Department, AP-HP, Lariboisière Hospital, Paris, France
| | - N Djebrani-Oussedik
- National Reference Centre for Wilson's Disease, AP-HP, Lariboisière Hospital, Paris, France.,Toxicology Laboratory, AP-HP, Lariboisière Hospital, Paris, France
| | - J Poupon
- National Reference Centre for Wilson's Disease, AP-HP, Lariboisière Hospital, Paris, France.,Toxicology Laboratory, AP-HP, Lariboisière Hospital, Paris, France
| | - C Collet
- National Reference Centre for Wilson's Disease, AP-HP, Lariboisière Hospital, Paris, France.,Molecular Biology and Biochemistry Department, AP-HP, Lariboisière Hospital, Paris, France
| | - N Girardot-Tinant
- National Reference Centre for Wilson's Disease, AP-HP, Lariboisière Hospital, Paris, France.,Neurology Department, AP-HP, Lariboisière Hospital, Paris, France
| | - R Sobesky
- National Reference Centre for Wilson's Disease, AP-HP, Lariboisière Hospital, Paris, France.,Hepatobiliary Centre, DHU Hepatinov, AP-HP, Paul Brousse Hospital, Villejuif, France
| | - D Habès
- National Reference Centre for Wilson's Disease, AP-HP, Lariboisière Hospital, Paris, France.,Hepatology and Pediatrics Department, AP-HP, Kremlin-Bicètre Hospital, Kremlin-Bicètre, France
| | - D Debray
- Hepatology and Pediatrics Department, AP-HP, Necker Hospital, Paris, France
| | - C Vanlemmens
- Hepatology and Gastroenterology Department, CHU Besancon, Besancon, France
| | - F Fluchère
- Neurology Department, CHU Marseille, Marseille, France
| | - F Ory-Magne
- Neurology Department, CHU Toulouse, Toulouse, France
| | - J Labreuche
- Biostatistics Unit, EA2694, CHRU Lille, Lille, France
| | - C Preda
- Mathematics Laboratory, UMR CNRS 8524, Lille, France
| | - F Woimant
- National Reference Centre for Wilson's Disease, AP-HP, Lariboisière Hospital, Paris, France.,Neurology Department, AP-HP, Lariboisière Hospital, Paris, France
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17
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Schmitt F, Pastore N, Abarrategui-Pontes C, Flageul M, Myara A, Laplanche S, Labrune P, Podevin G, Nguyen TH, Brunetti-Pierri N. Correction of Hyperbilirubinemia in Gunn Rats by Surgical Delivery of Low Doses of Helper-Dependent Adenoviral Vectors. Hum Gene Ther Methods 2014; 25:181-6. [DOI: 10.1089/hgtb.2013.236] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Françoise Schmitt
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS 1064, Centre Hospitalier Universitaire (CHU) Hôtel Dieu, 44093 Nantes, France
- Pediatric Hepatogastroenterology–HIFIH Laboratory, UPRES 3859, SFR 4038, 49933 Angers, France
| | - Nunzia Pastore
- Telethon Institute of Genetics and Medicine, 80131 Napoli, Italy
| | - Cecilia Abarrategui-Pontes
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS 1064, Centre Hospitalier Universitaire (CHU) Hôtel Dieu, 44093 Nantes, France
| | - Maude Flageul
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS 1064, Centre Hospitalier Universitaire (CHU) Hôtel Dieu, 44093 Nantes, France
| | - Anne Myara
- Service de Biologie, Groupe Hospitalier Saint Joseph, 75674 Paris, France
| | - Sophie Laplanche
- Service de Biologie, Groupe Hospitalier Saint Joseph, 75674 Paris, France
| | - Philippe Labrune
- Service de Pédiatrie, Hôpital Antoine Béclère, 92141 Clamart, France
| | - Guillaume Podevin
- Pediatric Hepatogastroenterology–HIFIH Laboratory, UPRES 3859, SFR 4038, 49933 Angers, France
- INSERM U948, Centre Hospitalier Universitaire (CHU) Hôtel Dieu, 44093 Nantes, France
| | - Tuan Huy Nguyen
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS 1064, Centre Hospitalier Universitaire (CHU) Hôtel Dieu, 44093 Nantes, France
| | - Nicola Brunetti-Pierri
- Telethon Institute of Genetics and Medicine, 80131 Napoli, Italy
- Department of Translational Medicine, Federico II University, 80131 Napoli, Italy
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18
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Weiss KH, Stremmel W. Clinical considerations for an effective medical therapy in Wilson's disease. Ann N Y Acad Sci 2014; 1315:81-5. [DOI: 10.1111/nyas.12437] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Karl Heinz Weiss
- Department of Gastroenterology; University Hospital Heidelberg; Heidelberg Germany
| | - Wolfgang Stremmel
- Department of Gastroenterology; University Hospital Heidelberg; Heidelberg Germany
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