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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Dang J, Chevalier K, Letavernier E, Tissandier C, Mouawad S, Debray D, Obadia M, Poujois A. Kidney involvement in Wilson's disease: a review of the literature. Clin Kidney J 2024; 17:sfae058. [PMID: 38660122 PMCID: PMC11040517 DOI: 10.1093/ckj/sfae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Indexed: 04/26/2024] Open
Abstract
Wilson's disease (WD) is a rare inherited disease due to the mutation of the ATP7B gene, resulting in impaired hepatic copper excretion and its pathological accumulation in various organs such as the liver, the nervous system, or the kidneys. Whereas liver failure and neuropsychiatric disorders are the most common features, less is known about the renal complications. We conducted a review of the literature to define the characteristics and pathophysiology of kidney involvement during WD. This review shed light on strong evidence for direct copper toxicity to renal tubular cells. Excessive tubular copper accumulation might present with various degrees of tubular dysfunction, ranging from mild hydroelectrolytic and acid-base disorders to complete Fanconi syndrome. Proximal and distal renal tubular acidosis also favors development of nephrolithiasis, nephrocalcinosis, and bone metabolism abnormalities. Indirect complications might involve renal hypoperfusion as occurs in hepatorenal or cardiorenal syndrome, but also tubular casts' formation during acute hemolysis, rhabdomyolysis, or bile cast nephropathy. Acute kidney failure is not uncommon in severe WD patients, and independently increases mortality. Finally, specific and long-term therapy by D-penicillamin, one of the most efficient drugs in WD, can cause glomerular injuries, such as membranous nephropathy, minimal-change disease, and, rarely, severe glomerulonephritis. Altogether, our study supports the need for interdisciplinary evaluation of WD patients involving nephrologists, with regular monitoring of tubular and glomerular functions, to provide adequate prevention of renal and bone involvement.
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Affiliation(s)
- Julien Dang
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France
- Centre de Compétence Maladies Rares «Syndrome Néphrotique Idiopathique», Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Kevin Chevalier
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
| | - Emmanuel Letavernier
- AP-HP, Hôpital Tenon, Service des Explorations Fonctionnelles Multidisciplinaires, Paris, France
| | - Come Tissandier
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France
- Centre de Compétence Maladies Rares «Syndrome Néphrotique Idiopathique», Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Sarah Mouawad
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France
- Centre de Compétence Maladies Rares «Syndrome Néphrotique Idiopathique», Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Dominique Debray
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
| | - Mickaël Obadia
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
| | - Aurélia Poujois
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Singh P, Subedi B, Mahato D, Karn M. Kayser-Fleischer rings: The pathognomonic for Wilson's disease. Clin Case Rep 2024; 12:e8642. [PMID: 38464582 PMCID: PMC10920319 DOI: 10.1002/ccr3.8642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024] Open
Abstract
Wilson's disease is a genetic disorder of copper metabolism that primarily manifests with hepatic and neurological features. Kayser-Fleischer rings (KF rings) are pathognomonic of Wilson's disease and helps in establishing its diagnosis.
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Affiliation(s)
- Priyanka Singh
- Department of OphthalmologyGandaki Medical College Teaching Hospital and Research CenterPokharaNepal
| | - Bachaspati Subedi
- Department of MedicineGandaki Medical College Teaching Hospital and Research CenterPokharaNepal
| | - Devraj Mahato
- Department of MedicineGandaki Medical College Teaching Hospital and Research CenterPokharaNepal
| | - Mitesh Karn
- Department of MedicineGandaki Medical College Teaching Hospital and Research CenterPokharaNepal
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7
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Jin P, Fu X, Wang Y, Ma X, Ai W, Xu Y, Li B, Ye Q, Wang G. Oculogyric Crisis in a Wilson's Disease Patient. Mov Disord Clin Pract 2024; 11:315-317. [PMID: 38468560 PMCID: PMC10928320 DOI: 10.1002/mdc3.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Ping Jin
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
| | - Xiao‐Ming Fu
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
- Institute of NeurologyAnhui University of Chinese MedicineHefeiChina
| | - Yu Wang
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
| | - Xin‐Feng Ma
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
| | - Wen‐Long Ai
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
| | - Ya‐Yun Xu
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
| | - Bo Li
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
| | - Qun‐Rong Ye
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
| | - Gong‐Qiang Wang
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
- Institute of NeurologyAnhui University of Chinese MedicineHefeiChina
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8
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Bozic M, Svetel M, Svetel M. Intraocular pressure in patients suffering from Wilson's disease. Eur J Ophthalmol 2024:11206721241229771. [PMID: 38304981 DOI: 10.1177/11206721241229771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
PURPOSE The purpose of this study was to evaluate intraocular pressure (IOP) levels in patients suffering from Wilsons disease. METHODS In observational, cross-sectional, non-interventional study, IOP was measured by applanation tonometry in 52 patients with Wilson's disease (WD), and compared to 52 healthy controls (HC). RESULTS Patients with Wilsons disease had significantly lower IOPs, compared to control group (CG) (13.20 ± 2.5 versus 14.98 ± 2.0, p < .000, t test). CONCLUSIONS We found that IOP is significantly lower in patients with WD.
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Affiliation(s)
- Marija Bozic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
- University Clinical Centre of Serbia, University Eye Hospital, Belgrade, Serbia
| | - Marina Svetel
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
- University Clinical Centre of Serbia, Neurology Clinic, Belgrade, Serbia
| | - Marko Svetel
- University Clinical Centre of Serbia, University Eye Hospital, Belgrade, Serbia
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9
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Yang Z, Su Y, Liu M, Sun L, Zhang F, Lin W. A rare concomitance of Wilson's disease and systemic lupus erythematosus in a teenage girl: a case report and literature review. Front Pediatr 2024; 11:1296426. [PMID: 38259603 PMCID: PMC10800781 DOI: 10.3389/fped.2023.1296426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024] Open
Abstract
Background Wilson's disease (WD) is an inherited disorder characterized by impaired biliary excretion of copper and excessive copper accumulation in multiple organs, primarily leading to hepatic, neurological, and psychiatric manifestations. The coexistence of WD and systemic lupus erythematosus (SLE) has rarely been reported, posing challenges in accurately diagnosing these two conditions because of overlapping clinical symptoms. Case presentation We presented the case of a 17-year-old girl initially suspected of having SLE due to positive anti-nuclear antibodies and lupus anticoagulants, decreased platelet count, hypocomplementemia, and pleural effusion. However, the patient also exhibited an unusual manifestation of decompensated liver cirrhosis, which is not typical of SLE. Further investigation revealed low serum ceruloplasmin levels, high 24-h urine copper levels, the presence of Kayser-Fleischer rings, and a compound heterozygous mutation in the ATP7B gene, confirming the diagnosis of WD. Conclusion The co-occurrence of WD and SLE poses a significant diagnostic challenge, often leading to misdiagnosis and delayed diagnosis. Therefore, in patients with well-controlled SLE presenting with unexplained liver fibrosis, neurological involvement, or psychiatric symptoms, it is crucial to consider the possibility of WD. However, further studies are required to elucidate the underlying pathophysiological mechanisms.
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Affiliation(s)
- Zigui Yang
- Department of Rheumatology and Immunology, Hebei General Hospital, Shijiazhuang, Hebei, China
- Department of Graduate School, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yashuang Su
- Department of Rheumatology and Immunology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Meilu Liu
- Department of Rheumatology and Immunology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Lijun Sun
- Department of Rheumatology and Immunology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Fengxiao Zhang
- Department of Rheumatology and Immunology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Wei Lin
- Department of Rheumatology and Immunology, Hebei General Hospital, Shijiazhuang, Hebei, China
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Pazos-Perez N, Guerrini L. Extending the range of metal ions SERS detection using hybrid plasmonic/ZIF-8 particles. Talanta 2024; 266:124941. [PMID: 37478767 DOI: 10.1016/j.talanta.2023.124941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
Nanosensors based on surface-enhanced Raman spectroscopy (SERS) have emerged as a class of promising optical tools for the ultrasensitive quantification of metal ions of environmental and biological interest. A central bottleneck in this field is the availability of suitable surface receptors able to convert the selective binding with these vibrationless analytes into measurable SERS signals. In this work, we tackle this issue by employing a hybrid substrate comprising a highly SERS-active plasmonic core and a ZIF-8 metal-organic framework (MOF) shell. The ZIF-8 shell firmly captures aromatic receptors close to the plasmonic structure regardless of their intrinsic affinity for the metallic surface and without altering their ability to coordinate metal ions. Furthermore, it imparts molecular sieving abilities enabling the direct use of the SERS sensing platform in complex media such as biological fluids. This was demonstrated by using different classes of chromogenic reagents (bathocuproine, a 2,6':2',2″-terpyridine derivative, and Arsenazo III) which were exploited for the SERS detection of both transition and alkaline earth metal ions (i.e., divalent copper, cobalt and calcium ions). Notably, we successfully applied this approach for the detection of Cu(II) in untreated urine samples for Wilson's disease diagnosis. Overall, we believe this class of multifunctional hybrid substrates will serve as a valuable material for expanding the applicability of SERS spectroscopy in real-life environmental and biomedical metal ions analysis.
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Affiliation(s)
- Nicolas Pazos-Perez
- Department of Physical and Inorganic Chemistry, Universitat Rovira I Virgili, Carrer de Marcel∙lí Domingo 1, 43007, Tarragona, Spain
| | - Luca Guerrini
- Department of Physical and Inorganic Chemistry, Universitat Rovira I Virgili, Carrer de Marcel∙lí Domingo 1, 43007, Tarragona, Spain.
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11
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Kumar VS, Dhananjaya S, Gowda S. Tuberculosis treatment spills the beans on Wilson's disease and more. Med J Armed Forces India 2023; 79:S276-S279. [PMID: 38144652 PMCID: PMC10746732 DOI: 10.1016/j.mjafi.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/29/2021] [Indexed: 11/29/2022] Open
Abstract
Drug-induced liver injury (DILI) is an unwarranted problem and has been a scourge in the treatment of tuberculosis (TB) infection in general and children in particular. Usually, when the Antituberculosis treatment (ATT) regime is temporarily interrupted and modified, DILI subsides, and the whole treatment can be completed under supervision. We report a case of ATT-induced DILI not improving despite modification in the ATT regime, which ultimately led to the revealing of a yet unreported constellation of syndromes that included Wilson Disease, 46 XX gonadal dysgenesis, and Mayer Rokitansky Kuster Hauser (MRKH) Syndrome.
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Affiliation(s)
- Vikram S. Kumar
- Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka, India
| | | | - Shivaraj Gowda
- Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka, India
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12
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Li KF, Li J, Liao YP, Zhu SH, Chhetri JK, Chen HZ, Yang WM. Elderly-onset severe parkinsonism in Wilson disease: A case report. Parkinsonism Relat Disord 2023:105924. [PMID: 37945393 DOI: 10.1016/j.parkreldis.2023.105924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/17/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Ke-Fan Li
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Jun Li
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China; Anhui Branch Center of National Clinical Research Center for Geriatric Disorders, Hefei, China.
| | - Ya-Ping Liao
- School of Life Science, Bengbu Medical College, Bengbu, China
| | - Si-Huan Zhu
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | | | - Huai-Zhen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China; Anhui Branch Center of National Clinical Research Center for Geriatric Disorders, Hefei, China
| | - Wen-Ming Yang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China; Anhui Branch Center of National Clinical Research Center for Geriatric Disorders, Hefei, China
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Allende DS, Kleiner DE. Fatty liver disease that is neither metabolic nor alcoholic. Hum Pathol 2023; 141:212-221. [PMID: 36702356 PMCID: PMC10363575 DOI: 10.1016/j.humpath.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. This article aims to summary less common etiologies of fatty liver and their key clinicopathological features.
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Affiliation(s)
| | - David E Kleiner
- National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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14
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Wooton-Kee CR. Therapeutic implications of impaired nuclear receptor function and dysregulated metabolism in Wilson's disease. Pharmacol Ther 2023; 251:108529. [PMID: 37741465 PMCID: PMC10841433 DOI: 10.1016/j.pharmthera.2023.108529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/29/2023] [Accepted: 09/08/2023] [Indexed: 09/25/2023]
Abstract
Copper is an essential trace element that is required for the activity of many enzymes and cellular processes, including energy homeostasis and neurotransmitter biosynthesis; however, excess copper accumulation results in significant cellular toxicity. The liver is the major organ for maintaining copper homeostasis. Inactivating mutations of the copper-transporting P-type ATPase, ATP7B, result in Wilson's disease, an autosomal recessive disorder that requires life-long medicinal therapy or liver transplantation. Current treatment protocols are limited to either sequestration of copper via chelation or reduction of copper absorption in the gut (zinc therapy). The goal of these strategies is to reduce free copper, redox stress, and cellular toxicity. Several lines of evidence in Wilson's disease animal models and patients have revealed altered hepatic metabolism and impaired hepatic nuclear receptor activity. Nuclear receptors are transcription factors that coordinate hepatic metabolism in normal and diseased livers, and several hepatic nuclear receptors have decreased activity in Wilson's disease and Atp7b-/- models. In this review, we summarize the basic physiology that underlies Wilson's disease pathology, Wilson's disease animal models, and the possibility of targeting nuclear receptor activity in Wilson's disease patients.
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Affiliation(s)
- Clavia Ruth Wooton-Kee
- Baylor College of Medicine, Department of Pediatrics-Nutrition, Children's Nutrition Research Center, Houston, TX, United States of America.
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15
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Berenguer M, Vergara M, Almohalla C, Hernandez A, Blanco S, Testillano M, Girona E, Casado M, García M, Catalina MV, Muñoz C, Gutierrez ML, Molina E, Romero M, Otero A, Hernáez-Alsina T, Bernal-Monterde V, Lorente S, Masnou H, Bonet L, Soto S, Gisbert C, Valer MP, Gomez J, Pacheco G, Morillas J, Gonzalez M, Dominguez N, Lazaro M, Pascual S, Castelló I, Gonzalez R. Significant heterogeneity in the diagnosis and long-term management of Wilson disease: Results from a large multicenter Spanish study. Gastroenterol Hepatol 2023; 46:577-584. [PMID: 36372257 DOI: 10.1016/j.gastrohep.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/15/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022]
Abstract
There is uncertainty regarding Wilson's disease (WD) management. OBJECTIVES To assess, in a multicenter Spanish retrospective cohort study, whether the approach to WD is homogeneous among centers. METHODS Data on WD patients followed at 32 Spanish hospitals were collected. RESULTS 153 cases, 58% men, 20.6 years at diagnosis, 69.1% hepatic presentation, were followed for 15.5 years. Discordant results in non-invasive laboratory parameters were present in 39.8%. Intrahepatic copper concentration was pathologic in 82.4%. Genetic testing was only done in 56.6% with positive results in 83.9%. A definite WD diagnosis (Leipzig score ≥4) was retrospectively confirmed in 92.5% of cases. Chelating agents were standard initial therapy (75.2%) with frequent modifications (57%), particularly to maintenance zinc. Enzyme normalization was not achieved by one third, most commonly in the setting of poor compliance, lack of genetic mutations and/or presence of cardiometabolic risk factors. Although not statistically significant, there were trends for sex differences in number of diagnosed cases, age at diagnosis and biochemical response. CONCLUSIONS Significant heterogeneity in diagnosis and management of WD patients emerges from this multicenter study that includes both small and large reference centers. The incorporation of genetic testing will likely improve diagnosis. Sex differences need to be further explored.
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Affiliation(s)
- Marina Berenguer
- Hepatology - Liver Transplantation Unit, IIS La Fe and CIBER-EHD, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Medicine, Universitat de València, Valencia, Spain.
| | - Mercedes Vergara
- Parc Tauli Sabadell Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univ Autonoma de Barcelona, Sabadell, Barcelona, Spain; Dept Medicina, Universitat Autonoma de Barcelona and CIBERhed, Insituto Carlos III, Madrid, Spain
| | - Carolina Almohalla
- Servicio de Aparato Digestivo, Unidad de Hepatología, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Alicia Hernandez
- Servicio de Aparato Digestivo, Hospital universitario de Ciudad Real, Ciudad real, Spain
| | - Sonia Blanco
- Servicio de Aparato Digestivo, Hospital Universitario Basurto, Euskadi, Spain
| | - Milagros Testillano
- Servicio de Aparato Digestivo, Unidad de Hepatología, Hospital Universitario Cruces, Bizkaia, Spain
| | - Eva Girona
- Servicio de Aparato Digestivo, Hospital de Elx, Alicante, Spain
| | - Marta Casado
- Servicio de Aparato Digestivo, Hospital Universitario Torrecárdenas, Almería, Spain
| | - Miren García
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de La Victoria, Málaga, Spain
| | - Maria-Vega Catalina
- Servicio de Aparato Digestivo, Unidad de Hepatología, Hospital General Universitario Gregorio Marañon. Madrid, Spain
| | - Carolina Muñoz
- Servicio de Aparato Digestivo, Unidad de Hepatología, Hospital 12 de Octubre, Madrid, Spain
| | - Maria Luisa Gutierrez
- Servicio de Aparato Digestivo, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Esther Molina
- Servicio de Aparato Digestivo, Unidad de Hepatología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Miriam Romero
- Servicio de Aparato Digestivo, Unidad de Hepatología, Hospital La Paz, Madrid, Spain
| | - Alejandra Otero
- Servicio de Aparato Digestivo, Hospital Universitario de A Coruña, Coruña, Spain
| | | | - Vanessa Bernal-Monterde
- Servicio de Aparato Digestivo, Hospital Miguel Servet, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Sara Lorente
- Unidad de Hepatología y Trasplante Hepático, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Helena Masnou
- Servei Aparell Digestiu, Unitat de Hepatologia, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Lucia Bonet
- Servicio Aparato Digestivo, Hospital Universitari Son Espases, Spain
| | - Susana Soto
- Servicio de Aparato Digestivo, Hospital del Tajo, Aranjuez, Spain
| | - Concha Gisbert
- Servicio de Medicina Interna, Hospital de Dénia - Marina Salud, Denia, Spain
| | - María-Paz Valer
- Servicio de Aparato Digestivo, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Judith Gomez
- Servicio de Aparato Digestivo, Hospital Universitario de Burgos, Burgos, Spain
| | - Gemma Pacheco
- Servicio de Aparato Digestivo, Hospital Universitario La Ribera, Spain
| | - Julia Morillas
- Servicio de Aparato Digestivo, Hospital Virgen de la Luz, Cuenca, Spain
| | - Martha Gonzalez
- Servicio de Aparato Digestivo, Hospital El Bierzo, Ponferrada, León, Spain
| | - Nuria Dominguez
- Servicio de Aparato Digestivo, Hospital University Infanta Cristina, Parla, Spain
| | - Maria Lazaro
- Servicio de Aparato Digestivo, Hospital General San Jorge, Huesca, Spain
| | - Sonia Pascual
- Servicio de Aparato Digestivo, Unidad Hepática, Hospital General Universitario de Alicante, Alicante, Spain; CiberEHD, Madrid, Spain
| | | | - Rocio Gonzalez
- Servicio de Aparato Digestivo, Hospital Regional Universitario de Málaga, Málaga, Spain
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Erratum: Novel mutations in ATP7B in Chinese patients with Wilson's disease and identification of kidney disorder of thinning of the glomerular basement membrane. Front Neurol 2023; 14:1290996. [PMID: 37799280 PMCID: PMC10548818 DOI: 10.3389/fneur.2023.1290996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fneur.2023.1231605.].
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Chevalier K, Obadia MA, Djebrani‐Oussedik N, Poujois A. Can Patients with Wilson's Disease Develop Copper Deficiency? Mov Disord Clin Pract 2023; 10:1306-1316. [PMID: 37772303 PMCID: PMC10525062 DOI: 10.1002/mdc3.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 09/30/2023] Open
Abstract
Background Wilson's disease (WD) is a rare genetic condition characterized by a copper overload in organs secondary to mutation in ATP7B gene. Lifelong decoppering treatments are the keystone of the treatment but must be regularly adapted to obtain a correct copper balance and could lead to copper deficiency (CD). Objectives Study the characteristics of CD in WD patients. Methods CD cases from our cohort of 338 WD patients have been investigated. CD was defined by the association of serum copper, exchangeable copper and urinary copper excretion assays less than two standard deviations from the mean with cytopenia and/or neurological damage of spinal cord origin. A systematic review of literature about cases of CD in WD patient was performed in PubMed database according to PRISMA guidelines. Results Three WD patients were diagnosed with CD in our cohort. Review of the literature found 17 other patients. Most of the patients had anemia and neutropenia associated with neurological symptoms (especially progressive posterior cord syndrome). All the patients were treated with Zinc salts and the symptoms occurred more than a decade after the initiation of treatment. The adaptation of the treatment allowed a correction of the cytopenia but only a partial improvement of the neurological symptoms. Conclusions WD patients can develop CD after many years of zinc therapy. Anemia and neutropenia are red flags that should evoke CD.
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Affiliation(s)
- Kevin Chevalier
- Department of NeurologyRothschild Foundation HospitalParisFrance
- National Reference Center for Wilson's Disease and Other Copper‐Related Rare DiseasesRothschild Foundation HospitalParisFrance
| | - Mickaël Alexandre Obadia
- Department of NeurologyRothschild Foundation HospitalParisFrance
- National Reference Center for Wilson's Disease and Other Copper‐Related Rare DiseasesRothschild Foundation HospitalParisFrance
| | - Nouzha Djebrani‐Oussedik
- National Reference Center for Wilson's Disease and Other Copper‐Related Rare DiseasesRothschild Foundation HospitalParisFrance
- Toxicology LaboratoryLariboisière Hospital, APHPParisFrance
| | - Aurélia Poujois
- Department of NeurologyRothschild Foundation HospitalParisFrance
- National Reference Center for Wilson's Disease and Other Copper‐Related Rare DiseasesRothschild Foundation HospitalParisFrance
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Xu H, Lv H, Chen X, Lian Y, Xing G, Wang Y, Hu R. Novel mutations in ATP7B in Chinese patients with Wilson's disease and identification of kidney disorder of thinning of the glomerular basement membrane. Front Neurol 2023; 14:1231605. [PMID: 37681011 PMCID: PMC10481399 DOI: 10.3389/fneur.2023.1231605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Wilson's disease is an autosomal recessive disorder caused by ATP7B pathogenic mutations. The hallmark of this disorder mainly consists of liver involvement, neurologic dysfunction and psychiatric features. In addition, the kidneys can also be affected by excessive copper deposition. Methods A total of 34 patients clinically diagnosed with WD were recruited. They underwent ATP7B gene sequencing and clinical data of symptoms, examination, and treatment were collected. Moreover, renal pathology information was also investigated. Results We identified 25 potentially pathogenic ATP7B variants (16 missense, 5 frameshift, 3 splicing variants and 1 large deletion mutation) in these 34 WD patients, 5 of which were novel. In our cases, the most frequent variant was c.2333G>T (R778L, 39.06%, exon 8), followed by c.2621C>T (A874V, 10.94%, exon 11) and c.3316G>A (V1106I, 7.81%, exon 11). Furthermore, we described the thinning of the glomerular basement membrane as a rare pathologically damaging feature of Wilson's disease for the first time. Additionally, two patients who received liver transplant were observed with good prognosis in present study. Discussion Our work expanded the spectrum of ATP7B variants and presented rare renal pathological feature in WD patients, which may facilitate the development of early diagnosis, counseling, treatment regimens of WD.
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Affiliation(s)
- Hongliang Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hanyu Lv
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xin Chen
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Guolan Xing
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yingzi Wang
- Department of Renal Electron Microscopy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ruimin Hu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Mbala J, Belmalih A, Guillaud O, Lachaux A, Couchonnal Bedoya E. Evaluation of vitamin B 6 supplementation in Wilson's disease patients treated with D-penicillamine. BMJ Open Gastroenterol 2023; 10:e001211. [PMID: 37652551 PMCID: PMC10476132 DOI: 10.1136/bmjgast-2023-001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Wilson's disease (WD) is a copper metabolism disorder characterised by a progressive accumulation of this metal mainly in the liver and the brain. Treatment is based on the removal of copper operated by the chelators, among which, D-penicillamine (DP) is prescribed as a first-line treatment in most situations. There is some evidence in linking the use of DP with a risk of vitamin B6; therefore, vitamin supplementation is sometimes recommended, although non-consensually. The objective of our study was to evaluate the level of vitamin B6 in WD patients treated with DP with and without associated supplementation. METHODOLOGY All WD patients followed at the National Reference Centre for WD in Lyon between January 2019 and December 2020 treated with DP for more than 1 year were included and separated in two groups according to vitamin B6 supplementation. The level of vitamin B6 was measured by the determination of pyridoxal phosphate (PLP). RESULTS A total of 37 patients were included. Average age of 23.3±14.8 years, 15 patients with <18 years. Median duration of treatment was 51 (55.8) months. 15 patients were under vitamin B6 supplementation and 22 had interrupted it for more than 1 year. The median PLP level was significantly higher in the group with supplementation, 137.2 (86.7) nmol/L vs 64.9 (30.8) nmol/(p<0.01). No patient had a PLP level<35 nmol/L. CONCLUSION Long-term stable WD patients under DP treatment probably do not need vitamin B6 supplementation.
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Affiliation(s)
- Justin Mbala
- Department of Pediatric, Kinshasa University Hospital, Kinshasa, Congo
| | - Abdelouahed Belmalih
- Centre National de Référence Pour la Maladie de Wilson, Hospices Civils de Lyon, Lyon, France
| | - Olivier Guillaud
- Centre National de Référence Pour la Maladie de Wilson, Hospices Civils de Lyon, Lyon, France
- Ramsay Générale de Santé, Clinique de la Sauvegarde, Lyon, France
| | - Alain Lachaux
- Centre National de Référence Pour la Maladie de Wilson, Hospices Civils de Lyon, Lyon, France
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Cheng C, Wang Q, Huang Y, Xue Q, Wang Y, Wu P, Liao F, Miao C. Gandouling inhibits hepatic fibrosis in Wilson's disease through Wnt-1/β-catenin signaling pathway. J Ethnopharmacol 2023; 311:116445. [PMID: 37015279 DOI: 10.1016/j.jep.2023.116445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 06/19/2023]
Abstract
ETHNOPHARMACOLOGIC SIGNIFICANCE Wilson's disease (WD) hepatic fibrosis is the result of chronic liver injury induced by Cu2+ deposition in the liver. Gandouling (GDL) is a hospital preparation of the First Affiliated Hospital of Anhui University of Chinese Medicine. Previous studies have found that GDL can play an anti-inflammatory, anti-oxidation, and promote Cu2+ excretion, which has a clear anti-WD effect. AIM OF THE STUDY We found that Wnt-1 was significantly up-regulated in the liver tissue of toxic-milk (TX) mouse in the WD gene mutant model, and the monomer components of GDL could combine well with Wnt-1. Therefore, in this work, we used RT-qPCR, Western blot, immunofluorescence, network pharmacology, molecular docking, and related methods to study the effects of GDL on hepatic stellate cell (HSC) activation and Wnt-1/β-catenin pathway in TX mice to clarify the effect of GDL on WD hepatic fibrosis. RESULTS GDL could alleviate hepatic fibrosis, improve liver function, and inhibit the activation of HSC in TX mice. Network pharmacology predicted that the Wnt-1/β-catenin was the target of GDL, and molecular dynamics further revealed that GDL has a good binding ability with Wnt-1 and inhibits the Wnt/β-catenin signaling pathway through Wnt-1. Furthermore, we found that GDL blocked the Wnt-1/β-catenin signaling pathway in the liver of TX mice in vivo. In vitro, serum containing GDL blocked the Cu2+ ion-induced Wnt-1/β-catenin signaling pathway in LX-2 cells. Therefore, GDL blocked the Wnt-1/β-catenin signaling pathway, inhibited HSC activation, and improved WD hepatic fibrosis by binding to Wnt-1. CONCLUSION GDL improves hepatic fibrosis in WD model mice by blocking the Wnt-1/β-catenin signaling pathway, and Wnt-1 may be a new target for the diagnosis and treatment of WD. This reveals a new mechanism of GDL against WD, and promotes the clinical promotion of GDL.
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Affiliation(s)
- Chenglong Cheng
- Department of Pharmacology, School of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, China.
| | - Qiang Wang
- Department of Pharmaceutical Preparation, School of Life and Health Sciences, Anhui University of Science and Technology, China.
| | - Yurong Huang
- Department of Pharmacology, School of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, China.
| | - Qiuyun Xue
- Department of Pharmacology, School of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, China.
| | - Yuting Wang
- Department of Pharmacology, School of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, China.
| | - Peng Wu
- Department of Anatomy, School of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, China.
| | - Faxue Liao
- Department of Orthopaedics, The First Affiliated Hospital, Anhui Medical University, Hefei, China; Anhui Public Health Clinical Center, Hefei, China.
| | - Chenggui Miao
- Department of Pharmacology, School of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, China.
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Zhang B, Peng J, Chen H, Hu W. Machine learning for detecting Wilson's disease by amplitude of low-frequency fluctuation. Heliyon 2023; 9:e18087. [PMID: 37483763 PMCID: PMC10362133 DOI: 10.1016/j.heliyon.2023.e18087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/18/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023] Open
Abstract
Wilson's disease (WD) is a genetic disorder with the A7P7B gene mutations. It is difficult to diagnose in clinic. The purpose of this study was to confirm whether amplitude of low-frequency fluctuations (ALFF) is one of the potential biomarkers for the diagnosis of WD. The study enrolled 30 healthy controls (HCs) and 37 WD patients (WDs) to obtain their resting-state functional magnetic resonance imaging (rs-fMRI) data. ALFF was obtained through preprocessing of the rs-fMRI data. To distinguish between patients with WDs and HCs, four clusters with abnormal ALFF-z values were identified through between-group comparisons. Based on these clusters, three machine learning models were developed, including Random Forest (RF), Support Vector Machine (SVM), and Logistic Regression (LR). Abnormal ALFF z-values were also combined with volume information, clinical variables, and imaging features to develop machine learning models. There were 4 clusters where the ALFF z-values of the WDs were significantly higher than that of the HCs. Cluster1 was in the cerebellar region, Cluster2 was in the left caudate nucleus, Cluster3 was in the bilateral thalamus, and Cluster4 was in the right caudate nucleus. In the training set and test set, the models trained with Cluster2, Cluster3, and Cluster4 achieved area of curve (AUC) greater than 0.80. In the Delong test, only the AUC values of models trained with Cluster4 exhibited statistical significance. The AUC values of the Logit model (P = 0.04) and RF model (P = 0.04) were significantly higher than those of the SVM model. In the test set, the LR model and RF model trained with Cluster3 had high specificity, sensitivity, and accuracy. By conducting the Delong test, we discovered that there was no statistically significant inter-group difference in AUC values between the model that integrates multi-modal information and the model before fusion. The LR models trained with multimodal information and Cluster 4, as well as the LR and RF models trained with multimodal information and Cluster 3, have demonstrated high accuracy, specificity, and sensitivity. Overall, these findings suggest that using ALFF based on the thalamus or caudate nucleus as markers can effectively differentiate between WDs and HCs. The fusion of multimodal information did not significantly improve the classification performance of the models before fusion.
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Affiliation(s)
- Bing Zhang
- Graduate School of Anhui University of Chinese Medicine,230012, China
| | - Jingjing Peng
- Graduate School of Anhui University of Chinese Medicine,230012, China
| | - Hong Chen
- Graduate School of Anhui University of Chinese Medicine,230012, China
| | - Wenbin Hu
- Graduate School of Anhui University of Chinese Medicine,230012, China
- Affiliated Hospital of Institute of Neurology, Anhui University of Chinese Medicine,230031, China
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22
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Ning W, Lyu C, Diao S, Huang Y, Liu A, Yu Q, Peng Z, Hong M, Zhou Z. Optical coherence tomography in patients with Wilson's disease. Brain Behav 2023; 13:e3014. [PMID: 37062885 PMCID: PMC10275519 DOI: 10.1002/brb3.3014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/22/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Morphological changes of retina in patients with Wilson's disease (WD) can be found by optical coherence tomography (OCT), and such changes had significant differences between neurological forms (NWD) and hepatic forms (HWD) of WD. The aim of this study was to evaluate the relationship between morphological parameters of retina and brain magnetic resonance imaging (MRI) lesions, course of disease, type of disease, and sexuality in WD. METHODS A total of 46 WD patients and 40 health controls (HC) were recruited in this study. A total of 42 WD patients were divided into different groups according to clinical manifestations, course of disease, sexuality, and brain MRI lesions. We employed the Global Assessment Scale to assess neurological severity of WD patients. All WD patients and HC underwent retinal OCT to assess the thickness of inner limiting membrane (ILM) layer to retinal pigment epithelium layer and inner retina layer (ILM to inner plexiform layer, ILM-IPL). RESULTS Compared to HWD, NWD had thinner superior parafovea zone (108.07 ± 6.89 vs. 114.40 ± 5.54 μm, p < .01), temporal parafovea zone (97.17 ± 6.65 vs. 103.60 ± 4.53 μm, p < .01), inferior parafovea zone (108.114 ± 7.65 vs. 114.93 ± 5.84 μm, p < .01), and nasal parafovea zone (105.53 ± 8.01 vs. 112.10 ± 5.44 μm, p < .01) in inner retina layer. Course of disease influenced the retina thickness. Male patients had thinner inner retina layer compared to female patients. CONCLUSION Our results demonstrated that WD had thinner inner retina layer compared to HC, and NWD had thinner inner retina layer compared to HWD. We speculated the thickness of inner retina layer may be a potential useful biomarker for NWD.
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Affiliation(s)
| | | | | | | | - Ai‐Qun Liu
- Department of NeurologyGuangzhouGuangdongChina
| | - Qing‐Yun Yu
- Department of NeurologyGuangzhouGuangdongChina
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23
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Yang X, Wang T, Tang Y, Shao Y, Gao Y, Wu P. Treatment of liver fibrosis in hepatolenticular degeneration with traditional Chinese medicine: systematic review of meta-analysis, network pharmacology and molecular dynamics simulation. Front Med (Lausanne) 2023; 10:1193132. [PMID: 37250630 PMCID: PMC10213944 DOI: 10.3389/fmed.2023.1193132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/18/2023] [Indexed: 05/31/2023] Open
Abstract
Background Traditional Chinese medicine (TCM) is widely used in the clinical treatment of hepatolenticular degeneration (HLD) and liver fibrosis (LF). In the present study, the curative effect was assessed using meta-analysis. The possible mechanism of TCM against LF in HLD was investigated using network pharmacology and molecular dynamics simulation. Methods For literature collection, we searched several databases, including PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals (VIP) and Wan Fang database until February 2023, and the Review Manager 5.3 was used to analyze the data. Network pharmacology and molecular dynamics simulation were used to explore the mechanism of TCM in treating LF in HLD. Results The results of the meta-analysis revealed that the addition of Chinese herbal medicine (CHM) in treating HLD resulted in a higher total clinical effective rate than western medicine alone [RR 1.25, 95% CI (1.09, 1.44), p = 0.002]. It not only has a better effect on liver protection [Alanine aminotransferase: SMD = -1.20, 95% CI (-1.70, -0.70), p < 0.00001; Aspartate aminotransferase: SMD = -1.41, 95% CI (-2.34, -0.49), p = 0.003; Total bilirubin: SMD = -1.70, 95% CI (-3.36, -0.03), p = 0.05] but also had an excellent therapeutic effect on LF through four indexes [Hyaluronic acid: SMD = -1.15, 95% CI (-1.76, -0.53), p = 0.0003; Procollagen peptide III: SMD = -0.72, 95% CI (-1.29, -0.15), p = 0.01; Collagen IV: SMD = -0.69, 95% CI (-1.21, -0.18), p = 0.008; Laminin: SMD = -0.47, 95% CI (-0.95, 0.01), p = 0.06]. Concurrently, the liver stiffness measurement decreased significantly [SMD = -1.06, 95% CI (-1.77, -0.36), p = 0.003]. The results of network pharmacological experiments and molecular dynamics simulation indicate that the three high-frequency TCMs (Rhei Radix Et Rhizoma-Coptidis Rhizoma-Curcumae Longae Rhizoma, DH-HL-JH) primarily act on the core targets (AKT1, SRC, and JUN) via the core components (rhein, quercetin, stigmasterol, and curcumin), regulate the signal pathway (PI3K-Akt, MAPK, EGFR, and VEGF signaling pathways), and play a role of anti-LF. Conclusion Meta-analysis indicates that TCM is beneficial in treating HLD patients and improving LF. The present study successfully predicts the effective components and potential targets and pathways involved in treating LF for the three high-frequency CHMs of DH-HL-JH. The findings of the present study are hoped to provide some evidence support for clinical treatment. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42022302374.
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Affiliation(s)
- Xulong Yang
- College of Integrated Traditional Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, China
| | - Tiancheng Wang
- College of Integrated Traditional Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, China
| | - Yiping Tang
- College of Integrated Traditional Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, China
| | - Yawen Shao
- College of Integrated Traditional Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, China
| | - Yaqin Gao
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Peng Wu
- College of Integrated Traditional Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, China
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24
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Stalke A, Behrendt A, Hennig F, Gohlke H, Buhl N, Reinkens T, Baumann U, Schlegelberger B, Illig T, Pfister ED, Skawran B. Functional characterization of novel or yet uncharacterized ATP7B missense variants detected in patients with clinical Wilson's disease. Clin Genet 2023. [PMID: 37157876 DOI: 10.1111/cge.14352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/10/2023]
Abstract
Wilson's disease (WD, MIM#277900) is an autosomal recessive disorder resulting in copper excess caused by biallelic variants in the ATP7B gene (MIM#606882) encoding a copper transporting P-type ATPase. ATP7B variants of unknown significance (VUS) are detected frequently, sometimes impeding a clear diagnosis. Functional analyses can help to classify these variants as benign or pathogenic. Additionally, variants already classified as (likely) pathogenic benefit from functional analyses to understand their pathomechanism, thus contribute to the development of personalized treatment approaches in the future. We described clinical features of six WD patients and functionally characterized five ATP7B missense variants (two VUS, three yet uncharacterized likely pathogenic variants), detected in these patients. We determined the protein level, copper export capacity, and cellular localization in an in vitro model and potential structural consequences using an ATP7B protein model based on AlphaFold. Our analyses give insight into the pathomechanism and allowed reclassification for the two VUS to likely pathogenic and for two of the three likely pathogenic variants to pathogenic.
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Affiliation(s)
- Amelie Stalke
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
- Department of Pediatric Gastroenterology and Hepatology, Division of Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Annika Behrendt
- Institute for Pharmaceutical and Medicinal Chemistry, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Finja Hennig
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Holger Gohlke
- Institute for Pharmaceutical and Medicinal Chemistry, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Bio- and Geosciences (IBG-4: Bioinformatics), Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Nicole Buhl
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
- Department of Pediatric Gastroenterology and Hepatology, Division of Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Thea Reinkens
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Ulrich Baumann
- Department of Pediatric Gastroenterology and Hepatology, Division of Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | | | - Thomas Illig
- Hannover Unified Bank, Hannover Medical School, Hannover, Germany
| | - Eva-Doreen Pfister
- Department of Pediatric Gastroenterology and Hepatology, Division of Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Britta Skawran
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
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25
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Stewart A, Dershwitz P, Stewart C, Sawaya MR, Yeates TO, Semrau JD, Zischka H, DiSpirito AA, Bobik TA. Crystal structure of MbnF: an NADPH-dependent flavin monooxygenase from Methylocystis strain SB2. Acta Crystallogr F Struct Biol Commun 2023; 79:111-118. [PMID: 37158309 PMCID: PMC10167746 DOI: 10.1107/s2053230x23003035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/02/2023] [Indexed: 05/10/2023] Open
Abstract
Methanobactins (MBs) are ribosomally produced and post-translationally modified peptides (RiPPs) that are used by methanotrophs for copper acquisition. The signature post-translational modification of MBs is the formation of two heterocyclic groups, either an oxazolone, pyrazinedione or imidazolone group, with an associated thioamide from an X-Cys dipeptide. The precursor peptide (MbnA) for MB formation is found in a gene cluster of MB-associated genes. The exact biosynthetic pathway of MB formation is not yet fully understood, and there are still uncharacterized proteins in some MB gene clusters, particularly those that produce pyrazinedione or imidazolone rings. One such protein is MbnF, which is proposed to be a flavin monooxygenase (FMO) based on homology. To help to elucidate its possible function, MbnF from Methylocystis sp. strain SB2 was recombinantly produced in Escherichia coli and its X-ray crystal structure was resolved to 2.6 Å resolution. Based on its structural features, MbnF appears to be a type A FMO, most of which catalyze hydroxylation reactions. Preliminary functional characterization shows that MbnF preferentially oxidizes NADPH over NADH, supporting NAD(P)H-mediated flavin reduction, which is the initial step in the reaction cycle of several type A FMO enzymes. It is also shown that MbnF binds the precursor peptide for MB, with subsequent loss of the leader peptide sequence as well as the last three C-terminal amino acids, suggesting that MbnF might be needed for this process to occur. Finally, molecular-dynamics simulations revealed a channel in MbnF that is capable of accommodating the core MbnA fragment minus the three C-terminal amino acids.
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Affiliation(s)
- Andrew Stewart
- Roy J. Carver Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, IA 50011-3260, USA
| | - Philip Dershwitz
- Roy J. Carver Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, IA 50011-3260, USA
| | - Charles Stewart
- Macromolecular X-ray Crystallography Facility, Office of Biotechnology, Iowa State University, Ames, IA 50011-3260, USA
| | - Michael R Sawaya
- UCLA-DOE Institute for Genomics and Proteomics, University of California Los Angeles, Los Angeles, CA 90095-1570, USA
| | - Todd O Yeates
- UCLA-DOE Institute for Genomics and Proteomics, University of California Los Angeles, Los Angeles, CA 90095-1570, USA
| | - Jeremy D Semrau
- Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, MI 48109-2125, USA
| | - Hans Zischka
- Institute of Molecular Toxicology and Pharmacology, Helmholtz Center Munich, German Research Center for Environmental Health, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany
| | - Alan A DiSpirito
- Roy J. Carver Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, IA 50011-3260, USA
| | - Thomas A Bobik
- Roy J. Carver Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, IA 50011-3260, USA
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Ghahremani GG, Hahn ME, Fishman EK. Computed tomography of hyper-attenuated liver: Pictorial essay. Clin Imaging 2023; 97:1-6. [PMID: 36857928 DOI: 10.1016/j.clinimag.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/07/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
Demonstration of a very dense or hyper-attenuated liver on the pre-contrast CT images of the abdomen can be an unexpected finding. It may present as a diagnostic challenge if the underlying cause of it is not apparent from the provided clinical history. There are about 12 different pathologic conditions that are associated with deposition of radiopaque elements within the hepatic parenchyma, resulting in diffuse or multi-lobar hyperdense appearance of the liver on abdominal radiographs and CT. Most of them are drug-induced or iatrogenic in nature, while others are the sequelae of genetic disorders like thalassemia, Wilson's disease, and primary hemochromatosis. This pictorial essay will present the CT appearance and etiology of hyper-attenuated liver in various clinical entities.
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Affiliation(s)
- Gary G Ghahremani
- Department of Radiology, University of California-San Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103, USA.
| | - Michael E Hahn
- Department of Radiology, University of California-San Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103, USA
| | - Elliot K Fishman
- Department of Radiology, Johns Hopkins University Hospital, 733 North Broadway, Baltimore, MD 21205, USA
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27
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Song W, Xin L, Wang J. A grading method for Kayser Fleischer ring images based on ResNet. Heliyon 2023; 9:e16149. [PMID: 37234668 PMCID: PMC10205591 DOI: 10.1016/j.heliyon.2023.e16149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
The corneal K-F ring is the most common ophthalmic manifestation of WD patients. Early diagnosis and treatment have an important impact on the patient's condition. K-F ring is one of the gold standards for the diagnosis of WD disease. Therefore, this paper mainly focused on the detection and grading of the K-F ring. The aim of this study is three-fold. Firstly, to create a meaningful database, the K-F ring images are collected which contains 1850 images with 399 different WD patients, and then this paper uses the chi-square test and Friedman test to analyze the statistical significance. Subsequently, the all collected images were graded and labeled with an appropriate treatment approach, as a result, these images could be used to detect the corneal through the YOLO. After the detection of corneal, image segmentation was realized in batches. Finally, in this paper, different deep convolutional neural networks (VGG, ResNet, and DenseNet) were used to realize the grading of the K-F ring images in the KFID. Experimental results reveal that the entire pre-trained models obtain excellent performance. The global accuracies achieved by the six models i.e., VGG-16, VGG-19, ResNet18, ResNet34, ResNet50, and DenseNet are 89.88%, 91.89%, 94.18%, 95.31%, 93.59%, and 94.58% respectively. ResNet34 displayed the highest recall, specificity, and F1-score of 95.23%, 96.99%, and 95.23%. DenseNet showed the best precision of 95.66%. As such, the findings are encouraging, demonstrating the effectiveness of ResNet in the automatic grading of the K-F ring. Moreover, it provides effective help for the clinical diagnosis of HLD.
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Affiliation(s)
- Wei Song
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230031, China
| | - Ling Xin
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230031, China
| | - Jiemei Wang
- Department of Otolaryngology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230031, China
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28
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Ueda M, Katsuse K, Kakumoto T, Kobayashi S, Ishiura H, Mitsui J, Toda T. Copper Deficiency in Wilson's Disease with a Normal Zinc Value. Intern Med 2023; 62:1073-1076. [PMID: 36047117 PMCID: PMC10125822 DOI: 10.2169/internalmedicine.9366-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Copper deficiency (CD) is a rare complication of long-term treatment of Wilson's disease (WD) and is usually accompanied by high serum zinc levels. A 57-year-old woman with WD presented with limb weakness and sensory disturbance due to myeloneuropathy and macrocytic anemia after 36 years of treatment. Markedly reduced serum free copper values confirmed CD, which was considered to be caused by progressive dysphagia and severe diarrhea rather than zinc overdose because of the normal serum zinc levels. Discontinuing copper-reducing therapy and increasing copper intake improved her symptoms. Physicians should be alert for the risk of CD in WD patients, especially those with dysphagia.
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Affiliation(s)
- Masayuki Ueda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Kazuto Katsuse
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Toshiyuki Kakumoto
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Satoshi Kobayashi
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Jun Mitsui
- Department of Molecular Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
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29
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Wang Y, Xuan H, Zhao T, Li X, Li S, Hu W. A study of linear measurement and clinical correlation of brain atrophy in Wilson's disease. Front Hum Neurosci 2023; 17:1142082. [PMID: 37056963 PMCID: PMC10086176 DOI: 10.3389/fnhum.2023.1142082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/14/2023] [Indexed: 03/30/2023] Open
Abstract
Background The aim of this study was to explore the clinical relevance of linear measures of Wilson's disease (WD). Methods Relative values of brain atrophy in 30 patients with WD and 30 healthy volunteers were measured and compared using a manual measurement method. Linear measurement indicators of brain atrophy in patients with and without mental disorders were also compared. In addition, correlations of patients' age, disease duration, and Unified Wilson's Disease Rating Scale (UWDRS) scores with brain atrophy indicators were determined. Results The results showed that the e-value, Huckman number, Evans index, and lateral ventricular body index were higher in the WD group compared with the control group. The age of patients with WD was negatively correlated with the k-value and significantly positively correlated with the brainstem index. WD duration was prominently positively correlated with the d-value and negatively correlated with the j-value. In addition, neurological function scores were significantly positively correlated with the c-value, e-value, caudate nucleus index, Huckman number, Evans index, and lateral ventricular body index. By contrast, patients with psychiatric symptoms had a higher a-value and fourth ventricular index than those without psychiatric symptoms. Conclusion Therefore, it can be concluded that patients with WD and those with psychiatric symptoms have more severe brain atrophy compared to normal subjects. The patient's age, disease duration, and neurological function scores were positively correlated with the severity of brain atrophy.
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Affiliation(s)
- Yun Wang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hongxia Xuan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Hongda Hospital, Jiamusi University, Jiamusi, China
| | - Tun Zhao
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaodong Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shujuan Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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30
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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31
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Chen Y, Qiu Y, Chen M, Jiang Y, Qiu X, Gao L. Penicillamine-induced degenerative dermopathy in a patient with Wilson's disease. Australas J Dermatol 2023; 64:126-130. [PMID: 36565232 DOI: 10.1111/ajd.13963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 12/25/2022]
Abstract
Penicillamine is a chelator that has been used in Wilson's disease, cystinuria, rheumatoid arthritis and heavy metal intoxication. We report a case of a 31-year-old man presented with skin atrophy, purpura and milia on the hips and shoulders after taking penicillamine for 1.5 years. According to literature review, this type of penicillamine-associated cutaneous adverse effect belongs to degenerative dermopathy, which mostly occurs on bony prominences and points of pressure in patients with Wilson's disease or cystinuria. Withdrawal or reduction of drug dose can improve the features of degenerative dermopathy.
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Affiliation(s)
- Yuting Chen
- Department of Dermatology, Zhongshan Hospital (Xiamen branch), Fudan University, Xiamen, China
| | - Yangyang Qiu
- Department of Dermatology, Zhongshan Hospital (Xiamen branch), Fudan University, Xiamen, China
| | - Meiqing Chen
- Department of Dermatology, Zhongshan Hospital (Xiamen branch), Fudan University, Xiamen, China
| | - Ying Jiang
- Department of Dermatology, Zhongshan Hospital (Xiamen branch), Fudan University, Xiamen, China.,Department of Dermatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyan Qiu
- Department of Dermatology, Zhongshan Hospital (Xiamen branch), Fudan University, Xiamen, China
| | - Lujuan Gao
- Department of Dermatology, Zhongshan Hospital (Xiamen branch), Fudan University, Xiamen, China.,Department of Dermatology, Zhongshan Hospital, Fudan University, Shanghai, China
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Nilles C, Obadia MA, Sobesky R, Dumortier J, Guillaud O, Laurencin C, Moreau C, Vanlemmens C, Ory-Magne F, de Ledinghen V, Bardou-Jacquet E, Fluchère F, Collet C, Oussedik-Djebrani N, Woimant F, Poujois A. Diagnosis and Outcomes of Late-Onset Wilson's Disease: A National Registry-Based Study. Mov Disord 2023; 38:321-332. [PMID: 36573661 DOI: 10.1002/mds.29292] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Wilson's disease (WD) is usually diagnosed in children and young adults; limited data exist on late-onset forms. OBJECTIVE The aim was to characterize the clinical and paraclinical presentations, therapeutic management, and outcomes in patients with late-onset WD. METHODS Patients diagnosed with WD after age 40 years were identified from the French Wilson's Disease Registry (FWDR). Clinical, laboratory, and imaging findings and treatment were reported at diagnosis and last follow-up. RESULTS Forty-five patients were identified (median age: 49, range: 40-64) and placed in three groups according to their clinical presentation: neurological (n = 20, median diagnostic delay: 20 months), hepatic (n = 13, diagnostic delay: 12 months), and family screening (n = 12), all confirmed genetically. Six neurological patients had an atypical presentation (1 torticollis, 2 writer's cramps, 2 functional movement disorders, and 1 isolated dysarthria), without T2/fluid-attenuated inversion recovery brain magnetic resonance imaging (MRI) hyperintensities; 5 of 6 had no Kayser-Fleischer ring (KFR); 5 of 6 had liver involvement. In the neurological group, 84% of patients improved clinically, and 1 developed copper deficiency. In the hepatic group, 77% had cirrhosis; 6 patients required liver transplantation. In the screened group, 43% had mild liver involvement; 3 were not treated and remained stable; 24-h urinary copper excretion was normal in 33% of patients at diagnosis. CONCLUSIONS In the FWDR, late-onset forms of WD affect 8% of patients, mostly with neurological presentations. Thirty percent of the neurological forms were atypical (isolated long-lasting symptoms, inconspicuous brain MRI, no KFR). With personalized treatment, prognosis was good. This study emphasized that WD should be suspected at any age and even in cases of atypical presentation. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Christelle Nilles
- Department of Neurology, Rothschild Foundation Hospital, Paris, France.,National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France
| | - Mickael Alexandre Obadia
- Department of Neurology, Rothschild Foundation Hospital, Paris, France.,National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France
| | - Rodolphe Sobesky
- Centre Hépato-Biliaire, AP-HP, DHU Hepatinov, INSERM UMR-S 1193, Hôpital Paul Brousse, Villejuif, France
| | - Jérôme Dumortier
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France.,Department of Hepatologie-Gastroenterologie, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Olivier Guillaud
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France.,Service d'explorations fonctionnelles digestives, CHU Lyon, Lyon, France
| | - Chloé Laurencin
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France.,Service de Neurologie HFME-GHE, Bron Cedex, France
| | - Caroline Moreau
- Service de neurologie et pathologies du mouvement, INSERM UMR, CHU Lille, Lille, France
| | - Claire Vanlemmens
- Service d'Hépatologie et soins intensifs digestifs, CHU Besançon, Hôpital Jean Minjoz, Besançon, France
| | - Fabienne Ory-Magne
- Service de Neurologie, Neurology Department, CHU Toulouse, Hôpital Purpan, Toulouse, France
| | - Victor de Ledinghen
- Service d'Hépatologie-Gastroentérologie, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac & INSERM U1312, Université de Bordeaux, Bordeaux, France
| | | | - Frederique Fluchère
- Service de Neurologie, Neurology Department, CHU Marseille, Hôpital de la Timone, Marseille, France
| | - Corinne Collet
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France.,Département de Génétique, Hôpital Robert Debré AP-HP, Paris, France
| | - Nouzha Oussedik-Djebrani
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France.,Laboratoire de Toxicologie Biologique, Hôpital Lariboisière AP-HP, Paris, France
| | - France Woimant
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France
| | - Aurélia Poujois
- Department of Neurology, Rothschild Foundation Hospital, Paris, France.,National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France
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Rędzia-Ogrodnik B, Członkowska A, Antos A, Bembenek J, Kurkowska-Jastrzębska I, Przybyłkowski A, Skowrońska M, Smoliński Ł, Litwin T. Pathognomonic neuroradiological signs in Wilson's disease - Truth or myth? Parkinsonism Relat Disord 2023; 107:105247. [PMID: 36543734 DOI: 10.1016/j.parkreldis.2022.105247] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Wilson's disease (WD) is a treatable genetic disorder caused by impaired copper metabolism. Early diagnosis and correct anti-copper treatment are crucial for therapeutic success. Brain magnetic resonance imaging (MRI) is used both for diagnosis and treatment monitoring. Several neuroradiological signs have been proposed to be pathognomonic for WD; however, their frequency and significance are not established. The frequency and significance of these brain MRI signs were analyzed in a large cohort of WD patients. METHODS We retrospectively analyzed 100 newly diagnosed, treatment-naive WD patients. Brain MRI was performed and the frequency of typical MRI changes was analyzed with demographic, clinical and laboratory characteristics of WD. RESULTS Potentially pathognomonic brain MRI signs for WD occurred in 24% patients and in 43% (24/55) patients with neurological WD. Signs detected included the "face of the giant panda" in 15% of all patients (27.3% of neurological cases), "miniature panda" in 12% (21.8% of neurological cases), "split thalamus" in 7% (12.7% of neurological cases), and "bright claustrum" and "whorl" signs in 1 patients each. Signs were observed only in patients with neurological symptoms and were significantly associated with early age of onset/diagnosis, more severe neurological presentation and lower ceruloplasmin level (all p < 0.05). CONCLUSIONS Potentially brain MRI pathognomonic signs occurred relatively rarely across all patients, most often in patients with early onset and severe neurological symptoms, and this knowledge may improve WD diagnosis. However, as these signs are also found in brain MRI in other disorders, they may not be truly pathognomonic of WD.
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Affiliation(s)
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Agnieszka Antos
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Jan Bembenek
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Adam Przybyłkowski
- Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, Poland
| | - Marta Skowrońska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Łukasz Smoliński
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
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Jing XZ, Li GY, Wu YP, Yuan XZ, Luo XG, Chen JL, Taximaimaiti R, Wang XP, Li JQ. Free water imaging as a novel biomarker in Wilson's disease: A cross-sectional study. Parkinsonism Relat Disord 2023; 106:105234. [PMID: 36481719 DOI: 10.1016/j.parkreldis.2022.105234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The bi-tensor free water imaging may provide more specific information in detecting microstructural brain tissue alterations than conventional single tensor diffusion tensor imaging. The study aimed to investigate microstructural changes in deep gray matter (DGM) nuclei of Wilson's disease (WD) using a bi-tensor free water imaging and whether the findings correlate with the neurological impairment in WD patients. METHODS The study included 29 WD patients and 25 controls. Free water and free water corrected fractional anisotropy (FAT) in DGM nuclei of WD patients were calculated. The correlations of free water and FAT with the Unified WD Rating Scale (UWDRS) neurological subscale of WD patients were performed. RESULTS Free water and FAT values were significantly increased in multiple DGM nuclei of neurological WD patients compared to controls. WD patients with normal appearing on conventional MRI also had significantly higher free water and FAT values in multiple DGM nuclei than controls. Positive correlations were noted between the UWDRS neurological subscores and free water values of the putamen and pontine tegmentum as well as FAT values of the dentate nucleus, red nucleus, and globus pallidus. In addition, the measured free water and FAT values of specific structures also showed a positive correlation with specific clinical symptoms in neurological WD patients, such as dysarthria, parkinsonian signs, tremor, dystonia, and ataxia. CONCLUSIONS Free water imaging detects microstructural changes in both normal and abnormal appearing DGM nuclei of WD patients. Free water imaging indices were correlated with the severity of neurological impairment in WD patients.
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Affiliation(s)
- Xiao-Zhong Jing
- Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Gai-Ying Li
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China.
| | - Yu-Peng Wu
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China.
| | - Xiang-Zhen Yuan
- Department of Neurology, Weifang People's Hospital, Weifang, Shandong, China.
| | - Xing-Guang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Jia-Lin Chen
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China.
| | - Reyisha Taximaimaiti
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xiao-Ping Wang
- Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jian-Qi Li
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China.
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Valamparampil JJ, Sachan D, Shanmugam N, Reddy SM, Rela M. Emergency ABO-incompatible living donor liver transplantation in Wilson disease-induced acute liver failure. Asian J Transfus Sci 2023; 17:128-130. [PMID: 37188013 PMCID: PMC10180780 DOI: 10.4103/ajts.ajts_55_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/16/2021] [Accepted: 08/01/2021] [Indexed: 11/04/2022] Open
Abstract
We report the clinical outcome of an emergency ABO incompatible-liver transplantation (LT) for an 8-year-old child with Wilson's disease-induced acute liver failure. The pretransplant anti-A antibody titer was 1:64, and hence he underwent three cycles of conventional plasma exchange as pretransplant liver supportive treatment for deranged coagulopathy and liver function followed by one cycle of immunoadsorption (IA) prior to LT. The posttransplant immunosuppression consisted of rituximab, tacrolimus, mycophenolate mofetil, and corticosteroid. The patient had anti-A isoagglutinin rebound with elevated aminotransferases levels from postoperative day 7 for which he was restarted on IA plasmapheresis, but antibody titers did not decrease. Hence, he was switched to conventional plasmapheresis (CP) with which anti-A antibody titers decreased. The total dose of rituximab (150 milligrams/square meter of body surface area) was given in two divided doses of 75 mg at D-1 and D + 8 which was much less than the dose conventionally advocated (375 milligrams/square meter of body surface area). He is clinically well with good graft function without rejection after 1 year of follow-up. This case illustrates that IA and CP in conjunction with adequate immunosuppression is a viable approach in emergency ABO-incompatible-LT in Wilson disease-induced acute liver failure.
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Affiliation(s)
| | - Deepti Sachan
- Department of Transfusion Medicine, Bharat Institute of Higher Education and Research, Dr. Rela Institute and Medical Centre, Chennai, Tamil Nadu, India
| | - Naresh Shanmugam
- Institute of Liver Disease and Transplantation, Chennai, Tamil Nadu, India
| | - Srinivas Mettu Reddy
- Institute of Liver Disease and Transplantation, Chennai, Tamil Nadu, India
- Department of Liver Transplantation and HPB Surgery, Gleneagles Global Hospital and Health City, Chennai, Tamil Nadu, India
| | - Mohamed Rela
- Institute of Liver Disease and Transplantation, Chennai, Tamil Nadu, India
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36
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Wang Y, He Q, Dang X, Wu X, Li X. Clinical features and familial mutations in the coexistence of Wilson's disease and Alport syndrome: A case report. Front Pediatr 2023; 11:1107280. [PMID: 37063668 PMCID: PMC10102471 DOI: 10.3389/fped.2023.1107280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/06/2023] [Indexed: 04/18/2023] Open
Abstract
Background Alport syndrome (AS) and Wilson's disease (WD) are genetic diseases that could lead to kidney damage. Herein, we report the clinical features and gene variants in a patient with WD and X-linked AS. Case presentation The proband was a 12-year-old boy diagnosed with AS coexisting with WD at the age of 11 years. The patient underwent a medical check-up when he was 4 years and 8 months. Laboratory tests revealed elevated liver enzymes, decreased serum ceruloplasmin, increased 24-h urinary copper excretion, and one variant in the ATP7B gene. Then, the patient was diagnosed with WD. After 2 months of treatment with D-penicillamine and zinc salt, his liver function had recovered to normal levels, but he presented with microscopic hematuria. The hematuria did not resolve after switching to dimercaptosuccinic acid from D-penicillamine. In addition, he presented with proteinuria 3 years later. A renal biopsy was performed more than 6 years after the patient was diagnosed with WD, and electron microscopy showed that the basement membrane thickness was uneven, layered, and focal torn. Copper staining was negative. A genetic analysis identified a hemizygous variant (c.1718G > A, p. Gly573Asp) in COL4A5 and a homozygous variant (c.2975C > T, p. Pro992leu) in ATP7B. The patient's urine protein-creatinine ratio was less than 1.0 mg/mg after a 1 year of follow-up, after enalapril was administered for treating AS. Conclusion This case highlights a lack of improvement in renal function after conventional treatment provides a possible indication for performing renal biopsy or genetic testing to determine the etiology in order to facilitate subsequent clinical management. Clinicians should prevent the occurrence of diagnostic inaccuracies caused by diagnostic anchoring because an accurate diagnosis is essential for achieving precise treatment and improved prognosis.
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Affiliation(s)
- Ying Wang
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Pediatrics Nephrology, Children’s Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qingnan He
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiqiang Dang
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Pediatrics Nephrology, Children’s Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaochuan Wu
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Pediatrics Nephrology, Children’s Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoyan Li
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Pediatrics Nephrology, Children’s Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Xiaoyan Li
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Yang Y, Hao W, Wei T, Tang L, Qian N, Yang Y, Xi H, Zhang S, Yang W. Role of serum ceruloplasmin in the diagnosis of Wilson's disease: A large Chinese study. Front Neurol 2022; 13:1058642. [PMID: 36570465 PMCID: PMC9768184 DOI: 10.3389/fneur.2022.1058642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022] Open
Abstract
Background Conventionally, serum ceruloplasmin levels below the lower reference limit (0. 20 g/L) is considered a diagnostic cutoff point for Wilson's disease (WD). However, the lower reference limit varies with assay methodologies and the individuals in the included studies. The objective of this study was to determine the optimal cutoff value of serum ceruloplasmin levels for the diagnosis of WD in a large Chinese cohort and to identify factors associated with serum ceruloplasmin. Methods The cutoff value of ceruloplasmin levels was developed based on a retrospective derivation cohort of 3,548 subjects (1,278 patients with WD and 2,270 controls) and was validated in a separate validation cohort of 313 subjects (203 patients with WD and 110 controls). The performance of immunoassay was tested by receiver operating characteristic curve (ROC) analysis, and differences among the groups were analyzed by using the Mann-Whitney U-test and the Kruskal-Wallis test. Results The conventional cutoff of serum ceruloplasmin levels of <0.2 g/L had an accuracy of 81.9%, which led to a false-positive rate of 30.5%. The optimal cutoff of the serum ceruloplasmin level for separating patients with WD from other participants was 0.13 g/L, as determined by ROC analysis. This cutoff value had the highest AUC value (0.99), a sensitivity of 97.0%, and a specificity of 96.1%. Moreover, it prevented unnecessary further investigations and treatments for 492 false-positive patients. By determining the correlation between serum ceruloplasmin and phenotypes/genotypes in patients with WD, we found that the serum ceruloplasmin level was lower in early-onset patients and higher in late-onset patients. Interestingly, patients with the R778L/R919G genotype had higher serum ceruloplasmin levels than patients with other hot spot mutation combinations. Conclusion Our work determined the optimal cutoff value of serum ceruloplasmin levels for the diagnosis of WD and identified differences in serum ceruloplasmin levels with respect to the age of symptom onset and ATP7B mutations, which may provide some valuable insights into the diagnosis and counsel of patients with WD.
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Affiliation(s)
- Yue Yang
- Department of Graduate, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Wenjie Hao
- Department of Graduate, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Taohua Wei
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - LuLu Tang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Nannan Qian
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Yulong Yang
- Department of Graduate, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Hu Xi
- Department of Graduate, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Shijie Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China,Shijie Zhang
| | - Wenming Yang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China,Xin'an Medical Education Ministry Key Laboratory, Hefei, Anhui, China,*Correspondence: Wenming Yang
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Smolinski L, Ziemssen T, Akgun K, Antos A, Skowrońska M, Kurkowska-Jastrzębska I, Członkowska A, Litwin T. Brain Atrophy Is Substantially Accelerated in Neurological Wilson's Disease: A Longitudinal Study. Mov Disord 2022; 37:2446-2451. [PMID: 36165286 DOI: 10.1002/mds.29229] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although brain atrophy is common in neurological Wilson's disease, longitudinal studies are lacking. OBJECTIVE The objective of this study was to measure longitudinal brain atrophy rate and to relate it to the change in neurological impairment in Wilson's disease. METHODS We included patients with brain imaging done at diagnosis and at least 12 months later. The atrophy rate was measured as percentage change in ventricular volume, whereas the change in neurological impairment was scored on the Unified Wilson's Disease Rating Scale. RESULTS Of 57 patients, 36 had neurological presentation, 17 had hepatic presentation, and 4 were presymptomatic. The annualized atrophy rate was significantly greater in patients with the neurological presentation than in other patients (P = 0.001). In the neurological presentation, the atrophy rate correlated with the change in impairment (rho = 0.39, P = 0.018) and was significantly greater in those with worsening after diagnosis than in those without worsening (P < 0.001). CONCLUSIONS Brain atrophy rate appears as a promising marker of neurodegeneration in Wilson's disease. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Lukasz Smolinski
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl Gustav Carus & Dresden University of Technology, Dresden, Germany
| | - Katja Akgun
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl Gustav Carus & Dresden University of Technology, Dresden, Germany
| | - Agnieszka Antos
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Marta Skowrońska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
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Daniel-Robin T, Bénichou B, Leboucher C, Blein C, Combal JP. Epidemiology, treatment and burden of Wilson disease in France: A 10-year analysis of the national health insurance database. Clin Res Hepatol Gastroenterol 2022; 46:101992. [PMID: 35793759 DOI: 10.1016/j.clinre.2022.101992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS Wilson disease (WD) is a rare hereditary, debilitating disease that is fatal if untreated. Given its low prevalence, collecting longitudinal information on large cohorts of patients is challenging. Analysis of health insurance databases offers an approach to meet this challenge. The aim of this study was to evaluate longitudinal trends in the presentation and management of patients with WD identified in the French national health insurance database (SNDS). METHODS This retrospective, longitudinal, observational study identified people with WD in the SNDS database through hospitalisation diagnosis codes and long-term illness status between 2009 and 2019 inclusive. For each patient, data were extracted on hospitalisations, liver transplantation, mortality, WD-specific treatments (d-penicillamine, trientine and zinc), disability status and sick leave. RESULTS 1,928 patients with WD were identified, of whom 1,520 (78.8%) were analysed. Prevalence of WD in 2019 was estimated as 2.2 cases per 100,000. Of the 670 patients first documented between 2010 and 2019, 76.1% were hospitalised at least once for a mean duration of 4.63±10.6 days. 152 patients (10.0%) underwent liver transplantation and 205 died (13.5%). The mean age at death was 57.9 ± 23.1 years. 665 patients (43.8%) received a WD-specific treatment at least once. 167 patients (17.1%) received a government disability pension and 624 (41.1%) benefited from long-term illness status due to WD. CONCLUSIONS Unexpectedly, less than half of patients with WD received treatment recommended in practice guidelines, which may contribute to a high disease burden in terms of hospitalisations, disability and reduced life expectancy. Improving treatment rates, building patient awareness of long-term disease impact or developing a new paradigm of treatment could make a significant contribution to reducing the disease burden.
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Zhang S, Liu A, Zhou Z, Huang Z, Cheng J, Chen D, Zhong Q, Yu Q, Peng Z, Hong M. Clinical features and power spectral entropy of electroencephalography in Wilson's disease with dystonia. Brain Behav 2022; 12:e2791. [PMID: 36282481 PMCID: PMC9759124 DOI: 10.1002/brb3.2791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/28/2022] [Accepted: 10/02/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To study the clinical features and power spectral entropy (PSE) of electroencephalography signals in Wilson's disease (WD) patients with dystonia. METHODS Several scale evaluations were performed to assess the clinical features of WD patients. Demographic information and electroencephalography signals were obtained in all subjects. RESULTS 34 WD patients with dystonia were recruited in the case group and 24 patients without dystonia were recruited in the control group. 20 healthy individuals were included in the healthy control group. The mean body mass index (BMI) in the case group was significantly lower than that in the controls (p < .05). The case group had significantly higher SAS, SDS, and Bucco-Facial-Apraxia Assessment scores (p < .05). Total BADS scores in the case group were lower than those in the control group (p < .01). Note that 94.11% of the case group presented with dysarthria and 70.59% of them suffered from dysphagia. Dysphagia was mainly related to the oral preparatory stage and oral stage. Mean power spectral entropy (PSE) values in the case group were significantly different (p < .05) from those in the control group and the healthy group across the different tasks. CONCLUSIONS The patients with dystonia were usually accompanied with low BMI, anxiety, depression, apraxia, executive dysfunction, dysarthria and dysphagia. The cortical activities of the WD patients with dystonia seemed to be more chaotic during the eyes-closed and reading tasks but lower during the swallowing stages than those in the control group.
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Affiliation(s)
- Shaoru Zhang
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Aiqun Liu
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Zhihua Zhou
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Zheng Huang
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Jing Cheng
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Danping Chen
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Qizhi Zhong
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Qingyun Yu
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Zhongxing Peng
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Mingfan Hong
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
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Członkowska A, Niewada M, Litwin T, Kraiński Ł, Skowrońska M, Piechal A, Antos A, Misztal M, Khanna I, Kurkowska-Jastrzębska I. Seven decades of clinical experience with Wilson's disease: Report from the national reference centre in Poland. Eur J Neurol 2022. [PMID: 36427277 DOI: 10.1111/ene.15646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/28/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Wilson's disease (WD) is a rare autosomal recessive disorder causing excessive copper deposition and a spectrum of manifestations, particularly neurological and hepatic symptoms. We analysed the clinical characteristics of patients with WD admitted to the country's only reference centre, which provided long-term care to most adult patients in Poland over seven decades (pre-1959 to 2019). METHODS Electronic prospective data collection began in the 2000s and, for prior years, medical records were analysed retrospectively. Demographic and clinical characteristics, treatment and outcomes were analysed by decade of diagnosis. Life-years lost were estimated in patients with WD compared with the general population. Kaplan-Meier curves were used for a time-to-death analysis using 2000-2009 as a reference. RESULTS In total, 929 patients were analysed. The number of patients increased from 21 before 1959 to 315 for 2000 to 2009 period. Mostly males were diagnosed before the 1990s, but the numbers of female patients diagnosed increased thereafter. Initially, most patients presented with neurological manifestations; however, the incidence of hepatic manifestations and asymptomatic presentations increased over time as patients were diagnosed early and consequently were more independent at diagnosis. Fewer Kayser-Fleischer rings were detected recently. Prior to 1970, patients were treated with D-penicillamine (DP); however, since the introduction of zinc, both therapies have been used as often. Since the 1990s, switches between DP and zinc were recorded in 6%-7% of patients. Consistent improvement in survival has been observed over the years. CONCLUSIONS This is the largest cohort of patients with WD reported in Poland, with the longest follow-up. Earlier diagnosis and prognosis have improved over seven decades.
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Affiliation(s)
- Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Łukasz Kraiński
- Decision Analysis and Support Unit, Warsaw School of Economics, Warsaw, Poland
| | - Marta Skowrońska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Agnieszka Piechal
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Antos
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Monika Misztal
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Ishani Khanna
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
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Zhu L, Yin H, Wang Y, Yang W, Dong T, Xu L, Hou Z, Shi Q, Shen Q, Lin Z, Zhao H, Xu Y, Chen Y, Wu J, Yu Z, Wen M, Huang J. Disrupted topological organization of the motor execution network in Wilson's disease. Front Neurol 2022; 13:1029669. [PMID: 36479050 PMCID: PMC9721349 DOI: 10.3389/fneur.2022.1029669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/08/2022] [Indexed: 07/25/2023] Open
Abstract
OBJECTIVE There are a number of symptoms associated with Wilson's disease (WD), including motor function damage. The neuropathological mechanisms underlying motor impairments in WD are, however, little understood. In this study, we explored changes in the motor execution network topology in WD. METHODS We conducted resting-state functional magnetic resonance imaging (fMRI) on 38 right-handed individuals, including 23 WD patients and 15 healthy controls of the same age. Based on graph theory, a motor execution network was constructed and analyzed. In this study, global, nodal, and edge topological properties of motor execution networks were compared. RESULTS The global topological organization of the motor execution network in the two groups did not differ significantly across groups. In the cerebellum, WD patients had a higher nodal degree. At the edge level, a cerebello-thalamo-striato-cortical circuit with altered functional connectivity strength in WD patients was observed. Specifically, the strength of the functional connections between the cerebellum and thalamus increased, whereas the cortical-thalamic, cortical-striatum and cortical-cerebellar connections exhibited a decrease in the strength of the functional connection. CONCLUSION There is a disruption of the topology of the motor execution network in WD patients, which may be the potential basis for WD motor dysfunction and may provide important insights into neurobiological research related to WD motor dysfunction.
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Aaseth JO, Nurchi VM. Chelation Combination-A Strategy to Mitigate the Neurotoxicity of Manganese, Iron, and Copper? Biomolecules 2022; 12:1713. [PMID: 36421727 PMCID: PMC9687779 DOI: 10.3390/biom12111713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 01/19/2024] Open
Abstract
The chelating thiol dimercaptosuccinate (DMSA) and the traditional agent D-penicillamine (PSH) are effective in enhancing the urinary excretion of copper (Cu) and lead (Pb) in poisoned individuals. However, DMSA, PSH, EDTA (ethylenediamine tetraacetate), and deferoxamine (DFOA) are water-soluble agents with limited access to the central nervous system (CNS). Strategies for mobilization of metals such as manganese (Mn), iron (Fe), and Cu from brain deposits may require the combined use of two agents: one water-soluble agent to remove circulating metal into urine, in addition to an adjuvant shuttler to facilitate the brain-to-blood mobilization. The present review discusses the chemical basis of metal chelation and the ligand exchange of metal ions. To obtain increased excretion of Mn, Cu, and Fe, early experiences showed promising results for CaEDTA, PSH, and DFOA, respectively. Recent experiments have indicated that p-amino salicylate (PAS) plus CaEDTA may be a useful combination to remove Mn from binding sites in CNS, while the deferasirox-DFOA and the tetrathiomolybdate-DMSA combinations may be preferable to promote mobilization of Fe and Cu, respectively, from the CNS. Further research is requested to explore benefits of chelator combinations.
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Affiliation(s)
- Jan O. Aaseth
- Department of Research, Innlandet Hospital Trust, P.O. Box 104, N-2381 Brumunddal, Norway
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, P.O. Box 104, N-2418 Elverum, Norway
| | - Valeria M. Nurchi
- Department of Life and Environmental Sciences, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Italy
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Chakraborty AP, Mukherjee A, Sarkar S, Sinharoy U, Biswas A. Evaluation of Non-Motor Symptoms in Wilson Disease Using the Parkinson's Disease Nonmotor Symptoms Questionnaire: A Pilot Cross-Sectional Study and Critical Assessment. Ann Indian Acad Neurol 2022; 25:1062-1066. [PMID: 36911485 PMCID: PMC9996490 DOI: 10.4103/aian.aian_1040_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 11/04/2022] Open
Abstract
Background There is a dearth of studies on non-motor symptoms of Wilson's disease (WD) which is primarily because of the non-availability of a suitable scale. Objective To assess the suitability of the Parkinson's Disease non motor symptoms questionnaire (PD-NMS Quest) in the assessment of non-motor symptoms of WD patients. Methods In this case-control study, patients of WD above ≥12 years of age diagnosed by Leipzig's criteria and age and gender-matched control subjects were recruited. Critically ill patients, patients with severe hepatic impairment, or with pure hepatic WD were excluded. PD-NMS Quest was applied and relevant statistical analyses were performed. Results A total of 18 cases and 25 controls were studied. Patients had a mean age of 22.6 years and a median disease duration of 8 years. WD patients had higher frequencies of all NMS than controls. Drooling (P = 0.0037), dysphagia or choking (P = 0.0088), nocturia (P = 0.0471), anxiety/fear (P = 0.0337), feeling sad or blue (P = 0.0020) and falling (P = 0.0197) were significantly higher in WD patients than controls. Conclusions Although many NMS of WD patients are picked up effectively with PD-NMS Quest, some of them need detail assessment including cognitive, behavioral, and psychiatric symptoms, drooling and dysphagia, sleep as well as autonomic disturbances. Questions pertaining to sexual activity may be omitted from the questionnaire.
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Affiliation(s)
- Arka P. Chakraborty
- Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India
| | - Adreesh Mukherjee
- Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India
| | - Sumanta Sarkar
- Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India
| | - Uma Sinharoy
- Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India
| | - Atanu Biswas
- Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Jouini W, Litaiem N, Zaimi Y, Mouelhi L, Debbeche R, Zeglaoui F. Omphalolith: An underdiagnosed entity. Clin Case Rep 2022; 10:e6443. [PMID: 36245467 PMCID: PMC9552982 DOI: 10.1002/ccr3.6443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/02/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Omphalolith is a rare and underdiagnosed entity due to the accumulation of sebum and keratin in the umbilicus. It usually occurs in the elderly with deep and narrow umbilicus. Early recognition of omphalolith is important to prevent complications, unnecessary investigations, and anxiety. We report herein two new cases of omphalolith.
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Affiliation(s)
- Wafa Jouini
- Department of DermatologyCharles Nicolle HospitalTunisTunisia,Faculté de Médecine de TunisUniversity of Tunis El ManarTunisTunisia
| | - Noureddine Litaiem
- Department of DermatologyCharles Nicolle HospitalTunisTunisia,Faculté de Médecine de TunisUniversity of Tunis El ManarTunisTunisia
| | - Yosra Zaimi
- Faculté de Médecine de TunisUniversity of Tunis El ManarTunisTunisia,Department of GastroenterologyCharles Nicolle HospitalTunisTunisia
| | - Leila Mouelhi
- Faculté de Médecine de TunisUniversity of Tunis El ManarTunisTunisia,Department of GastroenterologyCharles Nicolle HospitalTunisTunisia
| | - Radhouane Debbeche
- Faculté de Médecine de TunisUniversity of Tunis El ManarTunisTunisia,Department of GastroenterologyCharles Nicolle HospitalTunisTunisia
| | - Faten Zeglaoui
- Department of DermatologyCharles Nicolle HospitalTunisTunisia,Faculté de Médecine de TunisUniversity of Tunis El ManarTunisTunisia
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Lagrand TJ, McLaughlin L, Lehn AC. A Case to Tear One's Hair Out: Trichotillomania in Wilson's Disease. Mov Disord Clin Pract 2022; 9:829-831. [PMID: 35937476 PMCID: PMC9346243 DOI: 10.1002/mdc3.13514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/30/2022] [Accepted: 06/21/2022] [Indexed: 07/27/2023] Open
Affiliation(s)
- Tjerk J. Lagrand
- Department of NeurologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Laurie McLaughlin
- Department of NeurologyMater HospitalSouth BrisbaneQueenslandAustralia
- Faculty of MedicineGriffith UniversityGold CoastQueenslandAustralia
| | - Alexander C. Lehn
- Department of NeurologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
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Shribman S, Burrows M, Convery R, Bocchetta M, Sudre CH, Acosta-Cabronero J, Thomas DL, Gillett GT, Tsochatzis EA, Bandmann O, Rohrer JD, Warner TT. Neuroimaging Correlates of Cognitive Deficits in Wilson's Disease. Mov Disord 2022; 37:1728-1738. [PMID: 35723521 PMCID: PMC9542291 DOI: 10.1002/mds.29123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Cognitive impairment is common in neurological presentations of Wilson's disease (WD). Various domains can be affected, and subclinical deficits have been reported in patients with hepatic presentations. Associations with imaging abnormalities have not been systematically tested. OBJECTIVE The aim was to determine the neuroanatomical basis for cognitive deficits in WD. METHODS We performed a 16-item neuropsychological test battery and magnetic resonance brain imaging in 40 patients with WD. The scores for each test were compared between patients with neurological and hepatic presentations and with normative data. Associations with Unified Wilson's Disease Rating Scale neurological examination subscores were examined. Quantitative, whole-brain, multimodal imaging analyses were used to identify associations with neuroimaging abnormalities in chronically treated stable patients. RESULTS Abstract reasoning, executive function, processing speed, calculation, and visuospatial function scores were lower in patients with neurological presentations than in those with hepatic presentations and correlated with neurological examination subscores. Deficits in abstract reasoning and phonemic fluency were associated with lower putamen volumes even after controlling for neurological severity. About half of patients with hepatic presentations had poor performance in memory for faces, cognitive flexibility, or associative learning relative to normative data. These deficits were associated with widespread cortical atrophy and/or white matter diffusion abnormalities. CONCLUSIONS Subtle cognitive deficits in patients with seemingly hepatic presentations represent a distinct neurological phenotype associated with diffuse cortical and white matter pathology. This may precede the classical neurological phenotype characterized by movement disorders and executive dysfunction and be associated with basal ganglia damage. A binary phenotypic classification for WD may no longer be appropriate. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Samuel Shribman
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London
| | - Maggie Burrows
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London
| | - Rhian Convery
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Martina Bocchetta
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Carole H Sudre
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom.,Centre for Medical Image Computing, University College London, London, United Kingdom.,Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | | | - David L Thomas
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom.,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, United Kingdom.,Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Godfrey T Gillett
- Department of Clinical Chemistry, Northern General Hospital, Sheffield, United Kingdom
| | - Emmanuel A Tsochatzis
- UCL Institute of Liver and Digestive Health and Royal Free Hospital, London, United Kingdom
| | - Oliver Bandmann
- Sheffield Institute of Translational Neuroscience, Sheffield, United Kingdom
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Thomas T Warner
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London
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Majid Z, Abrar G, Laeeq SM, Khan SA, Ismail H, Soomro GB, Mehmood N, Tasneem AA, Hanif FM, Mandhwani R, Luck NH. Clinical Characteristics and Comparison of Different Prognostic Scores in Wilson's Disease. Euroasian J Hepatogastroenterol 2022; 12:69-72. [PMID: 36959988 PMCID: PMC10028702 DOI: 10.5005/jp-journals-10018-1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Aim Wilson's disease (WD) is a rare autosomal recessive disease, that can involve any organ of the body, the main ones being the liver and the brain. These patients can have varied presentations, ranging from having no symptoms to having neurological manifestations to features of chronic liver disease (CLD). Those patients that end up having CLD are prognosticated via the Child-Turcotte-Pugh (CTP) score and the Model for End-stage Liver Disease (MELD) score. However, two specific scores exist for prognostication in patients having WD, namely, the Nazar score and the Dhawan score. However, these are yet to be validated nor has their use been implemented in clinical practice. Materials and methods Our study involved 65 patients with WD, comprising both the pediatric and the adult population. We aimed at evaluating the clinical manifestations the lab parameters and the management of these patients. Furthermore, we tried validating the Nazar and the Dhawan score and later compared them with the CTP and the MELD score, which are well-known prognostic tools in CLD. Results Our patients were subdivided into the pediatric (more than 50%) and the adult group. The most common presenting complaint noted in both groups was abdominal distension. Values of the urine copper and serum ceruloplasmin did not defer between the pediatric and adult patients. Hepatic involvement is frequently seen in the pediatric age-group. Also, CTP class C was chiefly seen in pediatrics 17/33 (51.5%), while CTP class B was in adults 13/32 (40.6%). The mean Nazar score was 3 ± 3, while the mean Dhawan score was 5 ± 4. The main treatment offered for both groups was zinc along with penicillamine. Conclusion Our study showed the Dhawan score was comparable to the CTP and the MELD score in terms of predicting the disease severity of WD in our patient population. How to cite this article Majid Z, Abrar G, Laeeq SM, et al. Clinical Characteristics and Comparison of Different Prognostic Scores in Wilson's Disease. Euroasian J Hepato-Gastroenterol 2022;12(2):69-72.
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Affiliation(s)
- Zain Majid
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Ghazi Abrar
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Syed Mudassir Laeeq
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Shoaib Ahmed Khan
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Hina Ismail
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Ghous Bux Soomro
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Nasir Mehmood
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Abbas Ali Tasneem
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Farina Muhammad Hanif
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Rajesh Mandhwani
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Nasir Hasan Luck
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
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Jing XZ, Yuan XZ, Li GY, Chen JL, Wu R, Yang LL, Zhang SY, Wang XP, Li JQ. Increased Magnetic Susceptibility in the Deep Gray Matter Nuclei of Wilson's Disease: Have We Been Ignoring Atrophy? Front Neurosci 2022; 16:794375. [PMID: 35720701 PMCID: PMC9198485 DOI: 10.3389/fnins.2022.794375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Histopathological studies in Wilson's disease (WD) have revealed increased copper and iron concentrations in the deep gray matter nuclei. However, the commonly used mean bulk susceptibility only reflects the regional metal concentration rather than the total metal content, and regional atrophy may affect the assessment of mean bulk susceptibility. Our study aimed to quantitatively assess the changes of metal concentration and total metal content in deep gray matter nuclei by quantitative susceptibility mapping to distinguish patients with neurological and hepatic WD from healthy controls. Methods Quantitative susceptibility maps were obtained from 20 patients with neurological WD, 10 patients with hepatic WD, and 25 healthy controls on a 3T magnetic resonance imaging system. Mean bulk susceptibility, volumes, and total susceptibility of deep gray matter nuclei in different groups were compared using a linear regression model. The area under the curve (AUC) was calculated by receiver characteristic curve to analyze the diagnostic capability of mean bulk susceptibility and total susceptibility. Results Mean bulk susceptibility and total susceptibility of multiple deep gray matter nuclei in patients with WD were higher than those in healthy controls. Compared with patients with hepatic WD, patients with neurological WD had higher mean bulk susceptibility but similar total susceptibility in the head of the caudate nuclei, globus pallidus, and putamen. Mean bulk susceptibility of putamen demonstrated the best diagnostic capability for patients with neurological WD, the AUC was 1, and the sensitivity and specificity were all equal to 1. Total susceptibility of pontine tegmentum was most significant for the diagnosis of patients with hepatic WD, the AUC was 0.848, and the sensitivity and specificity were 0.7 and 0.96, respectively. Conclusion Brain atrophy may affect the assessment of mean bulk susceptibility in the deep gray matter nuclei of patients with WD, and total susceptibility should be an additional metric for total metal content assessment. Mean bulk susceptibility and total susceptibility of deep gray matter nuclei may be helpful for the early diagnosis of WD.
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Affiliation(s)
- Xiao-Zhong Jing
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang-Zhen Yuan
- Department of Neurology, Weifang People's Hospital, Weifang, China
| | - Gai-Ying Li
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Jia-Lin Chen
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Rong Wu
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling-Li Yang
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu-Yun Zhang
- Department of Neurology, Weifang People's Hospital, Weifang, China
| | - Xiao-Ping Wang
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Qi Li
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
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