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Hu S, Wei T, Li C, Wang X, Nguchu BA, Wang Y, Dong T, Yang Y, Ding Y, Qiu B, Yang W. Abnormalities in subcortical function and their treatment response in Wilson's disease. Neuroimage Clin 2024; 43:103618. [PMID: 38830274 DOI: 10.1016/j.nicl.2024.103618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/22/2024] [Accepted: 05/10/2024] [Indexed: 06/05/2024]
Abstract
Extensive neuroimaging abnormalities in subcortical regions build the pathophysiological basis of Wilson's disease (WD). Yet, subcortical topographic organization fails to articulate, leaving a huge gap in understanding the neural mechanism of WD. Thus, how functional abnormalities of WD subcortical regions influence complex clinical symptoms and response to treatment remain unknown. Using resting-state functional MRI data from 232 participants (including 130 WD patients and 102 healthy controls), we applied a connectivity-based parcellation technique to develop a subcortical atlas for WD. The atlas was further used to investigate abnormalities in subcortical function (ASF) by exploring intrasubcortical functional connectivity (FC) and topographic organization of cortico-subcortical FC. We further used support vector machine (SVM) to integrate these functional abnormalities into the ASF score, which serves as a biomarker for characterizing individual subcortical dysfunction for WD. Finally, the baseline ASF score and one-year treatment data of the follow-up WD patients were used to assess treatment response. A group set of subcortical parcellations was evaluated, in which 26 bilateral regions well recapitulated the anatomical nuclei of the subcortical areas of WD. The results of cortico-subcortical FC and intrasubcortical FC reveal that dysfunction of the somatomotor networks-lenticular nucleus-thalamic pathways is involved in complex symptoms of WD. The ASF score was able to characterize disease progression and was significantly associated with treatment response of WD. Our findings provide a comprehensive elaboration of functional abnormalities of WD subcortical regions and reveal their association with clinical presentations, improving our understanding of the functional neural underpinnings in WD. Furthermore, abnormalities in subcortical function could serve as a potential biomarker for understanding the disease progression and evaluating treatment response of WD.
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Affiliation(s)
- Sheng Hu
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, 230031, China; Center for Biomedical Imaging, University of Science and Technology of China, Hefei, Anhui, 2300026, China; School of Medical Information Engineering, Anhui University of Traditional Chinese Medicine, Hefei, Anhui, 230012, China
| | - Taohua Wei
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, 230031, China; Key Laboratory of Xin'an Medicine of the Ministry of Education, Anhui University of Traditional Chinese Medicine, Hefei, Anhui, 230031, China
| | - Chuanfu Li
- Medical Imaging Center, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, 230031, China.
| | - Xiaoxiao Wang
- Center for Biomedical Imaging, University of Science and Technology of China, Hefei, Anhui, 2300026, China
| | | | - Yanming Wang
- Center for Biomedical Imaging, University of Science and Technology of China, Hefei, Anhui, 2300026, China
| | - Ting Dong
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, 230031, China; Key Laboratory of Xin'an Medicine of the Ministry of Education, Anhui University of Traditional Chinese Medicine, Hefei, Anhui, 230031, China
| | - Yulong Yang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, 230031, China
| | - Yufeng Ding
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, 230031, China
| | - Bensheng Qiu
- Center for Biomedical Imaging, University of Science and Technology of China, Hefei, Anhui, 2300026, China.
| | - Wenming Yang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, 230031, China; Key Laboratory of Xin'an Medicine of the Ministry of Education, Anhui University of Traditional Chinese Medicine, Hefei, Anhui, 230031, China.
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Basal ganglia-orbitofrontal circuits are associated with prospective memory deficits in Wilson's disease. Brain Imaging Behav 2021; 16:141-150. [PMID: 34297310 DOI: 10.1007/s11682-021-00485-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
Degenerative changes in the basal ganglia (BG) are thought to contribute to neurological symptoms in Wilson's disease (WD). However, very little is known about whether and how the BG have an influence on prospective memory (PM) by interacting with the cerebral cortex. Here, we employed structural magnetic resonance imaging to systematically examine the effect of volume atrophy of BG on cortical thickness and to evaluate the relationships between cortical thickness of regions associated with BG atrophy and PM performance in WD. Cortical thickness atrophy in the left temporal pole and medial frontal gyrus are not related to degenerative changes in BG. Cortical thickness in the left superior frontal gyrus and right orbitofrontal gyrus (ORB) have stronger correlations with volume atrophy of the left accumbens, pallidum, and putamen in WD when compared with healthy controls. Furthermore, the cortical thickness of the right ORB is not only significantly correlated with PM performance but can also distinguish the severity of PM impairment in WD. Additionally, the middle cingulate cortex was related to volume atrophy of the accumbens, and its cortical thickness has a significant positive correlation with event-based PM. Together, these findings highlight that BG-orbitofrontal circuits may serve as neural biomarkers of PM and provide implications for the neural mechanisms underlying cognitive impairment in WD.
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Lin J, Zheng Y, Liu Y, Lin Y, Wang Q, Lin XH, Zhu W, Lin WH, Wang N, Chen WJ, Fu Y. Higher Concentration of Plasma Glial Fibrillary Acidic Protein in Wilson Disease Patients with Neurological Manifestations. Mov Disord 2021; 36:1446-1450. [PMID: 33502774 PMCID: PMC8248415 DOI: 10.1002/mds.28509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 12/21/2022] Open
Abstract
Background Wilson disease is a rare, disabling, neurological genetic disease. Biomarkers of brain damage are less well developed. Objective The aim of this study was to evaluate the utility of plasma glial fibrillary acidic protein as a biomarker for neurological involvement in patients with Wilson disease. Methods This prospective cross‐observational study compared plasma glial fibrillary acidic protein concentration among different subtypes of patients with Wilson disease and healthy control subjects. Plasma glial fibrillary acidic protein levels were measured in 94 patients and 25 healthy control subjects. Patients were divided into two subtypes: patients with neurological manifestations (n = 74) or hepatic manifestations (n = 20). Results Median levels of plasma glial fibrillary acidic protein were significantly elevated in patients with neurological manifestations (143.87 pg/mL) compared with those with hepatic manifestations (107.50 pg/mL) and healthy control subjects (86.85 pg/mL). Receiver operating characteristic curve revealed that a plasma glial fibrillary acidic protein cutoff value of 128.8 pg/mL provides sufficient sensitivity (80.0%) and specificity (63.5%) to differentiate patients with neurological manifestations from those with hepatic manifestations. Conclusions Plasma glial fibrillary acidic protein may serve as a biomarker for distinguishing different subtypes of Wilson disease. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Jie Lin
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Yexiang Zheng
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Ying Liu
- Department of Radiology of First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yi Lin
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Qiqi Wang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Xiao-Hong Lin
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Wenli Zhu
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Wei-Hong Lin
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Ning Wang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Wan-Jin Chen
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Ying Fu
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
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Dong J, Wang X, Xu C, Gao M, Wang S, Zhang J, Tong H, Wang L, Han Y, Cheng N, Han Y. Inhibiting NLRP3 inflammasome activation prevents copper-induced neuropathology in a murine model of Wilson's disease. Cell Death Dis 2021; 12:87. [PMID: 33462188 PMCID: PMC7813851 DOI: 10.1038/s41419-021-03397-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 12/14/2022]
Abstract
Wilson’s disease (WD) is an inherited disorder characterized by excessive accumulation of copper in the body, particularly in the liver and brain. In the central nervous system (CNS), extracellular copper accumulation triggers pathological microglial activation and subsequent neurotoxicity. Growing evidence suggests that levels of inflammatory cytokines are elevated in the brain of murine WD models. However, the mechanisms associated with copper deposition to neuroinflammation have not been completely elucidated. In this study, we investigated how the activation of NLR family pyrin domain containing 3 (NLRP3) inflammasome contributes to copper-mediated neuroinflammation in an animal model of WD. Elevated levels of interleukin-1β, interleukin-18, interleukin-6, and tumor necrosis factor-α were observed in the sera of WD patients and toxic milk (TX) mice. The protein levels of inflammasome adaptor molecule apoptosis-associated speck-like protein containing a C-terminal caspase recruitment domain (ASC), cleaved caspase-1, and interleukin-1β were upregulated in the brain regions of the TX mice. The NLRP3 inflammasome was activated in the TX mice brains. Furthermore, the activation of NLRP3 inflammasome was noted in primary microglia treated with CuCl2, accompanied by the increased levels of cleaved caspase-1, ASC, and interleukin-1β. Blocking NLRP3 inflammasome activation with siNlrp3 or MCC950 reduced interleukin-1β and interleukin-18 production, thereby effectively mitigating cognitive decline, locomotor behavior impairment, and neurodegeneration in TX mice. Overall, our study demonstrates the contribution of copper overload-mediated activation of NLRP3 inflammasome to progressive neuropathology in the CNS of a murine model of WD. Therefore, blockade of the NLRP3 inflammasome activation could be a potential therapeutic strategy for WD.
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Affiliation(s)
- Jianjian Dong
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, P. R. China.,University of Science and Technology of China, Hefei, 230026, P. R. China.,The Affiliated Hospital of the Neurology Institute, Anhui University of Chinese Medicine, Hefei, 230061, P. R. China
| | - Xun Wang
- The Affiliated Hospital of the Neurology Institute, Anhui University of Chinese Medicine, Hefei, 230061, P. R. China.,Anhui University of Chinese Medicine, Hefei, 230012, P. R. China
| | - Chenchen Xu
- The Affiliated Hospital of the Neurology Institute, Anhui University of Chinese Medicine, Hefei, 230061, P. R. China.,Anhui University of Chinese Medicine, Hefei, 230012, P. R. China
| | - Manli Gao
- The Affiliated Hospital of the Neurology Institute, Anhui University of Chinese Medicine, Hefei, 230061, P. R. China.,Anhui University of Chinese Medicine, Hefei, 230012, P. R. China
| | - Shijing Wang
- The Affiliated Hospital of the Neurology Institute, Anhui University of Chinese Medicine, Hefei, 230061, P. R. China.,Anhui University of Chinese Medicine, Hefei, 230012, P. R. China
| | - Jin Zhang
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, P. R. China
| | - Haiyang Tong
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, P. R. China
| | - Lulu Wang
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, P. R. China
| | - Yongzhu Han
- The Affiliated Hospital of the Neurology Institute, Anhui University of Chinese Medicine, Hefei, 230061, P. R. China.,Anhui University of Chinese Medicine, Hefei, 230012, P. R. China
| | - Nan Cheng
- The Affiliated Hospital of the Neurology Institute, Anhui University of Chinese Medicine, Hefei, 230061, P. R. China. .,Anhui University of Chinese Medicine, Hefei, 230012, P. R. China.
| | - Yongsheng Han
- The Affiliated Hospital of the Neurology Institute, Anhui University of Chinese Medicine, Hefei, 230061, P. R. China. .,Anhui University of Chinese Medicine, Hefei, 230012, P. R. China.
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Yuan XZ, Yang RM, Wang XP. Management Perspective of Wilson's Disease: Early Diagnosis and Individualized Therapy. Curr Neuropharmacol 2021; 19:465-485. [PMID: 32351182 PMCID: PMC8206458 DOI: 10.2174/1570159x18666200429233517] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 02/05/2023] Open
Abstract
Wilson's disease (WD) is an inherited disease caused by mutations in ATP7B and is characterized by the pathological accumulation of copper in the liver and brain. Common clinical manifestations of WD include a wide range of liver disease and neurological symptoms. In some patients, psychiatric symptoms may be the only manifestation at the time of diagnosis. The clinical features of WD are highly variable and can mimic any disease of internal medicine. Therefore, for unexplained medical diseases, the possibility of WD should not be ignored. Early diagnosis and treatment can improve the prognosis of WD patients and reduce disability and early death. Gene sequencing is becoming a valuable method to diagnose WD, and if possible, all WD patients and their siblings should be genetically sequenced. Copper chelators including D-penicillamine, trientine, and dimercaptosuccinic acid can significantly improve the liver injury and symptoms of WD patients but may have a limited effect on neurological symptoms. Zinc salts may be more appropriate for the treatment of asymptomatic patients or for the maintenance treatment of symptomatic patients. High-quality clinical trials for the drug treatment of WD are still lacking, therefore, individualized treatment options for patients are recommended. Individualized treatment can be determined based on the clinical features of the WD patients, efficacy and adverse effects of the drugs, and the experience of the physician. Liver transplantation is the only effective method to save patients with acute liver failure or with severe liver disease who fail drug treatment.
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Affiliation(s)
| | | | - Xiao-Ping Wang
- Address correspondence to this author at the Department of Neurology, TongRen Hospital, Shanghai Jiao Tong University School of Medicine, No.1111 Xianxia Road, 200336, Shanghai, China; Tel: +86-021-52039999-72223; Fax: +86-021-52039999-72223; E-mail:
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Dusek P, Smolinski L, Redzia‐Ogrodnik B, Golebiowski M, Skowronska M, Poujois A, Laurencin C, Jastrzebska‐Kurkowska I, Litwin T, Członkowska A. Semiquantitative Scale for Assessing Brain MRI Abnormalities in Wilson Disease: A Validation Study. Mov Disord 2020; 35:994-1001. [DOI: 10.1002/mds.28018] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 01/30/2023] Open
Affiliation(s)
- Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, Charles University in PragueFirst Faculty of Medicine and General University Hospital Prague Czech Republic
- Department of Radiology, Charles University in PragueFirst Faculty of Medicine and General University Hospital Prague Czech Republic
| | - Lukasz Smolinski
- 2nd Department of NeurologyInstitute of Psychiatry and Neurology Warsaw Poland
| | | | - Marek Golebiowski
- Department of Clinical RadiologyMedical University of Warsaw Warsaw Poland
| | - Marta Skowronska
- 2nd Department of NeurologyInstitute of Psychiatry and Neurology Warsaw Poland
| | - Aurelia Poujois
- Neurology Department, French National Reference Centre for Wilson's DiseaseFondation Ophtalmologique Adolphe de Rothschild Paris France
| | - Chloe Laurencin
- Neurology Department, French National Reference Centre for Wilson's DiseaseUniversity Hospital of Lyon Lyon France
| | | | - Tomasz Litwin
- 2nd Department of NeurologyInstitute of Psychiatry and Neurology Warsaw Poland
| | - Anna Członkowska
- 2nd Department of NeurologyInstitute of Psychiatry and Neurology Warsaw Poland
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Brain volume is related to neurological impairment and to copper overload in Wilson's disease. Neurol Sci 2019; 40:2089-2095. [PMID: 31147855 PMCID: PMC6745045 DOI: 10.1007/s10072-019-03942-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/16/2019] [Indexed: 12/16/2022]
Abstract
Introduction To determine whether brain volume was associated with functional and neurological impairments and with copper overload markers in patients with Wilson’s disease. Methods In 48 treatment-naïve patients, we assessed functional and neurological impairments with the Unified Wilson’s Disease Rating Scale, measured normalized brain volumes based on magnetic resonance images, and assessed concentration of non-ceruloplasmin-bound copper. We correlated brain volume measures with functional and neurological impairment scores and copper overload indices. Results Functional and neurological impairments correlated with all brain volume measures, including the total brain volume and the volumes of white matter and gray matter (both peripheral gray matter and deep brain nuclei). Higher non-ceruloplasmin-bound copper concentrations were associated with greater functional and neurological impairments and lower brain volumes. Conclusions Our findings provided the first in vivo evidence that the severity of brain atrophy is a correlate of functional and neurological impairments in patients with Wilson’s disease and that brain volume could serve as a marker of neurodegeneration induced by copper. Electronic supplementary material The online version of this article (10.1007/s10072-019-03942-z) contains supplementary material, which is available to authorized users.
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Dusek P, Litwin T, Członkowska A. Neurologic impairment in Wilson disease. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S64. [PMID: 31179301 DOI: 10.21037/atm.2019.02.43] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neurologic symptoms in Wilson disease (WD) appear at an older age compared to hepatic symptoms and manifest in patients with misdiagnosed liver disease, in patients when the hepatic stage is clinically silent, in the case of non-compliance with anti-copper treatment, or with treatment failure. Neurologic symptoms in WD are caused by nervous tissue damage that is primarily a consequence of extrahepatic copper toxicity. Copper levels in brain tissues as well as cerebrospinal fluid (CSF) are diffusely increased by a factor of 10 and its toxicity involves various mechanisms such as mitochondrial toxicity, oxidative stress, cell membrane damage, crosslinking of DNA, and inhibition of enzymes. Excess copper is initially taken-up and buffered by astrocytes and oligodendrocytes but ultimately causes dysfunction of blood-brain-barrier and demyelination. Most severe neuropathologic abnormalities, including tissue rarefaction, reactive astrogliosis, myelin palor, and presence of iron-laden macrophages, are typically present in the putamen while other basal ganglia, thalami, and brainstem are usually less affected. The most common neurologic symptoms of WD are movement disorders including tremor, dystonia, parkinsonism, ataxia and chorea which are associated with dysphagia, dysarthria and drooling. Patients usually manifest with various combinations of these symptoms while purely monosymptomatic presentation is rare. Neurologic symptoms are largely reversible with anti-copper treatment, but a significant number of patients are left with residual impairment. The approach for symptomatic treatment in WD is based on guidelines for management of common movement disorders. The vast majority of WD patients with neurologic symptoms have abnormalities on brain magnetic resonance imaging (MRI). Pathologic MRI changes include T2 hyperintensities in the basal ganglia, thalami and white matter, T2 hypointensities in the basal ganglia, and atrophy. Most importantly, brain damage and neurologic symptoms can be prevented with an early initiation of anti-copper treatment. Introducing population WD screening, e.g., by exome sequencing genetic methods, would allow early treatment and decrease the neurologic burden of WD.
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Affiliation(s)
- Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia.,Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Tomasz Litwin
- 2nd Department of Neurology, Institute Psychiatry and Neurology, Warsaw, Poland
| | - Anna Członkowska
- 2nd Department of Neurology, Institute Psychiatry and Neurology, Warsaw, Poland
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Poujois A, Woimant F. Challenges in the diagnosis of Wilson disease. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S67. [PMID: 31179304 PMCID: PMC6531657 DOI: 10.21037/atm.2019.02.10] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/31/2019] [Indexed: 01/17/2023]
Abstract
The understanding and management of Wilson disease (WD) have dramatically improved since the first description of the disease by K. Wilson more than a century ago. However, the persistent long delay between the first symptoms and diagnosis emphasizes challenges in diagnosing earlier this copper overload disorder. As a treatable disease, WD should be detected early in the course of the disease by any health professionals at any care level, but the rare prevalence of the disease explains the lack of awareness of referring physicians. The most important challenge is to train physicians to recognize atypical or rare symptoms of WD that will lead to discuss the diagnosis more systematically. Atypia can come from the age of onset, the liver [non-alcoholic steatohepatitis (NASH) presentation], the central or peripheral nervous system (neuropathy, epilepsy, sleep disorders…) or may be due to lesions of other organs (renal manifestations, osteo-articular disorders or endocrine disturbances). Isolated biological anomalies, rare radiological findings or inadequate interpretation of copper test may also lead to misdiagnosis. The second challenge is to confirm the diagnosis faster and more effectively so as not to delay the initiation of treatment, and expand family screening as the genetic prevalence is higher than previously expected. Generalization of the exchangeable copper assay and the next generation sequencing (NGS) are two promising ways to overcome this ultimate challenge. By drawing attention to the earliest and rare symptoms and to new biomarkers and diagnostic tools, we hope that this article will increase diagnostic awareness and reduce delays so that patients can start their treatment earlier in the course of the illness and thus have a better disease prognosis.
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Affiliation(s)
- Aurélia Poujois
- Neurology Department, AP-HP, Lariboisière University Hospital, Paris, France
- National Reference Centre for Wilson Disease, AP-HP, Lariboisière University Hospital, Paris, France
| | - France Woimant
- Neurology Department, AP-HP, Lariboisière University Hospital, Paris, France
- National Reference Centre for Wilson Disease, AP-HP, Lariboisière University Hospital, Paris, France
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Zou L, Song Y, Zhou X, Chu J, Tang X. Regional morphometric abnormalities and clinical relevance in Wilson's disease. Mov Disord 2019; 34:545-554. [PMID: 30817852 DOI: 10.1002/mds.27641] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/17/2018] [Accepted: 01/04/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Lin Zou
- Department of Electrical and Electronic Engineering; Southern University of Science and Technology; Shenzhen Guangdong China
| | - Yukun Song
- Department of Radiology; The First Affiliated Hospital of Xiamen University; Xiamen Fujian China
| | - Xiangxue Zhou
- Department of Neurology, Eastern Hospital; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou Guangdong China
| | - Jianping Chu
- Department of Radiology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou Guangdong China
| | - Xiaoying Tang
- Department of Electrical and Electronic Engineering; Southern University of Science and Technology; Shenzhen Guangdong China
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Woimant F, Djebrani-Oussedik N, Collet C, Girardot N, Poujois A. The hidden face of Wilson's disease. Rev Neurol (Paris) 2018; 174:589-596. [DOI: 10.1016/j.neurol.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 02/07/2023]
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Członkowska A, Litwin T, Dusek P, Ferenci P, Lutsenko S, Medici V, Rybakowski JK, Weiss KH, Schilsky ML. Wilson disease. Nat Rev Dis Primers 2018; 4:21. [PMID: 30190489 PMCID: PMC6416051 DOI: 10.1038/s41572-018-0018-3] [Citation(s) in RCA: 401] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Wilson disease (WD) is a potentially treatable, inherited disorder of copper metabolism that is characterized by the pathological accumulation of copper. WD is caused by mutations in ATP7B, which encodes a transmembrane copper-transporting ATPase, leading to impaired copper homeostasis and copper overload in the liver, brain and other organs. The clinical course of WD can vary in the type and severity of symptoms, but progressive liver disease is a common feature. Patients can also present with neurological disorders and psychiatric symptoms. WD is diagnosed using diagnostic algorithms that incorporate clinical symptoms and signs, measures of copper metabolism and DNA analysis of ATP7B. Available treatments include chelation therapy and zinc salts, which reverse copper overload by different mechanisms. Additionally, liver transplantation is indicated in selected cases. New agents, such as tetrathiomolybdate salts, are currently being investigated in clinical trials, and genetic therapies are being tested in animal models. With early diagnosis and treatment, the prognosis is good; however, an important issue is diagnosing patients before the onset of serious symptoms. Advances in screening for WD may therefore bring earlier diagnosis and improvements for patients with WD.
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Affiliation(s)
- Anna Członkowska
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland.
| | - Tomasz Litwin
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Petr Dusek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Peter Ferenci
- Internal Medicine 3, Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Svetlana Lutsenko
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valentina Medici
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznań University of Medical Sciences, Poznań, Poland
| | - Karl Heinz Weiss
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael L Schilsky
- Section of Digestive Diseases and Transplantation and Immunology, Department of Medicine and Surgery, Yale University School of Medicine, New Haven, CT, USA
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Belkhribchia MR, Belabbes S, Loukili M, El Hasni I, El Makkaoui M. An unusual and devastating presentation of neurologic Wilson's disease with extensive brain MRI lesions. Presse Med 2018; 47:588-591. [DOI: 10.1016/j.lpm.2018.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/28/2018] [Accepted: 03/27/2018] [Indexed: 11/26/2022] Open
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Song YK, Li XB, Huang XL, Zhao J, Zhou XX, Wang YL, Yan X, Wang JY, Chu JP. A study of neurite orientation dispersion and density imaging in wilson's disease. J Magn Reson Imaging 2017; 48:423-430. [PMID: 29251804 DOI: 10.1002/jmri.25930] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 12/04/2017] [Indexed: 11/07/2022] Open
Affiliation(s)
- Yu-kun Song
- Department of Radiology; First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Xin-bei Li
- Department of Radiology; Shenzhen Traditional Chinese Medicine Hospital; Shenzhen China
| | - Xiao-long Huang
- Department of Neurology; Sun Yat-sen Memorial Hospital of Sun Yat-sen University; Guangzhou China
| | - Jing Zhao
- Department of Radiology; First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Xiang-xue Zhou
- Department of Neurology, Eastern Hospital; First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Yu-liang Wang
- Department of Radiology; Shenzhen Nan Shan Hospital; Shenzhen China
| | - Xu Yan
- MR Collaboration NE Asia; Siemens Healthcare; Shanghai China
| | - Jing-yan Wang
- Department of Radiology; First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Jian-ping Chu
- Department of Radiology; First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
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Peyroux E, Santaella N, Broussolle E, Rigard C, Favre E, Brunet AS, Bost M, Lachaux A, Demily C. Social cognition in Wilson's disease: A new phenotype? PLoS One 2017; 12:e0173467. [PMID: 28384152 PMCID: PMC5383022 DOI: 10.1371/journal.pone.0173467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 02/22/2017] [Indexed: 12/24/2022] Open
Abstract
Studies focusing on neuropsychological impairments in Wilson’s disease (WD) have highlighted that patients showing neurological signs present significant deficits in a wide range of cognitive domains. Attentional and executive impairments have also been described in people with hepatic WD. However, social cognition abilities, i.e. cognitive processes required to perceive the emotions, intentions and dispositions of other people, have not been clearly investigated in WD. In this study we examined the social cognitive functioning in 19 patients with WD depending on their clinical status–Neurological versus Non-Neurological (“hepatic”) forms–compared to 20 healthy controls. For the very first time, results highlighted that patients with WD had significant impairments in the three major components of social cognition: emotion recognition, Theory of Mind and attributional style. However, these deficits differ depending on the form of the disease: patients with neurological signs showed a wide range of deficits in the three components that were assessed–results notably revealed impairments in recognizing “fear”, “anger”, and “disgust”, a significant Theory of Mind deficit and an “aggression bias”–whereas Non-Neurological patients only showed deficits on test assessing attributional bias, with a trend to react more “aggressively” to ambiguous social situations than healthy controls, as observed in Neurological WD patients, and a specific impairment in “anger” recognition. Our findings are discussed in the light of both neurocognitive impairments and brain damages, and especially those affecting the basal ganglia, as observed in people with WD.
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Affiliation(s)
- Elodie Peyroux
- Genopsy–Center for the Diagnosis and Management of Genetic Psychiatric Disorders, Le Vinatier Hospital, Lyon, France
- University Department of Rehabilitation (SUR/CL3R), Le Vinatier Hospital, Lyon, France
- * E-mail:
| | | | - Emmanuel Broussolle
- Department of Neurology C, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon, France
- Center of Cognitive Neurosciences, UMR 5229, CNRS, Lyon, France
- Claude Bernard–Lyon 1 University, Lyon, France
| | - Caroline Rigard
- Genopsy–Center for the Diagnosis and Management of Genetic Psychiatric Disorders, Le Vinatier Hospital, Lyon, France
| | - Emilie Favre
- Department of Neurology C, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon, France
- French National Center for Wilson’s Disease, Hospices Civils de Lyon, Lyon, France
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Lyon, Hospices Civils de Lyon, Lyon, France
| | - Anne-Sophie Brunet
- French National Center for Wilson’s Disease, Hospices Civils de Lyon, Lyon, France
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Lyon, Hospices Civils de Lyon, Lyon, France
| | - Muriel Bost
- French National Center for Wilson’s Disease, Hospices Civils de Lyon, Lyon, France
- Laboratory of Inherited Metabolic Diseases, CBPE, Lyon, France
- Laboratory of Trace Element and Toxic Metal Analysis, Edouard Herriot Hospital, Lyon, France
| | - Alain Lachaux
- Claude Bernard–Lyon 1 University, Lyon, France
- French National Center for Wilson’s Disease, Hospices Civils de Lyon, Lyon, France
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Lyon, Hospices Civils de Lyon, Lyon, France
| | - Caroline Demily
- Genopsy–Center for the Diagnosis and Management of Genetic Psychiatric Disorders, Le Vinatier Hospital, Lyon, France
- Center of Cognitive Neurosciences, UMR 5229, CNRS, Lyon, France
- Claude Bernard–Lyon 1 University, Lyon, France
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Nagesh C, Asranna A, K P D, Cherian A, Nanda S, Thomas B. Culpable brain lesion causing complex partial status in Wilson's disease: Deduction by arterial spin labeled perfusion MRI. Seizure 2017; 46:50-52. [PMID: 28242441 DOI: 10.1016/j.seizure.2017.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/15/2017] [Accepted: 02/14/2017] [Indexed: 10/20/2022] Open
Affiliation(s)
- Chinmay Nagesh
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
| | - Ajay Asranna
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Divya K P
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Ajith Cherian
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Satyan Nanda
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
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18
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Abstract
Copper is an essential trace metal that is required for several important biological processes, however, an excess of copper can be toxic to cells. Therefore, systemic and cellular copper homeostasis is tightly regulated, but dysregulation of copper homeostasis may occur in disease states, resulting either in copper deficiency or copper overload and toxicity. This chapter will give an overview on the biological roles of copper and of the mechanisms involved in copper uptake, storage, and distribution. In addition, we will describe potential mechanisms of the cellular toxicity of copper and copper oxide nanoparticles. Finally, we will summarize the current knowledge on the connection of copper toxicity with neurodegenerative diseases.
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Affiliation(s)
- Felix Bulcke
- Center for Biomolecular Interactions Bremen, Faculty 2 (Biology/Chemistry), University of Bremen, Bremen, Germany
- Center for Environmental Research and Sustainable Technology, Bremen, Germany
| | - Ralf Dringen
- Center for Biomolecular Interactions Bremen, Faculty 2 (Biology/Chemistry), University of Bremen, Bremen, Germany
- Center for Environmental Research and Sustainable Technology, Bremen, Germany
| | - Ivo Florin Scheiber
- Center for Biomolecular Interactions Bremen, Faculty 2 (Biology/Chemistry), University of Bremen, Bremen, Germany.
- Center for Environmental Research and Sustainable Technology, Bremen, Germany.
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20
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Dusek P, Schneider SA, Aaseth J. Iron chelation in the treatment of neurodegenerative diseases. J Trace Elem Med Biol 2016; 38:81-92. [PMID: 27033472 DOI: 10.1016/j.jtemb.2016.03.010] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 01/14/2023]
Abstract
Disturbance of cerebral iron regulation is almost universal in neurodegenerative disorders. There is a growing body of evidence that increased iron deposits may contribute to degenerative changes. Thus, the effect of iron chelation therapy has been investigated in many neurological disorders including rare genetic syndromes with neurodegeneration with brain iron accumulation as well as common sporadic disorders such as Parkinson's disease, Alzheimer's disease, and multiple sclerosis. This review summarizes recent advances in understanding the role of iron in the etiology of neurodegeneration. Outcomes of studies investigating the effect of iron chelation therapy in neurodegenerative disorders are systematically presented in tables. Iron chelators, particularly the blood brain barrier-crossing compound deferiprone, are capable of decreasing cerebral iron in areas with abnormally high concentrations as documented by MRI. Yet, currently, there is no compelling evidence of the clinical effect of iron removal therapy on any neurological disorder. However, several studies indicate that it may prevent or slow down disease progression of several disorders such as aceruloplasminemia, pantothenate kinase-associated neurodegeneration or Parkinson's disease.
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Affiliation(s)
- Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague, Czech Republic; Institute of Neuroradiology, University Göttingen, Göttingen, Germany.
| | | | - Jan Aaseth
- Innlandet Hospital Trust, Kongsvinger, Norway; Hedmark University College, Elverum, Norway
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21
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Dusek P, Bahn E, Litwin T, Jabłonka-Salach K, Łuciuk A, Huelnhagen T, Madai VI, Dieringer MA, Bulska E, Knauth M, Niendorf T, Sobesky J, Paul F, Schneider SA, Czlonkowska A, Brück W, Wegner C, Wuerfel J. Brain iron accumulation in Wilson disease: apost mortem7 Tesla MRI - histopathological study. Neuropathol Appl Neurobiol 2016; 43:514-532. [DOI: 10.1111/nan.12341] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/18/2016] [Accepted: 08/20/2016] [Indexed: 12/12/2022]
Affiliation(s)
- P. Dusek
- Institute of Neuroradiology; University Medical Center Göttingen; Göttingen Germany
- Department of Neurology and Center of Clinical Neuroscience; 1 Faculty of Medicine and General University Hospital in Prague; Charles University in Prague; Praha Czech Republic
| | - E. Bahn
- Institute of Neuropathology; University Medical Center Göttingen; Göttingen Germany
| | - T. Litwin
- 2 Department of Neurology; Institute Psychiatry and Neurology; Warsaw Poland
| | - K. Jabłonka-Salach
- Faculty of Chemistry; Biological and Chemical Research Centre; University of Warsaw; Warsaw Poland
| | - A. Łuciuk
- Faculty of Chemistry; Biological and Chemical Research Centre; University of Warsaw; Warsaw Poland
| | - T. Huelnhagen
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max-Delbrück Center for Molecular Medicine in the Helmholtz Association; Berlin Germany
| | - V. I. Madai
- Department of Neurology and Center for Stroke Research Berlin (CSB); Charité-Universitätsmedizin; Berlin Germany
| | - M. A. Dieringer
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max-Delbrück Center for Molecular Medicine in the Helmholtz Association; Berlin Germany
- Experimental and Clinical Research Center (ECRC); Charité-Universitätsmedizin and Max Delbrück Center for Molecular Medicine (MDC); Berlin Germany
| | - E. Bulska
- Faculty of Chemistry; Biological and Chemical Research Centre; University of Warsaw; Warsaw Poland
| | - M. Knauth
- Institute of Neuroradiology; University Medical Center Göttingen; Göttingen Germany
| | - T. Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max-Delbrück Center for Molecular Medicine in the Helmholtz Association; Berlin Germany
- Experimental and Clinical Research Center (ECRC); Charité-Universitätsmedizin and Max Delbrück Center for Molecular Medicine (MDC); Berlin Germany
| | - J. Sobesky
- Department of Neurology and Center for Stroke Research Berlin (CSB); Charité-Universitätsmedizin; Berlin Germany
- Experimental and Clinical Research Center (ECRC); Charité-Universitätsmedizin and Max Delbrück Center for Molecular Medicine (MDC); Berlin Germany
| | - F. Paul
- Experimental and Clinical Research Center (ECRC); Charité-Universitätsmedizin and Max Delbrück Center for Molecular Medicine (MDC); Berlin Germany
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center; Department of Neurology; Charité-Universitätsmedizin; Berlin Germany
| | - S. A. Schneider
- Neurology Department; University of Kiel; Kiel Germany
- Department of Neurology; Ludwig-Maximilians-University; Munich Germany
| | - A. Czlonkowska
- 2 Department of Neurology; Institute Psychiatry and Neurology; Warsaw Poland
- Department of Experimental and Clinical Pharmacology; Medical University; Warsaw Poland
| | - W. Brück
- Institute of Neuropathology; University Medical Center Göttingen; Göttingen Germany
| | - C. Wegner
- Institute of Neuropathology; University Medical Center Göttingen; Göttingen Germany
| | - J. Wuerfel
- Institute of Neuroradiology; University Medical Center Göttingen; Göttingen Germany
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center; Department of Neurology; Charité-Universitätsmedizin; Berlin Germany
- Medical Imaging Analysis Center AG; Basel Switzerland
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Stezin A, George L, Jhunjhunwala K, Lenka A, Saini J, Netravathi M, Yadav R, Pal PK. Exploring cortical atrophy and its clinical and biochemical correlates in Wilson’s disease using voxel based morphometry. Parkinsonism Relat Disord 2016; 30:52-7. [DOI: 10.1016/j.parkreldis.2016.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/15/2016] [Accepted: 06/20/2016] [Indexed: 12/27/2022]
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Haywood S, Vaillant C. Overexpression of Copper Transporter CTR1 in the Brain Barrier of North Ronaldsay Sheep: Implications for the Study of Neurodegenerative Disease. J Comp Pathol 2014; 150:216-24. [DOI: 10.1016/j.jcpa.2013.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/22/2013] [Accepted: 09/03/2013] [Indexed: 02/03/2023]
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Trocello JM, Broussolle E, Girardot-Tinant N, Pelosse M, Lachaux A, Lloyd C, Woimant F. Wilson's disease, 100 years later…. Rev Neurol (Paris) 2013; 169:936-43. [DOI: 10.1016/j.neurol.2013.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 04/30/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
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Wenisch E, De Tassigny A, Trocello JM, Beretti J, Girardot-Tinant N, Woimant F. Cognitive profile in Wilson's disease: a case series of 31 patients. Rev Neurol (Paris) 2013; 169:944-9. [PMID: 24120329 DOI: 10.1016/j.neurol.2013.06.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/29/2013] [Accepted: 06/04/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Wilson's disease (WD) is a rare autosomal recessive disorder of copper metabolism. If untreated, WD, which is initially a liver disease, can turn into a multi-systemic disease with neurological involvement. Very few studies have described cognitive impairment in WD. The aim of this study is to report the cognitive profile of 31 treated WD patients. METHODS Patients were classed into two groups using the Unified Wilson Disease Rating Scale (UWDRS): WD patients without neurological signs (WD-N(-)) (n=13), and WD patients with neurological signs (WD-N(+)) (n=18). The patients participated in a neuropsychological assessment evaluating memory, executive function and visuo-spatial abilities. RESULTS Both groups performed well for verbal intelligence and episodic memory skills. However, the majority of these patients exhibited altered performance for at least one cognitive test, particularly in the executive domain. The WD-N(+) group performed less well than the WD-N(-) group on cognitive tests involving rapid motor function, abstract thinking, working memory and top-down inhibitory control. CONCLUSIONS Cognitive impairment in treated WD patients essentially affects executive function involving fronto-striatal circuits. Verbal intelligence and episodic memory abilities seem to be remarkably preserved. Neuropsychological assessment is a valuable tool to evaluate the presence and the consequences of these cognitive impairments in WD patients with or without neurological signs in the course of this chronic disease.
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Affiliation(s)
- E Wenisch
- French national reference centre for Wilson's disease, neurology department, Lariboisière hospital, 2, rue Ambroise-Paré, 75010 Paris cedex 10, France.
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Unusual epileptic deterioration and extensive white matter lesion during treatment in Wilson's disease. BMC Neurol 2013; 13:127. [PMID: 24067156 PMCID: PMC3851542 DOI: 10.1186/1471-2377-13-127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 09/03/2013] [Indexed: 11/30/2022] Open
Abstract
Background Wilson’s disease (WD) is a genetic disorder which can be controlled fairly well with decupuration therapy. However, symptoms, on rare occasions, can worsen even when WD is being treated. Herein, we report a case involving unusual neurological deterioration during decupuration therapy for WD. Case presentation A 28-year-old man was diagnosed with WD 13 years prior to his clinical visit; however, his drug compliance has been poor over the years. He was treated with trientine because tremors and dysarthria have presented in recent years. However, dysarthria and dystonia developed in his limbs, which were worse on the right side and had been aggravated for several weeks despite good drug compliance. His symptoms were fluctuating. It was initially misdiagnosed as dystonia; although, it turned out to be a seizure due to cortical degeneration. These symptoms were completely resolved with antiepileptic drugs. Moreover, the cortical enhancement of bifrontal degeneration has disappeared on the MRI. Conclusion This case showed unusual epileptic neurologic deterioration due to cortical degeneration during decupuration therapy. Seizures in WD can easily be mistaken as part of dystonia. However, the fluctuating symptoms suggest a seizure.
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28
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Pal A, Badyal RK, Vasishta RK, Attri SV, Thapa BR, Prasad R. Biochemical, histological, and memory impairment effects of chronic copper toxicity: a model for non-Wilsonian brain copper toxicosis in Wistar rat. Biol Trace Elem Res 2013; 153:257-68. [PMID: 23613148 DOI: 10.1007/s12011-013-9665-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 04/05/2013] [Indexed: 10/26/2022]
Abstract
Animal models of copper toxicosis rarely exhibit neurological impairments and increased brain copper accumulation impeding the development of novel therapeutic approaches to treat neurodegenerative diseases having high brain Cu content. The aim of this study was to investigate the effects of intraperitoneally injected copper lactate (0.15 mg Cu/100 g body weight) daily for 90 days on copper and zinc levels in the liver and hippocampus, on biochemical parameters, and on neurobehavioral functions (by Morris water maze) of male Wistar rats. Copper-administered animals exhibited significantly decreased serum acetylcholinesterase (AChE) activity and impaired neuromuscular coordination and spatial memory compared to control rats. Copper-intoxicated rats showed significant increase in liver and hippocampus copper content (99.1 and 73 % increase, respectively), 40.7 % reduction in hepatic zinc content, and interestingly, 77.1 % increase in hippocampus zinc content with concomitant increase in copper and zinc levels in serum and urine compared to control rats. Massive grade 4 copper depositions and grade 1 copper-associated protein in hepatocytes of copper-intoxicated rats were substantiated by rhodanine and orcein stains, respectively. Copper-intoxicated rats demonstrated swelling and increase in the number of astrocytes and copper deposition in the choroid plexus, with degenerated neurons showing pyknotic nuclei and dense eosinophilic cytoplasm. In conclusion, the present study shows the first evidence in vivo that chronic copper toxicity causes impaired spatial memory and neuromuscular coordination, swelling of astrocytes, decreased serum AChE activity, copper deposition in the choroid plexus, neuronal degeneration, and augmented levels of copper and zinc in the hippocampus of male Wistar rats.
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Affiliation(s)
- Amit Pal
- Department of Biochemistry, PGIMER, Chandigarh, India 160012
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Sureka J, Jakkani RK. Clinico-radiological spectrum of bilateral temporal lobe hyperintensity: a retrospective review. Br J Radiol 2012; 85:e782-92. [PMID: 22422381 DOI: 10.1259/bjr/30039090] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bilateral temporal lobe hyperintensity (BTH) is a commonly encountered MRI finding in a wide spectrum of clinical conditions and often poses a diagnostic challenge to the radiologist. The purpose of this paper is to elucidate several diseases that manifest as BTH on MRI, based on a retrospective review of cranial MRI of 65 cases seen in our institution between October 2007 and September 2010. We found BTH in different clinical scenarios that included infective diseases (herpes simplex virus, congenital cytomegalovirus infection), epileptic syndrome (mesial temporal sclerosis), neurodegenerative disorders (Alzheimer's disease, frontotemporal dementia, Type 1 myotonic dystrophy), neoplastic conditions (gliomatosis cerebri), metabolic disorders (mitochondrial encephalopathy, lactic acidosis and stroke-like episodes, Wilson's disease, hyperammonemia), dysmyelinating disease (megalencephalic leukoencephalopathy with subcortical cysts), and vascular (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) and paraneoplastic (limbic encephalitis) disorders. The conventional MRI findings with advanced MRI such as diffusion-weighted imaging, susceptibility-weighted imaging and MR spectroscopy along with laboratory results are potentially helpful in distinguishing the different clinical conditions and thus affect the early diagnosis and clinical outcome.
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Affiliation(s)
- J Sureka
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamilnadu, India.
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Lee JH, Yang TI, Cho M, Yoon KT, Baik SK, Han YH. Widespread cerebral cortical mineralization in Wilson's disease detected by susceptibility-weighted imaging. J Neurol Sci 2011; 313:54-6. [PMID: 22014607 DOI: 10.1016/j.jns.2011.09.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 09/22/2011] [Accepted: 09/27/2011] [Indexed: 11/19/2022]
Abstract
Signal abnormalities of cortical gray matter, compared with the deep nuclear structures, have received less attention in Wilson's disease (WD). They nearly always accompanied white matter signal change, and commonly are associated with epilepsy and psychiatric features. We report herein two cases diagnosed as WD who, in addition to characteristic deep nuclear lesions on MR imaging, had widespread cerebral cortical paramagnetic signals dramatically detected by susceptibility-weighted imaging. T2-weighted MR images did not show any cortico-subcortical hyperintense lesions. To our knowledge, these findings have not been described before and may help to further characterize the disease.
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Affiliation(s)
- Jae-Hyeok Lee
- Department of Neurology, Pusan National University, Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Republic of Korea.
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Michael GJ, Esmailzadeh S, Moran LB, Christian L, Pearce RKB, Graeber MB. Up-regulation of metallothionein gene expression in parkinsonian astrocytes. Neurogenetics 2011; 12:295-305. [PMID: 21800131 DOI: 10.1007/s10048-011-0294-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 07/12/2011] [Indexed: 10/17/2022]
Abstract
The role of glial cells in Parkinson's disease (PD) is unclear. We have previously reported a striking up-regulation of DnaJB6 heat shock protein in PD substantia nigra astrocytes. Whole genome transcriptome analysis also indicated increased expression of metallothionein genes in substantia nigra and cortex of sporadic PD cases. Metallothioneins are metal-binding proteins in the CNS that are released by astrocytes and associated with neuroprotection. Metallothionein expression was investigated in 18 PD cases and 15 non-PD controls using quantitative real-time polymerase chain reaction (qRT-PCR), in situ hybridisation (ISH) and immunocytochemistry (ICC). We observed a strong increase in the expression of metallothioneins MT1E, MT1F, MT1G, MT1H, MT1M, MT1X and MT2A in both PD nigra and frontal cortex. Expression of LRP2 (megalin), the neuronal metallothionein receptor was also significantly increased. qRT-PCR confirmed metallothionein up-regulation. Astrocytes were found to be the main source of metallothioneins 1 and 2 based on ISH results, and this finding was confirmed by ICC. Our findings demonstrate metallothionein expression by reactive astrocytes in PD nigra and support a neuroprotective role for these cells. The traditional view that nigral astrocytes are non-reactive in PD is clearly incorrect. However, it is possible that astrocytes are themselves affected by the disease process which may explain their comparatively modest and previously overlooked response.
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Affiliation(s)
- Gregory J Michael
- Centre for Neuroscience and Trauma, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Whitechapel, London E1 2AT, UK
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32
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Scheiber IF, Dringen R. Copper-treatment increases the cellular GSH content and accelerates GSH export from cultured rat astrocytes. Neurosci Lett 2011; 498:42-6. [PMID: 21571036 DOI: 10.1016/j.neulet.2011.04.058] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 04/20/2011] [Accepted: 04/22/2011] [Indexed: 11/16/2022]
Abstract
To test whether copper exposure affects astroglial glutathione (GSH) metabolism, we have exposed astrocyte-rich primary cultures with copper chloride in concentrations of up to 30 μM and investigated cellular and extracellular GSH contents. Cultured astrocytes accumulated copper in a concentration-dependent manner thereby increasing the specific cellular copper content within 24h up to sevenfold. The increase in the cellular copper content was accompanied by a proportional increase in the specific cellular GSH content that reached up to 165% of the values of cells that had been incubated without copper, while the low cellular content of GSH disulfide (GSSG) remained unaltered in copper-treated cells. Also the rate of GSH export was significantly increased after copper exposure reaching up to 177% of control values. The export of GSH from control and copper-treated astrocytes was lowered by more than 70%, if cells were incubated in presence of the multidrug-resistance protein (Mrp) 1 inhibitor MK571 or at a low incubation temperature of 4°C. These data demonstrate that copper accumulation stimulates GSH synthesis and accelerates Mrp1-mediated GSH export from cultured astrocytes. These processes are likely to contribute to the resistance of astrocytes against copper toxicity and could improve the supply of GSH precursors from astrocytes to neurons.
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Affiliation(s)
- Ivo F Scheiber
- Center for Biomolecular Interactions Bremen, University of Bremen, D-28334 Bremen, Germany
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Abstract
The cause of idiopathic dystonia is not entirely elucidated. In the pathophysiological model of dystonia, the basal ganglia play a major role, mainly putamen, globus pallidus internus, thalamus, and cortex. However, using conventional structural neuroimaging methods, no specific alterations could be detected in this area. Using transcranial sonography (TCS) as a noninvasive, easy to perform, and side-effect-free method, it could be shown that in up to 75% of patients with cervical dystonia (CD), in a high percentage of other focal dystonias, but seldom in facial and genetically determined dystonia, hyperechogenicity of the medial part of the lentiform nuclei (LN) can be visualized in the third ventricular scanning plane. Based on these TCS findings an increased copper content of the LN could be verified in dystonia, opening new perspectives on possible pathophysiological aspects and future research. In clinical routine, this method may be used for early and differential diagnosis of primary dystonia.
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Wilson’s disease: two treatment modalities. Correlations to pretreatment and posttreatment brain MRI. Neuroradiology 2009; 51:627-33. [DOI: 10.1007/s00234-009-0536-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 05/12/2009] [Indexed: 12/13/2022]
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Haywood S, Paris J, Ryvar R, Botteron C. Brain copper elevation and neurological changes in north ronaldsay sheep: a model for neurodegenerative disease? J Comp Pathol 2008; 139:252-5. [PMID: 18786681 DOI: 10.1016/j.jcpa.2008.06.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 06/23/2008] [Indexed: 11/18/2022]
Abstract
This study in North Ronaldsay (NR) sheep showed that copper was elevated in both the liver and brain of older animals and that the elevation in these two sites was highly correlated. The accumulation of copper in the liver culminated in chronic active hepatitis. Evidence of tissue damage in the brain was equivocal, but the astrocytes showed strong immunoreactivity for metallothionein. The study suggested that the blood-brain barrier of NR sheep possesses unusual features in respect of the import of copper into the brain, and that NR sheep may provide a useful animal model for the investigation of brain copper homeostasis.
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Affiliation(s)
- S Haywood
- Department of Veterinary Pathology, Faculty of Veterinary Science, University of Liverpool, Liverpool L69 7ZJ, UK.
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Abstract
Wilson disease is an autosomal recessive disorder of copper overload. A principal characteristic of this disease is its wide phenotypic and genotypic variability. Its results from mutations of the ATP 7B gene located on chromosome 13, that encodes a hepatic copper transport protein. More than 300 mutations of this gene have been identified. This protein ensures the transport of copper in the hepatocyte, its incorporation with the apoceruloplasmin and its biliary excretion. The clinical manifestations are heterogeneous as well in their presentation, dominated by the neuropsychiatric and hepatic symptoms, as in the age of the first symptoms. Early recognition and initiation of therapy with chelators or zinc are essential for prognosis. Liver transplantation is indicated in cases with fulminant hepatitis, end-stage liver cirrhosis and should be considered in the therapy resistant neurological forms. A regular follow-up with monitoring of adverse effects of treatment and compliance is essential. Any discontinuation of treatments will involve, within a very variable time, but in constant manner, a reappearance or a reaggravation of the signs. Such relapses are often brutal and can be extremely serious, especially since response to subsequent treatment is often poor.
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