1
|
Li H, Seessle J, Staffer S, Tuma-Kellner S, Poschet G, Herrmann T, Chamulitrat W. FATP4 deletion in liver cells induces elevation of extracellular lipids via metabolic channeling towards triglycerides and lipolysis. Biochem Biophys Res Commun 2023; 687:149161. [PMID: 37931418 DOI: 10.1016/j.bbrc.2023.149161] [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: 08/14/2023] [Revised: 10/13/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
Evidence from mice with global deletion of fatty-acid transport protein4 (FATP4) indicates its role on β-oxidation and triglycerides (TG) metabolism. We reported that plasma glycerol and free fatty acids (FA) were increased in liver-specific Fatp4 deficient (L-FATP4-/-) mice under dietary stress. We hypothesized that FATP4 may mediate hepatocellular TG lipolysis. Here, we demonstrated that L-FATP4-/- mice showed an increase in these blood lipids, liver TG, and subcutaneous fat weights. We therefore studied TG metabolism in response to oleate treatment in two experimental models using FATP4-knockout HepG2 (HepKO) cells and L-FATP4-/- hepatocytes. Both FATP4-deificient liver cells showed a significant decrease in β-oxidation products by ∼30-35% concomitant with marked upregulation of CD36, FATP2, and FATP5 as well as lipoprotein microsomal-triglyceride-transfer protein genes. By using 13C3D5-glycerol, HepKO cells displayed an increase in metabolically labelled TG species which were further increased with oleate treatment. This increase was concomitant with a step-wise elevation of TG in cells and supernatants as well as the secretion of cholesterol very low-density and high-density lipoproteins. Upon analyzing TG lipolytic enzymes, both mutant liver cells showed marked upregulated expression of hepatic lipase, while that of hormone-sensitive lipase and adipose-triglyceride lipase was downregulated. Lipolysis measured by extracellular glycerol and free FA was indeed increased in mutant cells, and this event was exacerbated by oleate treatment. Taken together, FATP4 deficiency in liver cells led to a metabolic shift from β-oxidation towards lipolysis-directed TG and lipoprotein secretion, which is in line with an association of FATP4 polymorphisms with blood lipids.
Collapse
Affiliation(s)
- Huili Li
- Department of Internal Medicine IV, University Hospital Heidelberg, 69120, Heidelberg, Germany; Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, Hubei, China
| | - Jessica Seessle
- Department of Internal Medicine IV, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Simone Staffer
- Department of Internal Medicine IV, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Sabine Tuma-Kellner
- Department of Internal Medicine IV, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Gernot Poschet
- Metabolomics Core Technology Platform, Centre for Organismal Studies, University of Heidelberg, 69120, Heidelberg, Germany
| | - Thomas Herrmann
- Westkuesten Hospital, Esmarchstraße 50, 25746, Heide, Germany
| | - Walee Chamulitrat
- Department of Internal Medicine IV, University Hospital Heidelberg, 69120, Heidelberg, Germany.
| |
Collapse
|
2
|
Graf M, Lange CM, Langer MM, Schattenberg JM, Seessle J, Dietz J, Vermehren A, Michael FA, Mondorf A, Zeuzem S, Pathil A, Graf C. Primary Biliary Cholangitis (PBC)-Autoimmune Hepatitis (AIH) Variant Syndrome: Clinical Features, Response to Therapy and Long-Term Outcome. J Clin Med 2023; 12:7047. [PMID: 38002661 PMCID: PMC10672247 DOI: 10.3390/jcm12227047] [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: 08/06/2023] [Revised: 11/02/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Standardization of diagnostic criteria of autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) variant syndrome (AIH-PBC VS) has not been achieved so far and evidence-based recommendations for monitoring and treatment of the disease are still lacking. Our study aimed to assess the prevalence, biochemical, and serological features, as well as the clinical course, of VS. METHODS We performed a retrospective study including all patients with VS between 1999 and 2020 in four German centers. Data on demographic parameters, biochemical and serological tests, treatment, and outcome were collected. RESULTS Of 90 patients (3.1%) meeting Paris criteria for VS diagnosis, 65.6% showed AIH and PBC histological features, while biochemical Paris criteria were observed comparatively rarely. Further antibodies, which were not part of the diagnostic criteria of VS, were found in a subgroup of patients with available data (ACA: 30.0%; anti-CENP-A: 25.0%; anti-CENP-B: 33.3%; anti-SP100: 21.4%). Biochemical response was more frequently observed in patients treated with a combined therapy of ursodeoxycholic acid (UDCA) and immunosuppression (IS). Liver cirrhosis was detected in 31 patients (34.4%) and 25 patients (27.8%) developed clinical manifestations of portal hypertension. CONCLUSIONS Biochemical Paris criteria of VS were rarely detected, thus implying that these cut-off values should be redefined. Regarding pharmacological treatment, combined therapy of UDCA and IS appeared to be more effective than monotherapy with UDCA.
Collapse
Affiliation(s)
- Markus Graf
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| | - Christian M. Lange
- Department of Internal Medicine II, University Hospital Munich, 81377 Munich, Germany; (C.M.L.); (M.M.L.)
| | - Mona M. Langer
- Department of Internal Medicine II, University Hospital Munich, 81377 Munich, Germany; (C.M.L.); (M.M.L.)
| | - Jörn M. Schattenberg
- Department of Internal Medicine I, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Jessica Seessle
- Department of Internal Medicine IV, University of Heidelberg, 69120 Heidelberg, Germany;
| | - Julia Dietz
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| | - Annika Vermehren
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| | - Florian A. Michael
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| | - Antonia Mondorf
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| | - Stefan Zeuzem
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| | - Anita Pathil
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| | - Christiana Graf
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| |
Collapse
|
3
|
Seessle J, Waterboer T, Freund C, Müller B, Merle U. Reply to Fernández-de-las-Peñas. Clin Infect Dis 2022; 75:e1209-e1210. [PMID: 34989791 DOI: 10.1093/cid/ciac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jessica Seessle
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (Deutsches Krebsforschungszentrum [DKFZ]), Heidelberg, Germanyand
| | - Cora Freund
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Barbara Müller
- Department of Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
4
|
Graf C, Arncken J, Lange CM, Willuweit K, Schattenberg JM, Seessle J, Lang-Meli J, Böttler T, Dietz J, Wetzstein N, Mondorf A, Vermehren J, Rohde G, Zeuzem S, Pathil A. Hepatic sarcoidosis: Clinical characteristics and outcome. JHEP Rep 2021; 3:100360. [PMID: 34765958 PMCID: PMC8571721 DOI: 10.1016/j.jhepr.2021.100360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/13/2021] [Accepted: 08/25/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND & AIMS Clinical manifestation of hepatic involvement in sarcoidosis can vary from asymptomatic disease to severe complications such as cirrhosis and portal hypertension. However, data on hepatic sarcoidosis are limited, and evidence-based recommendations are lacking. Our study aimed to assess the features and clinical course of hepatic sarcoidosis in a predominantly Caucasian cohort. METHODS We performed a retrospective study including all patients with hepatic sarcoidosis between 2004 and 2020 in 5 German centres. The median follow-up time was 36 months (range 0.0-195). Data on demographic parameters, clinical manifestations, diagnostic test results, treatment, and outcome were collected. RESULTS A total of 1,476 patients with sarcoidosis and 62 patients with hepatic involvement (4.2%) were identified. Of the patients, 51.6% were female, and 80.6% were Caucasian. Most patients were asymptomatic and were observed to have a cholestatic pattern of liver enzyme elevations. Cirrhosis was detected in 9 patients (14.5%), of whom 6 developed clinical manifestations of portal hypertension. Fifty-four patients were medically treated, most commonly with glucocorticoids (69.4%) or ursodeoxycholic acid (UDCA) (40.3%). Levels of alkaline phosphatase (ALP) decreased by 60.8% on average from baseline in patients treated with glucocorticoids and by 59.9% in patients treated with UDCA. Seventeen patients received treatment augmentation with a second line agent, of whom 8 patients normalised ALP levels during follow-up. None of the patients underwent liver transplantation or developed hepatocellular carcinoma (HCC). Three of the patients died during follow-up owing to liver-related complications. CONCLUSIONS Hepatic involvement in sarcoidosis was found in 4.2% of patients with sarcoidosis and was clinically significant in 14.5% of those. These findings highlight the importance of early identifying, monitoring, and treating hepatic sarcoidosis, given its increased mortality when associated with end-stage liver disease. LAY SUMMARY Clinical diagnostic and surveillance of hepatic involvement in sarcoidosis has not been standardised, and management of hepatic involvement is a clinical challenge, since it remains poorly characterised in many ways. Our results show that one-third of patients with hepatic sarcoidosis presented with clinically significant portal hypertension, 14.5% suffered from cirrhosis, and 3 patients died owing to liver-related complications. Regarding pharmacological treatment options, corticosteroids and UDCA were the medical agents most frequently used, and both of them have been shown to induce biochemical response in the majority of patients. These findings highlight the importance of correctly and early identifying hepatic involvement in sarcoidosis, because of the potentially progressive course of disease.
Collapse
Key Words
- ACE, angiotensin-converting enzyme
- ACLF, acute-on-chronic liver failure
- ALP, alkaline phosphatase
- ALT, alanine transaminase
- AST, aspartate transaminase
- ATS, American Thoracic Society
- AZA, azathioprine
- GGT, gamma glutamyl transferase
- HCC, hepatocellular carcinoma
- HE, hepatic encephalopathy
- HRS, hepatorenal syndrome
- Hepatic granuloma
- Hepatic sarcoidosis
- ICD-10, International Classification of Diseases, Tenth Revision
- IL-2R, IL-2 receptor
- Liver involvement
- MMF, mycophenolatmofetil
- MTX, methotrexate
- Outcome
- SBP, spontaneous bacterial peritonitis
- Treatment
- UDCA, ursodeoxycholic acid
- ULN, upper limit of normal
Collapse
Affiliation(s)
- Christiana Graf
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jeannette Arncken
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian M. Lange
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Katharina Willuweit
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Jörn M. Schattenberg
- Department of Internal Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Jessica Seessle
- Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany
| | - Julia Lang-Meli
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
| | - Tobias Böttler
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
| | - Julia Dietz
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Nils Wetzstein
- Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - Antonia Mondorf
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Johannes Vermehren
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Gernot Rohde
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Anita Pathil
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
5
|
Seessle J, Liebisch G, Schmitz G, Stremmel W, Chamulitrat W. Compositional Changes Among Triglycerides and Phospholipids During FATP4 Sensitization with Palmitate Lead to ER Stress in Cultured Cells. EUR J LIPID SCI TECH 2019. [DOI: 10.1002/ejlt.201800394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Jessica Seessle
- Department of Internal Medicine IVGastroenterology and Infectious DiseaseIm Neuenheimer Feld 41069120HeidelbergGermany
| | - Gerhard Liebisch
- Institute of Clinical Chemistry and Laboratory MedicineUniversity of RegensburgFranz‐Josef‐Strauss‐Allee 1193053RegensburgGermany
| | - Gerd Schmitz
- Institute of Clinical Chemistry and Laboratory MedicineUniversity of RegensburgFranz‐Josef‐Strauss‐Allee 1193053RegensburgGermany
| | - Wolfgang Stremmel
- Department of Internal Medicine IVGastroenterology and Infectious DiseaseIm Neuenheimer Feld 41069120HeidelbergGermany
| | - Walee Chamulitrat
- Department of Internal Medicine IVGastroenterology and Infectious DiseaseIm Neuenheimer Feld 41069120HeidelbergGermany
| |
Collapse
|
6
|
Koschny R, Allgäuer M, Pfeiffenberger J, Seessle J, Fuchs J, Longerich T, Wielpütz M, Hoffmann K. Case report: a rare cause of a hypervascular nodule in a noncirrhotic liver. Z Gastroenterol 2019; 57:57-60. [DOI: 10.1055/a-0755-2478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AbstractA 37-year-old male patient with Crohn’s disease and multiple liver hemangiomas was referred to our hospital for an atypical hypervascular hepatic lesion detected on an external magnetic resonance imaging (MRI) scan. The patient was otherwise well and had no history of any liver disease. Liver values and tumor markers were normal. Contrast-enhanced ultrasound confirmed multiple hemangiomas in different liver segments and a hypervascular tumor with a hypovascular rim in segment II/IV. Repeat MRI showed a strongly enhancing neoplasm of 2.6 cm with a texture distinctly different from the otherwise relatively uniform hemangiomas, without evidence of interim growth. Ultrasound-guided biopsy revealed a hepatic small vessel neoplasm. Due to the unknown malignant potential, atypical segmental surgical resection was performed. Final histopathological analysis confirmed the complete resection of the lesion. The postoperative course was uneventful.
Collapse
Affiliation(s)
- Ronald Koschny
- Interdisciplinary Endoscopy Center (IEZ), Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Allgäuer
- Department of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jan Pfeiffenberger
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jessica Seessle
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Juri Fuchs
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Longerich
- Department of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Mark Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katrin Hoffmann
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
7
|
Schaefer M, Gotthardt DN, Ganion N, Wohnsland S, Seessle J, Stremmel W, Pfeiffenberger J, Weiss KH. Wilson disease: Health-related quality of life and risk for depression. Clin Res Hepatol Gastroenterol 2016; 40:349-356. [PMID: 26549350 DOI: 10.1016/j.clinre.2015.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 08/30/2015] [Accepted: 09/23/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Wilson disease is an autosomal recessive disorder of copper metabolism and requires lifelong medical treatment. Therefore, the analysis of quality of life has gathered more attention. Aims of this study were to examine risk for depression and health-related quality of life in patients suffering from Wilson disease. METHODS Sixty-eight patients were included in this retrospective cross sectional study. The Personal Health Questionnaire-9 Depression Scale was used to assess depression. The Short Form-36 Health Survey questionnaire was used to assess health-related quality of life. RESULTS The Personal Health Questionnaire-9 indicated that 21% (14/68) of patients were at risk for major depressive disorders (scores>10) and 35% (24/68) were at risk for mild depression (scores 5-9). Women had significantly lower life quality scores than men. Primary neurologic disease manifestation was associated with significantly lower total Short Form-36 and subdimension scores compared with primary hepatic or mixed presentation. Overall, patients with Wilson disease experienced higher quality of life than patients with other chronic liver diseases. CONCLUSIONS As patients with Wilson disease have a high risk for depressive disorders, active assessment for depression is mandatory. Patients with primary neurological symptoms are at higher risk for reduction of life quality.
Collapse
Affiliation(s)
- Mark Schaefer
- Department of Gastroenterology and Hepatology, University hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Daniel Nils Gotthardt
- Department of Gastroenterology and Hepatology, University hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Nicole Ganion
- Department of Anesthesiology, University hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, Germany
| | - Sascha Wohnsland
- Department of General Internal Medicine and Psychosomatics, University hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, Germany
| | - Jessica Seessle
- Department of Gastroenterology and Hepatology, University hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Wolfgang Stremmel
- Department of Gastroenterology and Hepatology, University hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Jan Pfeiffenberger
- Department of Gastroenterology and Hepatology, University hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Karl Heinz Weiss
- Department of Gastroenterology and Hepatology, University hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| |
Collapse
|
8
|
Seessle J, Gotthardt DN, Schäfer M, Gohdes A, Pfeiffenberger J, Ferenci P, Stremmel W, Weiss KH. Concomitant immune-related events in Wilson disease: implications for monitoring chelator therapy. J Inherit Metab Dis 2016; 39:125-30. [PMID: 26067812 DOI: 10.1007/s10545-015-9866-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/18/2015] [Accepted: 05/20/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Current guidelines favor the use of chelating agents (d-penicillamine, trientine) in first line therapy of symptomatic Wilson disease patients. Development of chelator induced immunological adverse events are a concern especially under d-penicillamine therapy. This study assessed the prevalence of co-existing or therapy-related immune-mediated diseases in Wilson disease patients, and evaluated the role of antinuclear antibodies in therapy monitoring. METHODS We retrospectively analyzed 235 Wilson disease patients. Medical regimens were classified and analyzed in relation to adverse events and antinuclear antibody courses. RESULTS Coexisting immune-mediated diseases were evident in 19/235 (8.1%) patients, of which 13/235 (5.5%) had pre-existing autoimmune diseases. Six patients (2.6%) developed an autoimmune disease under therapy, all of them under long-term d-penicillamine treatment. Data relating to antinuclear antibody courses during treatment and adverse events were available for patients treated with d-penicillamine (n = 91), trientine (n = 58), and zinc salts (n = 58). No significant increase in antinuclear antibody titers in patients treated with d-penicillamine (16/91; 17.6%), trientine (12/58; 20.7%), and zinc (7/58; 12.1%) were found. CONCLUSION Under long-term d-penicillamine therapy a minority of patients developed immune-mediated disease. Elevations in antinuclear antibodies were found frequently, but no correlations were evident between increases in antinuclear antibodies and the development of immune-mediated diseases or medical regimes. Thus, the value of antinuclear antibodies for monitoring adverse events under chelator therapy seems to be limited.
Collapse
Affiliation(s)
- Jessica Seessle
- Department of Gastroenterology, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Daniel Nils Gotthardt
- Department of Gastroenterology, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
- Liver Cancer Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Mark Schäfer
- Department of Gastroenterology, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Annina Gohdes
- Department of Gastroenterology, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Jan Pfeiffenberger
- Department of Gastroenterology, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Peter Ferenci
- Department of Gastroenterology, University Hospital Vienna, Vienna, Austria
| | - Wolfgang Stremmel
- Department of Gastroenterology, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Karl Heinz Weiss
- Department of Gastroenterology, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany.
- Liver Cancer Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany.
| |
Collapse
|
9
|
Weiss KH, Van de Moortele M, Gotthardt DN, Pfeiffenberger J, Seessle J, Ullrich E, Gielen E, Borghs H, Adriaens E, Stremmel W, Meersseman W, Boonen S, Cassiman D. Bone demineralisation in a large cohort of Wilson disease patients. J Inherit Metab Dis 2015; 38:949-56. [PMID: 25663473 DOI: 10.1007/s10545-015-9815-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 01/14/2015] [Accepted: 01/19/2015] [Indexed: 02/07/2023]
Abstract
AIMS AND BACKGROUND We compared the bone mineral density (BMD) of adult Wilson disease (WD) patients (n = 148), with an age- and gender-matched healthy control population (n = 148). Within the WD cohort, correlations of BMD with WD disease parameters, lab results, type of treatment and known osteoporosis risk factors were analysed. METHODS Hip and lumbar spine absolute BMD and T-score were measured by dual-energy X-ray absorptiometry. Osteoporosis and osteopenia were defined as a T-score ≤ -2.5, and between -1 and -2.5, respectively. RESULTS There were significantly more subjects with abnormal T-scores in the WD population (58.8%) than in the control population (45.3%) (χ(2) = 6.65, df = 2, p = 0.036), as there were 50.0% osteopenic and 8.8% osteoporotic WD patients, vs. 41.2% and 4.1%, respectively, in the controls. Especially L2-L4 spine BMD measurements (BMD and T-scores) differed significantly between the WD population and matched controls. L2-L4 spine BMD for WD patients was on average 0.054 g/cm(2) (5.1%) lower than in matched normal controls (0.995 ± 0.156 vs 1.050 ± 0.135; p = 0.002). We found no significant correlation between BMD values and any of the WD disease parameters (e.g. the severity of liver disease), lab results, type of treatment or known osteoporosis risk factors. Duration of D-penicillamine treatment was negatively correlated with femoral BMD value, but in a clinically irrelevant manner, compared to age and gender. Importantly, BMD remained significantly lower in WD patients (n = 89) vs. controls after excluding WD patients with cirrhosis (p = 0.009). CONCLUSIONS Our study suggests that WD is intrinsically associated with bone demineralisation.
Collapse
Affiliation(s)
- Karl Heinz Weiss
- Department of Internal Medicine IV, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany,
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Schaefer M, Weber L, Gotthardt D, Seessle J, Stremmel W, Pfeiffenberger J, Weiss KH. Coagulation Parameters in Wilson Disease. JGLD 2015; 24:183-8. [DOI: 10.15403/jgld.2014.1121.242.wls] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background & Aims: Wilson disease (WD) is an autosomal recessive disorder of copper metabolism. Alterations of copper metabolism have been associated with changes in coagulation factors. The aim of the present study was the analysis of coagulation factors in WD patients.Methods: 100 patients attending a tertiary WD outpatient clinic were analyzed in a prospective cross sectional cohort study. Out of peripheral venous blood samples coagulation factors were assessed including: full blood count, INR, partial thromboplastin time (PTT), clotting factors II, V, VII, VIII, IX, X, XI, XII, XIII, von Willebrand factor/-antigen, fibrinogen, antithrombin III, protein S, protein C, activated protein C (APC) resistance. Subgroup analyses of the blood tests were performed for sex, initial clinical presentation, WD treatment and liver function.Results: Subgroup analysis by liver function showed decreased levels of factors II, V, VII and X. Subgroup analysis by gender or clinical course of the disease did not reveal significant coagulation changes. In patients treated with trientine significantly decreased levels of factors II, VII and antithrombin III and increased von Willebrand factor/-antigen levels were detected. Factor VIII levels were significantly reduced in patients receiving zinc.Conclusion: Although significant differences of some coagulation parameters in subgroup analysis were found, no clinically relevant alterations of the coagulation system in WD patients could be detected.
Collapse
|
11
|
Abstract
A 26-year-old female patient presented with the clinical picture of an acute ileus. Since childhood the patient has been diagnosed as having a MELAS syndrome, a mitochondriopathy. A subtotal colectomy was performed some years ago because of a similar ileus episode. The further diagnostic work-up revealed an expanded small intestine in abdominal radiography. Laboratory analysis showed increased levels of serum lactate with a consecutive respiratory compensated metabolic acidosis. A conservative treatment regime with nasogastric tube, fluid therapy, parental nutrition via peripheral veins and peristalsis inducing drugs was initiated, but did not resolve ileus symptoms. Under the hypothesis that in MELAS syndrome the ileus-related catabolic state aggravates the ileus symptoms in terms of a circulus vitiosus, we started high-caloric parenteral nutrition by using a central venous catheter. A few hours after this intervention, a clear clinical improvement could be observed. Since this initial presentation, the patient was admitted to our hospital several times with the same ileus symptoms. Each of the episodes was successfully and rapidly treated by this high-caloric parenteral nutrition therapy. The reproducible rapid clinical improvement after starting parenteral nutrition supports the hypothesis that an optimal energy supply is the key therapy not only for cerebral but also for gastrointestinal symptoms in patients with MELAS syndrome.
Collapse
Affiliation(s)
- J Seessle
- Department of Internal Medicine IV, University Hospital Heidelberg, Germany
| | | | | | | |
Collapse
|
12
|
Pfeiffenberger J, Gotthardt DN, Herrmann T, Seessle J, Merle U, Schirmacher P, Stremmel W, Weiss KH. Iron metabolism and the role of HFE gene polymorphisms in Wilson disease. Liver Int 2012; 32:165-70. [PMID: 22098612 DOI: 10.1111/j.1478-3231.2011.02661.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 09/09/2011] [Indexed: 12/12/2022]
Abstract
UNLABELLED Wilson disease (WD) is a rare inherited disorder of copper metabolism, which can lead to severe liver failure and to a variety of neuropsychiatric symptoms. Previous animal studies and case reports suggest that hepatic iron overload and alterations in iron processing are associated with WD. The aim of this study was the assessment of iron metabolism and of the frequency of the most common HFE gene polymorphisms in WD patients. PATIENTS AND METHODS Data from 143 patients with WD were analysed. Clinical presentation, liver function and iron metabolism parameters were recorded. Blood samples of the patients were analysed for HFE gene alterations (H63D; C282Y). Twenty-seven liver biopsies of these patients were studied with regard to iron content and fibrosis score. RESULTS Contrary to previous reports of HFE gene polymorphisms in WD patients, in our cohort the allele frequencies (C282Y: 2.1%; H63D: 7.3%) were in line with frequencies obtained for general population. Male WD patients with decreased serum ceruloplasmin (Cp), showed increased serum ferritin levels. Hepatic iron content was normal in most cases. DISCUSSION Male patients with very low Cp serum concentrations showed slightly elevated median serum ferritin concentrations, probably related to lack of ferroxidase acitivity. However, in consideration of absolute numbers of ferritin concentrations, these changes seem to be of minor clinical relevance.
Collapse
Affiliation(s)
- Jan Pfeiffenberger
- Department of Gastroenterology, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Seessle J, Gohdes A, Gotthardt DN, Pfeiffenberger J, Eckert N, Stremmel W, Reuner U, Weiss KH. Alterations of lipid metabolism in Wilson disease. Lipids Health Dis 2011; 10:83. [PMID: 21595966 PMCID: PMC3127787 DOI: 10.1186/1476-511x-10-83] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 05/19/2011] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Wilson disease (WD) is an inherited disorder of human copper metabolism, characterised by accumulation of copper predominantly in the liver and brain, leading to severe hepatic and neurological disease. Interesting findings in animal models of WD (Atp7b-/- and LEC rats) showed altered lipid metabolism with a decrease in the amount of triglycerides and cholesterol in the serum. However, serum lipid profile has not been investigated in large human WD patient cohorts to date. PATIENTS AND METHODS This cohort study involved 251 patients examined at the Heidelberg and Dresden (Germany) University Hospitals. Patients were analysed on routine follow-up examinations for serum lipid profile, including triglycerides, cholesterol, high density lipoprotein (HDL) and low density lipoprotein (LDL). Data on these parameters at time of diagnosis were retrieved by chart review where available. For statistical testing, patients were subgrouped by sex, manifestation (hepatic, neurological, mixed and asymptomatic) and treatment (D-penicillamine, trientine, zinc or combination). RESULTS A significant difference in total serum cholesterol was found in patients with hepatic symptoms, which diminished under therapy. No alterations were observed for HDL, LDL and triglycerides. CONCLUSION Contradictory to previous reports using WD animal models (Atp7b-/- and LEC rats), the most obvious alteration in our cohort was a lower serum cholesterol level in hepatic-affected patients, which might be related to liver injury. Our data suggested unimpaired cholesterol metabolism in Wilson disease under therapy, independent of the applied medical treatment.
Collapse
Affiliation(s)
- Jessica Seessle
- Department of Gastroenterology, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | | | | |
Collapse
|