Wilson’s Disease

Abstract

Wilson’s disease (WD) is an autosomal recessive disorder characterized by copper accumulation in many organs. WD is caused by mutations in the ATP7B gene located on chromosome 13. Copper cellular metabolism is regulated by two copper-transporting ATPases (ATP7A and ATP7B). In WD, defective ATP7B function impaired both copper incorporation to ceruloplasmin and copper release into the bile, resulting in copper accumulation in the liver. In the absence of diagnosis and treatment at this stage, WD evolves towards a systemic disease, with copper accumulation in other organs including the brain, eyes, kidneys, etc. First symptoms are usually hepatic in children and neurological in adults. WD is characterized by low serum ceruloplasmin and total copper concentrations and increased urinary copper excretion. A new tool, the relative exchangeable copper is very useful for diagnosis and family screening. Differential diagnosis of copper abnormalities are reviewed. Molecular biology confirms the diagnosis in 95% of cases. Treatment is based on diet, copper chelators or zinc salts. Liver transplantation is the treatment of acute fulminant liver failure and of decompensated cirrhosis. It remains controversial in severe neurological forms. WD has a good prognosis if treatment is initiated early and continued all the lifetime. So, follow up of these patients is very important to make sure of the observance, the efficiency and the tolerance of the treatment and to search for hepatocellular carcinoma that is a late complication of the liver disease.