Dominik Huster

Wilson's disease (WD) is caused by ATP7B mutations and results in copper accumulation and toxicity in liver and brain tissues. The specific mechanisms underlying copper toxicity are still poorly understood. Mouse models have revealed new insights into pathomechanisms of hepatic WD. Mitochondrial damage is observed in livers of WD patients and in mouse models; copper induces fragmentation of mitochondrial membrane lipids, particularly cardiolipin, with deleterious effects on both mitochondrial integrity and function. Copper accumulation also induces chronic inflammation in WD livers, which is followed by regeneration in parts of the liver and occasionally neoplastic proliferation. Gene expression studies using microarrays have aided our understanding of the molecular basis of these changes. Copper overload alters cholesterol biosynthesis in hepatocytes resulting in reduced liver and serum cholesterol. Experiments are currently underway to elucidate the link between copper and cholesterol metabolism. These findings may facilitate the development of specific therapies to ameliorate WD progression.

Der M. Wilson ist eine autosomal-rezessiv vererbte Störung des hepatischen Kupferstoffwechsels. Er äußert sich klinisch in einer Leberschädigung unterschiedlicher Ausprägung und/oder neurologischen Symptomen. Kupferakkumulation und -toxizität führen zur direkten Beeinträchtigung von Hepatozyten mit nachfolgenden Entzündungsprozessen und irreversiblen Schädigungen von Neuronen vorwiegend des extrapyramidalen Systems. Nicht wenige Fälle beginnen akut mit fulminantem Leberversagen oder akut auftretenden neurologischen Störungen, beide Formen können unbehandelt oder bei verzögerter Diagnosestellung und Therapieeinleitung zu irreversiblen Schäden führen bzw. tödlich enden. Eine rasche und sichere Diagnose durch klinische, biochemische und genetische Untersuchung sowie die umgehende Therapieeinleitung mit Chelatoren und in Fällen fulminanten Leberversagens die orthotope Lebertransplantation sind für den Verlauf und die Prognose des akuten M. Wilson entscheidend. Wilson disease is an autosomal recessive inherited disorder of human copper metabolism clinically associated with hepatic damage and/or neurological symptoms of varying degree. Copper accumulation and toxicity result in direct injury to hepatocytes followed by inflammation and irreversible impairment of neurons, mainly in the extrapyramidal system. A not insignificant number of cases begin with fulminant liver failure or acute appearance of neurological symptoms. If left untreated or in the case of delayed diagnosis and treatment, both acute manifestations may result in irreversible symptoms or even death. Rapid and exact diagnosis by means of clinical, biochemical and genetic analysis and the immediate initiation of drug therapy with copper chelators or, in the case of fulminant liver failure, orthotopic liver transplantation are essential for a favourable outcome in patients with acute Wilson disease.