The treatment of Wilson's disease, a rare genetic disorder of copper metabolism

Sci Prog. 2013;96(Pt 1):19-32. doi: 10.3184/003685013X13587771579987.

Abstract

Wilson's disease is a rare autosomal recessive disease characterised by the deposition of copper in the brain, liver; cornea, and other organs. The overload of copper inevitably leads to progressive liver and neurological dysfunction. Copper overload in patients with Wilson's disease is caused by impairment to the biliary route for excretion of dietary copper A combination of neurological, psychiatric and hepatic symptoms can make the diagnosis of Wilson's disease challenging. Most symptoms appear in the second and third decades of life. The disease affects between one in 30,000 and one in 100,000 individuals, and is fatal if left untreated. Five drugs are currently available to treat Wilson's disease: British Anti-Lewisite; D-penicillamine; trientine; zinc sulfate or acetate; and ammonium tetrathiomolybdate. Each drug can reduce copper levels and/or transform copper into a metabolically inert and unavailable form in the patient. The discovery and introduction of these five drugs owes more to the inspiration of a few dedicated physicians and agricultural scientists than to the resources of the pharmaceutical industry.

Publication types

  • Historical Article
  • Review

MeSH terms

  • Brain / drug effects
  • Brain / metabolism
  • Brain / physiopathology
  • Chelating Agents / pharmacology
  • Chelating Agents / therapeutic use*
  • Copper / metabolism*
  • Cornea / drug effects
  • Cornea / metabolism
  • Cornea / physiopathology
  • Dimercaprol / pharmacology
  • Dimercaprol / therapeutic use*
  • Drug Discovery / history
  • Hepatolenticular Degeneration / drug therapy*
  • Hepatolenticular Degeneration / genetics
  • Hepatolenticular Degeneration / metabolism
  • Hepatolenticular Degeneration / physiopathology
  • History, 20th Century
  • Humans
  • Liver / drug effects
  • Liver / metabolism
  • Liver / physiopathology
  • Molybdenum / pharmacology
  • Molybdenum / therapeutic use*
  • Penicillamine / pharmacology
  • Penicillamine / therapeutic use*
  • Rare Diseases / drug therapy
  • Rare Diseases / genetics
  • Rare Diseases / metabolism
  • Rare Diseases / physiopathology
  • Trientine / pharmacology
  • Trientine / therapeutic use*
  • Zinc Sulfate / pharmacology
  • Zinc Sulfate / therapeutic use*

Substances

  • Chelating Agents
  • Dimercaprol
  • Zinc Sulfate
  • Copper
  • Molybdenum
  • tetrathiomolybdate
  • Penicillamine
  • Trientine