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Wilson’s DiseaseGeneral InformationWilson’s Disease (WD) an autosomal recessive disease, thus meaning both parents must be carrying the genetic defect in order for it to pass down to their child. Wilson’s effects males and females equally and has been founded in all races and ethnic groups around the world. Symptoms of WD usually begin to develop in late childhood, however often WD is undiagnosed or misdiagnosed. This is due to the rarity of WD found in approximately 1 out of 30,000 to 40,000 people and the broad range of symptoms which can vary from neurological behavioral issues to liver failure. Wilson’s Disease occurs because of a copper buildup which exists due to the inactive ATP7B gene which lies on chromosome 13q14.3. Currently, researchers have recorded 250 different gene mutations which are responsible for Wilson’s Disease. Different Mutations FormsIt has been identified that around half of the mutations which cause WD, change the 3D structure and shape, due to the fact one of the basic amino building blocks incorrect. One of the more common forms of WD has histidine replaced with glutamine at 1069 position. This form affects nearly 40% of all people carrying Wilson’s in Northern and Eastern Europe. Interestingly, different forms of Wilson’s affect those in different locations, for example in Costa Rica, their primary form of Wilson’s happens when the arginine and leucine are exchanged at position 1270. The most severe forms of Wilson’s occur when deletion or insertion happens within the ATP7B gene found on chromosome 13, this often leads to no signals occurring. Meaning copper is completely unable to be processed in the body resulting in the buildup.Path Of CopperThe average diet consists of an individual consuming 1-2 mg of copper (Cu) a day, the human body only needs around .75mg meaning the excess must be disposed of. In an unaffected individual, the Cu moves through the digestive tract and is transferred to the liver.  After landing in the liver, the Cu connects with the ATP7B gene which allows the Cu molecules to bind to the apoceruloplasmin a copper-carrying protein. Following this connection, the apoceruloplasmin becomes ceruloplasmin which can carry up to six Cu molecules. The ATP7B gene packages the remaining copper into vesicles which is then exocytosed into the bile and where 90% of the copper excreted in fecal matter and the remaining 10% is in urine. Without ATP7B GeneIn a person affected by Wilson’s Disease, the copper follows the same pathway until it enters the hepatocytes, this is when the inactive ATP7B gene becomes an issue. The apoceruloplasmin only can become ceruloplasmin after it has been incorporated with copper. Now, without the ATP7B it cannot incorporate into the ceruloplasmin and it is unable to be excreted into bile. Due to this inactivity, the free copper radicals build up within the hepatocytes. In the patients with Wilson’s, Cu stored as free radicals reacts with the hydrogen peroxide within the body, forming hydroxyl radicals which are extremely damaging to tissues. This is happening within the liver-damaging the hepatocytes, enough damage to the cells will cause them deteriorate allowing the free copper radicals to enter the bloodstream, this is where the most damage occurs. Now inside the bloodstream, they can begin to move to any organ and tissue within the body.Symptoms and Complicationsaccording to a recent review, 30-40% of patients have psychiatric manifestations at the time of diagnosis, and about 20% have already seen a psychiatrist prior to the diagnosis of WD.6,7Once in the bloodstream the copper can interact with any or organs or tissues, often it is found creating buildup in the brain, depending on the exact location there will be different symptoms. If the copper deposits within the Basal Ganglia it will mimic a movement disorder which has similar symptoms to Parkinson’s Disease. If the Cu begins to build up in the cerebral cortex the largest part of the brain, it will affect the neurons and can lead to Dementia. One of the more common ways which Wilson’s is diagnosed is if an individual has a copper ring around their cornea called Kayser Fleischer Rings, these rings occur when the free copper radicals begin to build up in the Descemet’s Membrane. Because the problem stems from the liver it seems obvious that liver damage will be an issue, but how severe is it? Usually, it begins as acute hepatitis however it is not always caught in time meaning it and can eventually lead to cirrhosis and in the worst cases liver failure. Patients experiencing WD can face and enlargement of their organs especially seen in their liver and spleen. Others can experience renal disease. Hepatosplenomegaly. Hemolytic anemia When observing the blood of an individual with Wilson’s there are signs that can make it easy to diagnose. Due to the fact that ceruloplasmin is only made after apoceruloplasmin connects with the blood, there will be a huge decrease in the ceruloplasmin without the ATP7B gene. The apoceruloplasmin is relatively unstable when existing alone within the plasma. With more free copper traveling through the blood to tissues and organs, it is only expected that there will be an increase in the amount of copper which is found in the blood. As mentioned previously in a body with a regularly functioning ATP7B gene only an estimated 10% of excess copper is excreted in urine, however, when it is existing as free radicals and not being processed correctly into the bile, there will be an increase of how much copper is found within the urine.    Personality disorders, mood disorders, cognitive deficits, psychotic manifestations, etc.6 Psychiatric symptoms can occur before, concurrent with or after the diagnosis and treatment of WD. Treatmentdescemet’s membrane-  a layer between the stroma and the endothelial layer of the cornea acute hepatitis renal diseasehepatocytes

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