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. 2023 Jan 17;21(1):e07728. doi: 10.2903/j.efsa.2023.7728
Reference Study design; Population Serum copper and/or CP Urinary copper Hepatic copper Liver toxicity markers Neurotoxicity markers
(Brewer,  2000 )

WD patients

Heterozygotes

CP‐Cu levels in heterozygotes were intermediate between those of normal individuals (higher) and those homozygote for WD (lower) Elevated Cu levels in 24‐h urine of siblings of WD patients, presumed heterozygotes Evidence of higher levels in suspected heterozygotes
(Gromadzka et al.,  2010 )

WD heterozygotes (Hzg) (parents of WD patients) (n = 68)

Age‐matched controls (n = 31)

24‐h urine collection

Reduced serum caeruloplasmin in Hzg (p < 0.001)

Carriers of H1069Q mutation had higher CP than other Hzg (p = 0.03)

No difference in serum copper

No difference Not measured

Reduced ALT (p = 0.014) and AST (p = 0.07) in Hzg

No difference in their ratio and on platelets

No related difference
(Ferenci et al.,  2007 )

WD patients (n = 46) late onset (> 40 years)

Hepatic WD: 15 of 46

Neurologic WD: 31 of 46

Asymptomatic: 2 of 46

CP < 20 mg/dL in 28 of 31 neurologic patients and in 13 of 15 hepatic patients > 100 μg/L in all

> 250 μg/g in 13 of 17 patients who were sampled

Levels similar to early onset patients

Histology evidence in 13 of 15 hepatic patients and in 14 of 31 neurologic patients In 2 of 5 hepatic patients (and all the neurologic patients)
(Ferenci,  2005 )

WD patients (n = 114)

Hepatic WD (n = 90)

Neurologic WD (n = 39)

Non‐cholestatic liver disease (NCLD) (n = 219)

No evidence of liver disease (n = 26)

Not measured All WD patients

> 250 μg/g in 95 of 114 WD patients (83.3%)

> 250 μg/g in 35 of 39 neurologic WD patients

> 250 μg/g in 18 of 20 hepatic WD patients (only 20 were measured)

> 250 μg/g in 3 of 219 NCLD patients

Histopathology

No correlation of severity of histological findings with copper content

Clinical diagnosis
(Yang et al.,  2015 )

Patients with various liver disease (n = 3,350) of whom 714 had two passes of liver biopsies and copper measurement,

WD patients (n = 178)

Hepatic WD (n = 105)

Neurological WD (n = 31)

Hepatoneurological WD (n = 25)

Presymptomatic WD (n = 17)

Heterozygote WD (n = 24)

Not reported Not reported

> 250 μg/g in 168 of 178 WD patients

> 250 μg/g in 105 of 105 hepatic WD patients

> 250 μg/g in 60 of 60 neurologic WD patients

> 250 μg/g in 1 of 24 heterozygotes; 4 of 24 had > 150 μg/g and 19 of 24 had > 75 μg/g

Clinical diagnosis

Hepatic copper was higher in hepatic WD than other phenotypes

Clinical diagnosis