Clinical curative effects of dimercaptosuccinic acid on hepatolenticular degeneration and the impact of DMSA on biliary trace elements.
OBJECTIVE
To observe the biliary copper content of nonhepatolenticular degeneration (HLD) controls and changes in the trace elements in the bile, cerebrospinal fluid, blood and urine of hepatolenticular degeneration patients before and after dimercaptosuccinic acid (DMSA) treatment in order to further explore the etiological mechanism of HLD and prove the therapeutic effect of DMSA on HLD patients.


METHODS
A consecutive series of 20 patients with HLD were given DMSA orally for 4 weeks. Adult dosage was 1.5 g/day and child dosage 1.0 g/day. Their bile, cerebrospinal fluid, blood and urine samples were obtained before and after treatment with DMSA through duodenal drainage and lumbar puncture. Biliary samples of 22 non-HLD controls were taken by drainage tube after surgical operation. Hitachi-208 atom absorption spectrophotometer was used to assay the content of copper, zinc and iron of each sample.


RESULTS
DMSA could effectively improve the symptoms such as dysphasia, salivation, dysphagia and darkening of the skin; limb trembling and myotonia came second; but it showed no obvious effect on dysstasia, limb contracture and deformity, and hepatosplenomegaly. It was effective for the patients who were younger and had no obvious hepatic damage. No serious side effects were seen through the course of treatment. Laboratory study showed that biliary copper content of HLD patients was evidently lower than that of non-HLD controls (P < 0.01); DMSA could evidently improve biliary copper excretion besides clearly increase urinary copper excretion (P < 0.01) and had nothing to do with biliary zinc excretion (P > 0.05).


CONCLUSIONS
Biliary copper excretion disturbance participates directly in the pathophysiology of copper retention of HLD patients. DMSA is a favorable cupruretic drug for patients with HLD.
Ren
M
M
Institute of Neurology, Affiliated Hospital of Anhui TCM College, Hefei, China.
Yang
R
R
D000293:Adolescent; D000328:Adult; D000931:Antidotes / Q000627:therapeutic use*; D001646:Bile / Q000378:metabolism*; D002648:Child; D003300:Copper / Q000378:metabolism*; D005260:Female; D006527:Hepatolenticular Degeneration / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000378:metabolism; D008297:Male; D004113:Succimer / Q000627:therapeutic use*; D014131:Trace Elements / Q000378:metabolism; D015032:Zinc / Q000378:metabolism
D000931:Antidotes; D014131:Trace Elements; D003300:Copper; D004113:Succimer; D007501:Iron; D015032:Zinc