title: Phenotypic and genetic characterization of a cohort of pediatric Wilson disease patients.
abstract: BACKGROUND
  In Egypt, Wilson disease seems to be under diagnosed and clinical data on large cohorts are limited. The aim of this study is to highlight the clinical, laboratory and genetic characteristics of this disease in our pediatric population as well as to report our experience with both treatment options and outcome.
  
  
  METHODS
  The study included 77 patients from 50 unrelated families (62 were followed up for a mean period of 58.9 ± 6.4 months and 27 were asymptomatic siblings). Data were collected retrospectively by record analysis and patient interviews. Diagnosis was confirmed by sequencing of the ATP7B gene in 64 patients.
  
  
  RESULTS
  Our patients had unique characteristics compared to other populations. They had a younger age of onset (median: 10 years), higher prevalence of Kayser-Fleischer rings (97.6% in the symptomatic patients), low ceruloplasmin (93.5%), high rate of parental consanguinity (78.9%) as well as a more severe course. 71.42% of those on long term D-penicillamine improved or were stable during the follow up with severe side effects occurring in only 11.5%. Preemptive treatment with zinc monotherapy was an effective non-toxic alternative to D-penicillamine. Homozygous mutations were found in 85.7%, yet limited by the large number of mutations detected, it was difficult to find genotype-phenotype correlations. Missense mutations were the most common while protein-truncating mutations resulted in a more severe course with higher incidence of acute liver failure and neurological symptoms.
  
  
  CONCLUSIONS
  Egyptian children with Wilson disease present with early Kayser-Fleischer rings and early onset of liver and neurological disease. The mutational spectrum identified differs from that observed in other countries. The high rate of homozygous mutations (reflecting the high rate of consanguinity) may potentially offer further insights on genotype-phenotype correlation.
authors.affiliation: Yassin Abdel Ghaffar Charity Center for Liver Disease and Research, Cairo, Egypt. tyghaffar@gmail.com
authors.forename: Tawhida Y
authors.initials: TY
authors.lastname: Abdel Ghaffar
authors.forename: Solaf M
authors.initials: SM
authors.lastname: Elsayed
authors.forename: Suzan
authors.initials: S
authors.lastname: Elnaghy
authors.forename: Ahmed
authors.initials: A
authors.lastname: Shadeed
authors.forename: Ezzat S
authors.initials: ES
authors.lastname: Elsobky
authors.forename: Hartmut
authors.initials: H
authors.lastname: Schmidt
mesh_terms: D000251:Adenosine Triphosphatases / Q000235:genetics*; D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D027682:Cation Transport Proteins / Q000235:genetics*; D002648:Child; D000073840:Copper-Transporting ATPases; D003316:Corneal Diseases / Q000235:genetics; D004534:Egypt; D005260:Female; D005500:Follow-Up Studies; D056726:Genetic Association Studies; D006527:Hepatolenticular Degeneration / Q000235:genetics* / Q000503:physiopathology*; D006801:Humans; D008107:Liver Diseases / Q000235:genetics; D008297:Male; D020125:Mutation, Missense; D009422:Nervous System Diseases / Q000235:genetics; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D027682:Cation Transport Proteins; D000251:Adenosine Triphosphatases; C000612464:ATP7B protein, human; D000073840:Copper-Transporting ATPases