biomedicines Review Wilson’s Disease: Facing the Challenge of Diagnosing a Rare Disease Ana Sánchez-Monteagudo 1,2, Edna Ripollés 1,2, Marina Berenguer 2,3,4,5,† and Carmen Espinós 1,2,*,† 1 Rare Neurodegenerative Diseases Laboratory, Centro de Investigación Príncipe Felipe (CIPF), 46012 Valencia, Spain;
[email protected] (A.S.-M.);
[email protected] (E.R.) 2 Joint Unit on Rare Diseases CIPF-IIS La Fe, 46012 Valencia, Spain;
[email protected] 3 Hepatology-Liver Transplantation Unit, Digestive Medicine Service, IIS La Fe and CIBER-EHD, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain 4 Department of Medicine, Universitat de València, 46010 Valencia, Spain 5 Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Instituto de Salud Carlos III, 28029 Madrid, Spain * Correspondence:
[email protected]; Tel.: +34-963289680 † These authors have contributed equally. Abstract: Wilson disease (WD) is a rare disorder caused by mutations in ATP7B, which leads to the defective biliary excretion of copper. The subsequent gradual accumulation of copper in different organs produces an extremely variable clinical picture, which comprises hepatic, neurological psychi- atric, ophthalmological, and other disturbances. WD has a specific treatment, so that early diagnosis is crucial to avoid disease progression and its devastating consequences. The clinical diagnosis is based on the Leipzig score, which considers clinical, histological, biochemical, and genetic data. However, even patients with an initial WD diagnosis based on a high Leipzig score may harbor other conditions that mimic the WD’s phenotype (Wilson-like). Many patients are diagnosed using current Citation: Sánchez-Monteagudo, A.; available methods, but others remain in an uncertain area because of bordering ceruloplasmin levels, Ripollés, E.; Berenguer, M.; Espinós, inconclusive genetic findings and unclear phenotypes.