977 resultados para Macular degeneration
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Exercise is known to reduce cardiovascular risk. However, its role on atherosclerotic plaque stabilization is unknown. Apolipoprotein E(-/-) mice with vulnerable (2-kidney, 1-clip: angiotensin [Ang] II-dependent hypertension model) or stable atherosclerotic plaques (1-kidney, 1-clip: Ang II-independent hypertension model and normotensive shams) were used for experiments. Mice swam regularly for 5 weeks and were compared with sedentary controls. Exercised 2-kidney, 1-clip mice developed significantly more stable plaques (thinner fibrous cap, decreased media degeneration, layering, macrophage content, and increased smooth muscle cells) than sedentary controls. Exercise did not affect blood pressure. Conversely, swimming significantly reduced aortic Ang II type 1 receptor mRNA levels, whereas Ang II type 2 receptor expression remained unaffected. Sympathetic tone also significantly diminished in exercised 2-kidney, 1-clip mice compared with sedentary ones; renin and aldosterone levels tended to increase. Ang II type 1 downregulation was not accompanied by improved endothelial function, and no difference in balance among T-helper 1, T-helper 2, and T regulatory cells was observed between sedentary and exercised mice. These results show for the first time, in a mouse model of Ang II-mediated vulnerable plaques, that swimming prevents atherosclerosis progression and plaque vulnerability. This benefit is likely mediated by downregulating aortic Ang II type 1 receptor expression independent from any hemodynamic change. Ang II type 1 downregulation may protect the vessel wall from the Ang II proatherogenic effects. Moreover, data presented herein further emphasize the pivotal and blood pressure-independent role of Ang II in atherogenesis.
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Oleoylethanolamide (OEA) is an agonist of the peroxisome proliferator-activated receptor α (PPARα) and has been described to exhibit neuroprotective properties when administered locally in animal models of several neurological disorder models, including stroke and Parkinson's disease. However, there is little information regarding the effectiveness of systemic administration of OEA on Parkinson's disease. In the present study, OEA-mediated neuroprotection has been tested on in vivo and in vitro models of 6-hydroxydopamine (6-OH-DA)-induced degeneration. The in vivo model was based on the intrastriatal infusion of the neurotoxin 6-OH-DA, which generates Parkinsonian symptoms. Rats were treated 2 h before and after the 6-OH-DA treatment with systemic OEA (0.5, 1, and 5 mg/kg). The Parkinsonian symptoms were evaluated at 1 and 4 wk after the development of lesions. The functional status of the nigrostriatal system was studied through tyrosine-hydroxylase (TH) and hemeoxygenase-1 (HO-1, oxidation marker) immunostaining as well as by monitoring the synaptophysin content. In vitro cell cultures were also treated with OEA and 6-OH-DA. As expected, our results revealed 6-OH-DA induced neurotoxicity and behavioural deficits; however, these alterations were less severe in the animals treated with the highest dose of OEA (5 mg/kg). 6-OH-DA administration significantly reduced the striatal TH-immunoreactivity (ir) density, synaptophysin expression, and the number of nigral TH-ir neurons. Moreover, 6-OH-DA enhanced striatal HO-1 content, which was blocked by OEA (5 mg/kg). In vitro, 0.5 and 1 μM of OEA exerted significant neuroprotection on cultured nigral neurons. These effects were abolished after blocking PPARα with the selective antagonist GW6471. In conclusion, systemic OEA protects the nigrostriatal circuit from 6-OH-DA-induced neurotoxicity through a PPARα-dependent mechanism.
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The Barcelona Euro-Mediterranean Conference (1995) was intended to be a launching pad" for creating a new, innovative relationship between the EU-Fifteen and a selected set of non-member Middle Eastern and North African countries. The Barcelona Process was to become the European Union´s first attempt, of several, to create postmodern inclusive policy spheres as a way to deal with the post-enlargement problems of ´ins´ and outs´ in its immediate periphery. Nevertheless, in spite of geographical proximity, common problems and stated interest in creating amorphous EU borders in different sectors, the Euro-Mediterranean Partnership is today all but abandoned. This paper will examine some of the factors behind the current degeneration of the EU´s post-bipolar foreign policy strategy in the Mediterranean, by exploring the dialectic between the Union´s desire to expand its geopolitical, economic and cultural boundaries and the need to secure its territorial area (from migration, proliferation, social instability etc.). In the final part of the paper some suggestions for how to revive the relationship across the Mare Nostrum will be forwarded.
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BACKGROUND: The aim of this study is to determine whether statistical associations can be demonstrated in ocular syphilis between baseline clinical and laboratory parameters with visual acuity at presentation and with any change in visual acuity after treatment. METHODS: Charts of 26 patients (42 eyes) with ocular syphilis presenting to the Uveitis clinic of the Jules-Gonin Eye Hospital were reviewed. A baseline cross-sectional analysis was performed in order to identify any association between visual acuity at presentation and demographic, clinical or laboratory parameters. After treatment, any analogy between these parameters and a change in visual acuity was subsequently assessed in a series of univariate comparisons. RESULTS: The following factors were associated with worse initial visual acuity: severity of visual field impairment at presentation (p=0.012), macular oedema (p=0.004) and optic neuropathy (p=0.031). There was a borderline association with the presence of vasculitis on fluroangiography (p=0.072). Improvement in best corrected visual acuity after treatment was significantly associated with the presence of vasculitis on fluroangiography (p=0.005), neurosyphilis, according to lumbar puncture findings (p=0.037) and marginally with anterior uveitis (p=0.070). Inflammation relapse was associated with the coexistence of pain as presenting sign (p<0.001) and with a longer duration of symptoms prior to the initial visit (p=0.023). CONCLUSIONS: Severe ocular inflammation associated with vasculitis, vitritis or anterior uveitis in ocular syphilis would appear to be a reversible phenomenon that responds well to appropriate antibiotic treatment, resulting in improvement in visual acuity. Prompt treatment enables a good visual prognosis, while any delay in therapy increases the risk of subsequent relapse.
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Multiple sclerosis is an inflammatory demyelinating disease affecting the central nervous system and considered one of the leading causes of disability in young adults. The precise cause of multiple sclerosis is unknown, although the current evidence points towards a combination of genetic and environmental factors leading to an autoimmune response that promotes neuronal degeneration. In this review, we will describe the association between the immune response and neurodegeneration in multiple sclerosis.
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Résumé : Cette recherche doctorale analyse l'engagement des médecins français autour de l'éducation physique entre 1741 et 1888. Basé sur un travail prosopographique d'identification des médecins qui ont participé à l'élaboration de l'éducation physique, ce travail repose sur une mise en dialogue de leurs prises de position respectives. Pour réaliser cette enquête, nous avons compulsé un large corpus de sources primaires, composé des ouvrages consacrés à la gymnastique médicale mais aussi une très large portion de la production d'imprimés touchant à l'anatomie, l'hygiène, la thérapeutique, la physiologie, l'orthopédie, etc. Le corpus contient également des articles des principaux dictionnaires médicaux de la période et des principales revues médicales du XIXe siècle. Avec une approche critique de l'historiographie et à partir de ce corpus, nous avons travaillé dans le cadre de contextes définis pour saisir au plus près les logiques sociales et scientifiques amenant les médecins auprès de l'éducation physique. Trois conjonctures successives structurent l'engagement médical. Entre 1741 et 1817, la thèse retrace l'émergence d'un questionnement ; les années 1817-1847 constituent un « moment orthopédique » dans la formulation de la gymnastique ; et finalement entre 1847 et 1888, on observe une diversification des voies de légitimation médicale des exercices du corps. Ces trois moments de l'histoire des « discours gymniques médicaux » proposent un certain nombre de convergences : la prégnance de l'orthopédie, une certaine concentration autour de la santé des corps féminins, l'inclusion dans un « projet hygiéniste » ; mais aussi des divergences et des singularités : relatives à la progressive structuration en cours du champ médical, à l'implication progressive du politique (surtout après 1845/1850), aux transformations des pathologies/doctrines médicales « dominantes », ainsi qu'à l'importance plus ou moins forte de l'une ou l'autre des facettes de l'éducation physique (militaire, athlétique, « médicinale » ou pédagogique). Le processus est aussi celui de l'expérimentation de la curation de certaines pathologies (scolioses, affections nerveuses), dans des configurations idéologiques/scientifiques marquées par la « dégénération » (XVIIIe siècle), l'anatomie pathologique (début du XIXe siècle) et plus tard la « dégénérescence » et les affections nerveuses (après 1850). Dans le cadre d'une dynamique d'inspiration « foucaldienne », ces recommandations évoluent d'une anatomopolitique - caractérisée par un essor de discours empreints d'anatomie au XVIIIe siècle - vers une biopolitique - caractérisée par l'engagement de l'Etat qui fait de la gymnastique une discipline d'enseignement, pensée à des fins hygiéniques dans la seconde moitié du XIXe - où le processus réside en fait dans une biologisation progressive des recommandations pratiques. Observée à l'aune de la formulation médicale de l'éducation physique, la biopolitique n'est pas réalisée dans la seconde moitié du XVIIIe, elle se compose lentement aux marges de l'institution scolaire et des gymnastiques pédagogico-militaires pour constituer un projet thérapeutique et hygiénique plus construit après 1850. Abstract : This dissertation analyzes French doctor's involvement in debates and initiatives concerning physical education between 1741 and 1888. Based on a prosopographic inventory of those physicians who participated in the development of physical education, it explores the variety of their discourses with respect to the practice of physical exercises. This investigation relies on a large selection of primary sources: works devoted to medical gymnastic, but also medical treatises related to anatomy, hygiene, therapeutics, physiology, orthopedics, etc. The sources also include articles from the major medical dictionaries and journals of the nineteenth century. These documents are used to explore the socio-scientific mechanisms that underlay physicians' commitment to physical education. Three chronological periods structure medical engagement in the area of physical education. Between 1741 and 1817 the thesis traces the emergence of a questioning; the years 1817 to 1847 represent an « orthopedic moment » in the development of gymnastics; finally between 1847 and 1888, one witnesses a diversification of the legitimation process between medicine and gymnastics. These three moments in the history of « medical and gymnastic discourses » offer a number of similarities: the weight of orthopedics, the ongoing focus on the health of the female body, and the association of these discourses with a « hygienic project ». But differences also distinguish these periods as the medical field became more structured and new medical doctrines became dominant, with the increasing involvement of politics (especially after 1850), and with the changing weight of priorities within physical education (military, athletic, « medical » or pedagogic). Medical discourses centered on the curing of certain diseases (scoliosis or nervous disorders) are analyzed within an ideological configuration marked by the idea of « degeneration » (in the eighteenth century), « pathological anatomy » (in the early nineteenth century) and later « dégénérescence » associated with nervous disorders (after 1850). The dissertation draws on Foucault's historical epistemology to understand how medical recommendations evolve from an anatomopolitics - characterized by a surge in anatomical discourses - toward a biopolitics - characterized by the commitment of the State to introduce gymnastics for hygienic purposes into schools in the second half of the nineteenth century. This process reveals a progressive "biologization" of practical recommendations. The medical discourses about physical education show that Foucault's biopolitical power is not achieved in the second half of the eighteenth century, but develops slowly at the margins of the school system and of pedagogical and military gymnastic, becoming a veritable hygienic and therapeutic project only after 1850.
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OBJECTIVES: The aim of the present study is to investigate the demographics, aetiologies, complications, treatments and visual outcomes in paediatric uveitis patients in the French-speaking part of Switzerland. METHODS: Chart review of all patients diagnosed with uveitis before the age of 16 years, presenting to two tertiary referral centres (uveitis and paediatric rheumatology clinics) in Lausanne, Switzerland, between 2000 and 2009. RESULTS: Seventy-nine children (37 girls) were identified, 62 living in Switzerland, 15 in Europe and 2 in North Africa. Median age at first symptoms was 9.0 years (range 1.5-15.8 years), with a median follow-up time of 1.8 years (0-8 years). Both eyes were involved in 51 patients (64.6%). The course was acute in 30.4%, chronic in 60.8% and recurrent in 8.9%. Anterior uveitis occurred in 39.2%, intermediate in 32.9%, posterior in 22.8% and panuveitis in 5.1%. The three main diagnoses were idiopathic uveitis (34.2%), JIA-related uveitis (22.8%) and toxoplasmic retinochoroiditis (15.2%). During the last follow-up visit, the visual acuity (VA) was ≥8/10 in 72% of all eyes with a measurable VA. Cataract (8%), ocular hypertension/glaucoma (8%) and macular fibrosis (4%) were the three most common severe complications. Systemic steroids were given to 56% and biological agents to 24% of patients with inflammatory uveitis. CONCLUSIONS: Uveitis in children can be a devastating disease. A strict classification of aetiologies and a tight collaboration between paediatric rheumatologists and ophthalmologists are important to ensure early control of ocular inflammation and improve long-term visual prognosis.
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Retinitis pigmentosa (RP) is an inherited form of retinal degeneration that leads to progressive visual-field constriction and blindness. Although the disease manifests only in the retina, mutations in ubiquitously expressed genes associated with the tri-snRNP complex of the spliceosome have been identified in patients with dominantly inherited RP. We screened for mutations in PRPF6 (NM_012469.3), a gene on chromosome 20q13.33 encoding an essential protein for tri-snRNP assembly and stability, in 188 unrelated patients with autosomal-dominant RP and identified a missense mutation, c.2185C>T (p.Arg729Trp). This change affected a residue that is conserved from humans to yeast and cosegregated with the disease in the family in which it was identified. Lymphoblasts derived from patients with this mutation showed abnormal localization of endogenous PRPF6 within the nucleus. Specifically, this protein accumulated in the Cajal bodies, indicating a possible impairment in the tri-snRNP assembly or recycling. Expression of GFP-tagged PRPF6 in HeLa cells showed that this phenomenon depended exclusively on the mutated form of the protein. Furthermore, analysis of endogenous transcripts in cells from patients revealed intron retention for pre-mRNA bearing specific splicing signals, according to the same pattern displayed by lymphoblasts with mutations in other PRPF genes. Our results identify PRPF6 as the sixth gene involved in pre-mRNA splicing and dominant RP, corroborating the hypothesis that deficiencies in the spliceosome play an important role in the molecular pathology of this disease.
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Hypertension is associated with increased risk of cardiovascular diseases. Antihypertensive treatment, particularly blockade of the renin-angiotensin system, contributes to prevent atherosclerosis-mediated cardiovascular events. Direct comparison of different antihypertensive treatments on atherosclerosis and particularly plaque stabilization is sparse. ApoE(-/-) mice with vulnerable (2-kidney, 1-clip renovascular hypertension model) or stable (1-kidney, 1-clip renovascular hypertension model) atherosclerotic plaques were used. Mice were treated with aliskiren (renin inhibitor), irbesartan (angiotensin-receptor blocker), atenolol (beta-blocker), or amlodipine (calcium channel blocker). Atherosclerosis characteristics were assessed. Hemodynamic and hormonal parameters were measured. Aliskiren and irbesartan significantly prevented atherosclerosis progression in 2-kidney, 1-clip mice. Indeed, compared with untreated animals, plaques showed thinner fibrous cap (P<0.05); smaller lipid core (P<0.05); decreased media degeneration, layering, and macrophage content (P<0.05); and increased smooth muscle cell content (P<0.05). Interestingly, aliskiren significantly increased the smooth muscle cell compared with irbesartan. Despite similar blood pressure lowering, only partial plaque stabilization was attained by atenolol and amlodipine. Amlodipine increased plaque smooth muscle cell content (P<0.05), whereas atenolol decreased plaque inflammation (P<0.05). This divergent effect was also observed in 1-kidney, 1-clip mice. Normalizing blood pressure by irbesartan increased the plasma renin concentration (5932+/-1512 ng/mL per hour) more than normalizing it by aliskiren (16085+/-5628 ng/mL per hour). Specific renin-angiotensin system blockade prevents atherosclerosis progression. First, evidence is provided that direct renin inhibition mediates atherosclerotic plaque stabilization. In contrast, beta-blocker and calcium channel blocker treatment only partially stabilize plaques differently influencing atherogenesis. Angiotensin II decisively mediates plaque vulnerability. The plasma renin concentration measurement by an indirect method did not confirm the excessive increase of plasma renin concentration reported in the literature during aliskiren compared with irbesartan or amlodipine treatment.
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INTRODUCTION: Symptomatic foraminal stenosis has been observed in patients with degenerative disc disease, scoliosis, asymmetrical disc degeneration and spondylolisthesis. Nevertheless not all patients with the above pathologies will develop symptomatic foraminal stenosis. We hypothesised that symptomatic patients have anatomical predisposition to foraminal stenosis, namely a larger pedicle height (PH) to vertebral body height (VH) ratio, leaving less room below the pedicle for the exiting nerve root compared to asymptomatic patients. PATIENT SAMPLE: 66 Patients were divided in two groups. The surgical group consisted of 37 patients (average age of 61 years) who presented with severe radicular symptoms resisting to conservative measures and requiring decompression and transforaminal lumbar interbody fusion (TLIF). The control group consisted of 29 patients (average age of 51 years) presenting with low back pain (LBP) but with no radicular symptoms and who were treated conservatively. METHODS: We measured VH at the level of the posterior wall as well as PH on parasagittal images (CT or MRI) on all lumbar levels (L1 to L5). Statistical analysis was performed using Student's t test. RESULTS: No difference in PH was found between the two groups for L1 to L4 levels. By contrast, there was a highly statistically significant difference in VH between the two groups from L1 to L4 level. In the surgical group, the VH was smaller (p < 0.001). CONCLUSIONS: Symptomatic patients with foraminal stenosis have smaller VH leading to lesser space beneath the pedicle and putting the exiting nerve root at risk in cases of spondylolisthesis or disc degeneration.
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Inner ear hair cells and supporting cells arise from common precursors and, in mammals, do not show phenotypic conversion. Here, we studied the role of the homeodomain transcription factor Prox1 in the inner ear sensory epithelia. Adenoviral-mediated Prox1 transduction into hair cells in explant cultures led to strong repression of Atoh1 and Gfi1, two transcription factors critical for hair cell differentiation and survival. Luciferase assays showed that Prox1 can repress transcriptional activity of Gfi1 independently of Atoh1. Prox1 transduction into cochlear outer hair cells resulted in degeneration of these cells, consistent with the known phenotype of Gfi1-deficient mice. These results together with the widespread expression of endogenous Prox1 within the population of inner ear supporting cells point to the role for Prox1 in antagonizing the hair cell phenotype in these non-sensory cells. Further, in vivo analyses of hair cells from Gfi1-deficient mice suggest that the cyclin-dependent kinase inhibitor p57(Kip2) mediates the differentiation- and survival-promoting functions of Gfi1. These data reveal novel gene interactions and show that these interactions regulate cellular differentiation within the inner ear sensory epithelia. The data point to the tight regulation of phenotypic characteristics of hair cells and supporting cells.
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BACKGROUND: In sporadic Tauopathies, neurofibrillary degeneration (NFD) is characterised by the intraneuronal aggregation of wild-type Tau proteins. In the human brain, the hierarchical pathways of this neurodegeneration have been well established in Alzheimer's disease (AD) and other sporadic tauopathies such as argyrophilic grain disorder and progressive supranuclear palsy but the molecular and cellular mechanisms supporting this progression are yet not known. These pathways appear to be associated with the intercellular transmission of pathology, as recently suggested in Tau transgenic mice. However, these conclusions remain ill-defined due to a lack of toxicity data and difficulties associated with the use of mutant Tau. RESULTS: Using a lentiviral-mediated rat model of hippocampal NFD, we demonstrated that wild-type human Tau protein is axonally transferred from ventral hippocampus neurons to connected secondary neurons even at distant brain areas such as olfactory and limbic systems indicating a trans-synaptic protein transfer. Using different immunological tools to follow phospho-Tau species, it was clear that Tau pathology generated using mutated Tau remains near the IS whereas it spreads much further using the wild-type one. CONCLUSION: Taken together, these results support a novel mechanism for Tau protein transfer compared to previous reports based on transgenic models with mutant cDNA. It also demonstrates that mutant Tau proteins are not suitable for the development of experimental models helpful to validate therapeutic intervention interfering with Tau spreading.
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ABSTRACT: Ultramarathons comprise any sporting event involving running longer than the traditional marathon length of 42.195 km (26.2 miles). Studies on ultramarathon participants can investigate the acute consequences of ultra-endurance exercise on inflammation and cardiovascular or renal consequences, as well as endocrine/energetic aspects, and examine the tissue recovery process over several days of extreme physical load. In a study published in BMC Medicine, Schütz et al. followed 44 ultramarathon runners over 4,487 km from South Italy to North Cape, Norway (the Trans Europe Foot Race 2009) and recorded daily sets of data from magnetic resonance imaging, psychometric, body composition and biological measurements. The findings will allow us to better understand the timecourse of degeneration/regeneration of some lower leg tissues such as knee joint cartilage, to differentiate running-induced from age-induced pathologies (for example, retropatelar arthritis) and finally to assess the interindividual susceptibility to injuries. Moreover, it will also provide new information about the complex interplay between cerebral adaptations/alterations and hormonal influences resulting from endurance exercise and provide data on the dose-response relationship between exercise and brain structure/function. Overall, this study represents a unique attempt to investigate the limits of the adaptive response of human bodies.Please see related article: http://www.biomedcentral.com/1741-7015/10/78.
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Projecte de recerca elaborat a partir d’una estada a la facultat de Medical Sciences de la Universitat de Bristol, Alemanya, entre 2011 i 2012. Aquest treball s'ha realitzat a la facultat de Medical Sciences de la Universitat de Bristol, al laboratori del Prof. Andrew Di cks,o ta la seva supe1visi6. Ei treball s'ha realitzat amb els seus col.laboradors, el Dr Richard Lee i Lauren Schew:tz. Objectiu: Els glucocorticoids (GCs) tenen diversos efectes sobre les cèl.lules T CD4+ per modular la resposta immune principalment mitjançant els seus efectes anti-proliferatius. Tot i això la dexametasona (Dex, glucocorticoid sintètic) també indueix la secreció de la citocina immunosupressora IL-10 . L'objectiu d'aquest treball ha estat comparar la capacitat dels glucocorticoids en modular la producció de citocines en cèl.lules T CD4+ en pacients uveítics sensibles (SS), i resistents (SR) a esteroids. Metodologia: Es van aïllar cèl• lules T CD4+ de pacients uveítics SS i SR. Es va induir la producció de cèl.lules T regulatories (Tregs) i mitjançant I'estimulació amb anti- CD3/CD28 en presència d'lL-2 i Després del cultiu es van analitzar els nivells d’expressió intracel•lular de les citocines IL-10, IL-4, IL-9, IL-17 i IFN-y per citometria de flux. D'altra banda, també es van separar cèl.lules T CD4t de pacients uveïtis segons I'expressió de CCR6 i es van polaritzar per obtenir els fenotips ThO i Th17 per estudiar I'efecte de Dex i ciclosporina (CsA) en aquests subtipus cel.lulars. Resultats: Les cèl.lules T CD4+ de pacients SR no van ser capaces de produir IL-10 en resposta al tractament amb Dex. Dex no va afectar els nivells d'expressió d'11-17, però va reduir els nivells de IL-4 i IFN-V. Els nivells d'lL-9 (marcador d'un subtipus cel.lular recentment descrit, Th9) v ise r sempre inferiors a 11%. En canvi, el traclament a amb CsA va reduir significativament els nivells d'lL-17 i IFN-y en cèl.lules Th17 i ThO. Conclusions: La Dex no és capaç d'induir cèl.lules Treg funcionalment supresores en pacients veiticsS R. Aquest fenòmen és Independent dels efectes en I'expressió d'altres citocines. Aquests resultats suggereixen que I'efecte de la Dex sobre la funció de cél.lules Treg és clau en el desenvolupament del fenotip SR en la uveïtis . D'altra banda, al llarg d'aquest temps he iniciat un nou projecte que ha donat lloc a un futur projecte de col elaboració. Resumidament, degut a que els nivells elevats de proteïna C-reactiva (CRP) són un factor de risc en la degeneració macular, malaltia inflamatòria crònica principal causa de ceguera en països industrialitzats, I'objectiu d'aquest altre treball ha estat iniciar un projecte per avaluar els efectes de les diferents isoformes de la CRP sobre la resposta inflamatòria d’epiteli pigmentari retinià.
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Wilson disease (WD) is an inherited disorder of hepatic copper excretion leading to toxic accumulation of copper in the liver as well as the brain, cornea, and other organs. The defect is due to mutations of the copper-transporting ATPase ATP7B. Clinical manifestations are highly variable and comprise acute liver failure, chronic hepatitis and cirrhosis as well as neurological or psychiatric symptoms. The Kayser-Fleischer corneal ring is pathognomonic but absent in about 50% of patients with hepatic manifestations alone. A high index of suspicion in clinically compatible situations is key, with a combination of laboratory tests allowing the diagnosis of WD. Treatment is based on the use of chelating agents, D-penicillamine or trientine. Liver transplantation should be considered for patients with acute liver failure or advanced cirrhosis.