Wilson disease — the impact of hyperimmunity on disease activity: A case report

Table 1 Laboratory values at start of treatment with D-penicilliamine

Date of testing	ALT (U/L)	AST (U/L)	GGT (U/L)	Non-CP-bound copper (µg/dL)
08/09	114	65	28	27
10/09	113	55	30	21
03/10	61	43	27	16
06/10	28	31	20	< 15
10/10	33	27	21	< 15
12/10	24	25	19	< 15
03/11	19	24	18	< 15
10/11	17	25	13	< 15

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; CP: Ceruloplasmin.

Table 2 Increase of transaminases during different chelator therapies

Therapy	Date of testing	ALT (U/L)	AST (U/L)	GGT (U/L)	Non-CP-bound copper (µg/dL)
Trientine-2HCl	02/16	38	24	< 40	< 15
	03/16	47	28	< 40	< 15
	07/16	44	30	< 40	< 15
	09/16	42	30	< 40	< 15
	10/16	39	21	< 40	< 15
	11/17	34	24	< 40	< 15
	05/17	39	24	< 40	< 15
	10/17	56	30	< 40	< 15
Trientine-2HCl + zinc	01/18	69	36	< 40	< 15
	04/18	24	23	< 40	< 15
	08/18	41	40	< 40	< 15
	10/18	66	30	< 40	< 15
Trientine-2HCl	05/19	174	61	ND	< 15
Trientine-4HCl	07/19	245	74	51	< 10
	08/19	285	80	76	< 15
	09/19	297	90	67	< 15
	10/19	367	81	87	< 15
	11/19	417	107	76	< 15
D-penicillamine	04/12/19	505	128	79	< 15
	10/12/19	571	147	77	< 15
	17/12/19	409	109	78	< 15
D-penicillamine+Prednisolone
40 mg	15/01/20	416	135	59	< 15
40 mg	30/01/20	268	79	56	< 15
20 mg	18/02/20	170	47	54	< 15
5 mg	15/03/20	84	37	33	< 15
D-penicillamine alone1	25/03/20	168	60	ND	< 15
	20/4/20	117	48
	29/5/20	127	46

¹Prednisolone was stopped on 15/03/20. AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; CP: Ceruloplasmin; GGT: Gamma-glutamyltransferase; ND: Not determined.