Author: ["Philipp A Lang","Marcus Schenck","Jan P Nicolay","Jan Ulrich Becker","Daniela S Kempe","Adrian Lupescu","Saisudha Koka","Kerstin Eisele","Barbara A Klarl","Herbert Rübben","Kurt W Schmid","Klaus Mann","Sibylle Hildenbrand","Harald Hefter","Stephan M Huber","Thomas Wieder","Andreas Erhardt","Dieter Häussinger","Erich Gulbins","Florian Lang"]
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Abstract
Wilson disease is caused by accumulation of Cu2+ in cells, which results in liver cirrhosis and, occasionally, anemia. Here, we show that Cu2+ triggers hepatocyte apoptosis through activation of acid sphingomyelinase (Asm) and release of ceramide. Genetic deficiency or pharmacological inhibition of Asm prevented Cu2+-induced hepatocyte apoptosis and protected rats, genetically prone to develop Wilson disease, from acute hepatocyte death, liver failure and early death. Cu2+ induced the secretion of activated Asm from leukocytes, leading to ceramide release in and phosphatidylserine exposure on erythrocytes, events also prevented by inhibition of Asm. Phosphatidylserine exposure resulted in immediate clearance of affected erythrocytes from the blood in mice. Accordingly, individuals with Wilson disease showed elevated plasma levels of Asm, and displayed a constitutive increase of ceramide- and phosphatidylserine-positive erythrocytes. Our data suggest a previously unidentified mechanism for liver cirrhosis and anemia in Wilson disease.
Cite this article
Lang, P., Schenck, M., Nicolay, J. et al. Liver cell death and anemia in Wilson disease involve acid sphingomyelinase and ceramide. Nat Med 13, 164–170 (2007). https://doi.org/10.1038/nm1539