The H1069Q mutation in ATP7B is associated with late and neurologic presentation in Wilson disease: results of a meta-analysis

Background and Aims Wilson disease is an hereditary disorder of copper metabolism, caused by mutations in the ATP7B gene, and leading to hepatic or neurologic disease. We examined whether H1069Q, the most common ATP7B mutation, is associated with a specific phenotype. Methods Genotyping results in 70 Dutch patients were related to clinical presentation. Subsequently a meta-analysis for genotype–phenotype correlation was performed on all patients available from literature, combined with the current Dutch group, a total of 577 patients. Results The Dutch patients homozygous or heterozygous for the H1069Q mutation presented more frequently with neurologic disease (63% and 43% vs. 15%), and at a later age (20.9 and 15.9 vs. 12.6 years) than patients without the H1069Q mutation. In the meta-analysis the odds-ratio for neurologic presentation in homozygous or heterozygous H1069Q vs. non-H1069Q patients was 3.50 (95% CI 2.01–6.09) and 2.13 (95% CI 1.18–3.83), respectively. Age at presentation was 21.1, 19.2 and 16.5 years, respectively, corresponding to a weighted mean difference (WMD) of 4.41 (95% CI 1.56–7.26) for homozygous H1069Q vs. heterozygous patients and 6.68 (95% CI 4.33–9.38) for homozygous H1069Q vs. non-H1069Q patients. Conclusions Our results indicate that the H1069Q mutation is associated with a late and neurologic presentation.