Zinc for Wilson’s Disease: What We Know and What We Don’t Know

Wilson's disease (WD) occurs due to excess copper leading to hepatic or neurologic symptoms, or a combination of both.Treatment for symptomatic WD typically includes initial therapy with a chelator, such as D-penicillamine or trientine, with zinc salts recommended in some guidance documents for neurologic WD, although this is not universally accepted.For presymptomatic patients, guidelines suggest either chelators or zinc as initial therapy.Zinc therapy has been used for over 60 years, with effectiveness demonstrated in a number of studies or retrospective case reviews.However, there are few head-to-head controlled trials of zinc compared to chelators.Accordingly, more such trials are needed to understand the use of zinc for WD.The main adverse event associated with zinc therapy is gastrointestinal issues, which can be a limiting factor in the usefulness of zinc.Copper deficiency may occur in a minority of patients taking zinc, with early warning signs including leukopenia and pancytopenia.Further studies are needed to understand the mechanism of action of zinc for WD, and long-term studies are also needed to understand the adverse event profile.Zinc can be an effective and safe choice for WD treatment; however, further studies are needed to fully understand the mechanism of action and use.