{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T13:03:58Z","timestamp":1781183038053,"version":"3.54.1"},"reference-count":32,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Wilson's disease (WD) is a genetic disorder of copper metabolism in which early diagnosis remains challenging, particularly in acute liver failure (ALF). Relative exchangeable copper (REC) and exchangeable copper (CuEXC) are emerging biomarkers for diagnosis and monitoring, but data from larger cohorts are limited. This monocentric retrospective cohort study evaluated the diagnostic accuracy of REC in WD patients, including adult ALF and assessed the utility of CuEXC during monitoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>299 paediatric\/adult patients with liver disease were analysed; 215 had confirmed WD (Leipzig score \u2265\u20094). Clinical data, parameters of copper metabolism and liver function tests were collected. REC was analysed in the full cohort. CuEXC was evaluated longitudinally at three standardized timepoints over 12\u2009months in treated adult WD patients and compared with 24\u2010h urinary copper excretion (UCE) after 48\u2010h treatment interruption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      REC demonstrated excellent diagnostic accuracy with an AUC of 0.955 (sensitivity 88.4%, specificity 91.7%). In adult ALF, REC perfectly discriminated WD (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092\/2, 100%) from other causes. CuEXC declined significantly in therapy\u2010na\u00efve patients and differentiated these from very stable patients, but showed limited discrimination between stable versus unstable patients during median follow\u2010up. UCE off\u2010treatment showed parallel trajectories to CuEXC.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>REC is a highly accurate diagnostic biomarker for WD, including adult ALF. CuEXC is useful to characterize initial treatment response and copper control, but its role as a routine monitoring biomarker between stable and unstable patients remains uncertain and requires prospective validation, whereas UCE remains as a robust follow\u2010up parameter in these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70666","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T04:47:44Z","timestamp":1777956464000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Relative Exchangeable and Exchangeable Copper: Emerging New Biomarkers for Diagnosis and Therapy Monitoring in Wilson's Disease"],"prefix":"10.1111","volume":"46","author":[{"given":"Sebastian","family":"K\u00f6hrer","sequence":"first","affiliation":[{"name":"Internal Medicine IV, Department of Gastroenterology University Hospital Heidelberg  Heidelberg 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