751
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Affiliation(s)
- Michelle P Zeller
- Division of Hematology and Thromboembolism (Zeller, Verhovsek), Department of Medicine, McMaster University, Hamilton, Ont.; Canadian Blood Services (Zeller), Ottawa, Ont.
| | - Madeleine Verhovsek
- Division of Hematology and Thromboembolism (Zeller, Verhovsek), Department of Medicine, McMaster University, Hamilton, Ont.; Canadian Blood Services (Zeller), Ottawa, Ont
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752
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Abstract
A number of human disorders are related to chronic iron overload, either of genetic or acquired origin. The multi-organ damage produced by iron excess leads, in adults and in children, to severe clinical consequences, affecting both quality of life and life expectancy. The diagnosis is increasingly based on a non-invasive strategy, resorting to clinical, biological and imaging data. The treatment rests on either venesection or chelation therapy, depending on the etiology. Major advances in the fields of molecular biology, pharmacology, and biotechnology pave the road for key improvements in the diagnostic and therapeutic management of the patients.
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Affiliation(s)
- Pierre Brissot
- a Hepatology-Faculty of Medicine, Inserm-UMR 991, National Center of Reference for Rare Iron Overload Diseases , University Hospital Pontchaillou , Rennes , France
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753
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Kobayashi M, Kato H, Hada H, Itoh-Nakadai A, Fujiwara T, Muto A, Inoguchi Y, Ichiyanagi K, Hojo W, Tomosugi N, Sasaki H, Harigae H, Igarashi K. Iron-heme-Bach1 axis is involved in erythroblast adaptation to iron deficiency. Haematologica 2016; 102:454-465. [PMID: 27927768 PMCID: PMC5394953 DOI: 10.3324/haematol.2016.151043] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/01/2016] [Indexed: 12/21/2022] Open
Abstract
Iron plays the central role in oxygen transport by erythrocytes as a constituent of heme and hemoglobin. The importance of iron and heme is also to be found in their regulatory roles during erythroblast maturation. The transcription factor Bach1 may be involved in their regulatory roles since it is deactivated by direct binding of heme. To address whether Bach1 is involved in the responses of erythroblasts to iron status, low iron conditions that induced severe iron deficiency in mice were established. Under iron deficiency, extensive gene expression changes and mitophagy disorder were induced during maturation of erythroblasts. Bach1−/− mice showed more severe iron deficiency anemia in the developmental phase of mice and a retarded recovery once iron was replenished when compared with wild-type mice. In the absence of Bach1, the expression of globin genes and Hmox1 (encoding heme oxygenase-1) was de-repressed in erythroblasts under iron deficiency, suggesting that Bach1 represses these genes in erythroblasts under iron deficiency to balance the levels of heme and globin. Moreover, an increase in genome-wide DNA methylation was observed in erythroblasts of Bach1−/− mice under iron deficiency. These findings reveal the principle role of iron as a regulator of gene expression in erythroblast maturation and suggest that the iron-heme-Bach1 axis is important for a proper adaptation of erythroblast to iron deficiency to avoid toxic aggregates of non-heme globin.
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Affiliation(s)
- Masahiro Kobayashi
- Department of Biochemistry, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroki Kato
- Department of Biochemistry, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Hada
- Department of Biochemistry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ari Itoh-Nakadai
- Department of Biochemistry, Tohoku University Graduate School of Medicine, Sendai, Japan.,AMED-CREST, Japan Agency for Medical Research and Development, Tokyo, Japan.,Department of Experimental Immunology, Institute of Development, Aging and Cancer, Tohoku University, Japan
| | - Tohru Fujiwara
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Center for Regulatory Epigenome and Diseases, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akihiko Muto
- Department of Biochemistry, Tohoku University Graduate School of Medicine, Sendai, Japan.,AMED-CREST, Japan Agency for Medical Research and Development, Tokyo, Japan
| | - Yukihiro Inoguchi
- Division of Epigenomics and Development, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - Kenji Ichiyanagi
- Division of Epigenomics and Development, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan.,Laboratory of Genome and Epigenome Dynamics, Department of Applied Molecular Biosciences, Graduate School of Bioagricultural Sciences, Nagoya University, Aichi, Japan
| | - Wataru Hojo
- Department of Research and Development, Cellspect Co. Ltd., Morioka, Japan
| | - Naohisa Tomosugi
- Division of Systems Bioscience for Drug Discovery, Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
| | - Hiroyuki Sasaki
- AMED-CREST, Japan Agency for Medical Research and Development, Tokyo, Japan.,Division of Epigenomics and Development, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - Hideo Harigae
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Center for Regulatory Epigenome and Diseases, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuhiko Igarashi
- Department of Biochemistry, Tohoku University Graduate School of Medicine, Sendai, Japan .,AMED-CREST, Japan Agency for Medical Research and Development, Tokyo, Japan.,Center for Regulatory Epigenome and Diseases, Tohoku University Graduate School of Medicine, Sendai, Japan
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754
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Shovlin CL, Gilson C, Busbridge M, Patel D, Shi C, Dina R, Abdulla FN, Awan I. Can Iron Treatments Aggravate Epistaxis in Some Patients With Hereditary Hemorrhagic Telangiectasia? Laryngoscope 2016; 126:2468-2474. [PMID: 27107394 PMCID: PMC5095791 DOI: 10.1002/lary.25959] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 01/31/2016] [Accepted: 02/10/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVES/HYPOTHESIS To examine whether there is a rationale for iron treatments precipitating nosebleeds (epistaxis) in a subgroup of patients with hereditary hemorrhagic telangiectasia (HHT). STUDY DESIGN Survey evaluation of HHT patients, and a randomized control trial in healthy volunteers. METHODS Nosebleed severity in response to iron treatments and standard investigations were evaluated by unbiased surveys in patients with HHT. Serial blood samples from a randomized controlled trial of 18 healthy volunteers were used to examine responses to a single iron tablet (ferrous sulfate, 200 mg). RESULTS Iron tablet users were more likely to have daily nosebleeds than non-iron-users as adults, but there was no difference in the proportions reporting childhood or trauma-induced nosebleeds. Although iron and blood transfusions were commonly reported to improve nosebleeds, 35 of 732 (4.8%) iron tablet users, in addition to 17 of 261 (6.5%) iron infusion users, reported that their nosebleeds were exacerbated by the respective treatments. These rates were significantly higher than those reported for control investigations. Serum iron rose sharply in four of the volunteers ingesting ferrous sulfate (by 19.3-33.1 μmol/L in 2 hours), but not in 12 dietary controls (2-hour iron increment ranged from -2.2 to +5.0 μmol/L). High iron absorbers demonstrated greater increments in serum ferritin at 48 hours, but transient rises in circulating endothelial cells, an accepted marker of endothelial damage. CONCLUSIONS Iron supplementation is essential to treat or prevent iron deficiency, particularly in patients with pathological hemorrhagic iron losses. However, in a small subgroup of individuals, rapid changes in serum iron may provoke endothelial changes and hemorrhage. LEVEL OF EVIDENCE 4. Laryngoscope, 126:2468-2474, 2016.
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Affiliation(s)
- Claire L Shovlin
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
- Respiratory Medicine, Imperial College Healthcare National Health Service Trust, London, United Kingdom.
| | - Clare Gilson
- Respiratory Medicine, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Mark Busbridge
- Clinical Chemistry, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Dilip Patel
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Chenyang Shi
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Roberto Dina
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - F Naziya Abdulla
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Imperial College London School of Medicine, London, United Kingdom
| | - Iman Awan
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Imperial College London School of Medicine, London, United Kingdom
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755
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McSorley ST, Jones I, McMillan DC, Talwar D. Quantitative data on the magnitude of the systemic inflammatory response and its relationship with serum measures of iron status. Transl Res 2016; 176:119-26. [PMID: 27337525 DOI: 10.1016/j.trsl.2016.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/18/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022]
Abstract
The present study aimed to quantify the magnitude of the systemic inflammatory response, measured by C-reactive protein (CRP) and albumin, and its relationship with common serum biochemical measures of iron status including total iron, transferrin, transferrin saturation, and ferritin. Retrospective interrogation of laboratory computer databases at 4 centers between 2006 and 2011 provided results from patients in which serum CRP and albumin had been measured together with iron studies (iron, transferrin, and transferrin saturation, n = 16,522) and ferritin (n = 7,226). Analyte results were categorized into groups according to CRP and albumin. When those groups with CRP <10 mg/L and albumin >35 g/L, CRP 11-80 mg/L and albumin 25-35 mg/L, and CRP >80 mg/L and albumin <25 g/L were compared, the median serum total iron was 15.0, 7.0, and 3.0 μmol/L, respectively (P < 0.001), an overall reduction of 80%. The median serum transferrin concentration was 2.6, 2.0, and 1.3 μmol/L respectively (P < 0.001), an overall reduction of 50%. The median transferrin saturation was 23%, 13%, and 10% respectively (P < 0.001), an overall reduction of 56%. The median serum ferritin was 77, 173, and 445 μg/L respectively (P < 0.001), an overall increase of 578%. The present study quantifies the impact of the systemic inflammatory response on serum measures of iron status. This association should be taken into account when measures of iron status are requested and interpreted to prevent misdiagnosis.
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Affiliation(s)
- Stephen T McSorley
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow.
| | - Iain Jones
- The Scottish Trace Elements and Micronutrients Reference Laboratory, Department of Clinical Biochemistry, Glasgow Royal Infirmary, Glasgow
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow
| | - Dinesh Talwar
- The Scottish Trace Elements and Micronutrients Reference Laboratory, Department of Clinical Biochemistry, Glasgow Royal Infirmary, Glasgow
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756
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Stein J, Connor S, Virgin G, Ong DEH, Pereyra L. Anemia and iron deficiency in gastrointestinal and liver conditions. World J Gastroenterol 2016; 22:7908-25. [PMID: 27672287 PMCID: PMC5028806 DOI: 10.3748/wjg.v22.i35.7908] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/18/2016] [Accepted: 08/10/2016] [Indexed: 02/06/2023] Open
Abstract
Iron deficiency anemia (IDA) is associated with a number of pathological gastrointestinal conditions other than inflammatory bowel disease, and also with liver disorders. Different factors such as chronic bleeding, malabsorption and inflammation may contribute to IDA. Although patients with symptoms of anemia are frequently referred to gastroenterologists, the approach to diagnosis and selection of treatment as well as follow-up measures is not standardized and suboptimal. Iron deficiency, even without anemia, can substantially impact physical and cognitive function and reduce quality of life. Therefore, regular iron status assessment and awareness of the clinical consequences of impaired iron status are critical. While the range of options for treatment of IDA is increasing due to the availability of effective and well-tolerated parenteral iron preparations, a comprehensive overview of IDA and its therapy in patients with gastrointestinal conditions is currently lacking. Furthermore, definitions and assessment of iron status lack harmonization and there is a paucity of expert guidelines on this topic. This review summarizes current thinking concerning IDA as a common co-morbidity in specific gastrointestinal and liver disorders, and thus encourages a more unified treatment approach to anemia and iron deficiency, while offering gastroenterologists guidance on treatment options for IDA in everyday clinical practice.
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757
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The impact of postpartum hemoglobin levels on maternal quality of life after delivery: a prospective exploratory study. Ann Hematol 2016; 95:2049-2055. [PMID: 27623626 DOI: 10.1007/s00277-016-2817-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
Abstract
Postpartum anemia has been associated with postpartum morbidities, such as depression and poor cognition. However, it is unclear whether postpartum anemia is associated with reduced health-related quality of life. We performed a prospective study to examine the relations between postpartum Hb levels with postpartum health-related quality of life (HRQoL). We collected data from 60 women intending vaginal delivery and assessed HRQoL and maternal fatigue on admission and on the first postpartum day using the RAND 36-Item Short-Form Health Survey (SF-36) and the Multidimensional Fatigue Inventory (MFI), respectively. Maternal Hb levels were measured on admission and on the first postpartum day. We also assessed patients for postpartum depression using the Edinburgh Postpartum Depression Scale (EPDS). We performed unadjusted and multivariate linear regression (adjusting for maternal age, parity, mode of delivery, and race) to assess the associations between postdelivery Hb with each subscale of the SF-36 and MFI. The mean predelivery and postpartum Hb levels were 12.3 (1.2) and 10.8 (1.4) g/dl, respectively. In our unadjusted and adjusted regression analyses, we observed no statistically significant associations between postpartum Hb levels with any SF-36 or MFI subscale (P > 0.05). Based on the EPDS, only one patient was depressed; her postpartum Hb was 11.2 g/dl. Our findings suggest that postpartum Hb levels may not influence HRQoL or fatigue. However, our findings may only apply to women without predelivery anemia, severe blood loss or moderate-to-severe anemia after delivery. Future studies are needed to determine whether postpartum Hb influences HRQoL among women with moderate or severe postpartum anemia.
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758
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Asthma as a disruption in iron homeostasis. Biometals 2016; 29:751-79. [PMID: 27595579 DOI: 10.1007/s10534-016-9948-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 12/28/2022]
Abstract
Over several decades, asthma has evolved from being recognized as a single disease to include a diverse group of phenotypes with dissimilar natural histories, pathophysiologies, responses to treatment, and distinctive molecular pathways. With the application of Occam's razor to asthma, it is proposed that there is one cause underlying the numerous phenotypes of this disease and that the responsible molecular pathway is a deficiency of iron in the lung tissues. This deficiency can be either absolute (e.g. asthma in the neonate and during both pregnancy and menstruation) or functional (e.g. asthma associated with infections, smoking, and obesity). Comparable associations between asthma co-morbidity (e.g. eczema, urticaria, restless leg syndrome, and pulmonary hypertension) with iron deficiency support such a shared mechanistic pathway. Therapies directed at asthma demonstrate a capacity to impact iron homeostasis, further strengthening the relationship. Finally, pathophysiologic events producing asthma, including inflammation, increases in Th2 cells, and muscle contraction, can correlate with iron availability. Recognition of a potential association between asthma and an absolute and/or functional iron deficiency suggests specific therapeutic interventions including inhaled iron.
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759
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Veltri F, Decaillet S, Kleynen P, Grabczan L, Belhomme J, Rozenberg S, Pepersack T, Poppe K. Prevalence of thyroid autoimmunity and dysfunction in women with iron deficiency during early pregnancy: is it altered? Eur J Endocrinol 2016; 175:191-9. [PMID: 27450694 DOI: 10.1530/eje-16-0288] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/08/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Thyroid disorders and iron deficiency (ID) are associated with obstetrical and fetal complications. Iron is essential for the normal functioning of thyroid peroxidase (TPO-abs) and ID is frequent during pregnancy. The aim of this study was to compare the prevalence of thyroid autoimmunity (TAI) and dysfunction during the first trimester of pregnancy in women with and without ID. DESIGN Cross-sectional data analysis of 1900 pregnant women nested within an ongoing prospective collection of pregnant women's data. METHOD The study was performed in a single, tertiary referral center. During the first antenatal visit, ferritin, TPO-abs, thyroid-stimulating hormone (TSH) and free T4 (FT4) were measured and age and BMI were recorded. ID was defined as ferritin <15µg/L, TAI when TPO-abs was >60kIU/L, and subclinical hypothyroidism (SCH) when TSH was >2.5mIU/L. RESULTS ID was present in 35% of women. Age and BMI were comparable between both groups. In the ID group, the prevalence of TAI and SCH was significantly higher, compared with that in the non-ID group (10% vs 6% and 20% vs 16%; P=0.011 and 0.049 respectively). Ferritin was inversely correlated with serum TSH (ρ=-0.076; P=0.001) and positive with FT4 levels (ρ=0.112; P<0.001). In the logistic regression model, ID remained associated with TAI after correction for confounding factors (P=0.017). The association with SCH was absent after correction for the confounders in the logistic regression model (P=0.082), but remained present in the linear regression model (P=0.035). CONCLUSIONS ID was frequent during the first trimester of pregnancy and was associated with a higher prevalence of TAI, higher serum TSH, and lower FT4 levels.
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Affiliation(s)
| | | | | | | | | | | | - Thierry Pepersack
- Geriatric UnitCentre Hosptilalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
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760
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Phatlhane DV, Zemlin AE, Matsha TE, Hoffmann M, Naidoo N, Ichihara K, Smit F, Erasmus RT. The iron status of a healthy South African adult population. Clin Chim Acta 2016; 460:240-5. [DOI: 10.1016/j.cca.2016.06.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/10/2016] [Accepted: 06/18/2016] [Indexed: 02/06/2023]
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761
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Wadowski B, Chang D, Khan SQ, Chadha T. Sometimes, It's Just Black and White: Dark Urine and Pallor in a 2-Year-Old Boy. Hosp Pediatr 2016; 6:560-5. [PMID: 27554269 DOI: 10.1542/hpeds.2015-0252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Denis Chang
- New York University Langone Medical Center, New York, New York
| | - Sabina Q Khan
- New York University Langone Medical Center, New York, New York
| | - Tanya Chadha
- New York University School of Medicine, New York, New York; and Division of Pediatric Critical Care,
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762
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Schmidt C, Ahmad T, Tulassay Z, Baumgart DC, Bokemeyer B, Howaldt S, Stallmach A, Büning C. Ferric maltol therapy for iron deficiency anaemia in patients with inflammatory bowel disease: long-term extension data from a Phase 3 study. Aliment Pharmacol Ther 2016; 44:259-70. [PMID: 27237709 PMCID: PMC5089582 DOI: 10.1111/apt.13665] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 02/27/2016] [Accepted: 04/26/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ferric maltol was effective and well-tolerated in iron deficiency anaemia patients with inflammatory bowel disease during a 12-week placebo-controlled trial. AIM To perform a Phase 3 extension study evaluating long-term efficacy and safety with ferric maltol in inflammatory bowel disease patients in whom oral ferrous therapies had failed to correct iron deficiency anaemia. METHODS After 12 weeks of randomised, double-blind treatment, patients with iron deficiency anaemia and mild-to-moderate ulcerative colitis or Crohn's disease received open-label ferric maltol 30 mg b.d. for 52 weeks. RESULTS 111 patients completed randomised treatment and 97 entered the open-label ferric maltol extension. In patients randomised to ferric maltol ('continued'; n = 50), mean ± s.d. haemoglobin increased by 3.07 ± 1.46 g/dL between baseline and Week 64. In patients randomised to placebo ('switch'; n = 47), haemoglobin increased by 2.19 ± 1.61 g/dL. Normal haemoglobin was achieved in high proportions of both continued and switch patients (89% and 83% at Week 64, respectively). Serum ferritin increased from 8.9 μg/L (baseline) to 26.0 μg/L (Week 12) in ferric maltol-treated patients, and to 57.4 μg/L amongst all patients at Week 64. In total, 80% of patients reported ≥1 adverse event by Week 64. Adverse events considered related to ferric maltol were recorded in 27/111 (24%) patients: 8/18 discontinuations due to adverse events were treatment-related. One patient was withdrawn due to increased ulcerative colitis activity. CONCLUSIONS Normal haemoglobin was observed in ≥80% of patients from weeks 20-64 of long-term ferric maltol treatment, with concomitant increases in iron storage parameters. Ferric maltol was well-tolerated throughout this 64-week study.
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Affiliation(s)
- C. Schmidt
- Clinic of Internal Medicine IVJena University HospitalJenaGermany
| | - T. Ahmad
- University of Exeter Medical SchoolExeterUK
| | - Z. Tulassay
- Department of MedicineSemmelweis University of MedicineBudapestHungary
| | - D. C. Baumgart
- Division of Gastroenterology and HepatologyDepartment of MedicineCharité Medical SchoolHumboldt‐University of BerlinBerlinGermany
| | | | - S. Howaldt
- Division of Inflammatory Bowel DiseaseHamburg Institute of ResearchHamburgGermany
| | - A. Stallmach
- Clinic of Internal Medicine IVJena University HospitalJenaGermany
| | - C. Büning
- Department of Internal MedicineHospital WaldfriedeBerlinGermany
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763
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Targeting, Monitoring and Effect of Oral Iron Therapy on Haemoglobin Levels in Older Patients Discharged to Primary Care from Inpatient Rehabilitation: A Cohort Study Using Routinely Collected Data. Drugs Aging 2016; 33:603-10. [DOI: 10.1007/s40266-016-0385-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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764
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Levi M, Rosselli M, Simonetti M, Brignoli O, Cancian M, Masotti A, Pegoraro V, Cataldo N, Heiman F, Chelo M, Cricelli I, Cricelli C, Lapi F. Epidemiology of iron deficiency anaemia in four European countries: a population-based study in primary care. Eur J Haematol 2016; 97:583-593. [DOI: 10.1111/ejh.12776] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Miriam Levi
- Health Search Italian College of General Practitioners and Primary Care; Florence Italy
- Department of Health Sciences; University of Florence; Florence Italy
| | - Matteo Rosselli
- Institute for Liver and Digestive Health; Royal Free Hospital; University College of London; London UK
| | - Monica Simonetti
- Health Search Italian College of General Practitioners and Primary Care; Florence Italy
| | - Ovidio Brignoli
- Italian College of General Practitioners and Primary Care; Florence Italy
| | - Maurizio Cancian
- Italian College of General Practitioners and Primary Care; Florence Italy
| | - Adriana Masotti
- Department of Transfusion Medicine; Local Health Authority n°5; Pordenone Italy
| | - Valeria Pegoraro
- IMS Health Information Solutions Medical Research srl; Milan Italy
| | - Nazarena Cataldo
- IMS Health Information Solutions Medical Research srl; Milan Italy
| | - Franca Heiman
- IMS Health Information Solutions Medical Research srl; Milan Italy
| | - Manuela Chelo
- Health Search Italian College of General Practitioners and Primary Care; Florence Italy
| | - Iacopo Cricelli
- Health Search Italian College of General Practitioners and Primary Care; Florence Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care; Florence Italy
| | - Francesco Lapi
- Health Search Italian College of General Practitioners and Primary Care; Florence Italy
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765
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Wieringa FT, Dahl M, Chamnan C, Poirot E, Kuong K, Sophonneary P, Sinuon M, Greuffeille V, Hong R, Berger J, Dijkhuizen MA, Laillou A. The High Prevalence of Anemia in Cambodian Children and Women Cannot Be Satisfactorily Explained by Nutritional Deficiencies or Hemoglobin Disorders. Nutrients 2016; 8:nu8060348. [PMID: 27338454 PMCID: PMC4924189 DOI: 10.3390/nu8060348] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Anemia is highly prevalent in Cambodian women and children, but data on causes of anemia are scarce. We performed a national micronutrient survey in children and women that was linked to the Cambodian Demographic Health Survey 2014 (CDHS-2014) to assess the prevalence of micronutrient deficiency, hemoglobin disorders and intestinal parasite infection. METHODS One-sixth of households from the CDHS-2014 were selected for a follow-up visit for the micronutrient survey. Households were visited from two weeks to two months after the CDHS-2014 visit. Data on micronutrient status were available for 1512 subjects (792 children and 720 women). RESULTS Anemia was found in 43% of the women and 53% of the children. Hemoglobin disorders affected >50% of the population, with Hemoglobin-E the most prevalent disorder. Deficiencies of iron (ferritin < 15 g/L), vitamin A (retinol-binding-protein (RBP) < 0.70 mol/L) or vitamin B12 (<150 pmol/L) were not prevalent in the women (<5% for all), whereas 17.8% of the women had low concentrations of folic acid (<10 nmol/L). In the children, the prevalence of iron, vitamin A, vitamin B12 or folic acid deficiency was <10%. Zinc deficiency, hookworm infection and hemoglobinopathy were significantly associated with anemia in children, whereas in the women none of the factors was significantly associated with anemia. Iron deficiency anemia (IDA) was more prevalent in children <2 years, but in older children and women, the prevalence of IDA was <5%. The most prevalent, preventable causes of anemia were hookworm infection and zinc and folic acid deficiency. Over 40% of the anemia was not caused by nutritional factors. CONCLUSION The very high prevalence of anemia in Cambodian women and children cannot be explained solely by micronutrient deficiencies and hemoglobin disorders. Micronutrient interventions to improve anemia prevalence are likely to have limited impact in the Cambodian setting. The focus of current interventions to reduce the high prevalence of anemia in children and women should be broadened to include zinc and folic acid as well as effective anti-hookworm measures.
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Affiliation(s)
- Frank Tammo Wieringa
- Institute of Research for Development (IRD), UMR Nutripass UM-IRD-SupAgro, Montpellier 3400, France.
| | - Miriam Dahl
- Department of Fisheries, Post-harvest Technologies and Quality control, Fisheries Administration, MAFF, 186 Preah Norodom Boulevard, Phnom Penh 12000, Cambodia.
| | - Chhoun Chamnan
- Department of Fisheries, Post-harvest Technologies and Quality control, Fisheries Administration, MAFF, 186 Preah Norodom Boulevard, Phnom Penh 12000, Cambodia.
| | - Etienne Poirot
- UNICEF, Maternal, Newborn and Child Health and Nutrition section, no11 street 75, Phnom Penh 12202, Cambodia.
| | - Khov Kuong
- Department of Fisheries, Post-harvest Technologies and Quality control, Fisheries Administration, MAFF, 186 Preah Norodom Boulevard, Phnom Penh 12000, Cambodia.
| | - Prak Sophonneary
- National Nutrition Program, Maternal and Child Health Center, No 31A, Rue de France (St. 47), Phnom Penh 12202, Cambodia.
| | - Muth Sinuon
- National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh 12202, Cambodia.
| | - Valerie Greuffeille
- Institute of Research for Development (IRD), UMR Nutripass UM-IRD-SupAgro, Montpellier 3400, France.
| | - Rathavuth Hong
- ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA.
| | - Jacques Berger
- Institute of Research for Development (IRD), UMR Nutripass UM-IRD-SupAgro, Montpellier 3400, France.
| | - Marjoleine Amma Dijkhuizen
- Nutrition, Exercise and Sports (NEXS), Copenhagen University, Rolighedsvej 25, 1958 Frederiksberg, Copenhagen DK-1958, Denmark.
| | - Arnaud Laillou
- UNICEF, Maternal, Newborn and Child Health and Nutrition section, no11 street 75, Phnom Penh 12202, Cambodia.
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766
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Inge TH, Courcoulas AP, Xanthakos SA. Weight Loss and Health Status after Bariatric Surgery in Adolescents. N Engl J Med 2016; 374:1989. [PMID: 27192678 DOI: 10.1056/nejmc1602007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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767
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Trace element concentration in organic and conventional milk: what are the nutritional implications of the recently reported differences? Br J Nutr 2016; 116:3-6. [DOI: 10.1017/s0007114516001616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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768
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Lane DJR, Jansson PJ, Richardson DR. Bonnie and Clyde: Vitamin C and iron are partners in crime in iron deficiency anaemia and its potential role in the elderly. Aging (Albany NY) 2016; 8:1150-2. [PMID: 27208799 PMCID: PMC4931859 DOI: 10.18632/aging.100966] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Darius J R Lane
- Department of Pathology and Bosch Institute, Molecular Pharmacology and Pathology Program, Blackburn Building, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Patric J Jansson
- Department of Pathology and Bosch Institute, Molecular Pharmacology and Pathology Program, Blackburn Building, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Des R Richardson
- Department of Pathology and Bosch Institute, Molecular Pharmacology and Pathology Program, Blackburn Building, University of Sydney, Sydney, New South Wales, 2006, Australia
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769
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Pawlowski JW, Kellicker N, Bobst CE, Kaltashov IA. Assessing the iron delivery efficacy of transferrin in clinical samples by native electrospray ionization mass spectrometry. Analyst 2016; 141:853-61. [PMID: 26646585 PMCID: PMC4727994 DOI: 10.1039/c5an02159f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Serum transferrin is a key player in iron homeostasis, and its ability to deliver iron to cells via the endosomal pathway critically depends on the presence of carbonate that binds this protein synergistically with ferric ion. Oxalate is another ubiquitous anionic species that can act as a synergistic anion, and in fact its interaction with transferrin is notably stronger compared to carbonate, preventing the protein from releasing the metal in the endosomal environment. While this raises concerns that high oxalate levels in plasma may interfere with iron delivery to tissues, concentration of free oxalate in blood appears to be a poor predictor of impeded availability of iron, as previous studies showed that it cannot displace carbonate from ferro-transferrin on a physiologically relevant time scale under the conditions mimicing plasma. In this work we present a new method that allows different forms of ferro-transferrin (carbonate- vs. oxalate-bound) to be distinguished from each other by removing this protein from plasma without altering the composition of the protein/metal/synergistic anion complexes, and determining their accurate masses using native electrospray ionization mass spectrometry (ESI MS). The new method has been validated using a mixture of recombinant proteins, followed by its application to the analysis of clinical samples of human plasma, demonstrating that native ESI MS can be used in clinical analysis.
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Affiliation(s)
- Jake W Pawlowski
- University of Massachusetts-Amherst, Department of Chemistry, 240 Thatcher Drive, Life Sciences Laboratories N369, Amherst, MA 01003, USA.
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770
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Högler W, Aguiar M, Kiely M, Tulchinsky T. Consensus Recommendations for Prevention of Nutritional Rickets: Food Fortification and Micronutrient Supplements for Global Health. AIMS Public Health 2016; 3:40-48. [PMID: 29546144 PMCID: PMC5690261 DOI: 10.3934/publichealth.2016.1.40] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/10/2016] [Indexed: 11/18/2022] Open
Affiliation(s)
- Wolfgang Högler
- Department of Endocrinology & Diabetes, Birmingham Children's Hospital; and Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Magda Aguiar
- Department of Health Economics, Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Mairead Kiely
- Vitamin D Research Group, School of Food and Nutritional Sciences, University College Cork, Ireland
| | - Theodore Tulchinsky
- Professor Emeritus: Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, 91220 Jerusalem, Israel. Head of School of Health Professions, Ashkelon College, Ashkelon, Israel
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771
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Gozzelino R, Arosio P. Iron Homeostasis in Health and Disease. Int J Mol Sci 2016; 17:E130. [PMID: 26805813 PMCID: PMC4730371 DOI: 10.3390/ijms17010130] [Citation(s) in RCA: 224] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/04/2016] [Accepted: 01/12/2016] [Indexed: 12/13/2022] Open
Abstract
Iron is required for the survival of most organisms, including bacteria, plants, and humans. Its homeostasis in mammals must be fine-tuned to avoid iron deficiency with a reduced oxygen transport and diminished activity of Fe-dependent enzymes, and also iron excess that may catalyze the formation of highly reactive hydroxyl radicals, oxidative stress, and programmed cell death. The advance in understanding the main players and mechanisms involved in iron regulation significantly improved since the discovery of genes responsible for hemochromatosis, the IRE/IRPs machinery, and the hepcidin-ferroportin axis. This review provides an update on the molecular mechanisms regulating cellular and systemic Fe homeostasis and their roles in pathophysiologic conditions that involve alterations of iron metabolism, and provides novel therapeutic strategies to prevent the deleterious effect of its deficiency/overload.
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Affiliation(s)
- Raffaella Gozzelino
- Inflammation and Neurodegeneration Laboratory, Chronic Diseases Research Center (CEDOC), Nova Medical School (NMS)/Faculdade de Ciências Médicas, University of Lisbon, Lisbon 1150-082, Portugal.
| | - Paolo Arosio
- Department of Molecular and Translational Medicine (DMMT), University of Brescia, Brescia 25123, Italy.
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772
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Grandone A, Marzuillo P, Perrone L, Del Giudice EM. Iron Metabolism Dysregulation and Cognitive Dysfunction in Pediatric Obesity: Is There a Connection? Nutrients 2015; 7:9163-70. [PMID: 26561830 PMCID: PMC4663586 DOI: 10.3390/nu7115458] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/23/2015] [Accepted: 10/29/2015] [Indexed: 12/21/2022] Open
Abstract
Obesity and iron deficiency (ID) are two of the most common nutritional disorders in the world. In children both conditions deserve particular attention. Several studies revealed an association between obesity and iron deficiency in children and, in some cases, a reduced response to oral supplementation. The connecting mechanism, however, is not completely known. This review is focused on: (1) iron deficiency in obese children and the role of hepcidin in the connection between body fat and poor iron status; (2) iron status and consequences on health, in particular on cognitive function; (3) cognitive function and obesity; (4) suggestion of a possible link between cognitive dysfunction and ID in pediatric obesity; and implications for therapy and future research.
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Affiliation(s)
- Anna Grandone
- Department of Woman, Child, General and Specialized Surgery, Second University of Naples Via De Crecchio 2-4, Naples 80138, Italy.
| | - Pierluigi Marzuillo
- Department of Woman, Child, General and Specialized Surgery, Second University of Naples Via De Crecchio 2-4, Naples 80138, Italy.
| | - Laura Perrone
- Department of Woman, Child, General and Specialized Surgery, Second University of Naples Via De Crecchio 2-4, Naples 80138, Italy.
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child, General and Specialized Surgery, Second University of Naples Via De Crecchio 2-4, Naples 80138, Italy.
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773
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Noto JM, Peek RM. Helicobacter pylori and CagA under conditions of iron deficiency. Gut Microbes 2015; 6:377-81. [PMID: 26727420 PMCID: PMC4826123 DOI: 10.1080/19490976.2015.1105426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/05/2015] [Indexed: 02/03/2023] Open
Abstract
Iron deficiency is the most common nutritional deficiency worldwide and compelling evidence has demonstrated that this condition heightens the risk of gastric cancer. Infection with Helicobacter pylori is the strongest known risk factor for the development of gastric adenocarcinoma. Recent work has demonstrated that, under conditions of iron deficiency, H. pylori-induced gastric carcinogenesis is augmented through increased formation of the strain-specific cag type IV secretion system and enhanced delivery of the bacterial oncoprotein CagA into host cells. Although CagA is a potent virulence factor that promotes oncogenic responses, additional studies have now demonstrated that CagA modulates host cell iron homeostasis in vitro and fundamental metabolic functions of the bacterial cell in vivo. Here we discuss these findings and describe working models by which CagA exerts its effects on gastric epithelial cells, with particular emphasis on its potential role in modulation of host iron homeostasis.
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Affiliation(s)
- Jennifer M Noto
- Division of Gastroenterology, Department of Medicine; Vanderbilt University Medical Center; Nashville, TN USA
| | - Richard M Peek
- Division of Gastroenterology, Department of Medicine; Vanderbilt University Medical Center; Nashville, TN USA
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