51
|
Maximova N, Gregori M, Simeone R, Sonzogni A, Zanon D, Boz G, D'Antiga L. Total body irradiation and iron chelation treatment are associated with pancreatic injury following pediatric hematopoietic stem cell transplantation. Oncotarget 2018; 9:19543-19554. [PMID: 29731964 PMCID: PMC5929407 DOI: 10.18632/oncotarget.24646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/26/2018] [Indexed: 12/15/2022] Open
Abstract
Whereas many studies have addressed the risk of organ dysfunction following hematopoietic stem cell transplantation (HSCT), little is known about pancreatic susceptibility in this setting. We aimed to investigate the effect of iron overload (IO) and total body irradiation (TBI) on pancreatic function of children undergoing HSCT. We retrospectively evaluated children admitted between 2012-2016 fulfilling the following criteria: normal pancreatic iron concentration (PIC), regular pancreatic function before HSCT, availability of abdominal magnetic resonance imaging with gradient-recalled-echo sequences and a full set of biochemical markers of IO and pancreatic function performed before HSCT and at discharge. We divided the patients according to the use of TBI or myeloablative chemotherapy (MCHT) in the conditioning regimen. All patients with severe IO or moderate IO with a high risk of engraftment delay or transplantation-related complications underwent chelation therapy with deferoxamine (DFO) from the first day of conditioning to discharge. 63 patients had a HSCT in the study period, 13 did not fulfill the inclusion criteria; 50 (25 in each group) are included in the analysis, and did not show differences at baseline evaluation. At follow up testing the TBI group showed a significantly higher PIC (107,8±100,3 μmol/g vs 28,4±37,9 in MCHT group, p<0,0001). In the TBI group the patients who had DFO treatment had higher PIC (223,2±48,8 μmol/g vs 55,7±10,5 without DFO treatment, p<0,0001), and all patients having PIC >100 μmol/g at follow up had DFO-based chelation therapy, versus 26% of those with lower PIC (p<0,0001). The number of patients presenting exocrine pancreatic dysfunctions one month after transplantation was significantly higher in the TBI group (48% vs 4%; p<0.0001). The mean pancreatic volume reduction was significantly greater in the TBI group (39,1% vs 0,9% in the MCHT group; p<0,05), and was significantly worse on those who received DFO therapy. Based on our data, we suggest that TBI is detrimental for pancreatic functions, and speculate that DFO may contribute to the rapid pancreatic IO observed in these patients.
Collapse
Affiliation(s)
- Natalia Maximova
- Bone Marrow Transplant Unit, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Massimo Gregori
- Department of Pediatric Radiology, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Roberto Simeone
- Department of Transfusion Medicine, Trieste University Hospital, Trieste, Italy
| | - Aurelio Sonzogni
- Department of Pathology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Davide Zanon
- Pharmacy, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Giulia Boz
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Lorenzo D'Antiga
- Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| |
Collapse
|
52
|
Pinto VM, Bacigalupo L, Gianesin B, Balocco M, De Franceschi L, Malagò R, Wood J, Forni GL. Lack of correlation between heart, liver and pancreas MRI-R2*: Results from long-term follow-up in a cohort of adult β-thalassemia major patients. Am J Hematol 2018; 93:E79-E82. [PMID: 29265491 DOI: 10.1002/ajh.25009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Valeria Maria Pinto
- Centro della Microcitemia e delle Anemie Congenite; Ospedale Galliera Genoa Italy
| | | | - Barbara Gianesin
- Centro della Microcitemia e delle Anemie Congenite; Ospedale Galliera Genoa Italy
| | - Manuela Balocco
- Centro della Microcitemia e delle Anemie Congenite; Ospedale Galliera Genoa Italy
| | - Lucia De Franceschi
- Department of Medicine; Policlinico GB Rossi, University of Verona and AOUI-Verona; Verona Italy
| | - Roberto Malagò
- Department of Radiology; University of Verona; Verona Italy
| | - John Wood
- Division of Cardiology; Children's Hospital Los Angeles; Los Angeles California
| | - Gian Luca Forni
- Centro della Microcitemia e delle Anemie Congenite; Ospedale Galliera Genoa Italy
| |
Collapse
|
53
|
Chapin J, Giardina PJ. Thalassemia Syndromes. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
|
54
|
Alústiza Echeverría J, Barrera Portillo M, Guisasola Iñiguiz A, Ugarte Muño A. Diagnosis and quantification of the iron overload through magnetic resonance. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
55
|
Diagnóstico y cuantificación de la sobrecarga férrica mediante resonancia magnética. RADIOLOGIA 2017; 59:487-495. [DOI: 10.1016/j.rx.2017.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 06/25/2017] [Accepted: 07/13/2017] [Indexed: 11/20/2022]
|
56
|
The Clinical Implications of Fatty Pancreas: A Concise Review. Dig Dis Sci 2017; 62:2658-2667. [PMID: 28791556 DOI: 10.1007/s10620-017-4700-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 07/27/2017] [Indexed: 12/19/2022]
Abstract
Fatty pancreas is a newly recognized condition which is poorly investigated until today as compared to nonalcoholic fatty liver disease. It is characterized by pancreatic fat accumulation and subsequent development of pancreatic and metabolic complications. Association of fatty pancreas have been described with type 2 diabetes mellitus, acute and chronic pancreatitis and even pancreatic carcinoma. In this review article, we provide an update on clinical implications, pathogenesis, diagnosis, treatment and outcomes.
Collapse
|
57
|
Wahidiyat PA, Sekarsari D, Adnani NB, Putriasih SA, Berdoukas V. Association of pancreatic MRI R2* with blood glucose and cardiac MRI R2* among thalassemia major patients in Indonesia. Am J Hematol 2017; 92:E620-E621. [PMID: 28707395 DOI: 10.1002/ajh.24860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/08/2017] [Accepted: 07/11/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Pustika Amalia Wahidiyat
- Pediatric Hematology-Oncology Division; Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital; Jakarta Indonesia
- Department of Child Health; Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital; Jakarta Indonesia
| | - Damayanti Sekarsari
- Department of Radiology; Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital; Jakarta Indonesia
| | - Nitish Basant Adnani
- Department of Child Health; Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital; Jakarta Indonesia
| | - Siti Ayu Putriasih
- Department of Child Health; Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital; Jakarta Indonesia
| | - Vasili Berdoukas
- Keck School of Medicine Children's Hospital; University of Southern California; Los Angeles California
| |
Collapse
|
58
|
Affiliation(s)
- John C Wood
- Department of Pediatrics and Radiology, Division of Pediatric Cardiology, Children's Hospital Los Angeles-USC Keck School of Medicine, Los Angeles, CA, United States
| |
Collapse
|
59
|
França M, Martí-Bonmatí L, Porto G, Silva S, Guimarães S, Alberich-Bayarri Á, Vizcaíno JR, Pessegueiro Miranda H. Tissue iron quantification in chronic liver diseases using MRI shows a relationship between iron accumulation in liver, spleen, and bone marrow. Clin Radiol 2017; 73:215.e1-215.e9. [PMID: 28863932 DOI: 10.1016/j.crad.2017.07.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/10/2017] [Accepted: 07/31/2017] [Indexed: 02/06/2023]
Abstract
AIM To investigate iron loading within the liver, pancreas, spleen, and bone marrow using magnetic resonance imaging (MRI) transverse relaxation rate (R2*), in patients with diffuse liver diseases; to evaluate the relationships between iron accumulation in these tissue compartments; and to assess the association between tissue iron overload and the pattern of hepatic cellular iron distribution (hepatocytes versus Kupffer cells). MATERIAL AND METHODS Fifty-six patients with diffuse liver diseases had MRI-derived R2* values, using a multi-echo chemical-shift encoded MRI sequence, of the liver, pancreas, spleen, and vertebral bone marrow. All patients had liver biopsy samples scored for hepatic iron grading (0-4) and iron cellular distribution (within hepatocytes only or within both hepatocytes and Kupffer cells). RESULTS Liver R2* increased with histological iron grade (RS=0.58, p<0.001) and correlated with spleen (RS=0.71, p<0.001) and bone marrow R2* (RS=0.66, p<0.001), but not with pancreatic R2* (RS=0.22, p=0.096). Splenic and bone marrow R2* values were also correlated (RS=0.72, p<0.001). Patients with iron inside Kupffer cells had the highest R2* in liver, spleen and bone marrow. CONCLUSIONS Patients with chronic diffuse liver diseases have concomitant hepatic, splenic, and bone marrow iron loading. The highest hepatic iron scores and iron inside Kupffer cells were associated with the highest splenic and bone marrow deposits, suggesting systemic iron accumulation in the mononuclear phagocytic system.
Collapse
Affiliation(s)
- M França
- Imaging Department - Centro Hospitalar do Porto, Largo Prof Abel Salazar, 4099-001 Porto, Portugal; i3S, Instituto de Investigação e Inovação em Saúde, IBMC, Institute for Molecular and Cell Biology, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal.
| | - L Martí-Bonmatí
- Radiology Department, Hospital Universitario y Politécnico La Fe and Biomedical Imaging Research Group (GIBI230), Av. Fernando Abril Martorell 106 Torre E, 46026 Valencia, Spain
| | - G Porto
- i3S, Instituto de Investigação e Inovação em Saúde, IBMC, Institute for Molecular and Cell Biology, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal; Haematology Department, Centro Hospitalar do Porto, Largo Prof Abel Salazar, 4099-001 Porto, Portugal; Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - S Silva
- Faculty of Sciences, University of Porto, Rua do Campo Alegre, 4169-007 Porto, Portugal
| | - S Guimarães
- Pathology Department, Centro Hospitalar de S. João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Á Alberich-Bayarri
- Radiology Department, Hospital Universitario y Politécnico La Fe and Biomedical Imaging Research Group (GIBI230), Av. Fernando Abril Martorell 106 Torre E, 46026 Valencia, Spain
| | - J R Vizcaíno
- Pathology Department - Centro Hospitalar do Porto, Largo Prof Abel Salazar, 4099-001 Porto, Portugal
| | - H Pessegueiro Miranda
- Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; Liver and Pancreas Transplantation Unit and Medicine Department - Centro Hospitalar do Porto, Largo Prof Abel Salazar, 4099-001 Porto, Portugal; Epidemiology Research Unit (EPIUnit), Institute of Public Health of the University of Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal
| |
Collapse
|
60
|
Maximova N, Gregori M, Boz G, Simeone R, Zanon D, Schillani G, Zennaro F. MRI-based evaluation of multiorgan iron overload is a predictor of adverse outcomes in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation. Oncotarget 2017; 8:79650-79661. [PMID: 29108345 PMCID: PMC5668078 DOI: 10.18632/oncotarget.19021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 06/19/2017] [Indexed: 01/11/2023] Open
Abstract
The medical records of 44 pediatric patients who underwent allogeneic transplantation from 2011 to 2015 were retrospectively reviewed. Magnetic resonance imaging was used to measure iron concentrations in the liver, spleen, pancreas and bone. These patients were divided into two groups, 18 with non-elevated (< 100 μmol/g; Group 1) liver iron concentration before transplantation and 26 with elevated (> 100 μmol/g; Group 2) concentration . We compared transplant-related outcomes in the two groups. Iron overload was a negative prognostic risk factor for sinusoidal obstruction syndrome (OR = 17), osteoporosis (OR = 6.8), pancreatic insufficiency (OR = 17) and metabolic syndrome (OR = 15.1). No statistically significant differences in overall survival, disease-free survival, relapse incidence and incidence of acute or chronic graft-versus host disease were observed between the two groups. Mean times to engraftment of platelets (43.0 ± 35.3 days vs. 22.1 ± 9.5 days, p < 0.05) and neutrophils (23.1 ± 10.4 days vs. 17.8 ± 4.6 days, p < 0.05) appear significantly longer in Group 2 than in Group 1. Time to platelet engraftment showed statistically significant correlation with pre-transplant liver (r = 0.5775; p < 0.001) and bone iron concentration (r = 0.7305; p < 0.001). Post-transplant evaluation pointed out that iron concentration analyzed at the first follow-up peaked in all tissues. The iron accumulation was highest in bone, followed by the spleen, liver and pancreas. One year post transplant 9 of 18 (50%) patients in Group 1 and 6 of 22 (27%) in Group 2 presented with bone and/or spleen iron overload, but not with liver overload. Liver iron concentration is not always a reliable indicator of systemic siderosis or of the efficacy of chelation therapy.
Collapse
Affiliation(s)
- Natalia Maximova
- Bone Marrow Transplant Unit, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Massimo Gregori
- Department of Radiology, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Giulia Boz
- University of Trieste, Piazzale Europa, 34128 Trieste, Italy
| | - Roberto Simeone
- Department of Transfusion Medicine, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Davide Zanon
- Pharmacy, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Giulia Schillani
- Bone Marrow Transplant Unit, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Floriana Zennaro
- Department of Radiology, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy
| |
Collapse
|
61
|
Abstract
Blood transfusion plays a prominent role in the management of patients with sickle cell disease (SCD), but causes significant iron overload. As transfusions are used to treat the severe complications of SCD, it remains difficult to distinguish whether organ damage is a consequence of iron overload or is due to the complications treated by transfusion. Better management has resulted in increased survival, but prolonged exposure to iron puts SCD patients at greater risk for iron-related complications that should be treated. The success of chelation therapy is dominated by patient adherence to prescribed treatment; thus, adjustment of drug regimens to increase adherence to treatment is critical. This review will discuss the current biology of iron homeostasis in patients with SCD and how this informs our clinical approach to treatment. We will present the clinical approach to treatment of iron overload at our centre using serial assessment of organ iron by magnetic resonance imaging.
Collapse
Affiliation(s)
- Thomas D. Coates
- Hematology Section, Children’s Centre for Cancer, Blood Diseases and Bone Marrow Transplantation, University of Southern California, Los Angeles California, USA
| | - John C. Wood
- Division of Cardiology, at the Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles California, USA
| |
Collapse
|
62
|
Abstract
Hypothyroidism may occur in association with congenital parathyroid disorders determining parathyroid hormone insufficiency, which is characterized by hypocalcemia and concomitant inappropriately low secretion of parathormone (PTH). The association is often due to loss of function of genes common to thyroid and parathyroid glands embryonic development. Hypothyroidism associated with hypoparathyroidism is generally mild and not associated with goiter; moreover, it is usually part of a multisystemic involvement not restricted to endocrine function as occurs in patients with 22q11 microdeletion/DiGeorge syndrome, the most frequent disorders. Hypothyroidism and hypoparathyroidism may also follow endocrine glands' damages due to autoimmunity or chronic iron overload in thalassemic disorders, both genetically determined conditions. Finally, besides PTH deficiency, hypocalcemia can be due to PTH resistance in pseudohypoparathyroidism; when hormone resistance is generalized, patients can suffer from hypothyroidism due to TSH resistance. In evaluating patients with hypothyroidism and hypocalcemia, physical examination and clinical history are essential to drive the diagnostic process, while routine genetic screening is not recommended.
Collapse
Affiliation(s)
- Giovanna Mantovani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesca Marta Elli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sabrina Corbetta
- Endocrinology Service, Department of Biomedical Sciences, University of Milan, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| |
Collapse
|
63
|
Henninger B, Rauch S, Zoller H, Plaikner M, Jaschke W, Kremser C. R2*-relaxometry of the pancreas in patients with human hemochromatosis protein associated hereditary hemochromatosis. Eur J Radiol 2017; 89:149-155. [PMID: 28267532 DOI: 10.1016/j.ejrad.2017.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/28/2017] [Accepted: 02/04/2017] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate pancreatic iron in patients with human hemochromatosis protein associated hereditary hemochromatosis (HHC) using R2* relaxometry. MATERIALS AND METHODS 81 patients (58 male, 23 female; median age 49.5, range 10-81 years) with HHC were retrospectively studied. All underwent 1.5T magnetic resonance imaging (MRI) of the abdomen. A fat-saturated multi-gradient echo sequence with 12 echoes (TR=200ms; TE-initial 0.99ms; Delta-TE 1.41ms; 12 echoes; flip-angle: 20°) was used for the R2* quantification of the liver and the pancreas. Parameter maps were analyzed using regions of interest (3 in the liver and 2 in the pancreas) and R2* values were correlated. RESULTS 59/81 patients had a liver R2*≥70 1/s of which 10/59 patients had a pancreas R2*≥50 1/s. No patient presented with a liver R2*<70 1/s and pancreas R2*≥50 1/s. All patients with pancreas R2* values≥50 1/s had liver R2* values≥70 1/s. ROC analysis resulted in a threshold of 209.4 1/s for liver R2* values to identify HFE positive patients with pancreas R2* values≥50 1/s with a median specificity of 78.87% and a median sensitivity of 90%. CONCLUSION In patients with HHC R2* relaxometry of the pancreas should be performed when liver iron overload is present and can be omitted in cases with no sign of hepatic iron.
Collapse
Affiliation(s)
- B Henninger
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
| | - S Rauch
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - H Zoller
- Department of Internal Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - M Plaikner
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - W Jaschke
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - C Kremser
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| |
Collapse
|
64
|
Chen B, Chen W, Chan Q, Zhou N, He J, Zhou Z. Functional MRI of human pancreas using BOLD contrast: Responses following glucose ingestion. J Magn Reson Imaging 2017; 46:831-836. [PMID: 28120404 DOI: 10.1002/jmri.25640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/03/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To evaluate the response of the pancreas to glucose ingestion in healthy volunteers by blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI). MATERIALS AND METHODS This study was approved by the local Ethics Committee, and informed consent was obtained from all subjects. A multiple gradient recalled echo (mGRE) sequence was performed on a 3.0T MR scanner in 12 healthy volunteers before and after glucose or water ingestion. Pancreatic T2* values were calculated from it at each timepoint, and changes following stimulation were analyzed using summary measures. The valley values and times were compared between the glucose and water ingestion by paired samples t-test. The repeatability of the pancreatic T2* measurements was assessed by calculating the intraclass correlation coefficient (ICC) and coefficient of variation (CV). RESULTS Pancreatic T2* measurements showed good repeatability (all ICC >0.75). CV for the six baseline acquisitions was 2.74 ± 0.97%, indicating a 5.37% measurement error. A transient but significant decrease (-6.88 ± 1.01%, P value, 0.0005-0.0467) in the pancreatic T2* values was observed within 5 minutes after glucose ingestion, rather than water consumption. Compared to water, glucose ingestion induced earlier (valley times: 3.46 ± 3.22 vs. 7.75 ± 4.09 min, P = 0.0006) and remarkable pancreatic T2* decrease (valley values: -15.33 ± 5.90% vs. -6.88 ± 3.11%, P = 0.0006). CONCLUSION BOLD MRI enabled noninvasive quantification of pancreatic T2* changes during glucose stimulation. Glucose ingestion resulted in a rapid and significant pancreatic T2* decrease in healthy young volunteers. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:831-836.
Collapse
Affiliation(s)
- Bozhu Chen
- Department of Radiology, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Weibo Chen
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | | | - Nan Zhou
- Department of Radiology, Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jian He
- Department of Radiology, Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhengyang Zhou
- Department of Radiology, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
| |
Collapse
|
65
|
Endothelial cells produce bone morphogenetic protein 6 required for iron homeostasis in mice. Blood 2016; 129:405-414. [PMID: 27864295 DOI: 10.1182/blood-2016-06-721571] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/14/2016] [Indexed: 02/06/2023] Open
Abstract
Bone morphogenetic protein 6 (BMP6) signaling in hepatocytes is a central transcriptional regulator of the iron hormone hepcidin that controls systemic iron balance. How iron levels are sensed to regulate hepcidin production is not known, but local induction of liver BMP6 expression by iron is proposed to have a critical role. To identify the cellular source of BMP6 responsible for hepcidin and iron homeostasis regulation, we generated mice with tissue-specific ablation of Bmp6 in different liver cell populations and evaluated their iron phenotype. Efficiency and specificity of Cre-mediated recombination was assessed by using Cre-reporter mice, polymerase chain reaction of genomic DNA, and quantitation of Bmp6 messenger RNA expression from isolated liver cell populations. Localization of the BMP co-receptor hemojuvelin was visualized by immunofluorescence microscopy. Analysis of the Bmp6 conditional knockout mice revealed that liver endothelial cells (ECs) expressed Bmp6, whereas resident liver macrophages (Kupffer cells) and hepatocytes did not. Loss of Bmp6 in ECs recapitulated the hemochromatosis phenotype of global Bmp6 knockout mice, whereas hepatocyte and macrophage Bmp6 conditional knockout mice exhibited no iron phenotype. Hemojuvelin was localized on the hepatocyte sinusoidal membrane immediately adjacent to Bmp6-producing sinusoidal ECs. Together, these data demonstrate that ECs are the predominant source of BMP6 in the liver and support a model in which EC BMP6 has paracrine actions on hepatocyte hemojuvelin to regulate hepcidin transcription and maintain systemic iron homeostasis.
Collapse
|
66
|
Chuansumrit A, Pengpis P, Mahachoklertwattana P, Sirachainan N, Poomthavorn P, Sungkarat W, Kadegasem P, Khlairit P, Wongwerawattanakoon P. Effect of Iron Chelation Therapy on Glucose Metabolism in Non-Transfusion-Dependent Thalassaemia. Acta Haematol 2016; 137:20-26. [PMID: 27838686 DOI: 10.1159/000450673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/07/2016] [Indexed: 01/15/2023]
Abstract
AIMS To compare insulin sensitivity, β-cell function and iron status biomarkers in non-transfusion-dependent thalassaemia (NTDT) with iron excess during pre- and post-iron chelation. METHODS Subjects with NTDT, aged older than 10 years, with serum ferritin >300 ng/ml, were included. Iron chelation with deferasirox (10 mg/kg/day) was prescribed daily for 6 months. RESULTS Ten patients with a median age of 17.4 years were enrolled. The comparison between pre- and post-chelation demonstrated significantly lower iron load: median serum ferritin (551.4 vs. 486.2 ng/ml, p = 0.047), median TIBC (211.5 vs. 233.5 µg/dl, p = 0.009) and median non-transferrin binding iron (5.5 vs. 1.4 µM, p = 0.005). All patients had a normal oral glucose tolerance test (OGTT) both pre- and post-chelation. However, fasting plasma glucose was significantly reduced after iron chelation (85.0 vs.79.5 mg/dl, p = 0.047). MRI revealed no significant changes of iron accumulation in the heart and liver after chelation, but there was a significantly lower iron load in the pancreas, assessed by higher T2* at post-chelation compared with pre-chelation (41.9 vs. 36.7 ms, p = 0.047). No adverse events were detected. CONCLUSIONS A trend towards improving insulin sensitivity and β-cell function as well as a reduced pancreatic iron load was observed following 6 months of iron chelation (TCTR20160523003).
Collapse
Affiliation(s)
- Ampaiwan Chuansumrit
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | | | | | | | | | | |
Collapse
|
67
|
Mahajan UM, Teller S, Sendler M, Palankar R, van den Brandt C, Schwaiger T, Kühn JP, Ribback S, Glöckl G, Evert M, Weitschies W, Hosten N, Dombrowski F, Delcea M, Weiss FU, Lerch MM, Mayerle J. Tumour-specific delivery of siRNA-coupled superparamagnetic iron oxide nanoparticles, targeted against PLK1, stops progression of pancreatic cancer. Gut 2016; 65:1838-1849. [PMID: 27196585 PMCID: PMC5099195 DOI: 10.1136/gutjnl-2016-311393] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 04/01/2016] [Accepted: 04/18/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive malignancies and is projected to be the second leading cause of cancer-related death by 2030. Despite extensive knowledge and insights into biological properties and genetic aberrations of PDAC, therapeutic options remain temporary and ineffective. One plausible explanation for the futile response to therapy is an insufficient and non-specific delivery of anticancer drugs to the tumour site. DESIGN Superparamagnetic iron oxide nanoparticles (SPIONs) coupled with siRNA directed against the cell cycle-specific serine-threonine-kinase, Polo-like kinase-1 (siPLK1-StAv-SPIONs), could serve a dual purpose for delivery of siPLK1 to the tumour and for non-invasive assessment of efficiency of delivery in vivo by imaging the tumour response. siPLK1-StAv-SPIONs were designed and synthesised as theranostics to function via a membrane translocation peptide with added advantage of driving endosomal escape for mediating transportation to the cytoplasm (myristoylated polyarginine peptides) as well as a tumour-selective peptide (EPPT1) to increase intracellular delivery and tumour specificity, respectively. RESULTS A syngeneic orthotopic as well as an endogenous cancer model was treated biweekly with siPLK1-StAv-SPIONs and tumour growth was monitored by small animal MRI. In vitro and in vivo experiments using a syngeneic orthotopic PDAC model as well as the endogenous LSL-KrasG12D, LSL-Trp53R172H, Pdx-1-Cre model revealed significant accumulation of siPLK1-StAv-SPIONs in PDAC, resulting in efficient PLK1 silencing. Tumour-specific silencing of PLK1 halted tumour growth, marked by a decrease in tumour cell proliferation and an increase in apoptosis. CONCLUSIONS Our data suggest siPLK1-StAv-SPIONs with dual specificity residues for tumour targeting and membrane translocation to represent an exciting opportunity for targeted therapy in patients with PDAC.
Collapse
Affiliation(s)
- Ujjwal M Mahajan
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Steffen Teller
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Matthias Sendler
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Raghavendra Palankar
- ZIK HIKE-Center for Innovation Competence Humoral Immune Reactions in Cardiovascular Diseases, Greifswald, Germany
| | - Cindy van den Brandt
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Theresa Schwaiger
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Jens-Peter Kühn
- Department of Radiology and Neuroradiology, University Medicine, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
| | - Silvia Ribback
- Institute of Pathology, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Gunnar Glöckl
- Institute of Pharmacy, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Matthias Evert
- Institute of Pathology, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Werner Weitschies
- Institute of Pharmacy, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Norbert Hosten
- Department of Radiology and Neuroradiology, University Medicine, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
| | - Frank Dombrowski
- Institute of Pharmacy, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Mihaela Delcea
- ZIK HIKE-Center for Innovation Competence Humoral Immune Reactions in Cardiovascular Diseases, Greifswald, Germany
| | - Frank-Ulrich Weiss
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Julia Mayerle
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| |
Collapse
|
68
|
De Sanctis V, Soliman AT, Elsedfy H, Yaarubi SAL, Skordis N, Khater D, El Kholy M, Stoeva I, Fiscina B, Angastiniotis M, Daar S, Kattamis C. The ICET-A Recommendations for the Diagnosis and Management of Disturbances of Glucose Homeostasis in Thalassemia Major Patients. Mediterr J Hematol Infect Dis 2016; 8:e2016058. [PMID: 27872738 PMCID: PMC5111521 DOI: 10.4084/mjhid.2016.058] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 09/20/2016] [Indexed: 01/19/2023] Open
Abstract
Iron overload in patients with thalassemia major (TM) affects glucose regulation and is mediated by several mechanisms. The pathogenesis of glycaemic abnormalities in TM is complex and multifactorial. It has been predominantly attributed to a combination of reduced insulin secretory capacity and insulin resistance. The exact mechanisms responsible for progression from norm glycaemia to overt diabetes in these patients are still poorly understood but are attributed mainly to insulin deficiency resulting from the toxic effects of iron deposited in the pancreas and insulin resistance. A group of endocrinologists, haematologists and paediatricians, members of the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine (ICET-A) convened to formulate recommendations for the diagnosis and management of abnormalities of glucose homeostasis in thalassemia major patients on the basis of available evidence from clinical and laboratory data and consensus practice. The results of their work and discussions are described in this article.
Collapse
Affiliation(s)
| | - Ashraf T. Soliman
- Department of Pediatrics, Division of Endocrinology, Alexandria University Children’s Hospital, Alexandria, Egypt
| | - Heba Elsedfy
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Saif AL Yaarubi
- Pediatric Endocrine Unit, Department of Child Health, Sultan Qaboos University Hospital, Al-Khoud, Sultanate of Oman
| | - Nicos Skordis
- Division of Pediatric and Adolescent Endocrinology, Paedi Center for Specialized Pediatrics, St. George’s University Medical School at the University of Nicosia, Cyprus
| | - Doaa Khater
- Department of Pediatrics, Endocrinology Unit, Alexandria University Children’s Hospital, Egypt, and Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Iva Stoeva
- Paediatric Endocrinologist,”Screening and Functional Endocrine Diagnostics” SBALDB. Professor Ivan Mitev, Medical University Sofia, Bulgaria
| | | | | | - Shahina Daar
- Department of Hematology, College of Medicine and Health Sciences Sultan Qaboos University Oman, Sultanate of Oman & Visiting Scholar, Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch 7600, South Africa
| | - Christos Kattamis
- First Department of Paediatrics, University of Athens, Athens, Greece
| |
Collapse
|
69
|
Meloni A, De Marchi D, Positano V, Neri MG, Mangione M, Keilberg P, Lendini M, Cirotto C, Pepe A. Accurate estimate of pancreatic T2* values: how to deal with fat infiltration. ACTA ACUST UNITED AC 2016; 40:3129-36. [PMID: 26288986 DOI: 10.1007/s00261-015-0522-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE We examined different approaches aimed to deal with the signal fluctuation of pancreatic T2* values due to fat infiltration in order to obtain accurate estimates of iron overload. METHODS Pancreatic T2* values were assessed in 20 patients (13 females, 37.24 ± 9.12 years) enrolled in the Myocardial Iron Overload in Thalassemia network without and with the application of fat suppression-FS (T2*-NoFS and T2*-FS). T2* values were assessed in three different ways: (1) from the immediate fit (original T2*); (2) discarding the echoes until the achievement of a good visual concordance between the signal and the model (final_vis T2*); (3) eliminating the echoes until the achievement of a fitting error (known) <5% (final_thres T2*). RESULTS For the T2*-NoFS sequence the original T2* values were significantly higher than the final_vis T2* values (difference:4.8 ± 6.1 ms; P < 0.0001) and the final_thres T2* values (difference:4.3 ± 6.1 ms; P = 0.006). For the T2*-FS sequence the original T2* values were comparable to final_vis and final_thres T2* values. The original T2*-FS values were significantly different from the original T2*-NoFS values. The final_vis T2*-FS values were comparable to the final_vis T2*-NoFS values and the final_thresh T2*-FS values were comparable to the final_thresh T2*-NoFS values. For both T2*-FS and T2*-NoFS sequences, the final_thres T2* values were not significantly different from the final_vis T2* values and no bias was present. CONCLUSIONS In the clinical practice, an accurate pancreatic iron overload assessment should be done by applying FS and, when needed, by discarding the TEs until the fitting error goes below 5%.
Collapse
Affiliation(s)
- Antonella Meloni
- CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi, 1, 56124, Pisa, Italy.
- U.O.C. Bioingegneria e Ingegneria Clinica, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
| | - Daniele De Marchi
- CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Vincenzo Positano
- CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi, 1, 56124, Pisa, Italy
- U.O.C. Bioingegneria e Ingegneria Clinica, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Maria Giovanna Neri
- CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Maurizio Mangione
- U.O.S. Sistemi Informatici, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Petra Keilberg
- CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi, 1, 56124, Pisa, Italy
| | | | - Carla Cirotto
- Servizio Trasfusionale, Azienda USL n° 1, Sassari, Italy
| | - Alessia Pepe
- CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi, 1, 56124, Pisa, Italy
| |
Collapse
|
70
|
Brown GC, Cowin GJ, Galloway GJ. A USPIO doped gel phantom for R2* relaxometry. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 30:15-27. [PMID: 27435747 DOI: 10.1007/s10334-016-0576-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/03/2016] [Accepted: 06/20/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This work describes a phantom containing regions of controlled R2* (1/T2*) values to provide a stable reference object for testing implementations of R2* relaxometry commonly used for liver and heart iron assessments. MATERIALS AND METHODS A carrageenan-strengthened gadolinium DTPA doped agarose gel was used to enclose nine gels additionally doped with ultra-small superparamagnetic iron oxide. R2* values were determined at 1.5 T using multi-echo GRE sequences and exponential regression of pixel values from a region of interest against echo time using non-linear regression algorithms. We measured R2*, R2 and R1 values and the inter-scan and inter-operator reproducibility. RESULTS The phantom reliably demonstrated R2* values in seven steps between 22.4 s-1 (SE 1.98) and 441.9 s-1 (SE 6.76), with an R2* relaxivity (r2*) of 792 (SE 5.6) mM-1 s-1. The doped gels displayed a concentration-dependent R2' component of R2* phantom, indicating superparamagnetic enhancement effects. We observed no significant change in relaxivity (r2*) over 12 months, and estimate a useful life of 3 years. Detailed descriptions of the production process and calculators are been provided as Online Resources. CONCLUSION The phantom provides a durable test object with controlled R2* relaxation behaviour, useful for a range of R2* relaxometry reference work.
Collapse
Affiliation(s)
- Gregory C Brown
- Centre for Advanced Imaging, The University of Queensland, Building 57, St Lucia, QLD, 4072, Australia.
| | - Gary J Cowin
- Centre for Advanced Imaging, The University of Queensland, Building 57, St Lucia, QLD, 4072, Australia
| | - Graham J Galloway
- Translational Research Centre, The University of Queensland, St Lucia, Australia
| |
Collapse
|
71
|
Grassedonio E, Meloni A, Positano V, De Marchi D, Toia P, Midiri M, Pepe A. Quantitative T2* magnetic resonance imaging for renal iron overload assessment: normal values by age and sex. ACTA ACUST UNITED AC 2016; 40:1700-4. [PMID: 25761947 DOI: 10.1007/s00261-015-0395-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Few studies of renal iron content have been performed with multiecho gradient-echo (ME-GRE) T2* magnetic resonance imaging (MRI). We assessed the feasibility and reproducibility of ME-GRE T2* MRI for measuring regional and global renal T2* values, and established the lower limits of normal in healthy subjects, also correlating the measured values with age and sex. METHODS Twenty consecutive healthy subjects (13 men and 7 women, mean age 29.1 ± 7.2 years, range 19-42 years) underwent MRI examinations using a 1.5 T magnet and an ME-GRE T2* sequence. For each kidney, T2* was measured in anterior, posterolateral, and posteromedial renal parenchymal regions. The mean T2* value was calculated as the average of the two kidneys T2* values. RESULTS For the mean kidney T2* value, the coefficients of variation for intra- and inter-operator reproducibility were 1.76% and 6.23%, respectively. The lower limit of normal for the mean kidney T2* value was 31 ms (median 51.39 ± 10.09). There was no significant difference between left and right kidney T2* values (p = 0.578). No significant correlation was found between T2* values and subjects' age or sex. CONCLUSIONS Renal ME-GRE T2* appears to be a feasible and reproducible technique. The renal T2* values showed no dependence on sex or age.
Collapse
|
72
|
Wood JC, Cohen AR, Pressel SL, Aygun B, Imran H, Luchtman-Jones L, Thompson AA, Fuh B, Schultz WH, Davis BR, Ware RE. Organ iron accumulation in chronically transfused children with sickle cell anaemia: baseline results from the TWiTCH trial. Br J Haematol 2015; 172:122-30. [PMID: 26523836 DOI: 10.1111/bjh.13791] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/25/2015] [Indexed: 10/22/2022]
Abstract
Transcranial Doppler (TCD) With Transfusions Changing to Hydroxyurea (TWiTCH) trial is a randomized, open-label comparison of hydroxycarbamide (also termed hydroxyurea) versus continued chronic transfusion therapy for primary stroke prevention in patients with sickle cell anaemia (SCA) and abnormal TCD. Severity and location of iron overload is an important secondary outcome measure. We report the baseline findings of abdominal organ iron burden in 121 participants. At enrollment, patients were young (9·8 ± 2·9 years), predominantly female (60:40), and previously treated with transfusions (4·1 ± 2·4 years) and iron chelation (3·1 ± 2·1 years). Liver iron concentration (LIC; 9·0 ± 6·6 mg/g dry weight) and serum ferritin were moderately elevated (2696 ± 1678 μg/l), but transferrin was incompletely saturated (47·2 ± 23·6%). Spleen R2* was 509 ± 399 Hz (splenic iron ~13·9 mg/g) and correlated with LIC (r(2) = 0·14, P = 0·0008). Pancreas R2* was increased in 38·3% of patients but not to levels associated with endocrine toxicity. Kidney R2* was increased in 80·7% of patients; renal iron correlated with markers of intravascular haemolysis and was elevated in patients with increased urine albumin-creatinine ratios. Extra-hepatic iron deposition is common among children with SCA who receive chronic transfusions, and could potentiate oxidative stress caused by reperfusion injury and decellularized haemoglobin.
Collapse
Affiliation(s)
- John C Wood
- Department of Cardiology, Childrens Hospital of Los Angeles, Los Angeles, CA, USA
| | - Alan R Cohen
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sara L Pressel
- Department of Biostatistics, University of Texas Health Science Center, Houston, TX, USA
| | - Banu Aygun
- Department of Pediatrics, Cohen Children's Medical Center of NY, New Hyde Park, NY, USA
| | - Hamayun Imran
- Department of Pediatrics, University of South Alabama, Mobile, AL, USA
| | - Lori Luchtman-Jones
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnnati, OH, USA
| | - Alexis A Thompson
- Department of Pediatrics, Anna and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Beng Fuh
- Department of Biostatistics, University of Texas Health Science Center, Houston, TX, USA
| | - William H Schultz
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnnati, OH, USA
| | - Barry R Davis
- Department of Biostatistics, University of Texas Health Science Center, Houston, TX, USA
| | - Russell E Ware
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnnati, OH, USA
| | | |
Collapse
|
73
|
Meloni A, Restaino G, Missere M, De Marchi D, Positano V, Valeri G, Giuseppe D'Ascola D, Peluso A, Caterina Putti M, Lendini M, Giovanna Neri M, Midiri M, Sallustio G, Pepe A. Pancreatic iron overload by T2* MRI in a large cohort of well treated thalassemia major patients: can it tell us heart iron distribution and function? Am J Hematol 2015; 90:E189-90. [PMID: 26044155 DOI: 10.1002/ajh.24081] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Antonella Meloni
- CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana; Pisa Italy
- Fondazione G. Monasterio CNR-Regione Toscana; U.O.C. Bioingegneria E Ingegneria Clinica; Pisa Italy
| | - Gennaro Restaino
- Dipartimento Di Radiologia, Centro Di Ricerca E Formazione Ad Alta Tecnologia Nelle Scienze Biomediche “Giovanni Paolo II,”; Campobasso Italy
| | - Massimiliano Missere
- Dipartimento Di Radiologia, Centro Di Ricerca E Formazione Ad Alta Tecnologia Nelle Scienze Biomediche “Giovanni Paolo II,”; Campobasso Italy
| | | | - Vincenzo Positano
- CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana; Pisa Italy
- Fondazione G. Monasterio CNR-Regione Toscana; U.O.C. Bioingegneria E Ingegneria Clinica; Pisa Italy
| | - Gianluca Valeri
- Dipartimento Di Radiologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti “Umberto I-Lancisi-Salesi,”; Ancona Italy
| | | | - Angelo Peluso
- Microcitemia, Azienda Unità Sanitaria Locale TA/1; Presidio Ospedaliero Centrale; Taranto Italy
| | - Maria Caterina Putti
- Clinica Di Emato-Oncologia Pediatrica, Dipartimento Di Pediatria, Università Di Padova/Azienda Ospedaliera; Padova Italy
| | | | | | - Massimo Midiri
- Istituto Di Radiologia, Policlinico “Paolo Giaccone”; Palermo Italy
| | - Giuseppina Sallustio
- Dipartimento Di Radiologia, Centro Di Ricerca E Formazione Ad Alta Tecnologia Nelle Scienze Biomediche “Giovanni Paolo II,”; Campobasso Italy
| | - Alessia Pepe
- CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana; Pisa Italy
| |
Collapse
|
74
|
İdilman İS, Gümrük F, Haliloğlu M, Karçaaltıncaba M. The Feasibility of Magnetic Resonance Imaging for Quantification of Liver, Pancreas, Spleen, Vertebral Bone Marrow, and Renal Cortex R2* and Proton Density Fat Fraction in Transfusion-Related Iron Overload. Turk J Haematol 2015; 33:21-7. [PMID: 26376710 PMCID: PMC4805342 DOI: 10.4274/tjh.2015.0142] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the feasibility of quantification of liver, pancreas, spleen, vertebral bone marrow, and renal cortex R2* and magnetic resonance imaging-proton density fat fraction (MRI-PDFF) and to evaluate the correlations among them in patients with transfusion-related iron overload. MATERIALS AND METHODS A total of 9 patients (5 boys, 4 girls) who were referred to our clinic with suspicion of hepatic iron overload were included in this study. All patients underwent T1-independent volumetric multi-echo gradient-echo imaging with T2* correction and spectral fat modeling. MRI examinations were performed on a 1.5 T MRI system. RESULTS All patients had hepatic iron overload. Severe hepatic iron overload was recorded in 5/9 patients (56%), and when we evaluated the PDFF maps of these patients, we observed an extensive patchy artifact in the liver in 4 of 5 patients (R2* greater than 671 Hz). When we performed MRI-PDFF measurements despite these artifacts, we observed artifactual high MRI-PDFF values. There was a close correlation between average pancreas R2* and average pancreas MRI-PDFF (p=0.003, r=0.860). There was a significant correlation between liver R2* and average pancreas R2* (p=0.021, r=0.747), liver R2* and renal cortex R2* (p=0.020, r=0.750), and average pancreas R2* and renal cortex R2* (p=0.003, r=0.858). There was a significant negative correlation between vertebral bone marrow R2* and age (p=0.018, r=-0.759). CONCLUSION High iron content of the liver, especially with a T2* value shorter than the first echo time can spoil the efficacy of PDFF calculation. Fat deposition in the pancreas is accompanied by pancreatic iron overload. There is a significant correlation between hepatic siderosis and pancreatic siderosis. Renal cortical and pancreatic siderosis are correlated, too.
Collapse
|
75
|
Heart, Liver, and Pancreas MRI Evaluation of Iron Overload. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0113-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
76
|
Jenkitkasemwong S, Wang CY, Coffey R, Zhang W, Chan A, Biel T, Kim JS, Hojyo S, Fukada T, Knutson MD. SLC39A14 Is Required for the Development of Hepatocellular Iron Overload in Murine Models of Hereditary Hemochromatosis. Cell Metab 2015; 22:138-50. [PMID: 26028554 PMCID: PMC4497937 DOI: 10.1016/j.cmet.2015.05.002] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 03/04/2015] [Accepted: 04/24/2015] [Indexed: 01/07/2023]
Abstract
Nearly all forms of hereditary hemochromatosis are characterized by pathological iron accumulation in the liver, pancreas, and heart. These tissues preferentially load iron because they take up non-transferrin-bound iron (NTBI), which appears in the plasma during iron overload. Yet, how tissues take up NTBI is largely unknown. We report that ablation of Slc39a14, the gene coding for solute carrier SLC39A14 (also called ZIP14), in mice markedly reduced the uptake of plasma NTBI by the liver and pancreas. To test the role of SLC39A14 in tissue iron loading, we crossed Slc39a14(-/-) mice with Hfe(-/-) and Hfe2(-/-) mice, animal models of type 1 and type 2 (juvenile) hemochromatosis, respectively. Slc39a14 deficiency in hemochromatotic mice greatly diminished iron loading of the liver and prevented iron deposition in hepatocytes and pancreatic acinar cells. The data suggest that inhibition of SLC39A14 may mitigate hepatic and pancreatic iron loading and associated pathologies in iron overload disorders.
Collapse
Affiliation(s)
- Supak Jenkitkasemwong
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL 32611, USA
| | - Chia-Yu Wang
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL 32611, USA
| | - Richard Coffey
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL 32611, USA
| | - Wei Zhang
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL 32611, USA
| | - Alan Chan
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL 32611, USA
| | - Thomas Biel
- Department of Surgery, University of Florida, Gainesville, FL 32611, USA
| | - Jae-Sung Kim
- Department of Surgery, University of Florida, Gainesville, FL 32611, USA
| | - Shintaro Hojyo
- RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan; Deutsches Rheuma-Forschungszentrum Berlin, Osteoimmunology, Charitéplatz, 10117 Berlin, Germany
| | - Toshiyuki Fukada
- RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan; Division of Pathology, Department of Oral Diagnostic Sciences, School of Dentistry, Showa University, Shinagawa 142-8666, Japan; Molecular and Cellular Physiology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima 770-8055, Japan
| | - Mitchell D Knutson
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL 32611, USA.
| |
Collapse
|
77
|
Abstract
Iron overload is becoming an increasing problem as haemoglobinopathy patients gain greater access to good medical care and as therapies for myelodysplastic syndromes improve. Therapeutic options for iron chelation therapy have increased and many patients now receive combination therapies. However, optimal utilization of iron chelation therapy requires knowledge not only of the total body iron burden but the relative iron distribution among the different organs. The physiological basis for extrahepatic iron deposition is presented in order to help identify patients at highest risk for cardiac and endocrine complications. This manuscript reviews the current state of the art for monitoring global iron overload status as well as its compartmentalization. Plasma markers, computerized tomography, liver biopsy, magnetic susceptibility devices and magnetic resonance imaging (MRI) techniques are all discussed but MRI has come to dominate clinical practice. The potential impact of recent pancreatic and pituitary MRI studies on clinical practice are discussed as well as other works-in-progress. Clinical protocols are derived from experience in haemoglobinopathies but may provide useful guiding principles for other iron overload disorders, such as myelodysplastic syndromes.
Collapse
Affiliation(s)
- John C Wood
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
78
|
Bas M, Gumruk F, Gonc N, Cetin M, Tuncer M, Hazırolan T, Yildirim G, Karabulut E, Unal S. Biochemical markers of glucose metabolism may be used to estimate the degree and progression of iron overload in the liver and pancreas of patients with β-thalassemia major. Ann Hematol 2015; 94:1099-104. [DOI: 10.1007/s00277-015-2342-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
|
79
|
Kühn JP, Berthold F, Mayerle J, Völzke H, Reeder SB, Rathmann W, Lerch MM, Hosten N, Hegenscheid K, Meffert PJ. Pancreatic Steatosis Demonstrated at MR Imaging in the General Population: Clinical Relevance. Radiology 2015; 276:129-36. [PMID: 25658037 DOI: 10.1148/radiol.15140446] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine the relationship between pancreatic fat content and type 2 diabetes and prediabetes. MATERIALS AND METHODS From the prospective population-based Study of Health in Pomerania (SHIP), 1367 volunteers (563 men, 678 women; median age, 50 years) underwent whole-body magnetic resonance (MR) imaging at 1.5 T, which included multiecho chemical shift-encoded acquisition of the abdomen. SHIP was approved by the institutional review board, and written informed consent was obtained from all participants. The proton density fat fraction (PDFF) was calculated after correction for T1 bias, T2* bias, multipeak spectral complexity of fat, and noise bias. On the basis of oral glucose tolerance test results, participants were grouped into those with normal glucose tolerance (n = 740), those with prediabetes (n = 431), and those with confirmed type 2 diabetes but without medication (n = 70). PDFF was assessed in the pancreatic head, body, and tail. Multivariable regression analysis was conducted to investigate possible relationships of PDFF with demographic factors, behavioral factors, and laboratory data associated with the metabolic syndrome. RESULTS In all subjects, the mean unadjusted pancreatic fat content was 4.4% (head, 4.6%; body, 4.9%; tail, 3.9%; being unequally distributed, P < .001). There was no significant difference in pancreatic PDFF among subjects with normal glucose tolerance, prediabetes, and type 2 diabetes (P = .980). Pancreatic PDFF showed a positive association with age and body mass index and a negative association with serum lipase activity (P < .001). CONCLUSION The presence of pancreatic fat is not related to prediabetes or diabetes, which suggests that it has little clinical relevance for an individual's glycemic status.
Collapse
Affiliation(s)
- Jens-Peter Kühn
- From the Department of Diagnostic Radiology and Neuroradiology (J.P.K., F.B., N.H., K.H.), Department of Medicine, Division of Gastroenterology (J.M., M.M.L.), and Institute for Community Medicine (H.V., P.J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, Greifswald D-17475, Germany; Departments of Radiology, Medical Physics, Biomedical Engineering and Medicine, University of Wisconsin, Madison, Wis (S.B.R.); and Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes, Heinrich Heine University Düsseldorf, Düsseldorf, Germany (W.R.)
| | - Friederike Berthold
- From the Department of Diagnostic Radiology and Neuroradiology (J.P.K., F.B., N.H., K.H.), Department of Medicine, Division of Gastroenterology (J.M., M.M.L.), and Institute for Community Medicine (H.V., P.J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, Greifswald D-17475, Germany; Departments of Radiology, Medical Physics, Biomedical Engineering and Medicine, University of Wisconsin, Madison, Wis (S.B.R.); and Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes, Heinrich Heine University Düsseldorf, Düsseldorf, Germany (W.R.)
| | - Julia Mayerle
- From the Department of Diagnostic Radiology and Neuroradiology (J.P.K., F.B., N.H., K.H.), Department of Medicine, Division of Gastroenterology (J.M., M.M.L.), and Institute for Community Medicine (H.V., P.J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, Greifswald D-17475, Germany; Departments of Radiology, Medical Physics, Biomedical Engineering and Medicine, University of Wisconsin, Madison, Wis (S.B.R.); and Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes, Heinrich Heine University Düsseldorf, Düsseldorf, Germany (W.R.)
| | - Henry Völzke
- From the Department of Diagnostic Radiology and Neuroradiology (J.P.K., F.B., N.H., K.H.), Department of Medicine, Division of Gastroenterology (J.M., M.M.L.), and Institute for Community Medicine (H.V., P.J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, Greifswald D-17475, Germany; Departments of Radiology, Medical Physics, Biomedical Engineering and Medicine, University of Wisconsin, Madison, Wis (S.B.R.); and Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes, Heinrich Heine University Düsseldorf, Düsseldorf, Germany (W.R.)
| | - Scott B Reeder
- From the Department of Diagnostic Radiology and Neuroradiology (J.P.K., F.B., N.H., K.H.), Department of Medicine, Division of Gastroenterology (J.M., M.M.L.), and Institute for Community Medicine (H.V., P.J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, Greifswald D-17475, Germany; Departments of Radiology, Medical Physics, Biomedical Engineering and Medicine, University of Wisconsin, Madison, Wis (S.B.R.); and Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes, Heinrich Heine University Düsseldorf, Düsseldorf, Germany (W.R.)
| | - Wolfgang Rathmann
- From the Department of Diagnostic Radiology and Neuroradiology (J.P.K., F.B., N.H., K.H.), Department of Medicine, Division of Gastroenterology (J.M., M.M.L.), and Institute for Community Medicine (H.V., P.J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, Greifswald D-17475, Germany; Departments of Radiology, Medical Physics, Biomedical Engineering and Medicine, University of Wisconsin, Madison, Wis (S.B.R.); and Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes, Heinrich Heine University Düsseldorf, Düsseldorf, Germany (W.R.)
| | - Markus M Lerch
- From the Department of Diagnostic Radiology and Neuroradiology (J.P.K., F.B., N.H., K.H.), Department of Medicine, Division of Gastroenterology (J.M., M.M.L.), and Institute for Community Medicine (H.V., P.J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, Greifswald D-17475, Germany; Departments of Radiology, Medical Physics, Biomedical Engineering and Medicine, University of Wisconsin, Madison, Wis (S.B.R.); and Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes, Heinrich Heine University Düsseldorf, Düsseldorf, Germany (W.R.)
| | - Norbert Hosten
- From the Department of Diagnostic Radiology and Neuroradiology (J.P.K., F.B., N.H., K.H.), Department of Medicine, Division of Gastroenterology (J.M., M.M.L.), and Institute for Community Medicine (H.V., P.J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, Greifswald D-17475, Germany; Departments of Radiology, Medical Physics, Biomedical Engineering and Medicine, University of Wisconsin, Madison, Wis (S.B.R.); and Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes, Heinrich Heine University Düsseldorf, Düsseldorf, Germany (W.R.)
| | - Katrin Hegenscheid
- From the Department of Diagnostic Radiology and Neuroradiology (J.P.K., F.B., N.H., K.H.), Department of Medicine, Division of Gastroenterology (J.M., M.M.L.), and Institute for Community Medicine (H.V., P.J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, Greifswald D-17475, Germany; Departments of Radiology, Medical Physics, Biomedical Engineering and Medicine, University of Wisconsin, Madison, Wis (S.B.R.); and Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes, Heinrich Heine University Düsseldorf, Düsseldorf, Germany (W.R.)
| | - Peter J Meffert
- From the Department of Diagnostic Radiology and Neuroradiology (J.P.K., F.B., N.H., K.H.), Department of Medicine, Division of Gastroenterology (J.M., M.M.L.), and Institute for Community Medicine (H.V., P.J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, Greifswald D-17475, Germany; Departments of Radiology, Medical Physics, Biomedical Engineering and Medicine, University of Wisconsin, Madison, Wis (S.B.R.); and Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes, Heinrich Heine University Düsseldorf, Düsseldorf, Germany (W.R.)
| |
Collapse
|
80
|
Puliyel M, Mainous AG, Berdoukas V, Coates TD. Iron toxicity and its possible association with treatment of Cancer: lessons from hemoglobinopathies and rare, transfusion-dependent anemias. Free Radic Biol Med 2015; 79:343-51. [PMID: 25463277 DOI: 10.1016/j.freeradbiomed.2014.10.861] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/22/2014] [Accepted: 10/30/2014] [Indexed: 01/19/2023]
Abstract
Exposure to elevated levels of iron causes tissue damage and organ failure, and increases the risk of cancer. The toxicity of iron is mediated through generation of oxidants. There is also solid evidence indicating that oxidant stress plays a significant role in a variety of human disease states, including malignant transformation. Iron toxicity is the main focus when managing thalassemia. However, the short- and long-term toxicities of iron have not been extensively considered in children and adults treated for malignancy, and only recently have begun to draw oncologists' attention. The treatment of malignancy can markedly increase exposure of patients to elevated toxic iron species without the need for excess iron input from transfusion. This under-recognized exposure likely enhances organ toxicity and may contribute to long-term development of secondary malignancy and organ failure. This review discusses the current understanding of iron metabolism, the mechanisms of production of toxic free iron species in humans, and the relation of the clinical marker, transferrin saturation (TS), to the presence of toxic free iron. We will present epidemiological data showing that high TS is associated with poor outcomes and development of cancer, and that lowering free iron may improve outcomes. Finally, we will discuss the possible relation between some late complications seen in survivors of cancer and those due to iron toxicity.
Collapse
Affiliation(s)
- Mammen Puliyel
- Section of Hematology, Childrens Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles California, USA
| | - Arch G Mainous
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Fla. USA
| | - Vasilios Berdoukas
- Section of Hematology, Childrens Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles California, USA
| | - Thomas D Coates
- Section of Hematology, Childrens Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles California, USA.
| |
Collapse
|
81
|
A significant proportion of thalassemia major patients have adrenal insufficiency detectable on provocative testing. J Pediatr Hematol Oncol 2015; 37:54-9. [PMID: 24942024 PMCID: PMC4393555 DOI: 10.1097/mph.0000000000000199] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Advances in chelation therapy and noninvasive monitoring of iron overload have resulted in substantial improvements in the survival of transfusion-dependent patients with thalassemia major. Myocardial decompensation and sepsis remain the major causes of death. Although endocrine abnormalities are a well-recognized problem in these iron-overloaded patients, adrenal insufficiency and its consequences are underappreciated by the hematology community. The aims of this study were to determine the prevalence of adrenal insufficiency in thalassemia major subjects, to identify risk factors for adrenal insufficiency, and to localize the origin of the adrenal insufficiency within the hypothalamic-pituitary-adrenal axis. Eighteen subjects with thalassemia major (18.9±9.3 y old, 7 female) were tested for adrenal insufficiency using a glucagon stimulation test. Those found to have adrenal insufficiency (stimulated cortisol <18 µg/dL) subsequently underwent an ovine corticotropin-releasing hormone (oCRH) stimulation test to define the physiological basis for the adrenal insufficiency. The prevalence of adrenal insufficiency was 61%, with an increased prevalence in males over females (92% vs. 29%, P=0.049). Ten of 11 subjects who failed the glucagon stimulation test subsequently demonstrated normal ACTH and cortisol responses to oCRH, indicating a possible hypothalamic origin to their adrenal insufficiency.
Collapse
|
82
|
Abstract
Abstract
Both primary and secondary iron overload are increasingly prevalent in the United States because of immigration from the Far East, increasing transfusion therapy in sickle cell disease, and improved survivorship of hematologic malignancies. This chapter describes the use of historical data, serological measures, and MRI to estimate somatic iron burden. Before chelation therapy, transfusional volume is an accurate method for estimating liver iron burden, whereas transferrin saturation reflects the risk of extrahepatic iron deposition. In chronically transfused patients, trends in serum ferritin are helpful, inexpensive guides to relative changes in somatic iron stores. However, intersubject variability is quite high and ferritin values may change disparately from trends in total body iron load over periods of several years. Liver biopsy was once used to anchor trends in serum ferritin, but it is invasive and plagued by sampling variability. As a result, we recommend annual liver iron concentration measurements by MRI for all patients on chronic transfusion therapy. Furthermore, it is important to measure cardiac T2* by MRI every 6-24 months depending on the clinical risk of cardiac iron deposition. Recent validation data for pancreas and pituitary iron assessments are also presented, but further confirmatory data are suggested before these techniques can be recommended for routine clinical use.
Collapse
|
83
|
Tzoulis P. Review of Endocrine Complications in Adult Patients with β-Thalassaemia Major. THALASSEMIA REPORTS 2014. [DOI: 10.4081/thal.2014.4871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Endocrine abnormalities are amongst the most common complications of β-thalassaemia major (TM). This is an overview of endocrinopathies of adult patients with β-thalassaemia major, excluding osteoporosis and fertility issues. This review will focus on emerging evidence in the last 5 years with regards to endocrinopathies in patients with TM.
Collapse
|
84
|
Casale M, Citarella S, Filosa A, De Michele E, Palmieri F, Ragozzino A, Amendola G, Pugliese U, Tartaglione I, Della Rocca F, Cinque P, Nobili B, Perrotta S. Endocrine function and bone disease during long-term chelation therapy with deferasirox in patients with β-thalassemia major. Am J Hematol 2014; 89:1102-6. [PMID: 25197009 DOI: 10.1002/ajh.23844] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 09/02/2014] [Indexed: 01/19/2023]
Abstract
Iron overload in β-thalassemia major (TM) typically results in iron-induced cardiomyopathy, liver disease, and endocrine complications. We examined the incidence and progression of endocrine disorders (hypothyroidism, diabetes, hypoparathyroidism, hypogonadism), growth and pubertal delay, and bone metabolism disease during long-term deferasirox chelation therapy in a real clinical practice setting. We report a multicenter retrospective cohort study of 86 transfusion-dependent patients with TM treated with once daily deferasirox for a median duration of 6.5 years, up to 10 years. No deaths or new cases of hypothyroidism or diabetes occurred. The incidence of new endocrine complications was 7% (P = 0.338, for change of prevalence from baseline to end of study) and included hypogonadism (n = 5) and hypoparathyroidism (n = 1). Among patients with hypothyroidism or diabetes at baseline, no significant change in thyroid parameters or insulin requirements were observed, respectively. Mean lumbar spine bone mineral density increased significantly (P < 0.001) and the number of patients with lumbar spine osteoporosis significantly decreased (P = 0.022) irrespective of bisphosphonate therapy, hormonal replacement therapy, and calcium or vitamin D supplementation. There were no significant differences in the number of pediatric patients below the 5th centile for height between baseline and study completion. Six pregnancies occurred successfully, and four of them were spontaneous without ovarian stimulation. This is the first study evaluating endocrine function during the newest oral chelation therapy with deferasirox. A low rate of new endocrine disorders and a stabilization of those pre-exisisting was observed in a real clinical practice setting.
Collapse
Affiliation(s)
- Maddalena Casale
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica; Second University of Naples; Naples Italy
| | - Serena Citarella
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica; Second University of Naples; Naples Italy
| | - Aldo Filosa
- UOSD Centro per le Microcitemie, AORN Cardarelli; Naples Italy
| | - Elisa De Michele
- Medicina Immunotrasfusionale; Ospedale San Giovanni di Dio e Ruggi d'Aragona; Salerno Italy
| | - Francesco Palmieri
- Unità di Radiologia e Diagnostica per Immagini; Ospedale S. Maria delle Grazie; Pozzuoli Italy
| | - Alfonso Ragozzino
- Unità di Radiologia e Diagnostica per Immagini; Ospedale S. Maria delle Grazie; Pozzuoli Italy
| | - Giovanni Amendola
- Dipartimento di Pediatria; Ospedale Umberto 1; Nocera Inferiore Salerno Italy
| | - Umberto Pugliese
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica; Second University of Naples; Naples Italy
| | - Immacolata Tartaglione
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica; Second University of Naples; Naples Italy
| | - Filomena Della Rocca
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica; Second University of Naples; Naples Italy
| | - Patrizia Cinque
- UOSD Centro per le Microcitemie, AORN Cardarelli; Naples Italy
| | - Bruno Nobili
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica; Second University of Naples; Naples Italy
| | - Silverio Perrotta
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica; Second University of Naples; Naples Italy
| |
Collapse
|
85
|
Pfeifer CD, Schoennagel BP, Grosse R, Wang ZJ, Graessner J, Nielsen P, Adam G, Fischer R, Yamamura J. Pancreatic iron and fat assessment by MRI-R2* in patients with iron overload diseases. J Magn Reson Imaging 2014; 42:196-203. [PMID: 25236606 DOI: 10.1002/jmri.24752] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 08/28/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To determine the pancreatic iron (R2*) and fat content (FC) in comparison to hepatic and cardiac R2* in patients with iron overload disorders like β-thalassemia major (TM), Diamond-Blackfan anemia (DBA) or hereditary hemochromatosis. METHODS R2* rates were assessed in the liver, heart and pancreas of 42 patients with TM, 29 subjects with other iron overload diseases, and 10 controls using an ECG-gated breathhold sequence (12 echo time [TE] = 1.3-25.7 ms, readout repetition time [TR] = 244 ms). Pancreatic R2* and FC were assessed from TE dependent region of interest based signal intensities performing water-fat chemical shift relaxometry and were compared with laboratory parameters (glucose, HbA1c, amylase and lipase). RESULTS A pancreatic iron gradient from tail (R2* = 122 s(-1) ) to head (R2* = 114 s(-1) , P < 10(-4) ) was found. The close association between cardiac and pancreatic R2* was also confirmed in patients with TM and other iron overload diseases (rs = 0.64, P < 10(-4) ). Receiver operator characteristic analysis (area: 0.89, P < 10(-4) ) identified patients with elevated cardiac iron at a pancreatic R2* cut-off level of 131s(-1) (sensitivity = specificity at 81%). Highest pancreatic R2* (211s(-1) ) and FC (36%) were found in the tail region of diabetic patients with TM. CONCLUSION Pancreatic tail showed highest R2* rates and fat contents, especially in patients with thalassemia. Besides iron accumulation fatty degeneration might be an additional risk factor for the development of diabetes in β-thalassemia major, but this hypothesis needs further studies in prediabetic patients.
Collapse
Affiliation(s)
- Charlotte D Pfeifer
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Bjoern P Schoennagel
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Regine Grosse
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | - Zhiyue J Wang
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Peter Nielsen
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Roland Fischer
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Germany.,UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Germany
| |
Collapse
|
86
|
Yacobovich J, Tamary H. Thalassemia major and sickle cell disease in adolescents and young adults. Acta Haematol 2014; 132:340-7. [PMID: 25228560 DOI: 10.1159/000360235] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The increased longevity of patients with thalassemia and sickle cell disease (SCD) introduces new clinical challenges due to the accumulation of disease-related morbidity, psychosocial issues and health care adjustments. Patients with thalassemia major now live into adulthood without suffering heart failure but must confront delayed puberty, impaired fertility and progressive bone disease. The increased survival in SCD brings to the front previously unrecognized complications including pulmonary hypertension, silent cerebral infarcts and also reproductive dysfunction. Adolescents and young adults (AYAs) have age-related psychosocial needs in their transition from the pediatric health care environment to the adult system. In this review we present the uniquely age-related medical issues facing the AYA thalassemia and SCD cohort in their transition into adulthood.
Collapse
Affiliation(s)
- Joanne Yacobovich
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | | |
Collapse
|
87
|
Abstract
Treatment of iron overload requires robust estimates of total-body iron burden and its response to iron chelation therapy. Compliance with chelation therapy varies considerably among patients, and individual reporting is notoriously unreliable. Even with perfect compliance, intersubject variability in chelator effectiveness is extremely high, necessitating reliable iron estimates to guide dose titration. In addition, each chelator has a unique profile with respect to clearing iron stores from different organs. This article presents the tools available to clinicians to monitor their patients, focusing on noninvasive magnetic resonance imaging methods because they have become the de facto standard of care.
Collapse
Affiliation(s)
- John C Wood
- Department of Pediatrics, Children's Hospital, Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA; Department of Radiology, Children's Hospital, Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA.
| |
Collapse
|
88
|
Coates TD. Physiology and pathophysiology of iron in hemoglobin-associated diseases. Free Radic Biol Med 2014; 72:23-40. [PMID: 24726864 PMCID: PMC4940047 DOI: 10.1016/j.freeradbiomed.2014.03.039] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 01/19/2023]
Abstract
Iron overload and iron toxicity, whether because of increased absorption or iron loading from repeated transfusions, can be major causes of morbidity and mortality in a number of chronic anemias. Significant advances have been made in our understanding of iron homeostasis over the past decade. At the same time, advances in magnetic resonance imaging have allowed clinicians to monitor and quantify iron concentrations noninvasively in specific organs. Furthermore, effective iron chelators are now available, including preparations that can be taken orally. This has resulted in substantial improvement in mortality and morbidity for patients with severe chronic iron overload. This paper reviews the key points of iron homeostasis and attempts to place clinical observations in patients with transfusional iron overload in context with the current understanding of iron homeostasis in humans.
Collapse
Affiliation(s)
- Thomas D Coates
- Children׳s Center for Cancer and Blood Diseases, Children׳s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA 90027, USA.
| |
Collapse
|
89
|
Meloni A, Puliyel M, Pepe A, Berdoukas V, Coates TD, Wood JC. Cardiac iron overload in sickle-cell disease. Am J Hematol 2014; 89:678-83. [PMID: 24664847 DOI: 10.1002/ajh.23721] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/19/2014] [Accepted: 03/21/2014] [Indexed: 12/15/2022]
Abstract
Chronically transfused sickle cell disease (SCD) patients have lower risk of myocardial iron overload (MIO) than comparably transfused thalassemia major (TM) patients. However, cardioprotection is incomplete. We present the clinical characteristics of six patients who have prospectively developed MIO, to identify potential risk factors for cardiac iron accumulation. From 2002 to 2011, cardiac, hepatic, and pancreatic iron overload were assessed by R2 and R2 * magnetic resonance imaging techniques in 201 chronic transfused SCD patients as part of their clinical care. At the time, they developed MIO, five of six patients had been on chronic transfusion for more than 11 years; only one was on exchange transfusion. The time to MIO was correlated with reticulocyte and hemoglobin S percentages. All patients had qualitatively poor chelation compliance (<50%). All patients had serum ferritin levels >4600 ng/ml and liver iron concentration >22 mg/g. Pancreatic R2 * was >100 Hz in every patient studied (5/6). Cardiac iron rose proportionally to pancreas R2 *, with all patients having pancreas R2 *>100 Hz when cardiac iron was present. MIO had a threshold relationship with liver iron that was higher than observed in TM patients. In conclusion, MIO occurs in a small percentage of chronically transfused SCD patients and is only associated with exceptionally poor control of total body iron stores. Duration of chronic transfusion is clearly important but other factors, such as levels of effective erythropoiesis, appear to contribute to cardiac risk. Pancreas R2 * can serve as a valuable screening tool for cardiac iron in SCD patients.
Collapse
Affiliation(s)
- Antonella Meloni
- CMR Unit; Fondazione G. Monasterio CNR-Regione Toscana; Pisa Italy
- Division of Cardiology; Children's Hospital Los Angeles; Los Angeles California
| | - Mammen Puliyel
- Division of Hematology-Oncology; Children's Hospital Los Angeles; Los Angeles California
| | - Alessia Pepe
- CMR Unit; Fondazione G. Monasterio CNR-Regione Toscana; Pisa Italy
| | - Vasili Berdoukas
- Division of Hematology-Oncology; Children's Hospital Los Angeles; Los Angeles California
| | - Thomas D. Coates
- Division of Hematology-Oncology; Children's Hospital Los Angeles; Los Angeles California
| | - John C. Wood
- Division of Cardiology; Children's Hospital Los Angeles; Los Angeles California
- Department of Radiology; Children's Hospital Los Angeles; Los Angeles California
| |
Collapse
|
90
|
Ruccione KS, Wood JC, Sposto R, Malvar J, Chen C, Freyer DR. Characterization of transfusion-derived iron deposition in childhood cancer survivors. Cancer Epidemiol Biomarkers Prev 2014; 23:1913-9. [PMID: 24962841 DOI: 10.1158/1055-9965.epi-14-0292] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood cancer survivors (CCS) receiving packed red blood cell (PRBC) transfusions may have increased risk for vital organ iron deposition causing serious late effects. METHODS This cross-sectional cohort study of a CCS cohort quantified organ iron content by magnetic resonance imaging. Iron status by serum markers and hemochromatosis gene mutation status were assessed. RESULTS Seventy-five patients who had received a range (0-392 mL/kg) of cumulative PRBC transfusion volumes were enrolled (median age 14 years, range 8-25.6 years at evaluation). Median follow-up time was 4.4 years, and median time since last transfusion was 4.9 years. Cancer diagnoses included acute lymphoblastic or myelogenous leukemia (ALL/AML; n = 33) and solid tumors (n = 42). Liver and pancreatic iron concentrations were elevated in 36 of 73 (49.3%) and 19 of 72 (26.4%) subjects, respectively. Cardiac iron concentration was not increased in this cohort. In multivariate analysis, cumulative PRBC volume (P < 0.0001) and older age at diagnosis (P < 0.0001) predicted elevated liver iron concentration. CONCLUSIONS Iron overload (IO) may occur in children and adolescents/young adults treated for cancer and is associated with cumulative PRBC transfusion volume and age at diagnosis. IMPACT These findings have implications for development of monitoring and management guidelines for cancer patients and survivors at risk for IO, exploration of the additive risk of liver/pancreatic damage from chemotherapeutic exposures, and health education to minimize further liver/pancreatic damage from exposures such as excessive alcohol intake and hepatotoxic medications.
Collapse
Affiliation(s)
| | - John C Wood
- Pediatric Cardiology and Radiology. Departments of Pediatrics and Keck School of Medicine of the University of Southern California, Los Angeles, California
| | | | - Jemily Malvar
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles. Divisions of
| | - Cheng Chen
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | | |
Collapse
|
91
|
Abu Rajab M, Guerin L, Lee P, Brown KE. Iron overload secondary to cirrhosis: a mimic of hereditary haemochromatosis? Histopathology 2014; 65:561-9. [PMID: 24635122 DOI: 10.1111/his.12417] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/12/2014] [Indexed: 01/19/2023]
Abstract
AIMS Hepatic iron deposition unrelated to hereditary haemochromatosis is common in cirrhosis. The aim of this study was to determine whether hepatic haemosiderosis secondary to cirrhosis is associated with iron deposition in extrahepatic organs. METHODS AND RESULTS Records of consecutive adult patients with cirrhosis who underwent autopsy were reviewed. Storage iron was assessed by histochemical staining of sections of liver, heart, pancreas and spleen. HFE genotyping was performed on subjects with significant liver, cardiac and/or pancreatic iron. The 104 individuals were predominantly male (63%), with a mean age of 55 years. About half (46%) had stainable hepatocyte iron, 2+ or less in most cases. In six subjects, there was heavy iron deposition (4+) in hepatocytes and biliary epithelium. All six of these cases had pancreatic iron and five also had cardiac iron. None of these subjects had an explanatory HFE genotype. CONCLUSIONS In this series, heavy hepatocyte iron deposition secondary to cirrhosis was commonly associated with pancreatic and cardiac iron. Although this phenomenon appears to be relatively uncommon, the resulting pattern of iron deposition is similar to haemochromatosis. Patients with marked hepatic haemosiderosis secondary to cirrhosis may be at risk of developing extrahepatic complications of iron overload.
Collapse
Affiliation(s)
- Murad Abu Rajab
- Division of Gastroenterology-Hepatology, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | | | | | | |
Collapse
|
92
|
Iron toxicity mediated by oxidative stress enhances tissue damage in an animal model of diabetes. Biometals 2014; 27:349-61. [PMID: 24549594 DOI: 10.1007/s10534-014-9717-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 02/10/2014] [Indexed: 12/28/2022]
Abstract
Although iron is a first-line pro-oxidant that modulates clinical manifestations of various systemic diseases, including diabetes, the individual tissue damage generated by active oxidant insults has not been demonstrated in current animal models of diabetes. We tested the hypothesis that oxidative stress is involved in the severity of the tissues injury when iron supplementation is administered in a model of type 1 diabetes. Streptozotocin (Stz)-induced diabetic and non-diabetic Fischer rats were maintained with or without a treatment consisting of iron dextran ip at 0.1 mL day(-1) doses administered for 4 days at intervals of 5 days. After 3 weeks, an extensive increase (p < 0.001) in the production of reactive oxygen species (ROS) in neutrophils of the diabetic animals on iron overload was observed. Histological analysis revealed that this treatment also resulted in higher (p < 0.05) tissue iron deposits, a higher (p < 0.001) number of inflammatory cells in the pancreas, and apparent cardiac fibrosis, as shown by an increase (p < 0.05) in type III collagen levels, which result in dysfunctional myocardial. Carbonyl protein modification, a marker of oxidative stress, was consistently higher (p < 0.01) in the tissues of the iron-treated rats with diabetes. Moreover, a significant positive correlation was found between ROS production and iron pancreas stores (r = 0.42, p < 0.04), iron heart stores (r = 0.54, p < 0.04), and change of the carbonyl protein content in pancreas (r = 0.49, p < 0.009), and heart (r = 0.48, p < 0.02). A negative correlation was still found between ROS production and total glutathione content in pancreas (r = -0.50, p < 0.03) and heart (r = -0.45, p < 0.04). In conclusion, our results suggest that amplified toxicity in pancreatic and cardiac tissues in rats with diabetes on iron overload might be attributed to increased oxidative stress.
Collapse
|
93
|
Ang AL, Tzoulis P, Prescott E, Davis BA, Barnard M, Shah FT. History of myocardial iron loading is a strong risk factor for diabetes mellitus and hypogonadism in adults with β thalassemia major. Eur J Haematol 2014; 92:229-36. [DOI: 10.1111/ejh.12224] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2013] [Indexed: 01/19/2023]
Affiliation(s)
- Ai Leen Ang
- Department of Haematology; The Whittington Hospital; London UK
- Department of Haematology; Singapore General Hospital; Singapore
| | | | - Emma Prescott
- Department of Haematology; The Whittington Hospital; London UK
| | | | - Maria Barnard
- Department of Endocrinology; The Whittington Hospital; London UK
| | - Farrukh T. Shah
- Department of Haematology; The Whittington Hospital; London UK
| |
Collapse
|
94
|
Latour C, Kautz L, Besson-Fournier C, Island ML, Canonne-Hergaux F, Loréal O, Ganz T, Coppin H, Roth MP. Testosterone perturbs systemic iron balance through activation of epidermal growth factor receptor signaling in the liver and repression of hepcidin. Hepatology 2014; 59:683-94. [PMID: 23907767 DOI: 10.1002/hep.26648] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 07/18/2013] [Indexed: 12/14/2022]
Abstract
UNLABELLED Gender-related disparities in the regulation of iron metabolism may contribute to the differences exhibited by men and women in the progression of chronic liver diseases associated with reduced hepcidin expression, e.g., chronic hepatitis C, alcoholic liver disease, or hereditary hemochromatosis. However, their mechanisms remain poorly understood. In this study we took advantage of the major differences in hepcidin expression and tissue iron loading observed between Bmp6-deficient male and female mice to investigate the mechanisms underlying this sexual dimorphism. We found that testosterone robustly represses hepcidin transcription by enhancing Egfr signaling in the liver and that selective epidermal growth factor receptor (Egfr) inhibition by gefitinib (Iressa) in males markedly increases hepcidin expression. In males, where the suppressive effects of testosterone and Bmp6-deficiency on hepcidin expression are combined, hepcidin is more strongly repressed than in females and iron accumulates massively not only in the liver but also in the pancreas, heart, and kidneys. CONCLUSION Testosterone-induced repression of hepcidin expression becomes functionally important during homeostatic stress from disorders that result in iron loading and/or reduced capacity for hepcidin synthesis. These findings suggest that novel therapeutic strategies targeting the testosterone/EGF/EGFR axis may be useful for inducing hepcidin expression in patients with iron overload and/or chronic liver diseases.
Collapse
Affiliation(s)
- Chloé Latour
- Inserm, U1043, Toulouse, France; CNRS, U5282, Toulouse, France; Université de Toulouse, UPS, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse, France
| | | | | | | | | | | | | | | | | |
Collapse
|
95
|
Li MJ, Peng SSF, Lu MY, Chang HH, Yang YL, Jou ST, Lin DT, Lin KH. Diabetes mellitus in patients with thalassemia major. Pediatr Blood Cancer 2014; 61:20-4. [PMID: 24115521 DOI: 10.1002/pbc.24754] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/05/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Diabetes mellitus is a major endocrinopathy for patients with thalassemia major. Although diabetes mellitus is multifactorial, iron loading is its primary cause and its management poses a clinical challenge. Detecting the pre-diabetes stage is critical because clinical diabetes can potentially be reversed or prevented. PROCEDURE Patients with thalassemia major who received regular blood transfusion therapy from 1994 to 2010 were evaluated for the incidence of diabetes mellitus and glucose dysregulation. The association between patients' clinical, biochemical, and image parameters was also evaluated. RESULTS The patients with diabetes were significantly older, had higher ferritin levels, a smaller pancreas volume, and lower cardiac T2* magnetic resonance imaging (MRI) values than the patients without diabetes. The pancreas T2* MRI values were higher in the patients without diabetes, but the difference was not statistically significant. The liver iron concentration did not differ between the patients with and without diabetes. The prevalence of hepatitis C infection and hypogonadism was also higher in the patients with diabetes. In the patients without diabetes, the cardiac T2* MRI values were higher in patients with normal fasting glucose levels (P = 0.03), and the homeostasis model assessment of insulin resistance level was associated with hepatitis C infection (P = 0.024, r = 0.32) and hypogonadism (P = 0.034, r = 0.301). CONCLUSIONS Fasting glucose and insulin levels were appropriate screening tools for evaluating glucose dysregulation and complemented the MRI findings. The cardiac T2* and pancreas volumes were significant predictors of diabetes.
Collapse
Affiliation(s)
- Meng-Ju Li
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
96
|
SCHOENNAGEL BP, REMUS CC, WEDEGAERTNER U, SALZMANN I, GRABHORN E, ADAM G, FISCHER R, HARMATZ P, KOOIJMAN H, YAMAMURA J. Quantification of Prenatal Liver and Spleen Iron in a Sheep Model and Assessment of Iron Stores in a Human Neonate with Neonatal Hemochromatosis using R2* Mapping. Magn Reson Med Sci 2014; 13:167-73. [DOI: 10.2463/mrms.2013-0096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
97
|
de Ville de Goyet M, Moniotte S, Robert A, Dupont S, Vermylen C, Veyckemans F, Brichard B. Iron overload in children undergoing cancer treatments. Pediatr Blood Cancer 2013; 60:1982-7. [PMID: 23897631 DOI: 10.1002/pbc.24705] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 07/04/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Iron overload is responsible for severe morbidity and mortality in polytransfused patients. Although repeated blood transfusions are needed during the treatment of most cancers, pediatric patients are not routinely screened for subsequent iron overload. PROCEDURE Seventy-five patients were identified as candidates for cancer treatment and enrolled prospectively in a yearly protocol including a cardiac and liver magnetic resonance imaging coupled with ferritin level measurements. Patients were divided into four groups using the intensity of treatment rating (ITR-3). RESULTS Fifty-nine patients reached 1-year of follow-up and liver iron overload was found in up to 66% of them. Such overload correlated with the total volume of red blood cells transfused and persisted at least 2 years after the initiation of therapy. Moderate myocardial overload was also, but less frequently (14%), observed in these patients. CONCLUSIONS Our study demonstrated that severe liver iron overload as well as moderate myocardial iron overload can be found 1 year after cancer treatment and that this overload persists overtime. The patients with higher ITR and those who have received more than a liter of blood red cells per square meter, regardless of their diagnosis or ITR, are at risk of iron overload and should be screened carefully.
Collapse
Affiliation(s)
- Maëlle de Ville de Goyet
- Department of Paediatric Haematology and Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | | | | | | | | | | | | |
Collapse
|
98
|
Berdoukas V, Nord A, Carson S, Puliyel M, Hofstra T, Wood J, Coates TD. Tissue iron evaluation in chronically transfused children shows significant levels of iron loading at a very young age. Am J Hematol 2013; 88:E283-5. [PMID: 23861216 DOI: 10.1002/ajh.23543] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/28/2013] [Accepted: 07/09/2013] [Indexed: 01/17/2023]
Abstract
Chronic blood transfusions start at a very young age in subjects with transfusion-dependent anemias, the majority of whom have hereditary anemias. To understand how rapidly iron overload develops, we retrospectively reviewed 308 MRIs for evaluation of liver, pancreatic, or cardiac iron in 125 subjects less than 10 years old. Median age at first MRI evaluation was 6.0 years. Median liver iron concentrations in patients less than 3.5 years old were 14 and 13 mg/g dry weight in thalassemia major (TM) and Diamond-Blackfan anemia (DBA) patients, respectively. At time of first MRI, pancreatic iron was markedly elevated (> 100 Hz) in DBA patients, and cardiac iron ( R₂* >50 Hz) was present in 5/112 subjects (4.5%), including a 2.5 years old subject with DBA. Five of 14 patients (38%) with congenital dyserythropoietic anemia (CDA) developed excess cardiac iron before their 10th birthday. Thus, clinically significant hepatic and cardiac iron accumulation occurs at an early age in patients on chronic transfusions, particularly in those with ineffective or absent erythropoiesis, such as DBA, CDA, and TM, who are at higher risk for iron cardiomyopathy. Performing MRI for iron evaluation in the liver, heart, and pancreas as early as feasible, particularly in those conditions in which there is suppressed bone marrow activity is very important in the management of iron loaded children in order to prescribe appropriate chelation to prevent long-term sequelae. .
Collapse
Affiliation(s)
- Vasilios Berdoukas
- Division of Hematology/Oncology, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles; University of Southern California; Los Angeles California
| | - Anne Nord
- Division of Hematology/Oncology, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles; University of Southern California; Los Angeles California
| | - Susan Carson
- Division of Hematology/Oncology, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles; University of Southern California; Los Angeles California
| | - Mammen Puliyel
- Division of Hematology/Oncology, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles; University of Southern California; Los Angeles California
| | - Thomas Hofstra
- Division of Hematology/Oncology, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles; University of Southern California; Los Angeles California
| | - John Wood
- Division of Cardiology, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles; University of Southern California; Los Angeles California
| | - Thomas D. Coates
- Division of Hematology/Oncology, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles; University of Southern California; Los Angeles California
| |
Collapse
|
99
|
Pepe A, Meloni A, Rossi G, Caruso V, Cuccia L, Spasiano A, Gerardi C, Zuccarelli A, D'Ascola DG, Grimaldi S, Santodirocco M, Campisi S, Lai ME, Piraino B, Chiodi E, Ascioti C, Gulino L, Positano V, Lombardi M, Gamberini MR. Cardiac complications and diabetes in thalassaemia major: a large historical multicentre study. Br J Haematol 2013; 163:520-7. [DOI: 10.1111/bjh.12557] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 07/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Alessia Pepe
- Cardiovascular MR Unit; Fondazione G. Monasterio CNR-Regione Toscana and Institute of Clinical Physiology; Pisa Italy
| | - Antonella Meloni
- Cardiovascular MR Unit; Fondazione G. Monasterio CNR-Regione Toscana and Institute of Clinical Physiology; Pisa Italy
| | - Giuseppe Rossi
- Epidemiology and Biostatistics Unit; Institute of Clinical Physiology; CNR; Pisa Italy
| | - Vincenzo Caruso
- Unità Operativa Dipartimentale Talassemia; P.O. “S. Luigi-Currò” - ARNAS Garibaldi; Catania Italy
| | - Liana Cuccia
- Serv. Prevenz. Diagnosi e Cura Talassemia; Ospedale “G. di Cristina”; Palermo Italy
| | - Anna Spasiano
- Unità Microcitemia; A.O.R.N. Cardarelli; Napoli Italy
| | | | - Angelo Zuccarelli
- Centro trasfusionale e di microcitemia; Ospedale civile; Olbia Italy
| | | | | | - Michele Santodirocco
- Centro Microcitemia - D.H. Thalassemia Poliambulatorio “Giovanni Paolo II”; Ospedale Casa Sollievo della Sofferenza; San Giovanni Rotondo Italy
| | | | - Maria E. Lai
- Centro Talassemici Adulti; Ospedale microcitemico; Cagliari Italy
| | - Basilia Piraino
- U.O. Genetica e Immunologia Pediatrica; Policlinico “G. Martino”; Messina Italy
| | - Elisabetta Chiodi
- Servizio Radiologia Ospedaliera-Universitaria; Arcispedale “S. Anna”; Ferrara Italy
| | - Claudio Ascioti
- Struttura Complessa di Cardioradiologia-UTIC; P.O. “Giovanni Paolo II”; Lamezia Terme Italy
| | - Letizia Gulino
- Cardiovascular MR Unit; Fondazione G. Monasterio CNR-Regione Toscana and Institute of Clinical Physiology; Pisa Italy
| | - Vincenzo Positano
- Cardiovascular MR Unit; Fondazione G. Monasterio CNR-Regione Toscana and Institute of Clinical Physiology; Pisa Italy
| | - Massimo Lombardi
- Cardiovascular MR Unit; Fondazione G. Monasterio CNR-Regione Toscana and Institute of Clinical Physiology; Pisa Italy
| | - Maria R. Gamberini
- Pediatria; Adolescentologia e Talassemia; Arcispedale “S. Anna”; Ferrara Italy
| |
Collapse
|
100
|
Affiliation(s)
- R. Ward
- Division of Medical Oncology and HematologyDepartment of Medicine, Toronto General Hospital, University Health Network, Canada
| |
Collapse
|