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Macdougall IC, Bircher AJ, Eckardt KU, Obrador GT, Pollock CA, Stenvinkel P, Swinkels DW, Wanner C, Weiss G, Chertow GM, Adamson JW, Akizawa T, Anker SD, Auerbach M, Bárány P, Besarab A, Bhandari S, Cabantchik I, Collins AJ, Coyne DW, de Francisco ÁL, Fishbane S, Gaillard CA, Ganz T, Goldsmith DJ, Hershko C, Jankowska EA, Johansen KL, Kalantar-Zadeh K, Kalra PA, Kasiske BL, Locatelli F, Małyszko J, Mayer G, McMahon LP, Mikhail A, Nemeth E, Pai AB, Parfrey PS, Pecoits-Filho R, Roger SD, Rostoker G, Rottembourg J, Singh AK, Slotki I, Spinowitz BS, Tarng DC, Tentori F, Toblli JE, Tsukamoto Y, Vaziri ND, Winkelmayer WC, Wheeler DC, Zakharova E. Iron management in chronic kidney disease: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference. Kidney Int 2016; 89:28-39. [DOI: 10.1016/j.kint.2015.10.002] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 09/22/2015] [Accepted: 09/29/2015] [Indexed: 12/21/2022]
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102
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Chao KC, Chang CC, Chiou HY, Chang JS. Serum Ferritin Is Inversely Correlated with Testosterone in Boys and Young Male Adolescents: A Cross-Sectional Study in Taiwan. PLoS One 2015; 10:e0144238. [PMID: 26646112 PMCID: PMC4672881 DOI: 10.1371/journal.pone.0144238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/16/2015] [Indexed: 11/30/2022] Open
Abstract
Objective The transition from childhood to teenaged years is associated with increased testosterone and a decreased iron status. It is not clear whether higher testosterone levels cause the decreased iron status, and to what extent, obesity-related inflammation influences the iron-testosterone relationship. The aim of the present study was to examine relationships of testosterone, iron status, and anti-/proinflammatory cytokines in relation to nutritional status in boys and young adolescent Taiwanese males. Methods In total, 137 boys aged 7~13 yr were included. Parameters for obesity, the iron status, testosterone, and inflammatory markers were evaluated. Results Overweight and obese (ow/obese) boys had higher mean serum testosterone, interleukin (IL)-1β, and nitric oxide (NO) levels compared to their normal-weight counterparts (all p<0.05). Mean serum ferritin was slightly higher in ow/obese boys compared to normal-weight boys, but this did not reach statistical significance. A multiple linear regression showed that serum ferritin (β = -0.7470, p = 0.003) was inversely correlated with testosterone, while serum IL-10 (β = 0.3475, p = 0.009) was positively associated with testosterone after adjusting for covariates. When normal-weight boys were separately assessed from ow/obesity boys, the association between testosterone and serum ferritin became stronger (β = -0.9628, p<0.0001), but the association between testosterone and IL-10 became non-significant (β = 0.1140, p = 0.4065) after adjusting for covariates. In ow/obese boys, only IL-10 was weakly associated with serum testosterone (β = 0.6444, p = 0.051) after adjusting for age. Conclusions Testosterone and serum ferritin are intrinsically interrelated but this relationship is weaker in ow/obese boys after adjusting for age.
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Affiliation(s)
- Kuo-Ching Chao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chao Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Jung-Su Chang
- School of Nutrition and Health Sciences, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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103
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Tandara L, Grubisic TZ, Ivan G, Jurisic Z, Tandara M, Gugo K, Mladinov S, Salamunic I. Systemic inflammation up-regulates serum hepcidin in exacerbations and stabile chronic obstructive pulmonary disease. Clin Biochem 2015; 48:1252-7. [DOI: 10.1016/j.clinbiochem.2015.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/25/2015] [Accepted: 07/06/2015] [Indexed: 10/24/2022]
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104
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Rukuni R, Knight M, Murphy MF, Roberts D, Stanworth SJ. Screening for iron deficiency and iron deficiency anaemia in pregnancy: a structured review and gap analysis against UK national screening criteria. BMC Pregnancy Childbirth 2015; 15:269. [PMID: 26487281 PMCID: PMC4618150 DOI: 10.1186/s12884-015-0679-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 10/04/2015] [Indexed: 12/22/2022] Open
Abstract
Background Iron deficiency anaemia is a common problem in pregnancy despite national recommendations and guidelines for treatment. The aim of this study was to appraise the evidence against the UK National Screening Committee (UKNSC) criteria as to whether a national screening programme could reduce the prevalence of iron deficiency anaemia and/or iron deficiency in pregnancy and improve maternal and fetal outcomes. Methods Search strategies were developed for the Cochrane library, Medline and Embase to identify evidence relevant to UK National Screening Committee (UKNSC) appraisal criteria which cover the natural history of iron deficiency and iron deficiency anaemia, the tests for screening, clinical management and evidence of cost effectiveness. Results Many studies evaluated haematological outcomes of anaemia, but few analysed clinical consequences. Haemoglobin and ferritin appeared the most suitable screening tests, although future options may follow recent advances in understanding iron homeostasis. The clinical consequences of iron deficiency without anaemia are unknown. Oral and intravenous iron are effective in improving haemoglobin and iron parameters. There have been no trials or economic evaluations of a national screening programme for iron deficiency anaemia in pregnancy. Conclusions Iron deficiency in pregnancy remains an important problem although effective tests and treatment exist. A national screening programme could be of value for early detection and intervention. However, high quality studies are required to confirm whether this would reduce maternal and infant morbidity and be cost effective. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0679-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruramayi Rukuni
- National Perinatal Epidemiology Unit, University of Oxford, Old Road, Campus, Oxford, OX3 7LF, UK.
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Old Road, Campus, Oxford, OX3 7LF, UK.
| | - Michael F Murphy
- Department of Haematology, John Radcliffe Hospital, NHS Blood & Transplant/Oxford University Hospital Trust, University of Oxford, Oxford, UK.
| | - David Roberts
- Department of Haematology, John Radcliffe Hospital, NHS Blood & Transplant/Oxford University Hospital Trust, University of Oxford, Oxford, UK.
| | - Simon J Stanworth
- Department of Haematology, John Radcliffe Hospital, NHS Blood & Transplant/Oxford University Hospital Trust, University of Oxford, Oxford, UK.
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105
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Biasiotto G, Di Lorenzo D, Archetti S, Zanella I. Iron and Neurodegeneration: Is Ferritinophagy the Link? Mol Neurobiol 2015; 53:5542-74. [PMID: 26468157 DOI: 10.1007/s12035-015-9473-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/01/2015] [Indexed: 12/12/2022]
Abstract
Mounting evidence indicates that the lysosome-autophagy pathway plays a critical role in iron release from ferritin, the main iron storage cellular protein, hence in the distribution of iron to the cells. The recent identification of nuclear receptor co-activator 4 as the receptor for ferritin delivery to selective autophagy sheds further light on the understanding of the mechanisms underlying this pathway. The emerging view is that iron release from ferritin through the lysosomes is a general mechanism in normal and tumour cells of different tissue origins, but it has not yet been investigated in brain cells. Defects in the lysosome-autophagy pathway are often involved in the pathogenesis of neurodegenerative disorders, and brain iron homeostasis disruption is a hallmark of many of these diseases. However, in most cases, it has not been established whether iron dysregulation is directly involved in the pathogenesis of the diseases or if it is a secondary effect derived from other pathogenic mechanisms. The recent evidence of the crucial involvement of autophagy in cellular iron handling offers new perspectives about the role of iron in neurodegeneration, suggesting that autophagy dysregulation could cause iron dyshomeostasis. In this review, we recapitulate our current knowledge on the routes through which iron is released from ferritin, focusing on the most recent advances. We summarise the current evidence concerning lysosome-autophagy pathway dysfunctions and those of iron metabolism and discuss their potential interconnections in several neurodegenerative disorders, such as Alzheimer's, Parkinson's and Huntington's diseases; amyotrophic lateral sclerosis; and frontotemporal lobar dementia.
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Affiliation(s)
- Giorgio Biasiotto
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
- Biotechnology Laboratory, Department of Diagnostics, Civic Hospital of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Diego Di Lorenzo
- Biotechnology Laboratory, Department of Diagnostics, Civic Hospital of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Silvana Archetti
- Biotechnology Laboratory, Department of Diagnostics, Civic Hospital of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Isabella Zanella
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
- Biotechnology Laboratory, Department of Diagnostics, Civic Hospital of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
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106
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Increased risk of iron deficiency and reduced iron absorption but no difference in zinc, vitamin A or B-vitamin status in obese women in India. Eur J Nutr 2015; 55:2411-2421. [DOI: 10.1007/s00394-015-1048-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 09/16/2015] [Indexed: 12/16/2022]
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107
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The Growth Attainment, Hematological, Iron Status and Inflammatory Profile of Guatemalan Juvenile End-Stage Renal Disease Patients. PLoS One 2015; 10:e0140062. [PMID: 26445018 PMCID: PMC4596869 DOI: 10.1371/journal.pone.0140062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 09/20/2015] [Indexed: 12/15/2022] Open
Abstract
Background Stunting, anemia and inflammation are frequently observed in children with end-stage renal disease (ESRD). Objectives To assess anthropometric, hematological and inflammatory data and to study their potential interrelationship in Guatemalan juveniles undergoing hemodialysis (HD) and peritoneal dialysis (PD). Methods 54 juveniles 7–20 years of age were recruited in FUNDANIER, Guatemala City: 27 on HD and 27 PD. Hemoglobin, serum iron, transferrin, serum transferrin receptor (sTfR), serum ferritin, transferrin saturation and iron-binding capacity, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), as well as IL-6, IL-1 and TNF-α, weight and height were determined by standard methods. Hepcidin–25 (Hep-25) was assessed by weak cation exchange time-of-flight mass-spectrometry. Results 92% and 55% of HD and PD children, respectively, were stunted and 95% and 85% were anemic. Among iron status biomarkers, serum ferritin was massively increased and significantly higher in the HD group compared to the PD group. Hep-25 was also greatly elevated in both groups. 41% of HD patients showed increments in three or more inflammatory biomarkers, while it was 2 or less in all PD subjects. Conclusions The degree of stunting, the prevalence and severity of anemia in Guatemalan juvenile ESRD far exceed the national statistics for this low-income Central American country. Ferritin and Hep-25 concentrations were elevated, with the latter to an extraordinary magnitude. Additional biomarkers of inflammation not directly related to iron status were elevated as well. The role of both disease- and environment-related factors in combination best explains the magnitude of the biomarker abnormalities.
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108
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Kali A, Yayar O, Erdogan B, Eser B, Buyukbakkal M, Ercan Z, Merhametsiz O, Haspulat A, Gök Oğuz E, Canbakan B, Ayli MD. Is hepcidin-25 a predictor of atherosclerosis in hemodialysis patients? Hemodial Int 2015; 20:191-7. [PMID: 26374145 DOI: 10.1111/hdi.12355] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Atherosclerotic cardiovascular disease is an important cause of mortality and morbidity in hemodialysis patients. Iron accumulation in arterial wall macrophages is increased in atherosclerotic lesions. Hepcidin is a key hepatic hormone regulating iron balance. It inhibits iron release from macrophages and iron absorption from enterocytes by binding and inactivating the cellular iron exporter ferroportin. The aim of this study is to investigate the relation of hepcidin-25, iron parameters, and atherosclerosis measured by carotid intima media thickness (CIMT) in hemodialysis patients. Eighty-two hemodialysis patients were enrolled in this cross-sectional study. Predialysis blood samples were centrifuged at 1500 g and 4°C for 10 minutes and stored at -80°C for the measurement of hepcidin-25. DRG hepcidin enzyme-linked immunosorbent assay kit was used for the measurement of hepcidin-25. Ultrasonographical B-mode imaging of bilateral carotid arteries was performed with a high-resolution real-time ultrasonography (Mindray DC7). Mean age of the study population was 57.90 ± 16.08 years and 43.9% were men. Total study population was grouped into two according to median value of hepcidin-25. There was no difference between groups with respect to age, dialysis vintage, and C-reactive protein. CIMT was found to be statistically significantly higher in low hepcidin-25 group. In correlation analysis, CIMT was found to be correlated with age (P < 0.01, R = 0.33) and hepcidin-25 (P < 0.01, R = 0.46). In linear regression analysis, age (β = 0.31) and hepcidin-25 (β = 0.44) were found to be the determinants of CIMT in hemodialysis patients. Our results implicate that hepcidin may take part in pathophysiology of atherosclerosis and cardiovascular disease in hemodialysis patients.
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Affiliation(s)
- Alaaddin Kali
- Department of Nephrology, Diskapi Yildirim Beyazid Research and Training Hospital, Ankara, Turkey
| | - Ozlem Yayar
- Department of Nephrology, Diskapi Yildirim Beyazid Research and Training Hospital, Ankara, Turkey
| | - Bulent Erdogan
- Department of Nephrology, Diskapi Yildirim Beyazid Research and Training Hospital, Ankara, Turkey
| | - Baris Eser
- Department of Nephrology, Diskapi Yildirim Beyazid Research and Training Hospital, Ankara, Turkey
| | - Mehmet Buyukbakkal
- Department of Nephrology, Diskapi Yildirim Beyazid Research and Training Hospital, Ankara, Turkey
| | - Zafer Ercan
- Department of Nephrology, Diskapi Yildirim Beyazid Research and Training Hospital, Ankara, Turkey
| | - Ozgur Merhametsiz
- Department of Nephrology, Diskapi Yildirim Beyazid Research and Training Hospital, Ankara, Turkey
| | - Ayhan Haspulat
- Department of Nephrology, Diskapi Yildirim Beyazid Research and Training Hospital, Ankara, Turkey
| | - Ebru Gök Oğuz
- Department of Nephrology, Diskapi Yildirim Beyazid Research and Training Hospital, Ankara, Turkey
| | - Basol Canbakan
- Department of Nephrology, Diskapi Yildirim Beyazid Research and Training Hospital, Ankara, Turkey
| | - Mehmet D Ayli
- Department of Nephrology, Diskapi Yildirim Beyazid Research and Training Hospital, Ankara, Turkey
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109
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Staroń R, Van Swelm RPL, Lipiński P, Gajowiak A, Lenartowicz M, Bednarz A, Gajewska M, Pieszka M, Laarakkers CMM, Swinkels DW, Starzyński RR. Urinary Hepcidin Levels in Iron-Deficient and Iron-Supplemented Piglets Correlate with Hepcidin Hepatic mRNA and Serum Levels and with Body Iron Status. PLoS One 2015; 10:e0136695. [PMID: 26323096 PMCID: PMC4556373 DOI: 10.1371/journal.pone.0136695] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/05/2015] [Indexed: 12/15/2022] Open
Abstract
Among livestock, domestic pig (Sus scrofa) is a species, in which iron metabolism has been most intensively examined during last decade. The obvious reason for studying the regulation of iron homeostasis especially in young pigs is neonatal iron deficiency anemia commonly occurring in these animals. Moreover, supplementation of essentially all commercially reared piglets with iron entails a need for monitoring the efficacy of this routine practice followed in the swine industry for several decades. Since the discovery of hepcidin many studies confirmed its role as key regulator of iron metabolism and pointed out the assessment of its concentrations in biological fluids as diagnostic tool for iron-related disorder. Here we demonstrate that urine hepcidin-25 levels measured by a combination of weak cation exchange chromatography and time-of-flight mass spectrometry (WCX-TOF MS) are highly correlated with mRNA hepcidin expression in the liver and plasma hepcidin-25 concentrations in anemic and iron-supplemented 28-day old piglets. We also found a high correlation between urine hepcidin level and hepatic non-heme iron content. Our results show that similarly to previously described transgenic mouse models of iron disorders, young pigs constitute a convenient animal model to explore accuracy and relationship between indicators for assessing systemic iron status.
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Affiliation(s)
- Robert Staroń
- Institute of Genetics and Animal Breeding PAS, Department of Molecular Biology, Jastrzębiec, Poland
| | - Rachel P. L. Van Swelm
- Department of Laboratory Medicine (LGEM 830), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Paweł Lipiński
- Institute of Genetics and Animal Breeding PAS, Department of Molecular Biology, Jastrzębiec, Poland
- * E-mail: (RRS); (PL)
| | - Anna Gajowiak
- Institute of Genetics and Animal Breeding PAS, Department of Molecular Biology, Jastrzębiec, Poland
| | - Małgorzata Lenartowicz
- Department of Genetics and Evolution, Institute of Zoology, Jagiellonian University, Kraków, Poland
| | - Aleksandra Bednarz
- Department of Genetics and Evolution, Institute of Zoology, Jagiellonian University, Kraków, Poland
| | - Małgorzata Gajewska
- Warsaw University of Life Sciences, Faculty of Veterinary Medicine, Department of Physiological Sciences, Warsaw, Poland
| | - Marek Pieszka
- Department of Animal Nutrition & Feed Science, National Research Institute of Animal Production, Kraków, Poland
| | - Coby M. M. Laarakkers
- Department of Laboratory Medicine (LGEM 830), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Dorine W. Swinkels
- Department of Laboratory Medicine (LGEM 830), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rafał R. Starzyński
- Institute of Genetics and Animal Breeding PAS, Department of Molecular Biology, Jastrzębiec, Poland
- * E-mail: (RRS); (PL)
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110
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Miseta A, Nagy J, Nagy T, Poór VS, Fekete Z, Sipos K. Hepcidin and its potential clinical utility. Cell Biol Int 2015; 39:1191-202. [PMID: 26109250 DOI: 10.1002/cbin.10505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/12/2015] [Indexed: 02/06/2023]
Abstract
A number of pathophysiological conditions are related to iron metabolism disturbances. Some of them are well known, others are newly discovered or special. Hepcidin is a newly identified iron metabolism regulating hormone, which could be a promising biomarker for many disorders. In this review, we provide background information about mammalian iron metabolism, cellular iron trafficking, and the regulation of expression of hepcidin. Beside these molecular biological processes, we summarize the methods that have been used to determine blood and urine hepcidin levels and present those pathological conditions (cancer, inflammation, neurological disorders) when hepcidin measurement may have clinical relevance.
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Affiliation(s)
- Attila Miseta
- Department of Laboratory Medicine, Faculty of Medical Sciences, University of Pécs, 7624 Ifjusag Street 13. Pecs, Hungary
| | - Judit Nagy
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences, University of Pécs, 7624 Ifjusag Street 13. Pecs, Hungary
| | - Tamas Nagy
- Department of Laboratory Medicine, Faculty of Medical Sciences, University of Pécs, 7624 Ifjusag Street 13. Pecs, Hungary
| | - Viktor Soma Poór
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Pécs, 7624 Szigeti Street 12. Pecs, Hungary
| | - Zsuzsanna Fekete
- Department of Medical Biology, Faculty of Medical Sciences, University of Pécs, 7624 Szigeti Street 12. Pecs, Hungary
| | - Katalin Sipos
- Department of Pharmaceutical Biology, Faculty of Medical Sciences, University of Pécs, 7624 Rokus Street 2. Pecs, Hungary
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111
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Abstract
Anemia in the setting of chronic inflammatory disorders is a very frequent clinical condition, which is, however, often neglected or not properly treated given the problems often caused by the diseases underlying the development of anemia. Mechanistically, anemia is mainly caused by inflammation-driven retention of iron in macrophages making the metal unavailable for heme synthesis in the course of erythropoiesis, and further by impaired biological activity of the red blood cell hormone erythropoietin and the reduced proliferative capacity of erythroid progenitor cells. Anemia can be aggravated by chronic blood loss, as found in subjects with gastrointestinal cancers, inflammatory or infectious bowel disease, or iatrogenic blood loss in the setting of dialysis, all resulting in true iron deficiency. The identification of such patients is a clinical necessity because these individuals need contrasting therapies in comparison to subjects suffering from only classical anemia of chronic disorders. The diagnosis is challenging because no state of the art laboratory test is currently available that can clearly separate patients with inflammatory anemia from those with additional true iron deficiency. However, based on our expanding knowledge on the pathophysiology of inflammatory anemia, new diagnostic markers, including the iron-regulatory hormone hepcidin, and hematologic parameters emerge. Apart from traditional anemia treatments such as blood transfusions, recombinant erythropoietin, and iron, including new high-molecular-weight formulations, new therapeutics are currently under preclinical and clinical evaluation. These novel compounds aim at correcting anemia by multiple pathways, including antagonizing the inflammation- and hepcidin-driven retention of iron in the monocyte-macrophage system and thereby promoting the supply of iron for erythropoiesis or by stimulating the endogenous formation of erythopoietin via stabilization of hypoxia-regulated factors.
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Affiliation(s)
- Guenter Weiss
- Department of Internal Medicine VI, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Innsbruck, Austria.
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112
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Kortman GAM, Mulder MLM, Richters TJW, Shanmugam NKN, Trebicka E, Boekhorst J, Timmerman HM, Roelofs R, Wiegerinck ET, Laarakkers CM, Swinkels DW, Bolhuis A, Cherayil BJ, Tjalsma H. Low dietary iron intake restrains the intestinal inflammatory response and pathology of enteric infection by food-borne bacterial pathogens. Eur J Immunol 2015; 45:2553-67. [PMID: 26046550 DOI: 10.1002/eji.201545642] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/07/2015] [Accepted: 06/03/2015] [Indexed: 12/21/2022]
Abstract
Orally administrated iron is suspected to increase susceptibility to enteric infections among children in infection endemic regions. Here we investigated the effect of dietary iron on the pathology and local immune responses in intestinal infection models. Mice were held on iron-deficient, normal iron, or high iron diets and after 2 weeks they were orally challenged with the pathogen Citrobacter rodentium. Microbiome analysis by pyrosequencing revealed profound iron- and infection-induced shifts in microbiota composition. Fecal levels of the innate defensive molecules and markers of inflammation lipocalin-2 and calprotectin were not influenced by dietary iron intervention alone, but were markedly lower in mice on the iron-deficient diet after infection. Next, mice on the iron-deficient diet tended to gain more weight and to have a lower grade of colon pathology. Furthermore, survival of the nematode Caenorhabditis elegans infected with Salmonella enterica serovar Typhimurium was prolonged after iron deprivation. Together, these data show that iron limitation restricts disease pathology upon bacterial infection. However, our data also showed decreased intestinal inflammatory responses of mice fed on high iron diets. Thus additionally, our study indicates that the effects of iron on processes at the intestinal host-pathogen interface may highly depend on host iron status, immune status, and gut microbiota composition.
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Affiliation(s)
- Guus A M Kortman
- Department of Laboratory Medicine-Translational Metabolic Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michelle L M Mulder
- Department of Laboratory Medicine-Translational Metabolic Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Thijs J W Richters
- Department of Laboratory Medicine-Translational Metabolic Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Nanda K N Shanmugam
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Estela Trebicka
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Rian Roelofs
- Department of Laboratory Medicine-Translational Metabolic Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erwin T Wiegerinck
- Department of Laboratory Medicine-Translational Metabolic Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Coby M Laarakkers
- Department of Laboratory Medicine-Translational Metabolic Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine-Translational Metabolic Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Albert Bolhuis
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - Bobby J Cherayil
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Harold Tjalsma
- Department of Laboratory Medicine-Translational Metabolic Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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113
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Badenhorst CE, Dawson B, Cox GR, Laarakkers CM, Swinkels DW, Peeling P. Timing of post-exercise carbohydrate ingestion: influence on IL-6 and hepcidin responses. Eur J Appl Physiol 2015; 115:2215-22. [PMID: 26084589 DOI: 10.1007/s00421-015-3202-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/08/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE Carbohydrate ingestion prior and during exercise attenuates exercise-induced interleukin-6. This investigation examined if an analogous effect was evident for interleukin-6 and hepcidin response when carbohydrates were ingested post-exercise. METHODS In a crossover design, 11 well-trained endurance athletes completed two experimental trials. Participants completed an 8 × 3 min interval running session at 85 % vVO2peak followed by 5 h of monitored recovery. During this period, participants were provided with two 1.2 g kg(-1) carbohydrate beverages at either an early feeding time (immediately post-exercise and 2 h post-exercise) or delayed feeding time (2 h post-exercise and 4 h post-exercise). Venous blood samples were collected pre-, immediately post-, 3 and 5 h post-exercise. Samples were analysed for Interleukin-6, serum iron, serum ferritin and hepcidin. RESULTS Interleukin-6 was significantly elevated (p = 0.004) immediately post-exercise compared to baseline for both trials. Hepcidin levels were significantly elevated at 3 h post-exercise (p = 0.001) and 5 h post-exercise (p = 0.002) compared to baseline levels in both trials, with no significant difference between the two conditions and any time point. Serum iron was significantly increased from baseline to immediately post-exercise (p = 0.001) for both trials, with levels decreasing by 3 h (p = 0.025) and 5 h post-exercise (p = 0.001). Serum ferritin levels increased immediately post-exercise compared to baseline (p = 0.006) in both conditions. CONCLUSIONS The timing and ingestion of post-exercise carbohydrate ingestion do not appear to impact post-exercise interleukin-6 and hepcidin responses; this is likely a result of the interval running task inducing an inflammatory response and subsequent up-regulation of hepcidin.
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Affiliation(s)
- Claire E Badenhorst
- School of Sport Science, Exercise and Health (M408), The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Brian Dawson
- School of Sport Science, Exercise and Health (M408), The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Gregory R Cox
- Sports Nutrition, Australian Institute of Sport, Gold Coast, Queensland, Australia
| | - Coby M Laarakkers
- Department of Laboratory Medicine (TML 830), Radboud University Medical Center, Nijmegen, The Netherlands.,Hepcidinanalysis.com, Geert Grooteplein 10 (830), 6525 GA, Nijmegen, The Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine (TML 830), Radboud University Medical Center, Nijmegen, The Netherlands.,Hepcidinanalysis.com, Geert Grooteplein 10 (830), 6525 GA, Nijmegen, The Netherlands
| | - Peter Peeling
- School of Sport Science, Exercise and Health (M408), The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
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114
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Scindia Y, Dey P, Thirunagari A, Liping H, Rosin DL, Floris M, Okusa MD, Swaminathan S. Hepcidin Mitigates Renal Ischemia-Reperfusion Injury by Modulating Systemic Iron Homeostasis. J Am Soc Nephrol 2015; 26:2800-14. [PMID: 25788528 DOI: 10.1681/asn.2014101037] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 01/11/2015] [Indexed: 12/14/2022] Open
Abstract
Iron-mediated oxidative stress is implicated in the pathogenesis of renal ischemia-reperfusion injury. Hepcidin is an endogenous acute phase hepatic hormone that prevents iron export from cells by inducing degradation of the only known iron export protein, ferroportin. In this study, we used a mouse model to investigate the effect of renal ischemia-reperfusion injury on systemic iron homeostasis and determine if dynamic modulation of iron homeostasis with hepcidin has therapeutic benefit in the treatment of AKI. Renal ischemia-reperfusion injury induced hepatosplenic iron export through increased ferroportin expression, which resulted in hepatosplenic iron depletion and an increase in serum and kidney nonheme iron levels. Exogenous hepcidin treatment prevented renal ischemia-reperfusion-induced changes in iron homeostasis. Hepcidin also decreased kidney ferroportin expression and increased the expression of cytoprotective H-ferritin. Hepcidin-induced restoration of iron homeostasis was accompanied by a significant reduction in ischemia-reperfusion-induced tubular injury, apoptosis, renal oxidative stress, and inflammatory cell infiltration. Hepcidin -: deficient mice demonstrated increased susceptibility to ischemia-reperfusion injury compared with wild-type mice. Reconstituting hepcidin-deficient mice with exogenous hepcidin induced hepatic iron sequestration, attenuated the reduction in renal H-ferritin and reduced renal oxidative stress, apoptosis, inflammation, and tubular injury. Hepcidin-mediated protection was associated with reduced serum IL-6 levels. In summary, renal ischemia-reperfusion injury results in profound alterations in systemic iron homeostasis. Hepcidin treatment restores iron homeostasis and reduces inflammation to mediate protection in renal ischemia-reperfusion injury, suggesting that hepcidin-ferroportin pathway holds promise as a novel therapeutic target in the treatment of AKI.
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Affiliation(s)
- Yogesh Scindia
- Division of Nephrology, Center for Inflammation, Immunity and Regenerative Medicine, and
| | - Paromita Dey
- Division of Nephrology, Center for Inflammation, Immunity and Regenerative Medicine, and
| | | | - Huang Liping
- Division of Nephrology, Center for Inflammation, Immunity and Regenerative Medicine, and
| | - Diane L Rosin
- Center for Inflammation, Immunity and Regenerative Medicine, and Department of Pharmacology, University of Virginia Health System, Charlottesville, Virginia
| | | | - Mark D Okusa
- Division of Nephrology, Center for Inflammation, Immunity and Regenerative Medicine, and
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115
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Enko D, Wagner H, Kriegshäuser G, Kimbacher C, Stolba R, Worf E, Halwachs-Baumann G. Hepcidin-25 vs. conventional clinical biomarkers in the diagnosis of functional iron deficiency. Eur J Haematol 2015; 95:507-13. [DOI: 10.1111/ejh.12523] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Dietmar Enko
- Institute of Laboratory Medicine; General Hospital Steyr; Steyr Austria
| | - Helga Wagner
- Department of Applied Statistics; Johannes Kepler University Linz; Linz Austria
| | | | | | - Robert Stolba
- Institute of Laboratory Medicine; General Hospital Steyr; Steyr Austria
| | - Elfriede Worf
- Institute of Laboratory Medicine; General Hospital Steyr; Steyr Austria
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116
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Wang J, Liu G, Xu Z, Dai J, Song P, Shi J, Hu Y, Hu Z, Nie G, Chang YZ, Zhao Y. Hepcidin levels in hyperprolactinemic women monitored by nanopore thin film based assay: correlation with pregnancy-associated hormone prolactin. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2015; 11:871-8. [PMID: 25659646 DOI: 10.1016/j.nano.2015.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/08/2015] [Accepted: 01/16/2015] [Indexed: 01/25/2023]
Abstract
UNLABELLED Hepcidin is a central regulator in human iron metabolism. Although it is often regarded as a promising indicator of iron status, the lack of effective quantification method has impeded the comprehensive assessment of its physiological and clinical significance. Herein we applied a newly established, nanopore film enrichment based hepcidin assay to examine the correlation between hepcidin and prolactin, the hormone with an important role during pregnancy and lactation. Women with pathologically elevated prolactin secretion (hyperprolactinemia) were found to have lower serum hepcidin compared to those with normal prolactin levels, without showing significant difference in other hepcidin-regulating factors. Moreover, prolactin-reducing drug bromocriptine mesylate resulted in elevated expression of the hepcidin in hyperprolactinemia patients. These findings suggest a possible role of prolactin in regulation of hepcidin, and may render hepcidin a useful biomarker for progress monitoring and treatment of iron-related diseases under hyperprolactinemic conditions. FROM THE CLINICAL EDITOR The level of hepcidin has been shown to reflect the underlying iron status of the patient. Nonentheless, there is an urgent need of reliable, fast and easy-to-do hepcidin assay in the clinical setting. In this paper, the authors described a further modification of their previously described nanopore silica film-based enrichment approach for quantification of hepcidin and found correlation between hepcidin and prolactin. This new knowledge may add to current understanding of iron homeostasis during pregnancy.
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Affiliation(s)
- Jing Wang
- Chinese Academy of Sciences Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology of China, Beijing, China; College of Materials Science and Opto-Electronic Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Gang Liu
- Chinese Academy of Sciences Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology of China, Beijing, China
| | - Zi Xu
- Laboratory of Molecular Iron Metabolism, College of Life Science, Hebei Normal University, Shijiazhuang, China
| | - Jiwei Dai
- Beijing Donghua Hospital, Beijing, China
| | - Ping Song
- Beijing Donghua Hospital, Beijing, China
| | - Jian Shi
- Chinese Academy of Sciences Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology of China, Beijing, China
| | - Ye Hu
- Department of Nanomedicine, Houston Methodist Hospital Research Institute, Houston, TX, USA
| | - Zhongbo Hu
- College of Materials Science and Opto-Electronic Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Guangjun Nie
- Chinese Academy of Sciences Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology of China, Beijing, China.
| | - Yan-Zhong Chang
- Laboratory of Molecular Iron Metabolism, College of Life Science, Hebei Normal University, Shijiazhuang, China.
| | - Yuliang Zhao
- Chinese Academy of Sciences Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology of China, Beijing, China.
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Origa R, Cazzola M, Mereu E, Danjou F, Barella S, Giagu N, Galanello R, Swinkels DW. Differences in the erythropoiesis-hepcidin-iron store axis between hemoglobin H disease and β-thalassemia intermedia. Haematologica 2015; 100:e169-71. [PMID: 25596269 DOI: 10.3324/haematol.2014.115733] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Raffaella Origa
- Ospedale Microcitemico-Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Mario Cazzola
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Italy
| | - Elisabetta Mereu
- Ospedale Microcitemico-Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Fabrice Danjou
- Ospedale Microcitemico-Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy
| | | | | | - Renzo Galanello
- Ospedale Microcitemico-Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Radboud University medical center, Nijmegen, The Netherlands
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118
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Uijterschout L, Swinkels DW, Akkermans MD, Zandstra T, Nuijsink M, Hendriks D, Hudig C, Tjalsma H, Vos R, van Goudoever JB, Brus F. The value of soluble transferrin receptor and hepcidin in the assessment of iron status in children with cystic fibrosis. J Cyst Fibros 2014; 13:639-44. [DOI: 10.1016/j.jcf.2014.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/20/2014] [Accepted: 03/24/2014] [Indexed: 01/07/2023]
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119
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Anaemia, iron deficiency and susceptibility to infections. J Infect 2014; 69 Suppl 1:S23-7. [DOI: 10.1016/j.jinf.2014.08.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2014] [Indexed: 12/11/2022]
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120
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Donker AE, Brons PPT, Swinkels DW. Microcytic anaemia with low transferrin saturation, increased serum hepcidin and non-synonymous TMPRSS6 variants: not always iron-refractory iron deficiency anaemia. Br J Haematol 2014; 169:150-1. [PMID: 25312922 DOI: 10.1111/bjh.13186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Albertine E Donker
- Department of Laboratory Medicine, Laboratory of Genetic, Endocrine and Metabolic diseases, Nijmegen, The Netherlands
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121
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Uijterschout L, Swinkels DW, Domellöf M, Lagerqvist C, Hudig C, Tjalsma H, Vos R, van Goudoever JB, Brus F. Serum hepcidin measured by immunochemical and mass-spectrometric methods and their correlation with iron status indicators in healthy children aged 0.5-3 y. Pediatr Res 2014; 76:409-14. [PMID: 25116229 DOI: 10.1038/pr.2014.109] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 04/30/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND The diagnostic use of hepcidin is limited by the absence of standardization and lack of age-specific reference ranges in children in particular. The aim of this study was to determine reference ranges of serum hepcidin in healthy children aged 0.5-3 y using mass spectometry (MS) and a commercial immunochemical (IC) assay, and to investigate its association with other indicators of iron status and inflammation. METHODS We included 400 healthy children aged 0.5-3 y. We constructed reference ranges for MS-hepcidin and IC-hepcidin concentrations using the median, P2.5, and P97.5 in a normative population of 219 children with no anemia, no infection and/or inflammation, and no iron deficiency. RESULTS Median concentrations (P2.5-P97.5) of MS-hepcidin and IC-hepcidin were 3.6 nmol/l (0.6-13.9 nmol/l) and 7.9 nmol/l (1.9-28.6 nmol/l), respectively. We found a good correlation between both methods. However, MS-hepcidin was consistently lower than IC-hepcidin. Hepcidin correlated with ferritin and C-reactive protein. CONCLUSION We provide reference ranges for hepcidin for an MS and commercial IC method. Absolute values between assays differed significantly, but hepcidin concentrations obtained by MS and IC methods correlate with each other, and both correlate with ferritin and CRP.
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Affiliation(s)
- Lieke Uijterschout
- Department of Pediatrics, Juliana Children's Hospital/ HAGA Hospital, The Hague, The Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Carina Lagerqvist
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Cisca Hudig
- Department of Clinical Chemistry, LabWest, HAGA Hospital, The Hague, The Netherlands
| | - Harrold Tjalsma
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rimke Vos
- HAGA Academy, HAGA Hospital, The Hague, The Netherlands
| | - Johannes B van Goudoever
- 1] Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands [2] Department of Pediatrics, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Frank Brus
- Department of Pediatrics, Juliana Children's Hospital/ HAGA Hospital, The Hague, The Netherlands
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122
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Kortman GAM, Raffatellu M, Swinkels DW, Tjalsma H. Nutritional iron turned inside out: intestinal stress from a gut microbial perspective. FEMS Microbiol Rev 2014; 38:1202-34. [PMID: 25205464 DOI: 10.1111/1574-6976.12086] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 08/27/2014] [Accepted: 08/29/2014] [Indexed: 12/16/2022] Open
Abstract
Iron is abundantly present on earth, essential for most microorganisms and crucial for human health. Human iron deficiency that is nevertheless highly prevalent in developing regions of the world can be effectively treated by oral iron administration. Accumulating evidence indicates that excess of unabsorbed iron that enters the colonic lumen causes unwanted side effects at the intestinal host-microbiota interface. The chemical properties of iron, the luminal environment and host iron withdrawal mechanisms, especially during inflammation, can turn the intestine in a rather stressful milieu. Certain pathogenic enteric bacteria can, however, deal with this stress at the expense of other members of the gut microbiota, while their virulence also seems to be stimulated in an iron-rich intestinal environment. This review covers the multifaceted aspects of nutritional iron stress with respect to growth, composition, metabolism and pathogenicity of the gut microbiota in relation to human health. We aim to present an unpreceded view on the dynamic effects and impact of oral iron administration on intestinal host-microbiota interactions to provide leads for future research and other applications.
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Affiliation(s)
- Guus A M Kortman
- Department of Laboratory Medicine, The Radboud Institute for Molecular Life Sciences (RIMLS) of the Radboud University Medical Center, Nijmegen, The Netherlands
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123
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Campuzano-Maya G. Hematologic manifestations of Helicobacter pylori infection. World J Gastroenterol 2014; 20:12818-12838. [PMID: 25278680 PMCID: PMC4177465 DOI: 10.3748/wjg.v20.i36.12818] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/10/2014] [Accepted: 07/16/2014] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) is the most common infection in humans, with a marked disparity between developed and developing countries. Although H. pylori infections are asymptomatic in most infected individuals, they are intimately related to malignant gastric conditions such as gastric cancer and gastric mucosa-associated lymphoid tissue (MALT) lymphoma and to benign diseases such as gastritis and duodenal and gastric peptic ulcers. Since it was learned that bacteria could colonize the gastric mucosa, there have been reports in the medical literature of over 50 extragastric manifestations involving a variety medical areas of specialization. These areas include cardiology, dermatology, endocrinology, gynecology and obstetrics, hematology, pneumology, odontology, ophthalmology, otorhinolaryngology and pediatrics, and they encompass conditions with a range of clear evidence between the H. pylori infection and development of the disease. This literature review covers extragastric manifestations of H. pylori infection in the hematology field. It focuses on conditions that are included in international consensus and management guides for H. pylori infection, specifically iron deficiency, vitamin B12 (cobalamin) deficiency, immune thrombocytopenia, and MALT lymphoma. In addition, there is discussion of other conditions that are not included in international consensus and management guides on H. pylori, including auto-immune neutropenia, antiphospholipid syndrome, plasma cell dyscrasias, and other hematologic diseases.
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124
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Chronic thromboembolic pulmonary hypertension is not associated with iron overload. Cardiovasc Pathol 2014; 24:76-9. [PMID: 25449047 DOI: 10.1016/j.carpath.2014.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/08/2014] [Accepted: 09/22/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized as the incomplete resolution of emboli after pulmonary embolism (PE) and the subsequent fibrotic organization and remodeling of pulmonary vascular bed. It has been reported that abnormal fibrin probably contributes to the incomplete resolution of emboli. And there is evidence that free iron could convert fibrinogen into fibrin which is remarkably resistant to lysis. Thus, we hypothesized that persistent iron overload might participate in the development of CTEPH. MATERIALS AND METHODS A case-control study was conducted. Forty-five CTEPH patients were enrolled as cases, and 36 age and sex frequency-matched chronic PE patients without pulmonary hypertension were selected as controls. Levels of free iron, soluble transferrin receptor (sTfR), ferritin, sTfR/ferritin ratio, hepcidin-25, tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, and malondialdehyde (MDA) were compared between the two groups. Logistic regression analysis was carried out to estimate odds ratios. RESULTS There was no difference of the levels of free iron, hepcidin-25, sTfR, ferritin, sTfR/ferritin ratio, TNF-α, and MDA between CTEPH patients and the controls. Levels of sTfR and ferritin in both groups were within the normal limits. Levels of IL-6 in CTEPH patients were significantly higher than that in the controls. A negative correlation was observed between hepcidin-25 and sTfR (Spearman's r=-0.438, P<.001), and a positive correlation was observed between hepcidin-25 and ferritin (Spearman's r=0.503, P<.001). In the univariate logistic regression model, there was no association observed between CTEPH and free iron, hepcidin-25, sTfR, ferritin, sTfR/ferritin ratio, TNF-α, IL-6, and MDA. CONCLUSIONS CTEPH has no association with iron overload. The iron status evaluated by sTfR and ferritin is within the normal limits in this CTEPH population.
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125
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Ryan E, Ryan JD, Russell J, Coughlan B, Tjalsma H, Swinkels DW, Stewart S, Crowe JP. Correlates of hepcidin and NTBI according to HFE status in patients referred to a liver centre. Acta Haematol 2014; 133:155-61. [PMID: 25277871 DOI: 10.1159/000363490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/08/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIMS Innately low hepcidin levels lead to iron overload in HFE-associated hereditary haemochromatosis. METHODS This study compared hepcidin and non-transferrin bound iron (NTBI) levels in untreated iron-loaded and non-iron-loaded C282Y homozygotes to levels in C282Y/H63D compound heterozygotes and individuals with other HFE genotypes associated with less risk of iron overload. RESULTS As the genotypic risk for iron overload increased, transferrin saturation and serum NTBI levels increased while serum hepcidin levels decreased. Overweight and obese male C282Y homozygotes had significantly higher hepcidin levels than male C282Y homozygotes with a normal BMI. Pearson product-moment analysis showed that serum hepcidin levels significantly correlated with HFE status, serum ferritin, age, NTBI, transferrin saturation, gender and BMI. Subsequent multiple regression analysis showed that HFE status and serum ferritin were significant independent correlates of serum hepcidin levels. CONCLUSIONS In summary, this study has shown that while serum ferritin and HFE status are the most important determinants of hepcidin levels, factors such age, gender, BMI, transferrin saturation and NTBI all interact closely in the matrix of homeostatic iron balance.
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Affiliation(s)
- Eleanor Ryan
- Liver Centre, Mater Misericordiae University Hospital, Dublin, Ireland
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126
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The aetiology of anaemia during pregnancy: a study to evaluate the contribution of iron deficiency and common infections in pregnant Ugandan women. Public Health Nutr 2014; 18:1423-35. [DOI: 10.1017/s1368980014001888] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo describe the aetiology of anaemia in pregnant Ugandan women and explore Fe deficiency and common infections as contributors to anaemia in this population.DesignCross-sectional study in which Hb, ferritin, transferrin receptor (sTfR), C-reactive protein, α-1 acid glycoprotein, hepcidin, malaria, hookworm infestation, syphilis and Helicobacter pylori infection were assessed.SettingAntenatal care clinic at Kawempe Health Centre, Kampala, Uganda.SubjectsHIV-negative women (n 151) in their first or second pregnancy at 10–16 weeks’ gestation.ResultsThe prevalence of anaemia was 29·1 %. Fe deficiency was 40·4 % and 14·6 % based on ferritin <30 μg/l and on adjusted ferritin <12 μg/l respectively, and 6·6 % based on sTfR >8·3 μg/ml. The prevalence of Fe-deficiency anaemia was 9·3 % based on ferritin <30 μg/l, 6·6 % based on adjusted ferritin <12 μg/l and 4·3 % based on sTfR >8·3 μg/ml. Hepcidin concentration was positively correlated with ferritin concentration (n 151, r=0·578, P<0·00001). H. pylori infection was highly prevalent (70 %) while malaria, hookworm infestation and syphilis were not common. Of all women, 60·3 % had α-1 acid glycoprotein >1 g/l and/or C-reactive protein >5 mg/l. Malaria parasitaemia (OR=6·85; 95 % CI 1·25, 37·41, P=0·026) and Fe deficiency defined using sTfR (OR=5·58; 95 % CI 1·26, 24·80, P=0·024) were independently and positively associated with anaemia. Population-attributable risk factors for anaemia for raised C-reactive protein, Fe deficiency defined by sTfR >8·3 μg/ml and presence of malaria parasites were 41·6 (95 % CI 11·1, 72·2) %, 13·5 (95 % CI 2·0, 25·0) % and 12·0 (95 % CI 1·4, 22·6) %, respectively.ConclusionsInfections and inflammation are of greater significance than Fe deficiency in the aetiology of anaemia in pregnant Ugandan women during the first trimester.
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127
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Vuong J, Qiu Y, La M, Clarke G, Swinkels DW, Cembrowski G. Reference intervals of complete blood count constituents are highly correlated to waist circumference: should obese patients have their own "normal values?". Am J Hematol 2014; 89:671-7. [PMID: 24644218 DOI: 10.1002/ajh.23713] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 03/11/2014] [Accepted: 03/14/2014] [Indexed: 01/13/2023]
Abstract
Body mass index (BMI), the prevalent indicator of obesity, is not easily grasped by patients nor physicians. Waist circumference (WC) is correlated to obesity, is better understood and has a stronger relationship to the metabolic syndrome. We compiled WC, complete blood count (CBC) parameters as well as other pertinent data of 6766 25-55-year-old US volunteers sampled in the US National Health and Nutrition Examination Survey, in the years 2005-2010. To determine reference intervals of typical US patients visiting their clinician, we used minimal exclusion criteria. We compiled hemoglobin, red blood cell count, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration, mean cell hemoglobin (MCH), red cell distribution width (RDW), platelet count, mean platelet volume, and counts of white blood cells (WBC), neutrophils, lymphocytes, monocytes, eosinophils, and basophils. In addition, we also compiled serum C reactive protein and serum iron. The three major US races were studied and reference interval diagrams were constructed for each CBC parameter plotted against WC. WBC count, RDW, lymphocyte, neutrophil, and red blood cell count increase with WC. Conversely, serum iron and MCH and MCV decrease. These relationships may be related to insulin resistance and chronic activation of the immune system and the resulting low-grade inflammatory state. WC is a strong predictor for many CBC parameters, suggesting that WC should be taken into account when evaluating blood count results. Clinicians who take care of obese patients should be aware of altered hematology and investigate and treat accordingly.
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Affiliation(s)
- Jennifer Vuong
- Faculty of Medicine and Dentistry; University of Alberta; Edmonton Alberta Canada
| | - Yuelin Qiu
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton Alberta Canada
| | - Myanh La
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton Alberta Canada
| | - Gwen Clarke
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton Alberta Canada
| | - Dorine W. Swinkels
- Department of Laboratory Medicine; Laboratory of Genetic; Endocrine and Metabolic diseases (LGEM 830), Radboud University Medical Centre; Nijmegen The Netherlands
| | - George Cembrowski
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton Alberta Canada
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Jonker FAM, Boele van Hensbroek M, Leenstra T, Vet RJWM, Brabin BJ, Maseko N, Gushu MB, Emana M, Kraaijenhagen R, Tjalsma H, Swinkels DW, Calis JCJ. Conventional and novel peripheral blood iron markers compared against bone marrow in Malawian children. J Clin Pathol 2014; 67:717-23. [PMID: 24915849 DOI: 10.1136/jclinpath-2014-202291] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM Iron deficiency is an important child health problem. Its diagnosis in areas of high infection exposure remains complicated as inflammation may interfere with the accuracy of peripheral iron markers. With this study, we aimed to validate the conventional iron markers and two novel iron markers, hepcidin and Red blood cell Size Factor (RSf), against the reference standard of iron status, bone marrow iron, in children living in an infectious setting. METHODS We compared ferritin, soluble transferrin receptor, Soluble Transferrin Log-Ferritin Index (sTfR-F), mean cellular volume, mean cellular haemoglobin concentration, hepcidin and RSf, against bone marrow iron in 87 healthy Malawian children (6-66 months) scheduled for elective surgery. RESULTS Of all children, 44.8% had depleted bone marrow iron stores. Using optimised cut-offs, ferritin (<18 µg/L) and sTfR-F (>1.85) best predicted depleted iron stores with a sensitivity/specificity of 73.7%/77.1% and 72.5%/75.0%, respectively. Hepcidin (<1.4 nmol/L) was a moderate sensitive marker (73.0%) although specificity was 54.2%; RSf poorly predicted depleted iron stores. CONCLUSIONS We provide the first bone marrow-validated data on peripheral iron markers in African children, and showed ferritin and sTfR-F best predicted iron status. Using appropriately defined cut-offs, these indicators can be applied in surveillance and research. As their accuracy is limited for clinical purposes, more reliable iron biomarkers are still required in African children.
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Affiliation(s)
- Femkje A M Jonker
- Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Tjalling Leenstra
- Department of Infectious Diseases, Division of Internal Medicine, Centre for Tropical Medicine and Travel Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Raymond J W M Vet
- Department of Specialized Hematology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Bernard J Brabin
- Liverpool School of Tropical Medicine, University of Liverpool, United Kingdom
| | - Nelson Maseko
- Community Health Department, College of Medicine, Blantyre, Malawi
| | - Montfort B Gushu
- Community Health Department, College of Medicine, Blantyre, Malawi
| | - Mercy Emana
- Community Health Department, College of Medicine, Blantyre, Malawi
| | - Rob Kraaijenhagen
- Laboratory for Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Harold Tjalsma
- Hepcidinanalysis.com, Nijmegen, The Netherlands Laboratory of Genetic, Endocrine and Metabolic diseases, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorine W Swinkels
- Hepcidinanalysis.com, Nijmegen, The Netherlands Laboratory of Genetic, Endocrine and Metabolic diseases, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Job C J Calis
- Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
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Theurl M, Nairz M, Schroll A, Sonnweber T, Asshoff M, Haschka D, Seifert M, Willenbacher W, Wilflingseder D, Posch W, Murphy AT, Witcher DR, Theurl I, Weiss G. Hepcidin as a predictive factor and therapeutic target in erythropoiesis-stimulating agent treatment for anemia of chronic disease in rats. Haematologica 2014; 99:1516-24. [PMID: 24895335 DOI: 10.3324/haematol.2013.099481] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Anemia of chronic disease is a multifactorial disorder, resulting mainly from inflammation-driven reticuloendothelial iron retention, impaired erythropoiesis, and reduced biological activity of erythropoietin. Erythropoiesis-stimulating agents have been used for the treatment of anemia of chronic disease, although with varying response rates and potential adverse effects. Serum concentrations of hepcidin, a key regulator of iron homeostasis, are increased in patients with anemia of chronic disease and linked to the pathogenesis of this disease, because hepcidin blocks cellular iron egress, thus limiting availability of iron for erythropoiesis. We tested whether serum hepcidin levels can predict and affect the therapeutic efficacy of erythropoiesis-stimulating agent treatment using a well-established rat model of anemia of chronic disease. We found that high pre-treatment hepcidin levels correlated with an impaired hematologic response to an erythropoiesis-stimulating agent in rats with anemia of chronic disease. Combined treatment with an erythropoiesis-stimulating agent and an inhibitor of hepcidin expression, LDN-193189, significantly reduced serum hepcidin levels, mobilized iron from tissue stores, increased serum iron levels and improved hemoglobin levels more effectively than did the erythropoiesis-stimulating agent or LDN-193189 monotherapy. In parallel, both the erythropoiesis-stimulating agent and erythropoiesis-stimulating agent/LDN-193189 combined reduced the expression of cytokines known to inhibit erythropoiesis. We conclude that serum hepcidin levels can predict the hematologic responsiveness to erythropoiesis-stimulating agent therapy in anemia of chronic disease. Pharmacological inhibition of hepcidin formation improves the erythropoiesis-stimulating agent's therapeutic efficacy, which may favor a reduction of erythropoiesis-stimulating agent dosages, costs and side effects.
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Affiliation(s)
- Milan Theurl
- Department of Internal Medicine VI, Innsbruck Medical University, Innsbruck, Austria Department of Ophthalmology and Optometry, Innsbruck Medical University, Innsbruck, Austria
| | - Manfred Nairz
- Department of Internal Medicine VI, Innsbruck Medical University, Innsbruck, Austria
| | - Andrea Schroll
- Department of Internal Medicine VI, Innsbruck Medical University, Innsbruck, Austria
| | - Thomas Sonnweber
- Department of Internal Medicine VI, Innsbruck Medical University, Innsbruck, Austria
| | - Malte Asshoff
- Department of Internal Medicine VI, Innsbruck Medical University, Innsbruck, Austria
| | - David Haschka
- Department of Internal Medicine VI, Innsbruck Medical University, Innsbruck, Austria
| | - Markus Seifert
- Department of Internal Medicine VI, Innsbruck Medical University, Innsbruck, Austria
| | | | - Doris Wilflingseder
- Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria
| | - Wilfried Posch
- Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria
| | - Anthony T Murphy
- Biotechnology Discovery Research, Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - Derrick R Witcher
- Biotechnology Discovery Research, Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - Igor Theurl
- Department of Internal Medicine VI, Innsbruck Medical University, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine VI, Innsbruck Medical University, Innsbruck, Austria
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130
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van Santen S, de Mast Q, Oosting JD, van Ede A, Swinkels DW, van der Ven AJAM. Hematologic parameters predicting a response to oral iron therapy in chronic inflammation. Haematologica 2014; 99:e171-3. [PMID: 24895340 DOI: 10.3324/haematol.2014.106799] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Susanne van Santen
- Department of General Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands Department of Laboratory Medicine, Laboratory of Genetic, Endocrine and Metabolic diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Quirijn de Mast
- Department of General Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Janine D Oosting
- Department of Laboratory Medicine, Laboratory of Clinical Chemistry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Annelies van Ede
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Laboratory of Genetic, Endocrine and Metabolic diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - André J A M van der Ven
- Department of General Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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Troutt JS, Butterfield AM, Konrad RJ. Hepcidin-25 concentrations are markedly increased in patients with chronic kidney disease and are inversely correlated with estimated glomerular filtration rates. J Clin Lab Anal 2014; 27:504-10. [PMID: 24218134 DOI: 10.1002/jcla.21634] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 05/08/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hepcidin-25 regulates iron homeostasis by binding the iron transporter ferroportin, causing its degradation. Increased hepcidin-25 causes decreased intestinal iron absorption and release from intracellular stores. Our objective in this study was to measure hepcidin-25 levels in patients with chronic kidney disease (CKD) to determine if they might contribute to the anemia of CKD. METHODS We used a hepcidin-25-specific enzyme-linked immunosorbent assay to measure hepcidin-25 in 103 CKD patients and 100 healthy individuals. We assessed in CKD subjects the correlation of hepcidin-25 with creatinine, estimated glomerular filtration rate (eGFR), hemoglobin, blood urea nitrogen, serum iron, transferrin, and ferritin. RESULTS Hepcidin-25 concentrations in CKD patients were significantly increased compared to healthy subjects (60.4 ± 6.1 μg/l vs. 3.0 ± 0.5 μg/l, P < 0.001). Hepcidin-25 concentrations were directly correlated with creatinine (R = 0.28, P = 0.004) and inversely correlated with eGFR (R = -0.32, P = 0.001). Hepcidin-25 levels were also correlated with transferrin (R = -0.28, P = 0.004) and ferritin (R = 0.80, P < 0.001). CONCLUSION The direct correlation of hepcidin-25 with creatinine and its inverse correlation with eGFR suggest that hepcidin-25 levels increase as renal function deteriorates, possibly due to decreased hepcidin-25 renal clearance.
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Affiliation(s)
- Jason S Troutt
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
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132
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Grebenchtchikov N, Geurts-Moespot AJ, Trentmann S, Andersen N, Bel Aiba RS, Allersdorfer A, Laarakkers CM, Sweep FC, Tjalsma H, Hohlbaum AM, Swinkels DW. Engineered Human Lipocalin as an Antibody Mimetic: Application to Analysis of the Small Peptide Hormone Hepcidin. Clin Chem 2014; 60:897-9. [DOI: 10.1373/clinchem.2014.221671] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nicolai Grebenchtchikov
- Department of Laboratory Medicine Laboratory of Genetic, Metabolic and Endocrine Diseases Radboud University Medical Centre Nijmegen, the Netherlands
| | - Anneke J Geurts-Moespot
- Department of Laboratory Medicine Laboratory of Genetic, Metabolic and Endocrine Diseases Radboud University Medical Centre Nijmegen, the Netherlands
| | | | | | | | | | - Coby M Laarakkers
- Department of Laboratory Medicine Laboratory of Genetic, Metabolic and Endocrine Diseases Radboud University Medical Centre Nijmegen, the Netherlands
| | - Fred C Sweep
- Department of Laboratory Medicine Laboratory of Genetic, Metabolic and Endocrine Diseases Radboud University Medical Centre Nijmegen, the Netherlands
| | - Harold Tjalsma
- Department of Laboratory Medicine Laboratory of Genetic, Metabolic and Endocrine Diseases Radboud University Medical Centre Nijmegen, the Netherlands
| | | | - Dorine W Swinkels
- Department of Laboratory Medicine Laboratory of Genetic, Metabolic and Endocrine Diseases Radboud University Medical Centre Nijmegen, the Netherlands
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133
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Schrader M, Schulz-Knappe P, Fricker LD. Historical perspective of peptidomics. EUPA OPEN PROTEOMICS 2014. [DOI: 10.1016/j.euprot.2014.02.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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134
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Delaby C, Vialaret J, Bros P, Gabelle A, Lefebvre T, Puy H, Hirtz C, Lehmann S. Clinical measurement of Hepcidin-25 in human serum: Is quantitative mass spectrometry up to the job? EUPA OPEN PROTEOMICS 2014. [DOI: 10.1016/j.euprot.2014.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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135
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Busti F, Campostrini N, Martinelli N, Girelli D. Iron deficiency in the elderly population, revisited in the hepcidin era. Front Pharmacol 2014; 5:83. [PMID: 24795637 PMCID: PMC4006029 DOI: 10.3389/fphar.2014.00083] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/04/2014] [Indexed: 12/13/2022] Open
Abstract
Iron deficiency (ID) is relatively common among the elderly population, contributing substantially to the high prevalence of anemia observed in the last decades of life, which in turn has important implications both on quality of life and on survival. In elderly subjects, ID is often multifactorial, i.e., due to multiple concurring causes, including inadequate dietary intake or absorption, occult bleeding, medications. Moreover, because of the typical multimorbidity of aged people, other conditions leading to anemia frequently coexist and make diagnosis of ID particularly challenging. Treatment of ID is also problematic in elderly, since response to oral iron is often slow, with a substantial fraction of patients showing refractoriness and requiring cumbersome intravenous administration. In the last decade, the discovery of the iron regulatory hormone hepcidin has revolutionized our understanding of iron pathophysiology. In this review, we revisit ID among elderly people in the light of the impressive recent advances on knowledge of iron regulation, and discuss how hepcidin may help in diagnosis and treatment of this common clinical condition.
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136
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Peeling P, Sim M, Badenhorst CE, Dawson B, Govus AD, Abbiss CR, Swinkels DW, Trinder D. Iron status and the acute post-exercise hepcidin response in athletes. PLoS One 2014; 9:e93002. [PMID: 24667393 PMCID: PMC3965532 DOI: 10.1371/journal.pone.0093002] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 02/27/2014] [Indexed: 12/21/2022] Open
Abstract
This study explored the relationship between serum ferritin and hepcidin in athletes. Baseline serum ferritin levels of 54 athletes from the control trial of five investigations conducted in our laboratory were considered; athletes were grouped according to values <30 μg/L (SF<30), 30-50 μg/L (SF30-50), 50-100 μg/L (SF50-100), or >100 μg/L (SF>100). Data pooling resulted in each athlete completing one of five running sessions: (1) 8 × 3 min at 85% vVO2peak; (2) 5 × 4 min at 90% vVO2peak; (3) 90 min continuous at 75% vVO2peak; (4) 40 min continuous at 75% vVO2peak; (5) 40 min continuous at 65% vVO2peak. Athletes from each running session were represented amongst all four groups; hence, the mean exercise duration and intensity were not different (p>0.05). Venous blood samples were collected pre-, post- and 3 h post-exercise, and were analysed for serum ferritin, iron, interleukin-6 (IL-6) and hepcidin-25. Baseline and post-exercise serum ferritin levels were different between groups (p<0.05). There were no group differences for pre- or post-exercise serum iron or IL-6 (p>0.05). Post-exercise IL-6 was significantly elevated compared to baseline within each group (p<0.05). Pre- and 3 h post-exercise hepcidin-25 was sequentially greater as the groups baseline serum ferritin levels increased (p<0.05). However, post-exercise hepcidin levels were only significantly elevated in three groups (SF30-50, SF50-100, and SF>100; p<0.05). An athlete's iron stores may dictate the baseline hepcidin levels and the magnitude of post-exercise hepcidin response. Low iron stores suppressed post-exercise hepcidin, seemingly overriding any inflammatory-driven increases.
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Affiliation(s)
- Peter Peeling
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia, Australia
- * E-mail:
| | - Marc Sim
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Claire E. Badenhorst
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Brian Dawson
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Andrew D. Govus
- Centre for Exercise and Sports Science Research, School of Exercise and Health Science, Edith Cowan University, Western Australia, Australia
| | - Chris R. Abbiss
- Centre for Exercise and Sports Science Research, School of Exercise and Health Science, Edith Cowan University, Western Australia, Australia
| | - Dorine W. Swinkels
- Department of Laboratory Medicine, Laboratory of Genetic, Endocrine and Metabolic diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
- Hepcidinanalysis.com, Nijmegen, The Netherlands
| | - Debbie Trinder
- School of Medicine and Pharmacology, The University of Western Australia, Fremantle, Western Australia, Australia
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Practice guidelines for the diagnosis and management of microcytic anemias due to genetic disorders of iron metabolism or heme synthesis. Blood 2014; 123:3873-86; quiz 4005. [PMID: 24665134 DOI: 10.1182/blood-2014-01-548776] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
During recent years, our understanding of the pathogenesis of inherited microcytic anemias has gained from the identification of several genes and proteins involved in systemic and cellular iron metabolism and heme syntheses. Numerous case reports illustrate that the implementation of these novel molecular discoveries in clinical practice has increased our understanding of the presentation, diagnosis, and management of these diseases. Integration of these insights into daily clinical practice will reduce delays in establishing a proper diagnosis, invasive and/or costly diagnostic tests, and unnecessary or even detrimental treatments. To assist the clinician, we developed evidence-based multidisciplinary guidelines on the management of rare microcytic anemias due to genetic disorders of iron metabolism and heme synthesis. These genetic disorders may present at all ages, and therefore these guidelines are relevant for pediatricians as well as clinicians who treat adults. This article summarizes these clinical practice guidelines and includes background on pathogenesis, conclusions, and recommendations and a diagnostic flowchart to facilitate using these guidelines in the clinical setting.
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Sdogou T, Tsentidis C, Gourgiotis D, Marmarinos A, Gkourogianni A, Papassotiriou I, Anastasiou T, Kossiva L. Immunoassay-based serum hepcidin reference range measurements in healthy children: differences among age groups. J Clin Lab Anal 2014; 29:10-4. [PMID: 24659514 DOI: 10.1002/jcla.21719] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/31/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Hepcidin is a peptide hormone that plays a key role in regulating iron absorption from the small intestine and body iron distribution. Alterations in hepcidin concentrations have been associated with chronic inflammatory conditions or inherited diseases of iron metabolism. The aim of our study was to evaluate healthy children in order to define normal reference range of serum hepcidin concentrations. The universal use of a reliable commercial ELISA kit gives the ability to compare our results with those from previous studies. METHODS We evaluated 180 healthy children (88 boys, mean age: 67.55 ± 39.26 months, median: 60, range: 24-156 months) aged 2-12 years, using an immunoassay kit. RESULTS Hepcidin median values were 46.94 ng/ml for boys and 46.79 ng/ml for girls. No significant differences were observed between boys and girls. There seem to be significantly higher values of hepcidin in older children (10-12 years old). This trend was constant and statistically significant in boys after gender and age group stratification. Although this trend was more prominent in girls, it was not statistically significant. CONCLUSIONS This study aims at setting up reference values for serum hepcidin concentrations in healthy pediatric population by using a well-established laboratory kit. The difference in hepcidin concentrations in older children could be attributed to different growth rates. Additionally, differences between values in adults and children could reflect alterations in iron metabolism between those two age groups.
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Affiliation(s)
- Triantafyllia Sdogou
- Second Department of Pediatrics, "P and A Kyriakou" Children's Hospital, Athens University Medical School, Athens, Greece
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Galesloot TE, Holewijn S, Kiemeney LA, de Graaf J, Vermeulen SH, Swinkels DW. Serum Hepcidin Is Associated With Presence of Plaque in Postmenopausal Women of a General Population. Arterioscler Thromb Vasc Biol 2014; 34:446-56. [DOI: 10.1161/atvbaha.113.302381] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Tessel E. Galesloot
- From the Department for Health Evidence (T.E.G., L.A.L.M.K., S.H.V.), Department of General Internal Medicine, Division of Vascular Medicine (S.H., J.d.G.), Department of Urology (L.A.L.M.K.), and Laboratory of Genetic, Endocrine and Metabolic Diseases, Department of Laboratory Medicine (D.W.S.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suzanne Holewijn
- From the Department for Health Evidence (T.E.G., L.A.L.M.K., S.H.V.), Department of General Internal Medicine, Division of Vascular Medicine (S.H., J.d.G.), Department of Urology (L.A.L.M.K.), and Laboratory of Genetic, Endocrine and Metabolic Diseases, Department of Laboratory Medicine (D.W.S.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lambertus A.L.M. Kiemeney
- From the Department for Health Evidence (T.E.G., L.A.L.M.K., S.H.V.), Department of General Internal Medicine, Division of Vascular Medicine (S.H., J.d.G.), Department of Urology (L.A.L.M.K.), and Laboratory of Genetic, Endocrine and Metabolic Diseases, Department of Laboratory Medicine (D.W.S.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacqueline de Graaf
- From the Department for Health Evidence (T.E.G., L.A.L.M.K., S.H.V.), Department of General Internal Medicine, Division of Vascular Medicine (S.H., J.d.G.), Department of Urology (L.A.L.M.K.), and Laboratory of Genetic, Endocrine and Metabolic Diseases, Department of Laboratory Medicine (D.W.S.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sita H. Vermeulen
- From the Department for Health Evidence (T.E.G., L.A.L.M.K., S.H.V.), Department of General Internal Medicine, Division of Vascular Medicine (S.H., J.d.G.), Department of Urology (L.A.L.M.K.), and Laboratory of Genetic, Endocrine and Metabolic Diseases, Department of Laboratory Medicine (D.W.S.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorine W. Swinkels
- From the Department for Health Evidence (T.E.G., L.A.L.M.K., S.H.V.), Department of General Internal Medicine, Division of Vascular Medicine (S.H., J.d.G.), Department of Urology (L.A.L.M.K.), and Laboratory of Genetic, Endocrine and Metabolic Diseases, Department of Laboratory Medicine (D.W.S.), Radboud University Medical Center, Nijmegen, The Netherlands
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140
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Jaspers A, Baron F, Willems E, Seidel L, Wiegerinck ET, Swinkels DW, Beguin Y. Serum hepcidin following autologous hematopoietic cell transplantation: an illustration of the interplay of iron status, erythropoiesis and inflammation. Haematologica 2014; 99:e35-7. [PMID: 24441148 DOI: 10.3324/haematol.2013.100032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Cortese S, Angriman M, Lecendreux M, Konofal E. Iron and attention deficit/hyperactivity disorder: what is the empirical evidence so far? A systematic review of the literature. Expert Rev Neurother 2014; 12:1227-40. [DOI: 10.1586/ern.12.116] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Jonker FAM, Calis JCJ, Phiri K, Kraaijenhagen RJ, Brabin BJ, Faragher B, Wiegerinck ET, Tjalsma H, Swinkels DW, Boele van Hensbroek M. Low hepcidin levels in severely anemic malawian children with high incidence of infectious diseases and bone marrow iron deficiency. PLoS One 2013; 8:e78964. [PMID: 24339866 PMCID: PMC3855157 DOI: 10.1371/journal.pone.0078964] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/17/2013] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION A reliable diagnostic biomarker of iron status is required for severely anemic children living in malarious areas because presumptive treatment with iron may increase their infection risk if they are not iron deficient. Current biomarkers are limited because they are altered by host inflammation. In this study hepcidin concentrations were assessed in severely anemic children living in a highly malarious area of Malawi and evaluated against bone marrow iron in order to determine the usefulness of hepcidin as a point of care test. METHODS 207 severely anemic children were assessed for levels of hepcidin, ferritin, serum transferrin receptor, erythropoietin, hematological indices, C-reactive protein, interleukin-6, malaria parasites and HIV infection. Deficiency of bone marrow iron stores was graded and erythroblast iron incorporation estimated. Interaction of covariates was assessed by structural-equation-modeling. RESULTS AND CONCLUSION Hepcidin was a poor predictor of bone marrow iron deficiency (sensitivity 66.7%; specificity 48.5%), and of iron incorporation (sensitivity 54.2%; specificity 61.8%), and therefore would have limitations as a point of care test in this category of children. As upregulation of hepcidin by inflammation and iron status was blunted by erythropoietin in this population, enhanced iron absorption through the low hepcidin values may increase infection risk. Current recommendations to treat all severely anemic children living in malarious areas with iron should therefore be reconsidered.
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Affiliation(s)
- Femkje A. M. Jonker
- Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
- * E-mail:
| | - Job C. J. Calis
- Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Kamija Phiri
- Community Health Department, College of Medicine, Blantyre, Malawi
| | - Rob J. Kraaijenhagen
- Meander Medical Centre, Laboratory for Clinical Chemistry and Haematology, Amersfoort, The Netherlands
| | - Bernard J. Brabin
- Liverpool School of Tropical Medicine, University of Liverpool, United Kingdom
| | - Brian Faragher
- Department of Biostatistics Liverpool School of Tropical Medicine, University of Liverpool, United Kingdom
| | - Erwin T. Wiegerinck
- Laboratory Medicine, Laboratory of Genetic, Endocrine and Metabolic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Harold Tjalsma
- Laboratory Medicine, Laboratory of Genetic, Endocrine and Metabolic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Hepcidinanalysis.com, 6525 GA Nijmegen, The Netherlands
| | - Dorine W. Swinkels
- Laboratory Medicine, Laboratory of Genetic, Endocrine and Metabolic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Hepcidinanalysis.com, 6525 GA Nijmegen, The Netherlands
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King A, Hildyard C, Clarke R, Watson C, Roberts D. Interpretation of iron studies. Br J Hosp Med (Lond) 2013; 74 Suppl 12:C184-7. [PMID: 24326759 DOI: 10.12968/hmed.2013.74.sup12.c184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Iron plays a vital role in the human body in oxygen transport, mitochondrial oxidative energy production, inactivation of drugs and toxins, and DNA synthesis (Munoz et al, 2011).
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Affiliation(s)
- Aj King
- Specialist Registrar, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford
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144
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Nicolardi S, Giera M, Kooijman P, Kraj A, Chervet JP, Deelder AM, van der Burgt YEM. On-line electrochemical reduction of disulfide bonds: improved FTICR-CID and -ETD coverage of oxytocin and hepcidin. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2013; 24:1980-7. [PMID: 24018861 PMCID: PMC3837188 DOI: 10.1007/s13361-013-0725-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/25/2013] [Accepted: 07/25/2013] [Indexed: 05/21/2023]
Abstract
Particularly in the field of middle- and top-down peptide and protein analysis, disulfide bridges can severely hinder fragmentation and thus impede sequence analysis (coverage). Here we present an on-line/electrochemistry/ESI-FTICR-MS approach, which was applied to the analysis of the primary structure of oxytocin, containing one disulfide bridge, and of hepcidin, containing four disulfide bridges. The presented workflow provided up to 80% (on-line) conversion of disulfide bonds in both peptides. With minimal sample preparation, such reduction resulted in a higher number of peptide backbone cleavages upon CID or ETD fragmentation, and thus yielded improved sequence coverage. The cycle times, including electrode recovery, were rapid and, therefore, might very well be coupled with liquid chromatography for protein or peptide separation, which has great potential for high-throughput analysis.
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Affiliation(s)
- Simone Nicolardi
- Leiden University Medical Center (LUMC), Center for Proteomics and Metabolomics, 2300 RC Leiden, The Netherlands
| | - Martin Giera
- Leiden University Medical Center (LUMC), Center for Proteomics and Metabolomics, 2300 RC Leiden, The Netherlands
| | - Pieter Kooijman
- Leiden University Medical Center (LUMC), Center for Proteomics and Metabolomics, 2300 RC Leiden, The Netherlands
| | | | | | - André M. Deelder
- Leiden University Medical Center (LUMC), Center for Proteomics and Metabolomics, 2300 RC Leiden, The Netherlands
| | - Yuri E. M. van der Burgt
- Leiden University Medical Center (LUMC), Center for Proteomics and Metabolomics, 2300 RC Leiden, The Netherlands
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145
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Laarakkers CMM, Wiegerinck ET, Klaver S, Kolodziejczyk M, Gille H, Hohlbaum AM, Tjalsma H, Swinkels DW. Improved mass spectrometry assay for plasma hepcidin: detection and characterization of a novel hepcidin isoform. PLoS One 2013; 8:e75518. [PMID: 24124495 PMCID: PMC3790851 DOI: 10.1371/journal.pone.0075518] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/14/2013] [Indexed: 12/15/2022] Open
Abstract
Mass spectrometry (MS)-based assays for the quantification of the iron regulatory hormone hepcidin are pivotal to discriminate between the bioactive 25-amino acid form that can effectively block the sole iron transporter ferroportin and other naturally occurring smaller isoforms without a known role in iron metabolism. Here we describe the design, validation and use of a novel stable hepcidin-25+40 isotope as internal standard for quantification. Importantly, the relative large mass shift of 40 Da makes this isotope also suitable for easy-to-use medium resolution linear time-of-flight (TOF) platforms. As expected, implementation of hepcidin-25+40 as internal standard in our weak cation exchange (WCX) TOF MS method yielded very low inter/intra run coefficients of variation. Surprisingly, however, in samples from kidney disease patients, we detected a novel peak (m/z 2673.9) with low intensity that could be identified as hepcidin-24 and had previously remained unnoticed due to peak interference with the formerly used internal standard. Using a cell-based bioassay it was shown that synthetic hepcidin-24 was, like the -22 and -20 isoforms, a significantly less potent inducer of ferroportin degradation than hepcidin-25. During prolonged storage of plasma at room temperature, we observed that a decrease in plasma hepcidin-25 was paralleled by an increase in the levels of the hepcidin-24, -22 and -20 isoforms. This provides first evidence that all determinants for the conversion of hepcidin-25 to smaller inactive isoforms are present in the circulation, which may contribute to the functional suppression of hepcidin-25, that is significantly elevated in patients with renal impairment. The present update of our hepcidin TOF MS assay together with improved insights in the source and preparation of the internal standard, and sample stability will further improve our understanding of circulating hepcidin and pave the way towards further optimization and standardization of plasma hepcidin assays.
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Affiliation(s)
- Coby M. M. Laarakkers
- Laboratory of Genetic, Endocrine and Metabolic Diseases, Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Hepcidinanalysis.com, Nijmegen, The Netherlands
| | - Erwin T. Wiegerinck
- Laboratory of Genetic, Endocrine and Metabolic Diseases, Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Hepcidinanalysis.com, Nijmegen, The Netherlands
| | - Siem Klaver
- Laboratory of Genetic, Endocrine and Metabolic Diseases, Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Hepcidinanalysis.com, Nijmegen, The Netherlands
| | | | | | | | - Harold Tjalsma
- Laboratory of Genetic, Endocrine and Metabolic Diseases, Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Hepcidinanalysis.com, Nijmegen, The Netherlands
| | - Dorine W. Swinkels
- Laboratory of Genetic, Endocrine and Metabolic Diseases, Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Hepcidinanalysis.com, Nijmegen, The Netherlands
- * E-mail:
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146
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Konz T, Alonso-García J, Montes-Bayón M, Sanz-Medel A. Comparison of copper labeling followed by liquid chromatography-inductively coupled plasma mass spectrometry and immunochemical assays for serum hepcidin-25 determination. Anal Chim Acta 2013; 799:1-7. [DOI: 10.1016/j.aca.2013.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/19/2013] [Accepted: 08/01/2013] [Indexed: 01/10/2023]
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147
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Ebner N, von Haehling S. Iron deficiency in heart failure: a practical guide. Nutrients 2013; 5:3730-9. [PMID: 24064572 PMCID: PMC3798931 DOI: 10.3390/nu5093730] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/27/2013] [Accepted: 09/04/2013] [Indexed: 12/12/2022] Open
Abstract
Iron is an element necessary for cells due to its capacity of transporting oxygen and electrons. One of the important co-morbidities in heart failure is iron deficiency. Iron has relevant biological functions, for example, the formation of haemoglobin, myoglobin and numerous enzymatic groups. The prevalence of iron deficiency increases with the severity of heart failure. For a long time, the influence of iron deficiency was underestimated especially in terms of worsening of cardiovascular diseases and of developing anaemia. In recent years, studies with intravenous iron agents in patients with iron deficiency and cardiovascular diseases indicated new insights in the improvement of therapy. Experimental studies support the understanding of iron metabolism. Many physicians remain doubtful of the use of intravenous iron due to reports of side effects. The aim of this review is to describe iron metabolism in humans, to highlight the influence of iron deficiency on the course and symptoms of heart failure, discuss diagnostic tools of iron deficiency and provide guidance on the use of intravenous iron.
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Affiliation(s)
- Nicole Ebner
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin 13353, Germany; E-Mail:
| | - Stephan von Haehling
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin 13353, Germany; E-Mail:
- Center for Cardiovascular Research (CCR), Charité Medical School, Campus Mitte, Berlin 10117, Germany
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +49-30-450-553506; Fax: +49-30-450-7553506
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148
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Wolff F, Deleers M, Melot C, Gulbis B, Cotton F. Hepcidin-25: Measurement by LC–MS/MS in serum and urine, reference ranges and urinary fractional excretion. Clin Chim Acta 2013; 423:99-104. [DOI: 10.1016/j.cca.2013.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/03/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
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149
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Moretti D, van Doorn GM, Swinkels DW, Melse-Boonstra A. Relevance of dietary iron intake and bioavailability in the management of HFE hemochromatosis: a systematic review. Am J Clin Nutr 2013; 98:468-79. [PMID: 23803887 DOI: 10.3945/ajcn.112.048264] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hereditary hemochromatosis (HH) leads to iron loading because of a disturbance in the negative-feedback mechanism between dietary iron absorption and iron status. The management of HH is achieved by repeated phlebotomies. OBJECTIVE We investigated whether HH patients would benefit from a diet with low iron intake and bioavailability. DESIGN We performed a systematic review of studies that linked iron bioavailability and status with dietary factors in subjects with diagnosed HH. Studies on heterozygotes for the HFE mutation were excluded. RESULTS No prospective, randomized study was reported. Nine studies that directly measured iron bioavailability from test meals in HH patients have been described as well as 3 small, prospective, longitudinal studies in HH patients. Eight cross-sectional studies were identified that investigated the effect of dietary composition on iron status. Calculations of iron bioavailability in HH were made by extrapolating data on hepcidin concentrations and their association with iron bioavailability. The potential reduction in the yearly amount of blood to be phlebotomized when restricting dietary iron absorbed was estimated in the 3 longitudinal studies and ranged between 0.5 and 1.5 L. This amount would be dependent on individual disease penetrance as well as the dietary intervention. CONCLUSIONS Despite the limited quantitative evidence and the lack of randomized, prospective trials, dietary interventions that modify iron intake and bioavailability may affect iron accumulation in HH patients. Although this measure may be welcome in patients willing to contribute to their disease management, limited data exist on the clinical and quality-of-life benefit.
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Affiliation(s)
- Diego Moretti
- Division of Human Nutrition and Science Shop, Wageningen University, Wageningen, Netherlands
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150
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Palaneeswari M S, Ganesh M, Karthikeyan T, Devi AJM, Mythili SV. Hepcidin-minireview. J Clin Diagn Res 2013; 7:1767-71. [PMID: 24086909 DOI: 10.7860/jcdr/2013/6420.3273] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/21/2013] [Indexed: 12/21/2022]
Abstract
Iron related disorders are encountered in daily clinical settings. Maintenance of stable extracellular iron concentrations requires the coordinate regulation of iron transport into plasma from dietary sources in the duodenum, from recycled senescent red cells in macrophages and from storage in hepatocytes. Hepcidin acts as a systemic iron-regulatory hormone. Many human diseases are associated with alterations in hepcidin concentrations. This review has focused on hepcidin structure, kinetics and function, its correlation with iron metabolism disorders, the therapeutic potential for modulating hepcidin expression and the diagnostic potential of hepcidin measurements in clinical practice.
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Affiliation(s)
- Subha Palaneeswari M
- Assistant Professor, Department of Biochemistry, Sree Balaji Medical College and Hospital (Bharath University) , Chrompet, Chennai-600 044, India
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