Factors affecting iron balance

Unraveling the unexpected: Interference in iron assay leads to diagnosis of multiple myeloma

BACKGROUND

Iron studies are critical for diagnosing iron deficiency and hemochromatosis. We present a case exhibiting macrocytic anemia with perplexingly high plasma iron concentrations.

METHODS AND RESULTS

The initial clinical presentation with significantly elevated iron results raised concerns for hemochromatosis. However, inconsistent results in dilution studies suggested the presence of an interfering substance. Inspection of the reaction curves from the instrument revealed very high background absorption in the 800 nm channel. This, coupled with the observation of an insoluble precipitate upon mixing the acid buffer reagent with the patient's serum, as well as the patient's high total protein and low albumin levels, suggested immunoglobulin overproduction. Serum protein electrophoresis confirmed a monoclonal gammopathy with a subsequent diagnosis of multiple myeloma.

CONCLUSION

Excessive monoclonal immunoglobulins can precipitate in acidic buffers and interfere with spectrophotometric measurements in iron testing. Although challenging, investigating an interference and determining its cause can uncover underlying diseases that have yet to be diagnosed.

Selenium and/or vitamin E upregulate the antioxidant gene expression and parameters in broilers

BACKGROUND

In contrast to free radicals, the first line of protection is assumed to be vitamin E and selenium. The present protocol was designed to assess the roles of vitamin E and/or a selenium-rich diet that affected the blood iron and copper concentrations, liver tissue antioxidant and lipid peroxidation, and gene expression linked to antioxidants in the liver tissue of broilers. The young birds were classified according to the dietary supplement into four groups; control, vitamin E (100 mg Vitamin/kg diet), selenium (0.3 mg sodium selenite/kg diet), and vitamin E pulse selenium (100 mg vitamin/kg diet with 0.3 mg sodium selenite/kg diet) group.

RESULTS

The results of this experiment suggested that the addition of vitamin E with selenium in the broiler diet significantly increased (P ≤ 0.05) serum iron when compared with the other groups and serum copper when compared with the vitamin E group. Moreover, the supplements (vitamin E or vitamin E with selenium) positively affected the enzymatic activity of the antioxidant-related enzymes with decreased malondialdehyde (MDA),which represents lipid peroxidation in broiler liver tissue. Moreover, the two supplements significantly upregulated genes expression related to antioxidants.

CONCLUSION

Therefore, vitamin E and/or selenium can not only act as exogenous antioxidants to prevent oxidative damage by scavenging free radicals and superoxide, but also act as gene regulators, regulating the expression of endogenous antioxidant enzymes.

Effects of Dietary Iron Level on Growth Performance, Immune Organ Indices and Meat Quality in Chinese Yellow Broilers

The objective of three trials was to investigate the effects of dietary Fe on growth performance, immune organ indices and meat quality of Chinese yellow broilers during the whole growth period. A total of 1440 1-day-old, 1440 22-day-old, and 1080 43-day-old Lingnan yellow male broilers were randomly assigned to one of six dietary treatments with six replicates per treatment (40 birds per replicate for both 1 to 21 d and 22 to 42 d, 30 birds for 43 to 63 d). Additional Fe (0, 20, 40, 60, 80, and 100 mg/kg) was added as FeSO₄ • H₂O to the three basal diets (calculated Fe 50 mg/kg, analyzed 48.3, 49.1, 48.7 mg/kg, respectively). The calculated final dietary Fe concentrations in Starter, Grower and Finisher phases were 50, 70, 90, 110, 130, and 150 mg/kg. The results showed that average daily gain (ADG), average daily feed intake (ADFI) and feed conversion rate (FCR) of the broilers were not influenced by the different levels of Fe (p> 0.05). Weight indices of the spleen, thymus and bursa of Fabricius were not influenced (p > 0.05) by the different levels of Fe during three 21-day experimental periods. Hematocrit, and Fe contents of the liver and kidney were not affected by different levels of Fe (p> 0.05). The diet with 150 mg/kg of Fe increased the a* (relative redness) value of breast muscle compared to the 50 and 70 mg/kg diets at 24 h post mortem (p< 0.05). The diet with 90 mg/kg Fe increased the pH of breast muscle compared to broilers fed 50 or 150 mg/kg Fe (p < 0.05) 45 min after slaughter. The diet with 90 mg/kg Fe decreased drip loss of breast muscle compared to 150 mg/kg Fe (p< 0.05). These data suggest that feeding yellow-feathered broilers on a conventional corn-soy based diet satisfies their requirements without additional Fe at ages 1 to 21, and 22 to 42 d, while 90 mg/kg in the finisher phase improved meat quality, and from the QP (quadratic polynomial) models of the key meat quality variables, pH of breast muscle and drip loss of breast muscle, the optimal dietary Fe level was 89 to 108 mg/kg, and daily Fe fed allowance was 11 to 13 mg in the finisher phase (43 to 63 d).

Dietary and prophylactic iron supplements : Helpful or harmful?

Mild hypoferremia represents an aspect of the ability of the body to withhold iron from pathogenic bacteria, fungi, and protozoa, and from neoplastic cells. However, our iron-withholding defense system can be thwarted by practices that enhance iron overload such as indiscriminate iron fortification of foods, medically prescribed iron supplements, alcohol ingestion, and cigarette smoking. Elevated standards for normal levels of iron can be misleading and even dangerous for individuals faced with medical insults such as chronic infection, neoplasia, cardiomyopathy, and arthritis. We are becoming increasingly aware that the wide-spread hypoferremia in human populations is a physiological response to insult rather than a pathological cause of insult, and that attempts to correct the condition by simply raising iron levels may not only be misguided but may actually impair host defense.

Urinary hepcidin level as an early predictor of iron deficiency in children: A case control study

Background

The ideal screening test would be capable of identifying iron deficiency in the absence of anemia. We tried to detect role of urinary hepcidin-25 level in early prediction of iron deficiency in children.

Methods

This is a case control study performed on 100 children in Hematology Unit of Pediatric Department, Zagazig University Hospital, Egypt. Our study included 25 cases of iron deficiency (ID) stage-1 (iron depletion), 25 cases ID stage-2 (iron-deficient erythropoiesis), 25 cases ID stage-3 (iron deficiency anemia) and 25 healthy children as a control group. Estimation of iron status parameters was done. Urinary hepcidin-25 level was detected.

Results

Urinary hepcidin-25 level was significantly lower in all stages of iron deficiency than in control group, more significant reduction in its level was observed with the progress in severity of iron deficiency. Urinary hepcidin showed significant positive correlation with hemoglobin, mean corpuscular volume, hematocrit value, serum iron and ferritin and transferrin saturation. In contrary, it showed significant negative correlation with serum transferrin and total iron binding capacity.

Urinary hepcidin at cutoff point ≤0.94 nmol/mmol Cr could Predict ID stage-1 with sensitivity 88% and specificity 88%. Cutoff point ≤0.42 nmol/mmol Cr could predict ID stage-2 with sensitivity 96% and specificity 92%. Cutoff point ≤0.08 nmol/mmol Cr could Predict ID stage-3 with Sensitivity 96% and specificity 100%.

Conclusions

We can conclude that detection of urinary hepcidin-25 level was a simple and non invasive test and could predict iron deficiency very early, before appearance of hematological affections.

Iron overload cardiomyopathy: better understanding of an increasing disorder

The prevalence of iron overload cardiomyopathy (IOC) is increasing. The spectrum of symptoms of IOC is varied. Early in the disease process, patients may be asymptomatic, whereas severely overloaded patients can have terminal heart failure complaints that are refractory to treatment. It has been shown that early recognition and intervention may alter outcomes. Biochemical markers and tissue biopsy, which have traditionally been used to diagnose and guide therapy, are not sensitive enough to detect early cardiac iron deposition. Newer diagnostic modalities such as magnetic resonance imaging are noninvasive and can assess quantitative cardiac iron load. Phlebotomy and chelating drugs are suboptimal means of treating IOC; hence, the roles of gene therapy, hepcidin, and calcium channel blockers are being actively investigated. There is a need for the development of clinical guidelines in order to improve the management of this emerging complex disease.

The effect of psychological stress on iron absorption in rats

BACKGROUND

Psychological stress (PS) is recognized as an important pathogenic factor which leads to metabolism disorder in many diseases. Previous studies have shown that systemic iron homeostasis in mammalians was changed under specific stress conditions.

METHODS

In present study, we used communication box to create psychological stress model and investigated the iron apparent absorption, iron accumulation in the apical poles of villous enterocytes and protein expressions of ferroportin 1 (FPN1), ferritin, divalent metal transporter 1 (DMT1).

RESULTS

Our study showed that iron apparent absorption decreased and iron significantly accumulated in the apical poles of villous enterocytes in 3 d and 7 d PS groups. The expression of intestinal FPN1 in 3 d and 7 d PS groups was lower than that of control, while the change of intestinal ferritin was opposite. However, the expression of DMT1 did not change.

CONCLUSION

These results demonstrate that PS can decrease iron absorption in rats, which might be related to regulation expression of iron transporters.

The selective quantification of iron by hexadentate fluorescent probes

The synthesis of four hexadentate fluorescent probes is described, where the fluorescent moiety is based on either coumarin or fluorescein and the chelating moiety is based on either 3-hydroxypyridin-4-one or 3-hydroxypyran-4-one. The fluorescence is quenched when the probe chelating moieties bind iron. The probes were found to be selective for iron over other metals such as Cu, Zn, Ni, Mn and Co. The effect of Cu on fluorescence quenching can be eliminated in the presence of N,N,N',N'-tetrakis(2-pyridylmethyl)-ethylenediamine. Competition studies demonstrate that the exchange of iron between pyridinone-based probes and apotransferrin is very slow. The ability to scavenge iron from oligomeric iron(III) citrate complexes demonstrate that the pyridinone probes scavenges iron faster than deferiprone and desferrioxamine. The fluorescence intensity of the fluorescein-based probe is quantitatively related to the iron concentration with the limit of detection being 10(-8)M.

Animal models with enhanced erythropoiesis and iron absorption

The regulation of iron absorption is of considerable interest in mammals since excretion is minimal. Recent advances in iron metabolism have expounded the molecular mechanisms by which iron absorption is attuned to the physiological demands of the body. The pinnacle was the discovery and identification of hepcidin, a hepatic antimicrobial peptide that regulates absorption to maintain iron homeostasis. While the intricacies of its expression and regulation by HFE, transferrin receptor 2 and hemojuvelin are still speculative, hepcidin responsiveness has correlated negatively with iron absorption in different models and disorders of iron metabolism. Consequently, hepcidin expression is repressed to enhance iron absorption during stimulated erythropoiesis even in situations of elevated iron stores. Animal models have been crucial to the advances in understanding iron metabolism and the present review focuses on phenylhydrazine treated and hypotransferrinaemic rodents. These, respectively, experimental and genetic models of enhanced erythropoiesis highlight the shifting focus of iron absorption regulation from the marrow to the liver.

Iron metabolism in the hemoglobin-deficit mouse: correlation of diferric transferrin with hepcidin expression

The iron requirements of the erythroid compartment modulate the expression of hepcidin in the liver, which in turn alters intestinal iron absorption and iron release from the reticuloendothelial system. We have taken advantage of an inherited anemia of the mouse (hemoglobin deficit, or hbd) to gain insights into the factors regulating hepcidin expression. hbd mice showed a significant anemia but, surprisingly, their iron absorption was not increased as it was in wild-type animals made anemic to a similar degree by dietary iron depletion. In wild-type mice hepatic hepcidin levels were decreased but in hbd animals a significant and unexpected increase was observed. The level of absorption was appropriate for the expression of hepcidin in each case, but in hbd mice did not reflect the degree of anemia. However, this apparent inappropriate regulation of hepcidin correlated with increased transferrin saturation and levels of diferric transferrin in the plasma, which in turn resulted from the reduced capacity of hbd animals to effectively use transferrin-bound iron. These data strengthen the proposal that diferric transferrin is a key indicator of body iron requirements.

Hepcidin expression inversely correlates with the expression of duodenal iron transporters and iron absorption in rats

BACKGROUND & AIMS

Hepcidin is an antimicrobial peptide thought to be involved in the regulation of intestinal iron absorption. To further investigate its role in this process, we examined hepatic and duodenal gene expression in rats after the switch from a control diet to an iron-deficient diet.

METHODS

Adult rats on an iron-replete diet were switched to an iron-deficient diet and the expression of iron homeostasis molecules in duodenal and liver tissue was studied over 14 days. Intestinal iron absorption was determined at these same time-points by measuring the retention of an oral dose of (59)Fe.

RESULTS

Iron absorption increased 2.7-fold within 6 days of switching to an iron-deficient diet and was accompanied by an increase in the duodenal expression of Dcytb, divalent metal transporter 1, and Ireg1. These changes precisely correlated with decreases in hepatic hepcidin expression and transferrin saturation. No change in iron stores or hematologic parameters was detected.

CONCLUSIONS

This study showed a close relationship between the expression of hepcidin, duodenal iron transporters, and iron absorption. Both hepcidin expression and iron absorption can be regulated before iron stores and erythropoiesis are affected, and transferrin saturation may signal such changes.

Cloning and gastrointestinal expression of rat hephaestin: relationship to other iron transport proteins

The membrane-bound ceruloplasmin homolog hephaestin plays a critical role in intestinal iron absorption. The aims of this study were to clone the rat hephaestin gene and to examine its expression in the gastrointestinal tract in relation to other genes encoding iron transport proteins. The rat hephaestin gene was isolated from intestinal mRNA and was found to encode a protein 96% identical to mouse hephaestin. Analysis by ribonuclease protection assay and Western blotting showed that hephaestin was expressed at high levels throughout the small intestine and colon. Immunofluorescence localized the hephaestin protein to the mature villus enterocytes with little or no expression in the crypts. Variations in iron status had a small but nonsignificant effect on hephaestin expression in the duodenum. The high sequence conservation between rat and mouse hephaestin is consistent with this protein playing a central role in intestinal iron absorption, although its precise function remains to be determined.

Expression of the duodenal iron transporters divalent-metal transporter 1 and ferroportin 1 in iron deficiency and iron overload

BACKGROUND & AIMS

Imbalances of iron homeostasis are accompanied by alterations of intestinal iron absorption. The identification of divalent-metal transporter 1 (DMT1) and ferroportin 1 (FP1) has improved our understanding of transmembrane iron trafficking. To gain insight into the regulatory properties of these transporters in the duodenum, we studied their expression in patients with hereditary hemochromatosis (HFE-associated and non-HFE-associated), secondary iron overload, and iron deficiency.

METHODS

DMT1, FP1 messenger RNA (mRNA), and protein expression were analyzed in duodenal biopsy specimens from patients by means of TaqMan real-time polymerase chain reaction, Western blotting technique, and immunohistochemistry.

RESULTS

DMT1 and FP1 mRNA levels are positively correlated with each other in all patient groups (P < 0.001). Moreover, DMT1 and FP1 mRNA levels were significantly increased in patients with iron deficiency, HFE and non-HFE hemochromatosis, whereas they were unchanged in patients with secondary iron overload. Alterations in DMT1 and FP1 mRNA levels were paralleled by comparable changes in the duodenal expression of these proteins. In patients with normal iron status or iron deficiency, significant negative correlations between DMT1, FP1 mRNA, and serum iron parameters were found, which were absent in subjects with primary hemochromatosis.

CONCLUSIONS

DMT1 and FP1 are centrally involved in iron uptake/transfer in the duodenum and in the adaptive changes of iron homeostasis to iron deficiency and overload.

A duodenal mucosal abnormality in the reduction of Fe(III) in patients with genetic haemochromatosis

BACKGROUND

Previous in vitro studies have shown that the uptake of Fe(III) by freshly isolated duodenal mucosal biopsy specimens is increased in patients with genetic haemochromatosis. Moreover, in the mouse it has recently been found that reduction of Fe(III) to Fe(II) is a prerequisite for iron uptake by the proximal intestine.

AIMS/METHODS

This study used the in vitro technique to investigate the rates of reduction and uptake of 59Fe(III) by duodenal mucosal biopsy specimens obtained at endoscopy from treated and untreated patients with genetic haemochromatosis.

RESULTS

The rate of reduction of iron in the medium was proportional to the incubation time and was not caused by the release of reducing factors from the tissue fragments. Ferrozine, a specific Fe(II) chelator and ferricyanide, a non-permeable oxidising agent, inhibited uptake of 59Fe showing that reduction of Fe(III) precedes uptake. The rates (all values given as pmol/mg/min) of reduction (152 (49) v 92 (23)) and uptake (8.3 (4.0) v 3.6 (1.3), mean (SD)), were significantly increased in biopsy specimens from the untreated group (n = 6) compared with those from 10 control subjects (p < 0.04). Furthermore, the reduction and uptake rates were still increased in five patients in whom iron stores were normal after venesection treatment.

CONCLUSIONS

These results show that there is a persistent abnormality in the reduction and uptake of iron by the intestine in genetic haemochromatosis.

Effects of intestinal resection, cholecalciferol and ascorbic acid on iron metabolism in rats

The effect of dietary supplementation with ascorbic acid or cholecalciferol on Fe utilization was studied using the metabolic balance technique, in rats in which 50% of the distal small intestine was removed, or in which the mid small intestine was transected and reanastomosed (controls). Three different diets were used. The first (basal diet) contained (g/kg dry wt): protein (casein + 50 mg D,L-methionine/g) 120 and fat (medium-chain triacylglycerols, olive oil and sunflower oil, in equal parts) 40. The other diets were obtained by adding ascorbic acid (150 mg/kg diet) or cholecalciferol (0.4 mg/kg diet) to the basal diet. Apparent digestibility coefficient (ADC) and Fe retention were significantly lower in resected animals than in their respective control groups (transected rats). However, the addition of ascorbic acid or cholecalciferol to the basal diet increased the ADC and Fe retention in both transected and resected rats. Five weeks after surgery, resection also resulted in a reduced concentration of Fe in the sternum, but did not reduce the concentration of haemoglobin or serum Fe total Fe-binding capacity or the concentration of Fe in liver, testes, femur or muscle (longissimus dorsi). Supplementation with ascorbic acid increased serum Fe concentration, while the concentration of Fe in muscle was reduced by supplementation with both ascorbic acid and cholecalciferol. Neither supplementation had any effect on the Fe concentration in other tissues, on haemoglobin concentration or plasma total Fe-binding capacity. Thus, supplementation with ascorbic acid or with cholecalciferol increased Fe absorption and reduced the concentration of Fe in muscle.

Assessment of intestinal blood-flux by laser Doppler fluxmetry in mice with altered intestinal iron absorption

Laser Doppler fluxmetry (LDF) has been used to assess mucosal blood-flux in the intestine of normal CD1 mice and groups of animals with altered iron metabolism (i.e. iron-deficient, hypoxic and hypotransferrinaemic [hpx/hpx]). All experimental animals showed a 2-3-fold increase in duodenal iron absorption, mainly due to changes in the 'mucosal transfer' phase. However, only the hypoxic mice exhibited any increases in duodenal blood-flux. In the hpx/hpx group, blood flux was maintained at control levels despite the anaemia and without any significant alterations in red blood cell velocity. Moreover, these two groups demonstrated a further capacity to increase blood-flux above basal levels during onset of acute hypoxia (inhalation of 10% O2). Changes in duodenal blood-flux were apparent on both the mucosal and serosal surfaces, suggesting that the LDF signal reflects flux throughout the thickness of the mouse intestine. Iron absorption is likely to be more related to plasma flux changes than to blood-flux changes. Deduction of plasma flux changes from blood-flux changes is complicated by vasodilation effects on capillary haematocrits. It is clear from the data, however, that plasma flux changes do not parallel changes in iron absorption in the experimental models. The lack of correlation between the duodenal blood-flux and iron absorption values in the experimental models argues against the possible involvement of blood-flux in the control of duodenal iron absorption.

Effects of high volume and/or intense exercise on selected blood chemistry parameters

The goal of athletic training is to provide the body with a stimulus to adapt, increasing the capacity of the various systems to perform increased work loads. However, the magnitude of the stress must be large enough to induce the synthesis of new enzymes, tissues, and yet not so large that the biochemical and physiological processes of recovery are depressed. As each individual undergoes this process at a different rate, objective evaluation of the level of fatigue and adaptation is of enormous value in directing the training program of an athlete. The role of iron in the body is such that this element can be used as a marker of both adaptation to training and as an indicator of an acute inflammatory response to exercise. The various clinical measurements of iron in transport, storage, and in hematological parameters are discussed in this paper, relative to athletic populations. In addition expected changes in the level of the acute inflammatory protein, alpha 1-antitrypsin are also discussed relative to acute and chronic training protocols. Data is presented indicating that measurement of serum iron, transferrin, serum ferritin, and alpha 1-antitrypsin can be used to differentiate between an inflammatory response to tissue damage and infection. These parameters can also provide information as to the state of recovery, or lack thereof, experienced by an athlete to both acute and chronic training programs. The use of biochemical markers can help to avoid an overstress situation.

Use of genetic recombination as a reporter of gene expression

An understanding of the patterns of gene expression in response to specific environmental signals can yield insight into a variety of complex biological systems such as microbial-host interactions, developmental cycles, cellular differentiation, ontogeny, etc. To extend the utility of the reporter gene fusion approach to such studies, we have constructed a gene expression reporter cassette that permits the generation of transcriptional fusions to tnpR encoding resolvase, a site-specific recombinase of the transposable element gamma delta. Induction of the transcriptional fusions results in production of resolvase, which in turn, catalyzes excision of a linked tetracycline-resistance reporter gene flanked by direct repeats of res, the DNA sequences at which resolvase functions. The loss of tetracycline resistance in descendant bacteria serves as a permanent and heritable marker of prior gene expression. This gene fusion approach will allow us to assay the induction of gene expression in as few as one cell. Additionally, gene expression can be assayed at a later time and/or different place from the inducing environment facilitating the study of gene expression in complex environments such as animal tissues.

Drugs affecting the hematologic system of the performance horse

Pharmacologic alterations in the hematologic and rheologic properties of blood may have an important effect on transport and delivery of oxygen to working muscle during exercise. This article briefly reviews erythropoiesis, hematologic and rheologic responses to training and exercise, and the influence of these alterations on exercise performance. The hemorrheologic and performance effects of hematinics, hematopoietic stimulants, and alterations in blood rheology are discussed. The effects of exercise on blood coagulation, fibrinolysis and platelet function, and the effects of drugs that alter platelet function are briefly described.

Microcytic anemia. Differential diagnosis and management of iron deficiency anemia

Microcytic anemia is defined as the presence of small, often hypochromic, red blood cells in a peripheral blood smear and is usually characterized by a low MCV (less than 83 micron 3). Iron deficiency is the most common cause of microcytic anemia. The absence of iron stores in the bone marrow remains the most definitive test for differentiating iron deficiency from the other microcytic states, ie, anemia of chronic disease, thalassemia, and sideroblastic anemia. However, measurement of serum ferritin, iron concentration, transferrin saturation and iron-binding capacity, and, more recently, serum transferrin receptors may obviate proceeding to bone marrow evaluation. The human body maintains iron homeostasis by recycling the majority of its stores. Disruptions in this balance are commonly seen during menstruation, pregnancy, and gastrointestinal bleeding. Although the iron-absorptive capacity is able to increase upon feedback regarding total body iron stores or erythropoietic activity, this physiologic response is minimal. Significant iron loss requires replacement with iron supplements. The vast majority of patients respond effectively to inexpensive and usually well-tolerated oral iron preparations. In the rare circumstances of malabsorption, losses exceeding maximal oral replacement, or true intolerance, parenteral iron dextran is effective. In either form of treatment, it is necessary to replete iron stores in addition to correcting the anemia.

Effect of orally-administered epidermal growth factor on intestinal iron absorption and mucosal permeability

A progressive increase in intestinal 59Fe3+ absorption was observed on oral feeding of mice with physiological doses of EGF/UGO. Maximal changes were apparent after 3d and appeared to be dose-dependent. In addition to a small increase in intestinal cell proliferation, as reflected by increased ornithine decarboxylase activity, EGF/UGO-feeding increased mucosal permeability (evaluated with [51Cr]-EDTA): the latter could account for the increase in iron absorption. Sialoadenectomy, to remove the major source of endogenous EGF/UGO, had no appreciable effect on the intestinal absorption of iron.

Hepatic injury in chronic iron overload. Role of lipid peroxidation

In both hereditary hemochromatosis and in the various forms of secondary hemochromatosis, there is a pathologic expansion of body iron stores due mainly to an increase in absorption of dietary iron. Excess deposition of iron in the parenchymal tissues of several organs (e.g. liver, heart, pancreas, joints, endocrine glands) results in cell injury and functional insufficiency. In the liver, the major pathological manifestations of chronic iron overload are fibrosis and ultimately cirrhosis. Evidence for hepatotoxicity due to iron has been provided by several clinical studies, however the specific pathophysiologic mechanisms for hepatocellular injury and hepatic fibrosis in chronic iron overload are poorly understood. The postulated mechanisms of liver injury in chronic iron overload include (a) increased lysosomal membrane fragility, perhaps mediated by iron-induced lipid peroxidation, (b) peroxidative damage to mitochondria and microsomes resulting in organelle dysfunction, (c) a direct effect of iron on collagen biosynthesis and (d) a combination of all of the above.

In vivo studies on the relationship between intestinal iron (Fe3+) absorption, hypoxia and erythropoiesis in the mouse

The effect of hypoxia and changes in erythropoiesis on the absorption of 59Fe3+ from in situ tied-off duodenal segments was studied in the mouse. Hypoxia led to an increase in mucosal uptake within 6 h, whilst mucosal transfer was unaffected for about 20 h, suggesting independent regulation of these two processes. Hypoxia (3 d) stimulated erythropoiesis and resulted in a 2-3-fold increase in the total mucosal uptake of 59Fe. Conversely, hyperoxia (100% O2) caused a decrease in reticulocyte counts and the total mucosal uptake. The changes in the transfer of 59Fe from the mucosa to the body were more marked than changes in uptake in both hypoxia and hyperoxia. Mice subjected to subtotal nephrectomy showed a normal increase in the total mucosal uptake of 59Fe3+ following hypoxic exposure, despite the absence of any changes in the reticulocyte count. Obliteration of the erythroid tissue of animals by splenectomy and 89Sr treatment was accompanied by a marked decrease in the transfer of 59Fe from mucosa to the carcass. However, exposure of splenectomized 89Sr-treated mice to hypoxia resulted in an increase in the total mucosal uptake and carcass transfer of 59Fe, without any change in erythropoiesis. These results indicate that hypoxia enhances mucosal iron uptake by a mechanism which is independent of stimulated erythropoiesis, but that changes in the rate of erythropoiesis have an additional effect, particularly on the transfer phase of iron absorption.

Lipid peroxidation and associated hepatic organelle dysfunction in iron overload

Iron overload can have serious health consequences. Since humans lack an effective means to excrete excess iron, overload can result from an increased absorption of dietary iron or from parenteral administration of iron. When the iron burden exceeds the body's capacity for safe storage, the result is widespread damage to the liver, heart and joints, and the pancreas and other endocrine organs. Clear evidence is now available that iron overload leads to lipid peroxidation in experimental animals, if sufficiently high levels of iron are achieved. In contrast, there is a paucity of data regarding lipid peroxidation in patients with iron overload. Data from experiments using an animal model of dietary iron overload support the concept that iron overload results in an increase in an hepatic cytosolic pool of low molecular weight iron which is catalytically active in stimulating lipid peroxidation. Lipid peroxidation is associated with hepatic mitochondrial and microsomal dysfunction in experimental iron overload, and lipid peroxidation may underlie the increased lysosomal fragility that has been detected in homogenates of liver samples from both iron-loaded human subjects and experimental animals. Some current hypotheses focus on the possibility that the demonstrated functional abnormalities in organelles of the iron-loaded liver may play a pathogenic role in hepatocellular injury and eventual fibrosis. The recent demonstration that hepatic fibrosis is produced in animals with long-term dietary iron overload will allow this model to be used to further investigate the relationship between lipid peroxidation and hepatic injury in iron overload.