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Bäckström F, Chmielewska A, Domellöf M, Berglund SK. Normal range and predictors of serum erythroferrone in infants. Pediatr Res 2023; 94:965-970. [PMID: 37069224 PMCID: PMC10444606 DOI: 10.1038/s41390-023-02594-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Erythroferrone (ERFE) has been identified as a hepcidin-regulating hormone synthetized by erythroblasts correlating to the erythropoietic activity and the needs for iron substrate in bone marrow of adults. The present study aimed to assess the ERFE serum concentrations and its predictors in infants. METHODS ERFE was explored at 4 time points during the first year of life in 45 healthy, breastfed, normal birth weight (NBW) infants, and 136 marginally low birth weight infants (LBW, 2000-2500 g) receiving iron (N = 58) or placebo (N = 78) between 6 weeks and 6 months of age. RESULTS ERFE concentrations were low at birth, increasing gradually during the first year of life. In NBW infants, reference ranges (5th to 95th percentile) were at 6 weeks <0.005-0.99 ng/mL and at 12 months <0.005-33.7 ng/mL. ERFE was higher in LBW infants at 6 weeks but lower at 12 months compared to NBW and minimally affected by iron supplementation among LBW infants. Correlations of ERFE with erythropoietic and iron status markers were weak and inconsistent. CONCLUSIONS The role of ERFE in the crosstalk of erythropoiesis and iron homeostasis remains unclear in infants and further studies on ERFE in infants and older children are warranted within the framework of the erythropoietin-ERFE-hepcidin axis. IMPACT Normal range of erythroferrone in healthy infants is described for the first time. Erythroferrone in infants lacks correlation to iron status and markers of erythropoiesis. The findings indicate differences in infant regulation of iron homeostasis as compared to adults. The findings point to a need to study infant erythropoiesis separately from its adult counterpart. The findings may have clinical impact on management strategies of iron-loading anemia in infancy.
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Affiliation(s)
- Fredrik Bäckström
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Anna Chmielewska
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Staffan K Berglund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
- Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden.
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Serum erythroferrone levels during the first month of life in premature infants. J Perinatol 2022; 42:97-102. [PMID: 34376791 DOI: 10.1038/s41372-021-01184-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine erythroferrone (ERFE)-hepcidin iron regulation in premature infants under intensive care at risk of iron metabolic disorders. STUDY DESIGN A retrospective cohort recruited 31 infants with a birth weight of <1500 g hospitalized in a tertiary center. Their hematological status was measured at birth and 2 and 4 weeks of life. RESULTS ERFE was positively correlated with the reticulocyte hemoglobin content at 2 (r2 = 0.2374) and 4 weeks (r2 = 0.6005). An assumed negative correlation between ERFE and hepcidin was not determined during the neonatal period. Hepcidin was positively correlated with the leukocyte count (r2 = 0.3089) and ferritin (r2 = 0.7476) at birth and C-reactive protein (r2 = 0.3591) at 2 weeks and negatively correlated with the reticulocyte count (r2 = 0.2887) at 4 weeks. CONCLUSION The vulnerability of the ERFE-hepcidin pathway within 4 weeks may contribute to iron imbalance in premature infants.
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王 燕, 黎 青, 孙 筱, 李 少, 何 健, 张 敏, 黄 玲, 何 文. [Whole exome sequencing analysis of compound heterozygous variants of CDAN1 gene in a Chinese family with non-immune hydrops fetalis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1899-1903. [PMID: 35012925 PMCID: PMC8752423 DOI: 10.12122/j.issn.1673-4254.2021.12.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To study the clinical characteristics and genetic variants in a family with non-immune hydrops fetalis. METHODS Peripheral blood samples were collected from a pregnant woman with suspected non-immune hydrops fetalis of the fetus for routine blood analysis, Rh typing and TORCH test. Amniotic fluid sample was collected for G-banded chromosomal karyotyping. The genomic DNA of the proband was extracted for analysis of chromosomal abnormalities using copy number variation sequencing. Whole-exome sequencing (Trios-WES) was performed on Illumina NovaSeq 6000 platform and exonic DNA was enriched using Agilent Sure Select XT Human All Exon V6. Sorting intolerant from tolerant (SIFT), I-mutant2, PolyPhen-2 and PROVEAN were used to predict the potential effects of amino acid substitution on protein function and splicing variation. The spatial structure of codanin-1 was modeled and visualized with Alpha Fold 2 and PyMOL 2.3 software, and the variants with potential clinical significance were confirmed by Sanger sequencing. RESULTS Fetal ultrasound at 17 weeks of gestation showed extensive subcutaneous edema, ascites, pleural effusion, enlarged liver and spleen, thickened placenta and pericardium defect. NGS reveals that proband has carried c.2140C>T, p.R714W, and c.1264_1265delCT, p.L422* compound heterozygous variants of CDAN1 gene, which were found to be pathogenic and inherited from proband's father and mother respectively. CONCLUSION We identified a novel heterozygous CDAN1 gene mutation causing fetal-onset congenital dyserythropoietic anemia type 1, which triggers non-immune hydrops fetalis.
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Affiliation(s)
- 燕超 王
- 广州医科大学附属第三医院妇产科研究所实验部,广东 广州 510150Experimental Department of Institute of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
- 广东省产科重大疾病重点实验室,广东 广州 510150Key Laboratory for Major Obstetrics Diseases of Guangdong Province, Guangzhou 510150, China
- 广东省普通高校生殖与遗传重点实验室,广东 广州 510150Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou 510150, China
| | - 青 黎
- 广州医科大学附属第三医院妇产科研究所实验部,广东 广州 510150Experimental Department of Institute of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
- 广东省产科重大疾病重点实验室,广东 广州 510150Key Laboratory for Major Obstetrics Diseases of Guangdong Province, Guangzhou 510150, China
- 广东省普通高校生殖与遗传重点实验室,广东 广州 510150Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou 510150, China
| | - 筱放 孙
- 广州医科大学附属第三医院妇产科研究所实验部,广东 广州 510150Experimental Department of Institute of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
- 广东省产科重大疾病重点实验室,广东 广州 510150Key Laboratory for Major Obstetrics Diseases of Guangdong Province, Guangzhou 510150, China
- 广东省普通高校生殖与遗传重点实验室,广东 广州 510150Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou 510150, China
| | - 少英 李
- 广州医科大学附属第三医院妇产科研究所实验部,广东 广州 510150Experimental Department of Institute of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
- 广东省产科重大疾病重点实验室,广东 广州 510150Key Laboratory for Major Obstetrics Diseases of Guangdong Province, Guangzhou 510150, China
- 广东省普通高校生殖与遗传重点实验室,广东 广州 510150Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou 510150, China
| | - 健淳 何
- 广州医科大学附属第三医院妇产科研究所实验部,广东 广州 510150Experimental Department of Institute of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
- 广东省普通高校生殖与遗传重点实验室,广东 广州 510150Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou 510150, China
| | - 敏聪 张
- 广州医科大学附属第三医院妇产科研究所实验部,广东 广州 510150Experimental Department of Institute of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
| | - 玲玲 黄
- 广州医科大学附属第三医院妇产科研究所实验部,广东 广州 510150Experimental Department of Institute of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
| | - 文智 何
- 广州医科大学附属第三医院妇产科研究所实验部,广东 广州 510150Experimental Department of Institute of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
- 广东省产科重大疾病重点实验室,广东 广州 510150Key Laboratory for Major Obstetrics Diseases of Guangdong Province, Guangzhou 510150, China
- 广东省普通高校生殖与遗传重点实验室,广东 广州 510150Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou 510150, China
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Congenital dyserythropoietic anemia type I: First report from the Congenital Dyserythropoietic Anemia Registry of North America (CDAR). Blood Cells Mol Dis 2020; 87:102534. [PMID: 33401150 DOI: 10.1016/j.bcmd.2020.102534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/19/2020] [Accepted: 12/19/2020] [Indexed: 12/17/2022]
Abstract
Congenital dyserythropoietic anemias (CDAs) are characterized by ineffective erythropoiesis and distinctive erythroblast abnormalities; the diagnosis is often missed or delayed due to significant phenotypic heterogeneity. We established the CDA Registry of North America (CDAR) to study the natural history of CDA and create a biorepository to investigate the pathobiology of this heterogeneous disease. Seven of 47 patients enrolled so far in CDAR have CDA-I due to biallelic CDAN1 mutations. They all presented with perinatal anemia and required transfusions during infancy. Anemia spontaneously improved during infancy in three patients; two became transfusion-independent rapidly after starting interferon-α2; and two remain transfusion-dependent at last follow-up at ages 5 and 30 y.o. One of the transfusion-dependent patients underwent splenectomy at 11 y.o due to misdiagnosis and returned to medical attention at 27 y.o with severe hemolytic anemia and pulmonary hypertension. All patients developed iron overload even without transfusions; four were treated with chelation. Genetic testing allowed for more rapid and accurate diagnosis; the median age of confirmed diagnosis in our cohort was 3 y.o compared to 17.3 y.o historically. In conclusion, CDAR provides an organized research network for multidisciplinary clinical and research collaboration to conduct natural history and biologic studies in CDA.
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Abstract
Congenital dyserythropoietic anaemia type I (CDA-I) is one of a heterogeneous group of inherited anaemias characterised by ineffective erythropoiesis. CDA-I is caused by bi-allelic mutations in either CDAN1 or C15orf41 and, to date, 56 causative mutations have been documented. The diagnostic pathway is reviewed and the utility of genetic testing in reducing the time taken to reach an accurate molecular diagnosis and avoiding bone marrow aspiration, where possible, is described. The management of CDA-I patients is discussed, highlighting both general and specific measures which impact on disease progression. The use of interferon alpha and careful management of iron overload are reviewed and suggest the most favourable outcomes are achieved when CDA-I patients are managed with a holistic and multidisciplinary approach. Finally, the current understanding of the molecular and cellular pathogenesis of CDA-I is presented, highlighting critical questions likely to lead to improved therapy for this disease.
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Affiliation(s)
- Noémi B. A. Roy
- MRC Molecular Haematology UnitMRC Weatherall Institute of Molecular MedicineUniversity of OxfordOxfordUK
- BRC Blood Theme and BRC/NHS Translational Molecular Diagnostics CentreJohn Radcliffe HospitalOxfordUK
- Oxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxfordUK
| | - Christian Babbs
- MRC Molecular Haematology UnitMRC Weatherall Institute of Molecular MedicineUniversity of OxfordOxfordUK
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