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Dinatolo E, Dasseni N, Metra M, Lombardi C, von Haehling S. Iron deficiency in heart failure. J Cardiovasc Med (Hagerstown) 2019; 19:706-716. [PMID: 30222663 DOI: 10.2459/jcm.0000000000000686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
: Due to aging of the patients with heart failure, comorbidities are an emerging problem and, among them, iron deficiency is an important therapeutic target, independently of concomitant hemoglobin level. Iron deficiency affects up to 50% of heart failure patients, and it has been largely established its association with poor quality of life, impaired exercise tolerance and higher mortality. Randomized controlled trials (RCTs) and meta-analyses have demonstrated that intravenous iron supplementation in heart failure patients with iron deficiency positively affects symptoms, quality of life, exercise tolerance (as measured by VO2 peak and 6MWT), with a global trend to reduction of hospitalization rates. Current European Society of Cardiology Guidelines for heart failure recommend a diagnostic work-up for iron deficiency in all heart failure patients and intravenous iron supplementation with ferric carboxymaltose for symptomatic patients with iron deficiency, defined by ferritin level less than 100 μg/l or by ferritin 100-300 μg/l with TSAT less than 20%. On-going studies will provide new evidence for a better treatment of this important comorbidity of heart failure patients.
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Affiliation(s)
- Elisabetta Dinatolo
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Nicolò Dasseni
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Carlo Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
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Murday HKM, Rusli FD, Blandy C, Vollenhoven B. Night sweats: it may be hemochromatosis. Climacteric 2016; 19:406-8. [DOI: 10.1080/13697137.2016.1191461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- H. K. M. Murday
- Final Year Medical Student, Monash University, Clayton Campus, Victoria, Australia
| | - F. D. Rusli
- Gastroenterologist, Centre for GI Health, Berwick, Victoria, Australia
| | - C. Blandy
- General Practitioner, Diploma in Obstetrics and Gynaecology, Jean Hailes Medical Centre, Clayton, Victoria, Australia
| | - B. Vollenhoven
- Head, Gynaecology, Monash Health and Deputy Head, Obstetrics and Gynaecology, Monash University, Monash IVF, Clayton, Victoria, Australia
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Assis RA, Kay FU, Conti FM, Campregher PV, Szarf G, Diniz MS, Rodrigues M, Helman R, Funari MB, Wood J, Hamerschlak N. The role of magnetic resonance imaging-T2* in the evaluation of iron overload early in hereditary hemochromatosis. A cross-sectional study with 159 patients. Am J Hematol 2015; 90:E220-1. [PMID: 26361371 DOI: 10.1002/ajh.24189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 09/04/2015] [Accepted: 09/09/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Reijâne A. Assis
- Department of Hematology; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Fernando U. Kay
- Imaging Departmemt; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Fabiana M. Conti
- Department of Hematology; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Paulo V. Campregher
- Department of Hematology; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Gilberto Szarf
- Imaging Departmemt; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Michelli S. Diniz
- Clinical Research Institute; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Morgani Rodrigues
- Department of Hematology; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Ricardo Helman
- Department of Hematology; Hospital Israelita Albert Einstein; São Paulo Brazil
| | | | - John Wood
- Division of Cardiology; University of Southern California, Children's Hospital; Los Angeles California
| | - Nelson Hamerschlak
- Department of Hematology; Hospital Israelita Albert Einstein; São Paulo Brazil
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Diego Quintaes K, Barberá R, Cilla A. Iron bioavailability in iron-fortified cereal foods: The contribution of in vitro studies. Crit Rev Food Sci Nutr 2015; 57:2028-2041. [DOI: 10.1080/10408398.2013.866543] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | - Reyes Barberá
- Nutrition and Food Chemistry, Faculty of Pharmacy, University of Valencia, Burjassot, Valencia, Spain
| | - Antonio Cilla
- Nutrition and Food Chemistry, Faculty of Pharmacy, University of Valencia, Burjassot, Valencia, Spain
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The iron-regulatory hormone hepcidin: A possible therapeutic target? Pharmacol Ther 2015; 146:35-52. [DOI: 10.1016/j.pharmthera.2014.09.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 01/19/2023]
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Bolann BJ, Distante S, Mørkrid L, Ulvik RJ. Bloodletting therapy in hemochromatosis: Does it affect trace element homeostasis? J Trace Elem Med Biol 2015; 31:225-9. [PMID: 25175510 DOI: 10.1016/j.jtemb.2014.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 07/02/2014] [Accepted: 07/31/2014] [Indexed: 12/20/2022]
Abstract
Hemochromatosis is the most common hereditary disorder in the Nordic population, if left untreated it can result in severe parenchymal iron accumulation. Bloodletting is mainstay treatment. Iron and trace elements partially share cellular uptake and transport mechanisms, and the aim of the present study was to see if bloodletting for hemochromatosis affects trace elements homeostasis. We recruited patients referred for diagnosis and treatment of hemochromatosis, four women and 22 men 23-68 years of age. Thirteen were C282Y homozygote, one was C282Y heterozygote, three were H63D homozygote, seven were compound heterozygote and two had none of the mutations above. Iron and liver function tests were performed; serum levels of trace elements were measured using inductively coupled plasma mass spectrometry. Results before the start of treatment and after normalization of iron parameters were compared. On completion of the bloodlettings the following average serum concentrations increased: Co from 5.6 to 11.5 nmol/L, serum Cu 16.2-17.6 μmol/L, Ni increased from 50.0 to 52.6 nmol/L and Sb from 13.2 to 16.3 nmol/L. Average serum Mn concentration declined from 30.2 to 28.3 nmol/L. All changes were statistically significant (by paired t-test). B, Ba, Cs, Mo, Se, Sr and Zn were not significantly changed. We conclude that bloodlettings in hemochromatosis lead to changes in trace element metabolism, including increased absorption of potentially toxic elements.
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Affiliation(s)
- Bjørn J Bolann
- Department of Clinical Science, University of Bergen, Bergen, Norway; Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.
| | - Sonia Distante
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Lars Mørkrid
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Rune J Ulvik
- Department of Clinical Science, University of Bergen, Bergen, Norway; Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
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Oliveira F, Rocha S, Fernandes R. Iron metabolism: from health to disease. J Clin Lab Anal 2014; 28:210-8. [PMID: 24478115 DOI: 10.1002/jcla.21668] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 07/24/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Iron is vital for almost all living organisms by participating in a wide range of metabolic processes. However, iron concentration in body tissues must be tightly regulated since excessive iron may lead to microbial infections or cause tissue damage. Disorders of iron metabolism are among the most common human diseases and cover several conditions with varied clinical manifestations. METHODS An extensive literature review on the basic aspects of iron metabolism was performed, and the most recent findings on this field were highlighted as well. RESULTS New insights on iron metabolism have shed light into its real complexity, and its role in both healthy and pathological states has been recognized. Important discoveries about the iron regulatory machine and imbalances in its regulation have been made, which may lead in a near future to the development of new therapeutic strategies against iron disorders. Besides, the toxicity of free iron and its association with several pathologies has been addressed, although it requires further investigations. CONCLUSION This review will provide students in the fields of biochemistry and health sciences a brief and clear overview of iron physiology and toxicity, as well as imbalances in the iron homeostasis and associated pathological conditions.
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Affiliation(s)
- Fernando Oliveira
- Ciências Químicas e das Biomoléculas e Unidade de Mecanismos Moleculares da Doença do Centro de Investigação em Saúde e Ambiente, Escola Superior de Tecnologia da Saúde do Porto, Instituto Politécnico do Porto, Portugal
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Fagiuoli S, Daina E, D'Antiga L, Colledan M, Remuzzi G. Monogenic diseases that can be cured by liver transplantation. J Hepatol 2013; 59:595-612. [PMID: 23578885 DOI: 10.1016/j.jhep.2013.04.004] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 04/02/2013] [Accepted: 04/02/2013] [Indexed: 02/08/2023]
Abstract
While the prevalence of most diseases caused by single-gene mutations is low and defines them as rare conditions, all together, monogenic diseases account for approximately 10 in every 1000 births according to the World Health Organisation. Orthotopic liver transplantation (LT) could offer a therapeutic option in monogenic diseases in two ways: by substituting for an injured liver or by supplying a tissue that can replace a mutant protein. In this respect, LT may be regarded as the correction of a disease at the level of the dysfunctional protein. Monogenic diseases that involve the liver represent a heterogeneous group of disorders. In conditions associated with predominant liver parenchymal damage (i.e., genetic cholestatic disorders, Wilson's disease, hereditary hemochromatosis, tyrosinemia, α1 antitrypsin deficiency), hepatic complications are the major source of morbidity and LT not only replaces a dysfunctional liver but also corrects the genetic defect and effectively cures the disease. A second group includes liver-based genetic disorders characterised by an architecturally near-normal liver (urea cycle disorders, Crigler-Najjar syndrome, familial amyloid polyneuropathy, primary hyperoxaluria type 1, atypical haemolytic uremic syndrome-1). In these defects, extrahepatic complications are the main source of morbidity and mortality while liver function is relatively preserved. Combined transplantation of other organs may be required, and other surgical techniques, such as domino and auxiliary liver transplantation, have been attempted. In a third group of monogenic diseases, the underlying genetic defect is expressed at a systemic level and liver involvement is just one of the clinical manifestations. In these conditions, LT might only be partially curative since the abnormal phenotype is maintained by extrahepatic synthesis of the toxic metabolites (i.e., methylmalonic acidemia, propionic acidemia). This review focuses on principles of diagnosis, management and LT results in both paediatric and adult populations of selected liver-based monogenic diseases, which represent examples of different transplantation strategies, driven by the understanding of the expression of the underlying genetic defect.
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Affiliation(s)
- Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
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Santos PCJDL, Dinardo CL, Cançado RD, Schettert IT, Krieger JE, Pereira AC. Non-HFE hemochromatosis. Rev Bras Hematol Hemoter 2012; 34:311-6. [PMID: 23049448 PMCID: PMC3460409 DOI: 10.5581/1516-8484.20120079] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 07/10/2012] [Indexed: 12/15/2022] Open
Abstract
Hereditary hemochromatosis (HH) is an autosomal recessive disorder classically related to HFE mutations. However, since 1996, it is known that HFE mutations explain about 80% of HH cases, with the remaining around 20% denominated non-HFE hemochromatosis. Nowadays, four main genes are implicated in the pathophysiology of clinical syndromes classified as non-HFE hemochromatosis: hemojuvelin (HJV, type 2Ajuvenile HH), hepcidin (HAMP, type 2B juvenile HH), transferrin receptor 2 (TFR2, type 3 HH) and ferroportin (SLC40A1, type 4 HH). The aim of this review is to explore molecular, clinical and management aspects of non-HFE hemochromatosis.
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Escobar-Morreale HF. Iron metabolism and the polycystic ovary syndrome. Trends Endocrinol Metab 2012; 23:509-15. [PMID: 22579050 DOI: 10.1016/j.tem.2012.04.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 04/11/2012] [Accepted: 04/12/2012] [Indexed: 01/17/2023]
Abstract
The polycystic ovary syndrome (PCOS) is associated with insulin resistance and abnormal glucose tolerance. Iron overload may lead also to insulin resistance and diabetes. Serum ferritin levels are increased in PCOS, especially when glucose tolerance is abnormal, suggesting mild iron overload. Factors contributing to potential iron overload in PCOS include the iron sparing effect of chronic menstrual dysfunction, insulin resistance, and a decrease in hepcidin leading to increased iron absorption. Enhancement of erythropoiesis by androgen excess is unlikely, because soluble transferrin receptor levels are not increased in PCOS. Future venues of research should address the long-term effects of PCOS treatment on iron overload and, conversely, the possible effects of iron lowering strategies on the glucose tolerance of patients with PCOS.
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Affiliation(s)
- Héctor F Escobar-Morreale
- Diabetes, Obesity and Human Reproduction Research Group, University of Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM & Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Carretera de Colmenar km 9'1, E-28034 Madrid, Spain.
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IRON STORAGE DISORDERS IN CAPTIVE WILD MAMMALS: THE COMPARATIVE EVIDENCE. J Zoo Wildl Med 2012; 43:S6-18. [DOI: 10.1638/2011-0152.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Adler RA. Laboratory testing for secondary osteoporosis evaluation. Clin Biochem 2012; 45:894-900. [DOI: 10.1016/j.clinbiochem.2012.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 01/23/2012] [Accepted: 01/24/2012] [Indexed: 01/10/2023]
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Abstract
PURPOSE OF REVIEW Nearly half of patients presenting with heart failure have a preserved left ventricular ejection fraction (LVEF), previously known as diastolic heart failure. The diagnosis requires fulfillment of three criteria: signs or symptoms of heart failure, presence of a normal LVEF, and evidence of diastolic dysfunction. Two of the criteria can be evaluated by echocardiography. This article reviews the echocardiographic approach to the patient with suspected heart failure with a normal left ventricular ejection fraction (HFNEF). RECENT FINDINGS Echocardiography is the primary modality for evaluating left ventricular (LV) systolic and diastolic function in heart failure patients. Measurements of LVEF from two-dimensional echocardiography can have significant variability despite the use of quantitative methods. The use of contrast agents and three-dimensional echocardiography can improve the accuracy. Newer modalities of tissue Doppler imaging and deformation imaging are challenging the concept that systolic function is preserved in HFNEF. Evaluation of diastolic function with echocardiography requires a comprehensive approach using multiple modalities to quantitate transmitral flow, pulmonary venous flow, mitral annular motion, myocardial deformation, and cardiac structure. The clinical applicability of parameters used for evaluating diastolic function and filling pressures is dependent on the LVEF, necessitating a unique approach in patients with suspected HFNEF. SUMMARY A comprehensive examination with knowledge of the potential limitations of echocardiography is required to accurately interpret LV systolic and diastolic function in patients with suspected HFNEF.
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Evaluation of MR imaging with T1 and T2* mapping for the determination of hepatic iron overload. Eur Radiol 2012; 22:2478-86. [PMID: 22645044 DOI: 10.1007/s00330-012-2506-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 03/30/2012] [Accepted: 04/15/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate MRI using T1 and T2* mapping sequences in patients with suspected hepatic iron overload (HIO). METHODS Twenty-five consecutive patients with clinically suspected HIO were retrospectively studied. All underwent MRI and liver biopsy. For the quantification of liver T2* values we used a fat-saturated multi-echo gradient echo sequence with 12 echoes (TR = 200 ms, TE = 0.99 ms + n × 1.41 ms, flip angle 20°). T1 values were obtained using a fast T1 mapping sequence based on an inversion recovery snapshot FLASH sequence. Parameter maps were analysed using regions of interest. RESULTS ROC analysis calculated cut-off points at 10.07 ms and 15.47 ms for T2* in the determination of HIO with accuracy 88 %/88 %, sensitivity 84 %/89.5 % and specificity 100 %/83 %. MRI correctly classified 20 patients (80 %). All patients with HIO only had decreased T1 and T2* relaxation times. There was a significant difference in T1 between patients with HIO only and patients with HIO and steatohepatitis (P = 0.018). CONCLUSIONS MRI-based T2* relaxation diagnoses HIO very accurately, even at low iron concentrations. Important additional information may be obtained by the combination of T1 and T2* mapping. It is a rapid, non-invasive, accurate and reproducible technique for validating the evidence of even low hepatic iron concentrations. KEY POINTS • Hepatic iron overload causes fibrosis, cirrhosis and increases hepatocellular carcinoma risk. • MRI detects iron because of the field heterogeneity generated by haemosiderin. • T2* relaxation is very accurate in diagnosing hepatic iron overload. • Additional information may be obtained by T1 and T2* mapping.
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Szőke D, Panteghini M. Diagnostic value of transferrin. Clin Chim Acta 2012; 413:1184-9. [PMID: 22546612 DOI: 10.1016/j.cca.2012.04.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/16/2012] [Accepted: 04/17/2012] [Indexed: 12/12/2022]
Abstract
Despite the growing interest in hepcidin and other relatively new biomarkers, guidelines and clinical pathways continue to recommend traditional markers, such as serum transferrin (Tf) and ferritin, as laboratory tests for the diagnostic evaluation of iron-related disorders. In this study, we aimed to critically evaluate the diagnostic role of Tf relying on the highest level of available evidence by a comprehensive literature search. The role of Tf in iron deficiency (ID) and iron overload (IO) syndrome as well as a risk marker was evaluated. The low accuracy of Tf and Tf saturation (TS) in the diagnosis and management of ID conditions does not permit definitively recommending their use, even if recently published guidelines still consider the TS investigation as a complementary test for ferritin. If a tissue IO is suspected, TS is often used, even if it may not be the best test for detecting this condition. Nevertheless, clinical guidelines strongly recommend the use of TS as a first-level test for performing genetic diagnosis of hereditary hemochromatosis. Recently reported data indicating elevated TS as a risk factor for diabetes mellitus, cancer, and total mortality, may provide useful additions to the debate over whether or not to screen for IO using TS.
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Affiliation(s)
- Dominika Szőke
- Cattedra di Biochimica Clinica e Biologia Molecolare Clinica, Dipartimento di Scienze Cliniche Luigi Sacco, Università degli Studi, Milano, Italy.
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Molecular diagnostic and pathogenesis of hereditary hemochromatosis. Int J Mol Sci 2012; 13:1497-1511. [PMID: 22408404 PMCID: PMC3291973 DOI: 10.3390/ijms13021497] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 01/12/2012] [Accepted: 01/13/2012] [Indexed: 12/15/2022] Open
Abstract
Hereditary hemochromatosis (HH) is an autosomal recessive disorder characterized by enhanced intestinal absorption of dietary iron. Without therapeutic intervention, iron overload leads to multiple organ damage such as liver cirrhosis, cardiomyopathy, diabetes, arthritis, hypogonadism and skin pigmentation. Most HH patients carry HFE mutant genotypes: homozygosity for p.Cys282Tyr or p.Cys282Tyr/p.His63Asp compound heterozygosity. In addition to HFE gene, mutations in the genes that encode hemojuvelin (HJV), hepcidin (HAMP), transferrin receptor 2 (TFR2) and ferroportin (SLC40A1) have been associated with regulation of iron homeostasis and development of HH. The aim of this review was to identify the main gene mutations involved in the pathogenesis of type 1, 2, 3 and 4 HH and their genetic testing indication. HFE testing for the two main mutations (p.Cys282Tyr and p.His63Asp) should be performed in all patients with primary iron overload and unexplained increased transferrin saturation and/or serum ferritin values. The evaluation of the HJV p.Gly320Val mutation must be the molecular test of choice in suspected patients with juvenile hemochromatosis with less than 30 years and cardiac or endocrine manifestations. In conclusion, HH is an example that genetic testing can, in addition to performing the differential diagnostic with secondary iron overload, lead to more adequate and faster treatment.
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