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Vlasveld LT, Janssen R, Bardou-Jacquet E, Venselaar H, Hamdi-Roze H, Drakesmith H, Swinkels DW. Twenty Years of Ferroportin Disease: A Review or An Update of Published Clinical, Biochemical, Molecular, and Functional Features. Pharmaceuticals (Basel) 2019; 12:ph12030132. [PMID: 31505869 PMCID: PMC6789780 DOI: 10.3390/ph12030132] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 12/14/2022] Open
Abstract
Iron overloading disorders linked to mutations in ferroportin have diverse phenotypes in vivo, and the effects of mutations on ferroportin in vitro range from loss of function (LOF) to gain of function (GOF) with hepcidin resistance. We reviewed 359 patients with 60 ferroportin variants. Overall, macrophage iron overload and low/normal transferrin saturation (TSAT) segregated with mutations that caused LOF, while GOF mutations were linked to high TSAT and parenchymal iron accumulation. However, the pathogenicity of individual variants is difficult to establish due to the lack of sufficiently reported data, large inter-assay variability of functional studies, and the uncertainty associated with the performance of available in silico prediction models. Since the phenotypes of hepcidin-resistant GOF variants are indistinguishable from the other types of hereditary hemochromatosis (HH), these variants may be categorized as ferroportin-associated HH, while the entity ferroportin disease may be confined to patients with LOF variants. To further improve the management of ferroportin disease, we advocate for a global registry, with standardized clinical analysis and validation of the functional tests preferably performed in human-derived enterocytic and macrophagic cell lines. Moreover, studies are warranted to unravel the definite structure of ferroportin and the indispensable residues that are essential for functionality.
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Affiliation(s)
- L Tom Vlasveld
- Department of Internal Medicine, Haaglanden MC-Bronovo, 2597AX The Hague, The Netherlands
| | - Roel Janssen
- Department of Laboratory Medicine, Translational Metabolic Laboratory, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Edouard Bardou-Jacquet
- Liver Diseases Department, French Reference Centre for Rare Iron Overload Diseases of Genetic Origin, University Hospital Pontchaillou, 35033 Rennes, France
| | - Hanka Venselaar
- Centre for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences, Radboud, University Medical Center, P.O. Box 9191, 6500 HB Nijmegen, The Netherlands
| | - Houda Hamdi-Roze
- Molecular Genetics Department, French Reference Centre for Rare Iron Overload Diseases of Genetic Origin, University Hospital Pontchaillou, 35033 Rennes, France
| | - Hal Drakesmith
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX39DS, UK
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Translational Metabolic Laboratory, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Ka C, Guellec J, Pepermans X, Kannengiesser C, Ged C, Wuyts W, Cassiman D, de Ledinghen V, Varet B, de Kerguenec C, Oudin C, Gourlaouen I, Lefebvre T, Férec C, Callebaut I, Le Gac G. The SLC40A1 R178Q mutation is a recurrent cause of hemochromatosis and is associated with a novel pathogenic mechanism. Haematologica 2018; 103:1796-1805. [PMID: 30002125 PMCID: PMC6278975 DOI: 10.3324/haematol.2018.189845] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 07/06/2018] [Indexed: 12/29/2022] Open
Abstract
Hemochromatosis type 4 is one of the most common causes of primary iron overload, after HFE-related hemochromatosis. It is an autosomal dominant disorder, primarily due to missense mutations in SLC40A1. This gene encodes ferroportin 1 (FPN1), which is the sole iron export protein reported in mammals. Not all heterozygous missense mutations in SLC40A1 are disease-causing. Due to phenocopies and an increased demand for genetic testing, rare SLC40A1 variations are fortuitously observed in patients with a secondary cause of hyperferritinemia. Structure/function analysis is the most effective way of establishing causality when clinical and segregation data are lacking. It can also provide important insights into the mechanism of iron egress and FPN1 regulation by hepcidin. The present study aimed to determine the pathogenicity of the previously reported p.Arg178Gln variant. We present the biological, clinical, histological and radiological findings of 22 patients from six independent families of French, Belgian or Iraqi decent. Despite phenotypic variability, all patients with p.Arg178Gln had elevated serum ferritin concentrations and normal to low transferrin saturation levels. In vitro experiments demonstrated that the p.Arg178Gln mutant reduces the ability of FPN1 to export iron without causing protein mislocalization. Based on a comparative model of the 3D structure of human FPN1 in an outward facing conformation, we argue that p.Arg178 is part of an interaction network modulating the conformational changes required for iron transport. We conclude that p.Arg178Gln represents a new category of loss-of-function mutations and that the study of “gating residues” is necessary in order to fully understand the action mechanism of FPN1.
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Affiliation(s)
- Chandran Ka
- UMR1078, INSERM, Université Bretagne Loire - Université de Bretagne Occidentale, Etablissement Français du Sang - Bretagne, Institut Brestois Santé-Agro-Matière, Brest, France.,Laboratoire de Génétique Moléculaire et Histocompatibilité, CHRU de Brest, Hôpital Morvan, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Julie Guellec
- UMR1078, INSERM, Université Bretagne Loire - Université de Bretagne Occidentale, Etablissement Français du Sang - Bretagne, Institut Brestois Santé-Agro-Matière, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France.,Association Gaetan Saleun, Brest, France
| | - Xavier Pepermans
- Center for Human Genetics, University Hospital of St-Luc, Brussels, Belgium
| | - Caroline Kannengiesser
- Laboratory of Excellence GR-Ex, Paris, France.,UMR1149, INSERM, Centre de Recherche sur l'Inflammation, Université Paris Diderot, AP-HP, Hôpital Bichat, Département de Génétique, France.,On behalf of the French National Network for the Molecular Diagnosis of Inherited Iron Overload Disorders (J. Rochette, E. Cadet, C. Kannengiesser, H. Puy, C. Ged, H. de Verneuil, G. Le Gac, C. Férec, S. Pissard, V. Gérolami), Brest, France
| | - Cécile Ged
- On behalf of the French National Network for the Molecular Diagnosis of Inherited Iron Overload Disorders (J. Rochette, E. Cadet, C. Kannengiesser, H. Puy, C. Ged, H. de Verneuil, G. Le Gac, C. Férec, S. Pissard, V. Gérolami), Brest, France.,INSERM U1035, BMGIC, CHU de Bordeaux, Laboratoire de Biochimie et Biologie Moléculaire, France
| | - Wim Wuyts
- Department of Medical Genetics, University and University Hospital of Antwerp, Edegem, Belgium
| | - David Cassiman
- Department of Gastroenterology-Hepatology and Metabolic Center, University Hospital of Leuven, Belgium
| | - Victor de Ledinghen
- Department of Gastroenterology and Digestive Oncology, University Hospital of Bordeaux, France
| | - Bruno Varet
- Université Paris Descartes et AP-HP, Hôpital Necker, Service d'Hématologie, France
| | | | - Claire Oudin
- UMR1149, INSERM, Centre de Recherche sur l'Inflammation, Université Paris Diderot, AP-HP, Hôpital Bichat, Département de Génétique, France
| | - Isabelle Gourlaouen
- UMR1078, INSERM, Université Bretagne Loire - Université de Bretagne Occidentale, Etablissement Français du Sang - Bretagne, Institut Brestois Santé-Agro-Matière, Brest, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Thibaud Lefebvre
- UMR1149, INSERM, Centre de Recherche sur l'Inflammation, Université Paris Diderot, AP-HP, Hôpital Bichat, Département de Génétique, France
| | - Claude Férec
- UMR1078, INSERM, Université Bretagne Loire - Université de Bretagne Occidentale, Etablissement Français du Sang - Bretagne, Institut Brestois Santé-Agro-Matière, Brest, France.,Laboratoire de Génétique Moléculaire et Histocompatibilité, CHRU de Brest, Hôpital Morvan, France.,On behalf of the French National Network for the Molecular Diagnosis of Inherited Iron Overload Disorders (J. Rochette, E. Cadet, C. Kannengiesser, H. Puy, C. Ged, H. de Verneuil, G. Le Gac, C. Férec, S. Pissard, V. Gérolami), Brest, France
| | - Isabelle Callebaut
- UMR7590, CNRS, Sorbonne Universités, Université Pierre et Marie Curie-Paris, France
| | - Gérald Le Gac
- UMR1078, INSERM, Université Bretagne Loire - Université de Bretagne Occidentale, Etablissement Français du Sang - Bretagne, Institut Brestois Santé-Agro-Matière, Brest, France .,Laboratoire de Génétique Moléculaire et Histocompatibilité, CHRU de Brest, Hôpital Morvan, France.,Laboratory of Excellence GR-Ex, Paris, France.,On behalf of the French National Network for the Molecular Diagnosis of Inherited Iron Overload Disorders (J. Rochette, E. Cadet, C. Kannengiesser, H. Puy, C. Ged, H. de Verneuil, G. Le Gac, C. Férec, S. Pissard, V. Gérolami), Brest, France
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Brissot P, Bernard DG, Brissot E, Loréal O, Troadec MB. Rare anemias due to genetic iron metabolism defects. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2018; 777:52-63. [PMID: 30115430 DOI: 10.1016/j.mrrev.2018.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/05/2018] [Accepted: 06/21/2018] [Indexed: 01/19/2023]
Abstract
Anemia is defined by a deficiency of hemoglobin, an iron-rich protein that binds oxygen in the blood. It can be due to multiple causes, either acquired or genetic. Alterations of genes involved in iron metabolism may be responsible, usually at a young age, for rare forms of chronic and often severe congenital anemia. These diseases encompass a variety of sideroblastic anemias, characterized by the presence of ring sideroblasts in the bone marrow. Clinical expression of congenital sideroblastic anemia is either monosyndromic (restricted to hematological lineages) or polysyndromic (with systemic expression), depending on whether iron metabolism, and especially heme synthesis, is directly or indirectly affected. Beside sideroblastic anemias, a number of other anemias can develop due to mutations of key proteins acting either on cellular iron transport (such as the DMT1 transporter), plasma iron transport (transferrin), and iron recycling (ceruloplasmin). Contrasting with the aforementioned entities which involve compartmental, and sometimes, systemic iron excess, the iron refractory iron deficiency anemia (IRIDA) corresponds to a usually severe anemia with whole body iron deficiency related to chronic increase of plasma hepcidin, the systemic negative regulator of plasma iron. Once clinically suggested, these diseases are confirmed by genetic testing in specialized laboratories.
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Affiliation(s)
- Pierre Brissot
- INSERM, Univ Rennes, INRA, Institut NUMECAN (Nutrition, Metabolisms and Cancer), UMR_S 1241, F-35000 Rennes, France.
| | - Delphine G Bernard
- UMR 1078 "Génétique, Génomique Fonctionnelle et Biotechnologies", INSERM, Univ. Brest, EFS, IBSAM, Brest, France
| | - Eolia Brissot
- Sorbonne Universités, UPMC Univ. Paris 06, AP-HP, Centre de recherche Saint-Antoine, UMR-S938, Paris, France; Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, Paris, France
| | - Olivier Loréal
- INSERM, Univ Rennes, INRA, Institut NUMECAN (Nutrition, Metabolisms and Cancer), UMR_S 1241, F-35000 Rennes, France
| | - Marie-Bérengère Troadec
- Univ. Rennes, CNRS, IGDR (Institut de génétique et développement de Rennes) - UMR 6290, F- 35000 Rennes, France.
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Pietrangelo A. Ferroportin disease: pathogenesis, diagnosis and treatment. Haematologica 2017; 102:1972-1984. [PMID: 29101207 PMCID: PMC5709096 DOI: 10.3324/haematol.2017.170720] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/25/2017] [Indexed: 12/14/2022] Open
Abstract
Ferroportin Disease (FD) is an autosomal dominant hereditary iron loading disorder associated with heterozygote mutations of the ferroportin-1 (FPN) gene. It represents one of the commonest causes of genetic hyperferritinemia, regardless of ethnicity. FPN1 transfers iron from the intestine, macrophages and placenta into the bloodstream. In FD, loss-of-function mutations of FPN1 limit but do not impair iron export in enterocytes, but they do severely affect iron transfer in macrophages. This leads to progressive and preferential iron trapping in tissue macrophages, reduced iron release to serum transferrin (i.e. inappropriately low transferrin saturation) and a tendency towards anemia at menarche or after intense bloodletting. The hallmark of FD is marked iron accumulation in hepatic Kupffer cells. Numerous FD-associated mutations have been reported worldwide, with a few occurring in different populations and some more commonly reported (e.g. Val192del, A77D, and G80S). FPN1 polymorphisms also represent the gene variants most commonly responsible for hyperferritinemia in Africans. Differential diagnosis includes mainly hereditary hemochromatosis, the syndrome commonly due to either HFE or TfR2, HJV, HAMP, and, in rare instances, FPN1 itself. Here, unlike FD, hyperferritinemia associates with high transferrin saturation, iron-spared macrophages, and progressive parenchymal cell iron load. Abdominal magnetic resonance imaging (MRI), the key non-invasive diagnostic tool for the diagnosis of FD, shows the characteristic iron loading SSL triad (spleen, spine and liver). A non-aggressive phlebotomy regimen is recommended, with careful monitoring of transferrin saturation and hemoglobin due to the risk of anemia. Family screening is mandatory since siblings and offspring have a 50% chance of carrying the pathogenic mutation.
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Affiliation(s)
- Antonello Pietrangelo
- Center for Hemochromatosis, Department of Internal Medicine II, University of Modena and Reggio Emilia Policlinico, Modena, Italy
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