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Larson LM, Thomas T, Kurpad AV, Martorell R, Hoddinott J, Adebiyi VO, Swaminathan S, Neufeld LM. Predictors of anaemia in mothers and children in Uttar Pradesh, India. Public Health Nutr 2024; 27:e30. [PMID: 38185818 PMCID: PMC10830375 DOI: 10.1017/s1368980024000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Anaemia affects more than half of Indian women and children, but the contribution of its causes remains unquantified. We examined interrelationships between Hb and nutritional, environmental, infectious and genetic determinants of anaemia in non-pregnant mothers and children in Uttar Pradesh (UP). DESIGN We conducted a cross-sectional survey of households in twenty-five districts of UP between October and December 2016. We collected socio-demographic data, anthropometry and venous blood in 1238 non-pregnant mothers and their children. We analysed venous blood samples for malaria, Hb, ferritin, retinol, folate, Zn, vitamin B12, C-reactive protein, α1-acid glycoprotein (AGP) and β-thalassaemia. We used path analysis to examine pathways through which predictors of anaemia were associated with Hb concentration. SETTING Rural and urban households in twenty-five districts of UP. PARTICIPANTS Mothers 18-49 years and children 6-59 months in UP. RESULTS A total of 36·4 % of mothers and 56·0 % of children were anaemic, and 26·7 % of women and 44·6 % of children had Fe deficiency anaemia. Ferritin was the strongest predictor of Hb (β (95 % CI) = 1·03 (0·80, 1·27) g/dL in women and 0·90 (0·68, 1·12) g/dL in children). In children only, red blood cell folate and AGP were negatively associated with Hb and retinol was positively associated with Hb. CONCLUSIONS Over 70 % of mothers and children with anaemia had Fe deficiency, needing urgent attention. However, several simultaneous predictors of Hb exist, including nutrient deficiencies and inflammation. The potential of Fe interventions to address anaemia may be constrained unless coexisting determinants are jointly addressed.
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Affiliation(s)
- Leila M Larson
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC29208, USA
| | - Tinku Thomas
- Department of Biostatistics, St John’s Medical College, Bangalore, India
| | - Anura V Kurpad
- Department of Physiology, St John’s Medical College, Bangalore, India
| | - Reynaldo Martorell
- The Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - John Hoddinott
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Victoria Oluwapamilerin Adebiyi
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC29208, USA
| | | | - Lynnette M Neufeld
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
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Karthikappallil R, Atkinson SH. Universal iron supplementation: the best strategy to tackle childhood anaemia in malaria-endemic countries? Wellcome Open Res 2023; 8:345. [PMID: 37786779 PMCID: PMC10541535 DOI: 10.12688/wellcomeopenres.19750.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 10/04/2023] Open
Abstract
Iron deficiency presents a major public health concern in many malaria-endemic regions, and both conditions affect young children most severely. Daily iron supplementation is the standard public health intervention recommended to alleviate rates of iron deficiency in children, but there is controversy over whether universal supplementation could increase the incidence and severity of malaria infection. Current evidence suggests that iron supplementation of deficient individuals is safe and effective in high-transmission settings when accompanied by malaria prevention strategies. However, low-resource settings often struggle to effectively control the spread of malaria, and it remains unclear whether supplementation of iron replete individuals could increase their risk of malaria and other infections. This review explores the evidence for and against universal iron supplementation programmes, and alternative strategies that could be used to alleviate iron deficiency in malaria-endemic areas, while minimising potential harm.
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Affiliation(s)
- Roshan Karthikappallil
- Department of Paediatrics, University of Oxford, Oxford, England, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, England, UK
| | - Sarah H. Atkinson
- Department of Paediatrics, University of Oxford, Oxford, England, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, England, UK
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
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Sun LM, Yu B, Luo YH, Zheng P, Huang Z, Yu J, Mao X, Yan H, Luo J, He J. Effect of small peptide chelated iron on growth performance, immunity and intestinal health in weaned pigs. Porcine Health Manag 2023; 9:32. [PMID: 37420289 DOI: 10.1186/s40813-023-00327-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Small peptide chelated iron (SPCI), a novel iron supplementation in pig diets, owns growth-enhancing characteristics. Although a number of researches have been performed, there is no clear-cut evidence to show the exact relationship between the dose and effects of small peptide chelated minerals. Therefore, we investigated the effect of dietary supplementation of SPCI at different doses in the growth performance, immunity, and intestinal health in weaned pigs. METHODS Thirty weaned pigs were randomly assigned into five groups and feed with basal diet or the basal diet containing 50, 75, 100, or 125 mg/kg Fe as SPCI diets. The experiment lasted for 21 d and on day 22, blood samples were collected 1 h later. The tissue and intestinal mucosa samples were collected following. RESULTS Our results showed that the feed to gain ratio (F:G) decreased with different levels of SPCI addition (P < 0.05). The average daily gain (ADG) (P < 0.05) and digestibility of crude protein (P < 0.01) decreased with 125 mg/kg SPCI addition. With dietary different levels of SPCI addition, the serum concentrations of ferritin (quadratic, P < 0.001), transferrin (quadratic, P < 0.001), iron content in liver (quadratic, P < 0.05), gallbladder (quadratic, P < 0.01) and fecal (quadratic, P < 0.01) increased quadraticly. While the iron content in tibia (P < 0.01) increased by 100 mg/kg SPCI supplementation. Dietary 75 mg/kg SPCI addition increased the serum insulin-like growth factor I (IGF-I) (P < 0.01) and SPCI (75 ~ 100 mg/kg) addition also increased the serum content of IgA (P < 0.01). The serum concentrations of IgG (quadratic, P < 0.05) and IgM (quadratic, P < 0.01) increased quadraticly by different levels of SPCI supplementation. Moreover, different levels of SPCI supplementation decreased the serum concentration of D-lactic acid (P < 0.01). The serum glutathione peroxidase (GSH-Px) (P < 0.01) elevated but the malondialdehyde (MDA) (P < 0.05) decreased by 100 mg/kg SPCI addition. Interestingly, SPCI supplementation at 75 ~ 100 mg/kg improved the intestinal morphology and barrier function, as suggested by enhanced villus height (P < 0.01) and villus height/crypt depth (V/C) (P < 0.01) in duodenum, as well as jejunum epithelium tight-junction protein ZO-1 (P < 0.01). Moreover, SPCI supplementation at 75 ~ 100 mg/kg increased the activity of duodenal lactase (P < 0.01), jejunal sucrase (P < 0.01) and ileal maltase (P < 0.01). Importantly, the expression levels of divalent metal transporter-1(DMT1) decreased with different levels of SPCI addition (P < 0.01). In addition, dietary SPCI supplementation at 75 mg/kg elevated the expression levels of critical functional genes such as peptide transporter-1(PePT1) (P = 0.06) and zinc transporter 1 (ZnT1) (P < 0.01) in ileum. The expression levels of sodium/glucose co-transporter-1 (SGLT1) in ileum (quadratic, P < 0.05) increased quadraticly by different levels of SPCI addition and amino acid transporter-1 (CAT1) in jejunum(P < 0.05) also increased by 100 mg/kg SPCI addition. CONCLUSIONS Dietary SPCI supplementation at 75 ~ 100 mg/kg improved growth performance by elevated immunity and intestinal health.
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Affiliation(s)
- Limei M Sun
- Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, 611130, Sichuan Province, P. R. China
- Key Laboratory of Animal Disease-resistant Nutrition, Chengdu, 611130, Sichuan Province, P. R. China
| | - Bing Yu
- Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, 611130, Sichuan Province, P. R. China
- Key Laboratory of Animal Disease-resistant Nutrition, Chengdu, 611130, Sichuan Province, P. R. China
| | - Yuheng H Luo
- Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, 611130, Sichuan Province, P. R. China
- Key Laboratory of Animal Disease-resistant Nutrition, Chengdu, 611130, Sichuan Province, P. R. China
| | - Ping Zheng
- Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, 611130, Sichuan Province, P. R. China
- Key Laboratory of Animal Disease-resistant Nutrition, Chengdu, 611130, Sichuan Province, P. R. China
| | - Zhiqing Huang
- Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, 611130, Sichuan Province, P. R. China
- Key Laboratory of Animal Disease-resistant Nutrition, Chengdu, 611130, Sichuan Province, P. R. China
| | - Jie Yu
- Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, 611130, Sichuan Province, P. R. China
- Key Laboratory of Animal Disease-resistant Nutrition, Chengdu, 611130, Sichuan Province, P. R. China
| | - Xiangbing Mao
- Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, 611130, Sichuan Province, P. R. China
- Key Laboratory of Animal Disease-resistant Nutrition, Chengdu, 611130, Sichuan Province, P. R. China
| | - Hui Yan
- Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, 611130, Sichuan Province, P. R. China
- Key Laboratory of Animal Disease-resistant Nutrition, Chengdu, 611130, Sichuan Province, P. R. China
| | - Junqiu Luo
- Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, 611130, Sichuan Province, P. R. China
- Key Laboratory of Animal Disease-resistant Nutrition, Chengdu, 611130, Sichuan Province, P. R. China
| | - Jun He
- Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, 611130, Sichuan Province, P. R. China.
- Key Laboratory of Animal Disease-resistant Nutrition, Chengdu, 611130, Sichuan Province, P. R. China.
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Byrd KA, Shieh J, Mork S, Pincus L, O'Meara L, Atkins M, Thilsted SH. Fish and Fish-Based Products for Nutrition and Health in the First 1000 Days: A Systematic Review of the Evidence from Low and Middle-Income Countries. Adv Nutr 2022; 13:2458-2487. [PMID: 36166842 PMCID: PMC9776644 DOI: 10.1093/advances/nmac102] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/26/2022] [Accepted: 09/22/2022] [Indexed: 01/29/2023] Open
Abstract
Fish provide essential nutrients for the critical window of growth and development in the first 1000 d of life and are thus an attractive option for inclusion in nutrition-sensitive and nutrition-specific programming. We conducted a systematic review of the evidence for fish and fish-based products for nutrition and health outcomes during the first 1000 d of life in low- and middle-income countries, searching the peer-reviewed and gray literature from 1999 to 2020. Databases included PubMed, Web of Science, Embase, ProQuest, and the Clinical Trials repository. Our search returned 1135 articles, 39 of which met the inclusion criteria. All studies were dual evaluated for risk of bias. Of the included studies, 18 measured maternal health and nutrition outcomes and 24 measured infant/child outcomes (3 measured both). Our search uncovered 10 impact evaluations, all of which measured consumption of fish or fish-based complementary food products in children aged 6-24 mo. We did not find strong evidence for fish consumption in children improving child growth from the impact evaluations; however, the studies were highly heterogeneous in their design and likely underpowered to detect an effect. Results from observational studies were mixed but provided evidence that adding fish to maternal and child diets is associated with improved nutrition outcomes, such as reducing the risk of anemia and improving vitamin D status. Given the nutrient richness of fish and the fact that production is often more environmentally friendly as compared with other animal source foods, more robust evidence is needed on the role of fish consumption in nutrition interventions to inform policy and programming recommendations in low- and middle-income countries.
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Affiliation(s)
| | | | | | | | - Lydia O'Meara
- WorldFish, Bayan Lepas, Penang, Malaysia
- Natural Resources Institute, University of Greenwich, Chatham Maritime, Kent, UK
| | - Molly Atkins
- WorldFish, Bayan Lepas, Penang, Malaysia
- International Development Department, University of Birmingham, Birmingham, UK
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Hodson DZ, Mbarga Etoundi Y, Mbatou Nghokeng N, Mohamadou Poulibe R, Magne Djoko S, Goodwin J, Cheteug Nguesta G, Nganso T, Armstrong JN, Andrews JJ, Zhang E, Wade M, Eboumbou Moukoko CE, Boum Y, Parikh S. Clinical characteristics of Plasmodium falciparum infection among symptomatic patients presenting to a major urban military hospital in Cameroon. Malar J 2022; 21:298. [PMID: 36273147 PMCID: PMC9588226 DOI: 10.1186/s12936-022-04315-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Urban malaria has received insufficient attention in the literature. The prevalence and clinical characteristics of Plasmodium falciparum infection amongst patients presenting with suspected malaria were investigated at a major urban hospital in Douala, Cameroon with a particular focus on anaemia. METHODS A cross-sectional, 18-week demographic and clinical survey was conducted of patients presenting to the Emergency Department of Douala Military Hospital with suspected malaria, largely defined by the presence or recent history of fever. Venous samples were tested for P. falciparum using rapid diagnostic tests and PCR, and anaemia was defined by haemoglobin level according to WHO definitions. Likelihood ratios (LR), odds ratios (OR), and population attributable risk percent (PARP) were calculated. RESULTS Participants were ages 8 months to 86 years, 51% were women (257/503), and all districts of Douala were represented. Overall, 38.0% (n = 189/497) were anaemic, including 5.2% (n = 26/497) with severe anaemia. Anaemia prevalence was significantly higher (OR: 2.20, 95% CI 1.41-3.45) among children < 15 years (53.1%, n = 52/98) compared to adults (34%, n = 133/392). Plasmodium falciparum was detected in 37.2% by nested PCR. Among all participants, several factors were associated with clinically significant LR for P. falciparum infection, including age 10-14 years (positive LR: 3.73), living in the island district of Douala VI (positive LR: 3.41), travel to any of three northern regions (positive LR: 5.11), and high fever > 40 °C at presentation (positive LR: 4.83). Among all participants, 8.7% of anaemia was associated with P. falciparum infection, while the PARP was 33.2% among those < 15 years of age and 81.0% among 10-14-year-olds. CONCLUSIONS The prevalence of P. falciparum infection in the urban hospital was high. Mirroring trends in many rural African settings, older children had the highest positivity rate for P. falciparum infection. Anaemia was also common in all age groups, and for those 10-14 years of age, 80% of the risk for anaemia was associated with P. falciparum infection. Malaria rates in major urban population centres can be high, and more research into the multifactorial causes of anaemia across the age spectrum are needed.
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Affiliation(s)
| | - Yannick Mbarga Etoundi
- Douala Military Hospital, Douala, Cameroon
- Douala Military Hospital School of Nursing, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | | | | | - Justin Goodwin
- Yale School of Medicine, New Haven, USA
- Yale School of Public Health, New Haven, USA
| | - Glwadys Cheteug Nguesta
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Malaria Research Service, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Tatiana Nganso
- Malaria Research Service, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | | | | | | | | | - Carole Else Eboumbou Moukoko
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Malaria Research Service, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Yap Boum
- Epicentre, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Sunil Parikh
- Yale School of Medicine, New Haven, USA.
- Yale School of Public Health, New Haven, USA.
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Iron Depletion in Systemic and Muscle Compartments Defines a Specific Phenotype of Severe COPD in Female and Male Patients: Implications in Exercise Tolerance. Nutrients 2022; 14:nu14193929. [PMID: 36235581 PMCID: PMC9571884 DOI: 10.3390/nu14193929] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 11/23/2022] Open
Abstract
We hypothesized that iron content and regulatory factors, which may be involved in exercise tolerance, are differentially expressed in systemic and muscle compartments in iron deficient severe chronic obstructive pulmonary disease (COPD) patients. In the vastus lateralis and blood of severe COPD patients with/without iron depletion, iron content and regulators, exercise capacity, and muscle function were evaluated in 40 severe COPD patients: non-iron deficiency (NID) and iron deficiency (ID) (20 patients/group). In ID compared to NID patients, exercise capacity, muscle iron and ferritin content, serum transferrin saturation, hepcidin-25, and hemojuvelin decreased, while serum transferrin and soluble transferrin receptor and muscle IRP-1 and IRP-2 increased. Among all COPD, a significant positive correlation was detected between FEV1 and serum transferrin saturation. In ID patients, significant positive correlations were detected between serum ferritin, hepcidin, and muscle iron content and exercise tolerance and between muscle IRP-2 and serum ferritin and hepcidin levels. In ID severe COPD patients, iron content and its regulators are differentially expressed. A potential crosstalk between systemic and muscle compartments was observed in the ID patients. Lung function and exercise capacity were associated with several markers of iron metabolism regulation. Iron status should be included in the overall assessment of COPD patients given its implications in their exercise performance.
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Mogire RM, Muriuki JM, Morovat A, Mentzer AJ, Webb EL, Kimita W, Ndungu FM, Macharia AW, Cutland CL, Sirima SB, Diarra A, Tiono AB, Lule SA, Madhi SA, Prentice AM, Bejon P, Pettifor JM, Elliott AM, Adeyemo A, Williams TN, Atkinson SH. Vitamin D Deficiency and Its Association with Iron Deficiency in African Children. Nutrients 2022; 14:nu14071372. [PMID: 35405984 PMCID: PMC9002534 DOI: 10.3390/nu14071372] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Vitamin D regulates the master iron hormone hepcidin, and iron in turn alters vitamin D metabolism. Although vitamin D and iron deficiency are highly prevalent globally, little is known about their interactions in Africa. To evaluate associations between vitamin D and iron status we measured markers of iron status, inflammation, malaria parasitemia, and 25-hydroxyvitamin D (25(OH)D) concentrations in 4509 children aged 0.3 months to 8 years living in Kenya, Uganda, Burkina Faso, The Gambia, and South Africa. Prevalence of iron deficiency was 35.1%, and prevalence of vitamin D deficiency was 0.6% and 7.8% as defined by 25(OH)D concentrations of <30 nmol/L and <50 nmol/L, respectively. Children with 25(OH)D concentrations of <50 nmol/L had a 98% increased risk of iron deficiency (OR 1.98 [95% CI 1.52, 2.58]) compared to those with 25(OH)D concentrations >75 nmol/L. 25(OH)D concentrations variably influenced individual markers of iron status. Inflammation interacted with 25(OH)D concentrations to predict ferritin levels. The link between vitamin D and iron status should be considered in strategies to manage these nutrient deficiencies in African children.
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Affiliation(s)
- Reagan M. Mogire
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
- KEMRI-Wellcome Trust Research Programme-Accredited Research Centre, Open University, P.O. Box 230, Kilifi 80108, Kenya
- Correspondence: (R.M.M.); (S.H.A.); Tel.: +254-709-983274 (R.M.M.); +254-709-983000 (S.H.A.)
| | - John Muthii Muriuki
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
| | - Alireza Morovat
- Department of Clinical Biochemistry, Oxford University Hospitals, Oxford OX3 9DU, UK;
| | - Alexander J. Mentzer
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK;
- Li Ka Shing Centre for Health Information and Discovery, Big Data Institute, University of Oxford, Oxford OX3 7LF, UK
| | - Emily L. Webb
- Medical Research Council (MRC) International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (E.L.W.); (S.A.L.)
| | - Wandia Kimita
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
| | - Francis M. Ndungu
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
| | - Alex W. Macharia
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
| | - Clare L. Cutland
- African Leadership in Vaccinology Expertise (Alive), Faculty of Health Sciences, University of the Witwatersrand, Private Bag 3, Johannesburg 2050, South Africa;
| | - Sodiomon B. Sirima
- Groupe de Recherche Action en Sante (GRAS), Ouagadougou 06 BP 10248, Burkina Faso; (S.B.S.); (A.D.); (A.B.T.)
| | - Amidou Diarra
- Groupe de Recherche Action en Sante (GRAS), Ouagadougou 06 BP 10248, Burkina Faso; (S.B.S.); (A.D.); (A.B.T.)
| | - Alfred B. Tiono
- Groupe de Recherche Action en Sante (GRAS), Ouagadougou 06 BP 10248, Burkina Faso; (S.B.S.); (A.D.); (A.B.T.)
| | - Swaib A. Lule
- Medical Research Council (MRC) International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (E.L.W.); (S.A.L.)
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
| | - Shabir A. Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Private Bag 3, Johannesburg 2050, South Africa;
| | - Andrew M. Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia;
| | - Philip Bejon
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - John M. Pettifor
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, R68 Old Potchefstroom Road, Bertsham, Johannesburg 2050, South Africa;
| | - Alison M. Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Adebowale Adeyemo
- Centre for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20891-5635, USA;
| | - Thomas N. Williams
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College, London SW7 2NA, UK
| | - Sarah H. Atkinson
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
- Correspondence: (R.M.M.); (S.H.A.); Tel.: +254-709-983274 (R.M.M.); +254-709-983000 (S.H.A.)
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Acheampong CO, Barffour MA, Schulze KJ, Chileshe J, Kalungwana N, Siamusantu W, West KP, Palmer AC. Age-specific differences in the magnitude of malaria-related anemia during low and high malaria seasons in rural Zambian children. EJHAEM 2021; 2:349-356. [PMID: 35844700 PMCID: PMC9175671 DOI: 10.1002/jha2.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 06/15/2023]
Abstract
Background Malaria causes anemia by destruction of red blood cells and inhibition of erythropoiesis. Objective We assessed whether the magnitude of the malaria-specific effect on anemia differs by age, during low and high malaria seasons. Method In rural Zambian children participating in a pro-vitamin A efficacy trial, we estimated differences in the prevalence of anemia (defined as hemoglobin < 110 g/L for children < 60 months. and < 115 g/L in older children) by malaria status and assessed malaria-age interactions. Regression models (with anemia as the outcome) were used to model malaria-age interaction in both the low and high malaria seasons, controlling for potential confounders. Results Average age was 68 months at baseline (n = 820 children). In the low malaria season, anemia prevalence was 29% in malaria-negative children and 54% in malaria-positive children (p < 0.001), with no malaria-age interactions (p = 0.44). In the high malaria season, anemia prevalence was 41% in malaria-negative children and 54% in malaria-positive children (p < 0.001), with significant malaria-age interactions (p = 0.02 for anemia). Age-stratified prevalence of anemia in malaria positive versus negative children was 67.0% versus 37.1% (in children < 60 months); 57.0% versus 37.2% (in 60-69 months.); 46.8% versus 37.2% (in 70-79 months.); 37.0% versus 37.3% (in 80-89 months) and 28.0% versus 37.4% (in 90+ months). Conclusions Malarial anemia is most severe in younger children, especially when transmission is intense. Anemia control programs must prioritize this vulnerable group.
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Affiliation(s)
- Clement O. Acheampong
- College of Health and Human Services, Public Health ProgramMissouri State UniversitySpringfieldMissouriUSA
| | - Maxwell A. Barffour
- College of Health and Human Services, Public Health ProgramMissouri State UniversitySpringfieldMissouriUSA
- University of Missouri School of MedicinePatient Centered Care Learning CenterColumbiaMissouriUSA
| | - Kerry J. Schulze
- Bloomberg School of Public Health, Department of International HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | | | | | - Keith P. West
- Bloomberg School of Public Health, Department of International HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Amanda C. Palmer
- Bloomberg School of Public Health, Department of International HealthJohns Hopkins UniversityBaltimoreMarylandUSA
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9
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The critical roles of iron during the journey from fetus to adolescent: Developmental aspects of iron homeostasis. Blood Rev 2021; 50:100866. [PMID: 34284901 DOI: 10.1016/j.blre.2021.100866] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 12/12/2022]
Abstract
Iron is indispensable for human life. However, it is also potentially toxic, since it catalyzes the formation of harmful oxidative radicals in unbound form and may facilitate pathogen growth. Therefore, iron homeostasis needs to be tightly regulated. Rapid growth and development require large amounts of iron, while (especially young) children are vulnerable to infections with iron-dependent pathogens due to an immature immune system. Moreover, unbalanced iron status early in life may have effects on the nervous system, immune system and gut microbiota that persist into adulthood. In this narrative review, we assess the critical roles of iron for growth and development and elaborate how the body adapts to physiologically high iron demands during the journey from fetus to adolescent. As a first step towards the development of clinical guidelines for the management of iron disorders in children, we summarize the unmet needs regarding the developmental aspects of iron homeostasis.
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10
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Bundi CK, Nalwoga A, Lubyayi L, Muriuki JM, Mogire RM, Opi H, Mentzer AJ, Mugyenyi CK, Mwacharo J, Webb EL, Bejon P, Williams TN, Gikunju JK, Beeson JG, Elliott AM, Ndungu FM, Atkinson SH. Iron Deficiency Is Associated With Reduced Levels of Plasmodium falciparum-specific Antibodies in African Children. Clin Infect Dis 2021; 73:43-49. [PMID: 32507899 PMCID: PMC8246895 DOI: 10.1093/cid/ciaa728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Iron deficiency (ID) and malaria are common causes of ill-health and disability among children living in sub-Saharan Africa. Although iron is critical for the acquisition of humoral immunity, little is known about the effects of ID on antibody responses to Plasmodium falciparum malaria. METHODS The study included 1794 Kenyan and Ugandan children aged 0-7 years. We measured biomarkers of iron and inflammation, and antibodies to P. falciparum antigens including apical merozoite antigen 1 (anti-AMA-1) and merozoite surface antigen 1 (anti-MSP-1) in cross-sectional and longitudinal studies. RESULTS The overall prevalence of ID was 31%. ID was associated with lower anti-AMA-1 and anti-MSP-1 antibody levels in pooled analyses adjusted for age, sex, study site, inflammation, and P. falciparum parasitemia (adjusted mean difference on a log-transformed scale (β) -0.46; 95 confidence interval [CI], -.66, -.25 P < .0001; β -0.33; 95 CI, -.50, -.16 P < .0001, respectively). Additional covariates for malaria exposure index, previous malaria episodes, and time since last malaria episode were available for individual cohorts. Meta-analysis was used to allow for these adjustments giving β -0.34; -0.52, -0.16 for anti-AMA-1 antibodies and β -0.26; -0.41, -0.11 for anti-MSP-1 antibodies. Low transferrin saturation was similarly associated with reduced anti-AMA-1 antibody levels. Lower AMA-1 and MSP-1-specific antibody levels persisted over time in iron-deficient children. CONCLUSIONS Reduced levels of P. falciparum-specific antibodies in iron-deficient children might reflect impaired acquisition of immunity to malaria and/or reduced malaria exposure. Strategies to prevent and treat ID may influence antibody responses to malaria for children living in sub-Saharan Africa.
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Affiliation(s)
- Caroline K Bundi
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Medical Laboratory Science, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Angela Nalwoga
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Lawrence Lubyayi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - John Muthii Muriuki
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Reagan M Mogire
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Alexander J Mentzer
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Cleopatra K Mugyenyi
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Burnet Institute, Melbourne, Australia
| | - Jedida Mwacharo
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Emily L Webb
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Philip Bejon
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Thomas N Williams
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Medicine, Imperial College, London, United Kingdom
| | - Joseph K Gikunju
- Department of Medical Laboratory Science, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - James G Beeson
- Burnet Institute, Melbourne, Australia
- Department of Microbiology, and Central Clinical School, Monash University, Melbourne, Australia
- Department of Medicine, University of Melbourne, Victoria, Australia
| | - Alison M Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Francis M Ndungu
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Sarah H Atkinson
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
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11
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Muriuki JM, Mentzer AJ, Mitchell R, Webb EL, Etyang AO, Kyobutungi C, Morovat A, Kimita W, Ndungu FM, Macharia AW, Ngetsa CJ, Makale J, Lule SA, Musani SK, Raffield LM, Cutland CL, Sirima SB, Diarra A, Tiono AB, Fried M, Gwamaka M, Adu-Afarwuah S, Wirth JP, Wegmüller R, Madhi SA, Snow RW, Hill AVS, Rockett KA, Sandhu MS, Kwiatkowski DP, Prentice AM, Byrd KA, Ndjebayi A, Stewart CP, Engle-Stone R, Green TJ, Karakochuk CD, Suchdev PS, Bejon P, Duffy PE, Davey Smith G, Elliott AM, Williams TN, Atkinson SH. Malaria is a cause of iron deficiency in African children. Nat Med 2021; 27:653-658. [PMID: 33619371 PMCID: PMC7610676 DOI: 10.1038/s41591-021-01238-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022]
Abstract
Malaria and iron deficiency (ID) are common and interrelated public health problems in African children. Observational data suggest that interrupting malaria transmission reduces the prevalence of ID1. To test the hypothesis that malaria might cause ID, we used sickle cell trait (HbAS, rs334 ), a genetic variant that confers specific protection against malaria2, as an instrumental variable in Mendelian randomization analyses. HbAS was associated with a 30% reduction in ID among children living in malaria-endemic countries in Africa (n = 7,453), but not among individuals living in malaria-free areas (n = 3,818). Genetically predicted malaria risk was associated with an odds ratio of 2.65 for ID per unit increase in the log incidence rate of malaria. This suggests that an intervention that halves the risk of malaria episodes would reduce the prevalence of ID in African children by 49%.
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Affiliation(s)
- John Muthii Muriuki
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
- Open University, KEMRI-Wellcome Trust Research Programme, Accredited Research Centre, Kilifi, Kenya.
| | - Alexander J Mentzer
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Ruth Mitchell
- Medical Research Council (MRC) Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily L Webb
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anthony O Etyang
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Alireza Morovat
- Department of Clinical Biochemistry, Oxford University Hospitals, Oxford, UK
| | - Wandia Kimita
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Francis M Ndungu
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Alex W Macharia
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Caroline J Ngetsa
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Johnstone Makale
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Swaib A Lule
- MRC/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Solomon K Musani
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Laura M Raffield
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Clare L Cutland
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sodiomon B Sirima
- Groupe de Recherche Action en Sante (GRAS), 06 BP 10248, Ouagadougou, Burkina Faso
| | - Amidou Diarra
- Groupe de Recherche Action en Sante (GRAS), 06 BP 10248, Ouagadougou, Burkina Faso
| | - Alfred B Tiono
- Groupe de Recherche Action en Sante (GRAS), 06 BP 10248, Ouagadougou, Burkina Faso
| | - Michal Fried
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Moses Gwamaka
- Mother Offspring Malaria Studies (MOMS) Project, Seattle Biomedical Research Institute, Seattle, WA, USA
- Muheza Designated District Hospital, Muheza, Tanzania
- University of Dar es Salaam, Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | | | | | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Robert W Snow
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Adrian V S Hill
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Centre for Clinical Vaccinology and Tropical Medicine and the Jenner Institute Laboratories, University of Oxford, Oxford, UK
| | - Kirk A Rockett
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Wellcome Sanger Institute, Hinxton, UK
| | | | - Dominic P Kwiatkowski
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- Wellcome Sanger Institute, Hinxton, UK
| | - Andrew M Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | | | | | | | - Reina Engle-Stone
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Tim J Green
- SAHMRi Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Crystal D Karakochuk
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Parminder S Suchdev
- Department of Pediatrics, Emory University and Emory Global Health Institute, Atlanta, GA, USA
| | - Philip Bejon
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - George Davey Smith
- Medical Research Council (MRC) Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison M Elliott
- MRC/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas N Williams
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Institute of Global Health Innovation, Imperial College, London, UK
| | - Sarah H Atkinson
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Department of Paediatrics, University of Oxford, Oxford, UK.
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12
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Iron in immune cell function and host defense. Semin Cell Dev Biol 2020; 115:27-36. [PMID: 33386235 DOI: 10.1016/j.semcdb.2020.12.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 12/13/2022]
Abstract
The control over iron availability is crucial under homeostatic conditions and even more in the case of an infection. This results from diverse properties of iron: first, iron is an important trace element for the host as well as for the pathogen for various cellular and metabolic processes, second, free iron catalyzes Fenton reaction and is therefore producing reactive oxygen species as a part of the host defense machinery, third, iron exhibits important effects on immune cell function and differentiation and fourth almost every immune activation in turn impacts on iron metabolism and spatio-temporal iron distribution. The central importance of iron in the host and microbe interplay and thus for the course of infections led to diverse strategies to restrict iron for invading pathogens. In this review, we focus on how iron restriction to the pathogen is a powerful innate immune defense mechanism of the host called "nutritional immunity". Important proteins in the iron-host-pathogen interplay will be discussed as well as the influence of iron on the efficacy of innate and adaptive immunity. Recently described processes like ferritinophagy and ferroptosis are further covered in respect to their impact on inflammation and infection control and how they impact on our understanding of the interaction of host and pathogen.
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13
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Lemoine A, Tounian P. Childhood anemia and iron deficiency in sub-Saharan Africa – risk factors and prevention: A review. Arch Pediatr 2020; 27:490-496. [DOI: 10.1016/j.arcped.2020.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 04/15/2020] [Accepted: 08/13/2020] [Indexed: 12/17/2022]
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14
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Abuga KM, Jones-Warner W, Hafalla JCR. Immune responses to malaria pre-erythrocytic stages: Implications for vaccine development. Parasite Immunol 2020; 43:e12795. [PMID: 32981095 PMCID: PMC7612353 DOI: 10.1111/pim.12795] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/26/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022]
Abstract
Radiation-attenuated sporozoites induce sterilizing immunity and remain the 'gold standard' for malaria vaccine development. Despite practical challenges in translating these whole sporozoite vaccines to large-scale intervention programmes, they have provided an excellent platform to dissect the immune responses to malaria pre-erythrocytic (PE) stages, comprising both sporozoites and exoerythrocytic forms. Investigations in rodent models have provided insights that led to the clinical translation of various vaccine candidates-including RTS,S/AS01, the most advanced candidate currently in a trial implementation programme in three African countries. With advances in immunology, transcriptomics and proteomics, and application of lessons from past failures, an effective, long-lasting and wide-scale malaria PE vaccine remains feasible. This review underscores the progress in PE vaccine development, focusing on our understanding of host-parasite immunological crosstalk in the tissue environments of the skin and the liver. We highlight possible gaps in the current knowledge of PE immunity that can impact future malaria vaccine development efforts.
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Affiliation(s)
- Kelvin Mokaya Abuga
- Department of Infection Biology, Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - William Jones-Warner
- Department of Infection Biology, Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Julius Clemence R Hafalla
- Department of Infection Biology, Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
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15
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Düzen Oflas N, Demircioğlu S, Yıldırım Doğan N, Eker E, Kutlucan A, Doğan A, Aslan M, Demir C. Comparison of the effects of oral iron treatment every day and every other day in female patients with iron deficiency anaemia. Intern Med J 2020; 50:854-858. [DOI: 10.1111/imj.14766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/26/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Nur Düzen Oflas
- Department of Internal MedicineFaculty of Medicine, Van Yüzüncü Yıl University Van Turkey
| | - Sinan Demircioğlu
- Department of HematologyFaculty of Medicine, Van Yüzüncü Yıl University Van Turkey
| | | | - Elife Eker
- Department of Internal MedicineVan Training and Research Hospital Van Turkey
| | - Ali Kutlucan
- Department of HematologyVan Training and Research Hospital Van Turkey
| | - Ali Doğan
- Department of HematologyFaculty of Medicine, Van Yüzüncü Yıl University Van Turkey
| | - Mehmet Aslan
- Department of Internal MedicineFaculty of Medicine, Van Yüzüncü Yıl University Van Turkey
| | - Cengiz Demir
- Department of HematologyFaculty of Medicine, Van Yüzüncü Yıl University Van Turkey
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16
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Abuga KM, Rockett KA, Muriuki JM, Koch O, Nairz M, Sirugo G, Bejon P, Kwiatkowski DP, Prentice AM, Atkinson SH. Interferon-gamma polymorphisms and risk of iron deficiency and anaemia in Gambian children. Wellcome Open Res 2020; 5:40. [PMID: 32420456 PMCID: PMC7202087 DOI: 10.12688/wellcomeopenres.15750.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Anaemia is a major public health concern especially in African children living in malaria-endemic regions. Interferon-gamma (IFN-γ) is elevated during malaria infection and is thought to influence erythropoiesis and iron status. Genetic variants in the IFN-γ gene (IFNG) are associated with increased IFN-γ production. We investigated putative functional single nucleotide polymorphisms (SNPs) and haplotypes of IFNG in relation to nutritional iron status and anaemia in Gambian children over a malaria season. Methods: We used previously available data from Gambian family trios to determine informative SNPs and then used the Agena Bioscience MassArray platform to type five SNPs from the IFNG gene in a cohort of 780 Gambian children aged 2-6 years. We also measured haemoglobin and biomarkers of iron status and inflammation at the start and end of a malaria season. Results: We identified five IFNG haplotype-tagging SNPs ( IFNG-1616 [rs2069705], IFNG+874 [rs2430561], IFNG+2200 [rs1861493], IFNG+3234 [rs2069718] and IFNG+5612 [rs2069728]). The IFNG+2200C [rs1861493] allele was associated with reduced haemoglobin concentrations (adjusted β -0.44 [95% CI -0.75, -0.12]; Bonferroni adjusted P = 0.03) and a trend towards iron deficiency compared to wild-type at the end of the malaria season in multivariable models adjusted for potential confounders. A haplotype uniquely identified by IFNG+2200C was similarly associated with reduced haemoglobin levels and trends towards iron deficiency, anaemia and iron deficiency anaemia at the end of the malaria season in models adjusted for age, sex, village, inflammation and malaria parasitaemia. Conclusion: We found limited statistical evidence linking IFNG polymorphisms with a risk of developing iron deficiency and anaemia in Gambian children. More definitive studies are needed to investigate the effects of genetically influenced IFN-γ levels on the risk of iron deficiency and anaemia in children living in malaria-endemic areas.
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Affiliation(s)
- Kelvin M. Abuga
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kirk A. Rockett
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - John Muthii Muriuki
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Open University, KEMRI-Wellcome Trust Research Programme – Accredited Research Centre, Kilifi, Kenya
| | - Oliver Koch
- Infection Medicine, The University of Edinburgh, Edinburgh, UK
| | - Manfred Nairz
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Giorgio Sirugo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Philip Bejon
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Dominic P. Kwiatkowski
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Wellcome Sanger Institute, Hinxton, Cambridge, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Andrew M. Prentice
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Sarah H. Atkinson
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Paediatrics, University of Oxford, Oxford, UK
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Abioye AI, Aboud S, Premji Z, Etheredge AJ, Gunaratna NS, Sudfeld CR, Noor RA, Hertzmark E, Spiegelman D, Duggan C, Fawzi W. Hemoglobin and hepcidin have good validity and utility for diagnosing iron deficiency anemia among pregnant women. Eur J Clin Nutr 2020; 74:708-719. [PMID: 31624364 PMCID: PMC7162716 DOI: 10.1038/s41430-019-0512-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND/OBJECTIVES Screening and diagnosis of iron deficiency anemia (IDA) is cumbersome as it may require testing for hemoglobin, ferritin, and an inflammatory biomarker. The aim of this study was to compare the diagnostic capacity of hematologic biomarkers to detect IDA among pregnant women in Tanzania. SUBJECTS/METHODS We pooled data from an iron supplementation trial of 1500 iron-replete pregnant woman and a prospective cohort of 600 iron-deficient pregnant women. Receiver operating characteristic curves (ROC) for hematologic biomarkers were used to assess the sensitivity, specificity, and area under the curve (AUC) for iron deficiency (ID) and iron deficiency anemia (IDA), crude, or corrected for inflammation. Regression models assessed the relationship of baseline biomarker categories (gestational age <27 weeks) and IDA at delivery. RESULTS Hemoglobin had the largest AUC for crude ID (0.96), while hepcidin had the largest AUC for corrected ID (0.80). The optimal hepcidin cutoff for the diagnosis of corrected IDA based on maximal sensitivity and specificity was ≤1.6 µg/L. An hepcidin cutoff of <4.3 µg/L had a sensitivity of 95% for regression-corrected ID. Among iron-replete women who did not receive iron, the association of baseline hemoglobin >110 g/L with IDA at delivery (RR = 0.73; 95% CI: 0.47, 1.13) was attenuated. Baseline hepcidin >1.6 µg/L was associated with reduced risk of anemia at delivery by 49% (95% CI: 27%, 45%). CONCLUSIONS Ascertaining hemoglobin and hepcidin levels may improve the targeting of iron supplementation programs in resource-limited countries, though hepcidin's high costs may limit its use.
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Affiliation(s)
- Ajibola I Abioye
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Zulfiqarali Premji
- Department of Parasitology/Medical Entomology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Analee J Etheredge
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ramadhani A Noor
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ellen Hertzmark
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Donna Spiegelman
- Center on Methods for Implementation and Prevention Science, Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Christopher Duggan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Wafaie Fawzi
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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18
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Abuga KM, Rockett KA, Muriuki JM, Koch O, Nairz M, Sirugo G, Bejon P, Kwiatkowski DP, Prentice AM, Atkinson SH. Interferon-gamma polymorphisms and risk of iron deficiency and anaemia in Gambian children. Wellcome Open Res 2020; 5:40. [PMID: 32420456 PMCID: PMC7202087 DOI: 10.12688/wellcomeopenres.15750.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2020] [Indexed: 11/08/2023] Open
Abstract
Background: Anaemia is a major public health concern especially in African children living in malaria-endemic regions. Interferon-gamma (IFN-γ) is elevated during malaria infection and is thought to influence erythropoiesis and iron status. Genetic variants in the IFN-γ gene (IFNG) are associated with increased IFN-γ production. We investigated putative functional single nucleotide polymorphisms (SNPs) and haplotypes of IFNG in relation to nutritional iron status and anaemia in Gambian children over a malaria season. Methods: We used previously available data from Gambian family trios to determine informative SNPs and then used the Agena Bioscience MassArray platform to type five SNPs from the IFNG gene in a cohort of 780 Gambian children. We also measured haemoglobin and biomarkers of iron status and inflammation at the start and end of a malaria season. Results: We identified five IFNG haplotype-tagging SNPs ( IFNG-1616 [rs2069705], IFNG+874 [rs2430561], IFNG+2200 [rs1861493], IFNG+3234 [rs2069718] and IFNG+5612 [rs2069728]). The IFNG+2200C [rs1861493] allele was associated with reduced haemoglobin concentrations (adjusted β -0.44 [95% CI -0.75, -0.12]; Bonferroni adjusted P = 0.03) and a trend towards iron deficiency compared to wild-type at the end of the malaria season in multivariable models adjusted for potential confounders. A haplotype uniquely identified by IFNG+2200C was similarly associated with reduced haemoglobin levels and trends towards iron deficiency, anaemia and iron deficiency anaemia at the end of the malaria season in models adjusted for age, sex, village, inflammation and malaria parasitaemia. Conclusion: We found limited statistical evidence linking IFNG polymorphisms with a risk of developing iron deficiency and anaemia in Gambian children. More definitive studies are needed to investigate the effects of genetically influenced IFN-γ levels on the risk of iron deficiency and anaemia in children living in malaria-endemic areas.
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Affiliation(s)
- Kelvin M. Abuga
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kirk A. Rockett
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - John Muthii Muriuki
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Open University, KEMRI-Wellcome Trust Research Programme – Accredited Research Centre, Kilifi, Kenya
| | - Oliver Koch
- Infection Medicine, The University of Edinburgh, Edinburgh, UK
| | - Manfred Nairz
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Giorgio Sirugo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Philip Bejon
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Dominic P. Kwiatkowski
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Wellcome Sanger Institute, Hinxton, Cambridge, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Andrew M. Prentice
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Sarah H. Atkinson
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Paediatrics, University of Oxford, Oxford, UK
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19
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Powers JM. A step toward an expanded iron toolkit: Hepcidin values in healthy Dutch children. Pediatr Blood Cancer 2020; 67:e28122. [PMID: 31850660 DOI: 10.1002/pbc.28122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Jacquelyn M Powers
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Houston, Texas
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20
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Armitage AE, Moretti D. The Importance of Iron Status for Young Children in Low- and Middle-Income Countries: A Narrative Review. Pharmaceuticals (Basel) 2019; 12:E59. [PMID: 30995720 PMCID: PMC6631790 DOI: 10.3390/ph12020059] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/09/2019] [Accepted: 04/12/2019] [Indexed: 12/21/2022] Open
Abstract
Early childhood is characterised by high physiological iron demand to support processes including blood volume expansion, brain development and tissue growth. Iron is also required for other essential functions including the generation of effective immune responses. Adequate iron status is therefore a prerequisite for optimal child development, yet nutritional iron deficiency and inflammation-related iron restriction are widespread amongst young children in low- and middle-income countries (LMICs), meaning iron demands are frequently not met. Consequently, therapeutic iron interventions are commonly recommended. However, iron also influences infection pathogenesis: iron deficiency reduces the risk of malaria, while therapeutic iron may increase susceptibility to malaria, respiratory and gastrointestinal infections, besides reshaping the intestinal microbiome. This means caution should be employed in administering iron interventions to young children in LMIC settings with high infection burdens. In this narrative review, we first examine demand and supply of iron during early childhood, in relation to the molecular understanding of systemic iron control. We then evaluate the importance of iron for distinct aspects of physiology and development, particularly focusing on young LMIC children. We finally discuss the implications and potential for interventions aimed at improving iron status whilst minimising infection-related risks in such settings. Optimal iron intervention strategies will likely need to be individually or setting-specifically adapted according to iron deficiency, inflammation status and infection risk, while maximising iron bioavailability and considering the trade-offs between benefits and risks for different aspects of physiology. The effectiveness of alternative approaches not centred around nutritional iron interventions for children should also be thoroughly evaluated: these include direct targeting of common causes of infection/inflammation, and maternal iron administration during pregnancy.
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Affiliation(s)
- Andrew E Armitage
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DS, UK.
| | - Diego Moretti
- Laboratory of Human Nutrition, Institute of Food Nutrition and Health, Department of Health Sciences and Technology, ETH Zürich, CH-8092 Zürich, Switzerland.
- Nutrition Group, Health Department, Swiss Distance University of Applied Sciences, CH-8105 Regensdorf, Switzerland.
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21
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Powers JM, Buchanan GR. Disorders of Iron Metabolism: New Diagnostic and Treatment Approaches to Iron Deficiency. Hematol Oncol Clin North Am 2019; 33:393-408. [PMID: 31030809 DOI: 10.1016/j.hoc.2019.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Iron deficiency anemia is the leading cause of anemia worldwide and affects many young children and adolescent girls in the United States. Its signs and symptoms are subtle despite significant clinical effects. Iron deficiency anemia is diagnosed clinically by the presence of risk factors and microcytic anemia. Improvement following a trial of oral iron therapy is confirmative. An array of iron laboratory tests is available with variable indications. Clinical trial and iron absorption data support a shift to lower-dose oral iron therapy. Intravenous iron should be considered in children who fail oral iron or who have more complex disorders.
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Affiliation(s)
- Jacquelyn M Powers
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Texas Children's Cancer and Hematology Centers, 6701 Fannin Street, Suite 1580, Houston, TX 77030, USA.
| | - George R Buchanan
- Pediatric Hematology-Oncology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, H3.104A, Dallas, TX 75390-9063, USA
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22
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Prentice AM, Bah A, Jallow MW, Jallow AT, Sanyang S, Sise EA, Ceesay K, Danso E, Armitage AE, Pasricha SR, Drakesmith H, Wathuo M, Kessler N, Cerami C, Wegmüller R. Respiratory infections drive hepcidin-mediated blockade of iron absorption leading to iron deficiency anemia in African children. SCIENCE ADVANCES 2019; 5:eaav9020. [PMID: 30944864 PMCID: PMC6436921 DOI: 10.1126/sciadv.aav9020] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
Iron deficiency anemia (IDA) is the most prevalent nutritional condition worldwide. We studied the contribution of hepcidin-mediated iron blockade to IDA in African children. We measured hepcidin and hemoglobin weekly, and hematological, inflammatory, and iron biomarkers at baseline, 7 weeks, and 12 weeks in 407 anemic (hemoglobin < 11 g/dl), otherwise healthy Gambian children (6 to 27 months). Each child maintained remarkably constant hepcidin levels (P < 0.0001 for between-child variance), with half consistently maintaining levels that indicate physiological blockade of iron absorption. Hepcidin was strongly predicted by nurse-ascribed adverse events with dominant signals from respiratory infections and fevers (all P < 0.0001). Diarrhea and fecal calprotectin were not associated with hepcidin. In multivariate analysis, C-reactive protein was the dominant predictor of hepcidin and contributed to iron blockade even at very low levels. We conclude that even low-grade inflammation, especially associated with respiratory infections, contributes to IDA in African children.
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Affiliation(s)
| | - Amat Bah
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | | | | | - Saikou Sanyang
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Ebrima A. Sise
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Kabiru Ceesay
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Ebrima Danso
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Andrew E. Armitage
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Sant-Rayn Pasricha
- Walter and Eliza Hall Institute for Medical Research, 1G Royal Parade, Melbourne, Parkville, Victoria 3052, Australia
| | - Hal Drakesmith
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Miriam Wathuo
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Noah Kessler
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
- Department of Genetics, University of Cambridge, Cambridge, UK
| | - Carla Cerami
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Rita Wegmüller
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
- GroundWork, 7306 Fläsch, Switzerland
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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23
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Nalado AM, Dickens C, Dix-Peek T, Mahlangu JN, Olorunfemi G, Paget G, Duarte R, Naicker S. TMPRSS6 rs855791 polymorphism and susceptibility to iron deficiency anaemia in non-dialysis chronic kidney disease patients in South Africa. INTERNATIONAL JOURNAL OF MOLECULAR EPIDEMIOLOGY AND GENETICS 2019; 10:1-9. [PMID: 30911357 PMCID: PMC6420716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 01/16/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND In genome-wide studies, there is a strong association between the TMPRSS6 allele A736V (rs855791) and significantly lower levels of serum iron, transferrin saturation, haemoglobin, and mean corpuscular volumes. The influence of this genetic variant on susceptibility to iron deficiency anaemia (IDA) in chronic kidney disease (CKD) patients is unknown. METHODS In this cross-sectional study, we measured the full blood count and TMPRSS6 T>C polymorphism in black adult participants (n=260) with CKD and healthy controls (n=146) at the Charlotte Maxeke Johannesburg Academic Hospital, South Africa. RESULTS The overall prevalence of anaemia in the CKD and control population was 46.9% and 19.6% respectively. Twenty-six per cent of CKD participants were iron deficient. The prevalence of rs855791 C homozygosity was similar among iron deficient and non-iron deficient anaemia groups (86.1% vs 84.2%, P=0.723). When the analysis was confined to subjects with or without functional iron deficiency anaemia, C homozygote (88.3% vs 84.4%, P=0.425) was similar for both groups. CONCLUSIONS Our study suggests that homozygosity for TMPRSS6 rs855791 C genotype does not influence IDA in non-dialysis CKD patients in our population.
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Affiliation(s)
- Aishatu Muhammad Nalado
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Science, University of The WitwatersrandJohannesburg, South Africa
- Department of Internal Medicine, College of Health Sciences, Bayero UniversityKano, Nigeria
| | - Caroline Dickens
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Science, University of The WitwatersrandJohannesburg, South Africa
| | - Therese Dix-Peek
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Science, University of The WitwatersrandJohannesburg, South Africa
| | - Johnny N Mahlangu
- School of Pathology, Faculty of Health Sciences, University of The WitwatersrandJohannesburg, South Africa
| | - Gbenga Olorunfemi
- Division of Epidemiology and Biostatistics, School of Public Health, University of The WitwatersrandJohannesburg, South Africa
| | - Graham Paget
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Science, University of The WitwatersrandJohannesburg, South Africa
| | - Raquel Duarte
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Science, University of The WitwatersrandJohannesburg, South Africa
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Science, University of The WitwatersrandJohannesburg, South Africa
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24
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Armitage AE, Agbla SC, Betts M, Sise EA, Jallow MW, Sambou E, Darboe B, Worwui A, Weinstock GM, Antonio M, Pasricha SR, Prentice AM, Drakesmith H, Darboe MK, Kwambana-Adams BA. Rapid growth is a dominant predictor of hepcidin suppression and declining ferritin in Gambian infants. Haematologica 2019; 104:1542-1553. [PMID: 30733275 PMCID: PMC6669141 DOI: 10.3324/haematol.2018.210146] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/31/2019] [Indexed: 12/18/2022] Open
Abstract
Iron deficiency and iron deficiency anemia are highly prevalent in low-income countries, especially among young children. Hepcidin is the major regulator of systemic iron homeostasis. It controls dietary iron absorption, dictates whether absorbed iron is made available in circulation for erythropoiesis and other iron-demanding processes, and predicts response to oral iron supplementation. Understanding how hepcidin is itself regulated is therefore important, especially in young children. We investigated how changes in iron-related parameters, inflammation and infection status, seasonality, and growth influenced plasma hepcidin and ferritin concentrations during infancy using longitudinal data from two birth cohorts of infants in rural Gambia (n=114 and n=193). This setting is characterized by extreme seasonality, prevalent childhood anemia, undernutrition, and frequent infection. Plasma was collected from infants at birth and at regular intervals, up to 12 months of age. Hepcidin, ferritin and plasma iron concentrations declined markedly during infancy, with reciprocal increases in soluble transferrin receptor and transferrin concentrations, indicating declining iron stores and increasing tissue iron demand. In cross-sectional analyses at 5 and 12 months of age, we identified expected relationships of hepcidin with iron and inflammatory markers, but also observed significant negative associations between hepcidin and antecedent weight gain. Correspondingly, longitudinal fixed effects modeling demonstrated weight gain to be the most notable dynamic predictor of decreasing hepcidin and ferritin through infancy across both cohorts. Infants who grow rapidly in this setting are at particular risk of depletion of iron stores, but since hepcidin concentrations decrease with weight gain, they may also be the most responsive to oral iron interventions.
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Affiliation(s)
- Andrew E Armitage
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Schadrac C Agbla
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Modupeh Betts
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Ebrima A Sise
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Momodou W Jallow
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Ellen Sambou
- WHO Collaborating Center for New Vaccines Surveillance, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Bakary Darboe
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Archibald Worwui
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | | | - Martin Antonio
- WHO Collaborating Center for New Vaccines Surveillance, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Sant-Rayn Pasricha
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.,Walter and Eliza Hall Institute for Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, The University of Melbourne, VIC, Melbourne, Australia
| | - Andrew M Prentice
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Hal Drakesmith
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.,Haematology Theme, Oxford Biomedical Research Centre, Oxford, UK
| | - Momodou K Darboe
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Brenda Anna Kwambana-Adams
- WHO Collaborating Center for New Vaccines Surveillance, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa .,NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, UK
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25
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Stoffel NU, Lazrak M, Bellitir S, Mir NE, Hamdouchi AE, Barkat A, Zeder C, Moretti D, Aguenaou H, Zimmermann MB. The opposing effects of acute inflammation and iron deficiency anemia on serum hepcidin and iron absorption in young women. Haematologica 2019; 104:1143-1149. [PMID: 30630976 PMCID: PMC6545852 DOI: 10.3324/haematol.2018.208645] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/02/2019] [Indexed: 01/19/2023] Open
Abstract
Hepatic hepcidin synthesis is stimulated by inflammation but inhibited during iron deficiency anemia (IDA). In humans, the relative strength of these opposing signals on serum hepcidin and the net effect on iron absorption and systemic iron recycling is uncertain. In this prospective, 45-day study, in young women (n=46; age 18-49 years) with or without IDA, we compared iron and inflammation markers, serum hepcidin and erythrocyte iron incorporation from 57Fe-labeled test meals, before and 8, 24 and 36 hours (h) after influenza/DPT vaccination as an acute inflammatory stimulus. Compared to baseline, at 24-36 h after vaccination: 1) interleukin-6 increased 2-3-fold in both groups (P<0.001); 2) serum hepcidin increased >2-fold in the non-anemic group (P<0.001), but did not significantly change in the IDA group; 3) serum iron decreased in the non-anemic group (P<0.05) but did not change in the IDA group; and 4) erythrocyte iron incorporation did not change in either of the two groups, but was approximately 2-fold higher in the IDA group both before and after vaccination (P<0.001). In this study, mild acute inflammation did not increase serum hepcidin in women with IDA, suggesting low iron status and erythropoietic drive offset the inflammatory stimulus on hepcidin expression. In non-anemic women, inflammation increased serum hepcidin and produced mild hypoferremia, but did not reduce dietary iron absorption, suggesting iron-recycling macrophages are more sensitive than the enterocyte to high serum hepcidin during inflammation. The study was registered as a prospective observational trial at clinicaltrials.gov identifier: 02175888 The study was funded by the International Atomic Energy Agency.
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Affiliation(s)
- Nicole U Stoffel
- ETH Zürich, Laboratory of Human Nutrition, Institute of Food Nutrition and Health, Department of Health Science and Technology, Zürich, Switzerland
| | - Meryem Lazrak
- Ibn Tofaïl University-CNESTEN, Joint Research Unit in Nutrition and Food, RDC-Nutrition AFRA/IAEA, Rabat-Kénitra, Morocco
| | - Souhaila Bellitir
- Ibn Tofaïl University-CNESTEN, Joint Research Unit in Nutrition and Food, RDC-Nutrition AFRA/IAEA, Rabat-Kénitra, Morocco
| | - Nissrine El Mir
- Ibn Tofaïl University-CNESTEN, Joint Research Unit in Nutrition and Food, RDC-Nutrition AFRA/IAEA, Rabat-Kénitra, Morocco
| | - Asmaa El Hamdouchi
- Ibn Tofaïl University-CNESTEN, Joint Research Unit in Nutrition and Food, RDC-Nutrition AFRA/IAEA, Rabat-Kénitra, Morocco
| | - Amina Barkat
- Mohamed V University, Unit of Research on Nutrition and Health of Mother and Nutrition, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Christophe Zeder
- ETH Zürich, Laboratory of Human Nutrition, Institute of Food Nutrition and Health, Department of Health Science and Technology, Zürich, Switzerland
| | - Diego Moretti
- ETH Zürich, Laboratory of Human Nutrition, Institute of Food Nutrition and Health, Department of Health Science and Technology, Zürich, Switzerland
| | - Hassan Aguenaou
- Ibn Tofaïl University-CNESTEN, Joint Research Unit in Nutrition and Food, RDC-Nutrition AFRA/IAEA, Rabat-Kénitra, Morocco
| | - Michael B Zimmermann
- ETH Zürich, Laboratory of Human Nutrition, Institute of Food Nutrition and Health, Department of Health Science and Technology, Zürich, Switzerland
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26
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Castberg FC, Sarbah EW, Koram KA, Opoku N, Ofori MF, Styrishave B, Hviid L, Kurtzhals JAL. Malaria causes long-term effects on markers of iron status in children: a critical assessment of existing clinical and epidemiological tools. Malar J 2018; 17:464. [PMID: 30537973 PMCID: PMC6290551 DOI: 10.1186/s12936-018-2609-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/01/2018] [Indexed: 01/13/2023] Open
Abstract
Background Most epidemiological studies on the interplay between iron deficiency and malaria risk classify individuals as iron-deficient or iron-replete based on inflammation-dependent iron markers and adjustment for inflammation by using C-reactive protein (CRP) or α-1-acid glycoprotein (AGP). The validity of this approach and the usefulness of fibroblast growth factor 23 (FGF23) as a proposed inflammation-independent iron marker were tested. Methods Conventional iron markers and FGF23 were measured in children with acute falciparum malaria and after 1, 2, 4, and 6 weeks. Children, who were transfused or received iron supplementation in the follow-up period, were excluded, and iron stores were considered to be stable throughout. Ferritin levels 6 weeks after admission were used as a reference for admission iron status and compared with iron markers at different time points. Results There were long-term perturbations in iron markers during convalescence from acute malaria. None of the tested iron parameters, including FGF23, were independent of inflammation. CRP and AGP normalized faster than ferritin after malaria episodes. Conclusion Malaria may bias epidemiological studies based on inflammation-dependent iron markers. Better markers of iron status during and after inflammation are needed in order to test strategies for iron supplementation in populations at risk of malaria.
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Affiliation(s)
- Filip C Castberg
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Centre for Medical Parasitology, Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Edem W Sarbah
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Kwadwo A Koram
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Nicholas Opoku
- Hohoe Municipality Hospital, Hohoe, Ghana.,School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Michael F Ofori
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Bjarne Styrishave
- Toxicology and Drug Metabolism Group, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Hviid
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Centre for Medical Parasitology, Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Jørgen A L Kurtzhals
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. .,Centre for Medical Parasitology, Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
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27
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Byrd KA, Williams TN, Lin A, Pickering AJ, Arnold BF, Arnold CD, Kiprotich M, Dentz HN, Njenga SM, Rao G, Colford JM, Null C, Stewart CP. Sickle Cell and α+-Thalassemia Traits Influence the Association between Ferritin and Hepcidin in Rural Kenyan Children Aged 14-26 Months. J Nutr 2018; 148:1903-1910. [PMID: 30517728 PMCID: PMC6669948 DOI: 10.1093/jn/nxy229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/23/2018] [Accepted: 08/16/2018] [Indexed: 01/01/2023] Open
Abstract
Background The relation between subclinical hemoglobinopathies and concentrations of the iron-regulatory hormone hepcidin is not well characterized. Objective We investigated the relation of hepcidin concentration with hemoglobinopathies among young children in Kenya. Methods We quantified serum hepcidin and ferritin in 435 Kenyan children aged 14-20 mo in a subsample of the Water, Sanitation, and Handwashing (WASH) Benefits Trial. Blood samples were genotyped for α+-thalassemia and for sickle cell disorder. Hepcidin was compared across sickle cell and α+-thalassemia genotypes separately by using generalized linear models, and children who were normozygous for both conditions were also compared with those who had either of these conditions. In the association between hepcidin and ferritin, we assessed effect modification by genotype. Results In this population, we found that 16.2% had sickle cell trait and 0.2% had sickle cell disorder, whereas 40.0% were heterozygous for α+-thalassemia and 8.2% were homozygous. Hepcidin concentration did not differ by genotype, but effect modification was found by genotype in the association between hepcidin and ferritin (P < 0.1). Among normozygous sickle cell children (HbAA), there was an association between hepcidin and ferritin (β = 0.92; 95% CI: 0.72, 1.10). However, among those with sickle cell trait (HbAS), the association was no longer significant (β = 0.31; 95% CI: -0.04, 0.66). Similarly, among children who were normozygous (αα/αα) or heterozygous (-α/αα) for α+-thalassemia, hepcidin and ferritin were significantly associated [β = 0.94 (95% CI: 0.68, 1.20) and β = 0.77 (95% CI: 0.51, 1.03), respectively]; however, in children who were homozygous for α+-thalassemia (-α/-α), there was no longer a significant association (β = 0.45; 95% CI: -0.10, 1.00). Conclusion Hepcidin was not associated with hemoglobin genotype, but there may be a difference in the way hepcidin responds to iron status among those with either sickle cell trait or homozygous α+-thalassemia in young Kenyan children. This trial was registered at clinicaltrials.gov as NCT01704105.
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Affiliation(s)
- Kendra A Byrd
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Thomas N Williams
- Imperial College, St. Mary's Hospital, London, United Kingdom
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Program, Kilifi, Kenya
| | - Audrie Lin
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA
| | - Benjamin F Arnold
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Charles D Arnold
- Department of Nutrition, University of California, Davis, Davis, CA
| | | | - Holly N Dentz
- Department of Nutrition, University of California, Davis, Davis, CA
- Innovations for Poverty Action, Nairobi, Kenya
| | | | | | - John M Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Clair Null
- Mathematica Policy Research, Washington, DC
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28
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Muriuki JM, Atkinson SH. How Eliminating Malaria May Also Prevent Iron Deficiency in African Children. Pharmaceuticals (Basel) 2018; 11:ph11040096. [PMID: 30275421 PMCID: PMC6315967 DOI: 10.3390/ph11040096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/21/2018] [Accepted: 09/21/2018] [Indexed: 02/07/2023] Open
Abstract
Malaria and iron deficiency are common among children living in sub-Saharan Africa. Several studies have linked a child’s iron status to their future risk of malaria infection; however, few have examined whether malaria might be a cause of iron deficiency. Approximately a quarter of African children at any one time are infected by malaria and malaria increases hepcidin and tumor necrosis factor-α concentrations leading to poor iron absorption and recycling. In support of a hypothetical link between malaria and iron deficiency, studies indicate that the prevalence of iron deficiency in children increases over a malaria season and decreases when malaria transmission is interrupted. The link between malaria and iron deficiency can be tested through the use of observational studies, randomized controlled trials and genetic epidemiology studies, each of which has its own strengths and limitations. Confirming the existence of a causal link between malaria infection and iron deficiency would readjust priorities for programs to prevent and treat iron deficiency and would demonstrate a further benefit of malaria control.
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Affiliation(s)
| | - Sarah H Atkinson
- KEMRI-Wellcome Trust Research Programme, 80108 Kilifi, Kenya.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK.
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK.
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29
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Hennig BJ, Unger SA, Dondeh BL, Hassan J, Hawkesworth S, Jarjou L, Jones KS, Moore SE, Nabwera HM, Ngum M, Prentice A, Sonko B, Prentice AM, Fulford AJ. Cohort Profile: The Kiang West Longitudinal Population Study (KWLPS)-a platform for integrated research and health care provision in rural Gambia. Int J Epidemiol 2018; 46:e13. [PMID: 26559544 PMCID: PMC5837564 DOI: 10.1093/ije/dyv206] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Branwen J Hennig
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Stefan A Unger
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,University of Edinburgh, Department of Child Life and Health, Edinburgh, UK
| | - Bai Lamin Dondeh
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Jahid Hassan
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Sophie Hawkesworth
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK.,MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK and
| | - Landing Jarjou
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Kerry S Jones
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK and
| | - Sophie E Moore
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK.,MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK and
| | - Helen M Nabwera
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Mohammed Ngum
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Ann Prentice
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK and
| | - Bakary Sonko
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Andrew M Prentice
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony J Fulford
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
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30
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Ghatpande NS, Apte PP, Naik SS, Kulkarni PP. Fruit and Vegetable Consumption and Their Association With the Indicators of Iron and Inflammation Status Among Adolescent Girls. J Am Coll Nutr 2018; 38:218-226. [PMID: 30130470 DOI: 10.1080/07315724.2018.1492470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The objective of this study was to identify an association among dietary components, iron, and inflammatory status among adolescent girls. METHOD Dietary information for 85 adolescent girls was collected through food frequency questionnaires. Biomarkers of iron and inflammatory status were analyzed. RESULTS We found that 28.2% of adolescent girls had anemia and 65.9% girls were iron-deficient. Girls who did not consume guava had 3.8-fold (95% confidence interval =1.1-9.4; p = 0.020) increased the risk of having low serum iron levels. Girls who consumed amaranth had significantly (p = 0.024) higher serum hepcidin levels (n = 44; 129.7 ± 81.40 pg/mL vs n = 41; 94.6 ± 55.8 pg/mL) as well as ferritin levels (n = 44; 19.7 ± 16.4 µg/L vs n = 41; 14.0 ± 10.2 µg/L). Overall consumption of fruits and green leafy vegetables among girls significantly affects their iron status. CONCLUSIONS Regular consumption of vitamin C-rich fruits and green leafy vegetable intake are imperative for improvement of iron status among adolescent girls.
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Affiliation(s)
- Niraj S Ghatpande
- a Bioprospecting Group, Agharkar Research Institute , Pune , India.,b Savitribai Phule Pune University, Ganeshkhind , Pune , India
| | - Priti P Apte
- b Savitribai Phule Pune University, Ganeshkhind , Pune , India
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31
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Wilson AL, Bradley J, Kandeh B, Salami K, D'Alessandro U, Pinder M, Lindsay SW. Is chronic malnutrition associated with an increase in malaria incidence? A cohort study in children aged under 5 years in rural Gambia. Parasit Vectors 2018; 11:451. [PMID: 30081945 PMCID: PMC6090805 DOI: 10.1186/s13071-018-3026-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Malnutrition is common in children in sub-Saharan Africa and is thought to increase the risk of infectious diseases, including malaria. The relationship between malnutrition and malaria was examined in a cohort of 6–59 month-old children in rural Gambia, in an area of seasonal malaria transmission. The study used data from a clinical trial in which a cohort of children was established and followed for clinical malaria during the 2011 transmission season. A cross-sectional survey to determine the prevalence of malaria and anaemia, and measure the height and weight of these children was carried out at the beginning and end of the transmission season. Standard anthropometric indices (stunting, wasting and underweight) were calculated using z-scores. Results At the beginning of the transmission season, 31.7% of children were stunted, 10.8% wasted and 24.8% underweight. Stunting was more common in Fula children than other ethnicities and in children from traditionally constructed houses compared to more modern houses. Stunted children and underweight children were significantly more likely to have mild or moderate anaemia. During the transmission season, 13.7% of children had at least one episode of clinical malaria. There was no association between stunting and malaria incidence (odds ratio = 0.79, 95% CI: 0.60–1.05). Malaria was not associated with differences in weight or height gain. Conclusions Chronic malnutrition remains a problem in rural Gambia, particularly among the poor and Fula ethnic group, but it was not associated with an increased risk of malaria. Trial registration Trial registration: ISRCTN, ISRCTN01738840, registered: 27/08/2010 (Retrospectively registered).
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Affiliation(s)
- Anne L Wilson
- Department of Biosciences, Durham University, Stockton Road, Durham, DH1 3LE, UK.
| | - John Bradley
- Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Ballah Kandeh
- National Malaria Control Programme, Banjul, The Gambia
| | - Kolawole Salami
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Margaret Pinder
- Department of Biosciences, Durham University, Stockton Road, Durham, DH1 3LE, UK.,Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Steven W Lindsay
- Department of Biosciences, Durham University, Stockton Road, Durham, DH1 3LE, UK.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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32
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Abstract
Iron deficiency remains the largest nutritional deficiency worldwide and the main cause of anaemia. Severe iron deficiency leads to anaemia known as iron deficiency anaemia (IDA), which affects a total of 1·24 billion people, the majority of whom are children and women from resource-poor countries. In sub-Saharan Africa, iron deficiency is frequently exacerbated by concomitant parasitic and bacterial infections and contributes to over 120 000 maternal deaths a year, while it irreparably limits the cognitive development of children and leads to poor outcomes in pregnancy.Currently available iron compounds are cheap and readily available, but constitute a non-physiological approach to providing iron that leads to significant side effects. Consequently, iron deficiency and IDA remain without an effective treatment, particularly in populations with high burden of infectious diseases. So far, despite considerable investment in the past 25 years in nutrition interventions with iron supplementation and fortification, we have been unable to significantly decrease the burden of this disease in resource-poor countries.If we are to eliminate this condition in the future, it is imperative to look beyond the strategies used until now and we should make an effort to combine community engagement and social science approaches to optimise supplementation and fortification programmes.
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33
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Approaches for Reducing the Risk of Early-Life Iron Deficiency-Induced Brain Dysfunction in Children. Nutrients 2018; 10:nu10020227. [PMID: 29462970 PMCID: PMC5852803 DOI: 10.3390/nu10020227] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 12/23/2022] Open
Abstract
Iron deficiency is the most common micronutrient deficiency in the world. Women of reproductive age and young children are particularly vulnerable. Iron deficiency in late prenatal and early postnatal periods can lead to long-term neurobehavioral deficits, despite iron treatment. This may occur because screening and treatment of iron deficiency in children is currently focused on detection of anemia and not neurodevelopment. Anemia is the end-stage state of iron deficiency. The brain becomes iron deficient before the onset of anemia due to prioritization of the available iron to the red blood cells (RBCs) over other organs. Brain iron deficiency, independent of anemia, is responsible for the adverse neurological effects. Early diagnosis and treatment of impending brain dysfunction in the pre-anemic stage is necessary to prevent neurological deficits. The currently available hematological indices are not sensitive biomarkers of brain iron deficiency and dysfunction. Studies in non-human primate models suggest that serum proteomic and metabolomic analyses may be superior for this purpose. Maternal iron supplementation, delayed clamping or milking of the umbilical cord, and early iron supplementation improve the iron status of at-risk infants. Whether these strategies prevent iron deficiency-induced brain dysfunction has yet to be determined. The potential for oxidant stress, altered gastrointestinal microbiome and other adverse effects associated with iron supplementation cautions against indiscriminate iron supplementation of children in malaria-endemic regions and iron-sufficient populations.
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34
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Spottiswoode N, Armitage AE, Williams AR, Fyfe AJ, Biswas S, Hodgson SH, Llewellyn D, Choudhary P, Draper SJ, Duffy PE, Drakesmith H. Role of Activins in Hepcidin Regulation during Malaria. Infect Immun 2017; 85:e00191-17. [PMID: 28893916 PMCID: PMC5695100 DOI: 10.1128/iai.00191-17] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/23/2017] [Indexed: 12/21/2022] Open
Abstract
Epidemiological observations have linked increased host iron with malaria susceptibility, and perturbed iron handling has been hypothesized to contribute to the potentially life-threatening anemia that may accompany blood-stage malaria infection. To improve our understanding of these relationships, we examined the pathways involved in regulation of the master controller of iron metabolism, the hormone hepcidin, in malaria infection. We show that hepcidin upregulation in Plasmodium berghei murine malaria infection was accompanied by changes in expression of bone morphogenetic protein (BMP)/sons of mothers against decapentaplegic (SMAD) pathway target genes, a key pathway involved in hepcidin regulation. We therefore investigated known agonists of the BMP/SMAD pathway and found that Bmp gene expression was not increased in infection. In contrast, activin B, which can signal through the BMP/SMAD pathway and has been associated with increased hepcidin during inflammation, was upregulated in the livers of Plasmodium berghei-infected mice; hepatic activin B was also upregulated at peak parasitemia during infection with Plasmodium chabaudi Concentrations of the closely related protein activin A increased in parallel with hepcidin in serum from malaria-naive volunteers infected in controlled human malaria infection (CHMI) clinical trials. However, antibody-mediated neutralization of activin activity during murine malaria infection did not affect hepcidin expression, suggesting that these proteins do not stimulate hepcidin upregulation directly. In conclusion, we present evidence that the BMP/SMAD signaling pathway is perturbed in malaria infection but that activins, although raised in malaria infection, may not have a critical role in hepcidin upregulation in this setting.
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Affiliation(s)
- Natasha Spottiswoode
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- Laboratory of Malaria Immunology & Vaccinology, NIAID, NIH, Bethesda, Maryland, USA
| | - Andrew E Armitage
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Andrew R Williams
- Department of Veterinary Disease Biology, University of Copenhagen, Frederiksberg, Denmark
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Alex J Fyfe
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Sumi Biswas
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | | | - David Llewellyn
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | | | - Simon J Draper
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Patrick E Duffy
- Laboratory of Malaria Immunology & Vaccinology, NIAID, NIH, Bethesda, Maryland, USA
| | - Hal Drakesmith
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
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35
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Ghatpande NS, Apte PP, Naik SS, Joshi BN, Gokhale MK, Kulkarni PP. Association of B12 deficiency and anemia synergistically increases the risk of high TNF-α levels among adolescent girls. Metallomics 2017; 8:734-8. [PMID: 27346169 DOI: 10.1039/c6mt00129g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We investigated the association between iron status, B12, and inflammatory markers among 101 adolescent girls. We found that B12 showed significant negative association with tumor necrosis factor-alpha (TNF-α) (rs = -0.232, P = 0.020) and positive association with serum ferritin (SF) (rs = 0.209, P = 0.036) among girls. Our results showed that hepcidin discriminates anemic and non-anemic population under normal B12 conditions. The logistic regression analysis revealed that the risk of having higher TNF-α levels was 13.2 times higher in low B12 girls in the presence of anemia compared to the girls having normal hemoglobin and B12 levels.
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Affiliation(s)
- N S Ghatpande
- Bioprospecting Group, Agharkar Research Institute, Pune, 411004, India.
| | - P P Apte
- Bioprospecting Group, Agharkar Research Institute, Pune, 411004, India.
| | - S S Naik
- K. E. M. Hospital and Research Center, Pune, 411011, India
| | - B N Joshi
- Bioprospecting Group, Agharkar Research Institute, Pune, 411004, India.
| | - M K Gokhale
- Bioprospecting Group, Agharkar Research Institute, Pune, 411004, India.
| | - P P Kulkarni
- Bioprospecting Group, Agharkar Research Institute, Pune, 411004, India.
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36
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Weinhouse C, Ortiz EJ, Berky AJ, Bullins P, Hare-Grogg J, Rogers L, Morales AM, Hsu-Kim H, Pan WK. Hair Mercury Level is Associated with Anemia and Micronutrient Status in Children Living Near Artisanal and Small-Scale Gold Mining in the Peruvian Amazon. Am J Trop Med Hyg 2017; 97:1886-1897. [PMID: 29016304 DOI: 10.4269/ajtmh.17-0269] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Anemia has been widely studied in global health contexts because of severe nutritional deficiency, and more recently, inflammatory status, but chemical exposures are rarely considered. Until recently, "anemia" was used synonymously with "iron deficiency anemia (IDA)" in global health settings. However, only 50% of anemia cases worldwide are IDA. Environmental toxicology studies of anemia risk have generally focused on populations in developed countries, albeit with high exposure to environmental toxicants, such as lead or cadmium. In the developing world, toxicant exposures commonly coexist with other risk factors for anemia. In particular, artisanal and small-scale gold mining (ASGM) communities are at risk for dietary methylmercury exposure through contaminated fish consumption, and for anemia due to food insecurity and infectious and chronic diseases. Here, we report analysis of total hair mercury content, hemoglobin, and serum micronutrient levels in children < 12 years of age (N = 83) near ASGM in the Peruvian Amazon. Forty-nine percent (N = 29/59) of those aged < 5 years were anemic (< 11 g/dL) and 52% (N = 12/23) of those aged 5-11 years (< 11.5 g/dL). Few children were stunted, wasted, or micronutrient deficient. Median total hair mercury was 1.18 μg/g (range: 0.06-9.70 μg/g). We found an inverse association between total mercury and hemoglobin (β = -0.12 g/dL, P = 0.06) that persisted (β = -0.14 g/dL, P = 0.04) after adjusting for age, sex, anthropometrics, and vitamin B12 in multivariate regression. This study provides preliminary evidence that methylmercury exposure is associated with anemia, which is especially relevant to children living near ASGM.
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Affiliation(s)
- Caren Weinhouse
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Ernesto J Ortiz
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Axel J Berky
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Paige Bullins
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - John Hare-Grogg
- Civil and Environmental Engineering, Duke University, Durham, North Carolina
| | - Laura Rogers
- Civil and Environmental Engineering, Duke University, Durham, North Carolina
| | - Ana-Maria Morales
- Centro de Estudios, Investigación y Servicios en Salud Publica, Lima, Peru
| | - Heileen Hsu-Kim
- Nicholas School of the Environment, Duke University, Durham, North Carolina.,Civil and Environmental Engineering, Duke University, Durham, North Carolina
| | - William K Pan
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Nicholas School of the Environment, Duke University, Durham, North Carolina
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37
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Gitaka J, Ogwang C, Ngari M, Akoo P, Olotu A, Kerubo C, Fegan G, Njuguna P, Nyakaya G, Otieno T, Mwambingu G, Awuondo K, Lowe B, Chilengi R, Berkley JA. Clinical laboratory reference values amongst children aged 4 weeks to 17 months in Kilifi, Kenya: A cross sectional observational study. PLoS One 2017; 12:e0177382. [PMID: 28493930 PMCID: PMC5426761 DOI: 10.1371/journal.pone.0177382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 04/26/2017] [Indexed: 12/24/2022] Open
Abstract
Reference intervals for clinical laboratory parameters are important for assessing eligibility, toxicity grading and management of adverse events in clinical trials. Nonetheless, haematological and biochemical parameters used for clinical trials in sub-Saharan Africa are typically derived from industrialized countries, or from WHO references that are not region-specific. We set out to establish community reference values for haematological and biochemical parameters amongst children aged 4 weeks to 17 months in Kilifi, Kenya. We conducted a cross sectional study nested within phase II and III trials of RTS, S malaria vaccine candidate. We analysed 10 haematological and 2 biochemical parameters from 1,070 and 423 community children without illness prior to experimental vaccine administration. Statistical analysis followed Clinical and Laboratory Standards Institute EP28-A3c guidelines. 95% reference ranges and their respective 90% confidence intervals were determined using non-parametric methods. Findings were compared with published ranges from Tanzania, Europe and The United States. We determined the reference ranges within the following age partitions: 4 weeks to <6 months, 6 months to less than <12 months, and 12 months to 17 months for the haematological parameters; and 4 weeks to 17 months for the biochemical parameters. There were no gender differences for all haematological and biochemical parameters in all age groups. Hb, MCV and platelets 95% reference ranges in infants largely overlapped with those from United States or Europe, except for the lower limit for Hb, Hct and platelets (lower); and upper limit for platelets (higher) and haematocrit(lower). Community norms for common haematological and biochemical parameters differ from developed countries. This reaffirms the need in clinical trials for locally derived reference values to detect deviation from what is usual in typical children in low and middle income countries.
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Affiliation(s)
- Jesse Gitaka
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Clinical Medicine, School of Health Sciences, Mount Kenya University, Thika, Kenya
| | - Caroline Ogwang
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Moses Ngari
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya.,The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya
| | - Pauline Akoo
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ally Olotu
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Christine Kerubo
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Greg Fegan
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom.,Swansea Trials Unit, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Patricia Njuguna
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Godfrey Nyakaya
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Tuda Otieno
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Gabriel Mwambingu
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ken Awuondo
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Brett Lowe
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom
| | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - James A Berkley
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya.,The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya.,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom
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38
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Wray K, Allen A, Evans E, Fisher C, Premawardhena A, Perera L, Rodrigo R, Goonathilaka G, Ramees L, Webster C, Armitage AE, Prentice AM, Weatherall DJ, Drakesmith H, Pasricha SR. Hepcidin detects iron deficiency in Sri Lankan adolescents with a high burden of hemoglobinopathy: A diagnostic test accuracy study. Am J Hematol 2017; 92:196-203. [PMID: 27883199 PMCID: PMC5324588 DOI: 10.1002/ajh.24617] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 12/23/2022]
Abstract
Anemia affects over 800 million women and children globally. Measurement of hepcidin as an index of iron status shows promise, but its diagnostic performance where hemoglobinopathies are prevalent is unclear. We evaluated the performance of hepcidin as a diagnostic test of iron deficiency in adolescents across Sri Lanka. We selected 2273 samples from a nationally representative cross-sectional study of 7526 secondary schoolchildren across Sri Lanka and analyzed associations between hepcidin and participant characteristics, iron indices, inflammatory markers, and hemoglobinopathy states. We evaluated the diagnostic accuracy of hepcidin as a test for iron deficiency with estimation of the AUCROC , sensitivity/specificity at each hepcidin cutoff, and calculation of the Youden Index to find the optimal threshold. Hepcidin was associated with ferritin, sTfR, and hemoglobin. The AUCROC for hepcidin as a test of iron deficiency was 0.78; hepcidin outperformed Hb and sTfR. The Youden index-predicted cutoff to detect iron deficiency (3.2 ng/mL) was similar to thresholds previously identified to predict iron utilization and identify deficiency in African populations. Neither age, sex, nor α- or β-thalassemia trait affected diagnostic properties of hepcidin. Hepcidin pre-screening would prevent most iron-replete thalassemia carriers from receiving iron whilst still ensuring most iron deficient children were supplemented. Our data indicate that the physiological relationship between hepcidin and iron status transcends specific populations. Measurement of hepcidin in individuals or populations could establish the need for iron interventions. Am. J. Hematol. 92:196-203, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Katherine Wray
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford; Oxford UK
- BRC Blood Theme; NIHR Oxford Biomedical Research Centre; Oxford UK
| | - Angela Allen
- Liverpool School of Tropical Medicine; Centre for Tropical and Infectious Diseases; Liverpool UK
| | - Emma Evans
- Department of Biochemistry and Immunology; Birmingham Heartlands Hospital; Birmingham UK
| | - Chris Fisher
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford; Oxford UK
| | | | - Lakshman Perera
- Department of Medicine; University of Kelaniya; Colombo Sri Lanka
| | - Rexan Rodrigo
- Department of Medicine; University of Kelaniya; Colombo Sri Lanka
| | | | - Lebbe Ramees
- Department of Medicine; University of Kelaniya; Colombo Sri Lanka
| | - Craig Webster
- Department of Biochemistry and Immunology; Birmingham Heartlands Hospital; Birmingham UK
| | - Andrew E Armitage
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford; Oxford UK
| | - Andrew M Prentice
- MRC Unit The Gambia, MRC Keneba; The Gambia
- MRC International Nutrition Group, London School of Hygiene and Tropical Medicine; London UK
| | - David J Weatherall
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford; Oxford UK
| | - Hal Drakesmith
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford; Oxford UK
- BRC Blood Theme; NIHR Oxford Biomedical Research Centre; Oxford UK
| | - Sant-Rayn Pasricha
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford; Oxford UK
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39
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Prentice AM, Mendoza YA, Pereira D, Cerami C, Wegmuller R, Constable A, Spieldenner J. Dietary strategies for improving iron status: balancing safety and efficacy. Nutr Rev 2017; 75:49-60. [PMID: 27974599 PMCID: PMC5155616 DOI: 10.1093/nutrit/nuw055] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In light of evidence that high-dose iron supplements lead to a range of adverse events in low-income settings, the safety and efficacy of lower doses of iron provided through biological or industrial fortification of foodstuffs is reviewed. First, strategies for point-of-manufacture chemical fortification are compared with biofortification achieved through plant breeding. Recent insights into the mechanisms of human iron absorption and regulation, the mechanisms by which iron can promote malaria and bacterial infections, and the role of iron in modifying the gut microbiota are summarized. There is strong evidence that supplemental iron given in nonphysiological amounts can increase the risk of bacterial and protozoal infections (especially malaria), but the use of lower quantities of iron provided within a food matrix, ie, fortified food, should be safer in most cases and represents a more logical strategy for a sustained reduction of the risk of deficiency by providing the best balance of risk and benefits. Further research into iron compounds that would minimize the availability of unabsorbed iron to the gut microbiota is warranted.
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Affiliation(s)
- Andrew M Prentice
- A.M. Prentice, D. Pereira, C. Cerami, and R. Wegmuller are with the Medical Research Council (MRC) Unit The Gambia, Fajara, Banjul, The Gambia. A.M. Prentice and R. Wegmuller are with the MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. Y.A. Mendoza, A. Constable, and J. Spieldenner are with the Nestlé Research Centre, Lausanne, Switzerland. D. Pereira is with the Department of Pathology, University of Cambridge, Cambridge, United Kingdom. C. Cerami is with the Division of Infectious Diseases, Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
| | - Yery A Mendoza
- A.M. Prentice, D. Pereira, C. Cerami, and R. Wegmuller are with the Medical Research Council (MRC) Unit The Gambia, Fajara, Banjul, The Gambia. A.M. Prentice and R. Wegmuller are with the MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. Y.A. Mendoza, A. Constable, and J. Spieldenner are with the Nestlé Research Centre, Lausanne, Switzerland. D. Pereira is with the Department of Pathology, University of Cambridge, Cambridge, United Kingdom. C. Cerami is with the Division of Infectious Diseases, Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Dora Pereira
- A.M. Prentice, D. Pereira, C. Cerami, and R. Wegmuller are with the Medical Research Council (MRC) Unit The Gambia, Fajara, Banjul, The Gambia. A.M. Prentice and R. Wegmuller are with the MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. Y.A. Mendoza, A. Constable, and J. Spieldenner are with the Nestlé Research Centre, Lausanne, Switzerland. D. Pereira is with the Department of Pathology, University of Cambridge, Cambridge, United Kingdom. C. Cerami is with the Division of Infectious Diseases, Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Carla Cerami
- A.M. Prentice, D. Pereira, C. Cerami, and R. Wegmuller are with the Medical Research Council (MRC) Unit The Gambia, Fajara, Banjul, The Gambia. A.M. Prentice and R. Wegmuller are with the MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. Y.A. Mendoza, A. Constable, and J. Spieldenner are with the Nestlé Research Centre, Lausanne, Switzerland. D. Pereira is with the Department of Pathology, University of Cambridge, Cambridge, United Kingdom. C. Cerami is with the Division of Infectious Diseases, Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Rita Wegmuller
- A.M. Prentice, D. Pereira, C. Cerami, and R. Wegmuller are with the Medical Research Council (MRC) Unit The Gambia, Fajara, Banjul, The Gambia. A.M. Prentice and R. Wegmuller are with the MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. Y.A. Mendoza, A. Constable, and J. Spieldenner are with the Nestlé Research Centre, Lausanne, Switzerland. D. Pereira is with the Department of Pathology, University of Cambridge, Cambridge, United Kingdom. C. Cerami is with the Division of Infectious Diseases, Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Anne Constable
- A.M. Prentice, D. Pereira, C. Cerami, and R. Wegmuller are with the Medical Research Council (MRC) Unit The Gambia, Fajara, Banjul, The Gambia. A.M. Prentice and R. Wegmuller are with the MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. Y.A. Mendoza, A. Constable, and J. Spieldenner are with the Nestlé Research Centre, Lausanne, Switzerland. D. Pereira is with the Department of Pathology, University of Cambridge, Cambridge, United Kingdom. C. Cerami is with the Division of Infectious Diseases, Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jörg Spieldenner
- A.M. Prentice, D. Pereira, C. Cerami, and R. Wegmuller are with the Medical Research Council (MRC) Unit The Gambia, Fajara, Banjul, The Gambia. A.M. Prentice and R. Wegmuller are with the MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. Y.A. Mendoza, A. Constable, and J. Spieldenner are with the Nestlé Research Centre, Lausanne, Switzerland. D. Pereira is with the Department of Pathology, University of Cambridge, Cambridge, United Kingdom. C. Cerami is with the Division of Infectious Diseases, Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Abstract
PURPOSE OF REVIEW Anemia is prevalent in patients with infections and other inflammatory conditions. Induction of the iron regulatory hormone hepcidin has been implicated in the pathogenesis of anemia of inflammation. This review outlines recent discoveries in understanding how hepcidin and its receptor ferroportin are regulated, how they contribute to anemia of inflammation, and how this knowledge may help guide new diagnostic and therapeutic strategies for this disease. RECENT FINDINGS IL-6 is a primary driver for hepcidin induction in many models of anemia of inflammation, but the SMAD1/5/8 pathway also contributes, likely via Activin B and SMAD-STAT3 interactions at the hepcidin promoter. Hepcidin has an important functional role in many, but not all forms of anemia of inflammation, although hepcidin-independent mechanisms also contribute. In certain populations, hepcidin assays may help target therapy with iron or erythropoiesis-stimulating agents to patients who may benefit most. New therapies targeting the hepcidin-ferroportin axis have shown efficacy in preclinical and early clinical studies. SUMMARY Recent studies confirm an important role for the hepcidin-ferroportin axis in the development of anemia of inflammation, but also highlight the diverse and complex pathogenesis of this disorder depending on the underlying disease. Hepcidin-based diagnostic and therapeutic strategies offer promise to improve anemia treatment, but more work is needed in this area.
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41
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Pasricha SR, Drakesmith H. Iron Deficiency Anemia: Problems in Diagnosis and Prevention at the Population Level. Hematol Oncol Clin North Am 2016; 30:309-25. [PMID: 27040956 DOI: 10.1016/j.hoc.2015.11.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Anemia is common among people living in low- and middle-income countries, and alleviation of the global burden of anemia is an essential global health target over the next decade. Estimates have attributed about half the cases of anemia worldwide to iron deficiency; a range of other causes probably make a similar overall contribution. Individuals living in low-income settings experience a simultaneous high burden of infection with inflammation and iron deficiency. At least in children, iron supplementation exacerbates the risk of infection in both malaria-endemic and nonendemic low-income countries, whereas iron deficiency is protective against clinical and severe malaria.
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Affiliation(s)
- Sant-Rayn Pasricha
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DS, UK.
| | - Hal Drakesmith
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DS, UK
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42
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Shen Y, Xue CJ, Zhong WG, Chen ZJ, You GL, Xue Y. Clinical significance of serum hepcidin in patients with acute pancreatitis. Shijie Huaren Xiaohua Zazhi 2016; 24:2236-2240. [DOI: 10.11569/wcjd.v24.i14.2236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the changes of serum hepcidin in patients with acute pancreatitis and analyze its clinical significance.
METHODS: Blood samples from 104 patients with mild acute pancreatitis, 45 patients with severe acute pancreatitis and 50 healthy controls were collected, and serum hepcidin was measured by enzyme linked immunosorbent assay at admission, 1, 3, and 7 d after admission. The association of serum hepcidin with acute pancreatitis was analyzed. Receiver operating characteristic curve analysis was performed.
RESULTS: The median concentration of serum hepcidin in patients with acute pancreatitis at admission was significantly higher than that in healthy controls (P < 0.05). The differences in median concentrations of serum hepcidin between severe and mild acute pancreatitis were significant at 1, 3, and 7 d after admission (P < 0.05), but not at admission. Correlation analysis showed that serum hepcidin was positively correlated with C-reactive protein levels and APACHE-II score (P = 0.004, 0.000), but was negatively correlated with serum calcium levels (P = 0.003). The area under the ROC curve of serum hepcidin in patients with severe acute pancreatitis and mild acute pancreatitis at 3 d after admission was 0.802. With a cutoff value of 133 ng/mL, the overall sensitivity was 95.6%, and specificity was 61.5%.
CONCLUSION: Serum hepcidin correlates with the extent of pancreatitis. It can be used for monitoring the development of acute pancreatitis and may be a potential marker for early diagnosis of severe acute pancreatitis.
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44
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Weiler HA, Jean-Philippe S, Cohen TR, Vanstone CA, Agellon S. Depleted iron stores and iron deficiency anemia associated with reduced ferritin and hepcidin and elevated soluble transferrin receptors in a multiethnic group of preschool-age children. Appl Physiol Nutr Metab 2015; 40:887-94. [DOI: 10.1139/apnm-2014-0328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Iron deficiency anemia is prevalent in subgroups of the Canadian population. The objective of this study was to examine iron status and anemia in preschool-age children. Healthy children (n = 430, 2–5 years old, Montreal, Quebec, Canada) were sampled from randomly selected daycares. Anthropometry, demographics, and diet were assessed. Biochemistry included hemoglobin, ferritin, soluble transferrin receptors (sTfR), ferritin index, markers of inflammation (C-reactive protein, interleukin 6 (IL-6), and tumour necrosis factor alpha (TNFα)), and hepcidin. Iron deficiency and anemia cutoffs conformed to the World Health Organization criteria. Differences among categories were tested using mixed-model ANOVA or χ2tests. Children were 3.8 ± 1.0 years of age, with a body mass index z score of 0.48 ± 0.97, and 51% were white. Adjusted intakes of iron indicated <1% were at risk for deficiency. Hemoglobin was higher in white children, whereas ferritin was higher with greater age and female sex. Inflammatory markers and hepcidin did not vary with any demographic variable. The prevalence of iron deficiency was 16.5% (95% confidence interval (CI), 13.0–20.0). Three percent (95% CI, 1.4–4.6) of children had iron deficiency anemia and 12.8% (95% CI, 9.6–16.0) had unexplained anemia. Children with iron deficiency, with and without anemia, had lower plasma ferritin and hepcidin but higher sTfR, ferritin index, and IL-6, whereas those with unexplained anemia had elevated TNFα. We conclude that iron deficiency anemia is not very common in young children in Montreal. While iron deficiency without anemia is more common than iron deficiency with anemia, the correspondingly reduced circulating hepcidin would have enabled heightened absorption of dietary iron in support of erythropoiesis.
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Affiliation(s)
- Hope A. Weiler
- School of Dietetics and Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC H9X 3V9, Canada
- School of Dietetics and Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC H9X 3V9, Canada
| | - Sonia Jean-Philippe
- School of Dietetics and Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC H9X 3V9, Canada
- School of Dietetics and Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC H9X 3V9, Canada
| | - Tamara R. Cohen
- School of Dietetics and Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC H9X 3V9, Canada
- School of Dietetics and Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC H9X 3V9, Canada
| | - Catherine A. Vanstone
- School of Dietetics and Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC H9X 3V9, Canada
- School of Dietetics and Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC H9X 3V9, Canada
| | - Sherry Agellon
- School of Dietetics and Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC H9X 3V9, Canada
- School of Dietetics and Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC H9X 3V9, Canada
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Erythrocytic Iron Deficiency Enhances Susceptibility to Plasmodium chabaudi Infection in Mice Carrying a Missense Mutation in Transferrin Receptor 1. Infect Immun 2015; 83:4322-34. [PMID: 26303393 DOI: 10.1128/iai.00926-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/20/2015] [Indexed: 01/26/2023] Open
Abstract
The treatment of iron deficiency in areas of high malaria transmission is complicated by evidence which suggests that iron deficiency anemia protects against malaria, while iron supplementation increases malaria risk. Iron deficiency anemia results in an array of pathologies, including reduced systemic iron bioavailability and abnormal erythrocyte physiology; however, the mechanisms by which these pathologies influence malaria infection are not well defined. In the present study, the response to malaria infection was examined in a mutant mouse line, Tfrc(MRI24910), identified during an N-ethyl-N-nitrosourea (ENU) screen. This line carries a missense mutation in the gene for transferrin receptor 1 (TFR1). Heterozygous mice exhibited reduced erythrocyte volume and density, a phenotype consistent with dietary iron deficiency anemia. However, unlike the case in dietary deficiency, the erythrocyte half-life, mean corpuscular hemoglobin concentration, and intraerythrocytic ferritin content were unchanged. Systemic iron bioavailability was also unchanged, indicating that this mutation results in erythrocytic iron deficiency without significantly altering overall iron homeostasis. When infected with the rodent malaria parasite Plasmodium chabaudi adami, mice displayed increased parasitemia and succumbed to infection more quickly than their wild-type littermates. Transfusion of fluorescently labeled erythrocytes into malaria parasite-infected mice demonstrated an erythrocyte-autonomous enhanced survival of parasites within mutant erythrocytes. Together, these results indicate that TFR1 deficiency alters erythrocyte physiology in a way that is similar to dietary iron deficiency anemia, albeit to a lesser degree, and that this promotes intraerythrocytic parasite survival and an increased susceptibility to malaria in mice. These findings may have implications for the management of iron deficiency in the context of malaria.
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Atkinson SH, Uyoga SM, Armitage AE, Khandwala S, Mugyenyi CK, Bejon P, Marsh K, Beeson JG, Prentice AM, Drakesmith H, Williams TN. Malaria and Age Variably but Critically Control Hepcidin Throughout Childhood in Kenya. EBioMedicine 2015; 2:1478-86. [PMID: 26629542 PMCID: PMC4634196 DOI: 10.1016/j.ebiom.2015.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/06/2015] [Accepted: 08/06/2015] [Indexed: 01/01/2023] Open
Abstract
Both iron deficiency (ID) and malaria are common among African children. Studies show that the iron-regulatory hormone hepcidin is induced by malaria, but few studies have investigated this relationship longitudinally. We measured hepcidin concentrations, markers of iron status, and antibodies to malaria antigens during two cross-sectional surveys within a cohort of 324 Kenyan children ≤ 8 years old who were under intensive surveillance for malaria and other febrile illnesses. Hepcidin concentrations were the highest in the youngest, and female infants, declined rapidly in infancy and more gradually thereafter. Asymptomatic malaria and malaria antibody titres were positively associated with hepcidin concentrations. Recent episodes of febrile malaria were associated with high hepcidin concentrations that fell over time. Hepcidin concentrations were not associated with the subsequent risk of either malaria or other febrile illnesses. Given that iron absorption is impaired by hepcidin, our data suggest that asymptomatic and febrile malaria contribute to the high burden of ID seen in African children. Further, the effectiveness of iron supplementation may be sub-optimal in the presence of asymptomatic malaria. Thus, strategies to prevent and eliminate malaria may have the added benefit of addressing an important cause of ID for African children.
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Affiliation(s)
- Sarah H Atkinson
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme (KWTRP), PO Box 230-80108, Kilifi, Kenya ; Department of Paediatrics, Oxford University Hospitals, University of Oxford, Oxford, UK ; Oxford University Clinical Academic Graduate School, Oxford, UK
| | - Sophie M Uyoga
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme (KWTRP), PO Box 230-80108, Kilifi, Kenya
| | - Andrew E Armitage
- Medical Research Unit (MRC) Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford University Hospitals, UK ; National Institute for Health Research Biomedical Research Centre Oxford, UK
| | - Shivani Khandwala
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme (KWTRP), PO Box 230-80108, Kilifi, Kenya ; Medical Research Unit (MRC) Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford University Hospitals, UK
| | - Cleopatra K Mugyenyi
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme (KWTRP), PO Box 230-80108, Kilifi, Kenya ; Burnet Institute, Melbourne, Victoria, Australia
| | - Philip Bejon
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme (KWTRP), PO Box 230-80108, Kilifi, Kenya
| | - Kevin Marsh
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme (KWTRP), PO Box 230-80108, Kilifi, Kenya
| | - James G Beeson
- Burnet Institute, Melbourne, Victoria, Australia ; Department of Microbiology, Monash University, Victoria, Australia
| | - Andrew M Prentice
- Medical Research Council (MRC) Unit, The Gambia ; Medical Research Council (MRC) International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Hal Drakesmith
- Medical Research Unit (MRC) Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford University Hospitals, UK ; National Institute for Health Research Biomedical Research Centre Oxford, UK
| | - Thomas N Williams
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme (KWTRP), PO Box 230-80108, Kilifi, Kenya ; Department of Medicine, Imperial College, London, UK
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Plasma Concentrations of Hepcidin in Anemic Zimbabwean Infants. PLoS One 2015; 10:e0135227. [PMID: 26252205 PMCID: PMC4529326 DOI: 10.1371/journal.pone.0135227] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 07/20/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Anemia in infancy is a global public health problem. We evaluated the relative contributions of iron deficiency and inflammation to infant anemia. METHODS We measured plasma hepcidin, ferritin, soluble transferrin receptor (sTfR), alpha-1-acid glycoprotein and C-reactive protein (CRP) by ELISA on archived plasma from 289 HIV-unexposed anemic or non-anemic Zimbabwean infants at ages 3 mo, 6 mo and 12 mo. Among anemic infants, we determined the proportion with iron-deficiency anemia (IDA) and anemia of inflammation (AI). We undertook regression analyses of plasma hepcidin and anemia status, adjusting for sex, age and birthweight. RESULTS Anemic infants at 3 mo were more stunted and had higher CRP (median 0.45 vs 0.21 mg/L; P = 0.037) and hepcidin (median 14.7 vs 9.7 ng/mL; P = 0.022) than non-anemic infants, but similar levels of ferritin and sTfR; 11% infants had IDA and 15% had AI. Anemic infants at 6 mo had higher hepcidin (median 7.9 vs 4.5 ng/mL; P = 0.016) and CRP (median 2.33 vs 0.32 mg/L; P<0.001), but lower ferritin (median 13.2 vs 25.1 μg/L; P<0.001) than non-anemic infants; 56% infants had IDA and 12% had AI. Anemic infants at 12 mo had lower ferritin (median 3.2 vs 22.2 μg/L; P<0.001) and hepcidin (median 0.9 vs 1.9 ng/mL; P = 0.019), but similar CRP levels; 48% infants had IDA and 8% had AI. Comparing anemic with non-anemic infants, plasma hepcidin was 568% higher, 405% higher and 64% lower at 3 mo, 6 mo and 12 mo, respectively, after adjusting for sex and birthweight (all p<0.01). Plasma hepcidin declined significantly with age among anemic but not non-anemic infants. Girls had 61% higher hepcidin than boys, after adjusting for age, anemia and birthweight (p<0.001). CONCLUSION Anemia is driven partly by inflammation early in infancy, and by iron deficiency later in infancy, with plasma hepcidin concentrations reflecting the relative contribution of each. However, there is need to better characterize the drivers of hepcidin during infancy in developing countries.
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Minchella PA, Armitage AE, Darboe B, Jallow MW, Drakesmith H, Jaye A, Prentice AM, McDermid JM. Elevated Hepcidin Is Part of a Complex Relation That Links Mortality with Iron Homeostasis and Anemia in Men and Women with HIV Infection. J Nutr 2015; 145:1194-201. [PMID: 25904736 PMCID: PMC4442111 DOI: 10.3945/jn.114.203158] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 03/23/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Early and chronic inflammation is a hallmark of HIV infection, and inflammation is known to increase hepcidin expression. Consequently, hepcidin may be a key determinant of the iron homeostasis and anemia associated with poorer HIV prognoses. OBJECTIVE The objective of this study was to understand how hepcidin is related to anemia, iron homeostasis, and inflammation at HIV diagnosis and to investigate associations between hepcidin and all-cause mortality in HIV infection. METHODS In a retrospective cohort, baseline plasma hepcidin was measured by competitive enzyme immunoassay within 3 mo of HIV diagnosis in 196 antiretroviral-naive Gambians. Iron homeostasis [hemoglobin, plasma transferrin, ferritin, iron, soluble transferrin receptor (sTfR)] and inflammation [α1-antichymotrypsin (ACT)] from the same plasma sample were available, as were absolute CD4 cell counts, age, gender, body mass index (BMI), and HIV type. RESULTS Anemia was common across the spectrum of immunosuppression [CD4 cell counts (prevalence of anemia): >500 cells/μL (68%), 200-500 cells/μL (73%), and <200 cells/μL (89%); P = 0.032] and in men (81%) and women (76%). Increasing hepcidin was associated with iron homeostasis biomarkers (higher ferritin and lower transferrin, hemoglobin, and sTfR), inflammation (higher ACT), and key health indicators (lower CD4 or BMI, advancing age, and male gender; P < 0.001 except for hemoglobin, P = 0.021). Elevated hepcidin was associated with greater all-cause mortality in a dose-dependent manner [intermediate vs. lowest tertile: unadjusted HR (95% CI), 1.95 (1.22, 3.10); upper vs. lowest tertile: 3.02 (1.91, 4.78)]. Principal components analysis identified 2 patterns composed of hepcidin-ferritin-transferrin, with or without ACT, and iron-sTfR-hemoglobin that may distinguish inflammation and erythropoiesis iron functions. CONCLUSIONS Elevated hepcidin is independently associated with greater mortality in men and women with HIV infection, and hepcidin is also part of a complex relation linking iron homeostasis, anemia, and HIV. Understanding the mechanisms and role of hepcidin modulation may further guide evidence-based interventions needed to counter detrimental iron homeostasis and anemia in HIV infection.
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Affiliation(s)
| | - Andrew E Armitage
- Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Bakary Darboe
- Medical Research Council Unit (UK), Fajara, The Gambia
| | | | - Hal Drakesmith
- Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Assan Jaye
- Medical Research Council Unit (UK), Fajara, The Gambia
| | - Andrew M Prentice
- International Nutrition Group, Department of Nutrition and Public Health Intervention Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; and
| | - Joann M McDermid
- Department of Nutritional Sciences, Cornell University, Ithaca, NY;
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Konz T, Montes-Bayón M, Vaulont S. Hepcidin quantification: methods and utility in diagnosis. Metallomics 2015; 6:1583-90. [PMID: 24874645 DOI: 10.1039/c4mt00063c] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hepcidin is a 25-amino acid peptide hormone that is produced and secreted predominantly by hepatocytes, circulates in the bloodstream, and is excreted by the kidneys. Since the discovery of hepcidin and the elucidation of its important role in iron homeostasis, hepcidin has been suggested as a promising diagnostic marker for iron-related disorders. In this regard, a number of analytical methods have been developed in order to assess hepcidin concentration in different biological fluids, particularly serum and urine. In this critical review we have tried to address the issues still pending in accurate determination of this peptide by evaluating the available analytical methodologies. Among them, the use of ELISA strategies (in competitive or sandwich formats) and molecular mass spectrometry (MS) including MALDI and/or LC-MS has been critically compared. The use of elemental mass spectrometry (ICP-MS) has also been included as a possible complementary tool to the previous ones. In addition, this manuscript has revised the existing and potentially emerging clinical applications of hepcidin testing for diagnosis. These include the iron disorders such as iron deficiency anemia (IDA, low hepcidin), anemia of chronic disease (ACD, high hepcidin) and the combined state of ACD and IDA or hemochromatosis. Other applications such as using hepcidin in assessing the response to existing therapies in cancer have also been revised in the manuscript.
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Affiliation(s)
- T Konz
- Department of Physical and Analytical Chemistry, Faculty of Chemistry, University of Oviedo, C/Julian Clavería 8, 33006 Oviedo, Spain.
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