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Tejada VFDS, Zhang L, Zogbi L. Efficacy and safety of topical application of tranexamic acid in patients undergoing reconstructive plastic surgery after excision of facial skin cancers: a randomised clinical trial. Rev Col Bras Cir 2024; 51:e20243761. [PMID: 39045920 DOI: 10.1590/0100-6991e-20243761-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/10/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Tranexamic acid (TA) has attracted increased attention among surgical specialties, but its use in plastic surgery is limited. The aim of this study was to assess the efficacy and safety of topical administration of 3% TA solution in reconstructive surgery of the face and scalp after excision of skin cancers. METHODS a randomized, double-blind, parallel-group clinical trial was conducted in patients aged 18 years or older with malignant skin neoplasms in the face or scalp region (ICD-10 C44.9). The primary outcome was volume of blood loss in the intraoperative and immediate postoperative period. Secondary outcomes included difficult-to-control intraoperative haemorrhage, hematoma, ecchymosis, and other adverse events. RESULTS of the 54 included patients, 26 were randomised to TA group and 28 to placebo group. The mean blood loss was 11.42ml (SD 6.40, range 8.83-14.01) in the TA group, and 17.6ml (SD 6.22, range 15.19-20.01) in the placebo group, representing a mean decrease of 6.18ml (35.11%) (p=0.001). TA significantly reduced the risk of ecchymosis (RR = 0.046; 95% CI: 0.007-0.323). Only two patients in the placebo group experienced ischemia in the flaps, and one patient in the placebo group experienced tissue necrosis requiring surgical reintervention. There were no surgical wound infections, thromboembolic phenomena, or other adverse events related to TA. CONCLUSIONS topical TA may reduce intraoperative and immediate postoperative bleeding, with a significantly decreased risk of ecchymosis. There is no evidence of ischemic damage of flaps, systemic thromboembolic complications, or other adverse events.
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Affiliation(s)
| | - Linjie Zhang
- - Universidade Federal do Rio Grande - Rio Grande - RS - Brasil
| | - Luciano Zogbi
- - Universidade Federal do Rio Grande - Rio Grande - RS - Brasil
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Huang DW, He GQ, Guo X, Wan Z, Gao J, Yang R. Iron-Refractory Iron Deficiency Anemia with Novel TMPRSS6 Mutation. Indian J Pediatr 2024; 91:311. [PMID: 38052955 DOI: 10.1007/s12098-023-04965-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Duo-Wen Huang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, 20, Section 3, Renmin South Road, Chengdu, Sichuan Province, People's Republic of China
| | - Guo-Qian He
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, 20, Section 3, Renmin South Road, Chengdu, Sichuan Province, People's Republic of China
| | - Xia Guo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, 20, Section 3, Renmin South Road, Chengdu, Sichuan Province, People's Republic of China
| | - Zhi Wan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, 20, Section 3, Renmin South Road, Chengdu, Sichuan Province, People's Republic of China
| | - Ju Gao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, 20, Section 3, Renmin South Road, Chengdu, Sichuan Province, People's Republic of China
| | - Rong Yang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.
- Department of Pediatrics, West China Second University Hospital, Sichuan University, 20, Section 3, Renmin South Road, Chengdu, Sichuan Province, People's Republic of China.
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Halfon P, Penaranda G, Ringwald D, Retornaz F, Boissel N, Bodard S, Feryn JM, Bensoussan D, Cacoub P. Laboratory tests for investigating anemia: From an expert system to artificial intelligence. Pract Lab Med 2024; 39:e00357. [PMID: 38404528 PMCID: PMC10883828 DOI: 10.1016/j.plabm.2024.e00357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 02/27/2024] Open
Abstract
Objective To compare the laboratory tests conducted in real-life settings for patients with anemia with the expected prescriptions derived from an optimal checkup. Methods A panel of experts formulated an "optimal laboratory test assessment" specific to each anemia profile. A retrospective analysis was done of the laboratory tests conducted according to the type of anemia (microcytic, normocytic or macrocytic). Using an algorithmic system, the laboratory tests performed in real-life practice were compared with the recommendations suggested in the "optimal laboratory test assessment" and with seemingly "unnecessary" laboratory tests. Results In the analysis of the "optimal laboratory test assessment", of the 1179 patients with microcytic anemia, 269 (22.8%) had had one of the three tests recommended by the expert system, and only 33 (2.8%) had all three tests. For normocytic anemia, 1054 of 2313 patients (45.6%) had one of the eleven recommended tests, and none had all eleven. Of the 384 patients with macrocytic anemia, 196 (51%) had one of the four recommended tests, and none had all four. In the analysis of "unnecessary laboratory tests", one lab test was unnecessarily done in 727/3876 patients (18.8%), i.e. 339 of 1179 (28.8%) microcytic, 171 of 2313 (7.4%) normocytic, and 217 of 384 (56.5 %) macrocytic anemias. Conclusion Laboratory investigations of anemia remain imperfect as more than half of the cases did not receive the expected tests. Analyzing other diagnostic domains, the authors are currently developing an artificial intelligence system to assist physicians in enhancing the efficiency of their laboratory test prescriptions.
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Affiliation(s)
- Philippe Halfon
- Pôle de Médecine Interne et Maladies infectieuses Hôpital Européen, 13000, Marseille, France
- Laboratoire Alphabio, 13000, Marseille, France
| | | | | | - Frederique Retornaz
- Pôle de Médecine Interne et Maladies infectieuses Hôpital Européen, 13000, Marseille, France
| | - Nicolas Boissel
- AP-HP, Service d'hématologie, Hôpital St Louis, Paris, France
| | - Sylvain Bodard
- Université Paris Cité, F-75006, Paris, France
- AP-HP, Service d’Imagerie Adulte, Hôpital Universitaire Necker - Enfants Malades, F-75015, Paris, France
- Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75006, Paris, France
| | | | - David Bensoussan
- Service de chirurgie vasculaire, Centre hospitalier, avenue des tamaris, 13100, Aix en Provence, France
| | - Patrice Cacoub
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France
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Iron Metabolism in the Disorders of Heme Biosynthesis. Metabolites 2022; 12:metabo12090819. [PMID: 36144223 PMCID: PMC9505951 DOI: 10.3390/metabo12090819] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 01/19/2023] Open
Abstract
Given its remarkable property to easily switch between different oxidative states, iron is essential in countless cellular functions which involve redox reactions. At the same time, uncontrolled interactions between iron and its surrounding milieu may be damaging to cells and tissues. Heme—the iron-chelated form of protoporphyrin IX—is a macrocyclic tetrapyrrole and a coordination complex for diatomic gases, accurately engineered by evolution to exploit the catalytic, oxygen-binding, and oxidoreductive properties of iron while minimizing its damaging effects on tissues. The majority of the body production of heme is ultimately incorporated into hemoglobin within mature erythrocytes; thus, regulation of heme biosynthesis by iron is central in erythropoiesis. Additionally, heme is a cofactor in several metabolic pathways, which can be modulated by iron-dependent signals as well. Impairment in some steps of the pathway of heme biosynthesis is the main pathogenetic mechanism of two groups of diseases collectively known as porphyrias and congenital sideroblastic anemias. In porphyrias, according to the specific enzyme involved, heme precursors accumulate up to the enzyme stop in disease-specific patterns and organs. Therefore, different porphyrias manifest themselves under strikingly different clinical pictures. In congenital sideroblastic anemias, instead, an altered utilization of mitochondrial iron by erythroid precursors leads to mitochondrial iron overload and an accumulation of ring sideroblasts in the bone marrow. In line with the complexity of the processes involved, the role of iron in these conditions is then multifarious. This review aims to summarise the most important lines of evidence concerning the interplay between iron and heme metabolism, as well as the clinical and experimental aspects of the role of iron in inherited conditions of altered heme biosynthesis.
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Hoving V, Korman SE, Antonopoulos P, Donker AE, Schols SEM, Swinkels DW. IRIDA Phenotype in TMPRSS6 Monoallelic-Affected Patients: Toward a Better Understanding of the Pathophysiology. Genes (Basel) 2022; 13:genes13081309. [PMID: 35893046 PMCID: PMC9331965 DOI: 10.3390/genes13081309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 12/19/2022] Open
Abstract
Iron-refractory iron deficiency anemia (IRIDA) is an autosomal recessive inherited form of iron deficiency anemia characterized by discrepantly high hepcidin levels relative to body iron status. However, patients with monoallelic exonic TMPRSS6 variants have also been reported to express the IRIDA phenotype. The pathogenesis of an IRIDA phenotype in these patients is unknown and causes diagnostic uncertainty. Therefore, we retrospectively summarized the data of 16 patients (4 men, 12 women) who expressed the IRIDA phenotype in the presence of only a monoallelic TMPRSS6 variant. Eight unaffected relatives with identical exonic TMPRSS6 variants were used as controls. Haplotype analysis was performed to assess the (intra)genetic differences between patients and relatives. The expression and severity of the IRIDA phenotype were highly variable. Compared with their relatives, patients showed lower Hb, MCV, and TSAT/hepcidin ratios and inherited a different wild-type allele. We conclude that IRIDA in monoallelic TMPRSS6-affected patients is a phenotypically and genotypically heterogeneous disease that is more common in female patients. We hypothesize that allelic imbalance, polygenetic inheritance, or modulating environmental factors and their complex interplay are possible causes. This explorative study is the first step toward improved insights into the pathophysiology and improved diagnostic accuracy for patients presenting with IRIDA and a monoallelic exonic TMPRSS6 variant.
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Affiliation(s)
- Vera Hoving
- Department of Hematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GE Nijmegen, The Netherlands;
| | - Scott E. Korman
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GE Nijmegen, The Netherlands; (S.E.K.); (P.A.); (D.W.S.)
| | - Petros Antonopoulos
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GE Nijmegen, The Netherlands; (S.E.K.); (P.A.); (D.W.S.)
| | - Albertine E. Donker
- Department of Pediatrics, Máxima Medical Center, De Run 4600, 5504 NB Veldhoven, The Netherlands;
| | - Saskia E. M. Schols
- Department of Hematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GE Nijmegen, The Netherlands;
- Correspondence:
| | - Dorine W. Swinkels
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GE Nijmegen, The Netherlands; (S.E.K.); (P.A.); (D.W.S.)
- Sanquin Blood Bank, Sanquin Diagnostics BV, Plesmanlaan 125, 1066 NH Amsterdam, The Netherlands
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Clinical interpretation of serum hepcidin-25 in inflammation and renal dysfunction. J Mass Spectrom Adv Clin Lab 2022; 24:43-49. [PMID: 35403094 PMCID: PMC8983384 DOI: 10.1016/j.jmsacl.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/16/2022] [Accepted: 03/27/2022] [Indexed: 11/22/2022] Open
Abstract
log[hepcidin]:log[ferritin] ratio may serve as a biomarker for iron deficiency in complex cases. Hepcidin testing is not warranted in patients with CRP > 10 mg/l and/or eGFR < 30 ml/min/1.73 m2. Inflammation is not a determinant of serum hepcidin-25 in the setting of renal dysfunction. eGFR is not a major determinant of serum hepcidin-25 concentration in patient with eGFR ≥ 30 ml/min/1.73 m2.
Introduction Hepcidin is a hormone that regulates systemic iron homeostasis. Serum hepcidin levels are under the influence of various stimuli, particularly inflammation and renal dysfunction. The measurement of hepcidin in circulation is a potentially useful clinical tool in the diagnosis, monitoring and treatment of iron metabolism disorder, although clinical interpretation of hepcidin level remains difficult. We evaluated he diagnostic potential and limitations of hepcidin-25 by investigating its relationship with iron and hematological indices, inflammation, and renal dysfunction. Methods This retrospective study included 220 adult patients not requiring dialysis. Variations of biologically active hepcidin-25 were examined using a mass spectrometry-based assay in various inflammatory and renal states. The log[hepcidin]:log[ferritin] ratio was calculated as an hepcidin index. Results In 220 adult patients not requiring dialysis, variation in hepcidin-25 level was significantly larger once CRP exceeded 10 mg/l (p < 0.001). Inflammation was not a determinant of hepcidin-25 in the setting of renal dysfunction. Hepcidin-25 median (7.37 nM) and variance were significantly higher (p < 0.001), once estimated glomerular filtration rate (eGFR) dropped below 30 ml/min/1.73 m2. The log[hepcidin]:log[ferritin] index normalized hepcidin levels. Patients with iron deficiency have a notably lower index when compared to controls (-0.66 vs 0.3). Conclusion Severe renal dysfunction (eGFR < 30) affected hepcidin-25 expression and clearance to variable degree between individuals. Although, hepcidin-25 testing is not warranted in patients with infection, inflammatory autoimmune conditions (CRP > 10 mg/l) and/or severe renal dysfunction (eGFR < 30), the hepcidin index may serve as a potential biomarker for iron deficiency in complex cases.
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van der Staaij H, Donker AE, Bakkeren DL, Salemans JMJI, Mignot-Evers LAA, Bongers MY, Dieleman JP, Galesloot TE, Laarakkers CM, Klaver SM, Swinkels DW. Transferrin Saturation/Hepcidin Ratio Discriminates TMPRSS6-Related Iron Refractory Iron Deficiency Anemia from Patients with Multi-Causal Iron Deficiency Anemia. Int J Mol Sci 2022; 23:ijms23031917. [PMID: 35163840 PMCID: PMC8836508 DOI: 10.3390/ijms23031917] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 02/04/2023] Open
Abstract
Pathogenic TMPRSS6 variants impairing matriptase-2 function result in inappropriately high hepcidin levels relative to body iron status, leading to iron refractory iron deficiency anemia (IRIDA). As diagnosing IRIDA can be challenging due to its genotypical and phenotypical heterogeneity, we assessed the transferrin saturation (TSAT)/hepcidin ratio to distinguish IRIDA from multi-causal iron deficiency anemia (IDA). We included 20 IRIDA patients from a registry for rare inherited iron disorders and then enrolled 39 controls with IDA due to other causes. Plasma hepcidin-25 levels were measured by standardized isotope dilution mass spectrometry. IDA controls had not received iron therapy in the last 3 months and C-reactive protein levels were <10.0 mg/L. IRIDA patients had significantly lower TSAT/hepcidin ratios compared to IDA controls, median 0.6%/nM (interquartile range, IQR, 0.4-1.1%/nM) and 16.7%/nM (IQR, 12.0-24.0%/nM), respectively. The area under the curve for the TSAT/hepcidin ratio was 1.000 with 100% sensitivity and specificity (95% confidence intervals 84-100% and 91-100%, respectively) at an optimal cut-off point of 5.6%/nM. The TSAT/hepcidin ratio shows excellent performance in discriminating IRIDA from TMPRSS6-unrelated IDA early in the diagnostic work-up of IDA provided that recent iron therapy and moderate-to-severe inflammation are absent. These observations warrant further exploration in a broader IDA population.
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Affiliation(s)
- Hilde van der Staaij
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud University Medical Center (Radboudumc), 6525 GA Nijmegen, The Netherlands; (H.v.d.S.); (A.E.D.); (C.M.L.); (S.M.K.)
- Máxima Medical Center (MMC), Department of Pediatrics, 5504 DB Veldhoven, The Netherlands
| | - Albertine E. Donker
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud University Medical Center (Radboudumc), 6525 GA Nijmegen, The Netherlands; (H.v.d.S.); (A.E.D.); (C.M.L.); (S.M.K.)
- Máxima Medical Center (MMC), Department of Pediatrics, 5504 DB Veldhoven, The Netherlands
| | - Dirk L. Bakkeren
- Máxima Medical Center (MMC), Department of Clinical Chemistry, 5504 DB Veldhoven, The Netherlands;
| | - Jan M. J. I. Salemans
- Máxima Medical Center (MMC), Department of Gastroenterology, 5504 DB Veldhoven, The Netherlands;
| | | | - Marlies Y. Bongers
- Máxima Medical Center (MMC), Department of Gynecology, 5504 DB Veldhoven, The Netherlands;
- Maastricht University Medical Center, Department of Gynecology, 6229 HX Maastricht, The Netherlands
| | - Jeanne P. Dieleman
- Máxima Medical Center Academy, Máxima Medical Center (MMC), 5504 DB Veldhoven, The Netherlands;
| | - Tessel E. Galesloot
- Department for Health Evidence, Radboud Institute for Health Sciences, 6500 HB Nijmegen, The Netherlands;
| | - Coby M. Laarakkers
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud University Medical Center (Radboudumc), 6525 GA Nijmegen, The Netherlands; (H.v.d.S.); (A.E.D.); (C.M.L.); (S.M.K.)
- Hepcidinanalysis, Translational Metabolic Laboratory, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Siem M. Klaver
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud University Medical Center (Radboudumc), 6525 GA Nijmegen, The Netherlands; (H.v.d.S.); (A.E.D.); (C.M.L.); (S.M.K.)
- Hepcidinanalysis, Translational Metabolic Laboratory, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Dorine W. Swinkels
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud University Medical Center (Radboudumc), 6525 GA Nijmegen, The Netherlands; (H.v.d.S.); (A.E.D.); (C.M.L.); (S.M.K.)
- Hepcidinanalysis, Translational Metabolic Laboratory, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
- Correspondence: ; Tel.: +31-(0)2-4361-8957
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Shah FT, Porter JB, Sadasivam N, Kaya B, Moon JC, Velangi M, Ako E, Pancham S. Guidelines for the monitoring and management of iron overload in patients with haemoglobinopathies and rare anaemias. Br J Haematol 2022; 196:336-350. [PMID: 34617272 DOI: 10.1111/bjh.17839] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/10/2021] [Accepted: 09/02/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Farrukh T Shah
- Department of Haematology, Whittington Health, London, UK
| | - John B Porter
- Department of Haematology, University College Hospitals, London, UK
| | - Nandini Sadasivam
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Banu Kaya
- Department of Paediatric Haematology and Oncology, Barts Health NHS Trust, London, UK
| | - James C Moon
- Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, UK
- Institutes for Cardiovascular Science, University College London, London, UK
| | - Mark Velangi
- Department of Haematology, Birmingham Children's Hospital, Birmingham, UK
| | - Emmanuel Ako
- Department of Cardiology, Chelsea and Westminster Hospital, London, UK
| | - Shivan Pancham
- Department of Haematology, Sandwell and West Birmingham NHS Trust, West Bromwich, UK
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Rana S, Prabhakar N. Iron disorders and hepcidin. Clin Chim Acta 2021; 523:454-468. [PMID: 34755647 DOI: 10.1016/j.cca.2021.10.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 12/13/2022]
Abstract
Iron is an essential element due to its role in a wide variety of physiological processes. Iron homeostasis is crucial to prevent iron overload disorders as well as iron deficiency anemia. The liver synthesized peptide hormone hepcidin is a master regulator of systemic iron metabolism. Given its role in overall health, measurement of hepcidin can be used as a predictive marker in disease states. In addition, hepcidin-targeting drugs appear beneficial as therapeutic agents. This review emphasizes recent development on analytical techniques (immunochemical, mass spectrometry and biosensors) and therapeutic approaches (hepcidin agonists, stimulators and antagonists). These insights highlight hepcidin as a potential biomarker as well as an aid in the development of new drugs for iron disorders.
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Affiliation(s)
- Shilpa Rana
- Department of Biochemistry, Sector-25, Panjab University, Chandigarh 160014, India
| | - Nirmal Prabhakar
- Department of Biochemistry, Sector-25, Panjab University, Chandigarh 160014, India.
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Cervera Bravo A, Osuna Marco MP, Morán-Jiménez MJ, Martín-Hernández E. Unexpected Cause of Persistent Microcytosis and Neurological Symptoms in a Child: Niemann-Pick Disease Type C. J Pediatr Hematol Oncol 2021; 43:e1238-e1240. [PMID: 33661177 DOI: 10.1097/mph.0000000000002135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/27/2021] [Indexed: 11/25/2022]
Abstract
Atypical microcytic anemias are rare diseases of iron/heme metabolism that can be diagnostically challenging. We report the case of a 2-year-old twin boy with neurodevelopmental delay and persistent microcytosis in whom atypical microcytic anemias was initially suspected. He had low blood iron and transferrin saturation with normal/high ferritin despite iron therapy. Hemoglobinopathies were excluded by conventional/DNA studies. Hepcidin was high but iron-refractory-iron-deficiency anemia was ruled out by a genetic panel. Bone marrow aspiration revealed foamy cells and iron depletion. A genetic study confirmed the diagnosis of Niemann-Pick disease type C which was finally considered the origin of microcytosis through anemia of chronic disease.
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Affiliation(s)
| | - Marta P Osuna Marco
- Department of Pediatric Hematology and Oncology, Montepríncipe HM Hospital, Boadilla del Monte
| | - María-José Morán-Jiménez
- Instituto de Investigación Sanitaria (Health Research Institute) of the 12 de Octubre University Hospital (imas12), Section 3: Rare Diseases, Group: Porphyrias, Hemochromatosis and Anemias
| | - Elena Martín-Hernández
- Unit of Hereditary Mitochondrial & Metabolic Diseases, Department of Pediatrics, 12 de Octubre University Hospital, National Reference Center for Hereditary Metabolic Diseases (C.S.U.R.) and European Reference Network for Hereditary Metabolic Disorders (MetabERN), Madrid, Spain
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Erten M, Tuncer T. Automated differential diagnosis method for iron deficiency anemia and beta thalassemia trait based on iterative Chi2 feature selector. Int J Lab Hematol 2021; 44:430-436. [PMID: 34709721 DOI: 10.1111/ijlh.13745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/13/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The differential diagnosis of anemia is an important issue for hematology laboratories. We aimed at investigating the performance of a powerful computer-based model to aid diagnosis. MATERIALS AND METHODS Our work presents a new feature selection-based automated disease diagnosis model. To create a testbed, a new corpus is collected retrospectively. Our data sets contain beta thalassemia trait, iron deficiency anemia, and healthy groups. Our presented automated ailment classification model consists iterative chi2 (IChi2) feature selection and classification phases. The used data set includes 25 features, and IChi2 selects the 20 most valuable of them. These are forwarded to 24 traditional classifiers. RESULTS In this work, two data sets have been used to test our proposal. In the classification phase of this model, 24 shallow classifiers have been used and the best accurate classifiers are Medium Gaussian Support Vector Machine (MGSVM) and Coarse Tree (CT) for the first and second data sets, respectively. These classifiers have been attained 97.48% and 99.73% classification accuracies using the first and second data sets, consecutively. These results are calculated using 10-fold cross-validation. Moreover, hold-out validation has been used in this work, and the results are given in the experiments. CONCLUSION Our results denoted the success of IChi2-based classification model for diagnosis on the laboratory data set. We have found a new and robust model to differentiate iron deficiency anemia and beta thalassemia trait. This model may be beneficial for rational laboratory use.
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Affiliation(s)
- Mehmet Erten
- Laboratory of Medical Biochemistry, Public Health Lab, Malatya, Turkey
| | - Turker Tuncer
- Department of Digital Forensics Engineering, Technology Faculty, Firat University, Elazig, Turkey
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12
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Hyperferritinemia-A Clinical Overview. J Clin Med 2021; 10:jcm10092008. [PMID: 34067164 PMCID: PMC8125175 DOI: 10.3390/jcm10092008] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 02/07/2023] Open
Abstract
Ferritin is one of the most frequently requested laboratory tests in primary and secondary care, and levels often deviate from reference ranges. Serving as an indirect marker for total body iron stores, low ferritin is highly specific for iron deficiency. Hyperferritinemia is, however, a non-specific finding, which is frequently overlooked in general practice. In routine medical practice, only 10% of cases are related to an iron overload, whilst the rest is seen as a result of acute phase reactions and reactive increases in ferritin due to underlying conditions. Differentiation of the presence or absence of an associated iron overload upon hyperferritinemia is essential, although often proves to be complex. In this review, we have performed a review of a selection of the literature based on the authors’ own experiences and assessments in accordance with international recommendations and guidelines. We address the biology, etiology, and epidemiology of hyperferritinemia. Finally, an algorithm for the diagnostic workup and management of hyperferritinemia is proposed, and general principles regarding the treatment of iron overload are discussed.
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13
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Kang W, Barad A, Clark AG, Wang Y, Lin X, Gu Z, O'Brien KO. Ethnic Differences in Iron Status. Adv Nutr 2021; 12:1838-1853. [PMID: 34009254 PMCID: PMC8483971 DOI: 10.1093/advances/nmab035] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
Iron is unique among all minerals in that humans have no regulatable excretory pathway to eliminate excess iron after it is absorbed. Iron deficiency anemia occurs when absorbed iron is not sufficient to meet body iron demands, whereas iron overload and subsequent deposition of iron in key organs occur when absorbed iron exceeds body iron demands. Over time, iron accumulation in the body can increase risk of chronic diseases, including cirrhosis, diabetes, and heart failure. To date, only ∼30% of the interindividual variability in iron absorption can be captured by iron status biomarkers or iron regulatory hormones. Much of the regulation of iron absorption may be under genetic control, but these pathways have yet to be fully elucidated. Genome-wide and candidate gene association studies have identified several genetic variants that are associated with variations in iron status, but the majority of these data were generated in European populations. The purpose of this review is to summarize genetic variants that have been associated with alterations in iron status and to highlight the influence of ethnicity on the risk of iron deficiency or overload. Using extant data in the literature, linear mixed-effects models were constructed to explore ethnic differences in iron status biomarkers. This approach found that East Asians had significantly higher concentrations of iron status indicators (serum ferritin, transferrin saturation, and hemoglobin) than Europeans, African Americans, or South Asians. African Americans exhibited significantly lower hemoglobin concentrations compared with other ethnic groups. Further studies of the genetic basis for ethnic differences in iron metabolism and on how it affects disease susceptibility among different ethnic groups are needed to inform population-specific recommendations and personalized nutrition interventions for iron-related disorders.
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Affiliation(s)
- Wanhui Kang
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Alexa Barad
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Andrew G Clark
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, USA,Department of Computational Biology, Cornell University, Ithaca, NY, USA
| | - Yiqin Wang
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Xu Lin
- Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, China
| | - Zhenglong Gu
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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14
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Deng Q, Wang Y, Wang X, Wang Q, Yi Z, Xia J, Hu Y, Zhang Y, Wang J, Wang L, Jiang S, Li R, Wan D, Yang H, Yin Y. Effects of dietary iron level on growth performance, hematological status, and intestinal function in growing-finishing pigs. J Anim Sci 2021; 99:skab002. [PMID: 33515478 PMCID: PMC7846194 DOI: 10.1093/jas/skab002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/07/2021] [Indexed: 12/30/2022] Open
Abstract
This study investigated the different addition levels of iron (Fe) in growing-finishing pigs and the effect of different Fe levels on growth performance, hematological status, intestinal barrier function, and intestinal digestion. A total of 1,200 barrows and gilts ([Large White × Landrace] × Duroc) with average initial body weight (BW; 27.74 ± 0.28 kg) were housed in 40 pens of 30 pigs per pen (gilts and barrows in half), blocked by BW and gender, and fed five experimental diets (eight replicate pens per diet). The five experimental diets were control diet (basal diet with no FeSO4 supplementation), and the basal diet being supplemented with 150, 300, 450, or 600 mg/kg Fe as FeSO4 diets. The trial lasted for 100 d and was divided into the growing phase (27 to 60 kg of BW) for the first 50 d and the finishing phase (61 to 100 kg of BW) for the last 50 d. The basal diet was formulated with an Fe-free trace mineral premix and contained 203.36 mg/kg total dietary Fe in the growing phase and 216.71 mg/kg in the finishing phase based on ingredient contributions. And at the end of the experiment, eight pigs (four barrows and four gilts) were randomly selected from each treatment (selected one pig per pen) for digesta, blood, and intestinal samples collection. The results showed that the average daily feed intake (P = 0.025), average daily gain (P = 0.020), and BW (P = 0.019) increased linearly in the finishing phase of pigs fed with the diets containing Fe. On the other hand, supplementation with different Fe levels in the diet significantly increased serum iron and transferrin saturation concentrations (P < 0.05), goblet cell numbers of duodenal villous (P < 0.001), and MUC4 mRNA expression (P < 0.05). The apparent ileal digestibility (AID) of amino acids (AA) for pigs in the 450 and 600 mg/kg Fe groups was greater (P < 0.05) than for pigs in the control group. In conclusion, dietary supplementation with 450 to 600 mg/kg Fe improved the growth performance of pigs by changing hematological status and by enhancing intestinal goblet cell differentiation and AID of AA.
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Affiliation(s)
- Qingqing Deng
- Hunan Provincial Key Laboratory of Animal Intestinal Function and Regulation, Hunan International Joint Laboratory of Animal Intestinal Ecology and Health, Laboratory of Animal Nutrition and Human Health, College of Life Sciences, Hunan Normal University, Changsha, Hunan, China
| | - Yancan Wang
- Hunan Provincial Key Laboratory of Animal Intestinal Function and Regulation, Hunan International Joint Laboratory of Animal Intestinal Ecology and Health, Laboratory of Animal Nutrition and Human Health, College of Life Sciences, Hunan Normal University, Changsha, Hunan, China
| | - Xin Wang
- Hunan Provincial Key Laboratory of Animal Intestinal Function and Regulation, Hunan International Joint Laboratory of Animal Intestinal Ecology and Health, Laboratory of Animal Nutrition and Human Health, College of Life Sciences, Hunan Normal University, Changsha, Hunan, China
| | - Qiye Wang
- Hunan Provincial Key Laboratory of Animal Intestinal Function and Regulation, Hunan International Joint Laboratory of Animal Intestinal Ecology and Health, Laboratory of Animal Nutrition and Human Health, College of Life Sciences, Hunan Normal University, Changsha, Hunan, China
| | - Zhenfeng Yi
- Hunan Provincial Key Laboratory of Animal Intestinal Function and Regulation, Hunan International Joint Laboratory of Animal Intestinal Ecology and Health, Laboratory of Animal Nutrition and Human Health, College of Life Sciences, Hunan Normal University, Changsha, Hunan, China
| | - Jun Xia
- Hunan Provincial Key Laboratory of Animal Intestinal Function and Regulation, Hunan International Joint Laboratory of Animal Intestinal Ecology and Health, Laboratory of Animal Nutrition and Human Health, College of Life Sciences, Hunan Normal University, Changsha, Hunan, China
| | - Yuyao Hu
- Hunan Provincial Key Laboratory of Animal Intestinal Function and Regulation, Hunan International Joint Laboratory of Animal Intestinal Ecology and Health, Laboratory of Animal Nutrition and Human Health, College of Life Sciences, Hunan Normal University, Changsha, Hunan, China
| | - Yiming Zhang
- Hunan Provincial Key Laboratory of Animal Intestinal Function and Regulation, Hunan International Joint Laboratory of Animal Intestinal Ecology and Health, Laboratory of Animal Nutrition and Human Health, College of Life Sciences, Hunan Normal University, Changsha, Hunan, China
| | - Jingjing Wang
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, Hunan, China
| | - Lei Wang
- Hunan Provincial Key Laboratory of Animal Intestinal Function and Regulation, Hunan International Joint Laboratory of Animal Intestinal Ecology and Health, Laboratory of Animal Nutrition and Human Health, College of Life Sciences, Hunan Normal University, Changsha, Hunan, China
| | - Shuzhong Jiang
- Hunan Jiuding Technology (Group) Co., Ltd. Yueyang, Hunan, China
| | - Rong Li
- Hunan Longhua Agriculture and Animal Husbandry Development Co., Ltd., TRS Group, Zhuzhou, Hunan, China
| | - Dan Wan
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, Hunan, China
| | - Huansheng Yang
- Hunan Provincial Key Laboratory of Animal Intestinal Function and Regulation, Hunan International Joint Laboratory of Animal Intestinal Ecology and Health, Laboratory of Animal Nutrition and Human Health, College of Life Sciences, Hunan Normal University, Changsha, Hunan, China
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, Hunan, China
| | - Yulong Yin
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, Hunan, China
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15
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Lira Zidanes A, Marchi G, Busti F, Marchetto A, Fermo E, Giorgetti A, Vianello A, Castagna A, Olivieri O, Bianchi P, Girelli D. A Novel ALAS2 Missense Mutation in Two Brothers With Iron Overload and Associated Alterations in Serum Hepcidin/Erythroferrone Levels. Front Physiol 2020; 11:581386. [PMID: 33281618 PMCID: PMC7689258 DOI: 10.3389/fphys.2020.581386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/01/2020] [Indexed: 01/19/2023] Open
Abstract
Iron loading anemias are characterized by ineffective erythropoiesis and iron overload. The prototype is non-transfusion dependent ß-thalassemia (NTDT), with other entities including congenital sideroblastic anemias, congenital dyserythropoietic anemias, some hemolytic anemias, and myelodysplastic syndromes. Differential diagnosis of iron loading anemias may be challenging due to heterogeneous genotype and phenotype. Notwithstanding the recent advances in linking ineffective erythropoiesis to iron overload, many pathophysiologic aspects are still unclear. Moreover, measurement of hepcidin and erythroferrone (ERFE), two key molecules in iron homeostasis and erythropoiesis, is scarcely used in clinical practice and of uncertain utility. Here, we describe a comprehensive diagnostic approach, including next-generation sequencing (NGS), in silico modeling, and measurement of hepcidin and erythroferrone (ERFE), in two brothers eventually diagnosed as X-linked sideroblastic anemia (XLSA). A novel pathogenic ALAS2 missense mutation (c.1382T>A, p.Leu461His) is described. Hyperferritinemia with high hepcidin-25 levels (but decreased hepcidin:ferritin ratio) and mild-to-moderate iron overload were detected in both patients. ERFE levels were markedly elevated in both patients, especially in the proband, who had a more expressed phenotype. Our study illustrates how new technologies, such as NGS, in silico modeling, and measurement of serum hepcidin-25 and ERFE, may help in diagnosing and studying iron loading anemias. Further studies on the hepcidin-25/ERFE axis in additional patients with XLSA and other iron loading anemias may help in establishing its usefulness in differential diagnosis, and it may also aid our understanding of the pathophysiology of these genetically and phenotypically heterogeneous entities.
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Affiliation(s)
- Acaynne Lira Zidanes
- Section of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy.,EuroBloodNet Referral Center for Rare Disorders of Iron Metabolism, University Hospital of Verona, Verona, Italy
| | - Giacomo Marchi
- Section of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy.,EuroBloodNet Referral Center for Rare Disorders of Iron Metabolism, University Hospital of Verona, Verona, Italy
| | - Fabiana Busti
- Section of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy.,EuroBloodNet Referral Center for Rare Disorders of Iron Metabolism, University Hospital of Verona, Verona, Italy
| | | | - Elisa Fermo
- Hematology and Pathophysiology of Anemias Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Ca' Granda Foundation, Policlinico Milano, Milan, Italy
| | | | - Alice Vianello
- Section of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy.,EuroBloodNet Referral Center for Rare Disorders of Iron Metabolism, University Hospital of Verona, Verona, Italy
| | - Annalisa Castagna
- Section of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy.,EuroBloodNet Referral Center for Rare Disorders of Iron Metabolism, University Hospital of Verona, Verona, Italy
| | - Oliviero Olivieri
- Section of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy.,EuroBloodNet Referral Center for Rare Disorders of Iron Metabolism, University Hospital of Verona, Verona, Italy
| | - Paola Bianchi
- Hematology and Pathophysiology of Anemias Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Ca' Granda Foundation, Policlinico Milano, Milan, Italy
| | - Domenico Girelli
- Section of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy.,EuroBloodNet Referral Center for Rare Disorders of Iron Metabolism, University Hospital of Verona, Verona, Italy
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16
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Grant ES, Clucas DB, McColl G, Hall LT, Simpson DA. Re-examining ferritin-bound iron: current and developing clinical tools. Clin Chem Lab Med 2020; 59:459-471. [PMID: 33090965 DOI: 10.1515/cclm-2020-1095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/01/2020] [Indexed: 12/11/2022]
Abstract
Iron is a highly important metal ion cofactor within the human body, necessary for haemoglobin synthesis, and required by a wide range of enzymes for essential metabolic processes. Iron deficiency and overload both pose significant health concerns and are relatively common world-wide health hazards. Effective measurement of total iron stores is a primary tool for both identifying abnormal iron levels and tracking changes in clinical settings. Population based data is also essential for tracking nutritional trends. This review article provides an overview of the strengths and limitations associated with current techniques for diagnosing iron status, which sets a basis to discuss the potential of a new serum marker - ferritin-bound iron - and the improvement it could offer to iron assessment.
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Affiliation(s)
- Erin S Grant
- School of Physics, University of Melbourne, Parkville, VIC, Australia
| | - Danielle B Clucas
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia.,Diagnostic Haematology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Gawain McColl
- Melbourne Dementia Research Centre, Florey Institute of Neuroscience and Mental Health and the University of Melbourne, Parkville, VIC, Australia
| | - Liam T Hall
- School of Physics, University of Melbourne, Parkville, VIC, Australia
| | - David A Simpson
- School of Physics, University of Melbourne, Parkville, VIC, Australia
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17
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Zhabchenko I. FOR A FEW STEPS TO..., OR HOW TO AVOID FOR IRON DEFICIENCY AT PREGNANCY. LITERATURE REVIEW. REPRODUCTIVE MEDICINE 2020. [DOI: 10.37800/rm2020-1-19(2)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The article presents modern data on the etiology, pathogenesis, diagnosis, prevention and treatment of iron deficiency anemia (IDA) and anemia of chronic disease, as well as their combination on the eve of and during pregnancy. The emphasis is made on the role of iron deficiency of any etiology in the development of obstetric and perinatal complications, especially its impact on the central nervous system formation and further psychophysical child development. Need for prevention of iron deficiency states in risk groups which includes all women of reproductive age who have menstruation is shown based on evidence-based medicine data. Effectiveness and safety of modern drugs containing iron in oral and parenteral forms has analyzed. The paper presents data on the safety and effectiveness of an innovative form of ferric iron in the form of liposomal iron, which differs in the mechanism of action, digestibility and the absence of side effects typical for this group of drugs. According to various authors the frequency of IDA in pregnant women ranges up to 80%, in puerperas up to 40%. It is unimpossible to stop IDA without iron supplementation only with an iron-rich diet. Two main groups of iron preparations are used to correct iron deficiency differing in the valence of iron atoms – bivalent iron salts and trivalent complexes. These drugs differ in the tolerability and bioavailability of atomic iron. Liposomal iron is a new drug for treatment of iron deficiency and IDA today; it has an innovative way of iron delivery to the body. Liposomal iron has advantages for the prevention of anemia in patients with anemia of chronic disease or its combination with IDA (inflammatory bowel diseases, obesity, after resection of the stomach and intestines, etc.). An innovative form of liposomal iron in Ukraine is represented by a dietary supplement Ferroview containing 30 mg of elemental iron, that is corresponds to the average prophylactic dose recommended in WHO documents.
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18
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Two Novel TMPRSS6 Variants in a Compound Heterozygous Child With Iron Refractory Iron Deficiency Anemia. J Pediatr Hematol Oncol 2020; 42:e238-e239. [PMID: 31714439 DOI: 10.1097/mph.0000000000001640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe a Caucasian family with asymptomatic, nonconsanguineous parents, and a daughter with unexplained microcytic anemia diagnosed on routine hemoglobin screening at her 12-month well child check. After failed response to oral and parental iron supplementation, iron refractory iron deficiency anemia was suspected. The family underwent genetic testing and the proband was found to be a compound heterozygote for 2 previously unreported TMPRSS6 variants.
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19
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Piperno A, Pelucchi S, Mariani R. Inherited iron overload disorders. Transl Gastroenterol Hepatol 2020; 5:25. [PMID: 32258529 DOI: 10.21037/tgh.2019.11.15] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/12/2019] [Indexed: 12/21/2022] Open
Abstract
Hereditary iron overload includes several disorders characterized by iron accumulation in tissues, organs, or even single cells or subcellular compartments. They are determined by mutations in genes directly involved in hepcidin regulation, cellular iron uptake, management and export, iron transport and storage. Systemic forms are characterized by increased serum ferritin with or without high transferrin saturation, and with or without functional iron deficient anemia. Hemochromatosis includes five different genetic forms all characterized by high transferrin saturation and serum ferritin, but with different penetrance and expression. Mutations in HFE, HFE2, HAMP and TFR2 lead to inadequate or severely reduced hepcidin synthesis that, in turn, induces increased intestinal iron absorption and macrophage iron release leading to tissue iron overload. The severity of hepcidin down-regulation defines the severity of iron overload and clinical complications. Hemochromatosis type 4 is caused by dominant gain-of-function mutations of ferroportin preventing hepcidin-ferroportin binding and leading to hepcidin resistance. Ferroportin disease is due to loss-of-function mutation of SLC40A1 that impairs the iron export efficiency of ferroportin, causes iron retention in reticuloendothelial cell and hyperferritinemia with normal transferrin saturation. Aceruloplasminemia is caused by defective iron release from storage and lead to mild microcytic anemia, low serum iron, and iron retention in several organs including the brain, causing severe neurological manifestations. Atransferrinemia and DMT1 deficiency are characterized by iron deficient erythropoiesis, severe microcytic anemia with high transferrin saturation and parenchymal iron overload due to secondary hepcidin suppression. Diagnosis of the different forms of hereditary iron overload disorders involves a sequential strategy that combines clinical, imaging, biochemical, and genetic data. Management of iron overload relies on two main therapies: blood removal and iron chelators. Specific therapeutic options are indicated in patients with atransferrinemia, DMT1 deficiency and aceruloplasminemia.
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Affiliation(s)
- Alberto Piperno
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Centre for Rare Diseases, Disorder of Iron Metabolism, ASST-Monza, S. Gerardo Hospital, Monza, Italy
| | - Sara Pelucchi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Raffaella Mariani
- Centre for Rare Diseases, Disorder of Iron Metabolism, ASST-Monza, S. Gerardo Hospital, Monza, Italy
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20
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Vila Cuenca M, Marchi G, Barqué A, Esteban-Jurado C, Marchetto A, Giorgetti A, Chelban V, Houlden H, Wood NW, Piubelli C, Dorigatti Borges M, Martins de Albuquerque D, Yotsumoto Fertrin K, Jové-Buxeda E, Sanchez-Delgado J, Baena-Díez N, Burnyte B, Utkus A, Busti F, Kaubrys G, Suku E, Kowalczyk K, Karaszewski B, Porter JB, Pollard S, Eleftheriou P, Bignell P, Girelli D, Sanchez M. Genetic and Clinical Heterogeneity in Thirteen New Cases with Aceruloplasminemia. Atypical Anemia as a Clue for an Early Diagnosis. Int J Mol Sci 2020; 21:E2374. [PMID: 32235485 PMCID: PMC7178074 DOI: 10.3390/ijms21072374] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/26/2020] [Indexed: 12/11/2022] Open
Abstract
Aceruloplasminemia is a rare autosomal recessive genetic disease characterized by mild microcytic anemia, diabetes, retinopathy, liver disease, and progressive neurological symptoms due to iron accumulation in pancreas, retina, liver, and brain. The disease is caused by mutations in the Ceruloplasmin (CP) gene that produce a strong reduction or absence of ceruloplasmin ferroxidase activity, leading to an impairment of iron metabolism. Most patients described so far are from Japan. Prompt diagnosis and therapy are crucial to prevent neurological complications since, once established, they are usually irreversible. Here, we describe the largest series of non-Japanese patients with aceruloplasminemia published so far, including 13 individuals from 11 families carrying 13 mutations in the CP gene (7 missense, 3 frameshifts, and 3 splicing mutations), 10 of which are novel. All missense mutations were studied by computational modeling. Clinical manifestations were heterogeneous, but anemia, often but not necessarily microcytic, was frequently the earliest one. This study confirms the clinical and genetic heterogeneity of aceruloplasminemia, a disease expected to be increasingly diagnosed in the Next-Generation Sequencing (NGS) era. Unexplained anemia with low transferrin saturation and high ferritin levels without inflammation should prompt the suspicion of aceruloplasminemia, which can be easily confirmed by low serum ceruloplasmin levels. Collaborative joint efforts are needed to better understand the pathophysiology of this potentially disabling disease.
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Affiliation(s)
- Marc Vila Cuenca
- Iron Metabolism: Regulation and Diseases Group, Josep Carreras Leukaemia Research Institute (IJC), Campus Can Ruti, Badalona, 08916 Barcelona, Spain; (M.V.C.); (A.B.); (C.E.-J.)
| | - Giacomo Marchi
- EuroBloodNet Referral Center for Iron Disorders and Gruppo Interdisciplinare Malattie del Ferro, Internal Medicine Unit, Azienda Ospedaliera Universitaria Integrata di Verona, 37134 Verona, Italy; (G.M.); (F.B.)
| | - Anna Barqué
- Iron Metabolism: Regulation and Diseases Group, Josep Carreras Leukaemia Research Institute (IJC), Campus Can Ruti, Badalona, 08916 Barcelona, Spain; (M.V.C.); (A.B.); (C.E.-J.)
| | - Clara Esteban-Jurado
- Iron Metabolism: Regulation and Diseases Group, Josep Carreras Leukaemia Research Institute (IJC), Campus Can Ruti, Badalona, 08916 Barcelona, Spain; (M.V.C.); (A.B.); (C.E.-J.)
| | - Alessandro Marchetto
- Department of Biotechnology, University of Verona, 37134 Verona, Italy; (A.M.); (A.G.); (E.S.)
| | - Alejandro Giorgetti
- Department of Biotechnology, University of Verona, 37134 Verona, Italy; (A.M.); (A.G.); (E.S.)
| | - Viorica Chelban
- National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (V.C.); (H.H.); (N.W.W.)
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London WC1N 3BG, UK
- Department of Neurology and Neurosurgery, Institute of Emergency Medicine, Toma Ciorbă 1, Chisinau, MD-2052 Chisinau, Republic of Moldova
| | - Henry Houlden
- National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (V.C.); (H.H.); (N.W.W.)
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London WC1N 3BG, UK
- Neurogenetics Laboratory, The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Nicholas W Wood
- National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (V.C.); (H.H.); (N.W.W.)
- Neurogenetics Laboratory, The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Chiara Piubelli
- Centre for Tropical Diseases, Ospedale Sacro Cuore - Don Calabria, 37024 Negrar (VR), Italy;
| | - Marina Dorigatti Borges
- Hematology and Hemotherapy Center—Hemocentro Campinas, University of Campinas—UNICAMP, Campinas 13083-878, Brazil; (M.D.B.); (D.M.d.A.); (K.Y.F.)
| | - Dulcinéia Martins de Albuquerque
- Hematology and Hemotherapy Center—Hemocentro Campinas, University of Campinas—UNICAMP, Campinas 13083-878, Brazil; (M.D.B.); (D.M.d.A.); (K.Y.F.)
| | - Kleber Yotsumoto Fertrin
- Hematology and Hemotherapy Center—Hemocentro Campinas, University of Campinas—UNICAMP, Campinas 13083-878, Brazil; (M.D.B.); (D.M.d.A.); (K.Y.F.)
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Ester Jové-Buxeda
- Internal Medicine Department, Parc Tauli Hospital Universitari, Institut d’ Investigació i Innovació Parc Tauli I3PT, Universidad Autonoma de Barcelona, 08208 Sabadell, Spain;
| | - Jordi Sanchez-Delgado
- Hepatology Unit, Digestive Diseases Department, Parc Tauli Hospital Universitari. Institut d’ Investigació i Innovació Parc Tauli I3PT, Universidad Autonoma de Barcelona, 08208 Sabadell, Spain;
- Centro de Investigación Biomedica y en red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Neus Baena-Díez
- Genetic Department, Parc Tauli Hospital Universitari, Institut d’ Investigació i Innovació Parc Tauli I3PT, Universidad Autonoma de Barcelona, 08208 Sabadell, Spain;
| | - Birute Burnyte
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (B.B.); (A.U.)
| | - Algirdas Utkus
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (B.B.); (A.U.)
| | - Fabiana Busti
- EuroBloodNet Referral Center for Iron Disorders and Gruppo Interdisciplinare Malattie del Ferro, Internal Medicine Unit, Azienda Ospedaliera Universitaria Integrata di Verona, 37134 Verona, Italy; (G.M.); (F.B.)
| | - Gintaras Kaubrys
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 08661 Vilnius, Lithuania;
| | - Eda Suku
- Department of Biotechnology, University of Verona, 37134 Verona, Italy; (A.M.); (A.G.); (E.S.)
| | - Kamil Kowalczyk
- Department of Adult Neurology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (K.K.); (B.K.)
| | - Bartosz Karaszewski
- Department of Adult Neurology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (K.K.); (B.K.)
| | - John B. Porter
- Joint Red Cell Unit, Haematology Department, University College London NHS Foundation Trust, Cancer Services, 250 Euston Road, London NW1 2PG, UK; (J.B.P.); (P.E.)
| | - Sally Pollard
- Consultant Paediatrician, Bradford Royal Infirmary, Duckworthlane, Bradford BD9 6RJ, UK;
| | - Perla Eleftheriou
- Joint Red Cell Unit, Haematology Department, University College London NHS Foundation Trust, Cancer Services, 250 Euston Road, London NW1 2PG, UK; (J.B.P.); (P.E.)
| | - Patricia Bignell
- Oxford Regional Genetics Laboratory, Oxford University Hospitals NHS Foundation Trust, The Churchill Hospital, Oxford OX3 7LE, UK;
| | - Domenico Girelli
- EuroBloodNet Referral Center for Iron Disorders and Gruppo Interdisciplinare Malattie del Ferro, Internal Medicine Unit, Azienda Ospedaliera Universitaria Integrata di Verona, 37134 Verona, Italy; (G.M.); (F.B.)
| | - Mayka Sanchez
- Iron Metabolism: Regulation and Diseases Group, Department of Basic Sciences, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC); Sant Cugat del Valles, 08017 Barcelona, Spain
- Program of Program of Predictive and Personalized Medicine of Cancer (PMPPC), Institut d ‘Investigació Germans Trias i Pujol (IGTP), Campus Can Ruti, Badalona, 08916 Barcelona, Spain
- BloodGenetics S.L., Esplugues de Llobregat, 08950 Barcelona, Spain
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21
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Johan A, Natalia A, Djauhari W, Effendi RF. CLINICAL AND HEMOGLOBIN PROFILE OF MALARIA PATIENTS IN KARITAS HOSPITAL, SOUTHWEST SUMBA, PERIOD OF YEAR 2017. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2020. [DOI: 10.20473/ijtid.v8i1.11455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Malaria infections in high endemic areas are not pathognomonic and often show non-specific symptoms. The Southwest Sumba district is a high endemic area of malaria with the annual parasite incidence (API) of 14.48‰. The research conducted in this area was to identify the clinical and hemoglobin profile of malaria patients and to obtain comprehensive information on the clinical characteristics of malaria in a high endemic area of Southwest Sumba district. This is a descriptive cross-sectional study. The data was obtained from the medical record of malaria patients between January 1st and December 31st, 2017 in Karitas Hospital, Southwest Sumba district. Inclusion criteria were patients with asexual stages of Plasmodium spp. on their Giemsa-stained thick and thin peripheral blood smears examination. Exclusion criteria were malaria patients with coexisting diseases and who had taken medication before admitted to the hospital. The total number of patients was 322 patients, 50.6% of the subjects were ≥ 15 years old and 59.3% were male. Among 322 patients, 133 subjects were treated as inpatients. The result shows that most infection was caused by a single infection of P. falciparum. The most common clinical symptom was fever (98.4%), followed by headache, vomiting, cough, and nausea. The most common physical finding was the axillary temperature of > 37.5°C (87.6%) followed by anemic conjunctiva and hepatomegaly, which was mostly found in pediatric patients. The number of patients with hemoglobin level ≤ 10 g/dL was 129. The MCV <80 fL was found in 79% of patients with anemia. Severe malaria was found in 116 subjects in this study according to severe malaria criteria set by the Indonesian Ministry of Health. Study results were consistent with other existing studies from other high endemic areas in East Nusa Tenggara province.
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22
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Elstrott B, Khan L, Olson S, Raghunathan V, DeLoughery T, Shatzel JJ. The role of iron repletion in adult iron deficiency anemia and other diseases. Eur J Haematol 2020; 104:153-161. [PMID: 31715055 PMCID: PMC7031048 DOI: 10.1111/ejh.13345] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/26/2019] [Accepted: 10/29/2019] [Indexed: 12/21/2022]
Abstract
Iron deficiency anemia (IDA) is the most prevalent and treatable form of anemia worldwide. The clinical management of patients with IDA requires a comprehensive understanding of the many etiologies that can lead to iron deficiency including pregnancy, blood loss, renal disease, heavy menstrual bleeding, inflammatory bowel disease, bariatric surgery, or extremely rare genetic disorders. The treatment landscape for many causes of IDA is currently shifting toward more abundant use of intravenous (IV) iron due to its effectiveness and improved formulations that decrease the likelihood of adverse effects. IV iron has found applications beyond treatment of IDA, and there is accruing data about its efficacy in patients with heart failure, restless leg syndrome, fatigue, and prevention of acute mountain sickness. This review provides a framework to diagnose, manage, and treat patients presenting with IDA and discusses other conditions that benefit from iron supplementation.
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Affiliation(s)
- Benjamin Elstrott
- Division of Hematology-Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Lubna Khan
- Division of Hematology-Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Sven Olson
- Division of Hematology-Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Vikram Raghunathan
- Division of Hematology-Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Thomas DeLoughery
- Division of Hematology-Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Joseph J. Shatzel
- Division of Hematology-Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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23
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Donker AE, Galesloot TE, Laarakkers CM, Klaver SM, Bakkeren DL, Swinkels DW. Standardized serum hepcidin values in Dutch children: Set point relative to body iron changes during childhood. Pediatr Blood Cancer 2020; 67:e28038. [PMID: 31724793 DOI: 10.1002/pbc.28038] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Use of serum hepcidin measurements in pediatrics would benefit from standardized age- and sex-specific reference ranges in children, in order to enable the establishment of clinical decision limits that are universally applicable. PROCEDURE We measured serum hepcidin-25 levels in 266 healthy Dutch children aged 0.3-17 years, using an isotope dilution mass spectrometry assay, standardized with our commutable secondary reference material (RM), assigned by a candidate primary RM. RESULTS We constructed age- and sex-specific values for serum hepcidin and its ratio with ferritin and transferrin saturation (TSAT). Serum hepcidin levels and hepcidin/ferritin and TSAT/hepcidin ratios were similar for both sexes. Serum hepcidin and hepcidin/ferritin ratio substantially declined after the age of 12 years and TSAT/hepcidin ratio gradually increased with increasing age. Serum hepcidin values for Dutch children <12 years (n = 170) and >12 years (n = 96) were 1.9 nmol/L (median); 0.1-13.1 nmol/L (p2.5-p97.5) and 0.9 nmol/L; 0.0-9.1 nmol/L, respectively. Serum ferritin was the most significant correlate of serum hepcidin in our study population, explaining 15.1% and 7.9% of variance in males and females, respectively. Multivariable linear regression analysis including age, blood sampling time, iron parameters, ALT, CRP, and body mass index as independent variables showed a statistically significant negative association between age as a dichotomous variable (≤12 vs >12 years) and log-transformed serum hepcidin levels in both sexes. CONCLUSIONS We demonstrate that serum hepcidin relative to indicators of body iron is age dependent in children, suggesting that the set point of serum hepcidin relative to stored and circulating iron changes during childhood.
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Affiliation(s)
- Albertine E Donker
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pediatrics, Máxima Medical Center, Veldhoven, The Netherlands
| | - Tessel E Galesloot
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Coby M Laarakkers
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Translational Metabolic Laboratory (TML, 830), Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Siem M Klaver
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Translational Metabolic Laboratory (TML, 830), Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dirk L Bakkeren
- Department of Clinical Chemistry, Máxima Medical Center , Veldhoven, The Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Translational Metabolic Laboratory (TML, 830), Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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24
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Abstract
Iron is an essential element that is indispensable for life. The delicate physiological body iron balance is maintained by both systemic and cellular regulatory mechanisms. The iron-regulatory hormone hepcidin assures maintenance of adequate systemic iron levels and is regulated by circulating and stored iron levels, inflammation and erythropoiesis. The kidney has an important role in preventing iron loss from the body by means of reabsorption. Cellular iron levels are dependent on iron import, storage, utilization and export, which are mainly regulated by the iron response element-iron regulatory protein (IRE-IRP) system. In the kidney, iron transport mechanisms independent of the IRE-IRP system have been identified, suggesting additional mechanisms for iron handling in this organ. Yet, knowledge gaps on renal iron handling remain in terms of redundancy in transport mechanisms, the roles of the different tubular segments and related regulatory processes. Disturbances in cellular and systemic iron balance are recognized as causes and consequences of kidney injury. Consequently, iron metabolism has become a focus for novel therapeutic interventions for acute kidney injury and chronic kidney disease, which has fuelled interest in the molecular mechanisms of renal iron handling and renal injury, as well as the complex dynamics between systemic and local cellular iron regulation.
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25
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Vlasveld LT, Janssen R, Bardou-Jacquet E, Venselaar H, Hamdi-Roze H, Drakesmith H, Swinkels DW. Twenty Years of Ferroportin Disease: A Review or An Update of Published Clinical, Biochemical, Molecular, and Functional Features. Pharmaceuticals (Basel) 2019; 12:ph12030132. [PMID: 31505869 PMCID: PMC6789780 DOI: 10.3390/ph12030132] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 12/14/2022] Open
Abstract
Iron overloading disorders linked to mutations in ferroportin have diverse phenotypes in vivo, and the effects of mutations on ferroportin in vitro range from loss of function (LOF) to gain of function (GOF) with hepcidin resistance. We reviewed 359 patients with 60 ferroportin variants. Overall, macrophage iron overload and low/normal transferrin saturation (TSAT) segregated with mutations that caused LOF, while GOF mutations were linked to high TSAT and parenchymal iron accumulation. However, the pathogenicity of individual variants is difficult to establish due to the lack of sufficiently reported data, large inter-assay variability of functional studies, and the uncertainty associated with the performance of available in silico prediction models. Since the phenotypes of hepcidin-resistant GOF variants are indistinguishable from the other types of hereditary hemochromatosis (HH), these variants may be categorized as ferroportin-associated HH, while the entity ferroportin disease may be confined to patients with LOF variants. To further improve the management of ferroportin disease, we advocate for a global registry, with standardized clinical analysis and validation of the functional tests preferably performed in human-derived enterocytic and macrophagic cell lines. Moreover, studies are warranted to unravel the definite structure of ferroportin and the indispensable residues that are essential for functionality.
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Affiliation(s)
- L Tom Vlasveld
- Department of Internal Medicine, Haaglanden MC-Bronovo, 2597AX The Hague, The Netherlands
| | - Roel Janssen
- Department of Laboratory Medicine, Translational Metabolic Laboratory, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Edouard Bardou-Jacquet
- Liver Diseases Department, French Reference Centre for Rare Iron Overload Diseases of Genetic Origin, University Hospital Pontchaillou, 35033 Rennes, France
| | - Hanka Venselaar
- Centre for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences, Radboud, University Medical Center, P.O. Box 9191, 6500 HB Nijmegen, The Netherlands
| | - Houda Hamdi-Roze
- Molecular Genetics Department, French Reference Centre for Rare Iron Overload Diseases of Genetic Origin, University Hospital Pontchaillou, 35033 Rennes, France
| | - Hal Drakesmith
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX39DS, UK
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Translational Metabolic Laboratory, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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26
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Burd E, Doyle EA. Challenges in the Treatment of Iron Deficiency Anemia in a Child With Autism Spectrum Disorder: A Case Study. J Pediatr Health Care 2019; 33:578-584. [PMID: 30683579 DOI: 10.1016/j.pedhc.2018.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/15/2018] [Accepted: 11/27/2018] [Indexed: 11/15/2022]
Abstract
Children with autism spectrum disorder (ASD) face many challenges, including feeding problems due to behavioral issues and food aversions. Therefore, pediatric nurse practitioners need to assess for different mineral deficiencies, including iron deficiency anemia (IDA). The following case study describes a 4-year-old with ASD with persistent IDA despite typical recommendation of oral iron supplementation. Other potential etiologies of IDA are reviewed. Finally, different management approaches for managing IDA in children with ASD are described.
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27
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Fouquet C, Le Rouzic M, Leblanc T, Fouyssac F, Leverger G, Hessissen L, Marlin S, Bourrat E, Fahd M, Raffoux E, Vannier J, Jäkel N, Knoefler R, Triolo V, Pasquet M, Bayart S, Thuret I, Lutz P, Vermylen C, Touati M, Rose C, Matthes T, Isidor B, Kannengiesser C, Ducassou S. Genotype/phenotype correlations of childhood‐onset congenital sideroblastic anaemia in a European cohort. Br J Haematol 2019; 187:530-542. [DOI: 10.1111/bjh.16100] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/08/2019] [Indexed: 01/19/2023]
Affiliation(s)
| | | | | | | | - Guy Leverger
- CHU de Paris Hôpital Armand Trousseau Paris France
| | | | | | | | - Mony Fahd
- CHU de Paris Hôpital Robert Debré Paris France
| | | | | | - Nadja Jäkel
- Department für Hämatologie Onkologie und Hämostaseologie Leipzig Germany
| | - Ralf Knoefler
- Department of Pediatric Haemostaseology University Hospital Carl Gustav Carus Dresden Germany
| | | | | | | | | | - Patrick Lutz
- CHU de Strasbourg Hôpital de Hautepierre Strasbourg France
| | - Christiane Vermylen
- Université Catholique de Louvain, Cliniques universitaires Saint‐Luc Brussels Belgium
| | | | | | - Thomas Matthes
- Geneva University Hospital, Hematology Service Geneva Switzerland
| | | | - Caroline Kannengiesser
- Assistance Publique des Hôpitaux de Paris, Département de Génétique Hôpital Bichat, Université Paris VII Paris France
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28
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Marchi G, Busti F, Lira Zidanes A, Castagna A, Girelli D. Aceruloplasminemia: A Severe Neurodegenerative Disorder Deserving an Early Diagnosis. Front Neurosci 2019; 13:325. [PMID: 31024241 PMCID: PMC6460567 DOI: 10.3389/fnins.2019.00325] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/21/2019] [Indexed: 01/01/2023] Open
Abstract
Aceruloplasminemia (ACP) is a rare, adult-onset, autosomal recessive disorder, characterized by systemic iron overload due to mutations in the Ceruloplasmin gene (CP), which in turn lead to absence or strong reduction of CP activity. CP is a ferroxidase that plays a key role in iron export from various cells, especially in the brain, where it maintains the appropriate iron homeostasis with neuroprotective effects. Brain iron accumulation makes ACP unique among systemic iron overload syndromes, e.g., various types of genetic hemochromatosis. The main clinical features of fully expressed ACP include diabetes, retinopathy, liver disease, and progressive neurological symptoms reflecting iron deposition in target organs. However, biochemical signs of the disease, namely a mild anemia mimicking iron deficiency anemia because of microcytosis and low transferrin saturation, but with "paradoxical" hyperferritinemia, usually precedes the onset of clinical symptoms of many years and sometimes decades. Prompt diagnosis and therapy are crucial to prevent neurological complications of the disease, as they are usually irreversible once established. In this mini-review we discuss some major issues about this rare disorder, pointing out the early clues to the right diagnosis, instrumental to reduce significant disability burden of affected patients.
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Affiliation(s)
- Giacomo Marchi
- Department of Medicine, University of Verona, Verona, Italy
| | - Fabiana Busti
- Department of Medicine, University of Verona, Verona, Italy
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29
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Fujiwara T, Harigae H. Molecular pathophysiology and genetic mutations in congenital sideroblastic anemia. Free Radic Biol Med 2019; 133:179-185. [PMID: 30098397 DOI: 10.1016/j.freeradbiomed.2018.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/02/2018] [Accepted: 08/04/2018] [Indexed: 01/19/2023]
Abstract
Sideroblastic anemia is a heterogeneous congenital and acquired disorder characterized by anemia and the presence of ring sideroblasts in the bone marrow. Congenital sideroblastic anemia (CSA) is a rare disease caused by mutations in genes involved in the heme biosynthesis, iron-sulfur [Fe-S] cluster biosynthesis, and mitochondrial protein synthesis. The most prevalent form of CSA is X-linked sideroblastic anemia, caused by mutations in the erythroid-specific δ-aminolevulinate synthase (ALAS2), which is the first enzyme of the heme biosynthesis pathway in erythroid cells. To date, a remarkable number of genetically undefined CSA cases remain, but a recent application of the next-generation sequencing technology has recognized novel causative genes for CSA. However, in most instances, the detailed molecular mechanisms of how defects of each gene result in the abnormal mitochondrial iron accumulation remain unclear. This review aims to cover the current understanding of the molecular pathophysiology of CSA.
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Affiliation(s)
- Tohru Fujiwara
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
| | - Hideo Harigae
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan.
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30
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Sourabh S, Bhatia P, Jain R. Favourable improvement in haematological parameters in response to oral iron and vitamin C combination in children with Iron Refractory Iron Deficiency Anemia (IRIDA) phenotype. Blood Cells Mol Dis 2018; 75:26-29. [PMID: 30594846 DOI: 10.1016/j.bcmd.2018.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 12/12/2022]
Abstract
Treatment in IRIDA focuses on use of intravenous iron preparations to circumvent oral absorptive defect resulting from high levels of hepcidin due to TMPRSS6 gene variations. However, recent case reports and recommendations on atypical microcytic hypochromic anemias advocate use of oral iron and vitamin c trial before parenteral iron, as the same results in comparable improvement in haemoglobin. We prospectively evaluated our IRIDA cohort (n = 7) with oral iron and vitamin c dose over a period of 10 weeks and noted complete response in majority (6/7 = 86%) with >2 g/dL rise in Hb along with significant improvement of other iron related indices.
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Affiliation(s)
- S Sourabh
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - P Bhatia
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - R Jain
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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31
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Colin JY, Vignon G, Mottaz P, Labrousse J, Carrere F, Augereau PF, Aucher P, Lellouche F. [Diagnostic workup in front of an atypical non hemolytic anemia]. Rev Med Interne 2018; 39:855-862. [PMID: 29661593 DOI: 10.1016/j.revmed.2018.03.382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/26/2022]
Abstract
The most potential causes of "non hemolytic" anemias are iron, folate or vitamin B12 deficiencies, severe renal impairment, endocrine diseases, inflammation and medullary disorders. In a non-exceptionnal way no cause is found, sometimes because of a wrong interpretation of analysis results and sometimes because of a little known etiology. The goal of this review is to point out analytical difficulties and to remember some rarer etiologies.
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Affiliation(s)
- J Y Colin
- Service de médecine interne, centre hospitalier de Royan, 20, avenue de St-Sordelin, 17640 Vaux-sur-Mer, France
| | - G Vignon
- Groupement de coopération sanitaire de Saintonge, laboratoire inter-hospitalier de biologie médicale, centres hospitaliers de St-Jean-d'Angély, Saintes-et-Royan, 18, avenue du Port, 17400 St-Jean-d'Angély, France
| | - P Mottaz
- Service de médecine interne, centre hospitalier de Royan, 20, avenue de St-Sordelin, 17640 Vaux-sur-Mer, France
| | - J Labrousse
- Groupement de coopération sanitaire de Saintonge, laboratoire inter-hospitalier de biologie médicale, centres hospitaliers de St-Jean-d'Angély, Saintes-et-Royan, 18, avenue du Port, 17400 St-Jean-d'Angély, France
| | - F Carrere
- Groupement de coopération sanitaire de Saintonge, laboratoire inter-hospitalier de biologie médicale, centres hospitaliers de St-Jean-d'Angély, Saintes-et-Royan, 18, avenue du Port, 17400 St-Jean-d'Angély, France
| | - P F Augereau
- Groupement de coopération sanitaire de Saintonge, laboratoire inter-hospitalier de biologie médicale, centres hospitaliers de St-Jean-d'Angély, Saintes-et-Royan, 18, avenue du Port, 17400 St-Jean-d'Angély, France
| | - P Aucher
- Groupement de coopération sanitaire de Saintonge, laboratoire inter-hospitalier de biologie médicale, centres hospitaliers de St-Jean-d'Angély, Saintes-et-Royan, 18, avenue du Port, 17400 St-Jean-d'Angély, France
| | - F Lellouche
- Service de médecine interne, centre hospitalier de Royan, 20, avenue de St-Sordelin, 17640 Vaux-sur-Mer, France; Groupement de coopération sanitaire de Saintonge, laboratoire inter-hospitalier de biologie médicale, centres hospitaliers de St-Jean-d'Angély, Saintes-et-Royan, 18, avenue du Port, 17400 St-Jean-d'Angély, France.
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32
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Effects of an Acute Exercise Bout on Serum Hepcidin Levels. Nutrients 2018; 10:nu10020209. [PMID: 29443922 PMCID: PMC5852785 DOI: 10.3390/nu10020209] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/30/2018] [Accepted: 02/11/2018] [Indexed: 02/07/2023] Open
Abstract
Iron deficiency is a frequent and multifactorial disorder in the career of athletes, particularly in females. Exercise-induced disturbances in iron homeostasis produce deleterious effects on performance and adaptation to training; thus, the identification of strategies that restore or maintain iron homeostasis in athletes is required. Hepcidin is a liver-derived hormone that degrades the ferroportin transport channel, thus reducing the ability of macrophages to recycle damaged iron, and decreasing iron availability. Although it has been suggested that the circulating fraction of hepcidin increases during early post-exercise recovery (~3 h), it remains unknown how an acute exercise bout may modify the circulating expression of hepcidin. Therefore, the current review aims to determine the post-exercise expression of serum hepcidin in response to a single session of exercise. The review was carried out in the Dialnet, Elsevier, Medline, Pubmed, Scielo and SPORTDiscus databases, using hepcidin (and “exercise” or “sport” or “physical activity”) as a strategy of search. A total of 19 articles were included in the review after the application of the inclusion/exclusion criteria. This search found that a single session of endurance exercise (intervallic or continuous) at moderate or vigorous intensity (60–90% VO2peak) stimulates an increase in the circulating levels of hepcidin between 0 h and 6 h after the end of the exercise bout, peaking at ~3 h post-exercise. The magnitude of the response of hepcidin to exercise seems to be dependent on the pre-exercise status of iron (ferritin) and inflammation (IL-6). Moreover, oxygen disturbances and the activation of a hypoxia-induced factor during or after exercise may stimulate a reduction of hepcidin expression. Meanwhile, cranberry flavonoids supplementation promotes an anti-oxidant effect that may facilitate the post-exercise expression of hepcidin. Further studies are required to explore the effect of resistance exercise on hepcidin expression.
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33
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Rodrigo R, Allen A, Manampreri A, Perera L, Fisher CA, Allen S, Weatherall DJ, Premawardhena A. Haemoglobin variants, iron status and anaemia in Sri Lankan adolescents with low red cell indices: A cross sectional survey. Blood Cells Mol Dis 2018; 71:11-15. [PMID: 29409695 DOI: 10.1016/j.bcmd.2018.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
Abstract
Iron deficiency complicates the use of red cell indices to screen for carriers of haemoglobin variants in many populations. In a cross sectional survey of 7526 secondary school students from 25 districts of Sri Lanka, 1963 (26.0%) students had low red cell indices. Iron deficiency, identified by low serum ferritin, was the major identifiable cause occurring in 550/1806 (30.5%) students. Low red cell indices occurred in iron-replete students with alpha-thalassaemia including those with single alpha-globin gene deletions. Anaemia and low red cell indices were also common in beta-thalassaemia trait. An unexpected finding was that low red cell indices occurred in 713 iron-replete students with a normal haemoglobin genotype. It is common practice to prescribe iron supplements to individuals with low red cell indices. Since low red cell indices were a feature of all forms of α thalassaemia and also of iron deficiency, in areas where both conditions are common, such as Sri Lanka, it is imperative to differentiate between the two, to allow targeted administration of iron supplements and avoid the possible deleterious effects of increased iron availability in iron replete individuals with low red cell indices due to other causes such as α thalassaemia.
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Affiliation(s)
- Rexan Rodrigo
- Faculty of Medicine, University of Kelaniya, Sri Lanka; Thalassemia Care Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - Angela Allen
- MRC Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK; Centre for Tropical and Infectious Disease, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Luxman Perera
- Thalassemia Care Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - Christopher A Fisher
- MRC Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Stephen Allen
- Centre for Tropical and Infectious Disease, Liverpool School of Tropical Medicine, Liverpool, UK
| | - David J Weatherall
- MRC Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Anuja Premawardhena
- Faculty of Medicine, University of Kelaniya, Sri Lanka; Thalassemia Care Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.
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Girelli D, Ugolini S, Busti F, Marchi G, Castagna A. Modern iron replacement therapy: clinical and pathophysiological insights. Int J Hematol 2017; 107:16-30. [PMID: 29196967 DOI: 10.1007/s12185-017-2373-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 11/24/2017] [Indexed: 12/13/2022]
Abstract
Iron deficiency, with or without anemia, is extremely frequent worldwide, representing a major public health problem. Iron replacement therapy dates back to the seventeenth century, and has progressed relatively slowly until recently. Both oral and intravenous traditional iron formulations are known to be far from ideal, mainly because of tolerability and safety issues, respectively. At the beginning of this century, the discovery of hepcidin/ferroportin axis has represented a turning point in the knowledge of the pathophysiology of iron metabolism disorders, ushering a new era. In the meantime, advances in the pharmaceutical technologies are producing newer iron formulations aimed at minimizing the problems inherent with traditional approaches. The pharmacokinetic of oral and parenteral iron is substantially different, and diversities have become even clearer in light of the hepcidin master role in regulating systemic iron homeostasis. Here we review how iron therapy is changing because of such important advances in both pathophysiology and pharmacology.
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Affiliation(s)
- Domenico Girelli
- Department of Medicine, Section of Internal Medicine, Veneto Region Referral Center for Iron Metabolism Disorders, Center of Excellence for Rare Hematological Diseases "EuroBloodNet", University of Verona, Policlinico G.B. Rossi, 37134, Verona, Italy.
| | - Sara Ugolini
- Department of Medicine, Section of Internal Medicine, Veneto Region Referral Center for Iron Metabolism Disorders, Center of Excellence for Rare Hematological Diseases "EuroBloodNet", University of Verona, Policlinico G.B. Rossi, 37134, Verona, Italy
| | - Fabiana Busti
- Department of Medicine, Section of Internal Medicine, Veneto Region Referral Center for Iron Metabolism Disorders, Center of Excellence for Rare Hematological Diseases "EuroBloodNet", University of Verona, Policlinico G.B. Rossi, 37134, Verona, Italy
| | - Giacomo Marchi
- Department of Medicine, Section of Internal Medicine, Veneto Region Referral Center for Iron Metabolism Disorders, Center of Excellence for Rare Hematological Diseases "EuroBloodNet", University of Verona, Policlinico G.B. Rossi, 37134, Verona, Italy
| | - Annalisa Castagna
- Department of Medicine, Section of Internal Medicine, Veneto Region Referral Center for Iron Metabolism Disorders, Center of Excellence for Rare Hematological Diseases "EuroBloodNet", University of Verona, Policlinico G.B. Rossi, 37134, Verona, Italy
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Pfeiffer CM, Looker AC. Laboratory methodologies for indicators of iron status: strengths, limitations, and analytical challenges. Am J Clin Nutr 2017; 106:1606S-1614S. [PMID: 29070545 PMCID: PMC5701713 DOI: 10.3945/ajcn.117.155887] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Biochemical assessment of iron status relies on serum-based indicators, such as serum ferritin (SF), transferrin saturation, and soluble transferrin receptor (sTfR), as well as erythrocyte protoporphyrin. These indicators present challenges for clinical practice and national nutrition surveys, and often iron status interpretation is based on the combination of several indicators. The diagnosis of iron deficiency (ID) through SF concentration, the most commonly used indicator, is complicated by concomitant inflammation. sTfR concentration is an indicator of functional ID that is not an acute-phase reactant, but challenges in its interpretation arise because of the lack of assay standardization, common reference ranges, and common cutoffs. It is unclear which indicators are best suited to assess excess iron status. The value of hepcidin, non-transferrin-bound iron, and reticulocyte indexes is being explored in research settings. Serum-based indicators are generally measured on fully automated clinical analyzers available in most hospitals. Although international reference materials have been available for years, the standardization of immunoassays is complicated by the heterogeneity of antibodies used and the absence of physicochemical reference methods to establish "true" concentrations. From 1988 to 2006, the assessment of iron status in NHANES was based on the multi-indicator ferritin model. However, the model did not indicate the severity of ID and produced categorical estimates. More recently, iron status assessment in NHANES has used the total body iron stores (TBI) model, in which the log ratio of sTfR to SF is assessed. Together, sTfR and SF concentrations cover the full range of iron status. The TBI model better predicts the absence of bone marrow iron than SF concentration alone, and TBI can be analyzed as a continuous variable. Additional consideration of methodologies, interpretation of indicators, and analytic standardization is important for further improvements in iron status assessment.
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Affiliation(s)
| | - Anne C Looker
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, GA
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Bhatia P, Jain R, Singh A. A structured approach to iron refractory iron deficiency anemia (IRIDA) diagnosis (SAID): The more is “SAID” about iron, the less it is. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2017. [DOI: 10.1016/j.phoj.2017.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Le Rouzic MA, Fouquet C, Leblanc T, Touati M, Fouyssac F, Vermylen C, Jäkel N, Guichard JF, Maloum K, Toutain F, Lutz P, Perel Y, Manceau H, Kannengiesser C, Vannier JP. Non syndromic childhood onset congenital sideroblastic anemia: A report of 13 patients identified with an ALAS2 or SLC25A38 mutation. Blood Cells Mol Dis 2017; 66:11-18. [PMID: 28772256 DOI: 10.1016/j.bcmd.2017.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/18/2017] [Accepted: 07/25/2017] [Indexed: 01/19/2023]
Abstract
The most frequent germline mutations responsible for non syndromic congenital sideroblastic anemia are identified in ALAS2 and SLC25A38 genes. Iron overload is a key issue and optimal chelation therapy should be used to limit its adverse effects on the development of children. Our multicentre retrospective descriptive study compared the strategies for diagnosis and management of congenital sideroblastic anemia during the follow-up of six patients with an ALAS2 mutation and seven patients with an SLC25A38 mutation. We described in depth the clinical, biological and radiological phenotype of these patients at diagnosis and during follow-up and highlighted our results with a review of available evidence and data on the management strategies for congenital sideroblastic anemia. This report confirms the considerable variability in manifestations among patients with ALAS2 or SLC25A38 mutations and draws attention to differences in the assessment and the monitoring of iron overload and its complications. The use of an international registry would certainly help defining recommendations for the management of these rare disorders to improve patient outcome.
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Affiliation(s)
| | | | | | | | | | - Christiane Vermylen
- Université Catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium.
| | - Nadja Jäkel
- Department für Hämatologie, Onkologie und Hämostaseologie, Leipzig, Germany.
| | | | - Karim Maloum
- Assistance Publique des Hôpitaux de Paris/Hôpital de la Pitié-Salpêtrière, Paris, France.
| | | | - Patrick Lutz
- CHU de Strasbourg/Hôpital de Hautepierre, Strasbourg, France.
| | - Yves Perel
- CHU de Bordeaux/Hôpital Pellegrin, Bordeaux, France.
| | - Hana Manceau
- INSERM U1149, Centre de Recherche sur l'inflammation CRI, Paris, France.
| | - Caroline Kannengiesser
- INSERM U1149, Centre de Recherche sur l'inflammation CRI, Paris, France; Université Paris Diderot, Site Bichat, Sorbonne Paris Cité, DHU UNITY, Paris, France; Laboratory of Excellence, GR-Ex, Paris, France; Assistance Publique des Hôpitaux de Paris, Département de Génétique, Hôpital Bichat, Paris, France.
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Capra AP, Ferro E, Cannavò L, La Rosa MA, Zirilli G. A child with severe iron-deficiency anemia and a complex TMPRSS6 genotype. ACTA ACUST UNITED AC 2017; 22:559-564. [PMID: 28447549 DOI: 10.1080/10245332.2017.1317990] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES We report a case of a 7-year-old girl with severe hypochromic microcytic anemia, who was unresponsive to classical iron supplements. We suspected IRIDA, iron-refractory iron-deficiency anemia, a genetic iron metabolism disorder, caused by TMPRSS6 variations. TMPRSS6 encodes matriptase-2, a negative regulator of hepcidin, and its pathological variants are related to normal to high levels of hepcidin. We analyzed the TMPRSS6 gene and we improved clinical management of the patient, selecting the appropriate supplementation therapy. Intervention & Technique: The parenteral iron therapy was started, but the patient was only partially responsive and the anemia persisted. To confirm the diagnosis, the TMPRSS6 gene sequence was analyzed by DNA sequencing and other relevant biochemical parameters were evaluated. RESULTS The TMPRSS6 sequence analysis showed a complex genotype with a rare heterozygous missense variant, in addition to other common polymorphisms. The serum hepcidin value was normal. We unexpectedly observed a normalization of patient's hemoglobin (Hb) levels only after liposomal iron treatment. DISCUSSION AND CONCLUSION The proband was symptomatic for IRIDA during a critical phase of growth and development, but we did not find a clearly causative genotype. A long-term result, improving stably patient's Hb levels, was obtained only after liposomal iron supplementation. Children may be at greater risk for iron deficiency and the degree of anemia as well as the response to the iron supplements varies markedly patient to patient. Here, we show the importance of comprehensive study of these patients in order to collect useful information about genotype-phenotype association of genes involved in iron metabolism.
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Affiliation(s)
- Anna Paola Capra
- a Department of Human Pathology of Adult and Developmental Age 'Gaetano Barresi' , 'Gaetano Martino' University Hospital of Messina , Messina , Italy
| | - Elisa Ferro
- a Department of Human Pathology of Adult and Developmental Age 'Gaetano Barresi' , 'Gaetano Martino' University Hospital of Messina , Messina , Italy
| | - Laura Cannavò
- a Department of Human Pathology of Adult and Developmental Age 'Gaetano Barresi' , 'Gaetano Martino' University Hospital of Messina , Messina , Italy
| | - Maria Angela La Rosa
- a Department of Human Pathology of Adult and Developmental Age 'Gaetano Barresi' , 'Gaetano Martino' University Hospital of Messina , Messina , Italy
| | - Giuseppina Zirilli
- a Department of Human Pathology of Adult and Developmental Age 'Gaetano Barresi' , 'Gaetano Martino' University Hospital of Messina , Messina , Italy
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Abstract
Iron deficiency is one of the most common causes of anemia. The 2 main etiologies of iron deficiency are blood loss due to menstrual periods and blood loss due to gastrointestinal bleeding. Beyond anemia, lack of iron has protean manifestations, including fatigue, hair loss, and restless legs. The most efficient test for the diagnosis of iron deficiency is the serum ferritin. Iron replacement can be done orally, or in patients in whom oral iron is not effective or contraindicated, with intravenous iron.
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Affiliation(s)
- Thomas G DeLoughery
- Division of Hematology/Medical Oncology, Department of Medicine, Knight Cancer Institute, Oregon Health and Science University, MC L586, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
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Pippard MJ. Microcytic anaemias in childhood and iron-refractory iron deficiency anaemia. Br J Haematol 2017; 177:167-168. [PMID: 28211569 DOI: 10.1111/bjh.14558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Vyoral D, Jiri Petrak. Therapeutic potential of hepcidin − the master regulator of iron metabolism. Pharmacol Res 2017; 115:242-254. [DOI: 10.1016/j.phrs.2016.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 12/14/2022]
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Donker AE, Schaap CC, Novotny VMJ, Smeets R, Peters TMA, van den Heuvel BLP, Raphael MF, Rijneveld AW, Appel IM, Vlot AJ, Versluijs AB, van Gelder M, Granzen B, Janssen MC, Rennings AJ, van de Veerdonk FL, Brons PP, Bakkeren DL, Nijziel MR, Vlasveld LT, Swinkels DW. Iron refractory iron deficiency anemia: a heterogeneous disease that is not always iron refractory. Am J Hematol 2016; 91:E482-E490. [PMID: 27643674 PMCID: PMC6586001 DOI: 10.1002/ajh.24561] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 12/16/2022]
Abstract
TMPRSS6 variants that affect protein function result in impaired matriptase‐2 function and consequently uninhibited hepcidin production, leading to iron refractory iron deficiency anemia (IRIDA). This disease is characterized by microcytic, hypochromic anemia and serum hepcidin values that are inappropriately high for body iron levels. Much is still unknown about its pathophysiology, genotype–phenotype correlation, and optimal clinical management. We describe 14 different TMPRSS6 variants, of which 9 are novel, in 21 phenotypically affected IRIDA patients from 20 families living in the Netherlands; 16 out of 21 patients were female. In 7 out of 21 cases DNA sequencing and multiplex ligation dependent probe amplification demonstrated only heterozygous TMPRSS6 variants. The age at presentation, disease severity, and response to iron supplementation were highly variable, even for patients and relatives with similar TMPRSS6 genotypes. Mono‐allelic IRIDA patients had a milder phenotype with respect to hemoglobin and MCV and presented significantly later in life with anemia than bi‐allelic patients. Transferrin saturation (TSAT)/hepcidin ratios were lower in IRIDA probands than in healthy relatives. Most patients required parenteral iron. Genotype alone was not predictive for the response to oral iron. We conclude that IRIDA is a genotypically and phenotypically heterogeneous disease. The high proportion of female patients and the discrepancy between phenotypes of probands and relatives with the same genotype, suggest a complex interplay between genetic and acquired factors in the pathogenesis of IRIDA. In the absence of inflammation, the TSAT/hepcidin ratio is a promising diagnostic tool, even after iron supplementation has been given. Am. J. Hematol. 91:E482–E490, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Albertine E. Donker
- Radboudumc Expert Center for Iron Disorders, Radboud University Medical CenterNijmegen, The Netherlands
- Translational Metabolic Laboratory, Department of Laboratory MedicineRadboud University Medical CenterNijmegen, The Netherlands
| | - Charlotte C.M. Schaap
- Radboudumc Expert Center for Iron Disorders, Radboud University Medical CenterNijmegen, The Netherlands
- Translational Metabolic Laboratory, Department of Laboratory MedicineRadboud University Medical CenterNijmegen, The Netherlands
| | - Vera M. J. Novotny
- Radboudumc Expert Center for Iron Disorders, Radboud University Medical CenterNijmegen, The Netherlands
- Department of HematologyRadboud University Medical CenterNijmegen The Netherlands
| | - Roel Smeets
- Radboudumc Expert Center for Iron Disorders, Radboud University Medical CenterNijmegen, The Netherlands
- Translational Metabolic Laboratory, Department of Laboratory MedicineRadboud University Medical CenterNijmegen, The Netherlands
| | - Tessa M. A. Peters
- Radboudumc Expert Center for Iron Disorders, Radboud University Medical CenterNijmegen, The Netherlands
- Translational Metabolic Laboratory, Department of Laboratory MedicineRadboud University Medical CenterNijmegen, The Netherlands
| | - Bert L. P. van den Heuvel
- Radboudumc Expert Center for Iron Disorders, Radboud University Medical CenterNijmegen, The Netherlands
- Translational Metabolic Laboratory, Department of Laboratory MedicineRadboud University Medical CenterNijmegen, The Netherlands
| | - Martine F. Raphael
- Department of Pediatric HematologyUniversity Medical CenterUtrecht The Netherlands
| | | | - Inge M. Appel
- Department of Pediatric HematologyErasmus MC, Sophia Children's Hospital Rotterdam The Netherlands
| | - Andre J. Vlot
- Department of Internal MedicineRijnstate Hospital Arnhem, Arnhem The Netherlands
| | | | | | - Bernd Granzen
- Department of PediatricsMaastricht UMCMaastricht The Netherlands
| | - Mirian C.H. Janssen
- Department of Internal MedicineRadboud University Medical CenterNijmegen The Netherlands
| | - Alexander J.M. Rennings
- Radboudumc Expert Center for Iron Disorders, Radboud University Medical CenterNijmegen, The Netherlands
- Department of Internal MedicineRadboud University Medical CenterNijmegen The Netherlands
| | | | - Paul P.T. Brons
- Radboudumc Expert Center for Iron Disorders, Radboud University Medical CenterNijmegen, The Netherlands
- Department of Pediatric Hemato‐OncologyRadboud University Medical CenterNijmegen, The Netherlands
| | - Dirk L. Bakkeren
- Department of Laboratory MedicineMáxima Medical Center, VeldhovenEindhoven The Netherlands
| | - Marten R. Nijziel
- Radboudumc Expert Center for Iron Disorders, Radboud University Medical CenterNijmegen, The Netherlands
- Department of HematologyRadboud University Medical CenterNijmegen The Netherlands
- Department of Hemato‐OncologyMáxima Medical CenterVeldhoven Eindhoven The Netherlands
| | - L. Thom Vlasveld
- Department of Internal MedicineBronovo HospitalThe Hague The Netherlands
| | - Dorine W. Swinkels
- Radboudumc Expert Center for Iron Disorders, Radboud University Medical CenterNijmegen, The Netherlands
- Translational Metabolic Laboratory, Department of Laboratory MedicineRadboud University Medical CenterNijmegen, The Netherlands
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van der Vorm LN, Hendriks JCM, Laarakkers CM, Klaver S, Armitage AE, Bamberg A, Geurts-Moespot AJ, Girelli D, Herkert M, Itkonen O, Konrad RJ, Tomosugi N, Westerman M, Bansal SS, Campostrini N, Drakesmith H, Fillet M, Olbina G, Pasricha SR, Pitts KR, Sloan JH, Tagliaro F, Weykamp CW, Swinkels DW. Toward Worldwide Hepcidin Assay Harmonization: Identification of a Commutable Secondary Reference Material. Clin Chem 2016; 62:993-1001. [DOI: 10.1373/clinchem.2016.256768] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/07/2016] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Absolute plasma hepcidin concentrations measured by various procedures differ substantially, complicating interpretation of results and rendering reference intervals method dependent. We investigated the degree of equivalence achievable by harmonization and the identification of a commutable secondary reference material to accomplish this goal.
METHODS
We applied technical procedures to achieve harmonization developed by the Consortium for Harmonization of Clinical Laboratory Results. Eleven plasma hepcidin measurement procedures (5 mass spectrometry based and 6 immunochemical based) quantified native individual plasma samples (n = 32) and native plasma pools (n = 8) to assess analytical performance and current and achievable equivalence. In addition, 8 types of candidate reference materials (3 concentrations each, n = 24) were assessed for their suitability, most notably in terms of commutability, to serve as secondary reference material.
RESULTS
Absolute hepcidin values and reproducibility (intrameasurement procedure CVs 2.9%–8.7%) differed substantially between measurement procedures, but all were linear and correlated well. The current equivalence (intermeasurement procedure CV 28.6%) between the methods was mainly attributable to differences in calibration and could thus be improved by harmonization with a common calibrator. Linear regression analysis and standardized residuals showed that a candidate reference material consisting of native lyophilized plasma with cryolyoprotectant was commutable for all measurement procedures. Mathematically simulated harmonization with this calibrator resulted in a maximum achievable equivalence of 7.7%.
CONCLUSIONS
The secondary reference material identified in this study has the potential to substantially improve equivalence between hepcidin measurement procedures and contributes to the establishment of a traceability chain that will ultimately allow standardization of hepcidin measurement results.
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Affiliation(s)
| | - Jan C M Hendriks
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Coby M Laarakkers
- Department of Laboratory Medicine and
- Hepcidinanalysis.com, Nijmegen, the Netherlands
| | | | - Andrew E Armitage
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK, and Blood Theme, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | | | | | | | - Outi Itkonen
- Helsinki University Central Hospital, Laboratory Division HUSLAB, Helsinki, Finland
| | | | - Naohisa Tomosugi
- Division of Advanced Medicine, Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
| | | | | | | | - Hal Drakesmith
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK, and Blood Theme, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Marianne Fillet
- Department of Analytical Pharmaceutical Chemistry, Institute of Pharmacy, University of Liège, Liège, Belgium
| | | | - Sant-Rayn Pasricha
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK, and Blood Theme, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | | | - Franco Tagliaro
- Department of Diagnostics and Public Health, University of Verona, Italy
| | - Cas W Weykamp
- Department of Clinical Chemistry, Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine and
- Hepcidinanalysis.com, Nijmegen, the Netherlands
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Méndez M, Moreno‐Carralero M, Morado‐Arias M, Fernández‐Jiménez M, de la Iglesia Iñigo S, Morán‐Jiménez M. Sideroblastic anemia: functional study of two novel missense mutations in ALAS2. Mol Genet Genomic Med 2016; 4:273-82. [PMID: 27247955 PMCID: PMC4867561 DOI: 10.1002/mgg3.202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/10/2015] [Accepted: 12/12/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND X-linked sideroblastic anemia (XLSA) is a disorder characterized by decreased heme synthesis and mitochondrial iron overload with ringed sideroblasts in bone marrow. XLSA is caused by mutations in the erythroid-specific gene coding 5-aminolevulinate synthase (ALAS2). Anemia in XLSA is extremely variable, characteristically microcytic and hypochromic with poikilocytosis, and the red blood cell distribution width is increased and prominent dimorphism of the red cell population. Anemia in XLSA patients responds variably to supplementation with pyridoxine. METHODS AND RESULTS We report four patients with XLSA and three mutations in ALAS2: c.611G>A (p.Arg204Gln), c.1218G>T (p.Leu406Phe) and c.1499A>G (p.Tyr500Cys). The in silico predictions of three ALAS2 mutations and the functional consequences of two ALAS2 mutations were assessed. We performed in silico analysis of these mutations using ten different softwares, and all of them predicted that the p.Tyr500Cys mutation was deleterious. The in vitro prokaryotic expression showed that the p.Leu406Phe and p.Tyr500Cys mutations reduced the ALAS2 specific activity (SA) to 14% and 7% of the control value, respectively. CONCLUSION In view of the results obtained in this study, a clear relationship between genotype and phenotype cannot be established; clinical variability or severity of anemia may be influenced by allelic variants in other genes or transcription factors and environmental conditions.
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Affiliation(s)
- Manuel Méndez
- Instituto de InvestigaciónHospital 12 de OctubreMadridSpain
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Abstract
The discovery of the iron-regulatory hormone hepcidin in 2001 has revolutionized our understanding of iron disorders, and its measurement should advance diagnosis/treatment of these conditions. Although several assays have been developed, a gold standard is still lacking, and efforts toward harmonization are ongoing. Nevertheless, promising applications can already be glimpsed, ranging from the use of hepcidin levels for diagnosing iron-refractory iron deficiency anemia to global health applications such as guiding safe iron supplementation in developing countries with high infection burden.
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Porto G, Brissot P, Swinkels DW, Zoller H, Kamarainen O, Patton S, Alonso I, Morris M, Keeney S. EMQN best practice guidelines for the molecular genetic diagnosis of hereditary hemochromatosis (HH). Eur J Hum Genet 2016; 24:479-95. [PMID: 26153218 PMCID: PMC4929861 DOI: 10.1038/ejhg.2015.128] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 04/29/2015] [Accepted: 05/06/2015] [Indexed: 12/14/2022] Open
Abstract
Molecular genetic testing for hereditary hemochromatosis (HH) is recognized as a reference test to confirm the diagnosis of suspected HH or to predict its risk. The vast majority (typically >90%) of patients with clinically characterized HH are homozygous for the p.C282Y variant in the HFE gene, referred to as HFE-related HH. Since 1996, HFE genotyping was implemented in diagnostic algorithms for suspected HH, allowing its early diagnosis and prevention. However, the penetrance of disease in p.C282Y homozygotes is incomplete. Hence, homozygosity for p.C282Y is not sufficient to diagnose HH. Neither is p.C282Y homozygosity required for diagnosis as other rare forms of HH exist, generally referred to as non-HFE-related HH. These pose significant challenges when defining criteria for referral, testing protocols, interpretation of test results and reporting practices. We present best practice guidelines for the molecular genetic diagnosis of HH where recommendations are classified, as far as possible, according to the level and strength of evidence. For clarification, the guidelines' recommendations are preceded by a detailed description of the methodology and results obtained with a series of actions taken in order to achieve a wide expert consensus, namely: (i) a survey on the current practices followed by laboratories offering molecular diagnosis of HH; (ii) a systematic literature search focused on some identified controversial topics; (iii) an expert Best Practice Workshop convened to achieve consensus on the practical recommendations included in the guidelines.
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Affiliation(s)
- Graça Porto
- Center for Predictive and Preventive Genetics (CGPP), Institute of Molecular and Cellular Biology (IBMC), Porto, Portugal
- Clinical Haematology, Hospital Santo António (CHP-HAS) and Department of Molecular Pathology and Immunology, Abel Salazar Institute for Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
| | - Pierre Brissot
- Liver Disease Unit, Pontchaillou University Hospital, University of Rennes, and National Reference Centre for Rare Iron Overload Diseases of Genetic Origin, Rennes, France
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Heinz Zoller
- Department of Medicine II, Gastroenterology and Hepatology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Simon Patton
- European Molecular Quality Network (EMQN), Manchester, UK
| | - Isabel Alonso
- Center for Predictive and Preventive Genetics (CGPP), Institute of Molecular and Cellular Biology (IBMC), Porto, Portugal
| | - Michael Morris
- European Molecular Quality Network (EMQN), Manchester, UK
- Synlab, Lausanne, Switzerland
| | - Steve Keeney
- European Molecular Quality Network (EMQN), Manchester, UK
- Molecular Diagnostics Centre (Haematology), Manchester Royal Infirmary, Manchester, UK
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49
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Abstract
Iron is essential for life because it is indispensable for several biological reactions, such as oxygen transport, DNA synthesis, and cell proliferation. Over the past few years, our understanding of iron metabolism and its regulation has changed dramatically. New disorders of iron metabolism have emerged, and the role of iron as a cofactor in other disorders has begun to be recognized. The study of genetic conditions such as hemochromatosis and iron-refractory iron deficiency anemia (IRIDA) has provided crucial insights into the molecular mechanisms controlling iron homeostasis. In the future, these advances may be exploited to improve treatment of both genetic and acquired iron disorders. IRIDA is caused by mutations in TMPRSS6, the gene encoding matriptase-2, which downregulates hepcidin expression under conditions of iron deficiency. The typical features of this disorder are hypochromic, microcytic anemia with a very low mean corpuscular volume of erythrocytes, low transferrin saturation, no (or inadequate) response to oral iron, and only a partial response to parenteral iron. In contrast to classic iron deficiency anemia, serum ferritin levels are usually low-normal, and serum or urinary hepcidin levels are inappropriately high for the degree of anemia. Although the number of cases reported thus far in the literature does not exceed 100, this disorder is considered the most common of the “atypical” microcytic anemias. The aim of this review is to share the current knowledge on IRIDA and increase awareness in this field.
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Affiliation(s)
- Ebru Yılmaz Keskin
- Samsun Education and Research Hospital, Clinic of Pediatric Hematology and Oncology, Samsun, Turkey. E-mail:
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Biology of Heme in Mammalian Erythroid Cells and Related Disorders. BIOMED RESEARCH INTERNATIONAL 2015; 2015:278536. [PMID: 26557657 PMCID: PMC4628764 DOI: 10.1155/2015/278536] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 06/14/2015] [Indexed: 01/19/2023]
Abstract
Heme is a prosthetic group comprising ferrous iron (Fe(2+)) and protoporphyrin IX and is an essential cofactor in various biological processes such as oxygen transport (hemoglobin) and storage (myoglobin) and electron transfer (respiratory cytochromes) in addition to its role as a structural component of hemoproteins. Heme biosynthesis is induced during erythroid differentiation and is coordinated with the expression of genes involved in globin formation and iron acquisition/transport. However, erythroid and nonerythroid cells exhibit distinct differences in the heme biosynthetic pathway regulation. Defects of heme biosynthesis in developing erythroblasts can have profound medical implications, as represented by sideroblastic anemia. This review will focus on the biology of heme in mammalian erythroid cells, including the heme biosynthetic pathway as well as the regulatory role of heme and human disorders that arise from defective heme synthesis.
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