1
|
Modi NB, Shames R, Lickliter JD, Gupta S. Pharmacokinetics, pharmacodynamics, and tolerability of an aqueous formulation of rusfertide (PTG-300), a hepcidin mimetic, in healthy volunteers: A double-blind first-in-human study. Eur J Haematol 2024; 113:340-350. [PMID: 38785334 DOI: 10.1111/ejh.14243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Rusfertide is a potent peptide mimetic of hepcidin being investigated for the treatment of polycythemia vera. This randomized, placebo-controlled, double-blind study evaluated the safety, pharmacokinetics, and pharmacodynamics of single and repeated subcutaneous doses of an aqueous formulation of rusfertide in healthy adult males. METHODS Subjects received single doses of 1, 3, 10, 20, 40, or 80 mg rusfertide or placebo. A separate cohort of subjects received two doses of 40 mg rusfertide or placebo 1 week apart. Blood samples for pharmacokinetics and pharmacodynamics were collected, and adverse events, clinical laboratory tests, 12-lead electrocardiograms, and vital signs were monitored. RESULTS Rusfertide was well tolerated. There were no serious or severe treatment-emergent adverse events, and no patterns of clinically important adverse events, or laboratory, vital sign, or electrocardiogram abnormalities. Mean maximum rusfertide plasma concentration (Cmax) and area under the concentration-time curve increased with dose, but less than dose proportionally. Median time to Cmax was 2-4.5 h for 40 and 80 mg rusfertide and 8-24 h for lower doses. Apparent clearance and half-life increased with dose. Single doses of rusfertide 1-80 mg were associated with dose-dependent decreases in serum iron and transferrin-iron saturation. CONCLUSIONS Rusfertide was well tolerated and showed dose-dependent pharmacokinetics and pharmacodynamics.
Collapse
Affiliation(s)
- Nishit B Modi
- Protagonist Therapeutics, Inc., Newark, California, USA
| | | | | | - Suneel Gupta
- Protagonist Therapeutics, Inc., Newark, California, USA
| |
Collapse
|
2
|
Mottelson M, Glenthøj A, Nordestgaard BG, Ellervik C, Petersen J, Bojesen SE, Helby J. Iron, hemochromatosis genotypes, and risk of infections: a cohort study of 142 188 general population individuals. Blood 2024; 144:693-707. [PMID: 38728387 DOI: 10.1182/blood.2023022235] [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: 08/18/2023] [Revised: 04/08/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
ABSTRACT It is unclear whether risk of infection is increased in individuals with hereditary hemochromatosis and in individuals with low or high plasma iron, transferrin saturation, or ferritin. Therefore, we tested whether high and low iron, transferrin saturation, and ferritin are associated with risk of infections observationally and genetically through HFE genotypes. We studied 142 188 Danish general population individuals. Iron, transferrin saturation, and ferritin were measured in 136 656, 136 599, and 38 020 individuals, respectively. HFE was genotyped for C282Y and H63D in 132 542 individuals. Median follow-up after study enrollment was 8 years (range, 0-38) for hospital and emergency room admissions with infections (n = 20 394) using the National Patient Register, covering all Danish hospitals. Hazard ratios for any infection were 1.20 (95% confidence interval [CI], 1.12-1.28) and 1.14 (95% CI, 1.07-1.22) in individuals with plasma iron ≤5th or ≥95th percentile compared with individuals with iron from 26th to 74th percentiles. Findings for transferrin saturation were similar, whereas infection risk was not increased in individuals with ferritin ≤5th or ≥95th percentile. Hazard ratios in C282Y homozygotes vs noncarriers were 1.40 (95% CI, 1.16-1.68) for any infection, 1.69 (95% CI, 1.05-2.73) for sepsis, and 2.34 (95% CI, 1.41-3.90) for death from infectious disease. Risk of infection was increased in C282Y homozygotes with normal plasma iron, transferrin saturation, or ferritin, and in C282Y homozygotes without liver disease, diabetes, and/or heart failure. In summary, low and high plasma iron and transferrin saturation were independently associated with increased infection risk. C282Y homozygotes had increased risk of any infection, sepsis, and death from infections. Even C282Y homozygotes with normal iron, transferrin saturation, or ferritin, not currently recommended for genotyping, had increased infection risk.
Collapse
Affiliation(s)
- Mathis Mottelson
- Department of Haematology, Danish Red Blood Cell Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Andreas Glenthøj
- Department of Haematology, Danish Red Blood Cell Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Børge Grønne Nordestgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christina Ellervik
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Production, Research, and Innovation, Region Zealand, Sorø, Denmark
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA
- Department of Pathology, Harvard Medical School, Boston, MA
| | - Jesper Petersen
- Department of Haematology, Danish Red Blood Cell Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Stig Egil Bojesen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jens Helby
- Department of Haematology, Danish Red Blood Cell Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| |
Collapse
|
3
|
Drakesmith H, Zoller H. The iron curve: infection at both ends. Blood 2024; 144:679-680. [PMID: 39145941 DOI: 10.1182/blood.2024025259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024] Open
|
4
|
Abadía Molina C, Goñi Ros N, González Tarancón R, Rello Varas L, Recasens Flores MDV, Izquierdo Álvarez S. Hereditary haemochromatosis: Prevalence and characterization of the disease in a tertiary hospital in Aragon. Med Clin (Barc) 2024:S0025-7753(24)00391-9. [PMID: 39003111 DOI: 10.1016/j.medcli.2024.05.015] [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: 02/01/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND The main genetic cause of iron overload is haemochromatosis (HC). In recent years, the study of non-HFE genes (HFE2, HJV, HAMP, TRF2, SLC40A1, and BMP6) has become relevant thanks to next-generation sequencing (NGS) and multiplex ligation-dependent probe amplification (MLPA) techniques. Our objectives were to estimate the prevalence of both HFE (C282Y/HY63D variants) and non-HFE variants attending a tertiary hospital in Aragón, to predict the effect of the variants on the protein, and to establish a genotype-phenotype correlation evaluating with the clinical context. METHODS Retrospective descriptive study from 2006 to 2020 of patients attended at genetic consultation in a reference hospital for HC in Aragon. We calculated prevalence of HFE and non-HFE variants. We analysed non-HFE genes (HFE2, HJV, HAMP, TRF2, SLC40A1, and BMP6), used bioinformatics tools, consulted different databases and measured clinical parameters (laboratory and imaging). RESULTS The prevalence of C282Y homozygous was 5.95% respect the total of cases and 0.025% respect our population. The prevalence of non-HFE HC variants was 1.94% respect the total of cases and 0.008% respect our population. We found 27 variants in non-HFE genes and 4 in HFE gene, of which 6 were classified as variant of uncertain clinical significance (VUS), or likely pathogenic or pathogenic according to the ACMG classification criteria. CONCLUSION Our prevalence results are as expected, and similar to those obtained by other studies. Although some of the genetic findings explain the clinical symptoms of some of our patients, we remain have a high number of patients without a clear molecular diagnosis.
Collapse
Affiliation(s)
- Claudia Abadía Molina
- Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Nuria Goñi Ros
- Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Ricardo González Tarancón
- Genetic Section, Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Luis Rello Varas
- Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Silvia Izquierdo Álvarez
- Genetic Section, Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain
| |
Collapse
|
5
|
Zarifian Yeganeh R, Akbari Kelishomi M, Ahmadpour Jenaghard A, Salmani B, Vahidi Z, Makvand M, Azad M, Kooshki M, Bouraqi Y, Azarkeivan A, Najmabadi H, Neishabury M. HFE and Non- HFE Hereditary Hemochromatosis Based on Screening of 854 Individuals: 12 Years of an Iranian Experience. Genet Test Mol Biomarkers 2024; 28:289-296. [PMID: 38980801 DOI: 10.1089/gtmb.2023.0764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Introduction: The genetics of hereditary hemochromatosis (HH) is understudied in Iran. Here, we report the result of genetic screening of 854 individuals, referred as "suspected cases of HH," to a diagnostic laboratory in Iran over a 12-year period. Materials and Methods: From 2011 to 2012, 121 cases were screened for HH using Sanger sequencing of HFE exons. After 2012, this method was replaced by a commercial reverse hybridization assay (RHA) targeting 18 variants in the HFE, TFR2, and FPN1(SLC40A1) genes and 733 cases were screened using this method. Results: From the total studied population, HH was confirmed by genetic diagnosis in only seven cases (0.82%): two homozygotes for HFE:C282Y and five homozygotes for TFR2:AVAQ 594-597 deletion. In 254 cases (29.7%), H63D, C282Y, S65C, and four other HFE variants not targeted by RHA were identified. Although the resulting genotypes in the latter cases did not confirm HH, some of them were known modifying factors of iron overload or could cause HH in combination with a possibly undetected variant. No variant was detected in 593 cases (69.4%). Conclusion: This study showed that the spectrum of genetic variants of HH in the Iranian population includes HFE and TFR2 variants. However, HH was not confirmed in the majority (99.2%) of suspected cases. This could be explained by limitations of our genetic diagnostics and possible inaccuracies in clinical suspicion of HH. A cooperative clinical and genetic investigation is proposed as a solution to this issue.
Collapse
Affiliation(s)
- Razieh Zarifian Yeganeh
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | | | | | - Zohreh Vahidi
- Kariminejad-Najmabadi Pathology & Genetic Center, Tehran, Iran
| | - Mina Makvand
- Kariminejad-Najmabadi Pathology & Genetic Center, Tehran, Iran
| | - Maryam Azad
- Kariminejad-Najmabadi Pathology & Genetic Center, Tehran, Iran
| | - Mahdieh Kooshki
- Kariminejad-Najmabadi Pathology & Genetic Center, Tehran, Iran
| | - Yassin Bouraqi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Azita Azarkeivan
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
- Iranian Blood Transfusion Organization, Thalassemia Clinic, Tehran, Iran
| | - Hossein Najmabadi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Kariminejad-Najmabadi Pathology & Genetic Center, Tehran, Iran
| | - Maryam Neishabury
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| |
Collapse
|
6
|
Villa Nogueyra S, Trujillo Rodríguez MF, Garcia Oliva ML, Vidal-Gallardo A, Ramírez Leal A, Beltran Hernandez J, Vargas Beltran AM, Guillen Sandoval JD, Arriaga Escamilla D, Martinez Ramirez M. The Genetic Diagnostics of Hemochromatosis: Disparities in Low- Versus High-Income Countries. Cureus 2024; 16:e64074. [PMID: 39114232 PMCID: PMC11305073 DOI: 10.7759/cureus.64074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
This study provides a comprehensive overview of hereditary hemochromatosis (HH), a genetic condition characterized by iron overload due to excessive iron absorption. It elucidates diverse inheritance patterns and clinical manifestations by exploring mutations in critical genes such as HFE (hemochromatosis), HJV (hemojuvelin), HAMP (hepcidin antimicrobial peptide), TfR2 (transferrin receptor 2), and FP (ferroportin). The significance of early screening, diagnosis, and personalized management strategies based on genetic classification is emphasized, particularly in terms of high-income vs. low-income countries. Addressing challenges in diagnosis, genetic testing accessibility, and healthcare disparities, the study highlights the importance of early detection, cost-effective screening strategies, and enhancing healthcare outcomes globally. Advanced genetic testing in high-income countries facilitates early diagnosis and management, reducing complications such as liver disease and cardiomyopathy. In contrast, low-income populations face several barriers, including limited access to genetic testing, high costs, and inadequate healthcare infrastructure. Cost-effective serum ferritin (SF) and transferrin saturation (TS) tests and emerging point-of-care (POC) tests offer affordable diagnostic options for low-resource settings. Additionally, the ongoing development of hepcidin measurement methods holds promise for enhancing diagnostic capabilities. Implementing these strategies can aid healthcare providers in improving global HH management and reducing the burden of iron overload complications. Furthermore, the study underscores the need for public health initiatives to raise awareness about HH, promote routine screenings, and advocate for equitable healthcare policies. Collaborative efforts between governments, healthcare organizations, and research institutions are crucial in addressing the global burden of HH. By fostering international cooperation and resource-sharing, it is possible to bridge the gap between high-income and low-income countries, ensuring all individuals have access to the necessary diagnostic and treatment options. This holistic approach can ultimately lead to better health outcomes and improved quality of life for individuals affected by HH worldwide. This comprehensive examination of HH not only illuminates the genetic and clinical aspects of the condition but also provides a roadmap for addressing the multifaceted challenges associated with its diagnosis and management.
Collapse
Affiliation(s)
| | | | | | | | - Amanda Ramírez Leal
- Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, MEX
| | | | | | | | | | | |
Collapse
|
7
|
Wang J, Xu J, Jiang N, Liu H, Li F, Wang B, Wang J, Chu Z, Tan L, Li S. Case report: A rare case of hereditary hemochromatosis caused by a mutation in the HAMP gene in Fuyang, China. Front Med (Lausanne) 2024; 11:1417611. [PMID: 39005658 PMCID: PMC11239416 DOI: 10.3389/fmed.2024.1417611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/10/2024] [Indexed: 07/16/2024] Open
Abstract
Hemochromatosis, also known as siderosis, is a disease caused by excessive iron deposition in human organs and tissues, resulting from iron metabolism disorders. It is clinically characterized by skin pigmentation (bronze color), liver cirrhosis, diabetes, weakness, and fatigue. Additional symptoms may include arthritis, hypothyroidism, heart failure, and sexual hypofunction. Clinical manifestations can vary from person to person, with a few patients showing no clinical manifestations, which makes the diagnosis difficult for clinicians. In this case report, we described hereditary hemochromatosis related to a mutation in the HAMP gene in Fuyang City, China, as a reference for clinicians. Hereditary hemochromatosis is rarely reported in China. Clinicians in China have relatively insufficient knowledge of this disease, which leads to frequent misdiagnosis. In this case report, we describe hereditary hemochromatosis related to HAMP gene mutation in Fuyang City, China, for the clinician's reference.
Collapse
Affiliation(s)
- Jinling Wang
- Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang, Anhui, China
| | - Jing Xu
- Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang, Anhui, China
| | - Ning Jiang
- Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang, Anhui, China
| | - Hui Liu
- Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Fengcheng Li
- Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang, Anhui, China
| | - Beibei Wang
- Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang, Anhui, China
| | - Jin Wang
- Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang, Anhui, China
| | - Ziyu Chu
- Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang, Anhui, China
| | - Lin Tan
- Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang, Anhui, China
| | - Shasha Li
- Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang, Anhui, China
| |
Collapse
|
8
|
Szczerbinska A, Kasztelan-Szczerbinska B, Rycyk-Bojarzynska A, Kocki J, Cichoz-Lach H. Hemochromatosis-How Not to Overlook and Properly Manage "Iron People"-A Review. J Clin Med 2024; 13:3660. [PMID: 38999226 PMCID: PMC11242024 DOI: 10.3390/jcm13133660] [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: 05/16/2024] [Revised: 06/20/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Hemochromatosis (HC) is the main genetic disorder of iron overload and is regarded as metal-related human toxicosis. HC may result from HFE and rare non-HFE gene mutations, causing hepcidin deficiency or, sporadically, hepcidin resistance. This review focuses on HFE-related HC. The illness presents a strong biochemical penetrance, but its prevalence is low. Unfortunately, the majority of patients with HC remain undiagnosed at their disease-curable stage. The main aim of HC management is to prevent iron overload in its early phase and remove excess iron from the body by phlebotomy in its late stage. Raising global awareness of HC among health staff, teaching them how not to overlook early HC manifestations, and paying attention to careful patient monitoring remain critical management strategies for preventing treatment delays, upgrading its efficacy, and improving patient prognosis.
Collapse
Affiliation(s)
- Agnieszka Szczerbinska
- Faculty of Medicine, Medical University of Warsaw, 61 Zwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Beata Kasztelan-Szczerbinska
- Department of Gastroenterology with Endoscopy Unit, Medical University of Lublin, 8 Jaczewski Street, 20-954 Lublin, Poland
| | - Anna Rycyk-Bojarzynska
- Department of Gastroenterology with Endoscopy Unit, Medical University of Lublin, 8 Jaczewski Street, 20-954 Lublin, Poland
| | - Janusz Kocki
- Department of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Street, 20-080 Lublin, Poland
| | - Halina Cichoz-Lach
- Department of Gastroenterology with Endoscopy Unit, Medical University of Lublin, 8 Jaczewski Street, 20-954 Lublin, Poland
| |
Collapse
|
9
|
Teschke R. Copper, Iron, Cadmium, and Arsenic, All Generated in the Universe: Elucidating Their Environmental Impact Risk on Human Health Including Clinical Liver Injury. Int J Mol Sci 2024; 25:6662. [PMID: 38928368 PMCID: PMC11203474 DOI: 10.3390/ijms25126662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Humans are continuously exposed to various heavy metals including copper, iron, cadmium, and arsenic, which were specifically selected for the current analysis because they are among the most frequently encountered environmental mankind and industrial pollutants potentially causing human health hazards and liver injury. So far, these issues were poorly assessed and remained a matter of debate, also due to inconsistent results. The aim of the actual report is to thoroughly analyze the positive as well as negative effects of these four heavy metals on human health. Copper and iron are correctly viewed as pollutant elements essential for maintaining human health because they are part of important enzymes and metabolic pathways. Healthy individuals are prepared through various genetically based mechanisms to maintain cellular copper and iron homeostasis, thereby circumventing or reducing hazardous liver and organ injury due to excessive amounts of these metals continuously entering the human body. In a few humans with gene aberration, however, liver and organ injury may develop because excessively accumulated copper can lead to Wilson disease and substantial iron deposition to hemochromatosis. At the molecular level, toxicities of some heavy metals are traced back to the Haber Weiss and Fenton reactions involving reactive oxygen species formed in the course of oxidative stress. On the other hand, cellular homeostasis for cadmium and arsenic cannot be provided, causing their life-long excessive deposition in the liver and other organs. Consequently, cadmium and arsenic represent health hazards leading to higher disability-adjusted life years and increased mortality rates due to cancer and non-cancer diseases. For unknown reasons, however, liver injury in humans exposed to cadmium and arsenic is rarely observed. In sum, copper and iron are good for the human health of most individuals except for those with Wilson disease or hemochromatosis at risk of liver injury through radical formation, while cadmium and arsenic lack any beneficial effects but rather are potentially hazardous to human health with a focus on increased disability potential and risk for cancer. Primary efforts should focus on reducing the industrial emission of hazardous heavy metals.
Collapse
Affiliation(s)
- Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, 63450 Hanau, Germany; ; Tel.: +49-6181/21859; Fax: +49-6181/2964211
- Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/Main, 60590 Hanau, Germany
| |
Collapse
|
10
|
Qin Y, Pillidge C, Harrison B, Adhikari B. Pathways in formulating foods for the elderly. Food Res Int 2024; 186:114324. [PMID: 38729692 DOI: 10.1016/j.foodres.2024.114324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 05/12/2024]
Abstract
The growth of the elderly population worldwide is posing significant challenges to human society. The progressive physical and physiological changes occur with aging, including decreased appetite, incomplete digestion, and reduced absorption of nutrients. A common feature of many elderly people's diets is a deficiency in proteins (especially easily digestible ones) and micronutrients (e.g., vitamins, zinc, iron, and calcium). One of the solutions to this problem is the incorporation of these components into suitably texture-modified foods. There is a dearth of products that meet the needs of the elderly with special medical/health conditions such as dysphagia, osteoporosis, diabetes, and cardiovascular disease, as well as those who are in hospital and palliative care. Future research and development of foods for the elderly must address specific dietary needs of different subgroups of elderly people with underlying health conditions. The existence of different physical and physiological stages of the elderly means that their specific dietary requirements must be considered. This review summarizes current knowledge on nutritional requirements including those with underlying health problems and outlines the research and innovation pathways for developing new foods considering nutrition, texture, flavor, and other sensory aspects.
Collapse
Affiliation(s)
- Yuxin Qin
- School of Science, RMIT University, Melbourne, VIC 3083, Australia.
| | | | | | - Benu Adhikari
- School of Science, RMIT University, Melbourne, VIC 3083, Australia; The Centre for Advanced Materials and Industrial Chemistry (CAMIC), Melbourne, VIC 3083, Australia.
| |
Collapse
|
11
|
Packer M, Anker SD, Butler J, Cleland JGF, Kalra PR, Mentz RJ, Ponikowski P, Talha KM. Critical re-evaluation of the identification of iron deficiency states and effective iron repletion strategies in patients with chronic heart failure. Eur J Heart Fail 2024; 26:1298-1312. [PMID: 38727791 DOI: 10.1002/ejhf.3237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/17/2024] [Accepted: 03/30/2024] [Indexed: 06/28/2024] Open
Abstract
According to current guidelines, iron deficiency is defined by a serum ferritin level <100 ng/ml or a transferrin saturation (TSAT) <20% if the serum ferritin level is 100-299 μg/L. These criteria were developed to encourage the use of intravenous iron as an adjunct to erythropoiesis-stimulating agents in the treatment of renal anaemia. However, in patients with heart failure, these criteria are not supported by any pathophysiological or clinical evidence that they identify an absolute or functional iron deficiency state. A low baseline TSAT-but not serum ferritin level-appears to be a reliable indicator of the effect of intravenous iron to reduce major heart failure events. In randomized controlled trials, intravenous iron decreased the risk of cardiovascular death or total heart failure hospitalization in patients with a TSAT <20% (risk ratio 0.67 [0.49-0.92]) but not in patients with a TSAT ≥20% (risk ratio 0.99 [0.74-1.30]), with the magnitude of the risk reduction being proportional to the severity of hypoferraemia. Patients who were enrolled in clinical trials solely because they had a serum ferritin level <100 μg/L showed no significant benefit on heart failure outcomes, and it is noteworthy that serum ferritin levels of 20-300 μg/L lie entirely within the range of normal values for healthy adults. Current guidelines reflect the eligibility criteria of clinical trials, which inadvertently adopted unvalidated criteria to define iron deficiency. Reliance on these guidelines would lead to the treatment of many patients who are not iron deficient (serum ferritin level <100 μg/L but normal TSAT) and ignores the possibility of iron deficiency in patients with a low TSAT but with serum ferritin level of >300 μg/L. Importantly, analyses of benefit based on trial eligibility-driven guidelines substantially underestimate the magnitude of heart-failure-event risk reduction with intravenous iron in patients who are truly iron deficient. Based on all available data, we recommend a new mechanism-based and trial-tested approach that reflects the totality of evidence more faithfully than the historical process adopted by clinical investigators and by the guidelines. Until additional evidence is forthcoming, an iron deficiency state in patients with heart failure should be defined by a TSAT <20% (as long as the serum ferritin level is <400 μg/L), and furthermore, the use of a serum ferritin level <100 μg/L alone as a diagnostic criterion should be discarded.
Collapse
Affiliation(s)
- Milton Packer
- Baylor University Medical Center, Dallas, TX, USA
- Imperial College, London, UK
| | - Stefan D Anker
- Department of Cardiology of German Heart Center Charité, Institute of Health Center for Regenerative Therapies, German Centre for Cardiovascular Research, Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Javed Butler
- Baylor Scott and White Research Institute, Baylor University Medical Center, Dallas, TX, USA
- University of Mississippi Medical Center, Jackson, MS, USA
| | - John G F Cleland
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Paul R Kalra
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
- Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Robert J Mentz
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, and Duke Clinical Research Institute, Durham, NC, USA
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | | |
Collapse
|
12
|
Forleo C, Carella MC, Basile P, Mandunzio D, Greco G, Napoli G, Carulli E, Dicorato MM, Dentamaro I, Santobuono VE, Memeo R, Latorre MD, Baggiano A, Mushtaq S, Ciccone MM, Pontone G, Guaricci AI. The Role of Magnetic Resonance Imaging in Cardiomyopathies in the Light of New Guidelines: A Focus on Tissue Mapping. J Clin Med 2024; 13:2621. [PMID: 38731153 PMCID: PMC11084160 DOI: 10.3390/jcm13092621] [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: 03/15/2024] [Revised: 04/27/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Cardiomyopathies (CMPs) are a group of myocardial disorders that are characterized by structural and functional abnormalities of the heart muscle. These abnormalities occur in the absence of coronary artery disease (CAD), hypertension, valvular disease, and congenital heart disease. CMPs are an increasingly important topic in the field of cardiovascular diseases due to the complexity of their diagnosis and management. In 2023, the ESC guidelines on cardiomyopathies were first published, marking significant progress in the field. The growth of techniques such as cardiac magnetic resonance imaging (CMR) and genetics has been fueled by the development of multimodal imaging approaches. For the diagnosis of CMPs, a multimodal imaging approach, including CMR, is recommended. CMR has become the standard for non-invasive analysis of cardiac morphology and myocardial function. This document provides an overview of the role of CMR in CMPs, with a focus on tissue mapping. CMR enables the characterization of myocardial tissues and the assessment of cardiac functions. CMR sequences and techniques, such as late gadolinium enhancement (LGE) and parametric mapping, provide detailed information on tissue composition, fibrosis, edema, and myocardial perfusion. These techniques offer valuable insights for early diagnosis, prognostic evaluation, and therapeutic guidance of CMPs. The use of quantitative CMR markers enables personalized treatment plans, improving overall patient outcomes. This review aims to serve as a guide for the use of these new tools in clinical practice.
Collapse
Affiliation(s)
- Cinzia Forleo
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Maria Cristina Carella
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Paolo Basile
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Donato Mandunzio
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Giulia Greco
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Gianluigi Napoli
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Eugenio Carulli
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Marco Maria Dicorato
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Ilaria Dentamaro
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Vincenzo Ezio Santobuono
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Riccardo Memeo
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Michele Davide Latorre
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (G.P.)
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (G.P.)
| | - Marco Matteo Ciccone
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (G.P.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20138 Milan, Italy
| | - Andrea Igoren Guaricci
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| |
Collapse
|
13
|
Tatsumi Y, Yano M, Wakusawa S, Miyajima H, Ishikawa T, Imashuku S, Takano A, Nihei W, Kato A, Kato K, Hayashi H, Yoshioka K, Hayashi K. A Revised Classification of Primary Iron Overload Syndromes. J Clin Transl Hepatol 2024; 12:346-356. [PMID: 38638373 PMCID: PMC11022062 DOI: 10.14218/jcth.2023.00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/02/2023] [Accepted: 12/11/2023] [Indexed: 04/20/2024] Open
Abstract
Background and Aims The clinical introduction of hepcidin25 (Hep25) has led to a more detailed understanding of its relationship with ferroportin (FP) and divalent metal transporter1 in primary iron overload syndromes (PIOSs). In 2012, we proposed a classification of PIOSs based on the Hep25/FP system, which consists of prehepatic aceruloplasminemia, hepatic hemochromatosis (HC), and posthepatic FP disease (FP-D). However, in consideration of accumulated evidence on PIOSs, we aimed to renew the classification. Methods We reviewed the 2012 classification and retrospectively renewed it according to new information on PIOSs. Results Iron-loading anemia was included in PIOSs as a prehepatic form because of the newly discovered erythroferrone-induced suppression of Hep25, and the state of traditional FP-D was remodeled as the BIOIRON proposal. The key molecules responsible for prehepatic PIOSs are low transferrin saturation in aceruloplasminemia and increased erythroferrone production by erythroblasts in iron-loading anemia. Hepatic PIOSs comprise four genotypes of HC, in each of which the synthesis of Hep25 is inappropriately reduced in the liver. Hepatic Hep25 synthesis is adequate in posthepatic PIOSs; however, two mutant FP molecules may resist Hep25 differently, resulting in SLC40A1-HC and FP-D, respectively. PIOS phenotypes are diagnosed using laboratory tests, including circulating Hep25, followed by suitable treatments. Direct sequencing of the candidate genes may be outsourced to gene centers when needed. Laboratory kits for the prevalent mutations, such as C282Y, may be the first choice for a genetic analysis of HC in Caucasians. Conclusions The revised classification may be useful worldwide.
Collapse
Affiliation(s)
- Yasuaki Tatsumi
- Department of Medical Biochemistry, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan
| | - Motoyoshi Yano
- Department of Gastroenterology, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Shinya Wakusawa
- Department of Medical Technology, Shubun University, Ichinomiya, Japan
| | - Hiroaki Miyajima
- Department of Medicine and Neurology, Tenryu Kohseikai Clinic, Hamamatsu, Japan
| | - Tetsuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinsaku Imashuku
- Department of Laboratory Medicine, Uji-Tokushukai Medical Center, Uji, Japan
| | - Atsuko Takano
- Department of Medicine, Saiseikai Takaoka Hospital, Takaoka, Japan
| | - Wataru Nihei
- Department of Medicine, Aichi-Gakuin University School of Pharmacy, Nagoya, Japan
| | - Ayako Kato
- Department of Medicine, Aichi-Gakuin University School of Pharmacy, Nagoya, Japan
| | - Koichi Kato
- Department of Medicine, Aichi-Gakuin University School of Pharmacy, Nagoya, Japan
| | - Hisao Hayashi
- Department of Medicine, Aichi-Gakuin University School of Pharmacy, Nagoya, Japan
| | - Kentaro Yoshioka
- Department of Gastroenterology, FNPS Meijo Hospital, Nagoya, Japan
| | - Kazuhiko Hayashi
- Department of Gastroenterology, FNPS Meijo Hospital, Nagoya, Japan
| |
Collapse
|
14
|
Moksnes MR, Hansen AF, Wolford BN, Thomas LF, Rasheed H, Simić A, Bhatta L, Brantsæter AL, Surakka I, Zhou W, Magnus P, Njølstad PR, Andreassen OA, Syversen T, Zheng J, Fritsche LG, Evans DM, Warrington NM, Nøst TH, Åsvold BO, Flaten TP, Willer CJ, Hveem K, Brumpton BM. A genome-wide association study provides insights into the genetic etiology of 57 essential and non-essential trace elements in humans. Commun Biol 2024; 7:432. [PMID: 38594418 PMCID: PMC11004147 DOI: 10.1038/s42003-024-06101-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 03/22/2024] [Indexed: 04/11/2024] Open
Abstract
Trace elements are important for human health but may exert toxic or adverse effects. Mechanisms of uptake, distribution, metabolism, and excretion are partly under genetic control but have not yet been extensively mapped. Here we report a comprehensive multi-element genome-wide association study of 57 essential and non-essential trace elements. We perform genome-wide association meta-analyses of 14 trace elements in up to 6564 Scandinavian whole blood samples, and genome-wide association studies of 43 trace elements in up to 2819 samples measured only in the Trøndelag Health Study (HUNT). We identify 11 novel genetic loci associated with blood concentrations of arsenic, cadmium, manganese, selenium, and zinc in genome-wide association meta-analyses. In HUNT, several genome-wide significant loci are also indicated for other trace elements. Using two-sample Mendelian randomization, we find several indications of weak to moderate effects on health outcomes, the most precise being a weak harmful effect of increased zinc on prostate cancer. However, independent validation is needed. Our current understanding of trace element-associated genetic variants may help establish consequences of trace elements on human health.
Collapse
Affiliation(s)
- Marta R Moksnes
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
| | - Ailin F Hansen
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Brooke N Wolford
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Laurent F Thomas
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Clinical and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- BioCore-Bioinformatics Core Facility, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Laboratory Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Humaira Rasheed
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Division of Medicine and Laboratory Sciences, University of Oslo, Oslo, Norway
| | - Anica Simić
- Department of Chemistry, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Laxmi Bhatta
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Lise Brantsæter
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ida Surakka
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Wei Zhou
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Pål R Njølstad
- Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
- Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway
| | - Ole A Andreassen
- NORMENT Centre, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Tore Syversen
- Department of Neuroscience, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Jie Zheng
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Shanghai Digital Medicine Innovation Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Bristol, UK
| | - Lars G Fritsche
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - David M Evans
- Institute for Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Frazer Institute, The University of Queensland, Woolloongabba, QLD, Australia
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - Nicole M Warrington
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Institute for Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Frazer Institute, The University of Queensland, Woolloongabba, QLD, Australia
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - Therese H Nøst
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjørn Olav Åsvold
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Centre, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Levanger, Norway
- Department of Endocrinology, Clinic of Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Trond Peder Flaten
- Department of Chemistry, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Cristen J Willer
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Kristian Hveem
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Centre, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Levanger, Norway
| | - Ben M Brumpton
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
- HUNT Research Centre, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Levanger, Norway.
- Clinic of Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
| |
Collapse
|
15
|
Singal M, Mahmoud A, Phatak PD. Clinical characteristics of HFE C282Y/H63D compound heterozygotes identified in a specialty practice: key differences from HFE C282Y homozygotes. Expert Rev Hematol 2024; 17:145-152. [PMID: 38551816 DOI: 10.1080/17474086.2024.2337950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/13/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Patients with p.C282Y homozygous (p.C282Y) HFE mutations are more likely to develop hemochromatosis (HC) than p.C282Y/p.H63D compound heterozygotes (p.C282Y/H63D). RESEARCH DESIGN AND METHODS We conducted a retrospective chart review of 90 p.C282Y and 31 p.C282Y/H63D patients at a referral practice to illustrate the differences in the natural history of the disease in these two HC cohorts. RESULTS Over a median follow-up of 17 years, p.C282Y had higher mean serum ferritin (1105 mg/dL vs. 534 mg/dL, p = 0.001) and transferrin saturations (75.3% vs. 49.5%, p = 0.001) at diagnosis. p.C282Y underwent more therapeutic phlebotomies (TP) till de-ironing (mean 24 vs. 10), had higher mean mobilized iron stores (4759 mg vs. 1932 mg), and required more annual maintenance TP (1.9/year vs. 1.1/year, p = 0.039). p.C282Y/H63D were more likely to have obesity (45.2% vs. 20.2%, p = 0.007) at diagnosis, with a non-significant trend toward consuming more alcohol. There was no significant difference in the development of HC-related complications between the two cohorts. CONCLUSIONS p.C282Y have a higher mobilizable iron and require more TP. p.C282Y/H63D likely require additional insults such as obesity or alcohol use to develop elevated ferritin. De-ironing may mitigate the risk of developing HC-related complications.
Collapse
Affiliation(s)
- Mukul Singal
- Hematology and Oncology, Rochester General Hospital, Rochester, NY, USA
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Amir Mahmoud
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, NY, USA
| | - Pradyumna Dinkar Phatak
- Hematology and Oncology, Rochester General Hospital, Rochester, NY, USA
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, NY, USA
- Mary M Gooley Hemophilia Center, Rochester, NY, USA
| |
Collapse
|
16
|
Infanti L, Leitner G, Moe M, Pehlic V, Cattaneo M, Benkert P, Holbro A, Passweg J, Worel N, Buser A. Blood donation for iron removal in individuals with HFE mutations: study of efficacy and safety and short review on hemochromatosis and blood donation. Front Med (Lausanne) 2024; 11:1362941. [PMID: 38566922 PMCID: PMC10986032 DOI: 10.3389/fmed.2024.1362941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Background Elevated serum ferritin with/without HFE variants in asymptomatic persons leads frequently to referral for blood donation. Hemochromatosis (p.C282Y/p.C282Y) only requires treatment. We evaluated safety and feasibility of iron removal in healthy persons with elevated ferritin and HFE variants using blood donation procedures. Materials and methods Thirty subjects with ferritin >200 ng/mL (women) or >300 ng/mL (men) with p.C282Y/p.C282Y, p.C282Y/p.H63D or p.H63D/p.H63D were randomized to weekly phlebotomy (removal of 450 mL whole blood) or erythrapheresis (removal of 360 mL red blood cells) every 14 days. The ferritin target was <100 ng/mL. A full blood count and ferritin were measured at each visit. Hemoglobin (Hb) ≥140 g/L was required at inclusion. If Hb dropped to <120 g/L (women) or <130 g/L (men), procedures were postponed (7 or 14 days). Primary endpoint was the number of procedures needed to the ferritin target; secondary objectives were duration of treatment and compliance. The treatment effect was tested with Poisson regression; number of procedures and treatment duration were compared between study arms with the Kruskal-Wallis test. Results Twenty-five of 30 participants were men (83%); mean age was 47 years (SD 10.5), mean BMI 26.6 kg/m2 (SD 3.6); 17 had p.C282Y/p.C282Y, nine p.C282Y/p.H63D, four p.H63D/p.H63D. Median baseline Hb was 150 g/L (IQR 144, 1,559), median ferritin 504 ng/mL (IQR 406,620). Twenty-seven subjects completed the study. Treatment arm (p < 0.001) and HFE variant (p = 0.007) influenced the primary endpoint significantly. To ferritin levels <100 ng/mL, a median number of 7.5 (IQR 6.2, 9.8) phlebotomies and 4.0 (IQR 3.0, 5.8) erythraphereses (p = 0.001) was needed during a median of 66.5 days (IQR 49,103) and 78.5 days (IQR 46139), respectively (p = 0.448). Low Hb was the principal reason for protocol violation; anemia occurred in 13 participants (48%). Immediate complications were infrequent; fatigue was reported after 25% of phlebotomies and 45% of erythraphereses. Thirty-five procedures were postponed because of low Hb and 15 for non-medical reasons. The median interval was 7.0 (IQR 7.7) and 14.0 (IQR 14, 20) days between phlebotomies and erythraphereses, respectively. Conclusion Blood donation procedures remove iron effectively in HC, but frequent treatments cause Hb decrease and fatigue that can impair feasibility.
Collapse
Affiliation(s)
- Laura Infanti
- Regional Blood Transfusion Centre Swiss Red Cross Basel, Basel, Switzerland
- Division of Hematology, University Hospital, University of Basel, Basel, Switzerland
| | | | - Morten Moe
- Unit of Medical Biochemistry, Division of Diagnostics and Technology, Akershus University Hospital, Akershus, Norway
| | - Vildana Pehlic
- Regional Blood Transfusion Centre Swiss Red Cross Basel, Basel, Switzerland
| | - Marco Cattaneo
- Clinical Trial Unit, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
| | - Pascal Benkert
- Clinical Trial Unit, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
| | - Andreas Holbro
- Regional Blood Transfusion Centre Swiss Red Cross Basel, Basel, Switzerland
- Division of Hematology, University Hospital, University of Basel, Basel, Switzerland
| | - Jakob Passweg
- Division of Hematology, University Hospital, University of Basel, Basel, Switzerland
| | - Nina Worel
- Department for Transfusion Medicine and Cell Therapy, Medical University Vienna, Vienna, Austria
| | - Andreas Buser
- Regional Blood Transfusion Centre Swiss Red Cross Basel, Basel, Switzerland
- Division of Hematology, University Hospital, University of Basel, Basel, Switzerland
| |
Collapse
|
17
|
Tatsumi Y, Hayash H, Kato K. Comment to a patient with SLC40A1-HC successfully treated using red blood cell apheresis. Med Mol Morphol 2024; 57:82. [PMID: 38010478 DOI: 10.1007/s00795-023-00375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Yasuaki Tatsumi
- Department of Medical Biochemistry, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, 274-8510, Japan
| | - Hisao Hayash
- Department of Medicine, Aichi Gakuin University School of Pharmacy, 1-100 Kusumoto-Cho, Chikusa-Ku, Nagoya, 464-8650, Japan
| | - Koichi Kato
- Department of Medicine, Aichi Gakuin University School of Pharmacy, 1-100 Kusumoto-Cho, Chikusa-Ku, Nagoya, 464-8650, Japan.
| |
Collapse
|
18
|
Schaefer B, Pammer LM, Pfeifer B, Neururer S, Troppmair MR, Panzer M, Wagner S, Pertler E, Gieger C, Kronenberg F, Lamina C, Tilg H, Zoller H. Penetrance, cancer incidence and survival in HFE haemochromatosis-A population-based cohort study. Liver Int 2024; 44:838-847. [PMID: 38263707 DOI: 10.1111/liv.15797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND AND AIMS Haemochromatosis is characterized by progressive iron overload affecting the liver and can cause cirrhosis and hepatocellular carcinoma. Most haemochromatosis patients are homozygous for p.C282Y in HFE, but only a minority of individuals with this genotype will develop the disease. The aim was to assess the penetrance of iron overload, fibrosis, hepatocellular carcinoma and life expectancy. METHODS A total of 8839 individuals from the Austrian region of Tyrol were genotyped for the p.C282Y variant between 1997 and 2021. Demographic, laboratory parameters and causes of death were assessed from health records. Penetrance, survival, and cancer incidence were ascertained from diagnosed cases, insurance- and cancer registry data. Outcomes were compared with a propensity score-matched control population. RESULTS Median age at diagnosis in 542 p.C282Y homozygous individuals was 47.8 years (64% male). At genotyping, the prevalence of iron overload was 55%. The cumulative penetrance of haemochromatosis defined as the presence of provisional iron overload was 24.2% in males and 10.5% in females aged 60 years or younger. Among p.C282Y homozygotes of the same ages, the cumulative proportion of individuals without fibrosis (FIB-4 score < 1.3) was 92.8% in males and 96.7% in females. Median life expectancy was reduced by 6.8 years in individuals homozygous for p.C282Y when compared with population-matched controls (p = .001). Hepatocellular carcinoma incidence was not significantly higher in p.C282Y homozygotes than in controls matched for age and sex. CONCLUSION Reduced survival and the observed age-dependent increase in penetrance among p.C282Y homozygotes call for earlier diagnosis of haemochromatosis to prevent complications.
Collapse
Affiliation(s)
- Benedikt Schaefer
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lorenz M Pammer
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Pfeifer
- Division for Digital Medicine and Telehealth, UMIT TIROL-Private University for Health Sciences and Health Technology, Hall (Tyrol), Austria
- Tyrolean Federal Institute for Integrated Care, Tirol Kliniken Gmbh, Innsbruck, Austria
| | - Sabrina Neururer
- Division for Digital Medicine and Telehealth, UMIT TIROL-Private University for Health Sciences and Health Technology, Hall (Tyrol), Austria
- Tyrolean Federal Institute for Integrated Care, Tirol Kliniken Gmbh, Innsbruck, Austria
| | - Maria R Troppmair
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marlene Panzer
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sonja Wagner
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
- Christian Doppler Laboratory for Iron and Phosphate Biology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Pertler
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
- Christian Doppler Laboratory for Iron and Phosphate Biology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Gieger
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Florian Kronenberg
- Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudia Lamina
- Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Tilg
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
| | - Heinz Zoller
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
- Christian Doppler Laboratory for Iron and Phosphate Biology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
19
|
Teschke R. Hemochromatosis: Ferroptosis, ROS, Gut Microbiome, and Clinical Challenges with Alcohol as Confounding Variable. Int J Mol Sci 2024; 25:2668. [PMID: 38473913 DOI: 10.3390/ijms25052668] [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: 01/29/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Hemochromatosis represents clinically one of the most important genetic storage diseases of the liver caused by iron overload, which is to be differentiated from hepatic iron overload due to excessive iron release from erythrocytes in patients with genetic hemolytic disorders. This disorder is under recent mechanistic discussion regarding ferroptosis, reactive oxygen species (ROS), the gut microbiome, and alcohol abuse as a risk factor, which are all topics of this review article. Triggered by released intracellular free iron from ferritin via the autophagic process of ferritinophagy, ferroptosis is involved in hemochromatosis as a specific form of iron-dependent regulated cell death. This develops in the course of mitochondrial injury associated with additional iron accumulation, followed by excessive production of ROS and lipid peroxidation. A low fecal iron content during therapeutic iron depletion reduces colonic inflammation and oxidative stress. In clinical terms, iron is an essential trace element required for human health. Humans cannot synthesize iron and must take it up from iron-containing foods and beverages. Under physiological conditions, healthy individuals allow for iron homeostasis by restricting the extent of intestinal iron depending on realistic demand, avoiding uptake of iron in excess. For this condition, the human body has no chance to adequately compensate through removal. In patients with hemochromatosis, the molecular finetuning of intestinal iron uptake is set off due to mutations in the high-FE2+ (HFE) genes that lead to a lack of hepcidin or resistance on the part of ferroportin to hepcidin binding. This is the major mechanism for the increased iron stores in the body. Hepcidin is a liver-derived peptide, which impairs the release of iron from enterocytes and macrophages by interacting with ferroportin. As a result, iron accumulates in various organs including the liver, which is severely injured and causes the clinically important hemochromatosis. This diagnosis is difficult to establish due to uncharacteristic features. Among these are asthenia, joint pain, arthritis, chondrocalcinosis, diabetes mellitus, hypopituitarism, hypogonadotropic hypogonadism, and cardiopathy. Diagnosis is initially suspected by increased serum levels of ferritin, a non-specific parameter also elevated in inflammatory diseases that must be excluded to be on the safer diagnostic side. Diagnosis is facilitated if ferritin is combined with elevated fasting transferrin saturation, genetic testing, and family screening. Various diagnostic attempts were published as algorithms. However, none of these were based on evidence or quantitative results derived from scored key features as opposed to other known complex diseases. Among these are autoimmune hepatitis (AIH) or drug-induced liver injury (DILI). For both diseases, the scored diagnostic algorithms are used in line with artificial intelligence (AI) principles to ascertain the diagnosis. The first-line therapy of hemochromatosis involves regular and life-long phlebotomy to remove iron from the blood, which improves the prognosis and may prevent the development of end-stage liver disease such as cirrhosis and hepatocellular carcinoma. Liver transplantation is rarely performed, confined to acute liver failure. In conclusion, ferroptosis, ROS, the gut microbiome, and concomitant alcohol abuse play a major contributing role in the development and clinical course of genetic hemochromatosis, which requires early diagnosis and therapy initiation through phlebotomy as a first-line treatment.
Collapse
Affiliation(s)
- Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, D-63450 Hanau, Germany
- Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/Main, D-60590 Frankfurt am Main, Germany
| |
Collapse
|
20
|
Ferrari F, Carini M, Zanella I, Treglia G, Luglio G, Bresciani R, Biasiotto G. Potential Diagnostic Role of Hepcidin in Anemic Patients Affected by Inflammatory Bowel Disease: A Systematic Review. Diagnostics (Basel) 2024; 14:375. [PMID: 38396414 PMCID: PMC10887700 DOI: 10.3390/diagnostics14040375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Anemia is the main extraintestinal comorbidity of Inflammatory Bowel Disease (IBD). Differentiating the type of anemia in these disorders is still a challenge. Hepcidin could be a promising biomarker to identify iron deficiency anemia (IDA), anemia of chronic disease (ACD) and the concomitant presence of both IDA and ACD. METHODS To evaluate the potential role of hepcidin dosage in the management of anemia in IBD patients, we performed a systematic review by a comprehensive literature analysis of original papers reporting the dosage of hepcidin in IBD patients. In all the articles reviewed, the dosage of ferritin was reported, and the correlation between hepcidin and ferritin has been used to compare these two biomarkers. RESULTS A total of 12 articles concerning the dosage of hepcidin in IBD were included, comprising in total of 976 patients. The results of the hepcidin values in IBD patients when compared with controls were conflicting. In fact, four articles described an increase in this biomarker, three showed a decrease and five did not find significant differences. The correlation with ferritin was positive and significant. In three studies, some differences between hepcidin dosages and ferritin levels indicate a possible role when IDA and ACD could be present at the same time. CONCLUSIONS Considering the contradictory data of the studies, the diagnostic role of hepcidin as a biomarker remains elusive in IBD patients. These differences could be due to the clinical characteristics of the patients enrolled that should be better defined in the future. A suitable clinical trial should be designed to outline the possible role of hepcidin in differentiating IDA, ACD and concomitant IDA and ACD in IBD patients. At the moment, ferritin still remains the best marker to diagnose these conditions, in addition to hemoglobin, transferrin saturation and CRP as recommended by the ECCO guidelines.
Collapse
Affiliation(s)
- Fabiana Ferrari
- Pediatrics, Mother’s and Baby’s Health Department, Poliambulanza Foundation Hospital Insitute, 25124 Brescia, Italy
| | - Mattia Carini
- Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
- Highly Specialized Laboratory, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Isabella Zanella
- Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
- Section of Genetics and Cytogenetics, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Giorgio Treglia
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6501 Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Gaetano Luglio
- Endoscopic Surgery Unit, Department of Medical and Surgical Gastrointestinal Disease, “Federico II” University, 80131 Naples, Italy
| | - Roberto Bresciani
- Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
- Highly Specialized Laboratory, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Giorgio Biasiotto
- Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
- Highly Specialized Laboratory, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| |
Collapse
|
21
|
Xu T, Wan S, Shi J, Xu T, Wang L, Guan Y, Luo J, Luo Y, Sun M, An P, He J. Antioxidant Minerals Modified the Association between Iron and Type 2 Diabetes in a Chinese Population. Nutrients 2024; 16:335. [PMID: 38337620 PMCID: PMC10857573 DOI: 10.3390/nu16030335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
Inconsistent findings exist regarding the relationship between heme iron intake and type 2 diabetes (T2D) among Western and Eastern populations. Easterners tend to consume a plant-based diet which is abundant in antioxidant minerals. To examine the hypothesis that antioxidant mineral may modify the relationship between iron and T2D, we performed a case-control study by measuring the serum mineral levels in 2198 Chinese subjects. A total of 2113 T2D patients and 2458 controls were invited; 502 T2D patients and 1696 controls were finally analyzed. In the total population, high serum iron showed a positive association with T2D odds (odds ratio [OR] = 1.27 [1.04, 1.55]); high magnesium (OR = 0.18 [0.14, 0.22]), copper (OR = 0.27 [0.21, 0.33]), zinc (OR = 0.37 [0.30, 0.46]), chromium (OR = 0.61 [0.50, 0.74]), or selenium concentrations (OR = 0.39 [0.31, 0.48]) were inversely associated with T2D odds. In contrast, in individuals with higher magnesium (>2673.2 µg/dL), zinc (>136.7 µg/dL), copper (>132.1 µg/dL), chromium (>14.0 µg/dL), or selenium concentrations (>16.8 µg/dL), serum iron displayed no association with T2D (p > 0.05). Serum copper and magnesium were significant modifiers of the association between iron and T2D in individuals with different physiological status (p < 0.05). Our findings support the idea that consuming a diet rich in antioxidant minerals is an effective approach for preventing T2D.
Collapse
Affiliation(s)
- Teng Xu
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China;
| | - Sitong Wan
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing 100190, China; (S.W.); (J.S.); (L.W.); (Y.G.); (J.L.); (Y.L.)
| | - Jiaxin Shi
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing 100190, China; (S.W.); (J.S.); (L.W.); (Y.G.); (J.L.); (Y.L.)
| | - Tiancheng Xu
- School of Food and Health, Beijing Technology & Business University, Beijing 100048, China;
| | - Langrun Wang
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing 100190, China; (S.W.); (J.S.); (L.W.); (Y.G.); (J.L.); (Y.L.)
| | - Yiran Guan
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing 100190, China; (S.W.); (J.S.); (L.W.); (Y.G.); (J.L.); (Y.L.)
| | - Junjie Luo
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing 100190, China; (S.W.); (J.S.); (L.W.); (Y.G.); (J.L.); (Y.L.)
| | - Yongting Luo
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing 100190, China; (S.W.); (J.S.); (L.W.); (Y.G.); (J.L.); (Y.L.)
| | - Mingyue Sun
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Peng An
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing 100190, China; (S.W.); (J.S.); (L.W.); (Y.G.); (J.L.); (Y.L.)
| | - Jingjing He
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing 100190, China; (S.W.); (J.S.); (L.W.); (Y.G.); (J.L.); (Y.L.)
| |
Collapse
|
22
|
Ganz T, Nemeth E. Hypoferremia of inflammation: Innate host defense against infections. Blood Cells Mol Dis 2024; 104:102777. [PMID: 37391347 DOI: 10.1016/j.bcmd.2023.102777] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/02/2023]
Abstract
Iron is an essential nutrient for microbes, plants and animals. Multicellular organisms have evolved multiple strategies to control invading microbes by restricting microbial access to iron. Hypoferremia of inflammation is a rapidly-acting organismal response that prevents the formation of iron species that would be readily accessible to microbes. This review takes an evolutionary perspective to explore the mechanisms and host defense function of hypoferremia of inflammation and its clinical implications.
Collapse
Affiliation(s)
- Tomas Ganz
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave., Los Angeles, CA 90095-1690, USA; Department of Pathology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave., Los Angeles, CA 90095-1690, USA.
| | - Elizabeta Nemeth
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave., Los Angeles, CA 90095-1690, USA
| |
Collapse
|
23
|
Duarte TL, Lopes M, Oliveira M, Santos AG, Vasco C, Reis JP, Antunes AR, Gonçalves A, Chacim S, Oliveira C, Porto B, Teles MJ, Moreira AC, Silva AMN, Schwessinger R, Drakesmith H, Henrique R, Porto G, Duarte D. Iron overload induces dysplastic erythropoiesis and features of myelodysplasia in Nrf2-deficient mice. Leukemia 2024; 38:96-108. [PMID: 37857886 DOI: 10.1038/s41375-023-02067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
Iron overload (IOL) is hypothesized to contribute to dysplastic erythropoiesis. Several conditions, including myelodysplastic syndrome, thalassemia and sickle cell anemia, are characterized by ineffective erythropoiesis and IOL. Iron is pro-oxidant and may participate in the pathophysiology of these conditions by increasing genomic instability and altering the microenvironment. There is, however, lack of in vivo evidence demonstrating a role of IOL and oxidative damage in dysplastic erythropoiesis. NRF2 transcription factor is the master regulator of antioxidant defenses, playing a crucial role in the cellular response to IOL in the liver. Here, we crossed Nrf2-/- with hemochromatosis (Hfe-/-) or hepcidin-null (Hamp1-/-) mice. Double-knockout mice developed features of ineffective erythropoiesis and myelodysplasia including macrocytic anemia, splenomegaly, and accumulation of immature dysplastic bone marrow (BM) cells. BM cells from Nrf2/Hamp1-/- mice showed increased in vitro clonogenic potential and, upon serial transplantation, recipients disclosed cytopenias, despite normal engraftment, suggesting defective differentiation. Unstimulated karyotype analysis showed increased chromosome instability and aneuploidy in Nrf2/Hamp1-/- BM cells. In HFE-related hemochromatosis patients, NRF2 promoter SNP rs35652124 genotype TT (predicted to decrease NRF2 expression) associated with increased MCV, consistent with erythroid dysplasia. Our results suggest that IOL induces ineffective erythropoiesis and dysplastic hematologic features through oxidative damage in Nrf2-deficient cells.
Collapse
Affiliation(s)
- Tiago L Duarte
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
- IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal.
| | - Marta Lopes
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
| | - Mónica Oliveira
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
| | - Ana G Santos
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
| | - Catarina Vasco
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
| | - Joana P Reis
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Ana Rita Antunes
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
| | - Andreia Gonçalves
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
| | - Sérgio Chacim
- Serviço de Hematologia e Transplantação de Medula Óssea, Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E. (IPO Porto), Porto, Portugal
| | - Cláudia Oliveira
- Laboratório de Citogenética, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Beatriz Porto
- Laboratório de Citogenética, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Maria José Teles
- Departmento de Patologia Clínica, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Ana C Moreira
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - André M N Silva
- LAQV-REQUIMTE, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, Porto, Portugal
- LAQV-REQUIMTE, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Ron Schwessinger
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- MRC WIMM Centre for Computational Biology, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Hal Drakesmith
- MRC Translational Immune Discovery Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Rui Henrique
- Serviço de Anatomia Patológica, IPO Porto, Porto, Portugal
- Departamento de Patologia e Imunologia Molecular, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Graça Porto
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
- Departamento de Patologia e Imunologia Molecular, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
- Serviço de Imuno-hemoterapia, Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal
| | - Delfim Duarte
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
- Serviço de Hematologia e Transplantação de Medula Óssea, Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E. (IPO Porto), Porto, Portugal.
- Departmento de Biomedicina, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal.
- P.CCC - Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal.
| |
Collapse
|
24
|
Corti P, Ferrari GM, Faraguna MC, Capitoli G, Longo F, Corradini E, Casini T, Boscarol G, Pinto VM, Ghilardi R, Russo G, Colombatti R, Mariani R, Piperno A. Haemochromatosis in children: A national retrospective cohort promoted by the A.I.E.O.P. (Associazione Italiana Emato-Oncologia Pediatrica) study group. Br J Haematol 2024; 204:306-314. [PMID: 37990447 DOI: 10.1111/bjh.19208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/25/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
Haemochromatosis (HC) encompasses a range of genetic disorders. HFE-HC is by far the most common in adults, while non-HFE types are rare due to mutations of HJV, HAMP, TFR2 and gain-of-function mutations of SLC40A1. HC is often unknown to paediatricians as it is usually asymptomatic in childhood. We report clinical and biochemical data from 24 paediatric cases of HC (10 cases of HFE-, 5 TFR2-, 9 HJV-HC), with a median follow-up of 9.6 years. Unlike in the adult population, non-HFE-HC constitutes 58% (14/24) of the population in our series. Transferrin saturation was significantly higher in TFR2- and HJV-HC compared to HFE-HC, and serum ferritin and LIC were higher in HJV-HC compared to TFR2- and HFE-HC. Most HFE-HC subjects had relatively low ferritin and LIC at the time of diagnosis, so therapy could be postponed for most of them after the age of 18. Our results confirm that HJV-HC is a severe form already in childhood, emphasizing the importance of early diagnosis and treatment to avoid the development of organ damage and reduce morbidity and mortality. Although phlebotomies were tolerated by most patients, oral iron chelators could be a valid option in early-onset HC.
Collapse
Affiliation(s)
- Paola Corti
- Pediatria, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Martha Caterina Faraguna
- Pediatria, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Residency in Pediatrics, University of Milano Bicocca, Milan, Italy
| | - Giulia Capitoli
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Filomena Longo
- Thalassemia Reference Centre, Orbassano, Italy
- Regional HUB Centre for Thalassaemia and Haemoglobinopathies, Department of Medicine, AOU S. Anna, Ferrara, Italy
| | - Elena Corradini
- Internal Medicine Unit and Centre for Hemochromatosis and Hereditary Liver Diseases, ERN-EuroBloodNet and ERN-RARE-LIVER, Azienda Ospedaliero-Universitaria di Modena-Policlinico, Modena, Italy
| | - Tommaso Casini
- Pediatric Hematology/Oncology Department, Meyer's Children University Hospital, Firenze, Italy
| | | | - Valeria Maria Pinto
- Centro della Microcitemia e delle Anemie Congenite, Ospedale Galliera, Genova, Italy
| | - Roberta Ghilardi
- Department of Pediatrics, Ospedale Maggiore Policlinico, IRCCS, Milano, Italy
| | - Giovanna Russo
- Pediatric Hematology and Oncology Unit, Azienda Policlinico "Rodolico-San Marco", University of Catania, Catania, Italy
| | - Raffaella Colombatti
- Pediatric Hematology Oncology and Bone Marrow Transplantation Unit, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Raffaella Mariani
- SSD Rare Diseases-European Reference Network for Rare Hematological Diseases-EuroBloodNet-Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alberto Piperno
- SSD Rare Diseases-European Reference Network for Rare Hematological Diseases-EuroBloodNet-Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Centro Ricerca Tettamanti, Monza, Italy
| |
Collapse
|
25
|
Tonna RF, Haddadin R, Iqbal H, Gemil H. A Rare Case of Heterozygous C282Y Mutation Causing Hereditary Hemochromatosis With Acute Pancreatitis. Cureus 2024; 16:e52584. [PMID: 38371159 PMCID: PMC10874645 DOI: 10.7759/cureus.52584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Hereditary hemochromatosis (HH) is the most common autosomal recessive genetic disorder globally for Caucasians. HH is known as an iron metabolism disorder where there is an increase in iron absorption in the body. HH is not localized but a systemic disease; the manifestations of HH include cirrhosis, diabetes mellitus, cardiomyopathy, and pancreatitis. This case is about a 53-year-old female with a past medical history of heterozygous hereditary hemochromatosis who presents to the emergency department with abdominal pain, nausea, and vomiting and was found to have acute pancreatitis. This case report helps signify the importance of identifying and treating symptomatic heterozygous carriers of the HH gene mutation.
Collapse
Affiliation(s)
- Roger F Tonna
- Internal Medicine, MountainView Hospital, Las Vegas, USA
| | | | - Humzah Iqbal
- Internal Medicine, University of California San Francisco, Fresno, Fresno, USA
| | - Hatim Gemil
- Internal Medicine, MountainView Hospital, Las Vegas, USA
| |
Collapse
|
26
|
Swinkels DW, Matlung HL. Does phlebotomy in people with haemochromatosis become history? Lancet Gastroenterol Hepatol 2023; 8:1063-1064. [PMID: 37863079 DOI: 10.1016/s2468-1253(23)00283-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Dorine W Swinkels
- Iron Expertise Center, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen 6500 HB, Netherlands; Iron Expertise Center, Sanquin Blood Bank, Amsterdam, Netherlands.
| | - Hanke L Matlung
- Sanquin Diagnostic Services, Amsterdam, Netherlands; Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| |
Collapse
|
27
|
Romero‐Cortadellas L, Venturi V, Martín‐Sánchez JC, Toska K, Prince D, Butzeck B, Porto G, Milman NT, Committee HIS, Sánchez M. Haemochromatosis patients' research priorities: Towards an improved quality of life. Health Expect 2023; 26:2293-2301. [PMID: 37503783 PMCID: PMC10632644 DOI: 10.1111/hex.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/16/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Chronic diseases are associated with a range of functional and psychosocial consequences that can adversely affect patients' quality of life (QoL). Haemochromatosis (HC) is a genetically heterogeneous disorder characterized by chronic iron overload that can ultimately lead to multiple organ dysfunction. Clinical diagnosis remains challenging due to the nonspecificity of symptoms and a lack of confirmatory genotyping in a substantial proportion of patients. Illness perception among HC patients has not been extensively investigated, lacking relevant information on how to improve their QoL. METHODS We present the results of the first worldwide survey conducted in nearly 1500 HC respondents, in which we collected essential demographic information and identified the aspects that concern HC patients the most. RESULTS Out of all the participants, 45.3% (n = 676) voiced their concern about physical and psychological consequences such as HC-related arthropathies, which can ultimately affect their social functioning. A similar proportion of patients (n = 635, 42.5%) also consider that better-informed doctors are key for improved HC disease management. Taking a patient-centred approach, we expose differences in patients' disease perspective by social and economic influences. CONCLUSIONS We identify potential targets to improve patients' health-related QoL and reflect on strategic measures to foster gender equity in access to health resources. Finally, we make a call for a highly coordinated effort across a range of public policy areas to empower participants in the HC research process and design. PATIENT OR PUBLIC CONTRIBUTION Nearly 1500 patients with hereditary HC responded to an anonymized online survey in which research and clinical priorities were addressed regarding this chronic and rare disease.
Collapse
Affiliation(s)
- Lídia Romero‐Cortadellas
- Department of Basic Sciences, Iron metabolism: Regulation and DiseasesUniversitat Internacional de Catalunya (UIC)Sant Cugat del VallèsBarcelonaSpain
| | - Veronica Venturi
- Department of Basic Sciences, Iron metabolism: Regulation and DiseasesUniversitat Internacional de Catalunya (UIC)Sant Cugat del VallèsBarcelonaSpain
| | - Juan Carlos Martín‐Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic SciencesUniversitat Internacional de CatalunyaSant Cugat del VallèsSpain
| | - Ketil Toska
- Norwegian Haemochromatosis AssociationBergenNorway
| | - Dianne Prince
- Haemochromatosis AustraliaMeridan PlainsQueenslandAustralia
| | - Barbara Butzeck
- Hämochromatose‐Vereinigung Deutschland e.V. HVDEuropean Federation of Associations of Patients with Haemochromatosis (EFAPH)HattingenGermany
| | - Graça Porto
- i3S—Instituto de Investigação e Inovação em SaúdeUniversidade do PortoPortoPortugal
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar.Universidade do PortoPortoPortugal
| | | | | | - Mayka Sánchez
- Department of Basic Sciences, Iron metabolism: Regulation and DiseasesUniversitat Internacional de Catalunya (UIC)Sant Cugat del VallèsBarcelonaSpain
- BloodGenetics S.L. Diagnostics in Inherited Blood DiseasesEsplugues de LlobregatSpain
| |
Collapse
|
28
|
Ruivard M, Lobbes H. [Diagnosis and treatment of iron overload]. Rev Med Interne 2023; 44:656-661. [PMID: 37507250 DOI: 10.1016/j.revmed.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
Etiological investigation of hyperferritinemia includes a full clinical examination, with the measurement of waist circumference, and simple biological tests including transferrin saturation. The classification between hyperferritinemia without iron overload (inflammation, excessive alcohol intake, cytolysis, L-ferritin mutation) or with iron overload is then relatively easy. Dysmetabolic iron overload syndrome is the most common iron overload disease and is defined by an unexplained serum ferritin level elevation associated with various metabolic syndrome criteria and mild hepatic iron content increase assessed by magnetic resonance imaging. Bloodlettings are often poorly tolerated without clear benefit. Type 1 genetic hemochromatosis (homozygous C282Y mutation on the HFE gene) leads to iron accumulation through an increase of dietary iron absorption due to hypohepcidinemia. More than 95% of hemochromatosis are type 1 hemochromatosis but the phenotypic expression is highly variable. Elastography is recommended to identify advanced hepatic fibrosis when serum ferritin exceeds 1000μg/L. Life expectancy is normal when bloodlettings are started early. Ferroportin gene mutation is an autosomal dominant disease with generally moderate iron overload. Chelators are used in iron overload associated with anaemia (myelodysplastic syndromes or transfusion-dependent thalassemia). Chelation is initiated when hepatic iron content exceeds 120μmol/g. Deferasirox is often used as first-line therapy, but deferiprone may be of interest despite haematological toxicity (neutropenia). Deferoxamine (parenteral route) is the treatment of choice for severe iron overload or emergency conditions.
Collapse
Affiliation(s)
- M Ruivard
- Service médecine Interne, CHU de Clermont-Ferrand, CHU d'Estaing, 63003 Clermont-Ferrand, France; UMR 6602 UCA/CNRS/SIGMA, thérapies guidées par l'image (TGI), université Clermont Auvergne, 63000 Clermont-Ferrand, France.
| | - H Lobbes
- Service médecine Interne, CHU de Clermont-Ferrand, CHU d'Estaing, 63003 Clermont-Ferrand, France; UMR 6602 UCA/CNRS/SIGMA, thérapies guidées par l'image (TGI), université Clermont Auvergne, 63000 Clermont-Ferrand, France.
| |
Collapse
|
29
|
Kowdley KV, Modi NB, Peltekian K, Vierling JM, Ferris C, Valone FH, Gupta S. Rusfertide for the treatment of iron overload in HFE-related haemochromatosis: an open-label, multicentre, proof-of-concept phase 2 trial. Lancet Gastroenterol Hepatol 2023; 8:1118-1128. [PMID: 37863080 DOI: 10.1016/s2468-1253(23)00250-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/23/2023] [Accepted: 07/27/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Hereditary haemochromatosis protein (HFE)-related haemochromatosis, an inherited iron overload disorder caused by insufficient hepcidin production, results in excessive iron absorption and tissue and organ injury, and is treated with first-line therapeutic phlebotomy. We aimed to investigate the efficacy and safety of rusfertide, a peptidic mimetic of hepcidin, in patients with HFE-related haemochromatosis. METHODS This open-label, multicentre, proof-of-concept phase 2 trial was done across nine academic and community centres in the USA and Canada. Adults (aged ≥18 years) with HFE-related haemochromatosis on a stable therapeutic phlebotomy regimen (maintenance phase) for at least 6 months before screening and who had a phlebotomy frequency of at least 0·25 per month (eg, at least three phlebotomies in 12 months or at least four phlebotomies in 15 months) and less than one phlebotomy per month, with serum ferritin of less than 300 ng/mL and haemoglobin of more than 11·5 g/dL, were eligible. Patients initiated 24 weeks of subcutaneous rusfertide treatment within 7 days of a scheduled phlebotomy at 10 mg once weekly. Rusfertide doses and dosing schedules could be adjusted to maintain serum transferrin iron saturation (TSAT) at less than 40%. During rusfertide treatment, investigators were to consider the need for phlebotomy when the serum ferritin and TSAT values exceeded the patient's individual pre-phlebotomy serum ferritin and TSAT values. No primary endpoint or testing hierarchy was prespecified. Prespecified efficacy endpoints included the change in the frequency of phlebotomies; the proportion of patients achieving phlebotomy independence; change in serum iron, TSAT, serum transferrin, serum ferritin, and liver iron concentration (LIC) as measured by MRI; and treatment-emergent adverse events (TEAEs). The key efficacy analyses for phlebotomy rate and LIC were conducted by use of paired t tests in the intention-to-treat population, defined as all patients who received any study drug and who had pretreatment and at least one post-dose measurement. We included all participants who received at least one dose of rusfertide in the safety analyses. This trial is closed and completed and is registered with ClinicalTrials.gov, NCT04202965. FINDINGS Between March 11, 2020, and April 23, 2021, 28 patients were screened and 16 (ten [63%] men and six [38%] women) were enrolled. 16 were included in analyses of phlebotomy endpoints and 14 for the LIC endpoint. 12 (75%) patients completed 24 weeks of treatment. The mean number of phlebotomies was significantly reduced during the 24-week rusfertide treatment (0·06 phlebotomies [95% CI -0·07 to 0·20]) compared with 24 weeks pre-study (2·31 phlebotomies [95% CI 1·77 to 2·85]; p<0·0001). 15 (94%) of 16 patients were phlebotomy-free during the treatment period. Mean LIC in the 14 patients in the intention-to-treat population was 1·4 mg iron per g dry liver weight (95% CI 1·0 to 1·8) at screening and 1·1 mg iron per g dry liver weight (95% CI 0·9 to 1·3) at the end of treatment (p=0·068). Mean TSAT was 45·3% (95% CI 33·2 to 57·3) at screening, 36·7% (24·2 to 49·2) after the pretreatment phlebotomy, 21·8% (15·8 to 27·9) 24 h after the first dose of rusfertide, 40·4% (27·1 to 53·8) at the end of treatment, and 32·6% (25·0 to 40·1) over the treatment duration. Mean serum iron was 24·6 μmol/L (95% CI 18·6 to 30·6), 20·1 μmol/L (14·8 to 25·3), 11·9 μmol/L (9·2 to 14·7), 22·5 μmol/L (15·9 to 29·1), and 19·0 μmol/L (15·3 to 22·6) at these same timepoints, respectively. Mean serum ferritin was 83·3 μg/L (52·2 to 114.4), 65·5 μg/L (32·1 to 98·9), 62·8 μg/L (33·8 to 91·9), 150·0 μg/L (86·6 to 213.3), and 94·3 μg/L (54·9 to 133.6) at these same timepoints, respectively. There were only minor changes in serum transferrin concentration. 12 (75%) patients had at least one TEAE, the most common of which was injection site pain (five [31%] patients). All TEAEs were mild or moderate in severity, except for a serious adverse event of pancreatic adenocarcinoma, which was considered severe and unrelated to treatment and was pre-existing and diagnosed 21 days after starting rusfertide treatment. INTERPRETATION Rusfertide prevents iron re-accumulation in the absence of phlebotomies and could be a viable therapeutic option for selected patients with haemochromatosis. FUNDING Protagonist Therapeutics.
Collapse
Affiliation(s)
- Kris V Kowdley
- Liver Institute Northwest, Seattle, WA, USA; Elson S Floyd College of Medicine, Washington State University, Seattle, WA, USA.
| | | | - Kevork Peltekian
- Division of Digestive Care and Endoscopy, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - John M Vierling
- Section of Gastroenterology and Hepatology and Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX, USA
| | | | | | | |
Collapse
|
30
|
Kardasis W, Naquin ER, Garg R, Arun T, Gopianand JS, Karmakar E, Gnana-Prakasam JP. The IRONy in Athletic Performance. Nutrients 2023; 15:4945. [PMID: 38068803 PMCID: PMC10708480 DOI: 10.3390/nu15234945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/21/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
Iron is an essential micronutrient for athletes, intricately linked to their performance, by regulating cellular respiration and metabolism. Impaired iron levels in the body can significantly hinder athletic performance. The increased demand for iron due to exercise, coupled with potential dietary iron insufficiencies, particularly among endurance athletes, amplifies the risk of iron deficiency. Moreover, prolonged exercise can impact iron absorption, utilization, storage, and overall iron concentrations in an athlete. On the contrary, iron overload may initially lead to enhanced performance; however, chronic excess iron intake or underlying genetic conditions can lead to detrimental health consequences and may negatively impact athletic performance. Excess iron induces oxidative damage, not only compromising muscle function and recovery, but also affecting various tissues and organs in the body. This narrative review delineates the complex relationship between exercise and iron metabolism, and its profound effects on athletic performance. The article also provides guidance on managing iron intake through dietary adjustments, oral iron supplementation for performance enhancement in cases of deficiency, and strategies for addressing iron overload in athletes. Current research is focused on augmenting iron absorption by standardizing the route of administration while minimizing side effects. Additionally, there is ongoing work to identify inhibitors and activators that affect iron absorption, aiming to optimize the body's iron levels from dietary sources, supplements, and chelators. In summary, by refining the athletic diet, considering the timing and dosage of iron supplements for deficiency, and implementing chelation therapies for iron overload, we can effectively enhance athletic performance and overall well-being.
Collapse
Affiliation(s)
| | | | | | | | | | - Eshani Karmakar
- School of Medicine, Saint Louis University, St. Louis, MO 63104, USA; (W.K.); (E.R.N.); (R.G.); (T.A.); (J.S.G.)
| | - Jaya P. Gnana-Prakasam
- School of Medicine, Saint Louis University, St. Louis, MO 63104, USA; (W.K.); (E.R.N.); (R.G.); (T.A.); (J.S.G.)
| |
Collapse
|
31
|
Graziotto ME, Kidman CJ, Adair LD, James SA, Harris HH, New EJ. Towards multimodal cellular imaging: optical and X-ray fluorescence. Chem Soc Rev 2023; 52:8295-8318. [PMID: 37910139 DOI: 10.1039/d3cs00509g] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Imaging techniques permit the study of the molecular interactions that underlie health and disease. Each imaging technique collects unique chemical information about the cellular environment. Multimodal imaging, using a single probe that can be detected by multiple imaging modalities, can maximise the information extracted from a single cellular sample by combining the results of different imaging techniques. Of particular interest in biological imaging is the combination of the specificity and sensitivity of optical fluorescence microscopy (OFM) with the quantitative and element-specific nature of X-ray fluorescence microscopy (XFM). Together, these techniques give a greater understanding of how native elements or therapeutics affect the cellular environment. This review focuses on recent studies where both techniques were used in conjunction to study cellular systems, demonstrating the breadth of biological models to which this combination of techniques can be applied and the potential for these techniques to unlock untapped knowledge of disease states.
Collapse
Affiliation(s)
- Marcus E Graziotto
- School of Chemistry, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Clinton J Kidman
- Department of Chemistry, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Liam D Adair
- School of Chemistry, The University of Sydney, Sydney, NSW, 2006, Australia.
- Sydney Nano Institute, The University of Sydney, Sydney, NSW, 2006, Australia
- Australian Research Council Centre of Excellence for Innovations in Peptide and Protein Science, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Simon A James
- Australian Nuclear Science and Technology Organisation, Clayton, Victoria, 3168, Australia
| | - Hugh H Harris
- Department of Chemistry, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Elizabeth J New
- School of Chemistry, The University of Sydney, Sydney, NSW, 2006, Australia.
- Sydney Nano Institute, The University of Sydney, Sydney, NSW, 2006, Australia
- Australian Research Council Centre of Excellence for Innovations in Peptide and Protein Science, The University of Sydney, Sydney, NSW, 2006, Australia
| |
Collapse
|
32
|
Carini M, Fredi M, Cavazzana I, Bresciani R, Ferrari F, Monti E, Franceschini F, Biasiotto G. Frequency Evaluation of the Interleukin-6 -174G>C Polymorphism and Homeostatic Iron Regulator (HFE) Mutations as Disease Modifiers in Patients Affected by Systemic Lupus Erythematosus and Rheumatoid Arthritis. Int J Mol Sci 2023; 24:16300. [PMID: 38003490 PMCID: PMC10671518 DOI: 10.3390/ijms242216300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
Autoimmune diseases are generally characterized by a multifactorial etiology and are often associated with a genetic predisposition. Both iron metabolism and the inflammatory cytokine system have been shown to play a pivotal role in the dysregulation of the immune response in many different autoimmune conditions, rheumatologic diseases included. The purpose of this work was to analyze the frequency of mutations altering the expression of IL-6 or influencing iron metabolism in patients affected by autoimmune diseases such as Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE). In this study, 144 patients were enrolled: 77 and 67 patients were affected by RA and SLE, respectively. In these cohorts, the frequency of the IL-6 polymorphism -174G>C located in the IL-6 gene promoter was tested. Moreover, the frequencies of the three HFE gene variations associated with iron overload were analyzed: p.His63Asp, p.Ser65Cys and p.Cys282Tyr. The two mutations p.His63Asp and p.Ser65Cys in the HFE gene did not reach statistical significance in any of the comparisons, regardless of the statistical model, cohorts of patients and control populations analyzed. The frequencies of the p.Cys282Tyr mutation and the IL-6 polymorphism -174G>C were found to be overall significantly decreased in RA and SLE patients when the Dominant model and Allele contrast were adopted with both the Odds Ratio and Chi-square. Although further investigation is needed, the examination of the frequencies of the -174G>C IL-6 promoter polymorphism and HFE mutations may add some valuable information on the interplay linking iron metabolism, inflammation and immunity in autoimmune diseases such as SLE and RA.
Collapse
Affiliation(s)
- Mattia Carini
- Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (M.C.); (R.B.); (E.M.)
- Highly Specialized Laboratory, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Micaela Fredi
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (M.F.); (F.F.)
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy;
| | - Ilaria Cavazzana
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy;
| | - Roberto Bresciani
- Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (M.C.); (R.B.); (E.M.)
- Highly Specialized Laboratory, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Fabiana Ferrari
- Pediatrics, Mother’s and Baby’s Health Department, Poliambulanza Foundation Hospital Insitute, 25124 Brescia, Italy;
| | - Eugenio Monti
- Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (M.C.); (R.B.); (E.M.)
| | - Franco Franceschini
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (M.F.); (F.F.)
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy;
| | - Giorgio Biasiotto
- Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (M.C.); (R.B.); (E.M.)
- Highly Specialized Laboratory, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| |
Collapse
|
33
|
Aguilar Hinojosa NK, Figueroa Saavedra EI. Desensibilización a deferasirox en una paciente con hemocromatosis. Reporte de un caso. REVISTA ALERGIA MÉXICO 2023; 70:159-162. [PMID: 37933925 DOI: 10.29262/ram.v70i3.1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 11/08/2023] Open
Abstract
Background Deferasirox is an active iron chelator, used in the treatment of iron overload such as hemochromatosis. Up to 28% may present adverse reactions to said drug. A desensitization protocol for this drug may be useful when there are no other therapeutic options. Case report A 52-year-old female with a diagnosis of hemochromatosis who began treatment with phlebotomy, poor response and tolerance, so it was decided to treat with deferasirox 500 mg daily, presenting symptoms of urticaria and angioedema on the third dose. Hospitalization was decided for a desensitization protocol with an initial dose of 0.6mg with a gradual increase in the dose, reaching a maintenance dose of 500 mg per day on the third day. Conclusions The rapid desensitization protocol for Deferasirox is useful when there is no response or therapeutic alternative.
Collapse
|
34
|
Cobilinschi CO, Săulescu I, Caraiola S, Nițu AF, Dumitru RL, Husar-Sburlan I, Bălănescu AR, Opriș-Belinski D. A "Mix and Match" in Hemochromatosis-A Case Report and Literature Focus on the Liver. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1586. [PMID: 37763705 PMCID: PMC10534457 DOI: 10.3390/medicina59091586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Hemochromatosis is a genetic disorder characterized by increased iron storage in various organs with progressive multisystemic damage. Despite the reports dating back to 1865, the diagnosis of hemochromatosis poses a challenge to clinicians due to its non-specific symptoms and indolent course causing significant delay in disease recognition. The key organ that is affected by iron overload is the liver, suffering from fibrosis, cirrhosis or hepatocellular carcinoma, complications that can be prevented via early diagnosis and treatment. This review aims to draw attention to the pitfalls in diagnosing hemochromatosis. We present a case with multiorgan complaints, abnormal iron markers and a consistent genetic result. We then examine the relevant literature and discuss hemochromatosis subtypes and liver involvement, including transplant outcome and treatment options. In summary, hemochromatosis remains difficult to diagnose due to its symptom heterogeneity and rarity; thus, further education for practitioners of all disciplines is useful in facilitating its early recognition and management.
Collapse
Affiliation(s)
- Claudia Oana Cobilinschi
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.O.C.); (I.S.); (S.C.); (A.R.B.); (D.O.-B.)
- Department of Rheumatology and Internal Medicine, Sfânta Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania
| | - Ioana Săulescu
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.O.C.); (I.S.); (S.C.); (A.R.B.); (D.O.-B.)
- Department of Rheumatology and Internal Medicine, Sfânta Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania
| | - Simona Caraiola
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.O.C.); (I.S.); (S.C.); (A.R.B.); (D.O.-B.)
- Department of Internal Medicine, Colentina Clinical Hospital, Bucharest, 020125 Bucharest, Romania
| | - Andra Florina Nițu
- Department of Radiology and Medical Imaging, Sf Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania;
| | - Radu Lucian Dumitru
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.O.C.); (I.S.); (S.C.); (A.R.B.); (D.O.-B.)
- Department of Radiology and Medical Imaging, Sf Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania;
| | - Ioana Husar-Sburlan
- Department of Gastroenterology, Sf Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania;
| | - Andra Rodica Bălănescu
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.O.C.); (I.S.); (S.C.); (A.R.B.); (D.O.-B.)
- Department of Rheumatology and Internal Medicine, Sfânta Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania
| | - Daniela Opriș-Belinski
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.O.C.); (I.S.); (S.C.); (A.R.B.); (D.O.-B.)
- Department of Rheumatology and Internal Medicine, Sfânta Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania
| |
Collapse
|
35
|
Girelli D, Busti F. Manipulating hepcidin in polycythemia vera. Blood 2023; 141:3132-3134. [PMID: 37383006 DOI: 10.1182/blood.2023020509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Affiliation(s)
- Domenico Girelli
- University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona
| | - Fabiana Busti
- University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona
| |
Collapse
|
36
|
Biasiotto G, Carini M, Bresciani R, Ferrari F. Hereditary hemochromatosis: The complex role of the modifier genes. J Trace Elem Med Biol 2023; 79:127248. [PMID: 37379682 DOI: 10.1016/j.jtemb.2023.127248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Giorgio Biasiotto
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; Highly Specialized Laboratory, ASST Spedali Civili di Brescia, Brescia, Italy.
| | - Mattia Carini
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; Highly Specialized Laboratory, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Roberto Bresciani
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; Highly Specialized Laboratory, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Fabiana Ferrari
- Pediatrics, Mother's and Baby's Health Department, Poliambulanza Foundation Hospital Insitute, Brescia, Italy
| |
Collapse
|
37
|
Olynyk JK, Grainger R, Currie H, Ramm LE, Ramm GA. The ancestral haplotype markers HLA -A3 and B7 do not influence the likelihood of advanced hepatic fibrosis or cirrhosis in HFE hemochromatosis. Sci Rep 2023; 13:7775. [PMID: 37179448 PMCID: PMC10183001 DOI: 10.1038/s41598-023-35028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/11/2023] [Indexed: 05/15/2023] Open
Abstract
Advanced hepatic fibrosis occurs in up to 25% of individuals with C282Y homozygous hemochromatosis. Our aim was to determine whether human leukocyte antigen (HLA)-A3 and B7 alleles act as genetic modifiers of the likelihood of advanced hepatic fibrosis. Between 1972 and 2013, 133 HFE C282Y homozygous individuals underwent clinical and biochemical evaluation, HLA typing, liver biopsy for fibrosis staging and phlebotomy treatment. Hepatic fibrosis was graded according to Scheuer as F0-2 (low grade hepatic fibrosis), F3-4 (advanced hepatic fibrosis), and F4 cirrhosis. We analysed associations between the severity of fibrosis and HLA-A3 homozygosity, heterozygosity or absence, with or without the presence of HLA-B7 using categorical analysis. The mean age of HLA-A3 homozygotes (n = 24), heterozygotes (n = 65) and HLA-A3 null individuals (n = 44) was 40 years. There were no significant differences between the groups for mean(± SEM) serum ferritin levels (1320 ± 296, 1217 ± 124, 1348 ± 188 [Formula: see text]g/L), hepatic iron concentration (178 ± 26, 213 ± 22, 199 ± 29 [Formula: see text]mol/g), mobilizable iron stores (9.9 ± 1.5, 9.5 ± 1.5, 11.5 ± 1.7 g iron removed via phlebotomy), frequency of advanced hepatic fibrosis (5/24[12%], 13/63[19%], 10/42[19%]) or cirrhosis (3/24[21%], 12/63[21%], 4/42[24%]), respectively. The presence or absence of HLA-B7 did not influence the outcome. Thus, HLA-A3 and HLA-B7 alleles are not associated with the risk of advanced hepatic fibrosis or cirrhosis in C282Y hemochromatosis.
Collapse
Affiliation(s)
- John K Olynyk
- Medical School, Curtin University, Bentley, WA, Australia.
- Department of Gastroenterology, Fiona Stanley Fremantle Hospital Group, Murdoch, WA, Australia.
| | - Richard Grainger
- Department of Gastroenterology, Fiona Stanley Fremantle Hospital Group, Murdoch, WA, Australia
| | - Helen Currie
- Department of Gastroenterology, Fiona Stanley Fremantle Hospital Group, Murdoch, WA, Australia
| | - Louise E Ramm
- QIMR-Berghofer Medical Research Institute, Herston, QLD, Australia
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Grant A Ramm
- QIMR-Berghofer Medical Research Institute, Herston, QLD, Australia
| |
Collapse
|
38
|
Molina CA, Ros NG, Tarancón RG, Varas LR, Flores VR, Álvarez SI. Hereditary hemochromatosis: An update vision of the laboratory diagnosis. J Trace Elem Med Biol 2023; 78:127194. [PMID: 37163822 DOI: 10.1016/j.jtemb.2023.127194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/20/2023] [Accepted: 05/05/2023] [Indexed: 05/12/2023]
Abstract
Haemochromatosis (HC) is an inherited disorder of iron metabolism. The 85-90% of Hereditary hemochromatosis cases are caused by mutations in HFE gene (HC type 1). The remaining 10-15% of HC cases are caused by mutations in other non-HFE genes (HJV, HAMP, TRF2, SLC40A1, BMP6). The study of patients for the diagnosis of HC has an important laboratory approached: analysis of biochemical parameters and genetic studies. To confirm a case, it is necessary to carry out a genetic study of the C282Y and H63D mutations. The presence of C282Y mutation in homozygosis is compatible with the diagnosis of HC type 1. Due to the incomplete penetrance of this mutation and the variable phenotypic expression, the severe forms of the disease are relatively rare. The study of variants in non-HFE genes allows more detailed study of both non-classic HC cases and those with more severe clinical expression. The genotype characterization of a patient not always justified the phenotype expression of the symptoms in this disease. All laboratory clinicians must consider recommendation provide by the experts in the Materia.
Collapse
Affiliation(s)
- Claudia Abadía Molina
- Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Nuria Goñi Ros
- Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Ricardo González Tarancón
- Genetic section, Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Luis Rello Varas
- Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Valle Recasens Flores
- Department of Hematology and Hemotherapy, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Silvia Izquierdo Álvarez
- Genetic section, Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain
| |
Collapse
|
39
|
Crawford DHG, Ramm GA, Bridle KR, Nicoll AJ, Delatycki MB, Olynyk JK. Clinical practice guidelines on hemochromatosis: Asian Pacific Association for the Study of the Liver. Hepatol Int 2023; 17:522-541. [PMID: 37067673 DOI: 10.1007/s12072-023-10510-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/28/2023] [Indexed: 04/18/2023]
Affiliation(s)
- Darrell H G Crawford
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Gallipoli Medical Research Foundation, Brisbane, Australia
| | - Grant A Ramm
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kim R Bridle
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- Gallipoli Medical Research Foundation, Brisbane, Australia.
| | - Amanda J Nicoll
- Department of Gastroenterology, Eastern Health, Box Hill, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | - Martin B Delatycki
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
- Victorian Clinical Genetics Services, Parkville, VIC, Australia
| | - John K Olynyk
- Department of Gastroenterology, Fiona Stanley Hospital, Murdoch, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| |
Collapse
|
40
|
Reeder SB, Yokoo T, França M, Hernando D, Alberich-Bayarri Á, Alústiza JM, Gandon Y, Henninger B, Hillenbrand C, Jhaveri K, Karçaaltıncaba M, Kühn JP, Mojtahed A, Serai SD, Ward R, Wood JC, Yamamura J, Martí-Bonmatí L. Quantification of Liver Iron Overload with MRI: Review and Guidelines from the ESGAR and SAR. Radiology 2023; 307:e221856. [PMID: 36809220 PMCID: PMC10068892 DOI: 10.1148/radiol.221856] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/20/2022] [Accepted: 11/16/2022] [Indexed: 02/23/2023]
Abstract
Accumulation of excess iron in the body, or systemic iron overload, results from a variety of causes. The concentration of iron in the liver is linearly related to the total body iron stores and, for this reason, quantification of liver iron concentration (LIC) is widely regarded as the best surrogate to assess total body iron. Historically assessed using biopsy, there is a clear need for noninvasive quantitative imaging biomarkers of LIC. MRI is highly sensitive to the presence of tissue iron and has been increasingly adopted as a noninvasive alternative to biopsy for detection, severity grading, and treatment monitoring in patients with known or suspected iron overload. Multiple MRI strategies have been developed in the past 2 decades, based on both gradient-echo and spin-echo imaging, including signal intensity ratio and relaxometry strategies. However, there is a general lack of consensus regarding the appropriate use of these methods. The overall goal of this article is to summarize the current state of the art in the clinical use of MRI to quantify liver iron content and to assess the overall level of evidence of these various methods. Based on this summary, expert consensus panel recommendations on best practices for MRI-based quantification of liver iron are provided.
Collapse
Affiliation(s)
- Scott B. Reeder
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Takeshi Yokoo
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Manuela França
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Diego Hernando
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Ángel Alberich-Bayarri
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - José María Alústiza
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Yves Gandon
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Benjamin Henninger
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Claudia Hillenbrand
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Kartik Jhaveri
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Musturay Karçaaltıncaba
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Jens-Peter Kühn
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Amirkasra Mojtahed
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Suraj D. Serai
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Richard Ward
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - John C. Wood
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Jin Yamamura
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Luis Martí-Bonmatí
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| |
Collapse
|
41
|
Scaramellini N, Fischer D, Agarvas AR, Motta I, Muckenthaler MU, Mertens C. Interpreting Iron Homeostasis in Congenital and Acquired Disorders. Pharmaceuticals (Basel) 2023; 16:ph16030329. [PMID: 36986429 PMCID: PMC10054723 DOI: 10.3390/ph16030329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
Mammalian cells require iron to satisfy their metabolic needs and to accomplish specialized functions, such as hematopoiesis, mitochondrial biogenesis, energy metabolism, or oxygen transport. Iron homeostasis is balanced by the interplay of proteins responsible for iron import, storage, and export. A misbalance of iron homeostasis may cause either iron deficiencies or iron overload diseases. The clinical work-up of iron dysregulation is highly important, as severe symptoms and pathologies may arise. Treating iron overload or iron deficiency is important to avoid cellular damage and severe symptoms and improve patient outcomes. The impressive progress made in the past years in understanding mechanisms that maintain iron homeostasis has already changed clinical practice for treating iron-related diseases and is expected to improve patient management even further in the future.
Collapse
Affiliation(s)
- Natalia Scaramellini
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milano, Italy
- Unit of Medicine and Metabolic Disease, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Dania Fischer
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Anand R. Agarvas
- Center for Translational Biomedical Iron Research, Department of Pediatric Oncology, Immunology, and Hematology, University of Heidelberg, INF 350, 69120 Heidelberg, Germany
| | - Irene Motta
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milano, Italy
- Unit of Medicine and Metabolic Disease, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Martina U. Muckenthaler
- Center for Translational Biomedical Iron Research, Department of Pediatric Oncology, Immunology, and Hematology, University of Heidelberg, INF 350, 69120 Heidelberg, Germany
- Molecular Medicine Partnership Unit, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Side, 69120 Heidelberg, Germany
| | - Christina Mertens
- Center for Translational Biomedical Iron Research, Department of Pediatric Oncology, Immunology, and Hematology, University of Heidelberg, INF 350, 69120 Heidelberg, Germany
- Molecular Medicine Partnership Unit, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221564582; Fax: +49-6221564580
| |
Collapse
|
42
|
Abstract
Hepcidin, the iron-regulatory hormone, determines plasma iron concentrations and total body iron content. Hepcidin, secreted by hepatocytes, functions by controlling the activity of the cellular iron exporter ferroportin, which delivers iron to plasma from intestinal iron absorption and from iron stores. Hepcidin concentration in plasma is increased by iron loading and inflammation and is suppressed by erythropoietic stimulation and during pregnancy. Hepcidin deficiency causes iron overload in hemochromatosis and anemias with ineffective erythropoiesis. Hepcidin excess causes iron-restrictive anemias including anemia of inflammation. The development of hepcidin diagnostics and therapeutic agonists and antagonists should improve the treatment of iron disorders.
Collapse
Affiliation(s)
- Elizabeta Nemeth
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA;
| | - Tomas Ganz
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA;
| |
Collapse
|
43
|
Affiliation(s)
- John K Olynyk
- From the Department of Gastroenterology and Hepatology, Fiona Stanley Fremantle Hospital Group, Murdoch, and the School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA (J.K.O.); and the Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Herston, QLD (G.A.R.) - all in Australia
| | - Grant A Ramm
- From the Department of Gastroenterology and Hepatology, Fiona Stanley Fremantle Hospital Group, Murdoch, and the School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA (J.K.O.); and the Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Herston, QLD (G.A.R.) - all in Australia
| |
Collapse
|
44
|
Pilling LC, Atkins JL, Melzer D. Genetic modifiers of penetrance to liver endpoints in HFE hemochromatosis: Associations in a large community cohort. Hepatology 2022; 76:1735-1745. [PMID: 35567766 PMCID: PMC9796074 DOI: 10.1002/hep.32575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The iron overload condition hereditary hemochromatosis (HH) can cause liver cirrhosis and cancer, diabetes, and arthritis. Males homozygous for the p.C282Y missense mutation in the Homeostatin Iron Regulator (HFE) gene have greatest risk; yet, only a minority develop these conditions. We aimed to determine whether common genetic variants influencing iron levels or liver disease risk in the general population also modify clinical penetrance in HFE p.C282Y and p.H63D carriers. METHODS We studied 1294 male and 1596 female UK Biobank HFE p.C282Y homozygous participants of European ancestry with medical records up to 14 years after baseline assessment. Polygenic scores quantified genetic effects of blood iron biomarkers and relevant diseases (identified in the general population). Analyses were also performed in other HFE p.C282Y/p.H63D genotype groups. RESULTS In male p.C282Y homozygotes, a higher iron polygenic score increased the risk of liver fibrosis or cirrhosis diagnoses (odds ratio for the top 20% of iron polygenic score vs. the bottom 20% = 4.90: 95% confidence intervals, 1.63-14.73; p = 0.005), liver cancer, and osteoarthritis but not diabetes. A liver cirrhosis polygenic score was associated with liver cancer diagnoses. In female p.C282Y homozygotes, the osteoarthritis polygenic score was associated with increased osteoarthritis diagnoses and type-2 diabetes polygenic score with diabetes. However, the iron polygenic score was not robustly associated with diagnoses in p.C282Y female homozygotes or in other p.C282Y/p.H63D genotypes. CONCLUSIONS HFE p.C282Y homozygote penetrance to clinical disease in a large community cohort was partly explained by common genetic variants that influence iron and risks of related diagnoses in the general population, including polygenic scores in HH screening and diagnosis, may help in estimating prognosis and treatment planning.
Collapse
Affiliation(s)
- Luke C Pilling
- Epidemiology and Public Health GroupUniversity of ExeterExeterUK
| | | | | |
Collapse
|
45
|
Alvarenga AM, Brissot P, Santos PCJL. Haemochromatosis revisited. World J Hepatol 2022; 14:1931-1939. [PMID: 36483608 PMCID: PMC9724105 DOI: 10.4254/wjh.v14.i11.1931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/27/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
Haemochromatosis is a genetic disease caused by hepcidin deficiency, responsible for an increase in intestinal iron absorption. Haemochromatosis is associated with homozygosity for the HFE p.Cys282Tyr mutation. However, rare cases of haemochromatosis (non-HFE haemochromatosis) can also be caused by pathogenic variants in other genes (such as HJV, HAMP, TFR2 and SLC40A1). A working group of the International Society for the Study of Iron in Biology and Medicine (BIOIRON Society) has concluded that the classification based in different molecular subtypes is difficult to be adopted in clinical practice and has proposed a new classification approaching clinical questions and molecular complexity. The aim of the present review is to provide an update on classification, pathophysiology and therapeutic recommendations.
Collapse
Affiliation(s)
- Aline Morgan Alvarenga
- Department of Pharmacology - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04044-020, Brazil
| | | | - Paulo Caleb Junior Lima Santos
- Department of Pharmacology - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04044-020, Brazil
| |
Collapse
|
46
|
Khatami F, Muka T, Groothof D, de Borst MH, Buttia C, van Hassel G, Baumgartner I, Kremer D, Bakker SJL, Bano A, Eisenga MF. Sex and N-terminal pro B-type natriuretic peptide: The potential mediating role of iron biomarkers. Front Cardiovasc Med 2022; 9:897148. [PMID: 36451923 PMCID: PMC9703058 DOI: 10.3389/fcvm.2022.897148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/24/2022] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Levels of N-terminal pro B-type natriuretic peptide (NT-proBNP), a marker of heart failure and cardiovascular risk, are generally higher in women than men. We explored whether iron biomarkers mediate sex differences in NT-proBNP levels. METHODS We included 5,343 community-dwelling individuals from the Prevention of Renal and Vascular Endstage Disease study. With linear regression analyses, we investigated the association of sex and iron biomarkers with NT-proBNP levels, independent of adjustment for potential confounders. The assessed iron biomarkers included ferritin, transferrin saturation (TSAT), hepcidin, and soluble transferrin receptor (sTfR). Next, we performed mediation analyses to investigate to which extent iron biomarkers influence the association between sex and NT-proBNP. RESULTS Of the included 5,343 participants, the mean standard deviation age was 52.2 ± 11.6 years and 52% were females. After adjustment for potential confounders, women compared to men, had higher NT-proBNP (β = 0.31; 95%CI = 0.29, 0.34), but lower ferritin (β = -0.37; 95%CI = -0.39, -0.35), hepcidin (β = -0.22, 95%CI = -0.24, -0.20), and TSAT (β = -0.07, 95% CI = -0.08, -0.06). Lower ferritin (β = -0.05, 95%CI = -0.08, -0.02), lower hepcidin (β = -0.04, 95%CI = -0.07, -0.006), and higher TSAT (β = 0.07; 95%CI = 0.01, 0.13) were associated with higher NT-proBNP. In mediation analyses, ferritin and hepcidin explained 6.5 and 3.1% of the association between sex and NT-proBNP, respectively, while TSAT minimally suppressed (1.9%) this association. CONCLUSION Our findings suggest that iron biomarkers marginally explain sex differences in levels of NT-proBNP. Future studies are needed to explore causality and potential mechanisms underlying these pathways.
Collapse
Affiliation(s)
- Farnaz Khatami
- Institute of Social and Preventive Medicine (ISPM), Graduate School of Health Sciences, University of Bern, Bern, Switzerland
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), Graduate School of Health Sciences, University of Bern, Bern, Switzerland
- Epistudia, Bern, Switzerland
| | - Dion Groothof
- Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, Netherlands
| | - Martin H. de Borst
- Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, Netherlands
| | - Chepkoech Buttia
- Institute of Social and Preventive Medicine (ISPM), Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Gaston van Hassel
- Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, Netherlands
| | - Iris Baumgartner
- Department of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daan Kremer
- Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, Netherlands
| | - Stephan J. L. Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, Netherlands
| | - Arjola Bano
- Institute of Social and Preventive Medicine (ISPM), Graduate School of Health Sciences, University of Bern, Bern, Switzerland
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michele F. Eisenga
- Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, Netherlands
| |
Collapse
|
47
|
Infanti L, Leitner G, Moe MK, Pehlic V, Benkert P, Cattaneo M, Holbro A, Passweg J, Worel N, Buser A. Indices of iron homeostasis in asymptomatic subjects with HFE mutations and moderate ferritin elevation during iron removal treatment. Blood Cells Mol Dis 2022; 97:102689. [DOI: 10.1016/j.bcmd.2022.102689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 10/31/2022]
|
48
|
Liang Y, Guo GL, Zhang L. Current and Emerging Molecular Markers of Liver Diseases: A Pathogenic Perspective. Gene Expr 2022; 21:9-19. [PMID: 38911667 PMCID: PMC11192043 DOI: 10.14218/gejlr.2022.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the past decade, with the rapid development of molecular medicine and the application of more sophisticated methods for disease diagnosis and treatment, a number of molecular markers have become available for liver diseases. Pathogenesis-related markers are likely to be effectively discovered and rigorously validated, due to the unique biological links to diseases. The present study reviews the predominant clinical and research articles in the previous decade to provide a pathogenic perspective of current and emerging biomarkers for liver diseases, including hepatocellular neoplasms (e.g. hepatocellular carcinoma), non-neoplastic hepatocellular diseases, intrahepatic biliary diseases, and other liver diseases. Although it remains challenging to cover all markers for the diagnosis and prognosis of liver diseases, current and emerging molecular markers in clinical practice and under investigation are reviewed in a wide spectrum of liver diseases, in order to help clinicians and researchers identify liver disease markers for reference.
Collapse
Affiliation(s)
- Yuanxin Liang
- Department of Pathology, Yale University, New Haven, Connecticut, USA
| | - Grace L Guo
- Department of Pharmacology and Toxicology, Ernst Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
- Research and Development Service, Veterans Health Administration, New Jersey Health Care System, East Orange, New Jersey, USA
| | - Lanjing Zhang
- Department of Pathology, Princeton Medical Center, Plainsboro, New Jersey, USA
- Department of Chemical Biology, Ernst Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
- Department of Biological Sciences, Rutgers University, Newark, New Jersey, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| |
Collapse
|
49
|
Baschant U, Altamura S, Steele-Perkins P, Muckenthaler MU, Spasić MV, Hofbauer LC, Steinbicker AU, Rauner M. Iron effects versus metabolic alterations in hereditary hemochromatosis driven bone loss. Trends Endocrinol Metab 2022; 33:652-663. [PMID: 35871125 DOI: 10.1016/j.tem.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/08/2022] [Accepted: 06/26/2022] [Indexed: 11/18/2022]
Abstract
Hereditary hemochromatosis (HH) is a genetic disorder in which mutations affect systemic iron homeostasis. Most subtypes of HH result in low hepcidin levels and iron overload. Accumulation of iron in various tissues can lead to widespread organ damage and to various complications, including liver cirrhosis, arthritis, and diabetes. Osteoporosis is another frequent complication of HH, and the underlying mechanisms are poorly understood. Currently, it is unknown whether iron overload in HH directly damages bone or whether complications associated with HH, such as liver cirrhosis or hypogonadism, affect bone secondarily. This review summarizes current knowledge of bone metabolism in HH and highlights possible implications of metabolic dysfunction in HH-driven bone loss. We further discuss therapeutic considerations managing osteoporosis in HH.
Collapse
Affiliation(s)
- Ulrike Baschant
- Department of Medicine III & Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany
| | - Sandro Altamura
- Department of Pediatric Hematology, Oncology and Immunology, University of Heidelberg, Heidelberg, Germany
| | - Peter Steele-Perkins
- Institute of Comparative Molecular Endocrinology, University of Ulm, Ulm, Germany
| | - Martina U Muckenthaler
- Department of Pediatric Hematology, Oncology and Immunology, University of Heidelberg, Heidelberg, Germany
| | - Maja Vujić Spasić
- Institute of Comparative Molecular Endocrinology, University of Ulm, Ulm, Germany
| | - Lorenz C Hofbauer
- Department of Medicine III & Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany
| | - Andrea U Steinbicker
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Martina Rauner
- Department of Medicine III & Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany.
| |
Collapse
|
50
|
Ferritin Increase in Hemochromatosis Subjects After Discontinuing Their Regular Maintenance Treatment: A Longitudinal Analysis Performed During the COVID-19 Imposed Hospital Lockdown. Hemasphere 2022; 6:e770. [PMID: 36034093 PMCID: PMC9400946 DOI: 10.1097/hs9.0000000000000770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/29/2022] [Indexed: 11/26/2022] Open
|