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Rostoker G, Dekeyser M, Francisco S, Loridon C, Griuncelli M, Languille-Llitjos E, Boulahia G, Cohen Y. Relationship between bone marrow iron load and liver iron concentration in dialysis-associated haemosiderosis. EBioMedicine 2024; 99:104929. [PMID: 38128412 PMCID: PMC10776950 DOI: 10.1016/j.ebiom.2023.104929] [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: 06/14/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Iron overload due to the excessive use of parenteral iron in haemodialysis is now an increasingly recognised clinical issue. Before erythropoiesis-stimulating agents (ESA) were introduced, a specific feature of patients treated by dialysis and having iron overload was that iron levels in the bone marrow were paradoxically low in most of them, despite severe hepatosplenic siderosis. Whether or not this paradox persists in the actual ESA era was unknown until recently, when an autopsy study in 21 patients treated by haemodialysis revealed similarities between liver and bone marrow iron content. The aim of this study was to further explore these recent findings in a cohort of alive patients on dialysis and to analyse the determinants of iron bone marrow. METHODS Liver iron concentration (LIC) and vertebral T2∗ (a surrogate marker of bone marrow iron) were analysed retrospectively in 152 alive patients on dialysis (38.8% female) of whom 47.4% had iron overload by quantitative magnetic resonance imaging (MRI). FINDINGS Vertebral T2∗ differed significantly between patients classified according to liver iron content at MRI: those with mild or moderate and severe liver iron overload had increased vertebral iron content at R2∗ relaxometry MRI (mild: vertebral T2∗ = 9.9 ms (4-24.8); moderate and severe: vertebral T2∗ = 8.5 ms (4.9-22.8)) when compared to patients with normal LIC (vertebral T2∗ = 13.2 ms (6.6-30.5) (p < 0.0001 Kruskal-Wallis test)). INTERPRETATION The paradoxical discrepancy between bone marrow and liver iron-storage compartments observed in the pre-ESA era has disappeared today, as shown by a recent autopsy study and the present study in a cohort of alive patients treated by dialysis. FUNDING None.
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Affiliation(s)
- Guy Rostoker
- Division of Nephrology and Dialysis, Ramsay Santé, Hôpital Privé Claude Galien, Quincy-sous-Sénart 91480, France; Collège de Médecine des Hôpitaux de Paris, 10 Rue des Fossés Saint-Marcel, Paris 75005, France.
| | - Manon Dekeyser
- Department of Nephrology, Regional University Centre, Orléans and INSERM 1186, Gustave Roussy Institute, Paris-Saclay University, Villejuif, Paris, France
| | - Sergio Francisco
- Division of Radiology, Ramsay Santé, Hôpital Privé Claude Galien, Quincy-sous-Sénart 91480, France
| | - Christelle Loridon
- Division of Nephrology and Dialysis, Ramsay Santé, Hôpital Privé Claude Galien, Quincy-sous-Sénart 91480, France
| | - Mireille Griuncelli
- Division of Nephrology and Dialysis, Ramsay Santé, Hôpital Privé Claude Galien, Quincy-sous-Sénart 91480, France
| | - Eva Languille-Llitjos
- Division of Nephrology and Dialysis, Ramsay Santé, Hôpital Privé Claude Galien, Quincy-sous-Sénart 91480, France
| | - Ghada Boulahia
- Division of Nephrology and Dialysis, Ramsay Santé, Hôpital Privé Claude Galien, Quincy-sous-Sénart 91480, France
| | - Yves Cohen
- Division of Radiology, Ramsay Santé, Hôpital Privé Claude Galien, Quincy-sous-Sénart 91480, France
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Ahmad A, Kumari N, Afangbedji N, Nekhai S, Jerebtsova M. Induction of Hepcidin Expression in the Renal Cortex of Sickle Cell Disease Mice. Int J Mol Sci 2023; 24:10806. [PMID: 37445980 PMCID: PMC10341858 DOI: 10.3390/ijms241310806] [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: 05/22/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
In patients with sickle cell disease (SCD), chronic hemolysis and frequent blood transfusions cause iron overload and accumulation in the kidneys. The iron deposition is found in the renal cortex and correlates with the severity of hemolysis. In this study, we observed a significant accumulation of iron in the renal cortex of a mouse model of SCD, and assessed the expression of the proteins involved in maintaining renal iron homeostasis. Despite the intracellular iron accumulation, the levels of the transferrin receptor in the kidneys were increased, but the levels of the iron exporter ferroportin were not altered in SCD mice. Ferroportin is regulated by hepcidin, which binds to it and promotes its degradation. We found reduced serum hepcidin levels but increased renal hepcidin production in SCD mice. Furthermore, we observed significant macrophage infiltration and increased expression of intercellular adhesion molecule 1 in the endothelial cells of the kidneys in SCD mice. These observations correlated with elevated levels of proinflammatory cytokines IL-1β and IL-6, which can potentially stimulate hepcidin expression. Taken together, our results demonstrate that in individuals with SCD, a renal inflammation state induces renal hepcidin production that blocks the upregulation of ferroportin levels, resulting in dysregulation of iron homeostasis in the kidney and iron deposition in the renal cortex.
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Affiliation(s)
- Asrar Ahmad
- Center for Sickle Cell Disease, Howard University, Washington, DC 20059, USA; (A.A.); (N.K.); (N.A.); (S.N.)
| | - Namita Kumari
- Center for Sickle Cell Disease, Howard University, Washington, DC 20059, USA; (A.A.); (N.K.); (N.A.); (S.N.)
- Department of Microbiology, Howard University, Washington, DC 20059, USA
| | - Nowah Afangbedji
- Center for Sickle Cell Disease, Howard University, Washington, DC 20059, USA; (A.A.); (N.K.); (N.A.); (S.N.)
| | - Sergei Nekhai
- Center for Sickle Cell Disease, Howard University, Washington, DC 20059, USA; (A.A.); (N.K.); (N.A.); (S.N.)
- Department of Microbiology, Howard University, Washington, DC 20059, USA
- Departments of Medicine, Howard University, Washington, DC 20059, USA
| | - Marina Jerebtsova
- Department of Microbiology, Howard University, Washington, DC 20059, USA
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Hereditary Hyperferritinemia. Int J Mol Sci 2023; 24:ijms24032560. [PMID: 36768886 PMCID: PMC9917042 DOI: 10.3390/ijms24032560] [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: 12/14/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 02/03/2023] Open
Abstract
Ferritin is a ubiquitous protein that is present in most tissues as a cytosolic protein. The major and common role of ferritin is to bind Fe2+, oxidize it and sequester it in a safe form in the cell, and to release iron according to cellular needs. Ferritin is also present at a considerably low proportion in normal mammalian sera and is relatively iron poor compared to tissues. Serum ferritin might provide a useful and convenient method of assessing the status of iron storage, and its measurement has become a routine laboratory test. However, many additional factors, including inflammation, infection, metabolic abnormalities, and malignancy-all of which may elevate serum ferritin-complicate interpretation of this value. Despite this long history of clinical use, fundamental aspects of the biology of serum ferritin are still unclear. According to the high number of factors involved in regulation of ferritin synthesis, secretion, and uptake, and in its central role in iron metabolism, hyperferritinemia is a relatively common finding in clinical practice and is found in a large spectrum of conditions, both genetic and acquired, associated or not with iron overload. The diagnostic strategy to reveal the cause of hyperferritinemia includes family and personal medical history, biochemical and genetic tests, and evaluation of liver iron by direct or indirect methods. This review is focused on the forms of inherited hyperferritinemia with or without iron overload presenting with normal transferrin saturation, as well as a step-by-step approach to distinguish these forms to the acquired forms, common and rare, of isolated hyperferritinemia.
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Ralbovsky NM, Zou L, Chen B, Zhang NR, Hines CDG, Vavrek M, Zhong W, Smith JP, Bu X. Simultaneous multielement imaging of liver tissue using laser ablation inductively coupled plasma mass spectrometry. Talanta 2021; 235:122725. [PMID: 34517593 DOI: 10.1016/j.talanta.2021.122725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 11/26/2022]
Abstract
Analysis of the spatial distribution of metals, metalloids, and non-metals in biological tissues is of significant interest in the life sciences, helping to illuminate the function and roles these elements play within various biological pathways. Chemical imaging methods are commonly employed to address biological questions and reveal individual spatial distributions of analytes of interest. Elucidation of these spatial distributions can help determine key elemental and molecular information within the respective biological specimens. However, traditionally utilized imaging methods prove challenging for certain biological tissue analysis, especially with respect to applications that require high spatial resolution or depth profiling. Laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) has been shown to be effective for direct elemental analysis of solid materials with high levels of precision. In this work, chemical imaging using LA-ICP-MS has been applied as a powerful analytical methodology for the analysis of liver tissue samples. The proposed analytical methodology successfully produced both qualitative and quantitative information regarding specific elemental distributions within images of thin tissue sections with high levels of sensitivity and spatial resolution. The spatial resolution of the analytical methodology was innovatively enhanced, helping to broaden applicability of this technique to applications requiring significantly high spatial resolutions. This information can be used to further understand the role these elements play within biological systems and impacts dysregulation may have.
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Affiliation(s)
- Nicole M Ralbovsky
- Analytical Research & Development, MRL, Merck & Co., Inc., West Point, PA, 19486, USA
| | - Lanfang Zou
- Analytical Research & Development, MRL, Merck & Co., Inc., West Point, PA, 19486, USA
| | - Bingming Chen
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, MRL, Merck & Co., Inc., West Point, PA, 19486, USA
| | - Nanyan Rena Zhang
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, MRL, Merck & Co., Inc., West Point, PA, 19486, USA
| | - Catherine D G Hines
- Translational Imaging Biomarkers, MRL, Merck & Co., Inc., West Point, PA, 19486, USA
| | - Marissa Vavrek
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, MRL, Merck & Co., Inc., West Point, PA, 19486, USA
| | - Wendy Zhong
- Analytical Research & Development, MRL, Merck & Co., Inc., West Point, PA, 19486, USA
| | - Joseph P Smith
- Analytical Research & Development, MRL, Merck & Co., Inc., West Point, PA, 19486, USA.
| | - Xiaodong Bu
- Analytical Research & Development, MRL, Merck & Co., Inc., West Point, PA, 19486, USA.
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MRI-based R2* mapping in patients with suspected or known iron overload. Abdom Radiol (NY) 2021; 46:2505-2515. [PMID: 33388804 DOI: 10.1007/s00261-020-02912-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE R2* relaxometry is a quantitative method for assessment of iron overload. The purpose is to analyze the cross-sectional relationships between R2* in organs across patients with primary and secondary iron overload. Secondary analyses were conducted to analyze R2* according to treatment regimen. METHODS This is a retrospective, cross-sectional, institutional review board-approved study of eighty-one adult patients with known or suspected iron overload. R2* was measured by segmenting the liver, spleen, bone marrow, pancreas, renal cortex, renal medulla, and myocardium using breath-hold multi-echo gradient-recalled echo imaging at 1.5 T. Phlebotomy, transfusion, and chelation therapy were documented. Analyses included correlation, Kruskal-Wallis, and post hoc Dunn tests. p < 0.01 was considered significant. RESULTS Correlations between liver R2* and that of the spleen, bone marrow, pancreas, and heart were respectively 0.49, 0.33, 0.27, and 0.34. R2* differed between patients with primary and secondary overload in the liver (p < 0.001), spleen (p < 0.001), bone marrow (p < 0.01), renal cortex (p < 0.001), and renal medulla (p < 0.001). Liver, spleen, and bone marrow R2* were higher in thalassemia than in hereditary hemochromatosis (all p < 0.01). Renal cortex R2* was higher in sickle cell disease than in hereditary hemochromatosis (p < 0.001) and in thalassemia (p < 0.001). Overall, there was a trend toward lower liver R2* in patients assigned to phlebotomy and higher liver R2* in patients assigned to transfusion and chelation therapy. CONCLUSION R2* relaxometry revealed differences in degree or distribution of iron overload between organs, underlying etiologies, and treatment.
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1H-MRS of femoral red and yellow bone marrow fat composition and water content in healthy young men and women at 3 T. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 32:591-597. [DOI: 10.1007/s10334-019-00750-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/16/2019] [Accepted: 04/23/2019] [Indexed: 12/11/2022]
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Regenboog M, Bohte AE, Akkerman EM, Stoker J, Hollak CE. Iron storage in liver, bone marrow and splenic Gaucheroma reflects residual disease in type 1 Gaucher disease patients on treatment. Br J Haematol 2017; 179:635-647. [DOI: 10.1111/bjh.14915] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/18/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Martine Regenboog
- Department of Internal Medicine; Division of Endocrinology & Metabolism; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
- Department of Radiology; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
| | - Anneloes E. Bohte
- Department of Radiology; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
| | - Erik M. Akkerman
- Department of Radiology; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
| | - Jaap Stoker
- Department of Radiology; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
| | - Carla E.M. Hollak
- Department of Internal Medicine; Division of Endocrinology & Metabolism; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
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Ropele S, Langkammer C. Iron quantification with susceptibility. NMR IN BIOMEDICINE 2017; 30:e3534. [PMID: 27119601 DOI: 10.1002/nbm.3534] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/19/2016] [Accepted: 03/11/2016] [Indexed: 05/26/2023]
Abstract
Iron is an essential trace element involved in a variety of biological mechanisms in the human body. Disturbances of iron homeostasis have been observed in several inflammatory and degenerative diseases, which have raised strong interest in non-invasive iron mapping techniques. Numerous MRI techniques have been proposed so far, mostly based on the field changes induced by the magnetic properties of iron. Each of these approaches has a specific sensitivity for iron and its microstructural environment. Quantitative susceptibility mapping is the latest development and provides a direct measure of bulk susceptibility. However, field changes induced by iron are not always directly related to the concentration of iron, but rather reflect the structure of iron compounds and its cellular distribution. This review provides an overview of the most relevant iron compounds in the human body, their magnetic properties and their cellular distribution. In addition, MRI methods based on direct or indirect susceptibility changes are presented and discussed with respect to technical aspects and clinical applicability. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
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