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Casu C, Rivella S. Iron age: novel targets for iron overload. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:216-221. [PMID: 25696858 PMCID: PMC5292264 DOI: 10.1182/asheducation-2014.1.216] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Excess iron deposition in vital organs is the main cause of morbidity and mortality in patients affected by β-thalassemia and hereditary hemochromatosis. In both disorders, inappropriately low levels of the liver hormone hepcidin are responsible for the increased iron absorption, leading to toxic iron accumulation in many organs. Several studies have shown that targeting iron absorption could be beneficial in reducing or preventing iron overload in these 2 disorders, with promising preclinical data. New approaches target Tmprss6, the main suppressor of hepcidin expression, or use minihepcidins, small peptide hepcidin agonists. Additional strategies in β-thalassemia are showing beneficial effects in ameliorating ineffective erythropoiesis and anemia. Due to the suppressive nature of the erythropoiesis on hepcidin expression, these approaches are also showing beneficial effects on iron metabolism. The goal of this review is to discuss the major factors controlling iron metabolism and erythropoiesis and to discuss potential novel therapeutic approaches to reduce or prevent iron overload in these 2 disorders and ameliorate anemia in β-thalassemia.
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Affiliation(s)
- Carla Casu
- Department of Pediatrics, Division of Hematology-Oncology, Weill Medical College, Cornell University, New York, NY
| | - Stefano Rivella
- Department of Pediatrics, Division of Hematology-Oncology, Weill Medical College, Cornell University, New York, NY
- Department of Cell and Developmental Biology, Weill Medical College, Cornell University, New York, NY
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Guo S, Casu C, Gardenghi S, Booten S, Aghajan M, Peralta R, Watt A, Freier S, Monia BP, Rivella S. Reducing TMPRSS6 ameliorates hemochromatosis and β-thalassemia in mice. J Clin Invest 2013; 123:1531-41. [PMID: 23524968 PMCID: PMC3613931 DOI: 10.1172/jci66969] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 01/17/2013] [Indexed: 01/24/2023] Open
Abstract
β-Thalassemia and HFE-related hemochromatosis are 2 of the most frequently inherited disorders worldwide. Both disorders are characterized by low levels of hepcidin (HAMP), the hormone that regulates iron absorption. As a consequence, patients affected by these disorders exhibit iron overload, which is the main cause of morbidity and mortality. HAMP expression is controlled by activation of the SMAD1,5,8/SMAD4 complex. TMPRSS6 is a serine protease that reduces SMAD activation and blocks HAMP expression. We identified second generation antisense oligonucleotides (ASOs) targeting mouse Tmprss6. ASO treatment in mice affected by hemochromatosis (Hfe(-/-)) significantly decreased serum iron, transferrin saturation and liver iron accumulation. Furthermore, ASO treatment of mice affected by β-thalassemia (HBB(th3/+) mice, referred to hereafter as th3/+ mice) decreased the formation of insoluble membrane-bound globins, ROS, and apoptosis, and improved anemia. These animals also exhibited lower erythropoietin levels, a significant amelioration of ineffective erythropoiesis (IE) and splenomegaly, and an increase in total hemoglobin levels. These data suggest that ASOs targeting Tmprss6 could be beneficial in individuals with hemochromatosis, β-thalassemia, and related disorders.
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Affiliation(s)
- Shuling Guo
- Isis Pharmaceuticals, Carlsbad, California, USA.
Weill Cornell Medical College, Department of Pediatrics, Division of Hematology-Oncology, New York, New York, USA.
Weill Cornell Medical College, Department of Cell and Development Biology, New York, New York, USA
| | - Carla Casu
- Isis Pharmaceuticals, Carlsbad, California, USA.
Weill Cornell Medical College, Department of Pediatrics, Division of Hematology-Oncology, New York, New York, USA.
Weill Cornell Medical College, Department of Cell and Development Biology, New York, New York, USA
| | - Sara Gardenghi
- Isis Pharmaceuticals, Carlsbad, California, USA.
Weill Cornell Medical College, Department of Pediatrics, Division of Hematology-Oncology, New York, New York, USA.
Weill Cornell Medical College, Department of Cell and Development Biology, New York, New York, USA
| | - Sheri Booten
- Isis Pharmaceuticals, Carlsbad, California, USA.
Weill Cornell Medical College, Department of Pediatrics, Division of Hematology-Oncology, New York, New York, USA.
Weill Cornell Medical College, Department of Cell and Development Biology, New York, New York, USA
| | - Mariam Aghajan
- Isis Pharmaceuticals, Carlsbad, California, USA.
Weill Cornell Medical College, Department of Pediatrics, Division of Hematology-Oncology, New York, New York, USA.
Weill Cornell Medical College, Department of Cell and Development Biology, New York, New York, USA
| | - Raechel Peralta
- Isis Pharmaceuticals, Carlsbad, California, USA.
Weill Cornell Medical College, Department of Pediatrics, Division of Hematology-Oncology, New York, New York, USA.
Weill Cornell Medical College, Department of Cell and Development Biology, New York, New York, USA
| | - Andy Watt
- Isis Pharmaceuticals, Carlsbad, California, USA.
Weill Cornell Medical College, Department of Pediatrics, Division of Hematology-Oncology, New York, New York, USA.
Weill Cornell Medical College, Department of Cell and Development Biology, New York, New York, USA
| | - Sue Freier
- Isis Pharmaceuticals, Carlsbad, California, USA.
Weill Cornell Medical College, Department of Pediatrics, Division of Hematology-Oncology, New York, New York, USA.
Weill Cornell Medical College, Department of Cell and Development Biology, New York, New York, USA
| | - Brett P. Monia
- Isis Pharmaceuticals, Carlsbad, California, USA.
Weill Cornell Medical College, Department of Pediatrics, Division of Hematology-Oncology, New York, New York, USA.
Weill Cornell Medical College, Department of Cell and Development Biology, New York, New York, USA
| | - Stefano Rivella
- Isis Pharmaceuticals, Carlsbad, California, USA.
Weill Cornell Medical College, Department of Pediatrics, Division of Hematology-Oncology, New York, New York, USA.
Weill Cornell Medical College, Department of Cell and Development Biology, New York, New York, USA
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Heli H, Mirtorabi S, Karimian K. Advances in iron chelation: an update. Expert Opin Ther Pat 2011; 21:819-56. [PMID: 21449664 DOI: 10.1517/13543776.2011.569493] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Oxidative stress (caused by excess iron) can result in tissue damage, organ failure and finally death, unless treated by iron chelators. The causative factor in the etiology of a variety of disease states is the presence of iron-generated reactive oxygen species (ROS), which can result in cell damage or which can affect the signaling pathways involved in cell necrosis-apoptosis or organ fibrosis, cancer, neurodegeneration and cardiovascular, hepatic or renal dysfunctions. Iron chelators can reduce oxidative stress by the removal of iron from target tissues. Equally as important, removal of iron from the active site of enzymes that play key roles in various diseases can be of considerable benefit to the patients. AREAS COVERED This review focuses on iron chelators used as therapeutic agents. The importance of iron in oxidative damage is discussed, along with the three clinically approved iron chelators. EXPERT OPINION A number of iron chelators are used as approved therapeutic agents in the treatment of thalassemia major, asthma, fungal infections and cancer. However, as our knowledge about the biochemistry of iron and its role in etiologies of seemingly unrelated diseases increases, new applications of the approved iron chelators, as well as the development of new iron chelators, present challenging opportunities in the areas of drug discovery and development.
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Affiliation(s)
- Hossein Heli
- Islamic Azad University, Science and Research Branch, Department of Chemistry, Fars, 7348113111, Iran
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