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Ginzburg YZ. Hepcidin and its multiple partners: Complex regulation of iron metabolism in health and disease. VITAMINS AND HORMONES 2023; 123:249-284. [PMID: 37717987 DOI: 10.1016/bs.vh.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
The peptide hormone hepcidin is central to the regulation of iron metabolism, influencing the movement of iron into the circulation and determining total body iron stores. Its effect on a cellular level involves binding ferroportin, the main iron export protein, preventing iron egress and leading to iron sequestration within ferroportin-expressing cells. Hepcidin expression is enhanced by iron loading and inflammation and suppressed by erythropoietic stimulation. Aberrantly increased hepcidin leads to systemic iron deficiency and/or iron restricted erythropoiesis as occurs in anemia of chronic inflammation. Furthermore, insufficiently elevated hepcidin occurs in multiple diseases associated with iron overload such as hereditary hemochromatosis and iron loading anemias. Abnormal iron metabolism as a consequence of hepcidin dysregulation is an underlying factor resulting in pathophysiology of multiple diseases and several agents aimed at manipulating this pathway have been designed, with some already in clinical trials. In this chapter, we assess the complex regulation of hepcidin, delineate the many binding partners involved in its regulation, and present an update on the development of hepcidin agonists and antagonists in various clinical scenarios.
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Affiliation(s)
- Yelena Z Ginzburg
- Tisch Cancer Institute, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United Sates.
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Tekin TO, Karis D, Ates Alkan F, Cetin G, Ercan AM. Evaluation of trace elements in essential thrombocytosis and reactive thrombocytosis. J Trace Elem Med Biol 2022; 73:127034. [PMID: 35839560 DOI: 10.1016/j.jtemb.2022.127034] [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: 06/28/2021] [Revised: 03/15/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trace elements (TE) are vital for cellular mechanisms at biological, chemical and molecular levels. The effects of TE in diagnosis, progression and treatment of essential thrombocytosis (ET), which is one of the chronic myeloproliferative neoplasms is a rare clonal stem cell disease characterized by increased thrombocyte numbers with impaired function, have not been elucidated in detail yet. The aim of the present study was to investigate the effects of TE alterations in an ET model and the efficacy of TE in ET treatment protocol by means of a vast number of TE. METHODS Study groups were categorized as patients with ET diagnosis (ET group, n:30), patients with reactive thrombocytosis secondary to iron deficiency anemia (IDA-RT) (IDA-RT group, n:30) and healthy controls (HC group, n:30). Serum levels of copper (Cu), iron (Fe), cobalt (Co), chromium (Cr), aluminum (Al), silicon (Si), nickel (Ni), zinc (Zn), selenium (Se), manganese (Mn), boron (B) and magnesium (Mg) were analyzed utilizing inductively coupled plasma-optical emission spectrophotometer instrument (ICP-OES). Statistical analysis was evaluated using SPSS 23.0. RESULTS ET group had statistically higher serum levels of Co and Mg (p < 0.05), Ni and Mn (p < 0.001), and lower Si (p < 0.05) than IDA-RT group. ET group had statistically higher serum levels of Co and Mn (p < 0.05), and Ni (p < 0.001), and lower Al, Si and Se (p < 0.001) than HC group. Serum levels of Fe, Al and Se (p < 0.001), and Mg (p < 0.01), and Zn (p < 0.05) in IDA-RT group were significantly lower than HC group. CONCLUSION This novel study pointed out that alterations of many serum TE by means of both increment or decrement might have close relationship with mechanisms and complications of ET onset and follow-up. We consider that further research of TE would elucidate ethiopathogenesis and prognosis of ET. Thus, analysis of serum trace elements in essential thrombocytosis patients may be an important protocol by means of diagnosis, treatment and follow-up intervals.
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Affiliation(s)
- Tuba Ozkan Tekin
- Department of Hematology, Department of Internal Medicine, Faculty of Medicine, Bezmialem University, Fatih, Istanbul, Turkey
| | - Denizhan Karis
- Department of Biophysics, Faculty of Medicine, İstanbul University-Cerrahpasa, Fatih, Istanbul, Turkey.
| | - Fatma Ates Alkan
- Department of Biophysics, Faculty of Medicine, İstanbul University-Cerrahpasa, Fatih, Istanbul, Turkey
| | - Guven Cetin
- Department of Hematology, Department of Internal Medicine, Faculty of Medicine, Bezmialem University, Fatih, Istanbul, Turkey
| | - Alev Meltem Ercan
- Department of Biophysics, Faculty of Medicine, İstanbul University-Cerrahpasa, Fatih, Istanbul, Turkey
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Prognostic Impact of Serum Growth Differentiation Factor 15 Level in Acute Myeloid Leukemia Patients. Indian J Hematol Blood Transfus 2021; 37:37-44. [PMID: 33707833 DOI: 10.1007/s12288-020-01315-7] [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: 04/06/2019] [Accepted: 06/25/2020] [Indexed: 10/24/2022] Open
Abstract
Growth differentiation factor 15 (GDF15) plays an important role in cancer pathophysiology and prognosis. However, limited studies analyzed its level and prognostic value in acute myeloid leukemia (AML) patients. This study included 56 adult AML patients. Serum GDF15 level was measured at diagnosis in all patients by enzyme-linked immunosorbent assay. Remission and survival statuses were assessed at 90 days following treatment. GDF15 level was significantly higher in patients than in controls (P < 0.001). GDF15 level correlated positively with age (P < 0.001), hemoglobin level (P = 0.027), and platelet count (P = 0.024). High GDF15 above the median level was associated with inferior OS (P = 0.044) together with high platelet count (P = 0.006) and high bone marrow blast percent (P = 0.038). There was no statistically significant difference between patients with GDF15 above and below the median level regarding DFS (P = 0.881). On multivariate analysis for OS, GDF15 level was an independent risk factor (P = 0.047). In conclusion, serum GDF15 level is significantly elevated in AML patients and high GDF15 level is associated with inferior OS.
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Ranjbaran R, Abbasi M, Rahimian E, Dehbidi GR, Seyyedi N, Zare F, Behzad-Behbahani A. GDF-15 negatively regulates excess erythropoiesis and its overexpression is involved in erythroid hyperplasia. Exp Cell Res 2020; 397:112346. [PMID: 33164866 DOI: 10.1016/j.yexcr.2020.112346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/21/2020] [Accepted: 10/24/2020] [Indexed: 01/28/2023]
Abstract
Growth differentiation factor-15 (GDF-15) is a member of TGF-β superfamily. Among hematopoietic cells, this factor is mainly produced by erythroid series and is recently considered a biomarker of ineffective erythropoiesis (IE). Whether IE induces enhanced GDF-15 expression or is prompted by it, has remained elusive. In this study we investigated how high levels of GDF-15 contribute to IE-associated erythroid dysplasia. We assessed mRNA levels of GDF-15 during erythroid maturation as well as in patients with IE using qRT-PCR. Later, the erythroid colony-forming capacity of GDF-15-treated hematopoietic stem cells (HSCs) was evaluated by CFC assay. Any effect of elevated levels of GDF-15 on erythroid maturation was ultimately examined by expression analysis of erythroid-associated transcription factors and flow cytometry analysis of CD235a expression. GDF-15 mRNA expression increased during erythroid differentiation and also in β-thalassemia and MDS patients which was directly correlated with erythropoiesis severity. Treating the cells with high GDF-15 concentration (50 ng/ml) resulted in an approximate 30% decline in the capacity of erythroid colony formation of HSCs and CD235a positive cells. Additionally, erythroid-specific transcription factors showed significant down-regulation in the early stages of erythroid differentiation. According to the expression level of GDF-15 and the role it plays in the erythroid system, high-levels of this factor could be an auto-modulatory mechanism to control the excessive production of erythroid cells.
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Affiliation(s)
- Reza Ranjbaran
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mojdeh Abbasi
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Elahe Rahimian
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Gholamreza Rafiei Dehbidi
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Noorossadat Seyyedi
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Farahnaz Zare
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Abbas Behzad-Behbahani
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Poulsen NS, Madsen KL, Hornsyld TM, Eisum ASV, Fornander F, Buch AE, Stemmerik MG, Ruiz-Ruiz C, Krag TO, Vissing J. Growth and differentiation factor 15 as a biomarker for mitochondrial myopathy. Mitochondrion 2019; 50:35-41. [PMID: 31669236 DOI: 10.1016/j.mito.2019.10.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/03/2019] [Accepted: 10/02/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE We investigated if Growth and Differentiation Factor 15 (GDF-15) can be used as a biomarker to distinguish patients with mitochondrial myopathy from patients with other myopathies. METHODS Serum GDF-15 was measured in 28 patients with mitochondrial disease, 24 with metabolic myopathies, 27 with muscular dystrophy and 21 healthy controls. RESULTS AND CONCLUSIONS Our findings indicate that elevated GDF-15 can distinguish patients with mitochondrial myopathy from other myopathies, including metabolic myopathies. This suggests that increases in GDF-15 is specific to respiratory chain dysfunction rather than general metabolic dysfunction or muscle defect.
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Affiliation(s)
- Nanna Scharff Poulsen
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark.
| | - Karen Lindhardt Madsen
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Tessa Munkeboe Hornsyld
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Anne-Sofie Vibæk Eisum
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Freja Fornander
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Astrid Emilie Buch
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Mads Godtfeldt Stemmerik
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Cristina Ruiz-Ruiz
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Thomas Oliver Krag
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
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ALBAYRAK C, TARKUN P, BİRTAŞ ATEŞOĞLU E, ERALDEMİR C, ÖZSOY ÖD, TERZİ DEMİRSOY E, MEHTAP Ö, GEDÜK A, HACIHANEFİOĞLU A. The role of hepcidin, GDF15, and mitoferrin-1 in iron metabolism of polycythemia vera and essential thrombocytosis patients. Turk J Med Sci 2019; 49:74-80. [PMID: 30761871 PMCID: PMC7350842 DOI: 10.3906/sag-1803-13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background/aim GDF15, hepcidin and mitoferrin-1 (mfrn-1) are proteins involved in systemic iron regulation. There are no studies in the literature demonstrating the serum mfrn-1 levels in polycythemia vera (PV) and essential thrombocythemia (ET) patients. The aim of this study was to investigate GDF15, hepcidin and mfrn-1 levels in PV and ET patients. Materials and methods Ten PV, 17 ET patients, and 27 healthy controls (HCs) were enrolled. GDF15, hepcidin and mfrn-1 values were measured with enzyme-linked immunosorbent assay (ELISA). Results GDF15 levels were higher in the myeloproliferative neoplasm (MPN) group (P = 0.002). Hepcidin levels were not different between MPN patients and HCs. The mfrn-1 levels were lower in MPN patients (P = 0.039). Hepcidin, GDF15, and mfrn-1 levels were not different between PV and ET patients. mfrn-1 levels were lower in ET patients than HCs (P = 0.038). Conclusion Increased erythropoiesis in MPNs may lead to high GDF15 levels in these patients. However, hepcidin was not suppressed despite the increased GDF15 levels and erythropoiesis in these patients. Decrease in mfrn-1 in MPNs can be the result of its increased turnover due to increased myelopoiesis. It can be hypothesized that similar hepcidin levels in patients and controls and low mfrn-1 levels in patients may be a defense mechanism against erythroid activity and thromboembolic complications.
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Affiliation(s)
- Canan ALBAYRAK
- Department of Internal Medicine, School of Medicine, Kocaeli University, KocaeliTurkey
| | - Pınar TARKUN
- Department of Hematology, School of Medicine, Kocaeli University, KocaeliTurkey
- * To whom correspondence should be addressed. E-mail:
| | | | - Ceyla ERALDEMİR
- Department of Biochemistry, School of Medicine, Kocaeli University, KocaeliTurkey
| | - Özgür Doğa ÖZSOY
- Department of Biochemistry, School of Medicine, Kocaeli University, KocaeliTurkey
| | - Esra TERZİ DEMİRSOY
- Department of Hematology, School of Medicine, Kocaeli University, KocaeliTurkey
| | - Özgür MEHTAP
- Department of Hematology, School of Medicine, Kocaeli University, KocaeliTurkey
| | - Ayfer GEDÜK
- Department of Hematology, School of Medicine, Kocaeli University, KocaeliTurkey
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Abstract
Hepcidin is central to regulation of iron metabolism. Its effect on a cellular level involves binding ferroportin, the main iron export protein, resulting in its internalization and degradation and leading to iron sequestration within ferroportin-expressing cells. Aberrantly increased hepcidin leads to systemic iron deficiency and/or iron restricted erythropoiesis. Furthermore, insufficiently elevated hepcidin occurs in multiple diseases associated with iron overload. Abnormal iron metabolism as a consequence of hepcidin dysregulation is an underlying factor resulting in pathophysiology of multiple diseases and several agents aimed at manipulating this pathway have been designed, with some already in clinical trials. In this chapter, we present an overview of and rationale for exploring the development of hepcidin agonists and antagonists in various clinical scenarios.
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Affiliation(s)
- Yelena Z Ginzburg
- Tisch Cancer Institute, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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Ginzburg YZ, Feola M, Zimran E, Varkonyi J, Ganz T, Hoffman R. Dysregulated iron metabolism in polycythemia vera: etiology and consequences. Leukemia 2018; 32:2105-2116. [PMID: 30042411 PMCID: PMC6170398 DOI: 10.1038/s41375-018-0207-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/07/2018] [Accepted: 06/18/2018] [Indexed: 01/19/2023]
Abstract
Polycythemia vera (PV) is a chronic myeloproliferative neoplasm. Virtually all PV patients are iron deficient at presentation and/or during the course of their disease. The co-existence of iron deficiency and polycythemia presents a physiological disconnect. Hepcidin, the master regulator of iron metabolism, is regulated by circulating iron levels, erythroblast secretion of erythroferrone, and inflammation. Both decreased circulating iron and increased erythroferrone levels, which occur as a consequence of erythroid hyperplasia in PV, are anticipated to suppress hepcidin and enable recovery from iron deficiency. Inflammation which accompanies PV is likely to counteract hepcidin suppression, but the relatively low serum ferritin levels observed suggest that inflammation is not a major contributor to the dysregulated iron metabolism. Furthermore, potential defects in iron absorption, aberrant hypoxia sensing and signaling, and frequency of bleeding to account for iron deficiency in PV patients have not been fully elucidated. Insufficiently suppressed hepcidin given the degree of iron deficiency in PV patients strongly suggests that disordered iron metabolism is an important component of the pathobiology of PV. Normalization of hematocrit levels using therapeutic phlebotomy is the most common approach for reducing the incidence of thrombotic complications, a therapy which exacerbates iron deficiency, contributing to a variety of non-hematological symptoms. The use of cytoreductive therapy in high-risk PV patients frequently works more effectively to reverse PV-associated symptoms in iron-deficient relative to iron-replete patients. Lastly, differences in iron-related parameters between PV patients and mice with JAK2 V617F and JAK2 exon 12 mutations suggest that specific regions in JAK2 may influence iron metabolism by nuanced changes of erythropoietin receptor signaling. In this review, we comprehensively discuss the clinical consequences of iron deficiency in PV, provide a framework for understanding the potential dysregulation of iron metabolism, and present a rationale for additional therapeutic options for iron-deficient PV patients.
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Affiliation(s)
- Yelena Z Ginzburg
- Division of Hematology Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Maria Feola
- Division of Hematology Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eran Zimran
- Division of Hematology Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Judit Varkonyi
- Third Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Tomas Ganz
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Ronald Hoffman
- Division of Hematology Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Lucijanic M, Prka Z, Pejsa V, Stoos-Veic T, Lucijanic J, Kusec R. Prognostic implications of low transferrin saturation in patients with primary myelofibrosis. Leuk Res 2018; 66:89-95. [PMID: 29407589 DOI: 10.1016/j.leukres.2018.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Transferrin saturation (TSAT) 20% or less is considered to represent functional iron deficiency in the context of malignant disease, phenomenon mediated through inflammatory changes of iron homeostasis. We aimed to investigate clinical and prognostic significance of low TSAT in patients with primary (PMF) and secondary myelofibrosis (SMF), malignant diseases characterized by strong inflammatory milieu. METHODS We retrospectively analyzed 87 patients with myelofibrosis and compared TSAT with disease specific parameters. RESULTS One-third of patients had TSAT ≤20%. Lower TSAT was significantly associated with Janus-kinase-2 (JAK2) mutation (P = 0.007), transfusion independency (P = 0.003), higher platelets (P = 0.004), lower mean-corpuscular-volume (P < 0.001), lower ferritin (P < 0.001), higher absolute-neutrophil-count (P = 0.027), lower absolute-lymphocyte-count (P = 0.041) and lower albumin (P = 0.018). PMF patients presenting with low TSAT (≤20%) experienced significantly shorter overall-survival (OS) (HR = 2.43; P = 0.017), whereas TSAT did not affect OS of SMF patients (HR = 1.48; P = 0.623). Low TSAT remained significantly associated with inferior OS in PMF in a series of multivariate Cox regression models comparing its properties to anemia, transfusion dependency, ferritin and Dynamic-International-Prognostic-System (DIPSS). CONCLUSIONS Low TSAT has detrimental effect on survival of PMF patients. This effect is independent of anemia and of ferritin levels that seem to be better at representing iron overload in PMF patients.
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Affiliation(s)
- Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia.
| | - Zeljko Prka
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia
| | - Vlatko Pejsa
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia; School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia
| | - Tajana Stoos-Veic
- Department of Clinical Cytology and Cytometry, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia; Faculty of Medicine, University of Osijek, Ul. Josipa Huttlera 4, 31000 Osijek, Croatia
| | - Jelena Lucijanic
- Health Care Center Zagreb-West, Prilaz baruna Filipovica 11, 10000 Zagreb, Croatia
| | - Rajko Kusec
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia; School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia; Divison of Molecular Diagnosis and Genetics, Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia
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Decreasing TfR1 expression reverses anemia and hepcidin suppression in β-thalassemic mice. Blood 2017; 129:1514-1526. [PMID: 28151426 DOI: 10.1182/blood-2016-09-742387] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/12/2017] [Indexed: 01/19/2023] Open
Abstract
Iron availability for erythropoiesis and its dysregulation in β-thalassemia are incompletely understood. We previously demonstrated that exogenous apotransferrin leads to more effective erythropoiesis, decreasing erythroferrone (ERFE) and derepressing hepcidin in β-thalassemic mice. Transferrin-bound iron binding to transferrin receptor 1 (TfR1) is essential for cellular iron delivery during erythropoiesis. We hypothesize that apotransferrin's effect is mediated via decreased TfR1 expression and evaluate TfR1 expression in β-thalassemic mice in vivo and in vitro with and without added apotransferrin. Our findings demonstrate that β-thalassemic erythroid precursors overexpress TfR1, an effect that can be reversed by the administration of exogenous apotransferrin. In vitro experiments demonstrate that apotransferrin inhibits TfR1 expression independent of erythropoietin- and iron-related signaling, decreases TfR1 partitioning to reticulocytes during enucleation, and enhances enucleation of defective β-thalassemic erythroid precursors. These findings strongly suggest that overexpressed TfR1 may play a regulatory role contributing to iron overload and anemia in β-thalassemic mice. To evaluate further, we crossed TfR1+/- mice, themselves exhibiting iron-restricted erythropoiesis with increased hepcidin, with β-thalassemic mice. Resultant double-heterozygote mice demonstrate long-term improvement in ineffective erythropoiesis, hepcidin derepression, and increased erythroid enucleation in relation to β-thalassemic mice. Our data demonstrate for the first time that TfR1+/- haploinsufficiency reverses iron overload specifically in β-thalassemic erythroid precursors. Taken together, decreasing TfR1 expression during β-thalassemic erythropoiesis, either directly via induced haploinsufficiency or via exogenous apotransferrin, decreases ineffective erythropoiesis and provides an endogenous mechanism to upregulate hepcidin, leading to sustained iron-restricted erythropoiesis and preventing systemic iron overload in β-thalassemic mice.
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Talbot NP, Smith TG, Lakhal-Littleton S, Gülsever C, Rivera-Ch M, Dorrington KL, Mole DR, Robbins PA. Suppression of plasma hepcidin by venesection during steady-state hypoxia. Blood 2016; 127:1206-7. [PMID: 26773043 DOI: 10.1182/blood-2015-05-647404] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Nick P Talbot
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Thomas G Smith
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Samira Lakhal-Littleton
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Cafer Gülsever
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Maria Rivera-Ch
- Laboratory of High Altitude Adaptation, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru; and
| | - Keith L Dorrington
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - David R Mole
- Henry Wellcome Building for Molecular Physiology, University of Oxford, Oxford, United Kingdom
| | - Peter A Robbins
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
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12
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Abstract
PURPOSE OF REVIEW Iron homeostasis and erythropoiesis regulate each other to ensure optimal delivery of oxygen and iron to cells and tissues. Defining the mechanisms of this crosstalk is important for understanding the pathogenesis of common conditions associated with disordered iron metabolism and erythropoiesis. RECENT FINDINGS Stress erythropoiesis causes suppression of hepcidin to increase iron availability for hemoglobin synthesis. The erythroid hormone erythroferrone (ERFE) was identified as the mediator of this process. ERFE and additional candidates (TWSG1 and GDF15) may also mediate hepcidin suppression in ineffective erythropoiesis. Several mechanisms by which iron regulates erythropoiesis were also recently identified. Iron deficiency suppresses erythropoietin production via the IRP1-HIF2α axis to prevent excessive iron usage by erythropoiesis during systemic iron restriction. Iron restriction also directly impairs erythroid maturation by inhibiting aconitase, and this can be reversed by the administration of the aconitase product isocitrate. Another novel target is GDF11, which is thought to autoinhibit erythroid maturation. GDF11 traps show promising pharmacologic activity in models of both ineffective erythropoiesis and iron-restricted anemia. SUMMARY This review summarizes exciting advances in understanding the mechanisms of iron and erythropoietic regulation, and development of novel therapeutic tools for disorders resulting from dysregulation of iron metabolism or erythropoiesis.
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Lotfi R, Kroll C, Plonné D, Jahrsdörfer B, Schrezenmeier H. Hepcidin/Ferritin Quotient Helps to Predict Spontaneous Recovery from Iron Loss following Blood Donation. Transfus Med Hemother 2015; 42:390-5. [PMID: 26733771 DOI: 10.1159/000440825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 05/06/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Iron supplementation is generally recommended for blood donors even though there are inter-individual differences in iron homeostasis. METHODS Ferritin levels of repeat donors were compared with first-time donors, retrospectively. Prospectively, we tested 27 male repeat donors for the following parameters at the day of blood donation as well as 1, 3, 7, 10, and 56 days thereafter: ferritin, hepcidin, transferrin, transferrin receptor, hemoglobin, erythropoietin, reticulocytes, hemoglobin in reticulocyte, twisted gastrulation protein homolog 1, and growth differentiation factor-15. RESULTS 56 days after blood donation, donors' average ferritin dropped to 55% (range 30-100%) compared to the initial value. Of all tested parameters hepcidin showed the highest and most significant changes beginning 1 day after donation and lasting for the whole period of 56 days. Along with ferritin, there was a high variation in hepcidin levels indicating inter-individual differences in hepcidin response to iron loss. Donors with a hepcidin/ferritin quotient < 0.3 regained 60% of their initial ferritin after 56 days, while those with a quotient ≥ 0.3 reached less than 50%. CONCLUSION As hepcidin appears to integrate erythropoietic and iron-loading signals, clinical measurement of hepcidin (together with the hepcidin-ferritin ratio) may become a useful indicator of erythropoiesis and iron kinetics.
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Affiliation(s)
- Ramin Lotfi
- Institute for Transfusion Medicine, University Hospital Ulm, Ulm, Germany; Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Services Baden-Württemberg-Hessen, Ulm, Germany
| | - Christine Kroll
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Services Baden-Württemberg-Hessen, Ulm, Germany
| | - Dietmar Plonné
- MVZ Humangenetik Ulm, Abteilung Laboratoriumsmedizin, Ulm, Germany
| | - Bernd Jahrsdörfer
- Institute for Transfusion Medicine, University Hospital Ulm, Ulm, Germany; Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Services Baden-Württemberg-Hessen, Ulm, Germany
| | - Hubert Schrezenmeier
- Institute for Transfusion Medicine, University Hospital Ulm, Ulm, Germany; Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Services Baden-Württemberg-Hessen, Ulm, Germany
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14
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Yatsuga S, Fujita Y, Ishii A, Fukumoto Y, Arahata H, Kakuma T, Kojima T, Ito M, Tanaka M, Saiki R, Koga Y. Growth differentiation factor 15 as a useful biomarker for mitochondrial disorders. Ann Neurol 2015; 78:814-23. [PMID: 26463265 PMCID: PMC5057301 DOI: 10.1002/ana.24506] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 08/12/2015] [Accepted: 08/15/2015] [Indexed: 01/17/2023]
Abstract
Objective The diagnosis of mitochondrial disorders (MDs) is occasionally difficult because patients often present with solitary, or a combination of, symptoms caused by each organ insufficiency, which may be the result of respiratory chain enzyme deficiency. Growth differentiation factor 15 (GDF‐15) has been reported to be elevated in serum of patients with MDs. In this study, we investigated whether GDF‐15 is a more useful biomarker for MDs than several conventional biomarkers. Methods We measured the serum levels of GDF‐15 and fibroblast growth factor 21 (FGF‐21), as well as other biomarkers, in 48 MD patients and in 146 healthy controls in Japan. GDF‐15 and FGF‐21 concentrations were measured by enzyme‐linked immunosorbant assay and compared with lactate, pyruvate, creatine kinase, and the lactate‐to‐pyruvate ratio. We calculated sensitivity and specificity and also evaluated the correlation based on two rating scales, including the Newcastle Mitochondrial Disease Rating Scale (NMDAS). Results Mean GDF‐15 concentration was 6‐fold higher in MD patients compared to healthy controls (2,711 ± 2,459 pg/ml vs 462.5 ± 141.0 pg/mL; p < 0.001). Using a receiver operating characteristic curve, the area under the curve was significantly higher for GDF‐15 than FGF‐21 and other conventional biomarkers. Our date suggest that GDF‐15 is the most useful biomarker for MDs of the biomarkers examined, and it is associated with MD severity. Interpretation Our results suggest that measurement of GDF‐15 is the most useful first‐line test to indicate the patients who have the mitochondrial respiratory chain deficiency. Ann Neurol 2015;78:Ann Neurol 2015;78:679–696
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Affiliation(s)
- Shuichi Yatsuga
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Yasunori Fujita
- Research Team for Mechanism of Aging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Akiko Ishii
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Hajime Arahata
- Department of Neurology, Neuro-Muscular Center, National Omuta Hospital, Fukuoka, Japan
| | - Tatsuyuki Kakuma
- Department of Biostatistics, Kurume University Graduate School of Medicine, Kurume, Japan
| | - Toshio Kojima
- Health Care Center, Toyohashi University of Technology, Toyohashi, Japan
| | - Masafumi Ito
- Research Team for Mechanism of Aging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Masashi Tanaka
- Department of Genomics for Longevity and Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Reo Saiki
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Yasutoshi Koga
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
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15
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Uchiyama T, Kawabata H, Miura Y, Yoshioka S, Iwasa M, Yao H, Sakamoto S, Fujimoto M, Haga H, Kadowaki N, Maekawa T, Takaori-Kondo A. The role of growth differentiation factor 15 in the pathogenesis of primary myelofibrosis. Cancer Med 2015; 4:1558-72. [PMID: 26276681 PMCID: PMC4618626 DOI: 10.1002/cam4.502] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/02/2015] [Accepted: 07/03/2015] [Indexed: 11/23/2022] Open
Abstract
Growth differentiation factor 15 (GDF15) is a pleiotropic cytokine that belongs to the transforming growth factor-β superfamily. Elevated serum concentrations of this cytokine have been reported in patients with various malignancies. To assess the potential roles of GDF15 in hematologic malignancies, we measured its serum levels in patients with these diseases. We found that serum GDF15 levels were elevated in almost all these patients, particularly in patients with primary myelofibrosis (PMF). Immunohistochemical staining of bone marrow (BM) specimens revealed that GDF15 was strongly expressed by megakaryocytes, which may be sources of increased serum GDF15 in PMF patients. Therefore, we further assessed the contribution of GDF15 to the pathogenesis of PMF. Recombinant human (rh) GDF15 enhanced the growth of human BM mesenchymal stromal cells (BM-MSCs), and it enhanced the potential of these cells to support human hematopoietic progenitor cell growth in a co-culture system. rhGDF15 enhanced the growth of human primary fibroblasts, but it did not affect their expression of profibrotic genes. rhGDF15 induced osteoblastic differentiation of BM-MSCs in vitro, and pretreatment of BM-MSCs with rGDF15 enhanced the induction of bone formation in a xenograft mouse model. These results suggest that serum levels of GDF15 in PMF are elevated, that megakaryocytes are sources of this cytokine in BM, and that GDF15 may modulate the pathogenesis of PMF by enhancing proliferation and promoting osteogenic differentiation of BM-MSCs.
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Affiliation(s)
- Tatsuki Uchiyama
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Kawabata
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuo Miura
- Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Satoshi Yoshioka
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Masaki Iwasa
- Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan.,Division of Gastroenterology and Hematology, Shiga University of Medical Science, Otsu, Japan
| | - Hisayuki Yao
- Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Soichiro Sakamoto
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Norimitsu Kadowaki
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Taira Maekawa
- Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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16
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Strati P, Pemmaraju N, Estrov Z, Cardenas-Turanzas M, Pierce S, Newberry KJ, Daver N, Cortes J, Kantarjian H, Verstovsek S. Clinical significance of microcytosis in patients with primary myelofibrosis. Leuk Res 2014; 38:1212-6. [PMID: 25217891 DOI: 10.1016/j.leukres.2014.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/13/2014] [Accepted: 08/17/2014] [Indexed: 12/11/2022]
Abstract
Microcytosis is a relatively frequent finding in primary myelofibrosis (PMF); however its prognostic significance is unknown. We identified factors associated with microcytosis in PMF and measured its impact on outcomes. Among 725 patients with PMF, 140 (19%) showed microcytosis. In multivariate analysis, factors associated with microcytosis were absence of prior therapy, low iron, low transferrin saturation (satTF), and splenomegaly. Among 375 untreated patients, low satTF and splenomegaly were associated with microcytosis. Overall, microcytosis was associated with a higher risk of transformation to leukemia (p=0.03), but not shorter leukemia-free survival. Microcytosis in PMF may be related to dysregulation of iron homeostasis.
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Affiliation(s)
- Paolo Strati
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Zeev Estrov
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Marylou Cardenas-Turanzas
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sherry Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kate J Newberry
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Naval Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jorge Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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17
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Abstract
Although most circulating iron in blood plasma is destined for erythropoiesis, the mechanisms by which erythropoietic demand modulates the iron supply ("erythroid regulators") remain largely unknown. Iron absorption, plasma iron concentrations, and tissue iron distribution are tightly controlled by the liver-produced hormone hepcidin. During the last decade, much progress has been made in elucidating hepcidin regulation by iron and inflammation. This review discusses the less understood mechanisms and mediators of hepcidin suppression in physiologically and pathologically stimulated erythropoiesis.
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