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Liu X. Association between dietary inflammation index with anemia in Americans: a cross-sectional study with U.S. National health and nutrition examination survey. Hematology 2024; 29:2337567. [PMID: 38573235 DOI: 10.1080/16078454.2024.2337567] [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: 02/04/2024] [Accepted: 03/27/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVES Dietary inflammatory index (DII) is utilized to determine the inflammatory effects of nutrients and foods on various diseases. Inflammation is a potential risk factor for anemia. We hypothesize that pro-inflammatory diets boost the incidence of anemia, as indicated by high DII. METHODS 41, 360 Americans were included in this study from the U.S. National Health and Nutrition Survey (NHANES) from 2003-2018. Multivariable logistic regression models were employed to examine the association between DII and anemia. RESULTS After adjustment for all the covariates, the odds ratios (ORs) (95% CI) between the risk of anemia and DII across tertile 3 were 1.2556 (95% CI 1.0621, 1.4843; P = 0.0077), and the trend test was statistically significant (P for trend = 0.009). Furthermore, in the subgroup analysis stratified by gender. The ORs (95% CI) between the risk of anemia and DII across tertile 2 and 3 were 1.8071 (95% CI 1.1754, 2.7783; P = 0.0070) and 2.1591 (95% CI 1.4009, 3.3278; P = 0.0005) in men after multivariable adjustment. However, in women, this association was only significantly different (P < 0.05) across tertile 3 in the crude model. In the subgroup analysis stratified by race, this association was significant (P < 0.05) between the risk of anemia and DII for Non-Hispanic Whites/Blacks after adjustment. DISCUSSION Together, anemia was significantly associated with DII using logistic regression. In stratified analyses, higher DII scores were linked to an increased incidence of anemia in men, while no association was found in women after adjustment. Additionally, anemia may be associated with greater pro-inflammatory diets in Non-Hispanic Whites/Blacks. CONCLUSION In the present study, we evaluate the potential relationship between DII and anemia using data from NHANES. This cross-sectional study confirmed the hypothesis that the higher DII was significantly associated with a higher risk of anemia in the U.S. population.
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Affiliation(s)
- Xue Liu
- Department of Hematology, Zhengzhou Central Hospital Affiliated with Zhengzhou University, Zhengzhou, People's Republic of China
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Ingham AR, Kong CY, Wong TN, McSorley ST, McMillan DC, Nicholson GA, Alani A, Mansouri D, Chong D, MacKay GJ, Roxburgh CSD. Robotic-assisted surgery for left-sided colon and rectal resections is associated with reduction in the postoperative surgical stress response and improved short-term outcomes: a cohort study. Surg Endosc 2024; 38:2577-2592. [PMID: 38498212 PMCID: PMC11078791 DOI: 10.1007/s00464-024-10749-3] [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: 11/30/2023] [Accepted: 02/10/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION There is growing evidence that the use of robotic-assisted surgery (RAS) in colorectal cancer resections is associated with improved short-term outcomes when compared to laparoscopic surgery (LS) or open surgery (OS), possibly through a reduced systemic inflammatory response (SIR). Serum C-reactive protein (CRP) is a sensitive SIR biomarker and its utility in the early identification of post-operative complications has been validated in a variety of surgical procedures. There remains a paucity of studies characterising post-operative SIR in RAS. METHODS Retrospective study of a prospectively collected database of consecutive patients undergoing OS, LS and RAS for left-sided and rectal cancer in a single high-volume unit. Patient and disease characteristics, post-operative CRP levels, and clinical outcomes were reviewed, and their relationships explored within binary logistic regression and propensity scores matched models. RESULTS A total of 1031 patients were included (483 OS, 376 LS, and 172 RAS). RAS and LS were associated with lower CRP levels across the first 4 post-operative days (p < 0.001) as well as reduced complications and length of stay compared to OS in unadjusted analyses. In binary logistic regression models, RAS was independently associated with lower CRP levels at Day 3 post-operatively (OR 0.35, 95% CI 0.21-0.59, p < 0.001) and a reduction in the rate of all complications (OR 0.39, 95% CI 0.26-0.56, p < 0.001) and major complications (OR 0.5, 95% CI 0.26-0.95, p = 0.036). Within a propensity scores matched model comparing LS versus RAS specifically, RAS was associated with lower post-operative CRP levels in the first two post-operative days, a lower proportion of patients with a CRP ≥ 150 mg/L at Day 3 (20.9% versus 30.5%, p = 0.036) and a lower rate of all complications (34.7% versus 46.7%, p = 0.033). CONCLUSIONS The present observational study shows that an RAS approach was associated with lower postoperative SIR, and a better postoperative complications profile.
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Affiliation(s)
- Abigail R Ingham
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Chia Yew Kong
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Tin-Ning Wong
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Stephen T McSorley
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Donald C McMillan
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Gary A Nicholson
- Department of General Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Ahmed Alani
- Department of General Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - David Mansouri
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - David Chong
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Graham J MacKay
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Campbell S D Roxburgh
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK.
- Academic Unit of Surgery, School of Cancer Sciences, Room 2.60, Level 2 New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
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Kaur T, Upadhyay J, Nandave M, Alsayari A, Alshehri SA, Pukale S, Wahab S, Ahmad W, Rashid S, Ansari MN. Exploring progress in iron supplement formulation approaches for treating iron deficiency anemia through bibliometric and thematic analysis. Heliyon 2024; 10:e29058. [PMID: 38623202 PMCID: PMC11016621 DOI: 10.1016/j.heliyon.2024.e29058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/04/2024] [Accepted: 03/28/2024] [Indexed: 04/17/2024] Open
Abstract
Anemia is a severe health issue that affects around one-third of the global population. Therefore, the present study aims to conduct a bibliometric analysis to investigate the research trends regarding advancements on iron formulations in treating iron deficiency anemia via oral or parenteral route. This study adopts thematic and bibliometric methods on existing research on novel iron formulations. It also provides perspective into the existing understanding on treatment strategies for iron deficiency anemia. This study is conducted on 543 papers on various ferrous and ferric formulations used in the treatment of iron deficiency anemia. The study period is from 1977 to 2022, and the papers are identified from the Scopus database. The bibliometric analysis was carried out using the R tool's Bibliometrix package. The study discusses performance analysis, including annual publications, geographic analysis, relevant affiliations, journal analysis, and citation analysis. In addition, the conceptual structure, including the co-occurrence network, thematic map, thematic evolution, intellectual structure highlighting co-citation analysis, and social structure depicting the collaboration network and collaboration world map, are presented. The results showed increased research on formulation strategies for the treatment of iron deficiency anemia from 2010 onwards. The top 5 contributing countries are the USA, Italy, India, Germany, and the UK, and peer-reviewed journals from the area of nutrition. The most trending areas of study are iron deficiency anemia in pregnancy, chronic kidney diseases, inflammatory bowel diseases, and various intravenous formulations used in its treatment. The authors from Europe collaborate the most with authors from other countries. The study concludes that a safer and more effective iron formulation is needed to reduce the prevalence of anemia. The findings of the study are helpful in advancing research on innovative formulations for treating iron deficiency anemia. The insights from the study are helpful to policymakers in designing specific health policies and investing more in research and development of novel formulations for the treatment of iron deficiency anemia.
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Affiliation(s)
- Tarnjot Kaur
- Department of Pharmaceutical Sciences, School of Health Sciences and Technology, UPES, Bidholi Campus, Dehradun 248007, Uttarakhand, India
| | - Jyoti Upadhyay
- Department of Pharmaceutical Sciences, School of Health Sciences and Technology, UPES, Bidholi Campus, Dehradun 248007, Uttarakhand, India
| | - Mukesh Nandave
- Department of Pharmacology, Delhi Pharmaceutical Sciences and Research University New Delhi, 110017, India
| | - Abdulrhman Alsayari
- Department of Pharmacognosy, College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia
| | - Saad Ali Alshehri
- Department of Pharmacognosy, College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia
| | - Sudeep Pukale
- Lupin Research Park, Nande, Maharashtra 412115, India
| | - Shadma Wahab
- Department of Pharmacognosy, College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia
| | - Wasim Ahmad
- Department of Pharmacy, Mohammed Al-Mana College for Medical Sciences, Dammam 34222, Saudi Arabia
| | - Summya Rashid
- Department of Pharmacology & Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
| | - Mohd Nazam Ansari
- Department of Pharmacology & Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
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Das D, Banerjee A, Manna K, Sarkar D, Shil A, Sikdar Ne E Bhakta M, Mukherjee S, Maji BK. Quercetin counteracts monosodium glutamate to mitigate immunosuppression in the thymus and spleen via redox-guided cellular signaling. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 126:155226. [PMID: 38387276 DOI: 10.1016/j.phymed.2023.155226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/13/2023] [Accepted: 11/18/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Chronic inflammation brought on by oxidative stress can result in several immunopathologies. Natural compounds with antioxidant characteristics, like quercetin, have shown effectiveness in reducing oxidative damage and regulating the immune response. PURPOSE The commonly used food additive monosodium glutamate (M) causes immunosuppression by disrupting redox equilibrium and inducing oxidative stress. The goal of this work is to examine the therapeutic potential of quercetin against immunotoxicity brought on by M, revealing the molecular route implicated in such immunopathology by targeting the thymus and spleen, to support the development of future anti-inflammatory and antioxidant therapies. STUDY DESIGN AND METHODS M-fed rats were employed as an immunotoxicity model and were supplemented with quercetin for four weeks. Hematological and biochemical parameters were measured; H&E staining, immunohistochemistry, flow cytometry, real-time quantitative PCR, and western blotting were performed. RESULTS Based on the findings, TLR4 was activated by M to cause oxidative stress-mediated inflammation, which was alleviated by the supplementation of quercetin by modulating redox homeostasis to neutralize free radicals and suppress the inflammatory response. To prevent M-induced inflammation, quercetin demonstrated anti-inflammatory functions by blocking NF-kB activation, lowering the production of pro-inflammatory cytokines, and increasing the release of anti-inflammatory cytokines. By normalizing lipid profiles and lowering the potential risk of immunological deficiency caused by M, quercetin also improves lipid metabolism. Additionally, it has shown potential for modifying insulin levels, suggesting a possible function in controlling M-induced alteration in glucose metabolism. The addition of quercetin to M enhanced the immune response by improving immunoglobulin levels and CD4/CD8 expression in the thymus and spleen. Additionally, quercetin inhibited apoptosis by controlling mitochondrial caspase-mediated cellular signaling, suggesting that it may be able to halt cell death in M-fed rats. CONCLUSION The results of this study first indicate that quercetin, via modulating redox-guided cellular signaling, has a promising role in reducing immune disturbances. This study illuminates the potential of quercetin as a safe, natural remedy for immunopathology caused by M, including thymic hypoplasia and/or splenomegaly, and paves the way for future anti-inflammatory and antioxidant supplements.
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Affiliation(s)
- Debasmita Das
- Department of Physiology (UG & PG), Serampore College, 9 William Carey Road, Serampore, Hooghly-712201, West Bengal, India
| | - Arnab Banerjee
- Department of Physiology (UG & PG), Serampore College, 9 William Carey Road, Serampore, Hooghly-712201, West Bengal, India
| | - Krishnendu Manna
- Department of Food & Nutrition, University of Kalyani, Kalyani, Nadia, West Bengal, India
| | - Deotima Sarkar
- Department of Bacteriology, National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research (ICMR-NICED), Kolkata 700010, India
| | - Aparna Shil
- Microbiology, Nutrition and Dietetics Laboratory, Physiology Unit, Department of Life Sciences, Presidency University, Kolkata-700073, India
| | - Mausumi Sikdar Ne E Bhakta
- Microbiology, Nutrition and Dietetics Laboratory, Physiology Unit, Department of Life Sciences, Presidency University, Kolkata-700073, India
| | - Sandip Mukherjee
- Department of Physiology (UG & PG), Serampore College, 9 William Carey Road, Serampore, Hooghly-712201, West Bengal, India
| | - Bithin Kumar Maji
- Department of Physiology (UG & PG), Serampore College, 9 William Carey Road, Serampore, Hooghly-712201, West Bengal, India.
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Novikov N, Buch A, Yang H, Andruk M, Liu G, Wu M, Howell H, MacDonald B, Savage W. First-in-Human Phase 1 Study Evaluating the Safety, Pharmacokinetics, and Pharmacodynamics of DISC-0974, an Anti-Hemojuvelin Antibody, in Healthy Participants. J Clin Pharmacol 2024. [PMID: 38515275 DOI: 10.1002/jcph.2432] [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: 12/06/2023] [Accepted: 02/27/2024] [Indexed: 03/23/2024]
Abstract
Pathologic elevations in hepcidin, a key regulator of iron homeostasis, contribute to anemia of inflammation in chronic disease. DISC-0974 is a monoclonal antibody that binds to hemojuvelin and blocks bone morphogenetic protein signaling, thereby suppressing hepcidin production. Reduction of systemic hepcidin levels is predicted to increase iron absorption and mobilize stored iron into circulation, where it may be utilized by red blood cell (RBC) precursors in the bone marrow to improve hemoglobin levels and to potentially alleviate anemia of inflammation. We conducted a first-in-human, double-blind, placebo-controlled, single-ascending dose study to evaluate safety, pharmacokinetics, and pharmacodynamics of DISC-0974 in healthy participants. Overall, 42 participants were enrolled and received a single dose of placebo or DISC-0974 at escalating dose levels (7-56 mg), administered intravenously (IV) or subcutaneously (SC). DISC-0974 was well tolerated, with a safety profile comparable to that of placebo. Pharmacokinetic data was dose and route related, with a terminal half-life of approximately 7 days. The bioavailability of SC dosing was ∼50%. Pharmacodynamic data showed dose-dependent decreases in serum hepcidin, with reductions of nearly 75% relative to baseline at the highest dose level tested, and corresponding increases in serum iron in response to DISC-0974 administration. Dose-dependent changes in serum ferritin and hematology parameters were also observed, indicating mobilization of iron stores and downstream effects of enhanced hemoglobinization and production of RBCs. Altogether, these data are consistent with the mechanism of action of DISC-0974 and support the selection of a biologically active dose range for evaluation in clinical trials for individuals with anemia of inflammation.
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Affiliation(s)
| | - Akshay Buch
- Disc Medicine, Watertown, Massachusetts, USA
| | - Hua Yang
- Disc Medicine, Watertown, Massachusetts, USA
| | | | - Guowen Liu
- Disc Medicine, Watertown, Massachusetts, USA
| | - Min Wu
- Disc Medicine, Watertown, Massachusetts, USA
| | | | | | - Will Savage
- Disc Medicine, Watertown, Massachusetts, USA
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6
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Marques O, Muckenthaler MU. Alterations of iron homeostasis as a potential druggable driver of long COVID. Nat Immunol 2024; 25:387-389. [PMID: 38429459 DOI: 10.1038/s41590-024-01759-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
- Oriana Marques
- Department of Pediatric Oncology, Hematology and Immunology and Hopp Children Cancer Center (KiTZ), University Hospital Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit (MMPU), EMBL and University of Heidelberg, Heidelberg, Germany
| | - Martina U Muckenthaler
- Department of Pediatric Oncology, Hematology and Immunology and Hopp Children Cancer Center (KiTZ), University Hospital Heidelberg, Heidelberg, Germany.
- Molecular Medicine Partnership Unit (MMPU), EMBL and University of Heidelberg, Heidelberg, Germany.
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.
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7
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Yu Y, Su Y, Yang S, Liu Y, Lin Z, Das NK, Wu Q, Zhou J, Sun S, Li X, Yue W, Shah YM, Min J, Wang F. Activation of Intestinal HIF2α Ameliorates Iron-Refractory Anemia. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307022. [PMID: 38243847 DOI: 10.1002/advs.202307022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/06/2023] [Indexed: 01/22/2024]
Abstract
In clinics, hepcidin levels are elevated in various anemia-related conditions, particularly in iron-refractory anemia and in high inflammatory states that suppress iron absorption, which remains an urgent unmet medical need. To identify effective treatment options for various types of iron-refractory anemia, the potential effect of hypoxia and pharmacologically-mimetic drug FG-4592 (Roxadustat) are evaluated, a hypoxia-inducible factor (HIF)-prolyl hydroxylase (PHD) inhibitor, on mouse models of iron-refractory iron-deficiency anemia (IRIDA), anemia of inflammation and 5-fluorouracil-induced chemotherapy-related anemia. The potent protective effects of both hypoxia and FG-4592 on IRIDA as well as other 2 tested mouse cohorts are found. Mechanistically, it is demonstrated that hypoxia or FG-4592 could stabilize duodenal Hif2α, leading to the activation of Fpn transcription regardless of hepcidin levels, which in turn results in increased intestinal iron absorption and the amelioration of hepcidin-activated anemias. Moreover, duodenal Hif2α overexpression fully rescues phenotypes of Tmprss6 knockout mice, and Hif2α knockout in the gut significantly delays the recovery from 5-fluorouracil-induced anemia, which can not be rescued by FG-4592 treatment. Taken together, the findings of this study provide compelling evidence that targeting intestinal hypoxia-related pathways can serve as a potential therapeutic strategy for treating a broad spectrum of anemia, especially iron refractory anemia.
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Affiliation(s)
- Yingying Yu
- The First Affiliated Hospital, The Second Affiliated Hospital, Institute of Translational Medicine, School of Public Health, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou, 310058, China
- The First Affiliated Hospital, Basic Medical Sciences, School of Public Health, Hengyang Medical School, University of South China, Hengyang, 421001, China
| | - Yunxing Su
- The First Affiliated Hospital, The Second Affiliated Hospital, Institute of Translational Medicine, School of Public Health, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Sisi Yang
- The First Affiliated Hospital, The Second Affiliated Hospital, Institute of Translational Medicine, School of Public Health, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Yutong Liu
- The First Affiliated Hospital, The Second Affiliated Hospital, Institute of Translational Medicine, School of Public Health, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Zhiting Lin
- The First Affiliated Hospital, Basic Medical Sciences, School of Public Health, Hengyang Medical School, University of South China, Hengyang, 421001, China
| | - Nupur K Das
- Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Qian Wu
- International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jiahui Zhou
- The First Affiliated Hospital, The Second Affiliated Hospital, Institute of Translational Medicine, School of Public Health, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Shumin Sun
- The First Affiliated Hospital, The Second Affiliated Hospital, Institute of Translational Medicine, School of Public Health, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Xiaopeng Li
- The First Affiliated Hospital, The Second Affiliated Hospital, Institute of Translational Medicine, School of Public Health, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Wuyang Yue
- The First Affiliated Hospital, The Second Affiliated Hospital, Institute of Translational Medicine, School of Public Health, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Yatrik M Shah
- Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Junxia Min
- The First Affiliated Hospital, The Second Affiliated Hospital, Institute of Translational Medicine, School of Public Health, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Fudi Wang
- The First Affiliated Hospital, The Second Affiliated Hospital, Institute of Translational Medicine, School of Public Health, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou, 310058, China
- The First Affiliated Hospital, Basic Medical Sciences, School of Public Health, Hengyang Medical School, University of South China, Hengyang, 421001, China
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8
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Bogdanova A, Kaestner L. Advances in Red Blood Cells Research. Cells 2024; 13:359. [PMID: 38391972 PMCID: PMC10887574 DOI: 10.3390/cells13040359] [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: 01/27/2024] [Accepted: 02/11/2024] [Indexed: 02/24/2024] Open
Abstract
This Editorial 'Advances in Red Blood Cell Research' is the preface for the special issue with the same title which files 14 contributions listed in Table 1 [...].
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Affiliation(s)
- Anna Bogdanova
- Red Blood Cell Group, Institute of Veterinary Physiology, University of Zurich, 8057 Zurich, Switzerland
| | - Lars Kaestner
- Theoretical Medicine and Biosciences, Campus of Saarland University Hospital, Saarland University, 66424 Homburg, Germany
- Dynamics of Fluids, Experimental Physics, Saarland University, 66123 Saarbrücken, Germany
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9
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Signorini C, Saso L, Ghareghomi S, Telkoparan-Akillilar P, Collodel G, Moretti E. Redox Homeostasis and Nrf2-Regulated Mechanisms Are Relevant to Male Infertility. Antioxidants (Basel) 2024; 13:193. [PMID: 38397791 PMCID: PMC10886271 DOI: 10.3390/antiox13020193] [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: 12/29/2023] [Revised: 01/20/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Infertility represents a significant global health challenge, affecting more than 12% of couples worldwide, and most cases of infertility are caused by male factors. Several pathological pathways are implicated in male infertility. The main mechanisms involved are driven by the loss of reduction-oxidation (redox) homeostasis and the resulting oxidative damage as well as the chronic inflammatory process. Increased or severe oxidative stress leads to sperm plasma membrane and DNA oxidative damage, dysregulated RNA processing, and telomere destruction. The signaling pathways of these molecular events are also regulated by Nuclear factor-E2-related factor 2 (Nrf2). The causes of male infertility, the role of oxidative stress in male infertility and the Keap1-Nrf2 antioxidant pathway are reviewed. This review highlights the regulatory role of Nrf2 in the balance between oxidants and antioxidants as relevant mechanisms to male fertility. Nrf2 is involved in the regulation of spermatogenesis and sperm quality. Establishing a link between Nrf2 signaling pathways and the regulation of male fertility provides the basis for molecular modulation of inflammatory processes, reactive oxygen species generation, and the antioxidant molecular network, including the Nrf2-regulated antioxidant response, to improve male reproductive outcomes.
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Affiliation(s)
- Cinzia Signorini
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (C.S.); (G.C.); (E.M.)
| | - Luciano Saso
- Department of Physiology and Pharmacology “Vittorio Erspamer”, Sapienza University of Rome, 00185 Rome, Italy
| | - Somayyeh Ghareghomi
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran 1417466191, Iran;
| | | | - Giulia Collodel
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (C.S.); (G.C.); (E.M.)
| | - Elena Moretti
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (C.S.); (G.C.); (E.M.)
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10
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Ma H, Deng W, Chen H, Ding X. Association between dietary inflammatory index and anemia in US adults. Front Nutr 2024; 10:1310345. [PMID: 38268667 PMCID: PMC10805879 DOI: 10.3389/fnut.2023.1310345] [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: 10/09/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024] Open
Abstract
Background and aims Anemia is a widespread global health concern, and recent research has unveiled a link between anemia and inflammation. The Dietary Inflammation Index (DII) is a novel tool used to assess the overall inflammatory potential of an individual's diet. However, until now, there have been no studies demonstrating a connection between DII and anemia. This study aimed to explore the relationship between DII and the risk of anemia among Americans, as well as to examine the influence of other risk factors on this association. Methods Data from 32,244 patients were collected from the National Health and Nutrition Examination Survey (NHANES) database spanning from 1999 to 2018. Using multivariable logistic regression, we examined the correlation between DII and anemia. Subgroup analyses and smoothed curve analyses were conducted to further investigate the association between DII and anemia. Results The analysis revealed a significant positive association between higher DII scores and increased anemia risk in the American population (Odds Ratio [OR] = 1.06, 95% Confidence Interval [CI] = 1.03 to 1.09, p < 0.0001). This association remained consistent in subgroup analyses, encompassing various age groups, distinct Body Mass Index (BMI) categories, varying diabetes mellitus statuses, histories of hypertension, females, individuals with a RIP <3.5, and Non-Hispanic Black individuals. Notably, the association was particularly significant among non-smokers. Smoothed curve fitting analysis demonstrated a linear relationship between DII and the prevalence of anemia. Conclusion Our findings underscore a positive correlation between the inflammatory potential of one's diet and the risk of anemia, especially when coupled with other risk factors. Consequently, reducing the consumption of pro-inflammatory foods may serve as one of the effective measures against the development of anemia. Given the variations in gender, age, BMI, and chronic diseases observed in our study, tailored policies could better cater to the specific needs of diverse populations.
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Affiliation(s)
- Huimiao Ma
- Department of Hematology, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Wenqi Deng
- Beijing University of Chinese Medicine, Beijing, China
| | - Haiyan Chen
- Department of Hematology, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoqing Ding
- Department of Hematology, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
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11
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Zhou C, Ma H, Wang G, Liu Y, Li B, Niu J, Zhao Y, Wang G. Association between different types of preoperative anemia and tumor characteristics, systemic inflammation, and survival in colorectal cancer. PeerJ 2023; 11:e16293. [PMID: 38144195 PMCID: PMC10749087 DOI: 10.7717/peerj.16293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/22/2023] [Indexed: 12/26/2023] Open
Abstract
Background Patients with colorectal cancer often have anemia and other symptoms after diagnosis, especially in patients with advanced colorectal cancer. This study explored the association between different types of preoperative anemia and tumor characteristics and inflammatory response in patients with colorectal cancer and to evaluate the prognosis of patients with different types of anemia before operation. Methods The clinical data of 95 patients with colorectal cancer treated in the Fourth Hospital of Hebei Medical University from February 2016 to January 2018 were retrospectively analyzed. According to the hemoglobin concentration (Hb), mean corpuscular volume (MCV), mean hemoglobin content (MCH) and mean hemoglobin concentration (MCHC), the patients were divided into the non-anemia group, normal cell anemia group, and small cell anemia group. The three groups' general data, oncological characteristics, and mGPS scores were compared. The patients were followed up for five years, and the survival analysis was carried out. The cox proportional hazard regression model was used to analyze the prognostic factors of patients with colorectal cancer. Results The preoperative anemia rate of patients with colorectal cancer was 43.15% (41/95). There were significant differences in gender, weight loss, CA724, tumor location, tumor size, TNM stage, mGPS score, and positive expression rate of Ki-67 among different anemia groups. There was a significant difference in survival time among a non-anemia group, small cell anemia group, and normal cell anemia group (P < 0.05). Multivariate analysis showed that tumor size, TNM stage, distant metastasis, mGPS score, Ki-67 positive expression rate, and anemia type were independent risk factors affecting the prognosis of colorectal cancer patients (P < 0.05). Conclusion The oncological characteristics of colorectal cancer patients with different types of preoperative anemia are different. Preoperative anemia and systemic inflammatory status are independent risk factors for the prognosis of colorectal cancer patients.
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Affiliation(s)
- Chaoxi Zhou
- Second Department of General Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongqing Ma
- Second Department of General Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guanglin Wang
- Second Department of General Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Youqiang Liu
- Second Department of General Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Baokun Li
- Second Department of General Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jian Niu
- Second Department of General Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yang Zhao
- Department of Research, Fourth Hospital of Hebei Medical University, Hebei, China
| | - Guiying Wang
- Department of General Surgery, Second Hospital of Hebei Medical University, Shijiazhuang, China
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12
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Kaserer A, David Mazer C, Braun J, Spahn DR. Achieving a preoperative haemoglobin above 130 g L -1 may be more important in female than in male patients before cardiac surgery. Br J Anaesth 2023; 131:636-638. [PMID: 37718093 DOI: 10.1016/j.bja.2023.06.058] [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: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 09/19/2023] Open
Abstract
Sex-specific preoperative haemoglobin levels and the need for perioperative red cell transfusion in men and women are still debated. Cavalli and colleagues examined the appropriateness of World Health Organization (WHO) anaemia thresholds (haemoglobin <130 g L-1 for males and <120 g L-1 for females) in a retrospective cohort analysis of >6000 adult patients undergoing cardiac surgery with cardiopulmonary bypass. The authors concluded that the WHO anaemia threshold disproportionately disadvantages female cardiac surgery patients, and a preoperative haemoglobin level of at least 130 g L-1 should be targeted in all cardiac surgical patients regardless of sex.
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Affiliation(s)
- Alexander Kaserer
- Institute of Anaesthesiology, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - C David Mazer
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Julia Braun
- Department of Epidemiology, University of Zurich, Zurich, Switzerland; Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anaesthesiology, University of Zurich and University Hospital of Zurich, Zurich, Switzerland.
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13
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Vinchi F, Asperti M, Marques O, Nai A, Silvestri L. Flavor of Iron at EHA2023: Novel Regulatory Mechanisms and Therapeutic Options for the Correction of Anemia. Hemasphere 2023; 7:e955. [PMID: 37799346 PMCID: PMC10550016 DOI: 10.1097/hs9.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Affiliation(s)
- Francesca Vinchi
- Iron Research Program, Lindsley Kimball Research Institute, New York Blood Center, New York City, NY, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York City, NY, USA
| | - Michela Asperti
- Department of Molecular and Translational Medicine, University of Brescia, Italy
| | - Oriana Marques
- Department of Pediatric Oncology, Hematology and Immunology and Hopp Children Cancer Center, University Hospital Heidelberg, Germany
- Molecular Medicine Partnership Unit, European Molecular Biology Laboratory (EMBL) and University of Heidelberg, Germany
| | - Antonella Nai
- Regulation of Iron Metabolism Unit, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Silvestri
- Regulation of Iron Metabolism Unit, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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14
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Walter S, Mertens C, Muckenthaler MU, Ott C. Cardiac iron metabolism during aging - Role of inflammation and proteolysis. Mech Ageing Dev 2023; 215:111869. [PMID: 37678569 DOI: 10.1016/j.mad.2023.111869] [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: 07/26/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/09/2023]
Abstract
Iron is the most abundant trace element in the human body. Since iron can switch between its 2-valent and 3-valent form it is essential in various physiological processes such as energy production, proliferation or DNA synthesis. Especially high metabolic organs such as the heart rely on iron-associated iron-sulfur and heme proteins. However, due to switches in iron oxidation state, iron overload exhibits high toxicity through formation of reactive oxygen species, underlining the importance of balanced iron levels. Growing evidence demonstrates disturbance of this balance during aging. While age-associated cardiovascular diseases are often related to iron deficiency, in physiological aging cardiac iron accumulates. To understand these changes, we focused on inflammation and proteolysis, two hallmarks of aging, and their role in iron metabolism. Via the IL-6-hepcidin axis, inflammation and iron status are strongly connected often resulting in anemia accompanied by infiltration of macrophages. This tight connection between anemia and inflammation highlights the importance of the macrophage iron metabolism during inflammation. Age-related decrease in proteolytic activity additionally affects iron balance due to impaired degradation of iron metabolism proteins. Therefore, this review accentuates alterations in iron metabolism during aging with regards to inflammation and proteolysis to draw attention to their implications and associations.
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Affiliation(s)
- Sophia Walter
- German Institute of Human Nutrition Potsdam-Rehbruecke, Department of Molecular Toxicology, Nuthetal, Germany; TraceAge-DFG Research Unit on Interactions of Essential Trace Elements in Healthy and Diseased Elderly, Potsdam-Berlin-Jena, Wuppertal, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Christina Mertens
- Center for Translational Biomedical Iron Research, Department of Pediatric Oncology, Immunology, and Hematology, University of Heidelberg, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), Heidelberg, Mannheim, Germany
| | - Martina U Muckenthaler
- Center for Translational Biomedical Iron Research, Department of Pediatric Oncology, Immunology, and Hematology, University of Heidelberg, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), Heidelberg, Mannheim, Germany; Molecular Medicine Partnership Unit, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Christiane Ott
- German Institute of Human Nutrition Potsdam-Rehbruecke, Department of Molecular Toxicology, Nuthetal, Germany; TraceAge-DFG Research Unit on Interactions of Essential Trace Elements in Healthy and Diseased Elderly, Potsdam-Berlin-Jena, Wuppertal, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.
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15
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Carson JL, Brittenham GM. How I treat anemia with red blood cell transfusion and iron. Blood 2023; 142:777-785. [PMID: 36315909 PMCID: PMC10485845 DOI: 10.1182/blood.2022018521] [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: 09/26/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
Severe anemia is commonly treated with red blood cell transfusion. Clinical trials have demonstrated that a restrictive transfusion strategy of 7 to 8 g/dL is as safe as a liberal transfusion strategy of 9 to 10 g/dL in many clinical settings. Evidence is lacking for subgroups of patients, including those with preexisting coronary artery disease, acute myocardial infarction, congestive heart failure, and myelodysplastic neoplasms. We present 3 clinical vignettes that highlight the clinical challenges in caring for patients with coronary artery disease with gastrointestinal bleeding, congestive heart failure, or myelodysplastic neoplasms. We emphasize that transfusion practice should be guided by patient symptoms and preferences in conjunction with the patient's hemoglobin concentration. Along with the transfusion decision, evaluation and management of the etiology of the anemia is essential. Iron-restricted erythropoiesis is a common cause of anemia severe enough to be considered for red blood cell transfusion but diagnosis and management of absolute iron deficiency anemia, the anemia of inflammation with functional iron deficiency, or their combination may be problematic. Intravenous iron therapy is generally the treatment of choice for absolute iron deficiency in patients with complex medical disorders, with or without coexisting functional iron deficiency.
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Affiliation(s)
- Jeffrey L. Carson
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Gary M. Brittenham
- Departments of Pediatrics and Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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16
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Kontoghiorghes GJ. Iron Load Toxicity in Medicine: From Molecular and Cellular Aspects to Clinical Implications. Int J Mol Sci 2023; 24:12928. [PMID: 37629109 PMCID: PMC10454416 DOI: 10.3390/ijms241612928] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Iron is essential for all organisms and cells. Diseases of iron imbalance affect billions of patients, including those with iron overload and other forms of iron toxicity. Excess iron load is an adverse prognostic factor for all diseases and can cause serious organ damage and fatalities following chronic red blood cell transfusions in patients of many conditions, including hemoglobinopathies, myelodyspasia, and hematopoietic stem cell transplantation. Similar toxicity of excess body iron load but at a slower rate of disease progression is found in idiopathic haemochromatosis patients. Excess iron deposition in different regions of the brain with suspected toxicity has been identified by MRI T2* and similar methods in many neurodegenerative diseases, including Alzheimer's disease and Parkinson's disease. Based on its role as the major biological catalyst of free radical reactions and the Fenton reaction, iron has also been implicated in all diseases associated with free radical pathology and tissue damage. Furthermore, the recent discovery of ferroptosis, which is a cell death program based on free radical generation by iron and cell membrane lipid oxidation, sparked thousands of investigations and the association of iron with cardiac, kidney, liver, and many other diseases, including cancer and infections. The toxicity implications of iron in a labile, non-protein bound form and its complexes with dietary molecules such as vitamin C and drugs such as doxorubicin and other xenobiotic molecules in relation to carcinogenesis and other forms of toxicity are also discussed. In each case and form of iron toxicity, the mechanistic insights, diagnostic criteria, and molecular interactions are essential for the design of new and effective therapeutic interventions and of future targeted therapeutic strategies. In particular, this approach has been successful for the treatment of most iron loading conditions and especially for the transition of thalassemia from a fatal to a chronic disease due to new therapeutic protocols resulting in the complete elimination of iron overload and of iron toxicity.
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Affiliation(s)
- George J Kontoghiorghes
- Postgraduate Research Institute of Science, Technology, Environment and Medicine, 3, Ammochostou Street, Limassol 3021, Cyprus
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17
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Cheng CY, Hsu TH, Yang YL, Huang YH. Hemoglobin and Its Z Score Reference Intervals in Febrile Children: A Cohort Study of 98,572 Febrile Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1402. [PMID: 37628401 PMCID: PMC10453815 DOI: 10.3390/children10081402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVES Febrile disease and age of children were associated with a variation in hemoglobin (Hb) level. Both CRP and Hb serve as laboratory markers that offer valuable insights into a patient's health, particularly in relation to inflammation and specific medical conditions. Although a direct correlation between CRP and Hb levels is not established, the relationship between these markers has garnered academic attention and investigation. This study aimed to determine updated reference ranges for Hb levels for age and investigated its correlation with CRP in febrile children under the age of 18. METHODS This is a cohort study of in Chang Gung Memorial Hospitals conducted from January 2010 to December 2019. Blood samples were collected from 98,572 febrile children who were or had been admitted in the pediatric emergency department. The parameters of individuals were presented as the mean ± standard deviation or 2.5th and 97.5th percentiles. We also determined the variation of Hb and Z score of Hb between CRP levels in febrile children. RESULT We observed that the Hb levels were the highest immediately after birth and subsequently underwent a rapid decline, reaching their lowest point at around 1-2 months of age, and followed by a steady increment in Hb levels throughout childhood and adolescence. In addition, there was a significant and wide variation in Hb levels during the infant period. It revealed a significant association between higher CRP levels and lower Hb levels or a more negative Z score of Hb across all age subgroups. Moreover, in patients with bacteremia, CRP levels were higher, Hb concentrations were lower, and Z scores of Hb were also lower compared to the non-bacteremia group. Furthermore, the bacteremia group exhibited a more substantial negative correlation between CRP levels and a Z score of Hb (r = -0.41, p < 0.001) compared to the non-bacteremia group (r = -0.115, p < 0.049). CONCLUSION The study findings revealed that the Hb references varied depending on the age of the children and their CRP levels. In addition, we established new reference values for Hb and its Z scores and explore their relationship with CRP. It provides valuable insights into the Hb status and its potential association with inflammation in febrile pediatric patients.
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Affiliation(s)
- Chu-Yin Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Ting-Hsuan Hsu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Ya-Ling Yang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 333, Taiwan
| | - Ying-Hsien Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 333, Taiwan
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18
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Levinson T, Feigin E, Berliner S, Shenhar-Tsarfaty S, Shapira I, Rogowski O, Zeltzer D, Goldiner I, Shtark M, Katz Shalhav M, Wasserman A. Normoferremia in Patients with Acute Bacterial Infections-A Hitherto Unexplored Field of the Dichotomy between CRP and Ferritin Expression in Patients with Hyper Inflammation and Failure to Increase Ferritin. Int J Mol Sci 2023; 24:11350. [PMID: 37511109 PMCID: PMC10379163 DOI: 10.3390/ijms241411350] [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: 06/08/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Ferritin is an acute phase response protein, which may not rise as expected in acute bacterial infections. This could be due to the time required for its production or to a lack of response of ferritin to the bacterial inflammatory process. Medical records of hospitalized patients with acute hyper inflammation were retrieved and studied, looking closely at two acute phase proteins: C-reactive protein (CRP) and ferritin. The estimated time between symptom onset and the procurement of blood tests was also measured. 225 patients had a median ferritin level of 109.9 ng/mL [IQR 85.1, 131.7] and a median CRP level of 248.4 mg/L [IQR 221, 277.5]. An infectious inflammatory process was identified in 195 patients. Ferritin levels were relatively low in comparison with the CRP in each group, divided according to time from symptom onset until the procurement of blood tests. The discrepancy between high CRP and low ferritin suggests that these two acute phase response proteins utilize different pathways, resulting in a failure to increase ferritin concentrations in a documented state of hyperinflammation. A new entity of normoferremic inflammation accounts for a significant percentage of patients with acute bacterial infections, which enables bacteria to better survive the inflammation and serves as a new "inflammatory stamp".
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Affiliation(s)
- Tal Levinson
- Infectious Diseases Unit, Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv 6423906, Israel
- Departments of Internal Medicine C, D and E, Tel Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Eugene Feigin
- Departments of Internal Medicine C, D and E, Tel Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Department of Endocrinology, Tel Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Shlomo Berliner
- Departments of Internal Medicine C, D and E, Tel Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Shani Shenhar-Tsarfaty
- Departments of Internal Medicine C, D and E, Tel Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Itzhak Shapira
- Departments of Internal Medicine C, D and E, Tel Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Ori Rogowski
- Departments of Internal Medicine C, D and E, Tel Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - David Zeltzer
- Department of Emergency Medicine, Tel-Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Ilana Goldiner
- Clinical Laboratory Services, Tel Aviv Sourasky Medical Center, Tel Aviv, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Moshe Shtark
- Clinical Laboratory Services, Tel Aviv Sourasky Medical Center, Tel Aviv, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Malka Katz Shalhav
- Department of Emergency Medicine, Tel-Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Asaf Wasserman
- Departments of Internal Medicine C, D and E, Tel Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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19
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Nordsborg NB, Bonne TC, Breenfeldt Andersen A, Sørensen H, Bejder J. Glucocorticoids Accelerate Erythropoiesis in Healthy Humans-Should the Use in Sports Be Reevaluated? Med Sci Sports Exerc 2023; 55:1334-1341. [PMID: 36878016 DOI: 10.1249/mss.0000000000003156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
PURPOSE The World Anti-Doping Agency prohibits glucocorticoid administration in competition but not in periods out of competition. Glucocorticoid usage is controversial as it may improve performance, albeit debated. A hitherto undescribed but performance-relevant effect of glucocorticoids in healthy humans is accelerated erythropoiesis. We investigated whether a glucocorticoid injection accelerates erythropoiesis, increases total hemoglobin mass, and improves exercise performance. METHODS In a counterbalanced, randomized, double-blinded, placebo-controlled crossover design (3 months washout), 10 well-trained males (peak oxygen uptake, 60 ± 3 mL O 2 ·min -1 ·kg -1 ) were injected with 40 mg triamcinolone acetonide (glucocorticoid group) or saline (placebo group) in the gluteal muscles. Venous blood samples collected before and 7-10 h, 1, 3, 7, 14, and 21 d after treatment were analyzed for hemoglobin concentration and reticulocyte percentage. Hemoglobin mass and mean power output in a 450-kcal time trial were measured before as well as 1 and 3 wk after treatment. RESULTS A higher reticulocyte percentage was evident 3 d (19% ± 30%, P < 0.05) and 7 d (48% ± 38%, P < 0.001) after glucocorticoid administration, compared with placebo, whereas hemoglobin concentration was similar between groups. Additionally, hemoglobin mass was higher ( P < 0.05) 7 d (glucocorticoid, 886 ± 104 g; placebo, 872 ± 103 g) and 21 d (glucocorticoid, 879 ± 111 g; placebo, 866 ± 103 g) after glucocorticoid administration compared with placebo. Mean power output was similar between groups 7 d (glucocorticoid, 278 ± 64 W; placebo, 275 ± 62 W) and 21 d (glucocorticoid, 274 ± 62 W; placebo, 275 ± 60 W) after treatment. CONCLUSIONS Intramuscular injection of 40 mg triamcinolone acetonide accelerates erythropoiesis and increases hemoglobin mass but does not improve aerobic exercise performance in the present study. The results are important for sport physicians administering glucocorticoids and prompt a reconsideration of glucocorticoid usage in sport.
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Affiliation(s)
| | - Thomas Christian Bonne
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | | | - Henrik Sørensen
- Department of Anesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, DENMARK
| | - Jacob Bejder
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
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20
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Rozental O, Cushing MM, Shander A, Isbister JP, Lasocki S, Meybohm P, Muñoz M, Spahn DR, Weiniger CF, Trentino KM, Girardi NI. Penny-wise and pound-foolish: the challenges of preoperative anaemia management. Br J Anaesth 2023:S0007-0912(23)00231-3. [PMID: 37244835 DOI: 10.1016/j.bja.2023.04.038] [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: 02/04/2023] [Revised: 04/15/2023] [Accepted: 04/20/2023] [Indexed: 05/29/2023] Open
Abstract
The timely correction of anaemia before major surgery is important for optimising perioperative patient outcomes. However, multiple barriers have precluded the global expansion of preoperative anaemia treatment programmes, including misconceptions about the true cost/benefit ratio for patient care and health system economics. Institutional investment and buy-in from stakeholders could lead to significant cost savings through avoided complications of anaemia and red blood cell transfusions, and through containment of direct and variable costs of blood bank laboratories. In some health systems, billing for iron infusions could generate revenue and promote growth of treatment programmes. The aim of this work is to galvanise integrated health systems worldwide to diagnose and treat anaemia before major surgery.
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Affiliation(s)
- Olga Rozental
- Department of Anesthesiology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Melissa M Cushing
- Department of Pathology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
| | - Aryeh Shander
- Department of Anesthesiology and Critical Care Medicine, TeamHealth, Englewood Health, Englewood, NJ, USA
| | - James P Isbister
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sigismond Lasocki
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire (CHU) Angers, Université d'Angers, Angers, France
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Manuel Muñoz
- Peri-operative Transfusion Medicine, Department of Surgical Specialties, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain
| | - Donat R Spahn
- Institute of Anesthesiology, University Hospital of Zurich, Zurich, Switzerland
| | - Carolyn F Weiniger
- Department of Anesthesia, Intensive Care and Pain, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kevin M Trentino
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Natalia I Girardi
- Department of Anesthesiology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
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21
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Hess SY, Owais A, Jefferds MED, Young MF, Cahill A, Rogers LM. Accelerating action to reduce anemia: Review of causes and risk factors and related data needs. Ann N Y Acad Sci 2023; 1523:11-23. [PMID: 36987993 PMCID: PMC10918744 DOI: 10.1111/nyas.14985] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Anemia is a major public health concern. Young children, menstruating adolescent girls and women, and pregnant women are among the most vulnerable. Anemia is the consequence of a wide range of causes, including biological, socioeconomic, and ecological risk factors. Primary causes include: iron deficiency; inherited red blood cell disorders; infections, such as soil-transmitted helminthiasis, schistosomiasis, and malaria; gynecological and obstetric conditions; and other chronic diseases that lead to blood loss, decreased erythropoiesis, or destruction of erythrocytes. The most vulnerable population groups in low- and middle-income countries are often at the greatest risk to suffer from several of these causes simultaneously as low socioeconomic status is linked with an increased risk of anemia through multiple pathways. Targeted and effective action is needed to prevent anemia. Understanding the causes and risk factors of anemia for different population subgroups within a country guides the design and implementation of effective strategies to prevent and treat anemia. A coordinated approach across various expert groups and programs could make the best use of existing data or could help to determine when newer and more relevant data may need to be collected, especially in countries with a high anemia burden and limited information on the etiology of anemia.
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Affiliation(s)
- Sonja Y. Hess
- Institute for Global Nutrition and Department of Nutrition, University of California Davis, Davis, California, USA
- Micronutrient Forum, Washington, DC, USA
| | - Aatekah Owais
- Centre for Global Child Health, Hospital for Sick Children on behalf of Exemplars in Global Health, Toronto, Ontario, Canada
| | | | - Melissa F. Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Andrew Cahill
- Gates Ventures on behalf of Exemplars in Global Health, Seattle, Washington, USA
| | - Lisa M. Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
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22
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Theobald V, Grünig E, Benjamin N, Seyfarth H, Halank M, Schneider MA, Richtmann S, Kazdal D, Hinderhofer K, Xanthouli P, Egenlauf B, Harutyunova S, Hoeper MM, Jonigk D, Sparla R, Muckenthaler MU, Eichstaedt CA. Is iron deficiency caused by BMPR2 mutations or dysfunction in pulmonary arterial hypertension patients? Pulm Circ 2023; 13:e12242. [PMID: 37292089 PMCID: PMC10247310 DOI: 10.1002/pul2.12242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/26/2023] [Accepted: 05/16/2023] [Indexed: 06/10/2023] Open
Abstract
Iron deficiency is common in idiopathic and heritable pulmonary arterial hypertension patients (I/HPAH). A previous report suggested a dysregulation of the iron hormone hepcidin, which is controlled by BMP/SMAD signaling involving the bone morphogenetic protein receptor 2 (BMPR-II). Pathogenic variants in the BMPR2 gene are the most common cause of HPAH. Their effect on patients' hepcidin levels has not been investigated. The aim of this study was to assess whether iron metabolism and regulation of the iron regulatory hormone hepcidin was disturbed in I/HPAH patients with and without a pathogenic variant in the gene BMPR2 compared to healthy controls. In this explorative, cross-sectional study hepcidin serum levels were quantified by enzyme-linked immunosorbent assay. We measured iron status, inflammatory parameters and hepcidin modifying proteins such as IL6, erythropoietin, and BMP2, BMP6 in addition to BMPR-II protein and mRNA levels. Clinical routine parameters were correlated with hepcidin levels. In total 109 I/HPAH patients and controls, separated into three groups, 23 BMPR2 variant-carriers, 56 BMPR2 noncarriers and 30 healthy controls were enrolled. Of these, 84% had iron deficiency requiring iron supplementation. Hepcidin levels were not different between groups and corresponded to the degree of iron deficiency. The levels of IL6, erythropoietin, BMP2, or BMP6 showed no correlation with hepcidin expression. Hence, iron homeostasis and hepcidin regulation was largely independent from these parameters. I/HPAH patients had a physiologically normal iron regulation and no false elevation of hepcidin levels. Iron deficiency was prevalent albeit independent of pathogenic variants in the BMPR2 gene.
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Affiliation(s)
- Vivienne Theobald
- Center for Pulmonary HypertensionThoraxklinik Heidelberg gGmbH at Heidelberg University HospitalHeidelbergGermany
- Translational Lung Research Center Heidelberg (TLRC)German Center for Lung Research (DZL)HeidelbergGermany
| | - Ekkehard Grünig
- Center for Pulmonary HypertensionThoraxklinik Heidelberg gGmbH at Heidelberg University HospitalHeidelbergGermany
- Translational Lung Research Center Heidelberg (TLRC)German Center for Lung Research (DZL)HeidelbergGermany
| | - Nicola Benjamin
- Center for Pulmonary HypertensionThoraxklinik Heidelberg gGmbH at Heidelberg University HospitalHeidelbergGermany
- Translational Lung Research Center Heidelberg (TLRC)German Center for Lung Research (DZL)HeidelbergGermany
| | - Hans‐Jürgen Seyfarth
- Department of Pneumology, Medical Clinic IIUniversity Hospital of LeipzigLeipzigGermany
| | - Michael Halank
- Medical Clinic IUniversity Hospital of DresdenDresdenGermany
| | - Marc A. Schneider
- Translational Lung Research Center Heidelberg (TLRC)German Center for Lung Research (DZL)HeidelbergGermany
- Translational Research UnitThoraxklinik Heidelberg gGmbH at Heidelberg University HospitalHeidelbergGermany
| | - Sarah Richtmann
- Translational Lung Research Center Heidelberg (TLRC)German Center for Lung Research (DZL)HeidelbergGermany
- Translational Research UnitThoraxklinik Heidelberg gGmbH at Heidelberg University HospitalHeidelbergGermany
| | - Daniel Kazdal
- Translational Lung Research Center Heidelberg (TLRC)German Center for Lung Research (DZL)HeidelbergGermany
- Institute of PathologyHeidelberg University HospitalHeidelbergGermany
| | - Katrin Hinderhofer
- Laboratory for Molecular Diagnostics, Institute of Human GeneticsHeidelberg UniversityHeidelbergGermany
| | - Panagiota Xanthouli
- Center for Pulmonary HypertensionThoraxklinik Heidelberg gGmbH at Heidelberg University HospitalHeidelbergGermany
- Translational Lung Research Center Heidelberg (TLRC)German Center for Lung Research (DZL)HeidelbergGermany
| | - Benjamin Egenlauf
- Center for Pulmonary HypertensionThoraxklinik Heidelberg gGmbH at Heidelberg University HospitalHeidelbergGermany
- Translational Lung Research Center Heidelberg (TLRC)German Center for Lung Research (DZL)HeidelbergGermany
| | - Satenik Harutyunova
- Center for Pulmonary HypertensionThoraxklinik Heidelberg gGmbH at Heidelberg University HospitalHeidelbergGermany
- Translational Lung Research Center Heidelberg (TLRC)German Center for Lung Research (DZL)HeidelbergGermany
| | - Marius M. Hoeper
- Department of Pneumology, Hannover Medical School, Biomedical Research in End‐stage and Obstructive Lung Disease Hannover (BREATH)German Center for Lung Research (DZL)HannoverGermany
| | - Danny Jonigk
- Hannover Medical School, Institute for Pathology, German Center for Lung Research (DZL)Biomedical Research in End‐stage and Obstructive Lung Disease Hannover (BREATH)HannoverGermany
- Institute of PathologyRWTH Aachen University HospitalAachenGermany
| | - Richard Sparla
- Translational Lung Research Center Heidelberg (TLRC)German Center for Lung Research (DZL)HeidelbergGermany
- Centre for Translational Biomedical Iron Research, Hematology, Immunology and PulmonologyUniversity Hospital HeidelbergHeidelbergGermany
| | - Martina U. Muckenthaler
- Translational Lung Research Center Heidelberg (TLRC)German Center for Lung Research (DZL)HeidelbergGermany
- Centre for Translational Biomedical Iron Research, Hematology, Immunology and PulmonologyUniversity Hospital HeidelbergHeidelbergGermany
- German Centre for Cardiovascular Research (DZHK)Partner Site Heidelberg/MannheimHeidelbergGermany
| | - Christina A. Eichstaedt
- Center for Pulmonary HypertensionThoraxklinik Heidelberg gGmbH at Heidelberg University HospitalHeidelbergGermany
- Translational Lung Research Center Heidelberg (TLRC)German Center for Lung Research (DZL)HeidelbergGermany
- Laboratory for Molecular Diagnostics, Institute of Human GeneticsHeidelberg UniversityHeidelbergGermany
- German Centre for Cardiovascular Research (DZHK)Partner Site Heidelberg/MannheimHeidelbergGermany
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23
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Oriá RB, Freitas RS, Roque CR, Nascimento JCR, Silva AP, Malva JO, Guerrant RL, Vitek MP. ApoE Mimetic Peptides to Improve the Vicious Cycle of Malnutrition and Enteric Infections by Targeting the Intestinal and Blood-Brain Barriers. Pharmaceutics 2023; 15:pharmaceutics15041086. [PMID: 37111572 PMCID: PMC10141726 DOI: 10.3390/pharmaceutics15041086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Apolipoprotein E (apoE) mimetic peptides are engineered fragments of the native apoE protein’s LDL-receptor binding site that improve the outcomes following a brain injury and intestinal inflammation in a variety of models. The vicious cycle of enteric infections and malnutrition is closely related to environmental-driven enteric dysfunction early in life, and such chronic inflammatory conditions may blunt the developmental trajectories of children with worrisome and often irreversible physical and cognitive faltering. This window of time for microbiota maturation and brain plasticity is key to protecting cognitive domains, brain health, and achieving optimal/full developmental potential. This review summarizes the potential role of promising apoE mimetic peptides to improve the function of the gut-brain axis, including targeting the blood-brain barrier in children afflicted with malnutrition and enteric infections.
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Affiliation(s)
- Reinaldo B. Oriá
- Laboratory of Tissue Healing, Ontogeny and Nutrition, Department of Morphology, School of Medicine, Institute of Biomedicine, Federal University of Ceara, Fortaleza 60430-270, Brazil
- Correspondence: ; Tel.: +55-85-3366-8239
| | - Raul S. Freitas
- Laboratory of Tissue Healing, Ontogeny and Nutrition, Department of Morphology, School of Medicine, Institute of Biomedicine, Federal University of Ceara, Fortaleza 60430-270, Brazil
| | - Cássia R. Roque
- Laboratory of Tissue Healing, Ontogeny and Nutrition, Department of Morphology, School of Medicine, Institute of Biomedicine, Federal University of Ceara, Fortaleza 60430-270, Brazil
| | - José Carlos R. Nascimento
- Laboratory of Tissue Healing, Ontogeny and Nutrition, Department of Morphology, School of Medicine, Institute of Biomedicine, Federal University of Ceara, Fortaleza 60430-270, Brazil
- Institute of Health Sciences, Medicine, University of International Integration of Afro-Brazilian Lusofonia, Redenção 62790-970, Brazil
| | - Ana Paula Silva
- Institute of Pharmacology and Experimental Therapeutics and Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine and Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal
| | - João O. Malva
- Institute of Pharmacology and Experimental Therapeutics and Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine and Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal
| | - Richard L. Guerrant
- Division of Infectious Diseases and International Health, Department of Medicine, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | - Michael P. Vitek
- Division of Neurology, Duke University Medical Center, Durham, NC 27710, USA
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24
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Zhang Q, Wu WW, Li L, McDonald VM, Chen YC, Wang G, Gibson PG. Workup of difficult-to-treat asthma: implications from treatable traits. PRECISION CLINICAL MEDICINE 2023; 6:pbad003. [PMID: 36968614 PMCID: PMC10037422 DOI: 10.1093/pcmedi/pbad003] [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: 11/21/2022] [Accepted: 02/19/2023] [Indexed: 03/26/2023] Open
Abstract
Traditional stepwise approach usually adjusts the treatment regimen based on changes in asthma symptoms and severity to achieve good asthma control. However, due to the generalized heterogeneity and complexity of asthma, its therapeutic efficacy in difficult-to-treat asthma is limited. Recently, a precision medicine approach based on the identification and intervention of treatable traits of chronic airway disease has been proposed and appears to be of greater benefit to asthmatics. We reported a 71-year-old male with uncontrolled asthma and multiple exacerbations over the past year. He complained of persistent dyspnea despite high-dose of inhaled corticosteroids plus other controllers. Does this patient have some potential treatable traits contributing to difficult-to-treat asthma? Through a multidimensional assessment of three domains including pulmonary, extrapulmonary, and behavioral/risk factors, 15 treatable traits were identified in the patient, mainly including airflow limitation, eosinophilic airway inflammation, small airway dysfunction, exacerbation prone, dilated cardiomyopathy, diabetes mellitus, inhaler device polypharmacy, smoking, and the absence of an asthma action plan. After targeted treatment for these treatable traits, the patient experienced significant improvement in dyspnea and he could maintain good asthma control with low-dose inhaled corticosteroids and long-acting β2-agonist. This study shows that, in response to the limitation of a stepwise approach to therapy, treatable traits is a new strategy where patients are individually assessed for a specified set of treatable problems, and an individualized treatment program is developed and implemented based on this multidimensional assessment, especially for difficult-to-treat asthma.
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Affiliation(s)
| | | | - Lei Li
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu 610041, Sichuan, China
| | - Vanessa M McDonald
- Center of Excellence in Severe Asthma and Priority Research Center for Asthma and Respiratory Disease, the University of Newcastle, Newcastle 2308, Australia
- National Health and Medical Research Council Center for Research Excellence in Severe Asthma and Treatable Traits, the University of Newcastle, Newcastle 2308, Australia
| | - Yu Cheng Chen
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | | | - Peter G Gibson
- Center of Excellence in Severe Asthma and Priority Research Center for Asthma and Respiratory Disease, the University of Newcastle, Newcastle 2308, Australia
- National Health and Medical Research Council Center for Research Excellence in Severe Asthma and Treatable Traits, the University of Newcastle, Newcastle 2308, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle 2305, Australia
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