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Zeidan RS, Martenson M, Tamargo JA, McLaren C, Ezzati A, Lin Y, Yang JJ, Yoon HS, McElroy T, Collins JF, Leeuwenburgh C, Mankowski RT, Anton S. Iron homeostasis in older adults: balancing nutritional requirements and health risks. J Nutr Health Aging 2024; 28:100212. [PMID: 38489995 DOI: 10.1016/j.jnha.2024.100212] [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: 12/13/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
Iron plays a crucial role in many physiological processes, including oxygen transport, bioenergetics, and immune function. Iron is assimilated from food and also recycled from senescent red blood cells. Iron exists in two dietary forms: heme (animal based) and non-heme (mostly plant based). The body uses iron for metabolic purposes, and stores the excess mainly in splenic and hepatic macrophages. Physiologically, iron excretion in humans is inefficient and not highly regulated, so regulation of intestinal absorption maintains iron homeostasis. Iron losses occur at a steady rate via turnover of the intestinal epithelium, blood loss, and exfoliation of dead skin cells, but overall iron homeostasis is tightly controlled at cellular and systemic levels. Aging can have a profound impact on iron homeostasis and induce a dyshomeostasis where iron deficiency or overload (sometimes both simultaneously) can occur, potentially leading to several disorders and pathologies. To maintain physiologically balanced iron levels, reduce risk of disease, and promote healthy aging, it is advisable for older adults to follow recommended daily intake guidelines and periodically assess iron levels. Clinicians can evaluate body iron status using different techniques but selecting an assessment method primarily depends on the condition being examined. This review provides a comprehensive overview of the forms, sources, and metabolism of dietary iron, associated disorders of iron dyshomeostasis, assessment of iron levels in older adults, and nutritional guidelines and strategies to maintain iron balance in older adults.
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Affiliation(s)
- Rola S Zeidan
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Matthew Martenson
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Javier A Tamargo
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christian McLaren
- Department of Clinical and Health Psychology, College of Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Armin Ezzati
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan, KS, USA
| | - Yi Lin
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jae Jeong Yang
- UF Health Cancer Center, Gainesville, FL, USA; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Hyung-Suk Yoon
- UF Health Cancer Center, Gainesville, FL, USA; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Taylor McElroy
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - James F Collins
- Department of Food Science & Human Nutrition, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, USA
| | - Christiaan Leeuwenburgh
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Robert T Mankowski
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Stephen Anton
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Health and Health Professions, University of Florida, Gainesville, Florida, USA.
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Dentand AL, Schubert MG, Krayenbuehl PA. Current iron therapy in the light of regulation, intestinal microbiome, and toxicity: are we prescribing too much iron? Crit Rev Clin Lab Sci 2024:1-13. [PMID: 38606523 DOI: 10.1080/10408363.2024.2331477] [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: 09/29/2023] [Accepted: 03/13/2024] [Indexed: 04/13/2024]
Abstract
Iron deficiency is a widespread global health concern with varying prevalence rates across different regions. In developing countries, scarcity of food and chronic infections contribute to iron deficiency, while in industrialized nations, reduced food intake and dietary preferences affect iron status. Other causes that can lead to iron deficiency are conditions and diseases that result in reduced intestinal iron absorption and blood loss. In addition, iron absorption and its bioavailability are influenced by the composition of the diet. Individuals with increased iron needs, including infants, adolescents, and athletes, are particularly vulnerable to deficiency. Severe iron deficiency can lead to anemia with performance intolerance or shortness of breath. In addition, even without anemia, iron deficiency leads to mental and physical fatigue, which points to the fundamental biological importance of iron, especially in mitochondrial function and the respiratory chain. Standard oral iron supplementation often results in gastrointestinal side effects and poor compliance. Low-dose iron therapy seems to be a valid and reasonable therapeutic option due to reduced hepatic hepcidin formation, facilitating efficient iron resorption, replenishment of iron storage, and causing significantly fewer side effects. Elevated iron levels influence gut microbiota composition, favoring pathogenic bacteria and potentially disrupting metabolic and immune functions. Protective bacteria, such as bifidobacteria and lactobacilli, are particularly susceptible to increased iron levels. Dysbiosis resulting from iron supplementation may contribute to gastrointestinal disorders, inflammatory bowel disease, and metabolic disturbances. Furthermore, gut microbiota alterations have been linked to mental health issues. Future iron therapy should consider low-dose supplementation to mitigate adverse effects and the impact on the gut microbiome. A comprehensive understanding of the interplay between iron intake, gut microbiota, and human health is crucial for optimizing therapeutic approaches and minimizing potential risks associated with iron supplementation.
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Affiliation(s)
- Anaëlle L Dentand
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Zurich, Switzerland
| | - Morton G Schubert
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Zurich, Switzerland
| | - Pierre-Alexandre Krayenbuehl
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Zurich, Switzerland
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Shi Y, Li J, Cai S, Zhao H, Zhao H, Sun G, Yang Y. Proton pump inhibitors induced fungal dysbiosis in patients with gastroesophageal reflux disease. Front Cell Infect Microbiol 2023; 13:1205348. [PMID: 37662013 PMCID: PMC10469693 DOI: 10.3389/fcimb.2023.1205348] [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: 04/13/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Gut mycobiota inhabits human gastrointestinal lumen and plays a role in human health and disease. We investigated the influence of proton pump inhibitors (PPIs) on gastric mucosal and fecal mycobiota in patients with gastroesophageal reflux diseases (GERD) by using Internal Transcribed Spacer 1 sequencing. A total of 65 participants were included, consisting of the healthy control (HC) group, GERD patients who did not use PPIs (nt-GERD), and GERD patients who used PPIs, which were further divided into short-term (s-PPI) and long-term PPI user (l-PPI) groups based on the duration of PPI use. The alpha diversity and beta diversity of gastric mucosal mycobiota in GERD patients with PPI use were significantly different from HCs, but there were no differences between s-PPI and l-PPI groups. LEfSe analysis identified Candida at the genus level as a biomarker for the s-PPI group when compared to the nt-GERD group. Meanwhile, Candida, Nothojafnea, Rhizodermea, Ambispora, and Saccharicola were more abundant in the l-PPI group than in the nt-GERD group. Furthermore, colonization of Candida in gastric mucosa was significantly increased after PPI treatment. However, there was no significant difference in Candida colonization between patients with endoscopic esophageal mucosal breaks and those without. There were significant differences in the fecal mycobiota composition between HCs and GERD patients regardless whether or not they used PPI. As compared to nt-GERD patient samples, there was a high abundance of Alternaria, Aspergillus, Mycenella, Exserohilum, and Clitopilus in the s-PPI group. In addition, there was a significantly higher abundance of Alternaria, Aspergillus, Podospora, Phallus, and Monographella in the l-PPI group than nt-GERD patients. In conclusion, our study indicates that dysbiosis of mycobiota was presented in GERD patients in both gastric mucosal and fecal mycobiota. PPI treatment may increase the colonization of Candida in the gastric mucosa in GERD patients.
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Affiliation(s)
- Yichao Shi
- Department of Gastroenterology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jianfeng Li
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shuntian Cai
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hong Zhao
- Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Huijun Zhao
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Gang Sun
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yunsheng Yang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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Hanna-Rivero N, Tu SJ, Elliott AD, Pitman BM, Gallagher C, Lau DH, Sanders P, Wong CX. Anemia and iron deficiency in patients with atrial fibrillation. BMC Cardiovasc Disord 2022; 22:204. [PMID: 35508964 PMCID: PMC9066804 DOI: 10.1186/s12872-022-02633-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/13/2022] [Indexed: 12/11/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac tachyarrhythmia and has a rising global prevalence. Given the increasing burden of AF-related symptoms and complications, new approaches to management are required. Anemia and iron deficiency are common conditions in patients with AF. Furthermore, emerging evidence suggests that the presence of anemia may be associated with worse outcome in these patients. The role of anemia and iron deficiency has been extensively explored in other cardiovascular states, such as heart failure and ischemic heart disease. In particular, the role of iron repletion amongst patients with heart failure is now an established treatment modality. However, despite the strong bidirectional inter-relationship between AF and heart failure, the implications of anemia and iron-deficiency in AF have been scarcely studied. This area is of mechanistic and clinical relevance given the potential that treatment of these conditions may improve symptoms and prognosis in the increasing number of individuals with AF. In this review, we summarise the current published literature on anemia and iron deficiency in patients with AF. We discuss AF complications such as stroke, bleeding, and heart failure, in addition to AF-related symptoms such as exercise intolerance, and the potential impact of anemia and iron deficiency on these. Finally, we summarize current research gaps on anemia, iron deficiency, and AF, and underscore potential research directions.
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Affiliation(s)
- Nicole Hanna-Rivero
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Samuel J Tu
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Bradley M Pitman
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Celine Gallagher
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Christopher X Wong
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia.
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia.
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5
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Tran PQ, Nguyen NTY, Nguyen B, Bui QTH. Quality of life assessment in patients on chronic dialysis: Comparison between haemodialysis and peritoneal dialysis at a national hospital in Vietnam. Trop Med Int Health 2021; 27:199-206. [PMID: 34873785 DOI: 10.1111/tmi.13709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES End-stage renal disease (ESRD) is a chronic disease that can adversely affect the patient's quality of life (QoL) in terms of functional limitation and cognitive impairment. This study aimed to identify the factors associated with QoL in patients with ESRD undergoing dialysis at a national hospital in Vietnam. METHODS A descriptive cross-sectional study was conducted among outpatients aged ≥18 years who underwent haemodialysis (HD) or peritoneal dialysis (PD) for at least 3 months at Thong Nhat Hospital, Ho Chi Minh City, Vietnam from May 2020 to July 2021. QoL was measured using the validated Vietnamese version of the EuroQol-5 Dimensional-5 Level (EQ-5D-5L). The factors associated with the QoL of patients with ESRD undergoing dialysis were identified using multiple linear regression analysis. RESULTS In total, 131 (73.6%) and 47 (26.4%) patients underwent HD and PD, respectively. Overall, 178 (55.6%) patients were men (median age, 66 [56-79] years). The mean EQ-5D-5L score was significantly higher in patients undergoing PD than in those undergoing HD (0.848 ± 0.183 vs. 0.766 ± 0.231; p = 0.030). Older age (β = -0.006; p < 0.001) and peptic ulcer disease (β = -0.083; p = 0.029) were associated with lower QoL scores. PD treatment was associated with higher QoL scores (β = 0.065; p = 0.046). CONCLUSIONS It is necessary to improve the QoL of patients undergoing dialysis, especially of elderly patients and patients with peptic ulcer disease. PD may be a better method for maintenance dialysis, if applicable, in terms of QoL.
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Affiliation(s)
- Phuong Que Tran
- Department of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Nhi Truc Y Nguyen
- Department of Pharmacy, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
| | - Bach Nguyen
- Department of Nephrology, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
| | - Quynh Thi Huong Bui
- Department of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.,Department of Pharmacy, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
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Boxer M. Iron deficiency anemia from iron malabsorption caused by proton pump inhibitors. EJHAEM 2020; 1:548-551. [PMID: 35845020 PMCID: PMC9175665 DOI: 10.1002/jha2.96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 12/04/2022]
Abstract
Background Iron deficiency anemia without evidence for blood loss can present a diagnostic challenge. Proton pump inhibitors have been associated with iron deficiency anemia for many years, yet the relationship between the two until recently was not fully understood. Treatment recommendations are lacking. Methods and methods This study evaluated 43 iron deficient patients who were taking proton pump inhibitors, 41 of whom were unresponsive to oral iron, and for whom no etiology for the iron deficiency could be found. Two patients who had hereditary hemochromatosis never were treated with oral iron. Results Forty-three patients taking a proton pump inhibitor had elevated serum gastrin ≥100 pg/mL. Upon treatment with intravenous iron, 95% (41/43) responded with increased hemoglobin concentration ≥2 g/dL. Improvements were also achieved in the mean corpuscular volume, ferritin, and transferrin saturation. Conclusions These findings suggest that proton pump inhibitors have been an under-recognized cause for iron deficiency anemia and need to be considered in patients who are taking a proton pump inhibitor. The iron deficiency does correct with intravenous iron replacement.
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Manckoundia P, Konaté A, Hacquin A, Nuss V, Mihai AM, Vovelle J, Dipanda M, Putot S, Barben J, Putot A. Iron in the General Population and Specificities in Older Adults: Metabolism, Causes and Consequences of Decrease or Overload, and Biological Assessment. Clin Interv Aging 2020; 15:1927-1938. [PMID: 33116447 PMCID: PMC7548223 DOI: 10.2147/cia.s269379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/01/2020] [Indexed: 12/15/2022] Open
Abstract
Iron is involved in many types of metabolism, including oxygen transport in hemoglobin. Iron deficiency (ID), ie a decrease in circulating iron, can have severe consequences. We provide an update on iron metabolism and ID, highlighting the particularities in older adults (OAs). There are three iron compartments in the human body: 1) the functional compartment, which consists of heme proteins including hemoglobin, myoglobin and respiratory enzymes; 2) iron reserves (IR), which consist mainly of liver stocks and are stored as ferritin; and 3) transferrin. There are two types of ID. Absolute ID is characterized by a decrease in IR. Its main pathophysiological mechanism is bleeding, which is often digestive and can be due to neoplasia, frequent in OAs. Biological assessment shows low serum ferritin and transferrin saturation (TS) levels. Furthermore, hypochromic microcytic anemia is frequent, and the serum-soluble transferrin receptor (sTfR) level is high. Functional ID, in which IR are high or normal, is due to inflammation, which is also frequent in OAs, particularly in its chronic form. Biological assessments show high serum ferritin, normal or low TS, and normal sTfR levels. Moreover, C-reactive protein is elevated, and there is moderate non-regenerative non-macrocytic anemia. The main characteristics of iron metabolism anomalies in the elderly are the high frequency of ID (20% of ID with anemia in adults ≥85 years) and the severity of its consequences, which include cognitive impairment in case of ID or iron overload and decrease of physical activity in case of ID. In conclusion, causes of ID are frequently intertwined in OAs as a result of the polymorbidity that characterizes them. ID can have dramatic consequences, especially in frail OAs. Thus, measuring the appropriate biological markers prevents errors in the positive diagnosis of ID type, clarifies etiology, and informs treatment-related decision-making.
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Affiliation(s)
- Patrick Manckoundia
- Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital of Dijon Burgundy, Dijon, France
| | - Amadou Konaté
- Unit of Diagnosis and Rapid Orientation (DIAGORA), Internal Medicine Department, Hospital of Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Arthur Hacquin
- Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital of Dijon Burgundy, Dijon, France
| | - Valentine Nuss
- Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital of Dijon Burgundy, Dijon, France
| | - Anca-Maria Mihai
- Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital of Dijon Burgundy, Dijon, France
| | - Jérémie Vovelle
- Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital of Dijon Burgundy, Dijon, France
| | - Mélanie Dipanda
- Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital of Dijon Burgundy, Dijon, France
| | - Sophie Putot
- Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital of Dijon Burgundy, Dijon, France
| | - Jérémy Barben
- Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital of Dijon Burgundy, Dijon, France
| | - Alain Putot
- Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital of Dijon Burgundy, Dijon, France
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Naveed A, Jilani K, Siddique AB, Akbar M, Riaz M, Mushtaq Z, Sikandar M, Ilyas S, Bibi I, Asghar A, Rasool G, Irfan M. Induction of Erythrocyte Shrinkage by Omeprazole. Dose Response 2020; 18:1559325820946941. [PMID: 32863802 PMCID: PMC7432979 DOI: 10.1177/1559325820946941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 11/16/2022] Open
Abstract
Omeprazole, a proton pump inhibitor blocks the H+/K+-ATPase
channels of gastric parietal cells. It is used for the treatment of peptic
ulcer. Prolonged use of omeprazole may involve in inducing anemia. The key
marker of eryptosis includes membrane blebbing, cell shrinkage and
phosphatidylserine (PS) exposure at the cell surface. In current study, the
eryptotic, oxidative as well as hemolytic effects of therapeutical doses (0.5, 1
and 1.5 µM) of omeprazole were investigated after exposing erythrocytes for 48
hours. Investigation of eryptosis was done by cell size measurement, PS exposure
determination and calcium channel inhibition. As a possible mechanism of
omeprazole induced eryptosis, oxidative stress was investigated by determining
the catalase, glutathione peroxidase and superoxide dismutase activities.
Similarly, necrotic effect of omeprazole on erythrocytes was also evaluated
through hemolysis measurement. Results of our study illustrated that 1.5 µM of
omeprazole may induce significant decrease in superoxide dismutase, glutathione
peroxidase and catalase activities as well as triggered the erythrocytes
shrinkage, PS exposure and hemolysis. Role of calcium was also confirmed in
inducing erythrocyte shrinkage. It is concluded that the exposure of
erythrocytes with 1.5 µM omeprazole may enhance the rate of eryptosis and
hemolysis by inducing oxidative stress.
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Affiliation(s)
- Ayesha Naveed
- Department of Biochemistry, University of Agriculture, Faisalabad, Pakistan
| | - Kashif Jilani
- Department of Biochemistry, University of Agriculture, Faisalabad, Pakistan
| | - Abu Bakar Siddique
- Department of Zoology, Wildlife and Fisheries, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Akbar
- Department of Biochemistry, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Riaz
- Department of Allied Health Sciences, University of Sargodha, Sargodha Medical College, Sargodha, Pakistan
| | - Zahid Mushtaq
- Department of Biochemistry, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Sikandar
- Department of Zoology, Wildlife and Fisheries, University of Agriculture, Faisalabad, Pakistan
| | - Sajida Ilyas
- Department of Biochemistry, University of Agriculture, Faisalabad, Pakistan
| | - Ismat Bibi
- Department of Chemistry, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Asma Asghar
- Department of Biochemistry, University of Agriculture, Faisalabad, Pakistan
| | - Ghulam Rasool
- Department of Allied Health Sciences, University of Sargodha, Sargodha Medical College, Sargodha, Pakistan
| | - Muhammad Irfan
- Department of Biochemistry, University of Agriculture, Faisalabad, Pakistan
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Abramenko N, Kejík Z, Kaplánek R, Tatar A, Brogyányi T, Pajková M, Sýkora D, Veselá K, Antonyová V, Dytrych P, Ikeda-Saito M, Martásek P, Jakubek M. Spectroscopic study of in situ-formed metallocomplexes of proton pump inhibitors in water. Chem Biol Drug Des 2020; 97:305-314. [PMID: 32854159 DOI: 10.1111/cbdd.13782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/16/2020] [Accepted: 08/16/2020] [Indexed: 12/20/2022]
Abstract
Proton pump inhibitors, such as omeprazole, pantoprazole and lansoprazole, are an important group of clinically used drugs. Generally, they are considered safe without direct toxicity. Nevertheless, their long-term use can be associated with a higher risk of some serious pathological states (e.g. amnesia and oncological and neurodegenerative states). It is well known that dysregulation of the metabolism of transition metals (especially iron ions) plays a significant role in these pathological states and that the above drugs can form complexes with metal ions. However, to the best of our knowledge, this phenomenon has not yet been described in water systems. Therefore, we studied the interaction between these drugs and transition metal ions in the surrounding water environment (water/DMSO, 99:1, v/v) by absorption spectroscopy. In the presence of Fe(III), a strong redshift was observed, and more importantly, the affinities of the drugs (represented as binding constants) were strong enough, especially in the case of omeprazole, so that the formation of a metallocomplex cannot be excluded during the explanation of their side effects.
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Affiliation(s)
- Nikita Abramenko
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Zdeněk Kejík
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,BIOCEV, First Faculty of Medicine, Charles University, Vestec, Czech Republic.,Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Czech Republic
| | - Robert Kaplánek
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,BIOCEV, First Faculty of Medicine, Charles University, Vestec, Czech Republic.,Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Czech Republic
| | - Ameneh Tatar
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Czech Republic
| | - Tereza Brogyányi
- Institute of pathological physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Martina Pajková
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,BIOCEV, First Faculty of Medicine, Charles University, Vestec, Czech Republic
| | - David Sýkora
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,BIOCEV, First Faculty of Medicine, Charles University, Vestec, Czech Republic.,Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Czech Republic
| | - Kateřina Veselá
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Czech Republic
| | - Veronika Antonyová
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,BIOCEV, First Faculty of Medicine, Charles University, Vestec, Czech Republic
| | - Petr Dytrych
- 1st Department of Surgery - Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 2, Czech Republic
| | - Masao Ikeda-Saito
- Institute of Multidisciplinary Research for Advanced Materials, Tohoku University, Katahira, Japan
| | - Pavel Martásek
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,General University Hospital Prague, Prague 2, Czech Republic
| | - Milan Jakubek
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,BIOCEV, First Faculty of Medicine, Charles University, Vestec, Czech Republic.,Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Czech Republic
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10
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Koyyada A. Long-term use of proton pump inhibitors as a risk factor for various adverse manifestations. Therapie 2020; 76:13-21. [PMID: 32718584 DOI: 10.1016/j.therap.2020.06.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
The long-term use of proton pump inhibitors (PPIs) can lead to increased gastric pH, hypochlorhydria and in some cases to achlorhydria when compared to other acid-suppressing agents like histamine-2 (H2) receptor blockers and antacids. These consequences by the use of long-term PPIs may lead to significant vitamin (B12 and C) and mineral (iron, calcium and magnesium) deficiencies which needs gastric acid for their absorption and bioavailability. Long-term use of PPIs by the pregnant patients may impose a potential risk of congenital malformations. Various studies have recommended the life style modifications and antacid use as first choice among pregnant womens by preserving PPIs (omeprazole as a safe choice of PPI) for severe conditions of gastroesophageal reflux disease. The long-term acid suppression by PPIs can also lead to enteric, respiratory and urinary tract infections. The hypochlorhydria by chronic PPIs use may induce hypergastrinemia, which ultimately mediates the gastric polyps, gastric carcinoids and gastric cancer. The concomitant use of PPIs with antiplatelet drugs like clopidogrel can impose the patients to major adverse cardiac events. This review has enlisted the comprehensive information regarding the adverse effects induced by long-term use of PPIs and their possible relations. Considerable studies like case-control, randomized trials, cohort studies and meta-analysis were reported in supporting these adverse effects. The clinicians and patients should be cautious about these effects so that they can avoid the serious outcomes. PPIs should be avoided for long-term use mainly in older adults unless there is a proper indication.
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Affiliation(s)
- Arun Koyyada
- GITAM Institute of Pharmacy, GITAM University, Rushikonda, Visakhapatnam, 530045 Andhra Pradesh, India.
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Paz MFCJ, de Alencar MVOB, de Lima RMP, Sobral ALP, do Nascimento GTM, dos Reis CA, Coêlho MDPSDS, do Nascimento MLLB, Gomes Júnior AL, Machado KDC, de Menezes AAPM, de Lima RMT, de Oliveira Filho JWG, Dias ACS, dos Reis AC, da Mata AMOF, Machado SA, Sousa CDDC, da Silva FCC, Islam MT, de Castro e Sousa JM, Melo Cavalcante AADC. Pharmacological Effects and Toxicogenetic Impacts of Omeprazole: Genomic Instability and Cancer. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:3457890. [PMID: 32308801 PMCID: PMC7146093 DOI: 10.1155/2020/3457890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/19/2019] [Accepted: 11/21/2019] [Indexed: 12/15/2022]
Abstract
Omeprazole (OME) is commonly used to treat gastrointestinal disorders. However, long-term use of OME can increase the risk of gastric cancer. We aimed to characterize the pharmacological effects of OME and to correlate its adverse effects and toxicogenetic risks to the genomic instability mechanisms and cancer-based on database reports. Thus, a search (till Aug 2019) was made in the PubMed, Scopus, and ScienceDirect with relevant keywords. Based on the study objective, we included 80 clinical reports, forty-six in vitro, and 76 in vivo studies. While controversial, the findings suggest that long-term use of OME (5 to 40 mg/kg) can induce genomic instability. On the other hand, OME-mediated protective effects are well reported and related to proton pump blockade and anti-inflammatory activity through an increase in gastric flow, anti-inflammatory markers (COX-2 and interleukins) and antiapoptotic markers (caspases and BCL-2), glycoprotein expression, and neutrophil infiltration reduction. The reported adverse and toxic effects, especially in clinical studies, were atrophic gastritis, cobalamin deficiencies, homeostasis disorders, polyp development, hepatotoxicity, cytotoxicity, and genotoxicity. This study highlights that OME may induce genomic instability and increase the risk of certain types of cancer. Therefore, adequate precautions should be taken, especially in its long-term therapeutic strategies and self-medication practices.
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Affiliation(s)
- Márcia Fernanda Correia Jardim Paz
- Postgraduate Program in Biotechnology (RENORBIO), Federal University of Piauí, Teresina, PI, Brazil
- Laboratory of Genetic Toxicity, Postgraduate Program in Pharmaceutical Sciences, Federal University of Piauí, Teresina, PI, Brazil
| | | | | | - André Luiz Pinho Sobral
- Laboratory of Genetic Toxicity, Postgraduate Program in Pharmaceutical Sciences, Federal University of Piauí, Teresina, PI, Brazil
- University Hospital, Teresina, PI, Brazil
| | | | | | | | | | - Antonio Luiz Gomes Júnior
- Laboratory of Genetic Toxicity, Postgraduate Program in Pharmaceutical Sciences, Federal University of Piauí, Teresina, PI, Brazil
- University Centre UNINOVAFAPI, Teresina, PI, Brazil
| | | | | | - Rosália Maria Torres de Lima
- Laboratory of Genetic Toxicity, Postgraduate Program in Pharmaceutical Sciences, Federal University of Piauí, Teresina, PI, Brazil
| | | | - Ana Carolina Soares Dias
- Laboratory of Genetics and Molecular Biology, Federal University of Maranhão, São Luís, MA, Brazil
| | - Antonielly Campinho dos Reis
- Laboratory of Genetic Toxicity, Postgraduate Program in Pharmaceutical Sciences, Federal University of Piauí, Teresina, PI, Brazil
| | | | | | | | - Felipe Cavalcanti Carneiro da Silva
- Postgraduate Program in Biotechnology (RENORBIO), Federal University of Piauí, Teresina, PI, Brazil
- Department of Biological Sciences, Federal University of Piauí, Picos, PI, Brazil
| | - Muhammad Torequl Islam
- Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City 700000, Vietnam
- Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City 700000, Vietnam
| | | | - Ana Amélia de Carvalho Melo Cavalcante
- Postgraduate Program in Biotechnology (RENORBIO), Federal University of Piauí, Teresina, PI, Brazil
- Laboratory of Genetic Toxicity, Postgraduate Program in Pharmaceutical Sciences, Federal University of Piauí, Teresina, PI, Brazil
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12
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Gender differences in determinants of iron-deficiency anemia: a population-based study conducted in four European countries. Ann Hematol 2019; 98:1573-1582. [PMID: 31073646 DOI: 10.1007/s00277-019-03707-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/28/2019] [Indexed: 12/21/2022]
Abstract
Iron-deficiency anemia (IDA) was the main condition contributing to higher rates of years lived with disabilities in women in 2016. To date, few studies have investigated gender differences in determinants of IDA in Europe. The aim of the present study was to evaluate the determinants of IDA among females and males in four European countries. IDA determinants were estimated using multivariable Cox regression based on information gathered from national primary care databases, namely Italy (for years 2002-2013), Belgium, Germany, and Spain (for years 2007-2012). Adjusted hazard ratios (aHR) with 95% confidence intervals (CIs) were estimated. Age was significantly associated with IDA in females of childbearing age in all four countries, as well as pregnancy, for which the aHR ranged from 1.20 (95% CI 1.15-1.25) in Italy to 1.88 (95% CI 1.53-2.31) in Germany. In males, the aHR increased with age starting from the 65-69 age group. Menometrorrhagia was associated with IDA in Germany (aHR 2.71, 95% CI 1.96-3.73), Italy (aHR 1.80, 95% CI 1.60-2.03), and Spain (aHR 1.52, 95% CI 1.31-1.76). A greater risk for women with alopecia was also observed. Weakness and headache indicated a higher risk in both men and women. Patients with diseases characterized by blood loss or gastrointestinal malabsorption were also at significantly increased risk. Physicians should encourage women of childbearing age to adhere to dietary recommendations regarding iron intake and regularly prescribe screening of iron status. Upper and lower gastrointestinal investigations should be recommended for patients with a confirmed diagnosis of IDA.
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Gröber U, Schmidt J, Kisters K. Important drug-micronutrient interactions: A selection for clinical practice. Crit Rev Food Sci Nutr 2018; 60:257-275. [PMID: 30580552 DOI: 10.1080/10408398.2018.1522613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Interactions between drugs and micronutrients have received only little or no attention in the medical and pharmaceutical world in the past. Since more and more pharmaceutics are used for the treatment of patients, this topic is increasingly relevant. As such interactions - depending on the duration of treatment and the status of micronutrients - impact the health of the patient and the action of the drugs, physicians and pharmacists should pay more attention to such interactions in the future. This review aims to sensitize physicians and pharmacists on drug micronutrient interactions with selected examples of widely pescribed drugs that can precipitate micronutrient deficiencies. In this context, the pharmacist, as a drug expert, assumes a particular role. Like no other professional in the health care sector, he is particularly predestined and called up to respond to this task. The following article intends to point out the relevance of mutual interactions between micronutrients and various examples of widely used drugs, without claiming to be exhaustive.
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Affiliation(s)
- Uwe Gröber
- Academy of Micronutrient Medicine, Essen, Germany
| | | | - Klaus Kisters
- Academy of Micronutrient Medicine, Essen, Germany.,Medizinische Klinik I, St. Anna Hospital, Herne, Germany
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Vinnakota RD, Brett AS. Iron Deficiency Anemia Associated With Acid-Modifying Medications: Two Cases and Literature Review. Am J Med Sci 2018; 357:160-163. [PMID: 30528320 DOI: 10.1016/j.amjms.2018.10.014] [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: 07/24/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 10/28/2022]
Abstract
Iron deficiency anemia is often listed among potential adverse effects of gastric acid-suppressive medications, given that gastric acidity promotes intestinal absorption of nonheme iron. Additionally, the antacid calcium carbonate can inhibit iron absorption. However, there is little direct clinical evidence that proton-pump inhibitors, histamine-2 receptor antagonists, or calcium carbonate cause iron deficiency anemia. Most case reports have had substantial limitations (e.g., minimal follow-up and presence of other causes of iron deficiency), and retrospective cohort studies have lacked sufficient patient-specific detail to make strong causal inferences. We present 2 cases-both with detailed, prospective 10-year follow-up-in which combinations of proton-pump inhibitors, histamine-2 receptor antagonists and calcium carbonate were clearly associated with development of iron deficiency anemia. Overt iron-deficiency anemia is probably uncommon in patients who use acid-modifying medications and who have no other conditions that predispose to iron deficiency. Nevertheless, clinicians should be aware of this potential complication, given widespread use of these agents.
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Affiliation(s)
- Ramya Deepthi Vinnakota
- Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Allan S Brett
- Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina.
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Wish JB, Aronoff GR, Bacon BR, Brugnara C, Eckardt KU, Ganz T, Macdougall IC, Núñez J, Perahia AJ, Wood JC. Positive Iron Balance in Chronic Kidney Disease: How Much is Too Much and How to Tell? Am J Nephrol 2018; 47:72-83. [PMID: 29439253 DOI: 10.1159/000486968] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/15/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Regulation of body iron occurs at cellular, tissue, and systemic levels. In healthy individuals, iron absorption and losses are minimal, creating a virtually closed system. In the setting of chronic kidney disease and hemodialysis (HD), increased iron losses, reduced iron absorption, and limited iron availability lead to iron deficiency. Intravenous (IV) iron therapy is frequently prescribed to replace lost iron, but determining an individual's iron balance and stores can be challenging and imprecise, contributing to uncertainty about the long-term safety of IV iron therapy. SUMMARY Patients on HD receiving judicious doses of IV iron are likely to be in a state of positive iron balance, yet this does not appear to confer an overt risk for clinically relevant iron toxicity. The concomitant use of iron with erythropoiesis-stimulating agents, the use of maintenance iron dosing regimens, and the reticuloendothelial distribution of hepatic iron deposition likely minimize the potential for iron toxicity in patients on HD. Key Messages: Because no single diagnostic test can, at present, accurately assess iron status and risk for toxicity, clinicians need to take an integrative approach to avoid iron doses that impose excessive exposure while ensuring sufficient replenishment of iron stores capable of overcoming hepcidin blockade and allowing for effective erythropoiesis.
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Affiliation(s)
- Jay B Wish
- Division of Nephrology, Indiana University Health, Indianapolis, Indiana, USA
| | - George R Aronoff
- Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
- DaVita Kidney Care, Denver, Colorado, USA
| | - Bruce R Bacon
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital and Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin, Berlin, Germany
| | - Tomas Ganz
- Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Iain C Macdougall
- Department of Renal Medicine, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Julio Núñez
- Cardiology Service, Hospital Clínico Universitario, INCLIVA, CIBERCV and University of Valencia, Valencia, Spain
| | - Adam J Perahia
- NorthStar Strategic Consulting, LLC, Gladstone, New Jersey, USA
| | - John C Wood
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California, USA
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