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Giorgetti A, Nyilima S, Stoffel NU, Moretti D, Mwasi E, Karanja S, Zeder C, Speich C, Netland C, Jin Z, Zimmermann MB, Brittenham GM. Stable iron ( 58 Fe) isotopic measurements in Kenyan toddlers during 3 months of iron supplementation demonstrate that half of the iron absorbed is lost. Br J Haematol 2024. [PMID: 38302093 DOI: 10.1111/bjh.19319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
Increased iron loss may reduce the effectiveness of iron supplementation. The objective of this study was to determine if daily oral iron supplementation increases iron loss, measured using a stable isotope of iron (58 Fe). We enrolled and dewormed 24 iron-depleted Kenyan children, 24-27 months of age, whose body iron was enriched and equilibrated with 58 Fe given at least 1 year earlier. Over 3 months of supplementation (6 mg iron/kg body weight [BW]/day), mean (±SD) iron absorption was 1.10 (±0.28) mg/day. During supplementation, 0.55 (±0.36) mg iron/day was lost, equal to half of the amount of absorbed iron. Supplementation did not increase faecal haem/porphyrin or biomarkers of enterocyte damage and gut or systemic inflammation. Using individual patient data, we examined iron dose, absorption and loss among all available long-term iron isotopic studies of supplementation. Expressed in terms of body weight, daily iron loss was correlated significantly with iron absorption (Pearson's r = 0.66 [95% confidence interval 0.48-0.78]) but not with iron dose (r = 0.16 [95% CI -0.10-0.40]). The results of this study indicate that iron loss is increased with daily oral iron supplementation and may blunt the efficacy of iron supplements in children. This study was registered at ClinicalTrials.gov as NCT04721964.
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Affiliation(s)
- Ambra Giorgetti
- Laboratory of Human Nutrition, ETH, Zurich, Switzerland
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Suzane Nyilima
- Public and Community Health Department, Jomo Kenyatta University, Nairobi, Kenya
| | - Nicole U Stoffel
- Laboratory of Human Nutrition, ETH, Zurich, Switzerland
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Diego Moretti
- Nutrition Group, Swiss Distance University of Applied Sciences, Regensdorf, Switzerland
| | - Edith Mwasi
- Paediatric Department, Msambweni District Hospital, Msambweni, Kwale County, Kenya
| | - Simon Karanja
- Public and Community Health Department, Jomo Kenyatta University, Nairobi, Kenya
| | | | | | | | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, ETH, Zurich, Switzerland
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Gary M Brittenham
- Department of Paediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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2
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Jefferds MED, Addo OY, Scanlon KS, Cogswell ME, Brittenham GM, Mei Z. The Centers for Disease Control and Prevention does not recommend race-adjusted thresholds to define anemia. Am J Clin Nutr 2024; 119:232-233. [PMID: 38176777 PMCID: PMC10880865 DOI: 10.1016/j.ajcnut.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 01/06/2024] Open
Affiliation(s)
- Maria Elena D Jefferds
- Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - O Yaw Addo
- Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kelley S Scanlon
- Food and Nutrition Service, US Department of Agriculture, Alexandria, VA, United States
| | - Mary E Cogswell
- Retired, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Gary M Brittenham
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Zuguo Mei
- Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Phillips L, Richmond M, Neunert C, Jin Z, Brittenham GM. Iron Deficiency in Chronic Pediatric Heart Failure: Overall Assessment and Outcomes in Dilated Cardiomyopathy. J Pediatr 2023; 263:113721. [PMID: 37673205 DOI: 10.1016/j.jpeds.2023.113721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/15/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To evaluate the frequency of iron status assessment in pediatric heart failure and the prevalence and adverse effects of absolute iron deficiency in dilated cardiomyopathy-induced heart failure. STUDY DESIGN We retrospectively reviewed records of children with chronic heart failure at our center between 2010 and 2020. In children with dilated cardiomyopathy, we analyzed baseline cardiac function, hemoglobin level, and subsequent risk of composite adverse events (CAE), including death, heart transplant, ventricular assist device (VAD) placement, and transplant registry listing. Absolute iron deficiency and iron sufficiency were defined as transferrin saturations <20% and ≥30%, respectively; and indeterminant iron status as 20%-29%. RESULTS Of 799 patients with chronic heart failure, 471 (59%) had no iron-related laboratory measurements. Of 68 children with dilated cardiomyopathy, baseline transferrin saturation, and quantitative left ventricular ejection fraction (LVEF), 33 (49%) and 14 (21%) were iron deficient and sufficient, respectively, and 21 (31%) indeterminant. LVEF was reduced to 23.6 ± 12.1% from 32.9 ± 16.8% in iron deficiency and sufficiency, respectively (P = .04), without a significant difference in hemoglobin. After stratification by New York Heart Association classification, in advanced class IV, hemoglobin was reduced to 10.9 ± 1.3 g/dL vs 12.7 ± 2.0 g/dL in iron deficiency and sufficiency, respectively (P = .01), without a significant difference in LVEF. CONCLUSIONS In this single-center study, iron deficiency was not monitored in most children with chronic heart failure. In pediatric dilated cardiomyopathy-induced heart failure, absolute iron deficiency was prevalent and associated with clinically consequential and possibly correctable decreases in cardiac function and hemoglobin concentration.
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Affiliation(s)
- Lia Phillips
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Irving Medical Center, New York, NY.
| | - Marc Richmond
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Cindy Neunert
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Irving Medical Center, New York, NY
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Gary M Brittenham
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Irving Medical Center, New York, NY
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Brittenham GM, Moir-Meyer G, Abuga KM, Datta-Mitra A, Cerami C, Green R, Pasricha SR, Atkinson SH. Biology of Anemia: A Public Health Perspective. J Nutr 2023; 153 Suppl 1:S7-S28. [PMID: 37778889 DOI: 10.1016/j.tjnut.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/04/2023] [Accepted: 07/31/2023] [Indexed: 10/03/2023] Open
Abstract
Our goal is to present recent progress in understanding the biological mechanisms underlying anemia from a public health perspective. We describe important advances in understanding common causes of anemia and their interactions, including iron deficiency (ID), lack of other micronutrients, infection, inflammation, and genetic conditions. ID develops if the iron circulating in the blood cannot provide the amounts required for red blood cell production and tissue needs. ID anemia develops as iron-limited red blood cell production fails to maintain the hemoglobin concentration above the threshold used to define anemia. Globally, absolute ID (absent or reduced body iron stores that do not meet the need for iron of an individual but may respond to iron supplementation) contributes to only a limited proportion of anemia. Functional ID (adequate or increased iron stores that cannot meet the need for iron because of the effects of infection or inflammation and does not respond to iron supplementation) is frequently responsible for anemia in low- and middle-income countries. Absolute and functional ID may coexist. We highlight continued improvement in understanding the roles of infections and inflammation in causing a large proportion of anemia. Deficiencies of nutrients other than iron are less common but important in some settings. The importance of genetic conditions as causes of anemia depends upon the specific inherited red blood cell abnormalities and their prevalence in the settings examined. From a public health perspective, each setting has a distinctive composition of components underlying the common causes of anemia. We emphasize the coincidence between regions with a high prevalence of anemia attributed to ID (both absolute and functional), those with endemic infections, and those with widespread genetic conditions affecting red blood cells, especially in sub-Saharan Africa and regions in Asia and Oceania.
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Affiliation(s)
- Gary M Brittenham
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, United States.
| | - Gemma Moir-Meyer
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Kelvin Mokaya Abuga
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ananya Datta-Mitra
- Department of Pathology and Laboratory Medicine, University of California, Davis, CA, United States
| | - Carla Cerami
- The Medical Research Council Unit, The Gambia, London School of Hygiene and Tropical Medicine, London, UK
| | - Ralph Green
- Department of Pathology and Laboratory Medicine, University of California, Davis, CA, United States
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia; Diagnostic Haematology, The Royal Melbourne Hospital; and Clinical Haematology at the Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, VIC Australia
| | - Sarah H Atkinson
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Paediatrics, University of Oxford, Oxford, UK
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Affiliation(s)
- Gary M Brittenham
- Department of Pediatrics, Columbia University, New York, NY, United States.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rachmühl C, Lacroix C, Giorgetti A, Stoffel NU, Zimmermann MB, Brittenham GM, Geirnaert A. Validation of a batch cultivation protocol for fecal microbiota of Kenyan infants. BMC Microbiol 2023; 23:174. [PMID: 37403024 DOI: 10.1186/s12866-023-02915-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND The combination of cultivation studies with molecular analysis approaches allows characterization of the complex human gut microbiota in depth. In vitro cultivation studies of infants living in rural sub-Saharan Africa are scarce. In this study, a batch cultivation protocol for Kenyan infant fecal microbiota was validated. METHODS Fresh fecal samples were collected from 10 infants living in a rural area of Kenya. Samples were transported under protective conditions and subsequently prepared for inoculation within less than 30 h for batch cultivation. A diet-adapted cultivation medium was used that mimicked the daily intake of human milk and maize porridge in Kenyan infants during weaning. 16 S rRNA gene amplicon sequencing and HPLC analyses were performed to assess the composition and metabolic activity, respectively, of the fecal microbiota after 24 h of batch cultivation. RESULTS High abundance of Bifidobacterium (53.4 ± 11.1%) and high proportions of acetate (56 ± 11% of total metabolites) and lactate (24 ± 22% of total metabolites) were detected in the Kenyan infant fecal microbiota. After cultivation started at an initial pH 7.6, the fraction of top bacterial genera (≥ 1% abundant) shared between fermentation and fecal samples was high at 97 ± 5%. However, Escherichia-Shigella, Clostridium sensu stricto 1, Bacteroides and Enterococcus were enriched concomitant with decreased Bifidobacterium abundance. Decreasing the initial pH to 6.9 lead to higher abundance of Bifidobacterium after incubation and increased the compositional similarity of fermentation and fecal samples. Despite similar total metabolite production of all fecal microbiota after cultivation, inter-individual differences in metabolite profiles were apparent. CONCLUSIONS Protected transport and batch cultivation in host and diet adapted conditions allowed regrowth of the top abundant genera and reproduction of the metabolic activity of fresh Kenyan infant fecal microbiota. The validated batch cultivation protocol can be used to study the composition and functional potential of Kenyan infant fecal microbiota in vitro.
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Affiliation(s)
- Carole Rachmühl
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Christophe Lacroix
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland.
| | - Ambra Giorgetti
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Nicole U Stoffel
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Gary M Brittenham
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, USA
| | - Annelies Geirnaert
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland.
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Mei Z, Addo OY, Jefferds MED, Sharma AJ, Flores-Ayala RC, Pfeiffer CM, Brittenham GM. Comparison of Current World Health Organization Guidelines with Physiologically Based Serum Ferritin Thresholds for Iron Deficiency in Healthy Young Children and Nonpregnant Women Using Data from the Third National Health and Nutrition Examination Survey. J Nutr 2023; 153:771-780. [PMID: 36803577 PMCID: PMC10472073 DOI: 10.1016/j.tjnut.2023.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Current WHO serum ferritin (SF) thresholds for iron deficiency (ID) in children (<12 μg/L) and women (<15 μg/L) are derived from expert opinion based on radiometric assays in use decades ago. Using a contemporary immunoturbidimetry assay, higher thresholds (children, <20 μg/L; women, <25 μg/L) were identified from physiologically based analyses. OBJECTIVE We examined relationships of SF measured using an immunoradiometric assay from the era of expert opinion with 2 independently measured indicators of ID, hemoglobin (Hb) and erythrocyte zinc protoporphyrin (eZnPP), using data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). The SF at which circulating Hb begins to decrease and eZnPP begins to increase provides a physiological basis for identifying the onset of iron-deficient erythropoiesis. METHODS We analyzed NHANES III cross-sectional data from 2616 apparently healthy children, aged 12-59 mo, and 4639 apparently healthy nonpregnant women, aged 15-49 y. We used restricted cubic spline regression models to determine SF thresholds for ID. RESULTS SF thresholds identified by Hb and eZnPP did not differ significantly in children, 21.2 μg/L (95% confidence interval: 18.5, 26.5) and 18.7 μg/L (17.9, 19.7), and, in women, were similar although significantly different, 24.8 μg/L (23.4, 26.9) and 22.5 μg/L (21.7, 23.3). CONCLUSIONS These NHANES results suggest that physiologically based SF thresholds are higher than the thresholds from expert opinion established during the same era. SF thresholds found using physiological indicators detect the onset of iron-deficient erythropoiesis, whereas the WHO thresholds identify a later, more severe stage of ID.
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Affiliation(s)
- Zuguo Mei
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, United States Centers for Disease Control and Prevention, Atlanta GA, United States.
| | - O Yaw Addo
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, United States Centers for Disease Control and Prevention, Atlanta GA, United States
| | - Maria Elena D Jefferds
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, United States Centers for Disease Control and Prevention, Atlanta GA, United States
| | - Andrea J Sharma
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, United States Centers for Disease Control and Prevention, Atlanta GA, United States
| | - Rafael C Flores-Ayala
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, United States Centers for Disease Control and Prevention, Atlanta GA, United States
| | - Christine M Pfeiffer
- Division of Laboratory Sciences, National Center for Environmental Health, United States Centers for Disease Control and Prevention, Atlanta GA, United States
| | - Gary M Brittenham
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, United States
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De A, Williams S, Yao Y, Jin Z, Brittenham GM, Kattan M, Lovinsky-Desir S, Lee MT. Acute chest syndrome, airway inflammation and lung function in sickle cell disease. PLoS One 2023; 18:e0283349. [PMID: 36996064 PMCID: PMC10062579 DOI: 10.1371/journal.pone.0283349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Acute chest syndrome (ACS) is an acute complication in SCD but its effects on lung function are not well understood. Inflammation is a key component of SCD pathophysiology but with an unclear association with lung function. We hypothesized that children with ACS had worse lung function than children without ACS and aimed to investigate the association of lung function deficits with inflammatory cytokines. METHODS Patients enrolled in a previous 2-year randomized clinical trial who had consented to future data use, were enrolled for the present exploratory study. Patients were categorized into ACS and non-ACS groups. Demographic and clinical information were collected. Serum samples were used for quantification of serum cytokines and leukotriene B4 levels and pulmonary function tests (PFTs) were assessed. RESULTS Children with ACS had lower total lung capacity (TLC) at baseline and at 2 years, with a significant decline in forced expiratory volume in 1 sec (FEV1) and mid-maximal expiratory flow rate (FEF25-75%) in the 2 year period (p = 0.015 and p = 0.039 respectively). For children with ACS, serum cytokines IL-5, and IL-13 were higher at baseline and at 2 years compared to children with no ACS. IP-10 and IL-6 were negatively correlated with PFT markers. In multivariable regression using generalized estimating equation approach for factors predicting lung function, age was significantly associated FEV1 (p = 0.047) and ratio of FEV1 and forced vital capacity (FVC)- FEV1/FVC ratio (p = 0.006); males had lower FEV1/FVC (p = 0.035) and higher TLC (p = 0.031). Asthma status was associated with FEV1 (p = 0.017) and FVC (p = 0.022); history of ACS was significantly associated with TLC (p = 0.027). CONCLUSION Pulmonary function abnormalities were more common and inflammatory markers were elevated in patients with ACS, compared with those without ACS. These findings suggest airway inflammation is present in children with SCD and ACS, which could be contributing to impaired pulmonary function.
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Affiliation(s)
- Aliva De
- Division of Pediatric Pulmonology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Sanford Williams
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Yujing Yao
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Gary M Brittenham
- Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Meyer Kattan
- Division of Pediatric Pulmonology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Margaret T Lee
- Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
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Hod EA, Brittenham GM, Bitan ZC, Feit Y, Gaelen JI, La Carpia F, Sandoval LA, Zhou AT, Soffing M, Mintz A, Schwartz J, Eng C, Scotto M, Caccappolo E, Habeck C, Stern Y, McMahon DJ, Kessler DA, Shaz BH, Francis RO, Spitalnik SL. A randomized trial of blood donor iron repletion on red cell quality for transfusion and donor cognition and well-being. Blood 2022; 140:2730-2739. [PMID: 36069596 PMCID: PMC9837440 DOI: 10.1182/blood.2022017288] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 01/21/2023] Open
Abstract
Although altruistic regular blood donors are vital for the blood supply, many become iron deficient from donation-induced iron loss. The effects of blood donation-induced iron deficiency on red cell transfusion quality or donor cognition are unknown. In this double-blind, randomized trial, adult iron-deficient blood donors (n = 79; ferritin < 15 μg/L and zinc protoporphyrin >60 μMol/mol heme) who met donation qualifications were enrolled. A first standard blood donation was followed by the gold-standard measure for red cell storage quality: a 51-chromium posttransfusion red cell recovery study. Donors were then randomized to intravenous iron repletion (1 g low-molecular-weight iron dextran) or placebo. A second donation ∼5 months later was followed by another recovery study. Primary outcome was the within-subject change in posttransfusion recovery. The primary outcome measure of an ancillary study reported here was the National Institutes of Health Toolbox-derived uncorrected standard Cognition Fluid Composite Score. Overall, 983 donors were screened; 110 were iron-deficient, and of these, 39 were randomized to iron repletion and 40 to placebo. Red cell storage quality was unchanged by iron repletion: mean change in posttransfusion recovery was 1.6% (95% confidence interval -0.5 to 3.8) and -0.4% (-2.0 to 1.2) with and without iron, respectively. Iron repletion did not affect any cognition or well-being measures. These data provide evidence that current criteria for blood donation preserve red cell transfusion quality for the recipient and protect adult donors from measurable effects of blood donation-induced iron deficiency on cognition. This trial was registered at www.clinicaltrials.gov as NCT02889133 and NCT02990559.
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Affiliation(s)
- Eldad A. Hod
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Gary M. Brittenham
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Zachary C. Bitan
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Yona Feit
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Jordan I. Gaelen
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Francesca La Carpia
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Luke A. Sandoval
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Alice T. Zhou
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Mark Soffing
- Department of Nuclear Medicine, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Akiva Mintz
- Department of Nuclear Medicine, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Connie Eng
- Department of Pharmacy, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Marta Scotto
- Department of Pharmacy, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Elise Caccappolo
- Department of Neurology, Division of Cognitive Neuroscience, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Christian Habeck
- Department of Neurology, Division of Cognitive Neuroscience, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Yaakov Stern
- Department of Neurology, Division of Cognitive Neuroscience, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Donald J. McMahon
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | | | | | - Richard O. Francis
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Steven L. Spitalnik
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
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11
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Dave CV, Brittenham GM, Carson JL, Setoguchi S. Risks for Anaphylaxis With Intravenous Iron Formulations. Ann Intern Med 2022; 175:W143-W144. [PMID: 36375166 DOI: 10.7326/l22-0283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Chintan V Dave
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, and Department of Veterans Affairs New Jersey Health Care System, New Brunswick, Piscataway, and East Orange, New Jersey
| | - Gary M Brittenham
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jeffrey L Carson
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Soko Setoguchi
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, Department of Medicine, Rutgers Robert Wood Johnson Medical School, and Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Brunswick and Piscataway, New Jersey
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Abstract
BACKGROUND The risks for anaphylaxis among intravenous (IV) iron products currently in use have not been assessed. OBJECTIVE To compare risks for anaphylaxis among 5 IV iron products that are used frequently. DESIGN Retrospective cohort study using a target trial emulation framework. SETTING Medicare fee-for-service data with Part D coverage between July 2013 and December 2018. PARTICIPANTS Older adults receiving their first administration of IV iron. MEASUREMENTS The primary outcome was the occurrence of anaphylaxis within 1 day of IV iron administration, ascertained using a validated case definition. Analysis was adjusted for 40 baseline covariates using inverse probability of treatment weighting. The adjusted incidence rates (IRs) for anaphylaxis per 10 000 first administrations and odds ratios (ORs) were computed. RESULTS The adjusted IRs for anaphylaxis per 10 000 first administrations were 9.8 cases (95% CI, 6.2 to 15.3 cases) for iron dextran, 4.0 cases (CI, 2.5 to 6.6 cases) for ferumoxytol, 1.5 cases (CI, 0.3 to 6.6 cases) for ferric gluconate, 1.2 cases (CI, 0.6 to 2.5 cases) for iron sucrose, and 0.8 cases (CI, 0.3 to 2.6 cases) for ferric carboxymaltose. Using iron sucrose as the referent category, the adjusted ORs for anaphylaxis were 8.3 (CI, 3.5 to 19.8) for iron dextran and 3.4 (CI, 1.4 to 8.3) for ferumoxytol. When cohort entry was restricted to the period after withdrawal of high-molecular-weight iron dextran from the U.S. market in 2014, the risk for anaphylaxis associated with low-molecular-weight iron dextran (OR, 8.4 [CI, 2.8 to 24.7]) did not change appreciably. Anaphylactic reactions requiring hospitalizations were observed only among patients using iron dextran or ferumoxytol. LIMITATION Generalizability to non-Medicare populations. CONCLUSION The rates of anaphylaxis were very low with all IV iron products but were 3- to 8-fold greater for iron dextran and ferumoxytol than for iron sucrose. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Chintan V Dave
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, and Department of Veterans Affairs New Jersey Health Care System, East Orange, New Jersey (C.V.D.)
| | - Gary M Brittenham
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York (G.M.B.)
| | - Jeffrey L Carson
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (J.L.C.)
| | - Soko Setoguchi
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, and Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey (S.S.)
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13
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Speich C, Brittenham GM, Cercamondi CI, Zeder C, Nkosi-Gondwe T, Phiri KS, Moretti D, Zimmermann MB. Isotopic measurement of iron requirements in sub-Saharan African children. Am J Clin Nutr 2021; 114:986-996. [PMID: 34113969 DOI: 10.1093/ajcn/nqab161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Prevention of iron deficiency in African children is a public health priority. Current WHO/FAO estimations of iron requirements are derived from factorial estimates based on healthy, iron-sufficient "model" children using data derived mainly from adults. OBJECTIVES In this study, we aimed to quantify iron absorption, loss, and balance in apparently healthy 5- to 7-y-old children living in rural Africa. METHODS We directly measured long-term iron absorption and iron loss in a 2-y observational study in Malawian children (n = 48) using a novel stable iron isotope method. RESULTS Of the 36 children with height-for-age and weight-for-age z scores ≥-2, 13 (36%) were iron deficient (soluble transferrin receptor >8.3 mg/L) and 23 were iron sufficient. Iron-deficient children weighed more than iron-sufficient children [mean difference (95% CI): +2.1 (1.4, 2.7) kg; P = 0.01]. Mean iron losses did not differ significantly between iron-deficient and iron-sufficient children and were comparable to WHO/FAO median estimates of 19 µg/(d × kg). In iron-sufficient children, median (95% CI) dietary iron absorption was 32 (28, 34) µg/(d × kg), comparable to WHO/FAO-estimated median requirements of 32 µg/(d × kg). In iron-deficient children, absorption of 28 (25, 30) µg/(d × kg) was not increased to correct their iron deficit, likely because of a lack of bioavailable dietary iron. Twelve children (25%) were undernourished (underweight, stunted, or both). CONCLUSIONS Our results suggest that WHO/FAO iron requirements are adequate for healthy iron-sufficient children in this rural area of Malawi, but iron-deficient children require additional bioavailable iron to correct their iron deficit.
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Affiliation(s)
- Cornelia Speich
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Gary M Brittenham
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Colin I Cercamondi
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Christophe Zeder
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Thandile Nkosi-Gondwe
- Training and Research Unit of Excellence, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kamija S Phiri
- Training and Research Unit of Excellence, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Diego Moretti
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland.,Nutrition Group, Health Department, Swiss Distance University of Applied Sciences, Regensdorf, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
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14
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Mei Z, Addo OY, Jefferds ME, Sharma AJ, Flores-Ayala RC, Brittenham GM. Physiologically based serum ferritin thresholds for iron deficiency in children and non-pregnant women: a US National Health and Nutrition Examination Surveys (NHANES) serial cross-sectional study. Lancet Haematol 2021; 8:e572-e582. [PMID: 34329578 DOI: 10.1016/s2352-3026(21)00168-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Serum ferritin concentrations are the most widely used indicator for iron deficiency. WHO determined that insufficient data are available to revise the serum ferritin thresholds of less than 12 μg/L for children and less than 15 μg/L for women, which were developed on the basis of expert opinion, to define iron deficiency. We aimed to derive new physiologically based serum ferritin concentration thresholds for iron deficiency in healthy young children and non-pregnant women using data from the US National Health and Nutrition Examination Survey (NHANES). METHODS In this serial cross-sectional study, we examined the relationship of serum ferritin with two independent indicators of iron-deficient erythropoiesis, haemoglobin and soluble transferrin receptor (sTfR), in children (12-59 months) and non-pregnant women (15-49 years) using cross-sectional NHANES data from 2003-06, 2007-10, and 2015-18. NHANES is a US national stratified multistage probability sample that includes a household interview followed by a standardised physical examination in a mobile examination centre. We excluded individuals with missing serum ferritin, sTfR, haemoglobin, or white blood cell counts measurements; non-pregnant women with missing C-reactive protein (CRP), alanine aminotransferase (ALT) or aspartate aminotransferase (AST) data were also excluded. In addition, individuals with infection (white blood cell counts >10·0×109/L) and non-pregnant women with possible liver disease (ALT >70 IU/L or AST >70 IU/L) and inflammation (CRP >5·0 mg/L) were excluded. We examined distributions of haemoglobin and sTfR with serum ferritin and used restricted cubic spline regression models to determine serum ferritin thresholds for iron-deficient erythropoiesis. FINDINGS 5964 children and 10 462 non-pregnant women had physical examinations and were screened for inclusion in the study, of whom 2569 (43·1%) children and 7498 (71·7%) non-pregnant women were included. At lower serum ferritin concentrations, median haemoglobin concentration decreased as sTfR concentration increased, with each varying in a curvilinear manner. Using restricted cubic spline plateau points to determine the onset of iron-deficient erythropoiesis, the serum ferritin thresholds identified by haemoglobin and sTfR concentrations were not different. For children, the haemoglobin identified serum ferritin threshold was 19·9 μg/L (95% CI 18·8-22·6) and the sTfR identified serum ferritin threshold was 20·0 μg/L (19·4-20·9; p=0·89). For women the haemoglobin identified serum ferritin threshold was 25·2 μg/L (24·2-26·2) and the sTfR identified serum ferritin threshold was 24·0 μg/L (23·3-24·6; p=0·05). INTERPRETATION The association between two independent indicators of iron-deficient erythropoiesis, haemoglobin and sTfR, identified serum ferritin concentration thresholds of about 20 μg/L for children and 25 μg/L for non-pregnant women, providing physiological evidence of potential new thresholds for consideration when determining the prevalence and distribution of iron deficiency in populations. In healthy children and non-pregnant women, physiologically based thresholds for iron deficiency might be more clinically and epidemiologically relevant than those based on expert opinion. Validation of this physiologically based approach in non-US populations might help the international harmonisation of serum ferritin thresholds for iron deficiency. FUNDING None.
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Affiliation(s)
- Zuguo Mei
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - O Yaw Addo
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Elena Jefferds
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrea J Sharma
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rafael C Flores-Ayala
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gary M Brittenham
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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15
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De A, Anekwe CV, Kattan M, Yao Y, Jin Z, Brittenham GM, Lee MT. Validation of a Questionnaire to Identify Respiratory Tract Infections in Children With Sickle Cell Disease. J Pediatr Hematol Oncol 2021; 43:e661-e665. [PMID: 33885042 PMCID: PMC8530454 DOI: 10.1097/mph.0000000000002164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 03/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND No validated questionnaires have been published that are specific for identifying respiratory infections in children with sickle cell disease (SCD). METHODS A questionnaire was developed that included 6 respiratory symptoms (difficulty breathing, wheezing, fever, cough, runny or stuffy nose, and sore throat) to identify respiratory events for a clinical trial. The questionnaire results were compared with identification of viral respiratory pathogens from nasal samples by reverse transcriptase polymerase chain reaction. RESULTS Eighty questionnaire responses (40 with symptom/s and 40 without) paired with isolation of viral respiratory pathogen from nasal samples were obtained from 53 children with SCD, ages 4 to 18 years over 2 separate periods in different seasons. The questionnaire yielded a sensitivity of 82%, specificity of 72% with an overall accuracy of 76%. The kappa value was 0.53, indicating moderate agreement, and the Fleiss' kappa test statistic was 4.77 with P<0.001, indicating that agreement between the 2 methods was not by chance. CONCLUSION These results provide evidence for validity of this 6-symptom respiratory questionnaire in identification of respiratory viral infections for use in SCD-related research.
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Affiliation(s)
- Aliva De
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - Chika Vera Anekwe
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine- Division of Endocrinology-Endocrine Unit Boston, MA, Harvard Medical School, Boston, MA
| | - Meyer Kattan
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - Yujing Yao
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Gary M Brittenham
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - Margaret T Lee
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
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16
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Speich C, Mitchikpè CES, Cercamondi CI, Zeder C, Brittenham GM, Moretti D, Zimmermann MB. Direct assessment of body iron balance in women with and without iron supplementation using a long-term isotope dilution method in Benin and Switzerland. Am J Clin Nutr 2021; 113:1657-1669. [PMID: 33693464 DOI: 10.1093/ajcn/nqaa433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/16/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Long-term isotopic dilution measurements of body iron may allow quantification of basal body iron balance and iron gains during an iron intervention with higher precision and accuracy than conventional iron indices. OBJECTIVES We compared body iron balance before, during, and after oral iron supplementation in women in Benin and in Switzerland. METHODS In prospective studies, Beninese (n = 11) and Swiss (n = 10) women previously labeled with stable iron isotopes were followed preintervention for 90-120 d, then received 50-mg iron daily for 90-120 d and were followed postintervention for 90-120 d. We used changes in blood isotopic composition to calculate iron absorption (Feabs), iron loss (Feloss), and net iron balance (Fegain). RESULTS Compliance with supplementation was >90%. In Benin, during the preintervention, intervention, and postintervention periods, Fe means ± SDs were as follows: 1) Feabs: 0.92 ± 1.05, 3.75 ± 2.07, and 0.90 ± 0.93 mg/d; 2) Feloss: 1.46 ± 1.95, 1.58 ± 1.57, and 1.84 ± 1.61 mg/d; and 3) Fegain: -0.55 ± 1.56 mg/d, 2.17 ± 1.81 mg/d, and -0.94 ± 1.13 mg/d. In Switzerland, the corresponding values were: 1) 1.51 ± 0.37, 4.09 ± 1.52, and 0.97 ± 0.41 mg/d; 2) 0.76 ± 1.37, 2.54 ± 1.43, and 2.08 ± 1.05 mg/d; and 3) 0.75 ± 1.37, 1.55 ± 1.75, and -1.11 ± 1.06 mg/d. Inflammation was low in both settings, and isotopically calculated iron balance was comparable to that calculated from changes in conventional iron indices. CONCLUSION Without iron supplementation, Beninese women had lower long-term dietary iron absorption and higher iron losses in the preintervention period than Swiss women. During iron supplementation, both groups had high iron absorption and similar iron gains. However, there was a 3-fold increase in iron losses in the Swiss women during the supplementation and postintervention period compared with the preintervention period. Body iron isotope dilution is a promising new method for quantifying long-term body iron balance and for assessing the impact of iron interventions. The studies were registered at clinicaltrials.gov as NCT02979080 and NCT02979132, respectively.
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Affiliation(s)
- Cornelia Speich
- Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zürich, Zurich, Switzerland
| | - Comlan Evariste S Mitchikpè
- Laboratory of Human Nutrition, Faculty of Agricultural Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Colin I Cercamondi
- Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zürich, Zurich, Switzerland
| | - Christophe Zeder
- Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zürich, Zurich, Switzerland
| | - Gary M Brittenham
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, USA
| | - Diego Moretti
- Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zürich, Zurich, Switzerland.,Nutrition and Dietetics Group, Health Department, Swiss Distance University of Applied Sciences, Regensdorf, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zürich, Zurich, Switzerland
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17
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Affiliation(s)
- Gary M Brittenham
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplant, Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, NY, USA
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18
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Jafari R, Hectors SJ, Koehne de González AK, Spincemaille P, Prince MR, Brittenham GM, Wang Y. Integrated quantitative susceptibility and R 2 * mapping for evaluation of liver fibrosis: An ex vivo feasibility study. NMR Biomed 2021; 34:e4412. [PMID: 32959425 PMCID: PMC7768551 DOI: 10.1002/nbm.4412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/08/2020] [Accepted: 08/31/2020] [Indexed: 05/10/2023]
Abstract
To develop a method for noninvasive evaluation of liver fibrosis, we investigated the differential sensitivities of quantitative susceptibility mapping (QSM) and R2 * mapping using corrections for the effects of liver iron. Liver fibrosis is characterized by excessive accumulation of collagen and other extracellular matrix proteins. While collagen increases R2 * relaxation, measures of R2 * for fibrosis are confounded by liver iron, which may be present in the liver over a wide range of concentrations. The diamagnetic collagen contribution to susceptibility values measured by QSM is much less than the contribution of highly paramagnetic iron. In 19 ex vivo liver explants with and without fibrosis, QSM (χ), R2 * and proton density fat fraction (PDFF) maps were constructed from multiecho gradient-recalled echo (mGRE) sequence acquisition at 3 T. Median parameter values were recorded and differences between the MRI parameters in nonfibrotic vs. advanced fibrotic/cirrhotic samples were evaluated using Mann-Whitney U tests and receiver operating characteristic analyses. Logistic regression with stepwise feature selection was employed to evaluate the utility of combined MRI measurements for detection of fibrosis. Median R2 * increased in fibrotic vs. nonfibrotic liver samples (P = .041), while differences in χ and PDFF were nonsignificant (P = .545 and P = .395, respectively). Logistic regression identified the combination of χ and R2 * significant for fibrosis detection (logit [prediction] = -8.45 + 0.23 R2 * - 28.8 χ). For this classifier, a highly significant difference between nonfibrotic vs. advanced fibrotic/cirrhotic samples was observed (P = .002). The model exhibited an AUC of 0.909 (P = .003) for detection of advanced fibrosis/cirrhosis, which was substantially higher compared with AUCs of the individual parameters (AUC 0.591-0.784). An integrated QSM and R2 * analysis of mGRE 3 T imaging data is promising for noninvasive diagnostic assessment of liver fibrosis.
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Affiliation(s)
- Ramin Jafari
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, 10021
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, 14853
| | - Stefanie J Hectors
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, 10021
| | | | - Pascal Spincemaille
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, 10021
| | - Martin R Prince
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, 10021
| | - Gary M Brittenham
- Department of Pediatrics, Columbia University, New York, New York, 10032
| | - Yi Wang
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, 10021
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, 14853
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19
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Speich C, Wegmüller R, Brittenham GM, Zeder C, Cercamondi CI, Buhl D, Prentice AM, Zimmermann MB, Moretti D. Measurement of long-term iron absorption and loss during iron supplementation using a stable isotope of iron ( 57 Fe). Br J Haematol 2020; 192:179-189. [PMID: 32862453 DOI: 10.1111/bjh.17039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/19/2020] [Indexed: 12/12/2022]
Abstract
We report the first measurements of long-term iron absorption and loss during iron supplementation in African children using a stable isotope of iron (57 Fe). After uniform labelling of body iron with 57 Fe, iron absorption is proportional to the rate of decrease in the 57 Fe tracer concentration, while iron loss is proportional to the rate of decrease in the 57 Fe tracer amount. Anaemic Gambian toddlers were given 2 mg 57 Fe orally to equilibrate with total body iron over 8-11 months. After assignment to the positive control arm of the HIGH study, 22 toddlers consumed a micronutrient powder containing 12 mg iron for 12 weeks followed by 12 weeks without iron supplementation. Their daily iron absorption increased 3·8-fold during the iron supplementation period compared to the control period [median (interquartile range, IQR): 1·00 (0·82; 1·28) mg/day vs. 0·26 (0·22; 0·35) mg/day; P = 0·001]. Unexpectedly, during the supplementation period, daily iron loss also increased by 3·4-fold [0·75 (0·55; 0·87) mg/day vs. 0·22 (0·19; 0·29) mg/day; P = 0·005]. Consequently, most (~72%) of the absorbed iron was lost during supplementation. Long-term studies of iron absorption and loss are a promising and accurate method for assessing and quantifying long-term iron balance and may provide a reference method for evaluating iron intervention programs in vulnerable population groups. This study was registered as ISRCTN 0720906.
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Affiliation(s)
- Cornelia Speich
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Rita Wegmüller
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland.,MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Gary M Brittenham
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, USA
| | - Christophe Zeder
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Colin I Cercamondi
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Daniela Buhl
- Department of Laboratory Medicine, Cantonal Hospital Luzern, Luzern, Switzerland
| | - Andrew M Prentice
- MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Diego Moretti
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland.,Nutrition Group, Health Department, Swiss Distance University of Applied Sciences, Regensdorf, Switzerland
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20
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Sarna K, Brittenham GM, Beall CM. Current WHO hemoglobin thresholds for altitude and misdiagnosis of anemia among Tibetan highlanders. Am J Hematol 2020; 95:E134-E136. [PMID: 32096880 DOI: 10.1002/ajh.25765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Kaylee Sarna
- Department of AnthropologyCase Western Reserve University Cleveland Ohio
| | | | - Cynthia M. Beall
- Department of AnthropologyCase Western Reserve University Cleveland Ohio
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21
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Sarna K, Brittenham GM, Beall CM. Detecting anaemia at high altitude. Evol Med Public Health 2020; 2020:68-69. [PMID: 32382420 PMCID: PMC7196337 DOI: 10.1093/emph/eoaa011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/12/2020] [Accepted: 04/07/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Kaylee Sarna
- Department of Anthropology, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Gary M Brittenham
- Department of Pediatrics, Columbia University, New York, NY 10027, USA
| | - Cynthia M Beall
- Department of Anthropology, Case Western Reserve University, Cleveland, OH 44106, USA
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22
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Stoffel NU, Zeder C, Brittenham GM, Moretti D, Zimmermann MB. Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron-deficient anemic women. Haematologica 2019; 105:1232-1239. [PMID: 31413088 PMCID: PMC7193469 DOI: 10.3324/haematol.2019.220830] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/12/2019] [Indexed: 11/25/2022] Open
Abstract
In iron-depleted women without anemia, oral iron supplements induce an increase in serum hepcidin (SHep) that persists for 24 hours, decreasing iron absorption from supplements given later on the same or next day. Consequently, iron absorption from supplements is highest if iron is given on alternate days. Whether this dosing schedule is also beneficial in women with iron-deficiency anemia (IDA) given high-dose iron supplements is uncertain. The primary objective of this study was to assess whether, in women with IDA, alternate-day administration of 100 and 200 mg iron increases iron absorption compared to consecutive-day iron administration. Secondary objectives were to correlate iron absorption with SHep and iron status parameters. We performed a cross-over iron absorption study in women with IDA (n=19; median hemoglobin 11.5 mg/dL; mean serum ferritin 10 mg/L) who received either 100 or 200 mg iron as ferrous sulfate given at 8 AM on days 2, 3 and 5 labeled with stable iron isotopes 57Fe, 58Fe and 54Fe; after a 16-day incorporation period, the other labeled dose was given at 8 AM on days 23, 24 and 26 (days 2, 3 and 5 of the second period). Iron absorption on days 2 and 3 (consecutive) and day 5 (alternate) was assessed by measuring erythrocyte isotope incorporation. For both doses, SHep was higher on day 3 than on day 2 (P<0.001) or day 5 (P<0.01) with no significant difference between days 2 and 5. Similarly, for both doses, fractional iron absorption (FIA) on days 2 and 5 was 40-50% higher than on day 3 (P<0.001), while absorption on day 2 did not differ significantly from day 5. There was no significant difference in the incidence of gastrointestinal side effects comparing the two iron doses (P=0.105). Alternate day dosing of oral iron supplements in anemic women may be preferable because it sharply increases FIA. If needed, to provide the same total amount of iron with alternate day dosing, twice the daily target dose should be given on alternate days, as total iron absorption from a single dose of 200 mg given on alternate days was approximately twice that from 100 mg given on consecutive days (P<0.001). In IDA, even if hepatic hepcidin expression is strongly suppressed by iron deficiency and erythropoietic drive, the intake of oral iron supplements leads to an acute hepcidin increase for 24 hours. The study was funded by ETH Zürich, Switzerland. This study has been registered at www.clinicaltrials.gov as #NCT03623997.
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Affiliation(s)
- Nicole U Stoffel
- ETH Zurich, Department of Health Science and Technology, Institute of Food, Nutrition and Health, Laboratory of Human Nutrition, Zürich, Switzerland
| | - Christophe Zeder
- ETH Zurich, Department of Health Science and Technology, Institute of Food, Nutrition and Health, Laboratory of Human Nutrition, Zürich, Switzerland
| | - Gary M Brittenham
- Columbia University, Department of Pediatrics, College of Physicians and Surgeons, New York, NY, USA
| | - Diego Moretti
- ETH Zurich, Department of Health Science and Technology, Institute of Food, Nutrition and Health, Laboratory of Human Nutrition, Zürich, Switzerland
| | - Michael B Zimmermann
- ETH Zurich, Department of Health Science and Technology, Institute of Food, Nutrition and Health, Laboratory of Human Nutrition, Zürich, Switzerland
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Sheth S, Allen CJ, Farrell DE, Tripp JH, Jafari R, Wang Y, Brittenham GM. Measurement of the liver iron concentration in transfusional iron overload by MRI R2* and by high-transition-temperature superconducting magnetic susceptometry. Clin Imaging 2019; 55:65-70. [PMID: 30754013 DOI: 10.1016/j.clinimag.2019.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 12/11/2018] [Accepted: 01/15/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE To compare measurement of the liver iron concentration in patients with transfusional iron overload by magnetic resonance imaging (MRI), using R2*, and by magnetic susceptometry, using a new high-transitiontemperature (high-Tc; operating at 77 K, cooled by liquid nitrogen) superconducting magnetic susceptometer. METHODS In 28 patients with transfusional iron overload, 43 measurements of the liver iron concentration were made by both R2* and high-Tc magnetic susceptometry. RESULTS Measurements of the liver iron concentration by R2* and high-Tc magnetic susceptometry were significantly correlated when comparing all patients (Pearson's r = 0.91, p < 0.0001) and those with results by susceptometry >7 mg Fe/g liver, dry weight (r = 0.93, p = 0.006). In lower ranges of liver iron, no significant correlations between the two methods were found (0 to <3.2 mg Fe/g liver, dry weight: r = 0.2, p = 0.37; 3.2 to 7 mg Fe/g liver, dry weight: r = 0.41; p = 0.14). CONCLUSION The lack of linear correlation between R2* and magnetic susceptibility measurements of the liver iron concentration with minimal or modest iron overload may be due to the effects of fibrosis and other cellular pathology that interfere with R2* but do not appreciably alter magnetic susceptibility.
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Affiliation(s)
- Sujit Sheth
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - John H Tripp
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Yi Wang
- Weill Cornell Medical College, New York, NY, USA; Cornell University, Ithaca, NY, USA
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Jafari R, Sheth S, Spincemaille P, Nguyen TD, Prince MR, Wen Y, Guo Y, Deh K, Liu Z, Margolis D, Brittenham GM, Kierans AS, Wang Y. Rapid automated liver quantitative susceptibility mapping. J Magn Reson Imaging 2019; 50:725-732. [PMID: 30637892 DOI: 10.1002/jmri.26632] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Accurate measurement of the liver iron concentration (LIC) is needed to guide iron-chelating therapy for patients with transfusional iron overload. In this work, we investigate the feasibility of automated quantitative susceptibility mapping (QSM) to measure the LIC. PURPOSE To develop a rapid, robust, and automated liver QSM for clinical practice. STUDY TYPE Prospective. POPULATION 13 healthy subjects and 22 patients. FIELD STRENGTH/SEQUENCES 1.5 T and 3 T/3D multiecho gradient-recalled echo (GRE) sequence. ASSESSMENT Data were acquired using a 3D GRE sequence with an out-of-phase echo spacing with respect to each other. All odd echoes that were in-phase (IP) were used to initialize the fat-water separation and field estimation (T2 *-IDEAL) before performing QSM. Liver QSM was generated through an automated pipeline without manual intervention. This IP echo-based initialization method was compared with an existing graph cuts initialization method (simultaneous phase unwrapping and removal of chemical shift, SPURS) in healthy subjects (n = 5). Reproducibility was assessed over four scanners at two field strengths from two manufacturers using healthy subjects (n = 8). Clinical feasibility was evaluated in patients (n = 22). STATISTICAL TESTS IP and SPURS initialization methods in both healthy subjects and patients were compared using paired t-test and linear regression analysis to assess processing time and region of interest (ROI) measurements. Reproducibility of QSM, R2 *, and proton density fat fraction (PDFF) among the four different scanners was assessed using linear regression, Bland-Altman analysis, and the intraclass correlation coefficient (ICC). RESULTS Liver QSM using the IP method was found to be ~5.5 times faster than SPURS (P < 0.05) in initializing T2 *-IDEAL with similar outputs. Liver QSM using the IP method were reproducibly generated in all four scanners (average coefficient of determination 0.95, average slope 0.90, average bias 0.002 ppm, 95% limits of agreement between -0.06 to 0.07 ppm, ICC 0.97). DATA CONCLUSION Use of IP echo-based initialization enables robust water/fat separation and field estimation for automated, rapid, and reproducible liver QSM for clinical applications. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:725-732.
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Affiliation(s)
- Ramin Jafari
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA.,Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
| | - Sujit Sheth
- Department of Pediatrics, Weill Medical College of Cornell University, New York, New York, USA
| | - Pascal Spincemaille
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
| | - Thanh D Nguyen
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
| | - Martin R Prince
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
| | - Yan Wen
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA.,Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
| | - Yihao Guo
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA.,School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Kofi Deh
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
| | - Zhe Liu
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA.,Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
| | - Daniel Margolis
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
| | - Gary M Brittenham
- Department of Pediatrics, Columbia University, New York, New York, USA
| | - Andrea S Kierans
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
| | - Yi Wang
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA.,Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
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Moretti D, Mettler S, Zeder C, Lundby C, Geurts-Moetspot A, Monnard A, Swinkels DW, Brittenham GM, Zimmermann MB. An intensified training schedule in recreational male runners is associated with increases in erythropoiesis and inflammation and a net reduction in plasma hepcidin. Am J Clin Nutr 2018; 108:1324-1333. [PMID: 30351387 DOI: 10.1093/ajcn/nqy247] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/21/2018] [Indexed: 01/24/2023] Open
Abstract
Background Iron status is a determinant of physical performance, but training may induce both low-grade inflammation and erythropoiesis, exerting opposing influences on hepcidin and iron metabolism. To our knowledge, the combined effects on iron absorption and utilization during training have not been examined directly in humans. Objective We hypothesized that 3 wk of exercise training in recreational male runners would decrease oral iron bioavailability by increasing inflammation and hepcidin concentrations. Design In a prospective intervention, nonanemic, iron-sufficient men (n = 10) completed a 34-d study consisting of a 16-d control phase and a 22-d exercise-training phase of 8 km running every second day. We measured oral iron absorption and erythroid iron utilization using oral 57Fe and intravenous 58Fe tracers administered before and during training. We measured hemoglobin mass (mHb) and total red blood cell volume (RCV) by carbon monoxide rebreathing. Iron status, interleukin-6 (IL-6), plasma hepcidin (PHep), erythropoietin (EPO), and erythroferrone were measured before, during, and after training. Results Exercise training induced inflammation, as indicated by an increased mean ± SD IL-6 (0.87 ± 1.1 to 5.17 ± 2.2 pg/mL; P < 0.01), while also enhancing erythropoiesis, as indicated by an increase in mean EPO (0.66 ± 0.42 to 2.06 ± 1.6 IU/L), mHb (10.5 ± 1.6 to 10.8 ± 1.8 g/kg body weight), and mean RCV (30.7 ± 4.3 to 32.7 ± 4.6 mL/kg) (all P < 0.05). Training tended to increase geometric mean iron absorption by 24% (P = 0.083), consistent with a decreased mean ± SD PHep (7.25 ± 2.14 to 5.17 ± 2.24 nM; P < 0.05). The increase in mHb and erythroid iron utilization were associated with the decrease in PHep (P < 0.05). Compartmental modeling indicated that iron for the increase in mHb was obtained predominantly (>80%) from stores mobilization rather than from increased dietary absorption. Conclusions In iron-sufficient men, mild intensification of exercise intensity increases both inflammation and erythropoiesis. The net effect is to decrease hepcidin concentrations and to tend to increase oral iron absorption. This trial was registered at clinicaltrials.gov as NCT01730521.
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Affiliation(s)
- Diego Moretti
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, ETH Zürich, Zurich, Switzerland
| | - Samuel Mettler
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, ETH Zürich, Zurich, Switzerland.,Swiss Federal Institute of Sports, Magglingen, Switzerland.,Department of Business, Health, and Social Work, Bern University of Applied Sciences, Bern, Switzerland
| | - Christophe Zeder
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, ETH Zürich, Zurich, Switzerland
| | - Carsten Lundby
- Zurich Center for Integrative Human Physiology, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Anneke Geurts-Moetspot
- Hepcidinanalysis.com and Department of Laboratory Medicine, Translational Metabolic Laboratory, Radboud University Medical Center, Nijmegen, Netherlands
| | - Arnaud Monnard
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, ETH Zürich, Zurich, Switzerland
| | - Dorine W Swinkels
- Hepcidinanalysis.com and Department of Laboratory Medicine, Translational Metabolic Laboratory, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gary M Brittenham
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, ETH Zürich, Zurich, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, ETH Zürich, Zurich, Switzerland
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Sarna K, Gebremedin A, Brittenham GM, Beall CM. WHO hemoglobin thresholds for altitude increase the prevalence of anemia among Ethiopian highlanders. Am J Hematol 2018; 93:E229-E231. [PMID: 30040139 DOI: 10.1002/ajh.25194] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/11/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Kaylee Sarna
- Department of Anthropology Case Western Reserve University Cleveland OH 44106 USA
| | - Amha Gebremedin
- Faculty of Medicine Addis Ababa University School of Medicine Addis Ababa Ethiopia
| | - Gary M. Brittenham
- Department of Pediatrics Columbia University New York New York 10032 USA
| | - Cynthia M. Beall
- Department of Anthropology Case Western Reserve University Cleveland OH 44106 USA
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Abstract
Patients with sickle cell disease (SCD) are at risk for bone fragility from multiple factors including vitamin D deficiency. To date, no studies have evaluated the efficacy and safety of long-term vitamin D therapy for bone disease in children with SCD. We report a cohort of 4 children with SCD found to have severe vitamin D deficiency, secondary hyperparathyroidism, and abnormal bone mineral density treated with monthly high-dose oral cholecalciferol over 2 years. All patients exhibited a positive response to therapy without hypervitaminosis D or hypercalcemia. Further studies are needed to standardize guidelines for optimal vitamin D dosing and prevention of toxicity.
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Affiliation(s)
- Kristen M Williams
- Division of Pediatric Endocrinology, Columbia University Medical
Center, New York, NY
| | - Margaret T Lee
- Division of Pediatric Hematology, Oncology, and Stem Cell
Transplantation, Columbia University Medical Center, New York, NY
| | - Maureen Licursi
- Division of Pediatric Hematology, Oncology, and Stem Cell
Transplantation, Columbia University Medical Center, New York, NY
| | - Gary M Brittenham
- Division of Pediatric Hematology, Oncology, and Stem Cell
Transplantation, Columbia University Medical Center, New York, NY
| | - Ilene Fennoy
- Division of Pediatric Endocrinology, Columbia University Medical
Center, New York, NY
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Li J, Lin H, Liu T, Zhang Z, Prince MR, Gillen K, Yan X, Song Q, Hua T, Zhao X, Zhang M, Zhao Y, Li G, Tang G, Yang G, Brittenham GM, Wang Y. Quantitative susceptibility mapping (QSM) minimizes interference from cellular pathology in R2* estimation of liver iron concentration. J Magn Reson Imaging 2018; 48:1069-1079. [PMID: 29566449 DOI: 10.1002/jmri.26019] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/06/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A challenge for R2 and R2* methods in measuring liver iron concentration (LIC) is that fibrosis, fat, and other hepatic cellular pathology contribute to R2 and R2* and interfere with LIC estimation. PURPOSE To examine the interfering effects of fibrosis, fat, and other lesions on R2* LIC estimation and to use quantitative susceptibility mapping (QSM) to reduce these distortions. STUDY TYPE Prospective. PHANTOMS, SUBJECTS Water phantoms with various concentrations of gadolinium (Gd), collagen (Cl, modeling fibrosis), and fat; nine healthy controls with no known hepatic disease, nine patients with known or suspected hepatic iron overload, and nine patients with focal liver lesions. FIELD STRENGTH/SEQUENCE The phantoms and human subjects were imaged using a 3D multiecho gradient-echo on clinical 1.5T and 3T MRI systems. ASSESSMENT QSM and R2* images were postprocessed from the same gradient-echo data. Fat contributions to susceptibility and R2* were corrected in signal models for LIC estimation. STATISTICAL TESTS Polynomial regression analyses were performed to examine relations among susceptibility, R2* and true [Gd] and [Cl] in phantoms, and among susceptibility and R2* in patient livers. RESULTS In phantoms, R2* had a strong nonlinear dependency on [Cl], [fat], and [Gd], while susceptibility was linearly dependent (R2 > 0.98). In patients, R2* was highly sensitive to liver pathological changes, including fat, fibrosis, and tumors, while QSM was relatively insensitive to these abnormalities (P = 0.015). With moderate iron overload, liver susceptibility and R2* were not linearly correlated over a common R2* range [0, 100] sec-1 (P = 0.35). DATA CONCLUSION R2* estimation of LIC is prone to substantial nonlinear interference from fat, fibrosis, and other lesions. QSM processing of the same gradient echo MRI data can effectively minimize the effects of cellular pathology. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;48:1069-1079.
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Affiliation(s)
- Jianqi Li
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, East China Normal University, Shanghai, China
| | - Huimin Lin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tian Liu
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
| | - Zhuwei Zhang
- Department of Radiology, Shanghai Tenth People's Hospital Affiliated to Tongji University, School of Medicine, Shanghai, China
| | - Martin R Prince
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
| | - Kelly Gillen
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
| | - Xu Yan
- MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China
| | - Qi Song
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Hua
- Department of Radiology, Shanghai Tenth People's Hospital Affiliated to Tongji University, School of Medicine, Shanghai, China
| | - Xiance Zhao
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, East China Normal University, Shanghai, China
| | - Miao Zhang
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, East China Normal University, Shanghai, China
| | - Yu Zhao
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, East China Normal University, Shanghai, China
| | - Gaiying Li
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, East China Normal University, Shanghai, China
| | - Guangyu Tang
- Department of Radiology, Shanghai Tenth People's Hospital Affiliated to Tongji University, School of Medicine, Shanghai, China
| | - Guang Yang
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, East China Normal University, Shanghai, China
| | - Gary M Brittenham
- Department of Pediatrics, Columbia University, New York, New York, USA
| | - Yi Wang
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, East China Normal University, Shanghai, China.,Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA.,Department of Biomedical Engineering, Cornell University, Ithaca, New York, USA
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Abdel-Wahab O, Abrahm JL, Adams S, Adewoye AH, Allen C, Ambinder RF, Anasetti C, Anastasi J, Anderson JA, Antin JH, Antony AC, Araten DJ, Armand P, Armstrong G, Armstrong SA, Arnold DM, Artz AS, Awan FT, Baglin TP, Benson DM, Benz EJ, Berliner N, Bhagat G, Bhardwaj N, Bhatia R, Bhatia S, Bhatt MD, Bhatt VR, Bitan M, Blinderman CD, Bollard CM, Braun BS, Brenner MK, Brittenham GM, Brodsky RA, Brown M, Broxmeyer HE, Brummel-Ziedins K, Brunner AM, Buadi FK, Burkhardt B, Burns M, Byrd JC, Caimi PF, Caligiuri MA, Canavan M, Cantor AB, Carcao M, Carroll MC, Carty SA, Castillo JJ, Chan AK, Chapin J, Chiu A, Chute JP, Clark DB, Coates TD, Cogle CR, Connell NT, Cooke E, Cooley S, Corradini P, Creager MA, Creger RJ, Cromwell C, Crowther MA, Cushing MM, Cutler C, Dang CV, Danial NN, Dave SS, DeCaprio JA, Dinauer MC, Dinner S, Diz-Küçükkaya R, Dodd RY, Donato ML, Dorshkind K, Dotti G, Dror Y, Dunleavy K, Dvorak CC, Ebert BL, Eck MJ, Eikelboom JW, Epperla N, Ershler WB, Evans WE, Faderl S, Ferrara JL, Filipovich AH, Fischer M, Fredenburgh JC, Friedman KD, Fuchs E, Fuller SJ, Gailani D, Galipeau J, Gallagher PG, Ganapathi KA, Gardner LB, Gee AP, Gerson SL, Gertz MA, Giardina PJ, Gibson CJ, Golan K, Golub TR, Gonzales MJ, Gotlib J, Gottschalk S, Grant MA, Graubert TA, Gregg XT, Gribben JG, Gross DM, Gruber TA, Guitart J, Gurbuxani S, Gur-Cohen S, Gutierrez A, Hamadani M, Hari PN, Hartwig JH, Hayman SR, Hayward CP, Hebbel RP, Heslop HE, Hillis C, Hillyer CD, Ho K, Hockenbery DM, Hoffman R, Hogg KE, Holtan SG, Horny HP, Hsu YMS, Hunter ZR, Huntington JA, Iancu-Rubin C, Iqbal A, Isenman DE, Israels SJ, Italiano JE, Jaffe ES, Jaffer IH, Jagannath S, Jäger U, Jain N, James P, Jeha S, Jordan MB, Josephson CD, Jung M, Kager L, Kambayashi T, Kanakry JA, Kantarjian HM, Kaplan J, Karafin MS, Karsan A, Kaufman RJ, Kaufman RM, Keller FG, Kelly KM, Kessler CM, Key NS, Keyzner A, Khandoga AG, Khanna-Gupta A, Khatib-Massalha E, Klein HG, Knoechel B, Kollet O, Konkle BA, Kontoyiannis DP, Koreth J, Koretzky GA, Kotecha D, Kremyanskaya M, Kumari A, Kuzel TM, Küppers R, Lacy MQ, Ladas E, Landier W, Lapid K, Lapidot T, Larson PJ, Levi M, Lewis RE, Liebman HA, Lillicrap D, Lim W, Lin JC, Lindblad R, Lip GY, Little JA, Lohr JG, López JA, Luscinskas FW, Maciejewski JP, Majhail NS, Manches O, Mandle RJ, Mann KG, Manno CS, Marcogliese AN, Mariani G, Marincola FM, Mascarenhas J, Massberg S, McEver RP, McGrath E, McKinney MS, Mehta RS, Mentzer WC, Merlini G, Merryman R, Michel M, Migliaccio AR, Miller JS, Mims MP, Mondoro TH, Moorehead P, Muniz LR, Munshi NC, Najfeld V, Nayak L, Nazy I, Neff AT, Ness PM, Notarangelo LD, O'Brien SH, O'Connor OA, O'Donnell M, Olson A, Orkin SH, Pai M, Pai SY, Paidas M, Panch SR, Pande RL, Papayannopoulou T, Parikh R, Petersdorf EW, Peterson SE, Pittaluga S, Ponce DM, Popolo L, Prchal JT, Pui CH, Puigserver P, Rak J, Ramos CA, Rand JH, Rand ML, Rao DS, Ravandi F, Rawlings DJ, Reddy P, Reding MT, Reiter A, Rice L, Riese MJ, Ritchey AK, Roberts DJ, Roman E, Rooney CM, Rosen ST, Rosenthal DS, Rossmann MP, Rot A, Rowley SD, Rubnitz JE, Rydz N, Salama ME, Sauk S, Saunthararajah Y, Savage W, Scadden D, Schaefer KG, Schiffman F, Schneidewend R, Schrier SL, Schuchman EH, Scullion BF, Selvaggi KJ, Senoo K, Shaheen M, Shaz BH, Shelburne SA, Shpall EJ, Shurin SB, Siegal D, Silberstein LE, Silberstein L, Silverstein RL, Sloan SR, Smith FO, Smith JW, Smith K, Steensma DP, Steinberg MH, Stock W, Storry JR, Stramer SL, Strauss RG, Stroncek DF, Taylor J, Thota S, Treon SP, Tulpule A, Valdes RF, Valent P, Vedantham S, Vercellotti GM, Verneris MR, Vichinsky EP, von Andrian UH, Vose JM, Wagner AJ, Wang E, Wang JH, Warkentin TE, Wasserstein MP, Webster A, Weisdorf DJ, Weitz JI, Westhoff CM, Wheeler AP, Widick P, Wiley JS, William BM, Williams DA, Wilson WH, Wolfe J, Wolgast LR, Wood D, Wu J, Yahalom J, Yee DL, Younes A, Young NS, Zeller MP. Contributors. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Mei Z, Flores-Ayala RC, Grummer-Strawn LM, Brittenham GM. Is Erythrocyte Protoporphyrin a Better Single Screening Test for Iron Deficiency Compared to Hemoglobin or Mean Cell Volume in Children and Women? Nutrients 2017; 9:nu9060557. [PMID: 28561801 PMCID: PMC5490536 DOI: 10.3390/nu9060557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 01/13/2023] Open
Abstract
Hemoglobin (Hb), mean cell volume (MCV), and erythrocyte protoporphyrin (EP) are commonly used to screen for iron deficiency (ID), but systematic evaluation of the sensitivity and specificity of these tests is limited. The objective of this study is to determine the sensitivity and specificity of Hb, MCV, and EP measurements in screening for ID in preschool children, non-pregnant women 15-49 years of age, and pregnant women. Data from the National Health and Nutrition Examination Surveys (NHANES) (NHANES 2003-2006: n = 861, children three to five years of age; n = 3112, non-pregnant women 15 to 49 years of age. NHANES 1999-2006: n = 1150, pregnant women) were examined for this purpose. Children or women with blood lead ≥10 µg/dL or C-reactive protein (CRP) >5.0 mg/L were excluded. ID was defined as total body iron stores <0 mg/kg body weight, calculated from the ratio of soluble transferrin receptor (sTfR) to serum ferritin (SF). The receiver operating characteristic (ROC) curve was used to characterize the sensitivity and specificity of Hb, MCV, and EP measurements in screening for ID. In detecting ID in children three to five years of age, EP (Area under the Curve (AUC) 0.80) was superior to Hb (AUC 0.62) (p < 0.01) but not statistically different from MCV (AUC 0.73). In women, EP and Hb were comparable (non-pregnant AUC 0.86 and 0.84, respectively; pregnant 0.77 and 0.74, respectively), and both were better than MCV (non-pregnant AUC 0.80; pregnant 0.70) (p < 0.01). We concluded that the sensitivity and specificity of EP in screening for ID were consistently superior to or at least as effective as those of Hb and MCV in each population examined. For children three to five years of age, EP screening for ID was significantly better than Hb and similar to MCV. For both non-pregnant and pregnant women, the performance of EP and Hb were comparable; both were significantly superior to MCV.
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Affiliation(s)
- Zuguo Mei
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, 30300 GA, USA.
| | - Rafael C Flores-Ayala
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, 30300 GA, USA.
| | | | - Gary M Brittenham
- Department of Pediatrics, Columbia University, New York, 10032 NY, USA.
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Wang Y, Spincemaille P, Liu Z, Dimov A, Deh K, Li J, Zhang Y, Yao Y, Gillen KM, Wilman AH, Gupta A, Tsiouris AJ, Kovanlikaya I, Chiang GCY, Weinsaft JW, Tanenbaum L, Chen W, Zhu W, Chang S, Lou M, Kopell BH, Kaplitt MG, Devos D, Hirai T, Huang X, Korogi Y, Shtilbans A, Jahng GH, Pelletier D, Gauthier SA, Pitt D, Bush AI, Brittenham GM, Prince MR. Clinical quantitative susceptibility mapping (QSM): Biometal imaging and its emerging roles in patient care. J Magn Reson Imaging 2017; 46:951-971. [PMID: 28295954 DOI: 10.1002/jmri.25693] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/10/2017] [Indexed: 12/13/2022] Open
Abstract
Quantitative susceptibility mapping (QSM) has enabled magnetic resonance imaging (MRI) of tissue magnetic susceptibility to advance from simple qualitative detection of hypointense blooming artifacts to precise quantitative measurement of spatial biodistributions. QSM technology may be regarded to be sufficiently developed and validated to warrant wide dissemination for clinical applications of imaging isotropic susceptibility, which is dominated by metals in tissue, including iron and calcium. These biometals are highly regulated as vital participants in normal cellular biochemistry, and their dysregulations are manifested in a variety of pathologic processes. Therefore, QSM can be used to assess important tissue functions and disease. To facilitate QSM clinical translation, this review aims to organize pertinent information for implementing a robust automated QSM technique in routine MRI practice and to summarize available knowledge on diseases for which QSM can be used to improve patient care. In brief, QSM can be generated with postprocessing whenever gradient echo MRI is performed. QSM can be useful for diseases that involve neurodegeneration, inflammation, hemorrhage, abnormal oxygen consumption, substantial alterations in highly paramagnetic cellular iron, bone mineralization, or pathologic calcification; and for all disorders in which MRI diagnosis or surveillance requires contrast agent injection. Clinicians may consider integrating QSM into their routine imaging practices by including gradient echo sequences in all relevant MRI protocols. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2017;46:951-971.
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Affiliation(s)
- Yi Wang
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA.,Department of Biomedical Engineering, Ithaca, New York, USA
| | - Pascal Spincemaille
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Zhe Liu
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA.,Department of Biomedical Engineering, Ithaca, New York, USA
| | - Alexey Dimov
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA.,Department of Biomedical Engineering, Ithaca, New York, USA
| | - Kofi Deh
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Jianqi Li
- Department of Physics, East China Normal University, Shanghai, P.R. China
| | - Yan Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, P.R. China
| | - Yihao Yao
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA.,Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, P.R. China
| | - Kelly M Gillen
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Alan H Wilman
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | | | - Ilhami Kovanlikaya
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | | | - Jonathan W Weinsaft
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | | | - Weiwei Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, P.R. China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, P.R. China
| | - Shixin Chang
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese & Western Medicine, Shanghai, P.R. China
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, P.R. China
| | - Brian H Kopell
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Michael G Kaplitt
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
| | - David Devos
- Department of Medical Pharmacology, University of Lille, Lille, France.,Department of Neurology and Movement Disorders, University of Lille, Lille, France.,Department of Toxicology, Public Health and Environment, University of Lille, Lille, France.,INSERM U1171, University of Lille, Lille, France
| | - Toshinori Hirai
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Xuemei Huang
- Department of Neurology, Penn State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.,Department of Pharmacology, Penn State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.,Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.,Department of Radiology, Penn State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Yukunori Korogi
- Department of Radiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Alexander Shtilbans
- Department of Neurology, Hospital for Special Surgery, New York, New York, USA.,Parkinson's Disease and Movement Disorder Institute, Weill Cornell Medical College, New York, New York, USA
| | - Geon-Ho Jahng
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Daniel Pelletier
- Department of Neurology, Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Susan A Gauthier
- Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, New York, USA
| | - David Pitt
- Department of Neurology, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Ashley I Bush
- Oxidation Biology Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Gary M Brittenham
- Department of Pediatrics, Columbia University, Children's Hospital of New York, New York, New York, USA
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
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Rapido F, Brittenham GM, Bandyopadhyay S, La Carpia F, L'Acqua C, McMahon DJ, Rebbaa A, Wojczyk BS, Netterwald J, Wang H, Schwartz J, Eisenberger A, Soffing M, Yeh R, Divgi C, Ginzburg YZ, Shaz BH, Sheth S, Francis RO, Spitalnik SL, Hod EA. Prolonged red cell storage before transfusion increases extravascular hemolysis. J Clin Invest 2016; 127:375-382. [PMID: 27941245 DOI: 10.1172/jci90837] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/27/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Some countries have limited the maximum allowable storage duration for red cells to 5 weeks before transfusion. In the US, red blood cells can be stored for up to 6 weeks, but randomized trials have not assessed the effects of this final week of storage on clinical outcomes. METHODS Sixty healthy adult volunteers were randomized to a single standard, autologous, leukoreduced, packed red cell transfusion after 1, 2, 3, 4, 5, or 6 weeks of storage (n = 10 per group). 51-Chromium posttransfusion red cell recovery studies were performed and laboratory parameters measured before and at defined times after transfusion. RESULTS Extravascular hemolysis after transfusion progressively increased with increasing storage time (P < 0.001 for linear trend in the AUC of serum indirect bilirubin and iron levels). Longer storage duration was associated with decreasing posttransfusion red cell recovery (P = 0.002), decreasing elevations in hematocrit (P = 0.02), and increasing serum ferritin (P < 0.0001). After 6 weeks of refrigerated storage, transfusion was followed by increases in AUC for serum iron (P < 0.01), transferrin saturation (P < 0.001), and nontransferrin-bound iron (P < 0.001) as compared with transfusion after 1 to 5 weeks of storage. CONCLUSIONS After 6 weeks of refrigerated storage, transfusion of autologous red cells to healthy human volunteers increased extravascular hemolysis, saturated serum transferrin, and produced circulating nontransferrin-bound iron. These outcomes, associated with increased risks of harm, provide evidence that the maximal allowable red cell storage duration should be reduced to the minimum sustainable by the blood supply, with 35 days as an attainable goal.REGISTRATION. ClinicalTrials.gov NCT02087514. FUNDING NIH grant HL115557 and UL1 TR000040.
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Hennig G, Homann C, Teksan I, Hasbargen U, Hasmüller S, Holdt LM, Khaled N, Sroka R, Stauch T, Stepp H, Vogeser M, Brittenham GM. Non-invasive detection of iron deficiency by fluorescence measurement of erythrocyte zinc protoporphyrin in the lip. Nat Commun 2016; 7:10776. [PMID: 26883939 PMCID: PMC4757790 DOI: 10.1038/ncomms10776] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 01/18/2016] [Indexed: 01/09/2023] Open
Abstract
Worldwide, more individuals have iron deficiency than any other health problem. Most of those affected are unaware of their lack of iron, in part because detection of iron deficiency has required a blood sample. Here we report a non-invasive method to optically measure an established indicator of iron status, red blood cell zinc protoporphyrin, in the microcirculation of the lower lip. An optical fibre probe is used to illuminate the lip and acquire fluorescence emission spectra in ∼1 min. Dual-wavelength excitation with spectral fitting is used to distinguish the faint zinc protoporphyrin fluorescence from the much greater tissue background fluorescence, providing immediate results. In 56 women, 35 of whom were iron-deficient, the sensitivity and specificity of optical non-invasive detection of iron deficiency were 97% and 90%, respectively. This fluorescence method potentially provides a rapid, easy to use means for point-of-care screening for iron deficiency in resource-limited settings lacking laboratory infrastructure. Iron deficiency, the most common health problem in the world, has required a blood test for diagnosis. Here, the authors show that iron deficiency can be detected non-invasively and quickly by measuring the fluorescence of red blood cell zinc protoporphyrin in the microcirculation of the lip.
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Affiliation(s)
- Georg Hennig
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Feodor-Lynen-Strasse 19, 81377 Munich, Germany
| | - Christian Homann
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Feodor-Lynen-Strasse 19, 81377 Munich, Germany
| | - Ilknur Teksan
- Perinatalzentrum Großhadern, Klinikum der Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - Uwe Hasbargen
- Perinatalzentrum Großhadern, Klinikum der Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - Stephan Hasmüller
- Perinatalzentrum Großhadern, Klinikum der Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - Lesca M Holdt
- Institut für Laboratoriumsmedizin, Klinikum der Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | | | - Ronald Sroka
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Feodor-Lynen-Strasse 19, 81377 Munich, Germany
| | - Thomas Stauch
- Deutsches Kompetenz-Zentrum für Porphyriediagnostik und Konsultation, MVZ Labor PD Dr. Volkmann und Kollegen GbR, Kriegsstrasse 99, 76133 Karlsruhe, Germany
| | - Herbert Stepp
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Feodor-Lynen-Strasse 19, 81377 Munich, Germany
| | - Michael Vogeser
- Institut für Laboratoriumsmedizin, Klinikum der Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - Gary M Brittenham
- Department of Pediatrics, Columbia University, Children's Hospital of New York, Room CHN 10-08, 3959 Broadway, New York, New York 10032, USA
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35
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L'Acqua C, Bandyopadhyay S, Francis RO, McMahon DJ, Nellis M, Sheth S, Kernie SG, Brittenham GM, Spitalnik SL, Hod EA. Red blood cell transfusion is associated with increased hemolysis and an acute phase response in a subset of critically ill children. Am J Hematol 2015; 90:915-20. [PMID: 26183122 DOI: 10.1002/ajh.24119] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/08/2015] [Indexed: 12/11/2022]
Abstract
In healthy adults, transfusion of older stored red blood cells (RBCs) produces extravascular hemolysis and circulating non-transferrin-bound iron. In a prospective, observational study of critically ill children, we examined the effect of RBC storage duration on the extent of hemolysis by comparing laboratory measurements obtained before, and 4 hr after, RBC transfusion (N = 100) or saline/albumin infusion (N = 20). Transfusion of RBCs stored for longer than 4 weeks significantly increased plasma free hemoglobin (P < 0.05), indirect bilirubin (P < 0.05), serum iron (P < 0.001), and non-transferrin-bound iron (P < 0.01). However, days of storage duration poorly correlated (R(2) <0.10) with all measured indicators of hemolysis and inflammation. These results suggest that, in critically ill children, most effects of RBC storage duration on post-transfusion hemolysis are overwhelmed by recipient and/or donor factors. Nonetheless, we identified a subset of patients (N = 21) with evidence of considerable extravascular hemolysis (i.e., increased indirect bilirubin ≥0.4 mg/dL). In these patients, transfusion-associated hemolysis was accompanied by increases in circulating non-transferrin-bound iron and free hemoglobin and by an acute phase response, as assessed by an increase in median C-reactive protein levels of 21.2 mg/L (P < 0.05). In summary, RBC transfusions were associated with an acute phase response and both extravascular and intravascular hemolysis, which were independent of RBC storage duration. The 21% of transfusions that were associated with substantial hemolysis conferred an increased risk of inducing an acute phase response.
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Affiliation(s)
- Camilla L'Acqua
- Department of Medical Surgical Pathophysiology and Organ Transplantation; Universita’ Degli Studi Di Milano; Milan Italy
- Department of Pathology and Cell Biology; Columbia University Medical Center, New York Presbyterian Hospital; New York New York
| | - Sheila Bandyopadhyay
- Department of Pathology and Cell Biology; Columbia University Medical Center, New York Presbyterian Hospital; New York New York
| | - Richard O. Francis
- Department of Pathology and Cell Biology; Columbia University Medical Center, New York Presbyterian Hospital; New York New York
| | - Donald J. McMahon
- Department of Medicine; Columbia University Medical Center, New York Presbyterian Hospital; New York New York
| | - Marianne Nellis
- Department of Pediatrics; Weill Cornell Medical College, New York Presbyterian Hospital; New York New York
| | - Sujit Sheth
- Department of Pediatrics; Weill Cornell Medical College, New York Presbyterian Hospital; New York New York
| | - Steven G. Kernie
- Department of; Pediatrics, Columbia University Medical Center, New York Presbyterian Hospital; New York New York
| | - Gary M. Brittenham
- Department of Medicine; Columbia University Medical Center, New York Presbyterian Hospital; New York New York
- Department of; Pediatrics, Columbia University Medical Center, New York Presbyterian Hospital; New York New York
| | - Steven L. Spitalnik
- Department of Pathology and Cell Biology; Columbia University Medical Center, New York Presbyterian Hospital; New York New York
| | - Eldad A. Hod
- Department of Pathology and Cell Biology; Columbia University Medical Center, New York Presbyterian Hospital; New York New York
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de Swart L, Hendriks JCM, van der Vorm LN, Cabantchik ZI, Evans PJ, Hod EA, Brittenham GM, Furman Y, Wojczyk B, Janssen MCH, Porter JB, Mattijssen VEJM, Biemond BJ, MacKenzie MA, Origa R, Galanello R, Hider RC, Swinkels DW. Second international round robin for the quantification of serum non-transferrin-bound iron and labile plasma iron in patients with iron-overload disorders. Haematologica 2015; 101:38-45. [PMID: 26385212 DOI: 10.3324/haematol.2015.133983] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/18/2015] [Indexed: 01/19/2023] Open
Abstract
Non-transferrin-bound iron and its labile (redox active) plasma iron component are thought to be potentially toxic forms of iron originally identified in the serum of patients with iron overload. We compared ten worldwide leading assays (6 for non-transferrin-bound iron and 4 for labile plasma iron) as part of an international inter-laboratory study. Serum samples from 60 patients with four different iron-overload disorders in various treatment phases were coded and sent in duplicate for analysis to five different laboratories worldwide. Some laboratories provided multiple assays. Overall, highest assay levels were observed for patients with untreated hereditary hemochromatosis and β-thalassemia intermedia, patients with transfusion-dependent myelodysplastic syndromes and patients with transfusion-dependent and chelated β-thalassemia major. Absolute levels differed considerably between assays and were lower for labile plasma iron than for non-transferrin-bound iron. Four assays also reported negative values. Assays were reproducible with high between-sample and low within-sample variation. Assays correlated and correlations were highest within the group of non-transferrin-bound iron assays and within that of labile plasma iron assays. Increased transferrin saturation, but not ferritin, was a good indicator of the presence of forms of circulating non-transferrin-bound iron. The possibility of using non-transferrin-bound iron and labile plasma iron measures as clinical indicators of overt iron overload and/or of treatment efficacy would largely depend on the rigorous validation and standardization of assays.
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Affiliation(s)
- Louise de Swart
- Departments of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan C M Hendriks
- Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisa N van der Vorm
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Z Ioav Cabantchik
- Department of Biochemical Chemistry, Hebrew University of Jerusalem, Israel
| | | | - Eldad A Hod
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Gary M Brittenham
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | | | - Boguslaw Wojczyk
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Mirian C H Janssen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - John B Porter
- Department of Haematology, University College London, UK
| | | | - Bart J Biemond
- Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marius A MacKenzie
- Departments of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Raffaella Origa
- Department of Biomedical Science and Biotechnology, Regional Microcythemia Hospital, University of Cagliari, Italy
| | - Renzo Galanello
- Department of Biomedical Science and Biotechnology, Regional Microcythemia Hospital, University of Cagliari, Italy
| | - Robert C Hider
- Institute of Pharmaceutical Science, King's College London, UK
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Glinz D, Hurrell RF, Ouattara M, Zimmermann MB, Brittenham GM, Adiossan LG, Righetti AA, Seifert B, Diakité VG, Utzinger J, N'Goran EK, Wegmüller R. The effect of iron-fortified complementary food and intermittent preventive treatment of malaria on anaemia in 12- to 36-month-old children: a cluster-randomised controlled trial. Malar J 2015; 14:347. [PMID: 26377199 PMCID: PMC4573684 DOI: 10.1186/s12936-015-0872-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/25/2015] [Indexed: 11/29/2022] Open
Abstract
Background Iron deficiency (ID) and malaria co-exist in tropical regions and both contribute to high rates of anaemia in young children. It is unclear whether iron fortification combined with intermittent preventive treatment (IPT) of malaria would be an efficacious strategy for reducing anaemia in young children. Methods A 9-month cluster-randomised, single-blinded, placebo-controlled intervention trial was carried out in children aged 12–36 months in south-central Côte d’Ivoire, an area of intense and perennial malaria transmission. The study groups were: group 1: normal diet and IPT-placebo (n = 125); group 2: consumption of porridge, an iron-fortified complementary food (CF) with optimised composition providing 2 mg iron as NaFeEDTA and 3.8 mg iron as ferrous fumarate 6 days per week (CF-FeFum) and IPT-placebo (n = 126); group 3: IPT of malaria at 3-month intervals, using sulfadoxine-pyrimethamine and amodiaquine and no dietary intervention (n = 127); group 4: both CF-FeFum and IPT (n = 124); and group 5: consumption of porridge, an iron-fortified CF with the composition currently on the Ivorian market providing 2 mg iron as NaFeEDTA and 3.8 mg iron as ferric pyrophosphate 6 days per week (CF-FePP) and IPT-placebo (n = 127). The primary outcome was haemoglobin (Hb) concentration. Linear and logistic regression mixed-effect models were used for the comparison of the five study groups, and a 2 × 2 factorial analysis was used to assess treatment interactions of CF-FeFum and IPT (study groups 1–4). Results After 9 months, the Hb concentration increased in all groups to a similar extent with no statistically significant difference between groups. In the 2 × 2 factorial analysis after 9 months, no treatment interaction was found on Hb (P = 0.89). The adjusted differences in Hb were 0.24 g/dl (95 % CI −0.10 to 0.59; P = 0.16) in children receiving IPT and −0.08 g/dl (95 % CI −0.42 to 0.26; P = 0.65) in children receiving CF-FeFum. At baseline, anaemia (Hb <11.0 g/dl) was 82.1 %. After 9 months, IPT decreased the odds of anaemia (odds ratio [OR], 0.46 [95 % CI 0.23–0.91]; P = 0.023), whereas iron-fortified CF did not (OR, 0.85 [95 % CI 0.43–1.68]; P = 0.68), although ID (plasma ferritin <30 μg/l) was decreased markedly in children receiving iron fortified CF (OR, 0.19 [95 % CI 0.09–0.40]; P < 0.001). Conclusions IPT alone only modestly decreased anaemia, but neither IPT nor iron fortified CF significantly improved Hb concentration after 9 months. Additionally, IPT did not augment the effect of the iron fortified CF. CF fortified with highly bioavailable iron improved iron status but not Hb concentration, despite three-monthly IPT of malaria. Thus, further research is necessary to develop effective combination strategies to prevent and treat anaemia in malaria endemic regions. Trial registration: http://www.clinicaltrials.gov; identifier NCT01634945; registered on July 3, 2012. Electronic supplementary material The online version of this article (doi:10.1186/s12936-015-0872-3) contains supplementary material, which is available to authorised users.
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Affiliation(s)
- Dominik Glinz
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland.
| | - Richard F Hurrell
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland.
| | - Mamadou Ouattara
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland.
| | - Gary M Brittenham
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, USA.
| | | | - Aurélie A Righetti
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | | | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Eliézer K N'Goran
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire. .,Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.
| | - Rita Wegmüller
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland.
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Sroka R, Stepp H, Hennig G, Brittenham GM, Rühm A, Lilge L. Medical laser application: translation into the clinics. J Biomed Opt 2015; 20:061110. [PMID: 26079966 DOI: 10.1117/1.jbo.20.6.061110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 05/11/2015] [Indexed: 06/04/2023]
Abstract
Medical laser applications based on widespread research and development is a very dynamic and increasingly popular field from an ecological as well as an economic point of view. Conferences and personal communication are necessary to identify specific requests and potential unmet needs in this multi- and interdisciplinary discipline. Precise gathering of all information on innovative, new, or renewed techniques is necessary to design medical devices for introduction into clinical applications and finally to become established for routine treatment or diagnosis. Five examples of successfully addressed clinical requests are described to show the long-term endurance in developing light-based innovative clinical concepts and devices. Starting from laboratory medicine, a noninvasive approach to detect signals related to iron deficiency is shown. Based upon photosensitization, fluorescence-guided resection had been discovered, opening the door for photodynamic approaches for the treatment of brain cancer. Thermal laser application in the nasal cavity obtained clinical acceptance by the introduction of new laser wavelengths in clinical consciousness. Varicose veins can be treated by innovative endoluminal treatment methods, thus reducing side effects and saving time. Techniques and developments are presented with potential for diagnosis and treatment to improve the clinical situation for the benefit of the patient.
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Affiliation(s)
- Ronald Sroka
- Laser-Forschungslabor, LIFE Center, University Hospital of Munich, Feodor-Lynen-Str 19, D-81377 Munich, Germany
| | - Herbert Stepp
- Laser-Forschungslabor, LIFE Center, University Hospital of Munich, Feodor-Lynen-Str 19, D-81377 Munich, Germany
| | - Georg Hennig
- Laser-Forschungslabor, LIFE Center, University Hospital of Munich, Feodor-Lynen-Str 19, D-81377 Munich, Germany
| | - Gary M Brittenham
- Columbia University, College of Physicians and Surgeons, Children's Hospital of New York, Room CHN 10-08, 3959 Broadway, New York, New York 10032, United States
| | - Adrian Rühm
- Laser-Forschungslabor, LIFE Center, University Hospital of Munich, Feodor-Lynen-Str 19, D-81377 Munich, Germany
| | - Lothar Lilge
- University of Toronto, Princess Margaret Cancer Centre, Medical Biophysics, 101 College Street 15-310, Toronto, Ontario M5G 1L7, Canada
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Brittenham GM. Reference method for measurement of the hepatic iron concentration. Am J Hematol 2015; 90:85-6. [PMID: 25488360 DOI: 10.1002/ajh.23914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 12/02/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Gary M. Brittenham
- Department of Pediatrics; Columbia University College of Physicians and Surgeons; New York New York
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Brittenham GM, Andersson M, Egli I, Foman JT, Zeder C, Westerman ME, Hurrell RF. Circulating non-transferrin-bound iron after oral administration of supplemental and fortification doses of iron to healthy women: a randomized study. Am J Clin Nutr 2014; 100:813-20. [PMID: 25057155 PMCID: PMC4135492 DOI: 10.3945/ajcn.113.081505] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND After the oral administration of iron, the production of circulating non-transferrin-bound iron may contribute to an increased risk of illness in malaria-endemic areas that lack effective medical services. OBJECTIVE In healthy women with a range of body iron stores, we aimed to determine effects on the production of circulating non-transferrin-bound iron resulting from the oral administration of 1) a supplemental dose of iron (60 mg) with water, 2) a supplemental dose of iron (60 mg) with a standard test meal, and 3) a fortification dose of iron (6 mg) with a standard test meal. DESIGN With the use of serum ferritin as the indicator, healthy women with replete iron stores (ferritin concentration >25 μg/L; n = 16) and reduced iron stores (ferritin concentration ≤25 μg/L; n = 16) were enrolled in a prospective, randomized, crossover study. After the oral administration of aqueous solutions of ferrous sulfate isotopically labeled with ⁵⁴Fe, ⁵⁷Fe, or ⁵⁸Fe, blood samples were collected for 8 h, and iron absorption was estimated by erythrocyte incorporation at 14 d. RESULTS At 4 h, serum non-transferrin-bound iron reached peaks with geometric mean (95% CI) concentrations of 0.81 μmol/L (0.56, 1.1 μmol/L) for 60 mg Fe with water and 0.26 μmol/L (0.15, 0.38 μmol/L) for 60 mg Fe with food but was at assay limits of detection (0.1 μmol Fe/L) for 6 mg Fe with food. For the 60 mg Fe without food, the area under the curve over 8 h for serum non-transferrin-bound iron was positively correlated with the amount of iron absorbed (R = 0.49, P < 0.01) and negatively correlated with serum ferritin (R = -0.39, P < 0.05). CONCLUSIONS In healthy women, the production of circulating non-transferrin-bound iron is determined by the rate and amount of iron absorbed. The highest concentrations of non-transferrin-bound iron resulted from the administration of supplemental doses of iron without food. Little or no circulating non-transferrin-bound iron resulted from the consumption of a meal with a fortification dose of iron.
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Affiliation(s)
- Gary M Brittenham
- From the Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland (IE, JTF, CZ, MA, and RFH); the Intrinsic LifeSciences LLC, La Jolla, CA (MEW); and the Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY (GMB)
| | - Maria Andersson
- From the Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland (IE, JTF, CZ, MA, and RFH); the Intrinsic LifeSciences LLC, La Jolla, CA (MEW); and the Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY (GMB)
| | - Ines Egli
- From the Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland (IE, JTF, CZ, MA, and RFH); the Intrinsic LifeSciences LLC, La Jolla, CA (MEW); and the Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY (GMB)
| | - Jasmin Tajeri Foman
- From the Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland (IE, JTF, CZ, MA, and RFH); the Intrinsic LifeSciences LLC, La Jolla, CA (MEW); and the Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY (GMB)
| | - Christophe Zeder
- From the Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland (IE, JTF, CZ, MA, and RFH); the Intrinsic LifeSciences LLC, La Jolla, CA (MEW); and the Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY (GMB)
| | - Mark E Westerman
- From the Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland (IE, JTF, CZ, MA, and RFH); the Intrinsic LifeSciences LLC, La Jolla, CA (MEW); and the Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY (GMB)
| | - Richard F Hurrell
- From the Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland (IE, JTF, CZ, MA, and RFH); the Intrinsic LifeSciences LLC, La Jolla, CA (MEW); and the Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY (GMB)
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41
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Hennig G, Gruber C, Vogeser M, Stepp H, Dittmar S, Sroka R, Brittenham GM. Dual-wavelength excitation for fluorescence-based quantification of zinc protoporphyrin IX and protoporphyrin IX in whole blood. J Biophotonics 2014; 7:514-524. [PMID: 23450826 DOI: 10.1002/jbio.201200228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/29/2013] [Accepted: 02/12/2013] [Indexed: 06/01/2023]
Abstract
Quantification of erythrocyte zinc protoporphyrin IX (ZnPP) and protoporphyrin IX (PPIX), individually or jointly, is useful for the diagnostic evaluation of iron deficiency, iron-restricted erythropoiesis, lead exposure, and porphyrias. A method for simultaneous quantification of ZnPP and PPIX in unwashed blood samples is described, using dual-wavelength excitation to effectively eliminate background fluorescence from other blood constituents. In blood samples from 35 subjects, the results of the dual-wavelength excitation method and a reference high performance liquid chromatography (HPLC) assay were closely correlated both for ZnPP (rs = 0.943, p < 0.0001; range 37-689 μmol ZnPP/mol heme, 84-1238 nmol/L) and for PPIX (rs = 0.959, p < 0.0001; range 42-4212 μmol PPIX/mol heme, 93-5394 nmol/L). In addition, for ZnPP, the proposed method is compared with conventional single-wavelength excitation and with commercial front-face fluorimetry of washed erythrocytes and whole blood. We hypothesize that dual-wavelength excitation fluorimetry will provide a new approach to the suppression of background fluorescence in blood and tissue measurements of ZnPP and PPIX.
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Affiliation(s)
- Georg Hennig
- Laser-Forschungslabor, LIFE Center, Klinikum der Universität München, Marchioninistr. 23, 81377 München, Germany.
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Laothamatas J, Sammet CL, Golay X, Van Cauteren M, Lekprasert V, Tangpukdee N, Krudsood S, Leowattana W, Wilairatana P, Swaminathan SV, DeLaPaz RL, Brown TR, Looareesuwan S, Brittenham GM. Transient lesion in the splenium of the corpus callosum in acute uncomplicated falciparum malaria. Am J Trop Med Hyg 2014; 90:1117-1123. [PMID: 24615139 PMCID: PMC4047739 DOI: 10.4269/ajtmh.13-0665] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/07/2014] [Indexed: 02/05/2023] Open
Abstract
Patients with acute uncomplicated Plasmodium falciparum malaria have no evident neurologic disorder, vital organ dysfunction, or other severe manifestations of infection. Nonetheless, parasitized erythrocytes cytoadhere to the endothelium throughout their microvasculature, especially within the brain. We aimed to determine if 3 Tesla magnetic resonance imaging studies could detect evidence of cerebral abnormalities in these patients. Within 24 hours of admission, initial magnetic resonance imaging examinations found a lesion with restricted water diffusion in the mid-portion of the splenium of the corpus callosum of 4 (40%) of 10 male patients. The four patients who had a splenial lesion initially had evidence of more severe hemolysis and thrombocytopenia than the six patients who had no apparent abnormality. Repeat studies four weeks later found no residua of the lesions and resolution of the hematologic differences. These observations provide evidence for acute cerebral injury in the absence of severe or cerebral malaria.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Sornchai Looareesuwan
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Institute of Neurology, University College London, London, United Kingdom; Philips Healthcare, Best, The Netherlands; The Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Departments of Radiology and Pediatrics and Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Gary M. Brittenham
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Institute of Neurology, University College London, London, United Kingdom; Philips Healthcare, Best, The Netherlands; The Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Departments of Radiology and Pediatrics and Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
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Prestia K, Bandyopadhyay S, Slate A, Francis RO, Francis KP, Spitalnik SL, Fidock DA, Brittenham GM, Hod EA. Transfusion of stored blood impairs host defenses against Gram-negative pathogens in mice. Transfusion 2014; 54:2842-51. [PMID: 24840185 DOI: 10.1111/trf.12712] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/14/2014] [Accepted: 03/13/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although human red blood cell (RBC) units may be refrigerator stored for up to 42 days, transfusion of older RBCs acutely delivers a large bolus of iron to mononuclear phagocytes. Similarly, iron dextran circulates in plasma for hours to days and is progressively cleared by mononuclear phagocytes, which return iron to plasma. Finally, malaria infection continuously delivers iron to macrophages by intra- and extravascular hemolysis. Studies suggest that iron administration increases infectious risk. STUDY DESIGN AND METHODS To assess the effects of increased iron availability on susceptibility to infection, we infected mice with model Gram-negative intracellular or extracellular pathogens (Salmonella typhimurium or Escherichia coli, respectively), accompanied by RBC transfusion, iron dextran administration, or malarial coinfection. RESULTS In our mouse models, transfusion of older RBCs exacerbates infection with both Gram-negative pathogens. Although iron dextran exacerbates E. coli infection to a similar extent as transfusion of corresponding amounts of iron, higher iron doses are required to produce comparable effects with S. typhimurium. Coinfection of mice with Plasmodium yoelii and S. typhimurium produces overwhelming Salmonella sepsis. Finally, treating mice with antibiotics abrogates the enhancing effect on E. coli infection of both older RBC transfusion and iron dextran administration. CONCLUSIONS Transfusion of older RBCs exacerbates Gram-negative infection to a similar extent as malaria coinfection or iron dextran administration. Appropriate antibiotic therapy abrogates the effect of older RBC transfusions on infection with E. coli. Iron delivery to macrophages may be an underappreciated mechanism mediating, at least some, adverse effects of RBC transfusions.
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Affiliation(s)
- Kevin Prestia
- Institute of Comparative Medicine, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York; Department of Pathology and Cell Biology, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York
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Cao P, Fan SJ, Wang AM, Xie VB, Qiao Z, Brittenham GM, Wu EX. Diffusion magnetic resonance monitors intramyocellular lipid droplet size in vivo. Magn Reson Med 2014; 73:59-69. [PMID: 24469956 DOI: 10.1002/mrm.25116] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/23/2013] [Accepted: 12/13/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE Intramyocellular lipid (IMCL) droplets are dynamic organelles whose morphology reflects their vital roles in lipid synthesis, usage, and storage in muscle energy metabolism. To develop noninvasive means to measure droplet microstructure in vivo, we investigated the molecular diffusion behavior of IMCL with diffusion magnetic resonance spectroscopy. METHODS Using extremely large diffusion weighting, we measured the IMCL apparent diffusion coefficients (ADCs) in hindlimb muscle of rodents from normal feeding, 60-h fasting, streptozotocin-induced diabetic, and high-fat-diet-induced obese groups. RESULTS IMCL ADCs decreased markedly with diffusion time, confirming the restricted diffusion of lipid molecules within IMCL droplets. IMCL droplet size, determined by transmission electron microscopy, was closely correlated with ADC. IMCL ADC was sensitive to metabolic alterations, decreasing in the 60-h fasting and diabetic groups while increasing in the obese group. These findings indicated that the IMCL droplet size decreased following 60-h fasting and in STZ-induced diabetes but increased in high-fat-diet-induced obesity. CONCLUSION MR diffusion characterization of IMCL droplet size provides a unique means to examine the intracellular lipid dynamics and metabolic abnormalities in vivo.
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Affiliation(s)
- Peng Cao
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong, China.,Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Shu-Juan Fan
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong, China.,Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Anna M Wang
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong, China.,Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Victor B Xie
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong, China.,Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Zhongwei Qiao
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong, China.,Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Gary M Brittenham
- Departments of Pediatrics and Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Ed X Wu
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong, China.,Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong, China
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Abstract
During the last 30 years, in addition to the considerable progress made in control and prevention of thalassemias(3), there have also been major advances in their symptomatic management, at least in wealthier countries where appropriate facilities are available. Remarkable improvements in survival in the severe forms of thalassemia have followed the more judicious use of blood transfusion and, in particular, the ability to manage the iron accumulation resulting from transfusion with its severe and ultimately lethal effects on endocrine and cardiac function.
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Affiliation(s)
- Nancy F Olivieri
- Hemoglobinopathy Research University Health Network, Toronto, Ontario M5G 2C4, Canada
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Tang H, Jensen JH, Sammet CL, Sheth S, Swaminathan SV, Hultman K, Kim D, Wu EX, Brown TR, Brittenham GM. MR characterization of hepatic storage iron in transfusional iron overload. J Magn Reson Imaging 2013; 39:307-16. [PMID: 23720394 DOI: 10.1002/jmri.24171] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 03/15/2013] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To quantify the two principal forms of hepatic storage iron, diffuse, soluble iron (primarily ferritin), and aggregated, insoluble iron (primarily hemosiderin) using a new MRI method in patients with transfusional iron overload. MATERIALS AND METHODS Six healthy volunteers and 20 patients with transfusion-dependent thalassemia syndromes and iron overload were examined. Ferritin- and hemosiderin-like iron were determined based on the measurement of two distinct relaxation parameters: the "reduced" transverse relaxation rate, RR2 , and the "aggregation index," A, using three sets of Carr-Purcell-Meiboom-Gill (CPMG) datasets with different interecho spacings. Agarose phantoms, simulating the relaxation and susceptibility properties of tissue with different concentrations of dispersed (ferritin-like) and aggregated (hemosiderin-like) iron, were used for validation. RESULTS Both phantom and in vivo human data confirmed that transverse relaxation components associated with the dispersed and aggregated iron could be separated using the two-parameter (RR2 , A) method. The MRI-determined total hepatic storage iron was highly correlated (r = 0.95) with measurements derived from biopsy or biosusceptometry. As total hepatic storage iron increased, the proportion stored as aggregated iron became greater. CONCLUSION This method provides a new means for noninvasive MRI determination of the partition of hepatic storage iron between ferritin and hemosiderin in iron overload disorders.
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Affiliation(s)
- Haiying Tang
- Imaging, Discovery Medicine & Clinical Pharmacology, Bristol Myers Squibb, Princeton, New Jersey, USA
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Hennig G, Brittenham GM, Sroka R, Kniebühler G, Vogeser M, Stepp H. Bandwidth-variable tunable optical filter unit for illumination and spectral imaging systems using thin-film optical band-pass filters. Rev Sci Instrum 2013; 84:043113. [PMID: 23635187 DOI: 10.1063/1.4803003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
An optical filter unit is demonstrated, which uses two successively arranged tunable thin-film optical band-pass filters and allows for simultaneous adjustment of the central wavelength in the spectral range 522-555 nm and of the spectral bandwidth in the range 3-16 nm with a wavelength switching time of 8 ms∕nm. Different spectral filter combinations can cover the complete visible spectral range. The transmitted intensity was found to decrease only linearly with the spectral bandwidth for bandwidths >6 nm, allowing a high maximum transmission efficiency of >75%. The image of a fiber bundle was spectrally filtered and analyzed in terms of position-dependency of the transmitted bandwidth and central wavelength.
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Affiliation(s)
- Georg Hennig
- Laser-Forschungslabor, LIFE Center, Klinikum der Universität München, München, Germany.
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Sammet CL, Swaminathan SV, Tang H, Sheth S, Jensen JH, Nunez A, Hultman K, Kim D, Wu EX, Brittenham GM, Brown TR. Measurement and correction of stimulated echo contamination in T2-based iron quantification. Magn Reson Imaging 2012; 31:664-8. [PMID: 23260394 DOI: 10.1016/j.mri.2012.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 10/11/2012] [Accepted: 10/30/2012] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to characterize the effects of stimulated echo contamination on MR-based iron measurement derived from quantitative T2 images and develop a method for retrospective correction. Two multiple spin-echo (MSE) pulse sequences were implemented with different amounts of stimulated echo contamination. Agarose-based phantoms were constructed that simulate the relaxation and susceptibility properties of tissue with different concentrations of dispersed (ferritin-like) and aggregated (hemosiderin-like) iron. Additionally, myocardial iron was assessed in nine human subjects with transfusion iron overload. These data were used to determine the influence of stimulated echoes on iron measurements made by an MR-based iron quantification model that can separately measure dispersed and aggregated iron. The study found that stimulated echo contamination caused an underestimation of dispersed (ferritin-like) iron and an overestimation of aggregated (hemosiderin-like) iron when applying this model. The relationship between the measurements made with and without stimulated echo appears to be linear. The findings suggest that while it is important to use MSE sequences with minimal stimulated echo in T2-based iron quantification, it appears that data acquired with sub-optimal sequences can be retrospectively corrected using the methodology described here.
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Abstract
This review considers the safety of iron supplementation and fortification for the prevention and correction of iron deficiency in malaria-endemic areas, with a focus on potential means whereby provision of additional iron might heighten the risks of malaria and other infections. Iron deficiency itself may increase the risk of morbidity and mortality from malaria and other infections. The available evidence indicates that iron interventions are safe in settings without endemic malaria, and, with adequate health care, in regions with high transmission of malaria and other infections. Without regular surveillance and treatment of malaria and other infections, iron supplementation of individuals who are iron deficient seems safe, but individuals who are iron replete may have an increased risk of adverse outcomes. The mechanisms responsible for harmful effects with iron supplementation have not been established. These are likely to include the effects of (a) increased amounts of absorbed iron, with the production of plasma non-transferrin-bound iron, (b) increased amounts of iron in the gastrointestinal tract, with effects on gastrointestinal structural integrity and on gut microflora, and (c) the complex immune effects of iron interventions. Iron fortification appears to be generally safe, although more data from malaria-endemic areas are needed.
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Affiliation(s)
- Gary M Brittenham
- Division of Pediatric Hematology, Department of Pediatrics, Columbia University, New York, NY, USA
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50
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Cheung JS, Au WY, Ha SY, Kim D, Jensen JH, Zhou IY, Cheung MM, Wu Y, Guo H, Khong PL, Brown TR, Brittenham GM, Wu EX. Reduced transverse relaxation rate (RR2) for improved sensitivity in monitoring myocardial iron in thalassemia. J Magn Reson Imaging 2011; 33:1510-6. [PMID: 21591022 DOI: 10.1002/jmri.22553] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the reduced transverse relaxation rate (RR2), a new relaxation index which has been shown recently to be primarily sensitive to intracellular ferritin iron, as a means of detecting short-term changes in myocardial storage iron produced by iron-chelating therapy in transfusion-dependent thalassemia patients. MATERIALS AND METHODS A single-breathhold multi-echo fast spin-echo sequence was implemented at 3 Tesla (T) to estimate RR2 by acquiring signal decays with interecho times of 5, 9 and 13 ms. Transfusion-dependent thalassemia patients (N = 8) were examined immediately before suspending iron-chelating therapy for 1 week (Day 0), after a 1-week suspension of chelation (Day 7), and after a 1-week resumption of chelation (Day 14). RESULTS The mean percent changes in RR2, R2, and R2* off chelation (between Day 0 and 7) were 11.9 ± 8.9%, 5.4 ± 7.7% and -4.4 ± 25.0%; and, after resuming chelation (between Day 7 and 14), -10.6 ± 13.9%, -8.9 ± 8.0% and -8.5 ± 24.3%, respectively. Significant differences in R2 and RR2 were observed between Day 0 and 7, and between Day 7 and 14, with the greatest proportional changes in RR2. No significant differences in R2* were found. CONCLUSION These initial results demonstrate that significant differences in RR2 are detectable after a single week of changes in iron-chelating therapy, likely as a result of superior sensitivity to soluble ferritin iron, which is in close equilibrium with the chelatable cytosolic iron pool. RR2 measurement may provide a new means of monitoring the short-term effectiveness of iron-chelating agents in patients with myocardial iron overload.
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Affiliation(s)
- Jerry S Cheung
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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