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Brissot P, Buffet C. Rapport 23-02. Le foie stéatosique non alcoolique: un défi de santé publique1. Bulletin de l'Académie Nationale de Médecine 2023. [DOI: 10.1016/j.banm.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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2
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Abstract
Haemochromatosis is a genetic disease caused by hepcidin deficiency, responsible for an increase in intestinal iron absorption. Haemochromatosis is associated with homozygosity for the HFE p.Cys282Tyr mutation. However, rare cases of haemochromatosis (non-HFE haemochromatosis) can also be caused by pathogenic variants in other genes (such as HJV, HAMP, TFR2 and SLC40A1). A working group of the International Society for the Study of Iron in Biology and Medicine (BIOIRON Society) has concluded that the classification based in different molecular subtypes is difficult to be adopted in clinical practice and has proposed a new classification approaching clinical questions and molecular complexity. The aim of the present review is to provide an update on classification, pathophysiology and therapeutic recommendations.
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Affiliation(s)
- Aline Morgan Alvarenga
- Department of Pharmacology - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04044-020, Brazil
| | | | - Paulo Caleb Junior Lima Santos
- Department of Pharmacology - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04044-020, Brazil
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3
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Girelli D, Busti F, Brissot P, Cabantchik I, Muckenthaler MU, Porto G. Hemochromatosis classification: update and recommendations by the BIOIRON Society. Blood 2022; 139:3018-3029. [PMID: 34601591 PMCID: PMC11022970 DOI: 10.1182/blood.2021011338] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 09/05/2021] [Indexed: 12/15/2022] Open
Abstract
Hemochromatosis (HC) is a genetically heterogeneous disorder in which uncontrolled intestinal iron absorption may lead to progressive iron overload (IO) responsible for disabling and life-threatening complications such as arthritis, diabetes, heart failure, hepatic cirrhosis, and hepatocellular carcinoma. The recent advances in the knowledge of pathophysiology and molecular basis of iron metabolism have highlighted that HC is caused by mutations in at least 5 genes, resulting in insufficient hepcidin production or, rarely, resistance to hepcidin action. This has led to an HC classification based on different molecular subtypes, mainly reflecting successive gene discovery. This scheme was difficult to adopt in clinical practice and therefore needs revision. Here we present recommendations for unambiguous HC classification developed by a working group of the International Society for the Study of Iron in Biology and Medicine (BIOIRON Society), including both clinicians and basic scientists during a meeting in Heidelberg, Germany. We propose to deemphasize the use of the molecular subtype criteria in favor of a classification addressing both clinical issues and molecular complexity. Ferroportin disease (former type 4a) has been excluded because of its distinct phenotype. The novel classification aims to be of practical help whenever a detailed molecular characterization of HC is not readily available.
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Affiliation(s)
- Domenico Girelli
- Department of Medicine, Section of Internal Medicine, EuroBloodNet Center, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Fabiana Busti
- Department of Medicine, Section of Internal Medicine, EuroBloodNet Center, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Pierre Brissot
- INSERM, Univ-Rennes, Institut National de la Recherche Agronomique, Unité Mixte de Recherche 1241, Institut NuMeCan, Rennes, France
| | - Ioav Cabantchik
- Alexander Silberman Institute of Life Sciences, Hebrew University, Jerusalem, Israel
| | - Martina U. Muckenthaler
- Department of Pediatric Oncology, Hematology, and Immunology and Molecular Medicine Partnership Unit, University of Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit, European Molecular Biology Laboratory, Heidelberg, Germany
- Translational Lung Research Center, German Center for Lung Research, Heidelberg, Germany
- German Centre for Cardiovascular Research, Partner Site Heidelberg, Mannheim, Germany
| | - Graça Porto
- Institute for Molecular and Cell Biology, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Clinical Hematology, Santo António Hospital, Porto University, Porto, Portugal
| | - on behalf of the Nomenclature Committee of the International Society for the Study of Iron in Biology and Medicine (BIOIRON Society)
- Department of Medicine, Section of Internal Medicine, EuroBloodNet Center, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
- INSERM, Univ-Rennes, Institut National de la Recherche Agronomique, Unité Mixte de Recherche 1241, Institut NuMeCan, Rennes, France
- Alexander Silberman Institute of Life Sciences, Hebrew University, Jerusalem, Israel
- Department of Pediatric Oncology, Hematology, and Immunology and Molecular Medicine Partnership Unit, University of Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit, European Molecular Biology Laboratory, Heidelberg, Germany
- Translational Lung Research Center, German Center for Lung Research, Heidelberg, Germany
- German Centre for Cardiovascular Research, Partner Site Heidelberg, Mannheim, Germany
- Institute for Molecular and Cell Biology, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Clinical Hematology, Santo António Hospital, Porto University, Porto, Portugal
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Acevedo LAU, Alvarenga AM, Fonseca PFS, da Silva NK, Cançado RD, Naoum FA, Dinardo CL, Pereira AC, Brissot P, Santos PCJL. Quality of Life Scores Remained Different among the Genotypic Groups of Patients with Suspected Hemochromatosis, Even after Treatment Period. Genes (Basel) 2022; 13:genes13010118. [PMID: 35052458 PMCID: PMC8774363 DOI: 10.3390/genes13010118] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Hemochromatosis is a genetic condition of iron overload caused by deficiency of hepcidin. In a previous stage of this study, patients with suspected hemochromatosis had their quality of life (QL) measured. We observed that QL scores differed among genotypic groups of patients. In this reported final phase of the study, the aims were to compare QL scores after a treatment period of approximately 3 years and to analyze a possible association of the serum ferritin values with QL scores. Methods: Sixty-five patients were enrolled in this final phase and divided into group 1 (patients that showed primary iron overload and homozygous genotype for the HFE p.Cys282Tyr mutation) and group 2 (other kinds of genotypes). Short Form 36 (SF-36) was performed and consisted of eight domains with a physical and also a mental component. Results: Both groups had a significant decrease in serum ferritin concentrations: group 1 had a variation from 1844 ± 1313 ng/mL to 281 ± 294 ng/mL, and group 2 had a variation from 1216 ± 631 ng/mL to 236 ± 174 ng/mL. Group 1 had a smaller mean value for these six SF-36 domains compared with group 2, indicating a worse QL. Conclusions: In this final stage, six domains demonstrated a difference among genotypic groups (role emotional and mental health, adding to the four of the initial phase), reassuring the impact of the identified genotype on the QL of hemochromatosis patients. Furthermore, despite that both patient groups demonstrated similar and significant decreases in serum ferritin values, no association was found between the decrease in this biological parameter and the SF-36 domains.
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Affiliation(s)
- Luis Alfredo Utria Acevedo
- Department of Pharmacology—Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM-Unifesp), Sao Paulo 05403-904, Brazil; (L.A.U.A.); (A.M.A.); (N.K.d.S.)
| | - Aline Morgan Alvarenga
- Department of Pharmacology—Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM-Unifesp), Sao Paulo 05403-904, Brazil; (L.A.U.A.); (A.M.A.); (N.K.d.S.)
| | - Paula Fernanda Silva Fonseca
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo 05403-904, Brazil; (P.F.S.F.); (A.C.P.)
| | - Nathália Kozikas da Silva
- Department of Pharmacology—Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM-Unifesp), Sao Paulo 05403-904, Brazil; (L.A.U.A.); (A.M.A.); (N.K.d.S.)
| | | | | | - Carla Luana Dinardo
- Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, Brazil, Universidade de São Paulo (USP), Sao Paulo 05403-904, Brazil;
| | - Alexandre Costa Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo 05403-904, Brazil; (P.F.S.F.); (A.C.P.)
| | - Pierre Brissot
- Institut NuMeCan, Inserm U-1241, Univ Rennes 1, 35000 Rennes, France;
| | - Paulo Caleb Junior Lima Santos
- Department of Pharmacology—Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM-Unifesp), Sao Paulo 05403-904, Brazil; (L.A.U.A.); (A.M.A.); (N.K.d.S.)
- Correspondence:
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Brissot P, Loréal O. Hemochromatoses. J Hepatol 2021; 75:723-724. [PMID: 34261579 DOI: 10.1016/j.jhep.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 12/04/2022]
Affiliation(s)
- Pierre Brissot
- Inserm, University of Rennes1, UMR 1241, Inrae, NuMeCan Institute, Rennes, France.
| | - Olivier Loréal
- Inserm, University of Rennes1, UMR 1241, Inrae, NuMeCan Institute, Rennes, France.
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Brissot E, Troadec M, Loréal O, Brissot P. Iron and platelets: A subtle, under-recognized relationship. Am J Hematol 2021; 96:1008-1016. [PMID: 33844865 DOI: 10.1002/ajh.26189] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/16/2021] [Accepted: 04/08/2021] [Indexed: 12/16/2022]
Abstract
The role of iron in the formation and functioning of erythrocytes, and to a lesser degree of white blood cells, is well established, but the relationship between iron and platelets is less documented. Physiologically, iron plays an important role in hematopoiesis, including thrombopoiesis; iron levels direct, together with genetic factors, the lineage commitment of megakaryocytic/erythroid progenitors toward either megakaryocyte or erythroid progenitors. Megakaryocytic iron contributes to cellular machinery, especially energy production in platelet mitochondria. Thrombocytosis, possibly favoring vascular thrombosis, is a classical feature observed with abnormally low total body iron stores (mainly due to blood losses or decreased duodenal iron intake), but thrombocytopenia can also occur in severe iron deficiency anemia. Iron sequestration, as seen in inflammatory conditions, can be associated with early thrombocytopenia due to platelet consumption and followed by reactive replenishment of the platelet pool with possibility of thrombocytosis. Iron overload of genetic origin (hemochromatosis), despite expected mitochondrial damage related to ferroptosis, has not been reported to cause thrombocytopenia (except in case of high degree of hepatic fibrosis), and iron-related alteration of platelet function is still a matter of debate. In acquired iron overload (of transfusional and/or dyserythropoiesis origin), quantitative or qualitative platelet changes are difficult to attribute to iron alone due to the interference of the underlying hematological conditions; likewise, hematological improvement, including increased blood platelet counts, observed under iron oral chelation is likely to reflect mechanisms other than the sole beneficial impact of iron depletion.
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Affiliation(s)
- Eolia Brissot
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine APHP Paris France
- Sorbonne Universités, UPMC Univ. Paris 06, Centre de recherche Saint‐Antoine, UMR‐S938 Paris France
| | - Marie‐Bérengère Troadec
- Univ Brest, Inserm, EFS, UMR 1078, GGB Brest France
- Service de génétique, laboratoire de génétique chromosomique CHRU Brest Brest France
| | - Olivier Loréal
- Inserm, University of Rennes1, UMR 1241, Inrae, NuMeCan Institute Rennes France
| | - Pierre Brissot
- Inserm, University of Rennes1, UMR 1241, Inrae, NuMeCan Institute Rennes France
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7
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Abstract
Major advances in the understanding of genetic iron overload have led to a clarification of the nosology and terminology of the related diseases. The term hemochromatosis should be reserved to the entities where iron overload is related to hepcidin deficiency or hepcidin resistance. The diagnosis of hemochromatosis is non-invasive, based on clinical examination, blood investigations and, whenever possible, magnetic resonance imaging. Phlebotomies remain the mainstay of the treatment, but new therapeutic approaches should, in the future, constitute a valuable advance, hopefully both as an adjunct to bleeding in the induction phase and as its replacement in the maintenance phase. The goal of the present review is to update the terminology of hemochromatosis in light of major pathophysiological advances, and the main features of its diagnostic and therapeutic approaches.
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Affiliation(s)
- Pierre Brissot
- Université de Rennes 1, Institut NuMeCan, Inserm U-1241, Univ Rennes 1, Rennes, France
| | - Eolia Brissot
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, Paris, France.,Sorbonne Universités, UPMC Univ. Paris 06, AP-HP, Centre de recherche Saint-Antoine, UMR-S938, Paris, France
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8
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Alvarenga AM, da Silva NK, Fonseca PFS, Oliveira TGM, da Silva Monteiro JB, Cançado RD, Naoum FA, Dinardo CL, Brissot P, Santos PCJL. Novel mutations in the bone morphogenetic protein 6 gene in patients with iron overload and non-homozygous genotype for the HFE p.Cys282Tyr mutation. Blood Cells Mol Dis 2020; 84:102444. [PMID: 32464486 DOI: 10.1016/j.bcmd.2020.102444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/17/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Five main genes are associated with hemochromatosis; however, current studies show that, in addition to these genes, others may be associated with primary iron overload (IO). One of these is the bone morphogenetic protein 6 (BMP6), which encodes a protein that modulates hepcidin synthesis and, consequently, iron homeostasis. AIM To identify BMP6 gene pathogenic variants in patients with IO and non-homozygous genotype for the HFE p.Cys282Tyr mutation. MATERIALS AND METHODS Fifty-three patients with primary IO and non-homozygous genotype for the HFE p.Cys282Tyr were selected. Subsequent bidirectional DNA sequencing of BMP6 exons was performed. RESULTS Two novel variants were found. One at homozygous state p.Gln158Ter (c.472C>T) was pathogenic, the other one at heterozygous state p.Val394Met (c.1180G>A) was of uncertain significance (VUS); the third variant at heterozygous state p.Arg257His (c.770G>A) has already been described and associated with IO. No BMP6 pathogenic variants that would explain iron overload phenotypes were detected in 94% of the studied patients. CONCLUSION Identification of the BMP6 pathogenic variants in Brazilian patients with primary IO might contribute to the genetic understanding of this phenotype.
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Affiliation(s)
- Aline Morgan Alvarenga
- Department of Pharmacology - Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, Brazil.
| | - Nathália Kozikas da Silva
- Department of Pharmacology - Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, Brazil.
| | - Paula Fernanda Silva Fonseca
- Department of Pharmacology - Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, Brazil.
| | - Theo G M Oliveira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
| | | | | | | | - Carla Luana Dinardo
- Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, SP, Brazil; Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - Pierre Brissot
- Institut NuMeCan, Inserm U-1241, Univ Rennes 1, Rennes, France.
| | - Paulo Caleb Junior Lima Santos
- Department of Pharmacology - Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, Brazil.
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9
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Zhang W, Wang X, Duan W, Xu A, Zhao X, Huang J, You H, Brissot P, Ou X, Jia J. HFE-Related Hemochromatosis in a Chinese Patient: The First Reported Case. Front Genet 2020; 11:77. [PMID: 32153640 PMCID: PMC7048005 DOI: 10.3389/fgene.2020.00077] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/23/2020] [Indexed: 01/04/2023] Open
Abstract
HFE-related Hemochromatosis is the most common genetic iron overload disease in European populations, particularly of Nordic or Celtic ancestry. It is reported that the HFE p.C282Y mutation is present in 1/10 people of northern European descent, resulting in one in two hundred people will be homozygous. However, the HFE p.C282Y heterozygosity is virtually absent among East Asians, including Japanese, Koreans, and Chinese. In this article, we report a case of HFE-related hemochromatosis caused by compound heterozygosity HFE p.C282Y/p.R71X. This is the first report of hemochromatosis associated with HFE p.C282Y mutation in China.
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Affiliation(s)
- Wei Zhang
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Beijing, China.,Clinical Research Center for Rare Liver Diseases, Capital Medical University, Beijing, China.,Liver Research Center, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Xiaoming Wang
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Beijing, China.,Clinical Research Center for Rare Liver Diseases, Capital Medical University, Beijing, China.,Liver Research Center, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Weijia Duan
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Beijing, China.,Clinical Research Center for Rare Liver Diseases, Capital Medical University, Beijing, China.,Liver Research Center, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Anjian Xu
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Beijing, China.,Liver Research Center, National Clinical Research Center for Digestive Diseases, Beijing, China.,Experimental Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xinyan Zhao
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Beijing, China.,Clinical Research Center for Rare Liver Diseases, Capital Medical University, Beijing, China.,Liver Research Center, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Jian Huang
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Beijing, China.,Clinical Research Center for Rare Liver Diseases, Capital Medical University, Beijing, China.,Liver Research Center, National Clinical Research Center for Digestive Diseases, Beijing, China.,Experimental Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong You
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Beijing, China.,Clinical Research Center for Rare Liver Diseases, Capital Medical University, Beijing, China.,Liver Research Center, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Pierre Brissot
- Institut NuMeCan, InsermU-1241, University of Rennes1, Rennes, France
| | - Xiaojuan Ou
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Beijing, China.,Clinical Research Center for Rare Liver Diseases, Capital Medical University, Beijing, China.,Liver Research Center, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Beijing, China.,Clinical Research Center for Rare Liver Diseases, Capital Medical University, Beijing, China.,Liver Research Center, National Clinical Research Center for Digestive Diseases, Beijing, China
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10
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Brissot E, Bernard DG, Loréal O, Brissot P, Troadec MB. Too much iron: A masked foe for leukemias. Blood Rev 2020; 39:100617. [DOI: 10.1016/j.blre.2019.100617] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/20/2019] [Accepted: 08/30/2019] [Indexed: 02/07/2023]
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11
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Kenawi M, Rouger E, Island ML, Leroyer P, Robin F, Rémy S, Tesson L, Anegon I, Nay K, Derbré F, Brissot P, Ropert M, Cavey T, Loréal O. Ceruloplasmin deficiency does not induce macrophagic iron overload: lessons from a new rat model of hereditary aceruloplasminemia. FASEB J 2019; 33:13492-13502. [DOI: 10.1096/fj.201901106r] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Moussa Kenawi
- INSERM, Univ Rennes, INRA, Platform Analyse Elémentaire et Métabolisme des Métaux, UMR 1241 Institut NuMeCan (Nutrition, Metabolism, and Cancer), Centre Hospitalier Universitaire (CHU) Pontchaillou, Rennes, France
| | - Emmanuel Rouger
- INSERM, Univ Rennes, INRA, Platform Analyse Elémentaire et Métabolisme des Métaux, UMR 1241 Institut NuMeCan (Nutrition, Metabolism, and Cancer), Centre Hospitalier Universitaire (CHU) Pontchaillou, Rennes, France
| | - Marie-Laure Island
- INSERM, Univ Rennes, INRA, Platform Analyse Elémentaire et Métabolisme des Métaux, UMR 1241 Institut NuMeCan (Nutrition, Metabolism, and Cancer), Centre Hospitalier Universitaire (CHU) Pontchaillou, Rennes, France
| | - Patricia Leroyer
- INSERM, Univ Rennes, INRA, Platform Analyse Elémentaire et Métabolisme des Métaux, UMR 1241 Institut NuMeCan (Nutrition, Metabolism, and Cancer), Centre Hospitalier Universitaire (CHU) Pontchaillou, Rennes, France
| | - François Robin
- INSERM, Univ Rennes, INRA, Platform Analyse Elémentaire et Métabolisme des Métaux, UMR 1241 Institut NuMeCan (Nutrition, Metabolism, and Cancer), Centre Hospitalier Universitaire (CHU) Pontchaillou, Rennes, France
| | - Séverine Rémy
- INSERM UMR 1064- Centre de Recherches en Transplantation et Immunologie (CRTI), Transgenic Rats ImmunoPhenomic facility, Nantes, France
| | - Laurent Tesson
- INSERM UMR 1064- Centre de Recherches en Transplantation et Immunologie (CRTI), Transgenic Rats ImmunoPhenomic facility, Nantes, France
| | - Ignacio Anegon
- INSERM UMR 1064- Centre de Recherches en Transplantation et Immunologie (CRTI), Transgenic Rats ImmunoPhenomic facility, Nantes, France
| | - Kévin Nay
- Laboratory Movement, Sport, and Health Sciences (M2S-EA7470), University Rennes 2–Ecole Normale Supérieure (ENS) Rennes, Bruz, France
| | - Frédéric Derbré
- Laboratory Movement, Sport, and Health Sciences (M2S-EA7470), University Rennes 2–Ecole Normale Supérieure (ENS) Rennes, Bruz, France
| | - Pierre Brissot
- INSERM, Univ Rennes, INRA, Platform Analyse Elémentaire et Métabolisme des Métaux, UMR 1241 Institut NuMeCan (Nutrition, Metabolism, and Cancer), Centre Hospitalier Universitaire (CHU) Pontchaillou, Rennes, France
| | - Martine Ropert
- INSERM, Univ Rennes, INRA, Platform Analyse Elémentaire et Métabolisme des Métaux, UMR 1241 Institut NuMeCan (Nutrition, Metabolism, and Cancer), Centre Hospitalier Universitaire (CHU) Pontchaillou, Rennes, France
| | - Thibault Cavey
- INSERM, Univ Rennes, INRA, Platform Analyse Elémentaire et Métabolisme des Métaux, UMR 1241 Institut NuMeCan (Nutrition, Metabolism, and Cancer), Centre Hospitalier Universitaire (CHU) Pontchaillou, Rennes, France
| | - Olivier Loréal
- INSERM, Univ Rennes, INRA, Platform Analyse Elémentaire et Métabolisme des Métaux, UMR 1241 Institut NuMeCan (Nutrition, Metabolism, and Cancer), Centre Hospitalier Universitaire (CHU) Pontchaillou, Rennes, France
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12
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Cavey T, Latour C, Island ML, Leroyer P, Guggenbuhl P, Coppin H, Roth MP, Bendavid C, Brissot P, Ropert M, Loréal O. Spleen iron, molybdenum, and manganese concentrations are coregulated in hepcidin‐deficient and secondary iron overload models in mice. FASEB J 2019; 33:11072-11081. [DOI: 10.1096/fj.201801381rr] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Thibault Cavey
- INSERMUniversité RennesINRAUMR 1241Analyse Elémentaire et Métabolisme des Métaux (AEM2) PlatformCHU Pontchaillou, NutritionMétabolismes et Cancer Institute (NuMeCan)RennesFrance
| | - Chloé Latour
- Institut de Recherche en Santé Digestive (IRSD)INSERMINRAÉcole Nationale Vétérinaire de Toulouse (ENVT)Université Paul Sabatier (UPS)-Université de ToulouseToulouseFrance
| | - Marie-Laure Island
- INSERMUniversité RennesINRAUMR 1241Analyse Elémentaire et Métabolisme des Métaux (AEM2) PlatformCHU Pontchaillou, NutritionMétabolismes et Cancer Institute (NuMeCan)RennesFrance
| | - Patricia Leroyer
- INSERMUniversité RennesINRAUMR 1241Analyse Elémentaire et Métabolisme des Métaux (AEM2) PlatformCHU Pontchaillou, NutritionMétabolismes et Cancer Institute (NuMeCan)RennesFrance
| | - Pascal Guggenbuhl
- INSERMUniversité RennesINRAUMR 1241Analyse Elémentaire et Métabolisme des Métaux (AEM2) PlatformCHU Pontchaillou, NutritionMétabolismes et Cancer Institute (NuMeCan)RennesFrance
| | - Hélène Coppin
- Institut de Recherche en Santé Digestive (IRSD)INSERMINRAÉcole Nationale Vétérinaire de Toulouse (ENVT)Université Paul Sabatier (UPS)-Université de ToulouseToulouseFrance
| | - Marie-Paule Roth
- Institut de Recherche en Santé Digestive (IRSD)INSERMINRAÉcole Nationale Vétérinaire de Toulouse (ENVT)Université Paul Sabatier (UPS)-Université de ToulouseToulouseFrance
| | - Claude Bendavid
- INSERMUniversité RennesINRAUMR 1241Analyse Elémentaire et Métabolisme des Métaux (AEM2) PlatformCHU Pontchaillou, NutritionMétabolismes et Cancer Institute (NuMeCan)RennesFrance
| | - Pierre Brissot
- INSERMUniversité RennesINRAUMR 1241Analyse Elémentaire et Métabolisme des Métaux (AEM2) PlatformCHU Pontchaillou, NutritionMétabolismes et Cancer Institute (NuMeCan)RennesFrance
| | - Martine Ropert
- INSERMUniversité RennesINRAUMR 1241Analyse Elémentaire et Métabolisme des Métaux (AEM2) PlatformCHU Pontchaillou, NutritionMétabolismes et Cancer Institute (NuMeCan)RennesFrance
| | - Olivier Loréal
- INSERMUniversité RennesINRAUMR 1241Analyse Elémentaire et Métabolisme des Métaux (AEM2) PlatformCHU Pontchaillou, NutritionMétabolismes et Cancer Institute (NuMeCan)RennesFrance
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Loréal O, Cavey T, Robin F, Kenawi M, Guggenbuhl P, Brissot P. Iron as a Therapeutic Target in HFE-Related Hemochromatosis: Usual and Novel Aspects. Pharmaceuticals (Basel) 2018; 11:ph11040131. [PMID: 30486249 PMCID: PMC6315470 DOI: 10.3390/ph11040131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 12/13/2022] Open
Abstract
Genetic hemochromatosis is an iron overload disease that is mainly related to the C282Y mutation in the HFE gene. This gene controls the expression of hepcidin, a peptide secreted in plasma by the liver and regulates systemic iron distribution. Homozygous C282Y mutation induces hepcidin deficiency, leading to increased circulating transferrin saturation, and ultimately, iron accumulation in organs such as the liver, pancreas, heart, and bone. Iron in excess may induce or favor the development of complications such as cirrhosis, liver cancer, diabetes, heart failure, hypogonadism, but also complaints such as asthenia and disabling arthritis. Iron depletive treatment mainly consists of venesections that permit the removal of iron contained in red blood cells and the subsequent mobilization of stored iron in order to synthesize hemoglobin for new erythrocytes. It is highly efficient in removing excess iron and preventing most of the complications associated with excess iron in the body. However, this treatment does not target the biological mechanisms involved in the iron metabolism disturbance. New treatments based on the increase of hepcidin levels, by using hepcidin mimetics or inducers, or inhibitors of the iron export activity of ferroportin protein that is the target of hepcidin, if devoid of significant secondary effects, should be useful to better control iron parameters and symptoms, such as arthritis.
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Affiliation(s)
- Olivier Loréal
- INSERM, Univ Rennes, INRA, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35033 Rennes, France.
| | - Thibault Cavey
- INSERM, Univ Rennes, INRA, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35033 Rennes, France.
| | - François Robin
- INSERM, Univ Rennes, INRA, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35033 Rennes, France.
| | - Moussa Kenawi
- INSERM, Univ Rennes, INRA, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35033 Rennes, France.
| | - Pascal Guggenbuhl
- INSERM, Univ Rennes, INRA, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35033 Rennes, France.
| | - Pierre Brissot
- INSERM, Univ Rennes, INRA, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35033 Rennes, France.
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Brissot P, Bernard DG, Brissot E, Loréal O, Troadec MB. Rare anemias due to genetic iron metabolism defects. Mutat Res Rev Mutat Res 2018; 777:52-63. [PMID: 30115430 DOI: 10.1016/j.mrrev.2018.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 12/06/2017] [Revised: 03/05/2018] [Accepted: 06/21/2018] [Indexed: 01/19/2023]
Abstract
Anemia is defined by a deficiency of hemoglobin, an iron-rich protein that binds oxygen in the blood. It can be due to multiple causes, either acquired or genetic. Alterations of genes involved in iron metabolism may be responsible, usually at a young age, for rare forms of chronic and often severe congenital anemia. These diseases encompass a variety of sideroblastic anemias, characterized by the presence of ring sideroblasts in the bone marrow. Clinical expression of congenital sideroblastic anemia is either monosyndromic (restricted to hematological lineages) or polysyndromic (with systemic expression), depending on whether iron metabolism, and especially heme synthesis, is directly or indirectly affected. Beside sideroblastic anemias, a number of other anemias can develop due to mutations of key proteins acting either on cellular iron transport (such as the DMT1 transporter), plasma iron transport (transferrin), and iron recycling (ceruloplasmin). Contrasting with the aforementioned entities which involve compartmental, and sometimes, systemic iron excess, the iron refractory iron deficiency anemia (IRIDA) corresponds to a usually severe anemia with whole body iron deficiency related to chronic increase of plasma hepcidin, the systemic negative regulator of plasma iron. Once clinically suggested, these diseases are confirmed by genetic testing in specialized laboratories.
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Affiliation(s)
- Pierre Brissot
- INSERM, Univ Rennes, INRA, Institut NUMECAN (Nutrition, Metabolisms and Cancer), UMR_S 1241, F-35000 Rennes, France.
| | - Delphine G Bernard
- UMR 1078 "Génétique, Génomique Fonctionnelle et Biotechnologies", INSERM, Univ. Brest, EFS, IBSAM, Brest, France
| | - Eolia Brissot
- Sorbonne Universités, UPMC Univ. Paris 06, AP-HP, Centre de recherche Saint-Antoine, UMR-S938, Paris, France; Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, Paris, France
| | - Olivier Loréal
- INSERM, Univ Rennes, INRA, Institut NUMECAN (Nutrition, Metabolisms and Cancer), UMR_S 1241, F-35000 Rennes, France
| | - Marie-Bérengère Troadec
- Univ. Rennes, CNRS, IGDR (Institut de génétique et développement de Rennes) - UMR 6290, F- 35000 Rennes, France.
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Abstract
Haemochromatosis is defined as systemic iron overload of genetic origin, caused by a reduction in the concentration of the iron regulatory hormone hepcidin, or a reduction in hepcidin-ferroportin binding. Hepcidin regulates the activity of ferroportin, which is the only identified cellular iron exporter. The most common form of haemochromatosis is due to homozygous mutations (specifically, the C282Y mutation) in HFE, which encodes hereditary haemochromatosis protein. Non-HFE forms of haemochromatosis due to mutations in HAMP, HJV or TFR2 are much rarer. Mutations in SLC40A1 (also known as FPN1; encoding ferroportin) that prevent hepcidin-ferroportin binding also cause haemochromatosis. Cellular iron excess in HFE and non-HFE forms of haemochromatosis is caused by increased concentrations of plasma iron, which can lead to the accumulation of iron in parenchymal cells, particularly hepatocytes, pancreatic cells and cardiomyocytes. Diagnosis is noninvasive and includes clinical examination, assessment of plasma iron parameters, imaging and genetic testing. The mainstay therapy is phlebotomy, although iron chelation can be used in some patients. Hepcidin supplementation might be an innovative future approach.
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Affiliation(s)
- Pierre Brissot
- INSERM, Univ. Rennes, INRA, Institut NUMECAN (Nutrition Metabolisms and Cancer) UMR_A 1341, UMR_S 1241, F-35000 Rennes, France
| | - Antonello Pietrangelo
- Division of Internal Medicine 2 and Center for Haemochromatosis, University Hospital of Modena, Modena, Italy
| | - Paul C. Adams
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | | | - Olivier Loréal
- INSERM, Univ. Rennes, INRA, Institut NUMECAN (Nutrition Metabolisms and Cancer) UMR_A 1341, UMR_S 1241, F-35000 Rennes, France
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Adams P, Altes A, Brissot P, Butzeck B, Cabantchik I, Cançado R, Distante S, Evans P, Evans R, Ganz T, Girelli D, Hultcrantz R, McLaren G, Marris B, Milman N, Nemeth E, Nielsen P, Pineau B, Piperno A, Porto G, Prince D, Ryan J, Sanchez M, Santos P, Swinkels D, Teixeira E, Toska K, Vanclooster A, White D. Therapeutic recommendations in HFE hemochromatosis for p.Cys282Tyr (C282Y/C282Y) homozygous genotype. Hepatol Int 2018; 12:83-86. [PMID: 29589198 PMCID: PMC5904234 DOI: 10.1007/s12072-018-9855-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/08/2018] [Indexed: 12/15/2022]
Abstract
Although guidelines are available for hereditary hemochromatosis, a high percentage of the recommendations within them are not shared between the different guidelines. Our main aim is to provide an objective, simple, brief, and practical set of recommendations about therapeutic aspects of HFE hemochromatosis for p.Cys282Tyr (C282Y/C282Y) homozygous genotype, based on the published scientific studies and guidelines, in a form that is reasonably comprehensible to patients and people without medical training. This final version was approved at the Hemochromatosis International meeting on 12th May 2017 in Los Angeles.
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Affiliation(s)
- Paul Adams
- University Hospital, Western University, London, ON, Canada
| | - Albert Altes
- Asociación Española de Hemocromatosis, Santa Coloma, Spain
| | - Pierre Brissot
- Inserm Unit 1241, University Hospital Pontchaillou, Rennes, France.
- HI - Haemochromatosis International, London, UK.
| | - Barbara Butzeck
- HI - Haemochromatosis International, London, UK
- European Federation of Associations of Patients with Haemochromatosis, Seine, France
- Haemochromatose-Vereinigung Deutschland, Hürth, Germany
| | - Ioav Cabantchik
- International Bioiron Society, Schaumburg, USA
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rodolfo Cançado
- Division of Hematology, Santa Casa Medical School of Sao Paulo, Sao Paulo, SP, Brazil
| | - Sonia Distante
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Patricia Evans
- HI - Haemochromatosis International, London, UK
- European Federation of Associations of Patients with Haemochromatosis, Seine, France
| | - Robert Evans
- HI - Haemochromatosis International, London, UK
- Department of Electronic and Computer Engineering, School of Engineering and Design, Brunel University, Uxbridge, UK
- The Haemochromatosis Society, Hertfordshire, UK
| | - Tomas Ganz
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Domenico Girelli
- Department of Medicine, University of Verona Veneto Region Referral Center for Iron Metabolism Disorders, Verona, Italy
| | - Rolf Hultcrantz
- Department of Medicine, Unit of Gastroenterology and Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Gordon McLaren
- Division of Hematology/Oncology, University of California, Irvine, CA, USA
| | - Ben Marris
- HI - Haemochromatosis International, London, UK
- Haemochromatosis Australia, Meridan Plains, Australia
| | - Nils Milman
- Danish Haemochromatosis Association, Copenhagen, Denmark
| | - Elizabeta Nemeth
- Center for Iron Disorders, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Peter Nielsen
- Institut für Biochemie und Molekulare Zellbiologie, University Medical Center Hamburg, Hamburg, Germany
| | - Brigitte Pineau
- Fédération Française des Associations de Malades de l'hémochromatose, Paris, France
| | - Alberto Piperno
- Department of Medicine and Surgery, Centre for Rare Diseases, University of Milano-Bicocca, Monza, Italy
- Association for the Study of Hemochromatosis and Iron Overload Diseases, Monza, Italy
| | - Graça Porto
- IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- CHP-HSA - Centro Hospitalar do Porto - Hospital Santo António, Porto, Portugal
| | - Dianne Prince
- HI - Haemochromatosis International, London, UK
- Haemochromatosis Australia, Meridan Plains, Australia
| | - John Ryan
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Mayka Sanchez
- Asociación Española de Hemocromatosis, Santa Coloma, Spain
| | - Paulo Santos
- HI - Haemochromatosis International, London, UK.
- Department of Pharmacology, Universidade Federal de Sao Paulo, São Paulo, Brazil.
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, 03 de Maio St. INFAR, 4° andar - Vila Clementino, São Paulo, SP, Brazil.
| | - Dorine Swinkels
- Department of Laboratory Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Emerência Teixeira
- HI - Haemochromatosis International, London, UK
- IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- FCUP - Faculdade de Ciências da Universidade do Porto, Porto, Portugal
- APH - Associação Portuguesa de Hemocromatose, Porto, Portugal
| | - Ketil Toska
- HI - Haemochromatosis International, London, UK
- Norwegian Haemochromatosis Association, Bergen, Norway
| | - Annick Vanclooster
- University Hospitals Leuven, Gasthuisberg, Louvain, Belgium
- Haemochromatose Vereniging Vlaanderen, Leuven, Belgium
| | - Desley White
- HI - Haemochromatosis International, London, UK
- University of Plymouth, Plymouth, UK
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Fonseca PFS, Cançado RD, Naoum FA, Dinardo CL, Fonseca GHH, Gualandro SFM, Krieger JE, Pereira AC, Brissot P, Santos PCJL. Quality of life scores differs between genotypic groups of patients with suspected hereditary hemochromatosis. BMC Med Genet 2018; 19:3. [PMID: 29301508 PMCID: PMC5755339 DOI: 10.1186/s12881-017-0513-5] [Citation(s) in RCA: 2] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/18/2017] [Indexed: 12/15/2022]
Abstract
Background Hereditary hemochromatosis (HH) encompasses a group of autosomal recessive disorders mainly characterized by enhanced intestinal absorption of iron and its accumulation in parenchymal organs. HH diagnosis is based on iron biochemical and magnetic resonance imaging (MRI) assessment, and genetic testing. Questionnaires, such as SF-36 (short form health survey), have been increasingly used to assess the impact of diseases on the patient’s quality of life (QL). In addition, different genotypes are identified as results of genetic tests in patients with suspected primary iron overload. In the present study, our aim was to evaluate whether domains of QL are different according to genotypic groups in patients suspected of HH. Methods Seventy-nine patients with primary iron overload were included and two genotypic groups were formed (group 1: homozygous genotype for the HFE p.Cys282Tyr mutation; group 2: other genotypes). Results Group 1 had higher means of plasma transferrin saturation (86 ± 19%) and serum ferritin (1669 ± 1209 ng/mL) compared to group 2 (71 ± 12%, 1252 ± 750 ng/mL, respectively; p = 0.001). Four domains were significantly different among groups 1 and 2: physical functioning (p = 0.03), bodily pain (p = 0.03), vitality (p = 0.02) and social functioning (p = 0.01). Conclusions Our main finding was that patients with p.Cys282Tyr homozygosity had a worse QL scenario assessed by SF-36, compared with patients with iron overload without the same genotype. Being aware of this relationship between genotypes and QL might be helpful in the overall management of patients suspected of hereditary hemochromatosis. Electronic supplementary material The online version of this article (doi: 10.1186/s12881-017-0513-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paula Fernanda Silva Fonseca
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Doutor Enéas de Carvalho Aguiar, 44-Cerqueira César, São Paulo, 05403 900, Brazil
| | | | | | - Carla Luana Dinardo
- Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, SP, Brazil.,Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Sandra Fatima Menosi Gualandro
- Hematology and Hemotherapy Discipline, Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| | - José Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Doutor Enéas de Carvalho Aguiar, 44-Cerqueira César, São Paulo, 05403 900, Brazil
| | - Alexandre Costa Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Doutor Enéas de Carvalho Aguiar, 44-Cerqueira César, São Paulo, 05403 900, Brazil
| | - Pierre Brissot
- Liver Disease Unit, Pontchaillou University Hospital, University of Rennes, and National Reference Centre for Rare Iron Overload Diseases of Genetic Origin, Rennes, France
| | - Paulo Caleb Junior Lima Santos
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Doutor Enéas de Carvalho Aguiar, 44-Cerqueira César, São Paulo, 05403 900, Brazil. .,Department of Pharmacology, Universidade Federal de Sao Paulo - UNIFESP, São Paulo, Brazil.
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Brissot P, Cavey T, Ropert M, Gaboriau F, Loréal O. Hemochromatosis: a model of metal-related human toxicosis. Environ Sci Pollut Res Int 2018; 25:2007-2013. [PMID: 27628916 DOI: 10.1007/s11356-016-7576-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/26/2016] [Accepted: 09/01/2016] [Indexed: 06/06/2023]
Abstract
Many environmental agents, such as excessive alcohol intake, xenobiotics, and virus, are able to damage the human body, targeting especially the liver. Metal excess may also assault the liver. Thus, chronic iron overload may cause, especially when associated with cofactors, diffuse organ damage that is a source of significant morbidity and mortality. Iron excess can be either of acquired (mostly transfusional) or of genetic origin. Hemochromatosis is the archetype of genetic iron overload diseases and represents a serious health problem. A better understanding of iron metabolism has deeply modified the hemochromatosis field which today benefits from much more efficient diagnostic and therapeutic approaches.
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Affiliation(s)
- Pierre Brissot
- Hepatology, Faculty of Medicine, University of Rennes1, 2, avenue Pr. Léon BERNARD, 35043, Rennes, France.
- Department of Biochemistry, Pontchaillou University Hospital, Rennes, France.
- Inserm-UMR 991, University of Rennes1, Rennes, France.
| | - Thibault Cavey
- Department of Biochemistry, Pontchaillou University Hospital, Rennes, France
- Inserm-UMR 991, University of Rennes1, Rennes, France
| | - Martine Ropert
- Department of Biochemistry, Pontchaillou University Hospital, Rennes, France
- Inserm-UMR 991, University of Rennes1, Rennes, France
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Brissot P. [Phlebotomy in medicine:a very long story that is not over yet]. Rev Prat 2017; 67:1154-1158. [PMID: 30512621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Pierre Brissot
- Professeur émérite de médecine, membre correspondant de l'Académie nationale de médecine, université de Rennes 1, unité Inserm 1241, Rennes, France
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Brissot P, Cavey T, Ropert M, Guggenbuhl P, Loréal O. Genetic hemochromatosis: Pathophysiology, diagnostic and therapeutic management. Presse Med 2017; 46:e288-e295. [PMID: 29158016 DOI: 10.1016/j.lpm.2017.05.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 12/01/2016] [Accepted: 05/18/2017] [Indexed: 12/15/2022] Open
Abstract
The term hemochromatosis (HC) corresponds to several diseases characterized by systemic iron overload of genetic origin and affecting both the quality of life and life expectancy. Major improvement in the knowledge of iron metabolism permits to divide these diseases into two main pathophysiological categories. For most HC forms (types 1, 2, 3 and 4B HC) iron overload is related to cellular hepcidin deprivation which causes an increase of plasma iron concentration and the appearance of plasma non-transferrin bound iron. In contrast, iron excess in type 4A ferroportin disease is related to decreased cellular iron export. Whatever the HC type, the diagnosis rests on a non-invasive strategy, combining clinical, biological and imaging data. The mainstay of the treatment remains venesection therapy with the perspective of hepcidin supplementation for hepcidin deprivation-related HC. Prevention of HC is critical at the family level and, for type 1 HC, remains a major goal, although still debated, at the population level.
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Affiliation(s)
- Pierre Brissot
- University of Rennes 1, Hepatology, Faculty of Medicine, 2, avenue du Pr. Léon-Bernard, 35000 Rennes, France; Inserm-UMR 991, 2, rue Henri-Le-Guilloux, 35033 Rennes, France.
| | - Thibault Cavey
- Inserm-UMR 991, 2, rue Henri-Le-Guilloux, 35033 Rennes, France; CHU Rennes, Department of Specialized Biochemistry, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Martine Ropert
- Inserm-UMR 991, 2, rue Henri-Le-Guilloux, 35033 Rennes, France; CHU Rennes, Department of Specialized Biochemistry, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Pascal Guggenbuhl
- Inserm-UMR 991, 2, rue Henri-Le-Guilloux, 35033 Rennes, France; CHU Rennes, Department of Rheumatology, 2, rue Henri-Le-Guilloux, Rennes, France
| | - Olivier Loréal
- Inserm-UMR 991, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
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22
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Abstract
A number of human disorders are related to chronic iron overload, either of genetic or acquired origin. The multi-organ damage produced by iron excess leads, in adults and in children, to severe clinical consequences, affecting both quality of life and life expectancy. The diagnosis is increasingly based on a non-invasive strategy, resorting to clinical, biological and imaging data. The treatment rests on either venesection or chelation therapy, depending on the etiology. Major advances in the fields of molecular biology, pharmacology, and biotechnology pave the road for key improvements in the diagnostic and therapeutic management of the patients.
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Affiliation(s)
- Pierre Brissot
- a Hepatology-Faculty of Medicine, Inserm-UMR 991, National Center of Reference for Rare Iron Overload Diseases , University Hospital Pontchaillou , Rennes , France
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23
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Hamdi‐Rozé H, Beaumont‐Epinette M, Ben Ali Z, Le Lan C, Loustaud‐Ratti V, Causse X, Loreal O, Deugnier Y, Brissot P, Jouanolle A, Bardou‐Jacquet E. Rare HFE variants are the most frequent cause of hemochromatosis in non-c282y homozygous patients with hemochromatosis. Am J Hematol 2016; 91:1202-1205. [PMID: 27518069 DOI: 10.1002/ajh.24535] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/02/2016] [Accepted: 08/09/2016] [Indexed: 02/01/2023]
Abstract
p.Cys282Tyr (C282Y) homozygosity explains most cases of HFE-related hemochromatosis, but a significant number of patients presenting with typical type I hemochromatosis phenotype remain unexplained. We sought to describe the clinical relevance of rare HFE variants in non-C282Y homozygotes. Patients referred for hemochromatosis to the National Reference Centre for Rare Iron Overload Diseases from 2004 to 2010 were studied. Sequencing was performed for coding region and intronic flanking sequences of HFE, HAMP, HFE2, TFR2, and SLC40A1. Nine private HFE variants were identified in 13 of 206 unrelated patients. Among those, five have not been previously described: p.Leu270Argfs*4, p.Ala271Valfs*25, p.Tyr52*, p.Lys166Asn, and p.Asp141Tyr. Our results show that rare HFE variants are identified more frequently than variants in the other genes associated with iron overload. Rare HFE variants are therefore the most frequent cause of hemochromatosis in non-C282Y homozygote HFE patients. Am. J. Hematol. 91:1202-1205, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Houda Hamdi‐Rozé
- CHU Rennes, French Reference Centre for Rare Iron Overload Diseases of Genetic OriginRennes France
- Molecular Genetics DepartmentCHU RennesRennes35000 France
| | - Marie‐Pascale Beaumont‐Epinette
- CHU Rennes, French Reference Centre for Rare Iron Overload Diseases of Genetic OriginRennes France
- Molecular Genetics DepartmentCHU RennesRennes35000 France
| | - Zeineb Ben Ali
- CHU Rennes, French Reference Centre for Rare Iron Overload Diseases of Genetic OriginRennes France
- Liver Disease DepartmentCHU RennesRennes35000 France
| | - Caroline Le Lan
- CHU Rennes, French Reference Centre for Rare Iron Overload Diseases of Genetic OriginRennes France
- Liver Disease DepartmentCHU RennesRennes35000 France
| | - Véronique Loustaud‐Ratti
- CHU Rennes, French Reference Centre for Rare Iron Overload Diseases of Genetic OriginRennes France
- CHU Limoges Service d'Hépato‐gastroentérologie, U850 INSERM Univ LimogesF‐87000Limoges France
| | - Xavier Causse
- CHU Rennes, French Reference Centre for Rare Iron Overload Diseases of Genetic OriginRennes France
- Hepatology and Gastroenterology departmentRegional Hospital of OrléansOrléans45000 France
| | - Olivier Loreal
- CHU Rennes, French Reference Centre for Rare Iron Overload Diseases of Genetic OriginRennes France
- University of Rennes1, Inserm UMR 991Rennes35000 France
| | - Yves Deugnier
- CHU Rennes, French Reference Centre for Rare Iron Overload Diseases of Genetic OriginRennes France
- Liver Disease DepartmentCHU RennesRennes35000 France
| | | | - Anne‐Marie Jouanolle
- CHU Rennes, French Reference Centre for Rare Iron Overload Diseases of Genetic OriginRennes France
- Molecular Genetics DepartmentCHU RennesRennes35000 France
| | - Edouard Bardou‐Jacquet
- CHU Rennes, French Reference Centre for Rare Iron Overload Diseases of Genetic OriginRennes France
- Liver Disease DepartmentCHU RennesRennes35000 France
- University of Rennes1, Inserm UMR 991Rennes35000 France
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Porto G, Brissot P, Swinkels DW, Zoller H, Kamarainen O, Patton S, Alonso I, Morris M, Keeney S. EMQN best practice guidelines for the molecular genetic diagnosis of hereditary hemochromatosis (HH). Eur J Hum Genet 2016; 24:479-95. [PMID: 26153218 PMCID: PMC4929861 DOI: 10.1038/ejhg.2015.128] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 04/29/2015] [Accepted: 05/06/2015] [Indexed: 12/14/2022] Open
Abstract
Molecular genetic testing for hereditary hemochromatosis (HH) is recognized as a reference test to confirm the diagnosis of suspected HH or to predict its risk. The vast majority (typically >90%) of patients with clinically characterized HH are homozygous for the p.C282Y variant in the HFE gene, referred to as HFE-related HH. Since 1996, HFE genotyping was implemented in diagnostic algorithms for suspected HH, allowing its early diagnosis and prevention. However, the penetrance of disease in p.C282Y homozygotes is incomplete. Hence, homozygosity for p.C282Y is not sufficient to diagnose HH. Neither is p.C282Y homozygosity required for diagnosis as other rare forms of HH exist, generally referred to as non-HFE-related HH. These pose significant challenges when defining criteria for referral, testing protocols, interpretation of test results and reporting practices. We present best practice guidelines for the molecular genetic diagnosis of HH where recommendations are classified, as far as possible, according to the level and strength of evidence. For clarification, the guidelines' recommendations are preceded by a detailed description of the methodology and results obtained with a series of actions taken in order to achieve a wide expert consensus, namely: (i) a survey on the current practices followed by laboratories offering molecular diagnosis of HH; (ii) a systematic literature search focused on some identified controversial topics; (iii) an expert Best Practice Workshop convened to achieve consensus on the practical recommendations included in the guidelines.
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Affiliation(s)
- Graça Porto
- Center for Predictive and Preventive Genetics (CGPP), Institute of Molecular and Cellular Biology (IBMC), Porto, Portugal
- Clinical Haematology, Hospital Santo António (CHP-HAS) and Department of Molecular Pathology and Immunology, Abel Salazar Institute for Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
| | - Pierre Brissot
- Liver Disease Unit, Pontchaillou University Hospital, University of Rennes, and National Reference Centre for Rare Iron Overload Diseases of Genetic Origin, Rennes, France
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Heinz Zoller
- Department of Medicine II, Gastroenterology and Hepatology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Simon Patton
- European Molecular Quality Network (EMQN), Manchester, UK
| | - Isabel Alonso
- Center for Predictive and Preventive Genetics (CGPP), Institute of Molecular and Cellular Biology (IBMC), Porto, Portugal
| | - Michael Morris
- European Molecular Quality Network (EMQN), Manchester, UK
- Synlab, Lausanne, Switzerland
| | - Steve Keeney
- European Molecular Quality Network (EMQN), Manchester, UK
- Molecular Diagnostics Centre (Haematology), Manchester Royal Infirmary, Manchester, UK
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Daher R, Kannengiesser C, Houamel D, Lefebvre T, Bardou-Jacquet E, Ducrot N, de Kerguenec C, Jouanolle AM, Robreau AM, Oudin C, Le Gac G, Moulouel B, Loustaud-Ratti V, Bedossa P, Valla D, Gouya L, Beaumont C, Brissot P, Puy H, Karim Z, Tchernitchko D. Heterozygous Mutations in BMP6 Pro-peptide Lead to Inappropriate Hepcidin Synthesis and Moderate Iron Overload in Humans. Gastroenterology 2016; 150:672-683.e4. [PMID: 26582087 DOI: 10.1053/j.gastro.2015.10.049] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 10/14/2015] [Accepted: 10/29/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Hereditary hemochromatosis is a heterogeneous group of genetic disorders characterized by parenchymal iron overload. It is caused by defective expression of liver hepcidin, the main regulator of iron homeostasis. Iron stimulates the gene encoding hepcidin (HAMP) via the bone morphogenetic protein (BMP)6 signaling to SMAD. Although several genetic factors have been found to cause late-onset hemochromatosis, many patients have unexplained signs of iron overload. We investigated BMP6 function in these individuals. METHODS We sequenced the BMP6 gene in 70 consecutive patients with a moderate increase in serum ferritin and liver iron levels who did not carry genetic variants associated with hemochromatosis. We searched for BMP6 mutations in relatives of 5 probands and in 200 healthy individuals (controls), as well as in 2 other independent cohorts of hyperferritinemia patients. We measured serum levels of hepcidin by liquid chromatography-tandem mass spectrometry and analyzed BMP6 in liver biopsy specimens from patients by immunohistochemistry. The functions of mutant and normal BMP6 were assessed in transfected cells using immunofluorescence, real-time quantitative polymerase chain reaction, and immunoblot analyses. RESULTS We identified 3 heterozygous missense mutations in BMP6 (p.Pro95Ser, p.Leu96Pro, and p.Gln113Glu) in 6 unrelated patients with unexplained iron overload (9% of our cohort). These mutations were detected in less than 1% of controls. p.Leu96Pro also was found in 2 patients from the additional cohorts. Family studies indicated dominant transmission. Serum levels of hepcidin were inappropriately low in patients. A low level of BMP6, compared with controls, was found in a biopsy specimen from 1 patient. In cell lines, the mutated residues in the BMP6 propeptide resulted in defective secretion of BMP6; reduced signaling via SMAD1, SMAD5, and SMAD8; and loss of hepcidin production. CONCLUSIONS We identified 3 heterozygous missense mutations in BMP6 in patients with unexplained iron overload. These mutations lead to loss of signaling to SMAD proteins and reduced hepcidin production. These mutations might increase susceptibility to mild-to-moderate late-onset iron overload.
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Affiliation(s)
- Raed Daher
- INSERM UMR1149, Centre de Recherche sur l'Inflammation, Paris, France; Université Paris Diderot, Site Bichat, Sorbonne Paris Cité, Paris, France; Laboratory of Excellence, GR-Ex, Paris, France
| | - Caroline Kannengiesser
- INSERM UMR1149, Centre de Recherche sur l'Inflammation, Paris, France; Université Paris Diderot, Site Bichat, Sorbonne Paris Cité, Paris, France; Laboratory of Excellence, GR-Ex, Paris, France; AP-HP, Département de Génétique, Hôpital Bichat, Paris, France
| | - Dounia Houamel
- INSERM UMR1149, Centre de Recherche sur l'Inflammation, Paris, France; Université Paris Diderot, Site Bichat, Sorbonne Paris Cité, Paris, France; Laboratory of Excellence, GR-Ex, Paris, France
| | - Thibaud Lefebvre
- INSERM UMR1149, Centre de Recherche sur l'Inflammation, Paris, France; Université Paris Diderot, Site Bichat, Sorbonne Paris Cité, Paris, France; Laboratory of Excellence, GR-Ex, Paris, France; AP-HP, Centre Français des Porphyries, Hôpital Louis Mourier, Colombes, France
| | | | - Nicolas Ducrot
- INSERM UMR1149, Centre de Recherche sur l'Inflammation, Paris, France; Université Paris Diderot, Site Bichat, Sorbonne Paris Cité, Paris, France; Laboratory of Excellence, GR-Ex, Paris, France
| | | | - Anne-Marie Jouanolle
- Department of Liver Disease and Molecular Genetics, CHU Rennes, Rennes, France; CHU Rennes, French Reference Center for Rare Iron Overload Diseases of Genetic Origin
| | - Anne-Marie Robreau
- AP-HP, Centre Français des Porphyries, Hôpital Louis Mourier, Colombes, France
| | - Claire Oudin
- AP-HP, Centre Français des Porphyries, Hôpital Louis Mourier, Colombes, France
| | - Gerald Le Gac
- INSERM U1078, Université de Brest, CHRU de Brest, Laboratoire de Génétique Moléculaire et d'Histocompatibilité, Bretagne, Brest, France
| | - Boualem Moulouel
- INSERM UMR1149, Centre de Recherche sur l'Inflammation, Paris, France
| | | | - Pierre Bedossa
- INSERM UMR1149, Centre de Recherche sur l'Inflammation, Paris, France; AP-HP, Laboratoire d'Anatomo-Pathologie, Hôpital Beaujon, Clichy, France
| | - Dominique Valla
- AP-HP, Département d'Hépatologie, Hôpital Beaujon, Clichy, France
| | - Laurent Gouya
- INSERM UMR1149, Centre de Recherche sur l'Inflammation, Paris, France; Université Paris Diderot, Site Bichat, Sorbonne Paris Cité, Paris, France; Laboratory of Excellence, GR-Ex, Paris, France; AP-HP, Centre Français des Porphyries, Hôpital Louis Mourier, Colombes, France
| | - Carole Beaumont
- INSERM UMR1149, Centre de Recherche sur l'Inflammation, Paris, France; Université Paris Diderot, Site Bichat, Sorbonne Paris Cité, Paris, France; Laboratory of Excellence, GR-Ex, Paris, France
| | - Pierre Brissot
- Department of Liver Disease and Molecular Genetics, CHU Rennes, Rennes, France
| | - Hervé Puy
- INSERM UMR1149, Centre de Recherche sur l'Inflammation, Paris, France; Université Paris Diderot, Site Bichat, Sorbonne Paris Cité, Paris, France; Laboratory of Excellence, GR-Ex, Paris, France; AP-HP, Centre Français des Porphyries, Hôpital Louis Mourier, Colombes, France
| | - Zoubida Karim
- INSERM UMR1149, Centre de Recherche sur l'Inflammation, Paris, France; Université Paris Diderot, Site Bichat, Sorbonne Paris Cité, Paris, France; Laboratory of Excellence, GR-Ex, Paris, France.
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Brissot P. Hemocromatosis: a changing world. Bull Acad Natl Med 2016; 200:309-325. [PMID: 29898327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Due to major advances in the understanding of iron metabolism as well as in the bioche- iuical, imaging, and genetic domains: i) The nosologicalframework of hemochromatosis (HC) encompasses not only HFE-HC, by far the most frequent HC form, but also non-HFE HC diseases which comprise essentially juvenile HC and the ferroportin disease. ii) The diagnostic approach has become totally non invasive, based on clinical, imaging and biological data. iii) The treatment remains, for most forms, based on venesections, but the innovative emerging therapeutic approach is represented by hepcidin supplementation.
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Brissot P. [IRON OVERLOAD: BETTER UNDERSTANDING, BETTER CARE]. Rev Prat 2015; 65:1305-1311. [PMID: 26979029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Chronic iron overload, either of genetic (hemochromatoses) or acquired (transfusions) origin, leads to frequent disorders, affecting both the quality of life and life expectancy. Major recent advances in the knowledge of iron metabolism, together with advances in biology, imaging and drug design have already significantly improved the diagnostic and therapeutic approaches. These conceptual and technological ameliorations should, in the near future, continue to benefit the clinical management of iron overloaded patients.
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Pawlowski M, Latute F, Bardou-Jacquet E, Latournerie M, Zerrouki S, Bendavid C, Brissot P, Ropert M. Portable hemoglobinometer is a reliable technology for the follow-up of venesections tolerance in hemochromatosis. Clin Res Hepatol Gastroenterol 2015; 39:570-5. [PMID: 25776452 DOI: 10.1016/j.clinre.2014.09.014] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 08/01/2014] [Accepted: 09/01/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND The treatment of HFE-related hemochromatosis, one of the most common genetic diseases, is based on phlebotomies whose tolerance is evaluated by regular monitoring of hemoglobin. Using a portable hemoglobinometer (PH) could provide an easy and fast determination of hemoglobin. Therefore, the aim of the present study was to compare, in hemochromatosis patients treated by bloodletting, the hemoglobin concentrations as assayed, on capillary blood, by a PH device and, on venous blood, by a cell counter (CC) device. METHODS For a total period of 12 weeks duration, all patients undergoing phlebotomies in the same hospital outpatient unit had hemoglobin determinations both by the HemoCue and by the laboratory's DxH 800 Coulter. To evaluate the sensitivity and specificity of the HemoCue, patients were classified as presenting or not anemia as defined by hemoglobin level below 11 g/dl. RESULTS Measurements of hemoglobin were performed in 122 patients. The sensitivity and specificity of PH compared to CC were 100 and 98.1%, respectively. Capillary hemoglobin by PH slightly underestimated venous hemoglobin by CC. The Pearson's correlation coefficient between PH and CC was 0.80 (P<0.0001). CONCLUSION PH is a reliable, quick and easy technology, which can be proposed to follow-up the tolerance of venesections in hemochromatosis patients.
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Affiliation(s)
- Maxime Pawlowski
- Laboratory of Biochemistry, University Hospital Pontchaillou, 35033 Rennes, France
| | - Fanny Latute
- Laboratory of Biochemistry, University Hospital Pontchaillou, 35033 Rennes, France.
| | - Edouard Bardou-Jacquet
- Inserm UMR991, University of Rennes 1, 35033 Rennes France; Liver Disease Department, University Hospital Pontchaillou, 35033 Rennes, France
| | - Marianne Latournerie
- Liver Disease Department, University Hospital Pontchaillou, 35033 Rennes, France
| | - Selim Zerrouki
- Liver Disease Department, University Hospital Pontchaillou, 35033 Rennes, France
| | - Claude Bendavid
- Laboratory of Biochemistry, University Hospital Pontchaillou, 35033 Rennes, France
| | - Pierre Brissot
- Inserm UMR991, University of Rennes 1, 35033 Rennes France; Liver Disease Department, University Hospital Pontchaillou, 35033 Rennes, France
| | - Martine Ropert
- Laboratory of Biochemistry, University Hospital Pontchaillou, 35033 Rennes, France; Liver Disease Department, University Hospital Pontchaillou, 35033 Rennes, France
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Cavey T, Ropert M, de Tayrac M, Bardou-Jacquet E, Island ML, Leroyer P, Bendavid C, Brissot P, Loréal O. Mouse genetic background impacts both on iron and non-iron metals parameters and on their relationships. Biometals 2015; 28:733-43. [PMID: 26041486 DOI: 10.1007/s10534-015-9862-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/20/2015] [Indexed: 12/17/2022]
Abstract
Iron is reported to interact with other metals. In addition, it has been shown that genetic background may impact iron metabolism. Our objective was to characterize, in mice of three genetic backgrounds, the links between iron and several non-iron metals. Thirty normal mice (C57BL/6, Balb/c and DBA/2; n = 10 for each group), fed with the same diet, were studied. Quantification of iron, zinc, cobalt, copper, manganese, magnesium and rubidium was performed by ICP/MS in plasma, erythrocytes, liver and spleen. Transferrin saturation was determined. Hepatic hepcidin1 mRNA level was evaluated by quantitative RT-PCR. As previously reported, iron parameters were modulated by genetic background with significantly higher values for plasma iron parameters and liver iron concentration in DBA/2 and Balb/c strains. Hepatic hepcidin1 mRNA level was lower in DBA/2 mice. No iron parameter was correlated with hepcidin1 mRNA levels. Principal component analysis of the data obtained for non-iron metals indicated that metals parameters stratified the mice according to their genetic background. Plasma and tissue metals parameters that are dependent or independent of genetic background were identified. Moreover, relationships were found between plasma and tissue content of iron and some other metals parameters. Our data: (i) confirms the impact of the genetic background on iron parameters, (ii) shows that genetic background may also play a role in the metabolism of non-iron metals, (iii) identifies links between iron and other metals parameters which may have implications in the understanding and, potentially, the modulation of iron metabolism.
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Legros L, Bardou-Jacquet E, Latournerie M, Guillygomarc'h A, Turlin B, Le Lan C, Désille Y, Lainé F, Moirand R, Brissot P, Deugnier Y, Guyader D. Non-invasive assessment of liver fibrosis in C282Y homozygous HFE hemochromatosis. Liver Int 2015; 35:1731-8. [PMID: 25495562 DOI: 10.1111/liv.12762] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/10/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS C282Y homozygotes with serum ferritin (SF) levels >1000 μg/L and/or increased serum transaminase levels are at risk of severe F3/F4 fibrosis. Current practical guidelines recommend liver biopsy in such individuals. This prospective observational cohort study aimed to evaluate non-invasive alternative means such as hyaluronic acid (HA) and transient elastography (TE) for the assessment of severe fibrosis in patients with SF >1000 μg/L or elevated transaminases. METHODS Between September 2005 and April 2013, 77 patients diagnosed C282Y homozygotes underwent a liver biopsy because of SF >1000 μg/L and/or increased transaminases according to current guidelines, with concomitant TE. All of them had clinical and biological evaluation, including HA measurement in 52 cases. RESULTS A total of 19.5% of patients had F3-F4 severe fibrosis. HA was higher in patients with severe fibrosis, but did not accurately predict severe fibrosis. TE was significantly higher in patients with severe fibrosis (17.2 vs. 4.9 kPa; P < 0.05) and was able to accurately predict fibrosis stage in 47/61 (77%) patients with valid measurement using a lower threshold of 6.4 kPa and an upper threshold of 13.9 kPa. Efficient assessment of severe fibrosis was not possible in patients with intermediate TE values. CONCLUSION An algorithm that successively employed SF and TE can accurately classify severe fibrosis in 61% of patients, restricting the need for liver biopsy to the 39% of patients with intermediate or unvalid TE values. This algorithm should be validated in independent cohorts before extended use.
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Affiliation(s)
- Ludivine Legros
- Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.,Inserm UMR991, CHU de Rennes, Rennes, France
| | - Edouard Bardou-Jacquet
- Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.,Inserm UMR991, CHU de Rennes, Rennes, France.,University of Rennes 1, CHU de Rennes, Rennes, France
| | - Marianne Latournerie
- Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France
| | - Anne Guillygomarc'h
- Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France
| | - Bruno Turlin
- University of Rennes 1, CHU de Rennes, Rennes, France.,Department of Pathology, CHU de Rennes, Rennes, France
| | - Caroline Le Lan
- Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France
| | - Yoann Désille
- Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France
| | - Fabrice Lainé
- Clinical Investigation Unit, Inserm CIC0203, CHU de Rennes, Rennes, France
| | - Romain Moirand
- Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.,Inserm UMR991, CHU de Rennes, Rennes, France.,University of Rennes 1, CHU de Rennes, Rennes, France
| | - Pierre Brissot
- Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.,Inserm UMR991, CHU de Rennes, Rennes, France.,University of Rennes 1, CHU de Rennes, Rennes, France
| | - Yves Deugnier
- Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.,University of Rennes 1, CHU de Rennes, Rennes, France
| | - Dominique Guyader
- Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.,University of Rennes 1, CHU de Rennes, Rennes, France
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Ropert M, Détivaud L, Fimbel d'Hauthuille B, Gautier M, Leroyer P, Jouanolle AM, Loréal O, Brissot P. Monoclonal anti-transferrin antibody: a paradigm for better understanding of iron metabolism. Am J Hematol 2015; 90:E129-30. [PMID: 25779881 DOI: 10.1002/ajh.24004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/10/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Martine Ropert
- National Center of Reference for Rare Genetic Iron Overload Diseases, Pontchaillou University Hospital, Rennes, France
- Inserm-UMR 991, University of Rennes, Rennes, France
- Laboratory of Biochemistry, Pontchaillou University Hospital, Rennes, France
| | - Lénaïck Détivaud
- National Center of Reference for Rare Genetic Iron Overload Diseases, Pontchaillou University Hospital, Rennes, France
- Inserm-UMR 991, University of Rennes, Rennes, France
| | | | - Mathilde Gautier
- National Center of Reference for Rare Genetic Iron Overload Diseases, Pontchaillou University Hospital, Rennes, France
| | | | - Anne-Marie Jouanolle
- National Center of Reference for Rare Genetic Iron Overload Diseases, Pontchaillou University Hospital, Rennes, France
- Laboratory of Molecular Genetics and Genomics, Pontchaillou University Hospital, Rennes, France
| | - Olivier Loréal
- National Center of Reference for Rare Genetic Iron Overload Diseases, Pontchaillou University Hospital, Rennes, France
- Inserm-UMR 991, University of Rennes, Rennes, France
| | - Pierre Brissot
- National Center of Reference for Rare Genetic Iron Overload Diseases, Pontchaillou University Hospital, Rennes, France
- Inserm-UMR 991, University of Rennes, Rennes, France
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Beaumont-Epinette MP, Delobel JB, Ropert M, Deugnier Y, Loréal O, Jouanolle AM, Brissot P, Bardou-Jacquet E. Hereditary hypotransferrinemia can lead to elevated transferrin saturation and, when associated to HFE or HAMP mutations, to iron overload. Blood Cells Mol Dis 2015; 54:151-4. [DOI: 10.1016/j.bcmd.2014.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 11/14/2014] [Indexed: 11/28/2022]
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Brissot P, Loreal O. Management of Liver Complications in Haemoglobinopathies. Thalassemia Reports 2014. [DOI: 10.4081/thal.2014.4869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Liver complications in haemoglobinopathies (thalassaemia and sickle cell disease) are due to several factors, dominated (beside chronic viral infections, not considered here) by chronic iron overload, biliary obstruction and venous thrombosis. Whereas the latter two factors can cause acute hepatic syndromes, all three mechanisms - when becoming chronic- can produce fibrosis and cirrhosis and even, in thalassaemia, hepatocellular carcinoma. These chronic hepatic complications are an indirect consequence of the significant improvement in life expectancy due to the overall amelioration of disease management. The diagnostic approach has benefited from non invasive (biochemical and imaging) approaches which have considerably reduced the indication of liver biopsy. The therapeutic management involves relatively efficient curative medical, endoscopic or surgical methods, but should rest primarily on preventive measures focused on the haematological causative factors but also on hepatic co-morbidities. This chapter will focus on hepatic complications in thalassaemia and sickle cell disease (SCD), without considering the complications related to virus B or C infections which will be described in another chapter.
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Cavey T, Ropert M, De Tayrac M, Bardou-Jacquet E, Leroyer P, Bendavid C, Brissot P, Loréal O. P006: Inter-relations entre le fer et des métaux non ferreux chez la souris : mise en évidence d’une incidence du contexte génétique. NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70649-1] [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: 11/29/2022]
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Teixeira E, Borlido-Santos J, Brissot P, Butzeck B, Courtois F, Evans RW, Fernau J, Nunes JA, Mullett M, Paneque M, Pineau B, Porto G, Sorrill R, Sanchez M, Swinkels DW, Toska K, Varkonyi J. The importance of the general practitioner as an information source for patients with hereditary haemochromatosis. Patient Educ Couns 2014; 96:86-92. [PMID: 24857332 DOI: 10.1016/j.pec.2014.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 11/27/2013] [Revised: 04/12/2014] [Accepted: 04/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore hereditary haemochromatosis (HH) patients' perspectives on genetic information, namely the types of sources used, preferred or trusted. METHODS A survey online was conducted by the European Federation of Associations of Patients with Haemochromatosis (EFAPH) and applied to members of nine National Associations. RESULTS From a total of 1019 validated questionnaires, 895 respondents had performed a genetic testing for HH. From these, 627 self-declared that they were sufficiently informed about the implications of the genetic test to their health. The majority (66%) obtained the information from a specialist doctor, but would like to obtain it from the family doctor. However, the specialist was still the one they trusted more (69%). Regarding the 298 respondents who did not feel sufficiently informed, the majority (78%) also would like to have information from the family doctor although they also trusted the specialist more (75%). A different perspective was reported when patients were asked about the implications of the genetic testing to their family members, where the majority of respondents preferred obtaining information from a specialist (69%). CONCLUSION This study elucidates the patients' needs for information and identifies the general practitioner (GP) as the preferred source to obtain information about HH. PRACTICE IMPLICATIONS These results may have important implications in future strategies for HH awareness, giving a special emphasis on GPs as the main players.
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Affiliation(s)
- Emerência Teixeira
- IBMC - Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal; FCUP - Faculty of Science, University of Porto, Porto, Portugal
| | - Júlio Borlido-Santos
- IBMC - Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
| | - Pierre Brissot
- National Reference Centre for Rare Iron Overload Disorders of Genetic Origin and Inserm U-991, Pontchaillou University Hospital, Rennes, France
| | - Barbara Butzeck
- Haemochromatose-Vereinigung Deutschland e.V.(HVD), Koeln, Germany; EFAPH - European Federation of Associations of Patients with Haemochromatosis, Croissy-sur-Seine, France
| | - Françoise Courtois
- FFAMH - Fédération Française des Associations de Malades de l'Hemochromatose, Paris, France; EFAPH - European Federation of Associations of Patients with Haemochromatosis, Croissy-sur-Seine, France
| | - Robert W Evans
- Doctor-on-a-Chip Laboratory, Department of Electronic and Computer Engineering, School of Engineering and Design, Brunel University, Uxbridge, United Kingdom; The Haemochromatosis Society, Hertfordshire, United Kingdom
| | - Janet Fernau
- The Haemochromatosis Society, Hertfordshire, United Kingdom
| | | | | | - Milena Paneque
- IBMC - Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal; CGPP - Centre for Predictive and Preventive Medicine, Porto, Portugal
| | - Brigitte Pineau
- FFAMH - Fédération Française des Associations de Malades de l'Hemochromatose, Paris, France
| | - Graça Porto
- IBMC - Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal; CGPP - Centre for Predictive and Preventive Medicine, Porto, Portugal; CHP-HSA, Porto Hospital Center - Santo António Hospital, Porto, Portugal; Associação Portuguesa de Hemocromatose, Porto, Portugal.
| | - Robert Sorrill
- Associazione per lo Studio di Emocromatosi e delle Malattie da Sovraccarico di Ferro, Monza, Italy
| | - Mayka Sanchez
- IMPPC - Institute of Predictive and Personalized Medicine of Cancer, Badalona, Barcelona, Spain; IJC - Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Laboratory of Genetic, Endocrine and Metabolic Diseases (LGEM 830) Radboud University Medical Centre, Nijmegen, The Netherlands; Hemochromatose Vereniging Nederland, Leidschendam, The Netherlands
| | - Ketil Toska
- Norwegian Haemochromatosis Association, Bergen, Norway
| | - Judit Varkonyi
- 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary; Hemokromatozisos Betegek Eyesülete, Budapest, Hungary
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Loréal O, Cavey T, Bardou-Jacquet E, Guggenbuhl P, Ropert M, Brissot P. Iron, hepcidin, and the metal connection. Front Pharmacol 2014; 5:128. [PMID: 24926268 PMCID: PMC4045255 DOI: 10.3389/fphar.2014.00128] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/13/2014] [Indexed: 12/20/2022] Open
Abstract
Identification of new players in iron metabolism, such as hepcidin, which regulates ferroportin and divalent metal transporter 1 expression, has improved our knowledge of iron metabolism and iron-related diseases. However, from both experimental data and clinical findings, "iron-related proteins" appear to also be involved in the metabolism of other metals, especially divalent cations. Reports have demonstrated that some metals may affect, directly or indirectly, the expression of proteins involved in iron metabolism. Throughout their lives, individuals are exposed to various metals during personal and/or occupational activities. Therefore, better knowledge of the connections between iron and other metals could improve our understanding of iron-related diseases, especially the variability in phenotypic expression, as well as a variety of diseases in which iron metabolism is secondarily affected. Controlling the metabolism of other metals could represent a promising innovative therapeutic approach.
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Affiliation(s)
- Olivier Loréal
- INSERM UMR 991, Iron and the Liver Team Rennes, France ; Faculty of Medicine, University of Rennes1 Rennes, France ; CHU Pontchaillou, French Reference Centre for Rare Iron Overload Diseases of Genetic Origin, University Hospital-Rennes Rennes, France
| | - Thibault Cavey
- INSERM UMR 991, Iron and the Liver Team Rennes, France ; Faculty of Medicine, University of Rennes1 Rennes, France ; Biochemistry and Enzymology Laboratory, Centre Hospitalier Universitaire Rennes, France
| | - Edouard Bardou-Jacquet
- INSERM UMR 991, Iron and the Liver Team Rennes, France ; Faculty of Medicine, University of Rennes1 Rennes, France ; CHU Pontchaillou, French Reference Centre for Rare Iron Overload Diseases of Genetic Origin, University Hospital-Rennes Rennes, France
| | - Pascal Guggenbuhl
- INSERM UMR 991, Iron and the Liver Team Rennes, France ; Faculty of Medicine, University of Rennes1 Rennes, France ; Department of Rheumatology, Centre Hospitalier Universitaire Rennes, France
| | - Martine Ropert
- INSERM UMR 991, Iron and the Liver Team Rennes, France ; CHU Pontchaillou, French Reference Centre for Rare Iron Overload Diseases of Genetic Origin, University Hospital-Rennes Rennes, France ; Biochemistry and Enzymology Laboratory, Centre Hospitalier Universitaire Rennes, France
| | - Pierre Brissot
- INSERM UMR 991, Iron and the Liver Team Rennes, France ; Faculty of Medicine, University of Rennes1 Rennes, France ; CHU Pontchaillou, French Reference Centre for Rare Iron Overload Diseases of Genetic Origin, University Hospital-Rennes Rennes, France
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Bardou-Jacquet E, Ben Ali Z, Beaumont-Epinette MP, Loreal O, Jouanolle AM, Brissot P. Non-HFE hemochromatosis: pathophysiological and diagnostic aspects. Clin Res Hepatol Gastroenterol 2014; 38:143-54. [PMID: 24321703 DOI: 10.1016/j.clinre.2013.11.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/04/2013] [Accepted: 11/13/2013] [Indexed: 02/04/2023]
Abstract
Rare genetic iron overload diseases are an evolving field due to major advances in genetics and molecular biology. Genetic iron overload has long been confined to the classical type 1 hemochromatosis related to the HFE C282Y mutation. Breakthroughs in the understanding of iron metabolism biology and molecular mechanisms led to the discovery of new genes and subsequently, new types of hemochromatosis. To date, four types of hemochromatosis have been identified: HFE-related or type1 hemochromatosis, the most frequent form in Caucasians, and four rare types, named type 2 (A and B) hemochromatosis (juvenile hemochromatosis due to hemojuvelin and hepcidin mutation), type 3 hemochromatosis (related to transferrin receptor 2 mutation), and type 4 (A and B) hemochromatosis (ferroportin disease). The diagnosis relies on the comprehension of the involved physiological defect that can now be explored by biological and imaging tools, which allow non-invasive assessment of iron metabolism. A multidisciplinary approach is essential to support the physicians in the diagnosis and management of those rare diseases.
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Affiliation(s)
- Edouard Bardou-Jacquet
- University Hospital of Rennes, French reference center for rare iron overload diseases of genetic origin, Rennes, France; University of Rennes1, Inserm UMR 991, 35000 Rennes, France; University Hospital of Rennes, Liver disease department, Rennes, France.
| | - Zeineb Ben Ali
- University Hospital of Rennes, French reference center for rare iron overload diseases of genetic origin, Rennes, France; University Hospital of Rennes, Liver disease department, Rennes, France
| | - Marie-Pascale Beaumont-Epinette
- University Hospital of Rennes, French reference center for rare iron overload diseases of genetic origin, Rennes, France; University Hospital of Rennes, Molecular Genetics Department, Rennes, France
| | - Olivier Loreal
- University Hospital of Rennes, French reference center for rare iron overload diseases of genetic origin, Rennes, France; University of Rennes1, Inserm UMR 991, 35000 Rennes, France
| | - Anne-Marie Jouanolle
- University Hospital of Rennes, French reference center for rare iron overload diseases of genetic origin, Rennes, France; University Hospital of Rennes, Molecular Genetics Department, Rennes, France
| | - Pierre Brissot
- University Hospital of Rennes, French reference center for rare iron overload diseases of genetic origin, Rennes, France; University of Rennes1, Inserm UMR 991, 35000 Rennes, France; University Hospital of Rennes, Liver disease department, Rennes, France
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Gasser B, Courtois F, Hojjat-Assari S, Sauleau E, Buffet C, Brissot P. Hémochromatose héréditaire : circonstances de découverte et délais diagnostiques. Rev Med Interne 2014; 35:160-5. [DOI: 10.1016/j.revmed.2013.02.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 02/12/2013] [Accepted: 02/25/2013] [Indexed: 01/19/2023]
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Bardou-Jacquet E, Philip J, Lorho R, Ropert M, Latournerie M, Houssel-Debry P, Guyader D, Loréal O, Boudjema K, Brissot P. Liver transplantation normalizes serum hepcidin level and cures iron metabolism alterations in HFE hemochromatosis. Hepatology 2014; 59:839-47. [PMID: 23775519 DOI: 10.1002/hep.26570] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 05/31/2013] [Indexed: 02/06/2023]
Abstract
UNLABELLED Defects in human hemochromatosis protein (HFE) cause iron overload due to reduced hepatic hepcidin secretion. Liver transplantation (LT) is a key treatment for potential complications from HFE-related hereditary hemochromatosis (HH). This study evaluated hepcidin secretion and iron burden after LT to elucidate HH pathophysiology. Patients (n=18) homozygous for the p.Cys282Tyr mutation in the HFE gene underwent LT between 1999 and 2008. Serum iron, serum hepcidin, and hepatic iron concentrations were determined before LT and at the end of follow-up (median 57 months). Mortality and causes of death were determined. Survival was compared to that of the overall patient population that received LT. Before LT, serum hepcidin levels were low (0.54 ± 2.5 nmol/L; normal range: 4-30 nmol/L). After LT, 11 patients had iron evaluations; none received iron depletion therapy; all had normal transferrin saturation. The mean serum ferritin was 185 (± 99) μg/L. Magnetic resonance imaging showed that iron overload was absent in nine patients, mild in one patient with metabolic syndrome, and high (180 μmol/g) in one patient with hereditary spherocytosis discovered after LT. At the end of follow-up, serum hepcidin was normal in 10 patients (11.12 ± 7.6 nmol/L; P<0.05) and low in one patient with iron deficiency anemia. Survival was 83% and 67% at 1 and 5 years, respectively. Survival was similar for patients with HH and patients that received LT for other causes. CONCLUSION In HH, LT normalized hepcidin secretion and prevented recurrence of hepatic iron overload. Survival was similar to that of patients who received LTs for other liver diseases.
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Affiliation(s)
- Edouard Bardou-Jacquet
- CHU Rennes, Liver Disease Unit, Rennes, France; INSERM UMR991, University of Rennes 1, Rennes, France; CHU Rennes, National Reference Center for Rare Iron Overload Diseases of Genetic Origin, Rennes, France
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Brissot P, Bardou-Jacquet E, Troadec MB, Mosser A, Island ML, Detivaud L, Loréal O, Jouanolle AM. Molecular diagnosis of genetic iron-overload disorders. Expert Rev Mol Diagn 2014; 10:755-63. [DOI: 10.1586/erm.10.55] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Détivaud L, Island ML, Jouanolle AM, Ropert M, Bardou-Jacquet E, Le Lan C, Mosser A, Leroyer P, Deugnier Y, David V, Brissot P, Loréal O. Ferroportin diseases: functional studies, a link between genetic and clinical phenotype. Hum Mutat 2013; 34:1529-36. [PMID: 23943237 DOI: 10.1002/humu.22396] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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: 04/04/2013] [Accepted: 08/05/2013] [Indexed: 12/21/2022]
Abstract
Ferroportin (FPN) mediates iron export from cells and this function is modulated by serum hepcidin. Mutations in the FPN gene (SLC40A1) lead to autosomal dominant iron overload diseases related either to loss or to gain of function, and usually characterized by normal or low transferrin saturation versus elevated transferrin saturation, respectively. However, for the same mutation, the phenotypic expression may vary from one patient to another. Using in vitro overexpression of wild-type or mutant FPN proteins, we characterized the functional impact of five recently identified FPN gene mutations regarding FPN localization, cell iron status, and hepcidin sensitivity. Our aim was to integrate functional results and biological findings in probands and relatives. We show that while the p.Arg371Gln (R371Q) mutation had no impact on studied parameters, the p.Trp158Leu (W158L), p.Arg88Gly (R88G), and p.Asn185Asp (N185D) mutations caused an iron export defect and were classified as loss-of-function mutations. The p.Gly204Ser (G204S) mutation induced a gain of FPN function. Functional studies are useful to determine whether or not a FPN gene mutation found in an iron overloaded patient is deleterious and to characterize its biological impact, especially when family studies are not fully informative and/or additional confounding factors may affect bio-clinical expression.
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Affiliation(s)
- Lénaïck Détivaud
- CHU Rennes, French Reference Centre for Rare Iron Overload Diseases of Genetic Origin, Rennes, France; CHU Rennes, Department of Molecular Biology, Rennes, France; CHU Rennes, Department of Liver Diseases, Rennes, France; INSERM UMR 991, Equipe Fer et Foie, Rennes, France
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Do THT, Gaboriau F, Cannie I, Batusanski F, Ropert M, Moirand R, Brissot P, Loreal O, Lescoat G. Iron-mediated effect of alcohol on hepatocyte differentiation in HepaRG cells. Chem Biol Interact 2013; 206:117-25. [PMID: 24025710 DOI: 10.1016/j.cbi.2013.08.016] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 08/19/2013] [Accepted: 08/30/2013] [Indexed: 01/16/2023]
Abstract
The development of alcoholic liver diseases depends on the ability of hepatocyte to proliferate and differentiate in the case of alcohol-induced injury. Our previous work showed an inhibitory effect of alcohol on hepatocyte proliferation. However, the effect of alcohol on hepatocyte differentiation has not yet been precisely characterized. In the present study, we evaluated the effect of alcohol on hepatocyte differentiation in relationship with changes of iron metabolism in HepaRG cells. This unique bipotent human cell line can differentiate into hepatocytes and biliary epithelial cells, paralleling liver development. Results showed that alcohol reduced cell viability, total protein level and enhanced hepatic enzymes leakage in differentiated HepaRG cells. Moreover, it caused cell enlargement, decreased number of hepatocyte and expression of C/EBPα as well as bile canaliculi F-actin. Alcohol increased expression of hepatic cell-specific markers and alcohol-metabolizing enzymes (ADH2, CYP2E1). This was associated with a lipid peroxidation and an iron excess expressed by an increase in total iron content, ferritin level, iron uptake as well as an overexpression of genes involved in iron transport and storage. Alcohol-induced hepatoxicity was amplified by exogenous iron via exceeding iron overload. Taken together, our data demonstrate that in differentiated hepatocytes, alcohol reduces proliferation while increasing expression of hepatic cell-specific markers. Moreover, iron overload could be one of the underlying mechanisms of effect of alcohol on the whole differentiation process of hepatocytes.
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Affiliation(s)
- Thi Hong Tuoi Do
- Inserm, UMR 991, «Foie, Métabolismes et Cancer», F-35033 Rennes, France; Université de Rennes 1, F-35043 Rennes, France; University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam.
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Davaine JM, Sebbag U, Bardou-Jacquet E, Brissot P. Brachial artery pseudoaneurysm after phlebotomy for iron overload: first case report. Transfusion 2013; 53:1373-5. [PMID: 23750932 DOI: 10.1111/trf.12184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bardou-Jacquet E, Cunat S, Beaumont-Epinette MP, Kannengiesser C, Causse X, Sauvion S, Pouliquen B, Deugnier Y, David V, Loréal O, Aguilar-Martinez P, Brissot P, Jouanolle AM. Variable age of onset and clinical severity in transferrin receptor 2 related haemochromatosis: novel observations. Br J Haematol 2013; 162:278-81. [PMID: 23600741 DOI: 10.1111/bjh.12350] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Lescoat G, Gouffier L, Cannie I, Lowe O, Morel I, Lepage S, Ropert M, Loréal O, Brissot P, Gaboriau F. Involvement of polyamines in iron(III) transport in human intestinal Caco-2 cell lines. Mol Cell Biochem 2013; 378:205-15. [PMID: 23494528 DOI: 10.1007/s11010-013-1611-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 03/02/2013] [Indexed: 01/01/2023]
Abstract
Natural polyamines such as putrescine (Put), spermidine (Spd), and spermine (Spm), which are present in the human diet in large amounts, associated with their active transporter, are assumed to play a role in non-heme iron uptake and iron bioavailability from nutrients. Enterocytes and hepatocytes play pivotal roles in the regulation of body iron homeostasis. In this study, we report the effects of natural polyamines on iron transport in the Caco-2 cell line. In enterocyte-like Caco-2 cells, polyamines did not significantly modulate the transepithelial iron flux across the cell monolayer cultured on permeable membranes. In contrast, Spd, Spm, and to a lesser extent, Put were shown to activate Caco-2 cell iron uptake and to induce an increase in the ferritin level. This iron co-transport in enterocytes, which involved an interaction between iron and polyamine then cell uptake of the polyamine-iron complexes by the polyamine transport system, was more pronounced in proliferating than in differentiated Caco-2 cells. Moreover, it was observed at physiological concentrations of both polyamines and iron. It could thus play a role in the rapid renewal of enterocytes. These data suggest the involvement of polyamines as components of the pool of transferrin-independent iron-chelating vectors. Further investigations are needed to demonstrate their biological relevance in physiological situations.
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Bardou-Jacquet E, Legros L, Soro D, Latournerie M, Guillygomarc’h A, Lan CL, Brissot P, Guyader D, Moirand R. Effect of alcohol consumption on liver stiffness measured by transient elastography. World J Gastroenterol 2013; 19:516-522. [PMID: 23382630 PMCID: PMC3558575 DOI: 10.3748/wjg.v19.i4.516] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 01/10/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the evolution of transient elastography (TE) in patients with alcoholic liver disease according to alcohol cessation or continuation.
METHODS: We retrospectively selected in our local database all patients who had two TE between June 2005 and November 2010 with chronic alcohol excessive consumption and excluded those with associated cause of liver disease. TE was performed at least one week apart by senior operator. TE examinations with less than ten successful measures or with an interquartile range above 30% were excluded. We retrospectively reviewed file of all patients to include only patient followed up by trained addictologist and for which definite information on alcohol consumption was available. Concomitant biological parameters [aspartate amino transferase (AST), alanine amino transferase and gamma-glutamyl transpeptidase (GGT)] within 4 wk of initial and final TE were recorded. Putative fibrosis score according to initial and final TE were determined with available cut-off for alcoholic liver disease and hepatitis C. Initial and final putative fibrosis score were compared according to alcohol consumption during follow-up.
RESULTS: During the study period 572 patients had TE examination for alcoholic liver disease and 79 of them had at least two examinations. Thirty-seven patients met our criteria with a median follow-up of 32.5 wk. At the end of the study, 13 (35%) were abstinent, and 24 (65%) relapsers. Eight patients had liver biopsy during follow-up. TE decreased significantly during follow-up in 85% of abstinent patients [median (range): -4.9 (-6.1,-1.9)], leading to a modification of the putative fibrosis stage in 28%-71% of patient according to different cut-off value. In relapsers TE increased in 45% and decreased in 54% of patient. There was no statistical difference between initial and final TE in relapsers. In the overall population, using 22.6 kPa as cut-off for cirrhosis, 4 patients had cirrhosis at initial TE and 3 patients had cirrhosis at final TE. Using 19.5 kPa as cut-off for cirrhosis, 7 patients had cirrhosis at initial TE and 5 patients had cirrhosis at final TE. Using 12.5 kPa as cut-off for cirrhosis, 16 patients had cirrhosis at initial TE and 15 patients had cirrhosis at final TE. Evolution of biological data was in accordance with the relapse or abstinent status: abstinence ratio (duration of abstinence/duration follow-up) was correlated with AST ratio (r = -0.465, P = 0.007) and GGT ratio (r = -0.662, P < 0.0001). GGT was correlated with initial (r = 0.488, P = 0.002) and final TE (r = 0.49, P < 0.005). Final TE was correlated with AST (r = 0.362, P < 0.05). Correlation between TE ratio and AST ratio (r = 0.44, P = 0.01) revealed that TE varied proportionally to AST for all patients irrespective of their alcohol status. The same relationship was observed between TE ratio and GGT ratio (r = 0.65, P < 0.0001). Evolution of TE was significantly correlated with the ratio of time of abstinence to observation time (r = -0.387, P = 0.016) and the evolution of liver enzymes.
CONCLUSION: TE significantly decreased with abstinence. Results of TE in alcoholic liver disease cannot be interpreted without taking into account alcohol consumption and liver enzymes.
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Loréal O, Bardou-Jacquet E, Jouanolle AM, Gandon Y, Deugnier Y, Brissot P, Ropert M. Métabolisme du fer et outils diagnostiques pour le clinicien. Rev Med Interne 2012; 33 Suppl 1:S3-9. [DOI: 10.1016/j.revmed.2012.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Saglini V, Brissot P. [Hyperferritinemia--Algorithm]. Rev Med Suisse 2012; 8:1135-1137. [PMID: 22734184] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Valerio Saglini
- Ospedale Bleniese di Acquarossa, Médecin-adjoint Ospedale Regionale, Bellinzona e Valli, 6500 Bellinzona.
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