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Short V, Allen R, Earley CJ, Bahrain H, Rineer S, Kashi K, Gerb J, Auerbach M. A randomized double-blind pilot study to evaluate the efficacy, safety, and tolerability of intravenous iron versus oral iron for the treatment of restless legs syndrome in patients with iron deficiency anemia. Am J Hematol 2024; 99:1077-1083. [PMID: 38476079 DOI: 10.1002/ajh.27290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
Restless legs syndrome (RLS) is a neurological disorder that can have a profound effect on sleep and quality of life. Idiopathic RLS is associated with brain iron insufficiency despite normal peripheral iron stores. There is, however, a five- to six-fold increase in prevalence of RLS in patients with iron deficiency anemia (IDA). Several open-label trials have demonstrated symptomatic improvement in RLS following treatment of IDA using oral or intravenous iron supplementation. To date, there have been no randomized double-blind controlled trials of intravenous iron compared with oral iron for the treatment of RLS patients with IDA. In the current study, oral ferrous sulfate and ferumoxytol were compared for efficacy and speed of response for treatment of RLS occurring in patients with IDA. The planned recruitment for this study was 70 patients with RLS and IDA, to be randomly assigned 1:1 to oral or intravenous iron, using double-blind, double-dummy procedures. At Week 6, the primary outcomes of Clinical Global Impression-Improvement score and change from baseline in the International Restless Legs Syndrome Study Group rating scale score were assessed. Due to challenges, performing the clinical trial during the COVID-19 pandemic, final-week data were found missing for 30 patients. As a result, in order to maintain the prespecified statistical analysis, an additional 30 patients were recruited. Both IV and oral iron were associated with a marked improvement in RLS symptoms, with no statistically significant difference between treatment groups. No serious adverse events were observed in either treatment group.
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Affiliation(s)
- Vanessa Short
- College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Richard Allen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher J Earley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Huzefa Bahrain
- Auerbach Hematology and Oncology, Baltimore, Maryland, USA
| | - Stella Rineer
- Auerbach Hematology and Oncology, Baltimore, Maryland, USA
| | - Kiumarce Kashi
- Baltimore Sleep and Wellness Center, Baltimore, Maryland, USA
| | - Jesse Gerb
- Auerbach Hematology and Oncology, Baltimore, Maryland, USA
| | - Michael Auerbach
- Auerbach Hematology and Oncology, Baltimore, Maryland, USA
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA
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Casellas Caro M, Hidalgo MJC, García-Erce JA, Baquero Úbeda JL, Torras Boatella MG, Gredilla Díaz E, Ruano Encinar M, Martín Bayón I, Nicolás Picó J, Arjona Berral JE, Muñoz Solano A, Jiménez Merino S, Cerezales M, Cuervo J. Applying reflective multicriteria decision analysis to understand the value of therapeutic alternatives in the management of gestational and peripartum anaemia in Spain. BMC Pregnancy Childbirth 2022; 22:157. [PMID: 35216553 PMCID: PMC8881868 DOI: 10.1186/s12884-022-04481-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the FeminFER project was to assess the value of ferric carboxymaltose following a multicriteria decision analysis in obstetrics and gynaecology in Spain. METHODS Ferric carboxymaltose (FCM) and ferrous sulphate were evaluated using the EVIDEM framework. Ten stakeholders participated to collect different perspectives. The framework was adapted considering evidence retrieved with a PICO-S search strategy and grey literature. Criteria/subcriteria were weighted by level of relevance and an evidence-based decision-making exercise was developed in each criterion; weights and scores were combined to obtain the value of intervention relative to each criterion/subcriterion, that were further combined into the Modulated Relative Benefit-Risk Balance (MRBRB). RESULTS The most important criterion favouring FCM was Compared Efficacy/Effectiveness (0.183 ± 0.07), followed by Patient Preferences (0.059 ± 0.10). Only Direct medical costs criterion favoured FS (-0.003 ± 0.03). MRBRB favoured FCM; 0.45 ± 0.19; in a scale from -1 to + 1. CONCLUSIONS In conclusion, considering the several criteria involved in the decision-making process, participants agreed with the use of FCM according to its MRBRB.
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Affiliation(s)
- Manel Casellas Caro
- Department of Obstetrics, Hospital Universitari Vall d´Hebron, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - María Jesús Cancelo Hidalgo
- Department of Obstetrics and Gynecology, Hospital Universitario Guadalajara, Calle Donante de Sangre, 19002, Guadalajara, S/N, Spain
| | - José Antonio García-Erce
- Banco de Sangre Y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Calle Irunlarrea, 3, 31008, Pamplona, Spain
- Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de La Salud, Avenida San Juan Bosco, 13, 50009, Zaragoza, Spain
- PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana, 261, 28046, Madrid, Spain
| | | | - Maria Glòria Torras Boatella
- Àrea d'Innovació, Hospital Universitari Bellvitge, Carrer de La Feixa Llarga, L'Hospitalet de Llobregat, 08907, Barcelona, S/N, Spain
- Institut Català de La Salut, Barcelona, Spain
| | - Elena Gredilla Díaz
- Anaesthesia Department, Hospital La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain
| | | | - Israel Martín Bayón
- CS Polop-La Nucía, Avenida de Sagi Barba, 24, Polop, La Nucía, 03520, Alicante, Spain
| | - Jordi Nicolás Picó
- Hospital Universitari Mutua Terrasa, Plaça del Doctor Robert, 5, 08221, Terrassa, Spain
| | | | - Alberto Muñoz Solano
- Department of Obstetrics and Gynecology, Hospital Universitario Marqués de Valdecilla, Avenida de Valdecilla, 25, 39008, Santander, Spain
| | | | - Mónica Cerezales
- Axentiva Solutions S.L., Calle Monte Cerrau, 28, 33006, Asturias, Oviedo, Spain
| | - Jesús Cuervo
- Axentiva Solutions S.L., Calle Monte Cerrau, 28, 33006, Asturias, Oviedo, Spain.
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Bumrungpert A, Pavadhgul P, Piromsawasdi T, Mozafari MR. Efficacy and Safety of Ferrous Bisglycinate and Folinic Acid in the Control of Iron Deficiency in Pregnant Women: A Randomized, Controlled Trial. Nutrients 2022; 14:nu14030452. [PMID: 35276810 PMCID: PMC8839493 DOI: 10.3390/nu14030452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/06/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 12/10/2022] Open
Abstract
Iron deficiency in pregnancy is a major public health problem that causes maternal complications. The objective of this randomized, controlled trial was to examine the bioavailability, efficacy, and safety of oral ferrous bisglycinate plus folinic acid supplementation in pregnant women with iron deficiency. Subjects (12−16 weeks of gestation, n = 120) were randomly allocated to receive oral iron as ferrous bisglycinate (equiv. iron 24 mg) in supplement form with folinic acid and multivitamins (test group, n = 60) or as ferrous fumarate (equiv. iron 66 mg iron, control group, n = 60) after breakfast daily. Iron absorption was assessed by measuring fasted serum iron levels at 1 and 2 h immediately after supplementation. Hematological biomarkers and iron status were assessed before intervention, and at 3 and 6 months. Side effects were monitored throughout the intervention. A significant increase in serum iron was seen in both groups (p < 0.001) during the bioavailability assessment; however, the test group increases were comparatively higher than the control values at each timepoint (p < 0.001). Similarly, both test and control groups demonstrated a statistically significant increases in hemoglobin (Hb) (p < 0.001), erythrocytes (p < 0.001), reticulocytes (p < 0.001), mean corpuscular volume (MCV) (p < 0.001), mean corpuscular hemoglobin (MCH) (p < 0.001), mean corpuscular hemoglobin concentration (MCHC) (p < 0.001), % transferrin saturation (p < 0.001), and ferritin (p < 0.001) at 3 and 6 months after supplementation. However, in all cases, the test group increases were numerically larger than the control group increases at each timepoint. The test intervention was also associated with significantly fewer reports of nausea, abdominal pain, bloating, constipation, or metallic taste (p < 0.001). In conclusion, ferrous bisglycinate with folinic acid as a multivitamin nutraceutical format is comparable to standard ferrous fumarate for the clinical management of iron deficiency during pregnancy, with comparatively better absorption, tolerability, and efficacy and with a lower elemental iron dosage.
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Affiliation(s)
- Akkarach Bumrungpert
- Research Center of Nutraceuticals and Natural Products for Health & Anti-Aging, College of Integrative Medicine, Dhurakij Pundit University, Bangkok 10210, Thailand
- Correspondence: ; Tel.: +66-65163-5419
| | - Patcharanee Pavadhgul
- Department of Nutrition, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - Theera Piromsawasdi
- Health Promotion Hospital, Health Center Region 5, Ratchaburi 70000, Thailand;
| | - M. R. Mozafari
- Australasian Nanoscience and Nanotechnology Initiative (ANNI), Monash University LPO, Clayton, VIC 3168, Australia;
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Mazgaj R, Lipiński P, Szudzik M, Jończy A, Kopeć Z, Stankiewicz AM, Kamyczek M, Swinkels D, Żelazowska B, Starzyński RR. Comparative Evaluation of Sucrosomial Iron and Iron Oxide Nanoparticles as Oral Supplements in Iron Deficiency Anemia in Piglets. Int J Mol Sci 2021; 22:9930. [PMID: 34576090 PMCID: PMC8466487 DOI: 10.3390/ijms22189930] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/06/2021] [Accepted: 09/11/2021] [Indexed: 12/15/2022] Open
Abstract
Iron deficiency is the most common mammalian nutritional disorder. However, among mammalian species iron deficiency anemia (IDA), occurs regularly only in pigs. To cure IDA, piglets are routinely injected with high amounts of iron dextran (FeDex), which can lead to perturbations in iron homeostasis. Here, we evaluate the therapeutic efficacy of non-invasive supplementation with Sucrosomial iron (SI), a highly bioavailable iron supplement preventing IDA in humans and mice and various iron oxide nanoparticles (IONPs). Analysis of red blood cell indices and plasma iron parameters shows that not all iron preparations used in the study efficiently counteracted IDA comparable to FeDex-based supplementation. We found no signs of iron toxicity of any tested iron compounds, as evaluated based on the measurement of several toxicological markers that could indicate the occurrence of oxidative stress or inflammation. Neither SI nor IONPs increased hepcidin expression with alterations in ferroportin (FPN) protein level. Finally, the analysis of the piglet gut microbiota indicates the individual pattern of bacterial diversity across taxonomic levels, independent of the type of supplementation. In light of our results, SI but not IONPs used in the experiment emerges as a promising nutritional iron supplement, with a high potential to correct IDA in piglets.
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Affiliation(s)
- Rafał Mazgaj
- Department of Molecular Biology, Institute of Genetics and Animal Biotechnology PAS, 28-130 Jastrzębiec, Poland; (R.M.); (M.S.); (A.J.); (Z.K.); (A.M.S.); (B.Ż.)
| | - Paweł Lipiński
- Department of Molecular Biology, Institute of Genetics and Animal Biotechnology PAS, 28-130 Jastrzębiec, Poland; (R.M.); (M.S.); (A.J.); (Z.K.); (A.M.S.); (B.Ż.)
| | - Mateusz Szudzik
- Department of Molecular Biology, Institute of Genetics and Animal Biotechnology PAS, 28-130 Jastrzębiec, Poland; (R.M.); (M.S.); (A.J.); (Z.K.); (A.M.S.); (B.Ż.)
| | - Aneta Jończy
- Department of Molecular Biology, Institute of Genetics and Animal Biotechnology PAS, 28-130 Jastrzębiec, Poland; (R.M.); (M.S.); (A.J.); (Z.K.); (A.M.S.); (B.Ż.)
| | - Zuzanna Kopeć
- Department of Molecular Biology, Institute of Genetics and Animal Biotechnology PAS, 28-130 Jastrzębiec, Poland; (R.M.); (M.S.); (A.J.); (Z.K.); (A.M.S.); (B.Ż.)
| | - Adrian M. Stankiewicz
- Department of Molecular Biology, Institute of Genetics and Animal Biotechnology PAS, 28-130 Jastrzębiec, Poland; (R.M.); (M.S.); (A.J.); (Z.K.); (A.M.S.); (B.Ż.)
| | - Marian Kamyczek
- Pig Hybridization Centre, National Research Institute of Animal Production, 43-246 Pawłowice, Poland;
| | - Dorine Swinkels
- Department of Laboratory Medicine (TLM 830), Radboud University Nijmegen Medical Center, 6525 GA Nijmegen, The Netherlands;
- Hepcidin Analysis, Department of Laboratory Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Beata Żelazowska
- Department of Molecular Biology, Institute of Genetics and Animal Biotechnology PAS, 28-130 Jastrzębiec, Poland; (R.M.); (M.S.); (A.J.); (Z.K.); (A.M.S.); (B.Ż.)
| | - Rafał R. Starzyński
- Department of Molecular Biology, Institute of Genetics and Animal Biotechnology PAS, 28-130 Jastrzębiec, Poland; (R.M.); (M.S.); (A.J.); (Z.K.); (A.M.S.); (B.Ż.)
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Giordano G, Napolitano M, Di Battista V, Lucchesi A. Oral high-dose sucrosomial iron vs intravenous iron in sideropenic anemia patients intolerant/refractory to iron sulfate: a multicentric randomized study. Ann Hematol 2021; 100:2173-2179. [PMID: 33263170 PMCID: PMC8357646 DOI: 10.1007/s00277-020-04361-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/23/2020] [Indexed: 01/01/2023]
Abstract
Iron deficiency anemia is among the most frequent causes of disability. Intravenous iron is the quickest way to correct iron deficiency, bypassing the bottleneck of iron intestinal absorption, the only true mechanism of iron balance regulation in human body. Intravenous iron administration is suggested in patients who are refractory/intolerant to oral iron sulfate. However, the intravenous way of iron administration requires several precautions; as the in-hospital administration requires a resuscitation service, as imposed in Europe by the European Medicine Agency, it is very expensive and negatively affects patient's perceived quality of life. A new oral iron formulation, Sucrosomial iron, bypassing the normal way of absorption, seems to be cost-effective in correcting iron deficiency anemia at doses higher than those usually effective with other oral iron formulations. In this multicentric randomized study, we analyze the cost-effectiveness of intravenous sodium ferrigluconate vs oral Sucrosomial iron in patients with iron deficiency anemia refractory/intolerant to oral iron sulfate without other interfering factors on iron absorption.
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Affiliation(s)
- Giulio Giordano
- Division of Internal Medicine, Hematology Service, Regional Hospital "A. Cardarelli", Campobasso, Italy
| | - Mariasanta Napolitano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), Haematology Unit, University Hospital "P. Giaccone", University of Palermo, Via del Vespro 127, 90127, Palermo, Italy.
| | - Valeria Di Battista
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alessandro Lucchesi
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Yang K, Yu G, Yang Z, Yue L, Zhang X, Sun C, Wei J, Rao L, Chen X, Wang R. Supramolecular Polymerization-Induced Nanoassemblies for Self-Augmented Cascade Chemotherapy and Chemodynamic Therapy of Tumor. Angew Chem Int Ed Engl 2021; 60:17570-17578. [PMID: 34041833 DOI: 10.1002/anie.202103721] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/05/2021] [Indexed: 01/19/2023]
Abstract
The clinical application of chemodynamic therapy is impeded by the insufficient intracellular H2 O2 level in tumor tissues. Herein, we developed a supramolecular nanoparticle via a simple one-step supramolecular polymerization-induced self-assembly process using platinum (IV) complex-modified β-cyclodextrin-ferrocene conjugates as supramolecular monomers. The supramolecular nanoparticles could dissociate rapidly upon exposure to endogenous H2 O2 in the tumor and release hydroxyl radicals as well as platinum (IV) prodrugs in situ, which is reduced into cisplatin to significantly promote the generation of H2 O2 in the tumor tissue. Thus, the supramolecular nanomedicine overcomes the limitation of conventional chemodynamic therapy via the self-augmented cascade radical generation and drug release. In addition, dissociated supramolecular nanoparticles could be readily excreted from the body via renal clearance to effectively avoid systemic toxicity and ensure long term biocompatibility of the nanomedicine. This work may provide new insights on the design and development of novel supramolecular nanoassemblies for cascade chemo/chemodynamic therapy.
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Affiliation(s)
- Kuikun Yang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Avenida da Universidade, Taipa, Macau, China
- MoE Frontiers Science Center for Precision Oncology, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Guocan Yu
- Key Lab of Organic Optoelectronics & Molecular Engineering, Department of Chemistry, Tsinghua University, Beijing, China
| | - Zhiqing Yang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Avenida da Universidade, Taipa, Macau, China
- MoE Frontiers Science Center for Precision Oncology, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Ludan Yue
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Avenida da Universidade, Taipa, Macau, China
- MoE Frontiers Science Center for Precision Oncology, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Xiangjun Zhang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Avenida da Universidade, Taipa, Macau, China
- MoE Frontiers Science Center for Precision Oncology, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Chen Sun
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Avenida da Universidade, Taipa, Macau, China
- MoE Frontiers Science Center for Precision Oncology, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Jianwen Wei
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Avenida da Universidade, Taipa, Macau, China
- MoE Frontiers Science Center for Precision Oncology, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Lang Rao
- Institute of Biomedical Health Technology and Engineering, Shenzhen Bay Laboratory, Shenzhen, China
| | - Xiaoyuan Chen
- Departments of Diagnostic Radiology, Surgery, Chemical and Biomolecular Engineering and Biomedical Engineering, Yong Loo Lin School of Medicine and Faculty of Engineering, National University of Singapore, Singapore, Singapore
- Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Nanomedicine Translational Research Program, NUS Center for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ruibing Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Avenida da Universidade, Taipa, Macau, China
- MoE Frontiers Science Center for Precision Oncology, University of Macau, Avenida da Universidade, Taipa, Macau, China
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Rogozińska E, Daru J, Nicolaides M, Amezcua-Prieto C, Robinson S, Wang R, Godolphin PJ, Saborido CM, Zamora J, Khan KS, Thangaratinam S. Iron preparations for women of reproductive age with iron deficiency anaemia in pregnancy (FRIDA): a systematic review and network meta-analysis. Lancet Haematol 2021; 8:e503-e512. [PMID: 34171281 PMCID: PMC7612251 DOI: 10.1016/s2352-3026(21)00137-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Numerous iron preparations are available for the treatment of iron deficiency anaemia in pregnancy. We aimed to provide a summary of the effectiveness and safety of iron preparations used in this setting. METHODS We did a systematic review and network meta-analysis of randomised trials. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, trial registers, and grey literature for trials published in any language from Jan 1, 2011, to Feb 28, 2021. We included trials including pregnant women with iron deficiency anaemia and evaluating iron preparations, irrespective of administration route, with at least 60 mg of elemental iron, in comparison with another iron or non-iron preparation. Three authors independently selected studies, extracted data, and did a risk of bias assessment using the Cochrane tool (version 1.0). The primary outcome was the effectiveness of iron preparations, evaluated by changes in haemoglobin concentration at 4 weeks from baseline. The secondary outcomes were change in serum ferritin concentration at 4 weeks from baseline and treatment-related severe and non-severe adverse events. We did random-effects pairwise and network meta-analyses. Side-effects were reported descriptively for each trial. This study is registered with PROSPERO, CRD42018100822. FINDINGS Among 3037 records screened, 128 full-text articles were further assessed for eligibility. Of the 53 eligible trials (reporting on 9145 women), 30 (15 interventions; 3243 women) contributed data to the network meta-analysis for haemoglobin and 15 (nine interventions; 1396 women) for serum ferritin. The risk of bias varied across the trials contributing to network meta-analysis, with 22 of 30 trials in the network meta-analysis for haemoglobin judged to have a high or medium global risk of bias. Compared with oral ferrous sulfate, intravenous iron sucrose improved both haemoglobin (mean difference 7·17 g/L, 95% CI 2·62-11·73; seven trials) and serum ferritin (mean difference 49·66 μg/L, 13·63-85·69; four trials), and intravenous ferric carboxymaltose improved haemoglobin (mean difference 8·52 g/L, 0·51-16·53; one trial). The evidence for other interventions compared with ferrous sulfate was insufficient. The most common side-effects with oral iron preparations were gastrointestinal effects (nausea, vomiting, and altered bowel movements). Side-effects were less common with parenteral iron preparations, although these included local pain, skin irratation, and, on rare occasions, allergic reactions. INTERPRETATION Iron preparations for treatment of iron deficiency anaemia in pregnancy vary in effectiveness, with good evidence of benefit for intravenous iron sucrose and some evidence for intravenous ferric carboxymaltose. Clinicians and policy makers should consider the effectiveness of individual preparations before administration, to ensure effective treatment. FUNDING None.
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Affiliation(s)
| | - Jahnavi Daru
- Institute for Population Health Science, Queen Mary University of London, London, UK.
| | - Marios Nicolaides
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carmen Amezcua-Prieto
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Susan Robinson
- Department of Haematology, Guy's and St Thomas' Hospital, London, UK
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Peter J Godolphin
- MRC Clinical Trials Unit at UCL, University College London, London, UK
| | - Carlos Martín Saborido
- Department of Health Planning and Economics, National School of Public Health, Institute of Health Carlos III, Madrid, Spain
| | - Javier Zamora
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Hospital Universitario Ramón y Cajal (IRYCIS), CIBERESP, Madrid, Spain
| | - Khalid S Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Komatsu N, Arita K, Mitsui H, Nemoto T, Hanaki K. Efficacy and safety of ferric citrate hydrate compared with sodium ferrous citrate in Japanese patients with iron deficiency anemia: a randomized, double-blind, phase 3 non-inferiority study. Int J Hematol 2021; 114:8-17. [PMID: 33719027 PMCID: PMC10917848 DOI: 10.1007/s12185-021-03123-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
Oral iron preparations are used as first-line treatment for iron deficiency anemia (IDA), but their gastrointestinal side effects prevent patients from appropriate adherence. We recently conducted a randomized, double-blind, phase 3 non-inferiority study to evaluate the efficacy and safety of two dosages of ferric citrate hydrate (FC) compared with sodium ferrous citrate (SF) in patients with IDA. FC at both 500 and 1000 mg/day was non-inferior to SF at 100 mg/day in terms of the change in the hemoglobin concentration at Week 7 from baseline. Logistic regression analysis suggested that the cumulative proportion of patients who achieved the target hemoglobin concentration (≥ 13.0 g/dL in male patients and ≥ 12.0 g/dL in female patients) at Week 7 was highest among those treated with FC at 1000 mg/day, followed by SF at 100 mg/day and FC at 500 mg/day. Both dosages of FC were well tolerated in patients with IDA. The incidences of nausea and vomiting were significantly lower in the FC treatment groups than in the SF group. In conclusion, FC has potential to be an oral iron preparation with sufficient efficacy for the treatment of IDA and a lower risk of nausea and vomiting.
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Affiliation(s)
- Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Kojo Arita
- Pharmaceutical Division, Japan Tobacco Inc., 3-4-1 Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-0023, Japan
| | - Hironori Mitsui
- Pharmaceutical Division, Japan Tobacco Inc., 3-4-1 Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-0023, Japan
| | - Takanori Nemoto
- Pharmaceutical Division, Japan Tobacco Inc., 3-4-1 Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-0023, Japan
| | - Koji Hanaki
- Pharmaceutical Division, Japan Tobacco Inc., 3-4-1 Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-0023, Japan
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Liu C, Wang Z, Hu X, Ito H, Takahashi K, Nakajima M, Tanaka T, Zhu P, Li XK. 5-aminolevulinic acid combined with sodium ferrous citrate ameliorated lupus nephritis in a mouse chronic graft-versus-host disease model. Int Immunopharmacol 2021; 96:107626. [PMID: 33862551 DOI: 10.1016/j.intimp.2021.107626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/11/2021] [Accepted: 03/28/2021] [Indexed: 12/24/2022]
Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by the abnormal activation of immune cells and hypersecretion of autoantibodies and causes irreversible chronic damage, such as lupus nephritis. Chronic graft-versus-host-disease (cGvHD) in mice induced by the injection of parental mouse lymphocytes into F1 hybrids leads to a disease similar to SLE. 5-aminolevulinic acid (5-ALA) is a key progenitor of heme, and its combination with sodium ferrous citrate (SFC) can up-regulate the heme oxygenase (HO-1) expression, resulting in an anti-inflammatory effect. While HO-1 had been reported to be involved in T cell activation and can limit immune-based tissue damage through Treg suppression, which promotes effector response. Thus, we hypothesized that treatment with 5-ALA/SFC could ameliorate lupus nephritis in a mouse cGvHD model. Our results showed that 5-ALA/SFC-treatment significantly decreased the anti-double-stranded DNA (ds-DNA) autoantibodies, blood urea nitrogen (BUN) and creatinine (Cre) levels, reduced kidney inflammatory dendritic cells (DCs) and B cell activation, and increased the regulatory T cells (Tregs) at nine weeks. Furthermore, 5-ALA/SFC suppressed mRNA expression of TNF-α, IL-1β, IFN-γ and markers on DCs. In addition, we also found that 5-ALA/SFC treatment increased the HO-1 expression on donor-derived DCs and Tregs concurrently, increased the number of Tregs, and reduced the population of activated DCs, B cells and CD8+ T cells at three weeks (early stage of the disease). We thus identified a novel role of 5-ALA/SFC for therapeutically improving the symptoms of lupus nephritis in a mouse cGvHD model and expanded the current understanding of how this immunoregulatory agent can be used to generate beneficial immune responses and treat autoimmune disease.
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Affiliation(s)
- Chi Liu
- Division of Transplantation Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Zhidan Wang
- Division of Transplantation Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Xin Hu
- Division of Transplantation Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | | | | | | | | | - Ping Zhu
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao-Kang Li
- Division of Transplantation Immunology, National Research Institute for Child Health and Development, Tokyo, Japan; Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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10
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Aung T, Coleman J, Davidson PW, Hetzel DJ, Aung ST. Intravenous iron infusion and newer non-dextran formulations. N Z Med J 2021; 134:118-127. [PMID: 33927444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
There are several newer intravenous iron formulations to treat iron deficiency and its anaemia. Its use in the primary care setting has been infrequent compared to tertiary centres, due to historical concerns such as anaphylaxis. There is a lack of overall comparison among the intravenous formulations of iron. Compared to oral iron therapy, the newer intravenous formulations, which allow a complete or near-complete replacement in a single sitting of 15-30 minutes, have an improved safety profile with better tolerability, efficacy and effectiveness. They are suited for administration in the primary care setting. The four non-dextran formulations (ferric carboxymaltose, iron sucrose, iron isomaltoside and ferumoxytol) share an equal or near equal efficacy and safety profile. This article also outlines how to provide iron infusion safely and effectively in the community.
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Affiliation(s)
- Tim Aung
- Primary Care Practitioner. Brisbane, QLD
| | | | - Peter W Davidson
- Haematologist (Princess Alexandra Hospital), and Director of QML Pathology. Brisbane, QLD
| | | | - Sandy T Aung
- Pharmacist, Logan Hospital, Queensland Health. Brisbane. QLD
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11
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Cirillo L, Somma C, Allinovi M, Bagalà A, Ferro G, Di Marcantonio E, Bellelli S, Dallari LA, Ballo P, Dattolo PC. Ferric carboxymaltose vs. ferrous sulfate for the treatment of anemia in advanced chronic kidney disease: an observational retrospective study and cost analysis. Sci Rep 2021; 11:7463. [PMID: 33811227 PMCID: PMC8018957 DOI: 10.1038/s41598-021-86769-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 03/15/2021] [Indexed: 01/02/2023] Open
Abstract
In non-dialysis-dependent chronic kidney disease (NDD-CKD), erythropoiesis-stimulating agents (ESAs) and iron supplementation are essential for anemia management. Ferric carboxymaltose (FCM) is a relatively novel intravenous iron formulation used in different clinical settings, although scarce data exist in NDD-CKD patients. Primary objective of this study was to retrospectively evaluate the efficacy of FCM compared with oral ferrous sulfate for the treatment of iron-deficiency anemia in a cohort of NDD-CKD patients, considering also the treatment costs. This was a monocentric, retrospective observational study reviewing 349 NDD-CKD patients attending an outpatient clinic between June 2013 and December 2016. Patients were treated by either FCM intravenous infusion or oral ferrous sulfate. We collected serum values of hemoglobin, ferritin and transferrin saturation (TSAT) and ESAs doses at 12 and 18 months. The costs related to both treatments were also analysed. 239 patients were treated with FCM intravenous infusion and 110 patients with oral ferrous sulfate. The two groups were not statistically different for age, BMI and eGFR values. At 18 months, hemoglobin, serum ferritin and TSAT values increased significantly from baseline in the FCM group, compared with the ferrous sulfate group. ESAs dose and rate of infusion decreased only in the FCM group. At 18 months, the treatment costs, analysed per week, was higher in the ferrous sulfate group, compared with the FCM group, and this was mostly due to a reduction in ESAs prescription in the FCM group. Routine intravenous FCM treatment in an outpatient clinic of NDD-CKD patients results in better correction of iron-deficiency anemia when compared to ferrous sulfate. In addition to this, treating NDD-CKD patients with FCM leads to a significant reduction of the treatment costs by reducing ESAs use.
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Affiliation(s)
- Luigi Cirillo
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Chiara Somma
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Marco Allinovi
- Nephrology, Dialysis and Transplant Unit, Careggi University Hospital, Florence, Italy
| | - Alfredo Bagalà
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Giuseppe Ferro
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Elio Di Marcantonio
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Stefania Bellelli
- Health Technology Assessment and Management (HTAM) Research Area, IRES Piemonte, Torino, Italy
| | - Lorenzo Antonio Dallari
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Piercarlo Ballo
- Cardiology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Pietro Claudio Dattolo
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy.
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Urso K, Leal Martínez-Bujanda J, del Prado JM. Iron Protein Succinylate in the Management of Iron Deficiency Anemia: A Comparative Study with Ferrous Sulphate at Low and High Therapeutic Doses. Nutrients 2021; 13:968. [PMID: 33802720 PMCID: PMC8002401 DOI: 10.3390/nu13030968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
Oral iron supplementation constitutes the first line treatment for iron deficiency anemia (IDA), with daily doses between 80 mg and 200 mg of elemental iron. Ferrous salts, such as ferrous sulphate (FeSO4), while efficacious, frequently give rise to gastrointestinal side effects. In the present paper we attempted to directly compare the efficacy of an alternative to the FeSO4 formulation, which presents a better tolerability profile, iron protein succinylate (Ferplex®). In a diet-induced anemia model, rats were treated by oral gavage with vehicle, FeSO4, or Ferplex® at a human-dose equivalent of 80 mg and 200 mg of elemental iron. We evaluated the change in anemia-related hematological and biochemical parameters, conducting a histological examination of the intestine at sacrifice. Results indicate that both types of iron supplementation are equally effective in the treatment of IDA, restoring hemoglobin, hematocrit, erythrocytes, free iron and transferrin levels in 15 days, with no statistical differences between treated groups and control. The impact of anemia on body weight was also attenuated following treatment with both iron supplements. Thrombocyte and reticulocyte levels, altered by the anemic condition, returned to homeostasis after 15 days of either FeSO4 or Ferplex® treatment. Importantly, the lower and higher doses of iron were equally effective, thus supporting the current school of thought which states that lower therapeutic doses are sufficient for management of IDA. In addition, the study shows for the first time that oral treatment with Ferplex® does not increase serum hepcidin. Finally, Ferplex® induced minimal iron depositions in the intestinal tissue compared to FeSO4.
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Affiliation(s)
- Katia Urso
- ITF Research Pharma S.L.U., San Rafael 3, 28108 Madrid, Spain;
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Tchum SK, Arthur FK, Adu B, Sakyi SA, Abubakar LA, Atibilla D, Amenga-Etego S, Oppong FB, Dzabeng F, Amoani B, Gyan T, Arhin E, Poku-Asante K. Impact of iron fortification on anaemia and iron deficiency among pre-school children living in Rural Ghana. PLoS One 2021; 16:e0246362. [PMID: 33571267 PMCID: PMC7877575 DOI: 10.1371/journal.pone.0246362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
Anaemia in young sub-Saharan African children may be due to the double burden of malaria and iron deficiency. Primary analysis of a double-blind, cluster randomized trial of iron containing micronutrient powder supplementation in Ghanaian children aged 6 to 35 months found no difference in malaria risk between intervention and placebo groups. Here, we performed a secondary analysis of the trial data to assess the impact of long-term prophylactic iron fortificant on the risk of iron deficiency and anaemia in trial subjects. This population-based randomized-cluster trial involved 1958 children aged between 6 to 35 months, identified at home and able to eat semi-solid foods. The intervention group (n = 967) received a daily dose containing 12.5 mg elemental iron (as ferrous fumarate), vitamin A (400 μg), ascorbic acid (30 mg) and zinc (5 mg). The placebo group (n = 991) received a similar micronutrient powder but without iron. Micronutrient powder was provided daily to both groups for 5 months. At baseline and endline, health assessment questionnaires were administered and blood samples collected for analysis. The two groups had similar baseline anthropometry, anaemia, iron status, demographic characteristics, and dietary intakes (p > 0.05). Of the 1904 (97.2%) children who remained at the end of the intervention, the intervention group had significantly higher haemoglobin (p = 0.0001) and serum ferritin (p = 0.0002) levels than the placebo group. Soluble transferrin receptor levels were more saturated among children from the iron group compared to non-iron group (p = 0.012). Anaemia status in the iron group improved compared to the placebo group (p = 0.03). Continued long-term routine use of micronutrient powder containing prophylactic iron reduced anaemia, iron deficiency and iron deficiency anaemia among pre-school children living in rural Ghana's malaria endemic area.
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Affiliation(s)
- Samuel Kofi Tchum
- Department of Biochemistry and Biotechnology, College of Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
- * E-mail:
| | - Fareed Kow Arthur
- Department of Biochemistry and Biotechnology, College of Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bright Adu
- Department of Immunology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Samuel Asamoah Sakyi
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Dorcas Atibilla
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Seeba Amenga-Etego
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Felix Boakye Oppong
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Francis Dzabeng
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Benjamin Amoani
- Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Thomas Gyan
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Emmanuel Arhin
- Faculty of Earth and Environmental Sciences, Department of Earth Science, C K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | - Kwaku Poku-Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
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14
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Womack R, Berru F, Panwar B, Gutiérrez OM. Effect of Ferric Citrate versus Ferrous Sulfate on Iron and Phosphate Parameters in Patients with Iron Deficiency and CKD: A Randomized Trial. Clin J Am Soc Nephrol 2020; 15:1251-1258. [PMID: 32694162 PMCID: PMC7480557 DOI: 10.2215/cjn.15291219] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Ferric citrate is an oral medication approved for treatment of iron deficiency anemia in patients with CKD not requiring dialysis. The relative efficacy of ferric citrate versus ferrous sulfate in treating iron deficiency in patients with CKD is unclear. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We randomized 60 adults with moderate to severe CKD (eGFR 15-45 ml/min per 1.73 m2) and iron deficiency (transferrin saturation [TSAT] ≤30% and ferritin ≤300 ng/ml) to ferric citrate (2 g three times a day with meals, n=30) or ferrous sulfate (325 mg three times a day, n=30) for 12 weeks. Primary outcomes were change in TSAT and ferritin from baseline to 12 weeks. Secondary outcomes were change in hemoglobin, fibroblast growth factor 23 (FGF23), and hepcidin. RESULTS Baseline characteristics were well balanced between study arms. There was a greater increase in TSAT (between-group difference in mean change, 8%; 95% confidence interval [95% CI], 1 to 15; P=0.02) and ferritin (between-group difference in mean change, 37 ng/ml; 95% CI, 10 to 64; P=0.009) from baseline to 12 weeks in participants randomized to ferric citrate as compared with ferrous sulfate. Similarly, as compared with ferrous sulfate, treatment with ferric citrate resulted in a greater increase in hepcidin from baseline to 12 weeks (between-group difference, 69 pg/ml; 95% CI, 8 to 130). There were no between-group differences in mean change for hemoglobin (0.3 g/dl; 95% CI, -0.2 to 0.8), intact FGF23 (-29 pg/ml; 95% CI, -59 to 0.1), or C-terminal FGF23 (61 RU/ml; 95% CI, -181 to 58). The incidence of adverse events did not differ between treatment arms. CONCLUSIONS As compared with ferrous sulfate, treatment with ferric citrate for 12 weeks resulted in a greater mean increase in TSAT and ferritin concentrations in individuals with moderate to severe CKD and iron deficiency. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Impact of Ferric Citrate vs Ferrous Sulfate on Iron Parameters and Hemoglobin in Individuals With Moderate to Severe Chronic Kidney Disease (CKD) With Iron Deficiency, NCT02888171.
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Affiliation(s)
- Rebecca Womack
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Fabian Berru
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bhupesh Panwar
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Orlando M Gutiérrez
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
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15
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Siddappa AM, Olson RM, Spector M, Northrop E, Zamora T, Brearley AM, Georgieff MK, Rao R. High Prevalence of Iron Deficiency Despite Standardized High-Dose Iron Supplementation During Recombinant Erythropoietin Therapy in Extremely Low Gestational Age Newborns. J Pediatr 2020; 222:98-105.e3. [PMID: 32418819 PMCID: PMC7461620 DOI: 10.1016/j.jpeds.2020.03.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the effects of protocolized recombinant human erythropoietin (r-HuEPO) therapy and standardized high dose iron supplementation on hematologic and iron status measures in a cohort of extremely low gestational age newborns (ELGANs). STUDY DESIGN Charts of extremely low gestational age newborns admitted from 2006 to 2016 and who had received r-HuEPO per neonatal intensive care unit protocol were reviewed. The r-HuEPO was started at a dose of 900 IU/kg per week after 7 days of age and continued until 35 weeks postmenstrual age. Oral iron supplementation at 6-12 mg/kg per day was used to maintain a transferrin saturation of >20% during r-HuEPO treatment. Data on demographic features, hematologic and iron panel indices, red blood cell transfusions, and clinical outcomes were collected. Quartile groups were created based on serum ferritin levels at the conclusion of the r-HuEPO treatment and the quartiles were compared. RESULTS The cohort included 116 infants with mean gestational age 25.8 ± 1.5 weeks and birth weight 793 ± 174.1 g. The r-HuEPO promoted erythropoiesis as indicated by increasing hemoglobin, hematocrit, and reticulocyte count. Serum ferritin decreased over time and was ≤75 ng/mL in 60.2% of infants at the conclusion of r-HuEPO therapy; 87% received packed red blood cell transfusions. Transfusion volume, total iron intake, total iron binding capacity, and transferrin concentration differed among infants in the different serum ferritin quartiles (P < .05). CONCLUSIONS In extremely low gestational age newborns, r-HuEPO therapy promoted erythropoiesis. Despite a biomarker-based standardized high-dose iron supplementation, the majority of infants had evidence of iron deficiency to a degree that is associated with reduced brain function.
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Affiliation(s)
- Ashajyothi M Siddappa
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN; Department of Pediatrics, University of Minnesota, Minneapolis, MN.
| | - Rose M Olson
- University of Minnesota Medical School, Minneapolis, MN
| | - Miriam Spector
- School of Public Health, University of Minnesota, Minneapolis, MN
| | - Elise Northrop
- Division of Biostatistics, School of Public Health, and Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Tara Zamora
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Ann M Brearley
- Division of Biostatistics, School of Public Health, and Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Michael K Georgieff
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Raghavendra Rao
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN
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Deng Z, Fang C, Ma X, Li X, Zeng YJ, Peng X. One Stone Two Birds: Zr-Fc Metal-Organic Framework Nanosheet for Synergistic Photothermal and Chemodynamic Cancer Therapy. ACS Appl Mater Interfaces 2020; 12:20321-20330. [PMID: 32293862 DOI: 10.1021/acsami.0c06648] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Metal-organic frameworks (MOFs) have been identified as promising materials for the delivery of therapeutics to cure cancer owing to their intrinsic porous structure. However, in a majority of cases, MOFs act as only a delivery cargo for anticancer drugs while little attention has been focused on the utilization of their intriguing physical and chemical properties for potential anticancer purposes. Herein for the first time, an ultrathin (16.4 nm thick) ferrocene-based MOF (Zr-Fc MOF) nanosheet has been synthesized for synergistic photothermal therapy (PTT) and Fenton reaction-based chemodynamic (CDT) therapy to cure cancer without additional drugs. The Zr-Fc MOF nanosheet acts not only as an excellent photothermal agent with a prominent photothermal conversion efficiency of 53% at 808 nm but also as an efficient Fenton catalyst to promote the conversion of H2O2 into hydroxyl radical (•OH). As a consequence, an excellent therapeutic performance has been achieved in vitro as well as in vivo through this combinational effect. This work aims to construct an "all-in-one" MOF nanoplatform for PTT and CDT treatments without incorporating any additional therapeutics, which may launch a new era in the investigation of MOF-based synergistic therapy platforms for cancer therapy.
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Affiliation(s)
- Zheng Deng
- State Key Laboratory of Silicon Materials, School of Materials Science and Engineering, Zhejiang University, Hangzhou 310027, P. R. China
- Shenzhen Key Laboratory of Laser Engineering, College of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, P. R. China
| | - Chao Fang
- State Key Laboratory of Silicon Materials, School of Materials Science and Engineering, Zhejiang University, Hangzhou 310027, P. R. China
| | - Xu Ma
- State Key Laboratory of Silicon Materials, School of Materials Science and Engineering, Zhejiang University, Hangzhou 310027, P. R. China
| | - Xiang Li
- State Key Laboratory of Silicon Materials, School of Materials Science and Engineering, Zhejiang University, Hangzhou 310027, P. R. China
| | - Yu-Jia Zeng
- Shenzhen Key Laboratory of Laser Engineering, College of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, P. R. China
| | - Xinsheng Peng
- State Key Laboratory of Silicon Materials, School of Materials Science and Engineering, Zhejiang University, Hangzhou 310027, P. R. China
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Bayen S, Le Grand C, Bayen M, Richard F, Messaadi N. Anemia management in non-menopausal women in a primary care setting: a prospective evaluation of clinical practice. BMC Fam Pract 2020; 21:13. [PMID: 31964335 PMCID: PMC6971881 DOI: 10.1186/s12875-020-1086-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The study aimed to analyze anemia management in non-pregnant, and non-menopausal women aged from 18 to 50 years old, in a French primary care setting. METHODS An observational descriptive prospective study was conducted between November 2018 and February 2019. Inclusion criteria were as followed: anemia diagnosed in women aged from 18 to 50, not pregnant and not menopausal. Quantitative and qualitative data were anonymized and collected through an electronic survey. Investigating general practitioners completed the questionnaire for each newly diagnosed woman. Mean values and medians were calculated for the quantitative data. Answers to the open questions were encoded manually and proportions of the different modalities have been calculated. RESULTS Altogether, 43 women with anemia were ascertained. Moderate microcytic anemia, due to an iron deficiency in a context of menorrhagia, was the most observed anemia profile. The mean value of hemoglobin was 10.5 ± 1 g/dl. Among these women: 32 (74%) presented an iron deficiency, 17 (53%) had inappropriate intakes, and 9 (28%) reported menorrhagia. For 17 (40%) women, unnecessary or inappropriate exams were prescribed. The investigations did not allow to establish a differential diagnosis for 12 women (28%). Even for similar clinical situations, anemia management was variable. Among the women who presented iron deficiency, 15 (47%) were informed about an iron-rich diet and received a daily iron supplementation of ferrous sulfate between 80 mg and 160 mg. CONCLUSIONS Our study highlights that, in the absence of specific national guidelines for anemia management in non-pregnant, non-menopausal women in primary care settings, French GPs undergo various clinical management strategies leading to a heterogeneous, sometimes inappropriate follow-up. Women with iron deficiency were prescribed higher daily iron supplementation than recommended, according to new evidence, suggesting a maximal daily dose of 50 mg of elementary iron in a context of Hepcidin up-regulation in the case of an iron overload. Additional longitudinal studies with a bigger sample size and randomized controlled trials are needed to confirm our results and to elaborate national guidelines.
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Affiliation(s)
- Sabine Bayen
- Department of General Practice, University of Lille (F), Pôle formation Faculté de médecine Henri Warembourg, 59045 Lille CEDEX 1, France
- Department of Medical Pharmacology & Neurology, INSERM UMRS 1171, University of Lille (F), Lille, France
| | - Charline Le Grand
- Department of General Practice, University of Lille (F), Pôle formation Faculté de médecine Henri Warembourg, 59045 Lille CEDEX 1, France
| | - Marc Bayen
- Department of General Practice, University of Lille (F), Pôle formation Faculté de médecine Henri Warembourg, 59045 Lille CEDEX 1, France
| | - Florence Richard
- Department of Epidemiology and Public Health, INSERM UMRS 1167, University of Lille (F), Lille, France
| | - Nassir Messaadi
- Department of General Practice, University of Lille (F), Pôle formation Faculté de médecine Henri Warembourg, 59045 Lille CEDEX 1, France
- SCALab CNRS UMR 9193, University of Lille, Lille, France
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Abstract
Innate and developed resistance mechanisms of bacteria to antibiotics are obstacles in the design of novel drugs. However, antibacterial prodrugs and conjugates have shown promise in circumventing resistance and tolerance mechanisms via directed delivery of antibiotics to the site of infection or to specific species or strains of bacteria. The selective targeting and increased permeability and accumulation of these prodrugs not only improves efficacy over unmodified drugs but also reduces off-target effects, toxicity, and development of resistance. Herein, we discuss some of these methods, including sideromycins, antibody-directed prodrugs, cell penetrating peptide conjugates, and codrugs.
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Affiliation(s)
- Ana V. Cheng
- Department of Chemistry, Emory University, 1515 Dickey Drive, Atlanta, Georgia 30322, United States
| | - William M. Wuest
- Department of Chemistry, Emory University, 1515 Dickey Drive, Atlanta, Georgia 30322, United States
- Emory Antibiotic Resistance Center, Emory School of Medicine, 201 Dowman Drive, Atlanta, Georgia 30322, United States
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19
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Dong Z, Feng L, Chao Y, Hao Y, Chen M, Gong F, Han X, Zhang R, Cheng L, Liu Z. Amplification of Tumor Oxidative Stresses with Liposomal Fenton Catalyst and Glutathione Inhibitor for Enhanced Cancer Chemotherapy and Radiotherapy. Nano Lett 2019; 19:805-815. [PMID: 30592897 DOI: 10.1021/acs.nanolett.8b03905] [Citation(s) in RCA: 269] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Amplification of intracellular oxidative stress has been found to be an effective strategy to induce cancer cell death. To this end, we prepare a unique type of ultrasmall gallic acid-ferrous (GA-Fe(II)) nanocomplexes as the catalyst of Fenton reaction to enable persistent conversion of H2O2 to highly cytotoxic hydroxyl radicals (•OH). Then, both GA-Fe(II) and l-buthionine sulfoximine (BSO), an inhibitor of glutathione (GSH) synthesis, are coencapsulated within a stealth liposomal nanocarrier. Interestingly, the obtained BSO/GA-Fe(II)@liposome is able to efficiently amplify intracellular oxidative stress via increasing •OH generation and reducing GSH biosynthesis. After chelating with 99mTc4+ radioisotope, such BSO/GA-Fe(II)@liposome could be tracked under in vivo single-photon-emission-computed-tomography (SPECT) imaging, which illustrates the time-dependent tumor homing of such liposomal nanoparticles after intravenous injection. With GA-Fe(II)-mediated •OH production and BSO-mediated GSH depletion, treatment with such BSO/GA-Fe(II)@liposome would lead to dramatically enhanced intratumoral oxidative stresses, which then result in remarkably improved therapeutic efficacies of concurrently applied chemotherapy or radiotherapy. This work thus presents the concise fabrication of biocompatible BSO/GA-Fe(II)@liposome as an effective adjuvant nanomedicine to promote clinically used conventional cancer chemotherapy and radiotherapy, by greatly amplifying the intratumoral oxidative stress.
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Affiliation(s)
- Ziliang Dong
- Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Institute of Functional Nano and Soft Materials (FUNSOM) , Soochow University , 199 Ren'ai Road , Suzhou 215123 , Jiangsu , P.R. China
| | - Liangzhu Feng
- Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Institute of Functional Nano and Soft Materials (FUNSOM) , Soochow University , 199 Ren'ai Road , Suzhou 215123 , Jiangsu , P.R. China
| | - Yu Chao
- Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Institute of Functional Nano and Soft Materials (FUNSOM) , Soochow University , 199 Ren'ai Road , Suzhou 215123 , Jiangsu , P.R. China
| | - Yu Hao
- Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Institute of Functional Nano and Soft Materials (FUNSOM) , Soochow University , 199 Ren'ai Road , Suzhou 215123 , Jiangsu , P.R. China
| | - Muchao Chen
- Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Institute of Functional Nano and Soft Materials (FUNSOM) , Soochow University , 199 Ren'ai Road , Suzhou 215123 , Jiangsu , P.R. China
| | - Fei Gong
- Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Institute of Functional Nano and Soft Materials (FUNSOM) , Soochow University , 199 Ren'ai Road , Suzhou 215123 , Jiangsu , P.R. China
| | - Xiao Han
- Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Institute of Functional Nano and Soft Materials (FUNSOM) , Soochow University , 199 Ren'ai Road , Suzhou 215123 , Jiangsu , P.R. China
| | - Rui Zhang
- Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Institute of Functional Nano and Soft Materials (FUNSOM) , Soochow University , 199 Ren'ai Road , Suzhou 215123 , Jiangsu , P.R. China
| | - Liang Cheng
- Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Institute of Functional Nano and Soft Materials (FUNSOM) , Soochow University , 199 Ren'ai Road , Suzhou 215123 , Jiangsu , P.R. China
| | - Zhuang Liu
- Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Institute of Functional Nano and Soft Materials (FUNSOM) , Soochow University , 199 Ren'ai Road , Suzhou 215123 , Jiangsu , P.R. China
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Abstract
BACKGROUND Restless legs syndrome (RLS) is a common neurologic disorder that is associated with peripheral iron deficiency in a subgroup of patients. It is unclear whether iron therapy is effective treatment for RLS. OBJECTIVES To evaluate the efficacy and safety of oral or parenteral iron for the treatment of restless legs syndrome (RLS) when compared with placebo or other therapies. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycNFO, and CINAHL for the time period January 1995 to September 2017. We searched reference lists for additional published studies. We searched Clinicaltrials.gov and other clinical trial registries (September 2017) for ongoing or unpublished studies. SELECTION CRITERIA Controlled trials comparing any formulation of iron with placebo, other medications, or no treatment, in adults diagnosed with RLS according to expert clinical interview or explicit diagnostic criteria. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed trial quality, with discussion to reach consensus in the case of any disagreement. The primary outcome considered in this review was restlessness or unpleasant sensations, as experienced subjectively by the patient. We combined treatment/control differences in the outcomes across studies using random-effects meta-analyses. We analysed continuous data using mean differences (MDs) where possible and performed standardised mean difference (SMD) analyses when different measurements were used across studies. We calculated risk ratios (RRs) for dichotomous data using the Mantel-Haenszel method and 95% confidence intervals (CIs). We analysed study heterogeneity using the I2 statistic. We used standard methodological procedures expected by Cochrane. We performed GRADE analysis using GRADEpro. MAIN RESULTS We identified and included 10 studies (428 total participants, followed for 2-16 weeks) in this review. Our primary outcome was restlessness or uncomfortable leg sensations, which was quantified using the International Restless Legs Scale (IRLS) (range, 0 to 40) in eight trials and a different RLS symptom scale in a ninth trial. Nine studies compared iron to placebo and one study compared iron to a dopamine agonist (pramipexole). The possibility for bias among the trials was variable. Three studies had a single element with high risk of bias, which was lack of blinding in two and incomplete outcome data in one. All studies had at least one feature resulting in unclear risk of bias.Combining data from the seven trials using the IRLS to compare iron and placebo, use of iron resulted in greater improvement in IRLS scores (MD -3.78, 95% CI -6.25 to -1.31; I2= 66%, 7 studies, 345 participants) measured 2 to 12 weeks after treatment. Including an eighth study, which measured restlessness using a different scale, use of iron remained beneficial compared to placebo (SMD -0.74, 95% CI -1.26 to -0.23; I2 = 80%, 8 studies, 370 participants). The GRADE assessment of certainty for this outcome was moderate.The single study comparing iron to a dopamine agonist (pramipexole) found a similar reduction in RLS severity in the two groups (MD -0.40, 95% CI -5.93 to 5.13, 30 participants).Assessment of secondary outcomes was limited by small numbers of trials assessing each outcome. Iron did not improve quality of life as a dichotomous measure (RR 2.01, 95% CI 0.54 to 7.45; I2=54%, 2 studies, 39 participants), but did improve quality of life measured on continuous scales (SMD 0.51, 95% CI 0.15 to 0.87; I2= 0%, 3 studies, 128 participants), compared to placebo. Subjective sleep quality was no different between iron and placebo groups (SMD 0.19, 95% CI -0.18 to 0.56; I2 = 9%, 3 studies, 128 participants), nor was objective sleep quality, as measured by change in sleep efficiency in a single study (-35.5 +/- 92.0 versus -41.4 +/- 98.2, 18 participants). Periodic limb movements of sleep were not significantly reduced with iron compared to placebo ( SMD -0.19, 95% CI -0.70 to 0.32; I2 = 0%, 2 studies, 60 participants). Iron did not improve sleepiness compared to placebo, as measured on the Epworth Sleepiness Scale (data not provided, 1 study, 60 participants) but did improve the daytime tiredness item of the RLS-6 compared to placebo (least squares mean difference -1.5, 95% CI -2.5 to -0.6; 1 study, 110 participants). The GRADE rating for secondary outcomes ranged from low to very low.Prespecified subgroup analyses showed more improvement with iron in those trials studying participants on dialysis. The use of low serum ferritin levels as an inclusion criteria and the use or oral versus intravenous iron did not show significant subgroup differences.Iron did not result in significantly more adverse events than placebo (RR 1.48, 95% CI 0.97 to 2.25; I2=45%, 6 studies, 298 participants). A single study reported that people treated with iron therapy experienced fewer adverse events than the active comparator pramipexole. AUTHORS' CONCLUSIONS Iron therapy probably improves restlessness and RLS severity in comparison to placebo. Iron therapy may not increase the risk of side effects in comparison to placebo. We are uncertain whether iron therapy improves quality of life in comparison to placebo. Iron therapy may make little or no difference to pramipexole in restlessness and RLS severity, as well as in the risk of adverse events. The effect on secondary outcomes such as quality of life, daytime functioning, and sleep quality, the optimal timing and formulation of administration, and patient characteristics predicting response require additional study.
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Affiliation(s)
- Lynn M Trotti
- Emory University School of MedicineDepartment of Neurology12 Executive Park Drive NEAtlantaUSA30329
| | - Lorne A Becker
- SUNY Upstate Medical UniversityDepartment of Family Medicine475 Irving AveSuite 200SyracuseNew YorkUSA13210
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von Haehling S, Ebner N, Evertz R, Ponikowski P, Anker SD. Iron Deficiency in Heart Failure: An Overview. JACC Heart Fail 2018; 7:36-46. [PMID: 30553903 DOI: 10.1016/j.jchf.2018.07.015] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [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: 03/23/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 12/17/2022]
Abstract
Iron deficiency is an extremely common comorbidity in patients with heart failure, affecting up to 50% of all ambulatory patients. It is associated with reduced exercise capacity and physical well-being and reduced quality of life. Cutoff values have been identified for diagnosing iron deficiency in heart failure with reduced ejection fraction as serum ferritin, <100 μg/l, or ferritin, 100 to 300 μg/l, with transferrin saturation of <20%. Oral iron products have been shown to have little efficacy in heart failure, where the preference is intravenous iron products. Most clinical studies have been performed using ferric carboxymaltose with good efficacy in terms of improvements in 6-min walk test distance, peak oxygen consumption, quality of life, and improvements in New York Heart Association functional class. Data from meta-analyses also suggest beneficial effects for hospitalization rates for heart failure and reduction in cardiovascular mortality rates. A prospective trial to investigate effects on morbidity and mortality is currently ongoing. This paper highlights current knowledge of the pathophysiology of iron deficiency in heart failure, its prevalence and clinical impact, and its possible treatment options.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Stefan D Anker
- Division of Cardiology and Metabolism-Heart Failure, Cachexia and Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Awidi M, Bawaneh H, Zureigat H, AlHusban M, Awidi A. Contributing factors to iron deficiency anemia in women in Jordan: A single-center cross-sectional study. PLoS One 2018; 13:e0205868. [PMID: 30395644 PMCID: PMC6218028 DOI: 10.1371/journal.pone.0205868] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/02/2018] [Indexed: 12/03/2022] Open
Abstract
Objectives This study aimed to understand the impact of iron deficiency anemia in female users of a hematology service in a developing country. Design Retrospective cross-sectional study of adult and adolescent women with iron deficiency anemia who presented to a hospital department of hematology. Setting A tertiary university hospital inpatient and outpatient hematology service. Participants All female patients who were ≥13 years of age with confirmed iron deficiency anemia and received hospital hematology services. Results A total of 208 patients were enrolled and analyzed in the registry. The mean age of the patients was 41.4 years (range, 14–82). A total of 195 patients had anemia that was moderate or severe according to the World Health Organization anemia classification with 13 patients having mild anemia. A total of 108 patients had comorbidities, which were primarily endocrine and cardiovascular. Iron deficiency anemia was associated with very heavy (n = 56, 30%) or heavy menses (n = 84, 45%) in 140 patients and was associated with poor (<200 g/week of red meat) (n = 101, 54%) or very poor (vegan, strict vegetarian) nutrition (n = 34, 18%) in 135 patients. A total of 101 patients had a previous pregnancy history with a mean of six previous pregnancies (range, 1–11 pregnancy episodes per patient). Blood film was performed on all patients; only four had a picture consistent with thalassemia minor. Conclusion Iron deficiency anemia is caused by multiple factors. Heavy menses and low consumption of red meat were found to be associated with the severity of anemia. Our findings may be useful for healthcare planners and policy makers in increasing efforts to reduce the prevalence and severity of iron deficiency anemia among women in Jordan.
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Affiliation(s)
- Muhammad Awidi
- Cell Therapy Center, University of Jordan, Amman, Jordan
- * E-mail:
| | - Hisham Bawaneh
- University of Jordan Hospital, University of Jordan, Amman, Jordan
| | - Hadil Zureigat
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Muna AlHusban
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Abdalla Awidi
- Cell Therapy Center, University of Jordan, Amman, Jordan
- University of Jordan Hospital, University of Jordan, Amman, Jordan
- Faculty of Medicine, University of Jordan, Amman, Jordan
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Asperti M, Gryzik M, Brilli E, Castagna A, Corbella M, Gottardo R, Girelli D, Tarantino G, Arosio P, Poli M. Sucrosomial ® Iron Supplementation in Mice: Effects on Blood Parameters, Hepcidin, and Inflammation. Nutrients 2018; 10:nu10101349. [PMID: 30241424 PMCID: PMC6213119 DOI: 10.3390/nu10101349] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 08/07/2018] [Revised: 09/15/2018] [Accepted: 09/18/2018] [Indexed: 02/07/2023] Open
Abstract
Sucrosomial® Iron is a recently developed formulation to treat iron deficiency based on ferric pyrophosphate covered by a matrix of phospholipids plus sucrose esters of fatty acids. Previous data indicated that Sucrosomial® Iron is efficiently absorbed by iron-deficient subjects, even at low dosage, and without side effects. Its structural properties may suggest that it is absorbed by an intestinal pathway which is different to the one used by ionic iron. Although, studies in vitro showed that Sucrosomial® Iron is readily absorbed, no animal models have been established to study this important aspect. To this aim, we induced iron deficient anemia in mice by feeding them with a low-iron diet, and then we treated them with either Sucrosomial® Iron or sulfate iron by gavage for up to two weeks. Both iron formulations corrected anemia and restored iron stores in a two-week period, but with different kinetics. Ferrous Sulfate was more efficient during the first week and Sucrosomial® Iron in the second week. Of note, when given at the same concentrations, Ferrous Sulfate induced the expression of hepcidin and four different inflammatory markers (Socs3, Saa1, IL6 and CRP), while Sucrosomial® Iron did not. We conclude that anemic mice are interesting models to study the absorption of oral iron, and that Sucrosomial® Iron is to be preferred over Ferrous Sulfate because of similar absorption but without inducing an inflammatory response.
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Affiliation(s)
- Michela Asperti
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy.
| | - Magdalena Gryzik
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy.
| | | | | | - Michela Corbella
- Department of Medicine, University of Verona, 37134 Verona, Italy.
| | - Rossella Gottardo
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy.
| | - Domenico Girelli
- Department of Medicine, University of Verona, 37134 Verona, Italy.
| | | | - Paolo Arosio
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy.
| | - Maura Poli
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy.
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Abstract
The last two decades have seen a surge in antimalarial drug development with product development partnerships taking a leading role. Resistance of Plasmodium falciparum to the artemisinin derivatives, piperaquine and mefloquine in Southeast Asia means new antimalarials are needed with some urgency. There are at least 13 agents in clinical development. Most of these are blood schizonticides for the treatment of uncomplicated falciparum malaria, under evaluation either singly or as part of two-drug combinations. Leading candidates progressing through the pipeline are artefenomel-ferroquine and lumefantrine-KAF156, both in Phase 2b. Treatment of severe malaria continues to rely on two parenteral drugs with ancient forebears: artesunate and quinine, with sevuparin being evaluated as an adjuvant therapy. Tafenoquine is under review by stringent regulatory authorities for approval as a single-dose treatment for Plasmodium vivax relapse prevention. This represents an advance over standard 14-day primaquine regimens; however, the risk of acute haemolytic anaemia in patients with glucose-6-phosphate dehydrogenase deficiency remains. For disease prevention, several of the newer agents show potential but are unlikely to be recommended for use in the main target groups of pregnant women and young children for some years. Latest predictions are that the malaria burden will continue to be high in the coming decades. This fact, coupled with the repeated loss of antimalarials to resistance, indicates that new antimalarials will be needed for years to come. Failure of the artemisinin-based combinations in Southeast Asia has stimulated a reappraisal of current approaches to combination therapy for malaria with incorporation of three or more drugs in a single treatment under consideration.
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Affiliation(s)
- Elizabeth A Ashley
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
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Takasawa K, Takaeda C, Wada T, Ueda N. Optimal Serum Ferritin Levels for Iron Deficiency Anemia during Oral Iron Therapy (OIT) in Japanese Hemodialysis Patients with Minor Inflammation and Benefit of Intravenous Iron Therapy for OIT-Nonresponders. Nutrients 2018; 10:nu10040428. [PMID: 29596361 PMCID: PMC5946213 DOI: 10.3390/nu10040428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 02/10/2018] [Revised: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 12/13/2022] Open
Abstract
Background: We determined optimal serum ferritin for oral iron therapy (OIT) in hemodialysis (HD) patients with iron deficiency anemia (IDA)/minor inflammation, and benefit of intravenous iron therapy (IIT) for OIT-nonresponders. Methods: Inclusion criteria were IDA (Hb <120 g/L, serum ferritin <227.4 pmol/L). Exclusion criteria were inflammation (C-reactive protein (CRP) ≥ 5 mg/L), bleeding, or cancer. IIT was withheld >3 months before the study. ΔHb ≥ 20 g/L above baseline or maintaining target Hb (tHB; 120-130 g/L) was considered responsive. Fifty-one patients received OIT (ferrous fumarate, 50 mg/day) for 3 months; this continued in OIT-responders but was switched to IIT (saccharated ferric oxide, 40 mg/week) in OIT-nonresponders for 4 months. All received continuous erythropoietin receptor activator (CERA). Hb, ferritin, hepcidin-25, and CERA dose were measured. Results: Demographics before OIT were similar between OIT-responders and OIT-nonresponders except low Hb and high triglycerides in OIT-nonresponders. Thirty-nine were OIT-responders with reduced CERA dose. Hb rose with a peak at 5 months. Ferritin and hepcidin-25 continuously increased. Hb positively correlated with ferritin in OIT-responders (r = 0.913, p = 0.03) till 5 months after OIT. The correlation equation estimated optimal ferritin of 30-40 ng/mL using tHb (120-130 g/L). Seven OIT-nonresponders were IIT-responders. Conclusions: Optimal serum ferritin for OIT is 67.4-89.9 pmol/L in HD patients with IDA/minor inflammation. IIT may be a second line of treatment for OIT-nonreponders.
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Affiliation(s)
- Kazuya Takasawa
- Department of Internal Medicine, Division of Nephrology, Public Central Hospital of Matto Ishikawa, Ishikawa 9248588, Japan.
| | - Chikako Takaeda
- Department of Internal Medicine, Division of Nephrology, Public Central Hospital of Matto Ishikawa, Ishikawa 9248588, Japan.
| | - Takashi Wada
- Department of Nephrology, Kanazawa University; Kanazawa, Ishikawa 9208641, Japan.
| | - Norishi Ueda
- Department of Pediatrics, Public Central Hospital of Matto Ishikawa, Ishikawa 9248588, Japan.
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Abstract
A 52-year-old man who had been taking omeprazole, a proton pump inhibitor (PPI), for 25 years developed iron deficiency anemia. An evaluation of the entire gastrointestinal tract did not reveal any possible causes of gastrointestinal blood loss. The cause of the iron deficiency was considered to be a reduction in gastrointestinal iron absorption in association with the reduced secretion of gastric acid due to PPI use. This case demonstrates that long-term PPI use for as long as 25 years may cause iron deficiency anemia and should be considered in the differential diagnosis of iron deficiency anemia in long-term PPI users.
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Affiliation(s)
- Ryosuke Imai
- Internal Medicine, St. Luke's International Hospital, Japan
| | - Takakazu Higuchi
- Division of Hematology, St. Luke's International Hospital, Japan
| | - Masaya Morimoto
- Division of Hematology, St. Luke's International Hospital, Japan
| | - Ryosuke Koyamada
- Division of Hematology, St. Luke's International Hospital, Japan
| | - Sadamu Okada
- Division of Hematology, St. Luke's International Hospital, Japan
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Khalid S, Shaikh F, Moeen S. Decreased activity of glutathione peroxidase with oral ferrous iron administration: A cause of oxidative stress. Pak J Pharm Sci 2018; 31:405-409. [PMID: 29618428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Iron deficiency anemia (IDA) during pregnancy not only results in the disturbance of hematological parameters but has been found to be an additional cause of oxidative stress (OS). Moreover, oral iron for IDA during pregnancy has been found to worsen the condition. Present study aims to detect any alteration in glutathione peroxidase (GSH-Px) activity as an enzymatic anti-oxidant and its association with oral iron supplements. For study, 40 anemic pregnant women were prescribed with 200mg ferrous sulphate for 12 weeks (wks). A significant improvement in hemoglobin (Hb) and serum ferritin concentration (SFC) was seen after treatment (p<0.05). In contrast to the values for hematological parameters, GSH-PX was found to be same for control and anemic groups before iron supplements (p>0.05). A significant decrease in GSH-PX levels of anemic women was seen after iron therapy when compared with both the initial values and the control group (p<0.05). We found a positive association between oral iron administration and OS. Our results showed a strong association between oral iron supplements and SFC which supports the iron overload theory. It is therefore concluded that OS is associated with oral iron supplements during pregnancy.
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Affiliation(s)
- Shamaila Khalid
- Department of Pharmacology, DMC, Dow University of Health Sciences, Karachi, Pakistan
| | - Fuad Shaikh
- Department of Pharmacology, DMC, Dow University of Health Sciences, Karachi, Pakistan
| | - Sara Moeen
- Department of Anatomy DMC, Dow University of Health Sciences, Karachi, Pakistan
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Abstract
Objective Iron deficiency anemia (IDA) has become important with regard to mortality in hemodialysis (HD) patients. Therefore, it is necessary to optimize the treatment of these patients. Methods IDA in end-stage renal disease patients on HD was observed in 42 (33.6%) of 125 patients. We examined the influence of daily orally iron [sodium ferrous citrate (SFC) iron/tablet 50 mg, 1-2 tablets] on the renal function markers, anemia and iron data for about 6 months. Results The hematocrit and hemoglobin levels were significantly increased in the patients treated with SFC [hematocrit: before 28.5%±2.1% (mean ± standard deviation), 1st month 30.0%±2.3%, p<0.05; 3rd month 32.4%±2.9%, p<0.05; 6th month 31.3%±3.4%, p<0.05; and hemoglobin: before 9.25±0.70, 1st month 9.72±0.71, p<0.05; 3rd month 10.54±0.96, p<0.05; 6th month 10.25±1.21 g/dL, p<0.05]. The transferrin saturation (TSAT) and serum ferritin levels were significantly increased in the patients treated with SFC (TSAT: before 21.5%±10.0%, 1st-3rd month, 34.1%±15.1%, p<0.05; 6-8th month 34.7%±11.9%, p<0.05; and ferritin: before 38.2±37.1, 6-8th month 67.5±44.0 ng/mL, p<0.05). The present findings clearly indicate that oral iron is an effective route of iron supplementation in HD patients, and no adverse effects associated with SFC occurred during the treatment and follow-up period. Conclusion Our results clearly indicate that oral iron delivered via SFC is a well-tolerated and effective form of iron supplementation in long-term HD and IDA patients in Japan.
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Affiliation(s)
- Toru Sanai
- The Division of Nephrology, Department of Internal Medicine, Fukumitsu Hospital, Japan
| | - Takashi Ono
- The Division of Nephrology, Department of Internal Medicine, Fukumitsu Hospital, Japan
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Mokhber S, Nikoyan P, Kabir A, Jesmi F, Pishgahroudsari M, Abdolhosseini M, Alibeigi P, Rezvani M, Pazouki A. Anemia Outcome After Laparascopic Mini Bypass : Analysis of 107 Consecutive Patients. Acta Gastroenterol Belg 2016; 79:201-205. [PMID: 27382938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The prevalence of obesity has dramatically increased globally. Weight loss procedures are known to be an effective and reliable method with relatively low complication rate and satisfactory results. Laparoscopic mini-gastric bypass (LMGB) is known as a modified Mason loop procedure with compatible results to laparoscopic Roux-en-Y gastric bypass (LRYGB), and is believed to have even less complication rate. Despite adequate and meticulous supplement therapy, anemia is one of the challenges in patients undergoing LMGB. Thus, we aimed to review the prevalence and severity of anemia in patients undergoing LMGB. METHOD A prospectively-maintained database of patients referring to Hazrat Rasoul Akram hospital who underwent LMGB from December 2013 to October 2014 was reviewed retrospectively. RESULTS A total of 113 consecutive patients were included in the study. The mean age was 38.7 ± 9.8 years. Mean Body mass index (BMI) was 45.5 ± 6.1 kg/m2 preoperatively and 36.7 ± 5.5 kg/m2 and 33.0 ± 5.3 kg/m2 three and six months after the procedure, respectively. (P = 0.001) Mean excess body weight loss after the procedure was 20% and 53% at three and six months post operatively. Serum hemoglobin (Hb) level decreased significantly in three months (P = 0.036) and remained unchanged in six months compared to 3-month (P = 0.385). Vitamin B12 level increased significantly in three months (P = 0.010) and then decrease in six months to the preoperative level (P = 0.889). CONCLUSION LMGB is a safe, feasible and an effective alternative weight loss procedure. Simply, anemia can be prevented by utilizing therapeutic dose of multivitamin in patients who underwent this procedure.
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Xiao C, Lei X, Wang Q, Du Z, Jiang L, Chen S, Zhang M, Zhang H, Ren F. Effects of a Tripeptide Iron on Iron-Deficiency Anemia in Rats. Biol Trace Elem Res 2016; 169:211-7. [PMID: 26109335 DOI: 10.1007/s12011-015-0412-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
Abstract
This study aims to investigate the effects of a tripeptide iron (REE-Fe) on iron-deficiency anemia rats. Sprague-Dawley rats were randomly divided into seven groups: a normal control group, an iron-deficiency control group, and iron-deficiency groups treated with ferrous sulfate (FeSO4), ferrous glycinate (Fe-Gly), or REE-Fe at low-, medium-, or high-dose groups. The rats in the iron-deficiency groups were fed on an iron-deficient diet to establish iron-deficiency anemia (IDA) model. After the model established, different iron supplements were given to the rats once a day by intragastric administration for 21 days. The results showed that REE-Fe had effective restorative action returning body weight, organ coefficients, and hematological parameters in IDA rats to normal level. In addition, comparing with FeSO4 or Fe-Gly, high-dose REE-Fe was more effective on improving the levels of renal coefficient, total iron-binding capacity, and transferrin. Furthermore, the liver hepcidin messenger RNA (mRNA) expression in the high-dose group was significantly higher (p < 0.05) than that in the FeSO4 or Fe-Gly group and showed no significant difference (p > 0.05) with the normal control group. The findings suggest that REE-Fe is an effective source of iron supplement for IDA rats and might be exploited as a new iron fortifier.
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Affiliation(s)
- Chen Xiao
- Beijing Laboratory of Food Quality and Safety, and Key Laboratory of Functional Dairy, College of Food Science and Nutritional Engineering, China Agricultural University, P.O. Box 287, No. 17 Qinghua East Road, Haidian, Beijing, 100083, People's Republic of China
| | - Xingen Lei
- Department of Animal Science, Cornell University, Ithaca, NY, 14853, USA
| | - Qingyu Wang
- Beijing Laboratory of Food Quality and Safety, and Key Laboratory of Functional Dairy, College of Food Science and Nutritional Engineering, China Agricultural University, P.O. Box 287, No. 17 Qinghua East Road, Haidian, Beijing, 100083, People's Republic of China
| | - Zhongyao Du
- Beijing Laboratory of Food Quality and Safety, and Key Laboratory of Functional Dairy, College of Food Science and Nutritional Engineering, China Agricultural University, P.O. Box 287, No. 17 Qinghua East Road, Haidian, Beijing, 100083, People's Republic of China
| | - Lu Jiang
- Beijing Laboratory of Food Quality and Safety, and Key Laboratory of Functional Dairy, College of Food Science and Nutritional Engineering, China Agricultural University, P.O. Box 287, No. 17 Qinghua East Road, Haidian, Beijing, 100083, People's Republic of China
| | - Silu Chen
- Beijing Laboratory of Food Quality and Safety, and Key Laboratory of Functional Dairy, College of Food Science and Nutritional Engineering, China Agricultural University, P.O. Box 287, No. 17 Qinghua East Road, Haidian, Beijing, 100083, People's Republic of China
| | - Mingjie Zhang
- Beijing Higher Institution Engineering Research Center of Animal Product, Beijing, 100083, People's Republic of China
| | - Hao Zhang
- Beijing Laboratory of Food Quality and Safety, and Key Laboratory of Functional Dairy, College of Food Science and Nutritional Engineering, China Agricultural University, P.O. Box 287, No. 17 Qinghua East Road, Haidian, Beijing, 100083, People's Republic of China.
| | - Fazheng Ren
- Beijing Laboratory of Food Quality and Safety, and Key Laboratory of Functional Dairy, College of Food Science and Nutritional Engineering, China Agricultural University, P.O. Box 287, No. 17 Qinghua East Road, Haidian, Beijing, 100083, People's Republic of China
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Masuki S, Morita A, Kamijo YI, Ikegawa S, Kataoka Y, Ogawa Y, Sumiyoshi E, Takahashi K, Tanaka T, Nakajima M, Nose H. Impact of 5-aminolevulinic acid with iron supplementation on exercise efficiency and home-based walking training achievement in older women. J Appl Physiol (1985) 2016; 120:87-96. [PMID: 26514619 PMCID: PMC4698441 DOI: 10.1152/japplphysiol.00582.2015] [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] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/25/2015] [Indexed: 11/22/2022] Open
Abstract
A reduction in exercise efficiency with aging limits daily living activities. We examined whether 5-aminolevulinic acid (ALA) with sodium ferrous citrate (SFC) increased exercise efficiency and voluntary achievement of interval walking training (IWT) in older women. Ten women [65 ± 3(SD) yr] who had performed IWT for >12 mo and were currently performing IWT participated in this study. The study was conducted in a placebo-controlled, double-blind crossover design. All subjects underwent two trials for 7 days each in which they performed IWT with ALA+SFC (100 and 115 mg/day, respectively) or placebo supplement intake (CNT), intermittently with a 2-wk washout period. Before and after each trial, subjects underwent a graded cycling test at 27.0 °C atmospheric temperature and 50% relative humidity, and oxygen consumption rate, carbon dioxide production rate, and lactate concentration in plasma were measured. Furthermore, for the first 6 days of each trial, exercise intensity for IWT was measured by accelerometry. We found that, in the ALA+SFC trial, oxygen consumption rate and carbon dioxide production rate during graded cycling decreased by 12% (P < 0.001) and 11% (P = 0.001) at every workload, respectively, accompanied by a 16% reduction in lactate concentration in plasma (P < 0.001), although all remained unchanged in the CNT trial (P > 0.2). All of the reductions were significantly greater in the ALA+SFC than the CNT trial (P < 0.05). Furthermore, the training days, impulse, and time at fast walking were 42% (P = 0.028), 102% (P = 0.027), and 69% (P = 0.039) higher during the ALA+SFC than the CNT intake period, respectively. Thus ALA+SFC supplementation augmented exercise efficiency and thereby improved IWT achievement in older women.
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Affiliation(s)
- Shizue Masuki
- Department of Sports Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan; Institute for Biomedical Sciences, Shinshu University, Matsumoto, Japan; and
| | - Atsumi Morita
- Department of Sports Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Yoshi-ichiro Kamijo
- Department of Sports Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan; Institute for Biomedical Sciences, Shinshu University, Matsumoto, Japan; and
| | - Shigeki Ikegawa
- Department of Sports Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Yufuko Kataoka
- Department of Sports Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Yu Ogawa
- Department of Sports Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Eri Sumiyoshi
- Department of Sports Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | | | - Tohru Tanaka
- Department of R&D, SBI Pharmaceuticals Co., Ltd., Tokyo, Japan
| | - Motowo Nakajima
- Department of R&D, SBI Pharmaceuticals Co., Ltd., Tokyo, Japan
| | - Hiroshi Nose
- Department of Sports Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan; Institute for Biomedical Sciences, Shinshu University, Matsumoto, Japan; and
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Chekhun VF, Mokhir A, Daum S, Todor IN, Lukianova NY, Shvets YV, Burlaka AP. Pharmacological effect of aminoferrocene in mice with L1210 leukemia. Exp Oncol 2015; 37:120-125. [PMID: 26112939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM To study the cytostatic and some biological effects of aminoferrocene using mice with L1210 lymphoid leukemia. MATERIALS AND METHODS Experiments were performed on BDF1 male mice (DBA/2, female × C57Bl/6, male) with transplantable L1210 lymphoid leukemia. Determination of antitumor activity of Benzyl-Fc Boron (Bn), it was injected intraperitoneally 6 times daily, starting on day 2 after L1210 leukemia cell transplantation. Doses of Bn such as 26; 260 and 2600 μg/kg were used. The determination of intracellular content of cardiolipin, thiols, reactive oxygen species (ROS) and also analysis of Annexin V positivity and mitochondrial transmembrane potential (JC-1 staining) were performed with use of flow cytometry. The levels of "free iron" complexes, transferrin active forms and the rate of NO generation were measured by EPR-specroscopy. RESULTS Six daily injections of Bn at a dose of 26 μg/kg resulted in an increased survival of mice with L1210 leukemia by 28% (p < 0.05). Bn led to an increase of apoptotic cells number and ROS amount in leukemia cells. Besides, Bn caused a decrease of cardiolipin and nonprotein thiol compounds content. The membrane electrochemical potential of cell mitochondria was decreased also after Bn administration. Studies using EPR-spectroscopy revealed a significant increase in a level of "free iron", content of transferrin active species and generation rate of NO by inducible NO-synthase in L1210 cells after aminoferrocene administration. CONCLUSION Our data indicate that Benzyl-Fc Boron can be promising candidate for realizing a new strategy of anticancer therapy with the use of ROS-inducing agents.
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Affiliation(s)
- V F Chekhun
- R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology, NAS of Ukraine, Kyiv 03022, Ukraine
| | - A Mokhir
- Friedrich-Alexander University of Erlangen-Nürnberg, Department of Chemistry and Pharmacy, Organic Chemistry II, Henkestr. 42, Erlangen 91054, Germany
| | - S Daum
- Friedrich-Alexander University of Erlangen-Nürnberg, Department of Chemistry and Pharmacy, Organic Chemistry II, Henkestr. 42, Erlangen 91054, Germany
| | - I N Todor
- R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology, NAS of Ukraine, Kyiv 03022, Ukraine
| | - N Yu Lukianova
- R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology, NAS of Ukraine, Kyiv 03022, Ukraine
| | - Yu V Shvets
- R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology, NAS of Ukraine, Kyiv 03022, Ukraine
| | - A P Burlaka
- R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology, NAS of Ukraine, Kyiv 03022, Ukraine
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Müller-Wiefel DE, Waldherr R, Feist D, van Kaick G. The assessment of iron stores in children on regular dialysis treatment. Contrib Nephrol 2015; 38:141-52. [PMID: 6713891 DOI: 10.1159/000408080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
IMPORTANCE Although blood donation is allowed every 8 weeks in the United States, recovery of hemoglobin to the currently accepted standard (12.5 g/dL) is frequently delayed, and some donors become anemic. OBJECTIVE To determine the effect of oral iron supplementation on hemoglobin recovery time (days to recovery of 80% of hemoglobin removed) and recovery of iron stores in iron-depleted ("low ferritin," ≤26 ng/mL) and iron-replete ("higher ferritin," >26 ng/mL) blood donors. DESIGN, SETTING, AND PARTICIPANTS Randomized, nonblinded clinical trial of blood donors stratified by ferritin level, sex, and age conducted in 4 regional blood centers in the United States in 2012. Included were 215 eligible participants aged 18 to 79 years who had not donated whole blood or red blood cells within 4 months. INTERVENTIONS One tablet of ferrous gluconate (37.5 mg of elemental iron) daily or no iron for 24 weeks (168 days) after donating a unit of whole blood (500 mL). MAIN OUTCOMES AND MEASURES Time to recovery of 80% of the postdonation decrease in hemoglobin and recovery of ferritin level to baseline as a measure of iron stores. RESULTS The mean baseline hemoglobin levels were comparable in the iron and no-iron groups and declined from a mean (SD) of 13.4 (1.1) g/dL to 12.0 (1.2) g/dL after donation in the low-ferritin group and from 14.2 (1.1) g/dL to 12.9 (1.2) g/dL in the higher-ferritin group. Compared with participants who did not receive iron supplementation, those who received iron supplementation had shortened time to 80% hemoglobin recovery in both the low-ferritin (mean, 32 days, interquartile range [IQR], 30-34, vs 158 days, IQR, 126->168) and higher-ferritin groups (31 days, IQR, 29-33, vs 78 days, IQR, 66-95). Median time to recovery to baseline ferritin levels in the low-ferritin group taking iron was 21 days (IQR, 12-84). For participants not taking iron, recovery to baseline was longer than 168 days (IQR, 128->168). Median time to recovery to baseline in the higher-ferritin group taking iron was 107 days (IQR, 75-141), and for participants not taking iron, recovery to baseline was longer than 168 days (IQR, >168->168). Recovery of iron stores in all participants who received supplements took a median of 76 days (IQR, 20-126); for participants not taking iron, median recovery time was longer than 168 days (IQR, 147->168 days; P < .001). Without iron supplements, 67% of participants did not recover iron stores by 168 days. CONCLUSIONS AND RELEVANCE Among blood donors with normal hemoglobin levels, low-dose iron supplementation, compared with no supplementation, reduced time to 80% recovery of the postdonation decrease in hemoglobin concentration in donors with low ferritin (≤26 ng/mL) or higher ferritin (>26 ng/mL). TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01555060.
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Affiliation(s)
- Joseph E Kiss
- Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | | | - Simone A Glynn
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | | | - Mars Stone
- Blood Systems Research Institute, San Francisco, California
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Martorell R, Ascencio M, Tacsan L, Alfaro T, Young MF, Addo OY, Dary O, Flores-Ayala R. Effectiveness evaluation of the food fortification program of Costa Rica: impact on anemia prevalence and hemoglobin concentrations in women and children. Am J Clin Nutr 2015; 101:210-7. [PMID: 25527765 PMCID: PMC5884061 DOI: 10.3945/ajcn.114.097709] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Food fortification is one approach for addressing anemia, but information on program effectiveness is limited. OBJECTIVE We evaluated the impact of Costa Rica's fortification program on anemia in women aged 15-45 y and children aged 1-7 y. DESIGN Reduced iron, an ineffective fortificant, was replaced by ferrous fumarate in wheat flour in 2002, and ferrous bisglycinate was added to maize flour in 1999 and to liquid and powdered milk in 2001. We used a one-group pretest-posttest design and national survey data from 1996 (baseline; 910 women, 965 children) and 2008-2009 (endline; 863 women, 403 children) to assess changes in iron deficiency (children only) and anemia. Data were also available for sentinel sites (1 urban, 1 rural) for 1999-2000 (405 women, 404 children) and 2008-2009 (474 women, 195 children), including 24-h recall data in children. Monitoring of fortification levels was routine. RESULTS Foods were fortified as mandated. Fortification provided about one-half the estimated average requirement for iron in children, mostly and equally through wheat flour and milk. Anemia was reduced in children and women in national and sentinel site comparisons. At the national level, anemia declined in children from 19.3% (95% CI: 16.8%, 21.8%) to 4.0% (95% CI: 2.1%, 5.9%) and in women from 18.4% (95% CI: 15.8%, 20.9%) to 10.2% (95% CI: 8.2%, 12.2%). In children, iron deficiency declined from 26.9% (95% CI: 21.1%, 32.7%) to 6.8% (95% CI: 4.2%, 9.3%), and iron deficiency anemia, which was 6.2% (95% CI: 3.0%, 9.3%) at baseline, could no longer be detected at the endline. CONCLUSIONS A plausible impact pathway suggests that fortification improved iron status and reduced anemia. Although unlikely in the Costa Rican context, other explanations cannot be excluded in a pre/post comparison.
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Affiliation(s)
- Reynaldo Martorell
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
| | - Melany Ascencio
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
| | - Luis Tacsan
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
| | - Thelma Alfaro
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
| | - Melissa F Young
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
| | - O Yaw Addo
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
| | - Omar Dary
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
| | - Rafael Flores-Ayala
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
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Xu C, Dong C, Xu C, Han T, Bao S, Gao X. Effect of iron supplementation on the expression of hypoxia-inducible factor and antioxidant status in rats exposed to high-altitude hypoxia environment. Biol Trace Elem Res 2014; 162:142-52. [PMID: 25380676 DOI: 10.1007/s12011-014-0166-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 09/05/2014] [Accepted: 10/28/2014] [Indexed: 12/18/2022]
Abstract
Iron and oxygen are essential substance for cellular activity in body tissues. Hypoxia-inducible factors (HIFs) can respond to available oxygen changes in the cellular environment and regulate the transcription of a series of target genes. The study was conducted to investigate the effects of iron supplementation on the expression of hypoxia-inducible factor-1 alpha (HIF-1α) and antioxidant status in rats exposed to high-altitude hypoxia environment. Forty rats were divided into control (CON), hypobaric hypoxia (HH), and hypobaric hypoxia plus ferrous sulfate (FeSO4) (9.93 mg/kg body weight (BW)/day) (HFS) and hypobaric hypoxia plus iron glycinate chelate (Fe-Gly) (11.76 mg/kg BW/day) (HFG) groups. Results showed that Fe-Gly effectively alleviated weight loss and intestinal mucosa damage induced by hypobaric hypoxia, whereas FeSO4 aggravated hypobaric hypoxia-induced weight loss, liver enlargement, spleen atrophy, and intestinal damage. Iron supplementation decreased liver superoxide dismutase (T-SOD) and catalase (CAT) activity (P < 0.01) and increased iron concentration in the liver compared to HH group (P < 0.001). Moreover, Fe-Gly upregulated liver transferrin expression in messenger RNA (mRNA) level (P < 0.05) and downregulated serum erythropoietin (EPO) concentration (P < 0.01) and liver HIF-1α expression level (P < 0.05 in mRNA level; P < 0.001 in protein level) compared to HH group. The study indicated that FeSO4 supplementation at high altitudes aggravated the oxidative damage of tissues and organs that could be mediated through production of malondialdehyde (MDA) and inhibition antioxidant enzyme activities. Fe-Gly can protect hypobaric hypoxia-induced tissues injury. Moreover, iron supplementation at high altitudes affected HIF-1α-mediated regulating expression of targeting genes such as EPO and transferrin. The study highlights that iron supplementation under hypobaric hypoxia environment has possible limitation, and efficient supplementation form and dosage need careful consideration.
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Affiliation(s)
- Chunlan Xu
- The Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, 127 West Youyixi Road, Xi'an, Shaanxi, 710072, People's Republic of China,
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Affiliation(s)
- Thomas G DeLoughery
- From the Hematology Section, Knight Cancer Institute; and the Departments of Medicine, Pathology, and Pediatrics, Oregon Health and Science University, Portland
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Remizova MI, Gerbout KA, Grishina GV, Nagornaya KN. [Influence of the nitric oxide donors on the microcirculation in infusion therapy of the experimental hemorrhagic shock]. Patol Fiziol Eksp Ter 2014:91-95. [PMID: 25980233] [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: 06/04/2023]
Abstract
Infusion of the nitric oxide donors L-Arginine (150 mg/kg bolus) and Oxacom (3,2 µM/ kg bolus) with saline solution has been shown improves cardiovascular and metabolic changes in animal model of hemorrhagic shock. As a result improves survival rats. These data made this effect clinically attractive.
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Altun D, Kurekci AE, Gursel O, Hacıhamdioglu DO, Kurt I, Aydın A, Ozcan O. Malondialdehyde, antioxidant enzymes, and renal tubular functions in children with iron deficiency or iron-deficiency anemia. Biol Trace Elem Res 2014; 161:48-56. [PMID: 25099508 DOI: 10.1007/s12011-014-0084-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 06/06/2014] [Accepted: 07/15/2014] [Indexed: 12/15/2022]
Abstract
We aimed to investigate the effects of iron deficiency (ID) or iron-deficiency anemia (IDA) on oxidative stress and renal tubular functions before and after treatment of children. A total of 30 children with a diagnosis of IDA constituted the IDA group and 32 children with a diagnosis of ID constituted the ID group. Control group consisted 38 age-matched children. Serum ferritin, soluble transferrin receptor (sTfR), serum, and urinary sodium (Na), potassium (K), calcium (Ca), phosphorus (P), creatinine (Cr), uric acid (UA), urinary N-acetyl-β-D-glucosaminidase (NAG) levels, and intra-erythrocyte malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) levels were measured before and after iron therapy in the IDA and ID groups, whereas it was studied once in the control group. We have divided the study group in groups according to age (infants <2 years, children 3-9 years, and adolescents 10-15 years). Patients with IDA (infant, adolescent) and ID (infant, children, and adolescent) had a significantly high level of MDA in post-treatment period in comparison to those of healthy control. Patients with IDA (children, adolescent) and ID (infant, children) had a significantly high level of pre-treatment GSH-Px than controls. Post-treatment SOD was lower in IDA (children and adolescent) groups than control and post-treatment CAT was lower in IDA and ID (adolescent) groups than control. These findings show that ferrous sulfate used in the treatment of ID or IDA could lead to oxidative stress; however, a marked deterioration of in proximal renal tubular functions was not seen.
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Affiliation(s)
- Demet Altun
- Department of Pediatrics, Gulhane Military Medical Academy and Medical Faculty, Ankara, Turkey
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Leonard AJ, Chalmers KA, Collins CE, Patterson AJ. A study of the effects of latent iron deficiency on measures of cognition: a pilot randomised controlled trial of iron supplementation in young women. Nutrients 2014; 6:2419-35. [PMID: 24959952 PMCID: PMC4073160 DOI: 10.3390/nu6062419] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/06/2014] [Accepted: 06/16/2014] [Indexed: 11/16/2022] Open
Abstract
Rates of iron deficiency are high amongst healthy young women. Cognitive impairment occurs secondary to iron deficiency in infants and children, but evaluation of the impact on cognition among young women is inconsistent. The aim was to determine the suitability of the IntegNeuro test battery for assessing cognitive function in iron-deficient and iron-sufficient young women. A pilot double-blinded, placebo-controlled intervention trial was conducted in iron-deficient (serum ferritin ≤ 20 μg/L and haemoglobin > 120 g/L) and iron-sufficient young women (18-35 years). Cognitive function and haematological markers of iron status were measured at baseline and follow-up. Iron-deficient participants (n = 24) were randomised to receive placebo, 60 mg or 80 mg elemental iron daily supplements for 16 weeks. A control group of iron-sufficient participants (n = 8) was allocated to placebo. Change scores for Impulsivity and Attention were significantly greater in plasma ferritin improvers than in non-improvers (p = 0.004, p = 0.026). IntegNeuro was easy to administer and acceptable to young women. Based on the differences in Memory and Attention scores between iron-deficient participants on iron treatment and those on placebo, it was decided that between 26 and 84 participants would be required in each iron treatment group for an adequately powered extension of this pilot RCT.
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Affiliation(s)
- Alecia J Leonard
- Priority Research Centre in Physical Activity and Nutrition and School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Kerry A Chalmers
- School of Psychology, Faculty of Science and IT, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Clare E Collins
- Priority Research Centre in Physical Activity and Nutrition and School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Amanda J Patterson
- Priority Research Centre in Physical Activity and Nutrition and School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia.
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Spoerlein-Guettler C, Mahal K, Schobert R, Biersack B. Ferrocene and (arene)ruthenium(II) complexes of the natural anticancer naphthoquinone plumbagin with enhanced efficacy against resistant cancer cells and a genuine mode of action. J Inorg Biochem 2014; 138:64-72. [PMID: 24907976 DOI: 10.1016/j.jinorgbio.2014.04.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 11/17/2022]
Abstract
A series of ferrocene and (arene)ruthenium(II) complexes attached to the naturally occurring anticancer naphthoquinones plumbagin and juglone was tested for efficacy against various cancer cell lines and for alterations in the mode of action. The plumbagin ferrocene and (p-cymene)Ru(II) conjugates 1c and 2a overcame the multi-drug drug resistance of KB-V1/Vbl cervix carcinoma cells and showed IC50 (72 h) values around 1 μM in growth inhibition assays using 3-(4,5-dimethyl-2-yl)-2,5-diphenyltetrazolium bromide (MTT). They were further investigated for their influence on the cell cycle of KB-V1/Vbl and HCT-116 colon carcinoma cells, on the generation of reactive oxygen species (ROS) by the latter cell line, for their substrate character for the P-glycoprotein drug eflux pump via the calcein-AM efflux assays, and for DNA affinity by the electrophoretic mobility shift assay (EMSA). The derivatives 1c and 2a increased the number of dead cancer cells (sub-G0/G1 fraction) in a dose- and time-dependent manner. ROS levels were significantly increased upon treatment with 1c and 2a. These compounds also showed a greater affinity to linear DNA than plumbagin. While plumbagin did not affect calcein-AM transport by P-glycoprotein the derivatives 1c and 2a exhibited a 50% or 80% inhibition of the P-glycoprotein-mediated calcein-AM efflux relative to the clinically established sensitizer verapamil.
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Affiliation(s)
| | - Katharina Mahal
- Organic Chemistry Laboratory, University of Bayreuth, Universitätsstrasse 30, 95447, Bayreuth, Germany
| | - Rainer Schobert
- Organic Chemistry Laboratory, University of Bayreuth, Universitätsstrasse 30, 95447, Bayreuth, Germany
| | - Bernhard Biersack
- Organic Chemistry Laboratory, University of Bayreuth, Universitätsstrasse 30, 95447, Bayreuth, Germany.
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Milman N, Jønsson L, Dyre P, Pedersen PL, Larsen LG. Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial. J Perinat Med 2014; 42:197-206. [PMID: 24152889 DOI: 10.1515/jpm-2013-0153] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/08/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the effects of oral ferrous bisglycinate 25 mg iron/day vs. ferrous sulfate 50 mg iron/day in the prevention of iron deficiency (ID) and iron deficiency anemia (IDA) in pregnant women. DESIGN Randomized, double-blind, intention-to-treat study. SETTING Antenatal care clinic. SAMPLE 80 healthy ethnic Danish pregnant women. METHODS Women were allocated to ferrous bisglycinate 25 mg elemental iron (Aminojern®) (n=40) or ferrous sulfate 50 mg elemental iron (n=40) from 15 to 19 weeks of gestation to delivery. Hematological status (hemoglobin, red blood cell indices) and iron status (plasma iron, plasma transferrin, plasma transferrin saturation, plasma ferritin) were measured at 15-19 weeks (baseline), 27-28 weeks and 36-37 weeks of gestation. MAIN OUTCOME MEASURES Occurrence of ID (ferritin <15 μg/L) and IDA (ferritin <12 μg/L and hemoglobin <110 g/L). RESULTS At inclusion, there were no significant differences between the bisglycinate and sulfate group concerning hematological status and iron status. The frequencies of ID and IDA were low and not significantly different in the two iron groups. The frequency of gastrointestinal complaints was lower in the bisglycinate than in the sulfate group (P=0.001). Newborns weight was slightly higher in the bisglycinate vs. the sulfate group (3601±517 g vs. 3395±426 g, P=0.09). CONCLUSIONS In the prevention of ID and IDA, ferrous bisglycinate was not inferior to ferrous sulfate. Ferrous bisglycinate in a low dose of 25 mg iron/day appears to be adequate to prevent IDA in more than 95% of Danish women during pregnancy and postpartum.
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43
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Zespoł Ekspertów Polskiego Towarzystwa Ginekologicznego. [Statement of the Polish Gynecological Society Expert Group on the prevention of iron deficiency and of anemia caused by iron deficiency with a low dose heme iron in women. State of the art, 2013]. Ginekol Pol 2014; 85:74-8. [PMID: 24505970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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Abstract
SUBJECTS AND METHODS Study was conducted in Ain Shams University hospitals on 100 pregnant women with iron-deficiency anemia (IDA), including 50 cases infected with Helicobacter pylori (H. pylori) and 50 cases negative for H. pylori infection. Cases with symptomatic gastritis or hyperemesis gravidarum were not included in the study, obstetric history, sociodemographic and dietary variables were also assessed. Hemoglobin level, serum iron, serum ferritin, total iron binding capacity (TIBC), H. pylori serum antibody, stool analysis to exclude parasitic infection causing IDA, occult blood in stool and ultrasound for the fetus to ensure its cardiac pulsations and to exclude any associated abnormality were all done for all patients. Iron therapy in a fixed dose was given to all patients for 1 month. Response was estimated and statistical comparison was done between both groups. Eradication of H. pylori was done in positive cases by triple therapy in the second trimester and iron therapy was given after treatment in the same dose for another month. Their response to treatment after eradication was compared to their response to iron therapy prior to H. pylori eradication. RESULTS Hb levels, serum iron, serum ferritin were lower and TIBC was higher in H. pylori-infected cases than negative ones. The average rise of Hb in cases negative to H. pylori was higher than those positive to H. pylori. After comparing response of cases infected with H. pylori to iron therapy before and after eradication of H. pylori, it was found that rise of Hb was higher after treatment than before eradication of H. pylori. CONCLUSION Response to iron therapy in cases of iron deficiency anemia in patients without H. pylori infection was better than those infected with H. pylori. H. pylori eradication in the infected cases increased their response to iron therapy.
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Affiliation(s)
- Ehab H Nashaat
- Department of Internal Medicine, Ain Shams University, Cairo, Egypt
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Hoogeveen M, Ten Tusscher B. The iron bowel. Neth J Med 2013; 71:527-531. [PMID: 24394740] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- M Hoogeveen
- Department of Intensive care, VU University Medical Center, Amsterdam, the Netherlands
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Bittencourt LLDA, Pedrosa C, Sousa VPD, Pierucci APT, Citelli M. Pea protein provides a promising matrix for microencapsulating iron. Plant Foods Hum Nutr 2013; 68:333-9. [PMID: 23990387 DOI: 10.1007/s11130-013-0383-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Worldwide, the most prevalent nutritional deficiency is iron. The strategies for iron supplementation often fail due to poor adherence to supplementation methods contributed to unpleasant sensory characteristics. An alternative is the use of microencapsulated nutrients for home fortification in order to mask undesirable tastes and to allow its release in strategic sites of the gastrointestinal tract. Toward this end, pea protein concentrate was tested as a natural, edible and alternative material and the spray-drying technique was utilized for the preparation of microparticles containing ferrous sulfate. Their physical and chemical characteristics were evaluated. The microparticles had a spherical shape and grooves with an average size ranging between 2 and 3 μm. Analysis by in vitro assays tested the release of iron in simulated salivary and gastric fluids and its intestinal absorption in Caco-2 cells. No dissolution of iron occurred in the salivary medium whereas the sensory analysis showed good acceptance of a product which incorporated 5.5 mg of iron per 100 g portion of food. Thus, the effectiveness of microencapsulation was demonstrated by utilizing a plant protein as an encapsulating matrix for the controlled release of iron and capable of preserving the bioaccessibility of ferrous sulfate.
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Affiliation(s)
- Luciana Linhares de Azevedo Bittencourt
- Instituto de Nutrição, Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde, Bloco J/2º andar-Ilha do Fundão, Rio de Janeiro, RJ, 21941-590, Brazil
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47
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Steurer J. [Not Available]. Praxis (Bern 1994) 2013; 102:1432-1433. [PMID: 24220066 DOI: 10.1024/1661-8157/a001474] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Johann Steurer
- Horten-Zentrum für praxisorientierte Forschung und Wissenstransfer Universitätsspital Zürich
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48
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Affiliation(s)
- Nicole M Loo
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
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49
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[Early replenishment of iron reserves!]. MMW Fortschr Med 2013; 155:26. [PMID: 24279143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Cembranel F, Corso ACT, González-Chica DA. Coverage and adequacy of ferrous sulfate supplementation in the prevention of anemia among children treated at health centers of Florianopolis, Santa Catarina. Rev Paul Pediatr 2013; 31:315-23. [PMID: 24142313 PMCID: PMC4182967 DOI: 10.1590/s0103-05822013000300007] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 04/29/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the National Program of Iron Supplementation (PNSF) coverage, the compliance with the directions for of using of this supplementation and the association with sociodemographic factors in children aged six to 18 months old and registered in 35 public health centers of Florinópolis (Southern Brazil). METHODS Cross-sectional study using secondary data obtained from the health information system of the Health Department of Florianópolis, Santa Catarina, Brazil (Infosaúde). Data on ferrous sulfate supplementation and sociodemographic variables were obtained of all children registered in PNSF in Florianópolis in 2010. STATA 11.0 software was used in the analyses. RESULTS The PNSF covered 6.3% (95%CI 5.9-6.7) of the children; the compliance with the directions regarding age at the onset of supplementation and its frequency was adequate only in 2.4% of the cases (95%CI 1.5-3.7). There was no association with the child's gender, maternal education level and ethnicity or the distance from home to the health center. CONCLUSIONS This study showed low coverage and inadequate compliance with the PNSF directions. Measures to improve this strategy are urgent.
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Affiliation(s)
- Francieli Cembranel
- Mestre pelo Programa de Pós-Graduação em Nutrição do
Departamento de Nutrição da UFSC, Florianópolis, SC,
Brasil
| | - Arlete Catarina T. Corso
- Doutor em Saúde Pública pela Universidade de São Paulo
(USP); Professor-Titular do Programa de Pós-Graduação em Nutrição do
Departamento de Nutrição da UFSC, Florianópolis, SC,
Brasil
| | - David Alejandro González-Chica
- Doutor em Epidemiologia pela Universidade Federal de Pelotas
(UFPel); Professor-Adjunto do Programa de Pós-Graduação em Nutrição do
Departamento de Nutrição da UFSC, Florianópolis, SC,
Brasil
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