- Iron deficiency anemia-related gut microbiota dysbiosis in infants and young children: A pilot study. [Journal Article]
- AMActa Microbiol Immunol Hung 2018 Nov 12; :1-14
- Nutritional iron deficiency (ID) causes not only anemia but also malfunction of the entire human organism. Recently, a role of the gut microbiota has been hypothesized, but limited data are available...
Nutritional iron deficiency (ID) causes not only anemia but also malfunction of the entire human organism. Recently, a role of the gut microbiota has been hypothesized, but limited data are available especially in infants. Here, we performed a pilot study to explore the gut microbiota in 10 patients with iron deficiency anemia (IDA) and 10 healthy controls aged 6-34 months. Fresh stool samples were collected from diapers, and the fecal microbiota was profiled by next-generation sequencing of the V3-V4 hypervariable region of the 16S rRNA gene. Except for diet diversity, the breastfeeding status at the enrollment, the exclusive breastfeeding duration, and the introduction of complementary foods did not differ between groups. Distinct microbial signatures were found in IDA patients, with increased relative abundance of Enterobacteriaceae (mean relative abundance, patients vs. controls, 4.4% vs. 3.0%) and Veillonellaceae (13.7% vs. 3.6%), and reduced abundance of Coriobacteriaceae (3.5% vs. 8.8%) compared to healthy controls. A decreased Bifidobacteriaceae/Enterobacteriaceae ratio was observed in IDA patients. Notwithstanding the low sample size, our data highlight microbiota dysbalance in IDA worth for further investigations, aimed at unraveling the ID impact on the microbiome trajectory in early life, and the possible long-term consequences.
- Successful Management of Blue Rubber Bleb Nevus Syndrome (BRBNS) with Sirolimus. [Journal Article]
- CRCase Rep Pediatr 2018; 2018:7654278
- Blue rubber bleb nevus syndrome (BRBNS) is a rare disease with vascular malformations in several systems of the body, most commonly the skin and gastrointestinal tract. Bleeding from the gastrointest...
Blue rubber bleb nevus syndrome (BRBNS) is a rare disease with vascular malformations in several systems of the body, most commonly the skin and gastrointestinal tract. Bleeding from the gastrointestinal (GI) tract is a major complication, which may lead to chronic iron deficiency anemia and the need for frequent blood transfusions due to ongoing gastrointestinal blood loss. In this case report, we describe a now 19-year-old female with BRBNS who required six blood transfusions per year and after starting sirolimus is symptom- and transfusion-free.
- Liver iron sensing and body iron homeostasis. [Journal Article]
- BloodBlood 2018 Nov 06
- The liver orchestrates systemic iron balance by producing and secreting hepcidin. Known as the iron hormone, hepcidin induces degradation of the iron exporter ferroportin to control iron entry into t...
The liver orchestrates systemic iron balance by producing and secreting hepcidin. Known as the iron hormone, hepcidin induces degradation of the iron exporter ferroportin to control iron entry into the bloodstream from dietary sources, iron recycling macrophages, and body stores. Under physiologic conditions, hepcidin production is reduced by iron deficiency and erythropoietic drive to increase the iron supply when needed to support red blood cell production and other essential functions. Conversely, hepcidin production is induced by iron loading and inflammation to prevent the toxicity of iron excess and limit its availability to pathogens. Inability to appropriately regulate hepcidin production in response to these physiologic cues underlies genetic disorders of iron overload and deficiency, including hereditary hemochromatosis and iron refractory iron deficiency anemia. Moreover, excess hepcidin suppression in the setting of ineffective erythropoiesis contributes to iron loading anemias such as β-thalassemia, whereas excess hepcidin induction contributes to iron restricted erythropoiesis and anemia in chronic inflammatory diseases. These diseases have provided key insights into understanding the mechanisms by which the liver senses plasma and tissue iron levels, the iron demand of erythrocyte precursors, and the presence of potential pathogens, and importantly, how these various signals are integrated to appropriately regulate hepcidin production. This review will focus on recent insights into how the liver senses body iron levels and coordinates this with other signals to regulate hepcidin production and systemic iron homeostasis.
- Anemia of inflammation. [Journal Article]
- BloodBlood 2018 Nov 06
- Anemia of inflammation (AI) also known as anemia of chronic disease (ACD) is regarded as the most frequent anemia in hospitalized and chronically ill patients. It is prevalent in patients with diseas...
Anemia of inflammation (AI) also known as anemia of chronic disease (ACD) is regarded as the most frequent anemia in hospitalized and chronically ill patients. It is prevalent in patients with diseases that cause prolonged immune activation including infection, auto-immune diseases and cancer. More recently, the list has grown to include chronic kidney disease, congestive heart failure, chronic pulmonary diseases and obesity. Inflammation-inducible cytokines and the master regulator of iron homeostasis, hepcidin, block intestinal iron absorption and cause iron retention in reticuloendothelial cells resulting in iron-restricted erythropoiesis. In addition, shortened erythrocyte half-life, suppressed erythropoietin response to anemia and inhibition of erythroid cell differentiation by inflammatory mediators, further contribute to AI, in a disease-specific pattern. While the diagnosis of AI is a diagnosis of exclusion and is supported by characteristic alterations of iron homeostasis, hypoferremia and hyperferritinemia, the diagnosis of AI patients with coexisting iron deficiency is more difficult. Apart from treatment of the disease underlying AI, the combination of iron therapy and erythropoiesis-stimulating agents can improve anemia in many patients. In the future, emerging therapeutics which antagonize hepcidin function and re-distribute endogenous iron for erythropoiesis may offer additional options. However, based on experience with anemia treatment in chronic kidney disease, critical illness and cancer, finding the appropriate indications for the specific treatment of AI will require improved understanding and a balanced consideration of the contribution of anemia to each patient's morbidity and the impact of anemia treatment on the patient's prognosis in a variety of disease settings.
- Iron deficiency. [Journal Article]
- BloodBlood 2018 Nov 06
- Iron deficiency anemia affects >1.2 billions individuals worldwide and iron deficiency in the absence of anemia is even more frequent. Total body (absolute) iron deficiency is caused by physiological...
Iron deficiency anemia affects >1.2 billions individuals worldwide and iron deficiency in the absence of anemia is even more frequent. Total body (absolute) iron deficiency is caused by physiologically increased iron requirements in children, adolescents, young and pregnant women, by reduced iron intake or by pathological defective absorption or chronic blood loss. Adaptation to iron deficiency at tissue level is controlled by Iron Regulatory Proteins to increase iron uptake and retention; at systemic level suppression of the iron hormone hepcidin increases iron release to plasma by absorptive enterocytes and recycling macrophages. The diagnosis of absolute iron deficiency is easy unless masked by inflammatory conditions. All cases of iron deficiency should be assessed for treatment and for the underlying cause. Special attention is needed in areas endemic for malaria and other infections to avoid infection worsening by iron treatment. Ongoing efforts aim at optimizing the iron salts-based therapy by protocols of administration based on the physiology of hepcidin control and at reducing the common side effects of oral iron. Intravenous iron, especially last generation compounds administered at high dose in single infusions, is becoming an effective alternative in an increasing number of conditions, because of a more rapid and persistent hematological response, and an acceptable safety profile. Risks/benefits of the different treatments should be weighted in a personalized therapeutic approach to iron deficiency.
- Contributing factors to iron deficiency anemia in women in Jordan: A single-center cross-sectional study. [Journal Article]
- PlosPLoS One 2018; 13(11):e0205868
- CONCLUSIONS: 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.
- How I approach iron deficiency with and without anemia. [Journal Article]
- PBPediatr Blood Cancer 2018 Nov 04; :e27544
- Iron deficiency anemia remains a common referral to the pediatric hematology-oncology subspecialist. Improved understanding of iron homeostasis, including the effects of the regulatory hormone hepcid...
Iron deficiency anemia remains a common referral to the pediatric hematology-oncology subspecialist. Improved understanding of iron homeostasis, including the effects of the regulatory hormone hepcidin, recent adult and pediatric clinical trial data, as well as the availability of safer formulations of intravenous iron, have resulted in additional considerations when making treatment recommendations in such patients. Young children and adolescent females remain the most commonly affected groups, but children with complex medical or chronic inflammatory conditions including comorbid gastrointestinal disorders also require special consideration.
- Comparison of hypersensitivity reactions of intravenous iron: iron isomaltoside-1000 (Monofer® ) versus ferric carboxy-maltose (Ferinject® ). A single center, cohort study. [Journal Article]
- BJBr J Clin Pharmacol 2018 Nov 04
- CONCLUSIONS: Ferric carboxymaltose is associated with a 75% lower risk on HSRs compared with iron isomaltoside-1000 in our population. The presence of a comorbidity raises the likelihood of a HSR with a factor three regardless of the type of intravenous iron infusion. Further research is needed to clarify the underlying mechanism in various patient groups.
- An unexpected benefit from E. coli: how enterobactin benefits host health. [Comment]
- MCMicrob Cell 2018 Sep 27; 5(10):469-471
- Iron plays many critical roles in human biology, such as aiding the transport of oxygen and mediating redox reactions. Iron is essential for life, yet little is known about how iron is taken up into ...
Iron plays many critical roles in human biology, such as aiding the transport of oxygen and mediating redox reactions. Iron is essential for life, yet little is known about how iron is taken up into mitochondria to impact the labile iron pool. Iron deficiency is one of the most prevalent human nutrient-deficiency diseases in the world and is a major cause of anemia that affects >25% of the world's population, but unfortunately the current treatment (oral iron supplementation) is inefficient and has many side effects. A greater understanding of iron uptake, and discovery of molecules that aid in this process, may lead to more effective treatments for iron deficiency. In this study, we uncovered a unique and surprising role for an Escherichia coli-produced siderophore enterobactin (Ent) that facilitates iron uptake by the host, observed in both C. elegans and mammalian cells. Although siderophores are well-known Fe+3 scavengers, this activity has previously been described to only benefit iron acquisition by bacteria, not the host. This unexpected function is dependent on the binding of Ent to the host's ATP synthase α-subunit but is independent of other subunits of the ATP synthase. This finding marks a major shift regarding the role of this siderophore in the "iron tug-of-war" paradigm, which is often used to describe the fight between the bacteria and the host for this essential micronutrient. Instead, this study presents E. coli as a commensal "friend" that provides a molecule that supports the host's iron homeostasis. This work reveals a novel, beneficial role of a bacteria-generated molecule in aiding the host's iron homeostasis, and points to surprising new benefits from commensal bacteria.
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- The iron status of South African blood donors: balancing donor safety and blood demand. [Journal Article]
- TTransfusion 2018 Nov 01
- CONCLUSIONS: ID is common among South African donors; low hemoglobin, gender, ethnicity, and past donation history is independently associated with ID. Recommendations aimed at protecting donor health may increase blood shortages in South Africa.