Dried plasma spot measurements of ferritin and transferrin receptor for assessing iron status.

BACKGROUND: Efforts to reduce the high global prevalence of nutritional anemia require the use of both reliable laboratory assays to distinguish iron deficiency from other causes of anemia and cost-effective methods for collection of blood specimens under field conditions. The suitability of using small plasma samples spotted and dried on filter paper for measurements of plasma ferritin and transferrin receptor was evaluated in the present study. METHODS: Blood specimens obtained from 73 male and 83 female subjects (19-40 years) representing a wide range of iron status were used to perform parallel measurements of plasma ferritin and transferrin receptor on whole plasma and spotted plasma samples. RESULTS: Ratio plots, evaluating the acceptability and precision of the spot method in ferritin and transferrin receptor assays, showed the expected proportion of data points within the 95% prediction interval. In the composite group of 156 subjects, both the whole plasma and plasma spot methods gave a geometric mean transferrin receptor/ferritin ratio of 18. The regression equation for the ratio was logy = 1.045 logx - 0.05126; r = 0.986; P <0.0001. The ratio of transferrin receptor/ferritin determined from plasma spots correctly identified all 12 subjects with iron deficiency anemia compared with 11 of the 12 for whole plasma measurements. CONCLUSIONS: Measurements of ferritin and transferrin receptor on plasma spotted and dried on filter paper are comparable to whole plasma values for the identification of iron deficiency anemia. The use of dried plasma spots will facilitate the collection, storage, and transport of samples in epidemiological studies of anemia prevalence.

Effects of TNF-alpha and IL-1beta on iron metabolism by A549 cells and influence on cytotoxicity.

Extracellular iron, which is predominantly bound by transferrin, is present in low concentrations within alveolar structures, and concentrations are increased in various pulmonary disorders. Iron accumulation by cells can promote oxidative injury. However, the synthesis of ferritin stimulated by metal exposure for intracellular iron storage is normally protective. The cytokines tumor necrosis factor (TNF)-alpha and interleukin (IL)-1beta may alter iron metabolism by alveolar cells. In this study, we assessed the effects of TNF-alpha and IL-1beta on iron metabolism with a cell line with properties of type 2 alveolar epithelial cells (A549) exposed to non-transferrin-bound (NTBI; FeSO(4)) or transferrin-bound (TBI) iron. In addition, we assessed the cytotoxicity of these exposures by measuring the cell accumulation of malondialdehyde (MDA), a product of lipid peroxidation, and cell death (MTT assay and lactate dehydrogenase release). A549 cells treated with NTBI or TBI in concentrations up to 40 microM accumulated iron and synthesized predominantly L-type ferritin without accumulation of MDA or cell death. Treatment of A549 cells with TNF-alpha (20 ng) or IL-1beta (20 ng) decreased cell transferrin-receptor expression and induced synthesis of H-type ferritin. TNF-alpha and IL-1beta decreased the uptake of TBI; however, the uptake of NTBI was increased. Both cytokines enhanced total ferritin synthesis (H plus L types) in response to iron treatments due to enhanced synthesis of H-type ferritin. Coexposure to TNF-alpha and NTBI, but not to TBI, induced MDA accumulation and greater cytotoxicity (MTT and lactate dehydrogenase release) than TNF-alpha alone. These findings indicate that TNF-alpha and IL-1beta modulate iron uptake by A549 cells, with differing effects on TBI and NTBI, as well as on H-ferritin synthesis. Enhanced iron uptake induced by TNF-alpha and NTBI was also associated with increased cytotoxicity to A549 cells.

An assessment of dried blood-spot technology for identifying iron deficiency.

The present study was undertaken to assess the feasibility of using ferritin and transferrin receptor measurements on dried capillary blood spots to identify iron deficiency (ID) in public health surveys. Measurements on serum and blood spots prepared from venous blood were performed in 71 healthy subjects, 41 of whom were iron-replete and 30 who had ID, either without (n = 20) or with (n = 10) anemia. Parallel measurements were performed on hemolyzed whole blood and washed hemolyzed red blood cells to assess the erythrocyte contribution of ferritin and transferrin receptor to dried blood samples. The concentration of ferritin in dried blood samples was threefold higher than serum assays due to the release of ferritin from hemolyzed erythrocytes, which diminished the usefulness of ferritin measurements for detecting ID. On the other hand, there was negligible erythrocyte contribution to the measurement of transferrin receptor in dried blood spots. The most sensitive parameter in dried blood spots was the ratio of receptor/ferritin, which was suitable for identifying iron-deficiency anemia (IDA), but less reliable than serum assays for detecting milder ID without anemia. We conclude that tandem measurements of serum ferritin and transferrin receptor in dried blood spots can be used to facilitate the identification of IDA in epidemiologic studies.

Alveolar macrophages accumulate iron and ferritin after in vivo exposure to iron or tungsten dusts.

Extracellular iron present in alveolar structures may contribute to oxidative lung injury induced by toxic mineral dusts by enhancing dust-induced generation of hydroxyl radicals. Alveolar macrophages (AMs) can sequester iron within ferritin and limit generation of hydroxyl radicals. In the current study we sought to assess whether AMs accumulate iron and ferritin after in vivo exposure to a dust with high iron content, to iron oxide, or to an inflammatory dust, calcium tungstate. We performed lung lavage 1, 7, 14, 28, 42, and 56 days after intratracheal instillation of mineral dust in saline solution or instillation of saline solution alone and quantitated cell recovery and AM content of iron and ferritin. Instillation of iron oxide increased neutrophil recovery only on a day 1 when compared with results in controls, whereas calcium tungstate increased neutrophil recovery through day 14. AMs recovered after instillation of iron oxide contained increased amounts of iron and ferritin, beginning on day 1 and progressing through day 56 after treatment (7.57 +/- 0.38 microgram iron per 10(6) AMs vs 1.54 +/- 0.28 microgram iron per 10(6) AMs for controls, p < 0.001; and 5908 +/- 768 ng ferritin per 10(6) AMs vs 395 +/- 20 ng ferritin per 10(6) AMs, p < 0.001). AMs recovered after calcium tungstate instillation also contained increased amounts of iron and ferritin beginning 14 days after treatment, with greatest content 42 days after treatment (4.85 +/- 0.68 microgram iron per 10(6) AMs, p < 0.001, and 2274 +/- 736 ng ferritin per 10(6) AMs, p < 0.001). Tumor necrosis factor, which can enhance iron accumulation by macrophages, was spontaneously released by AMs recovered from tungsten-treated rats. These studies indicate that AMs accumulate iron and ferritin in response to both iron loading of the lungs with iron oxide exposure and lung inflammation induced by calcium tungstate exposure.

MR of benign chondroblastoma of the temporal bone.

A benign chondroblastoma of the temporal bone in an 8-year-old boy is reported. Head CT showed an expansile mass with calcifications in the center. The tumor appeared as a well-lobulated, hypointense intraosseous mass on T1-weighted brain MR; it was isointense to brain parenchyma on intermediate-weighted images and enhanced homogenously with gadolinium.

Large amount of (apo)ferritin in the pancreatic insulin cell and its stimulation by glucose.

In screening a rat pancreatic islet cDNA library by differential hybridization for transcripts increased by glucose, the H chain of ferritin, an iron storage protein, was identified. An ELISA for rat ferritin showed that the insulin cell contains a surprisingly high amount of ferritin comparable to that of iron storage tissues. Most of the ferritin was located in the beta cell, as judged from colocalization of ferritin and insulin by immunohistochemical staining of the pancreas. Islets maintained for 24 h in culture medium containing 20 mM glucose are capable of releasing insulin in response to stimulation with glucose, but islets maintained at 1 mM glucose are incapacitated in response to glucose (see ref 1). Immunoassayable ferritin was threefold higher in 20 mM glucose islets than in 1 mM glucose islets and the glucose-stimulated increase in H ferritin mRNA was confirmed by probing Northern blots of islet RNA with authentic H and L chain cDNAs. This showed that H ferritin mRNA was four- to eightfold higher in 20 mM-glucose islets than in 1 mM glucose islets, whereas L ferritin mRNA was decreased 75-90% in 20 mM glucose islets relative to 1 mM glucose islets. The physiological reason for the abundance of (apo)ferritin in the beta cell is not readily apparent because the islet contains very little iron. Whether or not ferritin is used to handle another metal such as zinc, which is plentiful in the beta cell, is unknown. Another potential reason for ferritin in the beta cell is that ferritin has antioxidant properties and the beta cell is particularly sensitive to oxygen radicals. Regardless of its physiologic purpose, the high amount of ferritin can explain why iron is preferentially retained in the insulin cell and causes diabetes in diseases of iron overloading.

Alveolar macrophage content of isoferritins and transferrin. Comparison of nonsmokers and smokers with and without chronic airflow obstruction.

Alveolar macrophages (AM) contain iron and ferritin, and concentrations of both are increased in AM of smokers compared with nonsmokers. Ferritin stores iron in a nontoxic form but can release iron in the presence of reducing agents and thereby catalyze the generation of toxic hydroxyl radicals via the Haber-Weiss reaction. Two distinct isoferritins are found in peripheral monocytes, L ferritin and H ferritin. H ferritin is the predominant isoferritin in human monocytes and is more effective than L ferritin in detoxifying iron in vitro. In this study we quantitated content of H and L ferritins, transferrin, and iron in AM recovered by bronchoalveolar lavage (BAL) of 24 subjects, including eight nonsmokers, eight smokers with normal spirometry, and eight smokers with chronic airflow obstruction (CAO). Of total AM ferritin in nonsmokers 95% was composed of L ferritin. Smokers without CAO demonstrated a 6.5-fold increase in the AM content of L ferritin (1,886 +/- 266 versus 290 +/- 51 ng, mean +/- SEM; p less than 0.0001) and a 3.8-fold increase in H ferritin (61 +/- 18 versus 16 +/- 2 ng per 1 x 10(6) AM, p less than 0.01) compared with nonsmokers. Compared with smokers without CAO, AM recovered from smokers with CAO demonstrated a greater increase in L ferritin (5,059 +/- 493 versus 1,886 +/- 266 ng per 1 x 10(6) AM, p less than 0.002) but a similar increase in H ferritin (64 +/- 8 versus 61 +/- 18 per 1 x 10(6) AM).(ABSTRACT TRUNCATED AT 250 WORDS)

Stable lyophilized reagents for the serum ferritin assay.

Two monoclonal antibodies to human ferritin, including one that was coupled to horseradish peroxidase, were lyophilized. These reagents show little loss of activity on reconstitution and demonstrate acceptable stability in the accelerated degradation test. When applied in a simple ELISA for the assay of serum ferritin along with the WHO standard for serum ferritin (80/602) they provide a robust assay with standardized reagents which is potentially suitable for use as a reference assay.

Serum transferrin receptor is a truncated form of tissue receptor.

Recent studies have provided immunological evidence for the existence of transferrin receptor in human serum and have revealed that its concentration is a sensitive measure of erythropoiesis and iron deficiency. The present study was undertaken to establish the molecular identity of this immunoreactive component. Purification from human serum was accomplished by immunoaffinity chromatography using, as the ligand, monoclonal antitransferrin receptor antibody. The receptor preparation contained two major components with Mr of 75,000 and 85,000, which were identified as transferrin and transferrin receptor, respectively. The physicochemical and immunochemical properties of the 85,000 serum receptor were compared with those established for intact placental transferrin receptor. The serum receptor exhibited an apparent Mr = 85,000 on sodium dodecyl sulfate-polyacrylamide gel electrophoresis under non-reducing conditions, as compared with 190,000 for placental transferrin receptor. Upon reduction, the Mr of serum receptor was unaltered, whereas, the 190,000 placental receptor dimer decreased to the expected monomer value of 95,000. Amino-terminal amino acid sequence analysis revealed that residues 1-19 of serum receptor were identical to residues 101-119 of intact receptor. These findings provide physicochemical evidence for the existence of transferrin receptor in human serum, establish its molecular identity as a truncated form lacking the cytoplasmic and transmembrane domains (residues 1-100) of intact receptor, and demonstrate that it exists as a transferrin-receptor complex in serum.

Encephalopathy in AIDS patients: evaluation with MR imaging.

The presence and extent of encephalopathy were evaluated in 47 patients with AIDS or AIDS-related complex (ARC) by the use of MR imaging. Twenty-nine (62%) of the patients showed some form of white matter disease, exhibited as high signal intensity on T2-weighted images. Focal white matter lesions were seen in 23 (49%) of the patients, while a diffuse white matter process was observed in six patients (13%). Of the 29 patients who had white matter disease on MR scans, 17 (36%) had a suggestion of white matter involvement on an initial CT study. Meanwhile, 12 (26%) of the patients had a normal CT scan on the initial examination. MR findings showed predominant disease in the subinsular and peritrigonal white matter areas. Marked cerebral atrophy was observed in 17 (36%) of 47 patients, cerebellar atrophy in 18 (38%), and brainstem atrophy in seven patients (15%). Pathologic findings showed that toxoplasmosis was present in eight patients (17%), and primary CNS lymphoma was present in three patients (6%). Cryptococcal meningitis was noted in two (4%) of the patients at autopsy, and Mycobacterium tuberculosis was seen in one (2%) of the patients at autopsy. MR imaging has been shown to be a valuable technique for the detection of encephalopathy in AIDS patients.

Serum transferrin receptor measurements in hematologic malignancies.

An enzyme-linked immunosorbent assay using specific monoclonal antibodies was used to measure circulating transferrin receptor (TR) in 87 patients with various hematologic malignancies. The mean serum TR was significantly elevated in patients with myeloproliferative disorders (15.47 +/- 12.54 micrograms/ml), whereas there were no differences in chronic granulocytic leukemia (7.89 +/- 3.56 micrograms/ml), myelodysplastic disorders (9.25 +/- 4.73 micrograms/ml), and acute nonlymphocytic leukemia (3.85 +/- 3.50 micrograms/ml) as compared to normal (5.63 +/- 1.42 micrograms/ml). Among patients with lymphoproliferative disorders, the mean level was normal in lymphoma (5.73 +/- 2.59 micrograms/ml), multiple myeloma (5.47 +/- 1.31 micrograms/ml), and hairy cell leukemia (7.04 +/- 3.69 micrograms/ml). The serum TR was significantly elevated in chronic lymphocytic leukemia (CLL; 14.17 +/- 12.29 micrograms/ml), and the serum levels reflected the clinical stage of the disease. These findings suggest that serum TR measurement may provide a useful laboratory index of disease activity in certain disorders such as CLL, whereas it most likely reflects the intensity of erythropoiesis in the remaining hematological disorders that were evaluated in this study.

Serum transferrin receptor: a quantitative measure of tissue iron deficiency.

This study was undertaken to evaluate the role of serum transferrin receptor measurements in the assessment of iron status. Repeated phlebotomies were performed in 14 normal volunteer subjects to obtain varying degrees of iron deficiency. Serial measurements of serum iron, total iron-binding capacity, mean cell volume (MCV), free erythrocyte protoporphyrin (FEP), red cell mean index, serum ferritin, and serum transferrin receptor were performed throughout the phlebotomy program. There was no change in receptor levels during the phase of storage iron depletion. When the serum ferritin level reached subnormal values there was an increase in serum receptor levels, which continued throughout the phlebotomy program. Functional iron deficiency was defined as a reduction in body iron beyond the point of depleted iron stores. The serum receptor level was a more sensitive and reliable guide to the degree of functional iron deficiency than either the FEP or MCV. Our studies indicate that the serum receptor measurement is of particular value in identifying mild iron deficiency of recent onset. The iron status of a population can be fully assessed by using serum ferritin as a measure of iron stores, serum receptor as a measure of mild tissue iron deficiency, and hemoglobin concentration as a measure of advanced iron deficiency.

The clinical measurement of serum transferrin receptor.

Monoclonal antibody reagents were used to develop a sensitive enzyme-linked immunoassay for clinical measurement of circulating transferrin receptor. By using transferrin-bound receptor for the preparation of the immunologic reagents, we developed an assay that gives an identical dose-response curve with either free or transferrin-bound receptor. The mean concentration of circulating receptor in 82 normal male and female volunteers was 5.63 +/- 1.42 mg/L. The level was reduced significantly in patients with primary aplastic anemia and post-transplant aplasia (2.58 +/- 1.07 mg/L and 2.32 +/- 0.48 mg/L, respectively) and was sharply elevated in patients with hemolytic anemia and iron deficiency anemia (33.1 +/- 17 and 18.0 +/- 11.4 mg/L, respectively). Our assay values are approximately 20-fold higher than results published previously in a study that used an immunoradiometric assay. The disparity apparently relates to a difference in sensitivity of the latter assay for free and transferrin-bound receptor. Measurements of serum transferrin receptor provide a useful clinical index of either total or iron-deficiency erythropoiesis.