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1.
Sci Rep ; 11(1): 19618, 2021 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-34608227

RESUMO

The pathophysiology and the factors determining disease severity in COVID-19 are not yet clear, with current data indicating a possible role of altered iron metabolism. Previous studies of iron parameters in COVID-19 are cross-sectional and have not studied catalytic iron, the biologically most active form of iron. The study was done to determine the role of catalytic iron in the adverse outcomes in COVID-19. We enrolled adult patients hospitalized with a clinical diagnosis of COVID-19 and measured serum iron, transferrin saturation, ferritin, hepcidin and serum catalytic iron daily. Primary outcome was a composite of in-hospital mortality, need for mechanical ventilation, and kidney replacement therapy. Associations between longitudinal iron parameter measurements and time-to-event outcomes were examined using a joint model. We enrolled 120 patients (70 males) with median age 50 years. The primary composite outcome was observed in 25 (20.8%) patients-mechanical ventilation was needed in 21 (17.5%) patients and in-hospital mortality occurred in 21 (17.5%) patients. Baseline levels of ferritin and hepcidin were significantly associated with the primary composite outcome. The joint model analysis showed that ferritin levels were significantly associated with primary composite outcome [HR (95% CI) = 2.63 (1.62, 4.24) after adjusting for age and gender]. Both ferritin and serum catalytic iron levels were positively associated with in-hospital mortality [HR (95% CI) = 3.22 (2.05, 5.07) and 1.73 (1.21, 2.47), respectively], after adjusting for age and gender. The study shows an association of ferritin and catalytic iron with adverse outcomes in COVID-19. This suggests new pathophysiologic pathways in this disease, also raising the possibility of considering iron chelation therapy.


Assuntos
COVID-19/patologia , Ferro/sangue , Adulto , Idoso , COVID-19/mortalidade , COVID-19/virologia , Estudos Transversais , Feminino , Ferritinas/sangue , Ferritinas/metabolismo , Hepcidinas/sangue , Hepcidinas/metabolismo , Mortalidade Hospitalar , Humanos , Ferro/química , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Respiração Artificial , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Transferrina/química , Transferrina/metabolismo
2.
Nutrients ; 13(8)2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34444942

RESUMO

Celiac disease (CD) is an autoimmune chronic inflammatory disease occurring in genetically predisposed individuals in response to the intake of gluten. Clinical presentation can be heterogeneous. Iron-deficient anemia (IDA) is one of the most common extra-intestinal manifestations of CD. Although IDA usually reverts with a gluten-free diet (GFD), some patients show persistent IDA, the mechanisms of which are poorly understood. Recent studies suggest an association between the rs855791 polymorphism in the TMPRSS6 gene and persistent IDA in adults with CD. The current study aimed to assess the potential link between rs855791 and persistent IDA in pediatric patients with CD. The study included 106 children diagnosed with CD between 2015 and 2019. Clinical and blood parameters (including blood count, serum iron) were collected at diagnosis and after ≥12 months of GFD, and the rs855791 genotype was assessed for each patient. IDA was present at diagnosis in 25 patients (23.6%); only three (3%) had persistent IDA after GFD. The prevalence of rs855791 genotypes was 9% (n = 10) for TT, 53% (n = 56) for CT, and 38% (n = 40) for CC. There was a tendency toward a higher proportion of the T allele in patients with IDA and lower hemoglobin in the TT genotype but without statistical significance. An association between rs855791 and persistent IDA was not observed. These findings suggest that persistent IDA is uncommon in pediatric patients with CD. The prevalence of rs855791 in children with CD is reported for the first time.


Assuntos
Anemia Ferropriva/genética , Doença Celíaca/genética , Proteínas de Membrana/genética , Serina Endopeptidases/genética , Alelos , Anemia Ferropriva/sangue , Doença Celíaca/sangue , Doença Celíaca/dietoterapia , Criança , Dieta Livre de Glúten/métodos , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Ferro/sangue , Masculino , Polimorfismo de Nucleotídeo Único , Estudos Retrospectivos
3.
Nutrients ; 13(8)2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34444943

RESUMO

BACKGROUND: Micronutrient malnutrition is a form of undernutrition that causes diseases, and this is mainly due to insufficient intake of nutrients in daily foods. The status of micronutrients for people in Sudan remains scarce, and information is limited. The aim of this study is to highlight the status of micronutrients among women of reproductive age (15-49 years of age) and their children in Sudan. METHODS: This manuscript is a quantitative descriptive study, based on the data from Sudan Micronutrient Survey (SMS); it is part of the second round of the Simple Spatial Survey Method (S3M II) in Sudan (a total of 93,882 households). RESULTS: The level of consumption of vitamin A-rich foods was found to be moderate at 67.36% for reproductive-age women and low at 23.44% for under-five children. Similarly, consumption rate of vitamin B-rich foods among reproductive-age women was 62.13%, and low for children at 11.02%. The consumption of iron-, calcium-, and zinc-rich foods was moderate among women (66.75%, 47.69%, 69.72%, respectively) and very low in children (12.28%, 17.62%, 14.99%, respectively). The iron deficiency prevalence was 47% in non-pregnant women, 58% in pregnant women, and 54% in children. The prevalence of anemia was 30% in non-pregnant women, 37% in pregnant women, and 48% in children. Generally, urinary iodine concentration was inadequate in lactating and non-pregnant women as well as in pregnant women. Most indicators of micronutrients in Sudan for children and women of reproductive age were highly significant. Sudan needs more efforts to create an enabling environment through legislation, policies, and strategies to strengthen the nutrition-sensitive and specific interventions and improving status of micronutrients among women and children, focusing on food fortification, food supplements, and counseling on micronutrients intake for mothers during antenatal and postnatal services as well as raising community awareness.


Assuntos
Desnutrição/epidemiologia , Micronutrientes/deficiência , Estado Nutricional , Adolescente , Adulto , Anemia/epidemiologia , Anemia Ferropriva/epidemiologia , Pré-Escolar , Dieta/métodos , Suplementos Nutricionais , Feminino , Alimentos Fortificados , Humanos , Lactente , Ferro/administração & dosagem , Ferro/sangue , Masculino , Desnutrição/sangue , Desnutrição/urina , Pessoa de Meia-Idade , Gravidez , Reprodução , Sudão/epidemiologia , Inquéritos e Questionários , Vitamina A/administração & dosagem , Vitaminas/administração & dosagem , Vitaminas/sangue , Adulto Jovem , Zinco/administração & dosagem , Zinco/deficiência
5.
Nutrients ; 13(7)2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34371810

RESUMO

Ferrous sulphate (FS) is a cost effective, readily available iron supplement for iron deficiency (ID). The pro-oxidant effect of oral ferrous iron is known to induce inflammation, causing gastric side-effects and resulting in poor compliance. Curcumin is a potent antioxidant and has also been shown to exhibit iron chelation in-vitro, although it is not established whether these effects are retained in-vivo. The aim of this study was therefore to assess the influence of a formulated bioavailable form of curcumin (HydroCurcTM; 500 mg) on acute iron absorption and status in a double blind, placebo-controlled randomized trial recruiting 155 healthy participants (79 males; 26.42 years ± 0.55 and 76 females; 25.82 years ± 0.54). Participants were randomly allocated to five different treatment groups: iron and curcumin placebo (FS0_Plac), low dose (18 mg) iron and curcumin placebo (FS18_Plac), low dose iron and curcumin (FS18_Curc), high dose (65 mg) iron and curcumin placebo (FS65_Plac), and high dose iron and curcumin (FS65_Curc). Participants were provided with the supplements according to their relevant treatment groups at baseline (0 min), and blood collection was carried out at 0 min and at 180 min following supplementation. In the treatment groups, significant difference was observed in mean serum iron between baseline (0 min) and at end-point (180 min) (F (1, 144) = 331.9, p < 0.0001) with statistically significant intra-group increases after 180 min (p < 0.0001) in the FS18_Plac (8.79 µmol/L), FS18_Curc (11.41 µmol/L), FS65_Plac (19.09 µmol/L), and FS65_Curc (16.39 µmol/L) groups. A significant difference was also observed between the two time points in serum TIBC levels and in whole blood haemoglobin (HGB) in the treatment groups, with a significant increase (1.55%/2.04 g/L) in HGB levels from baseline to end-point observed in the FS65_Curc group (p < 0.05). All groups receiving iron demonstrated an increase in transferrin saturation (TS%) in a dose-related manner, demonstrating that increases in serum iron are translated into increases in physiological iron transportation. This study demonstrates, for the first time, that regardless of ferrous dose, formulated curcumin in the form of HydroCurc™ does not negatively influence acute iron absorption in healthy humans.


Assuntos
Absorção Fisiológica/efeitos dos fármacos , Curcumina/administração & dosagem , Suplementos Nutricionais , Compostos Ferrosos/administração & dosagem , Ferro/sangue , Administração Oral , Adulto , Disponibilidade Biológica , Método Duplo-Cego , Feminino , Ferritinas/sangue , Voluntários Saudáveis , Hemoglobinas/análise , Humanos , Proteínas de Ligação ao Ferro/sangue , Masculino , Transferrina/análise
7.
Am J Hematol ; 96(10): 1275-1286, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34310730

RESUMO

Hematopoietic cell transplantation (HCT) brings important alterations in erythropoiesis and iron metabolism. Hepcidin, which regulates iron metabolism, increases in iron overload or inflammation and decreases with iron deficiency or activated erythropoiesis. Erythroferrone (ERFE) is the erythroid regulator of hepcidin. We investigated erythropoiesis and iron metabolism after allogeneic HCT in 70 patients randomized between erythropoietin (EPO) treatment or no EPO, by serially measuring hepcidin, ERFE, CRP (inflammation), soluble transferrin receptor (sTfR, erythropoiesis), serum iron and transferrin saturation (Tsat; iron for erythropoiesis) and ferritin (iron stores). We identified biological and clinical factors associated with serum hepcidin and ERFE levels. Serum ERFE correlated overall with sTfR and reticulocytes and inversely with hepcidin. Erythroferrone paralleled sTfR levels, dropping during conditioning and recovering with engraftment. Inversely, hepcidin peaked after conditioning and decreased during engraftment. Erythroferrone and hepcidin were not significantly different with or without EPO. Multivariate analyses showed that the major determinant of ERFE was erythropoiesis (sTfR, reticulocytes or serum Epo). Pretransplant hepcidin was associated with previous RBC transfusions and ferritin. After transplantation, the major determinants of hepcidin were iron status (ferritin at all time points and Tsat at day 56) and erythropoiesis (sTfR or reticulocytes or ERFE), while the impact of inflammation was less clear and clinical parameters had no detectable influence. Hepcidin remained significantly higher in patients with high compared to low pretransplant ferritin. After allogeneic HCT with or without EPO therapy, significant alterations of hepcidin occur between pretransplant and day 180, in correlation with iron status and inversely with erythroid ERFE.


Assuntos
Eritropoese , Transplante de Células-Tronco Hematopoéticas , Hepcidinas/metabolismo , Ferro/metabolismo , Hormônios Peptídicos/metabolismo , Adulto , Idoso , Eritropoese/efeitos dos fármacos , Eritropoetina/uso terapêutico , Feminino , Hepcidinas/sangue , Humanos , Ferro/sangue , Masculino , Pessoa de Meia-Idade , Hormônios Peptídicos/sangue , Transplante Homólogo
8.
Nutrients ; 13(7)2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34203167

RESUMO

Polycystic ovary syndrome (PCOS) is a common disease in women of childbearing age. It is characterized by excessive androgen production, ovulation disorders, and developing metabolic syndrome. The aim of the study was to check whether selected minerals were related to the pathophysiological mechanisms of PCOS. The concentrations of minerals were determined using an inductively coupled atomic plasma-emission spectrometer (ICP-AES Jobin Yvon JY-24). Blood samples from PCOS and control women were collected, processed, and digested with a microwave system in women with PCOS with and without insulin resistance and in the control group. It was found: zinc (Zn)-10.14 ± 2.11, 9.89 ± 1.44 and 10.30 ± 1.67; nickel (Ni) 0.001 ± 0.0009, 0.001 ± 0.0006 and 0.002 ± 0.00001; iron (Fe) 868.0 ± 155.8, 835.3 ± 156.4 and 833.0 ± 94.6; manganese (Mn) 0.017 ± 0.006, 0.017 ± 0.008 and 0.020 ± 0.009; copper (Cu) 0.714 ± 0.129, 0.713 ± 0.114 and 0.761 ± 0.146; magnesium (Mg) 48.4 ± 8.3, 50.0 ± 8.4 and 45.3 ± 10.7; sodium (Na) 374.3 ± 84.3, 396.3 ± 66.6 and 367.9 ± 88.9; potassium (K) 2541.8 ± 330.9, 2409.6 ± 347.1 and 2336.9 ± 211.4 (µg/g). Some micronutrient deficiencies may have a negative effect on the lipid profile in PCOS patients (Ni, Na). Further studies are needed to better understand dependencies.


Assuntos
Minerais/sangue , Minerais/metabolismo , Síndrome do Ovário Policístico/sangue , Adolescente , Adulto , Composição Corporal , Cobre/sangue , Eritrócitos , Feminino , Humanos , Resistência à Insulina , Ferro/sangue , Metabolismo dos Lipídeos , Magnésio/sangue , Manganês/sangue , Níquel/sangue , Potássio/sangue , Sódio/sangue , Oligoelementos/sangue , Adulto Jovem , Zinco/sangue
10.
Am J Physiol Regul Integr Comp Physiol ; 321(2): R152-R161, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34160288

RESUMO

Current markers of iron deficiency (ID), such as ferritin and hemoglobin, have shortcomings, and hepcidin and erythroferrone (ERFE) could be of clinical relevance in relation to early assessment of ID. Here, we evaluate whether exposure to altitude-induced hypoxia (2,320 m) alone, or in combination with recombinant human erythropoietin (rHuEPO) treatment, affects hepcidin and ERFE levels before alterations in routine ID biomarkers and stress erythropoiesis manifest. Two interventions were completed, each comprising a 4-wk baseline, a 4-wk intervention at either sea level or altitude, and a 4-wk follow-up. Participants (n = 39) were randomly assigned to 20 IU·kg body wt-1 rHuEPO or placebo injections every second day for 3 wk during the two intervention periods. Venous blood was collected weekly. Altitude increased ERFE (P ≤ 0.001) with no changes in hepcidin or routine iron biomarkers, making ERFE of clinical relevance as an early marker of moderate hypoxia. rHuEPO treatment at sea level induced a similar pattern of changes in ERFE (P < 0.05) and hepcidin levels (P < 0.05), demonstrating the impact of accelerated erythropoiesis and not of other hypoxia-induced mechanisms. Compared with altitude alone, concurrent rHuEPO treatment and altitude exposure induced additive changes in hepcidin (P < 0.05) and ERFE (P ≤ 0.001) parallel with increases in hematocrit (P < 0.001), demonstrating a relevant range of both hepcidin and ERFE. A poor but significant correlation between hepcidin and ERFE was found (R2 = 0.13, P < 0.001). The findings demonstrate that hepcidin and ERFE are more rapid biomarkers of changes in iron demands than routine iron markers. Finally, ERFE and hepcidin may be sensitive markers in an antidoping context.


Assuntos
Doença da Altitude/sangue , Altitude , Epoetina alfa/administração & dosagem , Eritropoese/efeitos dos fármacos , Hematínicos/administração & dosagem , Hepcidinas/sangue , Ferro/sangue , Hormônios Peptídicos/sangue , Doença da Altitude/diagnóstico , Biomarcadores/sangue , Dinamarca , Método Duplo-Cego , Feminino , Homeostase , Humanos , Injeções Intravenosas , Masculino , Proteínas Recombinantes/administração & dosagem , Espanha , Fatores de Tempo
11.
J Pediatr Hematol Oncol ; 43(5): 186-192, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34157011

RESUMO

INTRODUCTION: To clarify mechanisms of ineffective erythropoiesis on iron metabolism, studies on erythroid factors that regulating hepcidin suppression have been carried out. The aim of the current study is to identify associations between erythropoiesis and iron homeostasis parameters in ß-thalassemias. MATERIALS AND METHODS: This study consisted of 83 subjects: 21 thalassemia major (TM), 20 thalassemia intermedia (TI), 20 thalassemia trait (TT), and 22 healthy subjects (HS). Erythroferrone (ERFE), hepcidin, growth differentiation factor-15 (GDF15), erythropoietin (EPO), and iron status parameters were measured. RESULTS: Our results showed that TM and TI patients had higher hepcidin than the TT and control groups. The hepcidin/ferritin in TM patients was significantly lower than the other groups. GDF15 in TM and TI patients was significantly higher than in the TT and control groups. Also, TI group had significantly higher ERFE concentration and EPO activity when compared with the TM, TT, and HS groups. EPO activity showed positive correlation with ERFE and GDF15 concentrations. We could not find any correlation between ERFE and hepcidin concentrations. CONCLUSIONS: ERFE may be one of the parameters used to demonstrate erythropoietic activity level in thalassemias. More detailed studies are needed to clarify the role of ERFE in iron metabolism in the patients with thalassemias.


Assuntos
Eritropoese , Ferro/sangue , Talassemia/sangue , Talassemia/terapia , Adolescente , Adulto , Transfusão de Sangue , Criança , Feminino , Fator 15 de Diferenciação de Crescimento/sangue , Hepcidinas/sangue , Humanos , Masculino , Hormônios Peptídicos/sangue , Adulto Jovem
12.
Salud Publica Mex ; 63(3 May-Jun): 359-370, 2021 May 03.
Artigo em Espanhol | MEDLINE | ID: mdl-34098609

RESUMO

OBJECTIVE: To describe the current status of micronutrient deficiencies (MD) and anemia in Mexican children. MATERIALS AND METHODS: Serum data from 1 382 pre-school-age chil-dren (1-4 years) and 3 590 school-age children (5-11 years) Ensanut 2018-19 participants were analyzed. Iron deficiency (ID), vitamin B12 deficiency (B12D), vitamin A depletion (VADp), and anemia were identified. Logistic regression models were used to identify associations between socio-demographic characteristics of children and MD. RESULTS: Anemia was present in 28.9 and 19.2% of the children aged 1-4 and 5-11, respectively; in ID 10 and 5.1%; B12D, in 5.1 and 4.8%, and VADp, in 4.7 and 4.3%. 18.5% of the preschool-age children and 13% of the school-age children had at least one MD associated to anemia. CONCLUSIONS: MD and anemia affect the younger children in larger proportion. Fortification and supplementation programs should be reinforced to avoid the long-term consequences of MD.


Assuntos
Anemia , Ferro , Estado Nutricional , Vitamina A , Vitamina B 12 , Anemia/epidemiologia , Criança , Pré-Escolar , Humanos , Lactente , Ferro/sangue , México/epidemiologia , Vitamina A/sangue , Vitamina B 12/sangue
13.
J Int Soc Sports Nutr ; 18(1): 44, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098993

RESUMO

BACKGROUND: Intensive physical exercise that competitive sports athletes participate in can negatively affect their pro-oxidative-antioxidant balance. Compounds with high antioxidant potential, such as those present in chokeberry (Aronia melanocarpa), can prevent these adverse changes. We here investigated the effect of antioxidant supplementation on oxidative stress balance in young footballers. METHODS: The study was designed as a double-blind randomized trial. Diet of a group of young football players (male; n = 20; mean age, 15.8 years-old) was supplemented with 200 ml of chokeberry juice per day, for 7 weeks. The players were randomly assigned to the experimental (supplemented, FP-S; n = 12) and control (placebo, FB-C; n = 8) groups. Before and after the supplementation period, the participants performed a beep test. Venous blood was sampled for serum analysis before, immediately after, 3 h, and 24 h after the beep test. Serum levels of thiobarbituric acid reactive products, 8-hydroxy-2'-deoxyguanosine, total antioxidant capacity, iron, hepcidin, ferritin, myoglobin, and albumin, and morphological blood parameters (red blood cells, (RBC), haemoglobin (HGB), haematocrit (HCT) mean corpuscular volume (MCV) mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), and lactic acid) were determined. RESULTS: Chokeberry juice supplementation did not significantly affect the outcome of the beep test. The supplementation did not significantly affect any of the morphological, biochemical, or performance parameters analysed. CONCLUSIONS: Chokeberry juice supplementation did not affect the measured parameters in the studied population, which may indicate insufficient antioxidant capacity of the juice.


Assuntos
Antioxidantes/administração & dosagem , Suplementos Nutricionais , Estresse Oxidativo , Futebol/fisiologia , Adolescente , Biomarcadores/sangue , Índice de Massa Corporal , Método Duplo-Cego , Sucos de Frutas e Vegetais , Testes Hematológicos , Hepcidinas/sangue , Humanos , Ferro/sangue , Masculino , Photinia , Albumina Sérica/metabolismo
14.
Nutrients ; 13(6)2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34064075

RESUMO

Celiac disease (CD) and autoimmune thyroid diseases (AITD) like Hashimoto's thyroiditis (HT) and Graves' disease (GD) frequently coexist, entailing numerous potential impacts on diagnostic and therapeutic approaches. Possible correlations might exist through gut microbiota, regulating the immune system and inflammatory responses, promoting autoimmune diseases, as well as shared cytokines in pathogenesis pathways, cross-reacting antibodies or malabsorption of micronutrients that are essential for the thyroid like iron or vitamin D. Vitamin D deficiency is a common finding in patients with AITD, but might protect from autoimmunity by wielding immunoregulatory and tolerogenic impacts. Additionally, vitamin D is assumed to be involved in the onset and progression of CD, presumably plays a substantial protective role for intestinal mucosa and affects the thyroid via its immunomodulatory effects. Iron is an essential micronutrient for the thyroid gland needed for effective iodine utilization by the iron-dependent enzyme thyroid iodine peroxidase (TPO). Despite being crucial for thyroid hormone synthesis, iron deficiency (ID) is a common finding in patients with hypothyroidism like HT and is frequently found in patients with CD. A literature research was conducted to examine the interplay between CD, AITD, vitamin D and iron deficiency. This narrative review highlights the relevant correlation of the two disease entities CD and AITD, their reciprocal impact and possible therapeutic options that should be further explored by future studies.


Assuntos
Doença Celíaca/imunologia , Ferro/imunologia , Glândula Tireoide/imunologia , Tireoidite Autoimune/imunologia , Vitamina D/imunologia , Autoimunidade/imunologia , Doença Celíaca/sangue , Microbioma Gastrointestinal/imunologia , Humanos , Ferro/sangue , Ferro/deficiência , Tireoidite Autoimune/sangue , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/imunologia
15.
Eur Rev Med Pharmacol Sci ; 25(10): 3772-3790, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34109586

RESUMO

Multiple epidemiological studies have suggested that industrialization and progressive urbanization should be considered one of the main factors responsible for the rising of atherosclerosis in the developing world. In this scenario, the role of trace metals in the insurgence and progression of atherosclerosis has not been clarified yet. In this paper, the specific role of selected trace elements (magnesium, zinc, selenium, iron, copper, phosphorus, and calcium) is described by focusing on the atherosclerotic prevention and pathogenesis plaque. For each element, the following data are reported: daily intake, serum levels, intra/extracellular distribution, major roles in physiology, main effects of high and low levels, specific roles in atherosclerosis, possible interactions with other trace elements, and possible influences on plaque development. For each trace element, the correlations between its levels and clinical severity and outcome of COVID-19 are discussed. Moreover, the role of matrix metalloproteinases, a family of zinc-dependent endopeptidases, as a new medical therapeutical approach to atherosclerosis is discussed. Data suggest that trace element status may influence both atherosclerosis insurgence and plaque evolution toward a stable or an unstable status. However, significant variability in the action of these traces is evident: some - including magnesium, zinc, and selenium - may have a protective role, whereas others, including iron and copper, probably have a multi-faceted and more complex role in the pathogenesis of the atherosclerotic plaque. Finally, calcium and phosphorus are implicated in the calcification of atherosclerotic plaques and in the progression of the plaque toward rupture and severe clinical complications. In particular, the role of calcium is debated. Focusing on the COVID-19 pandemia, optimized magnesium and zinc levels are indicated as important protective tools against a severe clinical course of the disease, often related to the ability of SARS-CoV-2 to cause a systemic inflammatory response, able to transform a stable plaque into an unstable one, with severe clinical complications.


Assuntos
Aterosclerose/patologia , Oligoelementos/metabolismo , Aterosclerose/metabolismo , COVID-19/patologia , COVID-19/virologia , Cálcio/sangue , Cálcio/metabolismo , Cobre/sangue , Cobre/metabolismo , Humanos , Ferro/sangue , Ferro/metabolismo , Magnésio/sangue , Magnésio/metabolismo , Metaloproteinases da Matriz/metabolismo , Fósforo/sangue , Fósforo/metabolismo , Risco , SARS-CoV-2/isolamento & purificação , Selênio/sangue , Selênio/metabolismo , Índice de Gravidade de Doença , Oligoelementos/sangue , Zinco/sangue , Zinco/metabolismo
16.
Sci Rep ; 11(1): 13431, 2021 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-34183735

RESUMO

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that leads to severe respiratory failure (RF). It is known that host exposure to viral infection triggers an iron-lowering response to mitigate pathogenic load and tissue damage. However, the association between host iron-lowering response and COVID-19 severity is not clear. This two-center observational study of 136 adult hospitalized COVID-19 patients analyzed the association between disease severity and initial serum iron, total iron-binding capacity (TIBC), and transferrin saturation (TSAT) levels. Serum iron levels were significantly lower in patients with mild RF than in the non-RF group; however, there were no significant differences in iron levels between the non-RF and severe RF groups, depicting a U-shaped association between serum iron levels and disease severity. TIBC levels decreased significantly with increasing severity; consequently, TSAT was significantly higher in patients with severe RF than in other patients. Multivariate analysis including only patients with RF adjusted for age and sex demonstrated that higher serum iron and TSAT levels were independently associated with the development of severe RF, indicating that inadequate response to lower serum iron might be an exacerbating factor for COVID-19.


Assuntos
COVID-19/patologia , Ferro/sangue , Adulto , Idoso , COVID-19/complicações , COVID-19/virologia , Feminino , Ferritinas/sangue , Hospitalização , Humanos , Ferro/metabolismo , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Insuficiência Respiratória/etiologia , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Transferrina/análise
17.
Nutrients ; 13(5)2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-34067098

RESUMO

Low-grade inflammation is often present in people living with obesity. Inflammation can impact iron uptake and metabolism through elevation of hepcidin levels. Obesity is a major public health issue globally, with pregnant women often affected by the condition. Maternal obesity is associated with increased pregnancy risks including iron deficiency (ID) and iron-deficiency anaemia (IDA)-conditions already highly prevalent in pregnant women and their newborns. This comprehensive review assesses whether the inflammatory state induced by obesity could contribute to an increased incidence of ID/IDA in pregnant women and their children. We discuss the challenges in accurate measurement of iron status in the presence of inflammation, and available iron repletion strategies and their effectiveness in pregnant women living with obesity. We suggest that pre-pregnancy obesity and overweight/obese pregnancies carry a greater risk of ID/IDA for the mother during pregnancy and postpartum period, as well as for the baby. We propose iron status and weight gain during pregnancy should be monitored more closely in women who are living with overweight or obesity.


Assuntos
Anemia Ferropriva/epidemiologia , Fenômenos Fisiológicos da Nutrição Materna , Obesidade/complicações , Sobrepeso/complicações , Complicações na Gravidez/epidemiologia , Adulto , Anemia Ferropriva/etiologia , Feminino , Ganho de Peso na Gestação , Humanos , Incidência , Ferro/sangue , Obesidade/sangue , Sobrepeso/sangue , Gravidez , Complicações na Gravidez/etiologia , Fatores de Risco
18.
Front Immunol ; 12: 624136, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33995348

RESUMO

Fetal anemia is common in malaria-endemic areas and a risk factor for anemia as well as mortality during infancy. Placental malaria (PM) and red cell abnormalities have been proposed as possible etiologies, but the relationship between PM and fetal anemia has varied in earlier studies, and the role of red cell abnormalities has not been studied in malaria-endemic areas. In a Tanzanian birth cohort study designed to elucidate the pathogenesis of severe malaria in young infants, we performed a cross-sectional analysis of risk factors for fetal anemia. We determined PM status, newborn red cell abnormalities, and maternal and cord blood levels of iron regulatory proteins, erythropoietin (EPO), cytokines and cytokine receptors. We examined the relationship between these factors and fetal anemia. Fetal anemia was present in 46.2% of the neonates but was not related to PM. Maternal iron deficiency was common (81.6%), most frequent in multigravidae, and interacted with parity to modify risk of fetal anemia, but it was not directly related to risk. Among offspring of iron-deficient women, the odds of fetal anemia increased with fetal α+-thalassemia, as well as these patterns of cord blood cytokines: increased cord IL-6, decreased TNF-RI, and decreased sTfR. The EPO response to fetal anemia was low or absent and EPO levels were significantly decreased in newborns with the most severe anemia. This study from an area of high malaria transmission provides evidence that 1) fetal α+-thalassemia and cytokine balance, but not PM at delivery, are related to fetal anemia; 2) maternal iron deficiency increases the risk that other factors may cause fetal anemia; and 3) fetal anemia has a multifactorial etiology that may require a variety of interventions, although measures that reduce maternal iron deficiency may be generally beneficial.


Assuntos
Anemia/etiologia , Citocinas/sangue , Eritropoetina/sangue , Doenças Fetais/etiologia , Feto/metabolismo , Malária/parasitologia , Placenta/parasitologia , Complicações Parasitárias na Gravidez/parasitologia , Talassemia alfa/complicações , Adulto , Anemia/sangue , Anemia/imunologia , Anemia/parasitologia , Biomarcadores/sangue , Estudos Transversais , Feminino , Doenças Fetais/sangue , Doenças Fetais/imunologia , Doenças Fetais/parasitologia , Feto/imunologia , Hemoglobinas/metabolismo , Humanos , Recém-Nascido , Ferro/sangue , Ferro/deficiência , Malária/sangue , Malária/imunologia , Masculino , Saúde Materna , Paridade , Placenta/imunologia , Placenta/metabolismo , Gravidez , Complicações Parasitárias na Gravidez/sangue , Complicações Parasitárias na Gravidez/imunologia , Medição de Risco , Fatores de Risco , Tanzânia , Transferrina/metabolismo , Adulto Jovem , Talassemia alfa/sangue , Talassemia alfa/imunologia
19.
Biomed Res Int ; 2021: 5560319, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33954177

RESUMO

Background: Iron overload in severe ß-thalassemia is a serious complication that occurs during the course of the disease. Information about the iron status during initial illness with ß-thalassemia major seemed to be limited. This study is aimed at analyzing iron status, serum hepcidin, and growth differentiation factor 15 (GDF15) levels in newly diagnosed ß-thalassemia major. Methods: A case-control study was performed at Dr. Hasan Sadikin General Hospital, which included 41 children with newly diagnosed ß-thalassemia major. Age- and sex-matched controls were enrolled. The subjects had no blood transfusion, had normal liver function, and had no sign of inflammation. The groups were compared in terms of the levels of hemoglobin (Hb), serum ferritin (SF), transferrin saturation (TS), serum hepcidin, and GDF15 as iron homeostasis parameters. Results: Of the 41 newly diagnosed ß-thalassemia major patients, those who were less than 24 months old had significantly lower median Hb levels than controls (5.0 vs. 11.7 g/dL, P < 0.001). The median SF and TS levels were significantly higher than those in controls (315.0 vs. 29.0 ng/mL, P < 0.001; 70.6 vs. 16.5%, P < 0.001), and median hepcidin was at the normal limit, but the value was higher in patients (251.0 vs. 123.1 ng/mL, P < 0.001). The median GDF15 level was significantly higher in patients (2,095.3 vs. 342.4 pg/mL, P < 0.001). There was a positive correlation between SF-TS, SF-hepcidin, TS-hepcidin, SF-GDF15, TS-GDF15, and hepcidin-GDF15 (P < 0.001). Conclusion: In newly diagnosed ß-thalassemia major, an increase in iron status occurred. This may be caused by increased iron absorption due to massive erythropoietic activity, characterized by an increase in GDF15 levels, which does not cause hepcidin suppression. The iron homeostasis response seems to be physiologically indicated by a tendency to increase hepcidin levels.


Assuntos
Eritropoese/fisiologia , Ferro/sangue , Talassemia beta , Estudos de Casos e Controles , Pré-Escolar , Feminino , Ferritinas/sangue , Fator 15 de Diferenciação de Crescimento/sangue , Hepcidinas/sangue , Humanos , Lactente , Recém-Nascido , Ferro/metabolismo , Masculino , Transferrina/análise , Talassemia beta/sangue , Talassemia beta/diagnóstico , Talassemia beta/epidemiologia
20.
Am J Physiol Gastrointest Liver Physiol ; 320(6): G1105-G1110, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33949198

RESUMO

Phlebotomies are performed in hereditary hemochromatosis (HH) to maintain normal iron concentrations. Proton-pump inhibitors (PPIs) can reduce the number of phlebotomies in patients with HH. However, in patients without HH, the iron concentrations do not appear to be compromised when using PPIs. Therefore, we aim to explain the differences in iron absorption between patients with and without HH. In 10 p.cysteine282tyrosine (p.C282Y) homozygous HH patients with normalized iron stores and 10 healthy control subjects (HCs), the iron parameters and hepcidin concentrations were determined before ingestion of a pharmacological dose of 50 mg iron [ferric iron (Fe3+)] polymaltose and hourly for 4 h afterward. This was repeated after 7 days of treatment with pantoprazole 40 mg once daily. Serum iron concentrations and transferrin saturation percentages dropped significantly during PPI use in the patients with HH, whereas no changes were observed in the HCs. Hepcidin concentrations were lower in the patients with HH compared with the HCs both before and during PPI use. In both groups, hepcidin levels did not significantly decrease during the treatment. Seven-day PPI use significantly reduces iron absorption in patients with HH but not in HCs. Changes in hepcidin concentrations could not explain these different PPI effects on iron absorption probably due to a small sample size.NEW & NOTEWORTHY This study confirms that lowering gastric acidity by proton pump inhibitors results in a reduction in iron absorption in patients with hemochromatosis and not in healthy control subjects. The presupposition that a decrease in hepcidin concentration in healthy control subjects in response to lowering gastric acidity can explain the difference in iron absorption between these groups could not be confirmed probably because of a small sample size.


Assuntos
Ferritinas/sangue , Hemocromatose/sangue , Hepcidinas/sangue , Ferro/sangue , Adulto , Índice de Massa Corporal , Feminino , Hemocromatose/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Pantoprazol/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico
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