Iron homeostasis during anemia of inflammation: a prospective study in patients with tuberculosis.

Cercamondi, Colin Ivano; Stoffel, Nicole; Moretti, Diego; Zoller, Thomas; Swinkels, Dorine W; Zeder, Christophe; Mhimibra, Francis; Hella, Jerry; Fenner, Lukas; Zimmermann, Michael Bruce (2021). Iron homeostasis during anemia of inflammation: a prospective study in patients with tuberculosis. (In Press). Blood American Society of Hematology 10.1182/blood.2020010562

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Anemia of inflammation is a hallmark of tuberculosis. Factors controlling iron metabolism during anemia of inflammation and its resolution are uncertain. Whether iron supplements should be given during anti-tuberculosis treatment to support Hb recovery is unclear. Before and during treatment of tuberculosis, we assessed iron kinetics, and changes in inflammation and iron metabolism indices. In a 26-wk prospective study, Tanzanian adults with tuberculosis (n=18) were studied before treatment and then every two weeks during treatment; oral and intravenous iron tracers were administered before treatment, after intensive phase (8/12 wk) and complete treatment (24 wk); no iron supplements were given. Before treatment, hepcidin and erythroferrone (ERFE) were greatly elevated, erythrocyte iron utilization was high (~80%) and iron absorption was negligible (<1%). During treatment, hepcidin and IL-6 decreased ~70% after only 2 wk (p<0.001); in contrast, ERFE did not significantly decrease until 8 wk (p<0.01). ERFE and IL-6 were the main opposing determinants of hepcidin (p<0.05) and greater ERFE was associated with reticulocytosis and hemoglobin (Hb) repletion (p<0.01). Dilution of baseline tracer concentration was 2.6-fold higher during intensive phase treatment (p<0.01) indicating enhanced erythropoiesis. After treatment completion, iron absorption increased ~20-fold (p<0.001); Hb increased ~25% (p<0.001). In tuberculosis-associated anemia of inflammation, our findings suggest elevated ERFE is unable to suppress hepcidin and iron absorption is negligible. During treatment, as inflammation resolves, ERFE may remain elevated, contributing to hepcidin suppression and Hb repletion. Iron is well-absorbed only after tuberculosis treatment and supplementation should be reserved for patients remaining anemic after treatment. (ClinicalTrials.gov Identifier:NCT02176772).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Fenner, Lukas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0006-4971

Publisher:

American Society of Hematology

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

28 Apr 2021 12:02

Last Modified:

29 Apr 2021 11:16

Publisher DOI:

10.1182/blood.2020010562

PubMed ID:

33876222

BORIS DOI:

10.48350/156078

URI:

https://boris.unibe.ch/id/eprint/156078

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