Discovery of hormone essential for iron supply

US researchers have discovered a new hormone that regulates the iron supply needed for the production of red blood cells. According to a study published in "Nature Genetics", the erythroferrone hormone is produced by red blood-cell progenitors in the bone marrow.

Stimulating the production of erythrocytes increases the release of erythroferrone. Subsequently, the hormone regulates the hormone hepcidin, which controls the absorption of iron from food and its distribution in the body. The higher the erythroferrone level, the higher the likelihood that hepcidin is blocked, which, in turn, makes more iron available for the production of red blood cells.

Both too much as well as too little iron can make a person ill. "Modulating the activity of erythroferrone could be a viable strategy for the treatment of iron disorders of both overabundance and scarcity", explained senior author Tomas Ganz from the University of California, Los Angeles.

The discovery may lead to treatments of other diseases associated with anaemia, such as chronic kidney disease, rheumatic disorders or inflammatory diseases. Under these conditions, hepcidin is increased due to inflammation, whereby the iron is practically "locked up". Erythroferrone, or drugs that have the same effect, could suppress hepcidin and thereby make more iron available for the production of red blood cells.

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Ref: Nature Genetics 46, 678–684 (2014)

Daily iron supplementation improved cognitive, physical performance in children with anemia

Children with anemia who received daily iron supplementation demonstrated improved cognitive performance and physical outcomes with few adverse effects, according to results of a systemic review and meta-analysis

Daily iron supplementation also improved hematologic outcomes, reducing the risk for anemia by 50% and the risk for iron deficiency by 79%.

Researchers used electronic databases, including MEDLINE and Embase, to search for randomized and quasi-randomized trials that evaluated the effects of daily iron supplementation in children aged 5 to 12 years.

Their analysis included 32 relevant studies, 31 of which were conducted in low- or middle-income settings. The most common study site was India (n=7), followed by Thailand (n=4), Indonesia (n=2) and Kenya (n=2).

The studies included a combined 7,089 children. Of them, 3,837 received oral iron supplementation at least 5 days per week. The other 3,252 children served as controls.

Nine of the studies assessed global cognitive performance.

Results showed children who received iron supplementation demonstrated higher global cognitive scores at the end of the intervention period compared with controls (standardized mean difference [SMD]=0.50; 95% CI, 0.11-0.90). Researchers also observed improvement among children who were anemic at baseline (SMD=0.29; 95% CI, 0.07-0.51).

IQ scores also improved in children with anemia who received iron supplementation (mean difference [MD]=4.55; 95% CI, 0.16-8.94).

All children who received iron supplementation demonstrated improvements in age-adjusted height, and those with anemia who received daily supplementation demonstrated improvements in age-adjusted weight.

Seven studies that included 1,763 children showed daily iron supplementation reduced risk for anemia (RR=0.50; 95% CI, 0.39-0.64). Four studies that included 1,020 children showed daily supplementation reduced risk for iron deficiency (RR=0.21; 95% CI, 0.07-0.63).

Researchers found that children who received iron were not at increased risk for malaria or gastrointestinal adverse effects compared with children who did not receive supplementation.

“Anemia and iron deficiency were prevalent in the included studies (69% and 59%, respectively, in the control groups. Thus, routine daily iron supplementation is likely to benefit cognitive performance in primary school-aged children in developing settings where anemia is prevalent and testing hemoglobin before iron supplementation may not be feasible,” the researchers wrote. “Daily iron supplementation could benefit educational attainment and economic potential at the individual level and, in settings where anemia is prevalent, population level.”

Low M. Can Med Assoc J. 2013;doi:10.1503/cmaj.130628.

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