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PubMed1993

Concordance of iron storage in siblings with genetic hemochromatosis: evidence for a predominantly genetic effect on iron storage.

Phenotypic concordance between siblings has been demonstrated in some inherited conditions, and such data provide strong evidence that the severity of disease is affected by genetic factors. We assessed the concordance of liver iron stores between siblings in 22 sibling pairs (15 same-sex pairs and 7 opposite-sex pairs) with genetic hemochromatosis. In this study population a wide range was found in the hepatic iron concentration and the hepatic iron index (32 to 833 mumol/gm dry wt and 1.65 to 14.4, respectively), which could not be accounted for by differing exposure to the environmental factors that influence iron stores. Despite the large variation of hepatic iron concentration within the group, siblings of identical sex had accumulated similar amounts of liver iron. A highly significant correlation for hepatic iron concentration (r = 0.81) and hepatic iron index (r = 0.70) was found between siblings of the same sex. The hepatic iron concentration and the hepatic iron index of one sibling was less than 50% of the other in only three same-sex sibling pairs. In each instance, reasons existed (blood donation, age at diagnosis and human leukocyte antigen nonidentity) for this discordance. In six of the seven opposite-sex pairs, the woman had lower hepatic iron stores than her male sibling, consistent with previous studies on the extent of iron overload in women and its modification by physiological blood loss.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Hemochromatosis and celiac sprue. Case report.

The patient presented with apparent hemochromatosis and celiac sprue, a unique combination not previously reported. Almost all patients with celiac sprue have an iron deficiency which is usually present very early, often antedating other manifestations of the condition.

Aged↗
PubMed1995

[Aplastic anemia complicated with secondary hemochromatosis after allogenic bone marrow transplantation].

We report a case of aplastic anemia complicated with secondary hemochromatosis after allogenic bone marrow transplantation (BMT). A 29-year-old man was diagnosed as having aplastic anemia at the age of 8. At the age of 28, BMT was performed from his HLA-identical sister. Total volume of blood transfusion before BMT was about 28,000 ml, and in three months after BMT was 8,000 ml. The transplantation was successful, but one month after BMT, dry eyes, skin pigmentation and hepatomegaly appeared. Serum bile duct enzymes and ferritin also increased remarkably. Moreover after thirteen months, glucose tolerance impaired seriously. Abdominal computed tomography (CT) revealed atrophic pancreas and an increased CT density in the liver and the tail of the pancreas. A large amount of iron deposition were also found in liver and stomach biopsy specimens. We concluded that diabetes mellitus was due to secondary hemochtomatosis in the present case. There is a possibility that tissue damage due to iron deposits may have been accelerated through BMT in this patient with a history of many blood transfusions.

Adult↗
PubMedDate not supplied

[Clinico-morphologic characteristics of primary hemochromatosis].

12 autopsy cases of primary hemochromatosis were studied: 11 males (aged between 29 and 69 years, mean age 51 years) and 1 57-year-old female. Clinical course in 6 patients ran with predominant liver damage to the small nodule or was of biliary cirrhosis type, in 3 cases main manifestation was diabetes mellitus and in 3 cases cardiomyopathy. Generalized pattern of hemosiderine deposits with involvement of the liver, pancreas, heart, adrenals, pituitary, epiphysis, thyroid and other organs was established by the Pearl's test. Apart from pigment degeneration, atrophy and fibrosis, compensatory and regenerative changes were found. These changes should be taken into account when the disease is analyzed clinically and morphologically.

Adult↗
PubMed1996

[Restrictive cardiac involvement in a patient with dyserythropoietic anemia and secondary hemochromatosis].

We report a case of a 63 year old woman diagnosed with dyserythropoietic anemia who was admitted to our hospital with congestive heart failure. Iron's metabolism disturbance, CT-Scan and magnetic resonance imaging allowed us to make the diagnosis of acquired hemochromatosis due to multiple transfusions. The echocardiographic study was compatible with a myocardial restrictive pattern caused by iron deposits.

Anemia, Dyserythropoietic, Congenital↗
PubMed1977

Idiopathic hemochromatosis and iron overload in alcoholic liver disease: differentiation by HLA phenotype.

HLA A and B antigens were determined in two groups of patients: 38 patients with idiopathic hemochromatosis (IH) and 22 patients with iron overload accompanying alcoholic liver disease (AH). As previously described, HLA A3 and HLA B14 antigens appeared more frequently in the IH group (76.3 and 28.9%, respectively) than in a control group of 204 subjects (27 and 3.4%). In the AH group the frequency of A3 (22.7%) and B14 (13.6%) was not significantly different from that observed in controls. The frequency of A3 was significantly lower in the AH group than in the IH group (P less than 0.001). On this basis a clear difference appears between the two conditions with iron overload, and genetic analysis of the results rules out the hypothesis that AH would be a heterozygous form of IH exposed by alcohol.

Adult↗
PubMed1996

[Current diagnosis: hereditary metabolic diseases of the liver (primary hemochromatosis, Wilson disease)].

Primary hemochromatosis is characterized by a specific pattern of clinical manifestations. It includes liver disease with hepatomegaly, glucose intolerance, e.g. diabetes, hyperpigmentation oft the skin, impotence/ amenorrhea, arthropathy, cardiomyopathy and fatigue. Laboratory investigation reveals significantly elevated serum ferritin and transferrin saturation with iron. The diagnosis is confirmed by liver biopsy and quantitative determination of elevated liver iron content. Wilson's disease represents a copper storage disease. Prominent clinical features are hepatomegaly and splenomegaly. Neurological alterations and detection of Kayser-Fleischer corneal rings are typical. In the acute initial phase the often young patients present with Coombs-negative hemolysis. Psychiatric alterations, cardiomyopathy, arthropathy, nephropathy, as well as thrombocytopenia and leucopenia are other clinical features. Laboratory parameters of Wilson's disease include low serum ceruloplasmin and serum copper. There is an elevated urinary copper excretion and elevated serum free copper concentration. The diagnosis is confirmed by liver biopsy with quantitative determination of an elevated liver copper content.

Adolescent↗
PubMed1997

Combined orthotopic heart and liver transplantation for genetic hemochromatosis.

A 47-year-old man with cirrhotic liver disease complicated by encephalopathy and class IV congestive heart failure caused by genetic hemochromatosis underwent combined orthotopic heart and liver transplantation. The patient remains well, working full time, 4 years after operation. Combined heart and liver transplantation is an effective therapy for selected patients with concurrent heart and liver failure caused by systemic iron overload.

Heart Failure↗
PubMed1997

Bone and joint involvement in genetic hemochromatosis: role of cirrhosis and iron overload.

OBJECTIVE: To evaluate the frequency of arthropathy and osteoporosis in genetic hemochromatosis (GH) and to quantify potential risk factors for these 2 conditions. METHODS: Radiographic evidence of arthropathy was systematically sought in plain radiographs of 32 patients (28 men) with histologically proven GH (17 with hepatic cirrhosis). Bone mineral density was measured by x-ray absorptiometry of L2-L4 and osteoporosis was defined as a T score > or = 2.5 standard deviation below the mean. Potential risk factors investigated were age, body mass index, cirrhosis, alcohol abuse, hepatitis B and C infections, HLA phenotype, serum free testosterone levels, and the amount of iron removed by phlebotomy to reach depletion. The independent role of risk factors for the presence of osteoporosis was tested by multiple logistic regression analysis. RESULTS: Radiologic signs of arthropathy were observed in 81.3% of cases. Patients with arthropathy were older than patients without (p < 0.001), but did not differ in the frequency of cirrhosis, amount of iron removed, and HLA typing. Osteoporosis was observed in 9 patients and was positively associated with the amount of iron removed and cirrhosis. However, in multivariate analysis, cirrhosis was not independently associated with osteoporosis, but patients with higher iron removed had a greater probability to have osteoporosis [odds ratio (OR) = 3.23 for any increase of 5 g, 95% confidence interval (CI): 1.09-9.58], whereas the presence of HLA-A3 was associated with a reduction of risk (OR 0.013, 95% CI: 0.0015-1.13). CONCLUSION: These findings indicate the high prevalence of osteoarticular involvement in Italian patients with GH. Neither cirrhosis nor the amount of iron removed was associated with arthropathy. In contrast, in univariate analysis the risk of osteoporosis was significantly increased by liver cirrhosis. With multivariate analysis we found that osteoporosis was highly influenced by the degree of iron overload, playing an independent role in accelerating bone loss in patients with GH.

Adult↗
PubMed1997

A recombination event close to HFE gene in hereditary hemochromatosis.

A candidate gene for Hereditary Hemochromatosis (HFE) has been recently cloned from a region 4 cM telomeric to HLA-A on the short arm of chromosome 6. This gene, defined HFE, is mutated in a high proportion of HFE patients. Positional cloning of HFE has been difficult, because of the extended region of linkage disequilibrium observed around the gene and of the rarity of recombination events in this DNA area. Here we describe a crossover in an Italian HFE patient which occurred close to the HFE gene in a restricted interval between D6S2221 and D6S2240-D6S2238 markers. The molecular analysis of this event and the segregation of the HFE mutations in the family are consistent with the position of the HFE gene telomeric to D6S2221.

Adult↗
PubMed1997

[Hereditary hemochromatosis. Genetic findings result in new therapeutic possibilities].

Hereditary haemochromatosis is a well-known disease characterised by abnormally high iron absorption and a variety of clinical manifestations. As it's expression is dependent on such factors as gender and diet, it has often been difficult to diagnose before the onset of damage to different organs. However, since the recent discovery of the gene for hereditary hemochromatosis, early detection and treatment of the disease has become possible.

Gene Frequency↗
PubMedDate not supplied

Understanding iron absorption and metabolism, aided by studies of hemochromatosis.

Duodenal iron absorption from food is selectively blocked to prevent iron intoxication. The prime example of pathologic increase in intestinal iron absorption is seen in patients with hemochromatosis. They suffer iron damage to the heart, liver, and other tissues resulting in premature death if the iron is not removed by vigorous phlebotomy. Examples of overcoming the intestinal barrier to iron are alcohol consumption, vitamin preparations with vitamin C, and iron consumed by individuals without anemia. Endogenous generation of excess iron by hemolysis, owing to abnormal hemoglobin or many transfusions, are not controlled by the intestinal barrier.

Ferritins↗
PubMed1998

Response of monocyte iron regulatory protein activity to inflammation: abnormal behavior in genetic hemochromatosis.

In genetic hemochromatosis (GH), iron overload affects mainly parenchymal cells, whereas little iron is found in reticuloendothelial (RE) cells. We previously found that RE cells from GH patients had an inappropriately high activity of iron regulatory protein (IRP), the key regulator of intracellular iron homeostasis. Elevated IRP should reflect a reduction of the iron pool, possibly because of a failure to retain iron. A defect in iron handling by RE cells that results in a lack of feedback regulation of intestinal absorption might be the basic abnormality in GH. To further investigate the capacity of iron retention in RE cells of GH patients, we used inflammation as a model system as it is characterized by a block of iron release from macrophages. We analyzed the iron status of RE cells by assaying IRP activity and ferritin content after 4, 8, and 24 hours of incubation with lipopolysaccharide (LPS) and interferon-gamma (IFN-gamma). RNA-bandshift assays showed that in monocytes and macrophages from 16 control subjects, IRP activity was transiently elevated 4 hours after treatment with LPS and IFN-gamma but remarkably downregulated thereafter. Treatment with NO donors produced the same effects whereas an inducible Nitric Oxide Synthase (iNOS) inhibitor prevented them, which suggests that the NO pathway was involved. Decreased IRP activity was also found in monocytes from eight patients with inflammation. Interestingly, no late decrease of IRP activity was detected in cytokine-treated RE cells from 12 GH patients. Ferritin content was increased 24 hours after treatment in monocytes from normal subjects but not in monocytes from GH patients. The lack of downregulation of IRP activity under inflammatory conditions seems to confirm that the control of iron release from RE cells is defective in GH.

Adult↗
PubMed1985

Genetic analysis of idiopathic hemochromatosis using both qualitative (disease status) and quantitative (serum iron) information.

An ongoing family study of idiopathic hemochromatosis in Brittany, France, allowed us to investigate the segregation of this trait and its linkage and association to the HLA-A locus in 147 pedigrees, comprising 1,408 individuals with over 900 characterized for relevant biological parameters and typed for HLA. The joint consideration of affection status and serum iron concentration reveals no dominance effect on the latter trait and documents the increased information afforded by the consideration of a biological correlate of liability to affection for disease exhibiting incomplete penetrance. Our overall results are in general agreement with published results on a Utah family study.

Female↗
PubMed1997

[Multiple hepatosplenic abscesses caused by Yersinia enterocolitica in a patient with hemochromatosis].

Yersinia enterocolitica is a gram-negative bacillus that thrives in conditions associated with iron overload. We describe an unusual case of a diabetic patient with a previously unrecognized hemochromatosis presenting with Y. enterocolitica septicemia. He was admitted because of a 10 day history of abdominal pain, fever and jaundice. Blood cultures grew Y. enterocolitica. The abdomen CT scan showed multiple liver and splenic abscesses. Antibiotic treatment with ciprofloxacin (2 months) resulted in a good clinical response. Serum iron studies showed iron overload. Liver biopsy revealed moderate fibrosis and early cirrhosis with large amounts of hemosiderin granules deposited in hepatocytes and bile duct epithelium. This report reviews the literature and highlights that iron overload must be ruled out in Yersinia septicemia patients.

Abscess↗
PubMed1998

Molecular genetics and control of iron metabolism in hemochromatosis.

BACKGROUND AND OBJECTIVES: Hereditary hemochromatosis (HC) is an inborn error of iron metabolism that leads to progressive iron overload. Considerable advances in the knowledge of molecular events in iron metabolism have been recently obtained. These molecular findings, the cloning of the gene responsible for HC (HFE gene) and the results of preliminary studies on the HFE protein prompted us to review this topic. INFORMATION SOURCES: The material examined in this review article includes papers and abstracts published in the Journals covered by the Science Citation Index and Medline. The authors have been working in the field of HC for several years and have contributed eleven of the quoted papers. STATE OF ART AND PERSPECTIVE: HC is now recognized as the genetic disease characterized by the homozygosity for the Cys-->Tyr substitution at position 282 (C282Y) of the HFE protein. The mutation abolishes the association of the HFE protein with beta 2-microglobulin (beta 2M), making the complex unable to gain the cell surface. Thus HC is an example of abnormal trafficking of the corresponding proteins. It is clear by the analysis of its structure that HFE protein is not an iron transporter itself, but has a regulatory role in iron metabolism. Its peculiar localization in the crypt cells of the small intestine suggests an important role in iron trafficking at this level. However, other proteins are involved in iron uptake, as the recently cloned Nramp2, the first iron transporter discovered in mammalians. Nramp2 has a recognized role both in the intestinal iron uptake and in the iron transport within the erythroblast. The relationships between HFE and Nramp2 are still unexplored. The recent association of HFE gene with transferrin receptor (TfR) in trophoblast cells opens new possibilities on its role in cellular iron uptake. The existence of other forms of genetic iron overload suggests that the scenario of iron proteins is not yet fully defined. Further studies in this field will contribute to our knowledge of iron metabolism regulation in humans.

Hemochromatosis↗
PubMed1998

Iron release from human monocytes after erythrophagocytosis in vitro: an investigation in normal subjects and hereditary hemochromatosis patients.

This study investigated the release of erythrocyte-derived iron from purified human monocytes obtained from healthy volunteers and hereditary hemochromatosis (HH) patients. After erythrophagocytosis of 59Fe-labeled erythrocytes, a complete transfer of iron from hemoglobin (Hb) to ferritin was observed within 24 hours in both control and HH monocytes. The iron was released from the monocytes in the form of ferritin, Hb, and as nonprotein bound low molecular weight iron (LMW-Fe). During the initial rapid phase (<1.5 hours), iron release mostly consisted of Hb and LMW-Fe, while in the later phase (>1.5 hours), it was composed of ferritin and LMW-Fe. The kinetics of iron release were identical for HH monocytes. A high percentage of the total amount of iron was released as Hb both by viable normal and HH monocytes, suggesting that iron release as Hb is a physiologic process, which may occur whenever the erythrocyte-processing capacity of macrophages is exceeded. Most remarkably, HH monocytes released twice as much iron in a LMW form as control cells. Iron released in the form of LMW-Fe readily binds to plasma transferrin and may contribute to the high transferrin saturation and the occurrence of circulating nontransferrin-bound iron observed in HH patients.

Adult↗
PubMed1998

[Pathogenetic aspects of hemolysis and changes of blood rheology in hereditary hemochromatosis].

AIM: To establish changes of and correlations between erythrodieresis and blood rheology in hereditary hemochromatosis (HHC). MATERIALS AND METHODS: Hemorheologic indices (asymptomatic blood and plasma viscosity, that of blood at low shift speed, red cell deformity and aggregation) were studied in 42 HHC patients and 23 healthy donors. The patients were divided into groups by homozygous (groups 1 and 2) or heterozygous (groups 3 and 4) allel genes and sex (females-groups 2 and 4, males-groups 1 and 3). RESULTS: All the patients had increased resistance of red cells in high percentage of their high-resistance populations (correlation index 0.8-0.9) due to destruction and elimination from the circulation. These changes were more pronounced in males, similar in homo- and heterozygotes. The presence in the peripheral blood of red cells with high resistance is associated with a 25-30% decrease in the red cell rigidity, in groups 1 and 3 this decrease reached 30-40%. To a certain degree high deformity and aggregation of red cells is explained by high plasma viscosity (correlation index 0.4). Plasma viscosity was high in all the patients of all groups. CONCLUSION: HHC runs with rejuvenascence of erythroid cells. Changed activity of erythrodieresis and damage to red cells at the level of microcirculation may be involved in iron metabolism disturbance and development of tissue hemosiderosis.

Adolescent↗