Abstract

Background: Oral iron supplementation is commonly used to treat and prevent anaemia. The transmembrane protease serine 6 gene (TMPRSS6), which encodes matriptase 2, is a negative regulator of hepcidin, the key controller of iron homeostasis. Genome-wide association studies (GWAS) have identified several single nucleotide polymorphisms (SNPs) in the TMPRSS6 gene that are associated with an increased risk of iron-deficiency anaemia. We will investigate the in vivo effects of three previously reported TMPRSS6 variants (rs855791, rs4820268 and rs2235321) on oral iron absorption in non-anaemic volunteers in The Gambia. Methods: A recall-by-genotype study design will be employed. Pre-genotyped participants will be recruited from the West African BioResouce (WABR), which currently contains over 3000 genotyped individuals. Male and female volunteers will be selected based on polymorphisms (rs855791, rs4820268 and rs2235321) in the TMPRSS6 gene in the Gambian population. The effects of a single variant allele at one SNP and the additive effect of two or three variant alleles from either two or all three SNPs will be investigated. Study participants will be given a single oral dose of 400mg ferrous sulfate, and blood samples will be collected at baseline, two hours and five hours post supplementation. Differences in iron absorption between genotype groups will be assessed by measuring the increase in serum iron concentration at five hours post iron ingestion. Discussion: This study will increase understanding of the role of genetic variations in TMPRSS6 on oral iron absorption in subjects of West African origin. This will test for the biological basis for the association of each of the three TMPRSS6 variants with iron absorption. This may help in guiding future iron intervention strategies, particularly in populations with a high frequency of these SNPs and a high frequency of anaemia. Study registration: ClinicalTrials.gov NCT03341338 14/11/17.

Highlights

  • The statement “and may partially be responsible for disproportionately high anaemia prevalence in sub-Saharan Africa” has been changed to “these and other genetic variations may contribute to the high anaemia prevalence in subSaharan Africa”

  • A single nucleotide polymorphism (SNP) in the transmembrane protease serine 6 gene (TMPRSS6) gene can lead to decreased expression or inactivation of matripase-27, which would lead to inappropriately elevated hepcidin levels, inhibited iron absorption and would thereby result in an increased risk of anaemia5

  • Study design We will employ a recall-by-genotype study design, in which participant selection will be based on TMPRSS6 SNPs reported to be associated with the risk of iron-deficiency anaemia: rs855791, rs4820268 and rs223532110,14,15

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Summary

21 May 2019

1. Dale Nyholt , Queensland University of Technology, Brisbane, Australia Hamzeh MESRIAN TANHA, QUT, Brisbane, Australia. 2. Alida Melse-Boonstra , Wageningen University & Research, Wageningen, The Netherlands. Any reports and responses or comments on the article can be found at the end of the article. SNPs and a high frequency of anaemia. Keywords recall-by-genotype, iron supplementation; anaemia; TMPRSS6; hepcidin regulatory genes; genetic variants. Version 2 contains modifications that were made in response to the independent reviews

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