Abstract
Iron supplementation and fortification are used to treat iron deficiency, which is often associated with gastrointestinal conditions, such as inflammatory bowel disease and colorectal cancer. Within the gut, commensal bacteria contribute to maintaining systemic iron homeostasis. Disturbances that lead to excess iron promote the replication and virulence of enteric pathogens. Consequently, research has been interested in better understanding the effects of iron supplementation and fortification on gut bacterial composition and overall gut health. While animal and human trials have shown seemingly conflicting results, these studies emphasize how numerous factors influence gut microbial composition. Understanding how different iron formulations and doses impact specific bacteria will improve the outcomes of iron supplementation and fortification in humans. Furthermore, discerning the nuances of iron supplementation and fortification will benefit subpopulations that currently do not respond well to treatment.
Highlights
The majority of living organisms require iron for survival
Iron absorption was reduced in rats [47] and rabbits [48] treated with antibiotics. These results, seem to conflict with a more recent study in mice that found iron absorption increased following antibiotic treatment [37]. These findings suggest that antibiotic administration may improve iron absorption in patients with iron deficiency
Iron supplementation and fortification studies have demonstrated that there are several factors, including diet, hygiene, inflammation status, disease burden, and genetics, that influence the complex interplay between iron and the gut
Summary
The majority of living organisms require iron for survival. Iron can exist in one of two oxidation states, and due to this redox potential, can function in several fundamental processes, such as respiration, DNA replication, energy production, and cellular proliferation [1]. Humans absorb iron from their diet in a dynamic, tightly regulated process within the intestine [2]. In addition to controlling the amount of iron absorbed, this process dictates iron availability for the complex community of bacteria living in the intestine, hereafter referred to as the gut microbiota. We cover the effects of oral iron supplementation and fortification on gut health and disease. Humtoasneasrclohsfeoraaprtpicrloexs irmelaatteedlyto0“.h5u–m2 amngiroonf mireotnabeovliesmry”,d“abyacftreorimal isrkoninmceetlalbdoleissmqu”,a“miroantiaonnd, ginuttestinal epitheliafllocreal”l,(aInEdC“)thsleoeuffgehctisnogf,iraonndonurthineeguatnmdicsrwobeiaottap/mroicdruobcitoiomne [in4]a.nAimdadlsitainodn/aorl hiruomnamnsa.”y be lost during s2p.eOcvifiercvpiehwyosfioIlroongiAcablsoprrpoticoensses, such as menstruation and lactation [5] To balance this loss, the human duodenum and proximal jejunum absorb approximately 2 mg of dietary iron daily, a small proportioenpitohfHetluhiamel cateonlstla(llIoEsdCea)aiplsylporduogixehitmianragyt,ealiynndt0a.u5k–rei2n[me6a,g7n]od.f Isirrwooennaetfvrpeorromyddutahcyteiofdrnoi[em4t].siskAifdnodcuietnliloddnpeaslrqiirmuoanamrmailtayiyoanas,lsihnoteebmsetielno,asdtl erived from mydougrlionbgisnpeacnifdichpehmysoioglologibcianl ,pororcnesosnesh, esumche airsomne, ndsetrruivateiodnfarnodmlapctlaatniotns a[5n].dTiorobanl-afnocretitfihiesdlofsos,ods [6]. W0]i.thFinerernoteproocrytitnes,isiroanlsios setoxrpedreisnsed on macrophfaegrreitsina,nudsehdeipnaatovcayriteetsy [o1f0c]e.llOulnarthpreobceasssoesla, toerrtarlanmspeomrtbedrainneto, hsyesptehmaeicstciinrcuolxaitdioinzebsyfcerrorsosuinsgiron to ferric irontFhe,erernobapabosrolitlniantgeirstahalelsmtoreaemxnpsbrpreaosnsreetadttohionrnomuogafhcirrootphnheaing1e2tshtaernabdnlsohmoepdemabtboyrcaytnrteaesn[sd1fo0em]r.raOiinnn[t5ph]re.obItenaisnco,olamfteerprraaolrpmiosreotmninbtro[a1nn0eo],.nheme iron, hemheepahbasesotrinptoixoindirzeesmfaerirnosuesniriognmtaotfiecrr[i1c1i]r.oTn,heenraebalirneg ttwheotrcaunrsrpeonrttahtiyonpootfhireosnesinfothreinbtloeostdinbayl heme absorptiotrna:nsEfeitrhrienr[5h]e. mInecoismepnadrisoocnytoosneodnhferomme irthone, ahpemicealabmsoermptbiornanreemoarintrsaennsigpmoarttiecd[1t1h].roTuhegrhe aarespecific receptor tiwnotocuthrreenctyhtoyspoolth[e1s2e]s. for intestinal heme absorption: Either heme is endocytosed from the apical membrane or transported through a specific receptor into the cytosol [12]
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