Free Erythrocyte Protoporphyrin Research Articles

Iron-related Biomarkers in the Diagnosis and Management of Iron Disorders.

Iron deficiency and iron-related disorders are common health issues worldwide, affecting a significant proportion of the population. Diagnosis and management of these disorders rely heavily on using various iron-related biomarkers that can provide valuable clinical information. This review article provides an overview of the most commonly used iron-related biomarkers, including serum ferritin, transferrin saturation, soluble transferrin receptor, zinc protoporphyrin, and free erythrocyte protoporphyrin. Other emerging biomarkers, such as hepcidin and retinol-binding protein 4, are also discussed. Iron plays a vital role in various physiological processes, including oxygen transport, energy metabolism, and DNA synthesis. The article highlights the advantages and limitations of iron biomarkers and their clinical applications in diagnosing and managing iron deficiency and iron-related anemia. Using iron-related biomarkers in screening and monitoring programs can improve patient outcomes and reduce healthcare costs.

Physicochemical, structural and functional properties of low methoxyl pectin‑iron (III) complex and its effect on rats with iron deficiency anemia

Iron deficiency anemia (IDA) is the most common nutritional disease worldwide. In this study, a low methoxyl pectin (LMP)‑iron(III) complex was prepared. The physicochemical and structural properties were characterized by HPSEC, HPIC, CV, FTIR, 1H NMR, XRD, SEM and CD. The results showed that iron increased the molecular weight of the LMP‑iron(III) from 11.50 ± 0.32 to 12.70 ± 0.45 kDa and improved its crystallinity. Moreover, the findings demonstrated that -OH and -COOH groups in LMP coordinate with Fe3+ to form β-FeOOH. The water-holding capacity, emulsion stability, and antioxidant activities of the LMP‑iron(III) were lower than those of LMP. Furthermore, the therapeutic effects of LMP‑iron(III) on IDA were investigated in rats. Following LMP‑iron(III) supplementation, compared with the model group, the administration of LMP‑iron(III) significantly increased the body weight, hemoglobin concentration, and serum iron concentration as well as decreased free erythrocyte protoporphyrin concentration. Therefore, the LMP‑iron(III) can potentially treat IDA in rats experiments, providing a theoretical basis for the development of a promising iron supplement.

Two Novel Mutations in FECH in a Patient With Erythropoietic Protoporphyria: A Case Report

Introduction: Erythropoietic protoporphyria (EPP) is a rare photodermatosis mainly caused by deficiency of the enzyme ferrochelatase (FECH). We herein report a case of EPP associated with 2 novel mutations in FECH. Case presentation: A 15-year-old boy experienced pain and pruritus after sunlight exposure. He had occasional claret-red urine, hepatomegaly with increased alanine aminotransferase and aspartate aminotransferase levels, and an elevated free erythrocyte protoporphyrin level. He was treated with oral β-carotene and cholestyramine and avoidance of sunlight as much as possible. Discussion: Genome sequencing revealed 2 novel FECH mutations that had been inherited from his healthy parents. Pathogenicity analysis involving prediction using PolyPhen-2, SIFT, and Mutation Taster revealed that the 2 novel mutations were likely pathogenic. Although the patient’s parents were healthy, they each had one of these 2 mutations. This finding is consistent with previous reports stating that individuals carrying low-expression alleles can be asymptomatic. The pathogenesis of the disease caused by these 2 mutations requires verification by larger and more detailed studies. Conclusion: Although the precise role of these mutations in EPP is not clear, the findings in the present case expand the genotypic spectrum of the disease.

Dietary Calcium and Lead Interact to Modify Maternal Blood Pressure, Erythropoiesis, and Fetal and Neonatal Growth in Rats during Pregnancy and Lactation

We studied the effects of dietary calcium and lead exposure on lead toxicity, fetal and neonatal growth, erythropoiesis and blood pressure during pregnancy and lactation in rats. Pregnant Sprague-Dawley rats (n = 43) were randomly assigned to one of six treatment groups of 7–8 rats each. Half of the rats were fed diets of low (0.1%), normal (0.5%) or high (2.5%) calcium as calcium carbonate and exposed to 250 mg/L of lead in their drinking water for the duration of the pregnancy and for 1 wk of lactation. Three control groups were fed the same diets without lead exposure. Pups were studied at 1 d and 1 wk of age. Maternal and fetal blood and organ samples from the groups fed the low calcium diet had the highest lead concentrations, whereas the lowest lead concentrations were found in the groups fed the high calcium diet. Dam and pup hemoglobin concentrations, hematocrits, and body weights and lengths were reduced by lead exposure and by the high calcium diet. The latter also reduced organ iron concentrations and prevented lead-induced increases in free erythrocyte protoporphyrin. Dam systolic blood pressures during the third trimester of gestation were significantly higher in rats exposed to lead and fed the low calcium diet than in rats in the other five treatment groups. The results demonstrate that dietary calcium and lead exposure interact in rats to influence maternal blood pressure, erythropoiesis, and fetal and neonatal growth during pregnancy and lactation.

Ultraviolet A phototest positivity is associated with higher free erythrocyte protoporphyrin IX concentration and lower transferrin saturation values in erythropoietic protoporphyria.

BackgroundErythropoietic protoporphyria (EPP) is a rare disorder of heme biosynthesis hallmarked by early‐onset photosensitivity and mainly due to defective ferrochelatase activity leading to increased erythrocyte protoporphyrin IX (PPIX) levels. Evidence regarding the relationship between erythrocyte PPIX concentration and photosensitivity is limited.MethodsTo investigate the relationship between free erythrocyte PPIX (FEP) concentration; routine laboratory tests, particularly iron metabolism biomarkers; and ultraviolet (UV) A/visible light phototesting findings, 20 genetically confirmed EPP and one XLPP treatment‐naive patients were included in our study. They underwent UVA and visible light phototesting. On the same day, blood samples were collected for measurement of FEP, serum iron, transferrin, transferrin saturation, and ferritin, 25‐hydroxyvitamin D, and liver enzyme levels.ResultsMedian FEP concentration at the time of phototesting was 57.50 (IQR: 34.58‐102.70) μg/g of Hb. UVA and visible light phototesting were positive in 9 (42.9%) and 8 (38.1%) patients, respectively. Median FEP concentration was significantly higher in UVA phototest–positive patients than in those negative (64.37 [IQR: 57.45‐121.82] vs 45.35 [IQR: 24.53‐74.61] μg/g of Hb, respectively; P = .04486). Similarly, UVA photosensitive individuals had significantly lower median serum iron levels (61.5 [IQR: 33.5‐84] μg/dL vs 109 [IQR: 63.25‐154] μg/dL, respectively; P = .01862) and transferrin saturation values (15.005 [IQR: 7.0775‐18.41] % vs 29.645 [IQR: 17.8225‐34.3575] %; P = .0109) than those negative.ConclusionsOur study demonstrates that UVA phototest positivity is associated with higher FEP concentration and lower transferrin saturation and serum iron concentration in EPP.

Relationship between blood Lead status and anemia in Ugandan children with malaria infection

BackgroundIn Uganda, childhood anemia remains a health challenge and is associated with malaria infection as well as iron deficiency. Iron deficiency is intertwined with nutritional status, age and other comorbidities including helminths and Lead toxicity. Environmental Lead levels accounts for one’s blood Lead (BL) levels. Blood Lead competitively blocks iron absorption, inhibits hemoglobin (Hb) biosynthesis and elevates free erythrocyte protoporphyrin (FEP) levels. Lead toxicity’s contribution towards anemia pathogenesis, especially during malaria infection has not been studied. Concomitant exposure to both malaria infection and Lead pollution, exacerbates the anemia status. This study therefore aimed at expounding the anemia status of these Ugandan children aged under 5years who are exposed to both malaria infection and environmental Lead pollution.MethodsBriefly, venous blood samples from 198 children were microscopically assayed for malaria parasite density (PD), and hemoglobin (Hb) concentrations using the cyanmethemoglobin method, while BL and FEP levels were determined by the standard atomic absorption spectrophotometric and fluorometric methods respectively.ResultsOne hundred and fifty-one (76.3%) of the children analyzed had moderate anemia (Hb <10>5 g/dL) with Means of BLL=8.6 µg/dL, Hb =7.5 g/dL, FEP/Hb =8.3 µg/g and PD =3.21×103 parasites / µL, while eight (4%) were severely anemic (<5 g/dL). Regression analysis and statistical correlation between PD and Hb (r = -0.231, R2= 0.15 P-value < 0.001) was negative and weak as compared to that between FEP/Hb and Hb (r = -0.6, R2=0.572 P-value=0.001).Conclusion Based on the study’s findings, we conclude that BL significantly contributes to the pathogenesis of anemia and therefore its co-existence with malaria infection in the host exacerbates the anemia status.

PREVALENCE OF IRON DEFICIENCY ANEMIA AMONG CHILDREN WITH SCHOOL FAILURE AND ITS RELATION TO INTELLIGENCE QUOTIENT

Introduction: An estimated 25% of school-aged children a worldwide is anemic. Iron deficiency is thought to account for about half of the global cases of anemia and is associated with inadequate dietary Recent years have shown a growing interest and concern in many countries about the problem of school failure and the determination of its main contributing factors. This problem is known as the “one hundred factors problem” and a great deal of research has been done on identifying the factors that affect the low performance of students (school failure and dropout) at different educational levels (primary, secondary and higher). Aim of the study: This study will be designed to evaluate the prevalence of iron deficiency anemia among children with school failure, the relationship between the degree of iron deficiency anemia (IDA) and changes in the level of intelligence quotient (IQ). Patients and Methods: This study is a prospective study on 100 children aged from 5 to 12 years old during the period from August 2018 – October 2019 and are divided in to two groups group A with IDA and group B without IDA. The patients who will be included in our study as anemic group who have: CBC: Hgb less than 11.5gm% Low MCV, Serum Ferritin: Less than 12ng/ml, and Free Erythrocyte Protoporphyrin: Increase than 23.8mg/dl. Then after confirmation that our patients are iron deficiency anemia the following was done for anemic and non-anemic group. Intelligence quotient: IQ was assessed by Stanford _Binet Intelligence scales. Before and after treatment, after correction of clinical and lab manifestations. Statistical analysis: Data were analyzed using Statistical Program for Social Science (SPSS) version 15.0. Quantitative data were expressed as mean ± standard deviation (SD). Qualitative data were expressed as frequency and percentage. Results: Prevalence of IDA was significantly higher among children with school failure. 68% of the studied group had IDA while the other 32% had no IDA (Mean hematological values of Hb, MCV and serum ferritn; respectively were low and FEP was elevated in anemic children, our results confirmed Free erythrocyte protoporphyrin (FEP) to be the most significant factor for the diagnosis of iron deficiency anemia in children, Our result revealed that there was a significant difference in the level of IQ between anemic and non-anemic group and in our study there was improvement of IQ after treatment with iron). Conclusion: The study found a positive correlation between IDA and poor school performance, although iron deficiency anemia (IDA) is a high risk factor for school failure but not the only cause in primary school children, free erythrocyte protoporphyrin (FEP) is the most sensitive and specific predictor for diagnosis of iron deficiency anemia in comparison to the other predictors although it is expensive. Recommendations: Pediatricians and mass media should raise awareness about iron deficiency and its sequelae, also the importance of the presence of the pediatric clinics for those apparently normal children. Screening of iron deficiency anemia in pale children and in poor school performance children to decrease its prevalence and impact on children. Proper complementary early feeding with iron rich foods to decrease iron deficiency anemia between infants and children. Treatment of IDA should occur early as possible by dietary improvement or by oral iron supplementation by giving 6mg elemental iron/kg/day divided into 2-3 doses continued for 2-3 month after correction of anemia to replenish body stores. Adding iron to widespread food as bread may be beneficial for prophylaxis of IDA.

1506 Poisoned by Indian Herbal Medicine: An Inconspicuous Cause for Abdominal Pain

INTRODUCTION: Symptoms of lead poisoning are nonspecific and include abdominal pain, constipation, irritability, weight loss, and anemia. Sources of exposure in adults are predominantly occupational (ex. batteries, paint, cable, or wires), but also include herbal remedies, or cookware. Here, we report a case of lead poisoning after oral intake of Ayurvedic supplements. CASE DESCRIPTION/METHODS: A 35 y/o man presented with 6 weeks of worsening diffuse abdominal pain and cramping, SOB, fatigue and nausea. Patient denied diarrhea, vomiting or weight loss. He traveled to India earlier this year. Examination was notable for severe abdominal tenderness and slight distention. Initial work up including CBC, CMP, UA and LFTs were notable for a normocytic anemia with a Hb 9.5 (baseline 16). Stool was brown and guaiac negative. Serum haptoglobin, LDH, B12 and iron studies were within normal limits. Abdominal CT and US were unremarkable. EGD showed no bleeding. Additional work-up such as GI PCR, Meckel scan, urine PBG, blood lead level (BLL) and C1-INH were ordered. However, Hb kept dropping without improvement in pain. On day 3 of hospitalization, he was started on laxatives for constipation and discharged after improvement in bowel movements and abdominal pain with outpatient follow up for his anemia. Lab results later revealed a BLL of 78.4 ug/dL, and a blood smear showed basophilic stippling of erythrocytes, consistent with lead poisoning. On further interview, patient noted taking Ayurvedic supplements obtained in India with last intake 3 weeks prior to admission. Patient stopped his herbal medication and was started on oral succimer and eventually switched to dimercaprol. Samples of the supplements were sent out for testing. DISCUSSION: Given that many differentials for abdominal pain and anemia were ruled out, less common causes were investigated, such as AIP, intestinal angioedema, and lead poisoning. Once absorbed, lead deposits in the blood, soft tissue and bone. The toxic effects of lead are due to oxidative stress caused by inactivation of anti-oxidant enzymes, which damages DNA, cell membranes and impairs DNA transcription. Common symptoms are microcytic anemia, abdominal colic, nausea, vomiting and neuropathy. Basic workup includes free erythrocyte protoporphyrin or zinc protoporphyrin, blood urea nitrogen, serum creatinine, and urinalysis for 5-Amino-laevulin acid. In this case elevated BLL and classic blood smear lead to the diagnosis of lead poisoning.

Iron deficiency, still a rarity in children with sickle cell anemia in Ile-Ife, Nigeria

In this study, children with sickle cell anemia were evaluated for iron deficiency. Serum ferritin and free erythrocyte protoporphyrin free erythrocyte protoporphyrin (FEP) levels, mean corpuscular volume mean corpuscular volume (MCV) and mean corpuscular hemoglobin mean corpuscular hemoglobin (MCH) were used in determining their iron status. The study was done at Pediatric Hematology Outpatient Clinic of the Obafemi Awolowo University Teaching Hospitals’ Complex, Ile-Ife. Forty-eight HbSS subjects in steady state and 48 apparently well age and sex matched HbAA controls were evaluated. Serum ferritin less than 25ng/dL FEP greater than cut off for age, mean corpuscular volume MCV and mean corpuscular hemoglobin MCH less than cut off for age were regarded as indicating iron deficiency. Serum ferritin values ranged from 34.2 to 3282.9μg/L, with a mean of 381.2 (1.0), median 180μg/L; which was significantly higher than the controls (p=0.000). FEP was lower in the subjects but none was iron deficient compared with the controls. The mean corpuscular hemoglobin MCH of subjects was significantly lower than the controls. Subjects had lower mean corpuscular volume MCV compared with controls. Iron deficiency was not detected in any of the subjects with sickle cell anemia in comparison to a prevalence of 43.75% in the controls. Iron deficiency anemia (IDA) was found in 16.7% of the controls, using the WHO cut off for anemia which is hemoglobin concentration of <11g/dl. While a high prevalence of iron deficiency was noted in the control group, patients with sickle cell anemia were largely iron sufficient, despite their anemia. Iron supplementation remains unnecessary as part of routine management of children with sickle cell anemia in our practice.

Evaluation of the Effect of Sprout Soybeans on the Iron Status of Anemic Adolescent Girls in Rural China.

Soybeans are a major source of nonheme iron in Chinese diet. Germination is considered to be effective in improving iron bioavailability in soybeans. The study is to evaluate the effect of sprout soybean supplementation on the iron status of anemic adolescent girls in rural area of China and to compare it with the effect of soybeans. Two hundred and eighty eight adolescent girls were assigned to receive one of three dietary supplements (100mL) a day for 6m: 1) rice milk as the control (C); 2) sprout soybean milk (SS); 3) soybean milk (S). In addition to anthropometric measurements, iron status was measured at baseline and at the end of the study. After sixmonths, the concentration of hemoglobin and plasma ferritin of participants in sprout soybean group were 138.6 ± 6.3g/L and 43.3 ± 12.6μg/L, significantly higher than those of the control. Significant decreases in the rate of anemia, iron deficiency and free erythrocyte protoporphyrin (FEP) concentration were found both in sprout soybean and soybean group. An obvious decrease in plasma transferritin receptor was found in the sprout soybean group comparing with the control, but not in the soybean group. Small but not significant differences were found in all iron indicators between the sprout soybean and soybean group. Sprout soybeans and soybeans could improve the iron status of anemic adolescent girls. Although sprout soybeans exhibited some priority to soybeans, no absolutely significant difference was found between them.

Evaluation of the Efficiency of the Reticulocyte Hemoglobin Content on Diagnosis for Iron Deficiency Anemia in Chinese Adults.

Our aim was to evaluate the cut-off value and efficiency of using reticulocyte hemoglobin content as a marker to diagnose iron deficiency anemia in Chinese adults. 140 adults who needed bone marrow aspiration for diagnosis at the hematology department of the Peking Union Medical College Hospital were enrolled according to the inclusive and exclusive criteria. Venous blood samples were collected to detect complete blood count, including hemoglobin, reticulocyte hemoglobin content, hematocrit, mean cellular volume, corpuscular hemoglobin concentration, hemoglobin content, free erythrocyte protoporphyrin; iron indexes of serum ferritin, serum transferrin receptor, and unsaturated iron-binding capacity; and inflammation markers of C-reactive protein and α-acid glycoprotein. Bone marrow samples were obtained for the bone marrow iron staining, which was used as the standard for the evaluation of iron status in this study. Subjects were divided into three groups according to hemoglobin levels and bone marrow iron staining results: the IDA (iron deficiency anemia) group, the NIDA (non-iron deficiency anemia) group, and the control group. The differences of the above-mentioned indexes were compared among the three groups and the effect of inflammation was also considered. The cut-off value of reticulocyte hemoglobin content was determined by receiver operation curves. The IDA group (n = 56) had significantly lower reticulocyte hemoglobin content, mean cellular volume, corpuscular hemoglobin concentration, hemoglobin content, and serum ferritin; and higher free erythrocyte protoporphyrin, unsaturated iron-binding capacity, and serum transferrin receptor (p < 0.05) compared with the NIDA group (n = 38) and control group (n = 46). Hematocrit, serum ferritin, and unsaturated iron-binding capacity were significantly affected by inflammation while reticulocyte hemoglobin content and other parameters were not. The cut-off value of reticulocyte hemoglobin content for diagnosing iron deficiency anemia was 27.2 pg, with a sensitivity of 87.5% and a specificity of 92.9%. The cut-off values for mean cellular volume, serum ferritin, and serum transferrin receptor were 76.6, 12.9, and 4.89 mg/L, respectively. Reticulocyte hemoglobin content had the largest area under the curve of 0.929, while those for mean cellular volume, serum ferritin, serum transferrin receptor were 0.922, 0.887, and 0.900, respectively. Reticulocyte hemoglobin content has a high sensitivity and specificity in the diagnosis of iron deficiency anemia, and its comprehensive diagnostic efficacy is better than other traditional indicators—such as serum ferritin and serum transferrin receptor.

Short repeats in the heme oxygenase 1 gene promoter is associated with increased levels of inflammation, ferritin and higher risk of type-2 diabetes mellitus

ObjectiveWe evaluated the relationship between the HO1 genotype, ferritin levels and the risk of type-2 diabetes and inflammation. Research methodsEight hundred thirty-five individuals were evaluated and classified according to their nutritional status and the presence of type-2 diabetes: 153 overweight (OW); 62 obese (OB); 55 type-2 diabetes mellitus (DM); 202 OWDM; 239 OBDM and 124 controls (C). We studied biochemical (glycemia, insulin, lipid profile, liver enzyme, creatinine, hsCRP), hematological (hemoglobin, free erythrocyte protoporphyrin, transferrin receptor and serum Fe and ferritin) and oxidative stress (SOD, GHS and TBARS) parameters. We determined heme oxygenase activity and the (GT)n polymorphism in its gene promoter. ResultsIndividuals with diabetes, independent of nutritional status, showed high levels of ferritin and HO activity compared to control subjects. Allelic frequency was not different between the groups (Chi2, NS) however, genotypes were different (Chi2, P<0.001). The SS (short-short) genotype was higher in all DM individuals compared to controls and MM was higher in controls. SM (short-medium) genotype was an independent risk factor for DM in logistic regression analysis. We observed high risk for type-2 diabetes mellitus in the presence of SM genotype and high levels of ferritin (OR adjusted: 2.7; 1.9–3.6; p<0.001; compared to control group). It was also significantly related to inflammation. ConclusionThe SM genotype in HO1 gene promoter and ferritin levels were associated with higher risk for type-2 diabetes and for having a higher marker of inflammation, which is the main risk factor for the development of chronic diseases.

Abstract P043: Alcohol Consumption, Transferrin Saturation and Risk of All-Cause Mortality in The National Health and Nutrition Examination Surveys

Background: Moderate alcohol consumers have a reduced risk for cardiovascular and all-cause mortality. Alcohol intake improves iron absorption and also has a profound effect on iron metabolism and thus could in part explain the observed inverse association between moderate alcohol intake and mortality. We sought to investigate whether moderate alcohol confers mortality benefits in part through improvement in iron status. Methods: Publicly available data from two consecutive National Health and Nutrition Examination Survey (NHANES) cycles (1999/2000 and 2001/2002) were obtained and linked to public data on all-cause mortality. Study participants were grouped as never, past, moderate (≤2 drinks/day for men, ≤ 1 drink/day for women) and heavy drinkers (&gt;2 drinks/day for men, &gt;1 drink/day for women). To assess the quality of alcohol data in NHANES, we tested whether self-reported alcohol consumption was associated with biomarkers of alcohol intake (HDL-C and γ-glutamyl transferase (GGT)). Cox-models, weighted using four-year sampling weights, were fitted to determine whether alcohol intake was associated with all-cause mortality. Measures of iron status, particularly serum ferritin, transferrin saturation, hemoglobin and free erythrocyte protoporphyrin were evaluated as potential mediators of the association between alcohol consumption and risk of all-cause mortality. Results: Among 7,532 men and women with complete data, 17% were never drinkers, 20% were past drinkers, 30% were moderate drinkers and 33% were heavy drinkers. We found an increase in HDL-C and GGT with increased alcohol intake, suggesting that self-reported alcohol intake is reliable in this population. In the weighted analysis, the hazard ratio (95% CI) for all-cause mortality among moderate alcohol users compared to never users was 0.56 (0.37-0.85), in models adjusted for age, race, smoking, statin use and history of diabetes, among other variables. Adjustment for transferrin saturation as a measure of iron status attenuated the benefit from moderate alcohol (HR = 0.69; 95% CI: 0.41-1.14), suggesting that moderate alcohol consumption may in part confer a benefit on mortality through improvement in iron status. These results warrant further evaluation in rigorous formal mediation analyses. Conclusions: Moderate alcohol consumption was associated with higher transferrin saturation and with reduced risk of mortality. Adjusting for iron status attenuated the association between moderate alcohol consumption and all-cause mortality suggesting that the effects of moderate alcohol on mortality may in part be via improvement in iron status.

Blood cadmium is elevated in iron deficient U.S. children: a cross-sectional study.

BackgroundCadmium (Cd), a widespread environmental contaminant, and iron deficiency (ID), the most common nutrient deficiency in the world, are known risk factors for neurodevelopmental delays, as well as other disorders, in infants and children. Studies assessing the cumulative effects of these factors are lacking in children, despite concerns of increased uptake of metals in the presence of ID. Here we sought to determine if blood and urine Cd levels were elevated in ID children compared to non-ID children.MethodsData for 5224 children, aged 3–19 years, were obtained from the 1999–2002 NHANES. ID was defined as ≥2 of 3 abnormal iron indicators (low serum ferritin [SF], high free erythrocyte protoporphyrin [FEP], low % transferrin saturation [TSAT]); ID anemia (IDA) was defined as ID plus low hemoglobin (Hgb). Logistic regression was used to evaluate associations between ID, IDA, and abnormal iron indicators and categories of blood and urine Cd.ResultsAdjusted odds of ID, IDA, low SF, and low TSAT were associated with increasing category of blood Cd but not urine Cd. Adjusted ORs (95% CI) for blood Cd ≥0.5 μg/L versus < LOD were = 1.74 (1.30-2.34), 4.02 (1.92-8.41), 4.08 (2.36-5.89) and 1.78 (1.32-2.39), for ID, IDA, low SF, and low TSAT, respectively. Age and sex specific analyses of blood Cd and ID/abnormal iron indicators revealed that the observed associations were strongest in females aged 16–19 years.ConclusionsGiven their shared neurotoxic effects in children, and that many people live in areas with high burdens of both ID and Cd, more research into the complex relationships between nutrient deficiencies and environmental toxicants is vital.

Clinical and biochemical improvement following low‐dose intravenous iron therapy in a patient with erythropoietic protoporphyria

Clinical and biochemical improvement following low‐dose intravenous iron therapy in a patient with erythropoietic protoporphyria

Antioxidant and micronutrient-rich milk formula reduces lead poisoning and related oxidative damage in lead-exposed mice

Lead poisoning is a global environmental disease that induces lifelong adverse health effects. The effect of a milk formula consisting of antioxidant of bamboo leaves (AOB), vitamin C (Vc), calcium lactate (CaLac), ferrous sulfate (FeSO₄) and zinc sulfate (ZnSO₄) on the reduction of lead and lead-induced oxidative damage in lead-exposed mice was studied. The lead-reducing effect of milk formula was investigated via a 7-week toxicokinetics study and a tissue distribution level examination. The ameliorating effect of milk formula on lead-induced oxidative damage was investigated. Results demonstrated current milk formula could effectively reduce blood lead levels (BLLs) and lead distribution levels of liver, kidneys, thighbones and brain in mice based on metal ion-mediated antagonism and chelation mechanisms. This milk formula could not only protect lead-susceptible tissues against lead poisoning, but also maintain normal absorption and distribution of essential elements in vivo. Meanwhile, current milk formula could prevent the reduction of δ-aminolevulinic acid dehydratase (δ-ALAD) activity and enhancement of free erythrocyte protoporphyrins (FEP) levels in blood erythrocytes of mice. Also, this formula could indirectly protect blood cell membranes against lead-induced lipid peroxidation. We conclude that current optimized milk formula effectively reduces lead poisoning and lead-induced in vivo oxidative damage in lead-exposed mice.

Lead and its Effects on Cytochromes P450

Background: The adverse effects of lead on heme biosynthesis and production of anemia are well known. Lead may disrupt the normal activity of other hemoproteins, such as cytochromes P450 (CYP) which are responsible for drug metabolism. While data in animals suggest a decrease in CYP function with lead exposure, there is little data in humans. Methods: After IRB approval, consented patients with asymptomatic, low to moderate level (10 mg/dl to 44 mg/ dl) lead poisoning were assessed for CYP1A2 and CYP2D6 activity at diagnosis, 1 month, 2 months and after lead level was less than 10 mg/dl. Low doses of caffeine (CYP1A2 activity) and dextromethorphan (DM) (CYP2D6 activity) were administered and urine collected for 12-24 hours at each visit. Lead levels, free erythrocyte protoporphyrin, and iron studies were performed as well. A mixed linear model was used to analyze the data. CYP2D6 genotyping was performed using PCR techniques. Results: Eleven out of the sixteen eligible children (7 males, 4 Caucasian, average age: 33 months) completed the study. Average time to complete the study was 20 months. Seven had lead levels between 10-25 mcg/dl. Eight had elevated EPP. None had low iron levels. A random intercepts mixed linear model was fit to the data. No statistical significance was found for CYP1A2 or CYP2D6 metabolic ratio related to the lead level, change in lead level or time. Discussion: Lead was found to have no effect on the CYP drug metabolizing enzymes at low blood lead levels. Lead has been shown to effect multiple sites on the hemoglobin synthesis pathway resulting in elevated EPP at lead levels >10 mg/dl. However, threshold for decreased hemoglobin levels in children is judged to be approximately 40 μg/dL. Thus, cytochromes may not be affected until higher lead levels are seen. The size of the study limits generalizability. Conclusion: Based on this study, no changes in drug treatment for children with low blood lead levels are necessary. However, further studies may be needed to assess the effect from higher blood lead levels.

What caused hemolytic anemia and colicky abdominal pain? Lead!

What caused hemolytic anemia and colicky abdominal pain? Lead!

Preparation, characterization, bioavailability in vitro and in vivo of tea polysaccharides–iron complex

The task of this study was to prepare a complex of tea polysaccharides (TPS) with ferric iron and research its bioavailability in vitro and in vivo. Optimum condition for preparing tea polysaccharides–iron complex (TPIC) was as follows: TPS and FeCl3 with a weight ratio of 1:2.4, reacted in a water bath at 60 °C for 3 h, generating an iron content for TPIC of 14.60 %. The digestion in vitro experiment showed that availability of TPIC was sufficient. Then, iron bioavailability in vivo of TPIC was evaluated by the rat hemoglobin-repletion bioassay with ferrous sulfate (FeSO4) as the positive control. Results indicated that at the end of 21 days’ iron regeneration phase, the values of hemoglobin (Hb) concentration, free erythrocyte protoporphyrin (FEP), serum iron (SI) concentration, and mean cell hemoglobin (MCHC) of rats supplemented with FeSO4 and TPIC increased quickly to those of normal ones. If the bioavailability of FeSO4 was given 100 % with Hb concentration, SI concentration and MCHC as the evaluation index, respectively, bioavailability of TPIC were in the range of 101.85–116 %. These results demonstrate that TPIC is a good iron supplement source for increasing uptake and bioavailability in the body.

Effectiveness of Fortified Flour for Enhancement of Vitamin and Mineral Intakes and Nutrition Status in Northwest Chinese Villages

Fortification of flour is one of the approaches for the control and prevention of vitamin and mineral deficiencies. To assess the effect of fortification of flour with seven vitamins and minerals on a population of Chinese women. Farmers who offered their land for reforestation in 25 northwest provinces of China received compensation in the form of wheat flour; the amount of flour given depended on the amount of land that was given up for reforestation. This study observed the effects of providing families with fortified flour in the reforestation areas in Gansu Province. The study was conducted for 3 years. Families in the intervention village who offered land for reforestation received flour fortified with seven vitamins and minerals, and those in the control village received unfortified flour. Seven surveys, spaced at least 6 months apart, were carried out in each village from 2004 to 2007. At baseline and at each annual survey, measurements and blood samples were taken from 300 adult female subjects aged 20 to 60 years to assess dietary intake, height, weight, body fat, hemoglobin, serum retinol, serum iron, free erythrocyte protoporphyrin, serum zinc. Serum folic acid was measured at baseline and 36-month only. At each 6-month survey, data were collected on anthropometric features, hemoglobin, and dietary intake. Consumption of fortified flour in the intervention village ranged from 158.7 to 232.7 g per person per day. Serum retinol status was significantly improved after 12-month intervention until the end of the trial compared with both the control group and the baseline level of the intervention group. Iron status expressed as FEP and SI levels showed higher than that of the control group and baseline levels only at 36-month. Hemoglobin levels of the intervention group were higher than that of the control group and baseline levels, but anemia prevalence of both the intervention and control groups remained unchanged in the intervention period. Levels of serum zinc showed increases compared with the control group and baseline data at 24-month and 36-month, and levels of serum folic acid of intervention group in 36-month was higher than that of both the control group and baseline level. The evidence from this study confirms the positive bioeffectiveness of fortified flour in the rural female population in China, but a higher dosage of electrolytic elementary iron in flour fortification was suggested for anemia prevention and control.