Venesection therapy of insulin resistance-associated hepatic iron overload.
OBJECTIVE
The association of hepatic iron overload with metabolic disorders has been coined as the insulin resistance-associated hepatic iron overload syndrome (IR-HIO).


METHODS
Fifty-six IR-HIO patients were phlebotomized either weekly (n = 14) or bimonthly (n = 42) and compared with C282Y homozygotes and with ten IR-HIO patients treated by a low calorie diet alone.


RESULTS
In venesected patients, the median amount of mobilized iron was 0.6 g in 2.8 months in females and 1.8 g in 5 months in males. Mobilized iron did not differ depending on the frequency of venesections or HFE genotype. When compared with C282Y homozygotes, IR-HIO patients had a similar amount of mobilized iron, but three-fold serum ferritin levels. The presenting symptoms (chronic fatigue and/or polyarthralgias) improved in 6/7 patients. Phlebotomies were well tolerated. In patients treated by a low calorie diet, serum ferritin levels remained stable.


CONCLUSIONS
In IR-HIO patients, body iron stores are significantly increased, overestimated by serum ferritin, not modified by a low calorie diet, and safely removed by phlebotomies. Based on these data and on studies indicating that iron excess is associated with increased risk for hepatic fibrosis, cancer and cardiovascular disorders, venesection therapy can be recommended in IR-HIO patients.
Guillygomarc'h
A
A
Clinique des Maladies du Foie, CHU Pontchaillou, Rennes, France.
Mendler
M H
MH
Moirand
R
R
Lainé
F
F
Quentin
V
V
David
V
V
Brissot
P
P
Deugnier
Y
Y
D000328:Adult; D000368:Aged; D002149:Energy Intake; D005260:Female; D006680:HLA Antigens / Q000235:genetics; D000071020:Hemochromatosis Protein; D015395:Histocompatibility Antigens Class I / Q000235:genetics; D006801:Humans; D007333:Insulin Resistance; D019190:Iron Overload / Q000628:therapy*; D008107:Liver Diseases / Q000628:therapy*; D008297:Male; D008565:Membrane Proteins; D008875:Middle Aged; D018962:Phlebotomy; D012189:Retrospective Studies
C103673:HFE protein, human; D006680:HLA Antigens; D000071020:Hemochromatosis Protein; D015395:Histocompatibility Antigens Class I; D008565:Membrane Proteins