Body iron metabolism and pathophysiology of iron overload.
Iron is an essential metal for the body, while excess iron accumulation causes organ dysfunction through the production of reactive oxygen species. There is a sophisticated balance of body iron metabolism of storage and transport, which is regulated by several factors including the newly identified peptide hepcidin. As there is no passive excretory mechanism of iron, iron is easily accumulated when exogenous iron is loaded by hereditary factors, repeated transfusions, and other diseased conditions. The free irons, non-transferrin-bound iron, and labile plasma iron in the circulation, and the labile iron pool within the cells, are responsible for iron toxicity. The characteristic features of advanced iron overload are failure of vital organs such as liver and heart in addition to endocrine dysfunctions. For the estimation of body iron, there are direct and indirect methods available. Serum ferritin is the most convenient and widely available modality, even though its specificity is sometimes problematic. Recently, new physical detection methods using magnetic resonance imaging and superconducting quantum interference devices have become available to estimate iron concentration in liver and myocardium. The widely used application of iron chelators with high compliance will resolve the problems of organ dysfunction by excess iron and improve patient outcomes.
Kohgo
Yutaka
Y
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College, Asahikawa, Japan. yskohgo@aol.com.
Ikuta
Katsuya
K
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College, Asahikawa, Japan.
Ohtake
Takaaki
T
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College, Asahikawa, Japan.
Torimoto
Yoshihiro
Y
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College, Asahikawa, Japan.
Kato
Junji
J
Fourth Department of Internal Medicine, Sapporo Medical University, Sapporo, Japan.
D001692:Biological Transport; D005293:Ferritins / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000378:metabolism*; D019190:Iron Overload / Q000000981:diagnostic imaging / Q000235:genetics / Q000378:metabolism* / Q000503:physiopathology; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D009206:Myocardium / Q000378:metabolism*; D011859:Radiography; D017382:Reactive Oxygen Species / Q000378:metabolism; D065227:Transfusion Reaction
D017382:Reactive Oxygen Species; D005293:Ferritins; D007501:Iron