A thesis presented for the degree of Doctor of Philosophy in Medicine of the University of the Witwatersrand, Johannesburg 1972 / For centuries iron was regarded as a source of health and vigour, and it has been known for at least 200 years that it is a component of blood and effective in the treatment of chlorosis. However, its metabolism remained largely a mystery until the advent of radioactive iron isotopes in 1938. Since then most of the major pathways of this metal into, through and out of the body have been elucidated. In addition the functions which it subserves have been partially characterized. / IT2018

A dissertation submitted to the Faculty of Medicine University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the Degree Master of Science in Medicine / Ferritin is an iron storage protein, made up of heavy (H) and light (L) subunits. Ferritin synthesis is regulated at a post transcriptional level by iron, which induces a redistribution of ferritin mRNA from a free cytoplasmic pool to polyribosomes. Inflammatory states influence iron metabolism, causing a decrease in serum iron levels associated with an increase in reticuloendothelial ferritin synthesis and iron storage. / IT2018

A dissertation submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg in fulfilment of the Degree of Master of Science in the branch of Medicine / The guinea pig clears circulating tissue ferritin in a manner different from other mammals. Previous work in man and in rats has shown that injected tissue ferritin is removed from the plasma predominantly by the liver; however, in the guinea pig it is cleared predominantly by red cell precursors and furthermore, the ferritin iron is utilised directly for haem synthesis. During pregnancy, the foeto-placental complex also has a high requirement for iron. / IT2018

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Introdução: A hiperferritinemia (HF) pode refletir o estado inflamatório do paciente com doença hepática gordurosa não alcoólica (DHGNA) e obesidade, porém em cerca de 33% reflete uma real sobrecarga de ferro hepática. A síndrome dismetabólica relacionada ao depósito de ferro (SDDF) é caracterizada por HF, saturação de transferrina normal, alterações metabólicas e um discreto depósito de ferro hepático. O método padrão ouro para o diagnóstico de sobrecarga de ferro é a biópsia hepática. Por se tratar de método invasivo, novos métodos se tornam necessários. Dentre eles a ressonância nuclear magnética (RM) é o mais disponível. Pacientes e Métodos: O presente estudo avaliou pacientes com HF, excesso de peso, e DHGNA comprovada por biópsia hepática. Os pacientes realizaram RM pela técnica de relaxometria (análise de gordura/ferro - máquina 3T), dosagem de marcadores inflamatórios (IL-6 e TNF-alfa), análise da expressão das subunidades da ferritina (FP - cadeia pesada e FL - cadeia leve) e dosagem de hepcidina. Os dados foram comparados com a biópsia hepática. Estes pacientes foram classificados segundo os níveis de ferritina e siderose. Foram classificados em ferritina normal (FN), hiperferritinemia dismetabólica (HFD) e SDDF. O grupo de FN foi caracterizado por ferritina < 200 ng/mL em mulheres e 300 ng/mL em homens, já os pacientes do grupo HFD têm níveis elevados de ferritina e ausência de siderose hepática. Os pacientes também foram avaliados considerando somente a siderose hepática. Resultados: Foram avaliados 152 pacientes com DHGNA comprovada pela biópsia hepática, sendo 67 incluídos no estudo. A frequência de SDDF e HFD foi de 37% e 16%, respectivamente. O nível de corte da ferritina sérica, a fim de identificar depósito de ferro, foi de 180.4 ng/mL para mulheres (sensibilidade de 76,9%, especificidade de 64,3%) e 350,7 ng/mL para homens (sensibilidade de 72,7% e especificidade de 75,5%). Os pacientes com SDDF E HFD não apresentaram piores características metabólicas e histológicas. Os níveis de hepcidina foram maiores nos grupos SDDF E HFD, se correlacionando com o conteúdo de ferro hepático quando > 30,2 ng/mL. Os marcadores inflamatórios (IL-6 e TNF-alfa) foram semelhantes entre os grupos. A expressão de FP e FL se comportaram de modo semelhante entre os grupos. A FL se correlacionou com síndrome metabólica e circunferência abdominal, enquanto a FP se correlaciona com níveis maiores de esteatose. A RM foi capaz de identificar o conteúdo de ferro destes pacientes, sendo o ponto de corte de R2* 58,9s-1. A porcentagem de gordura, identificada pela RM, foi de 17% nos grupos HFD e SDDF e de 13% no grupo FN. Conclusão: 1) RM utilizando a técnica de relaxometria com correção da interferência de gordura se mostrou acurado na avaliação de discreto depósito de ferro em pacientes com SDDF; 2) HF pode refletir depósito de ferro hepático quando acima de 180,4 ng/mL para mulheres e 350,7 ng/mL para homens, não foi encontrada relação entre HF e características piores metabólicas ou histológicas; 3) FL se correlacionou com síndrome metabólica e circunferência abdominal, enquanto a FP se correlaciona com esteatose; 4) Hepcidina se correlacionou com siderose e ferritina sérica nos pacientes com DHGNA / Introduction: Hyperferritinemia (HF) may reflect the inflammatory status of patients with NAFLD and obesity, but about 33 % reflects a real hepatic iron overload. The dysmetabolic iron overload syndrome (DIOS) definition is HF, normal transferrin saturation, and mild hepatic iron overload in a patient with metabolic disorders. The gold standard for diagnosis of iron overload is the liver biopsy. As it is an invasive method, new methods are necessary. Among them, magnetic resonance imaging (MRI) is the most available one. Patients and Methods: This study evaluated patients with HF, overweight and NAFLD. All patients were submitted to liver biopsy. MRI relaxometry (fat/iron analysis - 3T machine), measurement of inflammatory markers (TNF-alpha and IL-6), analysis of the expression of ferritin light and heavy chain subunits (FL and FP) and serum hepcidin were held. Data were correlated with liver biopsy. The patients were classified considering the ferritin levels and siderosis. They were classified in three groups: normal ferritin (NF), dysmetabolic hyperferrinemia (DHF) and DIOS. The NF group has serum ferritin (SF) below 200 ng/dL for women and 300 ng/dL for men, DHF must have SF above those values and negative siderosis, and DIOS have hyperferritinemia and positive siderosis. They are also classified considering only the iron status Results: 152 biopsy-proven NAFLD patients were screened but only 67 were included in this study. DIOS and HFD frequency in our sample were 37% and 16%, respectively. The cut-off of ferritin levels were correlated with iron overload in liver biopsy was 180.4 ng/mL for women (sensibility of 76.9% and specificity of 64.3%) and 350 ng/mL for men (sensibility of 72.7% and specificity of 75.5%). Although, DHF and DIOS patients did not have worst metabolic or histological characteristics, hepcidin levels were higher in DHF and DIOS groups, correlating with hepatic siderosis when hepcidin is above 30,2 ng/mL. The inflammatory markers (IL- 6 and TNF-alpha) were similar among the groups. The expression of FP and FL were similar in role sample. FL correlates with metabolic syndrome and abdominal circumference, while FP correlates with in higher fat scores. The MRI was able to identify mild iron overload. The R2* cut off level was 58,9 s -1. The fat percentage in DIOS and HFD was of 17% each and in NF 13%. Conclusion: 1) MRI using relaxometry method is accurate to evaluate mild iron overload in DIOS patients; 2) HF may reflect iron overload when above 180.4 ng/mL for women and 350.7 ng/mL for men, however, this study didn´t find correlation between HF and insulin resistance and worst NAFLD histological characteristics; 3) FL correlates with metabolic syndrome and abdominal circumference while FP correlates with in higher fat scores 4) Hepcidin correlates with iron and serum ferritin in NAFLD patients

Introdução: A hiperferritinemia (HF) pode refletir o estado inflamatório do paciente com doença hepática gordurosa não alcoólica (DHGNA) e obesidade, porém em cerca de 33% reflete uma real sobrecarga de ferro hepática. A síndrome dismetabólica relacionada ao depósito de ferro (SDDF) é caracterizada por HF, saturação de transferrina normal, alterações metabólicas e um discreto depósito de ferro hepático. O método padrão ouro para o diagnóstico de sobrecarga de ferro é a biópsia hepática. Por se tratar de método invasivo, novos métodos se tornam necessários. Dentre eles a ressonância nuclear magnética (RM) é o mais disponível. Pacientes e Métodos: O presente estudo avaliou pacientes com HF, excesso de peso, e DHGNA comprovada por biópsia hepática. Os pacientes realizaram RM pela técnica de relaxometria (análise de gordura/ferro - máquina 3T), dosagem de marcadores inflamatórios (IL-6 e TNF-alfa), análise da expressão das subunidades da ferritina (FP - cadeia pesada e FL - cadeia leve) e dosagem de hepcidina. Os dados foram comparados com a biópsia hepática. Estes pacientes foram classificados segundo os níveis de ferritina e siderose. Foram classificados em ferritina normal (FN), hiperferritinemia dismetabólica (HFD) e SDDF. O grupo de FN foi caracterizado por ferritina < 200 ng/mL em mulheres e 300 ng/mL em homens, já os pacientes do grupo HFD têm níveis elevados de ferritina e ausência de siderose hepática. Os pacientes também foram avaliados considerando somente a siderose hepática. Resultados: Foram avaliados 152 pacientes com DHGNA comprovada pela biópsia hepática, sendo 67 incluídos no estudo. A frequência de SDDF e HFD foi de 37% e 16%, respectivamente. O nível de corte da ferritina sérica, a fim de identificar depósito de ferro, foi de 180.4 ng/mL para mulheres (sensibilidade de 76,9%, especificidade de 64,3%) e 350,7 ng/mL para homens (sensibilidade de 72,7% e especificidade de 75,5%). Os pacientes com SDDF E HFD não apresentaram piores características metabólicas e histológicas. Os níveis de hepcidina foram maiores nos grupos SDDF E HFD, se correlacionando com o conteúdo de ferro hepático quando > 30,2 ng/mL. Os marcadores inflamatórios (IL-6 e TNF-alfa) foram semelhantes entre os grupos. A expressão de FP e FL se comportaram de modo semelhante entre os grupos. A FL se correlacionou com síndrome metabólica e circunferência abdominal, enquanto a FP se correlaciona com níveis maiores de esteatose. A RM foi capaz de identificar o conteúdo de ferro destes pacientes, sendo o ponto de corte de R2* 58,9s-1. A porcentagem de gordura, identificada pela RM, foi de 17% nos grupos HFD e SDDF e de 13% no grupo FN. Conclusão: 1) RM utilizando a técnica de relaxometria com correção da interferência de gordura se mostrou acurado na avaliação de discreto depósito de ferro em pacientes com SDDF; 2) HF pode refletir depósito de ferro hepático quando acima de 180,4 ng/mL para mulheres e 350,7 ng/mL para homens, não foi encontrada relação entre HF e características piores metabólicas ou histológicas; 3) FL se correlacionou com síndrome metabólica e circunferência abdominal, enquanto a FP se correlaciona com esteatose; 4) Hepcidina se correlacionou com siderose e ferritina sérica nos pacientes com DHGNA / Introduction: Hyperferritinemia (HF) may reflect the inflammatory status of patients with NAFLD and obesity, but about 33 % reflects a real hepatic iron overload. The dysmetabolic iron overload syndrome (DIOS) definition is HF, normal transferrin saturation, and mild hepatic iron overload in a patient with metabolic disorders. The gold standard for diagnosis of iron overload is the liver biopsy. As it is an invasive method, new methods are necessary. Among them, magnetic resonance imaging (MRI) is the most available one. Patients and Methods: This study evaluated patients with HF, overweight and NAFLD. All patients were submitted to liver biopsy. MRI relaxometry (fat/iron analysis - 3T machine), measurement of inflammatory markers (TNF-alpha and IL-6), analysis of the expression of ferritin light and heavy chain subunits (FL and FP) and serum hepcidin were held. Data were correlated with liver biopsy. The patients were classified considering the ferritin levels and siderosis. They were classified in three groups: normal ferritin (NF), dysmetabolic hyperferrinemia (DHF) and DIOS. The NF group has serum ferritin (SF) below 200 ng/dL for women and 300 ng/dL for men, DHF must have SF above those values and negative siderosis, and DIOS have hyperferritinemia and positive siderosis. They are also classified considering only the iron status Results: 152 biopsy-proven NAFLD patients were screened but only 67 were included in this study. DIOS and HFD frequency in our sample were 37% and 16%, respectively. The cut-off of ferritin levels were correlated with iron overload in liver biopsy was 180.4 ng/mL for women (sensibility of 76.9% and specificity of 64.3%) and 350 ng/mL for men (sensibility of 72.7% and specificity of 75.5%). Although, DHF and DIOS patients did not have worst metabolic or histological characteristics, hepcidin levels were higher in DHF and DIOS groups, correlating with hepatic siderosis when hepcidin is above 30,2 ng/mL. The inflammatory markers (IL- 6 and TNF-alpha) were similar among the groups. The expression of FP and FL were similar in role sample. FL correlates with metabolic syndrome and abdominal circumference, while FP correlates with in higher fat scores. The MRI was able to identify mild iron overload. The R2* cut off level was 58,9 s -1. The fat percentage in DIOS and HFD was of 17% each and in NF 13%. Conclusion: 1) MRI using relaxometry method is accurate to evaluate mild iron overload in DIOS patients; 2) HF may reflect iron overload when above 180.4 ng/mL for women and 350.7 ng/mL for men, however, this study didn´t find correlation between HF and insulin resistance and worst NAFLD histological characteristics; 3) FL correlates with metabolic syndrome and abdominal circumference while FP correlates with in higher fat scores 4) Hepcidin correlates with iron and serum ferritin in NAFLD patients

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-05-08T12:20:16Z No. of bitstreams: 2 Dissertação - Beatriz Assis Carvalho - 2015.pdf: 4617719 bytes, checksum: b0187daca51d7151c1658696f370401e (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-05-08T13:00:51Z (GMT) No. of bitstreams: 2 Dissertação - Beatriz Assis Carvalho - 2015.pdf: 4617719 bytes, checksum: b0187daca51d7151c1658696f370401e (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-05-08T13:00:51Z (GMT). No. of bitstreams: 2 Dissertação - Beatriz Assis Carvalho - 2015.pdf: 4617719 bytes, checksum: b0187daca51d7151c1658696f370401e (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-02-09 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / To evaluate the nutritional status of iron and its related factors in children 12 to 15 months assisted in Health Units in Goiânia, Goiás. METHODS: This is a cross-sectional study nested in research "Effectiveness of home fortification with vitamins and minerals in the prevention of iron deficiency and anemia in children under one year of age: a multicenter study in Brazilian cities ". The study was conducted with 230 children, aged between 12 and 15 months, assisted in Health Units in Goiânia, from June 2012 to February 2013. The prevalence of iron deficiency, iron deficiency anemia and anemia were assessed by the plasma means concentration of ferritin and transferrin receptor, hemoglobin and C-reactive protein. Multiple linear regression was used to estimate the effect of independent variables on the log plasma concentrations of ferritin. These variables were socioeconomic, demographic, maternal, pregnancy, anthropometric, breastfeeding, use of supplement, and biochemical parameters. RESULTS: Regarding the iron status, iron deficiency and iron deficiency anemia prevalence was 14.1% and 1.5%, respectively. Also, anemia prevalence was 5.6% of the infants studied. The predictors of ferritin were folate, vitamin B12 and the use of iron supplement at the time of collection, which each unit raised the log plasma concentration of ferritin in 0.009 mg/L, 0.001 mg/L and 0.315 mg/L, respectively. CONCLUSION: The results of this study showed low prevalence of iron deficiency and anemia in children studied. The use of iron supplements and serum concentrations of vitamin B12 and folate correlated ferritin concentrations and consequently the iron status in this population. Keywords: Iron Deficiency; Ferritins; Receptors, transferrin; Folic Acid; Vitamin B 12; Infant. / Avaliar o estado nutricional de ferro e os seus fatores relacionados em crianças de 12 a 15 meses atendidas em Unidades Básicas de Saúde de Goiânia, Goiás. MÉTODOS: Trata-se de um estudo transversal aninhado a pesquisa “Efetividade da fortificação caseira com vitaminas e minerais na prevenção da deficiência de ferro e anemia em crianças menores de um ano: estudo multicêntrico em cidades brasileiras”. O trabalho foi realizado com 230 crianças, de 12 e 15 meses, atendidas em Unidades Básicas de Saúde de Goiânia, no período de junho de 2012 a fevereiro de 2013. As prevalências de deficiência de ferro, anemia por deficiência de ferro e anemia foram avaliadas por meio da concentração plasmática de ferritina e receptor de transferrina, hemoglobina e proteína C-reativa. Foi utilizada regressão linear múltipla para estimar o efeito de variáveis independentes sobre o log das concentrações plasmáticas de ferritina. Estas variáveis foram condições socioeconômicas, demográficas, maternas, gestacionais, antropomêtricas, amamentação, uso de suplemento, e parâmetros bioquímicos. RESULTADOS: Com relação ao estado nutricional de ferro, as prevalências de deficiência de ferro e anemia por deficiência de ferro foram de 14,1% e 1,5% respectivamente. Além disso, foi encontrada prevalência de 5,6% de anemia nos lactentes estudados. Os fatores associados a ferritina foram o folato, a vitamina B12 e o uso de suplemento de ferro no momento da coleta, os quais cada unidade elevaram o log da concentração plasmática de ferritina em 0,009 μg/L, 0,001 μg/L e 0,315 μg/L, respectivamente. CONCLUSÃO: Os dados do presente estudo evidenciaram baixas prevalências de deficiência de ferro e anemia nas crianças estudadas. O uso de suplemento de ferro e as concentrações séricas das vitaminas B12 e folato correlacionaram-se as concentrações de ferritina e consequentemente, o estado nutricional de ferro nesta população.

The DNA binding proteins under starvation (Dps) from M. smegmatis are cage-like structures which internalize iron and bind DNA. They provide resistance to the cells from free radical damage, and physically protect the DNA from the harmful effects of reactive oxygen species by DNA compaction. The work compiled in this thesis has been an effort to study oligomerization and dynamics of iron metabolism by these nano-protein compartments. Chapter 1 gives a general introduction on stress, especially oxidative stress, and the ways bacteria fight back the host resistance systems. This has been elaborated from the point of view of the Dps proteins which is the focus of our work. Also, the competition for iron among the host and pathogens, and the modes of iron trafficking of the pathogens from host organisms has been summarized. Finally, the structural aspects of ferritin family proteins to which Dps belongs, has been discussed. Chapter 2 elaborates on the oligomerization pathways of the first M. smegmatis Dps MsDps1, which exists in vitro as two oligomeric forms. The GFP-tagging has been used to locate the Dps1 proteins by live cell imaging and the over-expression of these proteins during nutrient limiting conditions has been studied. The crystal structure of a point mutant F47E in the background of MsDps1, which shows no dodecamerization in vitro, has been solved. The possible ways of dodecamerization of MsDps1 has been concluded by analyzing the intermediates via glutaraldehyde cross-linking and native electrospray mass spectrometry. Chapter 3 documents the gating machinery of iron in MsDps2 protein, the second M. smegmatis Dps protein. Through graph theoretical approaches, a tight histidine-aspartate cluster was identified at the ferritin-like trimeric pore which harbors the channel for the entry and exit of iron. Sitespecific variants of MsDps2 were generated to disrupt this ionic knot, and the mutants were further assayed for ferroxidation, iron uptake and iron release properties. Our studies in MsDps2 show the importance of counter-acting positive and negatively charged residues for efficient assimilation and dispersion of iron. Chapter 4 describes crystallization studies of MsDps2 pore variants, done in an attempt to connect the changes in functional properties described in chapter 3, with structural alterations of the point mutants. We show here that the gating mechanism happens by alterations in side chain configuration at the pore and does not alter the over-all stability of the proteins. Chapter 5 is the final section where we have employed site specific mutations and cocrystallization studies to elucidate the behaviour of MsDps2 proteins upon the addition of iron. By studying the effect of substitutions at conserved sites near ferroxidation center, we attempt to arrive at a pathway which iron atoms take to reach the ferroxidation site. Also, by crystallization of proteins loaded with varying amounts of iron we tried to map the changes in the protein structure in the presence of its ligand. Chapter 6 concludes briefly the work that has been documented in this thesis. Appendix I relates the role of N-terminal tail for DNA binding in MsDp2. Appendix II gives the technical details of a modified protein preparation and oligomerization process for his-tagged MsDps1 protein. Appendix III gives the maps of the plasmids used in this study.