Iron is an essential nutrient for energy and DNA replication. Its homeostasis is commonly perturbed by chronic inflammatory mechanisms. Chronic inflammation upregulates a cytokine, hepcidin, that degrades the iron export protein ferroportin. Without a way to export iron into the bloodstream iron availability in blood becomes depleted. Iron depletion in the blood stream hinders erythropoiesis and is termed anemia. Herein I investigate and inhibit the mechanism of hepcidin activation. Inhibition of hepcidin activation has released iron from tissues and alleviated anemic conditions in a cancer model. I have laid the foundation to investigate this pathway in a 3D spheroid model. The results show that hepcidin-25 inhibition is a promising treatment for anemia of cancer. More work needs to be done to confirm efficacy in an in vivo model. In addition to anemia of cancer I have also worked with diabetic rats and investigated their anemic state using common anemia diagnostic methods. I found that in this high fat high sugar diet Wistar rat model anemia was not induced. In addition to my studies on anemia I have investigated the use of portable x-ray fluorescence (pXRF) as an accessible and affordable elemental analysis technique for lateral flow immunoassays and biological samples such as cell lysates and animal tissue. While pXRF shows promising results more work needs to be done to increase its sensitivity and pixel size.

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Einleitung: Eisenmangel ist ein häufiges Problem bei Ausdauersportlern, da dieser die Leistungsfähigkeit einschränken und zu einer Blutanämie führen kann. Von den klassischen Eisenstoffwechselparametern sind nur wenige geeignet, den tatsächlichen Eisenstatus anzuzeigen, da sie durch sportliche Aktivität per se beeinflusst werden können. In der Studie wird die Wertigkeit moderner Eisenstoffwechselparameter im Ausdauersport untersucht. Ergebnisse und Diskussion: Der Hämoglobingehalt der Retikulozyten (CHr) und der prozentuale Anteil der hypochromen Erythrozyten (% HYPO) bleiben als moderne Parameter der Eisenstoffwechseldiagnostik auch nach regenerativen, extensiven sowie intensiven Ausdauerbelastungen konstant. Sie zeigen somit unbeeinflusst von der (Ausdauer-)Sportart als auch von der Belastungsdauer und –intensität die aktuelle Eisenversorgung der Erythropoese im Knochenmark an. Als Monitoringparameter im Rahmen einer Eisensubstitution sind der CHr sowie der prozentuale Anteil hypochromer Retikulozyten sensible Parameter, mit denen sich schnell und zuverlässig die Effektivität einer oralen Eisensubstitution nachweisen lässt. Der Eisenstatus kann durch die alleinige Bestimmung des CHr bzw. des % HYPO nicht exakt ermittelt werden. Im Gegensatz zum Einsatz bei klinischen Fragestellungen können sie zu diesem Zeitpunkt in der Sportmedizin allenfalls nur ein ergänzender Parameter in der Differentialdiagnostik eines Eisenmangels sein. Die für Ausdauersportler ermittelten Referenzwerte liegen bei 28,8-35,9 pg für den CHr und bei 0-0,5 % für die hypochromen Erythrozyten. Ein belastungsbedingter Anstieg des Eisen-regulierenden Hormons Hepcidin könnte auf Grund seiner inhibitorischen Wirkung auf die intestinale Eisenabsorption sowie auf die Freisetzung von Eisen aus den Makrophagen zur Entwicklung von Eisenmangel-zuständen führen. Die Entwicklung von Hepcidin-Antagonisten könnte in Zukunft therapeutische Anwendungen finden. / Introduction: Athletes are commonly diagnosed with iron deficiency, particularly those involved in endurance sports. It often not only decreases athletic performance but also contributes to the development of anaemia. Many biochemical markers are used to evaluate body iron stores but some of them are affected by physical exercises. This study was designed to investigate new haematological parameters in endurance athletes. Results and discussion: Reticulocyte hemoglobin content (CHr) and percentage of hypochromic red cells (% HYPO) were highly stable in athletes subjected to varying physical loads. Furthermore, they were neither affected by different forms of endurance sports nor by their duration and intensity. These modern indices are able to reflect the availability of iron during erythropoiesis at all times. In the early prediction of response to oral iron supplementation, the reticulocyte indices CHr and % HYPOr (percentage of hypochromic reticulocytes) are the most sensitive parameters. However, it is not possible to assess the iron status in athletes by CHr and % HYPO alone. In contrast to other clinical cases they can only be an additional parameter in the differential diagnosis of iron deficiency. The calculated reference range for endurance athletes are 28,8 - 35,9 pg for CHr and 0-0,5 % for % HYPO. As the iron-regulating hormone hepcidin is inhibiting the absorption of iron from the diet at the site of the duodenal enterocytes and blocking the release of iron from macrophages that have collected senescent erythrocytes, an exercise induced up-regulation of hepcidin activity might potentially be a new mechanism causing iron deficiency in athletes. Therefore, the development of hepcidin antagonists could prove to be helpful with regard to therapeutic utilization.

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Iron storage disease is a significant cause of liver disease and mortality in captive Egyptian fruit bats (Rousettus aegyptiacus). The nature of the susceptibility in this and other captive exotic species to iron storage disease is not clear. Hepcidin, a key iron regulatory hormone, is involved in the regulation of iron absorption in humans and other mammalian species and a deficiency in hepcidin has been associated with a number of genetic mutations resulting in hemochromatosis in humans. The objectives of this thesis were to identify whether there is a functional mutation in the hepcidin gene in the Egyptian fruit bat that may increase the susceptibility of this species to iron storage disease, and whether there is a functional deficiency in hepcidin gene expression in the Egyptian fruit bat in response to iron challenge. We compared the coding region of the hepcidin gene amongst several species of bats and investigated hepcidin response to intramuscular injection of iron dextran amongst three species of bats with variable susceptibility to iron storage disease; the Egyptian fruit bat, the straw-colored fruit bat (Eidolon helvum), and the common vampire bat (Desmodus rotundus). While a number of genetic differences were identified amongst species, a functional mutation that could result in decreased hepcidin activity was not identified in the Egyptian fruit bat. Bats exhibited marked variation in hepcidin gene expression, with the highest level of hepcidin response to iron challenge in the common vampire bat. While the Egyptian fruit bat exhibited significant hepcidin response to iron challenge, the magnitude of response was lower than that in the common vampire bat and lower than expected based on findings in healthy humans. The straw-colored fruit bat did not exhibit any hepcidin response despite a significant increase in iron stores, which suggests this species may have evolved an alternate mechanism for coping with excessive iron or may be more susceptible to iron overload than previously recognized. / Toronto Zoo Scholarship Fund

<p><i>Chlamydophila pneumoniae</i> (<i>C. pneumoniae</i>) has been suggested as a stimulator of chronic inflammation in atherosclerosis. <i>C. pneumoniae</i> DNA was demonstrated in aortic biopsies in 50% of patients with stable angina pectoris or acute coronary syndrome undergoing coronary artery bypass grafting. <i>C. pneumoniae</i> mRNA, a marker of replicating bacteria, was demonstrated in 18% of the aortic biopsies. </p><p>Inflammation may have a role in the pathogenesis of thoracic aortic aneurysm, aortic dissection and aortic valve stenosis. <i>C. pneumoniae </i>DNA was demonstrated in aortic biopsies in 26% of thoracic aortic aneurysm patients and in 11% of aortic dissection patients undergoing thoracic surgery and in 22% of stenotic aortic heart valves from patients undergoing aortic valve replacement. No bacterial mRNA was demonstrated in these aortic biopsies, nor in the valves, suggesting that the infection has passed into a persistent state. <i>C. pneumoniae</i> DNA was demonstrated in peripheral blood mononuclear cells in only 5% of aortic valve stenosis patients and not in thoracic aortic aneurysm or aortic dissection patients, suggesting that the bacterium disseminated to the cardiovascular tissue long before the patient required surgery. The copper/zinc ratio in serum, a marker of infection/inflammation, was significantly elevated in thoracic aortic aneurysm patients, supporting an inflammatory pathogenesis. Patients positive for <i>C. pneumoniae</i> in the aortic valve had more advanced coronary atherosclerosis, further supporting a possible role for <i>C. pneumoniae</i> in atherosclerosis. </p><p>Mice were infected with <i>C. pneumoniae</i> that disseminated to all organs investigated (i.e. lungs, heart, aorta, liver and spleen). Trace element concentrations were altered in infected animals with an increased copper/zinc ratio in serum, a progressively increased iron concentration in the liver and a progressively decreased iron concentration in serum. Iron is important for <i>C. pneumoniae</i> metabolism, and a changed iron homeostasis was noted in infected mice by alterations in iron-regulating proteins, such as DMT1 and hepcidin.</p>

Le rôle de l'inflammation dans le développement et la progression des maladies rénales chroniques (MRC) chez le chat a été peu étudié. L'hepcidine est une protéine de la phase aigue (PPA) de l'inflammation qui contribue au développement des anémies lors de MRC chez l'homme. Les objectifs de cette étude sont de comparer les concentrations en PPAs, en erythropoietine (EPO) ainsi que le statut en fer entre un groupe de chats sains et en MRC. 18 chats sains et 38 chats en MRC ont été recrutés de façon prospective. Les examens réalisés incluaient hématologie, biochimie, analyse d'urine, Serum amyloid A (SAA), haptoglobine (HAP), EPO, hepcidine,fer, TIBC et ferritinne. Nous avons observé une augmentation significative des concentrations en SAA et en hepcidine ainsi qu'une diminution significative du fer et du TIBC dans le groupe MRC (P < .05). Une corrélation positive entre la créatinine et certaines PPAs (SAA and hepcidin; P < .05) était présente. L'augmentation de SAA et hepcidine était significativement associé avec une diminution du TIBC et de l'hématocrite dans le groupe MRC. Les 14 (37%) chats anémiques du groupe MRC avaient une concentration significativement plus basse en fer et en TIBC (P < .05), changements compatibles avec une déficience fonctionelle en fer. Aucun chat n'avait un panel de fer compatible avec une carence en fer absolue. En conclusion, les résultats de cette étude suggèrent que les MRC chez le chat sont des conditions pro-inflammatoires, ayant un impact sur le métabolisme du fer. / The role of inflammation in the development and progression of feline chronic kidney disease (CKD) is not well characterized. Hepcidin, a recently discovered acute phase protein (APP) contributes to the development of anemia in human patients with CKD. The objectives of our study was to compare plasma APP including hepcidin, iron status, and erythropoietin (EPO) concentrations between healthy and cats with naturally occurring CKD. Eighteen healthy control cats and 38 cats with CKD were prospectively recruited. Complete physical examination along with hematology, biochemistry, plasma amyloid A (SAA), haptoglobine (HAP), EPO, iron, TIBC and ferritin were performed using routine laboratory analyses and commercially available feline ELISA-assays. Hepcidin-25 concentration was assessed with a human ELISA kit (DRG® Diagnostics). We found that mean SAA and hepcidin concentration were significantly higher and mean total iron and TIBC were significantly lower in the CKD group (P < .05). There was a significant positive correlation between creatinine and APPs (SAA and hepcidin; P < .05). Increase in SAA and hepcidin was also significantly associated with decrease of TIBC and PCV in the CKD group. The 14 (37%) anaemic cats with CKD had significantly and lower iron, TIBC, consistent with functional iron deficiency (P < .05). There were no patients with an iron profile suggestive of a true iron deficiency. There was no association with survival. In conclusion, our data suggest that feline CKD is a pro-inflammatory state, having significant impact on iron metabolism. With further validation, hepcidin may help better characterize these interactions.

Chlamydophila pneumoniae (C. pneumoniae) has been suggested as a stimulator of chronic inflammation in atherosclerosis. C. pneumoniae DNA was demonstrated in aortic biopsies in 50% of patients with stable angina pectoris or acute coronary syndrome undergoing coronary artery bypass grafting. C. pneumoniae mRNA, a marker of replicating bacteria, was demonstrated in 18% of the aortic biopsies. Inflammation may have a role in the pathogenesis of thoracic aortic aneurysm, aortic dissection and aortic valve stenosis. C. pneumoniae DNA was demonstrated in aortic biopsies in 26% of thoracic aortic aneurysm patients and in 11% of aortic dissection patients undergoing thoracic surgery and in 22% of stenotic aortic heart valves from patients undergoing aortic valve replacement. No bacterial mRNA was demonstrated in these aortic biopsies, nor in the valves, suggesting that the infection has passed into a persistent state. C. pneumoniae DNA was demonstrated in peripheral blood mononuclear cells in only 5% of aortic valve stenosis patients and not in thoracic aortic aneurysm or aortic dissection patients, suggesting that the bacterium disseminated to the cardiovascular tissue long before the patient required surgery. The copper/zinc ratio in serum, a marker of infection/inflammation, was significantly elevated in thoracic aortic aneurysm patients, supporting an inflammatory pathogenesis. Patients positive for C. pneumoniae in the aortic valve had more advanced coronary atherosclerosis, further supporting a possible role for C. pneumoniae in atherosclerosis. Mice were infected with C. pneumoniae that disseminated to all organs investigated (i.e. lungs, heart, aorta, liver and spleen). Trace element concentrations were altered in infected animals with an increased copper/zinc ratio in serum, a progressively increased iron concentration in the liver and a progressively decreased iron concentration in serum. Iron is important for C. pneumoniae metabolism, and a changed iron homeostasis was noted in infected mice by alterations in iron-regulating proteins, such as DMT1 and hepcidin.

Thesis (MSc (Genetics))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Oesophageal cancer (OC) is the sixth leading cause of cancer related deaths in the world with approximately 300 000 new cases reported each year. OC may be characterized into two forms with 90% of cases presenting as squamous-cell carcinoma (SCC) and the remaining 10% as adenocarcinoma (ADC). Several factors have been attributed to the development of OC, including oesphageal injury and/or irritation, chronic inflammation and excess iron associated with enhanced tumour growth. The HAMP gene codes for a 25 amino-acid protein found to be primarily expressed in the liver and crucial to regulation of bodily iron status. Defects occurring in the HAMP gene could therefore lead to the dysregulation of the gene, resulting in an iron overload status. Iron overload is a previously described risk factor in the development of various cancers, including OC, and therefore the aim of this study was to investigate whether dysregulation of the HAMP gene may be involved in the cancer phenotype exhibition. The study cohort comprised of 48 unrelated patients presenting with SCC and a control group of 51 healthy, unrelated population-matched individuals. Mutation detection techniques included polymerase chain reaction (PCR) amplification, heteroduplex single-stranded conformation polymorphism (HEX-SSCP) analysis and bi-directional semi-automated DNA sequencing analysis. Screening of the 5’ regulatory region (5’UTR) of the HAMP gene revealed one known (-582A/G) and two novel (-188C/T and -429G/T) variants with the -429G/T variant showing statistically significant reduction in expression in patients relative to controls. Iron parameters were correlated between patient and control cohorts, as well as for variant presence and absence within individuals. Luciferase reporter constructs were used to investigate the functional implications of the presence of a variant on HAMP gene expression, and how these results correlated to the iron parameter statistics obtained. Luciferase reporter assay results indicated the -188C/T and -429G/T variants to result in under-, and the -582A/G variant to result in over-expression at the basal level, relative to the respective wild-type sequence constructs. Correlation of the luciferase data with the iron parameter statistics, indicate the -429G/T variant to be coupled to significantly higher levels of ferritin and C-reactive protein (CRP) and significantly lower levels of serum-iron and transferrin when compared to individuals without the variant. Considering only the patient group, the presence of the -188C/T and -429G/T variants were coupled to significantly lower levels of transferrin in patients with either variant, compared to patients without. The variants found within the HAMP promoter region are therefore able to alter gene regulation to an extent where iron parameters deviate between healthy and OC afflicted individuals, and also between patients with and without a variant. This dysregulation in iron homeostasis may play a role in the development and/ or progression of OC. Characterisation of the 5’ UTR of the HAMP gene may contribute to linking iron regulation to the establishment of an effective screening program, facilitating the early detection of OC. / AFRIKAANSE OPSOMMING: Slukdermkanker (SK) is die sesde grootste oorsaak van kanker-verwante sterftes in die wêreld, met sowat 300 000 nuwe gevalle wat aangemeld word elke jaar. SK kan geklassifiseer word in twee vorme, waar 90% van die gevalle plaveisel-selkarsinoom (SSC) vorm en die oorblywende 10%, adenokarsinoom (ADC). Verskeie faktore word toegeskryf aan die ontwikkeling van SK, insluitend slukderm beserings en/ of irritasie, chroniese inflammasie en oormatige ystervlakke wat geassosieer word met verhoogde gewasgroei. Die HAMP geen kodeer vir 'n 25 aminosuur proteïen wat hoofsaaklik in die lewer uitgedruk word en noodsaaklik is vir die regulering van ystervlakke in die liggaam. Defekte wat in die HAMP geen voorkom kan dus die onreëlmatige regulering van die geen tot gevolg hê, wat lei tot yster-oorlading. Yster-oorlading is voorheen beskryf as ‘n risiko faktor in die ontwikkeling van verskillende vorme van kanker, insluitend SK en gevolglik was die doel van hierdie studie om te bepaal of die wanregulering van die HAMP geen betrokke mag wees by die uitdrukking van die kanker fenotipe. Die studiepopulasie het bestaan uit 48 onverwante pasiënte met SSC en ‘n kontrole-groep van 51 gesonde, onverwante soortgelyke individue. Die mutasie opsporingstegnieke wat gebruik is, het polimerase kettingreaksie (PKR) amplifisering, heterodupleks enkelstring-konformasie polimorfisme (HEX-SSCP) analise en bidireksionele semi-outomatiese DNS volgordebepaling-analise van die geïdentifiseerde variante ingesluit. Sifting van die 5’ regulerende area (5'UTR) van die HAMP geen het een bekende (-582A/G) en twee nuwe (-188C/T en -429G/T) variante opgelewer, met die -429G/T variant wat statisties beduidend onderdruk is in pasiënt uitdrukkings vlakke relatief tot 'n gesonde kontole-groep. Yster-parameters van alle pasiënt en kontole individue is gekorreleerd tussen pasiënt en kontrole groepe, sowel as vir teenwoordigheid of afwesigheid van variante in elke individu. Luciferase verklikker konstrukte is gebruik om die funksionele implikasies van die teenwoordigheid van ‘n variant op HAMP geenuitdrukking te ondersoek, en hierdie resultate te korreleer met yster-parameter statistieke wat verkry is. Luciferase verklikkertoetse dui aan dat die -188C/T en -429G/T variante tot verminderde, en die -582A/G variant lei tot die verhoogte uitdrukking op die basale vlak lei, relatief tot die onderskeie wilde-tipe konstukte. Korrelasie van die luciferase data met die yster-parameter statistieke, dui aan dat die -429G/T-variant gekoppel is aan aansienlik hoër vlakke van feritien en C-reaktiewe proteïen (CRP) en beduidend laer vlakke van serum-yster en transferrien in vergelyking is met individue sonder die variant. Met oorweging van slegs die pasiënt-groep, is die teenwoordigheid van die -188C/T en -429G/T variante beduidend gekoppel aan laer vlakke van transferrien in pasiënte met die variant, in vergelyking met pasiënte daarsonder. Variante binne die HAMP promotor is dus in staat om geenregulasie te verander tot so 'n mate dat die yster-parameters afwyk tussen gesonde en SK geaffekteerde individue, sowel as tussen pasiënte met en sonder ’n variant. Hierdie wanregulering in yster homeostase kan 'n rol speel in die ontwikkeling en/ of die progressie van SK. Karakterisering van die 5’ regulerende area van die HAMP geen kan grootliks bydra om ysterregulasie te verbind met die implementering van ‘n effektiewe siftingsprogram, en sodoende die vroeë opsporing van SK fasiliteer.