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Hyperferritinemia.

Hyperferritinemia.

By * Dr Rita MONSIEUR and Dr Van Snick.

Introduction 

The hyperferritinemia is an excess of ferritin in the blood.

Ferritin is a glycoprotein located inside liver cells, which binds iron to sugar. This molecule is made by the liver and allows the storage of iron. It is the reserve of mobilizable iron by the body. The release of iron in the blood ensures its availability.

The ferritin dosage is a good indicator of the level of iron reserves in the body. Thus, the ferritin is low when the patient has a deficiency of iron, and the ferritin is high in cases of excess of iron in the blood.

This is observed particularly in cases of hemochromatosis.

We can therefore postulate that the excess of ferritin corresponds to an excess reserve of iron in the body.

What are the causes of overload in Iron ? 

They are very important in...

- Hereditary hemochromatosis
- Erythropoiesis (the entire process of production of erythrocytes ( red blood cells ) in red bone marrow from stem cells ) ineffective
- transfusions of red blood cells and massive repetition
- pulmonary haemosiderosis an abnormal form of iron storage in the body
- chronic hemoglobinuria red blood cells burst

Followed...

- The dysmetabolic hepatosiderosis. The association of hepatic iron overload and signs of insulin resistance (android obesity, dyslipidemia, type 2 diabetes, hypertension) , in the absence of the usual causes of iron overload
- The inflammatory syndrome biological board occurring during inflammatory reactions , manifested by an elevated sedimentation rate and changes in serum levels of certain proteins (including CRP, fibrinogen, albumin). So the consequences are asthenia, fever, weight loss
- The hemolytic anemias, excessive destruction of red blood cells
- An excessive dietary intake of iron fostered by a high vitamin C

What is the relationship between hyperferritinemia with other diseases ? 

hyperferritinemia pathologies

• In the increase of the ferritinemia the risk of type 2 diabetes is seven times higher and this independently of the risk factors (age, BMI, sex, family history, smoking and physical inactivity) dietary factors and alcohol intake. This is important for understanding the etiology of diabetes.

The deposition of iron in the liver may create a resistance to insulin (insulin inability to block the synthesis of glucose). Iron is self oxidized to form iron oxygen soluble complexes, that are highly reactive.

These free radicals are pro-oxidants and change the membrane properties causing cell destruction. Furthermore, accumulation of iron in hepatocytes may interfere with the ability of hepatic insulin extraction.
It is described as hypo-adiponectinemia is predictive of future diabetes. There is also the relationship between hyperferritinemia and the following pathologies :

• Hepatic disorders with as consequence a large number of pathologies and ranging from steatosis (Accumulation of fat - essentially triglycerides inside the cells of the body which usually do not contain it or in small proportions. It exists a macro-vesicular steatosis, with hepatocellular focal necrosis inflammatory and fibrosis. A complex pathology that may progress to hepatocellular carcinoma and hepatic decompensation with death)  to cirrhosis through Chronic hepatitis C (the assessment of steatosis in chronic hepatitis C shows that the increase of BMI has a role in the pathogenesis of hepatic fibrosis. The hepatic iron is a alternate marker of severe fibrosis in the hepatitis C)
• the acute mononucleosis
• the Metabolic Syndrome : The Metabolic Syndrome is defined by an abdominal obesity and an increased waist measurement (mandatory criterion) equal or upper to 94 cm for men and 80 cm in woman, plus two of the four following criteria :high Triglycerides (> 1,5 g/l), low HDL cholesterol < 0,5 g/l for women or < 0,4g/l for men, Hypertension artérielle with numbers equal to or superior than 135/85 mm Hg, fasting glycemia equal or superior to 1,00 g/l
• the lipodystrophy - abetalipoproteinemia - hypobetalipoproteinemia,
• the intestinal diverticulosis : presence of diverticula, kind of intestinal mucosa hernias through the muscular wall
• the chronic inflammatory disorders : evolutionary chronic polyarthritis, erythematosus lupus, ...
• different neurodegenerative pathologies such as Alzheimer disease and the Parkinson's disease seen the generation of free radicals by iron excess.
• the HIV

Hyperferritinemia Natural Treatment 

The physiological objectives are grouped in the complex FerriLow

Besides a diet, exercise and reduced dietary iron, treatment consists in taking cytoprotective agents, antioxidants, anti- inflammatory, anti-diabetic.

The plants or natural substances which compose it, have their place in the treatment of this hyperferritinemia.

They are specific to this pathology or this risk factor but the treatment will require in a complementary way, a therapeutic reflection on the associated factors like the causes of this hyperferritinemia

An adequate therapeutics will assure the control of a multifactorial situation.

The correction of the various associated parameters will be started.

References 

Forouhi NG and col.
Elevated serum ferritin levels predict new-onset type 2 diabetes: results from the EPIC-Norfolk prospective study.
Diabetologica. 2007 Mar 2

Jehn ML and col.
A prosfective study of Plasma Ferritin Level and Incident Diabetes; The atherosclerosis Risk in Communities Study. (ARIC)
Am J Epidemiol, 2007 Feb 6

Kowdley KV.
Alcohol intake and iron overload: an other role for hepcidin?
Hepatology 2007 jan 26;45(2):451-453

Lee DW, Andersen JK
Role of HIF-1 in iron regulation: potential therapeutic strategy for neurodegenerative disorders. Curr Mol Med. 2006 Dec; 6(8):883-93

Van Campenhout A and col
Impact of diabetes mellitus on the relationships between, inflammatory-and oxidative stress status.
Diabetes Metab Res Rev. 2006 Nov-Dec; 22(6):444-54

Nemeth E, Ganz T.
Regulation of iron metabolism by hepcidin.
Annu Rev Nutr. 2006;26:323-42 Review

You SA, Wang Q.
Ferritin in atherosclerosis.
Clin Chim Acta. 2005 Jul 1;357(1):1-16 Epub2005Mar 23.Review.

Silva and col.
Iron overload in patients with chronic hepatitis C virus infection/ clinical and histological study.
L gastroenterol Hepatol 2005 feb; 20(2):243-8

Gattoni A and col
.Role of hemochromatosis genes in chronic hepatitis C..
Clin.Ter.2006 Jan;157(1):61-8. Review.

Hachiro Y and col.
Evaluation of a model of latent pathologic factors in relation to serum ferritin elevation.
Clinical Biochemistry 40(2007) 359-364

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