Zughaier Susu M, Alvarez Jessica A, Sloan John H, Konrad Robert J, Tangpricha Vin
Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA ; Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA.
Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
J Clin Transl Endocrinol. 2014 Mar 21;1(1):19-25. doi: 10.1016/j.jcte.2014.01.003.
Chronic kidney disease affects 40% of adults aged 65 and older. Anemia of CKD is present in 30% of patients with CKD and is associated with increased cardiovascular risk, decreased quality of life, and increased mortality. Hepcidin-25 (hepcidin), the key iron regulating hormone, prevents iron egress from macrophages and thus prevents normal recycling of the iron needed to support erythropoiesis. Hepcidin levels are increased in adults and children with CKD. Vitamin D insufficiency is highly prevalent in CKD and is associated with erythropoietin hyporesponsiveness. Recently, hepcidin levels were found to be inversely correlated with vitamin D status in CKD. The aim of this study was to investigate the role of vitamin D in the regulation of hepcidin expression and . This study reports that 1,25-dihydroxyvitamin D (1,25(OH)D), the hormonally active form of vitamin D, is associated with decreased hepcidin and increased ferroportin expression in lipopolysaccharide (LPS) stimulated THP-1 cells. 1,25(OH)D also resulted in a dose-dependent decrease in pro-hepcidin cytokines, IL-6 and IL-1β, release . Further, we show that high-dose vitamin D therapy impacts systemic hepcidin levels in subjects with early stage CKD. These data suggest that improvement in vitamin D status is associated with lower systemic concentrations of hepcidin in subjects with CKD. In conclusion, vitamin D regulates the hepcidin-ferroportin axis in macrophages which may facilitate iron egress. Improvement in vitamin D status in patients with CKD may reduce systemic hepcidin levels and may ameliorate anemia of CKD.
慢性肾脏病影响40%的65岁及以上成年人。30%的慢性肾脏病患者存在慢性肾脏病贫血,其与心血管风险增加、生活质量下降及死亡率增加相关。铁调素-25(铁调素)是关键的铁调节激素,可阻止铁从巨噬细胞中流出,从而阻止支持红细胞生成所需铁的正常循环利用。慢性肾脏病成人和儿童的铁调素水平升高。维生素D不足在慢性肾脏病中非常普遍,且与促红细胞生成素反应低下相关。最近发现,慢性肾脏病患者的铁调素水平与维生素D状态呈负相关。本研究的目的是探讨维生素D在调节铁调素表达中的作用。本研究报告称,维生素D的激素活性形式1,25-二羟基维生素D(1,25(OH)D)与脂多糖(LPS)刺激的THP-1细胞中铁调素减少及铁转运蛋白表达增加有关。1,25(OH)D还导致促铁调素细胞因子IL-6和IL-1β释放呈剂量依赖性减少。此外,我们表明高剂量维生素D治疗会影响早期慢性肾脏病患者的全身铁调素水平。这些数据表明,维生素D状态改善与慢性肾脏病患者较低的全身铁调素浓度相关。总之,维生素D调节巨噬细胞中的铁调素-铁转运蛋白轴,这可能促进铁流出。改善慢性肾脏病患者的维生素D状态可能会降低全身铁调素水平,并可能改善慢性肾脏病贫血。