铁调素-25在慢性肾脏病中的作用:贫血及其他。

Role of Hepcidin-25 in Chronic Kidney Disease: Anemia and Beyond.

作者信息

Ueda Norishi, Takasawa Kazuya

机构信息

Department of Pediatrics, Public Central Hospital of Matto Ishikawa, 3-8 Kuramitsu, Hakusan, 924-8588 Ishikawa. Japan.

出版信息

Curr Med Chem. 2017;24(14):1417-1452. doi: 10.2174/0929867324666170316120538.

Abstract

Iron is an essential element for all living organisms, but produces toxic oxidants. Thus, iron homeostasis is tightly regulated in mammals. Hepcidin-25 (hepcidin) has emerged as a molecule that regulates iron metabolism. Binding of hepcidin to its receptor, ferroportin, inhibits intestinal iron absorption and iron efflux from hepatocytes and macrophages. Decreased hepcidin enhances iron absorption and efflux. Hepcidin could be predictive of iron status and the response to iron supplementation or erythropoietin-stimulating agents. Monitoring hepcidin is helpful for the management of anemia. Thus, it is urgent to obtain normal reference values in a large population of healthy subjects and to standardize various hepcidin assays, which enables to compare the data measured by different methods. Anemia is an important and common problem associated with chronic kidney disease (CKD), which is caused by erythropoietin deficiency, iron-restricted erythropoiesis, inflammation, hypoxia, vitamin D deficiency, hyperparathyroidism, and obesity. Anemia causes poor quality of life, progression of CKD, increased risk of cardiovascular events, and mortality. Besides its role in anemia, recent evidence suggests that hepcidin-25 plays a role in the pathogenesis and progression of kidney injury via modulation of iron-mediated oxidant injury. Despite accumulating experimental data, information about clinical significance of hepcidin-25 for anemia and kidney injury in CKD patients is scarce, especially in children. This review summarizes the current knowledge of the role of hepcidin-25 in the regulation of anemia and kidney injury in children and adults with CKD. Strategy for modulating hepcidin-25 to prevent anemia and kidney injury associated with CKD is also discussed.

摘要

铁是所有生物的必需元素,但会产生有毒的氧化剂。因此,哺乳动物体内的铁稳态受到严格调控。铁调素-25(hepcidin)已成为一种调节铁代谢的分子。铁调素与其受体铁转运蛋白结合,可抑制肠道铁吸收以及肝细胞和巨噬细胞的铁外流。铁调素水平降低会增强铁的吸收和外流。铁调素可预测铁状态以及对铁补充剂或促红细胞生成素刺激剂的反应。监测铁调素有助于贫血的管理。因此,迫切需要在大量健康受试者中获取正常参考值,并规范各种铁调素检测方法,以便能够比较不同方法测得的数据。贫血是慢性肾脏病(CKD)相关的一个重要且常见的问题,其由促红细胞生成素缺乏、铁限制的红细胞生成、炎症、缺氧、维生素D缺乏、甲状旁腺功能亢进和肥胖引起。贫血会导致生活质量下降、CKD进展、心血管事件风险增加以及死亡率上升。除了在贫血中的作用外,最近的证据表明,铁调素-25通过调节铁介导的氧化损伤在肾损伤的发病机制和进展中发挥作用。尽管实验数据不断积累,但关于铁调素-25对CKD患者贫血和肾损伤的临床意义的信息却很少,尤其是在儿童中。本综述总结了目前关于铁调素-25在CKD儿童和成人贫血及肾损伤调节中作用的知识。还讨论了调节铁调素-25以预防与CKD相关的贫血和肾损伤的策略。

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