铁调素疗法的当前态势

Current Landscape of Hepcidin Therapeutics.

作者信息

Nai Antonella, Silvestri Laura, Asperti Michela, Vinchi Francesca

机构信息

Regulation of Iron Metabolism Unit, Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, Milan, Italy.

Vita-Salute San Raffaele University, Milan, Italy.

出版信息

Adv Exp Med Biol. 2025;1480:399-418. doi: 10.1007/978-3-031-92033-2_26.

Abstract

Hepcidin, the master regulator of systemic iron homeostasis, modulates the absorption of dietary iron as well as its release from stores by blocking and inducing the degradation of ferroportin, the only known cellular iron exporter. Thus, the interaction between hepcidin and ferroportin negatively regulates iron transport into plasma and reduces systemic iron availability. Several genetic and acquired iron-related disorders are characterized by dysregulated hepcidin expression. While hereditary hemochromatosis and β-thalassemia exhibit hepcidin suppression, causing iron overload, iron-refractory iron-deficiency anemia and anemia of chronic diseases show hepcidin induction, promoting iron deficiency. In the last decade, experimental evidence demonstrated that targeting the hepcidin-ferroportin axis and restoring normal hepcidin levels offer potential therapeutic benefits to patients with iron-related disorders. Due to these reasons, the development of hepcidin therapeutics has been exponentially growing in recent years, with the aim to design hepcidin modulators that either mimic or inhibit hepcidin action, leading to reduced or increased iron availability, respectively. This chapter summarizes the current landscape of hepcidin therapeutics that reached clinical development and the pathologies that could benefit from these pharmacological approaches. Moreover, it provides novel experimental insights into new potential therapies combining hepcidin modulators with existing or novel approaches such as luspatercept or TfR2 targeting as a way to achieve further improvement of anemia in pathologic conditions.

摘要

铁调素是全身铁稳态的主要调节因子,它通过阻断和诱导唯一已知的细胞铁输出蛋白铁转运蛋白的降解,来调节膳食铁的吸收及其从储存部位的释放。因此,铁调素与铁转运蛋白之间的相互作用对铁向血浆中的转运起负向调节作用,并降低全身铁的可用性。几种遗传性和获得性铁相关疾病的特征是铁调素表达失调。遗传性血色素沉着症和β地中海贫血表现为铁调素抑制,导致铁过载,而铁难治性缺铁性贫血和慢性病贫血则表现为铁调素诱导,促进缺铁。在过去十年中,实验证据表明,针对铁调素-铁转运蛋白轴并恢复正常的铁调素水平,可为铁相关疾病患者带来潜在的治疗益处。由于这些原因,近年来铁调素治疗药物的研发呈指数级增长,目的是设计出能模拟或抑制铁调素作用的铁调素调节剂,分别导致铁可用性降低或增加。本章总结了已进入临床开发阶段的铁调素治疗药物的现状以及可能从这些药理学方法中获益的病理情况。此外,本章还提供了新的实验见解,探讨了将铁调素调节剂与现有或新方法(如罗特西普或靶向转铁蛋白受体2)相结合的新潜在疗法,以此作为在病理状态下进一步改善贫血的一种方式。

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