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Transferrin therapy ameliorates disease in β -thalassemic mice. Alisha Juman Lakeland High School Grade 10. Li H, Rybicki AC, Suzuka SM, et al. Nat Med. 2010 Jan 24; 16(2):177-82. Introduction. β -thalassemias are caused by mutations in gene encoding beta-globin (Weatherall et al., 1998)
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Transferrin therapy ameliorates disease in β-thalassemic mice Alisha Juman Lakeland High School Grade 10 Li H, Rybicki AC, Suzuka SM, et al. Nat Med. 2010 Jan 24; 16(2):177-82
Introduction • β-thalassemias are caused by mutations in gene encoding beta-globin (Weatherall et al., 1998) • Excess alpha-globin (α-globin) results in increased erythroid precursor apoptosis, causing ineffective erythropoiesis, extramedullary expansion, and splenomegaly (Pootrakul et al., 1988) • Along with shortened red blood cell (RBC) survival, these conditions result in anemia (Centis et al., 2000)
Hepcidin, produced by the liver, regulates iron absorption and recycling • In the case of β-thalassemia, hepcidin concentrations are low (Papanikolaou et al., 2005) • Transferrin functions as the main transporter of iron in the circulation • Patients with -thalassemia can develop iron overload beyond the iron-binding capacity of transferrin • In this case, labile plasma iron (LPI) can be found in the circulation, causing damage resulting in morbidity (Esposito et al., 2003)
Ginzburg et al. (2010) demonstrated that in Hbb th1/th1 mice treated with iron, iron induced extramedullary, not medullary erythroid expansion • Ineffective delivery of iron to the bone marrow may be an explanation • Hypothesized that inability to compensate for ineffective erythropoiesis and anemia in β-thalassemic mice, is in part a result of an insufficient amount of circulating transferrin
Objective • To increase the amount of transferrin to accommodate the expansion of erythropoiesis in Hbb th1/th1 mice, a commonly used mouse model of β-thalassemia intermedia
Methods • Hbb th1/th1 (thalassemic) mice bred from parental stock and backcrossed for 11 generations onto a C57/BL6 background • Both thalassemic mice and WT control mice were bred • Performed intraperitoneal injections for a total of 60 days • Optimum dose presumed to be 10 mg of transferrin per day • Apotransferrin and holotransferrin were prepared from human plasma
Results • Initially treated mice for a 10 day course • Extended treatment to 60 days • LPI levels were higher in thalassemic mice, but transferrin injections returned LPI levels to normal , while also increasing the total iron binding capacity (TIBC) • Partial reversal of anemia with fewer reticulocytes • Transferrin treated mice showed a higher number of RBCs, more abundant hemoglobin, and lower reticulocyte count
Reversed splenomegaly and extramedullary erythropoiesis • Injection resulted in a reduction in spleen size and weight, with more organized “splenic” architecture • Findings show that transferrin treatment reduced extramedullary erythropoiesis in both the spleen and liver • Shift in maturation and apoptosis of erythroid cells • Found that the distribution of erythroid precursors in the spleen and bone marrow shifted to a higher proportion of mature relative to immature cells • Hepcidin expression increased in the livers of treated thalassemic mice, while no difference in hepcidin expression was observed in WT mice
Discussion • The results of increasing the amount of circulating transferrin serves to support the hypothesis • Injections increased RBC survival and circulating hemoglobin concentrations, and decreased reticulocytosis, splenomegaly, and circulation of LPI • Reduction of α-globin resulted in an increased RBC survival
Since splenomegaly is often associated in worsening anemia, its reversal is a possible cause of increased hemoglobin levels • Enlarged spleen, which is a site for extramedullary erythropoiesis, was most likely transformed due to decrease in extramedullary erythropoiesis • Significance of research: • Transferrin treatment significantly decreased apoptosis of mature RBCs in spleen, increased apoptosis of immature RBCs, and increased expression of hepcidin
Further Research • Evidence of an “erythroid regulator” of hepcidin due to decreased extramedullary erythropoiesis caused by increase in hepcidin expression • Evaluation of growth differentiation factor 15 (GDF15) and the twisted gastrulation factor (TWSG1) is needed to clarify underlying mechanisms • Suggest that transferrin purified from human donors may have several potential uses • Treating diseases of concurrent anemia and iron overload • Treatment would first be administered to patients with β-thalassemia disease