Disorders of Iron Metabolism |

* Department of Neuroendocrinology;
° Clinical Research Branch, Human Studies Division, Office of Research and Development, U.S. Environmental Protection Agency, North Carolina 27599, USA;
# Department of Anaesthesia;
@ Obesity Centre, Spitalregion St. Gallen-Rorschach, CH-9400, Switzerland;
^ Department of Internal Medicine I;
Department of Psychiatry and Psychotherapy, University of Lübeck, D-23538, Germany
Correspondence: Christian Benedict, Department of Neuroendocrinology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. Phone: international +49.4515004602. Fax: international +49.451.5003640. E-mail: benedict{at}kfg.uni-luebeck.de
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Key words: prohepcidin, hypoxia, iron.
Systemic oxygen deficiency (i.e. hypoxia) results in elevated serum iron concentrations.1 This metabolic response to hypoxia appears to be primarily mediated by the downregulation of the hormone hepcidin which has been proposed to reduce circulating iron concentrations.2 The mechanisms responsible for this downregulation of circulating hepcidin concentrations are unknown but are likely to involve a direct effect of hypoxia on hepatocytes, since it is known that hepcidin gene expression in human HepG2 and Hep3B hepatoma cells is reduced under hypoxic conditions.3 Hepcidin originates from extrahepatic enzymatic cleavage of its prehormone prohepcidin, which in turn is produced by the liver.4
To examine the effects of transient hypoxia on circulating prohepcidin concentrations in humans, we measured prohepcidin levels in serum samples taken during a previous hypoxia study conducted in 14 healthy men of normal weight (age: 24.3±3.5 years).5 Additionally, circulating iron concentrations were measured. The subjects were tested under hypoxic and normoxic conditions while undergoing hyperinsulinemic euglycemic clamp procedures separated by an interval of at least 4 weeks. During the experimental sessions, subjects lay on a bed with the trunk in an almost upright position (60°). After 3 hours of clamping, hypoxia (oxygen saturation: 74.3±2.4%) was induced for 30 minutes. During the induction of hypoxia and also during the normoxic control period, participants breathed through a tightly fitting face mask connected to a Trajan 808 fresh gas supply (Draeger Medical Technology, Luebeck, Germany). During hypoxia, the oxygen supply was lowered by adjusting the oxygen and nitrogen balance. During normoxia, subjects breathed ambient air with an oxygen saturation averaging 98.3±1.7%. After 30 min of hypoxia, the oxygen saturation was quickly normalized. Blood samples for determination of circulating iron (Sigma Diagnostics, St. Louis, MO, USA) and prohepcidin (DRG International, Mountainside, NJ, USA) were collected at baseline (–5 min), during hypoxia or normoxia (+15 and +30 min), and 150 min after the hypoxic or normoxic control perdiod (+180 min). Each subject gave written informed consent, and the study was approved by the local ethics committee.
Statistical analyses revealed that circulating prohepcidin concentrations were distinctly lower 150 min after the end of hypoxia (+180 min) after the normoxic session (hypoxic vs. normoxic session: 136.10±26.69 vs. 208.00±34.77 ng/mL, p=0.028, after Bonferronis correction, Figure 1A). However, the undersupply of oxygen from 0 to 30 min did not affect circulating prohepcidin concentrations acutely during this time period (Figure 1A). Circulating iron concentrations during and after the hypoxic session did not differ from those during and after the normoxic session (p>0.155, Figure 1B).
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Figure 1. Effects of transient hypoxia on circulating prohepcidin concentrations in humans. Mean values (±SEM) are indicated. Serum prohepcidin and serum iron concentrations (1A and 1B, respectively) before, during and after a 30 min period of hypoxia (black bars) or normoxia (white bars). During the 30-min hypoxic session, the oxygen saturation was lowered to ~75%. Bonferronis correction was applied to p values. The large SEM values are attributable to the inter-individual differences in serum prohepcidin concentrations, not to differences between conditions.
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The striking statistical difference between serum prohepcidin levels following hypoxic and normoxic conditions was due partly to the decrease associated with hypoxia, but also to the unexpected increase observed with normoxia. Considering that all subjects underwent a hyperinsulinemic euglycemic clamp in both conditions, it cannot be ruled out that hyperinsulinemia induced the increase of circulating prohepcidin which occurred during normoxia. Even so, our results clearly demonstrate that hypoxia, which was also performed under hyperinsulinemic euglycemia, is a strong stimulus suppressing the prohepcidin pathway. Although not described in the literature, this increase of serum hepcidin in the normoxic condition might also originate from a circadian oscillation of the peptide. Further studies are needed to clarify this issue.
In summary, our study provides evidence that hypoxia lowers circulating prohepcidin concentrations in humans. The metabolic consequences of this decrease cannot be derived from our study because of the short sampling time and the lack of measurements of serum hepcidin and do, therefore, need to be assessed in further studies.
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