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Clinical Trial
. 2012 Aug;5(4):368-73.
doi: 10.1111/j.1752-8062.2012.00417.x. Epub 2012 Jun 1.

Iron homeostasis during cystic fibrosis pulmonary exacerbation

Alex H Gifford  1 , Lisa A Moulton, Dana B Dorman, Gordana Olbina, Mark Westerman, H Worth Parker, Bruce A Stanton, George A O'Toole
Affiliations
Clinical Trial

Iron homeostasis during cystic fibrosis pulmonary exacerbation

Alex H Gifford et al. Clin Transl Sci. 2012 Aug.

Abstract

Background: Hypoferremia is a marker of disease severity in cystic fibrosis (CF). The effect of systemic antibiotics on iron homeostasis during CF pulmonary exacerbation (CFPE) is unknown. Our central hypotheses were that, by the completion of treatment, serum iron would increase, serum concentrations of interleukin-6 (IL-6) and hepcidin-25, two mediators of hypoferremia, would decrease, and sputum iron would decrease.

Methods: Blood and sputum samples were collected from 12 subjects with moderate-to-severe CF (median percentage-predicted forced expiratory volume in 1 second (FEV(1) %) = 29%; median weight = 56 kg) within 24 hours of starting and completing a course of systemic antibiotics.

Results: After treatment, subjects showed median FEV(1) % and body weight improvements of 4.5% and 2.0 kg, respectively (p < 0.05). Median serum iron rose by 2.4 μmol/L (p < 0.05), but 75% of patients remained hypoferremic. Median serum IL-6 and hepcidin-25 levels fell by 12.1 pg/mL and 37.5 ng/mL, respectively (p < 0.05). Median serum erythropoietin (EPO) and hemoglobin levels were unaffected by treatment. We observed a trend toward lower sputum iron content after treatment.

Conclusions: Hypoferremia is a salient characteristic of CFPE that improves with waning inflammation. Despite antibiotic treatment, many patients remain hypoferremic and anemic because of ineffective erythropoiesis.

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Figures

Figure 1
Figure 1
Changes in body weight and FEV1% during treatment. Median values are denoted by the line within each shaded box. The upper and lower boundaries of the shaded box reflect the interquartile range of data. Whiskers signify minimum and maximum values. **p < 0.01 for comparison by Wilcoxon matched‐pairs signed‐rank test. CFPE = CF pulmonary exacerbation.
Figure 2
Figure 2
Changes in serum iron and sputum iron during treatment. Median values are denoted by the line within each shaded box. The upper and lower boundaries of the shaded box reflect the interquartile range of data. Whiskers signify minimum and maximum values. *p < 0.05 for comparison by Wilcoxon matched‐pairs signed rank test. CFPE = CF pulmonary exacerbation.
Figure 3
Figure 3
Changes in serum IL‐6 and hepcidin‐25 during treatment. IL‐6 = interleukin‐6. Median values are denoted by the line within each shaded box. The upper and lower boundaries of the shaded box reflect the interquartile range of data. Whiskers signify minimum and maximum values. *p < 0.05, **p < 0.01 for comparison by Wilcoxon matched‐pairs signed‐rank test. CFPE = CF pulmonary exacerbation. Note: logarithmic scale of ordinate.
Figure 4
Figure 4
Changes in hemoglobin and serum erythropoietin during treatment. Median values are denoted by the line within each shaded box. The upper and lower boundaries of the shaded box reflect the interquartile range of data. Whiskers signify minimum and maximum values. CFPE = CF pulmonary exacerbation. EPO = erythropoietin.
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References

    1. Abbott J, Holt A, Hart A, Morton AM, MacDougall L, Pogson M, Milne G, Rodgers HC, Conway SP. What defines a pulmonary exacerbation? The perceptions of adults with cystic fibrosis. J Cyst Fibros. 2009; 8: 356–359. - PubMed
    1. Flume PA, Mogayzel PJ, Jr. , Robinson KA, Goss CH, Rosenblatt RL, Kuhn RJ, Marshall BC. Cystic fibrosis pulmonary guidelines: treatment of pulmonary exacerbations. Am J Respir Crit Care Med. 2009; 180: 802–808. - PubMed
    1. de Boer K, Vandemheen KL, Tullis E, Doucette S, Fergusson D, Freitag A, Paterson N, Jackson M, Lougheed MD, Kumar V, et al. Exacerbation frequency and clinical outcomes in adult patients with cystic fibrosis. Thorax. 2011; 66: 680–685. - PubMed
    1. Emerson J, Rosenfeld M, McNamara S, Ramsey B, Gibson RL. Pseudomonas aeruginosa and other predictors of mortality and morbidity in young children with cystic fibrosis. Pediatr Pulmonol. 2002; 34: 91–100. - PubMed
    1. Sanders DB, Bittner RC, Rosenfeld M, Hoffman LR, Redding GJ, Goss CH. Failure to recover to baseline pulmonary function after cystic fibrosis pulmonary exacerbation. Am J Respir Crit Care Med. 2010; 182: 627–632. - PMC - PubMed

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