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Evaluation of perturbed iron-homeostasis in a prospective cohort of patients with COVID-19

Frost, Joe N., Hamilton, Fergus, Arnold, David, Elvers, Karen T., Shah, Akshay, Armitage, Andrew E., Milne, Alice, McKernon, Jorgen, Attwood, Marie, Chen, Yi-ling, Xue, Luzheng, Youngs, Jonathon, Provine, Nicholas M., Bicanic, Tihana, Klenerman, Paul, Drakesmith, Hal and Ghazal, Peter ORCID: 2022. Evaluation of perturbed iron-homeostasis in a prospective cohort of patients with COVID-19. Wellcome Open Research 77 , 173. 10.12688/wellcomeopenres.17904.1

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Background: Marked reductions in serum iron concentrations are commonly induced during the acute phase of infection. This phenomenon, termed hypoferremia of inflammation, leads to inflammatory anemia, but could also have broader pathophysiological implications. In patients with coronavirus disease 2019 (COVID-19), hypoferremia is associated with disease severity and poorer outcomes, although there are few reported cohorts. Methods: In this study, we leverage a well characterised prospective cohort of hospitalised COVID-19 patients and perform a set of analyses focussing on iron and related biomarkers and both acute severity of COVID-19 and longer-term symptomatology. Results: We observed no associations between acute serum iron and long-term outcomes (including fatigue, breathlessness or quality of life); however, lower haemoglobin was associated with poorer quality of life. We also quantified iron homeostasis associated parameters, demonstrating that among 50 circulating mediators of inflammation IL-6 concentrations were strongly associated with serum iron, consistent with its central role in inflammatory control of iron homeostasis. Surprisingly, we observed no association between serum hepcidin and serum iron concentrations. We also observed elevated erythroferrone concentrations in COVID-19 patients with anaemia of inflammation. Conclusions: These results enhance our understanding of the regulation and pathophysiological consequences of disturbed iron homeostasis during SARS-CoV-2 infection.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Taylor and Francis
ISSN: 2398-502X
Date of First Compliant Deposit: 8 December 2022
Date of Acceptance: 13 July 2022
Last Modified: 28 Feb 2024 07:42

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