Naveen Manchanda, MD

2010-12-04

Iron has occupied the fascination of humans from the time of the “Iron Age” until now. An increased understanding of the basic physiology of iron has led to the present day being known as the Golden Age of Iron. Iron has gained popularity with pumping iron (with the governor), golfing irons with Tiger Woods, and a host of other real and imaginary products associated with this Janus-faced, near-precious, occasionally toxic metal.

There is little daylight between iron and hemoglobin, and iron forms the basis for the structural and functional integrity of hemoglobin. Iron-containing hemoglobin can transport oxygen to distant sites, a fact not lost on phylogeny. Just as too much of a good thing can be bad, iron in surfeit can injure organs. It can also overload those who receive transfusional therapy and lurk in the interplay of genes among those who acquire excessive iron genetically. Methods to remove iron have been continuously refined and now may have reached a level of sophistication long sought after. A safe and effective iron chelator may be the best embodiment in modern medicine of the fabled Jason’s Golden Fleece. Iron chelation will be more widely discussed in the Education Session on Thalassemia, scheduled to take place this morning at 9:30 a.m. and again tomorrow at 7:30 a.m. in Room 224 of the Orange County Convention Center.

Meanwhile, iron deficiency affects a substantial portion of the world population. Oral iron therapy is often ineffective or unusable in certain patients. Parenteral iron therapy, while around for more than five decades, has been refined to make it safer and more user-friendly. During this morning’s “Parenteral Iron Therapy – Taking the Rust Off” education session, Dr. Michael Auerbach will discuss parenteral iron therapy, Dr. David Henry will speak about iron therapy in cancer patients, and Dr. Jeffrey Carson will present evidence for use of iron in heart failure. Each will discuss the established and newly discovered areas in the clinical use of these agents. This session is taking place in Room 311 of the Orange County Convention Center at 9:30 a.m. and again tomorrow at 7:30 a.m.

As with the clinical improvements in the use of iron, the basic understanding of the metabolism of iron has increased dramatically. Protection of the endothelium from iron during periods of hemolysis is a vital topic of interest. Heme-derived iron promotes an inflammatory and pro-thrombogenic phenotype that heme-oxygenase 1 (HO-1) protects against. In a scientific committee session on “Organ-Specific Iron Loading and Toxicity,” today at 7:30 a.m. in Room 315 of the Orange County Convention Center, Dr. Gregory M. Vercellotti will talk about how increased expression of this enzyme may help ameliorate hemolysis-related endothelial damage. Similar toxicity is also seen in the kidneys, and Dr. Karl Nath will describe how a renal siderophore-binding protein is protective as it too induces HO-1. Lastly, the link between iron and degenerative neurological illnesses is explored by Dr. Tracey Rouault, where hepcidin plays a less than salutary role (yet again). If you miss this early morning session, don’t worry; it’s also taking place at 4:00 p.m. this afternoon.

Need to explore more about iron? There is a cornucopia of iron-related talks in the oral sessions on Monday, December 6, and Tuesday, December 7.

Dr. Manchanda indicated no relevant conflicts of interest.