Iron as a comorbid factor in chronic viral hepatitis

Liver iron deposits in hepatitis B patients: Association with severity of liver disease but not with hemochromatosis gene mutations

“…Our results reinforce the hypothesis that even a small amount of iron may increase hepatic liver injury in chronic hepatitis patients. This is in agreement with evidence suggesting iron as a comorbid factor in chronic viral hepatitis 27 . The pathophysiological mechanisms involved in iron deposits in the liver in chronic viral hepatitis are not clear.…”

Serum measures of iron status and HFE gene mutations in patients with hepatitis B virus infection

“…Baruch S. Blumberg first drew attention to the positive correlation between levels of serum iron, transferrin saturation, ferritin and persistence of HBV infection in patients on chronic hemodialysis 11,12 . Indeed, total body iron and hepatic iron (with or without HFE gene mutations) have been implicated in the pathogenesis and/or progression of several liver diseases, especially CHB, CHC, NASH, alcoholic liver disease, and PCT 1–3,5–10 . Reduction in serum ferritin by limited therapeutic phlebotomies (well short of iron depletion) significantly improved the likelihood of response of CHB to interferon alpha therapy 13,14 .…”

“…T HERE IS GROWING evidence that increased body iron stores serve as a comorbid factor for development and/or progression of non-hemochromatotic (HHC) liver diseases. This subject has been extensively reviewed by Bonkovsky et al [1][2][3] Recent evidence also indicates that the prevalence of HFE gene mutations in non-HHC, especially chronic hepatitis C (CHC), [4][5][6][7] nonalcoholic steatohepatitis (NASH), 8 and porphyria cutanea tarda (PCT) 9 is increased and that patients with CHC harboring especially the major C282Y mutation are more likely to progress to advanced hepatic fibrosis or cirrhosis. 5,10 Blumberg et al and Lustbader et al were among the first to propose a relationship between body iron and outcome of hepatitis B and clearance of hepatitis B virus.…”

Disorders of iron overload

“…5.22). 235,241 Levels of inflammation and stage of disease may also correlate with the buildup of iron, 242,243 and numerous studies have demonstrated that therapeutic phlebotomy may decrease alanine aminotransferase, as summarized by Eisenbach et al 244 Further more, recent studies from Japan indicate that histological staging may improve with the institution of longterm phlebotomy. 235,241 Levels of inflammation and stage of disease may also correlate with the buildup of iron, 242,243 and numerous studies have demonstrated that therapeutic phlebotomy may decrease alanine aminotransferase, as summarized by Eisenbach et al 244 Further more, recent studies from Japan indicate that histological staging may improve with the institution of longterm phlebotomy.…”

“…Moyo et al documented a relative risk of 3.1 (95% confidence limits 1.05, 9.4) in Zimbabwean blacks with dietary iron overload after adjusting for the confounding effect of cirrhosis. The reason for this phenomenon is enigmatic but increased absorption of iron from the duodenum is postulated as well as other mechanisms including relative hepatic hypoxia, and pancreatic insufficiency with decreased bicarbonate secretion, as summarized by Bonkovsky et al 243 Iron overload and hepatocellular carcinoma Clinical observation, in vitro studies and biochemical data have long associated iron overload states and HCC. Thus, in a later case/control study, Mandishona et al reported a relative risk for HCC of 10.6 (95% confidence limits 1.5, 76.8) and a population attributable risk of 29 in rural black South Africans after adjusting for the possible confounding effects of other risk factors, namely chronic HBV and HCV infections, aflatoxin B 1 , and alcohol, but not of cirrhosis (Fig.…”