HFE-related hereditary hemochromatosis results in hepatic iron overload. Hepatocytes acquire transferrin-bound iron via transferrin receptor (Tfr) 1 and Tfr1-independent pathways (possibly Tfr2-mediated). In this study, the role of Hfe in the regulation of hepatic transferrin-bound iron uptake by these pathways was investigated using Hfe knockout mice. Iron and transferrin uptake by hepatocytes from Hfe knockout, non-iron-loaded and iron-loaded wild-type mice were measured after incubation with 50 nM 125 I-Tf-59 Fe (Tfr1 pathway) and 5 M 125 I-Tf-59 Fe (Tfr1-independent or putative Tfr2 pathway). Tfr1 and Tfr2 messenger RNA (mRNA) and protein expression were measured by real-time polymerase chain reaction and western blotting, respectively. Tfr1-mediated iron and transferrin uptake by Hfe knockout hepatocytes were increased by 40% to 70% compared with iron-loaded wild-type hepatocytes with similar iron levels and Tfr1 expression. Iron and transferrin uptake by the Tfr1-independent pathway was approximately 100-fold greater than by the Tfr1 pathway and was not affected by the absence of Hfe. Diferric transferrin increased hepatocyte Tfr2 protein expression, resulting in a small increase in transferrin but not iron uptake by the Tfr1-independent pathway. Conclusion: Tfr1-mediated iron uptake is regulated by Hfe in hepatocytes. The Tfr1-independent pathway exhibited a much greater capacity for iron uptake than the Tfr1 pathway but it was not regulated by Hfe. A homozygous C282Y mutation in the HFE gene results in hereditary hemochromatosis and is characterized by increased iron absorption and transferrin saturation that leads to hepatic iron overload. The hemochromatosis protein, HFE, is closely associated with transferrin receptor 1 (TFR1) and competes with transferrin for the same binding sites on TFR1. 1 Hepatocytes acquire transferrin-bound iron via TFR1 by a high-affinity endocytic process. 2 A second transferrin receptor has been identified and was named transferrin receptor 2 (TFR2). Like TFR1, it transports transferrin-bound iron by a receptor-mediated endocytic process, 3 although the affinity of this pathway is up to 30-fold lower than that of TFR1. 4 In iron overload, transferrin saturation and diferric transferrin levels are increased, resulting in an up-regulation of TFR2 protein expression, 5,6 suggesting that hepatocyte iron loading may involve TFR2. It has been postulated that TFR2 may mediate the TFR1-independent uptake process described previously in hepatic cells. [7][8][9] In addition to its role in iron transport, TFR2 also has a role in the regulation of cellular iron metabolism because mutations in TFR2 cause hepatic iron overload. 10,11 TFR2 is predominantly expressed in hepatocytes 12 and has recently been shown to interact with HFE. 13 Unlike TFR1, TFR2 is not regulated by intracellular iron levels because there are no iron-responsive elements in the untranslated region of its messenger RNA (mRNA). 12 Hepcidin is synthesized by hepatocytes and is a key regulator of iron homeostasis. 14 It ...