Page 43 - Haematologica-April 2018

Bone Marrow Failure
Involvement of hepcidin in iron metabolism dysregulation in Gaucher disease
Thibaud Lefebvre,1,2* Niloofar Reihani,3* Raed Daher,1 Thierry Billette de Villemeur,4 Nadia Belmatoug,5 Christian Rose,6 Yves Colin-Aronovicz,3 Hervé Puy,1,2 Caroline Le Van Kim,3 Mélanie Franco3** and Zoubida Karim1**
1University Sorbonne Paris Cité, Paris Diderot University, Inserm U1149 / ERL 8252, Inflammation Research Center (CRI), Laboratory of Excellence GR-Ex, Paris;
2AP-HP, Centre Français des Porphyries, Hôpital Louis Mourier, Colombes;
3University Sorbonne Paris Cité, Paris Diderot University, Inserm, INTS, “Biologie Intégrée du Globule Rouge” Department, Laboratory of Excellence GR-Ex, Paris; 4Sorbonne Universités, UPMC, GRC ConCer-LD and AP-HP, Hôpital Trousseau,
Service de Neuropédiatrie, Centre de Référence des Maladies Lysosomales, Paris; 5Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Service de Médecine Interne, Centre de Référence des Maladies Lysosomales, Clichy and 6Université Catholique de Lille, Hôpital Saint Vincent de Paul, Service d'Hématologie, France
*TL and NR contributed equally to this work. **MF and ZK contributed equally to this work.
ABSTRACT
Gaucher disease (GD) is an inherited deficiency of glucocerebrosi- dase leading to accumulation of glucosylceramide in tissues such as the spleen, liver, and bone marrow. The resulting lipid-laden macrophages lead to the appearance of “Gaucher cells”. Anemia associ- ated with an unexplained hyperferritinemia is a frequent finding in GD, but whether this pathogenesis is related to an iron metabolism disorder has remained unclear. To investigate this issue, we explored the iron sta- tus of a large cohort of 90 type I GD patients, including 66 patients treat- ed with enzyme replacement therapy. Ten of the patients treated with enzyme replacement were followed up before and during treatment. Serum levels of hepcidin, the iron regulatory peptide, remained within the physiological range, while the transferrin saturation was slightly decreased in children. Inflammation-independent hyperferritinemia was found in 65% of the patients, and Perl’s staining of the spleen and mar- row smear revealed iron accumulation in Gaucher cells. Treated patients exhibited reduced hyperferritinemia, increased transferrin saturation and transiently increased systemic hepcidin. In addition, the hepcidin and ferritin correlation was markedly improved, and, in most patients, the hemoglobin level was normalized. To further explore eventual iron sequestration in macrophages, we produce a Gaucher cells model by treating the J774 macrophage cell line with a glucocerebrosidase inhibitor and showed induced local hepcidin and membrane retrieval of the iron exporter, ferroportin. These data reveal the involvement of Gaucher cells in abnormal iron sequestration, which may explain the mechanism of hyperferritinemia in GD patients. Local hepcidin-ferro- portin interaction was involved in this pathogenesis.
Introduction
Gaucher Disease (GD) is caused by an inherited deficiency of the lysosomal enzyme glucocerebrosidase, leading to the accumulation of glycosphingolipids in various organ systems, particularly in myeloid mononuclear cells.1 GD is mostly characterized by the presence of lipid-laden macrophages that turn into "Gaucher cells" with a striated appearance and off-center nuclei.2 GD is classified into three clinical types according to the absence (type 1) or presence (types 2 and 3) of central neurological impairment. Type I GD (GD1) remains the most prevalent form of GD.3 In all forms, the clinical presentation of GD and the age of diagnosis are high- ly variable. The accumulation of Gaucher cells in the spleen, liver and bone mar- row leads to significant organomegaly, cytopenia and bone disorders.3 In addition,
Ferrata Storti Foundation
Haematologica 2018 Volume 103(4):587-596
Correspondence:
zoubida.karim@inserm.fr
Received: August 1, 2017. Accepted: January 3, 2018. Pre-published: January 5, 2018.
doi:10.3324/haematol.2017.177816
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/103/4/587
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