The Pancreatic changes affecting glucose homeostasis in transfusion dependent β- thalassemia (TDT): a short review
Pancreatic changes and glucose homeostasis in β-thalassemia
Keywords:
Thalassemia; Iron overload; Viral hepatitis; Chronic liver disease; Insulin resistance; Diabetes mellitusAbstract
Background : The natural history of the glycometabolic state in transfusion-dependent β-thalassemia (TDT) patients is characterized by a deterioration of glucose tolerance over time. Aims:
This review depicts our current knowledges on the complex and multifacet pathophysiologic mechanisms implicated in the development of alteration of glucose homeostasis in patients with TDT. Search strategy: A systematic search was done on December 2020 including Web of Science (ISI), Scopus, PubMed, Embase, and Scholar for papers published in the last 20 years. Moreover, we checked the reference lists of the relevant articles and previously performed reviews for additional pertinent studies. The personal experience on the care of patients with thalassemias is also reported. Conclusion: A regular packed red blood cells (PRBCs) transfusion program, optimization of chelation therapy, and prevention and treatment of liver infections are critical to achieve adequate glucometabolic control in TDT patients. Many exciting opportunities remain for further research and therapeutic development.
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3. Viprakasit V, Ekwattanakit S. Clinical Classification, Screening and Diagnosis for Thalassemia. Hematol Oncol Clin North Am. 2018; 32:193-211.
4. Taher AT, Saliba AN. Iron overload in thalassemia: different organs at different rates. Hematology Am Soc Hematol Educ Program. 2017;1:265-271.
5. Old J, Harteveld CL, Traeger-Synodinos J, Petrou M, Angastiniotis M, Galanello R. Prevention of Thalassaemias and Other Haemoglobin Disorders: Volume 2: Laboratory Protocols [Internet]. 2nd ed. Nicosia (Cyprus): Thalassaemia International Federation 2012.
6. Soliman AT, De Sanctis V, Yassin M, Soliman N. Iron deficiency anemia and glucose metabolism. Acta Biomed. 2017;88:112-118.
7. De Sanctis V, D'Ascola G, Wonke B. The development of diabetes mellitus and chronic liver disease in long term chelated beta thalassaemic patients. Postgrad Med J. 1986;62:831-836.
8. Mowla A, Karimi M, Afrasiabi A, De Sanctis V. Prevalence of diabetes mellitus and impaired glucose tolerance in beta-thalassemia patients with and without hepatitis C virus infection. Pediatr Endocrinol Rev. 2004;2 Suppl. 2:282-284.
9. Chern JP, Lin KH, Lu MY, et al. Abnormal glucose tolerance in trans-fusion-dependent ß-thalassemic patients. Diabetes Care. 2001;24:850-854.
10.Waldvogel-Abramowski S, Waeber G, Gassner C, Buser A, Frey BM, Favrat B, Tissot JD. Physiology of iron metabolism. Transfus Med Hemother. 2014;41:213-321.
11. Reichert CO, da Cunha J, Levy D, Maselli LMF, Bydlowski SP, Spada C. Hepcidin: Homeostasis and Diseases Related to Iron Metabolism. Acta Haematol. 2017;137:220-236.
12. Ganz T, Nemeth E. Hepcidin and iron homeostasis. Biochim Biophys Acta. 2012;1823:1434-443.
13. Muñoz M, Villar I, García-Erce JA. An update on iron physiology. World J Gastroenterol. 2009;15: 4617-4626.
14. Anderson GJ, Frazer DM. Current understanding of iron homeostasis. Am J Clin Nutr. 2017;106 Suppl. 6:1559S-1566S.
15. Sebastiani G, Pantopoulos K. Disorders associated with systemic or local iron overload: from pathophysiology to clinical practice. Metallomics. 2011;3:971-986.
16. Aydinok Y, Kattamis A, Viprakasit V. Current approach to iron chelation in children. Br J Haematol. 2014;165:745-775.
17. Wood JC. Use of Magnetic Resonance Imaging to Monitor Iron Overload. Hematol Oncol Clin North Am. 2014; 28: 747–764.
18. Knutson MD. Non-transferrin-bound iron transporters. Free Radic Biol Med. 2019;133:101-111.
19. Lee DH, Liu DY, Jacobs DR Jr, et al . Common presence of non-transferrin-bound iron among patients with type 2 diabetes. Diabetes Care. 2006;29:1090-1095.
20. Sumneang N, Siri-Angkul N, Kumfu S, Chattipakorn SC, Chattipakorn N. The effects of iron overload on mitochondrial function, mitochondrial dynamics, and ferroptosis in cardiomyocytes. Arch Biochem. Biophys. 2020;680:108241.
21. Maiese K, Chong ZZ, Shang YC. Mechanistic insights into diabetes mellitus and oxidative stress. Curr Med Chem. 2007;14:1729-1738.
22. Oudit GY, Sun H, Trivieri MG, et al. L-type Ca2+ channels provide a major pathway for iron entry into cardiomyocytes in iron-overload cardiomyopathy. Nat Med. 2003;9:1187-1194.
23. Wood JC. Guidelines for quantifying iron overload. Hematology (Am Soc Hematol Educ Program). 2014; 2014:210–215.
24. Fernández-Real JM, López-Bermejo A, Ricart W. Cross-talk between iron metabolism and diabetes. Diabetes. 2002;51:2348-2354.
25. Fischer R, Harmatz PR. Non-invasive assessment of tissue iron overload. Hematology Am Soc Hematol Educ Program. 2009;2009:215–221.
26. Bassett ML, Halliday JW, Powell LW. Value of hepatic iron measurements in early hemochromatosis and determination of the critical iron level associated with fibrosis. Hepatology.1986;6:24-29.
27. Olivieri NF, Brittenham GM. Iron-chelating therapy and the treatment of thalassemia. Blood. 1997;89: 739-761.
28. St Pierre TG, Clark PR, Chua-anusorn W, et al. Noninvasive measurement and imaging of liver iron concentrations using proton magnetic resonance. Blood. 2005;105:855-861.
29. Iancu TC, Ward RJ, Peters TJ. Ultrastructural changes in the pancreas of carbonyl iron-fed rats. J Pediatr Gastroenterol Nutr. 1990;10:95-101.
30. Iancu TC, Shiloh H. Experimental iron overload. Ultrastructural studies. Ann N Y Acad Sci. 1988; 526: 164-178.
31. Iancu TC, Shiloh H. Morphologic observations in iron overload: an update. Adv Exp Med Biol. 1994; 356:255-265.
32. Papanikolaou G, Pantopoulos K. Iron metabolism and toxicity. Toxicol Appl Pharmacol. 2005;202:199-211.
33. Awai M, Narasaki M, Yamanoi Y, Seno S. Induction of diabetes in animals by parenteral administration of ferric nitrilotriacetate. A model of experimental hemochromatosis. Am J Pathol. 1979;95:663-673.
34. Lu JP, Hayashi K, Okada S, Awai M. Transferrin receptors and selective iron deposition in pancreatic B cells of iron-overloaded rats. Acta Pathol Jpn. 1991;41:647-652.
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De Sanctis V, Soliman A, Tzoulis P, Daar S, Fiscina B, Kattamis C. The Pancreatic changes affecting glucose homeostasis in transfusion dependent β- thalassemia (TDT): a short review: Pancreatic changes and glucose homeostasis in β-thalassemia. Acta Biomed. 2021;92(3):e2021232. doi:10.23750/abm.v92i3.11685
