HIS02 Iron Metabolism And Haem Biosynthesis Flashcards

1
Q

Why do we need Fe and issues with Fe metabolism

A

Fe:

  • abundant metal
  • multiple oxidation states —> useful to **relay electrons from one molecule to another —> **Oxygen transport
  • can only acquire from external environment

Important issues:

  1. How to reduce toxicity of Fe
  2. Availability / Storage but without overloading —> Fe homeostasis
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2
Q

***Where is iron found in human body

A
  • Does not exist as free metal ion in body (∵ very toxic)
  • Must be bound to molecule (protein / organic compound e.g. **Heme OR in form of a structure: **Iron-sulphur cluster found in proteins in mitochondrial respiration)
  • Intracellularly: Fe usually exist in 2+ oxidation state (**Fe2+) —> excess Fe bound to **Ferritin (storing Fe)
  • Extracellularly (e.g. plasma): ***Fe3+
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3
Q

Problems with Fe homeostasis

A
  • Main issue: ***Uptake is controlled, Loss is not
  • Mechanisms exist for uptake of Fe but NO mechanism for excreting Fe
  • Fe is lost but not excreted from body
  • Loss of Fe cannot be controlled (natural slothing of cells from GI tract / menstrual cycle)
  • Fe homeostasis cannot be achieved by usual principle of balancing acquisition with excretion
  • Clinical significance: Fe overloading in blood transfusion
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4
Q

How to achieve Fe homeostasis

A
  1. Recycle Fe within body with 0% loss
    - but not possible due to inevitable loss for various reasons
    - also growth and development of body have ↑ demand for Fe
  2. Placing ***intake of Fe under control of the “uncontrollable loss” —> achieve Fe homeostasis
    —> Better option

Example of Hb:
Physiological / Pathological events (e.g. Hb biosynthesis, blood loss)
—> Loss of Fe
—> Reduction of total Fe pool
—> Stimulate uptake of Fe from dietary sources
—> Repletion of total Fe pool

Summary: Uncontrollable loss of Fe —> Depletion of Fe —> Repletion of Fe from dietary sources (Under Control)

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5
Q

Heme

A
  • Organic molecule of Fe
  • Fe confers Hb with ability to ***carry oxygen
  • Fe react with ***O2 chemically rather than remaining as stable partners without any chemical interactions —> ∴ free Fe is toxic
  • Fe complex with ***Porphyrin (a cage) —> Heme —> reactivity of Fe stabilised (stay in 2+ oxidation state) —> ∵ orbitals of Fe are now partially engaged
  • However, Heme in ***free state is still significantly reactive / toxic to cells
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6
Q

Toxicity of heme

A

Free heme react with organic hydroperoxide, unsaturated fatty acids, alcoholic compounds
—> ***Free radicals, Superoxide anions
—> Readily damaging other biological compounds

Toxicity of heme is much reduced when interact with **a.a residues of **Globin chains
—> Fe in Hb now only “active” enough to hold oxygen in ***molecular state without forming Fe/O2 compound

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7
Q

Heme synthesis

A

Synthesis of Porphyrin begins in mitochondria matrix:

**Glycine + **Succinyl-CoA (intermediate in TCA cycle)
—(condensation, by ALA synthase)—> 5-aminolevulinic acid (ALA)
—(transported out of mitochondria into cytoplasm, acted on by enzymes in stepwise manner)—> Coproporphyrinogen III
—(transported back to mitochondria matrix, at the same time further transformation)—> Porphyrin acquire Fe2+ ion on inner membrane of mitochondria
—> Heme

Problem: **Balance between Fe supply and Porphyrin synthesis
- too much Porphyrin / free Fe —> toxic
—> **
Biosynthesis of Porphyrin has to match with availability of Fe

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8
Q

Fe availability and Porphyrin synthesis

A

Erythropoietin (Epo)
—> secreted by Kidney
—> bind to Epo-receptor in **Erythroblast
—> stimulate Erythroblast-specific transcription factors responsive to Epo
—> activate transcription of **
ALAS-2 gene
—> ALAS-2 mRNA
—> ***an Iron-responsive-element (stem loop structures, cannot be translated, act as regulator) is present in the 5’ untranslated region of ALAS-2 mRNA

Absence of Fe / Fe depletion:
—> ***Iron Regulatory Protein (IRP) bind to Stem loop structure
—> ***block ribosome attachment
—> ***block translation of ALAS-2 mRNA
—> no enzyme to synthesise Porphyrin

Presence of Fe-S cluster / Presence of Fe2+:
—> bind to Fe-S cluster (S atoms from cysteine)
—> conformational change of IRP
—> Dissociation of IRP from Stem loop
—> allow translation of ALAS-2 mRNA
—> **
ALAS-2 protein (
*enzyme synthesising Porphyrin)
—> Porphyrin + Fe2+
—> Heme

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9
Q

Heme release and translation of ALAS-2 mRNA + Globin mRNA

A

Recruitment of initiator tRNA can be blocked by intracellular protein in erythroid cells know as **HRI (Heme-regulated inhibitor, a protein kinase)
—> HRI **
phosphorylate ribosome
—> ***block binding of initiator tRNA to ribosome

Presence of **Heme
—> **
block HRI action by binding to HRI (inactivated protein kinase)
—> allow binding of initiator tRNA to ribosome
—> translation of **ALAS-2 mRNA + **Globin mRNA
—> **Porphyrin + **Globin
—> Haemoglobin

***Overall:
Erythropoietin
—> Transcription of ALAS-2 gene
—> ALAS-2 mRNA
—> Presence of Fe2+
—> IRP dissociate from ALAS-2 mRNA
—> Translation of ALAS-2 mRNA
—> ↑ ALAS-2 protein
—> ↑ Porphyrin
—> ↑ Heme
—> block HRI
—> further translation of ALAS-2 mRNA + Globin mRNA
—> further ↑ Porphyrin + ↑ Globin (consume Heme —> prevent accumulation of free Heme (toxic))
—> ↑ Haemoglobin (↑ Haemoglobin formation to consume Fe2+ to avoid Fe overload)
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10
Q

***Whole process of haemoglobin formation

A
Erythropoietin
—> Transcription of ALAS-2 gene
—> ALAS-2 mRNA
—> ***Presence of Fe2+
—> ***IRP dissociate from ALAS-2 mRNA
—> Translation of ALAS-2 mRNA
—> ↑ ALAS-2 protein
—> ↑ Porphyrin
—> ***↑ Heme
—> ***block HRI
—> further translation of ALAS-2 mRNA + Globin mRNA
—> further ↑ Porphyrin + ↑ Globin (consume Heme —> prevent accumulation of free Heme (toxic))
—> ↑ Haemoglobin (↑ Haemoglobin formation to consume Fe2+ to avoid Fe overload)

Negative feedback pathway (Heme-mediated):
Heme: May inhibit ***unloading of Fe from transferrin (in form of Transferrin-bound Fe3+)
—> prevent release of Fe2+
—> make less heme
—> balance globin synthesis from time to time

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11
Q

***Transfer of Fe into RBC precursor and Regulation by heme

A

Transferrin-bound Fe3+
—> bind to Transferrin receptor
—> Transferrin + Fe3+ + Transferrin receptor
—> Endocytosis

  • Within endosome:
    1. Fe3+ is reduced by **
    Ferrireductase to Fe2+ —> transported out of endosome by **
    DMT1 (Divalent metal ion transporter 1)
    2. Transferrin dissociate from Fe3+ —> ***Apotransferrin —> Apotransferrin + Transferrin receptor —> Recycled to cell surface

Heme:

  • May inhibit unloading of Fe from transferrin —> prevent release of Fe2+
  • actual mechanism unknown
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12
Q

Heme regulation in termination of Hb synthesis during maturation of red cells

A
Postulated negative feedback model:
Fe2+
—> ↑ Heme synthesis
—> inhibition of unloading of Fe from Fe-loaded transferrin
—> ↓ Fe uptake
—> ↓ ALAS-2 expression
—> ↓ Heme synthesis
—> Termination of Hb synthesis
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13
Q

***Haemoglobin protein

A
  • Largest consumer of Fe in body
  • Fe mainly lost in form of Fe-containing protein
  • Most abundant protein in haematological system
  • Critical for aerobic respiration
  • Synthesised by erythroid cells in their late stage of differentiation
  • Mature Hb protein composed of multiple components:
    1. Globin polypeptides (α + β chains)
    2. Porphyrin
    3. Fe
    —> ALL components must be in balance (NO components should be in excess)
    —> Biosynthesis of Hb is a highly coordinated process
    —> Communication (***via Heme) between Fe availability, Porphyrin synthesis, Globin synthesis

Fe in excess: **Toxic
Porphyrin in excess: **
Porphyria (hereditary disorder)
Globin in excess: ***Protein stress in cells

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14
Q

Recycling of Fe in human body

A

Theoretically Fe is self-sufficient:
Aging of RBC
—> Phagocytised in Liver and Spleen (+ Bone marrow)
—> Degradation of senescent RBC
—> Release of Fe into blood (+ Turnover of Fe-containing proteins in non-erythroid cells e.g. CYP450)
—> Fe taken up by erythroid cells for Heme synthesis
—> Maturation of erythroid cells
—> RBC

—> However, there is inevitable loss of Fe from body due to sweating, blood, exfoliation of epithelial cells from body
—> Repletion of Fe from diet

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15
Q

***Degradation of Haemoglobin

A

Haemoglobin
—> Heme (+ Globin)
—(**Heme oxygenase)—> Porphyrin **break open
—> Biliverdin + Free Fe
—(
Biliverdin reductase)—> ***Bilirubin (transported in blood in association with serum albumin)
—> Urobilinogen
—> Urobilin / Stercobilin

Fe:
Fe2+ released from lysosome-related vesicles via **NRAMP1 (~ DMT1) into cytosol
—> exit cell via **
Ferroportin (at the same time oxidised by ***Ferroxidase / Hephaestin)
—> Fe3+
—> Transferrin-bound Fe3+ (transport in blood)

Enzymes involved:

  1. ***Heme oxygenase —> catalyse cleavage of one of Methine bridges of protoporphyrin
  2. ***Cytochrome P450 reductase —> maintain Fe as Fe2+ (NADPH provide electrons)
  3. ***Biliverdin reductase —> converts Biliverdin to Bilirubin (NADH, NADPH provide electrons)
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16
Q

***Recovery of Fe from Heme in macrophage

A

Phagocytosis of RBC
—> RBC broken down
—> Fe2+ released from lysosome-related vesicles via ***NRAMP1 (~ DMT1) into cytosol

Within cytosol:

  1. Released to extracellular space via **Ferroportin (at the same time oxidised by **Ferroxidase / Hephaestin)
    —> Fe3+
    —> transported in blood as Transferrin-bound Fe3+ (more stable form, Fe2+ is unstable as it will release electron —> toxic)
  2. Stored as protein-bound Fe3+
17
Q

Transport of Fe in blood

A

Major (High affinity) (20-30% occupation):
***Apotransferrin
—(+ Fe3+)—> Monoferric transferrin
—(+ Fe3+)—> Diferric transferrin (2 Fe)

Minor (Low affinity) / Non-transferrin bound Iron (NTBI):

  1. Serum albumin —(+ Fe3+)—> Iron-bound serum albumin
  2. Low molecular weight compound (e.g. a.a., glucose)—(+ Fe3+)—> complex
18
Q

Prevention of Fe overload in blood

A
  • Large buffer / reserve of free Transferrin in blood
  • High affinity of Transferrin for Fe (Kd: 10^-23)
  • Further Fe-binding capacity provided by non-proteinaceous compounds
  • ∴ Very low concentration of free Fe found in plasma —> important for minimising toxic effects of Fe
  • Excess Fe in blood can also be taken up by cells
19
Q

Dietary Fe to compensate for loss of Fe

A

2 types of Fe sources:

  1. **Non-heme Fe (Fe in a.a. / sugars, mostly Fe3+, low solubility)
    —(Gastric HCl)—> **
    Soluble Fe3+ (bioavailable)
    —> mostly absorbed in duodenum, jejunum
  2. **Heme Fe (e.g. in meat)
    —(digestion)—> **
    Isolated form (available for absorption)
    —> mostly absorbed in duodenum, jejunum (but by a different mechanism from that of Non-heme Fe)
20
Q

Absorption of Heme Fe by enterocyte

A
  1. Heme **transporter (apical)
    —> Heme directly transported out of cell (basolateral)
    —> Heme bound to **
    Hemopexin
    —> Heme-Hemopexin complex transported in blood and picked up by other cells
    OR
    —> Degradation to Fe2+
    —> Fe2+ stored as **Ferritin in enterocyte / transported out via **Ferroportin (at the same time oxidised by **Ferroxidase / Hephaestin)
    —> Fe3+ transported in blood as **
    Transferrin-bound Fe3+
  2. Heme **receptor (apical)
    —> **
    endocytosis
    —> degradation of Heme within endosome by **Heme oxygenase
    —> Fe2+ stored as **
    Ferritin in enterocyte / transported out via **Ferroportin (at the same time oxidised by **Ferroxidase / Hephaestin)
    —> Fe3+ transported in blood as ***Transferrin-bound Fe3+

Fe-Ferritin: storage form of Fe, when there is no immediate demand for Fe

21
Q

Absorption of non-Heme Fe by enterocyte

A

Non-Heme Fe (mostly Fe3+)
—(Ferrireductase / Duodenal cytochrome b at apical surface)—> Fe2+ (in GI lumen)
—> transported into cell via **DMT1
—> Fe2+ stored as **
Ferritin in enterocyte / transported out via **Ferroportin (at the same time oxidised by **Ferroxidase / Hephaestin)
—> Fe3+ transported in blood as ***Transferrin-bound Fe3+

22
Q

***Major factors influencing absorption of Fe

A
  1. Iron stores in body
  2. Rate of erythropoiesis
  3. Hypoxia
  4. Inflammation (***↑ Hepcidin!!!)

—> ALL induce liver to ↓ level of Hepcidin (a hormone)
—> ↓ Degradation of Ferroportin
—> ↑ Fe3+ transported out of enterocyte into blood

23
Q

Fe controls synthesis of Hepcidin

A
Major cellular Fe reservoir
—> ↑ Demand for heme
—> Depletion of Fe reservoir
—> ***↓ in Plasma Fe-Transferrin
—> ***Plasma Fe level sensed by liver
—> Hepcidin level changes
—> Change in uptake of Fe
—> Restore Fe in cellular Fe reservoir
24
Q

Regulation of Ferroportin by Hepcidin

A

Hepcidin bind to Ferroportin
—> ***Internalisation of Ferroportin-Hepcidin complex into cell by Endocytosis
—> Endosome
—> Degradation within cell

25
Q

Adjustment of Fe absorption in response to ↑ plasma Fe

A

↑ Plasma Transferrin-bound Fe3+ (Fe-Tf)
—> ↑ Hepcidin synthesis in liver
—> Hepcidin bind to Ferroportin
—> ↑ ***Internalisation of Ferroportin-Hepcidin complex into cell by Endocytosis
—> ↑ Degradation of Ferroportin
—> ↓ Release of Fe from basolateral side of enterocyte

26
Q

Model for regulation of expression of Hepcidin gene

A

Body Fe status —> reflected by ***plasma Fe-Tf level

**HFE-TfR1, **TfR2, **BMP receptor (all on hepatocyte surface, detect Fe-Tf level in blood)
—> down-stream signals
—> control **
SMAD family of proteins in cytosol
—> migrate to nucleus
—> Activate / Inhibit ***transcription of Hepcidin gene

BMP6 (a binding protein derived from non-parenchymal cells in liver)
—> bind to Fe-Tf
—> BMP6-Fe-Tf complex bind to BMP receptor

27
Q

Stress erythropoiesis

A

e.g. Hypoxia
—> ↑ Erythropoietin from Kidneys
—> ↑ **Erythroferrone (ERFE) from **bone marrow
—> ↓ Hepcidin from liver
—> ↓ Degradation of Ferroportin on enterocyte
—> ↑ Fe availability
—> ↑ Porphyrin (i.e. Heme)
—> ↑ Globin synthesis
—> ↑ Haemoglobin synthesis
—> ↑ Erythrocyte synthesis in bone marrow

28
Q

Ferritin vs Transferrin

A

Ferritin: Fe storage
Transferrin: Fe transport

DMT1: transport of Fe2+ into cell (from endosome / outside cell)
NRAMP1: transport of Fe2+ into cell (from lysosome)
Ferroportin (Macrophage + Enterocyte): transport of Fe2+ out of cell (ferroxidase convert Fe2+ into Fe3+)

Ferrireductase: convert Fe3+ to Fe2+ (uptake of Fe3+ by Erythroblast + absorption of Non-heme Fe)
Ferroxidase: convert Fe2+ to Fe3+ (transport of Fe3+ in blood)