Effects of Iron Loading and Iron Chelation Therapy on Innate Immunity During Human Endotoxemia

Iron affects immunity. However, the exact effect of iron on the innate immune response is not known. Animal data suggest that iron administration induced oxidative stress which enhances the innate immune response, whereas iron chelation has the opposite effect. The investigators tested the hypothesis that administration of iron sucrose 1.25 mg/kg augments the innate immune response, and iron chelation by deferasirox 30 mg/kg attenuates the innate immune response during human experimental endotoxemia.

Study Overview

• Status: Completed
• Conditions: Anemia; Systemic Inflammatory Process
• Intervention / Treatment: Drug: iron sucrose; Drug: endotoxin; Drug: Deferasirox; Drug: Placebo

Detailed Description

Systemic inflammation is accompanied by profound changes in iron distribution, mainly under the influence of hepcidin, leading to sequestration of iron in macrophages of the reticuloendothelial system, and ultimately anemia of inflammation. This redistribution of iron may represent an effective defense mechanism against a variety of pathogens, that need iron for replication and growth. The fact that iron withholding strategy is such a highly conserved part of the innate immune response illustrates that iron homeostasis and immunity are closely related. Concordantly, several studies in animal models have revealed immune modulatory effects of both iron and iron chelation: Iron sucrose has been shown to potentiate the inflammatory response and associated mortality, while iron chelation appears to attenuate inflammation and improve outcome in murine models of inflammation and sepsis. The immune modulatory effects of iron supplements and chelators are mainly attributed to their ability to potentiate or reduce the formation of reactive oxygen species (ROS). A subfraction of non-transferrin bound catalytically active iron, labile plasma iron, is thought to be responsible as this free iron is able to easily donate or accept electrons, thereby fueling redox reactions. Oxidative stress is associated with propagation of the immune response, endothelial dysfunction, and contributes to the organ damage that occurs during systemic inflammation. In accordance, anti-oxidants exert anti-inflammatory effects. As such, iron chelation has been suggested to be a valuable adjuvant therapy during infection for two distinct reasons: inhibition of bacterial growth and protection of organs against inflammation induced oxidative stress.

Effects of iron status on the immune response has up till now mainly been investigated in in vitro and in animal models, often using supra-therapeutic dosages of iron donors or iron chelators. Data on the effect of iron loading and iron chelation during systemic inflammation in humans are lacking. The objectives of the present study were to investigate the acute effect of therapeutic dosages of iron loading and iron chelation therapy on iron homeostasis, oxidative stress, the innate immune response, and subclinical organ injury during systemic inflammation induced by experimental endotoxemia in humans in vivo.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 35 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Male

Description

Inclusion Criteria:

• male
• healthy
• between 18 and 35 years of age

Exclusion Criteria:

• smoking
• use of prescription drugs
• febrile illness < 2 weeks before the study date
• abnormalities found at screening
• participation in another trial in the preceding 6 months
• iron disorders in the family

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Iron loading; Subjects will receive 1.25 mg/kg iron sucrose intravenously 1 hour before endoxin administration 2ng/kg.	Drug: iron sucrose; 1.25 mg/kg iron sucrose is administered intravenously 1 hr before endotoxin administration; Other Names: Venofer; Drug: endotoxin; at t=0 2ng/kg purified E.Coli endotoxin is administered intravenously; Other Names: LPS
Active Comparator: Iron chelation; Subjects will receive 30mg/kg deferasirox orally 2 hours before endotoxin administration 2ng/kg.	Drug: endotoxin; at t=0 2ng/kg purified E.Coli endotoxin is administered intravenously; Other Names: LPS; Drug: Deferasirox; 30 mg/kg deferasirox is administered orally 2 hrs before endotoxin administration.; Other Names: Exjade
Placebo Comparator: Placebo; Subjects will receive placebo instead of iron chelation or iron loading before endotoxin administration	Drug: endotoxin; at t=0 2ng/kg purified E.Coli endotoxin is administered intravenously; Other Names: LPS; Drug: Placebo; At t=-2 hrs starch is dissolved in water to serve as a placebo for exjade. It is prepared and administered orally by a research nurse that is unblinded to the protocol. At t=-1 hrs 0.9% NaCl is administered intravenously serving as a placebo for iron sucrose. The infused volume is identical, and the syringes en tubes are blinded by aluminum foil. The administration is carried out by a research nurse that is unblinded to the protocol.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
TNF-alfa	Level of TNF-alfa 90 minutes after endotoxin administration	Level of TNF-alfa 90 minutes after endotoxin administration

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cytokines	Levels of TNF-alfa, IL-6, IL-10 IL-1RA, ICAM and VCAM.	24 hrs after the administration of endotoxin
Oxidative stress	Several parameters of oxidative stress are measured: TBARS,carbonyls,oxidative radical production of neutrophils, ferric reducing ability of plasma.	24 hrs after the administration of iron / iron chelator / placebo
Hemodynamic response	Hemodynamic sequelae of endotoxin administration are monitored (heart rate, blood pressure) and the response of fore arm vessels to the infusion of vasoactive medication (norepinephrine, acetycholine, and nitroglycerine) is measured.	24 hours after the administration of endotoxin

Collaborators and Investigators

• Sponsor: Radboud University Medical Center
• Collaborators: ZonMw: The Netherlands Organisation for Health Research and Development
• Investigators: Principal Investigator: Peter Pickkers, MD, PhD, Radboud University Medical Center

Study record dates

Study Major Dates

• Study Start: February 1, 2010
• Primary Completion (Actual): May 1, 2010
• Study Completion (Actual): September 1, 2010

Study Registration Dates

• First Submitted: May 5, 2011
• First Submitted That Met QC Criteria: May 5, 2011
• First Posted (Estimate): May 6, 2011

Study Record Updates

• Last Update Posted (Estimate): November 17, 2015
• Last Update Submitted That Met QC Criteria: November 16, 2015
• Last Verified: November 1, 2015

More Information

Terms related to this study

• Keywords: inflammation; cytokines; iron; endotoxemia; iron chelation
• Additional Relevant MeSH Terms: Pathologic Processes; Infections; Systemic Inflammatory Response Syndrome; Inflammation; Sepsis; Bacteremia; Toxemia; Endotoxemia; Molecular Mechanisms of Pharmacological Action; Hematinics; Chelating Agents; Sequestering Agents; Iron Chelating Agents; Deferasirox; Ferric Oxide, Saccharated
• Other Study ID Numbers: 2009/189