Hepcidin in human iron disorders: Therapeutic implications☆

The discovery of hepcidin has triggered a virtual explosion of studies on iron metabolism and related disorders, the results of which have profoundly changed our view of human diseases associated with excess of iron, iron deficiency or iron misdistribution. Not only has new light been shed on the pathogenesis of these disorders, but therapeutic applications from these advances are now foreseen. The notion that hepcidin excess or deficiency may contribute to the dysregulation of iron homeostasis in hereditary and acquired iron disorders raises the possibility that hepcidin-lowering or enhancing agents may be an effective strategy for curing the main consequences of hepcidinopathies, anemia or iron overload, respectively. Experimental pre-clinical and clinical studies have shown that hepcidin antibodies, agonists or antagonists, cytokine receptor antibodies and small-molecules that modify hepcidin expression also reverse iron abnormalities in vivo, in a number of disease models. While future studies addressing safety and long-term efficacy of hepcidin-targeted treatments will clarify risks and benefits, a new era has begun based on the treatment of disorders of iron homeostasis through the modulation of its regulatory hormone, hepcidin.

Abbreviations: HC, hemochromatosis, TfR2, transferrin receptor 2, HAMP, hepcidin gene, HJV, hemojuvelin, Tf, transferrin, FPN, ferroportin, LEAP-1, liver expressed antimicrobial protein, BMPs, bone morphogenetic proteins, RGMs, repulsive guidance molecules, RGMs, transmembrane serine protease 6 gene, sHJV, soluble form of HJV, GDF15, growth differentiation factor 15, TWSG1, twisted gastrulation protein homolog 1, transferrin receptor 1