Now WHY .. in these three DIFFERENT diseases .. does the drop of iron
.. PARALLEL .. the drop in alanine aminotransferase (ALT) .. but in the
disease of .. juvenile rheumatoid arthritis / Still's .. do they NOT ..
use this marker .. WHEN .. iron HAS been shown to BE a .. problem .. ?

Especially .. when they have such high liver injury rates. Two thirds.

Stupidity .. ?

<<snip>>
There was a positive correlation between transaminases and serum
ferritin
<<snip>>

J Nephrol. 2003 Sep-Oct; 16(5): 703-9.  Related Articles, Links

Comparative study of intravenous ascorbic acid versus low-dose
desferroxamine
in patients on hemodialysis with hyperferritinemia.

Deira J, Diego J, Martinez R, Oyarbide A, Gonzalez A, Diaz H, Grande J.

Department of Internal Medicine, Division of Nephrology, Hospital
Virgen de la
Concha, Zamora, Spain. jde...@saludalia.com

BACKGROUND: In patients on hemodialysis (HD), parenteral iron improves
the
response to recombinant human erythropoietin (rhuEPO) therapy, but in
some
subjects it produces an iron overload, increasing their morbidity and
mortality
rates. In these cases, iron administration must be discontinued. This
study
aimed to investigate the efficiency of treatment with ascorbic acid
(AA) or
desferroxamine (DFO) to mobilize and reduce iron stores, and to
determine the
effect of these compounds on erythropoiesis. METHODS: We performed a
prospective and randomized trial over 6 months, which included 27
patients with
serum ferritin levels >800 ng/mL, TSAT >30% and stabilized hemoglobin
(Hb) and
rhuEPO doses. All patients had previously received parenteral iron
(Ferlecit).
Nine patients received 200 mg of intravenous (i.v.) AA 3 times/week and
nine
patients received 1 mg/Kg/week of DFO; the remaining nine patients were
the
control group. RESULTS: There were no significant differences in iron
loss or
mobilization due to dialysis. When Ferlecit was discontinued,
functional iron
did not vary and the epoetin resistance index (rhuEPO dose/Hb) was
reduced by
21% in the i.v. AA group. In the DFO and control groups, functional
iron levels
fell. In the DFO group the epoetin resistance index increased by 20%,
with no
modifications in the control group. There was a positive correlation
between
transaminases and serum ferritin. CONCLUSIONS: In HD patients with an
iron
overload, neither i.v. AA administration or low-dose DFO increased iron

mobilization or iron loss due to dialysis. I.v. AA administration
allows
elimination of iron from stores without any drop in the functional iron

produced by discontinuing parenteral maintenance iron; it also improves
the
response to rhuEPO. DFO did not elicit any positive effects on
erythropoiesis.

PMID: 14733417 [PubMed - in process]

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------

<<snip>>
The treatment reduced mean serum alanine aminotransferase (ALT)
activity
<<snip>>

Effect of iron reduction by phlebotomy in Japanese patients with
nonalcoholic steatohepatitis: A pilot study.
Sumida Y, Kanemasa K, Fukumoto K, Yoshida N, Sakai K, Nakashima T,
Okanoue T
Hepatol Res. 2006 Sep 11;

Increased hepatic iron deposition may play a role in the pathogenesis
of nonalcoholic steatohepatitis (NASH). This study aimed to test
whether iron removal by phlebotomy improves serum transaminase
activities in patients with NASH. Eleven patients (six males and five
females) with biopsy-proven NASH underwent phlebotomy biweekly until
they reached near-iron deficiency (NID) (serum ferritin concentration
lower than or equal to 30ng/ml). Nine patients completed this study.
Serum ferritin levels in these patients fell from 563+/-322 to
18+/-9ng/ml (p=0.001). The treatment reduced mean serum alanine
aminotransferase (ALT) activity from 126+/-47 to 56+/-17IU/l (p=0.002).

Their weight did not change significantly throughout the study period.
Although two patients withdrew from the study, none was affected by any

side effects of repeated phlebotomy that required discontinuing the
treatment. In conclusion, this pilot study suggests that iron reduction

therapy by phlebotomy will be one of the promising therapies for NASH.

---------------------------------------------------------------------------
<<snip>>
Serum alanine aminotransferase levels were significantly improved
<<snip>>

Hepatogastroenterology. 2005 Mar-Apr;52(62):563-6. Related Articles,
Links

Additional effect of low iron diet on iron reduction therapy by
phlebotomy for chronic hepatitis C.

Kimura F, Hayashi H, Yano M, Yoshioka K, Matsumura T, Fukuda T, Shigeto

N, Yamahara S, Koushi F, Mishima Y, Yoshino T, Tanimoto M, Kimura I.

Department of Internal Medicine, Tamano-Municipal Hospital, Tamano
City, Okayama, Japan. f-kim...@po1.oninet.ne.jp

BACKGROUND/AIMS: Iron-induced oxidative stress plays an important role
in the pathogenesis of chronic hepatitis C. Both phlebotomy for
removing body iron stores and low iron diet for minimizing portal iron
supply to the liver have been shown to improve serum transaminase
levels in patients with the disease. However, the cooperative effects
of phlebotomy and low iron diet have not yet been elucidated in detail.

METHODOLOGY: A pilot study was undertaken to investigate whether a low
iron diet could improve the efficacy of phlebotomy in iron reduction
therapy. Of 21 patients diagnosed with chronic hepatitis C, 10 patients

were treated with phlebotomy alone (group A) while 11 patients were
treated with a low iron plus phlebotomy (group B). Phlebotomy was
repeated biweekly until serum ferritin levels reached 10 ng/mL in both
A and B groups. In addition, a low iron diet (iron intake of 8 mg/day
or less) was recommended for group B, followed by estimation of iron
intake from daily diet records.

RESULTS: Serum alanine aminotransferase
levels were significantly improved from 106+/-30 to 68+/-22 IU/L
(p<0.005, paired t-test) in group A and from 100+/-33 to 46+/-10 IU/L
(p<0.002, paired t-test) in group B. The enzyme levels after treatment
were significantly higher in group A (p<0.02, non-paired t-test), which

showed a higher upward distribution of the enzyme activity. The
estimated dietary iron intake in group B was reduced from 17.6+/-6.1 to

8.2+/-3.7 mg/day.

CONCLUSIONS: These findings suggest that phlebotomy
alone does not completely remove iron-induced oxidative stress and a
low iron diet induces an additional effect in iron reduction therapy
for chronic hepatitis C.

PMID: 15816478 [PubMed - in process]

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