Analysis of the Modulation of Serum Hepcidin Level in Response to Iron Oral Intake: Potential Interest for the Differential Diagnosis Between Ferroportin Disease and Dysmetabolic Hepatosiderosis.

Phase 2

Completed

• Conditions: Hemochromatosis, Type 4; Diagnosis; Ferroportin Disease; Dysmetabolic Hepatosiderosis
• Interventions: Drug: iron fumarate

• Registration Number: NCT01949467
• Lead Sponsor: Rennes University Hospital

Brief Summary

The diagnosis of iron overload is a common problem. It is important to optimize the diagnosis to ensure support for patients and their relatives especially regarding genetic disease.

Iron overload revealed by a high level of serum ferritin and confirmed by the presence of an excessive amount of iron in the liver is a frequent situation. In a lot of case there is no increase in serum iron and transferrin saturation. This situation may arise in particular in patients with:

* a genetic iron overload related to mutation in the ferroportine gene, leading to a ferroportin disease. The diagnosis is based on the sequencing of the gene,

* a dysmetabolic hepatosiderosis, the most frequent situation , where iron overload is associated with abnormalities in the metabolism of carbohydrates and fats, whereas no genetic cause is identified.

However, patients often have similar biological signs and despite the implementation of strict algorithm regarding the diagnostic procedure, it appears that a large number of patients are tested for the mutation in the ferroportin gene, and that mutation is not found in most cases. It is therefore essential to optimize the diagnosis process by introducing additional criteria.

The investigators' hypothesis, based on the known elements, is that the response to a single dose of iron will modulate differently the iron parameters measured in serum, including hepcidin level which controls iron metabolism and metals associated with iron. This could be helpful for diagnosis procedure in patients with ferroportin disease or dysmetabolic hepatosiderosis.

Detailed Description

The quantification of serum hepcidin level is a potential method of investigation in iron metabolism disorders. However, apart from some extreme situations, the assay achieved solely is not helpful. This is due to the varying levels encountered from one subject to another for the same disease. This is related to the facts that values considered to be normal cover a wide range and that a value obtained for a given patient at a given time, can be influenced by many factors.

It has been reported that a a single oral iron dose induced an increase of serum hepcidin level in healthy subjects which is abolished in subjects with genetic hemochromatosis linked to insufficient hepcidin expression related to mutations in the HFE or TFR2 genes.

In patients with a dysmetabolic hepatosiderosis, it was suggested that the expected hepcidinemia increase found after an iron intake was altered, likely due to a slight inflammatory signal responsible for hepcidin induction.

The investigators hypothesize that a dynamic response of iron parameters, including modulation of hepcidin level, to an iron intake will allow to discriminate patients with ferroportin disease or dysmetabolic hepatosiderosis, situations whose clinicobiological presentation is often confusing.

Thus, the three objectives in this study will be :

1. To define pharmacokinetic characteristics of serum hepcidin in response to iron oral intake and to determine the ability of this pharmacokinetic to discriminate dysmetabolic hepatosiderosis and ferroportin disease.

2. To correlate amplitude of this response to the iron parameters modulation

3. To correlate amplitude of this response to the concentration of divalent cations whose metabolism uses common genes to those involved in iron metabolism.

Study Timeline

• Study First Submitted: 2013-09-20
• Study First Submitted QC: 2013-09-23
• Study First Posted: 2013-09-24
• Study Start: 2014-02-10
• Primary Completion: 2017-12-19
• Status Verified: 2018-08
• Study Completion: 2018-12-26
• Last Update Submitted: 2019-03-25
• Last Update Posted: 2019-03-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 62

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
HV	iron fumarate	20 Healthy volunteers (HV) patients
TDHS	iron fumarate	20 Patients with Treated Dysmetabolic Hepatosiderosis (TDHS)
UFPD	iron fumarate	20 patients with untreated Ferroportin Disease (UFPD)
TFPD	iron fumarate	20 patients with treated Ferroportin Disease (TFPD)
UDHS	iron fumarate	20 patients with untreated Dysmetabolic Hepatosiderosis (UDHS)

Primary Outcome Measures

Name	Time	Method
hepcidemia rate	Day 1	The primary endpoint is the maximum variation, of hepcidemia rate (Δmax) after iron oral intake. This variation will be compared between the different groups of included subjects

Secondary Outcome Measures

Name	Time	Method
ratios between serum hepcidin level and iron parameters	Day 1	Differential modulation, induced by the iron intake, of ratios between serum hepcidin level and iron parameters (serum iron, transferrin, ferritin) between the different groups.
serum level of other divalent cations	day 1	Modulation of serum level of other divalent cations.

Trial Locations

Locations (4)

CHU Limoges; 🇫🇷 Limoges, France

CHU Clermont-Ferrand; 🇫🇷 Clermont-Ferrand, France

CHU Montpellier; 🇫🇷 Montpellier, France

CHU Pontchaillou; 🇫🇷 Rennes, France