n Medical Technology SA - Hepcidin : a brief review




There can be no doubt that the many biological discoveries found in the research arena no matter how imperceptible, have a profound effect on the work of the clinical laboratory. To improve human health, scientific discoveries must be translated into practical applications. Such discoveries typically begin at 'the bench' with basic research in which scientists, including biomedical scientists study disease at a cellular or molecular level, then progress to the clinical level and eventually to the patient's 'bedside'. This translational research has proven to be a powerful process that drives ultimately the clinical research engine to aid medical diagnosis and treatment. The never static repertoire of laboratory tests is forever being extended by translational research and the discovery and story of hepcidin that has triggered a virtual explosion of studies on iron metabolism and related disorders is an example of this process. The existence of this amino acid peptide hormone was unheard of a decade ago, but with its discovery in 2000 from plasma ultrafiltrate and subsequently in urine in 2001, it not only opened the way to understand iron metabolism, but also helped in elucidating the pathomechanisms of many other diseases. In recent times international interest grew exponentially as the key role of hepcidin in body iron regulation became clearer. Confirmatory studies in regard to hepcidin's role in a number of disorders in humans, associated either with its relative decrease or increase, have been carried out. Until relatively recently the methods for the laboratory assessment of hepcidin were fairly cumbersome and somewhat technically demanding and mainly used in the research domain. They were centred on two types of assays: immunoassays based on anti-hepcidin antibodies using a reference standard of synthetic hepcidin and mass spectrometric assays that can detect the characteristic mass of the active 25 amino acid hepcidin species or its fragments. The analyser then quantifies the intensity of these peak(s) and compares them to a spiked internal standard. Many inherent problems in regard to assaying hepcidin in biological fluids using traditional immunochemical methods based on the production of specific anti-hepcidin antibodies still exist. For example, the development of these types of assays has been hampered by several causes, including the following: (1) the compact structure of the peptide with few antigenic epitopes and its small size (only 25 amino acids); (2) the high degree of protection between animal genus, with subsequent problems in developing an appropriate immunogenic response in host animals, and (3) limited availability of the necessary antigen. However, with the development of the first competitive enzyme-linked immunoassays (C-ELISA) for human hepcidin in serum, plasma the block to its measurement in the clinical laboratory setting has more or less been eliminated, enabling further transitional research into this unique peptide hormone. In a recent study, the authors described a prospective observational study to assess the ability of a hepcidin ELISA to ascertain the cause of anaemia among critically ill anaemic patients. In a more recent pilot study, the measurement of urinary hepcidin was proposed as a means of evaluating the need for iron supplementation.


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