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Iron and Heart Failure: Current Concepts and Emerging Pharmacological Paradigms

World Journal of Cardiovascular Diseases 2024年第4期14卷 195-216页

作者： maria Rosaria De Pascale maria beatrice rondinelli Flora Ascione Vincenzo Maffei Chiara Di Lorenzo Sarah Scagliarini Raffaella Faraonio Antonio Faiella Immunohematology and Transfusion Medicine Unit Cardarelli Hospital Naples Italy Immunohematology and Transfusion Medicine Unit San Camillo-Forlanini Hospital Rome Italy Health Management Office Cardarelli Hospital Naples Italy Anesthesiology Unit Cardarelli Hospital Naples Italy Department of Medical and Translational Sciences University of Naples Federico II Naples Italy Oncology Unit Cardarelli Hospital Naples Italy Department of Molecular Medicine and Medical Biotechnologies University of Naples Federico II Naples Italy

Background: Emerging evidence has recognized that anemia and iron deficiency are recurrent comorbidities in chronic heart failure (HF) and several trials have established that iron administration improves myocardial asset and clinical scenario in HF. Purpose: Recent acquisitions suggest that iron deficiency represents a concrete bias in the pathogenetic mechanism of chronic HF, so we have investigated the putative role of the hepcidin/ferroportin axis in the cardiovascular setting to advocate novel pharmacological and clinical approaches. Methods: Here, after an excursus on iron metabolism, we first reviewed the ongoing studies on novel iron targeted compounds. Then, we summarize large clinical interventional studies conducted on patient suffering from iron deficiency and HF which have tested the effects of drugging iron regard QoL, hospitalizations and cardiovascular death. Results: Novel compounds such as hepcidin agonist (PTG 300), synthetic human hepcidin (LJPC-401) and anti FPN (Vamifeport) are ongoing in iron overloaded patients, while the hepcidin blocker (PRS-080) is under investigation in anemic patients. Noteworthy, novel insights could arise from the results of a Phase IV interventional study regarding the modification of hepcidin pathway in a large cohort of HF patients (n = 1992) by sodium glucose cotransporter 2 inhibitors. To date, several studies highlight the beneficial effect of iron administration in cardiovascular setting and latest evidences consider hepcidin level as a novel biomarker of cardiac injury and atherosclerosis. Conclusions: We advocate that data from ongoing studies will suggest novel iron targeted therapies for diagnosis, prognosis and therapy transferable in selected heart failed patients.

关键词： Heart Failure Iron Anemia Iron Deficiency Hepcidin

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