Hepcidin and Iron Status in Anemia of Chronic Diseas

hepcidin is a peptide synthesized by liver in response to anaemia, hypoxia and inflammation. It has been suggested that hepcidin is the main iron regulatory hormone. Once secreted into the circulation, hepcidin binds ferroportin on enterocytes and macrophages, which triggers its internalization and lysosomal degradation. Thus, in chronic inflammation, the excess of hepcidin decreases iron absorption and prevents iron recycling, which results in hypoferremia.The cytokine IL-6 is the main inducer of hepcidin synthesis and higher level of IL-6 have been reported in patients with chronic inflammation. It has been suggested that hepcidin is an important mediator of ACD because it acts as an inhibitor of iron absorption in the intestine and iron release from macrophages. Then, hepcidin would contribute to the hypoferremia, usually observed in infection and inflammation processes. Additionally, hepcidin may inhibit erythroid colony formation at reduced erythropoietin concentrations and therefore, contribute to ACD in patients.