Assessment of Urinary Concentrations of Hepcidin Provides Novel Insight into Disturbances in Iron

Disturbances in iron homeostasis are frequently observed in individuals with malaria. To study the effect of malaria and its treatment on iron homeostasis and to provide amechanistic explanation for observed alterations in irondistribution,we studied the course of the iron regulatory hormonehepcidin in anemicTanzanian children with febrile Plasmodium falciparummalaria. Before initiation of antimalarial treatment, urinary concentrations ofhepcidinwere strongly elevatedandwereassociatedwith ironmaldistribution, aswas suggestedby thepresence of hypoferremia and high serum concentrations of ferritin. Antimalarial treatment resulted in a rapid decrease in urinary concentrations of hepcidin and reversal of the hypoferremia. Exploration of regulatory pathways of hep-cidin production by analysis of iron, erythropoietic, and inflammatory indices suggested that reduced erythro-poietic activity and inflammation stimulated hepcidin production.We conclude that high concentrations of hep-cidin explain the observed disturbances in host iron homeostasis associated with malaria and may contribute to malarial anemia and an impaired erythropoietic response to iron supplementation. Iron deficiency and malaria are among the most com-mon causes of anemia in African children, and the 2 conditions frequently coexist and interact in away that is currently poorly understood [1, 2]. Recently, the impor