Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Management of Anemia of Chronic Disease: Beyond Iron-Only Supplementation.

Version 1 : Received: 7 December 2020 / Approved: 8 December 2020 / Online: 8 December 2020 (06:58:25 CET)

A peer-reviewed article of this Preprint also exists.

Pasini, E.; Corsetti, G.; Romano, C.; Aquilani, R.; Scarabelli, T.; Chen-Scarabelli, C.; Dioguardi, F.S. Management of Anaemia of Chronic Disease: Beyond Iron-Only Supplementation. Nutrients 2021, 13, 237. Pasini, E.; Corsetti, G.; Romano, C.; Aquilani, R.; Scarabelli, T.; Chen-Scarabelli, C.; Dioguardi, F.S. Management of Anaemia of Chronic Disease: Beyond Iron-Only Supplementation. Nutrients 2021, 13, 237.

Journal reference: Nutrients 2021, 13, 237
DOI: 10.3390/nu13010237

Abstract

Chronic diseases are characterised by cell’s autophagy and proteins disarrangement resulting in sarcopenia, hypoalbuminemia and hypo-haemoglobinaemia. Hypo-haemoglobinaemia couses worse prognosis independentely of the principal disease. Currently, the cornerstone of therapy of anaemia is iron supplementation, with or without erythropoietin for the stimulation of hematopoiesis. However, treatment strategies should incorporate the addition of heme, the principal biochemical constituent of haemoglobin. Heme synthesis follows a complex biochemical pathway. The limiting step of heme synthesis is D-ALA availability which, for its synthesis, requires Glycine and Succinil-CoA. Consequently, treatment of anaemia should not be based only on iron availability, but also on the availability of the molecules fundamental for heme synthesis. Therefore, an adequate clinical therapeutic strategy should integrate the standard iron infusion and the supply of essential amino acids and vitamins involved in the heme synthesis. We report preliminary data in selected elderly anaemic patients with congestive heart failure (CHF) and catabolic disarrangement, who, in addition to standard iron therapy, received personalized therapy with essential-AAs and vitamins involved in the maintenance of heme. Notably, such individualized therapy resulted in a significant increase in the serum concentration of haemoglobin after 30 days of treatment compared to standard iron therapy.

Subject Areas

Chronic diseases; iron deficiency; haemoglobin; anaemia; aminoacids; rehabilitation

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