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Systemic iron reduction by venesection alters the gut microbiome in patients with haemochromatosis

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posted on 2024-06-18, 15:50 authored by Bhavika Parmanand, Michael Watson, Karen BolandKaren Boland, Narayan Ramamurthy, Victoria Wharton, Alireza Morovat, Elizabeth K Lund, Jane Collier, Gwénaëlle Le Gall, Lee Kellingray, Susan Fairweather-Tait, Jeremy F Cobbold, Arjan Narbad, John RyanJohn Ryan

Background & aims: Iron reduction by venesection has been the cornerstone of treatment for haemochromatosis for decades, and its reported health benefits are many. Repeated phlebotomy can lead to a compensatory increase in intestinal iron absorption, reducing intestinal iron availability. Given that most gut bacteria are highly dependent on iron for survival, we postulated that, by reducing gut iron levels, venesection could alter the gut microbiota.

Methods: Clinical parameters, faecal bacterial composition and metabolomes were assessed before and during treatment in a group of patients with haemochromatosis undergoing iron reduction therapy.

Results: Systemic iron reduction was associated with an alteration of the gut microbiome, with changes evident in those who experienced reduced faecal iron availability with venesection. For example, levels of Faecalibacterium prausnitzii, a bacterium associated with improved colonic health, were increased in response to faecal iron reduction. Similarly, metabolomic changes were seen in association with reduced faecal iron levels.

Conclusion: These findings highlight a significant shift in the gut microbiome of patients who experience reduced colonic iron during venesection. Targeted depletion of faecal iron could represent a novel therapy for metabolic and inflammatory diseases, meriting further investigation.

Lay summary: Iron depletion by repeated venesection is the mainstay of treatment for haemochromatosis, an iron-overload disorder. Venesection has been associated with several health benefits, including improvements in liver function tests, reversal of liver scarring, and reduced risk of liver cancer. During iron depletion, iron absorption from the gastrointestinal (GI) tract increases to compensate for iron lost with treatment. Iron availability is limited in the GI tract and is crucial to the growth and function of many gut bacteria. In this study we show that reduced iron availability in the colon following venesection treatment leads to a change in the composition of the gut bacteria, a finding that, to date, has not been studied in patients with haemochromatosis.

Funding

Oxford Health Service Research Committee, the University of Oxford Medical Research Fund

NIHR Oxford Biomedical Research Centre

In vitro studies on a colonic delivery system with potential health benefits

Biotechnology and Biological Sciences Research Council

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The original article is available at https://www.jhep-reports.eu/

Published Citation

Parmanand B. et al. Systemic iron reduction by venesection alters the gut microbiome in patients with haemochromatosis. JHEP Rep. 2020;2(6):100154.

Publication Date

28 July 2020

PubMed ID

32995714

Department/Unit

  • Beaumont Hospital
  • Medicine

Research Area

  • Population Health and Health Services
  • Endocrinology
  • Immunity, Infection and Inflammation

Publisher

Elsevier BV

Version

  • Published Version (Version of Record)