UVA: Anemia Discovery Offers New Targets to Treat Fatigue in Millions
A new discovery at the UVA School of Medicine sheds light on iron-restricted anemias that leave millions of people weak, tired and unable to concentrate.
CHARLOTTESVILLE, Va. (WVIR) - Researchers at the University of Virginia School of Medicine say they discovered new ways to treat millions of people who are dealing with fatigue.
For the past 12 years researchers have been studying the basic problem of how iron regulates red blood cell platelets. They believe they have discovered a previously unknown biological process that could help doctors treat people with anemia.
The new research sheds light on iron-restricted anemias, which leaves people weak, tired, and unable to concentrate. Researchers made the discovery while trying to better understand why iron-restricted anemias caused the body to create insufficient numbers of vital red blood cells.
UVA says there are treatments for these kinds of anemia, but they're not the best options in terms of cost, potential side effects, and some patients become resistant to treatments.
“This study helps us to understand that the molecular level - the level of those cells - what's going wrong that would cause the cells to become resistant to this therapy,” said University of Virginia professor of Pathology Dr. Adam Goldfarb. “And we've identified ways to which we can restore sensitivity of those cells to the treatment with erythropoietin.”
Researchers say the discovery is making an impact at the basic-scientific level in terms of understand how the resistance occurs. They also hope to start trial testing on patients with anemia in about 5 years. Depending on the outcome of those trials, it could become available to the public years later.
01/22/2018 Release from the University of Virginia Health System:
CHARLOTTESVILLE, Va., Jan. 22, 2018 – A new discovery from the University of Virginia School of Medicine has revealed an unknown clockwork mechanism within the body that controls the creation of oxygen-carrying red blood cells. The finding sheds light on iron-restricted anemias that leave millions of people weak, tired and unable to concentrate – and it may point the way to better treatments as well.
Adam Goldfarb, MD, and his colleagues made the discovery while seeking to better understand why iron-restricted anemias cause the body to create insufficient numbers of vital red blood cells. Members of the research team were working independently on what would prove to be key pieces of the puzzle, but it was only when they put them together that they could see the big picture.
Shadi Khalil, an MD/PhD student who worked in Goldfarb’s lab, was examining bone marrow cells when he noticed something intriguing about them. “I thought it was beautiful,” he recalled. “I just stood there at the microscope looking at these cells.”
What caught his eye was that the cells contained large pools of the receptor for erythropoietin, a hormone that directs the bone marrow to make red blood cells. (The hormone, known as EPO, has been used by Lance Armstrong and other athletes as a performance-enhancing drug.) To do its job receiving the instruction to make blood cells, the receptor must be on the outside of the marrow cells. Yet so much was stored up inside them.
Perhaps, Khalil thought, this might explain why some people’s bone marrow cells fail to follow the hormone’s instructions. And it did, partly. But there was still a piece missing, and, it would turn out, a colleague in the lab had already found it.
Researcher Lorrie Delehanty was studying anemia using a model the lab developed – “anemia in a dish,” the scientists call it. “If you drop the iron level way down, these cells act like anemic cells,” Delehanty explained. “They basically become anemic cells – they even look very pale.” Something else happens, too, she noticed: A particular protein disappeared.
The Scribble protein (named after the SCRIB gene that produces it) proved to be a key piece of the clockwork mechanism. Basically, it works like this: The amount of iron in the blood affects the amount of the Scribble protein available, and Scribble controls whether the hormone receptor is welled up inside the bone marrow cells or doing its job on the outside. “We realized that this was kind of a complicated symphony that starts with iron and ultimately controls how much and what kind of messages the cells get,” Khalil said.
The researchers used this knowledge to fix EPO resistance in their model, and they hope the discovery will eventually be useful for treating anemias in people, too. “We’ve got the key components, and we want to move up the hierarchy to the master regulatory element that’s controlling this,” said Goldfarb, of UVA’s Department of Pathology. “When we do that, that will get us that much closer to alternative treatments for anemia.”
Anemia Findings Published
The researchers have published their findings in the Journal of Experimental Medicine. The paper was authored by Khalil, Delehanty, Stephen Grado, Maja Holy, Zollie White III, Katie Freeman, Ryo Kurita, Yukio Nakamura, Grant Bullock and Goldfarb.
The research was supported by the National Institutes of Health (grants R01 DK079924, R01 DK101550 and K08 HL093355), the Leukemia and Lymphoma Society (grant LLS NIA-8988-15), the Farrow Fellowship, National Cancer Institute Cancer Center support grant P30 CA44579 and UVA’s Medical Scientist Training Program.
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