Early erythroferrone levels can predict the long-term hemoglobin
responses to erythropoiesis-stimulating agents
Abstract
Background and Purpose: Our previous study reported that erythroferrone
(ERFE), a newly identified hormone produced by erythroblasts, responded
to recombinant human erythropoietin (rHuEPO) sensitively but its
dynamics was complicated by double peaks and circadian rhythm. This
study intends to elucidate the underlying mechanisms for the double
peaks of ERFE dynamics, and further determine whether early ERFE
measurements can predict hemoglobin (HGB) responses to rHuEPO.
Experimental Approach: By expressing recombinant rat ERFE protein and
investigating its deposition in rats, the production of ERFE was
deconvoluted. To explore the role of iron in ERFE production, we
monitored short-term changes of iron status after injection of rHuEPO or
deferiprone (DFP). Pharmacokinetic/pharmacodynamic (PK/PD) modelling was
used to confirm the mechanisms and examine the predictive ability of
ERFE for long-term HGB responses. Key Results: The rRatERFE protein was
successfully expressed and purified. The production of ERFE was
deconvoluted and showed two independent peaks (2 h and 8 h). Transient
iron decrease was observed at 4h after rHuEPO injection and DFP induced
significant increases of ERFE. Based on this mechanism, the PK/PD model
could characterize the complex dynamics of ERFE. In addition, the model
predictions further revealed a stronger correlation between ERFE and HGB
peak values than that for observed values. Conclusions and Implications:
The complex dynamics of ERFE should be composited by an immediate
release and transient iron deficiency-mediated secondary production of
ERFE. The early peak values of ERFE, which occur within a few hours, can
predict HGB responses several weeks after ESA treatment.