Heart muscle weakness: More iron makes the heart more resilient

Iron deficiency can worsen heart muscle weakness
Iron is an important trace element that should be consumed in sufficient amounts through the daily diet. Scientists from the Hannover Medical School (MHH) have found that an iron deficiency has serious consequences for heart failure. But the damaging process appears to be reversible, as researchers confirm with new results. Heart failure patients should therefore take care not to suffer from deficiency symptoms. The study was published in the "European Heart Journal".

Patients with heart failure (heart failure) often suffer from an iron deficiency. When treated with iron, patients feel better, are more resilient, have to go to the hospital less often and may live longer. Scientists at the Hannover Medical School (MHH) have now found out why this is so: They have described the underlying mechanism and published it in the prestigious journal "European Heart Journal". This explains not only the positive effects of iron therapy that doctors and patients have been observing for a long time, but also why iron is so important for the functioning of the heart.

Iron is a trace element that all living things have to ingest with food. It has been known for some years that even a slight iron deficiency is disadvantageous for heart failure, even if there is no anemia yet. With iron deficiency anemia, not enough red blood cells can be formed that carry oxygen in the body. Here it is obvious that you get tired quickly and are physically less resilient.

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“But iron is not only important for the transport of oxygen, it is also needed in the cell's power plants, the mitochondria. If there is a lack of iron, the mitochondria can produce less energy. The heart muscle, however, relies on a high energy supply for its pumping function, ”explains Professor Dr. Tibor Kempf, who collaborated with Professor Dr. Kai Wollert has performed. The two scientists at the MHH Clinic for Cardiology and Angiology worked with Dr. Bruno Galy and Professor Dr. Matthias Hentze from Heidelberg together. The first author of the publication is Saba Haddad, who carried out this study as part of her doctoral thesis with Professor Kempf.

To find out how the iron balance in cardiac muscle cells is regulated, the researchers switched off so-called Irp proteins in cardiac muscle cells. “Irp proteins regulate the iron content in the cell. If Irp proteins are inactivated, less iron can be absorbed into the cell. There is no longer enough iron available for vital metabolic processes, and the mitochondria can then work worse, ”explains Professor Wollert.

Mice that turned off the Irp proteins developed iron deficiency in the heart, but not in the blood and other organs. The animals did not notice anything under resting conditions, but their hearts could not increase the pumping function during physical exertion. After a heart attack, the animals developed pronounced heart failure. The cause was insufficient energy production in the mitochondria. When the MHH researchers gave the mice iron, they were able to replenish their iron stores in the heart, the heart muscle cells again produced enough energy and the heart function normalized.

Heart failure is one of the most common causes of death in Germany and is caused by heart attacks, high blood pressure or heart valve defects. Further results of the MHH researchers show that a reduced activity of the Irp proteins also plays a role in patients. “Iron deficiency is therefore not only a sign of a poor prognosis, but also the reason for the poor prognosis of patients with heart failure. And it can be easily remedied, ”emphasizes Professor Dr. Johann Bauersachs, Director of the MHH Clinic for Cardiology and Angiology.

As of this year, the new guidelines have recommended that physicians prescribe iron for heart failure patients who have iron deficiency. Several clinical studies are currently examining whether iron administration can not only improve symptoms but also extend the life of patients. (sb)

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