Excess serum or hepatic iron Metformin order is a relatively frequent finding in HCV-infected patients, and has been associated with poor response to treatment, greater disease severity, and an increased risk of hepatocellular carcinoma.31, 34-38 Despite the presence of chronic inflammation, hepcidin levels in HCV patients are relatively reduced, thus preventing the appropriate regulation of iron absorption and release, leading to systemic

and hepatic iron excess.39, 40 In vitro studies have suggested that iron may enhance HCV replication,41, 42 although this has recently been challenged.43 Moreover, several reports have suggested an improved disease course and augmented treatment response following iron reduction therapy.31,

32 Weekly PEG-IFN-α administration, with hepcidin induction and the subsequent iron redistribution, may be of similar benefit to HCV patients. Indeed, reduced hepatic iron and an amelioration of hepcidin suppression have been reported following successful HCV eradication.44-46 Novel data from this study extends these clinical observations. Conversely, chronic hepcidin induction may contribute to the anemia associated with PEG-IFN-α therapy, through the development of iron-restricted erythropoiesis.47 IFN-α treatment exerts its antiviral effect through the induction of interferon-stimulated genes (ISGs) by way of activation of the Jak/STAT pathway.4, 5 Although ISG induction is predominantly by buy CH5424802 way of the STAT1 and STAT2 transcription factors, STAT3 activation, which mediates the inflammatory induction of hepcidin, is also critical to the antiviral effect

of IFN-α.48, 49 The significant correlation seen between serum hepcidin and CRP levels in HCV patients likely reflects STAT3 activation following PEG-IFN-α initiation.28, 50 Interestingly, disruption of STAT signaling by way of the suppressor of cytokine signaling-3 (SOCS3) has been reported in nonresponders to treatment in HCV, whereas this molecule also inhibits the induction of hepcidin by inflammation, and potentially its downstream effects on iron regulation.23, 51 This interference may be reflected in the differences in the check details ability of hepcidin to regulate iron levels between treatment responders and nonresponders seen here (Fig. 3D,E). In summary, hepcidin, the master regulator of iron homeostasis, is identified here as an IFN-α-responsive gene. IFN-α induces hepcidin production by way of the Jak/STAT3 signaling pathway, with increased serum hepcidin seen in HCV patients following a single PEG-IFN-α dose. The consequent systemic iron withdrawal was greatest in those with the most marked viral response to PEG-IFN-α, implicating hypoferremia as a surrogate marker of immediate PEG-IFN-α efficacy. The authors thank Dr. Jennifer Russell, Dr. Flavia D’Alessio, and Dr. Katarzyna Mleczko-Sanecka for excellent technical assistance and advice, and Dr.