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Iron Supplement in malaria endemic countries: a major challenge for health policy.

By Pierre Bush, PhD Moderator | 28 May, 2017

Dear Colleagues,
The importance of Iron for our blood health is very well documented. However, Iron supplementation has been suspected by some researchers to be deleterious in individuals infected with malaria caused by Plasmodium falciparum. The mechanism of how the Iron supplementation enhances malaria remains obscure. I am opening the debate: you are welcome to try and shed a light on this mechanism, and state your thoughts on the assertion that Iron supplementation enhances malaria. Related resources are attached to help you in this discussion.

Iron deficiency and malaria have similar global distributions, and frequently co-exist in pregnant women and young children. Where both conditions are prevalent, iron supplementation is complicated by observations that iron deficiency anaemia protects against falciparum malaria, and that iron supplements increase susceptibility to clinically significant malaria, but the mechanisms remain obscure. Here, using an in vitro parasite culture system with erythrocytes from iron-deficient and replete human donors, we demonstrate that Plasmodium falciparum infects iron-deficient erythrocytes less efficiently. In addition, owing to merozoite preference for young erythrocytes, iron supplementation of iron-deficient individuals reverses the protective effects of iron deficiency. Our results provide experimental validation of field observations reporting protective effects of iron deficiency and harmful effects of iron administration on human malaria susceptibility. Because recovery from anaemia requires transient reticulocytosis, our findings imply that in malarious regions iron supplementation should be accompanied by effective measures to prevent falciparum malaria

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Sandeep Saluja Replied at 8:26 PM, 28 May 2017

Interesting debate but we are all reminded that iron supplementation is not only supposedly linked with malaria but many other infections due to the effect on the immune system and even the gut microbiome.
While doing such studies at a clinical or epidemiological level,a holistic approach would be needed and one may also need to study if the iron salt makes a difference and the effect of diet.Does a probiotic rich diet make a difference?
I am also reminded of the recent work where at a clinical level,no harm of iron supplementation on malaria was reported.

Subbalaxmi Malladi Replied at 11:41 PM, 28 May 2017

Reg iron in malaria endemic areas, we need to find mechanisms to
During severe malaria pt develops extra vascular and intravascular hemolysis and causes hemosiderinuria and Pt develops severe anemia
We need not allow iron deficiency to continue to prevent malaria as anemia has several other problems in a community
I am a physician
Epidemiologists may think otherwise
With very beautiful diagnostics, and artemisinin compounds and ACTs we are seeing less of malaria here

In my view malaria eradication is possible in coming 10 to 20 years

Pierre Bush, PhD Moderator Replied at 8:29 PM, 30 May 2017

Thank you Dr. Saluja & Malladi. You are both right. I find it intriguing that Iron which is very important for the most vulnerable group of the society (pregnant women and children), can be thought to be an enhancement for infectious diseases. I am delighted that the preposition is being revisited.

Maimunat Alex-Adeomi Moderator Replied at 2:45 AM, 1 Jun 2017

Hello all,
Interesting discussion on Iron supplementation and malaria. It is great to see the link between the parasite and the affinity for iron deficient red cells.  
It would be very interesting to see the relationship in patients with a sickle cell disease or carrying the gene. The current clinical guidelines now is to avoid iron supplementation in sickle cell disease patients to avoid Iron overload. There is also the thought that carrying the sickling gene but no disease i.e Genotype AS or AC confers some level of immunity to malaria but not severe malaria.  Maimunat. T. Alex-Adeomi

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