Albertine Donker

Iron Function and Iron Handling from Fetus to Adult 77 2 Table 3. Future research challenges Knowledge gaps Physiology of iron and iron handling in childhood Critical roles of iron during the different phases of childhood The relation between iron status in children and with adult peak bone mass The effect of iron status in infants on vaccination response? Regulation of iron handling in utero Systemic fetal iron homeostasis, role of maternal and fetal hepcidin Hepcidin regulation in utero Cellular iron trafficking from mother to fetus Iron and epigenetic programming The relevance of the Barker hypothesis as described for metabolic syndrome for iron deficiency and iron excess in utero The existence of epigenetic programming of iron regulating genes Iron and lactation Factors contributing to iron content of mother milk and its bio- availability for neonate Developmental aspects of iron handling Survival advantage of relatively high hepcidin in relation to body iron parameters due to the role of hepcidin in the innate immune system Priorisation of iron acquiring versus iron withholding in children during inflammation Priorisation of iron between erytroblasts, brain, other iron requiring organs age dependent, does it change during childhood. Hierarchical distrubution of iron among different organ systems Diagnosis of iron status Diagnosis of iron deficiency and iron deficiency anemia Hepcidin as a possible marker for ID(A) in both adults and children? The value of hepcidin as a marker of ID before IDA occurs Hepcidin, in combination with other iron and inflammatory parameters as a marker to differentiate between ID, iron restriction in inflammation (recurrent upper airway infections, very common in childhood) and iron restriction in combination with ID. Hepcidin as a marker to personalize iron treatment in accordance with individual characteristics Diagnosis of ID of the brain Brain iron status indicators, i.e. serum biomarkers that provide information on brain iron status and detect brain iron deficiency before IDA occurs Hepcidin measurements Worldwide implementation of standardized hepcidin assays. Standardized serum hepcidin reference ranges for different age groups from different ethnicities. Development and analytical and clinical validation of non-invasive hepcidin measurements (saliva, urine) Treatment of iron deficiency Guidelines on iron treatment in premature and small for gestational age children balancing the risk of iron deficiency against the risk of dysbiosis/perturbation of the gut microbiotca