Can Iron worsen Malaria infection?

Iron is an essential mineral for most of organisms. The body cannot make enough healthy red blood cells, if it lacks the required quantity of iron. The lack of red blood cells is called iron deficiency anemia.

Dr Niti Kautish, Senior consultant, Obstetrics and Gynecology, Fortis Escorts Hospital, Faridabad, sheds light on the importance or iron.

It is an important component of hemoglobin and helps in transporting oxygen throughout the body. But at the same time an excess iron can also be very dangerous. It promotes the formation of damaging oxidative radicals. This can also deposit in organs such as the liver, heart and pancreas which can lead to conditions like cirrhosis, heart failure and diabetes. Since both iron deficiency and high concentration of iron can compromise cellular function, the levels of in the cells must be regulated precisely.

This can be well studied in the case of malaria. Malaria infections are a major global cause of anemia. The relationship between malaria and iron is often debated. It has been a subject of discussion in the global health community since 2006, ever since a large-scale trial on the island of Pemba discovered that iron supplementation in children related to the rise in malaria-related mortality.

Through the study conducted by National Institute of Health (NIH), let us further understand the relationship between iron and malaria; and how iron worsens malaria infection:

Malaria parasites feed on iron. Organisms have a protein called ferroprotein, which prevents toxic buildup of iron in RBC. It also protects the cells against malaria infection. By studying mice and samples from malaria patients, researchers found out that high concentration of iron interferes with ferroprotein.

The researchers observed that lack of ferroprotein in erythroid cells (red blood cells and their precursors) allowed iron to accumulate to toxic levels inside RBCs. The mice with intact ferroprotein were more stable, had less parasites and better outcomes as compared to the mice that lacked ferroprotein.

It was also observed that a hormone called hepcidin regulates ferroprotein in red blood cells and their precursors. The hormone is more abundant in high iron concentration and lowers the ferroprotein level. It also prevents iron from being removed from the cells.

The researchers also studied if the ferroprotein mutation Q248H, which is found in African population protects against malaria.

After studying children hospitalized for malaria in Zambia, it was observed that nearly 20 percent of the children who had the mutation, had fewer malarial parasites and tolerated fewer for longer period before visiting the hospital. The results stated that the mutation protects ferroprotein from hepcidin's effects, and thus protects against malaria. This further explains the presence of mutation in the people living in malaria endemic regions.

In another study on 290 pregnant women in Ghana, it was observed that the 9 percent, who had the ferroprotein mutation Q248H, were comparatively less prone to pregnancy associated malaria, in which malaria parasites cause adverse pregnancy and birth outcomes by accumulating in the placenta.