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Blood, 15 November 2008, Vol. 112, No. 10, pp. 4276-4283.
Prepublished online as a Blood First Edition Paper on August 20, 2008; DOI 10.1182/blood-2008-06-162008.
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Tumor necrosis factor SNP haplotypes are associated with iron deficiency anemia in West African children
Sarah H. Atkinson14,
Kirk A. Rockett3,
Gareth Morgan1,
Philip A. Bejon3,
Giorgio Sirugo1,
Maria A. O'Connell5,
Neil Hanchard3,
Dominic P. Kwiatkowski3,4,6, and
Andrew M. Prentice1,2
1 Medical Research Council (MRC) Keneba and MRC Laboratories, Banjul, The Gambia;
2 MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom;
3 Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom;
4 University of Oxford, Department of Paediatrics, Children's Hospital (John Radcliffe), Oxford, United Kingdom;
5 MRC Human Nutrition Research, Cambridge, United Kingdom; and
6 Wellcome Trust Sanger Institute, Hinxton, United Kingdom
Plasma levels of tumor necrosis factor- (TNF- ) are significantly raised in malaria infection and TNF- is thought to inhibit intestinal iron absorption and macrophage iron release. This study investigated putative functional single nucleotide polymorphisms (SNPs) and haplotypes across the major histocompatibility complex (MHC) class III region, including TNF and its immediate neighbors nuclear factor of light polypeptide gene enhancer in B cells (l BL), inhibitor-like 1 and lymphotoxin alpha (LTA), in relation to nutritional iron status and anemia, in a cohort of 780 children across a malaria season. The prevalence of iron deficiency anemia (IDA) increased over the malaria season (P < .001). The TNF–308 AA genotype was associated with an increased risk of iron deficiency (adjusted OR 8.1; P = .001) and IDA (adjusted OR 5.1; P = .01) at the end of the malaria season. No genotypes were associated with IDA before the malaria season. Thus, TNF appears to be a risk factor for iron deficiency and IDA in children in a malaria-endemic environment and this is likely to be due to a TNF- –induced block in iron absorption.

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