Systemic Iron Deficiency in a Nonhuman Primate Model of Endometriosis

Hannah Atkins, Hannah M Atkins, Appt SE, Susan E. Appt, Robert N. Taylor, Taylor RN, Yaritbel Torres-Mendoza, Torres-Mendoza Y, Lenk EE, Emily E. Lenk, Rosenthal NS, Nancy S. Rosenthal, David L. Caudell, Caudell DL
Comparative medicine · 2018 · vol. 68(4) , pp. 298–307 · doi:10.30802/aalas-cm-17-000082 · PMID:29871715 · PMC6103425 · W2805103751
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study found that macaques with endometriosis exhibited systemic iron deficiency, characterized by decreased red blood cells and iron stores, indicating that oral iron supplementation may be insufficient to replenish depleted stores.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

This paper studied iron kinetics in a nonhuman primate (macaque) model of endometriosis by analyzing hematologic data from 46 animals and comparing serum, bone marrow, liver measures, and additional iron-related markers, including intestinal biopsies with and without endometriosis. It found that almost half of the macaques with endometriosis were anemic and, overall, animals with endometriosis had decreased RBC counts, increased MCV and reticulocyte percentage, decreased serum hepcidin, and decreased hepatic and bone marrow iron, consistent with systemic iron depletion rather than compensatory iron retention. Intestinal ferroportin 1 expression was increased, but this did not translate into compensatory iron absorption, indicating iron loss outpaced absorption. The paper concludes that oral iron supplementation alone would not replenish iron stores in endometriosis and relates specifically to endometriosis by providing mechanistic evidence of systemic iron deficiency in this macaque endometriosis model.

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Abstract

Endometriosis is characterized by endometrial tissue development outside the uterus. Anemia and iron depletion do not commonly accompany endometriosis in women, despite chronic abdominal inflammation and heavy menstrual bleeding. The objective of this study was to examine iron kinetics associated with endometriosis by using a NHP model, to better understand the underlying mechanism of abnormal hematogram values in women with endometriosis. Hematologic data from 46 macaques with endometriosis were examined for signs of iron depletion. Bone marrow, liver, and serum were used to elucidate whether iron loss or inflammation best explained the hematologic findings. Additional serum markers and intestinal biopsies from NHP with and without endometriosis were evaluated for patterns in iron kinetics across the menstrual cycle and for relative dietary iron-absorbing capacity. Almost half of the NHP with endometriosis were anemic. Overall, NHP had decreased RBC counts, increased MCV, increased percentage of reticulocytes, decreased serum hepcidin, and decreased hepatic and bone marrow iron. Intestinal expression of ferroportin 1, a mediator of iron absorption, was increased, indicating that despite high dietary iron, intestinal iron absorption did not compensate for iron losses. We concluded that use of oral iron supplementation alone does not replenish iron stores in endometriosis. Consequently, iron stores should be evaluated in women with endometriosis, even without overt clinical signs of anemia.
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Endometriosis is characterized by endometrial tissue development outside the uterus. Anemia and iron depletion do not commonly accompany endometriosis in women, despite chronic abdominal inflammation and heavy menstrual bleeding. The objective of this study was to examine iron kinetics associated with endometriosis by using a NHP model, to better understand the underlying mechanism of abnormal hematogram values in women with endometriosis. Hematologic data from 46 macaques with endometriosis were examined for signs of iron depletion. Bone marrow, liver, and serum were used to elucidate whether iron loss or inflammation best explained the hematologic findings. Additional serum markers and intestinal biopsies from NHP with and without endometriosis were evaluated for patterns in iron kinetics across the menstrual cycle and for relative dietary iron-absorbing capacity. Almost half of the NHP with endometriosis were anemic. Overall, NHP had decreased RBC counts, increased MCV, increased percentage of reticulocytes, decreased serum hepcidin, and decreased hepatic and bone marrow iron. Intestinal expression of ferroportin 1, a mediator of iron absorption, was increased, indicating that despite high dietary iron, intestinal iron absorption did not compensate for iron losses. We concluded that use of oral iron supplementation alone does not replenish iron stores in endometriosis. Consequently, iron stores should be evaluated in women with endometriosis, even without overt clinical signs of anemia. Editorial Type: research-article | Online Publication Date: 01 Aug 2018 Systemic Iron Deficiency in a Nonhuman Primate Model of Endometriosis Systemic Iron Deficiency in a Nonhuman Primate Model of Endometriosis Full access Departments of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA Search for other papers by Hannah M Atkins in Departments of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA Search for other papers by Susan E Appt in Departments of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA Search for other papers by Robert N Taylor in Departments of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA Search for other papers by Yaritbel Torres-Mendoza in Departments of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA Search for other papers by Emily E Lenk in Departments of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA Search for other papers by Nancy S Rosenthal in Departments of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. [email protected] Search for other papers by David L Caudell in Article Category: Research Article Page Range: 298 – 307 Copyright: 2018

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Condition tags

endometriosis

MeSH descriptors

Anemia, Iron-Deficiency Endometriosis Iron Anemia Anemia Anemia, Iron-Deficiency Animals Bone Marrow Bone Marrow Bone Marrow Cells Endometriosis Endometriosis Female Hepcidins Hepcidins Iron Iron Macaca fascicularis Macaca mulatta Menstrual Cycle

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