Cited by 228Iron Metabolism and DisordersImmune Response and InflammationGut microbiota and health

The DOI matches its Crossref record; 246 of the 249 references it cites were found in a registry or an index; none of the 266 sources its claims cite is checked for support yet.

The Iron age of host–microbe interactions

Open access
Soares, Miguel P, Weiss, Günter·2015·The EMBO Reports

Abstract

Microbes exert a major impact on human health and disease by either promoting or disrupting homeostasis, in the latter instance leading to the development of infectious diseases. Such disparate outcomes are driven by the ever-evolving genetic diversity of microbes and the countervailing host responses that minimize their pathogenic impact. Host defense strategies that limit microbial pathogenicity include resistance mechanisms that exert a negative impact on microbes, and disease tolerance mechanisms that sustain host homeostasis without interfering directly with microbes. While genetically distinct, these host defense strategies are functionally integrated, via mechanisms that remain incompletely defined. Here, we explore the general principles via which host adaptive responses regulating iron (Fe) metabolism impact on resistance and disease tolerance to infection.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review proposes that host iron and heme metabolism is a central, pathogen-class-specific defense axis, with distinct strategies against extracellular versus intracellular microbes. It integrates nutritional immunity, resistance, and disease tolerance through hepcidin/ferroportin, macrophage iron handling, heme oxygenase-1, ferritin, and carbon monoxide, and discusses therapeutic implications.

Key findings

  • Host responses to extracellular pathogens generally lower circulating iron by retaining iron in macrophages (hypoferremia), via hepcidin-mediated ferroportin degradation, IFN-γ/TNF effects, DMT1, lactoferrin, lipocalin-2, and hemoglobin/heme scavenging; this limits microbial iron access but can produce anemia of inflammation. Macrophages recycle about 95% of the iron needed for erythropoiesis, over 80% of bioavailable mammalian iron is heme-bound, and ferritin can store roughly 4,500 Fe²⁺ atoms per molecule.
  • Host responses to intracellular pathogens generally reduce macrophage intracellular iron and promote iron export (hyperferremia), via NRAMP1, ferroportin, Nrf2, lipocalin-2, and IRP regulation; this restricts phagosomal iron and supports IFN-γ-driven microbicidal programs.
  • Disease tolerance is supported by heme catabolism by HO-1, ferritin-mediated iron storage, and CO; these mechanisms prevent labile heme/hemoglobin toxicity, sustain erythropoiesis, and protect tissues without necessarily changing pathogen burden. In mice, HO-1/CO and ferritin H protect against severe malaria and polymicrobial sepsis; sickle hemoglobin mutations confer malaria tolerance via CO-dependent HO-1 induction. Adult humans have ~2–3 × 10¹³ red blood cells, each with ~3 × 10⁸ hemoglobin and ~1.2 × 10⁹ heme molecules.
  • Therapeutic targeting is pathogen-class dependent: Nifedipine promoted macrophage iron efflux and resistance to Salmonella in mice; hepcidin/hepcidin mimetics limited Vibrio vulnificus in mice; lactoferrin and Lcn2 have shown anti-infective effects; iron chelation results are mixed (desferrioxamine in malaria gave no overt survival benefit; desferasirox improved survival in mucormycosis mice but a small clinical trial had unfavorable outcomes).

Methods

  • Narrative review, not primary research; it synthesizes mechanistic, genetic, and pharmacological studies across host–microbe interactions and iron/heme metabolism.
  • No systematic search, dataset, or statistical analysis is described; evidence comes from cited animal models, human genetic associations, and clinical studies.
  • Main analysis is conceptual integration: it proposes pathogen class-specific regulation of iron/heme metabolism as a framework linking nutritional immunity, resistance, and disease tolerance.

Limitations

  • The paper states no formal limitations.
  • Evident from the text: as a narrative review, it lacks a systematic search strategy or quantitative synthesis, so selection and interpretation of cited evidence may reflect author perspective.
  • Evident from the text: many mechanisms and translational claims remain unresolved or untested, including whether ROS/RNS drive hepcidin-independent hypoferremia, whether HO-1 acts mainly in macrophages or parenchyma, whether mouse findings extrapolate to human co-infections, and why clinical chelation outcomes are inconsistent.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.15252/embr.201540558

Cites

246 of 246 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 266 cited sources checked · 0 supported · 0 flagged

  • It may state two separate claims as one. 70
  • Probably not a substantial claim. 18
  • The quote only partly states this claim. 1
85 of 85
  • The paper relies on this without support.

    There is an urgent need for alternative treatment strategies to cope with rising microbial resistance to antimicrobial drugs.

    “There is an urgent need of alternative treatment strategies that can cope with the recent raise of microbial resistance to antimicrobial drugs.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Figure 2 reverses hepcidin's stated effect on iron retention

    Minor

    The figure caption says that hepcidin-driven FPN degradation inhibits cellular iron retention. Elsewhere, the paper says that hepcidin's action on FPN causes intracellular iron accumulation.

  • Heme-synthesis steps name incompatible pathway intermediates

    Minor

    The stated sequence proceeds through the I forms of uroporphyrinogen and coproporphyrinogen, but the next steps instead use the III forms without describing a change between them.

2 of 2

Citations

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Metadata

Authors
Soares, M. P., & Weiss, G.
Affiliations
  • Instituto Gulbenkian de Ciência (PT)
  • Innsbruck Medical University (AT)
Corresponding author
  • Soares, Miguel P
  • Weiss, Günter
Venue
The EMBO Reports
Published
2015-10-16
Volume
16
Issue
11
Pages
1482-1500
ISSN
  • 1469-221X (ISSN-L)
  • 1469-3178
OpenAlex
W2160852190
Cited by
227
References
249
Citations by year
2026: 17 · 2025: 23 · 2024: 14 · 2023: 20 · 2022: 19 · 2021: 19 · 2020: 28 · 2019: 29 · 2018: 20 · 2017: 25 · 2016: 12 · 2015: 1
FWCI
2.94
Type
journal article
Language
en
Open access
Locations
  • EMBO Reports (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Fundação para a Ciência e Tecnologia
  • PTDC/SAU (TOX/116627/2010, HMSP‐ICT/0022/2010)
  • European Community 7th Framework (ERC‐2011‐AdG, 294709–DAMAGECONTROL)
  • Austrian Research fund (FWF‐TRP‐188)
  • Eurocalin
Topics
  • Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
  • Life Sciences › Immunology and Microbiology › Immunology › Immune Response and Inflammation
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Keywords
host-microbe interactions, iron metabolism, host defense, disease resistance, disease tolerance, host homeostasis, microbial pathogenicity, iron regulation, infection
MeSH terms
Anemia, Chronic Disease, Heme, Homeostasis, Humans, Infections, Iron, Macrophages, Host-Pathogen Interactions, Disease Resistance

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