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conspectus of researchon copper metabolism and requirements

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COPPER METABOLISM AND REQUIREMENTS OF MAN 1985<br />

Scheinberg <strong>and</strong> Gitlin (674) laid the basis<br />

<strong>of</strong> the concept that Wilson's disease is<br />

usually characterized by a lifelong defi<br />

ciency or absence <strong>of</strong> ceruloplasmin, <strong>and</strong><br />

that this deficiency is autosomal recessive<br />

in nature.<br />

Advances in knowledge concerning ceru<br />

loplasmin, as well as the role <strong>of</strong> <strong>copper</strong> in<br />

human <strong>metabolism</strong>, have in large part been<br />

the consequence <strong>of</strong> intensive research on<br />

the nature, cause <strong>and</strong> treatment <strong>of</strong> Wilson's<br />

disease, resulting in truly voluminous lit<br />

erature. In contrast, investigations con<br />

cerning Menkes" disease have focused<br />

largely on the role <strong>of</strong> metallothionein-like<br />

cuproproteins <strong>and</strong> defects in intestinal ab<br />

sorption <strong>of</strong> <strong>copper</strong>. Here also, in the in<br />

terim since its first recognition in 1962<br />

(513), an extensive literature has evolved.<br />

On the other side <strong>of</strong> the ledger are ad<br />

vances made during the past 12 years in<br />

elucidating the role <strong>of</strong> <strong>copper</strong> in iron me<br />

tabolism. These have, in large part, re<br />

solved questions in the minds <strong>of</strong> those<br />

investigators <strong>of</strong> 50 years ago (311, 313)<br />

who first recognized the important role <strong>of</strong><br />

<strong>copper</strong> in nutrition.<br />

The role <strong>of</strong> ceruloplasmin in biological<br />

processes began to receive some rational<br />

explanation about 1960, with evidence that<br />

in vitro it catalyzed the oxidation <strong>of</strong> fer<br />

rous iron ( 141). Further investigation <strong>of</strong><br />

this oxidase activity <strong>of</strong> ceruloplasmin pro<br />

vided indications that it represented an<br />

enzyme in human plasma responsible for<br />

oxidation <strong>of</strong> ferrous iron, <strong>and</strong> that the latter<br />

was the substrate for its greatest activity<br />

(504, 583, 585). Based on these findings,<br />

Osaki et al. (583) proposed that the name<br />

ferroxidase may be more useful than desig<br />

nating this enzyme as a "sky-blue substance<br />

from plasma." Since then, ceruloplasmin<br />

<strong>and</strong> ferroxidase I have become synonymous<br />

terms. However, in the discussion to follow<br />

the more common designation "ceruloplas<br />

min" will be used.<br />

The hypothesis proposed was that by<br />

this mechanism ceruloplasmin may play an<br />

important biological role in the release <strong>and</strong><br />

transfer <strong>of</strong> iron from storage cells to plasma<br />

transferrin. This concept was promptly<br />

supported by studies on <strong>copper</strong>-deficient<br />

swine (445, 446, 625), <strong>and</strong> by liver per<br />

fusion studies on dogs <strong>and</strong> swine (584).<br />

The studies on <strong>copper</strong>-deficient swine<br />

clearly demonstrated the effectiveness <strong>of</strong><br />

ceruloplasmin in counteracting the defec<br />

tive movement <strong>of</strong> iron from hepatic cells,<br />

reticuloendothelial cells <strong>and</strong> the intestinal<br />

mucosa to the plasma. This general subject<br />

has been extensively discussed <strong>and</strong> re<br />

viewed elsewhere (211, 226-230, 390, 446).<br />

The current concept <strong>of</strong> ceruloplasmin<br />

function in iron <strong>metabolism</strong> appears to be<br />

as follows. For normal hemoglobin syn<br />

thesis iron must be transported from stor<br />

age sites in the liver, reticuloendothelial<br />

system <strong>and</strong> intestine to the bone marrow<br />

by transferrin. In the storage sites iron is<br />

present in the ferric state, as ferritin. This<br />

iron can be reduced by reduced rib<strong>of</strong>lavin<br />

<strong>and</strong> rib<strong>of</strong>lavin derivatives, liberating fer<br />

rous iron from the ferritin. This ferrous<br />

iron is then oxidized catalytically back to<br />

ferric iron by virtue <strong>of</strong> the ferroxidase ac<br />

tivity <strong>of</strong> ceruloplasmin, allowing the Fe3*<br />

to combine with apotransferrin, as the<br />

initial step in the mobilization <strong>of</strong> stored<br />

iron.<br />

The mechanism <strong>of</strong> iron transfer from the<br />

storage cell to transferrin has not been<br />

clearly established. It is possible that Fe2+<br />

<strong>and</strong> ceruloplasmin interact to form a ferric<br />

intermediate that transfers iron to apo<br />

transferrin by a specific lig<strong>and</strong> exchange<br />

reaction (850). In any case, Fe3* combines<br />

with transferrin <strong>and</strong> provides the progeni<br />

tors <strong>of</strong> the erythrocytes in the bone mar<br />

row with the necessary iron for hemoglobin<br />

synthesis. As has been expressed (230),<br />

the life cycle <strong>of</strong> the <strong>copper</strong> in ceruloplas<br />

min is a one-time journey to the tissues or<br />

a return to the liver for resynthesis.<br />

Ceruloplasmin is a multifunctional pro<br />

tein involved not only in the mobilization<br />

<strong>of</strong> plasma iron but also in <strong>copper</strong> transport<br />

<strong>and</strong> in regulation <strong>of</strong> biogenic amines. The<br />

suggestion <strong>of</strong> Broman (65) that it func<br />

tions as a <strong>copper</strong>-transport protein has been<br />

well substantiated by animal studies indi<br />

cating that its <strong>copper</strong> atoms are trans<br />

ferred to cytochrome c oxidase <strong>and</strong> prob<br />

ably to other <strong>copper</strong>-containing proteins <strong>of</strong><br />

body tissues (230, 365). Close correla<br />

tions between low serum ceruloplasmin<br />

<strong>and</strong> low cytochrome c oxidase in leuco<br />

cytes in Wilson's disease (715) suggest<br />

that the same is true in man. Ceruloplas-<br />

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