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Clinical Sciences
Analysis of HFE And Non-HFE Gene Mutations in Brazilian Patients with Hemochromatosis
Paulo Lisboa BittencourtI,II, Maria Lúcia Carnevale MarinIII, Cláudia Alves CoutoIV, Eduardo Luiz Rachid CançadoI, Flair José CarrilhoI, Anna Carla GoldbergV
I Portuguese Hospital – Salvador/BA, Brasil
II Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
III Laboratory of Immunology, Heart Institute, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
IV Federal University of Minas Gerais - Minas Gerais/MG, Brazil
V Instituto Israelita de Ensino e Pesquisa Albert Einstein - São Paulo/SP, Brazil., Tel.: 55 71 3203.3457
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Hereditary hemochromatosis &#40;HH&#41; is a recessive inherited disorder of iron metabolism that is characterized by systemic iron overload as a result of enhanced intestinal absorption&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;2</a> The disease usually affects males in the fourth to fifth decade of life and may lead to cirrhosis&#44; diabetes mellitus&#44; panhypopituitarism&#44; cardiomyopathy&#44; arthritis and skin hyperpigmentation&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;2</a> In European and North-American Caucasians&#44; HH has been linked to two missense mutations in the <span class="elsevierStyleItalic">HFE g</span>ene&#44; which maps to the 4 kb telomeric HLA-A locus on the short arm of chromosome 6&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib3">3</a> Furthermore&#44; 80&#37; to 100&#37; of Caucasian patients of Northern European descent with HH were shown to be homozygous for the <span class="elsevierStyleItalic">C282Y</span> mutation&#44; whereas 4&#37; to 6&#37; were reported to be compound heterozygotes for the <span class="elsevierStyleItalic">C282Y</span> and <span class="elsevierStyleItalic">H63D</span> mutations&#46;<a class="elsevierStyleCrossRef" href="#bib4">4</a></p><p id="para20" class="elsevierStylePara elsevierViewall">The frequencies of these HFE mutations are lower in Italian and Brazilian patients with HH&#44;<a class="elsevierStyleCrossRef" href="#bib5">5</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib7">7</a> and approximately half of Brazilian patients with the classical disease phenotype are neither homozygous for <span class="elsevierStyleItalic">C282Y</span> nor compound heterozygous for the <span class="elsevierStyleItalic">C282Y</span> and <span class="elsevierStyleItalic">H63D</span> mutations&#46;<a class="elsevierStyleCrossRef" href="#bib6">6</a> In addition&#44; none of these mutations were observed in African Americans with HH or in patients with African iron overload&#46;<a class="elsevierStyleCrossRefs" href="#bib8">8&#44;9</a></p><p id="para30" class="elsevierStylePara elsevierViewall">Other mutations in the HFE gene&#44; particularly <span class="elsevierStyleItalic">S65C</span>&#44; have been implicated in HH and are generally found in a compound heterozygous state with either <span class="elsevierStyleItalic">C282Y</span> or <span class="elsevierStyleItalic">H63D&#46;</span><a class="elsevierStyleCrossRefs" href="#bib3">3&#44;10</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib12">12</a> Furthermore&#44; mutations have been found in genes that have been recently implicated in iron homeostasis&#44; including the transferrin receptor 2 &#40;TfR2&#41; gene on chromosome 7&#44; the hepcidin antimicrobial peptide &#40;<span class="elsevierStyleItalic">HAMP</span>&#41; gene on chromosome 19&#44; the hemojuvelin &#40;HJV&#41; gene on chromosome 1 and the ferroportin 1 &#40;Fpn1&#44; also known as SCL40A1&#41; gene on chromosome 2&#46; The identification of causative mutations for HH in these genes has improved our understanding of iron homeostasis as well as suggested a genetic basis for a new classification of iron overload disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;3&#44;13</a></p><p id="para40" class="elsevierStylePara elsevierViewall">HH has different phenotypic presentations&#46; Types 1 and 3 HH are characterized by the classical HH phenotype&#44; which includes parenchymal iron overload and the presence of HFE and TfR2 mutations&#44; respectively&#46; Type 2 HH is associated with the previously described phenotype of juvenile hemochromatosis and mutations in the HAMP and HJV genes&#44; whereas type 4 HH is associated with heterogeneous clinical and laboratory findings of iron overload that are more pronounced in the reticuloendothelial system&#46;<a class="elsevierStyleCrossRef" href="#bib13">13</a></p><p id="para50" class="elsevierStylePara elsevierViewall">Mutations in the TfR2 gene&#44; particularly the <span class="elsevierStyleItalic">Y250X</span> variant&#44; and several different mutations in the SCL40A1 gene have been reported in Caucasian&#44; African and Asian patients with non-HFE linked iron overload&#46;<a class="elsevierStyleCrossRef" href="#bib13">13</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib18">18</a> The prevalence of these recently described gene mutations in Brazilian patients with HH has not been assessed&#44; and the purpose of the present study is to determine the frequency of non-classical <span class="elsevierStyleItalic">HFE</span> as well as TfR2 and SCL40A1 mutations in Brazilian subjects with the classical phenotype of HH&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">PATIENTS AND METHODS</span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">Subjects</span><p id="para60" class="elsevierStylePara elsevierViewall">Sixteen unrelated male patients from the metropolitan area of S&#227;o Paulo&#44; Brazil and three other subjects from Salvador&#44; Bahia were studied&#46; All had a diagnosis of HH based upon several criteria&#58; 1&#41; the absence of secondary causes of iron overload&#44; including chronic hemolytic anemia&#44; thalassemia major&#44; sideroblastic and spur cell anemia&#44; parenteral or dietary iron overload&#44; alcohol abuse and chronic liver disease due to either hepatitis C or non-alcoholic steatohepatitis&#59; 2&#41; transferrin saturation greater than 50&#37; and ferritin levels greater than 400 g&#47;L&#59; and 3&#41; grade III or IV siderosis by Perls stain and no other evidence of liver disease upon liver biopsy <a class="elsevierStyleCrossRef" href="#bib2">2</a>&#46; Fifteen patients had been enrolled in a previous study and were already typed for the HLA-A <span class="elsevierStyleItalic">C282Y</span> and <span class="elsevierStyleItalic">H63D</span> mutations&#46;<a class="elsevierStyleCrossRef" href="#bib6">6</a> All patients gave informed consent for participation in this study&#46;</p><p id="para70" class="elsevierStylePara elsevierViewall">The median age of the patients was 42 &#40;range&#58; 20&#8211;72&#41; years&#46; The clinical&#44; laboratory and histological features of the patients are summarized in <a class="elsevierStyleCrossRef" href="#t1-cln64_9p837">table 1</a>&#46;</p><elsevierMultimedia ident="t1-cln64_9p837"></elsevierMultimedia></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">DNA extraction</span><p id="para80" class="elsevierStylePara elsevierViewall">Genomic DNA was extracted from peripheral blood leukocytes using the DTAB&#47;CTAB technique&#46;<a class="elsevierStyleCrossRef" href="#bib19">19</a></p></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle110">Determination of HFE and non-HFE mutations</span><p id="para90" class="elsevierStylePara elsevierViewall">DNA samples from all patients&#44; with the exception of those who were previously confirmed as homozygous for the <span class="elsevierStyleItalic">C282Y</span> mutation&#44;<a class="elsevierStyleCrossRef" href="#bib6">6</a> were tested with a reverse transcriptase-based assay&#44; the Haemochromatosis StripAssay A&#174; &#40;Vienna Lab&#44; Labordiagnostika&#44; GmbH&#44; Vienna&#44; Austria&#41;&#44; according to the manufacturer&#8217;s instructions&#46; This assay can detect twelve mutations in the <span class="elsevierStyleItalic">HFE</span> gene&#44; which are <span class="elsevierStyleItalic">V53M&#44; V59M&#44; H63D&#44; H63H&#44; S65C&#44; Q127H&#44; P160delC&#44; E168Q&#44; E168X&#44; W169X&#44; C282Y and Q283P</span>&#44; four mutations in the TfR2 gene&#44; which are <span class="elsevierStyleItalic">E60X&#44; M172K&#44; Y250X</span> and <span class="elsevierStyleItalic">AVAQ594-597del</span>&#44; and two mutations in the <span class="elsevierStyleItalic">SCL40A1</span>gene&#44; which are <span class="elsevierStyleItalic">N144H and V162del</span>&#46;</p></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle120">Statistical analysis</span><p id="para100" class="elsevierStylePara elsevierViewall">Clinical and laboratory data are shown in the text and tables as median and range&#46; Differences in the frequencies of clinical and laboratory parameters were compared using the Fisher exact probability test when appropriate&#46; A p value &#60; 0&#46;05 was considered to be significant&#46;</p></span></span><span id="cesec70" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle130">RESULTS</span><p id="para110" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">C282Y</span> and <span class="elsevierStyleItalic">H63D</span> mutation status for each patient in our cohort is shown in <a class="elsevierStyleCrossRef" href="#t2-cln64_9p837">Table 2</a>&#46;</p><elsevierMultimedia ident="t2-cln64_9p837"></elsevierMultimedia><p id="para120" class="elsevierStylePara elsevierViewall">Nine &#40;47&#37;&#41; patients were homozygous for the <span class="elsevierStyleItalic">C282Y</span> mutation&#46; In addition&#44; two &#40;11&#37;&#41; patients were heterozygous for <span class="elsevierStyleItalic">H63D</span>&#44; and one each &#40;5&#37;&#41; was either heterozygous for <span class="elsevierStyleItalic">C282Y</span> or compound heterozygous for <span class="elsevierStyleItalic">C282Y</span> and <span class="elsevierStyleItalic">H63D</span>&#46;</p><p id="para130" class="elsevierStylePara elsevierViewall">None of the other ten HFE mutations and none of the TfR2 or <span class="elsevierStyleItalic">SCL40A1</span> mutations that were included in the assay were found in these patients&#46;</p><p id="para140" class="elsevierStylePara elsevierViewall">A comparison of the clinical and laboratory profiles of patients with and without homozygosity for the <span class="elsevierStyleItalic">C282Y</span> mutation revealed that the former had higher ferritin levels and a lower age of onset for the disease when compared to their counterparts who were non-homozygous for <span class="elsevierStyleItalic">C282Y</span>&#46; However&#44; this difference was not significant &#40;<a class="elsevierStyleCrossRef" href="#t2-cln64_9p837">Table 2</a>&#41;&#46;</p></span><span id="cesec80" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle140">DISCUSSION</span><p id="para150" class="elsevierStylePara elsevierViewall">Mutations in the <span class="elsevierStyleItalic">HFE</span> gene other than the <span class="elsevierStyleItalic">C282Y</span> substitution are uncommon in subjects with HH&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;3&#44;10&#44;13</a> In fact&#44; the majority of patients who are not homozygous for the <span class="elsevierStyleItalic">C282Y</span> mutation are usually found to be compound heterozygotes for the <span class="elsevierStyleItalic">C282Y</span> and <span class="elsevierStyleItalic">H63D</span> mutations&#46; Rare <span class="elsevierStyleItalic">HFE</span> mutations&#44; such as <span class="elsevierStyleItalic">S65C</span>&#44; <span class="elsevierStyleItalic">E168X</span>&#44; <span class="elsevierStyleItalic">W169X</span> and <span class="elsevierStyleItalic">Q238P&#44;</span> have been found in HH subjects who are heterozygous either for <span class="elsevierStyleItalic">C282Y</span> or <span class="elsevierStyleItalic">H63D&#46;</span><a class="elsevierStyleCrossRefs" href="#bib1">1&#44;3&#44;10</a>&#8211;<a class="elsevierStyleCrossRefs" href="#bib12">12&#44;20&#44;21</a> The occurrence of the <span class="elsevierStyleItalic">S65C</span> mutation&#44; as well as homozygosity for <span class="elsevierStyleItalic">H63D</span>&#44;<a class="elsevierStyleCrossRefs" href="#bib11">11&#44;12&#44;22&#44;23</a> has recently been associated with a milder form of iron overload disease&#46; In the present study&#44; no other mutation in the HFE gene&#44; apart from <span class="elsevierStyleItalic">C282Y</span> and <span class="elsevierStyleItalic">H63D</span>&#44; was identified in subjects with HH&#46; Similar results were also reported by Cancado et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib7">7</a> who were unable to find subjects with the <span class="elsevierStyleItalic">S65C</span> mutation in their cohort of Brazilian patients with iron overload&#46; These findings are also in accordance with several other reports from Europe and North America&#44;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;3</a> in which the <span class="elsevierStyleItalic">S65C</span> or another HFE mutation was found without the additional presence of either the <span class="elsevierStyleItalic">C282Y</span> and <span class="elsevierStyleItalic">H63D</span> mutations in only a few patients with HH or African iron overload&#46;</p><p id="para160" class="elsevierStylePara elsevierViewall">Non-HFE linked HH has been particularly associated with mutations in the ferroportin 1&#44; transferrin receptor 2 and hepcidin genes&#46;<a class="elsevierStyleCrossRef" href="#bib13">13</a> Hepcidin is a pleiotropic protein that plays a major role in cellular iron trafficking&#46; Mutations in the <span class="elsevierStyleItalic">HAMP</span> gene have been associated with type 2 HH or juvenile iron overload&#44; which is characterized by severe iron loading with end-stage organ damage in the second to third decade of life&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;3&#44;13</a> Given that our patients do not share clinical features that are compatible with type 2 HH&#44; HAMP gene variants were not assessed in the present study&#46;</p><p id="para170" class="elsevierStylePara elsevierViewall">On the other hand&#44; our search for several common mutations in the TfR2 and SCL40A1 genes also yielded negative results&#46; TfR2 variants have been implicated in HH type 3 HH&#44; which exhibits a phenotype that is indistinguishable from classical disease phenotype of type 1 HH&#46;<a class="elsevierStyleCrossRef" href="#bib13">13</a> Unexpectedly&#44; none of our patients with HH carried any one of the four most common TfR2 gene mutations&#44; <span class="elsevierStyleItalic">E60X</span>&#44; <span class="elsevierStyleItalic">M172K</span>&#44; <span class="elsevierStyleItalic">Y250X</span> and <span class="elsevierStyleItalic">AVAQ594</span>-<span class="elsevierStyleItalic">597del</span>&#44; that had been previously associated with non-HFE HH in Italy&#44; Portugal and Japan&#46;<a class="elsevierStyleCrossRef" href="#bib13">13</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib17">17</a> In addition&#44; two mutations in the SCL40A1 gene&#44; which have been correlated with type 4 HH in Europe&#44; North America and Australia&#44;<a class="elsevierStyleCrossRef" href="#bib13">13</a> were not encountered in our cohort of Brazilian patients with HH&#46; This is not surprising due to the stringent criteria we employed in this study&#44; selecting only patients with parenchymal iron overload and grade III or IV hepatic siderosis&#46; Type 4 HH is mainly associated with iron loading in reticuloendothelial cells&#44; especially macrophages&#44;<a class="elsevierStyleCrossRef" href="#bib13">13</a> and none of our patients had histopathological features that were consistent with type 4 HH upon liver biopsy&#46;</p><p id="para180" class="elsevierStylePara elsevierViewall">None of the individuals in our cohort of Brazilian patients with the classical phenotype of HH had any of the aforementioned non-<span class="elsevierStyleItalic">C282Y</span> mutations in the <span class="elsevierStyleItalic">HFE</span> gene or any mutations in the TfR2 and SCL40A1 genes&#46; Less than two-thirds of Brazilian subjects with either iron overload or HH were previously reported to be either homozygous for the <span class="elsevierStyleItalic">C282Y</span> mutation or compound heterozygous for the C282Y and H63D mutations&#46;<a class="elsevierStyleCrossRefs" href="#bib6">6&#44;7&#44;24</a> Moreover&#44; the frequency of both of these <span class="elsevierStyleItalic">HFE</span> mutations was reported to be lower in Brazilians when compared to healthy subjects from Europe and North America&#46;<a class="elsevierStyleCrossRefs" href="#bib25">25&#44;26</a></p><p id="para190" class="elsevierStylePara elsevierViewall">The absence of mutations in the TfR2 and SCL40A1 genes in subjects with non-HFE HH has also been reported in other of European and North American patient cohorts&#44; particularly in African-Americans and in patients with African iron overload&#46;<a class="elsevierStyleCrossRef" href="#bib27">27</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib30">30</a> This observation suggests a possible role for other mutations in the known HH genes or even for other undiscovered genes that are also involved in iron homeostasis&#46; In this regard&#44; mutations in the iron responsive element of the ferritin heavy chain polypeptide 1 gene &#40;<span class="elsevierStyleItalic">FTH1</span>&#41; have been recently reported in association with an autosomal dominant form of HH in Japan&#46;<a class="elsevierStyleCrossRef" href="#bib17">17</a></p><p id="para200" class="elsevierStylePara elsevierViewall">Due to the ethnic background of the Brazilian population&#44; other strategies&#44; including direct sequencing or denaturing HPLC screening of candidate genes&#44; may be more valuable in order to identify novel variants in the steadily increasing group of candidate genes for HH&#46;</p><p id="para210" class="elsevierStylePara elsevierViewall">As previously shown in our first report&#44;<a class="elsevierStyleCrossRef" href="#bib6">6</a> patients homozygous for the <span class="elsevierStyleItalic">C282Y</span> mutation tended to be younger and to have a more severe iron overload when compared to their counterparts who were non-homozygous for C282Y&#46; Even after the inclusion of four additional subjects from the present cohort of HH patients&#44; the difference is still not significant&#46; Interestingly&#44; <span class="elsevierStyleItalic">C282Y</span> homozygotes have been shown to have more pronounced iron overload when compared to heterozygotes or to patients without the C282Y mutation in other populations&#46;<a class="elsevierStyleCrossRef" href="#bib31">31</a></p><p id="para220" class="elsevierStylePara elsevierViewall">In summary&#44; only 52&#37; of Brazilian HH patients who were analyzed in this study were either homozygous for <span class="elsevierStyleItalic">C282Y</span> &#40;n&#61;9&#41; or compound heterozygous for the <span class="elsevierStyleItalic">C282Y</span> and <span class="elsevierStyleItalic">H63D</span> mutations &#40;n&#61;1&#41;&#46; None of these patients had another HFE variant or any mutation in the TfR2 and <span class="elsevierStyleItalic">SCL40A1</span> genes&#46;</p></span></span>"
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        1 => array:2 [
          "identificador" => "cesec10"
          "titulo" => "INTRODUCTION"
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          "titulo" => "PATIENTS AND METHODS"
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              "titulo" => "Subjects"
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              "titulo" => "DNA extraction"
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            2 => array:2 [
              "identificador" => "cesec50"
              "titulo" => "Determination of HFE and non-HFE mutations"
            ]
            3 => array:2 [
              "identificador" => "cesec60"
              "titulo" => "Statistical analysis"
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          "titulo" => "RESULTS"
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          "identificador" => "cesec80"
          "titulo" => "DISCUSSION"
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          "identificador" => "xack640417"
          "titulo" => "Acknowledgments"
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          "titulo" => "REFERENCES"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2009-05-25"
    "fechaAceptado" => "2009-06-01"
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          "palabras" => array:5 [
            0 => "Hereditary hemochromatosis"
            1 => "Iron overload"
            2 => "HFE mutations"
            3 => "Gene mutations"
            4 => "Brazil"
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        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">BACKGROUND</span><p id="spara40" class="elsevierStyleSimplePara elsevierViewall">Approximately one-half of Brazilian patients with hereditary hemochromatosis &#40;HH&#41; are neither homozygous for the C282Y mutation nor compound heterozygous for the H63D and C282Y mutations that are associated with HH in Caucasians&#46; Other mutations have been described in the <span class="elsevierStyleItalic">HFE</span> gene as well as in genes involved in iron metabolism&#44; such as transferrin receptor 2 &#40;TfR2&#41; and ferroportin 1 &#40;SCL40A1&#41;&#46;</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">AIMS</span><p id="spara50" class="elsevierStyleSimplePara elsevierViewall">To evaluate the role of HFE&#44; TfR2 and SCL40A1 mutations in Brazilian subjects with HH&#46;</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">PATIENTS AND METHODS</span><p id="spara60" class="elsevierStyleSimplePara elsevierViewall">Nineteen male subjects &#40;median age 42 &#91;range&#58; 20&#8211;72&#93; years&#41; with HH were evaluated using the Haemochromatosis StripAssay A&#174;&#46; This assay is capable of detecting twelve HFE mutations&#44; which are V53M&#44; V59M&#44; H63D&#44; H63H&#44; S65C&#44; Q127H&#44; P160delC&#44; E168Q&#44; E168X&#44; W169X&#44; C282Y and Q283&#44; four TfR2 mutations&#44; which are E60X&#44; M172K&#44; Y250X&#44; AVAQ594-597del&#44; and two SCL40A1 mutations&#44; which are N144H and V162del&#46;</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">RESULTS</span><p id="spara70" class="elsevierStyleSimplePara elsevierViewall">In our cohort&#44; nine &#40;47&#37;&#41; patients were homozygous for the C282Y mutation&#44; two &#40;11&#37;&#41; were heterozygous for the H63D mutation&#44; and one each &#40;5&#37;&#41; was either heterozygous for C282Y or compound heterozygous for C282Y and H63D&#46; No other mutations in the HFE&#44; TfR2 or SCL40A1 genes were observed in the studied patients&#46;</p></span> <span id="ceabs50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle50">CONCLUSIONS</span><p id="spara80" class="elsevierStyleSimplePara elsevierViewall">One-third of Brazilian subjects with the classical phenotype of HH do not carry HFE or other mutations that are currently associated with the disease in Caucasians&#46; This observation suggests a role for other yet unknown mutations in the aforementioned genes or in other genes involved in iron homeostasis in the pathogenesis of HH in Brazil&#46;</p></span>"
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            "titulo" => "AIMS"
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Clinical and laboratory features</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Age at onset&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Median &#91;range&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">42 &#91;20&#8211;72 &#93; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Signs and Symptoms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chronic liver disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Impotence&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Skin hyperpigmentation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Panhypopituitarism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiac Insufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laboratory features&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median &#91;range&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Iron saturation &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93 &#91;55&#8211;100&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ferritin &#40;&#956;g&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1102 &#91;563&#8211;13&#46;170&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ALT IU&#47;L &#40;normal&#58; &#8804;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#91;20&#8211;187&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bilirubin mg&#47;dL &#40;normal &#8804; 1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;5 &#91;0&#46;6&#8211;7&#46;2&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Albumin g&#47;dL &#40;normal 3&#46;5&#8211;5&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;3 &#91;2&#46;7&#8211;4&#46;9&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Liver biopsy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade III Siderosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade IV Siderosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleHsp" style=""></span>Cirrhosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">14 &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Clinical and laboratory features of Brazilian patients with HH</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "t2-cln64_9p837"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Numbers in parentheses are percentages</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">C282Y &#40;&#43;&#47;&#43;&#41; &#40;n&#61;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">C282Y &#40;&#43;&#47;&#8722;&#41; or &#40;&#8722;&#47;&#8722;&#41; &#40;n&#61;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age at onset&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median &#91;range&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median &#91;range&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#91;36&#8211;47&#93; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#91;20&#8211;72&#93; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Signs and symptoms of chronic liver disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laboratory features&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median &#91;range&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median &#91;range&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Iron saturation &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#91;36&#8211;100&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93 &#91;58&#8211;100&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ferritin &#40;&#956;g&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1351 &#91;576&#8211;13&#46;170&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1057 &#91;700&#8211;2333&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ALT IU&#47;L &#40;normal&#58; &#8804; 20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#91;36&#8211;187&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#91;20&#8211;98&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Liver biopsy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade III Siderosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade IV Siderosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleHsp" style=""></span>Cirrhosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">6 &#40;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">8 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Clinical and laboratory features of Brazilian patients with hemochromatosis with and without homozygosity for C282Y mutation</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "REFERENCES"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec10"
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normal iron metabolism and the pathophysiology of iron overload disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              CW Siah \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              J Ombiga \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              LA Adams \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              D Trinder \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              JK Olynyk \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Biochem Rev"
                        "fecha" => "2006"
                        "volumen" => "27"
                        "paginaInicial" => "5"
                        "paginaFinal" => "16"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16886043"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis and management of hemochromatosis"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "American Association for the Study of Liver Diseases&#59; American College of Gastroenterology&#59; American Gastroenterological Association"
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              AS Tavill \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/jhep.2001.24783"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2001"
                        "volumen" => "33"
                        "paginaInicial" => "1321"
                        "paginaFinal" => "1328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11343262"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathogenesis of hereditary hemochromatosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              RE Fleming \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RS Britton \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              A Waheed \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              WS Sly \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              BR Bacon \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cld.2004.06.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Liver Dis"
                        "fecha" => "2004"
                        "volumen" => "8"
                        "paginaInicial" => "755"
                        "paginaFinal" => "853"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15464654"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molecular medicine and hemochromatosis&#58; at the crossroads"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              BR Bacon \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              LW Powell \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
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Article information
ISSN: 18075932
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos