Urinary hepcidin in congenital chronic anemias.
BACKGROUND
Hepcidin, a regulator for iron homeostasis, is induced by inflammation and iron burden and suppressed by anemia and hypoxia. This study was conducted to determine the hepcidin levels in patients with congenital chronic anemias.


METHODS
Forty-nine subjects with anemia, varying degrees of erythropoiesis and iron burden were recruited. Eight children with immune thrombocytopenia were included as approximate age-matched controls. Routine hematologic labs and urinary hepcidin (uhepcidin) levels were assessed. For thalassemia major (TM) patients, uhepcidin was obtained pre- and post-transfusion.


RESULTS
In TM, uhepcidin levels increased significantly after transfusion, demonstrated wide variance, and the median did not significantly differ from controls or thalassemia intermedia (TI). In both thalassemia syndromes, the hepcidin to ferritin ratio, a marker of the appropriateness of hepcidin expression relative to the degree of iron burden, was low compared to controls. In TI and sickle cell anemia (SCA), median uhepcidin was low compared to controls, P = 0.013 and <0.001, respectively. In thalassemia subjects, uhepcidin levels were positively associated with ferritin. In subjects with SCA, uhepcidin demonstrated a negative correlation with reticulocyte count.


CONCLUSIONS
This study examines hepcidin levels in congenital anemias. In SCA, hepcidin was suppressed and inversely associated with erythropoietic drive. In thalassemic syndromes, hepcidin was suppressed relative to the degree of iron burden. Transfusion led to increased uhepcidin. In thalassemia, the relative influence of known hepcidin modifiers was more difficult to assess. In thalassemic syndromes where iron overload and anemia have opposing effects, the increased erythropoietic drive may positively influence hepcidin production.
Kearney
Susan L
SL
Division of Hematology/Oncology, Children's Hospital, Boston, Massachusetts, USA.
Nemeth
Elizabeta
E
Neufeld
Ellis J
EJ
Thapa
Dharma
D
Ganz
Tomas
T
Weinstein
David A
DA
Cunningham
Melody J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000755:Anemia, Sickle Cell / Q000097:blood / Q000503:physiopathology / Q000628:therapy / Q000652:urine*; D023181:Antimicrobial Cationic Peptides / Q000096:biosynthesis / Q000652:urine*; D015415:Biomarkers / Q000652:urine; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D004921:Erythropoietin; D005260:Female; D005786:Gene Expression Regulation; D064451:Hepcidins; D006801:Humans; D007501:Iron / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000151:congenital / Q000503:physiopathology / Q000628:therapy / Q000652:urine; D017701:Reticulocyte Count; D013577:Syndrome; D017086:beta-Thalassemia / Q000097:blood / Q000503:physiopathology / Q000628:therapy / Q000652:urine*
D023181:Antimicrobial Cationic Peptides; D015415:Biomarkers; C578702:HAMP protein, human; D064451:Hepcidins; D004921:Erythropoietin; C100266:erythrogenin; D007501:Iron