Increase of hepcidin plasma and urine levels is associated with acute proctitis and changes in hemoglobin levels in primary radiotherapy for prostate cancer.
OBJECTIVE
To analyse hepcidin serum and urine levels during radiotherapy for prostate cancer.


METHODS
In 18 patients undergoing radiotherapy for prostate cancer, blood, plasma, and urine samples were taken before and during radiotherapy. Complete blood cell count, pro-hepcidin-, ferritin-, transferrin-, IL-1beta-, IL-6-, and TNF-alpha concentration was determined. Pro-hepcidin concentration was additionally measured in urine samples. Toxicity was evaluated weekly. Differences among tested factors were tested by Wilcoxon rank sign test for paired data.


RESULTS
In ten patients developing acute radiation-induced proctitis, a significant increase in pro-hepcidin, IL-6, and TNF-alpha plasma levels (p < 0.05) was detected. Pro-hepcidin urine levels also showed a strong trend towards increase (p = 0.06). Concurrently, hemoglobin, and leucocytes were significantly decreased in the patients with acute proctitis (p < 0.05). In eight patients showing no symptoms of proctitis, solely a significant decrease for leucocytes was detected. Additive, these patients showed a significant increase of ferritin, and a decrease of transferrin levels (p < 0.05).


CONCLUSIONS
Hepcidin levels are increased and hemoglobin is decreased during radiotherapy for prostate cancer in patients who develop acute proctitis. Radiation-induced expression of cytokines may be responsible for increased hepcidin expression in the liver. Regulation of iron metabolism by hepcidin may be an underestimated response in radiotherapy.
Christiansen
Hans
H
Department of Radiation Oncology, University Hospital Goettingen, Robert-Koch-Strasse 40, 37099 Goettingen, Germany. hchrist@gwdg.de
Saile
Bernhard
B
Hermann
Robert M
RM
Rave-Fränk
Margret
M
Hille
Andrea
A
Schmidberger
Heinz
H
Hess
Clemens F
CF
Ramadori
Giuliano
G
D000208:Acute Disease; D000230:Adenocarcinoma / Q000378:metabolism / Q000532:radiotherapy*; D000368:Aged; D023181:Antimicrobial Cationic Peptides / Q000097:blood / Q000652:urine; D006454:Hemoglobins / Q000378:metabolism*; D064451:Hepcidins; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000097:blood* / Q000652:urine*; D011471:Prostatic Neoplasms / Q000378:metabolism / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology / Q000378:metabolism*; D011878:Radiotherapy / Q000009:adverse effects; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D023181:Antimicrobial Cationic Peptides; C578702:HAMP protein, human; D006454:Hemoglobins; D064451:Hepcidins; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha