title: The evaluation of iron overload through hepcidin level and its related factors in myelodysplastic syndromes.
abstract: We chose hepcidin and its related factors as evaluating indicators to determine the degrees of iron overload in myelodysplastic syndromes (MDS) patients. A total of 73 patients and 28 healthy volunteers were enrolled in this study. We performed enzyme-linked immunosorbent assay to measure both bone marrow and peripheral blood serum hepcidin. Real-time quantitative polymerase chain reaction was used to determine the gene expression of growth differentiation factor 15 and twisted gastrulation 1. Serum ferritin (SF), C-reactive protein (CRP), and erythropoietin were measured by routine standard laboratory assays. CD4(+) and CD19(+) lymphocytes and Th polarization were detected by flow cytometry. Twenty-four MDS patients were measured their cardiac and liver iron deposition levels through magnetic resonance imaging (MRI) T2* examination. No significant difference was found between the bone marrow hepcidin levels and peripheral blood hepcidin levels (P = 0.134). Stratified according to different World Health Organization subtypes, refractory anemia with ringed sideroblasts patients had the lowest hepcidin levels (105.40 ± 5.13 ng/ml), while refractory anemia with excess blasts-1 had the highest levels (335.71 ± 25.16 ng/ml). Stratified according to International Prognostic Scoring System and WHO Classification-based Prognostic Scoring System, there was a significant difference of hepcidin levels between low-risk group and high-risk group in two systems, respectively (P = 0.033 and 0.009). The hepcidin levels of CD4(+) high-expression group were demonstrated higher than the normal expression groups (P = 0.02), but the CD19(+) high-expression group did not show the same result (P = 0.206). Meanwhile, patients with a Th1 polarization trend had a high level of hepcidin versus normal group (P < 0.001). Liver iron concentration (LIC) measured by MRI T2* had a closer correlation (r = 0.582, P < 0.001) to hepcidin than serum ferritin, by stepwise regression. C-reactive protein and LIC seemed to be the key determinants of hepcidin, by multivariate regression. Inflammation plays an important role in the regulation of hepcidin expression. T-lymphocyte activation and Th polarization trend might participate in the regulatory mechanism partly. The capability of organ iron load assessment of MRI T2* seems better than that of SF. It seems that hepcidin with CRP and LIC measured by MRI T2* are potential indicators of iron overload in MDS patients.
authors.affiliation: Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China.
authors.forename: Shucheng
authors.initials: S
authors.lastname: Gu
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Song
authors.forename: Youshan
authors.initials: Y
authors.lastname: Zhao
authors.forename: Juan
authors.initials: J
authors.lastname: Guo
authors.forename: Chengming
authors.initials: C
authors.lastname: Fei
authors.forename: Feng
authors.initials: F
authors.lastname: Xu
authors.forename: Lingyun
authors.initials: L
authors.lastname: Wu
authors.forename: Xi
authors.initials: X
authors.lastname: Zhang
authors.forename: Jungong
authors.initials: J
authors.lastname: Zhao
authors.forename: Chunkang
authors.initials: C
authors.lastname: Chang
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001854:Bone Marrow Cells / Q000378:metabolism; D016022:Case-Control Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D064451:Hepcidins / Q000097:blood / Q000378:metabolism*; D006801:Humans; D019190:Iron Overload / Q000097:blood / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000097:blood / Q000378:metabolism* / Q000473:pathology; D055815:Young Adult
chemical_list: D064451:Hepcidins