title: Ischemia-modified albumin as a marker of vascular dysfunction and subclinical atherosclerosis in β-thalassemia major.
abstract: BACKGROUND
  Ischemia-modified albumin (IMA) is an altered type of serum albumin that forms under conditions of oxidative stress and an independent predictor of major adverse cardiovascular events.
  
  
  OBJECTIVE
  To measure the levels of IMA in 45 children and adolescents with β-thalassemia major (β-TM) compared with 30 healthy controls and assess its relation to lipid peroxidation, vascular complications and subclinical atherosclerosis.
  
  
  METHODS
  β-TM patients without symptoms of heart disease were studied focusing on transfusion history, chelation therapy, serum ferritin, malondialdehyde (MDA) and IMA levels. Echocardiography was performed and carotid intima media thickness (CIMT) was assessed.
  
  
  RESULTS
  IMA and MDA levels were significantly higher in β-TM patients compared with controls (p < 0.001). IMA was higher among patients with heart disease, pulmonary hypertension risk and serum ferritin ≥2500 µg/l than those without. TM patients compliant to chelation had significantly lower IMA levels. IMA levels were positively correlated to MDA and CIMT while negatively correlated to ejection fraction and fractional shortening.
  
  
  CONCLUSIONS
  Our results highlight the role of oxidative stress in the pathophysiology of vascular complications in thalassemia. IMA could be useful for screening of β-TM patients at risk of cardiopulmonary complications and atherosclerosis because its alteration occurs in early subclinical disease.
authors.affiliation: a Pediatrics Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
authors.forename: Amira Abdel Moneam
authors.initials: AAM
authors.lastname: Adly
authors.affiliation: a Pediatrics Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
authors.forename: Nayera Hazaa Khalil
authors.initials: NHK
authors.lastname: ElSherif
authors.affiliation: b Clinical Pathology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
authors.forename: Eman Abdel Rahman
authors.initials: EAR
authors.lastname: Ismail
authors.affiliation: c Radiology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
authors.forename: Yosra Abdelzaher
authors.initials: YA
authors.lastname: Ibrahim
authors.affiliation: c Radiology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
authors.forename: Gamal
authors.initials: G
authors.lastname: Niazi
authors.affiliation: a Pediatrics Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
authors.forename: Sara Hamed
authors.initials: SH
authors.lastname: Elmetwally
mesh_terms: D000293:Adolescent; D000328:Adult; D050197:Atherosclerosis / Q000378:metabolism* / Q000473:pathology*; D015415:Biomarkers / Q000378:metabolism*; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008315:Malondialdehyde / Q000378:metabolism; D018384:Oxidative Stress / Q000502:physiology; D000075462:Serum Albumin, Human / Q000378:metabolism*; D014652:Vascular Diseases / Q000378:metabolism* / Q000473:pathology*; D055815:Young Adult; D017086:beta-Thalassemia / Q000378:metabolism* / Q000473:pathology*
chemical_list: D015415:Biomarkers; C561522:ischemia-modified albumin; D008315:Malondialdehyde; D000075462:Serum Albumin, Human
keywords: CIMT; Thalassemia; ischemia-modified albumin; malondialdehyde; oxidative stress; vascular dysfunction