Hepcidin and Ferritin: Important Mediators in Inflammation Associated Anemia in Systemic Lupus Erythematosus Patients

Abstract

Systemic Lupus Erythematosus is an autoimmune disease with female preponderance. Anemia is found in 50% of Systemic Lupus Erythematosus patients. This is a cross sectional case control study with 30 female Systemic Lupus Erythematosus patients having inflammation associated anemia (Hemoglobin \ 10.0 gm/dl) and 30 age matched controls with the aim to measure serum hepcidin and ferritin levels, correlate and study their role as homeostatic regulators of iron metabolism and utility as markers. Serum transferrin, ferritin, iron, total iron binding capacity, hsCRP, liver enzymes and renal parameters were analyzed by using automated analyser. Hepcidin levels were estimated by Sandwich-ELISA method. There was significant decrease in Iron (p \ 0.0001), Iron Binding capacity (p \ 0.0001), Transferrin (p \ 0.0001) in patients, and a significant increase in inflammatory markers: hs-CRP (p \ 0.0001), ESR (p \ 0.0001) compared to controls. Significant increase in both Hepcidin (p \ 0.0001) and Ferritin (p \ 0.0001) was observed in patients with significant positive correlation (r = 0.711) with each other. Additionally, ferritin and hepcidin significantly positively correlated with hs-CRP and ESR (r = 0.526, 0.735); (r = 0.427, 0.742) respectively. Negative correlation with hemoglobin, iron, total iron binding capacity and transferrin with hepcidin (r =-0.80,-0.307,-0.553,-0.584) and ferritin (r =-0.722,-0.22,-0.654,-0.728) was observed respectively. On ROC analysis both hepcidin and ferritin has sensitivity of 96.7%, specificity of 100% at cutoff values of 110 and 49 respectively. AUC of hepcidin was 0.993 and ferritin was 0.978. We have established a positive linear correlation between Hepcidin and Ferritin levels in disease activity and the changes correlated with the inflammatory state and anemia in patients, making them important mediators and potential markers of inflammation associated anemia.

Role of Hypochromia and Microcytosis in theprediction of iron deficiency anemia

“…Similar results found in the study of Rubab et al, (2015) [23] who make a study in end-stage renal disease on hemodialysis. Similar results found in the study of Kunireddy et al, (2018) [24] who make a study in systemic lupus erythematosus patients. However, this is in disagreement with the findings of Muhsin et al, (2016) [25] who make study in the pre-eclamptic patients.…”

The hepcidin concentration decreases in hypothyroid patients with Hashimoto’s thyroiditis following restoration of euthyroidism

“…Kunireddy et al . reported positively correlated hepcidin and ferritin levels in both a healthy female group and another group that included patients with autoimmune diseases such as systemic lupus erythematosus 42 .…”

Effects of Ovariohysterectomy and Hyperbaric Oxygen Therapy on Systemic Inflammation and Oxidation in Dogs

“…Inflammation-related hypoferremia is multi-factorial. Upregulation of acute phase proteins such as ferritin and hepcidin leads to the sequestration of iron by the sarcoplasmic reticulum and the reduction of dietary iron absorption, resulting in increased UIBC (41)(42)(43)(44)(45). Simultaneously, the downregulation of the main iron binding transporter protein, transferrin, decreases TIBC (46).…”