Iron metabolism, cytokine secretion in patients with rheumatologic pathology

Abstract

Aim. To study the eff ect of hepcidin, soluble transferrin receptor (sTfR ), and cytokines on iron metabolism and the development of anemia in rheumatologic patients, to propose a working version of the classifi cation of anemia of chronic diseases (ACD) according to the major nosotropic factor.Material and methods. 126 patients with rheumatic disease, 34 men (45.8 (36–54.9) years old), 92 women (49.5 (38–60) years old) were examined. Group 1 included 41 patients with ACD. Group 2 included 29 patients with the combination of ACD and IDA and 34 patients with iron defi ciency anemia (IDA). Group 3 included 34 patients with IDA and 29 — with the combination of ACD and IDA. Control group included 22 patients without anemia. Comparative analysis between groups with and without anemia and correlation analysis of hemogram parameters, iron metabolism, C-reactive protein (CRP), hepcidin, sTfR , interleukin-6 (IL-6), IL-1β, IL-10, interferon gamma (INF-γ) and tumor necrosis factor alpha (TNF-α) were performed.Results. In the ACD group, the concentrations of hepcidin, ferritin, CRP, IL-6 were increased in comparison with other groups. The correlation was revealed between erythrocytes, hemoglobin and IL-6 (r = −0.3 and −0.6), IL-10 (r = −0.4 and −0.4), INF-γ (r = −0.4 and −0.3), TNF-α (r = −0.3 and −0.3), hepcidin (r = −0.5 and −0.7), sTfR (r = −0.5 and −0.7). Dependence was shown between IL-6 and iron (r = –0.6), transferrin saturation index (TSI) (r = −0.5), ferritin (r = −0.5), CRP (r = 0.5), between TNF-α and TIBС (r = −0.6), transferrin (r = −0.6), ferritin (r = −0.7), between IL-1β and TIBC, ferritin, transferrin (r = −0.4). The correlation was noted between hepcidin and IL-6 (r = 0.5), IL-10 (r = 0.4), between sTfR and IL-6 (r = 0.4), IL-10 (r = 0.6), INF-γ (r = 0.4).Conclusion. The multicomponent genesis of anemia in patients with rheumatologic disease was detected. The signifi cance of disorders in iron metabolism, the eff ect of hepcidin, sTfR and cytokines on the development of anemia was found. A working version of ACD classifi cation (with a predominant iron defi ciency, with violations of the regulatory mechanisms of erythropoiesis, with insuffi cient production of erythropoietin) has been put forward.