Serum hepcidin and interleukin-6 in systemic lupus erythematosus patients: crucial factors for correction of anemia

Abstract

Background: The incidence rate of anemia of chronic disease (ACD) in systemic lupus erythematosus (SLE) ranges between 30 and 80%. Serum iron is the main regulator of hepatic hepcidin production. Interleukin-6 (IL-6) upregulates hepcidin expression. The aim of this study is to compare between serum hepcidin and IL-6 in SLE patients and control subjects, and to find out if they are correlated with each other and with disease activity in order to find their role in treatment of anemia in SLE patients. The study was carried out on 50 SLE patients, suffering from anemia, diagnosed according to SLICC revision of the ACR classification criteria for SLE, and 50 healthy individuals, taken as control. Disease activity was assessed using the SLE disease activity index (SLEDAI-2 K). Serum hepcidin and IL-6 were measured by ELISA kit. Results: There was a highly statistically significant difference in serum hepcidin and IL-6 levels between patients and control subjects. There was a statistically significant correlation between serum hepcidin and IL-6 in SLE patients. Moreover, both of them were correlated with SLEDAI and ESR and negatively correlated with hemoglobin. The mean value of serum hepcidin in SLE patients with normocytic normochromic anemia was higher than that in patients with microcytic hypochromic anemia. However, this difference did not reach a statistically significant level. Conclusion: High serum IL-6 and hepcidin levels are associated with anemia in SLE. They are correlated with each other and with disease activity. Although our study revealed serum hepcidin to be correlated with disease activity, it should not be used as a marker of disease activity in SLE patients as our patient's group was SLE patients suffering from ACD. However, IL-6 inhibition should be considered in patients with SLE with anemia to guide the control of anemia of chronic diseases resulting from cytokine production as a result of high disease activity in SLE patients. It should be noted that the occurrence of ACD associated with IL-6 flare up could be a player in other systemic rheumatic diseases and is not specific to SLE patients.

Increased Serum Interleukin 10 Levels Are Associated with Increased Disease Activity and Increased Risk of Anti-SS-A/Ro Antibody Positivity in Patients with Systemic Lupus Erythematosus

“…Analysis of the data showed a negative correlation between serum IL-6 levels and hemoglobin concentration. The effect of elevated IL-6 levels on the suppression of erythropoiesis in SLE patients was confirmed by other studies, which showed higher serum IL-6 levels in SLE patients with anemia compared to SLE patients without anemia [40,41]. There was also a negative correlation between serum levels of IL-6 and hemoglobin in SLE patients with renal involvement [41].…”

“…Similar to other investigators, in our study, we did not find a significant correlation between serum IL-6 levels and disease activity as measured by SLEDAI [ 31 , 38 ]. Nevertheless, some other studies have shown a positive correlation between serum IL-6 levels and SLEDAI [ 4 , 34 , 40 , 41 ].…”

Gambaran Interleukin 6 dan Hepidin pada Penyakit Kronis yang Dapat Menyebabkan Anemia

“…33 Systemic lupus erythematosus (SLE) ialah penyakit autoimun yang berpotensi serius dengan produksi karakteristik sitokin inflamasi dan antibodi autoreaktif karena kurangnya toleransi imun, yang mengarah ke manifestasi klinis beragam dan kerusakan pada berbagai organ, termasuk kulit, sendi, ginjal, dan sistem saraf pusat. El-shafey et al 36 melaporkan bahwa terdapat perbedaan yang sangat bermakna secara statistik pada kadar serum hepsidin dan IL-6 antara pasien dan subjek kontrol. Hasil tersebut menunjukkan bahwa tingginya kadar serum hepsidin dan IL-6 berkontribusi terhadap keparahan anemia.…”

Elevated Serum Levels of Soluble Transferrin Receptor Are Associated with an Increased Risk of Cardiovascular, Pulmonary, and Hematological Manifestations and a Decreased Risk of Neuropsychiatric Manifestations in Systemic Lupus Erythematosus Patients

“…The incidence of anemia is influenced by many factors such as inflammation, renal failure, gastrointestinal complications, and hemolysis. Numerous studies in SLE patients have reported that the prevalence of ACD ranges from 30% to 80% [4,5]. In many SLE patients, the differentiation of ACD and IDA is difficult.…”