Labile plasma iron, more practical and more sensitive to iron overload in myelodysplastic syndromes

Figures & data

Table 1 The basic parameters of MDS patients according to their WHO classification

	Low-risk group (n = 15)	High-risk group (n = 7)	P value
ASF (mg/l)	2182 ± 465	1733 ± 488	0.014
LPI (U)	0.82 ± 0.18	0.71 ± 0.21	0.035
EPO (mIU/ml)	195.77 ± 28.25	202.26 ± 27.94	0.351
GDF15 (2^−ΔΔct)	1.88 ± 0.16	1.56 ± 0.16	0.048
Hepcidin (mg/l)	284.24 ± 17.02	336.47 ± 24.57	0.011
Hepcidin/ASF	0.13 ± 0.04	0.19 ± 0.05	0.025
ROS (DCF)	30.33 ± 3.7	26.82 ± 1.91	0.028
APAF-1 (2^−ΔΔct)	4.81 ± 1.19	2.65 ± 0.67	0.007
Erythroid apoptosis (%)	56.74 ± 5.73	36.36 ± 7.27	0.008

Figure 1 LPI and ASF of MDS patients during DFO treatment. LPI has a statistical difference (P < 0.001 by ANOVA), which decreased gradually, among three groups, while no difference was found in ASF (P = 0.086 by ANOVA)

Table 2 Iron biochemical parameters in MDS patients

	Week 0	Week 4	Week 26	ANOVA P value
ASF (mg/l)	1946 ± 701	1829 ± 497	1721 ± 365	0.086
LPI (U)	0.75 ± 0.25	0.51 ± 0.22	0.34 ± 0.15	<0.001
EPO (mIU/ml)	198.86 ± 31.34	204.67 ± 64.32	172.30 ± 51.24	0.247
GDF15 (2^−ΔΔct)	1.72 ± 0.32	1.55 ± 0.45	1.49 ± 0.57	0.172
Hepcidin (mg/l)	301.26 ± 59.78	325.48 ± 50.77	340.33 ± 49.78	0.032
Hepcidin/ASF	0.16 ± 0.08	0.17 ± 0.05	0.22 ± 0.03	0.045
ROS (DCF)	29.47 ± 4.56	21.67 ± 3.80	18.55 ± 3.12	0.005
APAF-1 (2^−ΔΔct)	3.99 ± 2.01	2.86 ± 1.34	1.85 ± 0.59	0.047
Erythroid apoptosis (%)	45.78 ± 16.69	32.18 ± 17.46	23.45 ± 13.89	0.009

Figure 2 The correlation between LPI and LIC, ASF and LIC of MDS patients during DFO treatment. On week 0 and week 26, we used MRI T2* to test LIC in MDs patients, while their LPI and ASF were tested at the same time. We put data together (week 0 + week 26) to perform a linear regression to analyze the correlation between LPI and LIC, ASF and LIC. As Fig. 2 shows, LPI has a closer connection to LIC than ASF (r = 0.739, P < 0.001 vs. r = 0.321, P = 0.034)

Table 3 Clinical parameters in MDS patients

	Week 0	Week 4	Week 26	ANOVA P value
RBC transfusion (U/month)	—	2.36 ± 1.57	2.33 ± 0.69	0.838*
ASF (mg/l)	1946 ± 701	1829 ± 497	1721 ± 505	0.086
LPI (U)	0.69 ± 0.25	0.51 ± 0.22	0.34 ± 0.15	<0.001
LIC (mg/g dry weight)	9.83 ± 4.84	—	6.28 ± 4.01	<0.001*
Cardiac T2* (ms)	27.45 ± 3.88	—	28.85 ± 4.51	0.594*
Hb (g/l)	62.59 ± 18.85	68.76 ± 19.97	75.48 ± 16.69	0.169
ALT (U/l)	39.47 ± 10.68	43.74 ± 16.49	36.77 ± 17.71	0.379
LVEF (%)	53.45 ± 4.65	—	54.38 ± 4.65	0.856*

*RBC transfusion, LIC, cardiac T2*, and LVEF were analyzed by paired Student's t-test.

Figure 3 DCF and erythroid apoptosis rate of MDS patients during DFO treatment. With the decrease of LPI, DCF and erythroid apoptosis rate both reduced. Figure 3 shows the changes of one patient's DCF and erythroid apoptosis rate, whose DCF decreases from 72.17 to 40.16 and erythroid apoptosis rate from 42.60 to 18.05%

Figure 4 The improvement of ALT, hemoglobin, and LIC. Before DFO treatment, a patient had an abnormal liver function. Along with iron chelation therapy, his LPI decreased rapidly. Meanwhile, his ALT dropped and his hemoglobin increased gradually. Furthermore, his LIC decreased after receiving DFO treatment. Lane a: LIC was 9.97 mg/g dry weight on week 0. Lane b: LIC was 5.81 mg/g dry weight on week 26