Evaluation of Erythroferrone, Hepcidin, and Iron Overload Status in Iraqi Transfusion-Dependent β-Thalassemia Major Patients

Abstract

Patients with β-thalassemia major (β-TM) show ineffective erythropoiesis and iron overload, which is the leading cause of mortality and organ injury. The present study aimed to investigate the relationships between two iron regulatory hormones, hepcidin and erythroferrone (ERFE) levels, and iron status parameters in Iraqi patients with β-TM. Iron status parameters and hormones were measured in 60 patients and compared with 30 healthy controls. The results indicated significant changes in different iron status parameters, while ferritin with the ∼11-fold increase showed the most change. Significant reduction in hepcidin and an increase in ERFE levels were detected in patients when compared to the control group, while no direct correlation was identified with the other measured iron status parameters. The receiver operating characteristic (ROC) analysis showed that the z-score of the composite of ERFE + ferritin has a full diagnostic ability for β-TM. In conclusion, our findings indicated the correlation between different iron status parameters and ferritin as the leading predictor of iron overload and two main iron regulatory hormones.

Keywords:

• β-Thalassemia (β-thal)
• erythroferrone (ERFE)
• hepcidin
• ferritin
• iron overload

Acknowledgments

We would like to thank the staff at the Al-Zahraa Teaching Hospital, Najaf, Iraq, for their help in the collection of the samples. We also acknowledge the work of the highly skilled staff of Asia Laboratory, Najaf, Iraq, in the estimation of the biomarkers levels. Authors’ contribution: H.N.K. Smesam and H.A.Q. Albuthabhak collected the data, prepared the figure and tables, and drafted the manuscript. S. Arjmand wrote the main manuscript and contributed to the interpretation of data. H.K. Al-Hakeim devised the project, performed the statistical analysis, contributed to the interpretation of data, and supervised the project. S.O.R. Siadat contributed to the interpretation of the data and supervised the project.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.