The Role of Hepcidin in Anemia of Chronic Disease Associated with Rheumatoid Arthritis
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- Category: Vol. 78, March 2010
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The Role of Hepcidin in Anemia of Chronic Disease Associated with Rheumatoid Arthritis,MERVAT M. MATAR, HALA I. ELGENDY, RANDA M. SABRY and SHAWKY ABD ELHAMEED
Abstract
Background: Hepcidin, a circulating peptide hormone primarily produced by hepatocytes, is the master regulator of systemic iron homeostasis being a negative regulator of iron entry into plasma and it is proposed that hepcidin may play a key role in the pathogenesis of anemia of chronic disease (ACD). Rheumatoid arthritis (RA) is associated with ACD.
Aim of the Work: We aimed to assess levels of serum pro-hepcidin, the pro-hormone form of hepcidin, (as there are no commercial kits available for the measurement of hepcidin in serum specimens) and its relation to iron status and acute-phase reactants, and its possible role in the development of anemia in a cohort of RA patients.
Subjects and Methods: The study included 30 patients with RA (24 females and 6 males with mean age 39.7±13.9 years) and 30 healthy controls (HC). Complete blood count, ESR, CRP, RF, albumin, hepatic and renal function tests, ferritin and soluble transferrin receptors, sTfR/log ferritin index and pro-hepcidin were determined.
Results: Pro-hepcidin, Hb% and Hct levels were signifi-cantly lower in RA group than healthy control group. We found a negative correlation between pro-Hepcidin levels and ESR in the RA group however, the pro-hepcidin levels did not correlate with Hb%, Hct, TLC, platelet count, duration of disease, ferritin, soluble transferrin receptor (sTfR) con-centration and sTfR/log ferritin index (TfR-F index) in this group. Also, there was a positive correlation between Hb% & albumin and a negative correlation between Hb% & RAI in RA group. There was no significant difference in pro-hepcidin levels in anemia of chronic disease (ACD) subgroup in comparison to iron deficiency anemia (IDA) and ACD/IDA subgroups of the RA group. Also we didn't found significant correlation between RF positivity and any clinical laboratory parameters in RA group. Also there is no significant correlation between pro-hepcidin and ferritin in both RA and HC groups.
Conclusion: pro-hepcidin levels correlate with disease activity as a negative acute phase reactant but its' levels did not correlate with anemia in RA group and it has no role in the development of anemia of chronic disease in RA patients. Future strategies may include the use of hepcidin antagonists that overcome the retention of iron within the reticuloendot-helial system, and hormones or cytokines that might effectively stimulate erythropoiesis under inflammatory conditions.