Determination of hepcidin and erythroferrone levels in beta thalassemia cases

Objective: To clarify the relationship between erythropoiesis and iron metabolism, studies on erythroid factors that play role in the regulation of hepcidin have being studied. One of these factors is erythroferrone (ERFE) in glycoprotein structure is released from erythroblasts. The aim of this study is to measure levels of ERFE, hepcidin, GDF15 and erythropoietin (EPO) in individuals with thalassemia major (TM), thalassemia intermedia (TI) and thalassemia traits (TT) and to evaluate the role of ERFE in erythropoiesis and iron metabolism in different thalassemia groups. Method: 80 subjects (20 controls, 20 TT, 20 TI and 20 TM) were included in this study. ERFE, hepcidin and GDF15 concentrations were measured by sandwich ELISA method. Erythropoietin was measured by immunoassay method. Ferritin was measured by the chemiluminescence method. Transferrin was measured nephelometrically and iron spectrophotometrically. Results: In the TI group ERFE concentration and EPO activity were higher than the levels of TM, TT and control groups. Hepcidin concentrations of the patients with TM and TI were higher than the hepcidin concentrations of individuals in TT and control groups. However, the hepcidin / ferritin ratio of TM group was lower than the ratio of TI, TT and control groups. The GDF15 concentrations of TM and TI groups were higher than those of TT and control groups. There was a positive correlation between EPO and ERFE, EPO and GDF15, hepcidin and GDF15 in all subjects. No correlation was found between hepcidin and ERFE concentrations. Conclusions: This is the first study in which hepcidin, GDF15 and ERFE were measured at the same time in thalassemia patients. ERFE and EPO levels were found to be higher in the TI patients and ERFE was found to be increased in all individuals as EPO increased. We think that one of the parameters used for the demonstration of erythropoietic activity in the thalassemia may be ERFE. More detailed studies are needed to clarify the role of ERFE in iron metabolism. Key words: erythroferrone, hepcidin, GDF15, iron, thalassemia