Expression of Hepcidin and Growth Differentiation Factor 15 (GDF-15) Levels in Thalassemia Patients with Iron Overload and Positive Anti Hepatitis C Virus
Abstract: Thalassemia patients
who undergo life-long recurrent blood transfusion will experience iron overload
in various organs including the liver and possibly suffer from chronic
hepatitis C infection which may lead to liver impairment. The liver produces
hepcidin, a hormone which plays role in the regulation of iron level in the
blood. Various factors may influence hepcidin level in the blood. Chronic
hepatitis C causes iron overload and liver impairment. Liver impairment and
haemolytic anaemia due to haemoglobinopathy will suppress hepcidin production.
Anaemia stimulates growth differentiation factor 15 (GDF-15) to increase
erythropoiesis and suppress hepcidin production. Iron overload causes increase
in hepcidin level. Presence of factors which decrease or increase hepcidin
production will express various levels of hepcidin. This study aimed to
identify the expression of hepcidin and GDF-15 levels in thalassemia patients
with iron overload and positive anti-HCV. Information on hepcidin and GDF-15 levels
are beneficial in the management of iron overload in thalassemia with positive
anti-HCV.
Method: This study was a descriptive analytic study in thalassemia
patients who had received recurrent blood transfusion ≥ 12 times, suffered from
iron overload (transferrin saturation > 55% and ferritin > 1,000 ng/mL),
which consisted of 31 individuals with positive anti-HCV and 27 individuals
with negative anti-HCV. This study was performed in Thalassemia Centre
Department of Child Health and Department of Clinical Pathology, Faculty of
Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, in October
2011–January 2012. Serum hepcidin and GDF-15 examinations were performed using
enzyme-linked immunosorbent assay (ELISA) method. Aspartate aminotransferase (AST)
and alanine aminotransferase (ALT) examinations were performed using
colorimetry method. Data on ferritin and transferrin saturation were obtained
from medical records in the last 3 months. Data was analysed using SPSS Windows
version 17 software.
Results: Characteristics of subjects in this study included ferritin
level, transferrin saturation, AST, and ALT were 5,289 (SD 2,492) ng/mL, 96.7
(SD 9.2)%, 41.8 (SD 26.7) U/L, and 50.6 (24.9) U/L, respectively. It was obtained that the hepcidin levels were
within the normal limits with median of 51.5 (19-166) pg/mL, while GDF-15
levels were higher than the normal range with median of 1,936 (643-2,475)
pg/mL. There was no significant difference of hepcidin and GDF-15 levels
between positive and negative anti-HCV groups, with p value of 0.842 and 0.115,
respectively.
Conclusion: We obtained that the hepcidin levels were within normal
limits and GDF-15 levels were higher than the normal range. There was no
significant difference of hepcidin and GDF-15 levels between positive and
negative anti-HCV group.
Keywords: thalassemia; iron
overload; hepatitis C; hepcidin; growth differentiation factor 15 (GDF-15)
Author: Nuri Dyah Indrasari,
Ina Susianti Timan, Pustika Amalia
Journal Code: jpkedokterangg160409
