Patients with
myelodysplastic syndromes (MDS) often show
elevated serum ferritin levels at diagnosis, probably caused by increased intestinal
iron uptake attributable to ineffective erythropoiesis. Many patients also develop transfusional
iron overload.
Hepcidin, a pivotal regulator of
iron homeostasis, controls
iron uptake in the duodenum as well as
iron release from macrophages and is potentially involved in
iron distribution to different organs. We measured serum
hepcidin, together with other laboratory parameters related to
iron metabolism and hematopoiesis (
ferritin,
transferrin,
transferrin saturation, soluble
transferrin receptor,
erythropoietin, and
hemoglobin), and
C-reactive protein as marker of
inflammation, in 89 MDS patients.
Hepcidin levels were measured with two different competitive ELISAs: (a) EIA-4705 as described by Schwarz et al. (J Gastroenterol 46:648-656; 2011) and (b)
Hepcidin 25 bioactive ELISA (EIA-5258), which was develop by DRG Diagnostics, Marburg, in 2012. Median
hepcidin levels with EIA-5258 were as follows: entire cohort 17.5 ng/ml (n = 89), RA/RARS 5.9 ng/ml (n = 5), RCMD 17.8 ng/ml (n = 38), RS-RCMD 8.7 ng/ml (n = 7),
RAEB I/II 29.1 ng/ml (n = 22), CMML I/II 16.9 ng/ml (n = 10), and MDS with del(5q) 26.3 ng/ml (n = 7).
Hepcidin levels of the RA/RARS patients were significantly lower than in the other groups except RS-RCMD. RS-RCMD had significantly lower levels than
RAEB and 5q- patients. There was a positive correlation between
hepcidin levels and serum
ferritin and
transferrin saturation, and a negative correlation between
hepcidin and
hemoglobin and
transferrin. Malcovati et al. (Blood 112:2676a, 2008), Santini et al. (PLoS One 6:e23109, 2011), and Ambaglio et al. (Haematologica 98:420-423, 2013), using mass spectrometry, reported similar results. We further assessed transfusional status and could show that patients who had been transfused have significantly higher
hepcidin levels (median 33.3 versus 8.8 ng/ml (p < 0.001)). A dichotomized
hepcidin level correlated with worse survival. EIA-4705 as described by Schwarz showed no correlation with markers of
iron metabolism. Measurement of serum
hepcidin with an improved ELISA yield results that correlate with other parameters of
iron metabolism as well as survival and transfusion needs.