The relationship of serum growth differentiating factor 15 with hepcidin in posttransplant adult Egyptian patients and its prognostic significance

Background Hepcidin is a small peptide that is produced in the liver that is most likely the major regulator of iron. Based upon the importance of iron, multiple mechanisms exist for the regulation of hepcidin. Iron levels, inflammation, erythropoiesis, and the combined effects of several proteins expressed on hepatocyte membranes are involved. Growth differentiation factor 15 (GDF15) is a member of the transforming growth factor-b. GDF15 expression level is usually low in resting cells but may be substantially increased following response to diverse cellular stress signals, such as hypoxia, inflammation, acute tissue injury, and during cancer progression. Aim The aim was to assess the relationship of serum GDF15 with hepcidin in posttransplant adult Egyptian patients as an assessment for iron overload and their relationship with posttransplantation complications. Patients and methods Serum GDF15 and hepcidin were measured using enzyme-linked immunosorbent assay in 45 postallogenic (23 patients) and autologous (22 patients) bone marrow transplanted patients 1 year after transplantation in comparison with 15 healthy controls recruited from the bone marrow transplantation unit, Ain Shams University Hospitals. Results Serum level of GDF15 and hepcidin level were elevated 1 year after allogenic and autologous transplantation patients in comparison with control group, with a statistically significant difference between patients and controls (P<0.001). GDF15 and hepcidin were positively correlated with ferritin level (P<0.001). GDF15 and ferritin were positively correlated with acute graft-versus-host disease (GVHD) and chronic GVHD (P=0.004 and 0.002, respectively), but hepcidin did not show any significant correlation with acute GVHD (P=0.110). Moreover, GDF15, hepcidin and ferritin were positively correlated with serum levels of alanine transferase and aspartate transferase in both autologous and allogenic transplanted patients. However, GDF15, hepcidin, and ferritin were not correlated with bacterial or viral infections in both allogenic and autologous groups of patients. Conclusion Both GDF15 and hepcidin are useful biomarkers for iron overload in late postallogenic and autologous bone marrow transplantation, and both can be used as a predictor for posttransplantation complications.