[Regulatory mechanisms of iron metabolism in patients with acute leukemia]

To estimate the levels of hepsidine, HIF-1alpha, erythropoietin, other proteins of iron metabolism; to characterize dysregulation of metabolic processes in leukogenesis.

Thirty eight patients with newly diagnosed acute leukemia (AL) were divided into three groups by anemia severity: group 1 (Hb > 90 g/l), group 2 (Hb 90-70 g/l), group 3 (Hb < 70 g/l). Erythropoietin concentration was measured with enzyme immunoassay, serum ferritin (SF)--by radioimmunoassay; HIF-1alpha, hepsidine--by sandvich enzyme immunoassay with use of monospecific antisera and monoclonal antibodies against relevant antigens.

In AL patients SF before treatment was 10 times higher than in healthy subjects, administration of cytostatics elevated this concentration even more. Hepsidine and HIF-1alpha are also elevated. Treatment reduces hepsidine level twice in all the groups. This may be due to reduction of the tumor mass. Erythropoietin was 20-35 times higher in all the patients, especially in myelotoxic agranulocytosis (up to 1000 mU/ml) with reduction after recovery of hemopoiesis (in some patients to normal values 20-30 mU/ml). Hepsidine and HIF-1alpha concentrations were also maximal in myelotoxic agranulocytosis (20-28 pg/ml). After recovery of hemopoiesis these values fell to initial values 7-9 pg/ ml). Transfusion of donor erythrocytic mass normalized HIF-1alpha concentration and decreased that of hepsidine. Its elevation and high HIF-1alpha were observed after the transfusion in 17% patients.

Disorders in regulatory mechanisms in AL patients throughout the observation confirm the role of the proteins studied in homeostasis. Changes in HIF-1alpha and hepsidine concentrations can be used as indicators of transfusion efficacy.