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Published on: July 17, 2014
[Hepcidin and Plasmodium falciparum malaria in anemic school children in Mali]
M A Ayoya1, R J Stoltzfus, G M Spiekermann-Brouwer
1UNICEF, 73 Lodi Estate, New Delhi 110-003, India. mayoya@unicef.org
Insights
Malaria infection in children significantly increases urinary hepcidin levels, a peptide hormone. This finding highlights hepcidin
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Biochemistry
Background:
- Hepcidin, a peptide hormone produced by hepatocytes, is detectable in blood and urine.
- Urinary hepcidin levels increase in response to infections and inflammation.
- The impact of tropical parasitic infections on hepcidin requires further investigation.
Purpose of the Study:
- To examine the effects of Plasmodium falciparum malaria and Schistosoma haematobium infections on urinary hepcidin excretion in Malian school children.
- To investigate the correlation between urinary hepcidin, inflammation markers, and anemia in this population.
Main Methods:
- Cross-sectional study involving school children in Mali with high prevalence of malaria and schistosomiasis.
- Assessment of urinary hepcidin levels in a sub-sample of children with S. haematobium, P. falciparum malaria, or no infection.
- Analysis of C-reactive protein (CRP) and serum ferritin levels.
Main Results:
- Children with P. falciparum malaria exhibited significantly higher urinary hepcidin excretion compared to those with S. haematobium or no infection (p < 0.05).
- Urinary hepcidin levels showed a significant positive correlation with CRP (Spearman's r = 0.59; p = 0.001) and serum ferritin (Spearman's r = 0.73; p = 0.003).
- High prevalence of anemia (68%) and iron deficiency anemia (24%) was observed in the study population.
Conclusions:
- This study provides further evidence for an association between malaria and elevated urinary hepcidin levels.
- Increased hepcidin may contribute to anemia observed in children with malaria.
- Further research is needed to elucidate the role of hepcidin in malaria-associated anemia.
Abstract:
Hepcidin is a peptide produced by hepatocytes and detectable in blood and urine. Urinary hepcidin excretion appeared to be significantly increasing in humans with acute and chronic infections or inflammatory diseases. However, the effects of common tropical parasitic infections on hepcidin have not been sufficiently examined. We carried out a study in school children from Mali living in a neighborhood where Plasmodium falciparum malaria and Schistosoma haematobium infections are prevalent. Anemia (hemoglobin < 120 g/l) prevalence was very high among these children (68%); 24% had iron deficiency anemia. The prevalence of infections was also high (65% had at least one infection and 41% had C-reactive protein (CRP) levels > 10 mg/L). S. haematobium was diagnosed in 64%. We assessed first morning urine hepcidin excretion in a sub-sample of 15 children with either S. haematobium, P. falciparum malaria or none; 14 of these 15 children were included in the analyses. Children with P. falciparum malaria excreted significantly higher levels of hepcidin than those with S. haematobium (chi2 = 3.86; p = 0.05) or without any infection (chi2 = 5.95; p = 0.01). Urinary hepcidin correlated significantly with CRP (Spearman's r = 0.59; p = 0.001) and serum ferritin (Spearman's r = 0.73; p = 0.003). Our study confirms the still limited evidence of an association between human malaria and increased urinary hepcidin and points out the need for further studies to define the contribution of hepcidin to anemia associated with this disease.
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