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Can biomarkers predict myocardial iron overload in children with thalassemia major?
Hasan Karakaş1, Ayşe Güler Eroğlu2, Nazlı Gülsüm Akyel3
1İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Pediatrics, İstanbul, Turkey.
Insights
Growth differentiation factor-15, galectin-3, and N-terminal pro-B-type natriuretic peptide do not predict cardiac iron overload in children with beta-thalassemia major. However, galectin-3 showed a weak association with liver iron accumulation.
Area of Science:
- Cardiology
- Hematology
- Biomarker Discovery
Background:
- Beta-thalassemia major necessitates lifelong blood transfusions, leading to iron overload.
- Cardiac T2* MRI is the gold standard for assessing cardiac iron but is not always accessible.
- Novel biomarkers are needed to monitor iron accumulation in beta-thalassemia patients.
Purpose of the Study:
- To investigate the predictive value of growth differentiation factor-15 (GDF-15), galectin-3, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for cardiac iron accumulation.
- To assess these biomarkers in asymptomatic children with beta-thalassemia major.
- To explore the relationship between these biomarkers and cardiac/hepatic iron levels measured by T2* MRI.
Main Methods:
- Serum levels of GDF-15, galectin-3, and NT-proBNP were measured in 41 children with beta-thalassemia major and 41 matched healthy controls.
- Biomarker levels were compared between patients and controls.
- Correlations between biomarker levels and cardiac/liver T2* MRI measurements were analyzed in patients.
Main Results:
- Patients with beta-thalassemia major exhibited significantly higher levels of GDF-15, galectin-3, and NT-proBNP compared to healthy controls.
- No significant correlations were found between GDF-15 or NT-proBNP levels and cardiac or liver T2* MRI findings.
- Serum galectin-3 did not correlate with cardiac iron but showed a weak negative correlation with liver iron accumulation.
Conclusions:
- GDF-15, galectin-3, and NT-proBNP are not reliable predictors of myocardial iron accumulation in asymptomatic children with beta-thalassemia major.
- Serum galectin-3 may have a limited role in assessing hepatic iron burden.
- Further research is needed to identify effective biomarkers for monitoring iron overload in this population.
Aim:
Beta-thalassemia major requires regular blood transfusions throughout life, which in turn leads to iron accumulation in the body. While cardiac T2* MRI is the gold standard in determining cardiac iron accumulation, it is not always feasible, which has led to the search for new biomarkers. Herein, the value of growth differentiation factor-15, galectin-3, and N-terminal pro-B-type natriuretic peptide in predicting cardiac iron accumulation is investigated in asymptomatic children with beta-thalassemia major.
Materials And Method:
Forty-one patients aged 11-21 years and 41 age-, gender-, body mass index-matched healthy controls were included. Serum growth differentiation factor-15, galectin-3, and N-terminal pro-B-type natriuretic peptide levels were compared between the patients and controls. Additionally, the relations of these biomarkers with cardiac and liver T2 * MRI were investigated in the patients.
Results:
In the patients, growth differentiation factor-15, galectin-3, and N-terminal pro-B-type natriuretic peptide levels were higher than healthy controls (p < 0.001, p = 0.025, p < 0.001, respectively). There were no significant correlations of growth differentiation factor-15 and N-terminal pro-B-type natriuretic peptide levels with both cardiac and liver T2 * MRI measurements. While there was no significant correlation of serum galectin-3 with cardiac T2 * MRI measurements, a negative correlation was found with liver T2 * MRI measurements (p = 0.040, rho = -0.325).
Conclusion:
All three biomarkers investigated in this study failed to predict myocardial iron accumulation in asymptomatic children with beta-thalassemia major. However, a weak relation between serum galectin-3 level and hepatic iron accumulation was demonstrated.
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