Association between Neutrophil Gelatinase-Associated Lipocalin and Fetal Hemoglobin Levels in Patients with Type 2 Diabetes Mellitus.

Jong Weon Choi,Tatsuyoshi Fujii,Moon Hee Lee

doi:10.1155/2021/8383875

Abstract

The effect of neutrophil gelatinase-associated lipocalin (NGAL) on fetal hemoglobin (HbF) levels in diabetic patients is rarely investigated. This study is aimed at investigating the possible association between NGAL and HbF levels in type 2 diabetes mellitus (T2DM). A total of 160 patients with T2DM and 61 healthy individuals were evaluated. NGAL, HbF, tumor necrosis factor-α (TNF-α), interleukin-5 (IL-5), glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and urine albumin levels were measured. HbF levels were significantly higher in patients with elevated NGAL than in those without elevated NGAL (1.44% versus 0.94%, P = 0.001). High HbF was 2.3 times more prevalent in patients with elevated NGAL than in those without elevated NGAL. In addition, NGAL, TNF-α, and IL-5 levels were significantly higher in patients with high HbF than in those with low HbF; however, there was no significant difference in HbA1c and FPG levels between the two groups. HbF was positively correlated with NGAL (r = 0.275, P < 0.001), TNF-α (r = 0.256, P < 0.001), and IL-5 (r = 0.212, P < 0.001), but not with HbA1c and FPG. An elevated NGAL level led to a 1.27-fold increase in the prevalence of high HbF (odds ratio: 1.27, 95% CI: 1.03–2.51, and P < 0.001). The diagnostic efficacy of NGAL to identify an elevated HbF level was superior to that of HbA1c (area under the curve: 0.697, 95% CI: 0.609–0.786 versus 0.584, 95% CI: 0.488–0.681, and P = 0.022). In conclusion, enhanced NGAL production may be closely linked to elevated HbF in conjunction with proinflammatory cytokines in patients with T2DM.

Highlights

Fetal hemoglobin, known as hemoglobin F (HbF), is a major hemoglobin fraction during the gestational period and in early infancy
The concentrations of neutrophil gelatinase-associated lipocalin (NGAL), HbF, and tumor necrosis factor-α (TNF-α) were significantly higher in diabetic patients than in healthy individuals
The main findings of this study were that (1) high HbF was more prevalent in patients with elevated NGAL than in those without elevated NGAL, (2) HbF was more closely associated with NGAL, TNF-α, and IL-5 than HbA1c and fasting plasma glucose (FPG), and (3) NGAL elevation led to a 1.27-fold increase in the prevalence of high HbF

Summary

Introduction

Known as hemoglobin F (HbF), is a major hemoglobin fraction during the gestational period and in early infancy. HbF is produced by erythroid precursors from 12 weeks of pregnancy to the first 6 months of postnatal life [1]. HbF is almost entirely replaced by adult hemoglobin by the first year of life; it constitutes less than 0.6% of the total hemoglobin of healthy adults [2]. HbF production can be reactivated under certain conditions in adulthood. Pregnancy, starvation ketoacidosis, and some cancers lead to an increase in the production of HbF [3,4,5]. HbF synthesis occurs under stress erythropoiesis conditions, such as hemolysis, hypoxia, and acute blood loss [6]

Objectives

Methods

Results

Conclusion