Abstract
Multiple myeloma (MM) is a malignancy of clonal plasma cells accounting for approximately 10% of haematological malignancies. MM mainly affects older patients, more often males and is more frequently seen in African Americans. The most frequent manifestations of MM are anaemia, osteolytic bone lesions, kidney failure and hypercalcemia. The anaemia develops secondary to suppression of erythropoiesis by cytokine networks, similarly to the mechanism of anaemia of chronic disease. The concomitant presence of kidney failure, especially chronic kidney disease (CKD) and MM per se, leading to anaemia of chronic disease (ACD) in combination, provoked us to pose the question about their reciprocal dependence and relationship with specific biomarkers; namely, soluble transferrin receptor (sTfR), growth differentiation factor 15 (GDF15), hepcidin 25 and zonulin. One or more of these are new biomarkers of ferric management may be utilized in the near future as prognostic predictors for patients with MM and kidney failure.
Highlights
growth differentiation factor 15 (GDF15), soluble transferrin receptor (sTfR), hepcidin 25 and zonulin may all be involved in iron metabolism, so may form new biomarkers of ferric management and one or more may serve as a predictor for MM-associated kidney failure
Serum, urine divergent member of the TGF-beta family bone marrow stromal cells may be a major source in MM, while serum concentrations correlate with bone marrow levels pro-inflammatory cytokines induce GDF15 expression in macrophages in vitro experiments of a hepatocyte system indicate GDF-15 may reduce mRNA expression of hepcidin, and contribute to anaemia serum concentrations may be affected by kidney function, and iron deficiency described as an “early response molecule to tissue injury” in the setting of cardiovascular disease, and shown to predict decline in glomerular filtration currently investigated in a wide range of diseases prognostic role in AL amyloidosis recently reported sTfR [42,43,44]
This study revealed significantly elevated serum hepcidin and GDF15 levels in MM patients as a whole, and in subgroups depending on disease stage
Summary
Multiple myeloma (MM) is a malignancy of clonal plasma cells accounting for 10% of haematological malignancies and 1.8% of all malignancies [1]. Recent scientific research has shown that disorders of iron metabolism, and anaemia, may be associated with a positive regulation of hepcidin 25 expression caused by cytokines [7]. This small peptide hormone composed of 25 amino acids synthesized in hepatocytes regulates iron absorption from the gut and iron release from the spleen [8]. GDF15, sTfR, hepcidin 25 and zonulin may all be involved in iron metabolism, so may form new biomarkers of ferric management and one or more may serve as a predictor for MM-associated kidney failure.
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