Differentiating iron-loading anemias using a newly developed and analytically validated ELISA for human serum erythroferrone

PLoS One. 2021 Jul 20;16(7):e0254851. doi: 10.1371/journal.pone.0254851. eCollection 2021.

Abstract

Erythroferrone (ERFE), the erythroid regulator of iron metabolism, inhibits hepcidin to increase iron availability for erythropoiesis. ERFE plays a pathological role during ineffective erythropoiesis as occurs in X-linked sideroblastic anemia (XLSA) and β-thalassemia. Its measurement might serve as an indicator of severity for these diseases. However, for reliable quantification of ERFE analytical characterization is indispensable to determine the assay's limitations and define proper methodology. We developed a sandwich ELISA for human serum ERFE using polyclonal antibodies and report its extensive analytical validation. This new assay showed, for the first time, the differentiation of XLSA and β-thalassemia major patients from healthy controls (p = 0.03) and from each other (p<0.01), showing the assay provides biological plausible results. Despite poor dilution linearity, parallelism and recovery in patient serum matrix, which indicated presence of a matrix effect and/or different immunoreactivity of the antibodies to the recombinant standard and the endogenous analyte, our assay correlated well with two other existing ERFE ELISAs (both R2 = 0.83). Nevertheless, employment of one optimal dilution of all serum samples is warranted to obtain reliable results. When adequately performed, the assay can be used to further unravel the human erythropoiesis-hepcidin-iron axis in various disorders and assess the added diagnostic value of ERFE.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anemia / blood
  • Anemia / diagnosis
  • Anemia, Sideroblastic / blood
  • Anemia, Sideroblastic / diagnosis*
  • Cytokines / metabolism
  • Enzyme-Linked Immunosorbent Assay
  • Erythropoiesis
  • Female
  • Hepcidins / blood
  • Humans
  • Iron / metabolism
  • Iron Overload / diagnosis
  • Iron Overload / metabolism
  • Male
  • Middle Aged
  • Peptide Hormones / analysis*
  • Peptide Hormones / blood
  • beta-Thalassemia / blood
  • beta-Thalassemia / diagnosis*

Substances

  • Cytokines
  • Erfe protein, human
  • Hepcidins
  • Peptide Hormones
  • Iron

Grants and funding

This research was partly funded by the Noyons stipendium of the E.C. Noyons foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.