Features of the secretion of interleukin-6, interleukin-1β, interferon-γ and their influence on the development of anemia of chronic diseases in patients with rheumatic pathology
Authors:   Ministry of Defense of the Russian Federation, Krasnogorsk, pos. Novy, Russia, Sakhin V.T. , Kryukov E.V. ,   Russian Military Medical Academy of the Ministry of Defense of Russia, St. Petersburg, Russia, Grigoriev M.A. ,   Leningrad Regional Clinical Hospital, St. Petersburg, Russia, Kazakov S.P. ,   Main Military Clinical Hospital named after academician N.N. Burdenko Russian Defense Ministry, Moscow, Russia, Sotnikov A.V. ,   Russian Military Medical Academy of the Ministry of Defense of Russia, St. Petersburg, Russia, Gordienko A.V. ,   Main Military Clinical Hospital named after academician N.N. Burdenko Russian Defense Ministry, Moscow, Russia, Gulyaev N.I ,   Ministry of Defense of the Russian Federation, Krasnogorsk, pos. Novy, Russia, Rukavitsyn O.A. ,   Main Military Clinical Hospital named after academician N.N. Burdenko Russian Defense Ministry, Moscow, Russia
Published: July 2021

Aim. To study the characteristics of interleukin-6 (IL-6), interleukin-1β(IL-1β), interferon-γ(INF-γ) secretion in rheumatic patients with and without anemia of chronic diseases. To assess the influence of these cytokines on the development of anemia of chronic iseases in patients with various rheumatic pathologies. To propose a working version of the classification of anemia of chronic diseases based on the leading pathogenetic factor in the development of anemia. Material and methods. 126 rheumatic patients, 34 men (45,8 (36–54,9) years old), 92 women (49,5 (38–60) years old) were examined. Group 1 included 41 patients with ACD, 34 with iron deficiency anemia (IDA). Group 2 had 29 patients with a combination of ACD and IDA, 22 in the control group without anemia. Comparative analysis between groups with and without anemia and correlation analysis of hemogram parameters, iron metabolism, C-reactive protein (CRP), interleukin-6 (IL-6), IL-1β, interferon gamma (INF-γ) were performed. Results. In the ACD group, the concentrations of ferritin, CRP, IL-6 were increased in comparison with other groups. With regard to IL-1β, INF-γ, no intergroup differences were found in the study groups (p>0,05). It was found that the greatest influence on the maturation of erythrocytes is exerted by INF-γ (r=-0,4). The greatest effect on hemoglobin synthesis is exerted by IL-6 (r=-0,6) and IL-1β (r=-0,4). The effect of the studied cytokines on erythropoiesis and hemoglobin synthesis can be realized through their effect on iron metabolism. This is confirmed by the results of the performed correlation analysis. A negative moderate correlation was shown between IL-6 and iron (r=-0,6), total iron binding capacity (TIBС)(r=-0,3), transferrin saturation index (TSI) (r=-0,5), ferritin (r=-0,5), transferrin (r=-0,3), and a moderately positive correlation with CRP (r=0,5). For INF-γ, a negative correlation was found with TIBC (r=-0,3), ferritin and transferrin (r=-0,3). For IL-1β, a moderate negative correlation was shown with TIBC, ferritin and transferrin (r=-0,4). Conclusion. It was found that patients with rheumatic pathology and anemia of chronic diseases had high concentration of IL-6, while the concentrations of INF-γ and IL-1β did not differ from the values in the groups of patients with IDA, a combination of AChD / IDA and without anemia. Despite this, the influence of all three investigated cytokines on erythropoiesis, hemoglobin synthesis and iron metabolism has been proven. The data obtained reflect the complex pathogenesis of ACD in patients with rheumatic pathology, including erythropoiesis disorders, changes in iron metabolism, and increased synthesis of some pro-inflammatory cytokines. A working version of the classification of ACD (with a predominant iron deficiency, with violations of the regulatory mechanisms of erythropoiesis, with insufficient production of erythropoietin) has been proposed.