Role of malonaldehyde as a surrogate biomarker for iron overload in the β-thalassemia patient: A systematic meta-analysis

Abstract

Malonaldehyde (MDA), a biomarker of oxidative stress is found to be increased in many individuals suffering from β-thalassemia. This may possibly be attributed to iron overload that is seen occurring in varying degrees in the condition as evident from increased ferritin (the storage form of body iron) levels in afflicted individuals. This study hypothesized that MDA may be used as a surrogate marker for iron overload in β-thalassemia. We performed a systematic review and meta-analysis of case-control studies for both parameters. The mean difference (MD) and confidence interval at 95% was calculated using a random effect model after exclusion of unsuitable data and study imputed of bias by trim-fill analysis. The study subjects were divided into two groups; transfusion-dependent β-thalassemia (TDT) and non-transfusion-dependent β-thalassemia (NTDT). The study population for MDA comprised of 2001 candidates (1159 Cases and 842 Controls) and 429 individuals (289 Cases and 140 Controls) respectively, for TDT and NTDT groups. While 1332 (803 Cases vs. 529 Controls) and 342 (234 Cases vs. 108 Controls) candidates were included in the analysis of ferritin in the aforesaid two groups. It was found that MDA levels were significantly increased in TDT [MD 2.221 (1.80-2.646), p<0.001] as well as in NTDT [MD 1.89 (1.20-2.581), p<0.001] when compared with normal individuals. Ferritin level is also found to be significantly increased in these two groups: in TDT [MD 2.288 (1.883-2.693), p<0.001] and in NTDT [MD 1.946 (0.883-3.009), p<0.001] when compared with normal individuals. In conclusion, it is seen that all β-thalassemia patients irrespective of blood transfusion dependency suffer from the curse of iron overload-induced oxidative stress.

Keywords

• β-Thalassemia major
• β-Thalassemia minor
• Publication bias
• Oxidative stress
• Forest plot