The Role of Hepcidin in Myelodysplastic Syndromes (MDS): A Systematic Review of Observational Studies

Simple Summary In our systematic review, we analyzed and summarized observational studies revealing a potential association between myelodysplastic syndromes (MDS) and hepcidin. The extensive studies available in this area enabled us to draw the conclusion that hepcidin has a potential importance in the pathophysiology of MDS and the prediction of poor MDS patient outcomes. A summary of the mechanisms leading to iron overload in MDS and the potential causes of elevated serum hepcidin levels are shown in a graphical abstract created with BioRender. It is important to note that this systematic review is based on a relatively small number of MDS patients and control participants. Hence, additional research is crucial for the further exploration of these findings.Abstract Iron overload emerges as a serious complication in myelodysplastic syndromes (MDS), particularly associated with frequent transfusions during the course of the disease. The discovery and description of hepcidin's mechanisms of action have contributed to a deeper understanding of iron metabolism. The existing literature reports a potential role of hepcidin in MDS, yet these data are fragmented and presented in an unstructured, somewhat chaotic manner. Hence, to address the existing data, we performed a systematic review of observational studies examining hepcidin levels in MDS. An extensive review of three bibliographic databases (Pubmed, Web of Science, and Scopus) enabled us to identify 12 observational studies. These studies focused primarily on adult patients with low-risk MDS who underwent transfusions and chelation therapy. An in-depth analysis of these manuscripts led to four main conclusions: (1) although high serum hepcidin levels are associated with MDS, most studies generally have not found a significant difference in these levels between patients and healthy individuals; (2) serum hepcidin levels are specific to MDS type; (3) serum hepcidin levels in MDS are strongly associated with transfusions and the genetic status of patients; and (4) high-risk MDS is associated with high serum hepcidin levels. While we have furnished a comprehensive summary of the significance of hepcidin in MDS, there are still gaps that future research should address. This pertains primarily to the capacity of hepcidin in predicting adverse outcomes for MDS patients and evaluating the efficacy of chelation therapy or the need for transfusion.