Increased ferritin levels in non-transfusion-dependent β°-thalassaemia/HbE are associated with reduced CXCR2 expression and neutrophil migration

Br J Haematol. 2020 Apr;189(1):187-198. doi: 10.1111/bjh.16295. Epub 2019 Dec 29.


Severe bacterial infection is a major complication causing morbidity and mortality in β-thalassaemia/HbE patients. Innate immunity constitutes the first line of defence against bacterial infection. This study aimed to comprehensively investigate the innate immune phenotype and function related to factors predisposing to infection in non-transfusion-dependent (NTD) β°-thalassaemia/HbE patients. Twenty-six patients and 17 healthy subjects were recruited to determine complement activity (C3, C4, mannose-binding lectin and CH50) and surface receptor expression including markers of phagocytosis (CD11b, CD16 and C3bR), inflammation (C5aR) and migration (CD11b, CXCR1 and CXCR2) on neutrophils and monocytes. In addition, phagocytosis and oxidative burst activity of neutrophils and monocytes against Escherichia coli and neutrophil migration were examined. Decreased C3 and surface expression of CD11b and C3bR on neutrophils were found in patients. However, phagocytosis of neutrophils in patients was still in the normal range. Interestingly, patients displayed a significant reduction of surface expression of CXCR2 [1705 ± 217 mean fluorescent intensity (MFI)] on neutrophils, leading to impaired neutrophil migration (9·2 ± 7·7%) when compared to neutrophils from healthy subjects (2261 ± 627 MFI and 27·8 ± 9% respectively). Moreover, surface expression of CXCR2 on neutrophils was associated with splenectomy status, serum ferritin and haemoglobin levels. Therefore, impaired neutrophil migration could contribute to the increased susceptibility to infection seen in NTD β°-thalassaemia/HbE patients.

Keywords: bacterial infection; innate immunity; iron overload; β-thalassaemia/HbE.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cell Movement*
  • Complement System Proteins / metabolism
  • Female
  • Ferritins / blood*
  • Gene Expression Regulation*
  • Hemoglobin E / metabolism*
  • Humans
  • Male
  • Middle Aged
  • Monocytes / metabolism
  • Monocytes / pathology
  • Neutrophils / metabolism*
  • Neutrophils / pathology
  • Phagocytosis
  • Receptors, Interleukin-8B / blood*
  • Splenectomy
  • beta-Thalassemia / blood*
  • beta-Thalassemia / pathology
  • beta-Thalassemia / surgery


  • CXCR2 protein, human
  • Receptors, Interleukin-8B
  • Complement System Proteins
  • Ferritins
  • Hemoglobin E