Plasma Endocan as a Biomarker of Endothelial Dysfunction in Egyptian Children with Beta-Thalassemia Major: A Single-Center Analysis

Abstract

Background: Beta-thalassemia major (β-TM) is a transfusion-dependent disorder associated with iron overload and endothelial dysfunction. Endocan is a proteoglycan secreted by endothelial cells and has been proposed as an indicator of endothelial activation and inflammation. Children with β-TM face various problems, such as glomerular and tubular degeneration, cardiomyopathy, and endothelial damage, which require regular monitoring using a reliable and practical method. This study aimed to evaluate plasma endocan levels in Egyptian children with β-TM. Materials and Methods: A case-control study was conducted at the Medical Research Institute, Alexandria University. The experimental group consisted of 40 children with transfusion-dependent β-TM who were aged between 12 and 16 years, and the control group involved 40 age- and gender-matched healthy children. Clinical assessments and laboratory tests, including hemoglobin, serum ferritin, and C-reactive protein, were performed. Plasma endocan levels were measured using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using SPSS version 20. Appropriate parametric or non-parametric tests, based on data distribution, were applied, and a p value of < 0.05 was considered statistically significant. Results: Children with β-TM had significantly higher plasma endocan levels than controls (median 332 vs. 44 ng/L, p < 0.001). Endocan levels did not significantly differ based on gender (p = 0.575) or splenectomy status (p = 0.986). A significant difference was observed between hepatitis C virus (HCV)-negative and HCV-positive cases (p = 0.005), with higher endocan levels in HCV-positive patients. No significant correlation was found between endocan levels and age, ferritin, or transfusion frequency (p> 0.05). Conclusion: Children with transfusion-dependent β-TM exhibited significantly higher plasma endocan levels, as compared to the healthy controls. Endocan can serve as a potential non-invasive biomarker of endothelial dysfunction in pediatric thalassemia.