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Interactions between serum hephaestin, iron and other biochemical features in Iraqi smokers (tobacco cigarette and water pipe).


Smoking is a widely accepted practice in Iraqi and sometimes is associated with socializing, sharing and male identity. A smoker defined as a person who has smoked 10 or more cigarettes per day continually for at least one year, while non-smoker is a person who has no previous smoking experience (Shah, 2012)". Additionally, smokers have a fivefold increased risk of cancer of the larynx and oral cavity, but one third of all cancers of the kidneys and pancreas are attributing to smoking as well. The risk of smoking having a heart attack is more than twice that of nonsmokers and smokers risk for sudden cardiac death is two to four times the risk of nonsmokers (Bashar, 2004)". Other study found that water pipe tobacco smoking negatively affects lung function and may be as harmful as cigarette smoking. In spite of these deleterious health effects, water pipe smoking is widely believed to be a less harmful form of tobacco smoking, and a safer alternative to cigarette smoking (Akl, 2011)".

Hephaestin is predicted to be a trans membrane protein with a molecular weight of approximately 130 kDa (Syed, 2002)". The predicted amino acid sequence of human hephaestin is 50% identical and 68% similar to the sequence of human ceruloplasmin (Syed, 2002)". Hephaestin is involved in the metabolism of iron. It is a trans membrane copper-dependent peroxidase responsible for transporting dietary iron from intestinal enterocytes into the circulatory system (Chen, 2006)". No previous study referred to level of hephaestin in tobacco cigarette and water pipe smokers . Iron is an essential metal for hemoglobin synthesis of erythrocytes, oxidation-reduction reactions, and cellular proliferation, whereas excess iron accumulation causes organ dysfunction through the production of reactive oxygen species (ROS) (Kohgo, 2008)". The vast majority of body iron (at least 2.1 g in humans) is distributed in the hemoglobin of red blood cells and developing erythroid cells and serves in oxygen transport. Significant amounts of iron are also present in macrophages (up to 600 mg) and in the myoglobin of muscles (~300 mg), whereas excess body iron (~1 g) is stored in the liver (Olsson, 2008)". Transferrin is the major plasma protein involved in transport of iron (Dales, 2008)". Binding of iron by transferrin, results in striking conformational changes in the two lobes (Lewis, 2002)". The delivery of transferrin-bound iron to cells is dependent upon the expression of transferrin-binding molecules, which are known as transferrin receptors (Dales, 2008)". Thus, serum transferrin has considerable reserve capacity to bind iron, called unsaturated iron binding capacity (UIBC) (Fukuhara, 1996)". The aim of the present study is to evaluate the effect of Tobacco Cigarette and water pipe smoking on hephaestin and other biochemical and hematological parameters.


Blood samples were collected from three groups of 30 cigarette smokers, 30 waterpipe smokers and 30 non-smokers (control group) whose ages ranged between (18-35) years. The study was done at College Health and Medical Technical, Department of Medical analysis. The study was performed from October 2013 to January 2014. The medical history was taken. None of the participants had any chronic diseases.Venous blood samples were drawn about 10 ml of venous blood was aspirated by disposable syringe, two ml of this blood was transferred to EDTA container tube, then mixed gently using blood shaker to prevent clotting of the blood. This blood was used for estimation of complete blood count (CBC), the rest of the blood was allowed to clot for 10-15 min. at room temperature, centrifuged for (10) min. at (3000rpm). to separate serum which was transferred into a new tube and frozen at(-20c[degrees]).

The Hb and other hematological parameters are measured by Hematocrit. The serum hephaestin was measured by Enzyme Linked Immunosorbent Assay(CUSABIO BIOTECH COM.).

Serum TIBC and iron level were measured by spectrophotometric methods supplied by Human kits. To calculate the unsaturated iron binding capacity (UIBC), the serum iron concentration was subtracted from the TIBC.

UIBC = TIBC--Serum iron concentration

Transferrin can be estimated indirectly from the TIBC value by the following equation (Mehde, 2013)".

Transferrin ([micro]g/dl) = 0.7 x TIBC ([micro]g/dl)

The percentage of saturation of transferrin with iron is determined by the following equation:

% Saturation of transferrn with iron = Serum Iron/TIBC x 100

All statistical analysis in the study was performed using SPSS version 19.0 for Windows (Statistical Package for Social Science, Inc., Chicago, IL, USA). Expressive analysis was presented the mean and standard deviation of variables. The significance of differences between mean values was assessed by Student t-test. The probability p < 0.05 was considered statistically significant, while p > 0.05 was referred to statistically insignificant.


The Mean [+ or -] SD of age for water pipe smokers was [24.97 [+ or -] 4.17] and for cigarette smokers was [28.03 [+ or -] 5.42] and for the control group was [26.40 [+ or -] 4.47]. There were a non-significant differences at p > 0.05 in water pipe and cigarette smokers when compared with that found in control group, Table 1.

The WBC and LYM are showed a significant difference [p < 0.05] in smokers groups when compared with that found in control groupas shown in Table 2, table 3 showed a statistically increase in the WBC from a mean value of [4.91 * [10.sup.3] cell/ml] in nonsmokers group to about [5.99 * [10.sup.3] cell/ml], [5.93 * 103 cell/ml], for water pipe smokers, cigarette smokersgroups respectively. There were a non-significant differences [p > 0.05] in MID and GRA when compared smokers groups with that found in control group Table 2.

Table 3 showed a statistically increase in the MID [%] from a mean value of [9.31 [+ or -] 1.91%] in nonsmokers group to about [12.36 [+ or -] 4.69%], [9.88 [+ or -] 1.54%], for water pipe smokers, cigarette smokers groups respectively.

The present findings are conflicting to those of Baronchelli (Baronchelh, 1952)" and Minuth (Minuth, 1957)". who reported eosinopenia following cigarette smoking, on the other hand our result are similar to the findings of Shenwai M, Aundhakar M (Shenwai, 2012)", and Tell G.S. & Grimm RH et al (Grimm, 1985)"who described increased total leucocyte count in smokers who have started smoking in recent times (Grimm, 1985)". Marked leucocytosis has been reported by several other researchers even in subjects smokingless than 10 cigarettes per day (Whitehead, 1995)".

As a result of the our study illustrates that there is a continuous effect of smoking on total leucocyte count especially water pipe smokers .The lymphocytosis may be due to chronic tissue damage and inflammation produced by toxic smoke Products. This agrees with the findings of Silvermann NA et al that leucocytosis in smokers is essentially attributable to an increased lymphocyte count and as well of the 'T' lymphocytes (Silverman, 1974)". Chronic tissue damage may be a probable mechanism for the increased leucocyte count in water pipe smokers. Smoking (Tobacco Cigarette and waterpipe) have an irritation effect on the respiratory with resultant chronic inflammation. This probably explains the leukocytosis in smokers.

Table 4 ,5showed a statistically increase [p < 0.01] in the RBC and HGBin smokers groups when compared with that found in control group. The HCT[%] was significantly elevated [p < 0.05] in smokers groups when compared with that found in control group. Mean of platelets for smokers group was [267.18 * [10.sup.3] cell/ml] and for nonsmokers was [291.53 * [10.sup.3] cell/ml]. There was significantly low [p < 0.05] in smokers groups when compared with that found in control group. The present study didn't find any significant difference in MCV, MCH, MCHC, RDW and MPV between smokers group and nonsmokers group. The current result agreement with Whithead TD et al, hemoglobin levels and PCV increase significantly in smokers group more than 10 cigarettes per day (Whitehead, 1995)"., while other study though the mean values for all these parameters in smokers was found to be greater than nonsmokers, but the difference is not statistically significant (Shenwai, 2012)". Smoking is also considered as a major cause of polycythemia (Attchison, 1998)".

Table 5 demonstrates a significant increase in RBC,HGB and HCT[%] in water pipe smokers group (p < 0.01) when compared tonon-smokers group. As our knowledge no previous study referred to these results. Smoking is known cause of increase in hemoglobin (Hb) concentration, that is believed to be mediated by exposure of carbon monoxide. Carbon monoxide binds to Hb to form carboxyhemoglobin, an inactive form of hemoglobin having no oxygen carrying capacity. Carboxyhemoglobin also shifts the Hb dissociation curve in the left side, resulting in a reduction in ability of Hb to deliver oxygen to the tissue. To compensate the decreased oxygen delivering capacity, smokers maintain a higher hemoglobin level than non-smokers (4h) (Arthur, 2006)".

Iron, TIBC, UIBC, transferrin ([micro]g/dl) showed a significant increase (p < 0.01) and significant decrease in the mean of % Saturation of transferrin with iron level showed in water pipe smokers group when compared to cigarette smokers and non-smokers groups as shown in table 6.Unusual iron status can be certainly clarified by the sign of inflammation and the transfusions carried out. A possiblecause for this portent could be improved intestinal iron absorption caused by water pipe smoking--induced mucosal damage. Carbon monoxide has a higher distribution coefficient paralleled to oxygen and enzyme in the human body that generates carbon monoxide is hemeoxygenase which is found in all cells and breaks down heme (Dunn, 2001)". While carbon monoxide is not expressed it binds to hemoglobin, which is the principal oxygen-carrying compound in blood. The traditional belief is that carbon monoxide toxicity arises from the formation of carboxyhemoglobin, which decreases the oxygen-carrying ability of the blood and inhibits the transport, distribution, and use of oxygen by the body (Fan, 2009)".

Total iron-binding capacity (TIBC) is performed by drawing blood and measuring the maximum amount of iron that it can carry, which circuitously measures transferrin, since transferrin is the most dynamic carrier. Total iron-binding capacity is a measure of the maximum concentration of iron in serum bound to protein. Transferrin saturation is nothing but present of saturation value with iron (Yamanishi, 2003)". Another mechanism includes effects on the mitochondrial respiratory enzyme chain that is accountable for effective tissue consumption of oxygen. Carbon monoxide binds to cytochrome oxidase with less affinity than oxygen, so it is probable that it requires significant intracellular hypoxia before binding (Kalantar-Zaden, 2003)". As our knowledge no previous study referred to these result in water pipe smokers.

Table 7 shows a significant increase (p < 0.01) in serum hephaestin [ng/dl] in water pipe smokers and cigarette smokersgroups when compared tonon-smokers group. As our knowledge no previous study referred to these results.

The results in table 8 indicated high correlation between hephaestin with WBC * [10.sup.3] cell/ml, LYM [%], MID [%], S. Iron [[micro]g/dl], TIBC [[micro]g/dl], UIBC [[micro]g/dl], Transferrin [[micro]g/dl], in water pipe smokers and cigarette smokers groups while no significant correlation were found in non-smokers group.

Hepcidin, a circulating peptide hormone is essential in systemic iron regulation. It is produced by the liver is secreted into plasma, and cleared by the kidneys. Hepcidin controls iron levels by interacting directly with FPN1 in duodenal enterocytes, hepatocytes, and macrophages resulting in internalization and degradation of FPN1 (Nemeth, 2005)". This blocks cellular iron export. When iron stores are high, hepcidin is formed in the liver and transported to intestine which effects in the blockage of iron delivery from the plasma via FPN1 degradation. Therefore, shedding of enterocytes results in iron loss. While iron stores are low, Hepcidin production is inhibited, enabling FPN1 to transmission iron from enterocytes to the plasma and therefore dietary iron distribution in the body (Nemeth, 2005)".


In summary, it can be concluded that water pipe smoking is associated with increased WBC counts and increased serum hephaestin, change of lymphocyte count and MID [%], TIBC and Transferrin contributes to the increased risk of infection and neoplasia in smokers. Thereforewater pipe smoking is considered as one of the major avoidable risk factors for cardiovascular diseases and death. Also, the risk of infection had increased in water pipe smoking more than cigarette smokers smoking. This fact is of immense importance for the young smokers who are else free from other predisposing factors like obesity, hypertension, diabetes etc.


Article history:

Received 4 September 2014

Received in revised form 24 November 2014

Accepted 8 December 2014

Available online 16 December 2014


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Atheer A. Mehde and Ahmed M. Salim

Department of Medical analysis, Health and Medical Technical College, Baghdad, Iraq

Corresponding Author: Atheer A. Mehde, Department of Medical analysis, Health and Medical Technical College, Baghdad, Iraq

Table 1: The mean and standard deviation of age [year] in
group A[water pipe smokers], group B [cigarette smokers],
and group C[nonsmokers]

                                   Smokers groups
                                                       Control group
                     Group A [n=30]   Group B[n=30]
                       Water pipe       Cigarette      Group C[n=30]
Characteristic          smokers          smokers        Non smokers

Age [year]           25.97 [+ or -]   28.03 [+ or -]   26.40 [+ or -]
Mean [+ or -] SD]         4.17             5.42             4.47

Table 2: The mean and standard deviation of WBC, LYM, MID and
GRA in smokers and nonsmoker groups

          Non -smokers group       Smokers groups
P          Mean [+ or -] SD       Mean [+ or -] SD      Characteristic

<0.05     4.91 [+ or -] 1.00     5.96 [+ or -] 1.35    WBC * [10.sup.3]

<0.05    29.61 [+ or -] 6.22    31.01 [+ or -] 7.71        LYM [%]

NS        9.31 [+ or -] 1.91    10.72 [+ or -] 3.84        MID [%]

NS       60.78 [+ or -] 7.02    63.14 [+ or -] 7.78        GRA [%]

Non-significant mean P>0.05

Table 3: The mean and standard deviation of WBC ,LYM ,MID
and GRA in group A[water pipe smokers],group B [cigarette
smokers], and group C[nonsmokers]

                                Smokers groups
                                                     Control group
                  group A [n=30]   group B[n=30]
Characteristic      Water pipe       Cigarette       Group C[n=30]
                     smokers          smokers         Non smokers

WBC * 103         5.99 [+ or -]    5.93 [+ or -]    4.91  [+ or -]
cell/ml Mean        1.13 (a,b)        1.40 (a)           1.00
[+ or -] SD

LYM [%] Mean      33.94 [+ or -]   29.98 [+ or -]   29.61 [+ or -]
[+ or -] SD         7.88 (a,b)          7.52             6.22

MID [%] Mean      12.36 [+ or -]   9.88 [+ or -]    9.31 [+ or -]
[+ or -] SD         4.69 (a,b)          1.54             1.91

GRA [%] Mean      63.14 [+ or -]   62.54 [+ or -]   60.78 [+ or -]
[+ or -] SD            7.78             8.09             7.02

Results were expressed as the mean [+ or -] SD.

(a) p<0.01 compared with control group.

(b) p<0.001 compared with group B

Table 4: The mean and standard deviation of RBC, HGB, HCT,
MCV, MCH, MCHC, RDW, platelets and MPV in smokers and
nonsmokers groups

           Nonsmokers group         Smokers groups
P          Mean [+ or -] SD        Mean [+ or -] SD      Characteristic

<0.01     5.14 [+ or -] 0.59      5.49 [+ or -] 0.34         RBC *

<0.01     14.47 [+ or -] 1.18     16.97 [+ or -] 1.22      HGB [g/dl]

<0.05     44.11 [+ or -] 3.30     47.07 [+ or -] 2.64        HCT[%]

NS        87.33 [+ or -] 6.82     89.23 [+ or -] 4.38       MCV [fL]

NS        30.31 [+ or -] 2.66     31.97 [+ or -] 1.65    MCH [pg/cell]

NS        35.08 [+ or -] 0.71     35.86 [+ or -] 1.08     MCHC [g/dl]

NS        13.07 [+ or -] 0.82     13.18 [+ or -] 0.76       RDW [%]

<0.05    291.53 [+ or -] 57.80   267.18 [+ or -] 54.52     Platelets

NS        7.97 [+ or -] 0.94      8.28 [+ or -] 0.62        MPV[fL]

Table 5: The mean and standard deviation of RBC, HGB, HCT,
MCV, MCH, MCHC, RDW, platelets and MPV in group A[water pipe
smokers],group B [cigarette smokers], and group

                                   Smokers groups
                                                         Control group
                    Group A [n=30]     Group B[n=30]
                      Water pipe         Cigarette       Group C[n=30]
Characteristic          smokers           smokers         Non smokers

RBC * [10.sup.6]     5.59 [+ or -]     5.34 [+ or -]     5.14 [+ or -]
cell/ml                0.29 (a)            0.36              0.59
Mean [+ or -] SD

HGB [g/dl]          17.39 [+ or -]    16.42 [+ or -]    14.47 [+ or -]
Mean [+ or -] SD       1.25 (a)            0.98              1.18

HCT[%]              49.64 [+ or -]    46.50 [+ or -]    41.11 [+ or -]
Mean [+ or -] SD       2.59 (a)            2.62              3.30

MCV [fL]            88.09 [+ or -]    90.39 [+ or -]    87.33 [+ or -]
Mean [+ or -] SD         3.00            5.29 (a)            6.82

MCH [pg/cell]       32.13 [+ or -]    31.80 [+ or -]    30.31 [+ or -]
Mean [+ or -] SD         1.45              1.84              2.66

MCHC [g/dl]         36.46 [+ or -]    35.26 [+ or -]    35.08 [+ or -]
Mean [+ or -] SD         1.09              0.64              0.71

RDW [%]             13.35 [+ or -]    13.01 [+ or -]    13.07 [+ or -]
Mean [+ or -] SD         0.78              0.71              0.82

Platelets           264.00 [+ or -]   270.37 [+ or -]   291.53 [+ or -]
[10.sup.3] cell/      48.35 (a),         60.74 (a)           57.80
ml Mean [+ or -]

MPV[fL]              8.23 [+ or -]     8.32 [+ or -]     7.97 [+ or -]
Mean [+ or -] SD         0.58              0.67              0.94

Results were expressed as the mean [+ or -] SD.

(a) p<0.01 compared with control group.

Table 6: The mean and standard deviation of serum iron ,
TIBC, UIBC, Transferrin and % Saturation of transferrin in
group A[water pipe smokers],group B [cigarette smokers], and
group C [nonsmokers].

                    Smokers groups
                    Group A [n=30]     Group B[n=30]     Control group
                      Water pipe         Cigarette       Group C[n=30]
Characteristic          smokers           smokers         Non smokers

S. Iron             112.57 [+ or -]   106.60 [+ or -]   105.27 [+ or -]
[[micro]g/dl]         15.03 (a,b)          13.85             10.63
Mean [+ or -] SD

TIBC                329.70 [+ or -]   311.67 [+ or -]   313.17 [+ or -]
[[micro]g/dl]         14.07 (a,b)          13.50             16.39
Mean [+ or -] SD

UIBC                224.07 [+ or -]   209.93 [+ or -]   210.47 [+ or -]
[[micro]g/dl]         18.21 (a,b)          15.40             19.30
Mean [+ or -] SD

Transferrin         230.80 [+ or -]   218.47 [+ or -]   220.97 [+ or -]
[pg/dl]               9.88 (a,b)           9.36              13.80
Mean [+ or -] SD

% Saturation        29.03 [+ or -]    32.37 [+ or -]    33.30 [+ or -]
of Transferrin        4.33 (a,b)           4.24              3.36
Mean [+ or -] SD

Results were expressed as the mean[+ or -]SD.

(a) p<0.01 compared with control group.

(b) p<0.01 compared with group B

Table 7: The mean and standard deviation of serum hephaestin
[ng/dl] in group A [water pipe smokers], group B [cigarette
smokers], and group C [nonsmokers].

                                  Smokers groups
                                                     Control group
                    Group A [n=30]   Group B[n=30]
                      Water pipe       Cigarette     Group C[n=30]
Characteristic         smokers          smokers       Non smokers

S. HEPH [ng/dl]     3.39 [+ or -]    2.89 [+ or -]   2.27 [+ or -]
Mean [+ or -] SD        1.01a          1.02 (a)          1.27

Results were expressed as the mean[+ or -]SD.
(a) p<0.01 compared with control group.

Table 8: Correlation between hephaestin [ng/dl] with serum
protein and several antioxidants in patients with ALL.

                              Hephaestin               Hephaestin
                              [ng/dl]                  [ng/dl]
Characteristic                Water pipe smokers       Cigarette
                              Group                    smokers Group

                     Pearson       Sig.       Pearson       Sig.
                   correlation  (2-tailed)  correlation  (2-tailed)

WBC* 103 cell/ml      0.89         0.01        0.81         0.01
LYM [%]               0.86         0.01        0.75         0.01
MID [%]               0.77         0.01        0.77         0.01
S. Iron [pg/dl]       0.75         0.01        0.68         0.01
TIBC [pg/dl]          0.86         0.01        0.80         0.01
UIBC [pg/dl]          0.80         0.01        0.74         0.01
Transferrin           0.83         0.01        0.77         0.01
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Author:Mehde, Atheer A.; Salim, Ahmed M.
Publication:Advances in Natural and Applied Sciences
Article Type:Report
Geographic Code:7IRAQ
Date:Mar 1, 2015
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