Dynamics of Pro- and Anti-Inflammatory Cytokines (IL-6 and IL-10) in Thalassemia Patients: Evaluating the IL-6/IL-10 Ratio as a Candidate Biomarker for Detecting Latent Toxoplasma gondii Co-Infection

Abstract

Thalassemia is a hereditary hemolytic anemia associated with profound chronic immune activation and heightened susceptibility to opportunistic infections, including latent Toxoplasma gondii. Although IL-6 and IL-10 are widely studied individually in thalassemia, their ratio as a composite immunological biomarker for detecting latent Toxoplasma co-infection has not been systematically explored. A cross-sectional comparative study enrolled 90 participants equally distributed across three groups: healthy controls (Normal, n = 30), thalassemia patients without co-infection (Thalassemia, n = 30), and thalassemia patients with confirmed T. gondii infection (Thala+Toxo, n = 30). Serum IL-6 and IL-10 were quantified by enzyme-linked immunosorbent assay (ELISA). Non-parametric group comparisons used the Kruskal–Wallis H test with Bonferroni-corrected Mann–Whitney U post-hoc tests (adjusted α = 0.017), and Spearman rank correlation assessed cytokine co-regulation. Both cytokines were markedly elevated in the thalassemia groups compared with healthy controls (p < 0.001). The IL-6/IL-10 ratio was 0.895 in controls, 0.488 in the thalassemia-only group, and 0.556 in co-infected patients, representing a 14% directional shift associated with Toxoplasma co-infection. Pairwise cytokine differences between the two thalassemia subgroups did not reach significance individually (IL-6: p = 0.167; IL-10: p = 1.000), yet the ratio exhibited a consistent directional trend. No significant IL-6–IL-10 co-regulation was observed within any group. The IL-6/IL-10 ratio may serve as a supplementary immunological biomarker for latent T. gondii co-infection in thalassemia patients, complementing conventional serological screening. Validation in larger longitudinal cohorts with receiver operating characteristic (ROC) analysis is warranted.