Neurodegeneration with brain iron accumulation (NBIA)
is a group
of neurodegenerative diseases that are typically caused by a monogenetic
mutation, leading to development of disordered movement symptoms such
as dystonia, hyperreflexia, etc. Brain iron accumulation can be diagnosed
through MRI imaging and is hypothesized to be the cause of oxidative
stress, leading to the degeneration of brain tissue. There are four
main types of NBIA: pantothenate kinase-associated neurodegeneration
(PKAN), PLA2G6-associated neurodegeneration (PLAN), mitochondrial
membrane protein-associated neurodegeneration (MKAN), and beta-propeller
protein-associated neurodegeneration (BPAN). There are no causative
therapies for these diseases, but iron chelators have been shown to
have potential toward treating NBIA. Three chelators are investigated
in this Review: deferoxamine (DFO), desferasirox (DFS), and deferiprone
(DFP). DFO has been investigated to treat neurodegenerative diseases
such as Alzheimer’s disease (AD) and Parkinson’s disease
(PD); however, dose-related toxicity in these studies, as well as
in PKAN studies, have shown that the drug still requires more development
before it can be applied toward NBIA cases. Iron chelation therapies
other than the ones currently in clinical use have not yet reached
clinical studies, but they may possess characteristics that would
allow them to access the brain in ways that current chelators cannot.
Intranasal formulations are an attractive dosage form to study for
chelation therapy, as this method of delivery can bypass the blood-brain
barrier and access the CNS. Gene therapy differs from iron chelation
therapy as it is a causal treatment of the disease, whereas iron chelators
only target the disease progression of NBIA. Because the pathophysiology
of NBIA diseases is still unclear, future courses of action should
be focused on causative treatment; however, iron chelation therapy
is the current best course of action.