Various pathologies are characterized by the accumulation of toxic iron in cell compartments. In anemia of chronic disease, iron is withheld by macrophages, leaving extracellular fluids iron-depleted. In Friedreich ataxia, iron levels rise in the mitochondria of excitable cells but decrease in the cytosol. We explored the possibility of using deferiprone, a membrane-permeant iron chelator in clinical use, to capture labile iron accumulated in specific organelles of cardiomyocytes and macrophages and convey it to other locations for physiologic reuse. Deferiprone's capacity for shuttling iron between cellular organelles was assessed with organelle-targeted fluorescent iron sensors in conjunction with time-lapse fluorescence microscopy imaging. Deferiprone facilitated transfer of iron from extracellular media into nuclei and mitochondria, from nuclei to mitochondria, from endosomes to nuclei, and from intracellular compartments to extracellular apotransferrin. Furthermore, it mobilized iron from iron-loaded cells and donated it to preerythroid cells for hemoglobin synthesis, both in the presence and in the absence of transferrin. These unique properties of deferiprone underlie mechanistically its capacity to alleviate iron accumulation in dentate nuclei of Friedreich ataxia patients and to donate tissuechelated iron to plasma transferrin in thalassemia intermedia patients. Deferiprone's shuttling properties could be exploited clinically for treating diseases involving regional iron accumulation.
IntroductionThe pathologic effects of iron accumulation in tissue are recognized in diseases of systemic iron overload, in which the liver, heart, and endocrine glands are the principal affected organs. 1 At the cellular level, labile iron begins to rise once the intracellular capacity for iron storage is surpassed, leading to catalytic formation of reactive oxygen species (ROS) that ultimately overwhelm the cellular antioxidant defense mechanisms and lead to cell damage. 2 In recent years, several pathologies have been shown to be associated with specific defects in cellular iron metabolism that do not give rise to conspicuous systemic iron overload. 3 In the neuromuscular disorder Friedreich ataxia, the deficiency of the iron-chaperone protein frataxin is thought to lead to mitochondrial iron accumulation due to improper processing of iron for heme and iron-sulfur-cluster formation. 4 In the group of neuromuscular disorders termed NBIA (neurodegeneration with brain iron accumulation), a deficiency in pantothenate kinase (PKAN-2), a key enzyme in coenzyme A synthesis, 5 leads to iron deposition and ensuing brain damage by still-unresolved mechanisms. 6 In hereditary X-linked sideroblastic anemia, impaired heme synthesis causes mitochondrial iron accumulation and siderosis in erythroid cells. 3 However, an extreme example of systemic misdistribution of iron is encountered in anemia of chronic disease (ACD), where iron accumulates in reticuloendothelial cells responsible for recycling aged erythrocytes, presumably due to d...