Iron chelation therapy

Abstract

Iron overload is a pathological condition resulting from a congenital impairment of its regulation, increased intestinal iron absorption secondary to bone marrow erythroid hyperplasia, or a chronic transfusional regimen. In normal conditions, intracellular and systemic mechanisms contribute to maintaining iron balance. When this complex homeostatic mechanism fails, an iron overload could be present. Detecting an iron overload is not easy. The gold standard remains the liver biopsy, even if it is invasive and dangerous.Identifying iron using noninvasive techniques allowed a better understanding of the rate of iron overload in different organs, with a low risk for the patient. Estimating serum ferritin (mg/L) is the easiest and, consequently, the most employed diagnostic tool for assessing body iron stores, even if it could be a not specific method. The most common hematological causes of iron overload are myelodysplastic syndromes, sickle cell disease, and thalassemia. In all of these conditions, three drugs have been approved for the treatment of iron overload: deferiprone, deferoxamine, and deferasirox. These chelators have been demonstrated to help lower tissue iron levels and prevent iron overload complications, improving event-free survival (EFS). Nowadays, the decision to start chelation and which chelator to choose remains the joint decision of the clinician and patient.chelation therapy, iron metabolism, iron overload Novelty statementsConsidering the new diagnostic and therapeutic frontiers of iron chelation, we have conducted an accurate review of the literature to provide the clinician with indications for managing patients with iron accumulation. | INTRODUCTIONIron overload may result from a congenital impairment of regulation mechanisms, increased intestinal iron absorption (secondary to bone marrow erythroid hyperplasia), or a chronic transfusional regimen.A single unit of packed red cells, derived from 420 mL of whole blood, contains roughly 200 mg of iron. The transfusion regimens commonly employed, that is, in patients with thalassemia major or patients with myelodysplastic syndromes (MDS), deliver a total amount of 100-200 mL/kg of erythrocytes/year, leading to an annual iron burden of about 116-232 mg/kg. 1In hereditary iron overload, the primary treatment is represented by venesection. In contrast, iron-chelating therapy is the only Massimo Gentile and Ernesto Vigna contributed equally as senior authors.

FTH1 overexpression using a dCasRx translation enhancement system protects the kidney from calcium oxalate crystal-induced injury

“…Therefore, the single-vector dCasRx translation enhancement tool was selected for the following experiments. Additionally, deferoxamine (DFO), an iron chelator, can reduce iron accumulation to inhibit ferroptosis [ 28 ]. Following the addition of DFO (50 μM and 100 μM), the levels of Fe 2+ and MDA (Fig.…”

Clinical Significance of Serum Iron in the Diagnosis of Iron Deficiency Anemia in Patients from Local Population of Punjab-Lahore

“…23 Thus, in the presence of H2O2, this free nonheme iron can catalyse the Haber-Weiss reaction, producing a feryl moiety and a hydroxyl radical. 24 Erythrocyte lipids and membrane proteins are further harmed by it. 25 Comparable outcomes, too.…”

Myelodysplastic syndromes del(5q): Pathogenesis and its therapeutic implications

“…39,40 This anemic condition is associated with an impaired quality of life, increased hospitalization rate, adverse outcomes, and iron overload. [41][42][43][44] 1…”

“…The prevailing clinical manifestation reported in patients with MDS‐5q is macrocytic anemia, usually characterized by a lack of responsiveness to erythropoiesis‐stimulating agents (ESAs) 39,40 . This anemic condition is associated with an impaired quality of life, increased hospitalization rate, adverse outcomes, and iron overload 41–44 …”