Role of vitamin C as an adjuvant therapy to different iron chelators in young β‐thalassemia major patients: efficacy and safety in relation to tissue iron overload

Elalfy, Mohsen Saleh; Saber, Maha M.; Adly, Amira Abdel Moneam; Ismail, Eman Abdel Rahman; Tarif, Mohamed; Ibrahim, Fatma A. A.; Elalfy, Omar

doi:10.1111/ejh.12594

Cited by 34 publications

(22 citation statements)

References 57 publications

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“…Antioxidant cocktails improved anemia, iron overload, oxidative stress, and hypercoagulable state in β-thalassemia/HbE. In addition, the efficacy and safety of oral vitamin C supplementation as an adjuvant therapy to the three available iron chelators in moderately iron-overloaded pediatric patients with β-TM has been explored in a prospective study by Elalfy et al [76] and showed promising results. Thus, intervention studies using IMA/MDA as a primary outcome measure would provide additional information and prove our findings.…”

Section: Discussionmentioning

confidence: 99%

Ischemia-modified albumin as a marker of vascular dysfunction and subclinical atherosclerosis in β-thalassemia major

et al. 2017

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Background: Ischemia-modified albumin (IMA) is an altered type of serum albumin that forms under conditions of oxidative stress and an independent predictor of major adverse cardiovascular events. Objectives: To measure the levels of IMA in 45 children and adolescents with β-thalassemia major (β-TM) compared with 30 healthy controls and assess its relation to lipid peroxidation, vascular complications and subclinical atherosclerosis. Methods: β-TM patients without symptoms of heart disease were studied focusing on transfusion history, chelation therapy, serum ferritin, malondialdehyde (MDA) and IMA levels. Echocardiography was performed and carotid intima media thickness (CIMT) was assessed. Results: IMA and MDA levels were significantly higher in β-TM patients compared with controls (p < 0.001). IMA was higher among patients with heart disease, pulmonary hypertension risk and serum ferritin ≥2500 µg/l than those without. TM patients compliant to chelation had significantly lower IMA levels. IMA levels were positively correlated to MDA and CIMT while negatively correlated to ejection fraction and fractional shortening. Conclusion: Our results highlight the role of oxidative stress in the pathophysiology of vascular complications in thalassemia. IMA could be useful for screening of β-TM patients at risk of cardiopulmonary complications and atherosclerosis because its alteration occurs in early subclinical disease.

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Section: Discussionmentioning

confidence: 99%

Ischemia-modified albumin as a marker of vascular dysfunction and subclinical atherosclerosis in β-thalassemia major

et al. 2017

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“…In contrast to iron deficiency, ascorbic acid is considered as a standard adjuvant therapy, widely used with iron chelation therapy in thalassaemia patients for increasing iron excretion, especially in combination with deferoxamine [ 193 , 194 , 195 , 196 ]. In general, ascorbate status is considered a major factor determining the route and level of iron excretion, and many related studies have demonstrated substantial increases in iron excretion following administration of the combination [ 193 , 194 , 195 , 196 ]. In one study in thalassaemia patients, ascorbic acid therapy was invariably associated with increased iron excretion after subcutaneous deferoxamine ranging from 24% to 245% [ 194 ].…”

Section: The Role Of Ascorbic Acid In Iron Absorption and Iron Excmentioning

confidence: 99%

Trying to Solve the Puzzle of the Interaction of Ascorbic Acid and Iron: Redox, Chelation and Therapeutic Implications

et al. 2020

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Iron and ascorbic acid (vitamin C) are essential nutrients for the normal growth and development of humans, and their deficiency can result in serious diseases. Their interaction is of nutritional, physiological, pharmacological and toxicological interest, with major implications in health and disease. Millions of people are using pharmaceutical and nutraceutical preparations of these two nutrients, including ferrous ascorbate for the treatment of iron deficiency anaemia and ascorbate combination with deferoxamine for increasing iron excretion in iron overload. The main function and use of vitamin C is its antioxidant activity against reactive oxygen species, which are implicated in many diseases of free radical pathology, including biomolecular-, cellular- and tissue damage-related diseases, as well as cancer and ageing. Ascorbic acid and its metabolites, including the ascorbate anion and oxalate, have metal binding capacity and bind iron, copper and other metals. The biological roles of ascorbate as a vitamin are affected by metal complexation, in particular following binding with iron and copper. Ascorbate forms a complex with Fe3+ followed by reduction to Fe2+, which may potentiate free radical production. The biological and clinical activities of iron, ascorbate and the ascorbate–iron complex can also be affected by many nutrients and pharmaceutical preparations. Optimal therapeutic strategies of improved efficacy and lower toxicity could be designed for the use of ascorbate, iron and the iron–ascorbate complex in different clinical conditions based on their absorption, distribution, metabolism, excretion, toxicity (ADMET), pharmacokinetic, redox and other properties. Similar strategies could also be designed in relation to their interactions with food components and pharmaceuticals, as well as in relation to other aspects concerning personalized medicine.

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“…The results showed reduced serum ferritin, liver iron concentration and transferrin index, as well as an increase in hemoglobin level and cardiac MRI T2* in the vitamin C supplemented group. Interestingly, vitamin C combined with deferoxamine increased hemoglobin level, reduced serum ferritin and transferrin saturation compared with those receiving deferiprone or deferasirox with vitamin C [ 19 ]. Therefore, supplementing vitamin C might potentiate the efficacy of deferoxamine better than deferiprone and deferasirox to bind the iron and effectively reduce the iron overload, contributing to alteration of the immune system.…”

Section: Resultsmentioning

confidence: 99%

Vitamin and Mineral Supplementation for β-Thalassemia During COVID-19 Pandemic

et al. 2020

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Aim: Low levels of immune-related micronutrients have been identified in β-thalassemia samples. Moreover, the excess amount of iron, contributing to oxidative stress in the pathogenesis of the disease, alters the immune system in β-thalassemia, which is important during the COVID-19 pandemic. Materials & Methods: Searches of PUBMED and EMBASE were conducted to identify the level and supplementation of micronutrients in β-thalassemia, published from 2001-May 2020. Results: The review found six observational and five interventional studies supporting the importance of supplementing vitamins and minerals among patients with β-thalassemia. Conclusion: Supplementation of immune-related vitamins and minerals might bring benefits to the immune system, especially in reducing oxidative stress in β-thalassemia.

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Role of vitamin C as an adjuvant therapy to different iron chelators in young β‐thalassemia major patients: efficacy and safety in relation to tissue iron overload

Abstract: Vitamin C as an adjuvant therapy possibly potentiates the efficacy of DFO more than DFP and DFX in reducing iron burden in the moderately iron-overloaded vitamin C-deficient patients with β-TM, with no adverse events.

Cited by 34 publications

References 57 publications

Ischemia-modified albumin as a marker of vascular dysfunction and subclinical atherosclerosis in β-thalassemia major

Ischemia-modified albumin as a marker of vascular dysfunction and subclinical atherosclerosis in β-thalassemia major

Trying to Solve the Puzzle of the Interaction of Ascorbic Acid and Iron: Redox, Chelation and Therapeutic Implications

Vitamin and Mineral Supplementation for β-Thalassemia During COVID-19 Pandemic

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