Iron plays a critical role in host-parasite interactions, and iron chelators have been demonstrated to serve as effective adjunct therapeutic agents against malaria. The effects of the parenteral iron chelator deferoxamine (DFO) on the growth of rat-derived Pneumocystis carinii were studied in a human fibroblast cell culture model and in two in vivo models of experimental infection. In addition, the effects of the investigational oral iron chelator CP20 and its 3-hydroxypyridin-4-one analogs CP51, CP94, and CP96 on the growth of P. carinii in vitro were assessed. DFO suppressed the growth of P. carinii in vitro in a dose-dependent manner, and daily injections of DFO markedly reduced the intensity of P. carinii infection in both mice and rats. Cell cultures treated with iron chelators that are administered orally to humans also showed substantial P. carinii growth inhibition. Reduction of P. carinii numbers after iron chelator therapy correlated with alterations in P. carinii morphology, as viewed by transmission electron microscopy. Since the use of current anti-P. carinii drugs is limited by toxicity or incomplete efficacy, or both, the role of iron chelation as adjunctive anti-P. carinii chemotherapy merits additional investigation.In the absence of specific antimicrobial prophylaxis, Pneumocystis carinii causes pneumonia in the majority of individuals infected with human immunodeficiency virus and remains an important pathogen in persons treated with immunosuppressive therapy for malignancy and after organ transplantation (6). The toxicity and the incomplete efficacy of the standard treatment regimens for P. carinii pneumonia have prompted the development of new or adjunctive modes of therapy (6, 27).The availability of iron plays a critical role in host-parasite interactions (13,28,29,41,42). Iron is required for the growth of nearly all forms of bacterial, fungal, protozoal, plant, and animal cells (43,44). Vertebrate animals have developed elaborate strategies to withhold growth-essential iron from microbial invaders while retaining their own access to the metal (41,42,45). It has been suggested, therefore, that manipulation of iron availability be exploited as a therapeutic tool (13,41,42). In fact, several iron chelators, among them deferoxamine (DFO), demonstrate antimalarial activity in cell culture and animal models (14,33,47,48), and recently, iron chelation with DFO has been shown to be an effective adjunct to traditional antimalarial therapy in asymptomatic parasitemic adults and children with cerebral malaria (16,19,40).Clarkson et al. (11) examined the effects of DFO on the progression of reactivated latent P. carinii pneumonia in rats and showed that DFO therapy reduces the lung cyst count in a dose-dependent manner. A subsequent preliminary study from the laboratory of Weinberg and Shaw (46) showed that DFO suppresses the growth of P. carinii in an established cell culture model at concentrations safely achievable in human serum. However, despite the efficacy and safety of DFO as a chelator, i...