Hyperferritinemia in patients with COVID-19: An opportunity for iron chelation?

Abstract

Studies from China on COVID-19 revealed that nonsurvivors had cytokine storm with high IL-6 and hyperferritinemia. Iron liberated from necrotic cells may catalyze free radical production and amplify lipid peroxidation causing membrane dysfunction and multiorgan failure. Consequently, iron chelators have been successfully utilized in various experimental and clinical models of cytokine storm and multiorgan damage, such as in ischemia-reperfusion injury, sepsis, and infections. Since viral replication may be influenced by iron accumulation, iron chelation has been proven beneficial in a variety of viral infections, such as HIV-1, hepatitis B virus, Mengovirus, Marburg hemorrhagic fever, Enterovirus 71, and West Nile virus. In this commentary, we elaborate on the idea of considering iron chelation as a therapeutic modality in patients with severe COVID-19 infection. For critically ill patients in the ICU, intravenous deferoxamine would provide sufficient and rapid iron chelation to ameliorate cytokine storm, whereas in less severe cases an oral chelator could prevent the development of excessive inflammatory response.

• Authors: Vassilios D Vlahakos, Katerina P Marathias, Nikolaos Arkadopoulos, Demetrios V Vlahakos
• Journal: Artificial organs (Artif Organs) Vol. 45 Issue 2 Pg. 163-167 (Feb 2021) ISSN: 1525-1594 [Electronic] United States
• PMID: 32882061 (Publication Type: Journal Article)
• Copyright: © 2020 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.

Chemical References

• Iron Chelating Agents
• Deferoxamine

Topics

• Administration, Oral
• COVID-19 (complications)
• Cytokine Release Syndrome (drug therapy, virology)
• Deferoxamine (therapeutic use)
• Humans
• Hyperferritinemia (drug therapy, virology)
• Infusions, Intravenous
• Iron Chelating Agents (therapeutic use)
• COVID-19 Drug Treatment