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

• Published in: Artificial organs 2021-02, Vol.45 (2), p.163-167
• Main Authors: Vlahakos, Vassilios D., Marathias, Katerina P., Arkadopoulos, Nikolaos, Vlahakos, Demetrios V.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Chelating agents; Chelation; COVID-19; COVID-19 - complications; COVID-19 - drug therapy; Cytokine Release Syndrome - drug therapy; Cytokine Release Syndrome - virology; Cytokine storm; Cytokines; Deferoxamine; Deferoxamine - therapeutic use; Enteroviruses; Free radicals; Hemorrhage; Hemorrhagic fever; Hepatitis; Hepatitis B; HIV; Human immunodeficiency virus; Humans; Hyperferritinemia - drug therapy; Hyperferritinemia - virology; Infections; Inflammation; Inflammatory response; Infusions, Intravenous; Intravenous administration; Iron; Iron Chelating Agents - therapeutic use; iron chelation; Ischemia; Lipid peroxidation; Lipids; Peroxidation; Reperfusion; SARS‐CoV‐2; Sepsis; Storm damage; Vector-borne diseases; Viral diseases; Viral infections; West Nile virus
• ISSN: 0160-564X; 1525-1594
• DOI: 10.1111/aor.13812

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.