Iron chelating agents in clinical practice

The relevance of iron chelators in medicine has increased in recent years, Iron is essential for life but it is also potentially more toxic than other trace elements. This is due to the lack of effective means to protect huma n cells against iron overload and to the role of iron in the generation of free radicals. To protect patients from the consequences of iron toxicity, iron chelating agents have been introduced in clinical practice. Unfortunat ely, the ideal chelator for treating iron overload in humans has not been i dentified yet. The aim of this review is to report the experience with desf errioxamine therapy in patients affected by beta-thalassemia major accordin g to: bioavailability; mechanism of interactions with hepatocellular iron: release of iron chelates and their excretion, impact of iron chelation on s urvival in thalassemia patients and side effects of prolonged therapy. Prob lems related to the development of non-toxic oral iron chelators are also d iscussed, with particular emphasis on the preliminary data on usefulness an d safety of deferiprone (L1), recently evaluated in different clinical tria ls. Iron chelating therapy has been introduced, in recent years, ec en in t he therapy of disorders not characterized by iron overload. Here the follow ing new therapeutic indications are discussed: adult respiratory distress s yndrome, myocardial ischemia, cancer and malaria. (C) 1999 Elsevier Science S.A. All rights reserved.