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

Vlahakos, Vassilios D; Marathias, Katerina P; Arkadopoulos, Nikolaos; Vlahakos, Demetrios V

Studies from China on Covid-19 revealed that non-survivors 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, Mengo virus, Marburg hemorrhagic fever, Enterovirus 71 and West Nile virus. In this commentary we elaborate on the idea of considering iron chelation, as therapeutic modality in patients with severe COVID-19 infection. For critically ill patients in 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.