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 human 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. Unfortunately, the ideal chelator for treating iron overload in humans has not been identified yet. The aim of this review is to report the experience with desferrioxamine therapy in patients affected by beta-thalassemia major according to: bioavailability; mechanism of interactions with hepatocellular iron: release of iron chelates and their excretion, impact of iron chelation on survival in thalassemia patients and side effects of prolonged therapy. Problems related to the development of non-toxic oral iron chelators are also discussed, with particular emphasis on the preliminary data on usefulness and safety of deferiprone (L1), recently evaluated in different clinical trials. Iron chelating therapy has been introduced, in recent years, ec en in the therapy of disorders not characterized by iron overload. Here the following new therapeutic indications are discussed: adult respiratory distress syndrome, myocardial ischemia, cancer and malaria. (C) 1999 Elsevier Science S.A. All rights reserved.