Deferiprone, sold under the brand name Ferriprox among others, is a medication that chelates iron and is used to treat iron overload in thalassaemia major. It was first approved and indicated for use in treating thalassaemia major in 1994 and had been licensed for use in the European Union for many years while awaiting approval in Canada and in the United States. On 14 October 2011, it was approved for use in the US under the FDA's accelerated approval program.
The most common side effects include red-brown urine (showing that iron is being removed through the urine), nausea (feeling sick), abdominal pain (stomach ache) and vomiting. Less common but more serious side effects are agranulocytosis (very low levels of granulocytes, a type of white blood cell) and neutropenia (low levels of neutrophils, a type of white blood cell that fights infections).
|
Read full article at Wikipedia
|
InChI=1S/C7H9NO2/c1-5-7(10)6(9)3-4-8(5)2/h3-4,10H,1-2H3 |
TZXKOCQBRNJULO-UHFFFAOYSA-N |
|
iron chelator
|
|
protective agent
Synthetic or natural substance which is given to prevent a disease or disorder or are used in the process of treating a disease or injury due to a poisonous agent.
|
|
View more via ChEBI Ontology
3-hydroxy-1,2-dimethylpyridin-4(1H)-one
|
1,2-Dimethyl-3-hydroxypyrid-4-one
|
ChemIDplus
|
3-Hydroxy-1,2-dimethyl-4(1H)-pyridone
|
ChemIDplus
|
1447108
|
Reaxys Registry Number
|
Reaxys
|
30652-11-0
|
CAS Registry Number
|
KEGG DRUG
|
30652-11-0
|
CAS Registry Number
|
ChemIDplus
|
Mohammadpour M, Behjati M, Sadeghi A, Fassihi A (2013) Wound healing by topical application of antioxidant iron chelators: kojic acid and deferiprone. International wound journal 10, 260-264 [PubMed:22621771] [show Abstract] Kojic acid and deferiprone are iron chelators used for skin lightening and iron-overload treatment, respectively. As iron chelation and free radical scavenging are principal factors for wound healing, it was hypothesised that the local application of these compounds might accelerate wound healing in rats. Ointments of 3%, 6% and 9% of deferiprone and kojic acid were prepared and topical treatment was performed on in vivo wound models for 12 days twice in day for test and control groups. Topical treatment with 3%, 6% and 9% showed significant improvement in wound healing after 4 days (P < 0·001). Topical application of 3% and 6% deferiprone enhanced wound healing after 8 days (P < 0·026 and P < 0·001, respectively). Accelerated wound healing was seen using 3% and 6% deferiprone after 12 days (P = 0·003 and P < 0·001, respectively). DPPH scavenging assay was also performed to compare the antioxidant potencies of kojic acid and deferiprone. Deferiprone had more free radical scavenging power than kojic acid. Generally, deferiprone topical treatment, accelerated wound healing more than kojic acid because of its higher antioxidant and iron chelation abilities. | Kolnagou A, Natsiopoulos K, Kleanthous M, Ioannou A, Kontoghiorghes GJ (2013) Liver iron and serum ferritin levels are misleading for estimating cardiac, pancreatic, splenic and total body iron load in thalassemia patients: factors influencing the heterogenic distribution of excess storage iron in organs as identified by MRI T2*. Toxicology mechanisms and methods 23, 48-56 [PubMed:22943064] [show Abstract] A comparative assessment of excess storage iron distribution in the liver, heart, spleen and pancreas of β-thalassemia major (β-ΤΜ) patients has been carried out using magnetic resonance imaging (MRI) relaxation times T2*. The β-ΤΜ patients (8-40 years, 11 males, 9 females) had variable serum ferritin levels (394-5603 μg/L) and were treated with deferoxamine (n = 10), deferiprone (n = 5) and deferoxamine/deferiprone combination (n = 5). MRI T2* assessment revealed that excess iron is not proportionally distributed among the organs but is stored at different concentrations in each organ and the distribution is different for each β-ΤΜ patient. There is random variation in the distribution of excess storage iron from normal to severe levels in each organ among the β-ΤΜ patients by comparison to the same organs of ten normal volunteers. The correlation of serum ferritin with T2* was for spleen (r = -0.81), liver (r = -0.63), pancreas (r = -0.33) and none with heart. Similar trend was observed in the correlation of liver T2* with the T2* of spleen (r = 0.62), pancreas (r = 0.61) and none with heart. These studies contradict previous assumptions that serum ferritin and liver iron concentration is proportional to the total body iron stores in β-ΤΜ and especially cardiac iron load. The random variation in the concentration of iron in the organs of β-ΤΜ patients appears to be related to the chelation protocol, organ function, genetic, dietary, pharmacological and other factors. Monitoring of the iron load for all the organs is recommended for each β-ΤΜ patient. | Rajapurkar MM, Hegde U, Bhattacharya A, Alam MG, Shah SV (2013) Effect of deferiprone, an oral iron chelator, in diabetic and non-diabetic glomerular disease. Toxicology mechanisms and methods 23, 5-10 [PubMed:22978744] [show Abstract] Compelling experimental evidence exists for the role of oxidants and iron in glomerular disease. In preliminary studies, we confirmed increased urinary catalytic iron in patients with glomerulonephritis and diabetic nephropathy. We conducted two separate single-center, prospective, single-armed, open-labeled, proof-of-concept studies to evaluate the safety and efficacy of an oral iron chelator in patients with glomerulonephritis and diabetic nephropathy. Study 1 comprised 15 patients with biopsy-proven glomerulonephritis who had persistent proteinuria despite treatment with steroids and/or cyclophosphamides. Study 2 comprised 38 adult patients with diabetic nephropathy. Patients in Study 1 were treated with deferiprone (50 mg/kg/day) in three divided doses for 6 months and Study 2 patients were treated for 9 months. In Study 1, two patients had severe gastrointestinal intolerance and withdrew from the study after one dose and are not included in the results. There was a significant reduction (47 ± 9% mean) in 24-h urinary protein (4.01 ± 1.61 to 2.21 ± 1.62 [p = 0.009]), with no significant changes in serum creatinine. In Study 2, treatment with deferiprone resulted in a marked, persistent drop in the mean albumin/creatinine ratio (187 ± 47 at baseline to 25 ± 7 mg/g, [p = 0.01]) and stable renal function over a 9-month period. No clinically significant adverse events were observed in either study. Although these are small, open-labeled, and non-randomized studies, our results suggest that future randomized, double-blind trials examining the utility of deferiprone to treat glomerular diseases appear warranted. | Maggio A, Vitrano A, Lucania G, Capra M, Cuccia L, Gagliardotto F, Pitrolo L, Prossomariti L, Filosa A, Caruso V, Gerardi C, Campisi S, Cianciulli P, Rizzo M, D'Ascola G, Ciancio A, Di Maggio R, Calvaruso G, Pantalone GR, Rigano P (2012) Long-term use of deferiprone significantly enhances left-ventricular ejection function in thalassemia major patients. American journal of hematology 87, 732-733 [PubMed:22622672] [show Abstract] A multicenter randomized open-label long-term sequential deferiprone–deferoxamine (DFP-DFO) versus DFP alone trial (sequential DFP-DFO) performed in patients with thalassemia major (TM) was retrospectively reanalyzed to assess the variation in the left ventricular ejection fraction (LVEF) [1]. | Cassinerio E, Roghi A, Pedrotti P, Brevi F, Zanaboni L, Graziadei G, Pattoneri P, Milazzo A, Cappellini MD (2012) Cardiac iron removal and functional cardiac improvement by different iron chelation regimens in thalassemia major patients. Annals of hematology 91, 1443-1449 [PubMed:22572843] [show Abstract] Heart failure due to myocardial iron overload remains the leading cause of morbidity and mortality in adult thalassemia major (TM) patients. We evaluated the removal of cardiac iron and the changes of cardiac function by different iron chelation in TM patients by T2* cardiac magnetic resonance (CMR). Sixty-seven TM patients (27 males/40 females; mean age, 35 ± 6 years) on different chelation regimens underwent T2* CMR at baseline (t (0)), after 6-14 months (t (1)) and after 32 ± 7 months (t (2)). Patients were divided in four groups according to chelation treatment: group A (deferasirox), group B (deferoxamine), group C (combined treatment, deferoxamine plus deferiprone) and group D (deferiprone alone). Myocardial T2* at t (0) was <10 ms in 8 patients, between 10 and 20 ms in 22 patients and ≥ 20 ms in 37 patients. Progressive changes in T2* were observed at t (1) and t (2). Ten patients (10/36, 27.8 %) in group A, three patients (3/15, 20 %) in group B and three patients (3/12, 25 %) in group C moved from an abnormal T2* to normal values. We observed an improvement of left ventricular ejection fraction and a reduction of end-systolic and end-diastolic left ventricular volumes only in patients in group A with baseline cardiac T2* between 10 and 20 ms. Rigorous compliance to any chelation therapy at proper doses significantly improve myocardial T2*. Treatment with deferasirox significantly improves left ventricular function. Combination therapy seems to ameliorate cardiac T2* in a shorter period of time in severe siderosis. | Thompson MG, Corey BW, Si Y, Craft DW, Zurawski DV (2012) Antibacterial activities of iron chelators against common nosocomial pathogens. Antimicrobial agents and chemotherapy 56, 5419-5421 [PubMed:22850524] [show Abstract] The activities of iron chelators (deferoxamine, deferiprone, Apo6619, and VK28) were evaluated against type strains of Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae, and Escherichia coli. Deferiprone, Apo6619, and VK28 each inhibited growth in standard and RPMI tissue culture medium, while deferoxamine had no effect. Additionally, time-kill assays revealed that VK28 had a bacteriostatic effect against S. aureus. Therefore, these newly developed iron chelators might provide a nontraditional approach for treatment of bacterial infections. | Song TS, Hsieh YW, Peng CT, Liu CH, Chen TL, Hour MJ (2012) Development of a fast LC-MS/MS assay for the determination of deferiprone in human plasma and application to pharmacokinetics. Biomedical chromatography : BMC 26, 1575-1581 [PubMed:22457166] [show Abstract] A fast and accurate liquid chromatography/tandem mass spectrometric (LC-MS/MS) assay was first developed and validated for the determination of deferiprone in human plasma. The analytes were extracted with acetonitrile from only 50 μL aliquots of human plasma to achieve the protein precipitation. After extraction, chromatographic separation of analytes in human plasma was performed using a Synergi Fusion-RP 80A column at 30 °C. The mobile phase consisted of methanol and 0.2% formic acid containing 0.2 mM EDTA (60:40, v/v). The flow rate of the mobile phase was 0.8 mL/min. The total run time for each sample analysis was 4 min. Detection was performed using electrospray ionization in positive ion multiple reaction monitoring mode by monitoring the precursor-to-parent ion transitions m/z 140.1 → 53.1 for deferiprone and m/z 143.1 → 98.1 for internal standard. A linear range was established from 0.1 to 20 µg/mL. The limit of detection was determined as 0.05 µg/mL. The validated method was estimated for linearity, recovery, stability, precision and accuracy. Intraday and interday precisions were 4.3-5.5 and 4.6-7.3%, respectively. The recovery of deferiprone was in the range of 80.1-86.8%. The method was successfully applied to a pharmacokinetic study of deferiprone in six thalassemia patients. | Puglisi A, Spencer J, Oliveri V, Vecchio G, Kong X, Clarke J, Milton J (2012) Synthesis, physicochemical properties and antioxidant activity of deferiprone-cyclodextrin conjugates and their iron(III) complexes. Dalton transactions (Cambridge, England : 2003) 41, 2877-2883 [PubMed:22130677] [show Abstract] 3-Hydroxy-1,2-dimethylpyridin-4(1H)-one (deferiprone) is a successful iron chelator, which has been widely investigated for its activity in mitigating iron overload and in protecting against oxidative stress due to Reactive Oxygen Species (ROS). Herein, we present the synthesis, characterisation, physicochemical properties and antioxidant activity of two novel bioconjugates of β-cyclodextrin bearing the deferiprone moiety either on the upper rim (1) or on the lower rim (2) of the cyclodextrin and their iron(III) complexes. Protonation and iron stability constants were measured by spectrophotometric titration for the two systems and antioxidant activity studied for both the ligands and the iron(III) complexes. | Song D, Song Y, Hadziahmetovic M, Zhong Y, Dunaief JL (2012) Systemic administration of the iron chelator deferiprone protects against light-induced photoreceptor degeneration in the mouse retina. Free radical biology & medicine 53, 64-71 [PubMed:22579919] [show Abstract] Oxidative stress plays a key role in a light-damage (LD) model of retinal degeneration as well as in age-related macular degeneration (AMD). Since iron can promote oxidative stress, the iron chelator deferiprone (DFP) was tested for protection against light-induced retinal degeneration. To accomplish this, A/J mice were treated with or without oral DFP and then were placed in constant bright white fluorescent light (10,000 lx) for 20 h. Retinas were evaluated at several time points after light exposure. Photoreceptor apoptosis was assessed using the TUNEL assay. Retinal degeneration was assessed by histology 10 days after exposure to damaging white light. Two genes upregulated by oxidative stress, heme oxygenase 1 (Hmox1) and ceruloplasmin (Cp), as well as complement component 3 (C3) were quantified by RT-qPCR. Cryosections were immunolabeled for an oxidative stress marker (nitrotyrosine), a microglial marker (Iba1), as well as both heavy (H) and light (L) ferritin. Light exposure resulted in substantial photoreceptor-specific cell death. Dosing with DFP protected photoreceptors, decreasing the numbers of TUNEL-positive photoreceptors and increasing the number of surviving photoreceptors. The retinal mRNA levels of oxidative stress-related genes and C3 were upregulated following light exposure and diminished by DFP treatment. Immunostaining for nitrotyrosine indicated that DFP reduced the nitrative stress caused by light exposure. Robust H/L-ferritin-containing microglial activation and migration to the outer retina occurred after light exposure and DFP treatment reduced microglial invasion. DFP is protective against light-induced retinal degeneration and has the potential to diminish oxidative stress in the retina. | Aydinok Y, Evans P, Manz CY, Porter JB (2012) Timed non-transferrin bound iron determinations probe the origin of chelatable iron pools during deferiprone regimens and predict chelation response. Haematologica 97, 835-841 [PubMed:22180427] [show Abstract]
BackgroundPlasma non-transferrin bound iron refers to heterogeneous plasma iron species, not bound to transferrin, which appear in conditions of iron overload and ineffective erythropoiesis. The clinical utility of non-transferrin bound iron in predicting complications from iron overload, or response to chelation therapy remains unproven. We undertook carefully timed measurements of non-transferrin bound iron to explore the origin of chelatable iron and to predict clinical response to deferiprone.Design and methodsNon-transferrin bound iron levels were determined at baseline and after 1 week of chelation in 32 patients with thalassemia major receiving deferiprone alone, desferrioxamine alone, or a combination of the two chelators. Samples were taken at baseline, following a 2-week washout without chelation, and after 1 week of chelation, this last sample being taken 10 hours after the previous evening dose of deferiprone and, in those receiving desferrioxamine, 24 hours after cessation of the overnight subcutaneous infusion. Absolute or relative non-transferrin bound iron levels were related to transfusional iron loading rates, liver iron concentration, 24-hour urine iron and response to chelation therapy over the subsequent year.ResultsChanges in non-transferrin bound iron at week 1 were correlated positively with baseline liver iron, and inversely with transfusional iron loading rates, with deferiprone-containing regimens but not with desferrioxamine monotherapy. Changes in week 1 non-transferrin bound iron were also directly proportional to the plasma concentration of deferiprone-iron complexes and correlated significantly with urine iron excretion and with changes in liver iron concentration over the next 12 months.ConclusionsThe widely used assay chosen for this study detects both endogenous non-transferrin bound iron and the iron complexes of deferiprone. The week 1 increments reflect chelatable iron derived both from liver stores and from red cell catabolism. These increments correlate with urinary iron excretion and the change in liver iron concentration over the subsequent year thus predicting response to deferiprone-containing chelation regimes. This clinical study was registered at clinical.trials.gov with the number NCT00350662. | Mirbehbahani N, Jahazi A, Rahim Abad HH (2012) The effect of combined therapy with deferoxamine and deferiprone on serum ferritin level of beta-thalassemic patients. Hematology (Amsterdam, Netherlands) 17, 183-186 [PubMed:22664119] [show Abstract]
ObjectiveTo determine the effect of combined therapy with deferoxamine and deferiprone on serum ferritin level of beta-thalassemic patients.Method and materialsThis controlled clinical trial was conducted on 26 major beta-thalassemic patients. Twelve patients in case group received deferiprone 75 mg/kg/day three times a day (TDS) orally with deferoxamine 30-50 mg/kg subcutaneously every other day. Fourteen patients in control group received deferoxamine 30-50 mg/kg/day subcutaneously for 6-12 hours/day and 5-6 days per week. Serum ferritin level was measured at the beginning and at the end of the third and the sixth months of study. Side effects of combined therapy were assessed. Data were analyzed by SPSS software v: 16.0 and t-Student and compared t-tests.ResultsThe mean of serum ferritin level in case group significantly decreased from 7539.8 ± 3434.9 µg/l at the beginning of study to 4848.7 ± 2706.2 µg/l (P < 0.001) and to 4338.3 ± 2308.8 µg/l (P < 0.001) at the end of the third and the sixth months of study, respectively. The mean of serum ferritin level in control group insignificantly increased from 5668 ± 3613.8 to 6210.8 ± 3940.9 µg/l and to 5742 ± 3205.9 µg/l at the end of the third and the sixth months of study, respectively. The common side effects of combined therapy were nausea (8.3%) and arthropathy (8.3%). A mild transient neutropenia and liver enzymes elevation happened in four patients of case group.ConclusionCombined therapy with deferoxamine and deferiprone significantly decreases serum ferritin level. It has little side effect and is suggested for major beta-thalassemic patients as a suitable therapy. | Šebestík J, Safařík M, Bouř P (2012) Ferric complexes of 3-hydroxy-4-pyridinones characterized by density functional theory and Raman and UV-vis spectroscopies. Inorganic chemistry 51, 4473-4481 [PubMed:22468647] [show Abstract] Deferiprone and other 3-hydroxy-4-pyridinones are used in metal chelation therapy of iron overload. To investigate the structure and stability of these compounds in the natural aqueous environment, ferric complexes of deferiprone and amino acid maltol conjugates were synthesized and studied by computational and optical spectroscopic methods. The complexation caused characteristic intensity changes, a 300× overall enhancement of the Raman spectrum, and minor changes in UV-vis absorption. The spectra were interpreted on the basis of density functional theory (DFT) calculations. The CAM-B3LYP and ωB97XD functionals with CPCM solvent model were found to be the most suitable for simulations of the UV-vis spectra, whereas B3LYP, B3LYPD, B3PW91, M05-2X, M06, LC-BLYP, ωB97XD, and CAM-B3LYP functionals were all useful for simulation of the Raman scattering. Characteristic Raman band frequencies for 3-hydroxy-4-pyridinones were assigned to molecular vibrations. The computed conformer energies consistently suggest the presence of another isomer of the deferiprone-ferric complex in solution, in addition to that found previously by X-ray crystallography. However, the UV-vis and Raman spectra of the two species are similar and could not be resolved. In comparison to UV-vis, the Raman spectra and their combination with calculations appear more promising for future studies of iron sequestrating drugs and artificial metalloproteins as they are more sensitive to structural details. | Prasanthi JR, Schrag M, Dasari B, Marwarha G, Dickson A, Kirsch WM, Ghribi O (2012) Deferiprone reduces amyloid-β and tau phosphorylation levels but not reactive oxygen species generation in hippocampus of rabbits fed a cholesterol-enriched diet. Journal of Alzheimer's disease : JAD 30, 167-182 [PubMed:22406440] [show Abstract] Accumulation of amyloid-β (Aβ) peptide and the hyperphosphorylation of tau protein are major hallmarks of Alzheimer's disease (AD). The causes of AD are not well known but a number of environmental and dietary factors are suggested to increase the risk of developing AD. Additionally, altered metabolism of iron may have a role in the pathogenesis of AD. We have previously demonstrated that cholesterol-enriched diet causes AD-like pathology with iron deposition in rabbit brain. However, the extent to which chelation of iron protects against this pathology has not been determined. In this study, we administered the iron chelator deferiprone in drinking water to rabbits fed with a 2% cholesterol diet for 12 weeks. We found that deferiprone (both at 10 and 50 mg/kg/day) significantly decreased levels of Aβ40 and Aβ42 as well as BACE1, the enzyme that initiates cleavage of amyloid-β protein precursor to yield Aβ. Deferiprone also reduced the cholesterol diet-induced increase in phosphorylation of tau but failed to reduce reactive oxygen species generation. While deferiprone treatment was not associated with any change in brain iron levels, it was associated with a significant reduction in plasma iron and cholesterol levels. These results demonstrate that deferiprone confers important protection against hypercholesterolemia-induced AD pathology but the mechanism(s) may involve reduction in plasma iron and cholesterol levels rather than chelation of brain iron. We propose that adding an antioxidant therapy to deferiprone may be necessary to fully protect against cholesterol-enriched diet-induced AD-like pathology. | Alpendurada F, Smith GC, Carpenter JP, Nair SV, Tanner MA, Banya W, Dessi C, Galanello R, Walker JM, Pennell DJ (2012) Effects of combined deferiprone with deferoxamine on right ventricular function in thalassaemia major. Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance 14, 8 [PubMed:22277065] [show Abstract]
BackgroundCombination therapy with deferoxamine and oral deferiprone is superior to deferoxamine alone in removing cardiac iron and improving left ventricular ejection fraction (LVEF). The right ventricle (RV) is also affected by the toxic effects of iron and may cause additional cardiovascular perturbation. We assessed the effects of combination therapy on the RV in thalassaemia major (TM) using cardiovascular magnetic resonance (CMR).MethodsWe retrieved imaging data from 2 treatment trials and re-analyzed the data for the RV responses: Trial 1 was a randomized controlled trial (RCT) of 65 TM patients with mild-moderate cardiac siderosis receiving combination therapy or deferoxamine with placebo; Trial 2 was an open label longitudinal trial assessing combination therapy in 15 TM patients with severe iron loading.ResultsIn the RCT, combination therapy with deferoxamine and deferiprone was superior to deferoxamine alone for improving RVEF (3.6 vs 0.7%, p = 0.02). The increase in RVEF was greater with lower baseline T2* 8-12 ms (4.7 vs 0.5%, p = 0.01) than with T2* 12-20 ms (2.2 vs 0.8%, p = 0.47). In patients with severe cardiac siderosis, substantial improvement in RVEF was seen with open-label combination therapy (10.5% ± 5.6%, p < 0.01).ConclusionsIn the RCT of mild to moderate cardiac iron loading, combination treatment improved RV function significantly more than deferoxamine alone. Combination treatment also improved RV function in severe cardiac siderosis. Therefore adding deferiprone to deferoxamine has beneficial effects on both RV and LV function in TM patients with cardiac siderosis. | Sandmeier P, Clauss M, Donati OF, Chiers K, Kienzle E, Hatt JM (2012) Use of deferiprone for the treatment of hepatic iron storage disease in three hornbills. Journal of the American Veterinary Medical Association 240, 75-81 [PubMed:22171759] [show Abstract]
Case description3 hornbills (2 Papua hornbills [Aceros plicatus] and 1 longtailed hornbill [Tockus albocristatus]) were evaluated because of general listlessness and loss of feather glossiness.Clinical findingsBecause hepatic iron storage disease was suspected, liver biopsy was performed and formalin-fixed liver samples were submitted for histologic examination and quantitative image analysis (QIA). Additional frozen liver samples were submitted for chemical analysis. Birds also underwent magnetic resonance imaging (MRI) under general anesthesia for noninvasive measurement of liver iron content. Serum biochemical analysis and analysis of feed were also performed. Results of diagnostic testing indicated that all 3 hornbills were affected with hepatic iron storage disease.Treatment and outcomeThe iron chelator deferiprone was administered (75 mg/kg [34.1 mg/lb], PO, once daily for 90 days). During the treatment period, liver biopsy samples were obtained at regular intervals for QIA and chemical analysis of the liver iron content and follow-up MRI was performed. In all 3 hornbills, a rapid and large decrease in liver iron content was observed. All 3 methods for quantifying the liver iron content were able to verify the decrease in liver iron content.Clinical relevanceOrally administered deferiprone was found to effectively reduce the liver iron content in these 3 hornbills with iron storage disease. All 3 methods used to monitor the liver iron content (QIA, chemical analysis of liver biopsy samples, and MRI) had similar results, indicating that all of these methods should be considered for the diagnosis of iron storage disease and monitoring of liver iron content during treatment. | Flaten TP, Aaseth J, Andersen O, Kontoghiorghes GJ (2012) Iron mobilization using chelation and phlebotomy. Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements (GMS) 26, 127-130 [PubMed:22565013] [show Abstract] Knowledge of the basic mechanisms involved in iron metabolism has increased greatly in recent years, improving our ability to deal with the huge global public health problems of iron deficiency and overload. Several million people worldwide suffer iron overload with serious clinical implications. Iron overload has many different causes, both genetic and environmental. The two most common iron overload disorders are hereditary haemochromatosis and transfusional siderosis, which occurs in thalassaemias and other refractory anaemias. The two most important treatment options for iron overload are phlebotomy and chelation. Phlebotomy is the initial treatment of choice in haemochromatosis, while chelation is a mainstay in the treatment of transfusional siderosis. The classical iron chelator is deferoxamine (Desferal), but due to poor gastrointestinal absorption it has to be administered intravenously or subcutaneously, mostly on a daily basis. Thus, there is an obvious need to find and develop new effective iron chelators for oral use. In later years, particularly two such oral iron chelators have shown promise and have been approved for clinical use, namely deferiprone (Ferriprox) and deferasirox (Exjade). Combined subcutaneous (deferoxamine) and oral (deferiprone) treatment seems to hold particular promise. | Manzoori JL, Amjadi M, Soleymani J, Tamizi E, Rezamand A, Jouyban A (2012) Determination of deferiprone in urine and serum using a terbium-sensitized luminescence method. Luminescence : the journal of biological and chemical luminescence 27, 268-273 [PubMed:21853518] [show Abstract] Optimized conditions, validation and practical applications of a new, rapid and specific fluorometric method for the determination of deferiprone (DFP) in urine and serum samples are reported. The proposed method, which is based on the formation of a luminescent complex with Tb(3+) ion, is evaluated in terms of linearity, accuracy, precision, stability, recovery and limits of detection (LOD) and quantification (LOQ). Under optimum conditions (pH 7.5, [Tb(3+)] = 3 × 10(-4) mol/L, temperature 0 °C and excitation wavelength 295 nm), the relative intensities at 545 nm are linear, with the concentration of DFP in the range 0.072-13 mmol/L for urine and serum samples. The LOD and LOQ, respectively, are calculated to be 0.014 and 0.045 mmol/L for urine and 0.022 and 0.072 mmol/L for serum samples. The intra-day and inter-day values for the precision and accuracy of the proposed method are all < 5%, and the recovery of the method is in the range 97.1-103.8%. The method was applied to human urine and serum samples collected from patients receiving DFP. The results indicated that the method can be successfully applied to the determination of DFP in human urine and serum samples collected for clinical or biopharmaceutical investigations in which simple, rapid, cheap and specific determination methods facilitate and speed up the analytical procedure. | Prakash A, Aggarwal R (2012) Thalassemia Major in Adults: Short Stature, Hyperpigmentation, Inadequate Chelation, and Transfusion-Transmitted Infections are Key Features. North American journal of medical sciences 4, 141-144 [PubMed:22454828] [show Abstract]
BackgroundEffective transfusion and chelation have prolonged the quality and longevity of life in thalassemics, who now survive into adulthood. Hence, adult physicians need to be aware of their clinical and laboratory profile and the problems faced by them.AimThe present study was aimed to evaluate the clinical profile of adult thalassemics.Materials and methodsAdult (>18 years) thalassemia major patients (n=19) were evaluated clinically and fasting pretransfusion blood samples were analyzed for complete blood counts, kidney and liver function tests, plasma glucose, serum ferritin, and thyroid hormone levels.ResultsAverage age was 21.65±2.47 years (range 19-28 years), 42.1% had Body mass index (BMI) <18.5. Splenectomy had been performed in 47.4% before reaching adulthood, males significantly outnumbered females (72% vs. 12.5%). Hemoglobin levels <8 g/dl were observed in 31.6% and none had serum ferritin levels in the recommended range suggesting inadequacy of both transfusion and chelation. Indirect hyperbilirubinemia was observed in 21.1% patients although kidney functions, serum protein, and albumin were normal in all patients. Electrocardiographic abnormalities, diabetes mellitus or hypothyroidism were absent. Five patients (26.3%) had contracted transfusion-transmitted viral infections - 21.1% and 5.3% respectively had antibodies to hepatitis C virus and HIV, while 5.3% were positive for Australia antigen. All patients were receiving chelation therapy - deferiprone alone (78.9%) or along with desferrioxamine (21.1%). Average dose of deferiprone being used was 95±8 mg/kg.ConclusionAdult thalassemia major patients present with a distinct clinical profile having low BMI, generalized hyperpigmentation, most are splenectomized, have low hemoglobin, inadequate chelation and harbor transfusion-transmitted infections. Adult physician needs to be aware of this profile. | Abbas M, Nawaz R, Iqbal T, Alim M, Asi MR (2012) Quantitative determination of deferiprone in human plasma by reverse phase high performance liquid chromatography and its application to pharmacokinetic study. Pakistan journal of pharmaceutical sciences 25, 343-348 [PubMed:22459459] [show Abstract] Deferiprone (1, 2 dimethyl-3-hydroxypyrid-4-one) is considered to be the standard iron chelator. Pharmacokinetic studies of generic formulations are required in local condition before placed on the market. High performance liquid chromatographic (HPLC) method was used for quantification of deferiprone in human plasma using UV/VIS detector. Chromatographic separation was carried out on C(18) column, with a mobile phase of methanol-buffer (18:82, v/v), pH 3.5, and caffeine was used as an internal standard. The calibration curve was linear over the range 0.25-10 μg/mL in human plasma (R(2) = 0.9994). After oral administration of deferiprone (500 mg) to human, the plasma concentration-time curve of deferiprone was conformed to two-compartment open model. The deferiprone plasma concentration showed a rapid absorption and average area under the plasma concentration-time curve (AUC) of deferiprone was 17.0 ± 1.23 h.μg/ml. Average absorption and elimination half-life values of deferiprone of 24 volunteers were 0.62 ± 0.12 and 2.65 ± 0.43 hours. This study confirms the rapid absorption of deferiprone in humans. AUC was similar to that previously reported but C(max) was slightly lower than that stated in the literature. | Rodrat S, Yamanont P, Tankanitlert J, Chantraraksri U, Fucharoen S, Morales NP (2012) Comparison of pharmacokinetics and urinary iron excretion of two single doses of deferiprone in β-thalassemia/hemoglobin E patients. Pharmacology 90, 88-94 [PubMed:22759897] [show Abstract] Dose-related pharmacokinetics and urinary iron excretion (UIE) of an orally active iron chelator, deferiprone (L1), was investigated in 12 severe β-thalassemia/hemoglobin E patients. The patients received two single doses of 25 and 50 mg/kg with a 2-week washout period. Deferiprone was rapidly absorbed and reached maximum concentration (C(max)) within 1 h after administration. Pharmacokinetic parameters including C(max) and area under concentration time curve from time zero to infinity (AUC(0-∞)) as well as urinary excretion of non-conjugated and glucuronide-conjugated deferiprone (L1 and L1-G) increased proportionally with the dose of deferiprone. A constant ratio of AUC(0-∞) of L1-G to L1 and a percentage of urinary excretion of L1-G indicated that increasing the dosage does not influence deferiprone biotransformation. Longer terminal elimination half-lifeand higher volume of distribution of L1 were observed with the high dose and correlated with deferiprone-chelated iron in serum. Unexpectedly, UIE did not show a linear relationship with the increased dose of deferiprone. The correlation between UIE and creatinine clearance suggested the possibility of L1-iron complex redistribution in patients with renal impairment treated with high-dose deferiprone. | Levy M, Llinas R (2012) Pilot safety trial of deferiprone in 10 subjects with superficial siderosis. Stroke 43, 120-124 [PubMed:22034002] [show Abstract]
Background and purposeSuperficial siderosis is a neurodegenerative disease caused by toxic accumulation of hemosiderin on the surface of the brain and spinal cord for which there is no known effective treatment.MethodsOral deferiprone, a lipid-soluble iron chelator with ability to cross the blood-brain barrier, at a dose of 30 mg/kg per day was tested for safety in an open pilot study in 10 subjects with superficial siderosis.ResultsOver a 90-day period, deferiprone had no significant adverse effects on hematologic, liver, or neurological function. Ad hoc MRI assessments of the brain indicated a reduction in hemosiderin deposition in some subjects.ConclusionsDeferiprone proved safe in this small population of superficial siderosis subjects. There was MRI evidence of reduced hemosiderin deposition with deferiprone. Prospectively designed efficacy studies are necessary to determine the clinical efficacy of deferiprone in superficial siderosis. | (2012) Deferiprone (Ferriprox) for iron overload. The Medical letter on drugs and therapeutics 54, 15-16 [PubMed:22354281] | Saljooghi AS (2012) Chelation of aluminum by combining deferasirox and deferiprone in rats. Toxicology and industrial health 28, 740-745 [PubMed:22025507] [show Abstract] The hypothesis that two known chelators deferasirox and deferiprone (L1) might be more efficient as combined treatment than as single therapies in removing aluminum from the body was tested in a new acute rat model. Seven-week-old male Wistar rats received chelators: deferasirox (orally [p.o.]), L1 (p.o.) or deferasirox + L1 as 100 or 200 mg/kg dose half an hour after a single intraperitoneal administration of 6 mg Al/kg body weight in the form of chloride. Serum aluminum concentration, urinary aluminum and iron excretions were determined by graphite furnace atomic absorption spectrometry. Both chelators were effective only at the higher dose level. While deferasirox was more effective than L1 in enhancing urinary aluminum excretion, L1 was more effective than deferasirox in enhancing urinary iron excretion. In the combined treatment group, deferasirox did not increase the L1 effect on aluminum and L1 did not increase the effect of deferasirox on iron elimination. Our results support the usefulness of this animal model for preliminary in vivo testing of aluminum chelators. Urinary values were more useful due to the high variability of serum results. |
|