COVID-19 as part of the hyperferritinemic syndromes: is there a role for
iron depletion therapy?
AbstractSARS-CoV-2 infection is characterized by a protean clinical picture that
can range from asymptomatic patients to life threatening conditions.
Severe COVID-19 patients often display a severe pulmonary involvement
and develop neutrophilia, lymphopenia, and strikingly elevated levels of
IL-6. There is an over-exuberant cytokine release with hyperferritinemia
leading to the idea that COVID-19 is part of the hyperferritinemic
syndromes spectrum. Indeed, very high levels of ferritin can occur in
other diseases including hemophagocytic lymphohistiocytosis, macrophage
activation syndrome, adult onset Still's disease, catastrophic
antiphospholipid syndrome and septic shock. Numerous studies have
demonstrated the immunomodulatory effects of ferritin and its
association with mortality and sustained inflammatory process. High
levels of free iron are harmful in tissues, especially through the redox
damage that can lead to fibrosis. Iron chelation represents a pillar in
the treatment of iron overload. In addition, it was proven to have an
anti-viral and anti-fibrotic activity. Herein, we analyse the pathogenic
role of ferritin and iron during SARS-CoV-2 infection and propose iron
depletion therapy as a novel therapeutic approach in COVID-19 pandemic.