Iron overload disorders such as hereditary hemochromatosis, thalassemia, and sickle cell disease can lead to severe complications if excess iron is allowed to accumulate in the body’s tissues and organs. Iron chelators are an important treatment option for preventing iron overload and reducing associated health risks. Here we review the mechanisms, benefits, and limitations of this therapeutic approach.
How Iron Chelators Work
Iron chelators bind to excess iron in the bloodstream and promote its excretion in urine and feces. Different chelators have varying affinities for iron and other metals. The goal is to reach an optimal balance between removing toxic iron levels while still allowing the body enough iron for essential functions.
Established and Emerging Iron Chelators
Deferoxamine, an injectable iron chelator, has been used clinically since the 1970s. Oral chelators deferasirox and deferiprone were more recently approved to improve adherence and quality of life. There is also interest in developing new chelators with improved selectivity, potency, and side effect profiles.
When used appropriately, iron chelators can reduce risks of liver disease, diabetes, cardiomyopathy and other complications of iron overload. Chelation therapy tailored to the individual can promote patient adherence and enable people with iron disorders to enjoy longer, healthier lives.
Limitations and Considerations
Iron chelators may cause mild side effects like nausea, abdominal pain and diarrhea. They can also deplete levels of beneficial metals like zinc. Patients on chelation therapy require ongoing blood monitoring. Some chelators carry warnings about organ impairment risks or failure to excrete iron. Choosing the right chelator and dosage is important.
While iron chelators are a cornerstone of managing iron overload, there are opportunities to enhance current approaches through new formulations, combination therapies, and better dosing strategies. As research continues, iron chelators will remain an indispensable tool for improving quality of life for those with chronic iron overload disorders.