Chelator-facilitated removal of iron from transferrin: relevance to combined chelation therapy.

Current iron chelation therapy consists primarily of DFO (desferrioxamine), which has to be administered via intravenous infusion, together with deferiprone and deferasirox, which are orally-active chelators. These chelators, although effective at decreasing the iron load, are associated with a number of side effects. Grady suggested that the combined administration of a smaller bidentate chelator and a larger hexadentate chelator, such as DFO, would result in greater iron removal than either chelator alone [Grady, Bardoukas and Giardina (1998) Blood 92, 16b]. This in turn could lead to a decrease in the chelator dose required. To test this hypothesis, the rate of iron transfer from a range of bidentate HPO (hydroxypyridin-4-one) chelators to DFO was monitored. Spectroscopic methods were utilized to monitor the decrease in the concentration of the Fe-HPO complex. Having established that the shuttling of iron from the bidentate chelator to DFO does occur under clinically relevant concentrations of chelator, studies were undertaken to evaluate whether this mechanism of transfer would apply to iron removal from transferrin. Again, the simultaneous presence of both a bidentate chelator and DFO was found to enhance the rate of iron chelation from transferrin at clinically relevant chelator levels. Deferiprone was found to be particularly effective at 'shuttling' iron from transferrin to DFO, probably as a result of its small size and relative low affinity for iron compared with other analogous HPO chelators.

The fenton activity of iron(III) in the presence of deferiprone.

Hydroxyl radical production from a range of clinically relevant iron chelators in the presence of hydrogen peroxide was measured using the deoxyribose oxidation assay. Hydroxyl radical production from an iron complex is dependent on whether the ligand is able to completely surround the iron, thereby preventing access of reductants to the coordinated iron cation. The partially coordinated [(deferiprone)(2)Fe(III)](+) complex is able to generate hydroxyl radicals in the presence of oxidants, whereas the fully coordinated [(deferiprone)(3)Fe(III)](0) complex is not. Hydroxyl radical production from iron(III)deferiprone complexes is dependent on the molar ratio of iron to deferiprone, which, in turn, affects the speciation of the complex. Mass spectrometry data have confirmed the presence of the [(deferiprone)(2)Fe(III)](+) complex in aqueous solution. Hydroxyl radical production from the [(deferiprone)(2)Fe(III)](+) complex is maximal in the presence of equimolar ascorbate and hydrogen peroxide and is abolished in the absence of hydrogen peroxide. Under biological conditions, any [(deferiprone)(2)Fe(III)](+) complex formed intracellularly will be rapidly reduced by ascorbate. The resulting unstable iron(II) complex will dissociate to hexa-aquo iron(II), a major component of the endogenous intracellular labile iron pool.