Clinical Studies of Iron-Chelating Treatment in Malaria
Clinical studies have demonstrated that iron chelation therapy has acitivity against human malaria. Desferoxamine B clears parasitemia and symptoms in patients with uncomplicated falciparum and vivax malaria as a single agent, but recrudescence is common. In combination with quinine, desferrioxamine B enhances parasite clearance and speeds recovery from deep coma in children with cerebral malaria. At least two mechanisms have been proposed for the clinical activity of desferrioxamine B: (i) the inhibition of parasite growth by the withholding of iron and (ii) the protection of central nervous system tissue from free radical-mediated damage. Numerous in vitro studies have supported the first mechanism: the withholding of iron by iron chelators suppressed plasmodial growth in erythrocytes and hepatocytes. Studies of transferrin saturation in children with cerebral malaria have been consistent with the second mechanism. Prolonged coma was associated with abnormally high transferrin saturations, and the addition of iron chelation to the therapeutic regimen appeared to hasten recovery of full consciousness specifically in the children with high transferrin saturations.
KeywordsCerebral Malaria Iron Chelation Vivax Malaria Transferrin Saturation Deep Coma
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