Description

Ferritin is principally important for regulating the body's iron metabolism, since it contains twenty-four light and heavy chains in various amounts in different tissues. It has a typical range of 10 to 200 ng/mL in men and 30 to 300 ng/mL in women. They transport iron to the tissue and operate as immunomodulators, signalling molecules, and inflammatory indicators. When the ferritin level surpasses 1000g/L, the patient is diagnosed with hyperferritinemia. To treat iron overload, iron chelators such as deferiprone, deferirox, and deferoxamine are now FDA authorised. High ferritin levels may be responsible for the COVID-19 inflammatory cascade and poor prognosis. Deferasirox, an iron chelator delivered orally at 20-40 mg once in a day, can help critically unwell patients. As well as 1000 mg of intravenous deferoxamine at first, followed by 500 mg every 4 to 12 hours. Iron chelation therapy for COVID-19 patients can be made more successful by combining it with monoclonal antibodies, antioxidants, corticosteroids, and lactoferrin. The studies investigated the antiviral and antifibrotic activities of iron chelators, suggesting iron depletion therapy as a possible novel therapeutic method for COVID-19. Iron is a key component of hemoproteins and is required for oxygen transport in the electron transport chain as well as hepatic metabolism in cytochrome oxidase. A proper physiologic iron level is critical for preventing abnormalities in oxygen transit, oxidative phosphorylation, and consequent metabolic disruptions. Because the fraction of serum ferritin is controlled by the intracellular iron pool, it is an excellent diagnostic marker for excess iron or deficiency. Hyperferritinaemia-cataract syndrome is frequently caused by high serum ferritin levels in the absence of an erythrogenic response. Macrophage Activation Syndrome (MAS), Adult-onset Still's Disease (AOSD), Catastrophic Antiphospholipid Syndrome (CAPS), and septic shock are the four primary immune-directed illnesses linked with elevated ferritin levels. Because these diseases have comparable laboratory, clinical, and treatment symptoms, hyperferritinemia is most likely a role in their genesis.

COVID-19, which is produced by SARS-CoV-2, has presented a major threat to humans worldwide. A blood ferritin content of more than 300g/L raised the probability of mortality in COVID-19 patients ninefold. These indicators are used to determine the degree of hyperferritinemia and its association to COVID-19. This syndrome is linked to a number of immune-mediated disorders due to its usual immunomodulatory qualities. Deferiprone, deferoxamine, and deferasirox are the most often utilised iron-chelating drugs in the treatment of hyperferritinemia. Iron chelators have been demonstrated to considerably improve iron chelation and ferritin catabolization while simultaneously lowering macrophage-derived cytotoxicity and boosting antioxidant capacity, which may be effective in treating COVID-19 organised pathology.

This study has been conducted to reduce COVID 19 mortality as well as understand their usefulness in hyperferritinemia therapy. The motivation of the study is to encourage doctors to consider iron chelation therapy as a treatment option for COVID-19 and its associated consequences. An iron chelation therapy regimen aiming at improving clinical outcomes in COVID-19 patients can speed scientific progress.

The iron held in serum ferritin is a biological form of iron that protects DNA, lipids, and proteins from the intrinsic toxicity of iron metal. Their responsibility is carrying out the functional lead in cancer, inflammatory illness, and brain disease. The shell has twenty four subunits of light [L] and heavy [H] chains and is formed like a spherical. 4,500 oxidised iron atoms are detected within its core hollow. Only the H subunit has ferroxidase activity. Many in vitro studies identified L-ferritin as a role in iron incorporation, while new study indicates that L-ferritin is not a factor in iron incorporation. Ferritin stimulates cell growth independently of iron availability. The percentage of L or H subunits changes according to cell type and biological condition, with the heart and kidneys having a high concentration of H-subunits and the liver having a high concentration of L-subunits. Cytokines influence ferritin production at all phases of gene expression, including cell division, expansion, inflammation, and integration. The remaining tissue receptors bind just the H-ferritin subunit, as opposed to those produced on hepatic cells, which bind both the L and H subunits. H-chain phagocytosis receptors were found on mucin domain TIM-2 and T-cell immunoglobulins in kidney, liver, and B and T lymphocyte cells during laboratory animal tests. Scara5 is a scavenger that may function on a range of substrates, preferentially L-ferritin, according to recent study.

Iron-overload diseases and symptoms caused by iron deficiency anaemia are important indicators of iron status that may be examined with a ferritin test. Hereditary hemochromatosis and transfusion overload are two specific examples. Blood routine testing, such as serum value tests, is usually indicated to confirm and treat certain disorders. Elevated iron levels may be suggestive of illnesses such as herediary hemophagocytic syndrome and Still's disease, in addition to uncommon inflammatory conditions. The usual range for women is 10-200 ng/mL, whereas the normal range for males is 30-300 ng/mL.

Conclusion

In the human body, iron and its storage molecule ferritin play a plausible pathogenic function. Several underlying etiological aspects of hyperferritinemia were identified, and chelators were offered as a treatment for excess iron. Iron chelating drugs such as Deferoxamine, Deferriprone, and Desferasirox assist to treat hyperferritinemia by removing excess iron from the body. Iron chelating medications were required alone or in combination with antioxidants, corticosteroids, and monoclonal antibodies to treat SARS-CoV-2 infection, which resulted in cytokine release syndrome and hyperferritinemia. Mucormycosis, one of COVID-19's secondary consequences, is extremely dependent on chelating medicines like Deferriprone for life. In the COVID-19 epidemic, this serves as a new treatment technique.