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COVID-19 as part of the hyperferritinemic syndromes: is there a role for iron depletion therapy?
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  • Carlo Perricone,
  • Elena Bartoloni,
  • Roberto Bursi,
  • Giacomo Cafaro,
  • Giacomo Maria Guidelli,
  • Yehuda Shoenfeld,
  • Roberto Gerli
Carlo Perricone
University of Perugia
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Elena Bartoloni
University of Perugia
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Roberto Bursi
University of Perugia
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Giacomo Cafaro
University of Perugia
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Giacomo Maria Guidelli
Humanitas Research Hospital
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Yehuda Shoenfeld
Sheba Medical Center
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Roberto Gerli
University of Perugia
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Abstract

SARS-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.