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 syndrome 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 the COVID-19 pandemic.

SARS-CoV-2感染的特征是无蛋白的临床表现，其范围从无症状患者到危及生命的状况。严重的COVID-19患者经常表现出严重的肺部受累，并出现嗜中性粒细胞增多，淋巴细胞减少和IL-6水平显着升高。高铁蛋白血症有过度旺盛的细胞因子释放，导致这样的想法，即COVID-19是高铁蛋白综合征症状的一部分。确实，在其他疾病中可能会发生很高水平的铁蛋白，包括吞噬细胞的淋巴组织细胞增生，巨噬细胞活化综合征，成年性斯蒂尔氏病，灾难性抗磷脂综合征和败血性休克。许多研究表明铁蛋白的免疫调节作用及其与死亡率和持续的炎症过程的关系。高含量的游离铁对组织有害，尤其是通过氧化还原损伤而导致纤维化。铁螯合代表了铁超负荷治疗的支柱。另外，已证明其具有抗病毒和抗纤维化活性。在本文中，我们分析了铁蛋白和铁在SARS-CoV-2感染期间的致病作用，并提出了铁耗竭疗法作为COVID-19大流行中的一种新型治疗方法。