Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027947 (neutropenia)
 17,527 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Deficiency symptoms of trace elements developed in patients receiving long-term total parenteral nutrition (TPN) are as follows. [Zinc deficiency]: moist eczematoid dermatitis and alopetia are occurred in patients receiving TPN which not containing zinc. Plasma zinc level was very low. The response to intravenous zinc therapy is striking. [Copper deficiency]: anemie and neutropenia caused in patients receiving TPN which not containing copper. These abnormalities disappeared after copper therapy. [Manganese deficiency]: bone changes which thought to be due to manganese deficiency was observed in patient receiving TPN. [Selenium deficiency]: dilated cardiomyopathy resembles to Keshan disease was occurred in patients receiving TPN for long term. [Chromium deficiency]: TPN induced chromium deficiency developed characterized by peripheral neuropathy and glucose intolerance. [Molybudenum deficiency]: Amino acid intolerance due to molybudenum deficiency is occurred in patients receiving TPN. Requirement of trace elements for human adults from TPN estimated as follows. zinc: 3-4 mg/day, copper: 0.02-0.05 mg/day, iron: 1-2 mg/day, manganese: 0.15-0.80 mg/day, selenium: 0.02-0.05 mg/day, chromium: 0.01-0.015 mg/day, molybudenum: 0.075-0.250 mg/day and iodine: 0.070-0.140 mg/day.
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PMID:[Trace elements in long-term total parenteral nutrition]. 858 86

Evaluation of new chelators for clinical use is limited by the availability of models which will predict the therapeutic safety margin of chelators in iron-overloaded humans such as those with thalassaemia major. Animal models show significant differences with respect to the relative toxicity of different chelators compared with human. These differences can be ascribed to several factors: differences in iron metabolism between different species, human metabolism being significantly more conservative than in rodents or nonhuman primates; differences in drug metabolism between different species which are often difficult to predict from first principles, and difficulties in obtaining iron-overloaded models that are truly representative of transfusional iron overload clinically. These differences have been highlighted by clinical studies on hydroxypyridinone iron chelators such as 1,2-dimethyl-3-hydroxypyridin-4-one (L1, CP20, deferiprone) and 1,2-diethyl-3-hydroxypyridin-4-one (CP94). New tissue culture approaches towards understanding the mechanisms of neutropenia, cytostasis and apoptosis induced by chelators as well as the relative rates of inhibition of non-haem-iron-containing enzymes such as ribonucleotide reductase are predicted to identify chelators with a higher therapeutic safety margin.
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PMID:Evaluation of new iron chelators for clinical use. 860 83

Animal and human studies have shown that copper is involved in the function of several enzymes. Studies have also shown that copper is required for infant growth, host defense mechanisms, bone strength, red and white cell maturation, iron transport, cholesterol and glucose metabolism, myocardial contractility, and brain development. Copper deficiency can result in the expression of an inherited defect such as Menkes syndrome or in an acquired condition. Acquired deficiency is mainly a pathology of infants; however, it has been diagnosed also in children and adults. Most cases of copper deficiency have been described in malnourished children. The most constant clinical manifestations of acquired copper deficiency are anemia, neutropenia, and bone abnormalities. Other, less frequent manifestations are hypopigmentation of the hair, hypotonia, impaired growth, increased incidence of infections, alterations of phagocytic capacity of the neutrophils, abnormalities of cholesterol and glucose metabolism, and cardiovascular alterations. Measurements of serum copper and ceruloplasmin concentrations are currently used to evaluate copper status. These indexes are diminished in severe to moderate copper deficiency; however, they are less sensitive to marginal copper deficiency. Erythrocyte superoxide dismutase and platelet cytochrome c activities may be more promising indexes for evaluating marginal copper deficiency.
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PMID:Copper as an essential nutrient. 861 66

Renal allograft recipients are prone to opportunistic infections due to their need of immunosuppression to prevent rejection. Mucormycosis is a rare opportunistic infection caused by a fungi of the order Mucorales. Risk factors predisposing to this disease include prolonged neutropenia, chelation therapy for iron or aluminum overdose, diabetes, and patients who are immunosuppressed. Life-threatening infections can occur, as this fungi has the propensity to invade blood vessel endothelium, resulting in hematologic dissemination. Early diagnosis and prompt aggressive therapy is imperative to achieve an improved outcome. We present two cases of pulmonary mucormycosis in diabetic renal allograft recipients who were treated successfully with amphotericin B and surgical resection of the lesions with preservation of their allograft function. In this era of intensified immunosuppression, we may see an increased incidence of mucormycosis in our transplant population.
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PMID:Pulmonary mucormycosis in diabetic renal allograft recipients. 904 Dec 26

Desferrioxamine (DFX) remains the most effective and safe iron chelator for treatment of patients with transfusional iron overload. It is usually given by intermittent subcutaneous infusions for 8-12 h on 4-6 days weekly using a battery-driven pump. Disposable balloon infusers provide a suitable method of giving continuous subcutaneous infusions with improved patient compliance. For patients with cardiac abnormalities due to iron overload, continuous intravenous desferrioxamine is essential to eliminate toxic plasma non-transferrin bound iron and to reduce body iron stores. Deferiprone (L1, l-2 dimethyl-3hydroxy-pyrid-4-one) is a less effective iron chelator but has the advantage of being orally active. Long-term trials in which patients have taken 75 mg/kg/day have shown that deferiprone is capable of maintaining body iron stores at safe levels in a proportion of thalassaemia major patients but body iron stores, assessed by liver biopsy remain at high levels (> 15.0 mg/g dry weight) in a substantial number of patients. These concentrations have been associated with tissue damage. Trials of increased doses of deferiprone (up to 100 mg/kg/day) or of combined therapy with daily deferiprone and DFX or 1 or 2 days each week are being carried out in an attempt to achieve lower body iron burden in these patients. Preliminary results show that the drugs can be given safely together and urine iron excretion produced is additive, implying that the drugs chelate different body iron pools. Patients previously well chelated with serum ferritin levels less than 2500 micrograms/L have the fewest side-effects from deferiprone and usually may be kept at the same level of body iron for periods of at least 4 years, assessed by serum ferritin and urine iron excretion. The side-effects of deferiprone result in some patients discontinuing therapy. These side-effects, especially arthropathy, mainly occur in previously poorly chelated and so the most heavily iron-loaded patients. Nausea and other gastrointestinal symptoms, agranulocytosis or milder degrees of neutropenia account with arthropathy for nearly all the withdrawals from deferiprone therapy. Patients with cardiomyopathy due to iron overload should be given intravenous DFX rather than deferiprone. Deferiprone, licensed for pharmaceutical use in India, awaits official approval for widespread clinical use in Western Europe and North America. Meanwhile, attempts to find new orally active iron chelators and improved methods of administration of desferrioxamine are in progress.
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PMID:Iron chelation therapy. 935 Jan 80

Fifty-one transfusion-dependent iron-loaded adult patients (38 with thalassemia major) were treated with the orally active iron chelator deferiprone (1,2 dimethyl-3-hydroxypyrid-4-one, L1) at a dose of 75 mg/kg/d (range, 50 to 79). Twenty patients discontinued the drug and five died after a mean of 18.7 months (range, 4 to 35). Of the 20, 5 had arthropathy, 5 had gastrointestinal symptoms, 4 had a rising serum ferritin, 3 had agranulocytosis or neutropenia, 1 had tachycardia, 1 had renal failure, and 1 went abroad. Twenty-six patients continued deferiprone for a mean of 39.4 months (range, 12 to 49). Among these patients, there was no overall significant change in serum ferritin (initial mean, 2,937 microg/L; range, 980 to 5,970; final mean, 2,323 microg/L; range, 825 to 5,970) or in urine iron excretion (initial mean, 31.2 mg/24 h; range, 16.3 to 58. 2; final mean, 32.1 mg/24 h; range, 9.4 to 75.8), implying no overall change in iron stores. When the patients who had received deferiprone for longer than 3 years were considered separately, there was also no significant change in serum ferritin or urinary iron excretion. The initial serum ferritin levels in the 26 patients who continued deferiprone treatment were significantly lower than in those who discontinued the drug (P < .01). The liver iron content in 17 patients who had received deferiprone for 24 to 48 months ranged from 5.9 to 41.2 mg/g dry weight, 50% having levels above 15.0 mg, a level associated with a high risk of cardiac disease due to iron overload. In this study the drug caused fewer side effects and was more effective at maintaining iron status among patients previously well chelated and with lower initial serum ferritin levels.
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PMID:Long-term trial of deferiprone in 51 transfusion-dependent iron overloaded patients. 941 97

While the parenteral iron-chelating agent desferrioxamine B has anti-malarial activity in humans, the usefulness of an orally active chelator for this indication has not been investigated previously in vivo. We conducted a prospective, double-blind, placebo-controlled, cross-over trial of deferiprone (L1; CP20; 1,2-dimethyl-3-hydroxypyridin-4-one) in 25 adult Zambians with asymptomatic Plasmodium falciparum parasitemia. Deferiprone was administered daily for three or four days in divided doses of 75 or 100 mg/kg of body weight, dosages that are effective for treating iron overload. No reduction in asexual intra-erythrocytic parasites was observed during or after deferiprone treatment. The mean peak plasma concentration of deferiprone (108.9 +/- 24.9 micromol/L) achieved was within the range demonstrated to inhibit the growth of P. falciparum in vitro, but the systemic exposure as determined by the 24-hr plasma concentration-time curve would not be predicted inhibit growth in vivo. No evidence of deferiprone-associated hematological toxicity was noted in this short-term study of these subjects, all of whom had clinical evidence of normal body iron stores. Because of the risk of neutropenia and other adverse effects with higher doses or prolonged use of the chelator, additional trials of deferiprone as a sole anti-malarial agent would not seem to be justified. In contrast, further efforts are needed to develop other orally active iron-chelating agents specifically for their anti-malarial action.
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PMID:Assessment of the effect of the oral iron chelator deferiprone on asymptomatic Plasmodium falciparum parasitemia in humans. 954 19

Deferiprone, also known as L1, is an orally active iron chelator that has been studied extensively in clinical trials. The sporadic occurrence of agranulocytosis in association with deferiprone and the highly variable frequency of other possible side effects such as arthralgia have created uncertainty about the true incidence of deferiprone-related complications. A multi-center, 1-year trial was initiated to determine the safety profile of deferiprone. Using the Apotex formulation of deferiprone, 187 patients with thalassemia who were unable or unwilling to use deferoxamine were enrolled in four centers; 162 patients completed one year of therapy. Agranulocytosis (ANC < 500/mm3) occurred in one patient after 15 weeks of treatment, was not accompanied by infection and resolved following treatment with G-CSF. Nine other subjects developed less severe neutropenia (ANC 500-1500/mm3) with the lowest absolute neutrophil count reaching 500-1250/mm3. The neutropenia in these patients developed after 1-50 weeks of therapy, frequently accompanied febrile illnesses, and occurred predominantly in non-splenectomized patients. Reasons other than neutropenia for discontinuing use of deferiprone included nausea (4), voluntary withdrawal (3), high ALT (2), platelet count < 100,000/mm3 (2), low but unconfirmed ANC (1), protocol violation (1) fatigue (1), and depression (1). Mean ALT levels rose within three months of therapy and stabilized thereafter. Arthralgia and nausea and/or vomiting occurred in 6% and 24% of subjects, respectively. In this multi-center trial with weekly monitoring of blood counts, the incidence of agranulocytosis was 0.58 per 100 patient-years, and the frequency of agranulocytosis after one year was 0.5%. These findings support the safety of this formulation of deferiprone, using the careful monitoring system employed in this trial.
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PMID:A multi-center safety trial of the oral iron chelator deferiprone. 966 43

Saudi Rhazya stricta is used in folkloric medicine for the treatment of various disorders. R stricta leaves were fed to male Wistar albino rats at 2%, 10% or 50% of the diet for 6 w. Decreased growth rate, soft feces, dullness, ruffled hair and hepatonephrotoxicity were observed in rats on 10% and 50% Rhazya diet. Fifty percent Rhazya was fatal to rats, and hepatorenal lesions at 3 and 6 w confirmed changes in serum enzyme activity and in total protein, albumin, bilirubin and urea concentrations. Serum copper was decreased and zinc was increased in rats on 50% R stricta at 3 and 6 w, and were accompanied by anemia and neutropenia. Two percent Rhazya diet promoted growth as the plant leaves contained 28.3% crude protein and 16.6% crude fat and were not deficient in copper, zinc or iron.
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PMID:Experimental Rhazya stricta toxicosis in rats. 994 75

Tick-borne fever (TBF) is a rickettsial disease of domestic and wild ruminants in temperate climates where the hard tick Ixodes ricinus is present. The disease is characterized by a high temperature and severe leukopenia. In the present study, the effects of TBF on the activity of serum alkaline phosphatase (ALP), and on the concentrations of plasma zinc, iron, total bilirubin, urea, creatinine and albumin were investigated by inoculating one group of eight sheep and one group of eight goats with the Old Sourhope (OS) strain of Ehrlichia (Cytoecetes) phagocytophila. All goats and sheep experimentally infected with E. phagocytophila reacted with fever, rickettsiaemia and leukopenia. The leukopenia was due to an acute lymphocytopenia and prolonged neutropenia. In both groups of animals. TBF was characterized by significant reductions in the activities of serum ALP and concentrations of plasma zinc, iron and albumin. However, there were significant increases in the concentrations of plasma total bilirubin, urea and creatinine in both species of animals. The reductions in ALP and iron were significantly more pronounced in sheep than in goats.
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PMID:The effects of Ehrlichia (Cytoecetes) phagocytophila on the clinical chemistry of sheep and goats. 1021 52


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