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Dose titration of deferasirox iron chelation therapy by magnetic resonance imaging for chronic iron storage disease in three adult red bald-headed uakari (Cacajao calvus rubicundus)

Brewer, Casey and Tyszka, J. Michael and Stadler, Cynthia K. and Garner, Michael and Baer, Janet and Wood, John C. (2014) Dose titration of deferasirox iron chelation therapy by magnetic resonance imaging for chronic iron storage disease in three adult red bald-headed uakari (Cacajao calvus rubicundus). Journal of Zoo and Wildlife Medicine, 45 (2). pp. 339-349. ISSN 1042-7260. doi:10.1638/2013-0228R.1.

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Iron overload is common in lemurs and some New World nonhuman primates raised in captivity, but there is no such documentation in the red bald-headed uakari (Cacajao calvus rubicundus). This study describes postmortem documentation of severe iron storage disease in one red bald-headed uakari and the use of iron chelation with oral deferasirox in the three surviving members of the colony. Magnetic resonance imaging was used to quantify pretreatment iron burden and to follow the response to therapy in two females, 22 and 28 yr of age, and one male 33 yr of age. Baseline liver iron concentrations ranged from 16 to 23 mg/g dry weight. In humans, a liver iron concentration greater than 15 mg/g is considered severe and associated with endocrine and cardiac toxicity. The uakaris were otherwise asymptomatic, generally healthy, nonpregnant, and on a stable, low-iron diet. Quantitative magnetic resonance imaging indicated that dosage escalations up to 100 mg/kg were needed to produce meaningful reductions in iron stores. After 5 yr of therapy, two animals continue at a dosage of 100 mg/kg per day, and the third was transitioned to twice-weekly maintenance dosing because of successful de-ironing. The animals tolerated iron chelation therapy well, having stable hematologic, renal, and hepatic function profiles before, during, and after treatment. Deferasirox monotherapy may represent a therapeutic option in primates with iron storage disease when dietary measures are ineffective and phlebotomy is logistically challenging.

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Tyszka, J. Michael0000-0001-9342-9014
Additional Information:© 2014 by American Association of Zoo Veterinarians. Received for publication 19 September 2013. The authors are grateful for the support of Novartis Pharmaceuticals who generously provided the deferasirox free of charge. Additionally, they are indebted to the California Institute of Technology for sponsoring the imaging time on the research 3T magnet. They also thank Hannah Thompson-Garner of Northwest ZooPath for data retrieval, Christie Buie of Northwest ZooPath for image layout, and Roy Brown of Histology Consulting Service, Everson, Washington, for slide preparation and special stains. Dr. Wood is a consultant for Shire, ApoPharma, and Novartis and has received research funds from Novartis and Shire.
Funding AgencyGrant Number
Novartis PharmaceuticalsUNSPECIFIED
Subject Keywords:Cacajao, chelation, iron, liver, imaging, uakari
Issue or Number:2
Record Number:CaltechAUTHORS:20140902-114604483
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Official Citation:Casey Brewer, J. Michael Tyszka, Cynthia K. Stadler, Michael Garner, Janet Baer, and John C. Wood (2014) DOSE TITRATION OF DEFERASIROX IRON CHELATION THERAPY BY MAGNETIC RESONANCE IMAGING FOR CHRONIC IRON STORAGE DISEASE IN THREE ADULT RED BALD-HEADED UAKARI (CACAJAO CALVUS RUBICUNDUS). Journal of Zoo and Wildlife Medicine: June 2014, Vol. 45, No. 2, pp. 339-349.
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:49115
Deposited By: Ruth Sustaita
Deposited On:02 Sep 2014 20:20
Last Modified:10 Nov 2021 18:40

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