As you will remember Daniel Kosman studied also how ATH434 works on the capillary level of the brain. This paper below is a review and comes after his ATH434 paper. The poor results of Deferiprone in treating PD were not yet published when this review came out. But he is discussing also strong about iron chelators and their problems and states about ATH434: " In short, PBT434 reflects the chemical properties that appear most desirable in a rationally developed pharmaceutical approach to managing the cell dysfunction associated with BIA".

It is a free paper, here is the abstract.

Review

Front Neurol

. 2022 Mar 15;13:855751.

doi: 10.3389/fneur.2022.855751. eCollection 2022.

Aberrant Cerebral Iron Trafficking Co-morbid With Chronic Inflammation: Molecular Mechanisms and Pharmacologic Intervention

Shaina L Rosenblum ¹, Daniel J Kosman ¹

Affiliations expand

• PMID: 35370907

PMCID: PMC8964494 DOI: 10.3389/fneur.2022.855751Free PMC article

Abstract

The redox properties that make iron an essential nutrient also make iron an efficient pro-oxidant. Given this nascent cytotoxicity, iron homeostasis relies on a combination of iron transporters, chaperones, and redox buffers to manage the non-physiologic aqueous chemistry of this first-row transition metal. Although a mechanistic understanding of the link between brain iron accumulation (BIA) and neurodegenerative diseases is lacking, BIA is co-morbid with the majority of cognitive and motor function disorders. The most prevalent neurodegenerative disorders, including Alzheimer's Disease (AD), Parkinson's Disease (PD), Multiple System Atrophy (MSA), and Multiple Sclerosis (MS), often present with increased deposition of iron into the brain. In addition, ataxias that are linked to mutations in mitochondrial-localized proteins (Friedreich's Ataxia, Spinocerebellar Ataxias) result in mitochondrial iron accumulation and degradation of proton-coupled ATP production leading to neuronal degeneration. A comorbidity common in the elderly is a chronic systemic inflammation mediated by primary cytokines released by macrophages, and acute phase proteins (APPs) released subsequently from the liver. Abluminal inflammation in the brain is found downstream as a result of activation of astrocytes and microglia. Reasonably, the iron that accumulates in the brain comes from the cerebral vasculature via the microvascular capillary endothelial cells whose tight junctions represent the blood-brain barrier. A premise amenable to experimental interrogation is that inflammatory stress alters both the trans- and para-cellular flux of iron at this barrier resulting in a net accumulation of abluminal iron over time. This review will summarize the evidence that lends support to this premise; indicate the mechanisms that merit delineation; and highlight possible therapeutic interventions based on this model.