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D-Penicillamine in the neonatal period
Chelation as neuroprotectant in the neonatal period
D-penicillamine (D-PA) was first recognized as a potential benefit for neonatal hyperbilirubinemia (NHBI). During this time there was a remarkably low incidence of retinopathy of prematurity (ROP) in the infants treated with D-PA. Later, our studies were replicated in other institutes in Hungary, Poland, U.S. A., India and Mexico. It is important to note that there was no intolerance or short- or long-term toxicity of the medication, in spite of the fact that in the newborn period D-PA was used 10-20 times higher doses than those in adult. Furthermore, the aim of this book was to demonstrate a new concept in the etiology of bilirubin-induced neurologic dysfunction (BIND) and highlight the role of D-PA. Unconjugated bilirubin has a special affinity for the globus pallidus, the hippocampus, and the subthalamic nucleus (basal ganglia). Furthermore, immaturity of the blood-brain barrier also contributes to the development of kernicterus. Homeostasis of metal ions usually involves a huge set of proteins which regulate the proper metal biology. Metal ions, especially copper and iron play very important roles in the pathogenesis of neurodegenerative diseases including BIND and ROP.