Science review: Recombinant human erythropoietin in critical illness: a role beyond anemia?
Open Access
- 1 January 2004
- journal article
- review article
- Published by Springer Science and Business Media LLC in Critical Care
- Vol. 8 (5), 337-341
- https://doi.org/10.1186/cc2897
Abstract
Erythropoiesis usually fails during severe illness because of a blunting of the kidney–erythropoietin (EPO)–bone marrow axis. In this setting, clinical studies have shown that recombinant human erythropoietin (rhEPO), administered in pharmacological amounts, significantly reduces the need for blood transfusions. In addition to the kidney, however, EPO is also produced locally by other tissues in a paracrine–autocrine manner. Here, similar to its role in the bone marrow, EPO rescues cells from apoptosis. Additionally, EPO reduces inflammatory responses, restores vascular autoregulation, and promotes healing. The results of many studies (including a phase II clinical trial in ischemic stroke) demonstrate that rhEPO protects the brain, spinal cord, retina, heart, and kidney from ischemic and other types of injury. Although rhEPO is efficacious in the treatment of EPO-deficient anemia during illness, inadequate effort has been devoted to determining whether direct tissue protection might also result from its administration. Here, we speculate on the potential utility of EPO as a protective cytokine in the context of acute critical illness and suggest key parameters required for a proof-of-concept clinical study.Keywords
This publication has 48 references indexed in Scilit:
- Erythropoietin may impair, not improve, cancer survivalNature Medicine, 2003
- The correction of anemia in severe resistant heart failure with erythropoietin and intravenous iron prevents the progression of both the heart and the renal failure and markedly reduces hospitalization.2002
- HIF-1-induced erythropoietin in the hypoxic retina protects against light-induced retinal degenerationNature Medicine, 2002
- Normobaric Hypoxia Induces Tolerance to Focal Permanent Cerebral Ischemia in Association with an Increased Expression of Hypoxia-Inducible Factor-1 and its Target Genes, Erythropoietin and VEGF, in the Adult Mouse BrainJournal of Cerebral Blood Flow & Metabolism, 2002
- Erythropoietin and erythropoietin receptor expression in human cancer.2001
- Blunted erythropoietic response to anemia in multiply traumatized patientsCritical Care Medicine, 2001
- Erythropoietin and Erythropoietin Receptors in Human CNS Neurons, Astrocytes, Microglia, and Oligodendrocytes Grown in CultureJournal of Neuropathology and Experimental Neurology, 2001
- Erythropoietin and erythropoietin receptor in human ischemic/hypoxic brainActa Neuropathologica, 2001
- Erythropoietin crosses the blood–brain barrier to protect against experimental brain injuryProceedings of the National Academy of Sciences of the United States of America, 2000
- Efficacy of recombinant human erythropoietin in the critically ill patient: A randomized, double-blind, placebo-controlled trialCritical Care Medicine, 1999