- CAN ERYTHROPOIETIN AND MIMETICS BE USED AS NOVEL NEUROPROT...
CAN ERYTHROPOIETIN AND MIMETICS BE USED AS NOVEL NEUROPROTECTIVE AGENTS?
Abstract
Erythropoietin (EPO) is a glycopeptide hormone produced in the
kidney in response to hypoxia. It is known for its role in red
blood cell formation but has also, in recent years, been found in
other locations like the central nervous system where its receptors
are specifically expressed, suggesting an endogenous role in this
location. EPO and its mimetics hold promise for clinical use in
neuroprotection. As in studies of previous neuroprotective agents,
in vitro and in vivo animal models have found that EPO has
important neuroprotective actions in stroke, ischaemia and other
neurological injury, mediated by inhibition of apoptosis and
induction of angiogenesis. Although a randomised trial of 40 stroke
patients found a non-significant neurological improvement with EPO,
there are no large trials of EPO neuroprotection. Therefore the
benefits of EPO recorded in animal models have not yet been
replicated in human populations.
Larger trials of EPO in stroke and other neurological disease
patients will need to be embarked upon. Practical issues like drug
dosing, randomisation and point in therapeutic window at which
intervention is received will need to be reviewed.
EPO and its mimetics hold an impressive promise for potential
clinical use in neuroprotection. As in studies of previous
neuroprotective agents, in vitro and in vivo animal models have
found that EPO has important neuroprotective actions in stroke,
ischaemia and other neurological injury, mediated by inhibition of
apoptosis and induction of angiogenesis. Although a small
randomised trial of stroke patients found a non-significant
neurological improvement with high dose EPO, there are no large
trials of EPO neuroprotection. Therefore the benefits of EPO
recorded in animal models have not yet been replicated in human
populations. The likelihood of this happening in the near future
will be determined by a number of factors, favourable and
unfavourable. Larger trials of EPO in stroke and other neurological
disease patients will need to be embarked upon. Practical issues
like drug dosing, randomisation and point in therapeutic window at
which intervention is received will need to be reviewed.
These do not however take away from the fact that EPO is a
promising weapon in the armament against neurological injury and
will someday, along with its mimetics, prove useful novel
neuroprotective agents.
