Department of Clinical and Molecular Medicine, II Faculty of Medicine, University La Sapienza, Rome, Italy.
Clin Sci (Lond). 2011 Jan;120(2):51-63. doi: 10.1042/CS20100305.
EPO (erythropoietin) has long been identified as a primary regulator of erythropoiesis. Subsequently, EPO has been recognized as playing a role in a broad variety of processes in cardiovascular pathophysiology. In particular, the tight interactions of EPO with the nitric oxide pathway, apoptosis, ischaemia, cell proliferation and platelet activation appear of great interest. Although enhanced EPO synthesis is viewed as an appropriate compensatory mechanism in the cardio-renal syndrome, which features CHF (congestive heart failure) and CRF (chronic renal failure), maladaptative excessive EPO synthesis in the advanced stages of these diseases appears to be predictive of higher mortality. Clinical trials based on the use of EPO in both heart and renal failure have so far produced contradictory results, whereas treatment targeted to restore low Hb levels appears rational and is supported by regulatory authorities. New areas for therapeutic use of EPO, such as acute coronary syndromes, are under investigation, and they are discussed in the present review together with other clinical applications in cardiovascular diseases. The revisited concept of a potential use of endogenous EPO levels as a predictor of CHF severity, as well as in the monitoring of responses to treatment, deserves appropriate investigation, as this may identify EPO as a useful biomarker in the clinical management of cardiovascular diseases.
EPO（促红细胞生成素）长期以来一直被认为是红细胞生成的主要调节剂。随后，EPO 被认为在心血管病理生理学的广泛过程中发挥作用。特别是 EPO 与一氧化氮途径、细胞凋亡、缺血、细胞增殖和血小板激活的紧密相互作用似乎非常有趣。虽然在以心力衰竭和慢性肾衰竭为特征的心肾综合征中，增强的 EPO 合成被视为一种适当的代偿机制，但在这些疾病的晚期，适应性过度的 EPO 合成似乎预示着更高的死亡率。基于 EPO 在心力衰竭和肾衰竭中的应用的临床试验迄今为止产生了相互矛盾的结果，而针对恢复低 Hb 水平的治疗似乎是合理的，并得到了监管机构的支持。EPO 的新治疗用途领域，如急性冠状动脉综合征，正在进行研究，本文对其进行了讨论，并与心血管疾病的其他临床应用进行了讨论。重新审视内源性 EPO 水平作为心力衰竭严重程度以及治疗反应监测的预测因子的潜在用途值得适当研究，因为这可能将 EPO 确定为心血管疾病临床管理中的有用生物标志物。
