Centre for Translational Medicine & Therapeutics, Queen Mary University of London, William Harvey Research Institute, Barts and The London, London, UK.
Ann Intensive Care. 2011 Sep 23;1:40. doi: 10.1186/2110-5820-1-40.
Erythropoietin (EPO) is the major hormone stimulating the production and differentiation of red blood cells. EPO is used widely for treating anemia of critical illness or anemia induced by chemotherapy. EPO at pharmacological doses is used in this setting to raise hemoglobin levels (by preventing the apoptosis of erythroid progenitor cells) and is designed to reduce patient exposure to allogenic blood through transfusions. Stroke, heart failure, and acute kidney injury are a frequently encountered clinical problem. Unfortunately, in the intensive care unit advances in supportive interventions have done little to reduce the high mortality associated with these conditions. Tissue protection with EPO at high, nonpharmacological doses after injury has been found in the brain, heart, and kidney of several animal models. It is now well known that EPO has anti-apoptotic effects in cells other than erythroid progenitor cells, which is considered to be independent of EPOs erythropoietic activities. This review article summarizes what is known in preclinical models of critical illness and discusses why this does not correlate with randomized, controlled clinical trials.
促红细胞生成素(EPO)是主要的激素,刺激红细胞的生成和分化。EPO 被广泛用于治疗危重病或化疗引起的贫血。在这种情况下,使用药理学剂量的 EPO 来提高血红蛋白水平(通过防止红系祖细胞的凋亡),旨在通过输血减少患者对异体血液的暴露。中风、心力衰竭和急性肾损伤是常见的临床问题。不幸的是,在重症监护病房,支持性干预措施的进步几乎没有降低这些疾病相关的高死亡率。在几种动物模型中,损伤后高剂量(非药理学剂量)的 EPO 已被发现对大脑、心脏和肾脏具有组织保护作用。现在人们已经知道,EPO 在除红系祖细胞以外的细胞中具有抗凋亡作用,这被认为与 EPO 的促红细胞生成活性无关。本文综述了危重病的临床前模型中已知的情况,并讨论了为什么这与随机对照临床试验不相关。