Erythropoietin (EPO) is a hormone that helps treat anemia and kidney diseases. It helps to improve muscular performance, aids with bone regeneration.

What is Erythropoietin?

Erythropoietin is also known as EPO, hematopoietin, or hemopoietin is a glycoprotein hormone which controls erythropoiesis or red blood cell production. It is a protein signaling molecule for red blood cell (erythrocyte) precursors in the bone marrow.

Erythropoietin (EPO) levels in the blood are quite low in the absence of anemia, but in the condition of hypoxic stress, EPO production may increase up to 1,000-fold. Tissue hypoxia is the only physiological mechanism for increasing erythropoietin production [1].

Erythropoietin controls the proliferation, differentiation, and survival of red blood cell precursors [2].

Erythropoietin (EPO) is produced by the kidney in the adult and by the liver in the fetus, also by the brain in very little quantities [3].

Production of EPO

Loss of red blood cells in a normal individual due to bleeding or hemolysis reduce the delivery of oxygen to the tissues. When cells in the kidney and liver find this low oxygen level in tissues, they produce EPO [3].

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Health Benefits of Erythropoietin

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1) Anti-inflammatory

In a randomized controlled trial, 94 patients with necrotizing enterocolitis were treated with recombinant EPO, results showed that EPO was able to reduce the levels of the inflammatory response of TNF-α and IL-6 [4].

EPO increases the production of some cytokines (Th2 cytokines: IL-2, IL-4, and IL-10) by activated T cells. It could directly reduce the regulation of pro-inflammatory T cell responses and it cannot affect the T cell activation status [5].

Inflammation is said to play a key role in meconium aspiration syndrome (MAS). Recombinant human EPO is associated with improved BAL (bronchoalveolar lavage) fluid and serum cytokine levels. Pretreatment might also reduce the risk of developing MAS [6].

2) Helps Treat Anemia

The approved clinical uses of EPO are the anemias associated with end-stage kidney disease, cancer chemotherapeutic agents and patients with HIV infection [7].

A prospective observational case series study in Chronic kidney failure (CKD) patients with anemia suggested the use of erythropoietin along with iron as an effective and beneficial treatment especially in patients with low hemoglobin [8].

EPO treatment reduced the number of blood transfusions in preterm infants with anemia [9].

For the treatment of anemia in patients receiving cytotoxic chemotherapy, administered EPO shortens the period of symptomatic anemia [10].

3) Enhances Muscular Performance

EPO as blood doping improved the athletes longduration muscular performances much more than expected by increasing red blood cells which carry the oxygen to tissues [11].

Experimental evidence and clinical experience show that erythropoietin has a positive effect on skeletal and cardiac muscle. Mice lacking EPO or its receptor suffer from incomplete development of the heart and have a reduced number of proliferating cardiac muscle cells [11].

4) Protects the Brain

EPO is a promising neuroprotective agent and is currently in Phase III clinical trials for the treatment of traumatic brain injury. It has a bimodal effect on cell death, glial reactivity, and oxidative stress [12].

5) Could Prevent Eye Damage

Studies showed that treatment with EPO protects the retina after trauma. Either intraocular delivery of EPO or treatment with non-erythropoietic forms of EPO may be more effective [12].

6) May Regenerate Bone

Studies in animals showed that EPO has significant effects on bone formation and angiogenesis (development of new blood vessels) and has the capacity to promote the repair of bone defects [13].

7) Wound Healing

A Phase II clinical study states that low doses of EPO promoted wound healing of ulcers in diabetics [14].

In a Double-blind, randomized, placebo-controlled trial EPO mouthwash when given to patients with Oral mucositis (OM) and undergoing autologous hematopoietic stem cell transplantation reduced the incidence and duration of OM [15].

Increasing Erythropoietin

Cautions

The use of recombinant human erythropoietin as a performance-enhancing agent is dangerous particularly in the less fit athlete [1].

Elevation of red cell mass by recombinant human EPO  is associated with the reduction in plasma level and also hypertension is induced in some patients [1].

Irregular Erythropoietin Levels?

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