Erythropoietin
From Wikipedia, the free encyclopedia
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Erythropoietin
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| Available structures: 1buy, 1cn4, 1eer | ||||||||||||||
| Identifiers | ||||||||||||||
| Symbol(s) | EPO; EP; MGC138142 | |||||||||||||
| External IDs | OMIM: 133170 MGI: 95407 HomoloGene: 624 | |||||||||||||
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| RNA expression pattern | ||||||||||||||
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| Orthologs | ||||||||||||||
| Human | Mouse | |||||||||||||
| Entrez | 2056 | 13856 | ||||||||||||
| Ensembl | ENSG00000130427 | ENSMUSG00000029711 | ||||||||||||
| Uniprot | P01588 | Q0VED9 | ||||||||||||
| Refseq | NM_000799 (mRNA) NP_000790 (protein) |
NM_007942 (mRNA) NP_031968 (protein) |
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| Location | Chr 7: 100.16 - 100.16 Mb | Chr 5: 137.71 - 137.71 Mb | ||||||||||||
| Pubmed search | [2] | [3] | ||||||||||||
Erythropoietin (pronounced /ɨˌrɪθoʊˈpɔɪɨtɨn/, /ɨˌrɪθroʊˈpɔɪtən/, or /ɨˌriːθroʊ-/) or EPO is a glycoprotein hormone that is a cytokine for erythrocyte (red blood cell) precursors in the bone marrow. Also called hematopoietin or hemopoietin, it is produced by the liver and kidney, and is the hormone that regulates red blood cell production. It also has other known biological functions. For example, erythropoietin plays an important role in the brain's response to neuronal injury.[1] EPO is also involved in the wound healing process.[2]
As a class of drug EPO is an Erythropoietin Stimulating Agent (ESA).
They may be synthesized and administered exogenously. However, such molecules can at a latter stage be detected, since they differ slightly from the endogenous ones in e.g. features of posttranslational modification.
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[edit] History
Haematologist Dr. John Adamson and nephrologist Dr. Joseph W. Eschbach looked at various forms of renal failure and the role of the natural hormone EPO in the formation of red blood cells. Studying sheep and other animals in the 1970s, the two scientists helped establish that EPO stimulates the production of red cells in bone marrow and could lead to a treatment for anaemia in humans.
In the 1980s, Adamson, Eschbach and others helped lead a clinical trial at the Northwest Kidney Centers for a synthetic form of the hormone, Epogen produced by Amgen. The trial was successful; its results were published in The New England Journal of Medicine in January 1987. The study authors were Dr. Adamson, Dr. Joseph W. Eschbach, Dr. Joan C. Egrie, Dr. Michael R. Downing and Dr. Jeffrey K. Browne.
In 1989, the Food and Drug Administration approved the hormone, called Epogen, which remains in use.
[edit] Regulation
EPO is produced mainly by peritubular fibroblasts of the renal cortex. Regulation is believed to rely on a feed-back mechanism measuring blood oxygenation. Constitutively synthesized transcription factors for EPO, known as hypoxia inducible factors (HIFs), are hydroxylized and proteosomally digested in the presence of oxygen.[3]
[edit] Uses
Erythropoietin is available as a therapeutic agent produced by recombinant DNA technology in mammalian cell culture. It is used in treating anaemia resulting from chronic kidney disease, from the treatment of cancer (chemotherapy & radiation), and from other critical illnesses (heart failure).
[edit] Anaemia due to chronic kidney disease
In patients who require dialysis (have stage 5 chronic kidney disease(CKD)), iron should be given with erythropoietin.[4] People in the US and on dialysis are most often given Epogen, outside the US other brands of epoetin may be used.
Outside of people on dialysis, erythropoietin is used most commonly to treat anaemia in people with chronic kidney disease who are not on dialysis (those in stage 3 or 4 CKD and those living with a kidney transplant). There are two types of erythropoietin (and three brands) for people with anaemia due to chronic kidney disease (not on dialysis), these are:
- epoetin (Procrit(also known as Eprex), NeoRecormon)
- darbepoetin (Aranesp).
- PDpoetin(an erythropoietin produced in Iran by Pooyesh Darou Pharmaceuticals)
Brands available in the USA include: epoetin (Procrit and Epogen)
[edit] Anaemia due to treatment for cancer
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Please help improve this section by expanding it. Further information might be found on the talk page or at requests for expansion. |
In March 2008 a panel of advisers for the Food and Drug Administration (FDA) supported keeping ESAs from Amgen and Johnson & Johnson on the market for use in cancer patients. The FDA has focused its concern on study results showing an increased risk of death and tumor growth in chemo patients taking the anti-anaemia drugs. According to the FDA increases have been seen in various types of cancer, including breast, lymphoid, cervical, head and neck, and the "non-small cell" type of lung cancer.[5]
[edit] Anaemia in critically ill patients
There are two types of erythropoietin (and three brands) for people with anaemia, due to critical illness. These are:
- epoetin (Procrit(also known as Eprex), NeoRecormon)
- darbepoetin (Aranesp).
- PDpoetin(an erythropoietin produced in Iran by Pooyesh Darou pharmaceuticals)
In a recent randomized controlled trial,[6] erythropoietin was shown to not change the number of blood transfusions required by critically ill patients. A surprising finding in this study was a small mortality benefit in patients receiving erythropoietin. This result was statistically significant after 29 days but not at 140 days. This mortality difference was most marked in patients admitted to the ICU for trauma. The authors speculate several hypothesis of potential etiologies for reduced mortality, but given the known increase in thrombosis and increase benefit in trauma patients as well as marginal nonsignificant benefit (adjusted hazard ratio of 0.9) in surgery patients, one might speculate that some of the benefit might be secondary to the procoagulant effect of erythropoetin. Regardless, this study suggests further research may be necessary to see which critical care patients, if anyone, might benefit from administration of erythropoeitin. Any benefit of erythropoetin must be weighed against the 50% increase in thrombosis, which has been well substantiated by numerous trials.
[edit] Blood doping
EPO has a history of usage as a blood doping agent in endurance sports such as cycling, distance running, cross country skiing, biathlon, triathlons, and most recently, billiards.[7]
[edit] Adverse effects
Erythropoietin is associated with an increased risk of adverse cardiovascular complications in patients with kidney disease if it is used to increase haemoglobin levels above 13.0 g/dl.[8]
Early treatment with erythropoietin has been shown to significantly increase the risk of Retinopathy of prematurity in premature infants, and is not recommended. [9]
[edit] Safety advisories in anaemic cancer patients
Amgen sent a "dear doctor" letter in January, 2007, that highlighted results from a recent anaemia of cancer trial, and warned doctors to consider use in that off-label indication with caution.
Amgen advised the United States FDA as to the results of the DAHANCA 10 clinical trial. The DAHANCA 10 data monitoring committee found that 3-year loco-regional control in subjects treated with Aranesp was significantly worse than for those not receiving Aranesp (p=0.01).
In response to these advisories, the FDA released a Public Health Advisory[10] on March 9, 2007, and a clinical alert[11] for doctors on February 16, 2007, about the use of erythropoeisis-stimulating agents (ESAs) such as epogen and darbepoetin. The advisory recommended caution in using these agents in cancer patients receiving chemotherapy or off chemotherapy, and indicated a lack of clinical evidence to support improvements in quality of life or transfusion requirements in these settings.
In addition, on March 9, 2007, drug manufacturers agreed to new black box warnings about the safety of these drugs.
On March 22, 2007, a congressional inquiry into the safety of erythropoeitic growth factors was reported in the news media. Manufacturers were asked to suspend drug rebate programs for physicians and to also suspend marketing the drugs to patients.
Several recent publications and FDA communications have increased the level of concern related to adverse effects of ESA therapy in selected groups. In a revised Black Box Warning FDA notes significant risks associated with use. ESAs should only be used in patients with cancer when treating anemia specifically caused by chemotherapy and not for other causes of anemia. Further, it states that ESAs should be discontinued once the patient's chemotherapy course has been completed. For more information visit the FDA website at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#ESA2, http://www.fda.gov/cder/foi/label/2007/103234s5158lbl.pdf, http://www.fda.gov/cder/foi/label/2007/103951s5164lbl.pdf and http://www.fda.gov/cder/drug/infopage/RHE/default.htm.
[edit] See also
- Erythropoiesis
- Amgen, producer of artificial EPO (Brand Names: Epogen and Aranesp)
- Dynepo, trademark name for an erythropoiesis stimulating protein, by TKT
- Blood doping, transfusions and EPO use as doping methods; testing and enforcement
- Jehovah's Witnesses and blood transfusions
- The German company AplaGen Biopharmaceuticals[4] has developed a new EPO-mimetic peptide, HemoMer. The active compound is bound to a polysacharid-based polymeric carrier (Hydroxyethylstarch). Half-Life is increased by increase of molecular weight above the filtration threshold of the kidney, comparable to PEGylation. The so-called supravalence concept has significant advantages to PEGylation, because Half-Life and efficacy are improved simultaneously but not of the cost of the each other. The drug is completely biodegradable and can thus be eliminated even by dialysis patients. At the moment the drug is still preclinical.[12]
[edit] Additional images
 EPO hematopoiesis (German) |
 EPO structure |
 EPO sales |
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 Epo blotting |
[edit] References
- ^ Siren AL et al. (2001). "Erythropoietin prevents neuronal apoptosis after cerebral ischemia and metabolic stress". Proc Natl Acad Sci USA 98: 4044-4049. doi:.
- ^ Haroon ZA et al. (2003). "A novel role for erythropoietin during fibrin-induced wound-healing response". Am J Pathol 163: 993-1000.
- ^ Jelkmann, W (2007). "Erythropoietin after a century of research: younger than ever". Eur J Haematol. 78 (3): 183-205. doi:. PMID 17253966.
- ^ Macdougall IC, Tucker B, Thompson J, Tomson CR, Baker LR, Raine AE (1996). "A randomized controlled study of iron supplementation in patients treated with erythropoietin". Kidney Int. 50 (5): 1694-9. doi:. PMID 8914038.
- ^ [1]CNN Money article
- ^ Howard L. Corwin et al., “Efficacy and Safety of Epoetin Alfa in Critically Ill Patients,” N Engl J Med 357, no. 10 (September 6, 2007): 965-976, http://content.nejm.org/cgi/content/abstract/357/10/965 (accessed September 6, 2007).
- ^ "Cueless: Billiards Player a Real Dope." Chicago Tribune/Associated Press, March 18, 2008.
- ^ Drüeke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, Burger HU, Scherhag A (2006). "Normalization of hemoglobin level in patients with chronic kidney disease and anemia". N. Engl. J. Med. 355 (20): 2071-84. doi:. PMID 17108342.
- ^ Ohlsson A, Aher SM. Early erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2006 Jul 19;3:CD004863. PMID 16856062
- ^ FDA Public Health Advisory: Erythropoiesis-Stimulating Agents (ESAs): Epoetin alfa (marketed as Procrit, Epogen), Darbepoetin alfa (marketed as Aranesp). Retrieved on 2007-06-05.
- ^ Information for Healthcare Professionals: Erythropoiesis Stimulating Agents (ESA). Retrieved on 2007-06-05.
- ^ AplaGen Biopharmaceuticals - About AplaGen
[edit] Further reading
- Takeuchi M, Kobata A (1992). "Structures and functional roles of the sugar chains of human erythropoietins.". Glycobiology 1 (4): 337-46. PMID 1820196.
- Semba RD, Juul SE (2002). "Erythropoietin in human milk: physiology and role in infant health.". Journal of human lactation : official journal of International Lactation Consultant Association 18 (3): 252-61. PMID 12192960.
- Ratcliffe PJ (2003). "From erythropoietin to oxygen: hypoxia-inducible factor hydroxylases and the hypoxia signal pathway.". Blood Purif. 20 (5): 445-50. PMID 12207089.
- Westenfelder C (2003). "Unexpected renal actions of erythropoietin.". Exp. Nephrol. 10 (5-6): 294-8. PMID 12381912.
- Becerra SP, Amaral J (2002). "Erythropoietin--an endogenous retinal survival factor.". N. Engl. J. Med. 347 (24): 1968-70. doi:. PMID 12477950.
- Genc S, Koroglu TF, Genc K (2004). "Erythropoietin and the nervous system.". Brain Res. 1000 (1-2): 19-31. doi:. PMID 15053948.
- Fandrey J (2004). "Oxygen-dependent and tissue-specific regulation of erythropoietin gene expression.". Am. J. Physiol. Regul. Integr. Comp. Physiol. 286 (6): R977-88. doi:. PMID 15142852.
- Juul S (2004). "Recombinant erythropoietin as a neuroprotective treatment: in vitro and in vivo models.". Clinics in perinatology 31 (1): 129-42. doi:. PMID 15183662.
- Buemi M, Caccamo C, Nostro L, et al. (2005). "Brain and cancer: the protective role of erythropoietin.". Med Res Rev 25 (2): 245-59. doi:. PMID 15389732.
- Sytkowski AJ (2007). "Does erythropoietin have a dark side? Epo signaling and cancer cells.". Sci. STKE 2007 (395): pe38. doi:. PMID 17636183.
[edit] External links
- NYT 1987 announcement of Epogen's clinical success
- Patient information on Epogen
- Patient information on Aranesp
- Patient information on Procrit
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