Erythropoietin (EPO) is a candidate compound for neuroprotection in human brain disease capable of combating a spectrum of pathophysiological processes operational during the progression of schizophrenic psychosis. The purpose of the present study was to prepare the ground for its application in a first neuroprotective add-on strategy in schizophrenia, aiming at improvement of cognitive brain function as well as prevention/slowing of degenerative processes. Using rodent studies, primary hippocampal neurons in culture, immunohistochemical analysis of human post-mortem brain tissue and nuclear imaging technology in man, we demonstrate that: (1) peripherally applied recombinant human (rh) EPO penetrates into the brain efficiently both in rat and humans, (2) rhEPO is enriched intracranially in healthy men and more distinctly in schizophrenic patients, (3) EPO receptors are densely expressed in hippocampus and cortex of schizophrenic subjects but distinctly less in controls, (4) rhEPO attenuates the haloperidol-induced neuronal death in vitro, and (4) peripherally administered rhEPO enhances cognitive functioning in mice in the context of an aversion task involving cortical and subcortical pathways presumably affected in schizophrenia. These observations, together with the known safety of rhEPO, render it an interesting compound for neuroprotective add-on strategies in schizophrenia and other human diseases characterized by a progressive decline in cognitive performance.

Objective: To characterize clinical features, CSF biomarkers and genetic polymorphisms of patients suffering from a rapidly progressing subtype of Alzheimer’s dementia (rpAD). Methods: Retrospective analyses of 32 neuropathologically confirmed cases differentially diagnosed as AD out of a group with rapidly progressive dementia. CSF biomarkers (14-3-3, tau, β-amyloid 1–42) and genetic markers (PRNP codon 129, apolipoprotein E, ApoE, polymorphism) were determined. Results: Median survival was 26 months, age at onset 73 years. Biomarkers: mean β-amyloid 1–42: 266 pg/ml, median tau: 491 pg/ml, 14-3-3 positive: 31%. Genetic polymorphisms showed a predominance of methionine homozygosity at PRNP codon 129 and a low frequency of ApoE4 (38%, no homozygous patients). Thirty-five symptoms were studied. Frequent symptoms were myoclonus (75%), disturbed gait (66%) and rigidity (50%). Discussion: rpAD is associated with a diversity of neurological signs even able to mimic Creutzfeldt-Jakob disease. Biomarkers and genetic profile differ from those seen in classical AD. The findings on biomarkers, symptomatology and genetics may aid the differential diagnostic process.

Central nervous and hematopoietic systems share developmental features. We report that thrombopoietin (TPO), a stimulator of platelet formation, acts in the brain as a counterpart of erythropoietin (EPO), a hematopoietic growth factor with neuroprotective properties. TPO is most prominent in postnatal brain, whereas EPO is abundant in embryonic brain and decreases postnatally. Upon hypoxia, EPO and its receptor are rapidly reexpressed, whereas neuronal TPO and its receptor are down-regulated. Unexpectedly, TPO is strongly proapoptotic in the brain, causing death of newly generated neurons through the Ras-extracellular signal-regulated kinase 1͞2 pathway. This effect is not only inhibited by EPO but also by neurotrophins. We suggest that the proapoptotic function of TPO helps to select for neurons that have acquired targetderived neurotrophic support.astrocytes ͉ erythropoietin ͉ neurons ͉ differentiation ͉ development I n the hematopoietic system, survival, proliferation, and differentiation of cells are regulated by a plethora of growth factors (1-4). The effect of erythropoietin (EPO) on the generation of red blood cells is well known. The hematopoietic growth factor thrombopoietin (TPO) stimulates megakaryopoiesis and thrombocyte formation (1-3, 5, 6). During hematopoiesis, EPO and TPO can interact in a synergistic and an antagonistic fashion (1-3, 7).EPO and TPO exhibit significant homology in their receptorbinding domain (20% identity and 25% similarity). Likewise, they bind to receptors, erythropoietin receptor (EPOR) and thrombopoietin receptor (TPOR), respectively, that belong to the same cytokine receptor superfamily (1)(2)(3)(8)(9)(10). Previous studies reported a neurotrophin-like motif in the N-terminal receptor binding region of the TPO molecule, with conflicting data about the presence of TPO in the brain (5,6,(11)(12)(13).For EPO, it is well established that the gene is expressed in the embryonic CNS. EPO has a marked effect as a survival factor for neurons and their progenitors (14, 15), presumably to overcome phases of physiological hypoxia (16, 17). The widespread but rather ''unspecific'' neuroprotective potential of EPO is regained in the adult CNS upon distress or injury. This finding has been confirmed in rodent models of cerebral ischemia (18-23), brain trauma (18), and neurodegenerative disease (18), as well as in a clinical study with stroke patients (24).Here we show that TPO plays a previously unrecognized proapoptotic role in the brain. Materials and MethodsAll experiments were approved by and conducted in accordance with the regulations of the local Animal Care and Use Committee. For detailed information on all methods see Supporting Materials and Methods, which is published as supporting information on the PNAS web site.Cell Culture. Primary hippocampal neuronal cultures were prepared from newborn Wistar-Imamichi rats, cultured under serum-free conditions (25, 26), and used for experiments after five days (purity: Ͼ95% neurons). Neuronal cell number and viability was assessed by try...

In conclusion, our data do not show a pronounced developmental regulation of IMPDH activity in PBMCs in the paediatric population and there is a comparable inhibition of IMPDH activity by MPA in children and adolescents after renal transplantation.

The German Multicenter EPO Stroke Trial, which investigated safety and efficacy of erythropoietin (EPO) treatment in ischemic stroke, was formally declared a negative study. Exploratory subgroup analysis, however, revealed that patients not receiving thrombolysis most likely benefited from EPO during clinical recovery, a result demonstrated in the findings of the Göttingen EPO Stroke Study. The present work investigated whether the positive signal on clinical outcome in this patient subgroup was mirrored by respective poststroke biomarker profiles. All patients of the German Multicenter EPO Stroke Trial nonqualifying for thrombolysis were included if they (a) were treated per protocol and (b) had at least two of the five follow-up blood samples for circulating damage markers drawn (n = 163). The glial markers S100B and glial fibrillary acid protein (GFAP) and the neuronal marker ubiquitin C-terminal hydrolase (UCH-L1) were measured by enzyme-linked immunosorbent assay in serum on d 1, 2, 3, 4 and 7 poststroke. All biomarkers increased poststroke. Overall, EPO-treated patients had significantly lower concentrations (area under the curve) over 7 d of observation, as reflected by the composite score of all three markers (Cronbach α = 0.811) and by UCH-L1. S100B and GFAP showed a similar tendency. To conclude, serum biomarker profiles, as an outcome measure of brain damage, corroborate an advantageous effect of EPO in ischemic stroke. In particular, reduction in the neuronal damage marker UCH-L1 may reflect neuroprotection by EPO.