Erythropoietin (EPO) is the glycoprotein hormone which controls the production of erythrocytes in mammals. Erythrocytes contain hemoglobin which delivers oxygen from the lungs to other tissues throughout the body. The amount of oxygen delivered to the tissues is controlled by the number of erythrocytes in the bloodstream. Erythrocytes have a finite life span, and, therefore, maintenance of normal oxygen delivery requires continuous replacement of those aged erythrocytes normally lost from the circulation. Adjustments in this basal rate of erythrocyte production are made when tissue oxygenation becomes either decreased or increased compared to the normal level. Development of anemia due to blood loss or inspiration of decreased atmospheric oxygen at high altitude results in decreased oxygen delivery to the tissues. In response to this tissue hypoxia, plasma EPO levels increase due to increased EPO production by the kidney, erythrocyte production increases and the resulting increase in circulating erythrocytes permits more oxygen delivery. Conversely, when tissue oxygenation is increased above normal, which occurs during a sudden change from high altitude to sea level or in a transfusion of erythrocytes to greater than normal numbers, plasma EPO levels decrease, erythrocyte production is decreased and the resultant decline in circulating erythrocytes decreases oxygen delivery to the tissues. Thus, a negativefeedback mechanism exists in which the amount of oxygen delivered by erythrocytes to the body tissues determines the plasma EPO concentration, and, in turn, the EPO concentration determines the number of circulating erythrocytes by controlling the rate of erythrocyte production.Significant progress in understanding the central role of EPO in the oxygenation/EPO/erythrocyte cycle has been made in the last few years. This progress is the result of multiple research efforts, which have resulted in the purification of EPO and the cloning of the EPO gene, an increased understanding of how EPO production is controlled by oxygen in the kidney and liver, the development of in vitro model systems Abbreviations. BFU-E, burst-forming-unit erythroid; CFU-E, colony-forming-unit erythroid; CHO, Chinese hamster ovary; EPO, erythropoietin; FVA cells, splenic erythroblasts from mice infected with Friend leukemia virus (anemia-inducing strain); GATA-I, transcription factor that binds DNA sequence GATA in erythroid cells; GM-CSF, granulocyte-macrophage colony-stimulating factor; HCD cells, an erythropoietin-dependent murine erythroleukemia cell line; rh-EPO, recombinant human erythropoietin; SFFVp, Friend spleen focus-forming virus (polycythemia-inducing); uh-EPO, urinary human erythropoietin; IL, interleukin. of erythropoiesis which provide EPO-responsive cell populations, and the cloning of the EPO receptor gene. These scientific advances have also had a dramatic impact on clinical medicine. Commercially produced, recombinant human EPO is used routinely in the care of patients with renal failure. Patients with renal failure are...