Erythropoietin (EPO) in acute kidney injury

Abstract

Erythropoietin (EPO) is a 30.4 kDa glycoprotein produced by the kidney, and is mostly well-known for its physiological function in regulating red blood cell production in the bone marrow. Accumulating evidence, however, suggests that EPO has additional organ protective effects, which may be useful in the prevention or treatment of acute kidney injury. These protective mechanisms are multifactorial in nature and include inhibition of apoptotic cell death, stimulation of cellular regeneration, inhibition of deleterious pathways, and promotion of recovery.In this article, we review the physiology of EPO, assess previous work that supports the role of EPO as a general tissue protective agent, and explain the mechanisms by which it may achieve this tissue protective effect. We then focus on experimental and clinical data that suggest that EPO has a kidney protective effect.

Erythropoietin ameliorates genetamicin-induced renal toxicity: A biochemical and histopathological study

“…Erythropoietin has also been found to ameliorate toxic renal injury caused by Cisplatin (31,32). Similarly, its renoprotective effect in ischemia-reperfusion renal injury, as the most common cause of ARF in the community was also reported (15,31). It seems that erythropoietin is not solely a hormone charged with regulating the proliferation and differentiation of erythroid progenitor cells (33,34).…”

“…While erythropoietin receptors Group 1; sham, group 2: GM treated for 10 days (positive control), group 3: GM treated for 10 days following by Eprex treated for 10 days, group 4; GM plus Eprex treated for 10 days. Ns: non-significant, ∆: concentration difference (after-before) are expressed on renal tubular epithelial cells (15,31), it is possible that the systemic administration of erythropoietin may also provide protection against acute renal damage (15, 31). Erythropoietin has also been found to ameliorate toxic renal injury caused by Cisplatin (31,32).…”

“…Moreover, it has been shown to exert pleiotropic properties, such as cytoprotection, anti-inflammation and antiapoptosis, in the central nervous, kidney and liver (12)(13)(14)(15). Studies also suggested that erythropoietin may act directly on damaged tubular cells and stimulates their regeneration (9,15). It has been shown that erythropoietin receptors are found on renal tubular epithelial, mesangial and endothelial cells.…”

“…However, due to in-vitro human recombinant erythropoietin stimulates endothelial cell proliferation (10)(11)(12) and angiogenesis (10,13,14), erythropoietin effects may not be limited to bone marrow cells. Moreover, it has been shown to exert pleiotropic properties, such as cytoprotection, anti-inflammation and antiapoptosis, in the central nervous, kidney and liver (12)(13)(14)(15). Studies also suggested that erythropoietin may act directly on damaged tubular cells and stimulates their regeneration (9,15).…”

“…It has been shown that erythropoietin receptors are found on renal tubular epithelial, mesangial and endothelial cells. This effect may be through activation signaling pathways to prevent apoptosis and/ or stimulate reparative proliferation of the injured cells (9,14,15). Gentamicin (GM) is widely known to induce ARF as a result of renal tubular epithelial cell injury by direct acute tubular necrosis which is primarily localized to the proximal tubule.…”