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Erythropoietin (EPO)

MVSAT 2024

Erythropoietin, also known as erythropoietin, hematopoietin, or hemopoietin, is a glycoprotein cytokine that stimulates red blood cell formation (erythropoiesis) in the bone marrow in response to cellular hypoxia. EPO erythropoietin is secreted at low levels (around 10 mU/mL) in order to compensate for normal red blood cell turnover. Any anaemia, as well as hypoxemia due to chronic lung disease, are common causes of cellular hypoxia resulting in elevated EPO levels (up to 10 000 mU/mL).

Interstitial fibroblasts in the kidney contain erythropoietin in near proximity to the peritubular capillary and proximal convoluted tubule. It's also made in the liver's perisinusoidal cells. In the foetal and perinatal age, liver production predominates; in adulthood, renal production predominates. It is linked to thrombopoietin.

This article will study recombinant human erythropoietin, erythropoietin therapy and erythropoietin treatment in detail.

Functions of EPO Erythropoietin

  • EPO Erythropoietin is a hormone that is needed for the development of red blood cells. It is required for conclusive erythropoiesis to occur. The kidney can generate and secrete erythropoietin in hypoxic conditions to increase red blood cell development by targeting CFU-E, proerythroblast, and basophilic erythroblast subsets in differentiation. Erythropoietin's primary effect is to promote the survival of red blood cell progenitors and precursors (which are located in the bone marrow of humans) by shielding them from apoptosis, or cell death.

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  • Erythropoietin is the main erythropoietic factor that works with a variety of other growth factors (such as IL-3, IL-6, glucocorticoids, and SCF) to help multipotent progenitors evolve into erythroid lineages. The burst-forming unit-erythroid (BFU-E) cells begin to express erythropoietin receptors and are erythropoietin responsive. The colony-forming unit erythroid (CFU-E) stage expresses the highest level of erythropoietin receptor density and is entirely reliant on erythropoietin for differentiation. Proerythroblasts and basophilic erythroblasts, which are precursors to red cells, express the erythropoietin receptor and are thus impaired by it.

  • Beyond erythropoiesis stimulation, erythropoietin has been shown to have a variety of actions, including vasoconstriction-dependent hypertension, angiogenesis stimulation, and cell survival through activation of EPO receptors, resulting in anti-apoptotic effects on ischemic tissues. However, several studies have shown that this proposal has little impact. It's also incongruent with the cells' low levels of EPO receptors.

  • Epogen/Procrit (epoetin alfa) and Aranesp are erythropoietin that are available for use as therapeutic agents and are developed using recombinant DNA technology in cell culture. They are used to treat anaemia caused by chronic kidney disease, chemotherapy-induced anaemia in cancer patients, and inflammatory bowel disease.

Recombinant Human Erythropoietin

Recombinant Erythropoietin

Recombinant DNA technology was used to manufacture recombinant human erythropoietin in vitro (outside the body). The purified recombinant hormone could help people with chronic renal failure who suffer from anaemia due to a lack of erythropoietin. The first hematopoietic growth factor to be produced for medicinal purposes is erythropoietin. In addition to treating anaemia caused by chronic renal failure, it is also used to treat anaemia caused by zidovudine (AZT) therapy in HIV patients. It can also aid in the reversal of anaemia in cancer patients who are undergoing chemotherapy. After strokes, recombinant human erythropoietin has also been used to stimulate or accelerate the development of neurons.

Erythropoietin Test

The primary purpose of the erythropoietin (EPO) test is to determine the cause of anaemia. A full blood count (CBC) with irregular findings, such as a low red blood cell (RBC) count, low haemoglobin, and low hematocrit, is normally followed up with an EPO examination. These tests aid in the diagnosis of anaemia and provide clues to the possible cause of the condition. Erythropoietin monitoring is used to see whether a lack of EPO is causing or exacerbating anaemia.

Erythropoietin Treatment

An EPO test can be ordered if you have chronic kidney disease to see if your kidneys are still producing enough erythropoietin. Testing will help you figure out whether you need erythropoietin replacement therapy. Erythropoietin replacement therapy can help increase red cell production in the bone marrow if the erythropoietin level is poor.

Did You Know?

Some athletes use synthetic erythropoietin as a "blood doping" agent. By increasing the count of RBCs in their blood, users hope to improve their stamina and oxygen capability. This type of drug use is risky, as it can cause hypertension and blood viscosity to rise. Most sports bodies, including the International Association of Athletics Federations, have banned its use, and erythropoietin is now being screened as part of the Olympic anti-doping programme. 

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FAQs on Erythropoietin

1. Is There a Way to Handle Low EPO Levels?

Ans: People with chronic kidney disease and other anaemias linked to bone marrow suppression and/or failures, such as those caused by radiation or chemotherapy treatment for cancer, can benefit from a synthetic type of erythropoietin (recombinant human erythropoietin or RH-EPO). The drug therapy, which is administered through a vein (intravenously) or under the skin (subcutaneous injection), is costly, and the bone marrow stimulation only lasts a few hours. The use of synthetic hormones has shown potential, reducing the need for blood transfusions and improving the quality of life for many people who are affected.

2. Is it Possible For My Kidneys to Produce Enough Erythropoietin Again?

Ans: Not in a direct way. If your low EPO is caused by a temporary kidney problem, it may go away when the issue is solved. Low EPO, on the other hand, is often caused by chronic kidney failure and may not improve over time. Your healthcare provider will work with you to correct and mitigate the symptoms of the anaemia you've developed, and you could be prescribed synthetic erythropoietin (i.e., erythropoietin replacement therapy).

3. What Does a High Erythropoietin Level Mean?

Ans: However, higher erythropoietin levels in the blood may indicate that the body is not getting enough oxygen. This may be due to anaemia or another disease that causes a low red blood cell count. Low levels of erythropoietin in the blood in someone with anaemia, on the other hand, may indicate other problems.

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