Cardioprotective effects of erythropoietin: A journey from the bedside back to the bench

Recombinant human erythropoietin (rHuEPO) has been used for 15 years for the clinical management of anemia. Mitigation of chronic anemia has led to improved cardiac function, which served as a clinical indication for chronic EPO therapy in renal failure and congestive heart failure patients. Although it was originally believed that EPO acted solely on hematopoietic cells, recent evidence suggests additional non-hematopoietic effects involving direct actions in target tissues. For example, in animal models, a single dose (1,000-5,000 U/kg) administered around the time of myocardial infarction or reperfusion after ischemia can have a profound therapeutic effect on cardiac function independent of hematocrit. This direct cardioprotective effect of EPO appears to limit infarct size by preserving myocardium in the ischemic zone, leading to enhanced cardiac contractile function and increased inotropic reserve. Thus, a window of therapeutic opportunity may exist where a single dose of EPO following or in anticipation of an ischemic cardiac event may offer acute protection as well as long-lasting benefit, through preservation of viable myocardium during or after ischemic events.

Duke Scholars

Author Walter J. Koch Surgery, Cardiovascular and Thoracic Surgery