New alternatives for erythropoietin therapy in chronic renal failure |
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Authors: | Irina Stoian Bogdan Manolescu Valeriu Atanasiu Olivera Lupescu |
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Institution: | (1) Department of Biochemistry, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050473 Bucharest, Romania;(2) Department of Thrauma and Ortopaedics, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050473 Bucharest, Romania |
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Abstract: | Erythropoietin (EPO) is one of the main cytokines involved in the regulation of erythropoiesis. The main site of EPO production
are the kidneys. An altered EPO production leads to pathological conditions such as anemia and polycythaemia. Due to the progressive
loss of renal peritubular cells, patients with chronic kidney disease (CKD) have low EPO plasma levels. This decreases erythron
stimulation with the direct consequence of developing anemia. Before the introduction in the clinical practice of rHuEpo,
in the late 1980s, the only solution for treating this type of anemia were blood transfusions and anabolic steroids. Even
rHuEpo has proven to be safe and effective for treatment of anemias, there are some concerns about its cost, the need for
frequent parenteral administration, and development of anti-EPO antibodies. These inconveniences prompted the search for novel
erythropoiesis stimulating agents. Different strategies lead to isolation or chemical synthesis of such agents as darbepoetin
alfa and EPO mimetics. In this review, we present some general aspects of EPO biology, with emphasis on chronic renal failure,
and expose some of the alternatives to EPO used for anemia correction. |
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Keywords: | Erythropoietin darbepoetin hematide synthetic erythropoiesis protein chronic kidney disease hepcidin |
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