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OBJECTIVE To compare the effects of roxadustat and recombination human erythropoietin （rHuEPO） on coronary artery calcification in maintenance hemodialysis （MHD） patients. METHODS In retrospective analysis， MHD patients prescribed roxadustat in the Blood Purification Center of the First Affiliated Hospital of Chongqing Medical University from April 2019 to June 2021 were selected as the ROX group （56 patients）， and MHD patients prescribed rHuEPO during the same period were selected as the EPO group （60 patients）， and follow-up observation was conducted for 12 months. The differences in laboratory index， coronary artery calcification score （CACS）， and cardiac ultrasound parameters before and after treatment as well as the occurrence of cardiac and cerebrovascular adverse events during follow-up period were compared between the two groups. RESULTS There was no statistical difference in CACS between the two groups before and after treatment （P＞0.05）； but the difference of CACS in the ROX group was significantly lower than the EPO group （P＜0.05）. There was no statistically significant difference in cardiac ultrasound parameters and laboratory indexes between the two groups before and after treatment （P＜0.05）. The incidence of apoplexy and myocardial infarction in the ROX group was lower than that in the EPO group （P＜0.05）， and there was no statistically significant difference in the incidence of hospitalization due to heart failure between the two groups （P＞0.05）. CONCLUSIONS Compared with rHuEPO， roxadustat may have a positive effect on delaying coronary artery calcification in MHD patients and may be beneficial in reducing the incidence of myocardial infarction and apoplexy in MHD patients.
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Objective:To compare the clinical curative effect of roxadustat and recombinant human erythropoietin (rhEPO) on non-dialysis stage 3 to 5 chronic kidney disease (CKD) combined with renal anemia (RA).Methods:A total of 108 patients with non-dialysis stage 3 to 5 CKD and RA admitted to Jiangbei Branch of Zhongda Hospital Affiliated to Southeast University were prospectively enrolled between January 2020 and October 2022. According to random number table method, they were divided into group A and group B, 54 cases in each group. The group A was treated with roxadustat and polysaccharide-iron complex (PIC) for 3 months, while group B was treated with rhEPO and PIC for 3 months. The clinical curative effect, levels of hemoglobin (Hb), red blood cell count (RBC), hematocrit (Hct), serum ferritin (SF), transferrin saturation (TSAT), transferrin (TRF), blood urea nitrogen (BUN), serum creatinine (Scr) and β2-microglobulin (β2-MG) before and after treatment, and the incidence of adverse reactions during treatment in the two groups were compared.Results:The total response rate of treatment in group A was significantly higher than that in group B: 87.04% (47/54) vs. 70.37% (38/54), and the difference was statistically significant ( P<0.05). After treatment, levels of RBC, Hb and Hct in group A were significantly higher than those in group B: (3.47 ± 0.59) × 10 12/L vs. (2.60 ± 0.51) × 10 12/L, (110.45 ± 12.97) g/L vs. (93.64 ± 10.58) g/L, 0.358 ± 0.054 vs. 0.303 ± 0.043, and the difference was statistically significant ( P<0.05). The levels of TSAT, SF and TRF in group A were significantly higher than those in group B: (35.17 ± 3.65)% vs. (29.82 ± 3.10)%, (286.74 ± 17.23) μg/L vs. (243.16 ± 15.49) μg/L, (2.76 ± 0.45) g/L vs. (2.40 ± 0.32) g/L, and the difference was statistically significant ( P<0.05). The levels of BUN, Scr and β2-MG in group A were significantly lower than those in group B: (3.98 ± 0.41) mmol/L vs. (4.36 ± 0.54) mmol/L, (62.57 ± 7.89) μmol/L vs. (80.34 ± 9.65) μmol/L, (1.50 ± 0.42) μg/L vs. (1.99 ± 0.58) μg/L, and the difference was statistically significant ( P<0.05). During treatment, incidence of adverse reactions in group A was significantly lower than that in group B: 11.11% (6/54) vs. 25.93% (14/54), and the difference was statistically significant ( P<0.05). Conclusions:Compared with rhEPO, roxadustat has better curative effect, which can effectively relieve anemia and improve iron metabolism in patients with non-dialysis stage 3 to 5 CKD and RA, with good safety.
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Objective:To study the effects of recombinant human erythropoietin (rhEPO) on cerebral blood flow (CBF) in preterm infants using arterial spin labeling (ASL) magnetic resonance imaging (MRI).Methods:From September 2021 to June 2022, preterm infants (gestational age ≤32 weeks, birth weight ≤1 500 g) admitted to NICU of our hospital within 24 h after birth were randomly assigned into rhEPO group and control group for this prospective study. The rhEPO group was given rhEPO (500 IU/kg iv, once every other day for 2 weeks) within 72 h after birth plus symptomatic supportive treatment. The control group received same amount of normal saline injection. Both groups received brain MRI, diffusion-weighted imaging and ASL at adjusted gestational age of 35~37 weeks and CBF values of interested areas were measured.Results:A total of 85 infants were enrolled, including 40 in the rhEPO group and 45 in the control group. No significant differences existed in the incidences of periventricular-intraventricular hemorrhage, periventricular leukomalacia, focal white matter injury and extensive white matter injury between the two groups ( P>0.05). The CBF values [ml/(100 g·min)] of frontal cortex [left 15.1±3.9 vs. 17.9±3.1, right 15.9 (12.5, 17.8) vs. 18.1(16.1,20.2)], temporal cortex [left 15.8±4.3 vs. 18.6±3.8, right 16.3(13.2,19.4) vs. 18.1(15.7,19.7)], occipital cortex (left 15.8±6.1 vs. 18.8±3.3, right 16.8±5.5 vs. 19.3±4.8), basal ganglia (left 24.7±7.2 vs. 28.7±6.2, right 26.0±7.9 vs. 29.3±6.4) and thalamus (left 32.7±11.8 vs. 37.9±8.6, right 32.1±11.6 vs. 37.6±10.2) in the rhEPO group were significantly lower than the control group ( P<0.05). No significant differences existed of CBF value at the parietal cortex between the two groups ( P>0.05). Conclusions:Early application of rhEPO can reduce CBF in premature infants, which may be related to the neuro-protective effects of EPO.
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Objective To compare the efficacy and safety of cyclosporin A(CsA)and CsA combined with recombined human erythropoietin(rhEPO)in the treatment of patients with chronic aplastic anemia(CAA).Methods Data of 79 patients with CAA treated at Department of Hematology,PUMC Hospital between January 2016 and June 2018 were collected for retrospective analysis.Forty-five patients were treated with CsA+rhEPO,and the other 34 patients with CsA alone.All the enrolled patients were treated for at least 1.5-2.0 years and followed for at least 1.0 year.The efficacy,side effects,long-term outcomes were compared between the two groups,and factors that may influence the efficacy were analyzed.Results The patients treated with CsA+rhEPO included 14 males and 31 females,with a median age of 43(19,73)years old.The median treatment duration of CsA and rhEPO was 26(12,38)and 4(3,6)months,respectively,and the median followed-up time was 24(12,42)months.The patients treated with CsA alone included 16 males and 18 females,with a median age of 36(16,85)years old.The median CsA treatment duration was 24(12,40)months and the median follow-up time was 25(12,40)months.There was no statistical difference in baseline characteristics between the two groups(all
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Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Anemia Aplásica/tratamiento farmacológico , Ciclosporina/uso terapéutico , Eritropoyetina/uso terapéutico , Proteínas Recombinantes , Inducción de Remisión , Estudios RetrospectivosRESUMEN
RESUMEN Fundamento: La quemadura grave representa el tipo de agresión biológica más severo que puede sufrir el organismo y ponen en peligro la vida del paciente por el permanente riesgo de sepsis y falla multisistémica progresiva. La anemia incide en la morbilidad y mortalidad del quemado en estado grave; su tratamiento ha pasado por diversos momentos en la historia y su corrección depende de las transfusiones sanguíneas que aumentan el riesgo de complicaciones y reacciones adversas. Objetivo: Actualizar los conocimientos sobre la utilidad de la eritropoyetina en el tratamiento de la anemia en el quemado grave. Desarrollo: La gravedad de la quemadura está determinada por la intensidad de la temperatura y la duración de la exposición. La anemia es una de las complicaciones más frecuentes en los quemados graves y su tratamiento en ocasiones se limita al uso de transfusiones de sangre, sin embrago la eritropoyetina es una alternativa terapéutica; pertenece a la familia de las citoquinas, alcanza la médula ósea, donde estimula células progenitoras cuyo objetivo es lograr su transformación en eritrocitos. La administración de eritropoyetina humana recombinante en el paciente quemado grave con anemia se considera eficaz, ya que al estimular los mecanismos de la eritropoyesis, produce una elevación paulatina pero mantenida del hematocrito acompañándose de otros efectos beneficiosos. Conclusiones: La eritropoyetina humana por sus características farmacológicas, se muestra como una opción de tratamiento para el paciente quemado grave con anemia al permitir la recuperación de manera sostenida de los valores de hemoglobina con un mínimo de complicaciones, disminuye el uso de transfusiones de sangre que pueden aumentar la morbilidad de estos enfermos.
ABSTRACT Background: The serious burn represents the most severe type of biological aggression the body can suffer and endangers the patient's life due to the permanent risk of sepsis and progressive multisystem failure. Anemia affects the morbidity and mortality of seriously burned patient in serious condition; its treatment has gone through different moments in history and its correction depends on blood transfusions that increase the risk of complications and adverse reactions. Objective: To update knowledge about the usefulness of erythropoietin in the treatment of anemia in seriously burned patient. Development: The severity of the burn is determined by the intensity of the temperature and the duration of the exposure. Anemia is one of the most frequent complications in seriously burned patient and its treatment is sometimes limited to the use of blood transfusions. However, erythropoietin is a therapeutic alternative; it belongs to the family of cytokines, reaches the spinal cord, where it stimulates progenitor cells with the objective of achieving their transformation into erythrocytes. The administration of recombinant human erythropoietin in seriously burned patient with anemia is considered effective, since by stimulating the mechanisms of erythropoiesis, it produces a gradual but sustained elevation of the hematocrit accompanied by other beneficial effects. Conclusions: Human erythropoietin, due to its pharmacological characteristics, is shown as a treatment option for seriously burned patient with anemia by allowing the sustained recovery of hemoglobin values with a minimum of complications, reducing the use of blood transfusions that can increase the morbidity of these patients.
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Quemaduras , Eritropoyetina/uso terapéutico , Anemia/tratamiento farmacológicoRESUMEN
Objective : To investigate the effectiveness of recombinant human erythropoietin (rHuEPO) combined with iron in treatment of anemia in elderly patients with intertrochanteric fractures during perioperative period. Methods: A clinical data of 71 patients with intertrochanteric fractures met the inclusion criteria between April 2016 and October 2017 was retrospectively analyzed. All patients were treated with closed reduction and proximal femoral intramedullary nail fixation. Thirty-one patients were treated with rHuEPO and iron before operation as trial group, and 40 patients were not treated with rHuEPO and iron as control group. There was no significant difference in gender, age, body mass index, cause of injury, fracture side and classification, American Society of Anesthesiologists (ASA) classification, combined medical diseases, time from fracture to admission, preoperative hospital stay, and operation time between the two groups ( P>0.05).The hemoglobin levels before operation and at 1, 3, and 7 days after operation, number of blood transfusion, blood transfusion rate, blood transfusion volume, postoperative hospital stay, complications were recorded and compared. Results: After operation, 8 patients (25.8%) in trial group and 22 patients (55.0%) in control group received blood transfusion; the blood transfusion volume was (1.96±0.85) units in trial group and (3.19±1.61) units in control group. There were significant differences in blood transfusion rate and volume between the two groups ( P0.05). The postoperative hemoglobin level was higher in trial group than in control group, and the difference between the two groups was significant at 7 days ( P0.05). All patients were discharged from hospital normally, and no one died during hospitalization. Conclusion: The application of rHuEPO combined with iron before operation in elderly patients with intertrochanteric fractures can rapidly increase the hemoglobin level after operation, shorten the hospital stay, and do not increase the risk of deep venous thrombosis after operation.
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Objective To observe the effect of recombinant human erythropoietin injection (RHEI) assisted with mild hypothermia on the clinical efficacy and safety of children with hypoxic-ischemic encephalopathy (HIE). Methods From January 2015 to December 2017, 110 children with HIE were treated in Shijiazhuang No.1 Hospital. Fifty-five children with routine treatment were taken as Western medicine routine treatment group. In addition, 55 children treated with mild hypothermia combined with RHEI were taken as mild hypothermia+RHEI group. Both groups were treated for 14 days and followed up for 10 months. The neonatal behavioral neurological assessment (NBNA) score, mental development index (MDI), psychomotor development index (PDI), myelin basic protein (MBP), S100B protein and neuron specific enolization enzyme (NSE), nerve growth factor (NGF), brain derived neurotrophic factor (BDNF), insulin growth factor-1 (IGF-1), growth hormone (GH), and differences in clinical efficacy in two groups were compared, and the occurrence of adverse reactions was observed. Results The NBNA, MDI, PDI, NGF (μg/L), BDNF (ng/L), IGF-1 (pg/L), and GH (pg/L) of two groups after treatment were higher than those before treatment (the Western medicine routine treatment group: 33.72±3.19 vs. 26.81±2.38, 78.95±5.51 vs. 71.39±4.24, 79.62±4.93 vs. 71.84±4.15, 123.74±22.98 vs. 104.29±15.36, 1 518.35±174.92 vs. 1 197.28±148.43, 38.25±4.96 vs. 23.16±2.87, 39.27±5.24 vs. 20.97±3.15; the mild hypothermia+RHEI group: 39.82±3.36 vs. 26.78±2.53, 84.13±6.29 vs. 71.34±4.27, 85.26±5.74 vs. 71.88±4.13, 145.28±27.52 vs. 104.72±15.41, 1 925.71±204.37 vs. 1 192.61±150.26, 57.94±6.62 vs. 23.13±2.91, 56.43±7.14 vs. 20.94±3.17), NSE (μg/L), MBP (μg/L) and S100B (μg/L) were lower than those before treatment (the Western medicine routine treatment group: 17.05±2.26 vs. 24.96±2.83, 9.71±1.85 vs. 23.14±3.37, 0.93±0.12 vs. 1.49±0.24; the mild hypothermia+RHEI group:12.48±1.94 vs. 25.03±2.81, 5.48±1.42 vs. 23.17±3.35, 0.61±0.07 vs. 1.51±0.25). After treatment, the changes of each index in the mild hypothermia+RHEI group were more significant than those in the control group [NABA:39.82±3.36 vs. 33.72±3.19, MDI: 84.13±6.29 vs. 78.95±5.51, PDI: 85.26±5.74 vs. 79.62±4.93, NSE (μg/L):12.48±1.94 vs. 17.05±2.26, MBP (μg/L): 5.48±1.42 vs. 9.71±1.85, S100B (μg/L): 0.61±0.07 vs. 0.93±0.12, NGF (μg/L): 145.28±27.52 vs. 123.74±22.98, BDNF (ng/L): 1 925.71±204.37 vs. 1 518.35±174.92, IGF-1 (pg/L):57.94±6.62 vs. 38.25±4.96, GH (pg/L): 56.43±7.14 vs. 39.27±5.24, all P < 0.05]. The total effective rate of mild hypothermia+RHEI group was significantly higher than that of Western medicine routine treatment group [94.55% (52/55) vs. 81.82% (45/55), P < 0.05]. There were no serious adverse reactions in the two groups. Conclusion RHEI assisted with mild hypothermia therapy can significantly improve the clinical efficacy and NBNA, MDI, PDI scores of HIE children, reduce the degree of brain injury, and improve the neurological function, with good safety.
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OBJECTIVES: To evaluate the effects of epoetin (EPO) alfa treatment on overall survival, event-free survival and response duration in patients with myelodysplastic syndrome (MDS) who were treated at a haematological referral centre in northeastern Brazil. METHODS: This was a retrospective cohort study of 36 patients diagnosed with MDS and treated with EPO alfa at 30,000 to 60,000 IU per week. Clinical data were collected from medical records. The events assessed were non-response to treatment and progression to acute myeloid leukaemia (AML). Statistical analyses were performed using GraphPad Prism 7 and SPSS 24 software. RESULTS: The overall survival of patients who received EPO alfa treatment was 51.64%, with a median of 65 months of treatment, and the overall survival of this group was 100% during the first 24 months. We detected a 43.5-month median event-free survival, with a response rate of 80.5%. We observed responses from 25 to 175 months. Patients with transfusion dependence and those with a high-risk stratification, as determined by the International Prognostic Scoring System (IPSS), the Revised International Prognostic Scoring System (IPSS-R), the WHO classification-based Prognostic Scoring System (WPSS) and the WHO 2016, had a lower event-free survival than other patients. CONCLUSIONS: Despite the wide use of EPO alfa in the treatment of anaemia in patients with MDS, the median response duration is approximately only 24 months. Our data provide encouraging results concerning the benefits of using EPO alfa for the improvement of the quality of life, as patients treated with EPO showed higher overall survival, event-free survival rates and longer response durations than have been previously described in the literature.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Síndromes Mielodisplásicos/mortalidad , Síndromes Mielodisplásicos/tratamiento farmacológico , Epoetina alfa/uso terapéutico , Hematínicos/uso terapéutico , Recuento de Plaquetas , Valores de Referencia , Factores de Tiempo , Transfusión Sanguínea , Brasil , Hemoglobinas/análisis , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Progresión de la Enfermedad , Estimación de Kaplan-Meier , Cariotipo , Supervivencia sin ProgresiónRESUMEN
OBJECTIVE: To detect and analyze the degree of salivary acidification of rhEPO isoforms. METHODS: The isoelectric points of rhEPO isoforms were determined with full column imaging capillary isoelectric focusing electrophoresis. And the charge distribution among rhEPO isoforms was analyzed. The degrees of rhEPO's total saliva acidification were measured using the method of appendices of Chinese Pharmacopoeia. At last, the degrees of saliva acidification of rhEPO isoforms were obtained using multivariate linear fitting. RESULTS: Nine kinds of rhEPO isoforms were distinguished and defined as isoform 1 to 9 with isoelectric points in the range of 3.6 to 5.1. There was one sialic acid molecule between two contiguous rhEPO isoform. Furthermore, the degrees of salivary acidification of the main four kinds of isoforms, 4-7, were 13, 12, 11 and 10 mol/mol, respectively. CONCLUSION :This study lays foundation for rhEPO biosimilar evaluation and further analysis of each isoform of rhEPO.
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Objective To study the effects and side effects of different dose of rHu-EPO on the treatment of brain injury in premature infants. Methods The infants who had suffered fetal distress and first one minute of Apgar was under 7score after birth and were sent to NICU within 24h were studied. We totally collected 90 infants and divided into three groups randomly, including large dose group, small dose group and control group. The large and small group were injected hypodermicly with rHu-EPO 1000U/kg, 500U/kg, three times per week for three weeks, and the control group were given general treatment without rHu-EPO at same time. Before treatment, one week and three weeks after treatment, we collected concentration of NSE, S100B and skull ultrasound to assess the effects. Neonatal behavioral neurological assessment(NBNA) were performed twice before and at weeks of correct gestational age. To survey the side effects, we collected general information such as the incidence rate of ROP and hemangioma, AST/ALT/PLT/Urea /Cr and so on. Results After one-week treatment, the concentration of NSE and S100B were no significant difference(P ＞ 0. 05) in the small dose group, but were statistically significant in the large dose group(P ＜ 0. 05). After three-week treatment, the comparison of NSE、S100B in both groups was statistically significant(P ＜ 0. 05). The head ultrasound comparison was of statistically significant in both group(P ＜ 0. 05), and so as NBNA and head MRI. The frequency of blood transfusion was statistically significant in both group(P ＜ 0. 05) compared with control group. Routine blood test including liver and kidney function showed that there was no significant difference before and after treatment(P ＞ 0. 05). Conclusion The neuroprotective effect of rHu-EPO on brain injury in preterm infants is connected with its dose and period of treatment, it need high dose or long time to express neuroprotective function.
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Objective@#To explore the effects of human erythropoietin (hEPO) on healing related transforming growth factor β1 (TGF-β1)/Smad3 signal transduction pathway in acute wounds of rats.@*Methods@#Seventy-two healthy Sprague Dawley rats were divided into normal saline control group, low dose group, middle dose group, and high dose group according to the random number table, with 18 rats in each group, after round acute wounds with diameter of 2.5 cm were inflicted on the back of rats. Rats in the 4 groups had debridement routinely. Wounds of rats in normal saline control group were covered by gauzes infiltrated with 1 mL normal saline, while wounds of rats in low dose group, middle dose group, and high dose group were respectively covered by gauze infiltrated with 1 mL hEPO in doses of 50, 100, and 150 U every day, and then the wounds were bandaged with 6 layers of dry gauze. Dressing change was performed once every day. On treatment day (TD) 3, 7, and 14, 6 rats from each group were taken for general observation and calculation of wound healing rate. Then the wound tissue samples were harvested after the rats were sacrificed for observation of expressions of CD31 and transforming growth factor β1 (TGF-β1) with immunohistochemical method. Protein expression of phosphorylated Smad3 of the wound tissue of 3 rats were detected by Western blotting. Data were processed with analysis of variance of factorial design, one-way analysis of variance, least-significant difference test, and Bonferroni correction.@*Results@#(1) On TD 3, obvious exudation and scab were observed in the wounds of rats in the 4 groups. On TD 7, the wounds of rats in low dose group, middle dose group, and high dose group were reduced compared with those in normal saline control group. On TD 14, all wounds of rats in the 4 groups were healed. On TD 7, the wound healing rates of rats in middle dose group and high dose group were significantly higher than the rate in normal saline control group (P<0.01). At the other time points, the wound healing rates of rats in the 4 groups were close (P>0.05). (2) CD31 mainly expressed in blood vessels. Except for those in low dose group on TD 3 and 7 (P>0.05), the expressions of CD31 in wound tissue of rats in low dose group on TD 14 and in middle dose group and high dose group on TD 3, 7, and 14 were significantly higher than those in normal saline control group (P<0.01). Except for those on TD 3 (P>0.05), the expressions of CD31 in wound tissue of rats in middle dose group and high dose group on TD 7 and 14 were significantly higher than those in low dose group (P<0.01). Except for that on TD 3 (P>0.05), the expressions of CD31 in wound tissue of rats in high dose group on TD 7 and 14 were significantly higher than those in middle dose group (P<0.01). (3) Except for that in low dose group on TD 3 (1.9±0.7, P>0.05), the expressions of TGF-β1 in wound tissue of rats in low dose group on TD 7 and 14 (3.3±1.0, 3.7±0.7), and in middle dose group and high dose group on TD 3, 7, and 14 (3.3±1.0, 3.6±1.0, 3.9±0.9, 3.4±0.7, 3.8±0.8, 4.2±0.4) were significantly higher than those in normal saline control group (1.7±0.5, 2.7±1.0, 3.0±0.9, P<0.01). Except for those on TD 7 (P>0.05), the expressions of TGF-β1 in wound tissue of rats in middle dose group and high dose group on TD 3 and 14 were significantly higher than those in low dose group (P<0.01). Except for that on TD 14 (P<0.01), the expressions of TGF-β1 in wound tissue of rats in high dose group on TD 3 and 7 were close to those in middle dose group (P>0.05). (4) Except for those in low dose group on TD 3 and 14 and in middle dose group and high dose group on TD 14 (P>0.05), the protein expressions of phosphorylated Smad3 in wound tissue of rats in the 3 groups at the other time points were significantly higher than those in normal saline control group (P<0.01). Except for those on TD 14 (P>0.05), the protein expressions of phosphorylated Smad3 in wound tissue of rats in middle dose group and high dose group on TD 3 and 7 were significantly higher than those in low dose group (P<0.01). Except for that on TD 14 (P>0.05), the protein expressions of phosphorylated Smad3 in wound tissue of rats in high dose group on TD 3 and 7 were significantly lower than those in middle dose group (P<0.01).@*Conclusions@#Exogenous hEPO can increase the expressions of CD31, TGF-β1, and phosphorylated Smad3 in acute wounds of rats, promote angiogenesis of wounds, and activate TGF-β1/Smad3 signal transduction pathway to promote wound healing.
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Objective:To study the effect of recombinant human erythropoietin and β-aescin on functional recovery and secondary injury of nerve cells in rats after spinal cord injury.Methods:A total of 50 female SD rats were randomly divided into five groups according to their injury and treatment.The rats in the rh-EPO group were treated with recombinant human erythropoietin,and the β-SE group was treated with β-aescin,and the combination group was treated with recombinant human erythropoietin and the treatment of β-aescin,compared the indicators.Results: The BBB motor function scores of the combination therapy group were significantly higher than those of rh-EPO group,β-SE group and injury group.The neurological function of the combined treatment group was better than that of rh-EPO group and β-SE group(P<0.05).The content of Mg2+in the combination group was significantly higher than that in the rhEPO group and the β-SE group,and the difference was significant (P<0.05).Conclusion: The combination of re-combinant human erythropoietin and β-aescin can help improve the BBB motor function score,promote the recovery of motor function and delay the development of secondary injury of nerve cells.
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Objective:To study the adverse reactions (ADRs) of recombinant human erythropoietin (rHuEPO) to provide refer-ence for clinical rational and safe medication. Methods:ADRs induced by rHuEPO reported at home and abroad were collected and analyzed in respects of age,gender,original illness, occurrence time, clinical manifestations and the results. Results: After the re-trieval,there were 149 cases of rHuEPO-induced ADRs with the damage of cardio vascular system, hematologic system, skin and its appendents accounting for 43.4%,20.8% and 12.7%,respectively. The top three main clinical manifestations of rHuEPO drug reac-tions were hypertension,pure red-cell aplastic anemia (PRCA) and hyperkalemia. The occurrence time should be paid particular at-tention in 5-12 weeks after the administration (43.0%). Conclusion:Physicians should be aware of rHuEPO-induced ADRs (espe-cially the occurrence time),pay attention to patients' medication education and avoid serious adverse reactions.
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Objective To investigate the effects of recombinant human erythropoietin βinjection on levels of superoxide dismutase ( SOD ) , glutathione peroxidase ( GSH-PX ) , malondialdehyde ( MDA ) and homocysteine ( Hcy ) in patients with diabetic peritoneal dialysis.Methods 92 patients of parallel peritoneal dialysis in diabetic nephropathy who received therapy from September 2014 to September 2016 in our hospital were selected and randomly divided into the observation group and the control group with 46 cases in each group.The control group was treated with peritoneal dialysis routine treatment, while the observation group was treated with recombinant human erythropoietin βinjection on this basis.The levels of hemoglobin (Hb), hematocrit (Hct), renal function, SOD, GSH-PX, MDA and Hcy were compared.Results After treatment, the levels of Hb and Hct in the observation group were higher than the control group, the difference was statistically significant (P<0.05), the urinary albumin excretion rate (UAER) and serum creatinine (SCr) in the observation group were lower than the control group, the difference was statistically significant (P<0.05), the levels of SOD and GSH-PX in the observation group were higher than the control group, the levels of MDA and Hcy were lower the control group, the difference was statistically significant (P<0.05).Conclusion The effect of recombinant human erythropoietin βinjection on diabetic nephropathy patients with peritoneal dialysis was significant, which could improve the levels of SOD, GSH-PX, MDA and Hcy.
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Objective To explore the effect of exogenous recombinant human erythropoietin (rhEPO) on neuronal apoptosis in neonatal rats after hyperoxia brain injury.Methods Thirty neonatal Wistar rats were randomly divided into 3 groups by random number table method:rhEPO treatment + 800 mL/L hyperoxia group (group A),9 g/L saline +800 mL/L hyperoxia group (group B),9 g/L saline + air group (group C).Group A was given subcutaneous injection of rhEPO 1 000 IU/kg for 5 days.Group B and group C received the same dose of 9 g/L saline.Group A and group B were continuously exposed to atmospheric pressure hyperoxia model cabin to maintain the oxygen concentration in the container (800 ± 30) mL/L for 5 days.During the course of the experiment,the general situation and weight changes in rats were observed.After 5 d,all rats were sacrificed and brain tissues were taken.Neuronal apoptosis in hippocampal structural region of the newborn rats was observed by terminal deoxynucleotidyl transferase dUTP nick and labeling(TUNEL) staining.Immunohistochemical method was used to detect the expression of 5-lipoxygenase in hippocampal structural region of newborn rats.Results The weight gain and brain weight of group B were lower than those of group C,the weight gain and brain weight of group A were higher than those of group B,and the differences were statistically significant(F =11.179,8.140,all P ＜ 0.05).In group A and group B were found that the neuronal nucleus of the hippocampal neurons was partially contracted,deeply dyed,and the neuronal arrangement was loose,even with local neuron deletions and focal necrosis,but in group A neuron density was higher with less necrosis than that in group B.The neuronal cells in hippocampal structural region were neat and intact in group C.The number of TUNEL positive cells in hippocampal structural region of group B[(6.20 ± 1.93) number/high power field] was significantly higher than that in group C [(1.80 ± 0.79) number/high power field],the number of TUNEL positive cells in hippocampal structural region of group A [(4.20 ± 1.32) number/high power field] was significantly lower than that in group B,and the difference was statistically significant (F =23.912,P ＜ 0.05).The number of 5-lipoxygenase positive cells in group B [(6.90 ± 1.29) number/high power field] was significantly higher than that in group C [(1.00 ± 0.67) number/high power field],the number of 5-lipoxygenase positive cells in group A [(5.60 ± 0.97)number/high power field] was significantly lower than that in group B,and the difference was statistically significant (F =95.044,P ＜ 0.05).Conclusion rhEPO has a protective effect on neonatal rats with hyperoxia brain injury,and alleviates brain cell apoptosis caused by hyperoxia brain injury,which may interfere with the 5-lipoxygenase pathway.
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Objective To evaluate the effect of recombinant human erythropoietin (rhEPO) combined with methylprednisolone sodium succinate (MPSS),compared to MPSS alone,in the treatment of neurological function of patients with acute spinal cord injury (SCI).Methods Twenty-one patients presenting in hospital within less than 8 hours after acute SCI were randomly divided into two groups,the control group (10 cases) and the intervention group (11 cases).The control group was treated by MPSS combined with placebo,while the intervention group received MPSS with rhEPO.Both groups received MPSS 30 mg/kg within the first hour,and if the patient was admitted within 4 hours,MPSS would be applied in the treatment with 5.4 mg/kg per hour in the subsequent 23 hours and till 47 hours if the patient was admitted within 4-8 hours after injury.The intervention group received 500 U/kg rhEPO on admission and another 500 U/kg in the next 24 hours,compared with the control group where placebo was used.The evaluation on neurologic function recovery was made on admission,24 h,72 h,one week,2 months and 6 months later,and statistical analysis was performed.Results The change in ASIA score: in the control group,the increase was seen from admission to 6 months after injury in terms of exercise,algesia and tactile sensation ((31.2±6.6) points vs.(57.8±9.8) points,(41.4±9.5) points vs.(64.3±10.6) points, (39.2±6.8) points vs,(61.5±11.3) points),the increase also took place in the intervention group ((29.5±7.2) points vs.(77.4±10.3) points,(39.7±7.2) points vs.(82.3±12.1) points,(37.4±6.2) points vs.(78.6±12.4) points).As time went on,the increase range in the intervention group became larger,compared with the control group.The difference between the two groups in ASLA score was statistically significant (P0.05).Conclusion The application of MPSS combined with rhEPO within 8 hours after acute spinal injury may be more effective than MPSS with placebo in the neurologic dysfunction recovery.
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OBJECTIVE: To characterize and compare the primary structures of recombinant human erythropoietin marketed in China. METHODS: Recombinant human erythropoietin reference substances were obtained from nine manufacturers, for which the molecular mass, peptide mass mapping, oligosaccharide profile and content of sialic acid were analyzed and compared. RESULTS: The measured molecular masses of de-N-glycosylated EPO were all in agreement with the theoretical values with mass error less than 1. All the samples had consistent amino acid sequence, disulfide bonds (Cys7-Cys161, Cys29-Cys33), O-glycosylation site (Ser126), and N-glycosylation sites (Asn24, Asn38, Asn83), but different glycosylation pattern and ratio of glycoforms. The sialic acid content of the nine samples were within 11.5-15.7 mol∶mol EPO. CONCLUSION: Recombinant human erythropoietins from nine manufacturers have identical primary structures except for glycosylation patterns.
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In this study, we compared the results of potency determination of recombinant human erythropoietin (rhEPO) obtained between 2010 and 2012 by the National Institute of Quality Control in Health (INCQS/Fiocruz), i.e., the National Control Laboratory (NCL), and by a manufacturer of rhEPO. In total, 47 different batches of commercially prepared rhEPO (alpha isoform) were analyzed. All results, including those of the control and warning limits, remained within the limits recommended by European Pharmacopoeia (Ph. Eur.). All relative error (RE) values were less than ± 30%, wh ereas most were approximately ± 20%. Applying the Bland-Altman plot, only two of 47 values remained outside the limits of agreement (LA). In addition, agreement of potency determination between INCQS and the manufacturer coefficient of variation of reproducibility (% CVR) was considered satisfactory. Taken together, our results demonstrate (i.) the potency assay of rhEPO performed at INCQS, is standardized and controlled, (ii.) the comparison of our results with those of the manufacturer, revealed an adequate inter-laboratory variation, and (iii.) the critical appraisal proposed here appears to be a feasible tool to assess the reproducibility of biological activity, providing additional information regarding monitoring and production consistency to manufacturers and NCLs.
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Objectives To investigate the effect of rhEPO on newborn rats with necrotizing enterocolitis (NEC). Meth-ods Sixty newborn Sprague-Dewley (SD) rats at the age of 48 hours were randomly divided into 5 groups:control group, NEC group, and intervention groups 1, 2 and 3 treated with rhEPO. The rats were fed rat breast milk substitutes and stressed under hypoxia and cold exposure to establish NEC model. The rats with NEC were treated with different doses of rhEPO (0.1U/ml, 1U/ml and 10U/ml) in intervention groups. The expression of Bcl-2 and caspase-3 were measured by immunohistochemistry, and intestinal pathological changes were observed using HE staining. The value of positive expression was analyzed by IOD (integral optical density) image analysis system. Results Abdominal distention, decreased activity and unresponsiveness occurred in NEC rats 24 hours after stress exposure, and pale skin, decreased skin temperature and respiratory rhythm change were observed in severe cases. The symptoms appeared later and milder in three intervention groups. The NEC incidence of newborn rats was as followings:control group(0%), model group(60%), intervention group 1( 30%), intervention group 2(18.2%), intervention group 3(9.1%) and the difference was signiifcant between each group (P=0.008). The grades of intestinal injury, the expression of active caspase-3 and Bcl-2 were signiifcantly different among groups (P<0.01). Intestinal injury was the most severe and the expression level of active caspase-3 was the highest in NEC group. After rhEPO treatment, the intestinal injury and the production of active caspase-3 protein were decreased, and the expression of Bcl-2 was increased. Conclusions Oral rhEPO could decrease the ex-pression of intestinal active caspase 3, and increase the expression of Bcl-2. The protective effect of rhEPO on NEC is dosede-pendent.
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Objective Clinical treatment can delay the development of renal interstitial fibrosis , but it can not reverse renal dysfuntion.The article was to discuss the influence of recombinant human erythropoietin ( rHuEPO ) on inflammatory factors in the process of renal interstitial fibrosis and its possible mechanism . Methods The vitro cultured HK-2 cells were randomized into 7 groups:the blank control group , rHuEPO control group ( addition of 20U/mL rHuEPO), albumin stimulation group (addition of 5mg/mL albumin), 5mg/mL rHuEPO intervention group (5mg/mL albumin +5U/mL rHuEPO), 10 U/mL rHuEPO intervention group (5mg/mL albumin +10 U/mL rHuEPO), 20U/mL rHuEPO intervention group (5mg/mL albumin +20U/mL rHuEPO), and Rho inhibi-taion group (addition of 5mg/mL albumin 30min after 10μmol/L Y27632), 24 h acting time for each group.We observed the changes of cell morphology in each group .Reverse transcription polymerase chain reaction ( RT-PCR) was used to evaluate the mRNA levels of RhoA, ROCK1 and IL-6 , and ELISA was applied to measure the levels of supernatant TNF-αand IL-6 protein. Results The form of pebbles or paving stone was observed in blank control group and rHuEPO intervention groups , a long and thin spindle change with the appearance of fibre cells in albumin stimulation group , the transformation to pebbles in 5, 10, 20 mg/mL rHuEPO intervention groups , the form of oval and slightly increased intercellular space in Rho inhibitaion group .Compared with the blank control group , the expressions of RhoA mRNA, ROCK1 mRNA and IL-6 mRNA significantly increased in the albumin stimulation group (P<0.05), while significantly reduced in 5, 10, 20 mg/mL rHuEPO intervention groups (P<0.05), which was in negative relation with the rHuEPO concentrations .Compared with the albumin stimulation group , the expressions of ROCK 1 mRNA and IL-6 mRNA reduced in Rho inhibtation group (P<0.05), while there was no significant difference as to the expression of RhoA mRNA .ELISA results showed:compared with blank control group , the expressions of supernatant TNF-α([452.32 ±33.23] ng/L vs [1347.54 ±41.52] ng/L), IL-6 protein([884.62 ±0.73] pg/L vs [95.12 ±0.32]pg/LP<0.05) increased significantly.Compared with albumin stim-ulation group, the expressions of TNF-αin 5, 10, 20 mg/mL rHuEPO intervention groups and Rho inhibitation group reduced signifi-cantly([1003.32 ±3.42] ng/L, [821.32 ±21.32] ng/L, [590.15 ±7.68] ng/L, [488.13 ±65.03] ng/L vs [1 347.54 ± 41.52]ng/L,P<0.05), while the expressions of IL-6 mRNA reduced accordingly in 5, 10, 20 mg/mL rHuEPO intervention groups and Rho inhibitation group reduced significantly ([656.68 ±0.55] pg/L, [422.35 ±0.22] pg/L, [217.32 ±0.35] pg/L, [309.49 ±0.21] pg/L vs [884.62 ±0.73]pg/L,P<0.05).Moreover, there was significant statistical difference among 5, 10, 20 mg/mL rHuEPO intervention groups(P<0.05). Conclusion RHuEPO can inhibit the transdifferentiation process of HK-2 cells in-duced by albumin by suppressing inflammation factors , and the mechanism may be involved in RhoA/ROCK signaling pathway .