Neurosurgical applications for erythropoietin administration

Antonios Mammis, John C. Quinn, Nitin Agarwal, Charles J. Prestigiacomo

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

Neurosurgery as a field has made significant advances in treating pathological processes within the central nervous system. The surgical techniques and tools neurosurgeons use have been rapidly evolving and have led to a significant improvement in the morbidity and mortality of many devastating neurological conditions. There exists a limit however, to what can be achieved with the tools currently employed by neurosurgeons due to the relative poor regenerative capacity of the adult brain following injury. The interest in discovery of novel therapeutics which promote cell survival and lessen secondary neuronal death following a neurological injury is of great interest. Apart from their hematopoetic actions EPO and EPO variants are directly neuroprotective [1-6]. EPO and its receptors are expressed in brain cells during development and are upregulated after injury. Peripherally administered EPO crosses the blood brain barrier and activates, in the brain, anti-apoptotic anti-oxidant and anti-inflammatory signaling in neuronal, glial and cerebrovascular endothelial cells and stimulates angiogenesis and neurogenesis. These mechanisms underlie its potent tissue protective effects in experimental models of stroke, intracerebral hemorrhage, subarachnoid hemorrhage traumatic brain injury, spinal cord injury and other neurodegenerative disease [2-4, 7-15]. While initial experimental models had shown great promise for EPO as a potential therapeutic for a number of neurological conditions , the results of several subsequent clinical trials in humans have tempered the excitement over questions of efficacy and safety for certain indications most notably treatment of acute ischemic stroke [14, 16, 17]. Despite these recent concerns, there does exist a number of potential neurosurgical indications that the use of EPO may prove to positively affect neurological outcome despite the well established potential adverse effects.

Original languageEnglish
Title of host publicationErythropoietin
Subtitle of host publicationHuman Production, Potential Uses and Adverse Effects
PublisherNova Science Publishers, Inc.
Pages75-92
Number of pages18
ISBN (Print)9781624171055
StatePublished - Apr 2013

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