Ischemic tolerance exists in many organs, among which the cerebral ischemic tolerance and its potential clinical applications are most notable. The discovery of new triggers of cerebral ischemic tolerance has brought more interesting insights into the molecular mechanisms. The remote ischemic preconditioning and pharmacological induction of cerebral ischemic tolerance have shown promising clinical safety and feasibility, and therefore may be important breakthroughs in the clinical application of cerebral ischemic tolerance.
Brain Ischemia ; physiopathology ; Erythropoietin ; therapeutic use ; Humans ; Ischemic Preconditioning ; methods

Erythropoietin ; pharmacology ; Folic Acid ; pharmacology ; therapeutic use ; Humans ; Infant, Newborn ; Infant, Premature ; Platelet Count ; Vitamin B 12 ; pharmacology ; therapeutic use

Adenosine ; therapeutic use ; Brain-Derived Neurotrophic Factor ; therapeutic use ; Erythropoietin ; therapeutic use ; Glucocorticoids ; therapeutic use ; Humans ; Infant, Newborn ; Infant, Premature ; Interleukin-10 ; therapeutic use ; Leukomalacia, Periventricular ; drug therapy ; Nitric Oxide ; therapeutic use ; Receptors, N-Methyl-D-Aspartate ; antagonists & inhibitors

Immunosuppressive therapy (IST) is essential to treat aplastic anemia. The pharmacological mechanism, therapeutic effect of main drugs and their application method, reasonable dosage, synergistic action are briefly reviewed in this article. These reviewed drugs include ATG/ALG, CsA, ALG/ATG + CsA, IIST (ALG + CsA) + HGFs, McAb-T, HD-MP and HD-IVIG. The purpose of this review was to direct to clinical therapy for patients with aplastic anemia.
Anemia, Aplastic ; drug therapy ; Antilymphocyte Serum ; therapeutic use ; Cyclosporine ; therapeutic use ; Drug Therapy, Combination ; Erythropoietin ; therapeutic use ; Granulocyte-Macrophage Colony-Stimulating Factor ; therapeutic use ; Humans ; Immunosuppressive Agents ; therapeutic use ; Recombinant Proteins

OBJECTIVETo study the efficacy of erythropoietinin (EPO) in the treatment of moderate or severe hypoxic-ischemic encephalopathy (HIE) in neonates.

METHODSSeventy neonates with moderate or severe HIE were randomly assigned to two groups: EPO treatment and control (n=35 each). The EPO treatment group included 22 cases of moderate HIE and 13 cases of severe HIE. The control group included 24 cases of moderate HIE and 11 cases of severe HIE. Thirty-five healthy full-term infants served as normal group. The control group received a conventional treatment. Beside the conventional treatment, the EPO treatment group was intravenously injected with EPO of 200 IU/kg•d, 3 times weekly. Routine blood test was performed every 6 days. EPO dose was adjusted based on the results of the routine blood test. The course of EPO treatment was 2 to 4 weeks. Neonatal Behavioral Neurological Assessment (NBNA) was performed at age of 28 days. The infant development test of Child Development Centre of China (CDCC) was performed at ages of 3 months and 6 months.

RESULTSThe percentage of normal NBNA scores in the EPO treatment group was significantly higher than that in the control group at age of 28 days (P<0.05), but was significantly lower than that in the normal group (P<0.01). The CDCC test including physical development index (PDI) and physical development index (MDI) showed the percentage of normal results in the EPO treatment group was significantly higher than in the control group at age of 3 months (P<0.05), but was significantly lower than in the normal group (P<0.01). The CDCC test including PDI and MDI showed that the percentage of normal results in the EPO treatment group was significantly higher than in the control group at age of 6 months. The MDI test results in the EPO treatment group were not significantly different from those in the normal group at age of 6 months, but the percentage of normal results in the PDI test in the EPO treatment group was still significantly lower than that in the normal group (P<0.05).

CONCLUSIONSEPO treatment has neuroprotective effects against moderate or severe HIE and improves long-term behavioral neurological developments in neonates.

Child Development ; Erythropoietin ; therapeutic use ; Female ; Humans ; Hypoxia-Ischemia, Brain ; drug therapy ; psychology ; Infant Behavior ; Infant, Newborn ; Male

The aim of this study was to investigate the curative effects of amifostine (AMF) combined with recombinant human beta-erythropoietin (rhbeta-EPO) on patients with pure erythroid aplasia (PEA). Two patients with PEA were treated with amifostine and rhbeta-EPO. The therapeutic regimen was adopted with AMF 0.4 g/day given by intravenous injection for 5 days first, then after a break of 2 days it went on for 3 weeks consecutively, that was considered as one treatment cycle. The rhbeta-EPO 6 000 U was used by subcutaneous injection for 3 times per week. The results showed that the red cell count, hemoglobin and reticulocyte count of two patients obviously increased after treatment. The erythroid ratio in bone marrow increased. Bone marrow biopsy showed that the erythroid proliferation improved. Intervals of red cell transfusions (RCT) in the two patients who live by red cell transfusion were prolonged after AMF treatments, and the amounts of each RCT was decreased obviously. The main side effect of amifostine was discomfort of digestive system, but was tolerated by all patients. In conclusion, amifostine plus rhbeta-EPO may be a new, effective and safety method especially for the elder PEA patients. The long-term curative effects and mechanism of amifostine still need further evaluation.
Aged, 80 and over ; Amifostine ; adverse effects ; therapeutic use ; Anemia, Aplastic ; drug therapy ; Drug Therapy, Combination ; Erythropoietin ; administration & dosage ; therapeutic use ; Humans ; Male ; Recombinant Proteins ; Treatment Outcome

The study was aimed to investigate the curative effects and adverse effects of amifostine in the treatment of patients with myelodysplastic syndrome (MDS). Amifostine (AMF) was used alone (4/12) or combined with recombinant human erythropoietin (rh-EPO) (8/12) in 12 MDS patients. The therapeutic regimen was adopted with AMF 0.4 g/day for 5 days, then took a break of 2 days and then went on for 3 weeks consecutively, that was reputed as one treatment cycle. rh-EPO 6 000 U was used for 3 days per week. The results showed that 12 patients all attained hematological improvement in peripheral blood. 11 cases showed major effective response rate (91.7%), while 1 case showed minor response rate (8.3%). The effective response rate of hemoglobin, leukocytes and platelets was 100%, 75% and 58.3% respectively. The intervals of red cell transfusions (RCT) in 2 cases living on red cell transfusion before AMF treatment were prolonged after AMF treatments, and the amount of each RCT was decreased obviously. The side effect was usually discomfort of digestive system, but all patients can endure. In conclusion, Amifostine is a potential drug in the treatment of MDS patients with safety especially to those elder patients who often suffered from other multiple organ disfunctions, and the curative effect will be improved by more treatment cycles.
Adult ; Aged ; Aged, 80 and over ; Amifostine ; adverse effects ; therapeutic use ; Drug Therapy, Combination ; Erythropoietin ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Myelodysplastic Syndromes ; drug therapy ; Recombinant Proteins

OBJECTIVETo investigate the mechanism of Zishen Shengxue Recipe (ZSR) in treating renal anemia by observing its effect on serum level of endogenous erythropoietin in patients undergoing long-term hemodialysis.

METHODSSixty renal anemia patients undergoing long-term hemodialysis were randomly and equally assigned to two groups. The treated group was treated with subcutaneous injection of erythropoiesis stimulating factor (rHuEpo) combined with oral intake of ZSR, and the control group treated with rHuEpo alone. They were observed for eight weeks, and the blood levels of endogenous human erythropoietin (Epo), hemoglobin (Hgb), hematocrit (Hct), as well as the residual renal function (RRF) in the two groups were compared.

RESULTSSerum Epo level in the control group was unchanged after treatment (P>0.05), while that in the treated group increased significantly, and showed significant difference in comparing with that in the control group (P<0.05). Levels of Hgb and Hct increased and RRF decreased in both groups (P<0.01), but the treated group showed higher increments and lesser decrement than those in the control group (P<0.05).

CONCLUSIONSZSR can enhance the blood levels of Hgb, Hct and Epo, postpone the descent of RRF, and correct the anemic status in patients. Its mechanism of action is possibly through alleviating the inhibition of uremic toxin on erythropoiesis, in the meanwhile of promoting the secretion of Epo.

Adult ; Anemia ; blood ; therapy ; Drugs, Chinese Herbal ; therapeutic use ; Erythropoiesis ; drug effects ; Erythropoietin ; blood ; Female ; Hematinics ; therapeutic use ; Hematocrit ; Hemoglobins ; analysis ; Humans ; Male ; Middle Aged ; Renal Dialysis

The aim of this study was to investigate the curative effect of amifostine (AMF) combined with recombinant human erythropoietin (rhEPO) on the aged patients with myelodysplastic syndrome. Two aged MDS patients (one aged 91; another 86) were treated with amifostine and rhEPO over a period of 4 weeks. The results showed that a short-term curative effect was observed and transfusion interval was prolonged in both patients after 4 week treatment with 5 x 0.4 g AMF plus 3 x 6,000 U rhEPO per week. The reticulocyte count in MDS-RA patient returned to normal at first week of treatment and still remained in normal level for 4 weeks; leukocyte, hemoglobin and platelet values in peripheral blood of MDS-RCMD patient obviousby increased, the abnormally increased reticulocyte value displayed a decrease trend after amifostine plus rh-EPO treatment. In conclusion, amifostine plus rhEPO may have a good therapeutic effect for aged MDS patients, and its clinical long-term curative effect still needs further evaluation.
Aged ; Aged, 80 and over ; Amifostine ; therapeutic use ; Drug Therapy, Combination ; Erythropoietin ; therapeutic use ; Humans ; Male ; Myelodysplastic Syndromes ; drug therapy ; Recombinant Proteins ; Time Factors ; Treatment Outcome

Anti-erythropoietin antibodies usually cross-react with all kinds of recombinant erythropoietins; therefore, erythropoiesis-stimulating agent (ESA)-induced pure red-cell aplasia (PRCA) is not rescued by different ESAs. Here, we present a case of ESA-induced PRCA in a 36-yr-old woman with chronic kidney disease, whose anemic condition improved following reintroduction of darbepoetin-alpha. The patient developed progressive, severe anemia after the use of erythropoietin-alpha. As the anemia did not improve after the administration of either other erythropoietin-alpha products or erythropoietin-beta, all ESAs were discontinued. Oxymetholone therapy failed to improve the transfusion-dependent anemia and a rechallenge with ESAs continuously failed to obtain a sustained response. However, her anemia improved following reintroduction of darbepoetin-alpha at 3 yr after the initial diagnosis. Interestingly, anti-erythropoietin antibodies were still detectable, although their concentration was too low for titration. In conclusion, darbepoetin-alpha can improve ESA-induced PRCA when the anti-erythropoietin antibody titer declines and its neutralizing capacity is lost.
Adult ; Anemia/drug therapy/etiology ; Antibodies/*blood/immunology ; Bone Marrow Cells/pathology ; Drug Hypersensitivity/immunology ; Erythropoietin/*analogs & derivatives/therapeutic use ; Erythropoietin, Recombinant/adverse effects/*immunology/therapeutic use ; Female ; Glomerulonephritis, IGA/complications ; Hematinics/adverse effects/immunology/*therapeutic use ; Humans ; Kidney Failure, Chronic/complications ; Oxymetholone/therapeutic use ; Red-Cell Aplasia, Pure/chemically induced/*drug therapy/immunology