title: Erythropoietin therapy for acute stroke is both safe and beneficial.
abstract: BACKGROUND
  Erythropoietin (EPO) and its receptor play a major role in embryonic brain, are weakly expressed in normal postnatal/adult brain and up-regulated upon metabolic stress. EPO protects neurons from hypoxic/ ischemic injury. The objective of this trial is to study the safety and efficacy of recombinant human EPO (rhEPO) for treatment of ischemic stroke in man.
  
  
  METHODS
  The trial consisted of a safety part and an efficacy part. In the safety study, 13 patients received rhEPO intravenously (3.3 X 10(4) IU/50 ml/30 min) once daily for the first 3 days after stroke. In the double-blind randomized proof-of-concept trial, 40 patients received either rhEPO or saline. Inclusion criteria were age <80 years, ischemic stroke within the middle cerebral artery territory confirmed by diffusion-weighted MRI, symptom onset <8 hr before drug administration, and deficits on stroke scales. The study endpoints were functional outcome at day 30 (Barthel Index, modified Rankin scale), NIH and Scandinavian stroke scales, evolution of infarct size (sequential MRI evaluation using diffusion-weighted [DWI] and fluid-attenuated inversion recovery sequences [FLAIR]) and the damage marker S100ss.
  
  
  RESULTS
  No safety concerns were identified. Cerebrospinal fluid EPO increased to 60-100 times that of nontreated patients, proving that intravenously administered rhEPO reaches the brain. In the efficacy trial, patients received rhEPO within 5 hr of onset of symptoms (median, range 2:40-7:55). Admission neurologic scores and serum S100beta concentrations were strong predictors ofoutcome. Analysis of covariance controlled for these two variables indicated that rhEPO treatment was associated with an improvement in follow-up and outcome scales. A strong trend for reduction in infarct size in rhEPO patients as compared to controls was observed by MRI.
  
  
  CONCLUSIONS
  Intravenous high-dose rhEPO is well tolerated in acute ischemic stroke and associated with an improvement in clinical outcome at 1 month. A larger scale clinical trial is warranted.
authors.affiliation: Max-Planck-Institute for Experimental Medicine, Departments of Neurology and Psychiatry, Georg-August-University, Goettingen, Germany. ehrenreich@em.mpg.de
authors.forename: Hannelore
authors.initials: H
authors.lastname: Ehrenreich
authors.forename: Martin
authors.initials: M
authors.lastname: Hasselblatt
authors.forename: Christoph
authors.initials: C
authors.lastname: Dembowski
authors.forename: Lukas
authors.initials: L
authors.lastname: Cepek
authors.forename: Piotr
authors.initials: P
authors.lastname: Lewczuk
authors.forename: Michael
authors.initials: M
authors.lastname: Stiefel
authors.forename: Hans-Heino
authors.initials: HH
authors.lastname: Rustenbeck
authors.forename: Norbert
authors.initials: N
authors.lastname: Breiter
authors.forename: Sonja
authors.initials: S
authors.lastname: Jacob
authors.forename: Friederike
authors.initials: F
authors.lastname: Knerlich
authors.forename: Matthias
authors.initials: M
authors.lastname: Bohn
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Poser
authors.forename: Eckart
authors.initials: E
authors.lastname: Rüther
authors.forename: Michael
authors.initials: M
authors.lastname: Kochen
authors.forename: Olaf
authors.initials: O
authors.lastname: Gefeller
authors.forename: Christoph
authors.initials: C
authors.lastname: Gleiter
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Wessel
authors.forename: Marc
authors.initials: M
authors.lastname: De Ryck
authors.forename: Loretta
authors.initials: L
authors.lastname: Itri
authors.forename: Hilmar
authors.initials: H
authors.lastname: Prange
authors.forename: Anthony
authors.initials: A
authors.lastname: Cerami
authors.forename: Michael
authors.initials: M
authors.lastname: Brines
authors.forename: Anna-Leena
authors.initials: AL
authors.lastname: Sirén
mesh_terms: D001792:Blood Platelets / Q000187:drug effects; D004311:Double-Blind Method; D004912:Erythrocytes / Q000187:drug effects; D004921:Erythropoietin / Q000008:administration & dosage*; D006400:Hematocrit; D006801:Humans; D007262:Infusions, Intravenous; D020521:Stroke / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D004921:Erythropoietin