title: Effect of epoetin on HO-1 mRNA level and plasma antioxidants in hemodialysis patients.
abstract: OBJECTIVE
  Patients with renal failure and undergoing hemo- (HD) or peritoneal dialysis are under oxidative stress which is thought to contribute to the long-term complications noted in this patient population. One effect of HD-induced oxidative stress is via red blood cell (RBC) membrane lipid peroxidation leading to RBC destruction and anemia. Interaction of this oxidative stress with epoetin (EPO) treatment to increase RBC number and Hb concentration remains unexplored.
  
  
  METHODS
  This preliminary study used RT-PCR as well as colorimetric based assay approaches to evaluate the effect of EPO-alpha treatment on markers of oxidative stress in hemodialysis patients. Eighteen patients (12 males, 6 females, age range 45 - 68), were treated with EPO-alpha (Eprex) 50 UI/kg thrice weekly over an 8-month study period. Monocytes were isolated at baseline, then monthly thereafter, monocyte heme-oxygenase-1 (HO-1) and plasma Hb and antioxidant power (AOP) were determined.
  
  
  CONCLUSIONS
  Treatment with EPO increased Hb (9.4 +/- 0.7 g/dl to 10.9 +/- 0.5, mean +/- SD p < 0.001). In addition, both monocyte HO-1 mRNA (0.34 +/- 0.08 vs. 0.59 +/- 0.02 d.u. p < 0.001) and plasma AOP (1,379.8 +/- 175 micromol/l to 1,624 +/- 170, p < 0.04) increased. While AOP changes showed no correlation with other indices, increases in HO-1 and Hb were positively correlated using 2 different measures: delta Hb (peak Hb - baseline Hb) vs. delta HO-1 (peak HO-1 mRNA - baseline HO-1 mRNA) as well as delta Hb(5 months-baseline) vs. delta HO-1 (5 months - baseline) mRNA (r = 0.81, p < 0.001 and r = 0.76, p < 0.001; respectively). In conclusion, the increases upon EPO treatment of both HO-1 gene expression and plasma AOP as well as the significant correlation between delta Hb and delta HO-1 mRNA suggest that EPO treatment reduces oxidative stress via a combination of effects. These could potentially include effects on oxidative stress directly as well as effects on the levels and types of antioxidants present in plasma.
authors.affiliation: Department of Clinical and Experimental Medicine, Clinica Medica 4, University of Padova, Italy. renzcalo@unipd.it
authors.forename: L A
authors.initials: LA
authors.lastname: Calò
authors.forename: L
authors.initials: L
authors.lastname: Stanic
authors.forename: P A
authors.initials: PA
authors.lastname: Davis
authors.forename: E
authors.initials: E
authors.lastname: Pagnin
authors.forename: G
authors.initials: G
authors.lastname: Munaretto
authors.forename: M
authors.initials: M
authors.lastname: Fusaro
authors.forename: S
authors.initials: S
authors.lastname: Landini
authors.forename: A
authors.initials: A
authors.lastname: Semplicini
authors.forename: A
authors.initials: A
authors.lastname: Piccoli
mesh_terms: D000328:Adult; D000368:Aged; D000975:Antioxidants / Q000378:metabolism*; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006419:Heme Oxygenase (Decyclizing) / Q000235:genetics / Q000378:metabolism*; D051547:Heme Oxygenase-1; D006801:Humans; D008297:Male; D008565:Membrane Proteins; D008875:Middle Aged; D012333:RNA, Messenger / Q000378:metabolism*; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000009:adverse effects*; D051437:Renal Insufficiency / Q000378:metabolism / Q000628:therapy; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D000975:Antioxidants; D006397:Hematinics; D008565:Membrane Proteins; D012333:RNA, Messenger; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa; C496541:HMOX1 protein, human; D006419:Heme Oxygenase (Decyclizing); D051547:Heme Oxygenase-1