title: Erythropoietin improves skeletal muscle microcirculation and tissue bioenergetics in a mouse sepsis model.
abstract: BACKGROUND
  The relationship between oxygen delivery and consumption in sepsis is impaired, suggesting a microcirculatory perfusion defect. Recombinant human erythropoietin (rHuEPO) regulates erythropoiesis and also exerts complex actions promoting the maintenance of homeostasis of the organism under stress. The objective of this study was to test the hypothesis that rHuEPO could improve skeletal muscle capillary perfusion and tissue oxygenation in sepsis.
  
  
  METHODS
  Septic mice in three experiments received rHu-EPO 400 U/kg subcutaneously 18 hours after cecal ligation and perforation (CLP). The first experiment measured the acute effects of rHuEPO on hemodynamics, blood counts, and arterial lactate level. The next two sets of experiments used intravital microscopy to observe capillary perfusion and nicotinamide adenine dinucleotide (NADH) fluorescence post-CLP after treatment with rHuEPO every 10 minutes for 40 minutes and at 6 hours. Perfused capillary density during a three-minute observation period and NADH fluorescence were measured.
  
  
  RESULTS
  rHuEPO did not have any effects on blood pressure, lactate level, or blood cell numbers. CLP mice demonstrated a 22% decrease in perfused capillary density compared to the sham group (28.5 versus 36.6 capillaries per millimeter; p < 0.001). Treatment of CLP mice with rHuEPO resulted in an immediate and significant increase in perfused capillaries in the CLP group at all time points compared to baseline from 28.5 to 33.6 capillaries per millimeter at 40 minutes; p < 0.001. A significant increase in baseline NADH, suggesting tissue hypoxia, was noted in the CLP mice compared to the sham group (48.3 versus 43.9 fluorescence units [FU]; p = 0.03) and improved with rHuEPO from 48.3 to 44.4 FU at 40 minutes (p = 0.02). Six hours after treatment with rHuEPO, CLP mice demonstrated a higher mean perfused capillary density (39.4 versus 31.7 capillaries per millimeter; p < 0.001) and a lower mean NADH fluorescence as compared to CLP+normal saline mice (49.4 versus 52.7 FU; p = 0.03).
  
  
  CONCLUSIONS
  rHuEPO produced an immediate increase in capillary perfusion and decrease in NADH fluorescence in skeletal muscle. Thus, it appears that rHuEPO improves tissue bioenergetics, which is sustained for at least six hours in this murine sepsis model.
authors.affiliation: Department of National Defense, Canadian Forces Medical Group, 1745 Alta Vista Drive, Ottawa, Ontario, K1A 0K6, Canada. rkao3@uwo.ca
authors.forename: Raymond
authors.initials: R
authors.lastname: Kao
authors.forename: Anargyros
authors.initials: A
authors.lastname: Xenocostas
authors.forename: Tao
authors.initials: T
authors.lastname: Rui
authors.forename: Pei
authors.initials: P
authors.lastname: Yu
authors.forename: Weixiong
authors.initials: W
authors.lastname: Huang
authors.forename: James
authors.initials: J
authors.lastname: Rose
authors.forename: Claudio M
authors.initials: CM
authors.lastname: Martin
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004734:Energy Metabolism / Q000187:drug effects; D004921:Erythropoietin / Q000627:therapeutic use*; D051379:Mice; D008810:Mice, Inbred C57BL; D008833:Microcirculation / Q000187:drug effects; D018482:Muscle, Skeletal / Q000098:blood supply*; D018805:Sepsis / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D004921:Erythropoietin