title: Erythropoietin reduces necrosis in critically ischemic myocutaneous tissue by protecting nutritive perfusion in a dose-dependent manner.
abstract: BACKGROUND
  Erythropoietin (Epo), the primary regulator of erythropoiesis, has recently been shown to exert antiinflammatory and antiapoptotic properties in neuronal and myocardial tissue. We herein studied whether Epo pretreatment can reduce cell death and ischemic necrosis in a chronic in vivo model.
  
  
  METHODS
  C57BL/6 mice were treated daily for 3 consecutive days with either 500 IU EPO/kg body weight (bw) (group Epo 500, n = 8) or 5000 IU EPO/kg bw (group Epo 5000, n = 8) administered intraperitoneally 24 hours before surgery. Thereafter, a random pattern myocutaneous flap subjected to acute persistent ischemia was elevated and fixed into a dorsal skinfold chamber. Flap elevation in animals receiving the water-soluble vitamin E analog Trolox (6-hydroxy-2, 5, 7, 8-tetramethylchroman-2-carboxylic acid) served as a nonspecific antiinflammatory agent control group (Tro); untreated control animals (Con) received saline only. Capillary perfusion, leukocyte-endothelial cell interaction, apoptotic cell death, and tissue necrosis were determined over a 10-day observation period using intravital multifluorescence microscopy.
  
  
  RESULTS
  Epo 5000 (44 +/- 26 cm/cm(2)) but, more noticeably, Epo 500 (116 +/- 32 cm/cm(2)) improved capillary perfusion compared with the two control groups, particularly the Con group (9 +/- 7 cm/cm(2); P < .05). The ischemia-associated leukocytic inflammation was found drastically attenuated in both Epo-pretreatment groups. Epo 500 further decreased apoptotic cell death and was effective in significantly reducing tissue necrosis (16% +/- 4% vs Tro: 48% +/- 7% and Con: 52% +/- 4%; P < .001). No angiogenic blood vessel formation could be observed in either of the Epo groups. Of interest, Epo 5000-but not Epo 500-increased systemic hematocrit.
  
  
  CONCLUSIONS
  Despite the lack of neovascularization, Epo pretreatment was capable of reducing ischemic tissue necrosis by protecting capillary perfusion, ie, nutrition of the tissue. Low-dose pretreatment was more effective, a result that was most likely due to the better perfusion conditions without an increase of the hematocrit values. Thus, low-dose Epo pretreatment might represent a promising strategy to protect critically perfused ischemic tissue.
authors.affiliation: Institute for Clinical and Experimental Surgery, University of Saarland, Germany. yvesharder@bluewin.ch
authors.forename: Yves
authors.initials: Y
authors.lastname: Harder
authors.forename: Michaela
authors.initials: M
authors.lastname: Amon
authors.forename: René
authors.initials: R
authors.lastname: Schramm
authors.forename: Claudio
authors.initials: C
authors.lastname: Contaldo
authors.forename: Eva
authors.initials: E
authors.lastname: Metzkow
authors.forename: Anne
authors.initials: A
authors.lastname: Matzen
authors.forename: Martin
authors.initials: M
authors.lastname: Rücker
authors.forename: Brigitte
authors.initials: B
authors.lastname: Vollmar
authors.forename: Michael D
authors.initials: MD
authors.lastname: Menger
mesh_terms: D000818:Animals; D017209:Apoptosis / Q000187:drug effects*; D002448:Cell Adhesion / Q000187:drug effects; D042783:Endothelial Cells / Q000187:drug effects; D004730:Endothelium, Vascular / Q000276:immunology; D004921:Erythropoietin / Q000494:pharmacology / Q000627:therapeutic use*; D006400:Hematocrit; D007511:Ischemia / Q000188:drug therapy* / Q000276:immunology; D007962:Leukocytes / Q000187:drug effects; D051379:Mice; D008810:Mice, Inbred C57BL; D008833:Microcirculation / Q000187:drug effects*; D009336:Necrosis / Q000517:prevention & control; D018919:Neovascularization, Physiologic / Q000187:drug effects; D017467:Receptors, Erythropoietin / Q000378:metabolism; D013524:Surgical Flaps / Q000098:blood supply / Q000473:pathology*
chemical_list: D017467:Receptors, Erythropoietin; D004921:Erythropoietin