Is erythropoietin a worthy candidate for traumatic brain injury or are we heading the wrong way?

Giovanni Grasso,Pietro Ghezzi,Concetta Alafaci

doi:10.12688/f1000research.8723.1

Giovanni Grasso, Pietro Ghezzi + Show 1 more

Open Access

https://doi.org/10.12688/f1000research.8723.1

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Abstract

Traumatic brain injury (TBI) is a leading cause of death and disability in the modern society. Although primary prevention is the only strategy that can counteract the primary brain damage, numerous preclinical studies have been accumulated in order to find therapeutic strategies against the secondary damage. In this scenario erythropoietin (EPO) has been shown to be a promising candidate as neuroprotective agent. A recent clinical trial, however, has shown that EPO has not an overall effect on outcomes following TBI thus renewing old concerns. However, the results of a prespecified sensitivity analysis indicate that the effect of EPO on mortality remains still unclear. In the light of these observations, further investigations are needed to resolve doubts on EPO effectiveness in order to provide a more solid base for tailoring conclusive clinical trials.

Highlights

Traumatic brain injury (TBI) is a leading cause of death and disability in the modern society
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The authors found that EPO did not reduce the number of patients with a Glasgow Outcome Scale (GOS-E) level of 4 or lower, and did not affect the incidence of deep venous thrombosis events. The results of this international multicenter randomized placebo-controlled trial suggest that EPO may not be useful in TBI. This result is in contrast with a number of experimental studies suggesting that EPO might improve neurological outcomes following TBI

Summary

Introduction

Traumatic brain injury (TBI) is a leading cause of death and disability in the modern society. This result is in contrast with a number of experimental studies suggesting that EPO might improve neurological outcomes following TBI. It must be taken into account that earlier preclinical studies showed that recombinant human EPO treatment at a dose of 1000 IU/kg administered every 8 hours starting following TBI, is effective as neuroprotective agent[5].

Results

Conclusion