Treatment of Neonatal Hypoxic-Ischemic Encephalopathy with Erythropoietin Alone, and Erythropoietin Combined with Hypothermia: History, Current Status, and Future Research

Autor: Dorothy E. Oorschot, Ashraf R. Amer, Rachel J. Sizemore
Rok vydání: 2020
Předmět:
moderate hypothermia
Encephalopathy
Review
Anemia of prematurity
Infant
Newborn
Diseases
Catalysis
Brain Ischemia
Cerebral palsy
lcsh:Chemistry
Inorganic Chemistry
perinatal hypoxic-ischemic encephalopathy
03 medical and health sciences
0302 clinical medicine
Hypothermia
Induced
030225 pediatrics
medicine
Humans
Physical and Theoretical Chemistry
lcsh:QH301-705.5
Molecular Biology
Spectroscopy
business.industry
Standard treatment
Organic Chemistry
Infant
Newborn
neonatal hypoxia-ischemia
Infant
General Medicine
Hypothermia
medicine.disease
Neuroprotection
Computer Science Applications
Perinatal asphyxia
Clinical trial
anemia of prematurity
lcsh:Biology (General)
lcsh:QD1-999
Erythropoietin
Child
Preschool
Anesthesia
erythropoietin
medicine.symptom
business
030217 neurology & neurosurgery
medicine.drug
Zdroj: International Journal of Molecular Sciences
International Journal of Molecular Sciences, Vol 21, Iss 4, p 1487 (2020)
ISSN: 1422-0067
DOI: 10.3390/ijms21041487
Popis: Perinatal hypoxic-ischemic encephalopathy (HIE) remains a major cause of morbidity and mortality. Moderate hypothermia (33.5 °C) is currently the sole established standard treatment. However, there are a large number of infants for whom this therapy is ineffective. This inspired global research to find neuroprotectants to potentiate the effect of moderate hypothermia. Here we examine erythropoietin (EPO) as a prominent candidate. Neonatal animal studies show that immediate, as well as delayed, treatment with EPO post-injury, can be neuroprotective and/or neurorestorative. The observed improvements of EPO therapy were generally not to the level of control uninjured animals, however. This suggested that combining EPO treatment with an adjunct therapeutic strategy should be researched. Treatment with EPO plus hypothermia led to less cerebral palsy in a non-human primate model of perinatal asphyxia, leading to clinical trials. A recent Phase II clinical trial on neonatal infants with HIE reported better 12-month motor outcomes for treatment with EPO plus hypothermia compared to hypothermia alone. Hence, the effectiveness of combined treatment with moderate hypothermia and EPO for neonatal HIE currently looks promising. The outcomes of two current clinical trials on neurological outcomes at 18–24 months-of-age, and at older ages, are now required. Further research on the optimal dose, onset, and duration of treatment with EPO, and critical consideration of the effect of injury severity and of gender, are also required.
Databáze: OpenAIRE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje