A Review on the Pretreatment Effect of EPO on Ischemic Tolerance in Different Tissues with an Approach to the Tissue Protection Mechanisms

Introduction: Ischemia due to oxygen and nutrient deficit, as well as waste producing causes tissue damage or organ dysfunction. Ischemia can be achieved in various tissues during surgery, organ transplantation, and use of certain drugs, sickle cell anemia, congestive heart disease, stroke and other motives. Also reperfusion of ischemic tissue can cause more serious damage. Recently, research strategies have been concentrated on the preconditioning mechanisms, such as pharmacological preconditioning which is used to increase tolerance to ischemia. Erythropoietin has antioxidant and anti-inflammatory properties and can be effective in reducing the damage caused by ischemia. Methods: In this paper, a review was performed on erythropoietin role in reducing the tissue damage related to ischemia in brain, heart, kidney, intestine, liver and lung. The review was done between 2003 up 2016 years in regard to preconditioning mechanisms and protective signaling pathway in tissues. Findings: The results suggest that erythropoietin may be increase tolerance to ischemia in tissues through its effects on oxidative pathways, inhibition of inflammatory reactions and anti-apoptotic effects. The drug efficiency is related to dose and time of drug administration, and it appears that the greatest protective effect is related to its antioxidant property. Conclusion: According to the studies, there is a hope that the drug could be used in the future as a preventive agent of ischemia, in ischemia-threatening conditions, especially during the surgeries. However, investigation of probable side effects of the drug use is mandatory for its final approval.