rhEPO

Recombinant human erythropoietin (rhEPO) is a synthetic form of the natural hormone erythropoietin produced by recombinant DNA technology. It acts as a growth factor for red blood cell precursors in the bone marrow, binding to the erythropoietin receptor and activating signaling that promotes erythropoiesis, thereby increasing red blood cell mass in patients with anemia due to insufficient erythropoietin production.

RhEPO is used to treat anemia associated with chronic kidney disease, anemia resulting from cancer chemotherapy, and some cases of HIV-related anemia. It can reduce the need for blood transfusions and may improve symptoms and quality of life in selected patients. Administration is by injection, either intravenously or subcutaneously, with dosing schedules that vary by product and indication. Short-acting formulations (epoetins) typically require more frequent dosing, while longer-acting forms (darbepoetin alfa) allow less frequent administration.

Pharmacology and products: rhEPO is produced in mammalian cell lines, such as Chinese hamster ovary cells, and marketed in several forms, including epoetin alfa, epoetin beta, and the longer-acting darbepoetin alfa. Although structurally similar, these products have different pharmacokinetics and dosing regimens. Efficacy depends on factors such as iron status and proper iron supplementation.

Safety and regulation: Potential adverse effects include hypertension, thromboembolic events, injection-site reactions, and flu-like symptoms. A rare but serious risk is pure red cell aplasia due to anti-EPO antibodies. In cancer care, use is carefully weighed because of concerns about potential effects on tumor biology and survival in some settings; guidelines advocate using the lowest effective dose to reach and maintain a target hemoglobin. Regulatory authorities oversee indications, labeling, and monitoring; rhEPO is prohibited for performance enhancement in sports by organizations such as WADA.