Doping agent against Corona: Erythropoietin, known from athlete doping, could help in three ways against Covid-19. Because the blood-forming hormone supports breathing and lung function, inhibits inflammation-promoting messenger substances and can protect the nervous system from damage, as researchers report. Initial case reports also indicate that an EPO application can alleviate severe corona courses. A clinical study is now to check this.
Most commonly, erythropoietin (EPO) is common as a doping centerl known. But this growth hormone also occurs naturally in our body. It is released when there is a lack of oxygen, such as can occur in the thin air of the high mountains. Erythropoietin then stimulates the formation of red blood cells, but also affects the respiratory center in the brain stem. This improves oxygen uptake and transport.
But that’s not all: “Over the past 30 years it has become increasingly clear that EPO is released in many tissues and organs of the body. There it performs a variety of functions and acts as a tissue-protecting cytokine, ”explains Hannelore Ehrenreich from the Max Planck Institute for Experimental Medicine in Göttingen and her colleagues. Studies show that EPO Wound healing for diabetics as well as new education and networking of brain cells stimulates.
First signs of positive effects
In the wake of the corona pandemic, erythropoietin could even prove helpful against Covid-19. In fact, there are initial observations that support this. An intensive care patient in Iran received EPO because of poor blood values, after which he recovered remarkably quickly from his severe Covid 19 symptoms. The same can be seen in patients who received EPO for other reasons: “We have observed that dialysis patients survive Covid-19 remarkably well – and it is precisely these patients who receive erythropoietin regularly during their dialysis,” says Ehrenreich.
In South America, it is also becoming apparent that residents of the higher mountain regions develop severe courses of Covid-19 far less frequently than people in the lowlands. This could be due to the fact that the high mountain residents naturally produce more erythropoietin because of the thinner air. According to Ehrenreich and her team, this is no accident. Because their long-term research on this hormone suggests that EPO can act in several ways against SARS-CoV-2 and the consequences of the infection.
Help for breathing and lungs
The first starting point for EPO are lungs and breathing in Covid 19 patients: the coronavirus destroys lung tissue, causes severe inflammation and also appears to attack the neuronal control of breathing. Here EPO could even intervene in a protective manner in three ways, as the researchers explain. Animal experiments have shown that the anti-inflammatory effect of EPO can protect lung cells from damage and prevent pulmonary edema.
“EPO also has positive effects on the nervous system that could improve patient breathing,” said Ehrenreich and her colleagues. It is known that EPO acts on the respiratory center in the brain stem and thus stimulates breathing activity. There are also indications that the agent also activates the diaphragmatic nerve when there is a lack of oxygen and can thus intensify breathing.
Inhibits the cytokine storm
A second area of action is the excessive immune response in many Covid-19 patients. With this “Cytokinsturm“The infected cells and tissues release enormous amounts of inflammatory messenger substances. This causes lung tissue and vessels to swell, destroys cells and can lead to a collapse of the entire body.
EPO counteracts this derailment of the immune response: “Erythropoietin inhibits inflammation-promoting cytokines, protects cells from apoptosis and promotes wound healing,” report Ehrenreich and her colleagues. “In addition, EPO receptors are expressed on various immune cells, which means that the hormone can directly influence their activation, differentiation and function.”
Protective effect also on nerves and brain
A third protective effect of EPO affects the nervous system. Case reports have long shown that the coronavirus too Nerves and brain attacks and can cause a whole range of neurological damage and failures – from Olfactory disorders headaches and dizziness, cramps, paralysis and strokes. Some Covid 19 patients have sustained nerve damage after recovery.
However, animal studies and initial clinical studies in humans have shown that EPO can also protect nerve and brain cells. “Under damaging conditions such as brain injuries, EPO and the EPO receptor are increasingly formed,” report Ehrenreich and her colleagues. “This has neuroprotective effects, counteracts cell suicide and promotes the regeneration of nerve cells.” This effect the researchers have among other things for strokes, multiple sclerosis or schizophrenia already proven.
Clinical trial is in preparation
According to Ehrenreich and her team, there is sufficient evidence that EPO could help with severe Covid-19 courses. “Covid-19 can have such serious health consequences that we have to investigate any indication that EPO has a protective effect,” emphasizes Ehrenreich. “We are currently preparing a human study to investigate the effects of EPO on Covid-19.”
In this proof-of-concept study, 20 to 40 patients with severe course of Covid-19 should receive erythropoietin in addition to their normal intensive treatment. “Intravenous EPO therapy begins as soon as the critical condition of the patient requires mechanical ventilation,” said the researchers. Comparisons with a placebo group should then show whether this treatment can have a positive effect on the course of the disease.
If EPO works, this could be another cheap and well-available therapy option. Because the patents for this drug have long since expired, so that many manufacturers are already producing it. At the same time, this also explains why pharmaceutical manufacturers have little interest in funding larger clinical studies on the positive effects of EPO – it does not pay off for them, as Ehrenreich explains. (Molecular Medicine, 2020; doi: 10.1186/s10020-020-00186-y)
Source: Max Planck Society
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