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Molecular Medicine

, Volume 21, Issue 1, pp 979–987 | Cite as

Erythropoietin for the Treatment of Subarachnoid Hemorrhage: A Feasible Ingredient for a successful Medical Recipe

  • Giovanni Grasso
  • Giovanni Tomasello
  • Marcello Noto
  • Concetta Alafaci
  • Francesco Cappello
Review Article

Abstract

Subarachnoid hemorrhage (SAH) following aneurysm bleeding accounts for 6% to 8% of all cerebrovascular accidents. Although an aneurysm can be effectively managed by surgery or endovascular therapy, delayed cerebral ischemia is diagnosed in a high percentage of patients resulting in significant morbidity and mortality. Cerebral vasospasm occurs in more than half of all patients after aneurysm rupture and is recognized as the leading cause of delayed cerebral ischemia after SAH. Hemodynamic strategies and endovascular procedures may be considered for the treatment of cerebral vasospasm. In recent years, the mechanisms contributing to the development of vasospasm, abnormal reactivity of cerebral arteries and cerebral ischemia following SAH, have been investigated intensively. A number of pathological processes have been identified in the pathogenesis of vasospasm, including endothelial injury, smooth muscle cell contraction from spasmogenic substances produced by the sub-arachnoid blood clots, changes in vascular responsiveness and inflammatory response of the vascular endothelium. To date, the current therapeutic interventions remain ineffective as they are limited to the manipulation of systemic blood pressure, variation of blood volume and viscosity and control of arterial carbon dioxide tension. In this scenario, the hormone erythropoietin (EPO) has been found to exert neuroprotective action during experimental SAH when its recombinant form (rHuEPO) is administered systemically. However, recent translation of experimental data into clinical trials has suggested an unclear role of recombinant human EPO in the setting of SAH. In this context, the aim of the current review is to present current evidence on the potential role of EPO in cerebrovascular dysfunction following aneurysmal subarachnoid hemorrhage.

Notes

Acknowledgments

The study has been supported by FFR 2012 of the University of Palermo, Italy.

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Authors and Affiliations

  • Giovanni Grasso
    • 1
  • Giovanni Tomasello
    • 2
  • Marcello Noto
    • 3
  • Concetta Alafaci
    • 4
  • Francesco Cappello
    • 2
  1. 1.Neurosurgical Clinic, Department of Experimental Biomedicine and Clinical NeurosciencesPoliclinico Universitario di PalermoPalermoItaly
  2. 2.Section of Anatomy, Department of Experimental Biomedicine and Clinical NeurosciencesEuro-Mediterranean Institute of Science and Technology (IEMEST)PalermoItaly
  3. 3.AOU Policlinico of PalermoPalermoItaly
  4. 4.Department of NeurosurgeryUniversity of MessinaMessinaItaly

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