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      Erythropoietin, a putative neurotransmitter during hypoxia, is produced in RVLM neurons and activates them in neonatal Wistar rats

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          Abstract

          Recent studies indicate that erythropoietin (EPO) is present in many areas of the brain and is active in the restoration of impaired neurons. In this study, we examined the presence of EPO and its role in bulbospinal neurons in the rostral ventrolateral medulla (RVLM). Hypoxia is often accompanied by a high blood pressure (BP). We hypothesized that EPO is produced in response to hypoxia in RVLM neurons and then activates them. To investigate whether RVLM neurons are sensitive to EPO, we examined the changes in the membrane potentials (MPs) of bulbospinal RVLM neurons using the whole cell patch-clamp technique during superfusion with EPO. A brainstem-spinal cord preparation was used for the experiments. EPO depolarized the RVLM neurons, and soluble erythropoietin receptor (SEPOR), an antagonist of EPO, hyperpolarized them. Furthermore, hypoxia-depolarized RVLM neurons were significantly hyperpolarized by SEPOR. In histological examinations, the EPO-depolarized RVLM neurons showed the presence of EPO receptor (EPOR). The RVLM neurons that possessed EPORs showed the presence of EPO and hypoxia-inducible factor (HIF)-2α. We also examined the levels of HIF-2α and EPO messenger RNA (mRNA) in the ventral sites of the medullas (containing RVLM areas) in response to hypoxia. The levels of HIF-2α and EPO mRNA in the hypoxia group were significantly greater than those in the control group. These results suggest that EPO is produced in response to hypoxia in RVLM neurons and causes a high BP via the stimulation of those neurons. EPO may be one of the neurotransmitters produced by RVLM neurons during hypoxia.

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          Regulation of erythropoiesis by hypoxia-inducible factors.

          A classic physiologic response to systemic hypoxia is the increase in red blood cell production. Hypoxia-inducible factors (HIFs) orchestrate this response by inducing cell-type specific gene expression changes that result in increased erythropoietin (EPO) production in kidney and liver, in enhanced iron uptake and utilization and in adjustments of the bone marrow microenvironment that facilitate erythroid progenitor maturation and proliferation. In particular HIF-2 has emerged as the transcription factor that regulates EPO synthesis in the kidney and liver and plays a critical role in the regulation of intestinal iron uptake. Its key function in the hypoxic regulation of erythropoiesis is underscored by genetic studies in human populations that live at high-altitude and by mutational analysis of patients with familial erythrocytosis. This review provides a perspective on recent insights into HIF-controlled erythropoiesis and iron metabolism, and examines cell types that have EPO-producing capability. Furthermore, the review summarizes clinical syndromes associated with mutations in the O(2)-sensing pathway and the genetic changes that occur in high altitude natives. The therapeutic potential of pharmacologic HIF activation for the treatment of anemia is discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study.

            To assess whether sleep apnoea syndrome is an independent risk factor for hypertension. Population study. Sleep clinic in Toronto. 2,677 adults, aged 20-85 years, referred to the sleep clinic with suspected sleep apnoea syndrome. Medical history, demographic data, morning and evening blood pressure, and whole night polysomnography. Blood pressure and number of patients with hypertension increased linearly with severity of sleep apnoea, as shown by the apnoea-hypopnoea index. Multiple regression analysis of blood pressure levels of all patients not taking antihypertensives showed that apnoea was a significant predictor of both systolic and diastolic blood pressure after adjustment for age, body mass index, and sex. Multiple logistic regression showed that each additional apnoeic event per hour of sleep increased the odds of hypertension by about 1%, whereas each 10% decrease in nocturnal oxygen saturation increased the odds by 13%. Sleep apnoea syndrome is profoundly associated with hypertension independent of all relevant risk factors.
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              Anaemia in kidney disease: harnessing hypoxia responses for therapy.

              Improved understanding of the oxygen-dependent regulation of erythropoiesis has provided new insights into the pathogenesis of anaemia associated with renal failure and has led to the development of novel therapeutic agents for its treatment. Hypoxia-inducible factor (HIF)-2 is a key regulator of erythropoiesis and iron metabolism. HIF-2 is activated by hypoxic conditions and controls the production of erythropoietin by renal peritubular interstitial fibroblast-like cells and hepatocytes. In anaemia associated with renal disease, erythropoiesis is suppressed due to inadequate erythropoietin production in the kidney, inflammation and iron deficiency; however, pharmacologic agents that activate the HIF axis could provide a physiologic approach to the treatment of renal anaemia by mimicking hypoxia responses that coordinate erythropoiesis with iron metabolism. This Review discusses the functional inter-relationships between erythropoietin, iron and inflammatory mediators under physiologic conditions and in relation to the pathogenesis of renal anaemia, as well as recent insights into the molecular and cellular basis of erythropoietin production in the kidney. It furthermore provides a detailed overview of current clinical experience with pharmacologic activators of HIF signalling as a novel comprehensive and physiologic approach to the treatment of anaemia.
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                Author and article information

                Journal
                Am J Physiol Regul Integr Comp Physiol
                Am. J. Physiol. Regul. Integr. Comp. Physiol
                ajpregu
                Am J Physiol Regul Integr Comp Physiol
                AJPREGU
                American Journal of Physiology - Regulatory, Integrative and Comparative Physiology
                American Physiological Society (Bethesda, MD )
                0363-6119
                1522-1490
                1 May 2018
                14 February 2018
                14 February 2018
                : 314
                : 5
                : R700-R708
                Affiliations
                [1] 1Department of Nephrology and Endocrinology, National Defense Medical College, Tokorozawa, Saitama, Japan
                [2] 2Department of Physiology, Showa University School of Medicine , Tokyo, Japan
                [3] 3Department of Physiology, National Defense Medical College, Tokorozawa, Saitama, Japan
                Author notes
                Address for reprint requests and other correspondence: N. Oshima, Dept. of Nephrology and Endocrinology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan (e-mail: oshima@ 123456ndmc.ac.jp ).
                Article
                R-00455-2017 R-00455-2017
                10.1152/ajpregu.00455.2017
                6008112
                29443550
                24632aef-4072-4702-a531-d25f3161cff5
                Copyright © 2018 the American Physiological Society

                Licensed under Creative Commons Attribution CC-BY 4.0: © the American Physiological Society.

                History
                : 27 December 2017
                : 6 February 2018
                : 6 February 2018
                Categories
                Research Article
                Neural Control

                Anatomy & Physiology
                epor,erythropoietin,hif-2α,hypoxia,rvlm neurons
                Anatomy & Physiology
                epor, erythropoietin, hif-2α, hypoxia, rvlm neurons

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