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  • Review Article
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Emerging erythropoiesis-stimulating agents

Nature Reviews Nephrology volume 6, pages 218–223 (2010)Cite this article

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Abstract

The stimulation of erythropoiesis is a rapidly evolving area of research, with mechanistic insights often developing rapidly into therapeutic agents. A broad range of erythropoiesis-stimulating agents are currently in clinical use and many more under development are likely to enter the marketplace in the near future. To date, much of the investigative activity in this field has targeted activation of the erythropoietin receptor and factors that modulate hypoxia-related pathways of erythropoietin production within cells. This Review discusses newer erythropoiesis-stimulating agents currently under assessment for the treatment of anemia in patients with chronic kidney disease. Such agents include proteins and peptides that activate erythropoietin receptors, non-protein agents, and strategies with targets other than erythropoietin receptors.

Key Points

  • Considerable advances have been made in our understanding of the mechanisms that link oxygen sensing and erythropoiesis

  • Knowledge of the biology of erythropoietin production and the function of the erythropoietin receptor is critical for understanding and developing new therapeutic agents for anemia

  • Most novel erythropoiesis-stimulating agents (ESAs) involve stimulation of the erythropoietin receptor; post-translational modifications of the erythropoietin protein can affect the duration of action of ESAs

  • Chemically synthesized peptides that act on the erythropoietin receptor are also in clinical development

  • Non-peptide agents that directly or indirectly stimulate the erythropoietin gene (EPO) have the potential to become oral ESAs in the future

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Figure 1: Erythropoiesis, and interventions that might increase this process.

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  1. Chronic Disease Research Group, 914 South 8th Street, Suite D-253, Minneapolis, 55404, MN, USA

    Robert N. Foley

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The author declares associations with the following companies: Affymax, Amgen, Ortho Biotech and Roche (consulting fees).

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Foley, R. Emerging erythropoiesis-stimulating agents. Nat Rev Nephrol 6, 218–223 (2010). https://doi.org/10.1038/nrneph.2010.19

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