Effect of recombinant erythropoietin on inflammatory markers in patients with affective disorders: A randomised controlled study
AIM This study investigated the effect of repeated infusions of recombinant human erythropoietin (EPO) on markers of inflammation in patients with affective disorders and whether any changes in inflammatory markers were associated with improvements on verbal memory. METHODS In total, 83 patients were recruited: 40 currently depressed patients with treatment resistant depression (TRD) (Hamilton Depression Rating Scale 17 items (HDRS 17) score >17) (sub study 1) and 43 patients with bipolar disorder (BD) in partial remission (HDRS 17 and Young Mania Rating Scale (YMRS)14) (sub study 2) In both sub studies, patients were randomised in a double blind, parallel group design to receive eight weekly intravenous infusions of EPO (Eprex; 40,000IU/ml) or saline (0.9% NaCl) Plasma concentrations of interleukin 6 (IL 6) interleukin 18 (IL 18) and high sensitive c reactive protein (hsCRP) were measured at week 1 (baseline) and weeks 5, 9 and 14. HDRS 17 and neuropsychological function was assessed at weeks 1, 9 and 14 using a test battery including the RAVLT Auditory Verbal Learning Test (primary depression and primary cognition outcomes in the original trial) RESULTS EPO had no cumulative effect on plasma levels of IL 6 or IL 18 but increased hsCRP levels in patients with TRD (mean+ SD change in ng/L: EPO: 0.43+ 1.64; Saline: 0.90+ 2.43; F(1,39)=4.78, p=0.04) EPO had no effects on inflammatory markers in BD. There was no correlation between change in inflammatory markers and change in verbal memory. CONCLUSIONS Repeated EPO infusions had no effect on IL 6 and IL 18 levels but produced a modest increase in hsCRP levels in patients with TRD. Changes over time in inflammatory markers were not correlated with changes in cognition suggesting that modulation of the inflammatory pathway is not a putative mechanism of the EPO associated improvement of cognition in affective disorders.
Brain, Behavior, and Immunity