HIF prolyl hydroxylase inhibition results in endogenous erythropoietin induction, erythrocytosis, and modest fetal hemoglobin expression in rhesus macaques

Blood. 2007 Sep 15;110(6):2140-7. doi: 10.1182/blood-2007-02-073254. Epub 2007 Jun 8.

Abstract

The hypoxia-inducible factor (HIF) pathway is crucial in mitigating the deleterious effects of oxygen deprivation. HIF-alpha is an essential component of the oxygen-sensing mechanisms and under normoxic conditions is targeted for degradation via hydroxylation by HIF-prolyl hydroxylases. Several HIF-prolyl hydroxylase inhibitors (PHIs) induced erythropoietin (epo) expression in vitro and in mice, with peak epo expression ranging from 5.6- to 207-fold above control animals. Furthermore, several PHIs induced fetal hemoglobin (HbF) expression in primary human erythroid cells in vitro, as determined by flow cytometry. One PHI, FG-2216, was further tested in a nonhuman primate model without and with chronic phlebotomy. FG-2216 was orally bioavailable and induced significant and reversible Epo induction in vivo (82- to 309-fold at 60 mg/kg). Chronic oral dosing in male rhesus macaques was well tolerated, significantly increased erythropoiesis, and prevented anemia induced by weekly phlebotomy. Furthermore, modest increases in HbF-containing red cells and reticulocytes were demonstrated by flow cytometry, though significant increases in HbF were not demonstrated by high-pressure liquid chromatography (HPLC). HIF PHIs represent a novel class of molecules with broad potential clinical application for congenital and acquired anemias.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Administration, Oral
  • Animals
  • Carcinoma, Hepatocellular / metabolism
  • Carcinoma, Hepatocellular / pathology
  • Chronic Disease
  • Enzyme Inhibitors / pharmacology*
  • Erythrocytes / drug effects
  • Erythrocytes / metabolism
  • Erythroid Cells / drug effects
  • Erythroid Cells / metabolism
  • Erythroid Precursor Cells / drug effects
  • Erythroid Precursor Cells / metabolism
  • Erythropoietin / metabolism*
  • Fetal Hemoglobin / metabolism*
  • Flow Cytometry
  • Humans
  • Hypoxia*
  • Liver Neoplasms / metabolism
  • Liver Neoplasms / pathology
  • Macaca mulatta
  • Male
  • Mice
  • Oxygen
  • Phlebotomy
  • Polycythemia*
  • Procollagen-Proline Dioxygenase / antagonists & inhibitors*
  • Procollagen-Proline Dioxygenase / metabolism
  • Reticulocytes / cytology
  • Reticulocytes / drug effects
  • Reticulocytes / metabolism

Substances

  • Enzyme Inhibitors
  • Erythropoietin
  • Fetal Hemoglobin
  • Procollagen-Proline Dioxygenase
  • Oxygen