Erythropoetin in der Plastischen Chirurgie

Zusammenfassung

Erythropoetin (EPO) ist ein körpereigenes Hormon, welches durch Fibroblasten des Nierenpa­renchyms produziert wird und die Ausdifferenzierung der Erythrozyten im Knochenmark steuert. Seit 30 Jahren wird es therapeutisch bei ­Anämien der terminalen Niereninsuffizienz, bei tumorinduzierten Anämien und vor der Eigenblutspende eingesetzt.

Mittlerweile konnte in einer großen Anzahl von Arbeiten demonstriert werden, dass EPO zudem eine Schlüsselrolle bei der Reaktion auf akute und chronische Gewebeschäden einnimmt. Es konnte gezeigt werden, dass EPO in einer Vielzahl von Geweben in der Akutphase nach Trauma synthetisiert wird. Es hemmt die initiale Entzündungsreaktion und die Apoptose, stimuliert die Stammzellrekrutierung und die Ausschüttung verschiedener Wachstumsfaktoren sowie die Angiogenese und die Re-Epithelialisierung. Unerwünschte Wirkungen von EPO sind u. a. Erhöhung der Thromboseneigung und des Blutdrucks sowie kürzere Überlebenszeiten von mit EPO behandelten Patienten mit Tumoranämien. Wissenschaftlich untersuchte Einsatzbereiche von EPO in dem Gebiete der plastischen Chirurgie sind: Lappenplastiken (lokale und freie), die Regeneration peripherer Nerven sowie die Wundheilungsförderung in thermischen Verletzungen und in chronischen Wunden.

Aktuell ist die Evidenzlage insbesondere für den konkreten klinischen Einsatz aufgrund mangelnder Ergebnisse von GCP (good clinical practice) -gerechten klinischen Studien jedoch ungenügend. Die Durchführung weiterer wissenschaftlich und formal anspruchsvoller Studien ist daher notwendig.

Abstract

EPO is an autologous hormone, which is known to regulate erythropoiesis. For 30 years it has been used for the therapy of diverse forms of anaemia, such as renal anaemia, tumour-related anaemias, etc. Meanwhile, a multitude of scientific publications were able to demonstrate its pro-regenerative effects after trauma. These include short-term effects such as the inhibition of the „primary injury response“ or apoptosis, and mid- and long-term effects for example the stimula­tion of stem cell recruitment, growth factor production, angiogenesis and re-epithelialisation. Known adverse reactions are increases of thromboembolic events and blood pressure, as well as a higher mortality in patients with tumour anaemias treated with EPO. Scientific investigations of EPO in the field of plastic surgery included: free and local flaps, nerve regeneration, wound healing enhancement after dermal thermal injuries and in chronic wounds.

Acute evidence for the clinical use of EPO in the field of plastic surgery is still not satisfactory, due to the insufficient number of Good Clinical Practice (GCP)-conform clinical trials. Thus, the initiation of more scientifically sound trials is ­indicated.

Schlüsselworter

Erythropoetin - Plastische Chirurgie - regenerative Medizin - klinische Studie

Key words

erythropoietin - plastic surgery - regenerative medicine - clinical trials

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