Anti-apoptotic pathways regulated by erythropoietin. The binding of erythropoietin (EPO) to its dimerised cell surface receptor causes conformational change, leading to activation and autophosphorylation of Janus-tyrosine kinase-2 (Jak2). Jak2 phosphorylates nine tyrosine residues in the intracellular portion of the receptor, which allows interaction with signal transducers and activators of transcription protein (STATs) signalling molecules, and activates phosphoinostitol-3 kinase (PI3K) and hence protein kinase B (AKT). AKT regulates multiple pro-apoptotic and anti-apoptotic intermediates, including glycogen storage kinase-3β (GSK-3B), B-cell lymphoma protein 2 (Bcl-2)-related death promoter (Bad) and the pro-apoptotic forkhead box transcription factor O3a (FOXO3a), rendering it unable to activate transcription of apoptotic signalling genes. STATs cause transcription of the anti-apoptotic molecules Bcl-2 and proto-oncogene serine/threonine-protein kinase 3 (PIM-3). EPO also activates NF-κB, possibly in a cell-type-specific manner, which alters transcription of pro-apoptotic and anti-apoptotic proteins including inhibitor of apoptosis proteins. ASK-1, apoptosis signal-regulating kinase 1; Bcl-xL, B-cell lymphoma extra large; cIAP, baculoviral inhibitor of apoptosis protein repeat-containing protein; eNOS, endogenous nitric oxide synthase; EpoR, erythropoietin receptor; HSP70, heat shock protein 70; XIAP, X-linked inhibitor of apoptosis protein.
Walden et al. Critical Care 2010 14:227 doi:10.1186/cc9049