Fig. 1

Suppression of EPO expression as a consequence of SARS-CoV2 infection and the rationale for rhEPO supplementation. Putative action of viral nonstructural proteins (NSP) and viral proteases on host protein biosynthesis and stability of host proteins (see text for references and details). Failure of EPO response to hypoxia may result in anemia and enhanced tissue/brain/neural injury. External EPO or EPO biosimilars are expected to combat anemia, reconstitute neuroprotection and tissue protection and mediate beneficial immune modulation. PAMP (pathogen-associated molecular pattern) and DAMP (damage-associated molecular pattern) recognition can induce primary and secondary cytokine storms, respectively. EPO suppression by TNFα and by TNFα/NF-κB-mediated induction of miR-122 has been demonstrated under various inflammatory conditions (Cluzeau et al. 2017; Rivkin et al. 2016). Anti-inflammatory actions, vascular protection and beneficial effects of EPO on respiratory functions have been reviewed in detail earlier (Ehrenreich et al. 2020)