Erythropoietin mediated neuroprotection across neurological disorders through molecular signaling and cellular repair

Erythropoietin (EPO) has emerged as a multifunctional, significant, neuroprotective, and anti-inflammatory agent, extending beyond its traditional hematopoietic role. This review highlights EPO’s therapeutic potential in addressing neurodegenerative and neuropsychiatric disorders, such as Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), autism, and traumatic brain injury (TBI). By modulating key signaling pathways, including JAK2/STAT5, PI3K/Akt, and MAPK/ERK, EPO reduces oxidative stress, apoptosis, and inflammation while enhancing neurogenesis, synaptic plasticity, and angiogenesis. Preclinical evidence demonstrates EPO’s ability to preserve cognitive function, reduce tau pathology, and mitigate neuroinflammation in AD, as well as to protect dopaminergic neurons in PD models. Additionally, EPO promotes remyelination in MS and spinal cord injury models while improving behavioral and cognitive outcomes in neuropsychiatric disorders. However, clinical translation faces challenges, primarily due to EPO’s limited blood–brain barrier (BBB) penetration, necessitating high systemic doses that lead to hematopoietic side effects such as polycythemia and thromboembolism. Innovations in drug delivery, including intranasal formulations, nanoparticle systems, and receptor-specific analogs like carbamylated EPO (CEPO) and NeuroEPO, aim to enhance CNS targeting and safety. Despite promising preclinical findings, inconsistent clinical trial outcomes underscore the need for optimized dosing strategies, personalized medicine approaches, and rigorous safety evaluations. Moving forward, isoform-selective targeting and combination therapies present exciting avenues for expanding EPO’s applications, positioning it as a transformative agent for neurotherapeutic interventions.