Erythropoietic agents from natural sources

Anemia occurs frequently in individuals who suffer from chronic kidney disease (CKD) or gynecologic disease or who receive anticancer therapy. Since 1988, medical practitioners have treated patients with anemia successfully with recombinant human erythropoietin (EPO), which is currently the largest therapeutic protein class in the world. It has some disadvantages, however, such as high cost, parenteral administration, and immunogenicity. A novel, economical, orally administrable, and nonimmunogenic hematopoietic agent would be valuable as an alternative or supportive therapy for EPO. Considering the long history of usage of natural products and the recent progress in identification of their active constituents, especially of herbal medicines, researchers and clinicians should find natural products to be useful sources of hematopoietic drugs. In this review, the authors have described EPO therapy and traditional medicines for anemia, including their mechanisms of action for erythropoiesis.