Continuous versus pulsatile administration of erythropoietin (EPO) via the uterus in anemic rats

We have recently discovered that peptides are absorbed biologically intact from the rat uterus. The purpose of this investigation was to assess whether EPO, a large polypeptide hormone (34.5 kDa), can be absorbed from the uterus into the systemic blood circulation in a biologically active form, and to compare the biological effects of continuous transendometrial (TE) administration of EPO with those of the pulsatile mode. Sprague-Dawley rats with gentamicin-induced anemia were treated with recombinant human erythropoietin (r-HuEPO) 200 U/kg per day for 5 days as follows: (1) the daily dose was instilled as a bolus through an indwelling cannula in the uterus; (2) the daily dose was continuously delivered into the uterus at a constant rate of 2 U /h by mini-osmotic pump connected to a similar cannula; (3) the third group received the daily r-HuEPO dose through the jugular vein; and (4) a control group treated with normal saline solution instilled in the uterus (as in group 1). The hematological parameters were measured for 53 days following initiation of r-HuEPO treatment. It was found that the biological effects following bolus daily transendometrial (TE) administration of EPO, expressed by red blood cell count and hematocrit levels, were equipotent to i.v. injection. On the other hand, the biological response following continuous TE EPO administration was significantly better than that observed following pulsatile administration. It is concluded that r-HuEPO is absorbed from the uterus in its bioactive form, with no deleterious effects on the uterine tissue. Slow release of EPO from a TE device may induce a beneficial biological response in comparison to pulsatile delivery.