Home Life Sciences Treatment of pure red cell aplasia in a chronic kidney disease patient with roxadustat: A case report
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Treatment of pure red cell aplasia in a chronic kidney disease patient with roxadustat: A case report

  • Shanlin Liu , Bonan Yan and Yuhua He EMAIL logo
Published/Copyright: October 4, 2025
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From the journal Open Life Sciences Volume 20 Issue 1

Abstract

Pure red cell aplasia (PRCA) is a rare blood disorder that is characterized by severe hypo-erythroid bone marrow hypoplasia leading to severe anemia that usually does not respond to standard treatment. In patients with chronic kidney disease (CKD), especially in those patients who are erythropoiesis-stimulating agent (ESA) resistant, management can be quite difficult. In this case report, we will present a 67-year-old woman with CKD (not on dialysis) who presented with refractory anemia (hemoglobin 45–65 g/L) and was ultimately diagnosed with PRCA after bone marrow aspirate. This patient had previously received treatment (ESAs, iron supplementation, and multiple blood transfusions) without improvement in her blood counts. After initiation of oral Roxadustat 100 mg t.i.w., her hemoglobin increased gradually and stabilized between 100 and 106 g/L, and she no longer required blood transfusions. This case report highlights the potential role of Roxadustat as a new therapeutic option for PRCA and ESA-resistant CKD. While these data are encouraging, larger controlled studies are going to be required to evaluate measures of efficacy, dosing, and long-term safety in this population.

Keywords: roxadustat; pure red cell aplasia; chronic kidney disease; renal anemia

1 Introduction

Pure red cell aplasia (PRCA) is a rare hematological condition that presents as severe reticulocytopenia and marked reduction of erythroblasts in the bone marrow [1]. PRCA can be congenital or acquired, and the acquired type of PRCA is sometimes associated with autoimmune disease, viral infections, malignancies, and certain medications [2]. In patients suffering from chronic kidney disease (CKD), PRCA can complicate the already impaired erythropoiesis from decreased erythropoietin (EPO) secretion and production [3]. The cornerstone of treatment for PRCA includes glucocorticoids, immunosuppressive medications, or erythropoiesis-stimulating agents (ESAs), although many patients have little or no response [4,5]. For cases of PRCA that are refractory, there could be the option of splenectomy, thymectomy, and hematopoietic stem cell transplantation, but these could pose a significant risk [6]. Blood transfusions provide symptomatic relief but may carry the risks of iron overload [7].

Genetic influences may also be associated with the development and progression of CKD and anemia, especially in populations with predisposed variations of iron regulation/erythropoiesis-related genes [8].

We chose this case due to clinical rarity, extremely refractory to recommended treatment, and notable hematologic improvement experienced with Roxadustat, thus providing evidence for a new potential treatment. Roxadustat is a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), which stimulates endogenous EPO production, regulates iron metabolism, and promotes erythropoiesis [9]. Roxadustat stabilizes hypoxia-inducible factors (HIFs) as a contrast to ESAs, which stimulate erythropoiesis even in the context of inflammation or ESA resistance [10]. There are limited clinical data on the use of Roxadustat in PRCA, particularly in adult patients with CKD not on dialysis, and this case can provide useful insights into the potential use of Roxadustat.

2 Case presentation

2.1 Patient background and initial presentation

A 67-year-old female patient with a background of hypertension was brought to a county-level hospital in June 2020 due to complaints of fatigue and chest tightness. At admission, laboratory studies indicated severe anemia, with hemoglobin levels of 69 g/L, RBC count of 2.17 × 10¹²/L, and a hematocrit level of 22%. The MCV was recorded at 101.1 fL and MCHC 312 g/L. Platelet counts were moderately low at 118 × 10⁹/L. Other biochemistry investigations showed high transferrin saturation (95.15%) and elevated ferritin (741.40 ng/mL), suggesting possible iron overload. Additionally, kidney panel tests indicated increased serum creatinine (326 μmol/L) and urea concentrations (18.45 mmol/L), consistent with CKD.

After the first diagnosis, the patient was subsequently prescribed Ferrous Succinate Sustained Release Tablets (0.2 g per day) and Yiqi Weixue Capsules (1.35 g, three times a day). Yiqi Weixue capsules are an example of traditional Chinese medicine, which contains Astragalus membranaceus and Angelica sinensis to help enhance hematopoiesis and promote blood circulation. After 1 month of treatment, there was no change in hemoglobin levels, so another line of therapy was warranted.

  1. Informed consent: Informed consent has been obtained from all individuals included in this study.

  2. Ethical approval: The research related to human use has been complied with all the relevant national regulations and institutional policies and in accordance with the tenets of the Helsinki Declaration and has been approved by the Ethics Committee of the Hospital of Chengdu University of Traditional Chinese Medicine.

2.2 Progression and initial treatment attempts

The patient was started on recombinant human EPO (EPIAO, 20,000 IU, twice a week) with monthly transfusions of euphoric red blood cell suspension (1.0–2.0 units for each transfusion) for the next ten months. Unfortunately, despite these interventions, her hemoglobin levels continued to swing up and down, ranging from 44–60 g/L. This ongoing anemia that was resistant to ESA therapy and transfusion led to concerns for possible erythropoietic failure, possibly from a marrow agent. In March 2021, Roxadustat was introduced at a low dose of 100 mg once a week as another option. One month post-initiation, there was no discernible hematology response, and she was sent to the Hematology Department of our hospital in May 2021 for further treatment (Table 1).

Table 1

Key laboratory trends over time

Date Hemoglobin (g/L) Ferritin (ng/mL) Treatment changes
March 2021 55 1,925 ESA + transfusions
Nov 2022 77 855.1 Roxadustat (100 mg three times/week)
Aug 2023 100–106 513.3 Stable outcome

2.3 Hematologic evaluation and PRCA diagnosis

Based on the clinical and lab work, the patient was seen on the other side of the track. On physical examination, she was quite pale, without any signs of mucosal or cutaneous bleeding. No lymphadenopathy could be palpated; cardiovascular examination showed a heart rate of 87 beats per minute with a regular rhythm. There was no evidence from the examination of her legs suggesting volume overload contributed to her anemia. At the time of referral, she had worsening anemia with decreased hemoglobin at 55 g/L and reticulocyte % of 0.11%. The reticulocyte count was extremely low, at 2 × 10⁹/L, confirming very severe suppression of erythropoiesis. Serum ferritin increased to 1,925 ng/mL, further substantiating the iron overload. Renal function tests were still abnormal: creatinine at 305.3 μmol/L and cystatin C at 3.69 mg/L.

The patient had a bone marrow aspiration and biopsy to evaluate the cause of the refractory anemia. Morphological examination showed erythroid hypoplasia, with the granulocyte precursors making up 84% of the nucleated cells and only minimal amounts of the erythroid precursors. The myeloblasts were 0.5%, and the megakaryocytes were normal in morphology. The biopsy showed PRCA. Flow cytometric analysis and other work-ups were negative for neoplastic, autoimmune, and parvovirus B19 causes.

2.4 Treatment modifications and response to therapy

After the diagnosis of PRCA with underlying CKD, the treatment plan was revised. Cyclosporine was no longer an option, given the patient’s renal impairment, and initiation of Prednisone (5 mg/day) and a number of other medications were started, i.e., α-Ketoacid Tablets, Med Charcoal Tablets, Nifedipine Controlled Release Tablets, Lansoprazole Enteric Coated Tablets, and Deferasirox Dispersible Tablets. Even with the medications changed around, hemoglobin levels remained very low (45–65 g/L), requiring ongoing transfusions.

In November 2022, given the ongoing anemia and my lack of sustained response, Roxadustat was reintroduced at a higher professed dose of 100 mg t.i.w. Hemoglobin began to improve slowly over the next few months, reaching a level of 100 and then stabilizing at 106 g/L. In tandem, serum ferritin levels began to decline from 855.1 to 513.3 ng/mL, suggesting an improvement in iron metabolism. During this entire timeframe, the patient was free from transfusions, thromboembolic complications, or any significant reno- or hepato-toxicity.

2.5 Key laboratory trends over time

The results indicate that a greater and sustained dose of Roxadustat was necessary for hematologic recovery. Compared to the previous trial (March 2021) study (hemoglobin 55 g/L, ferritin 1,925 ng/mL), the modified regimen not only improved hemoglobin (77 g/L by November 2022) but also stabilized hemoglobin (100–106 g/L by August 2023) with trending decrease in ferritin (855.1–513.3 ng/mL) indicating that the patient was becoming less erythroid suppressive with improved erythropoiesis (making use of iron). Figure 1a and b shows a bone marrow smear and erythroid suppression, Figure 2a–b shows biopsy-confirmed PRCA, and Figure 3a–c shows the hematologic function and renal function trends post-Roxadustat treatment.

Figure 1 Morphological analysis of bone marrow cells. (a and b) Bone marrow smears showing reduced erythroid precursors, with normal granulocyte and megakaryocyte morphology, support the diagnosis of pure red cell aplasia (PRCA).
Figure 1

Morphological analysis of bone marrow cells. (a and b) Bone marrow smears showing reduced erythroid precursors, with normal granulocyte and megakaryocyte morphology, support the diagnosis of pure red cell aplasia (PRCA).

Figure 2 Pathological diagnosis of aspirated bone marrow tissue. (a and b) Bone marrow biopsy revealing low hematopoietic tissue hyperplasia, marked erythroid hypoplasia, and preserved myeloid and megakaryocyte lineages, consistent with PRCA.
Figure 2

Pathological diagnosis of aspirated bone marrow tissue. (a and b) Bone marrow biopsy revealing low hematopoietic tissue hyperplasia, marked erythroid hypoplasia, and preserved myeloid and megakaryocyte lineages, consistent with PRCA.

Figure 3 Laboratory parameter trends. (a) Hemoglobin status over time, showing initial low levels and subsequent improvement following Roxadustat therapy. (b) Creatinine levels reflecting renal function status throughout treatment. (c) Hemoglobin changes before and after Roxadustat administration, illustrating treatment response and stabilization of anemia.
Figure 3

Laboratory parameter trends. (a) Hemoglobin status over time, showing initial low levels and subsequent improvement following Roxadustat therapy. (b) Creatinine levels reflecting renal function status throughout treatment. (c) Hemoglobin changes before and after Roxadustat administration, illustrating treatment response and stabilization of anemia.

3 Results

3.1 Hematologic response to roxadustat treatment

After starting treatment with high-dose Roxadustat at 100 mg administered three times per week, the patient’s hemoglobin concentration increased steadily. Patient’s pre-treatment hemoglobin was 77 g/L as of November 2022. Following continuous dosing until March 2023, hemoglobin concentration was 85 g/L. Hemoglobin concentration remained stable by April 2023 in the range of 100–106 g/L and continued to remain essentially the same through August 2023 (Figure 3c). During this time, serum ferritin concentration dropped from a high of 855.1–513.3 ng/mL with meaning the patient was able to improve its iron utilization and erythropoiesis (Table 1). Most importantly, the patient no longer required red blood cell transfusions, showing that Roxadustat was effective for the patient in obtaining transfusion independence.

3.2 Comparison of initial and adjusted roxadustat therapy

The initial trial of Roxadustat in March 2021, at 100 mg once a week, found no hematologic benefit; hemoglobin was still at 55 g/L, with ferritin rising to 1.925 ng/mL, indicating ineffective erythropoiesis. This could be indicative of underdosing or an underlying pathologic disturbance, such as PRCA was not addressed. PRCA was subsequently confirmed, and the dose was escalated in November 2022 (100 mg three times weekly). There was a dramatic and sustained increase in hemoglobin concentration consistent with a dose response in cases of PRCA, also with CKD. This program also allowed the patient to discontinue transfusions.

3.3 Morphological analysis of bone marrow cells

Bone marrow aspiration showed severe erythroid hypoplasia with few erythroid precursors, and 84% of nucleated cells constituted granulocyte precursors (Figure 1a and b). Myeloblasts were noted at 0.5%, and the megakaryocytes were morphologically normal. There was no fibrosis or dysplastic changes, meaning other marrow pathology was effectively ruled out.

3.4 Histopathological evaluation of bone marrow biopsy

A bone marrow biopsy showed severely decreased hematopoiesis with only 35% hematopoietic cellularity and 65% adipocytes. The granulocyte-to-erythrocyte ratio was very high due to severe depletion of all erythroid elements and was consistent with PRCA. After visualizing the smear, there were occasions of clusters of granulocytes, while cells from the erythroid lineage were rarely noted. Megakaryocytes were noted at a frequency of 3–6 per high-power field and appeared normative. There were no signs of myelofibrosis or malignancy, or infiltrative processes (Figure 2a and b).

3.5 Renal function and safety outcomes

During high-dose Roxadustat treatment, the patient’s renal function remained stable without evidence of acute kidney injury. Serum creatinine (Figure 3b) and no hepatic toxicity, thromboembolic complications or other side effects were documented. This is supportive of Roxadustat’s tolerability and safety in this CKD-PRCA case.

4 Discussion

PRCA is a rare hematological disease characterized by selective erythroid aplasia and reticulocytopenia, often resulting from autoimmunity, virus infections, malignancies, or medication exposure [11,12]. In patients with CKD, the situation is complicated by low endogenous EPO production, causing a more challenging anemia to treat [13]. The case described below highlights the significance of this dual treatment burden experienced by a CKD patient, who remained transfusion dependent despite being on recombinant human EPO and iron supplementation, and subsequently diagnosed with PRCA by bone marrow biopsy.

Standard immunosuppressive treatment (IST) for patients with PRCA, including corticosteroids, cyclosporine A, and sirolimus, is a widely used therapy; however, as outlined above, IST has a high side effect profile and cannot be used in some patients due to nephrotoxicity and recurring complications from immunosuppression [5,14,15]. In our case, IST was not an option due to renal dysfunction, so we had to follow a different approach. Roxadustat, a HIF-PHI, is an exciting contemporary option to treat renal anemia because it is a non-immunosuppressive therapeutic option whereby Roxadustat, through the stabilization of HIF-α, stimulates endogenous EPO production and iron metabolism while inhibiting hepcidin [16,17,18,19,20,21,22].

Furthermore, Roxadustat may be able to circumvent the immune-mediated suppression of erythropoiesis, which makes it attractive for patients with EPO-resistant PRCA. Recent evidence suggests that Roxadustat has potential benefits in this regard. Zheng et al. [23] and Fu et al. [24] demonstrated resolution of anemia in patients with CKD and PRCA who had no EPO response. Wan et al. [25] reported a patient with anti-EPO antibody-mediated PRCA who had improved clinical outcomes using Roxadustat. In our case report, we also observed an initial rise in hemoglobin from 77 to 100–106 g/L following initiation of high-dose Roxadustat, with transfusion independence.

Zhao et al. showed that Roxadustat promotes erythropoiesis in ESA-resistant patients by altering pro-inflammatory cytokines and downregulating the hepcidin expression, suggesting a role in immune-refractory anemia [26]. Liu et al. determined that the dose-dependence of Roxadustat was also strongly associated with faster erythroid recovery, in dialysis and non-dialysis patients [27]. These studies further strengthen the notion that Roxadustat can have utility beyond the classical mechanisms of action offered by ESA therapy.

On the flipside, we need to consider the limitations of the approach. First, this is a single-patient case report, which limits generalizability. Second, there was no comparator group, which prevents concluding efficacy. Third, we do not clearly understand the long-term safety of Roxadustat to treat PRCA, especially concerning thromboembolic events.

Future research should focus on multicenter and randomized controlled trials of Roxadustat and IST in the clinical management of patients with PRCA, particularly among those with concurrent CKD. Future molecular studies may help to identify additional pathways that Roxadustat affects beyond HIF stabilization and provide more comprehensive avenues for patient selection and dosing strategies.

5 Conclusions

This case emphasizes the promise of Roxadustat as a therapeutic option for PRCA in a CKD patient who had failed all other conventional therapies. A higher dosing strategy with Roxadustat (100 mg three times weekly) provided hemoglobin stabilization, and transfusions were eliminated. While this outcome is promising, this is a single case, which cannot define general efficacy, so larger and controlled studies are required to characterize a therapeutic effect with Roxadustat for PRCA. If a timely diagnosis is made, consideration of alternative therapies such as Roxadustat could provide a clinical advantage in similarly refractory cases.

Acknowledgments

We thank the Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine (Sichuan Provincial Hospital of Traditional Chinese Medicine) for the technical support of this study. The patient has signed an informed consent form to publish this case.

  1. Funding information: Authors state no funding involved.

  2. Author contributions: S.L. and B.Y. wrote the main manuscript text, and S.L. and Y.H. prepared Figures 1–3 and Table 1. All authors reviewed the manuscript.

  3. Conflict of interest: Authors state no conflict of interest.

  4. Data availability statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Received: 2025-04-18
Revised: 2025-06-11
Accepted: 2025-06-24
Published Online: 2025-10-04

© 2025 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  114. Biogenic Cu/Ni nanotherapeutics from Descurainia sophia (L.) Webb ex Prantl seeds for the treatment of lung cancer
  115. Dapagliflozin attenuates atrial fibrosis via the HMGB1/RAGE pathway in atrial fibrillation rats
  116. Glycitein alleviates inflammation and apoptosis in keratinocytes via ROS-associated PI3K–Akt signalling pathway
  117. ADH5 inhibits proliferation but promotes EMT in non-small cell lung cancer cell through activating Smad2/Smad3
  118. Apoptotic efficacies of AgNPs formulated by Syzygium aromaticum leaf extract on 32D-FLT3-ITD human leukemia cell line with PI3K/AKT/mTOR signaling pathway
  119. Novel cuproptosis-related genes C1QBP and PFKP identified as prognostic and therapeutic targets in lung adenocarcinoma
  120. Bee venom promotes exosome secretion and alters miRNA cargo in T cells
  121. Treatment of pure red cell aplasia in a chronic kidney disease patient with roxadustat: A case report
  122. Comparative bioinformatics analysis of the Wnt pathway in breast cancer: Selection of novel biomarker panels associated with ER status
  123. Kynurenine facilitates renal cell carcinoma progression by suppressing M2 macrophage pyroptosis through inhibition of CASP1 cleavage
  124. RFX5 promotes the growth, motility, and inhibits apoptosis of gastric adenocarcinoma cells through the SIRT1/AMPK axis
  125. ALKBH5 exacerbates early cardiac damage after radiotherapy for breast cancer via m6A demethylation of TLR4
  126. Phytochemicals of Roman chamomile: Antioxidant, anti-aging, and whitening activities of distillation residues
  127. Circadian gene Cry1 inhibits the tumorigenicity of hepatocellular carcinoma by the BAX/BCL2-mediated apoptosis pathway
  128. The TNFR-RIPK1/RIPK3 signalling pathway mediates the effect of lanthanum on necroptosis of nerve cells
  129. Longitudinal monitoring of autoantibody dynamics in patients with early-stage non-small-cell lung cancer undergoing surgery
  130. The potential role of rutin, a flavonoid, in the management of cancer through modulation of cell signaling pathways
  131. Construction of pectinase gene engineering microbe and its application in tobacco sheets
  132. Construction of a microbial abundance prognostic scoring model based on intratumoral microbial data for predicting the prognosis of lung squamous cell carcinoma
  133. Sepsis complicated by haemophagocytic lymphohistiocytosis triggered by methicillin-resistant Staphylococcus aureus and human herpesvirus 8 in an immunocompromised elderly patient: A case report
  134. Sarcopenia in liver transplantation: A comprehensive bibliometric study of current research trends and future directions
  135. Advances in cancer immunotherapy and future directions in personalized medicine
  136. Can coronavirus disease 2019 affect male fertility or cause spontaneous abortion? A two-sample Mendelian randomization analysis
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  139. Hyperosmolar hyperglycemic state with severe hypernatremia coexisting with central diabetes insipidus: A case report and literature review
  140. Efficacy and mechanism of escin in improving the tissue microenvironment of blood vessel walls via anti-inflammatory and anticoagulant effects: Implications for clinical practice
  141. Merkel cell carcinoma: Clinicopathological analysis of three patients and literature review
  142. Genetic variants in VWF exon 26 and their implications for type 1 Von Willebrand disease in a Saudi Arabian population
  143. Lipoxin A4 improves myocardial ischemia/reperfusion injury through the Notch1-Nrf2 signaling pathway
  144. High levels of EPHB2 expression predict a poor prognosis and promote tumor progression in endometrial cancer
  145. Knockdown of SHP-2 delays renal tubular epithelial cell injury in diabetic nephropathy by inhibiting NLRP3 inflammasome-mediated pyroptosis
  146. Exploring the toxicity mechanisms and detoxification methods of Rhizoma Paridis
  147. Concomitant gastric carcinoma and primary hepatic angiosarcoma in a patient: A case report
  148. Ecology and Environmental Science
  149. Optimization and comparative study of Bacillus consortia for cellulolytic potential and cellulase enzyme activity
  150. The complete mitochondrial genome analysis of Haemaphysalis hystricis Supino, 1897 (Ixodida: Ixodidae) and its phylogenetic implications
  151. Epidemiological characteristics and risk factors analysis of multidrug-resistant tuberculosis among tuberculosis population in Huzhou City, Eastern China
  152. Indices of human impacts on landscapes: How do they reflect the proportions of natural habitats?
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  154. Diversity and environmental drivers of Suillus communities in Pinus sylvestris var. mongolica forests of Inner Mongolia
  155. Global assessment of the fate of nitrogen deposition in forest ecosystems: Insights from 15N tracer studies
  156. Fungal and bacterial pathogenic co-infections mainly lead to the assembly of microbial community in tobacco stems
  157. Influencing of coal industry related airborne particulate matter on ocular surface tear film injury and inflammatory factor expression in Sprague-Dawley rats
  158. Temperature-dependent development, predation, and life table of Sphaerophoria macrogaster (Thomson) (Diptera: Syrphidae) feeding on Myzus persicae (Sulzer) (Homoptera: Aphididae)
  159. Eleonora’s falcon trophic interactions with insects within its breeding range: A systematic review
  160. Agriculture
  161. Integrated analysis of transcriptome, sRNAome, and degradome involved in the drought-response of maize Zhengdan958
  162. Variation in flower frost tolerance among seven apple cultivars and transcriptome response patterns in two contrastingly frost-tolerant selected cultivars
  163. Heritability of durable resistance to stripe rust in bread wheat (Triticum aestivum L.)
  164. Molecular mechanism of follicular development in laying hens based on the regulation of water metabolism
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  176. Comparative efficiency and residue levels of spraying programs against powdery mildew in grape varieties
  177. The DREB7 transcription factor enhances salt tolerance in soybean plants under salt stress
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  186. Polyphenolic spectrum of cornelian cherry fruits and their health-promoting effect
  187. Optimizing the encapsulation of the refined extract of squash peels for functional food applications: A sustainable approach to reduce food waste
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  189. Impact of saline sprouting on antioxidant properties and bioactive compounds in chia seeds
  190. The dilemma of food genetics and improvement
  191. Bioengineering and Biotechnology
  192. Impact of hyaluronic acid-modified hafnium metalorganic frameworks containing rhynchophylline on Alzheimer’s disease
  193. Emerging patterns in nanoparticle-based therapeutic approaches for rheumatoid arthritis: A comprehensive bibliometric and visual analysis spanning two decades
  194. Application of CRISPR/Cas gene editing for infectious disease control in poultry
  195. Preparation of hafnium nitride-coated titanium implants by magnetron sputtering technology and evaluation of their antibacterial properties and biocompatibility
  196. Preparation and characterization of lemongrass oil nanoemulsion: Antimicrobial, antibiofilm, antioxidant, and anticancer activities
  197. Corrigendum
  198. Corrigendum to “Utilization of convolutional neural networks to analyze microscopic images for high-throughput screening of mesenchymal stem cells”
  199. Corrigendum to “Effects of Ire1 gene on virulence and pathogenicity of Candida albicans”
  200. Retraction
  201. Retraction of “Down-regulation of miR-539 indicates poor prognosis in patients with pancreatic cancer”
https://doi.org/10.1515/biol-2025-1155
Keywords for this article
roxadustat; pure red cell aplasia; chronic kidney disease; renal anemia
Creative Commons
BY 4.0

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  118. Apoptotic efficacies of AgNPs formulated by Syzygium aromaticum leaf extract on 32D-FLT3-ITD human leukemia cell line with PI3K/AKT/mTOR signaling pathway
  119. Novel cuproptosis-related genes C1QBP and PFKP identified as prognostic and therapeutic targets in lung adenocarcinoma
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  121. Treatment of pure red cell aplasia in a chronic kidney disease patient with roxadustat: A case report
  122. Comparative bioinformatics analysis of the Wnt pathway in breast cancer: Selection of novel biomarker panels associated with ER status
  123. Kynurenine facilitates renal cell carcinoma progression by suppressing M2 macrophage pyroptosis through inhibition of CASP1 cleavage
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  126. Phytochemicals of Roman chamomile: Antioxidant, anti-aging, and whitening activities of distillation residues
  127. Circadian gene Cry1 inhibits the tumorigenicity of hepatocellular carcinoma by the BAX/BCL2-mediated apoptosis pathway
  128. The TNFR-RIPK1/RIPK3 signalling pathway mediates the effect of lanthanum on necroptosis of nerve cells
  129. Longitudinal monitoring of autoantibody dynamics in patients with early-stage non-small-cell lung cancer undergoing surgery
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  132. Construction of a microbial abundance prognostic scoring model based on intratumoral microbial data for predicting the prognosis of lung squamous cell carcinoma
  133. Sepsis complicated by haemophagocytic lymphohistiocytosis triggered by methicillin-resistant Staphylococcus aureus and human herpesvirus 8 in an immunocompromised elderly patient: A case report
  134. Sarcopenia in liver transplantation: A comprehensive bibliometric study of current research trends and future directions
  135. Advances in cancer immunotherapy and future directions in personalized medicine
  136. Can coronavirus disease 2019 affect male fertility or cause spontaneous abortion? A two-sample Mendelian randomization analysis
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  138. PSME2 exacerbates ulcerative colitis by disrupting intestinal barrier function and promoting autophagy-dependent inflammation
  139. Hyperosmolar hyperglycemic state with severe hypernatremia coexisting with central diabetes insipidus: A case report and literature review
  140. Efficacy and mechanism of escin in improving the tissue microenvironment of blood vessel walls via anti-inflammatory and anticoagulant effects: Implications for clinical practice
  141. Merkel cell carcinoma: Clinicopathological analysis of three patients and literature review
  142. Genetic variants in VWF exon 26 and their implications for type 1 Von Willebrand disease in a Saudi Arabian population
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  144. High levels of EPHB2 expression predict a poor prognosis and promote tumor progression in endometrial cancer
  145. Knockdown of SHP-2 delays renal tubular epithelial cell injury in diabetic nephropathy by inhibiting NLRP3 inflammasome-mediated pyroptosis
  146. Exploring the toxicity mechanisms and detoxification methods of Rhizoma Paridis
  147. Concomitant gastric carcinoma and primary hepatic angiosarcoma in a patient: A case report
  148. Ecology and Environmental Science
  149. Optimization and comparative study of Bacillus consortia for cellulolytic potential and cellulase enzyme activity
  150. The complete mitochondrial genome analysis of Haemaphysalis hystricis Supino, 1897 (Ixodida: Ixodidae) and its phylogenetic implications
  151. Epidemiological characteristics and risk factors analysis of multidrug-resistant tuberculosis among tuberculosis population in Huzhou City, Eastern China
  152. Indices of human impacts on landscapes: How do they reflect the proportions of natural habitats?
  153. Genetic analysis of the Siberian flying squirrel population in the northern Changbai Mountains, Northeast China: Insights into population status and conservation
  154. Diversity and environmental drivers of Suillus communities in Pinus sylvestris var. mongolica forests of Inner Mongolia
  155. Global assessment of the fate of nitrogen deposition in forest ecosystems: Insights from 15N tracer studies
  156. Fungal and bacterial pathogenic co-infections mainly lead to the assembly of microbial community in tobacco stems
  157. Influencing of coal industry related airborne particulate matter on ocular surface tear film injury and inflammatory factor expression in Sprague-Dawley rats
  158. Temperature-dependent development, predation, and life table of Sphaerophoria macrogaster (Thomson) (Diptera: Syrphidae) feeding on Myzus persicae (Sulzer) (Homoptera: Aphididae)
  159. Eleonora’s falcon trophic interactions with insects within its breeding range: A systematic review
  160. Agriculture
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  162. Variation in flower frost tolerance among seven apple cultivars and transcriptome response patterns in two contrastingly frost-tolerant selected cultivars
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  164. Molecular mechanism of follicular development in laying hens based on the regulation of water metabolism
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  166. Effect of sex ratio on the life history traits of an important invasive species, Spodoptera frugiperda
  167. Plant Sciences
  168. Hairpin in a haystack: In silico identification and characterization of plant-conserved microRNA in Rafflesiaceae
  169. Widely targeted metabolomics of different tissues in Rubus corchorifolius
  170. The complete chloroplast genome of Gerbera piloselloides (L.) Cass., 1820 (Carduoideae, Asteraceae) and its phylogenetic analysis
  171. Field trial to correlate mineral solubilization activity of Pseudomonas aeruginosa and biochemical content of groundnut plants
  172. Correlation analysis between semen routine parameters and sperm DNA fragmentation index in patients with semen non-liquefaction: A retrospective study
  173. Plasticity of the anatomical traits of Rhododendron L. (Ericaceae) leaves and its implications in adaptation to the plateau environment
  174. Effects of Piriformospora indica and arbuscular mycorrhizal fungus on growth and physiology of Moringa oleifera under low-temperature stress
  175. Effects of different sources of potassium fertiliser on yield, fruit quality and nutrient absorption in “Harward” kiwifruit (Actinidia deliciosa)
  176. Comparative efficiency and residue levels of spraying programs against powdery mildew in grape varieties
  177. The DREB7 transcription factor enhances salt tolerance in soybean plants under salt stress
  178. Using plant electrical signals of water hyacinth (Eichhornia crassipes) for water pollution monitoring
  179. Food Science
  180. Phytochemical analysis of Stachys iva: Discovering the optimal extract conditions and its bioactive compounds
  181. Review on role of honey in disease prevention and treatment through modulation of biological activities
  182. Computational analysis of polymorphic residues in maltose and maltotriose transporters of a wild Saccharomyces cerevisiae strain
  183. Optimization of phenolic compound extraction from Tunisian squash by-products: A sustainable approach for antioxidant and antibacterial applications
  184. Liupao tea aqueous extract alleviates dextran sulfate sodium-induced ulcerative colitis in rats by modulating the gut microbiota
  185. Toxicological qualities and detoxification trends of fruit by-products for valorization: A review
  186. Polyphenolic spectrum of cornelian cherry fruits and their health-promoting effect
  187. Optimizing the encapsulation of the refined extract of squash peels for functional food applications: A sustainable approach to reduce food waste
  188. Advancements in curcuminoid formulations: An update on bioavailability enhancement strategies curcuminoid bioavailability and formulations
  189. Impact of saline sprouting on antioxidant properties and bioactive compounds in chia seeds
  190. The dilemma of food genetics and improvement
  191. Bioengineering and Biotechnology
  192. Impact of hyaluronic acid-modified hafnium metalorganic frameworks containing rhynchophylline on Alzheimer’s disease
  193. Emerging patterns in nanoparticle-based therapeutic approaches for rheumatoid arthritis: A comprehensive bibliometric and visual analysis spanning two decades
  194. Application of CRISPR/Cas gene editing for infectious disease control in poultry
  195. Preparation of hafnium nitride-coated titanium implants by magnetron sputtering technology and evaluation of their antibacterial properties and biocompatibility
  196. Preparation and characterization of lemongrass oil nanoemulsion: Antimicrobial, antibiofilm, antioxidant, and anticancer activities
  197. Corrigendum
  198. Corrigendum to “Utilization of convolutional neural networks to analyze microscopic images for high-throughput screening of mesenchymal stem cells”
  199. Corrigendum to “Effects of Ire1 gene on virulence and pathogenicity of Candida albicans”
  200. Retraction
  201. Retraction of “Down-regulation of miR-539 indicates poor prognosis in patients with pancreatic cancer”
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