Pomegranate juice (PJ) has a unique chemical composition rich in antioxidant polyphenols (e.g., tannins, anthocyanins, gallic acid, chlorogenic acid, ferulic acid, and coumaric acids) and flavonoids (e.g., quercetin, catechin, and phloridzin) [1, 2]. Several studies revealed that PJ has a strong antioxidant activity, which is, to some extent, greater than the well-known antioxidants in green tea and red wine [3, 4]. PJ consumption was found to be associated with various health benefits due to these dietary phytochemicals. Studies have shown that PJ has anti-inflammatory [5, 6], anticancer [7], anti-atherogenic [8], antihypertensive [9, 10], and antidiabetic effects [11]. Very recently, pomegranate polyphenols supplementation (equivalent to levels in approximately 8 oz of PJ) has been found to improve cognitive and functional recovery in ischemic stroke patients [12].
Actually, the well-recognized mechanism by which PJ induces its health benefits in various pathological conditions is by reducing oxidative stress, an imbalance between reactive oxygen species (ROS) and antioxidants for the favor of the former [13], and lipid peroxidation [1, 14]. This reduction may occur by enhancing the activity of certain antioxidant enzymes, neutralizing the generated ROS, and inducing metal chelation activity [1].
Erythropoietin (EPO), also called hemopoietin or hematopoietin, is a glycoprotein secreted from interstitial fibroblasts in the kidney in response to cellular hypoxia [15]. The main known function of EPO is the stimulation erythrocytes production (erythropoiesis) in the bone marrow [16]. EPO secreted approximately at 10 mU mL−1 is sufficient to compensate for the normal erythrocyte’s turnover. On the other hand, in cases of cellular hypoxia such as anemia, blood EPO level can reach up to 10000 mU mL−1 [16].
The evidence above shows the various biological effects of PJ in several pathological conditions. Particularly, in 2017, the results from Manthou and co-workers showed that PJ enhances the level of hemoglobin and the number of erythrocytes in the human body [17], while the authors did not investigate the exact mechanisms behind such effects. Here, we assessed the short-term effect of fresh PJ on the level of EPO in patients with type 2 diabetes (T2D) compared to healthy individuals. We chose patients with T2D as these people may develop hypoxic cases such as anemia.
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