Human erythropoietin is a haematopoietic cytokine required for the dif
ferentiation and proliferation of precursor cells into red blood cells
(1). It activates cells by binding and orientating two cell-surface er
ythropoietin receptors (EPORs) which trigger an intracellular phosphor
ylation cascade(2). The half-maximal response in a cellular proliferat
ion assay is evoked at an erythropoietin concentration of 10 pM (ref.
3), 10(-2) of its K-d value for erythropoietin-EPOR binding site 1 (K-
d approximate to 1 nM), and 10(-5) of the K-d for erythropoietin-EPOR
binding site 2 (K-d approximate to 1 mu M)(4). Overall half-maximal bi
nding (IC50) of cell-surface receptors is produced with similar to 0.1
8 nM erythropoietin, indicating that only similar to 6% of the recepto
rs would be bound in the presence of 10 pM erythropoietin. Other effec
tive erythropoietin-mimetic ligands that dimerize receptors can evoke
the same cellular responses(5,6) but much less efficiently, requiring
concentrations close to their K-d values (similar to 0.1 mu M). The cr
ystal structure of erythropoietin complexed to the extracellular ligan
d-binding domains of the erythropoietin receptor, determined at 1.9 An
gstrom from two crystal forms, shows that erythropoietin imposes a uni
que 120 degrees angular relationship and orientation that is responsib
le for optimal signalling through intracellular kinase pathways.