title: Screening for recombinant human erythropoietin using [Hb], reticulocytes, the OFF(hr score), OFF(z score) and Hb(z score): status of the Blood Passport.
abstract: Haemoglobin concentration ([Hb]), reticulocyte percentage (retic%) and OFF(hr score) are well-implemented screening tools to determine potential recombinant human erythropoietin (rHuEpo) abuse in athletes. Recently, the International Cycling Union implemented the OFF(z score) and the Hb(z score) in their anti-doping testing programme. The aim of this study is to evaluate the sensitivity of these indirect screening methods. Twenty-four human subjects divided into three groups with eight subjects each (G1; G2 and G3) were injected with rHuEpo. G1 and G2 received rHuEpo for a 4-week period with 2 weeks of "boosting" followed by 2 weeks of "maintenance" and a wash-out period of 3 weeks. G3 received rHuEpo for a 10-week period (boost = 3 weeks; maintenance = 7 weeks; wash out = 1 week). Three, seven and eight of the 24 volunteers exceeded the cut-off limits for OFF(hr score), [Hb] and retic%, respectively. One subject from G1, nobody from G2, and seven subjects from G3 exceeded the cut-off limit for Hb(z score.) In total, ten subjects exceeded the cut-off limit for the OFF(z score); two subjects from G1, two subjects from G2 and six subjects from G3. In total, indirect screening methods were able to indicate rHuEpo injections in 58% of subjects. However, 42% of our rHuEpo-injected subjects were not detected. It should be emphasised that the test frequency in real world anti-doping is far less than the present study, and hence the detection rate will be lower.
authors.affiliation: Copenhagen Muscle Research Centre, Rigshospitalet, Section 7652, Copenhagen Ø, Denmark.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bornø
authors.forename: Niels J
authors.initials: NJ
authors.lastname: Aachmann-Andersen
authors.forename: Thor
authors.initials: T
authors.lastname: Munch-Andersen
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Hulston
authors.forename: Carsten
authors.initials: C
authors.lastname: Lundby
mesh_terms: D000328:Adult; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D004300:Doping in Sports; D004334:Drug Administration Schedule; D004921:Erythropoietin / Q000008:administration & dosage / Q000097:blood*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D011237:Predictive Value of Tests; D011994:Recombinant Proteins; D017701:Reticulocyte Count; D012156:Reticulocytes / Q000187:drug effects* / Q000378:metabolism; D012680:Sensitivity and Specificity; D015813:Substance Abuse Detection / Q000379:methods*; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin