title: Erythropoietin as a performance-enhancing drug: Its mechanistic basis, detection, and potential adverse effects.
abstract: Erythropoietin (EPO) is the main hormone regulating red blood cell (RBC) production. The large-scale production of a recombinant human erythropoietin (rHuEPO) by biotechnological methods has made possible its widespread therapeutic use as well as its misuse in sports. Since the marketing of the first epoetin in 1989, the development has progressed to the third-generation analogs. However, the production of rHuEPO is costly, and the frequent administration of an injectable formula is not optimal for compliance of therapeutic patients. Hence, pharmaceutical industries are currently developing alternative approaches to stimulate erythropoiesis, which might offer new candidates for doping purposes. The hypoxia inducible factors (HIF) pathway is of particular interest. The introduction of new erythropoiesis-stimulating agents (ESAs) for clinical use requires subsequent development of anti-doping methods for detecting the abuse of these substances. The detection of ESAs is based on two different approaches, namely, the direct detection of exogenous substances and the indirect detection, for which the effects of the substances on specific biomarkers are monitored. Omics technologies, such as ironomics or transcriptomics, are useful for the development of new promising biomarkers for the detection of ESAs. Finally, the illicit use of ESAs associates with multiple health risks that can be irreversible, and an essential facet of anti-doping work is to educate athletes of these risks. The aim of this review is to provide an overview of the evolution of ESAs, the research and implementation of the available detection methods, and the side effects associated with the misuse of ESAs.
authors.affiliation: Center for Research and Expertise in Anti-Doping Sciences - REDs, University of Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Salamin
authors.affiliation: Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
authors.forename: Tiia
authors.initials: T
authors.lastname: Kuuranne
authors.affiliation: Center for Research and Expertise in Anti-Doping Sciences - REDs, University of Lausanne, Switzerland.
authors.forename: Martial
authors.initials: M
authors.lastname: Saugy
authors.affiliation: Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland. Electronic address: Nicolas.leuenberger@chuv.ch.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Leuenberger
mesh_terms: D004300:Doping in Sports; D004921:Erythropoietin / Q000009:adverse effects* / Q000032:analysis* / Q000494:pharmacology; D006801:Humans; D058573:Performance-Enhancing Substances / Q000009:adverse effects* / Q000032:analysis* / Q000494:pharmacology; D059467:Transcriptome / Q000235:genetics
chemical_list: D058573:Performance-Enhancing Substances; D004921:Erythropoietin
keywords: Athlete biological passport; Biomarkers; Doping detection; Erythropoietin; Omics technologies