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Sugasawa T, Hirokawa A, Otani N, Kanki Y, Nguyen KDM, Takemasa T, Watanabe K, Takeuchi Y, Yahagi N, Takahashi Y. Detection Method for Gene Doping in a Mouse Model Expressing Human Erythropoietin from Adeno-Associated Virus Vector-9. Genes (Basel) 2024; 15:709. [PMID: 38927645 PMCID: PMC11203218 DOI: 10.3390/genes15060709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
With the rapid development of gene therapy technology in recent years, its abuse as a method of sports doping in athletics has become a concern. However, there is still room for improvement in gene-doping testing methods, and a robust animal model needs to be developed. Therefore, the purposes of this study were to establish a model of gene doping using recombinant adeno-associated virus vector-9, including the human erythropoietin gene (rAAV9-hEPO), and to establish a relevant testing method. First, it was attempted to establish the model using rAAV9-hEPO on mice. The results showed a significant increase in erythrocyte volume accompanied by an increase in spleen weight, confirming the validity of the model. Next, we attempted to detect proof of gene doping by targeting DNA and RNA. Direct proof of gene doping was detected using a TaqMan-qPCR assay with certain primers/probes. In addition, some indirect proof was identified in RNAs through the combination of a TB Green qPCR assay with RNA sequencing. Taken together, these results could provide the foundation for an effective test for gene doping in human athletes in the future.
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Affiliation(s)
- Takehito Sugasawa
- Laboratory of Clinical Examination and Sports Medicine, Department of Clinical Medicine, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan
- Department of Sports Medicine Analysis, Open Facility Network Office, Organization for Open Facility Initiatives, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan
| | - Atsushi Hirokawa
- College of Medicine, School of Medicine and Health Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan
| | - Norihiro Otani
- College of Medicine, School of Medicine and Health Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan
| | - Yasuharu Kanki
- Laboratory of Clinical Examination and Sports Medicine, Department of Clinical Medicine, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan
| | - Kieu DM Nguyen
- Human Biology Program, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan
| | - Tohru Takemasa
- Institute of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8574, Japan; (T.T.)
| | - Koichi Watanabe
- Institute of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8574, Japan; (T.T.)
| | - Yoshinori Takeuchi
- Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University, Shimotsuke 329-0498, Japan
| | - Naoya Yahagi
- Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University, Shimotsuke 329-0498, Japan
| | - Yoichiro Takahashi
- Department of Legal Medicine, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
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Breenfeldt Andersen A, Graae J, Bejder J, Bonne TC, Seier S, Debertin M, Eibye K, Hostrup M, Nordsborg NB. Microdoses of Recombinant Human Erythropoietin Enhance Time Trial Performance in Trained Males and Females. Med Sci Sports Exerc 2023; 55:311-321. [PMID: 36317927 DOI: 10.1249/mss.0000000000003052] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE We investigated the effects of recombinant human erythropoietin (rHuEPO) administration on exercise endurance, maximal aerobic performance, and total hemoglobin mass (tHb). We hypothesized that frequent, small intravenous injections of epoetin β would increase time trial performance, peak oxygen uptake (V̇O 2peak ), and tHb in both males and females. METHODS We included 48 healthy, recreational to trained males ( n = 24, mean ± SD V̇O 2peak = 55 ± 5 mL O 2 ·kg -1 ⋅min -1 ) and females ( n = 24; V̇O 2peak of 46 ± 4 mL O 2 ·kg -1 ⋅min -1 ) in a counterbalanced, double-blind, randomized, placebo-controlled study design stratified by sex. Time trial performance, V̇O 2peak , and tHb were determined before and after intravenous injections of either rHuEPO (9 IU·kg bw -1 epoetin β) or saline (0.9% NaCl) three times weekly for 4 wk. RESULTS A time-treatment effect ( P < 0.05) existed for time trial performance. Within the rHuEPO group, mean power output increased by 4.1% ± 4.2% ( P < 0.001). Likewise, a time-treatment effect ( P < 0.001) existed for V̇O 2peak , where the rHuEPO group improved V̇O 2peak and peak aerobic power by 4.2% ± 6.1% ( P < 0.001) and 2.9% ± 4.0% ( P < 0.01), respectively. A time-treatment effect ( P < 0.001) existed for tHb, where the rHuEPO group increased tHb by 6.7% ± 3.4% ( P < 0.001). A main effect of "sex" alone was also evident ( P < 0.001), but no sex-specific interactions were found. No changes were observed in the placebo group for mean power output, V̇O 2peak , peak aerobic power, or tHb. CONCLUSIONS Microdoses with intravenous rHuEPO provide a sufficient erythropoietic stimuli to augment tHb and enhance aerobic-dominated performance in both trained males and females.
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Affiliation(s)
| | - Jonathan Graae
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | - Jacob Bejder
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | - Thomas C Bonne
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | - Søren Seier
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | - Maren Debertin
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | - Kasper Eibye
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | - Morten Hostrup
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | - Nikolai B Nordsborg
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
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Tonino RPB, Zwaginga LM, Schipperus MR, Zwaginga JJ. Hemoglobin modulation affects physiology and patient reported outcomes in anemic and non-anemic subjects: An umbrella review. Front Physiol 2023; 14:1086839. [PMID: 36875043 PMCID: PMC9975154 DOI: 10.3389/fphys.2023.1086839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
Background: An abnormal hemoglobin concentration has a substantial effect on a person's quality of life and physiology. Lack of tools that effectively evaluate hemoglobin-related outcomes leads to uncertainty regarding optimal hemoglobin levels, transfusion thresholds and treatment targets. We therefore aim to summarize reviews that assess the effects of hemoglobin modulation on the human physiology at various baseline hemoglobin levels, and identify gaps in existing evidence. Methods: We conducted an umbrella review of systematic reviews. PubMed, MEDLINE (OVID), Embase, Web of Science, Cochrane Library and Emcare were searched from inception to the 15th of April 2022 for studies that reported on physiological and patient reported outcomes following a hemoglobin change. Results: Thirty-three reviews were included of which 7 were scored as of high quality and 24 of critically low quality using the AMSTAR-2 tool. The reported data generally show that an increase in hemoglobin leads to improvement of patient reported and physical outcomes in anaemic and non-anaemic subjects. At lower hemoglobin levels, the effect of a hemoglobin modulation on quality of life measures appears more pronounced. Conclusion: This overview has revealed many knowledge gaps due to a lack of high-quality evidence. For chronic kidney disease patients, a clinically relevant benefit of increasing the hemoglobin levels up until 12 g/dL was found. However, a personalized approach remains necessary due to the many patient-specific factors that affect outcomes. We strongly encourage future trials to incorporate physiological outcomes as objective parameters together with subjective, but still very important, patient reported outcome measures.
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Affiliation(s)
- R P B Tonino
- Research, TRIP, Leiden, Netherlands.,Hematology, Haga Teaching Hospital, The Hague, Netherlands.,Hematology, LUMC, Leiden, Netherlands
| | | | - M R Schipperus
- Research, TRIP, Leiden, Netherlands.,Hematology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Clinical Affairs, Sanquin Bloodbank, Amsterdam, Netherlands
| | - J J Zwaginga
- Research, TRIP, Leiden, Netherlands.,Hematology, LUMC, Leiden, Netherlands
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Mahmood AH. The Utility of Various Pre-anesthetic Medications Based on Type of General
Anesthesia. CURRENT DRUG THERAPY 2022. [DOI: 10.2174/1574885517666220421130015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Premedication is used prior to surgery to reduce the adverse effects that
might result from general anesthesia.
Objective:
This study was performed to examine the types and utility of various pre-anesthetic agents
in 100 patients aged between 3 and 60 years who were admitted to Baladrooz General Hospital for different
surgical operations during February (winter) and April (spring) 2021.
Methods:
A total of 62 patients received isoflurane, and 7 patients received sevoflurane, both by inhalational
administration. The other 31 subjects were administered Marcaine (bupivacaine) by spinal anesthesia.
Results:
In this study, eight types of pre-anesthetic medication were administered prior to anesthesia,
as follows: hydrocortisone (35 patients), metoclopramide (25 patients), atropine (13 patients), dexamethasone
(12 patients), midazolam (7 patients), morphine (3 patients), ephedrine (3 patients), and fentanyl
(2 patients).
The most commonly used pre-anesthetic agent administered with isoflurane was hydrocortisone (37
patients), while the least used were fentanyl and morphine, which were administered to 3 patients
each. Hydrocortisone was the premedication most often used (6 patients) with isoflurane, followed by
dexamethasone, midazolam, and metoclopramide (5, 2, and 2 patients, respectively). The preanesthetic
agent used most often with sevoflurane was hydrocortisone (6 patients), followed by dexamethasone
(5 patients) and metoclopramide and midazolam (2 patients each). The premedication most
commonly used with bupivacaine was metoclopramide (25 patients), while the least used was midazolam
(2 patients).
Conclusion:
The study showed that several different pre-anesthetic drugs were used prior to anesthetic
agents, which suggests that the selection of a pre-anesthetic drug depends on the risks that might be
incurred when using a specific anesthetic drug.
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Affiliation(s)
- Adnan Hussein Mahmood
- The Medical Technical Institute of Baghdad, The Middle Technical University, Baghdad, Iraq
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5
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Adami PE, Koutlianos N, Baggish A, Bermon S, Cavarretta E, Deligiannis A, Furlanello F, Kouidi E, Marques-Vidal P, Niebauer J, Pelliccia A, Sharma S, Solberg EE, Stuart M, Papadakis M. Cardiovascular effects of doping substances, commonly prescribed medications and ergogenic aids in relation to sports: a position statement of the sport cardiology and exercise nucleus of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:559-575. [PMID: 35081615 DOI: 10.1093/eurjpc/zwab198] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 02/06/2023]
Abstract
The use of substances and medications with potential cardiovascular effects among those practicing sports and physical activity has progressively increased in recent years. This is also connected to the promotion of physical activity and exercise as core aspects of a healthy lifestyle, which has led also to an increase in sport participation across all ages. In this context, three main users' categories can be identified, (i) professional and amateur athletes using substances to enhance their performance, (ii) people with chronic conditions, which include physical activity and sport in their therapeutic plan, in association with prescribed medications, and (iii) athletes and young individuals using supplements or ergogenic aids to integrate their diet or obtaining a cognitive enhancement effect. All the substances used for these purposes have been reported to have side effects, among whom the cardiovascular consequences are the most dangerous and could lead to cardiac events. The cardiovascular effect depends on the type of substance, the amount, the duration of use, and the individual response to the substances, considering the great variability in responses. This Position Paper reviews the recent literature and represents an update to the previously published Position Paper published in 2006. The objective is to inform physicians, athletes, coaches, and those participating in sport for a health enhancement purpose, about the adverse cardiovascular effects of doping substances, commonly prescribed medications and ergogenic aids, when associated with sport and exercise.
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Affiliation(s)
- Paolo Emilio Adami
- Health and Science Department, World Athletics, 6-8 Quai Antoine 1er, Monaco 98000, Monaco
| | - Nikolaos Koutlianos
- Sports Medicine Laboratory, Aristotle University of Thessaloniki, Thermi, AUTH DPESS, 54124, Thessaloniki, Greece
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, 55 Fruit Street Boston, MA 02114, USA
| | - Stéphane Bermon
- Health and Science Department, World Athletics, 6-8 Quai Antoine 1er, Monaco 98000, Monaco
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica, 79 - 04100 - Latina (LT), Italy.,Mediterranea Cardiocentro, Via Orazio, 2, 80122, Napoli (NA), Italy
| | - Asterios Deligiannis
- Sports Medicine Laboratory, Aristotle University of Thessaloniki, Thermi, AUTH DPESS, 54124, Thessaloniki, Greece
| | - Francesco Furlanello
- Aritmologia Clinica e Sportiva, IRCCS Gruppo MultiMedica Elettrofisiologia, Via Milanese 300, 20099, Sesto San Giovanni(MI), Italy
| | - Evangelia Kouidi
- Sports Medicine Laboratory, Aristotle University of Thessaloniki, Thermi, AUTH DPESS, 54124, Thessaloniki, Greece
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Josef Niebauer
- Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Antonio Pelliccia
- Sports Medicine and Science Institute, CONI, Largo Piero Gabrielli, 1, 00197, Rome, Italy
| | - Sanjay Sharma
- Cardiovascular Clinical Academic Group, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | | | - Mark Stuart
- International Testing Agency-ITA, Av. de Rhodanie 58, 1007 Lausanne, Switzerland
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
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6
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Proof of Gene Doping in a Mouse Model with a Human Erythropoietin Gene Transferred Using an Adenoviral Vector. Genes (Basel) 2021; 12:genes12081249. [PMID: 34440425 PMCID: PMC8392868 DOI: 10.3390/genes12081249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 12/18/2022] Open
Abstract
Despite the World Anti-Doping Agency (WADA) ban on gene doping in the context of advancements in gene therapy, the risk of EPO gene-based doping among athletes is still present. To address this and similar risks, gene-doping tests are being developed in doping control laboratories worldwide. In this regard, the present study was performed with two objectives: to develop a robust gene-doping mouse model with the human EPO gene (hEPO) transferred using recombinant adenovirus (rAdV) as a vector and to develop a detection method to identify gene doping by using this model. The rAdV including the hEPO gene was injected intravenously to transfer the gene to the liver. After injection, the mice showed significantly increased whole-blood red blood cell counts and increased expression of hematopoietic marker genes in the spleen, indicating successful development of the gene-doping model. Next, direct and potentially indirect proof of gene doping were evaluated in whole-blood DNA and RNA by using a quantitative PCR assay and RNA sequencing. Proof of doping could be detected in DNA and RNA samples from one drop of whole blood for approximately a month; furthermore, the overall RNA expression profiles showed significant changes, allowing advanced detection of hEPO gene doping.
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7
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Kayser B, De Block A. Would Relaxation of the Anti-doping Rule Lead to Red Queen Effects? SPORT, ETHICS AND PHILOSOPHY 2021. [DOI: 10.1080/17511321.2020.1770846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Bengt Kayser
- Institute of Sport Sciences, University of Lausanne, Synathlon, Uni-Centre, Lausanne, Switzerland
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An Abductive Inference Approach to Assess the Performance-Enhancing Effects of Drugs Included on the World Anti-Doping Agency Prohibited List. Sports Med 2021; 51:1353-1376. [PMID: 33811295 DOI: 10.1007/s40279-021-01450-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 12/18/2022]
Abstract
Some have questioned the evidence for performance-enhancing effects of several substances included on the World Anti-Doping Agency's Prohibited List due to the divergent or inconclusive findings in randomized controlled trials (RCTs). However, inductive statistical inference based on RCTs-only may result in biased conclusions because of the scarcity of studies, inter-study heterogeneity, too few outcome events, or insufficient power. An abductive inference approach, where the body of evidence is evaluated beyond considerations of statistical significance, may serve as a tool to assess the plausibility of performance-enhancing effects of substances by also considering observations and facts not solely obtained from RCTs. Herein, we explored the applicability of an abductive inference approach as a tool to assess the performance-enhancing effects of substances included on the Prohibited List. We applied an abductive inference approach to make inferences on debated issues pertaining to the ergogenic effects of recombinant human erythropoietin (rHuEPO), beta2-agonists and anabolic androgenic steroids (AAS), and extended the approach to more controversial drug classes where RCTs are limited. We report that an abductive inference approach is a useful tool to assess the ergogenic effect of substances included on the Prohibited List-particularly for substances where inductive inference is inconclusive. Specifically, a systematic abductive inference approach can aid researchers in assessing the effects of doping substances, either by leading to suggestions of causal relationships or identifying the need for additional research.
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Heuberger JAAC, Posthuma JJ, Ziagkos D, Rotmans JI, Daniels JMA, Gal P, Stuurman FE, Spronk HMH, Ten Cate H, Burggraaf J, Moerland M, Cohen AF. Additive effect of erythropoietin use on exercise-induced endothelial activation and hypercoagulability in athletes. Eur J Appl Physiol 2020; 120:1893-1904. [PMID: 32537688 PMCID: PMC7340646 DOI: 10.1007/s00421-020-04419-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/05/2020] [Indexed: 11/25/2022]
Abstract
Purpose Recombinant human erythropoietin (rHuEPO) is known to increase thrombotic risk in patients and might have similar effects in athletes abusing the drug. rHuEPO is prohibited by anti-doping legislation, but this risk has not been investigated thoroughly. This analysis was designed to evaluate whether rHuEPO impacts hemostatic profile and endothelial and platelet activation markers in trained subjects, and whether the combination with exercise affects exercise induced alterations. Methods This double-blind, randomized, placebo-controlled trial enrolled healthy, trained male cyclists aged 18–50 years. Participants were randomly allocated (1:1) to receive subcutaneous injections of rHuEPO (epoetin-β; mean dose 6000 IU per week) or placebo (0.9% NaCl) for 8 weeks. Subjects performed five maximal exercise tests and a road race, coagulation and endothelial/platelet markers were measured at rest and directly after each exercise effort. Results rHuEPO increased P-selectin (+ 7.8% (1.5–14.5), p = 0.02) and E-selectin (+ 8.6% (2.0–15.7), p = 0.01) levels at rest. Maximal exercise tests significantly influenced all measured coagulation and endothelial/platelet markers, and in the rHuEPO group maximal exercise tests led to 15.3% ((7.0–24.3%), p = 0.0004) higher E-selectin and 32.1% ((4.6–66.8%), p = 0.0207) higher Platelet factor 4 (PF4) levels compared to the placebo group. Conclusion In conclusion, rHuEPO treatment resulted in elevated E- and P-selectin levels in trained cyclists, indicating enhanced endothelial activation and/or platelet reactivity. Exercise itself induces hypercoagulability, and the combination of rHuEPO and exercise increased E-selectin and PF4 levels more than either intervention alone. Based on this, exercise potentially increases thrombotic risk, a risk that might be enhanced in combination with rHuEPO use. Electronic supplementary material The online version of this article (10.1007/s00421-020-04419-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Jelle J Posthuma
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Dimitrios Ziagkos
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, The Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Frederik E Stuurman
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Henri M H Spronk
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Hugo Ten Cate
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
- Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - Matthijs Moerland
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
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10
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Pugh J, Pugh C. Neurostimulation, doping, and the spirit of sport. NEUROETHICS-NETH 2020; 14:141-158. [PMID: 34824648 PMCID: PMC8590673 DOI: 10.1007/s12152-020-09435-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/27/2020] [Indexed: 12/19/2022]
Abstract
There is increasing interest in using neuro-stimulation devices to achieve an ergogenic effect in elite athletes. Although the World Anti-Doping Authority (WADA) does not currently prohibit neuro-stimulation techniques, a number of researchers have called on WADA to consider its position on this issue. Focusing on trans-cranial direct current stimulation (tDCS) as a case study of an imminent so-called ‘neuro-doping’ intervention, we argue that the emerging evidence suggests that tDCS may meet WADA’s own criteria (pertaining to safety, performance-enhancing effect, and incompatibility with the ‘spirit of sport’) for a method’s inclusion on its list of prohibited substances and methods. We begin by surveying WADA’s general approach to doping, and highlight important limitations to the current evidence base regarding the performance-enhancing effect of pharmacological doping substances. We then review the current evidence base for the safety and efficacy of tDCS, and argue that despite significant shortcomings, there may be sufficient evidence for WADA to consider prohibiting tDCS, in light of the comparable flaws in the evidence base for pharmacological doping substances. In the second half of the paper, we argue that the question of whether WADA ought to ban tDCS turns significantly on the question of whether it is compatible with the ‘spirit of sport’ criterion. We critique some of the previously published positions on this, and advocate our own sport-specific and application-specific approach. Despite these arguments, we finally conclude by suggesting that tDCS ought to be monitored rather than prohibited due to compelling non-ideal considerations.
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Affiliation(s)
- Jonathan Pugh
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford, OX1 1PT UK
| | - Christopher Pugh
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, UK
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Trinh KV, Diep D, Chen KJQ, Huang L, Gulenko O. Effect of erythropoietin on athletic performance: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 2020; 6:e000716. [PMID: 32411382 PMCID: PMC7213874 DOI: 10.1136/bmjsem-2019-000716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Athletes have attempted to glean the ergogenic benefits of recombinant human erythropoietin (rHuEPO) since it became available in the 1980s. However, there is limited consensus in the literature regarding its true performance-enhancing effects. In fact, some studies suggest there is no conclusive evidence; therefore, it is necessary to evaluate and quantify the strength of the evidence. Objective To determine the effects of erythropoietin on enhancing athletic performance. Design At least two independent reviewers conducted citation identification through abstract and full-text screening, and study selection, and extracted raw data on demographics, descriptions of interventions and all outcomes to predesigned abstraction forms. Outcomes were stratified by treatment periods and dosages. Study quality was assessed using the Cochrane Risk of Bias Tool and Cochrane Grading of Recommendations Assessment Development and Education (GRADE) scale. Where appropriate, quantitative analysis was performed. Data sources EMBASE, MEDLINE and SPORTDiscus were searched from their inception to January 2020. Eligibility criteria Trials that examined any enhancement in sport in healthy participants aged 18-65 using rHuEPO compared with placebo were included. Results Overall, there is low-to-moderate quality evidence suggesting rHuEPO may be more beneficial than placebo in enhancing haematological parameters, pulmonary measures, maximal power output and time to exhaustion independent of dosage. However, these improvements are almost exclusively seen during maximal exercise intensities, which may be less relevant to athletic competition conditions. Conclusion Due to heterogeneity among trials, more high-quality randomised controlled trials with larger sample sizes in conditions that mirror actual competition are needed to further elucidate these effects.
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Affiliation(s)
- Kien Vinh Trinh
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Dion Diep
- MD Program, University of Toronto, Toronto, Ontario, Canada
| | | | - Le Huang
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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12
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Current Anti-Doping Crisis: The Limits of Medical Evidence Employing Inductive Statistical Inference. Sports Med 2020; 49:497-500. [PMID: 30805910 DOI: 10.1007/s40279-019-01074-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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Heuberger JAAC, van Eenoo P, Rotmans JI, Gal P, Stuurman FE, Post TE, Daniels JMA, Ram H, de Hon O, Burggraaf J, Cohen AF. Sensitivity and specificity of detection methods for erythropoietin doping in cyclists. Drug Test Anal 2019; 11:1290-1301. [PMID: 31232530 PMCID: PMC6790592 DOI: 10.1002/dta.2665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 11/12/2022]
Abstract
Recombinant human erythropoietin (rHuEPO) is used as doping a substance. Anti‐doping efforts include urine and blood testing and monitoring the athlete biological passport (ABP). As data on the performance of these methods are incomplete, this study aimed to evaluate the performance of two common urine assays and the ABP. In a randomized, double‐blinded, placebo‐controlled trial, 48 trained cyclists received a mean dose of 6000 IU rHuEPO (epoetin β) or placebo by weekly injection for eight weeks. Seven timed urine and blood samples were collected per subject. Urine samples were analyzed by sarcosyl‐PAGE and isoelectric focusing methods in the accredited DoCoLab in Ghent. A selection of samples, including any with false presumptive findings, underwent a second sarcosyl‐PAGE confirmation analysis. Hematological parameters were used to construct a module similar to the ABP and analyzed by two evaluators from an Athlete Passport Management Unit. Sensitivity of the sarcosyl‐PAGE and isoelectric focusing assays for the detection of erythropoietin abuse were 63.8% and 58.6%, respectively, with a false presumptive finding rate of 4.3% and 6%. None of the false presumptive findings tested positive in the confirmation analysis. Sensitivity was highest between 2 and 6 days after dosing, and dropped rapidly outside this window. Sensitivity of the ABP was 91.3%. Specificity of the urine assays was high; however, the detection window of rHuEPO was narrow, leading to questionable sensitivity. The ABP, integrating longitudinal data, is more sensitive, but there are still subjects that evade detection. Combining these methods might improve performance, but will not resolve all observed shortcomings.
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Affiliation(s)
| | | | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, Netherlands
| | | | - Titiaan E Post
- Centre for Human Drug Research, Leiden, Netherlands.,Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, Netherlands
| | - Herman Ram
- Anti-Doping Authority the Netherlands, Capelle aan den IJssel, Netherlands
| | - Olivier de Hon
- Anti-Doping Authority the Netherlands, Capelle aan den IJssel, Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, Netherlands.,Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, Netherlands.,Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
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14
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Fitzgerald SP, Grote Beverborg N, Beguin Y, Artunc F, Falhammar H, Bean NG. Population data provide evidence against the presence of a set point for hemoglobin levels or tissue oxygen delivery. Physiol Rep 2019; 7:e14153. [PMID: 31243891 PMCID: PMC6594924 DOI: 10.14814/phy2.14153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/25/2019] [Accepted: 05/27/2019] [Indexed: 01/25/2023] Open
Abstract
Hemoglobin levels are believed to be regulated as per a set point model of regulation. This model of regulation, by which specific levels of a parameter are targeted and defended by physiological systems, implies a particular population correlation between the parameter and its controlling hormone. Empirical population correlations of other parameters and their controlling hormones, have denied the presence of such set point-based regulation. To assess if hemoglobin is regulated according to a set point model we performed a systematic search of PubMed/MEDLINE and Web of Science identifying relevant reports published up to November 2018. Population hemoglobin/erythropoietin level correlations were retrieved, and these empirically derived correlations were compared with the positive correlation implied by a set point model of regulation. Authors of papers containing potentially suitable data were contacted with requests for further analyses, and a meta-analysis was performed. Twelve correlations between hemoglobin and erythropoietin levels from eleven papers were analyzed. None of these correlations were significantly positive, three, restricted to the normal range of hemoglobin, were significantly negative. All but one of the other correlations showed a negative trend. New analyses of previously published data sets resulted in similar findings. In particular a new analysis of large data sets of males (n = 2417) and females (n = 2592) with normal range hemoglobin levels, revealed significantly negative correlations. A meta-analysis of our results indicated that the data overall are not consistent with a positive relationship between hemoglobin and erythropoietin (P < 0.0001). Population data indicate that individuals do not have set point levels of hemoglobin.
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Affiliation(s)
- Stephen P. Fitzgerald
- Departments of General Medicine and EndocrinologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Niels Grote Beverborg
- Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden
- Department of Medicine‐CardiologyKarolinska InstitutetStockholmSweden
- Department of CardiologyUniversity Medical Center Groningen and Rijksuniversiteit GroningenGroningenThe Netherlands
| | - Yves Beguin
- Department of HaematologyCHU de Liège and University of LiègeLiègeBelgium
| | - Ferruh Artunc
- Department of Internal MedicineDivision of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical ChemistryUniversity Hospital TübingenTübingenGermany
| | - Henrik Falhammar
- Department of Endocrinology, Metabolism and DiabetesKarolinska University HospitalStockholmSweden
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Menzies School of Health Research and Royal Darwin HospitalTiwiNorthern TerritoryAustralia
| | - Nigel G. Bean
- School of Mathematical Sciences and ARC Centre of Excellence for Mathematical and Statistical FrontiersUniversity of AdelaideAdelaideSouth AustraliaAustralia
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15
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Heuberger JAAC, Cohen AF. Review of WADA Prohibited Substances: Limited Evidence for Performance-Enhancing Effects. Sports Med 2019; 49:525-539. [PMID: 30411235 PMCID: PMC6422964 DOI: 10.1007/s40279-018-1014-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The World Anti-Doping Agency is responsible for maintaining a Prohibited List that describes the use of substances and methods that are prohibited for athletes. The list currently contains 23 substance classes, and an important reason for the existence of this list is to prevent unfair competition due to pharmacologically enhanced performance. The aim of this review was to give an overview of the available evidence for performance enhancement of these substance classes. We searched the scientific literature through PubMed for studies and reviews evaluating the effects of substance classes on performance. Findings from double-blind, randomized controlled trials were considered as evidence for (the absence of) effects if they were performed in trained subjects measuring relevant performance outcomes. Only 5 of 23 substance classes show evidence of having the ability to enhance actual sports performance, i.e. anabolic agents, β2-agonists, stimulants, glucocorticoids and β-blockers. One additional class, growth hormone, has similar evidence but only in untrained subjects. The observed effects all relate to strength or sprint performance (and accuracy for β-blockers); there are no studies showing positive effects on reliable markers of endurance performance. For 11 classes, no well-designed studies are available, and, for the remaining six classes, there is evidence of an absence of a positive effect. In conclusion, for the majority of substance classes, no convincing evidence for performance enhancement is available, while, for the remaining classes, the evidence is based on a total of only 266 subjects from 11 studies.
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Affiliation(s)
| | - Adam F Cohen
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
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16
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HAILE DIRESIBACHEWW, DURUSSEL JÉRÔME, MEKONEN WONDYEFRAW, ONGARO NEFORD, ANJILA EDWIN, MOOSES MARTIN, DASKALAKI EVANGELIA, MOOSES KERLI, MCCLURE JOHND, SUTEHALL SHAUN, PITSILADIS YANNISP. Effects of EPO on Blood Parameters and Running Performance in Kenyan Athletes. Med Sci Sports Exerc 2019; 51:299-307. [DOI: 10.1249/mss.0000000000001777] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Birkhoff WAJ, Heuberger JAAC, Post TE, Gal P, Stuurman FE, Burggraaf J, Cohen AF. Recombinant human erythropoietin does not affect several microvascular parameters in well-trained cyclists. Physiol Rep 2018; 6:e13924. [PMID: 30592183 PMCID: PMC6308108 DOI: 10.14814/phy2.13924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 12/23/2022] Open
Abstract
Recombinant human erythropoietin (rHuEPO) has been used as a performance-enhancing agent by athletes in a variety of sports. The resulting increase in hematocrit levels leads to increased blood viscosity and can affect blood flow, potentially increasing the athlete's risk of developing health complications. However, the actual effects of using rHuEPO on microvascular blood flow and post-occlusive reactive hyperemia are currently unknown. We therefore evaluated the effect of rHuEPO on the cutaneous microcirculation in well-trained cyclists using laser speckle contrast imaging (LSCI). This study was part of a randomized, double-blind, placebo-controlled, parallel trial designed to investigate the effects of rHuEPO in 47 well-trained adult cyclists (age 18-50 years). Subjects received a weekly dose of either rHuEPO or placebo for 8 weeks, and LSCI was performed at baseline, after a maximal exercise test in week 6, and before maximal exercise in week 8. Endpoints included basal blood flux, maximum post-occlusion reperfusion, and time to return to baseline. Despite an increase in hematocrit levels in the rHuEPO-treated group, we found no statistically significant difference in microvascular function measured between the rHuEPO-treated group and the placebo group. Our results suggest that the increased hematocrit levels in rHuEPO-treated well-trained cyclists are not associated with changes in microvascular blood flow or post-occlusive reactive hyperemia measured using LSCI.
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Affiliation(s)
- Willem A. J. Birkhoff
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden University Medical CenterLeidenThe Netherlands
| | | | - Titiaan E. Post
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden Academic Centre for Drug ResearchLeidenThe Netherlands
| | - Pim Gal
- Centre for Human Drug ResearchLeidenThe Netherlands
| | | | - Jacobus Burggraaf
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden Academic Centre for Drug ResearchLeidenThe Netherlands
| | - Adam F. Cohen
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden University Medical CenterLeidenThe Netherlands
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18
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Erythropoietin on cycling performance. LANCET HAEMATOLOGY 2018; 4:e460-e461. [PMID: 28962677 DOI: 10.1016/s2352-3026(17)30176-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/31/2017] [Indexed: 11/23/2022]
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Sgrò P, Sansone M, Sansone A, Romanelli F, Di Luigi L. Effects of erythropoietin abuse on exercise performance. PHYSICIAN SPORTSMED 2018; 46:105-115. [PMID: 29113535 DOI: 10.1080/00913847.2018.1402663] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The present review provides a comprehensive overview on the erythropoietic and non-erythropoietic effects of rHuEpo on human sport performance, paying attention to quantifying numerically how rHuEpo affects exercise performance and describing physiological changes regarding the most important exercise variables. Much attention has been paid to treatment schedules, in particular, to assess the effects of microdoses of rHuEpo and the prolonged effects on sport performance following withdrawal. Moreover, the review takes into account non-erythropoietic ergogenic effects of rHuEpo, including cognitive benefits of rHuEpo. A significant increase in both Vo2max and maximal cycling power was evidenced in studies taken into account for this review. rHuEpo, administered at clinical dosage, may have significant effects on haematological values, maximal and submaximal physiological variables, whereas few reports show positive effects on exercise perfomance. However, the influence of micro-dose rHuEpo on endurance performance in athletes is still unclear and further studies are warranted.
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Affiliation(s)
- Paolo Sgrò
- a Department of Movement, Human and Health Sciences, Unit of Endocrinology , Università degli Studi di Roma "Foro Italico" Piazza Lauro de Bosis , Rome , Italy
| | - Massimiliano Sansone
- b Department of Experimental Medicine , "Sapienza" Università di Roma , Rome , Italy
| | - Andrea Sansone
- b Department of Experimental Medicine , "Sapienza" Università di Roma , Rome , Italy
| | - Francesco Romanelli
- b Department of Experimental Medicine , "Sapienza" Università di Roma , Rome , Italy
| | - Luigi Di Luigi
- a Department of Movement, Human and Health Sciences, Unit of Endocrinology , Università degli Studi di Roma "Foro Italico" Piazza Lauro de Bosis , Rome , Italy
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Heuberger JAAC, Rotmans JI, Gal P, Stuurman FE, Daniels JMA, de Kam ML, Cohen AF. Erythropoietin on cycling performance - Authors' reply. LANCET HAEMATOLOGY 2017; 4:e462-e464. [PMID: 28962681 DOI: 10.1016/s2352-3026(17)30181-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, Netherlands
| | | | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, Netherlands
| | | | - Adam F Cohen
- Centre for Human Drug Research, Leiden, Netherlands; Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
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21
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Perrey S. Do we perform better when we increase red blood cells? LANCET HAEMATOLOGY 2017; 4:e344-e345. [PMID: 28693986 DOI: 10.1016/s2352-3026(17)30123-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 06/30/2017] [Indexed: 10/19/2022]
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22
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Heuberger JAAC, Rotmans JI, Gal P, Stuurman FE, van 't Westende J, Post TE, Daniels JMA, Moerland M, van Veldhoven PLJ, de Kam ML, Ram H, de Hon O, Posthuma JJ, Burggraaf J, Cohen AF. Effects of erythropoietin on cycling performance of well trained cyclists: a double-blind, randomised, placebo-controlled trial. LANCET HAEMATOLOGY 2017; 4:e374-e386. [PMID: 28669689 DOI: 10.1016/s2352-3026(17)30105-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Substances that potentially enhance performance (eg, recombinant human erythropoietin [rHuEPO]) are considered doping and are therefore forbidden in sports; however, the scientific evidence behind doping is frequently weak. We aimed to determine the effects of rHuEPO treatment in well trained cyclists on maximal, submaximal, and race performance and on safety, and to present a model clinical study for doping research on other substances. METHODS We did this double-blind, randomised, placebo-controlled trial at the Centre for Human Drug Research in Leiden (Netherlands). We enrolled healthy, well trained but non-professional male cyclists aged 18-50 years and randomly allocated (1:1) them to receive abdominal subcutaneous injections of rHuEPO (epoetin β; mean dose 6000 IU per week) or placebo (0·9% NaCl) for 8 weeks. Randomisation was stratified by age groups (18-34 years and 35-50 years), with a code generated by a statistician who was not masked to the study. The primary outcome was exercise performance, measured as maximal power output (Pmax), maximal oxygen consumption VO2 max, and gross efficiency in maximal exercise tests with 25 W increments per 5 min, as lactate threshold and ventilatory threshold 1 (VT1) and 2 (VT2) at submaximal levels during the maximal exercise test, and as mean power, VO2, and heart rate in the submaximal exercise tests at the highest mean power output for 45 min in a laboratory setting and in a race to the Mont Ventoux (France) summit, using intention-to-treat analyses. The trial is registered with the Dutch Trial Registry (Nederlands Trial Register), number NTR5643. FINDINGS Between March 7, 2016, and April 13, 2016, we randomly assigned 48 participants to the rHuEPO group (n=24) or the placebo group (n=24). Mean haemoglobin concentration (9·6 mmol/L vs 9·0 mmol/L [estimated difference 0·6, 95% CI 0·4 to 0·8]) and maximal power output (351·55 W vs 341·23 W [10·32, 3·47 to 17·17]), and VO2 max (60·121 mL/min per kg vs 57·415 mL/min per kg [2·707, 0·911 to 4·503]) in a maximal exercise test were higher in the rHuEPO group compared with the placebo group. Submaximal exercise test parameters mean power output (283·18 W vs 277·28 W [5·90, -0·87 to 12·67]) and VO2 (50·288 mL/min per kg vs 49·642 mL/min per kg [0·646, -1·307 to 2·600]) at day 46, and Mont Ventoux race times (1 h 40 min 32 s vs 1 h 40 min 15 s [0·3%, -8·3 to 9·6]) did not differ between groups. All adverse events were grade 1-2 and were similar between both groups. No events of grade 3 or worse were observed. INTERPRETATION Although rHuEPO treatment improved a laboratory test of maximal exercise, the more clinically relevant submaximal exercise test performance and road race performance were not affected. This study shows that clinical studies with doping substances can be done adequately and safely and are relevant in determining effects of alleged performance-enhancing drugs. FUNDING Centre for Human Drug Research, Leiden.
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Affiliation(s)
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, Netherlands
| | | | - Juliëtte van 't Westende
- Centre for Human Drug Research, Leiden, Netherlands; Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Titiaan E Post
- Centre for Human Drug Research, Leiden, Netherlands; Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, Netherlands
| | | | | | | | - Herman Ram
- Anti-Doping Authority of the Netherlands, Capelle aan de IJssel, Netherlands
| | - Olivier de Hon
- Anti-Doping Authority of the Netherlands, Capelle aan de IJssel, Netherlands
| | - Jelle J Posthuma
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, Netherlands; Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, Netherlands; Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
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Miller DJ, Blum AB, Levine WN, Ahmad CS, Popkin CA. Preparticipation Evaluation of the Young Athlete: What an Orthopaedic Surgeon Needs to Know. Am J Sports Med 2016; 44:1605-15. [PMID: 26330569 DOI: 10.1177/0363546515598994] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The preparticipation evaluation (PPE) is a widely used tool for detecting health conditions that may delay or disqualify athletic participation. The medical interview is the most valuable tool for identifying athletes who may be at increased risk for injury. Physical examination is tailored to identifying cardiac abnormalities or factors that may place an athlete at increased risk for injury. Although practiced in Europe, universal cardiac screening with electrocardiography is not currently recommended in the United States largely due to the high rate of false-positive results. Neuropsychological testing for management of concussion and laboratory testing for sickle cell trait may be indicated in select groups of athletes. Health care providers should view the PPE as a chance for anticipatory guidance and athlete-directed health counseling. Despite widespread acceptance of the PPE, the quality of such examinations varies significantly, which is an area for possible improvement and further research.
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Affiliation(s)
- Daniel J Miller
- Center for Shoulder, Elbow and Sports Medicine, Department of Orthopedic Surgery, Columbia University, New York, New York, USA
| | | | - William N Levine
- Center for Shoulder, Elbow and Sports Medicine, Department of Orthopedic Surgery, Columbia University, New York, New York, USA
| | - Christopher S Ahmad
- Center for Shoulder, Elbow and Sports Medicine, Department of Orthopedic Surgery, Columbia University, New York, New York, USA
| | - Charles A Popkin
- Center for Shoulder, Elbow and Sports Medicine, Department of Orthopedic Surgery, Columbia University, New York, New York, USA
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24
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Bianchi S, Fusi J, Franzoni F, Giovannini L, Galetta F, Mannari C, Guidotti E, Tocchini L, Santoro G. "Effects of recombinant human erythropoietin high mimicking abuse doses on oxidative stress processes in rats". Biomed Pharmacother 2016; 82:355-63. [PMID: 27470373 DOI: 10.1016/j.biopha.2016.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 12/21/2022] Open
Abstract
Although many studies highlight how long-term moderate dose of Recombinant Human Erythropoietin (rHuEPO) treatments result in beneficial and antioxidants effects, few studies take into account the effects that short-term high doses of rHuEPO (mimicking abuse conditions) might have on the oxidative stress processes. Thus, the aim of this study was to investigate the in vivo antioxidant activity of rHuEPO, administered for a short time and at high doses to mimic its sports abuse as doping. Male Wistar healthy rats (n=36) were recruited for the study and were treated with three different concentrations of rHuEPO: 7.5, 15, 30μg/kg. Plasma concentrations of erythropoietin, 8-epi Prostaglandin F2α, plasma and urinary concentrations of NOx were evaluated with specific assay kit, while hematocrit levels were analyzed with an automated cell counter. Antioxidant activity of rHuEPO was assessed analyzing the possible variation of the plasma scavenger capacity against hydroxylic and peroxylic radicals by TOSC (Total Oxyradical Scavenging Capacity) assay. Statistical analyses showed higher hematocrit values, confirmed by a statistically significant increase of plasmatic EPO concentration. An increase in plasma scavenging capacity against peroxyl and hydroxyl radicals, in 8-isoprostane plasmatic concentrations and in plasmatic and urinary levels of NOX were also found in all the treated animals, though not always statistically significant. Our results confirm the literature data regarding the antioxidant action of erythropoietin administered at low doses and for short times, whereas they showed an opposite incremental oxidative stress action when erythropoietin is administered at high doses.
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Affiliation(s)
- Sara Bianchi
- Department of Translational Research and New Technologies in Medicine and Surgery, Pharmacology, Medical School, University of Pisa, Via Roma 55, 56126, Pisa, Italy.
| | - Jonathan Fusi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Ferdinando Franzoni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Luca Giovannini
- Department of Translational Research and New Technologies in Medicine and Surgery, Pharmacology, Medical School, University of Pisa, Via Roma 55, 56126, Pisa, Italy
| | - Fabio Galetta
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Claudio Mannari
- Department of Translational Research and New Technologies in Medicine and Surgery, Pharmacology, Medical School, University of Pisa, Via Roma 55, 56126, Pisa, Italy
| | - Emanuele Guidotti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Leonardo Tocchini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Gino Santoro
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
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25
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Diem R, Molnar F, Beisse F, Gross N, Drüschler K, Heinrich SP, Joachimsen L, Rauer S, Pielen A, Sühs KW, Linker RA, Huchzermeyer C, Albrecht P, Hassenstein A, Aktas O, Guthoff T, Tonagel F, Kernstock C, Hartmann K, Kümpfel T, Hein K, van Oterendorp C, Grotejohann B, Ihorst G, Maurer J, Müller M, Volkmann M, Wildemann B, Platten M, Wick W, Heesen C, Schiefer U, Wolf S, Lagrèze WA. Treatment of optic neuritis with erythropoietin (TONE): a randomised, double-blind, placebo-controlled trial-study protocol. BMJ Open 2016; 6:e010956. [PMID: 26932144 PMCID: PMC4785322 DOI: 10.1136/bmjopen-2015-010956] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Optic neuritis leads to degeneration of retinal ganglion cells whose axons form the optic nerve. The standard treatment is a methylprednisolone pulse therapy. This treatment slightly shortens the time of recovery but does not prevent neurodegeneration and persistent visual impairment. In a phase II trial performed in preparation of this study, we have shown that erythropoietin protects global retinal nerve fibre layer thickness (RNFLT-G) in acute optic neuritis; however, the preparatory trial was not powered to show effects on visual function. METHODS AND ANALYSIS Treatment of Optic Neuritis with Erythropoietin (TONE) is a national, randomised, double-blind, placebo-controlled, multicentre trial with two parallel arms. The primary objective is to determine the efficacy of erythropoietin compared to placebo given add-on to methylprednisolone as assessed by measurements of RNFLT-G and low-contrast visual acuity in the affected eye 6 months after randomisation. Inclusion criteria are a first episode of optic neuritis with decreased visual acuity to ≤ 0.5 (decimal system) and an onset of symptoms within 10 days prior to inclusion. The most important exclusion criteria are history of optic neuritis or multiple sclerosis or any ocular disease (affected or non-affected eye), significant hyperopia, myopia or astigmatism, elevated blood pressure, thrombotic events or malignancy. After randomisation, patients either receive 33,000 international units human recombinant erythropoietin intravenously for 3 consecutive days or placebo (0.9% saline) administered intravenously. With an estimated power of 80%, the calculated sample size is 100 patients. The trial started in September 2014 with a planned recruitment period of 30 months. ETHICS AND DISSEMINATION TONE has been approved by the Central Ethics Commission in Freiburg (194/14) and the German Federal Institute for Drugs and Medical Devices (61-3910-4039831). It complies with the Declaration of Helsinki, local laws and ICH-GCP. TRIAL REGISTRATION NUMBER NCT01962571.
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Affiliation(s)
- Ricarda Diem
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Fanni Molnar
- Eye Center, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany
| | - Flemming Beisse
- Department of Ophthalmology, Heidelberg University Hospital, Heidelberg, Germany
| | - Nikolai Gross
- Eye Center, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany
| | - Katharina Drüschler
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sven P Heinrich
- Eye Center, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany
| | - Lutz Joachimsen
- Eye Center, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian Rauer
- Department of Neurology and Neuroscience, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany
| | - Amelie Pielen
- Clinic for Ophthalmology, Hannover Medical School, Hannover, Germany
| | | | | | - Cord Huchzermeyer
- Department of Ophthalmology, University Hospital Erlangen, Erlangen, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Andrea Hassenstein
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Orhan Aktas
- Department of Neurology, Medical faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Tanja Guthoff
- Department of Ophthalmology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | | | | | - Kathrin Hartmann
- Department of Ophthalmology, University Hospital Munich LMU, Munich, Germany
| | - Tania Kümpfel
- Department of Neurology, University Hospital Munich, Munich, Germany
| | - Katharina Hein
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Birgit Grotejohann
- Clinical Trials Unit, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany
| | - Julia Maurer
- Clinical Trials Unit, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany
| | - Matthias Müller
- Competence Center “Vision Research”, Study Course Ophthalmological Optics, Faculty of Optics and Mechatronics, University of Applied Sciences, Aalen, Germany
| | - Martin Volkmann
- Medical Service Center PD Dr. Volkmann and Colleges, Karlsruhe, Germany
| | - Brigitte Wildemann
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Platten
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Heesen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Schiefer
- University Eye Hospital Tübingen, Tübingen, Germany
- Competence Center “Vision Research”, Study Course Ophthalmological Optics, Faculty of Optics and Mechatronics, University of Applied Sciences, Aalen, Germany
- Center for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
| | - Sebastian Wolf
- Department of Ophthalmology, Bern Photographic Reading Center, University Hospital and University of Bern, Bern, Switzerland
| | - Wolf A Lagrèze
- Eye Center, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany
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26
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Gambardella L, Vona R, Pichini S, Pacifici R, Malorni W, Straface E. Gender difference in platelet aggregation and reactivity induced by recombinant human erythropoietin. Br J Clin Pharmacol 2016; 81:789-91. [PMID: 26592206 DOI: 10.1111/bcp.12835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/21/2015] [Accepted: 11/13/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Rosa Vona
- Section of Cell Aging and Gender Medicine
| | - Simona Pichini
- Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicine Evaluation, Istituto Superiore di Sanità, Rome, 00161, Italy
| | - Roberta Pacifici
- Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicine Evaluation, Istituto Superiore di Sanità, Rome, 00161, Italy
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Annaheim S, Jacob M, Krafft A, Breymann C, Rehm M, Boutellier U. RhEPO improves time to exhaustion by non-hematopoietic factors in humans. Eur J Appl Physiol 2016; 116:623-33. [PMID: 26729211 DOI: 10.1007/s00421-015-3322-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/17/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Erythropoietin (EPO) controls red cell volume (RCV) and plasma volume (PV). Therefore, injecting recombinant human EPO (rhEPO) increases RCV and most likely reduces PV. RhEPO-induced endurance improvements are explained by an increase in blood oxygen (O2) transport capacity, which increases maximum O2 uptake ([Formula: see text]O2max). However, it is debatable whether increased RCV or [Formula: see text]O2max are the main reasons for the prolongation of the time to exhaustion (t lim) at submaximal intensity. We hypothesized that high rhEPO doses in particular contracts PV such that the improvement in t lim is not as strong as at lower doses while [Formula: see text]O2max increases in a dose-dependent manner. METHODS We investigated the effects of different doses of rhEPO given during 4 weeks [placebo (P), low (L), medium (M), and high (H) dosage] on RCV, PV, [Formula: see text]O2max and t lim in 40 subjects. RESULTS While RCV increased in a dose-dependent manner, PV decreased independent of the rhEPO dose. The improvements in t lim (P +21.4 ± 23.8%; L +16.7 ± 29.8%; M +44.8 ± 62.7%; H +69.7 ± 73.4%) depended on the applied doses (R (2) = 0.89) and clearly exceeded the dose-independent [Formula: see text]O2max increases (P -1.7 ± 3.2%; L +2.6 ± 6.8%; M +5.7 ± 5.1 %; H +5.6 ± 4.3 %) after 4 weeks of rhEPO administration. Furthermore, the absolute t lim was not related (R (2) ≈ 0) to RCV or to [Formula: see text]O2max. CONCLUSIONS We conclude that a contraction in PV does not negatively affect t lim and that rhEPO improves t lim by additional, non-hematopoietic factors.
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Affiliation(s)
- Simon Annaheim
- Exercise Physiology, Institute of Human Movement Sciences, ETH Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.,Laboratory for Protection and Physiology, EMPA, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014, St. Gallen, Switzerland.,Exercise Physiology, Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Matthias Jacob
- Department of Anaesthesiology, University Hospital, Nussbaumstrasse 20, 80336, Munich, Germany
| | - Alexander Krafft
- Division of Obstetrics, Department of Obstetrics and Gynaecology, University Hospital, 8000, Zurich, Switzerland
| | - Christian Breymann
- Division of Obstetrics, Department of Obstetrics and Gynaecology, University Hospital, 8000, Zurich, Switzerland
| | - Markus Rehm
- Department of Anaesthesiology, University Hospital, Nussbaumstrasse 20, 80336, Munich, Germany
| | - Urs Boutellier
- Exercise Physiology, Institute of Human Movement Sciences, ETH Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland. .,Exercise Physiology, Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland. .,Exercise Physiology, ETH Zurich, Rychenbergstr. 49a, 8400, Winterthur, Switzerland.
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28
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Birzniece V. Doping in sport: effects, harm and misconceptions. Intern Med J 2015; 45:239-48. [DOI: 10.1111/imj.12629] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
- V. Birzniece
- School of Medicine; University of Western Sydney; Sydney New South Wales Australia
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29
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Bishop-Bailey D. Mechanisms governing the health and performance benefits of exercise. Br J Pharmacol 2014; 170:1153-66. [PMID: 24033098 DOI: 10.1111/bph.12399] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 07/18/2013] [Accepted: 07/23/2013] [Indexed: 12/18/2022] Open
Abstract
Humans are considered among the greatest if not the greatest endurance land animals. Over the last 50 years, as the population has become more sedentary, rates of cardiovascular disease and its associated risk factors such as obesity, type 2 diabetes and hypertension have all increased. Aerobic fitness is considered protective for all-cause mortality, cardiovascular disease, a variety of cancers, joint disease and depression. Here, I will review the emerging mechanisms that underlie the response to exercise, focusing on the major target organ the skeletal muscle system. Understanding the mechanisms of action of exercise will allow us to develop new therapies that mimic the protective actions of exercise.
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Affiliation(s)
- D Bishop-Bailey
- Comparative Biomedical Sciences, The Royal Veterinary College, London, UK
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30
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Feder D, Rugollini M, Santomauro A, Oliveira LP, Lioi VP, Santos RD, Ferreira LG, Nunes MT, Carvalho MH, Delgado PO, Carvalho AAS, Fonseca FLA. Erythropoietin reduces the expression of myostatin in mdx dystrophic mice. ACTA ACUST UNITED AC 2014. [PMID: 25296358 PMCID: PMC4230286 DOI: 10.1590/1414-431x20143858] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Erythropoietin (EPO) has been well characterized as a renal glycoprotein hormone
regulating red blood cell production by inhibiting apoptosis of erythrocyte
progenitors in hematopoietic tissues. EPO exerts regulatory effects in cardiac and
skeletal muscles. Duchenne muscular dystrophy is a lethal degenerative disorder of
skeletal and cardiac muscle. In this study, we tested the possible therapeutic
beneficial effect of recombinant EPO (rhEPO) in dystrophic muscles in mdx mice. Total
strength was measured using a force transducer coupled to a computer. Gene expression
for myostatin, transforming growth factor-β1 (TGF-β1), and tumor necrosis factor-α
(TNF-α) was determined by quantitative real time polymerase chain reaction. Myostatin
expression was significantly decreased in quadriceps from mdx mice treated with rhEPO
(rhEPO=0.60±0.11, control=1.07±0.11). On the other hand, rhEPO had no significant
effect on the expression of TGF-β1 (rhEPO=0.95±0.14, control=1.05±0.16) and TNF-α
(rhEPO=0.73±0.20, control=1.01±0.09). These results may help to clarify some of the
direct actions of EPO on skeletal muscle.
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Affiliation(s)
- D Feder
- Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - M Rugollini
- Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - A Santomauro
- Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - L P Oliveira
- Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - V P Lioi
- Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - R dos Santos
- Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L G Ferreira
- Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M T Nunes
- Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M H Carvalho
- Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - P O Delgado
- Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | | | - F L A Fonseca
- Faculdade de Medicina do ABC, Santo André, SP, Brasil
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Sperlich B, Zinner C, Pfister R, Holmberg HC, Michels G. Repeated apnea-induced contraction of the spleen in cyclists does not enhance performance in a subsequent time-trial. Eur J Appl Physiol 2014; 115:205-12. [PMID: 25260245 DOI: 10.1007/s00421-014-3003-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/15/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Splenic contraction induced by repeated apneas has been shown to increase oxygen availability. Our aim was to determine whether repeated maximal voluntary apnea enhances the performance of cyclists in a subsequent 4-km time trial. METHODS Seven male cyclists [age: 27.1 ± 2.1 years; height: 182 ± 8 cm; body mass: 74.8 ± 9.2 kg; peak oxygen uptake: 56.9 ± 6.6 mL min(-1) kg(-1) (mean ± SD)] performed a 4-km time trial on an ergometer with and without four prior maximal bouts of apnea interspersed with 2 min of recovery. RESULTS The average power output during the time trial was similar with (293 ± 48 W) and without (305 ± 42 W) prior apnea (P = 0.11, d = 0.27). The spleen was reduced in size after the fourth bout of apnea (-12.4 ± 9.0 %), as well as one (-36.6 ± 10.3 %) and 10 min (-19.5 ± 17.9 %) after the time trial, while with normal breathing the spleen was smaller one (-35.0 ± 11.3 %) and 10 min (-23.4 ± 19.7 %) after the time trial. Heart rate; oxygen uptake and carbon dioxide production; tissue oxygen saturation; and the lactate concentration, pH, oxygen saturation, level of hemoglobin and hematocrit of the blood were similar under both conditions. CONCLUSIONS Our present findings reveal that four apneas by cyclists prior to a 4-km time trial led to splenic contraction, but no change in mean power output, the level of hemoglobin, hematocrit, oxygen saturation of the m. vastus lateralis or oxygen uptake.
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Affiliation(s)
- Billy Sperlich
- Integrative and Experimental Training Science, Department of Sport Science, Julius-Maximilians-Universität Würzburg, University of Würzburg, Judenbühlweg 11, 97082, Würzburg, Germany,
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Seear K. What do we really know about doping ‘effects’? An argument for doping effects as co-constituted ‘phenomena’. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.peh.2014.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Thevis M, Kuuranne T, Geyer H, Schänzer W. Annual banned-substance review: analytical approaches in human sports drug testing. Drug Test Anal 2013; 6:164-84. [DOI: 10.1002/dta.1591] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 11/06/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Mario Thevis
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Am Sportpark Müngersdorf 6 50933 Cologne Germany
- European Monitoring Center for Emerging Doping Agents; Cologne Germany
| | - Tiia Kuuranne
- Doping Control Laboratory; United Medix Laboratories; Höyläämötie 14 00380 Helsinki Finland
| | - Hans Geyer
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Am Sportpark Müngersdorf 6 50933 Cologne Germany
| | - Wilhelm Schänzer
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Am Sportpark Müngersdorf 6 50933 Cologne Germany
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van Breda E, Benders J, Kuipers H. Little soldiers in their cardboard cells. Br J Clin Pharmacol 2013; 77:580-1. [PMID: 23772979 DOI: 10.1111/bcp.12187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/24/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Eric van Breda
- High Performance Sports Expertise & Innovation Centre, Sittard-Geleen, The Netherlands
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