Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
Department of Public Health, Section for Sport Science, Aarhus University, Aarhus, Denmark.
Scand J Med Sci Sports. 2024 Jan;34(1):e14243. doi: 10.1111/sms.14243. Epub 2022 Dec 26.
Blood doping is prohibited for athletes but has been a well-described practice within endurance sports throughout the years. With improved direct and indirect detection methods, the practice has allegedly moved towards micro-dosing, that is, reducing the blood doping regime amplitude. This narrative review evaluates whether blood doping, specifically recombinant human erythropoietin (rhEpo) treatment and blood transfusions are performance-enhancing, the responsible mechanism as well as detection possibilities with a special emphasis on micro-dosing. In general, studies evaluating micro-doses of blood doping are limited. However, in randomized, double-blinded, placebo-controlled trials, three studies find that infusing as little as 130 ml red blood cells or injecting 9 IU × kg bw rhEpo three times per week for 4 weeks improve endurance performance ~4%-6%. The responsible mechanism for a performance-enhancing effect following rhEpo or blood transfusions appear to be increased O -carrying capacity, which is accompanied by an increased muscular O extraction and likely increased blood flow to the working muscles, enabling the ability to sustain a higher exercise intensity for a given period. Blood doping in micro-doses challenges indirect detection by the Athlete Biological Passport, albeit it can identify ~20%-60% of the individuals depending on the sample timing. However, novel biomarkers are emerging, and some may provide additive value for detection of micro blood doping such as the immature reticulocytes or the iron regulatory hormones hepcidin and erythroferrone. Future studies should attempt to validate these biomarkers for implementation in real-world anti-doping efforts and continue the biomarker discovery.
血液兴奋剂在运动员中是被禁止的，但多年来一直是耐力运动中一种被广泛描述的做法。随着直接和间接检测方法的改进，这种做法据称已经转向微量给药，即减少血液兴奋剂的剂量。本叙述性综述评估了血液兴奋剂，特别是重组人促红细胞生成素（rhEpo）治疗和输血是否具有增强运动表现的作用、其作用机制以及检测的可能性，特别强调了微量给药。一般来说，评估血液兴奋剂微量剂量的研究是有限的。然而，在随机、双盲、安慰剂对照试验中，有三项研究发现，输注少至 130ml 红细胞或每周注射 9IU×kg bw rhEpo 三次，持续 4 周，可使耐力表现提高约 4%-6%。rhEpo 或输血后增强运动表现的作用机制似乎是增加了 O 携带能力，这伴随着肌肉 O 提取的增加，可能还伴随着向工作肌肉的血流量增加，从而使个体能够在给定的时间内维持更高的运动强度。微量血液兴奋剂给药对运动员生物护照的间接检测构成了挑战，尽管根据样本时间，它可以识别约 20%-60%的个体。然而，新的生物标志物正在出现，其中一些可能为微量血液兴奋剂的检测提供附加价值，例如未成熟网织红细胞或铁调节激素铁调素和红细胞生成素。未来的研究应该尝试验证这些生物标志物，以便在实际的反兴奋剂工作中实施，并继续进行生物标志物的发现。
