Detection of erythropoietin misuse by the Athlete Biological Passport combined with reticulocyte percentage

Abstract

The sensitivity of the adaptive model of the Athlete Biological Passport (ABP) and reticulocyte percentage (ret%) in detection of recombinant human erythropoietin (rHuEPO) misuse was evaluated using both a long-term normal dose and a brief high dose treatment regime. Sixteen subjects received either 65 IU rHuEPO × kg every second day for two weeks (normal-dose), 390 IU rHuEPO × kg on three consecutive days (high-dose), or frequent placebo treatment for 13 days in a randomized, placebo-controlled, double-blind crossover design. Blood variables were measured 4, 11, and 25 days following treatment initiation. The ABP based on haemoglobin concentration ([Hb]) and OFF-hr score ([Hb] - 60 × √ret%) yielded atypical profiles following both normal-dose and high-dose treatment (0 %, 31 %, 13 % vs. 21 %, 33 %, 20 % at days 4, 11, and 25 after normal and high dose, respectively). Including ret% as a stand-alone marker for atypical blood profiles increased (P < 0.05) the sensitivity of the adaptive model at day 11 to 63 % and 67 % for normal-dose and high-dose rHuEPO administration, respectively. In conclusion, ~30 % of subjects injecting a normal-dose rHuEPO for two weeks or a high-dose rHuEPO for three days will present an atypical ABP profile. Including ret% as a stand-alone parameter improves the sensitivity two-fold. Copyright © 2015 John Wiley & Sons, Ltd.

Detection of autologous blood transfusions using a novel dried blood spot method

“…Using OFF‐score data alone, 1 subject breached the threshold level which could result in a positive test. Using Ret%, 3 subjects would have a positive test, which supports a previous report suggesting that analysis of Ret% in addition to OFF‐score could improve detection of EPO abuse . Finally, using the CD71/Band3 ratio, 7 subjects would have a positive test, suggesting that the DBS method may improve the sensitivity of the test for autologous blood transfusions.…”

“…Using Ret%, 3 subjects would have a positive test, which supports a previous report suggesting that analysis of Ret% in addition to OFF-score could improve detection of EPO abuse. [27] Finally, using the CD71/Band3 ratio, 7 subjects would have a positive test, suggesting that the DBS method may improve the sensitivity of the test for autologous blood transfusions. Graphs displaying the response of each subject to blood or saline transfusion for Ret% and CD71/Band3 ratio are shown in Supplemental Figure S-2 in the Supporting Information.…”

Plasma volume reduction and hematological fluctuations in high‐level athletes after an increased training load

“…Interestingly, only Ret% met the requirements for specificity, adding to previous studies demonstrating the potential of Ret% . Further, ABPS has been suggested as marker of blood manipulation.…”

“…Interestingly, only Ret% met the requirements for specificity, adding to previous studies demonstrating the potential of Ret%. 33,34 Further, ABPS has been suggested as marker of blood manipulation. The present study demonstrates that increased training load periods can be a confounding factor to the specificity of ABPS.…”

Annual banned‐substance review: Analytical approaches in human sports drug testing

“…For instance, Bejder et al. demonstrated the utility of combining the reticulocyte percentage (ret%) with established ABP parameters such as the hemoglobin concentration ([Hb]) and the so‐called OFF‐hr score . A placebo‐controlled proof‐of‐concept study with 16 male volunteers was conducted, where either a normal‐dose (65 IU/kg every other day for 2 weeks) or a high dose (390 IU/kg for 3 days) of rhEPO was administered.…”