Little soldiers in their cardboard cells

Breda, Eric van; Benders, Jos; Kuipers, H.

doi:10.1111/bcp.12187

Cited by 3 publications

(2 citation statements)

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“…In aerobic disciplines, such as long-distance or treadmill running, cycling, cross-country skiing, the main factors determining performance are oxygen (O 2 ) delivery to exercising skeletal muscles and its use (28)(29)(30). Endurance training induces physiological changes that can improve exercise performance in terms of haematopoietic induction, which increases O 2 transport to muscles.…”

Section: Physical Activity and Blood Dopingmentioning

confidence: 99%

Erythropoietin between therapy and doping : Two sides of the same coin

Ostojić¹,

Trbojević-Stanković²,

Nešić³

2016

Medicinski podmladak

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SažetakEritropoetin je hormon koji se kod odraslih stvara pretežno u bubrezima, a u manjoj meri i u jetri, kao odgovor na hipoksiju. Primarno stimuliše eritropoezu u koštanoj srži i deluje antiapoptozno, antiinflamatorno i citoprotektivno. Stvara se lokalno i deluje i u mnogim drugim, nehematopoetskim tkivima, ispoljavajući u njima i svoj proangiogeni potencijal. Eritropoetin se vezuje za citokinski receptor koji eksprimiraju ciljne ćelije, prekursori eritrocita, ali i neuroni, ćelije glije, endotelne ćelije, kardiomiociti, miociti i dr. Pronalaskom sintetskih formi eritropoetina, krajem osamdesetih godina prošlog veka, značajno je unapređeno lečenje bolesnika sa anemijom usled hroničnih bolesti, najčešće renalne insuficijencije. Anemija u hroničnoj bubrežnoj insuficijenciji je multifaktorska, ali u najvećoj meri posledica manjka eritropoetina. Do sada su razvijene tri generacije stimulatora eritropoeze, koji se razlikuju u ugljenohidratnom delu, veličini, polu-životu u cirkulaciji, načinu primene i dozi. I pored značajno poboljšanog kvaliteta života anemičnih bolesnika, postoje ozbiljni, potencijalno ugrožavajući efekti ove terapije. Sinteza rekombinovanog humanog eritropoetina, s druge strane, otvorila je nove mogućnosti i za zloupotrebu u sportu, u domenu krvnog dopinga. Davanje eritropoetina zdravim sportistima podiže njihov aerobni kapacitet i poboljšava izdržljivost i rezultate, posebno u aerobnim disciplinama. Time se ozbiljno narušava sportski duh, ali i ozbiljno ugrožava zdravlje sportista. U upotrebi su različiti testovi za otkrivanje nedozvoljenih supstanci, ali je uspeh ovih metoda još uvek ograničen. Uporedo se stalno razvijaju i pronalaze drugi načini zloupotrebe u sportu, poput novijih, različitih modela genetskog dopinga. Zbog svega navedenog razvoj novih modela antidoping testova i bolja zdravstvena kontrola sportista i dalje predstavljaju veliki izazov. Ključne reči: eritropoetin, eritropoeza, anemija, sportisti, doping AbstractErythropoietin is a hormone that promotes the formation of red blood cells by the bone marrow. In adults it is mainly produced by the kidneys as a response to hypoxia. Besides its main role, it also acts as antiapoptotic, anti-inflammatory and cytoprotective agent. Furthermore, it is produced in many non-hematopoietic tissues where it acts locally, stimulating angiogenesis. Erythropoietin binds cytokine receptors on target cells, such as erythrocyte precursor cells, neurons, glial and endothelial cells, cardiomyocytes, myocytes etc. The discovery of synthetic erythropoietin forms, in the late eighties of the last century, has significantly improved treatment outcome of patients with anaemia related to chronic diseases, especially chronic renal failure. Renal anaemia is multifactorial, but predominantly a consequence of erythropoietin deficiency. Today, three generations of erythropoiesis stimulating agents are available, differing in glycosylation pattern, molecular size, half-life and modes of administration and dosage. In anaemic patients this therapy significantly imp...

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Section: Physical Activity and Blood Dopingmentioning

confidence: 99%

Erythropoietin between therapy and doping : Two sides of the same coin

Ostojić¹,

Trbojević-Stanković²,

Nešić³

2016

Medicinski podmladak

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“…In response to the Letter to the Editors by van Breda et al [1] 'Little soldiers in their cardboard cells' , we would like to acknowledge the point that the authors make regarding medical malpractice. Indeed, because of the 'omerta' (code of silence) in the cycling culture, the possible harm or injury caused by use of erythropoietin (EPO) in cyclists rarely sees daylight, and medical malpractice cannot be proved.…”

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World-class cyclists on erythropoietin

Heuberger

Cohen

2014

Br J Clin Pharmacol

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In response to the Letter to the Editors by van Breda et al.[1] 'Little soldiers in their cardboard cells' , we would like to acknowledge the point that the authors make regarding medical malpractice. Indeed, because of the 'omerta' (code of silence) in the cycling culture, the possible harm or injury caused by use of erythropoietin (EPO) in cyclists rarely sees daylight, and medical malpractice cannot be proved. Interestingly, Dr Eufemiano Fuentes was recently found guilty in Operación Puerto of endangering public health through his doping practices. This verdict was possible partly because of the testimony by Jesus Manzano about his injury in the Tour de France of 2003, mentioned by van Breda et al. The case report in our paper [2] underlines the dangers into which these physicians put the athletes, and we hope to show the negative risk-benefit in EPO use and to encourage them to make a stand against these physicians who are practising negligence at least.Regarding the second point the authors make, it is true that a gain in maximal oxygen uptake is seen in the published studies. However, these studies are performed with trained cyclists at best, which are incomparable to worldclass cyclists,as we showed in the original paper.The effects of EPO on performance parameters in elite cyclists are therefore unknown, making any further conclusions about the benefits of EPO use in this population unjustified. Additionally, it remains unclear even in trained cyclists whether EPO has an effect on submaximal exercise parameters, including power output at submaximal exercise, which is indeed the best predictor of cycling performances such as time trials [3][4][5]. An increase of maximal oxygen uptake or maximal power output does not necessarily indicate a positive effect on submaximal parameters and therefore performance. Thus, on the basis of the evidence available in the literature, we conclude that it is not proved that EPO has a performance-enhancing effect in elite cyclists. Competing InterestsAll authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.

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Erythropoietin on cycling performance

Breda

Truijen

2017

The Lancet Haematology

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Little soldiers in their cardboard cells

Cited by 3 publications

References 3 publications

Erythropoietin between therapy and doping : Two sides of the same coin

Erythropoietin between therapy and doping : Two sides of the same coin

World-class cyclists on erythropoietin

Erythropoietin on cycling performance

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