EPO (erythropoietin)

EPO is actually a synthetic version of the naturally occurring erythropoietin. It is actually called Epoetin Alfa

Epoetin alfa is not identical to erythropoietin, but it is a synthetic form that mimics the action of erythropoietin. Epoetin alfa is produced using recombinant DNA technology, where the gene for erythropoietin is inserted into cells, such as Chinese hamster ovary (CHO) cells, which then produce the protein.

While epoetin alfa has a similar structure and function to endogenous erythropoietin, there may be slight differences in their molecular structures due to the manufacturing process. However, in terms of therapeutic effect, Epoetin Alfa acts similarly to erythropoietin by stimulating the production of red blood cells in the bone marrow.

Blood doping before EPO

The introduction of genetically engineered EPO was a big deal in medicine. Before it, the main ways to boost red blood cell counts were using steroids or getting blood transfusions. Blood transfusions became popular because steroid testing was strict in sports. People stored their own blood and then used it later to increase their red blood cell counts. This boosted endurance, energy, and protein synthesis. This practice, called blood doping, got attention, especially in 2010 with Floyd Landis. But with exogenous EPO compounds like Epoetin Alfa, people could raise EPO levels without needing blood transfusions or steroids.

Benefits to endurance athletes

Erythropoietin (EPO) is a hormone naturally produced by the kidneys that stimulates the production of red blood cells in the bone marrow. Athletes have sought to exploit the effects of EPO to gain an advantage in endurance sports due to its ability to increase oxygen delivery to muscles.

Increases oxygen delivery

Increased Oxygen Delivery is one of the primary advantages athletes seek with EPO usage. Red blood cells carry oxygen from the lungs to the muscles. By increasing the production of red blood cells, EPO enhances the blood’s oxygen-carrying capacity, which can lead to improved endurance during aerobic activities such as long-distance running, cycling, and swimming.

Enhanced endurance

Enhanced Endurance Performance is another significant benefit attributed to EPO. With more oxygen available to working muscles, athletes may experience reduced fatigue and improved endurance. This can result in the ability to sustain higher levels of effort for longer durations, leading to better overall performance in endurance events.

EPO is often associated with doping in endurance sports

Moreover, EPO can contribute to Faster Recovery post-exercise. Improved oxygen delivery facilitated by EPO can enhance recovery after intense exercise or competition. By supplying muscles with more oxygen and nutrients, EPO may help expedite the repair of muscle tissue damage and reduce the recovery time between training sessions or competitions.

Increased Energy Levels are also observed with EPO usage. Adequate oxygen supply is essential for cellular energy production through aerobic metabolism. With higher levels of red blood cells and oxygen delivery, athletes may experience increased energy levels, enabling them to push harder and maintain higher work rates during exercise.

Improves cardiovascular ability

Furthermore, EPO has been linked to Improved Aerobic Capacity. Aerobic capacity, often measured by VO2 max (the maximum amount of oxygen an individual can utilize during intense exercise), is a key determinant of endurance performance. EPO can potentially increase VO2 max by improving oxygen transport and utilization, thereby enhancing an athlete’s aerobic capacity and overall performance.

Reduces lactic acid burn

Lastly, EPO usage may elevate Thresholds, specifically lactate threshold. By delaying the onset of lactate accumulation, athletes can sustain higher intensities for longer periods before fatigue sets in, leading to improved performance in endurance activities.

Health effects and dangers of EPO

Epoetin alfa, like any medication, carries potential health effects and risks. Some of the common side effects of epoetin alfa include:

  1. High blood pressure (hypertension)
  2. Headaches
  3. Fever
  4. Nausea or vomiting
  5. Joint or muscle pain
  6. Redness, pain, or swelling at the injection site
  7. Fatigue
  8. Dizziness

However, there are more serious risks associated with the use of epoetin alfa, particularly when used in high doses or inappropriately. These risks include:

  1. Increased risk of blood clots, including deep vein thrombosis and pulmonary embolism
  2. Increased risk of stroke or heart attack
  3. Pure red cell aplasia (PRCA), a condition where the bone marrow stops producing red blood cells
  4. Worsening of hypertension, especially in patients with pre-existing high blood pressure
  5. Seizures

Furthermore, using epoetin alfa to achieve higher-than-normal red blood cell levels can lead to a condition called polycythemia, which can cause symptoms such as fatigue, headache, and difficulty breathing.

It’s important for patients receiving epoetin alfa to be closely monitored by their healthcare provider for signs of adverse effects and to follow their prescribed dosage and treatment schedule carefully. Epoetin alfa should only be used under the guidance of a healthcare professional and for approved medical conditions.

EPO dosing for various causes of anemia

The dosing for Epoetin Alfa, a form of erythropoietin (EPO), varies depending on the medical condition being treated and individual patient factors. In a therapeutic setting, the dosing of Epoetin Alfa is typically based on body weight and the severity of anemia.

For the treatment of anemia associated with chronic kidney disease (CKD), the typical starting dose of Epoetin Alfa is in the range of 50 to 100 units per kilogram of body weight, administered subcutaneously or intravenously. This dose is usually given three times per week, although the frequency and dosage may be adjusted based on the patient’s response, as assessed by hematocrit levels.

For chemotherapy-induced anemia or anemia associated with certain other medical conditions, the dosing of Epoetin Alfa may differ. It is important for healthcare providers to carefully assess each patient’s needs and tailor the dosing regimen accordingly.

It’s crucial to note that the dosing of Epoetin Alfa should only be determined by a qualified healthcare professional, taking into account factors such as the underlying medical condition, the severity of anemia, kidney function, and other individual patient characteristics. Misuse or inappropriate dosing of Epoetin Alfa can lead to serious health risks, including blood clots, hypertension, and other adverse effects.

Dosing for athletes

For athletes seeking performance enhancement, starting with a very low dose is common. Many find that beginning with 10 units per kilogram of body weight is effective, while some may start with as little as 5 units per kilogram. Regardless of the specific dosage, administering three injections per week for two weeks is often sufficient to yield results. These effects can maintain increased red blood cell counts for up to three months or even longer.

Results of studies for improved athletic performance

In general, the available evidence indicates that EPO may offer greater benefits compared to a placebo in improving hematological parameters, pulmonary measures, maximal power output, and time to exhaustion, regardless of the dosage used. However, it’s important to note that these enhancements are primarily observed during maximal exercise intensities, which may have limited relevance to actual athletic competition conditions.

However in endurance sports where the slightest enhancement can lead to success these advantages often prove decisive.

Conclusion

Erythropoietin (EPO) holds considerable clinical value and serves therapeutic purposes when used correctly. However, misusing it for performance enhancement can lead to severe health complications. According to WADA, EPO thickens the blood, heightening the risk of life-threatening conditions such as heart disease, stroke, and embolisms in the brain or lungs. Additionally, athletes who misuse synthetic EPO are vulnerable to autoimmune diseases with potentially serious consequences