Cyclist’s doping associated with cerebral sinus thrombosis

Abstract

Erythropoietin (EPO) plays a key role in modulation of erythropoiesis and is required for the survival and proliferation of committed erythroid progenitor cells. 1 EPO has been approved for treatment of anemia in several conditions and for facilitating autologous blood donation. When used as doping agent in sport, EPO increases the ability to exercise as the result of increasing the packed-cell volume (PCV).Case report. A 26-year-old man, a professional cyclist, presented with a 2-month history of headache that had greatly increased in the previous week during a competition. There was no history of head trauma. He was referred to an institution with the diagnosis of idiopathic intracranial hypertension, which was nonresponsive to standard treatment. On admission he was cognitively normal, but reported diffuse headache with nausea, vomiting, and photophobia. Physical examination was unremarkable, except for the presence of a mild left retinal venous engorgement. A lumbar puncture disclosed an increase in CSF pressure, without abnormalities in CSF composition. Blood analysis showed a red blood cell count of 5.4 ϫ 10 12 /L (normal range, 3.5 to 5.0), hemoglobin ϭ 150 g/dL (normal range, 140 to 180), PCV ϭ 0.47 (normal range, 0.39 to 0.49), with normal values for the white cell count and platelet number. The other routine laboratory tests performed in serum and urine were within the normal range. Although the cranial CT scan examination on admission was normal, MRI of the brain revealed occlusion of the superior sagittal and the right transverse sinuses (figure). A diagnosis of cerebral sinus thrombosis was made, and anticoagulation treatment with intravenous sodium heparin infusion was started. A 400-mL phlebotomy also was performed because the PCV spontaneously increased to 0.51. Previously, a coagulation study had been performed with normal values for prothrombin time, activated partial thromboplastin time, fibrinogen, thrombin time, D-dimer, plasminogen, antithrombin III, protein C, protein S, lupus anticoagulant, and anticardiolipin antibodies. A PCR for factor V Leiden also was negative.Because EPO doping was suspected, the patient was questioned about the use of forbidden agents. He admitted to using EPO during the previous 3 months at a dose of 2000 U every 2 days, and growth hormone over the last 15 days of competition to improve his physical exercise capacity. Moreover, he reported habitual, long-lasting consumption of high doses of vitamin A and vitamin E supplements. Anticoagulation resulted in a clinical response and was continued with acenocoumarol for 3 months. A control MRI showed resolution of the thrombosis. When last seen he remained well; currently, he continues to compete.Discussion. The practice of doping to enhance athletic performance is becoming a medical and public health problem because of simplicity of administration and difficulty of detection. 2 The use of forbidden substances in the form of human recombinant peptide hormones with ergogenic action, such as growth hormone and EPO, is curr...

Prevention of Erythropoietin-Associated Hypertension

“…Other potential adverse effects of Epo include increased vascular and thrombotic events, such as pulmonary embolism, stroke, and myocardial infarct, especially Epoassociated thrombosis in young healthy athletes. 18,34 The Epo receptor has been cloned. 35,36 We do not know, however, at the present time what the biophysiological mechanisms of Epo are, nor what the second messenger system involved in the interaction between Epo and the Epo receptor in their binding activities and subsequent processes are.…”

World-class cyclists on erythropoietin

“…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.…”

“…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.…”

Gene doping: an overview and current implications for athletes

“…The first documented illicit use of rHuEPO was in the 1989 Tour de France,60 and more cases have since been documented 61. Since EPO stimulates erythropoiesis, it increases the viscosity of the blood, thus raising the risk of microcirculation blockage, heart failure and strokes,19 which makes overdosing and overexpression a risk 3 9 19.…”