Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: WEDNESDAY, April 4, 1990 TAG: 9004040205
SECTION: NATIONAL/INTERNATIONAL PAGE: A1 EDITION: METRO
SOURCE: The Washington Post
DATELINE: STOCKHOLM, SWEDEN LENGTH: Long
Then the EPO injections began. Within weeks, the slowest among them began performing almost like professionals. The best had turned into supermen.
"The effects were truly remarkable," said Bjorn Ekblom, professor of physiology at the Karolinska Institute here, and the world's foremost expert on methods of souping-up an athlete's blood.
"They improved by at least 10 percent in every case. It is as if someone entered a 100-meter race, but started instead at the 10-meter line."
Ekblom and his colleagues treated the young subjects, all students at Stockholm's Institute of Gymnastics and Sports, with small doses of the hormone erythropoietin, or EPO.
In large doses, the hormone, useful in treating a number of blood deficiencies, can be fatal.
Normally produced in minute amounts within the human kidney, EPO stimulates the bone marrow to produce oxygen-carrying red blood cells.
Now, however, EPO can be produced in the laboratory by bacteria that have been implanted with the human gene that directs cells to make the substance.
For endurance athletes, the ability to ferry oxygen around the body is especially important. That's the job of hemoglobin molecules found in red blood cells.
The more of them athletes have to carry oxygen, the more aerobic power athletes have at their disposal. And aerobic power is the most important measure of such a competitor's abilities.
Athletes have often trained at high altitudes to develop their circulatory systems.
That practice works because air is thin at high altitudes and the body responds by making extra red cells, which carry extra hemoglobin, to scavenge more oxygen from each breath.
When the athlete descends to lower altitudes, the blood retains its extra oxygen-carrying capacity and can deliver more to the muscles than it otherwise would have.
EPO appears to be a far more efficient way of boosting the red blood cell count and, of course, much more convenient.
Even at small doses administered for a seven-week period, the concentration of hemoglobin present in Ekblom's subjects' blood increased by an average of nearly one-third.
Trying to enhance blood is nothing new for world-class sports figures.
Until it was outlawed, "blood doping" was often practiced by endurance athletes, who froze and stored their own blood for months before a competition and then injected it back into their veins the day before their event. By then, the athletes' blood levels would have returned to normal and the infusion would provide them with a huge concentration of new red blood cells to carry oxygen.
Now that genetic tools have enabled pharmaceutical companies to produce an artificial version of EPO in huge amounts, the implications for competitive sports are staggering.
Although sophisticated tests can detect even the smallest trace of most drugs in urine, EPO is made naturally by the human kidney, making it very difficult and expensive to prove that someone has used an additional synthetic version.
"It could ruin athletics," said Ekblom, who for years has worked in a laboratory in the shadow of Stockholm's Olympic Stadium studying the effects of endurance training on the circulatory system.
"Among the world's elite athletes, the difference between the best and the 10th best is often only a fraction. If the 10th best takes the drug, he becomes the best overnight."
Improving the performance of athletes was not what researchers had in mind when they developed the genetically engineered version of EPO.
It was originally approved by the U.S. Food and Drug Administration last June for the treatment of patients suffering kidney failure, which causes them to lose red blood cells.
But it has proved immensely useful to many others as well, including Acquired Immune Deficiency Syndrome patients with anemia caused by the drug AZT and those with rheumatoid arthritis.
The drug, first produced by the California biotechnology company, Amgen, has far exceeded its clinical expectations, despite costing about $5,000 to $10,000 for a year's treatment.
But its usefulness to athletes poses several potential problems.
It is unclear, for example, what side effects, if any, EPO would cause in a person taking it in large quantities. The 30 people in Ekblom's trial, 15 on the drug and 15 on a placebo, took such small amounts that no side effects were detected.
But at much larger doses the drug could cause the blood to become too thick with red cells, experts say.
At doses 10 times as high as he has tested, Ekblom said, it could cause strokes or heart attacks. Indeed, over the past two years seven bicycle racers from the Netherlands have died during races or after completing them.
Last month, the Royal Dutch Cycling Federation announced an investigation into "possible stimulant abuse among many of those who died," and EPO is among the chief suspects.
There is little some athletes won't try to improve their performance. Blood doping was so common before it was banned by the International Olympic Committee and other groups that as many as half the U.S. cyclists on 1984's Olympic team admitted doing it.
Perhaps it is no coincidence that so many of them won medals for the first time in U.S.-cycling history.
But blood doping may have been the most benign way athletes abused their bodies to win.
When Ben Johnson had to return the gold medal he won in the 1988 Olympics after steroids were found in his blood, most observers of the sport said he was far from unusual.
Estimates and published studies of high school and college athletes suggested that up to one-third of those who compete have used steroids to build their muscles and bolster their endurance.
But use of EPO, because it is a natural hormone manufactured by the body, poses a new challenge to sports officials and scientists seeking to detect it.
Because it is a drug legally on the market - unlike many of the steroids used by athletes - it is easy to obtain. Any doctor can write a prescription for any drug approved by the Food and Drug Administration.
Detection will be tricky and may require extremely expensive tests.
Ekblom says that he is close to perfecting a test, but says that it "will be sensitive enough to detect what company actually made the EPO a person has used."
That suggests the test will rely on expensive, state-of-the-art analytic methods which would cost far more to administer than all other drug tests combined.
The question is whether some effective form of regulation can be devised before EPO does what Ekblom fears - ruins athletics.
by CNB