Products
EPO or rEPO is the name given to recombinant erythropoietin. Various epoetins are commercially available in many countries. Recombinant erythropoietin has been approved as a drug since 1988.
Structure and properties
EPO is a recombinant glycoprotein with a molecular weight of approximately 30 kDa produced by biotechnological methods. It is composed of 165 amino acids and has the same sequence as the natural peptide hormone produced primarily in the kidney and in smaller amounts in the liver. Biosynthesis is stimulated when there is an oxygen deficiency, hypoxia. The various recombinant epoetins differ in their glycosylation pattern, that is, the sugar residues on the protein.
Effects
EPO (ATC B03XA) stimulates the formation of red blood cells in the bone marrow. It thus increases the oxygen-carrying capacity of the blood and the supply of oxygen to the muscle. At the same time, more carbon dioxide is removed. As a doping agent, EPO promotes fitness, physical endurance and shortens the recovery phase. It has a relatively short half-life of about 8 to 24 hours. It depends on the method of application.
Indications
For the treatment of anemia of various causes (including chronic renal failure, tumor patients undergoing chemotherapy, prior to surgery with autologous blood donation, HIV).
Dosage
According to the SmPC. The drug administered either intravenously or subcutaneously.
Abuse as a doping agent
EPO became known to a wide public in the 1990s because it was abused as a doping agent by numerous athletes in professional cycling. The best-known EPO user is American Lance Armstrong, the seven-time winner of the Tour de France and – as it later turned out – the biggest cheater in sports history. He had doped himself at every Tour. In 1998, the entire Festina team was banned from the Tour de France for systematically doping with EPO. Swiss rider Alex Zülle was also affected at the time. EPO has been banned in professional sports since 1990, both outside and during competition. Since EPO is a hormone produced naturally in the body and recombinant EPO has the same amino acid sequence, analysis is difficult. In addition, EPO has a short half-life. Since 2000, EPO can be detected and this can also be done in urine. The direct method is based on the different glycosylation of the natural and the recombinant protein. Indirect detection is possible due to altered blood parameters (e.g. hematocrit, hemoglobin, reticulocytes, EPO concentration). Misuse is also not advised because of the potential adverse effects (see below).
Contraindications
For complete precautions, see the drug label.
Adverse effects
The most common possible adverse effects of recombinant EPO include diarrhea, nausea, vomiting, fever, headache, flu-like symptoms, skin rashes, and hypertension. Hypersensitivity reactions can occur and EPO increases the risk of thromboembolic events because it “thickens” the blood. These include heart attack, stroke, and pulmonary embolism.
