Advances in Analytical Methods for Erythropoietin Identification: From Clinical Use to Anti-Doping Applications
From Clinical Use to Anti-Doping Applications
DOI:
https://doi.org/10.22456/2527-2616.151882Keywords:
Erythropoietin, doping, analytical methodsAbstract
Erythropoietin (EPO) is an endogenous glycoprotein essential for erythropoiesis regulation and is produced mainly by the kidneys and to a lesser extent by the liver. Its synthesis is stimulated by hypoxia and regulated by a complex feedback system. Endogenous EPO has 165 amino acids and plays a critical role in the survival, proliferation, and differentiation of erythroid progenitor cells through intracellular signaling pathways such as JAK2/STAT5, MAPK/ERK, and PI3K/AKT. Recombinant erythropoietin (rhEPO), produced in CHO cells using recombinant DNA technology, share the structure and biological activity of endogenous EPO and is widely used to treat anemia associated with chronic kidney disease, chemotherapy, chronic inflammatory diseases, and HIV/AIDS. It is also administered in elective surgery to reduce transfusion needs. However, rhEPO is misused in sports doping because it increases red blood cells, enhances oxygen delivery and physical performance. This misuse is common in endurance sports and presents technical, ethical, and medical concerns. To address this, analytical methods—including isoelectric focusing, SDS-PAGE, and isoform profiling—have been developed to detect exogenous EPO. Nevertheless, these techniques still face challenges related to sensitivity, microheterogeneity, and overlapping between endogenous and recombinant forms. This work reviews the biochemical, clinical, and technological aspects of erythropoietin, emphasizing analytical strategies for its detection, therapeutic applications, and ongoing challenges in anti-doping contexts.
Downloads
References
Lacerda L, Marques C, Zuanazzi C. Eritropoetina: breve revisão, doping e estatística. EFDeportes. 134, 2009. Available from: https://www.efdeportes.com/efd134/eritropoetina-breve-revisao-doping-e- estatistica.htm.
Marieb EN, Hoehn K. Anatomy & Physiology. 6 ed. Benjamin-Cummings Publishing Company, f. 524, 2004. 1048 p.
Elliott S, Pham E, Macdougall IC. Erythropoietins: a common mechanism of action. Exp Hematol. 2008; 36: 1573-1584. DOI: https://doi.org/10.1016/j.exphem.2008.08.003
Zago MA. Tratado de Hematologia. 1 ed. Atheneu, 2013. 924 p.
Tóthová Z, Šemeláková M, Solárová Z, Tomc J, Debeljak N, Solár P. The role of PI3K/AKT and MAPK signaling pathways in erythropoietin signalization. Int J Mol Sci. 2021; 22: 7682. DOI: https://doi.org/10.3390/ijms22147682
Reinhart D. Bioprocessing of recombinant CHO-K1, CHO-DG44, and CHO-S: CHO expression hosts favor either mAb production or biomass synthesis. Biotechnol J. 2019; 14: e1700686. DOI: https://doi.org/10.1002/biot.201700686
Schmidt CA, Ramos AS, da Silva JEP, Fronza M, Dalmora SL. Avaliação da atividade e caracterização de eritropoietina humana recombinante em produtos farmacêuticos. Arq Bras Endocrinol Metab. 2003; 47: 183-189. DOI: https://doi.org/10.1590/S0004-27302003000200012
Hanna RM, Streja E, Kalantar-Zadeh K. Burden of anemia in chronic kidney disease: beyond erythropoietin. Adv Ther. 2020; 38: 52–75. DOI: https://doi.org/10.1007/s12325-020-01524-6
Obeagu EI, Obeagu GU. Anemia and erythropoietin in HIV: a multifaceted review. Haematol Int J. 2024; 8: 00244. DOI: https://doi.org/10.23880/hij-16000244
Spahn DR, Schoenrath F, Spahn GH, Seifert B, Stein P, Theusinger OM, Kaserer A, Hegemann I, Hofmann A, Maisano F, Falk V. Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery: a prospective randomised trial. Lancet 2019; 393: 2201-2212. DOI: https://doi.org/10.1016/S0140-6736(18)32555-8
Colomina MJ, Bagó J, Pellisé F, Godet C, Villanueva C. Preoperative erythropoietin in spine surgery. Eur Spine J. 2004; 13: S40–S49. DOI: https://doi.org/10.1007/s00586-004-0754-9
Hirata A, Minamino T, Asanuma H, Sanada S, Fujita M, Tsukamoto O, Wakeno M, Myoishi M, Okada KI, Koyama H, Komamura K, Takashima S, Shinozaki Y, Mori H, Tomoike H, Hori M, Kitakaze M. Erythropoietin just before reperfusion reduces both lethal arrhythmias and infarct size via the phosphatidylinositol-3 kinase-dependent pathway in canine hearts. Cardiovasc Drugs Ther. 2005; 19: 33-40. DOI: https://doi.org/10.1007/s10557-005-6895-1
Brines M, Ghezzi P, Keenan S, Agnello D, de Lanerolle NC, Cerami C, Itri LM, Cerami A. Erythropoietin crosses the blood–brain barrier to protect against experimental brain injury. Proc Natl Acad Sci USA. 2000; 97: 10526-10531. DOI: https://doi.org/10.1073/pnas.97.19.10526
Zhou S, Murphy JE, Escobedo JA, Dwarki VJ. Adeno-associated virus-mediated delivery of erythropoietin leads to sustained elevation of hematocrit in nonhuman primates. Gene Ther. 1998; 5: 665–670. DOI: https://doi.org/10.1038/sj.gt.3300648
Chenuaud P, Larcher T, Rabinowitz JE, Provost N, Cherel Y, Casadevall N, Samulski RJ, Moullier P. Autoimmune anemia in macaques following erythropoietin gene therapy. Blood. 2004; 103: 3303-3304. DOI: https://doi.org/10.1182/blood-2003-11-3845
Silva P. Farmacologia. 7 ed. Guanabara Koogan, 2006. 1369 p.
Artioli G, Hirata R, Lancha-Junior AH. Terapia gênica, doping genético e esporte: fundamentação e implicações para o futuro. Rev Bras Med Esporte. 2007; 13: 349-354. DOI: https://doi.org/10.1590/S1517-86922007000500013
Santhanam A, d'Úscio LV, Zvonimir K. Cardiovascular effects of erythropoietin an update. Adv Pharmacol. 2010; 60: 257-285. DOI: https://doi.org/10.1016/B978-0-12-385061-4.00009-X
Casadevall N, Nataf J, Viron B, Kolta A, Kiladjian JJ, Martin-Dupont P, Michaud P, Papo T, Ugo V, Teyssandier I, Varet B, Mayeuxet P. Pure red-cell aplasia and antierythropoietin antibodies in patients treated with recombinant erythropoietin. N Engl J Med. 2002; 14; 346: 469-75. DOI: https://doi.org/10.1056/NEJMoa011931
Guan X, Chen L. Role of erythropoietin in cancer-related anaemia: a double-edged sword? J Int Med Res. 2008; 36: 1-8. DOI: https://doi.org/10.1177/147323000803600101
Bohlius J, Schmidlin K, Brillant C, Schwarzer G, Trelle S, Seidenfeld J, Zwahlen M, Clarke M, Weingart O, Kluge S, Piper M, Rades D, Steensma DP, Djulbegovic B, Fey MF, Ray-Coquard I, Machtay M, Moebus V, Thomas G, Untch M, Schumacher M, Egger M, Engert A. Recombinant human erythropoiesis-stimulating agents and mortality in patients with cancer: a meta-analysis of randomised trials. Lancet. 2009; 373: 1532-42. DOI: https://doi.org/10.1016/S0140-6736(09)60502-X
Liu L, Li H, Hamilton SR, Gomathinayagam S, Rayfield WJ, van Maanen M, Yin KC, Hong L, Prueksaritanont T. The impact of sialic acids on the pharmacokinetics of a PEGylated erythropoietin. J Pharm Sci. 2012; 101: 4414-4418. DOI: https://doi.org/10.1002/jps.23320
Krzyzanski W, Wyska E. Pharmacokinetics and pharmacodynamics of erythropoietin receptor in healthy volunteers. Naunyn Schmiedebergs Arch Pharmacol. 2008; 377: 637-645. DOI: https://doi.org/10.1007/s00210-007-0225-z
Locatelli F, Del Vecchio L. Erythropoiesis stimulating agents in renal medicine. The Oncologist. 16; S3: 19–24. DOI: https://doi.org/10.1634/theoncologist.2011-S3-19
World Anti-Doping Agency. WADA The Prohibited List. 2024. Available at: https://www.wada-ama.org/en.
UOL. Senado francês revela que 3 primeiros da Volta da França de 1998 estavam dopadoS. Disponível em: Senado francês revela que 3 primeiros da Volta da França de 1998 estavam dopados. 2013. Available at: https://www.uol.com.br/esporte/ciclismo/ultimas-noticias/2013/07/24/senado-frances-revela-que-3-primeiros-da-volta-da-franca-de-1998-estavam-dopados.htm.
Roan D. Banido do ciclismo por doping, Lance Armstrong diz: 'Faria tudo de novo'. BBC Brasil. 2015. Available at: https://www.bbc.com/portuguese/noticias/2015/01/150126_lance_armstrong_entrevis ta_rm.
Lasne F, Martin L, Crepin N, de Ceaurriz J. Detection of isoelectric profiles of erythropoietin in urine: differentiation of natural and administered recombinant hormones. Anal Biochem. 2002; 311: 119-126. DOI: https://doi.org/10.1016/S0003-2697(02)00407-4
Bento RMA, Damasceno LMP, Aquino Neto FR. Recombinant human erythropoietin in sports: a review. Rev Bras Med Esporte. 2003; 9: 181-190. DOI: https://doi.org/10.1590/S1517-86922003000300006
Beullens M, Delanghe JR, Bollen M. False-positive detection of recombinant human erythropoietin in urine following strenuous physical exercise. Blood. 2006; 107: 4711-4713. DOI: https://doi.org/10.1182/blood-2006-01-0028
DEMEDITEC DIAGNOSTICS GMBH. Enzyme immunoassay for the quantitative determination of Erythropoietin (EPO) in human serum. Available at: https://www.demeditec.com/en/products/epo-erythropoietin-elisa-de3646.
Kohler M, Ayotte C, Desharnais P, Flenker U, Lüdke S, Thevis M, Völker-Schänzer E, Schänzer W. Discrimination of recombinant and endogenous urinary erythropoietin by calculating relative mobility values from SDS gels. Int J Sports Med. 2008; 29: 1-6. DOI: https://doi.org/10.1055/s-2007-989369
Bagué JM. Detection of recombinant human erythropoietin and analogues through immunorecognition and N-glycolyl-neuraminic acid identification [Thesis]. Barcelona (CT): Pompeu Fabra University; 2011.
Reichel C. Recent developments in doping testing for erythropoietin. Anal Bional Chem. 2011; 401: 463-81. DOI: https://doi.org/10.1007/s00216-011-5116-y
Reichel C, Gmeiner G. Erythropoietin and analogs. Handb Exp Pharmacol. 2010; 195: 251-294. DOI: https://doi.org/10.1007/978-3-540-79088-4_12
WADA Science. EPO Working Group. Harmonization of analysis and reporting of erythropoietin (EPO) receptor agonists (ERAs) and transforming growth factor-beta (TGF-β) signalling inhibitors by polyacrylamide gel electrophoretic (PAGE) analytical methods. 2024. Available at: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.wada-ama.org/sites/default/files/2024-03/td2024epo_eng_final.pdf.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Drug Analytical Research

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The Copyright holder of manuscripts published is Drug Analytical Research. Authors who publish with this journal are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Licensing:
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author.





