Abstract

The origins of blood transfusion go a long way back in time and have a touch of the legendary about them. In olden days, blood was taken in orally for therapeutic purposes and also used in a number of magical rites. The idea of transfusion was born when physicians noted that the intake of blood by mouth did not bring any benefit. Various studies were carried out from 1600 onwards aimed at discovering the characteristics of blood and techniques for effective transfusion. Important discoveries emerged from these studies like the existence of haemoglobin, erythropoietin and the development of a cell line capable of producing recombinant human erythropoietin (rHuEpo) in vitro. Erythropoietin is a glycoprotein synthesised in the adult by the kidney and, to a small extent, by the liver too and its blood levels can increase 100-1000 times in response to hypoxia. This is capable of activating a heterodimeric transcription factor, Hypoxia-Inducible Factor (HIF-1), which is moved to the nucleus by activating the expression of erythropoietin which stimulates the rapid expansion of the erythroid progenitors. Epo binds to its receptor (EPO-R) localised on the surface of the erythroid progenitors, thus determining its internalisation. The substance rHuEpo is produced for clinical purposes but has found illicit use in sporting events involving stamina where the demand for oxygen is high. Its illicit use is difficult to spot because of its short plasma half-life. Recent progress in genetics has opened up new and very interesting prospects for the treatment of certain pathologies by means of gene therapy, but the fear is that these discoveries will be used in sport to boost performance. Genetic doping has in fact already been added to the WADA list of forbidden methods even though tests for evaluating its surreptitious use are not yet available.