http://www.bikemagic.com/news/article/mps/uan/189
Epo may be out in the open but now a new doping controversy is brewing. Pfc — Artificial blood — can carry 50 times more oxygen than real blood and It's undetectable. but for cyclists, it may be lethal.
story: ian austen.
The post-EPO era in cycling began late in spring last year, on a back road in the Swiss canton of Ticino, when Mauro Gianetti slipped out of the back of the bunch in the Tour of Romandie and waved for the race ambulance. Gianetti was to spend the next fortnight fighting for his life in intensive care in hospital in Lausanne.
This was the event that brought perfluoro-carbon (PFC) to the notice of the cycling authorities. Gianetti is currently suing a Swiss doctor who treated him in the Lausanne hospital to which he was taken, over allegations that the drug was responsible for his illness. Gianetti himself blames a combination of stomach trouble and dehydration.
Whatever the truth of those particular allegations, the fact is that only a few days later, at the start of the Giro d'Italia in Nice, the Union Cycliste Internationale issued a letter to all the teams taking part warning them of the dangers of using PFC.
The Gianetti controversy was largely forgotten for the next couple of months, only to resurface in the Tour de France. It was then that the French press began talking to the men who had treated the Swiss rider - and they remained adamant, despite Gianetti's denials, that his illness was due to the use of the new drug.
Others maintained that Johan Museeuw's illness after his crash in Paris-Roubaix last year was due to use of PFC. The 1996 world champion was adamant in his denial.
So no-one knows for sure whether PFC is being used by professional cyclists. There was, though, the same kind of uncertainty with EPO until last July: that episode proved once again that in the fight against drugs in sport, the cheats are always one step ahead of the authorities.
Just as the 1998 Tour de France doping scandal is finally forcing the development of effective measures against EPO and other cloned hormones, PFC is just one of a whole new range of products that may soon make EPO and its ilk passé.
The new drugs, known as 'artificial blood', offer those seeking an illicit edge all the performance enhancement of EPO without the lag time, and at lower cost. Unfortunately, the potential for health problems among top athletes is equally dramatic.
Human experiments for legitimate uses of one blood substitute, made by the American drug giant Baxter, resulted in an unexpected number of unexplained deaths - despite careful supervision and supporting research.
The recent scares over blood tainted by HIV, CJD and other potentially devastating diseases have sparked a rush by drug companies to create a new form of the most vital of bodily fluids.
Without exception, all the substitutes so far in production perform the one task that is vital for performance enhancement - they deliver oxygen quickly to oxygen-starved muscles. None of them, though, are ambitious or inventive enough to attempt to recreate all the other vital functions of blood, including disease suppression and clotting.
Whatever the performance benefits, squirting fake blood into the veins of cyclists whose bodies are already under enormous stress would seem to be irresponsible in the extreme.
To date, only one blood substitute - PFC, the substance Gianetti is accused of using - has attracted any substantial notice in the cycling world. Gianetti spent the best part of a month in hospital after his initial scare, and only came back to racing late in the season. PFC is also the only fake blood that has so far received full approval for use on humans. Even so Dr Laurent Rivier, head of the Institute of Legal Medicine at the University of Lausanne, Switzerland's IOC-approved anti-doping lab, thinks PFC might be a waste of time and money for its illicit users. "The riders will not tell us why they use it," says Dr Rivier. "I am very doubtful of its value."
At first glance, PFC looks like a doper's dream. To start with, it can carry 50 times more oxygen than real blood in some circumstances. Mind-bogglingly, that means you can fill a beaker with oxygenated PFC, drop a mouse in it, and the mouse will stay alive even after its lungs have filled with the liquid.
Detection of PFC using current anti-doping controls is also impossible. It's expelled from the body by breathing rather than being passed in urine, and its use has no impact on red blood cell or haematocrit levels - the current, unsatisfactory, indicator used by the UCI to monitor EPO use.
But there is, of course, a catch. PFC is a chemical cousin of Teflon, that slippery substance used in non-stick frying pans and chain lubricants. So while that swimming mouse may not drown while paddling in the beaker, it might not come out in the best of health.
PFC has been transformed into synthetic blood to try to get around that problem, through some chemical manipulations and a degree of control over the level of exposure that users are subject to.
Generally, PFC can only be safely used for a couple of hours in relatively small quantities, usually between 500ml and one litre. Yet that strips away much of its dramatic oxygen-carrying power.
Patients using Fluosol, a brand of PFC approved for use during heart surgery, must also breath pure oxygen during surgery. Most doctors found that process so awkward that the product was pulled from the market because of poor sales in 1994.
Extra oxygen is also likely to be required for users of Oxycyte, an improved version of PFC that's likely to undergo human tests this year. Obviously, riders are unlikely to strap on cylinders of oxygen before heading out to sign on. And that's why Dr Rivier is sceptical about the value of PFC for abuse in sport. Either its abusers are taking dangerous doses or they're wasting their money.
"If this is something that is being used," says Dr Rivier, "it is still very rare." Nevertheless, Dr Rivier's lab, as well as the IOC's approved facility in Montreal, are developing methods to detect PFC.
Looking for a pure synthetic like PFC should be far easier than detecting cloned EPO, which is largely indistinguishable from that produced naturally by the body. By contrast, says Dr Rivier, "the body does not produce PFC, so far as we know."
Instead, his chief frustration is the agreement between riders and the UCI, preventing his lab from testing riders' blood for anything other than haematocrit levels and other EPO-related indicators - the infamous 50 per cent test. "We need to get access," says Dr Rivier pointedly. That may be coming. But it might, in any case, ultimately be irrelevant. The other major approach to artificial blood, which is nearing the market, may make PFC obsolete even before it catches on.
At least four companies are chasing a new plan that's compellingly simple: purified haemoglobin.
Haemoglobin molecules within red blood cells deliver oxygen throughout the body. As long ago as the early '80s, a US military project managed to remove pure haemoglobin from the red cells. But only now has a way of safely reintroducing modified haemoglobin into the bloodstream been devised.
The new development has given rise to several new products; three are currently undergoing tests on humans. They are packed into the same kind of intravenous bags now used for regular blood, and are administered in much the same way.
Best of all for both legitimate and illegitimate users, they are the height of convenience. A rider with a low haematocrit count could raise it instantly with an infusion - like adding oil to a car engine.
By comparison, EPO abuse is an extremely long and complicated process. Because the hormone only stimulates natural red cell production, it must be injected up to two weeks before competition. And, if deadly blood thickening is to be avoided, dosages have to be calculated using a formula based on body weight and a rider's programme.
As with any new product that has doping-abuse potential, the big question on modified haemoglobin is whether top athletes are actually using it. Privately, a top executive at one of the modified haematocrit makers acknowledges that there's great potential for abuse of his product by athletes. But Dr Rivier simply doesn't know what, if anything, is happening.