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The Explainer: Blood doping’s Achilles’ heel?

A reader wonders how and if there might ever be a test for autologous blood doping.

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Oh, Riccò, you're so fine ... in 2008, before being booted from the Tour de France.

Q. Dear Explainer,
I’ve been following cycling for years and, unfortunately, that means that I have learned more about doping than I ever cared to. While most of the world has been focused on EPO users and riders that use blood transfusions and have been caught, we rarely hear about guys who store and reinject their own blood.

Are they ever going to get a test for that?

― Andrew

A. Dear Andrew,
Admittedly it’s a heck of a lot harder to test for an athlete’s own blood than it is to test for someone else’s blood coursing through their veins.

As you probably recall, the test for the presence of other peoples’ blood has been around for a while. It was back in 2004 that testers applied an already established technology — flow cytometry — to test for the presence of a secondary population of red blood cells. Homologous blood doping — the injection of red blood cells from another person — is relatively easy to detect. Blood cells from different people have distinctly different antigen receptors and those can be distinguished when blood samples are exposed to antigens that have been treated with a fluorescent dye. Exposed to a laser beam, individual cells emit different light patterns and a full analysis can show those differences and give a fairly accurate accounting of how many of those cells didn’t originate in your own body.

Obviously, that technique can’t be used to distinguish whether you might be walking around with a bunch of your own blood that you might have extracted and stored three months ago. But storage is the weak link in that process.

It’s all about the storage

To restate the obvious, the only way you can derive a benefit from autologous blood doping is to extract and store your blood and then wait for your body to recover the cells you lost. It wouldn’t do you much good, for example, to extract blood on Monday and reinject it on Tuesday.

So, you have to store what you take out. There are obvious — and not-so-obvious — risks with that. You might remember the rather amateurish efforts by Riccardo “the refrigerator” Riccò, who found himself in the emergency room after allegedly reinjecting blood he’d been storing next to the pesto in the icebox at home. Yup, and he nearly died from that one. So, in doping — as in all aspects of life — boneheaded stupidity can be a major risk.

While not a lot has come from the case, Spain’s Operación Puerto investigation showed that even relying on the services of a professional poses at least a legal hazard to the autologous cheat. Investigators seized more than 100 stored blood bags in raids on the home and offices of Madrid-based gynecologist Eufemiano Fuentes. The two most notable catches in that case were Jan Ullrich and Ivan Basso, both of whom were tied to individual bags of blood through DNA testing.

Last year, there was also some preliminary work done on the development of a test to detect the presence of plasticizers in blood, which might indicate that the athlete had reinjected blood that had been stored in plastic bags. There have been some problems in applying that test, though, since many of us are regularly exposed to phthalates, the industrial chemical used to soften plastics.

But let’s assume for the moment that a significant majority of those cheating by means of autologous blood doping are relying on the services of a professional, that professional is not the target of a police investigation and has learned about the wonders of storing blood in glass containers. Now the testers have a problem, right? Well, not so fast.

It is beginning to look like storage may offer yet another clue. Last month, David Cowan, the man pegged to head up the anti-doping effort at next year’s Olympic Games in London, told an audience at the British Science Festival in Bradford, England, that he is close to developing a test for autologous blood doping.

Cowan, who is also the tester calling for uniformity in tests and standards for clenbuterol, said the test will focus on the degradation of Ribonucleic Acid (RNA) in blood that has been stored.

It’s way beyond my grasp of the science behind the technique, but I believe that Cowan is attempting to measure FOS (genes that encode leucine zipper proteins) and IL1B gene transcription levels in messenger RNA. Apparently, there are detectable changes in both when blood is stored for extended periods. Most of the studies I’ve read on the topic tend to focus on blood stored for periods of a year or more. There is one ongoing study involving blood that has been stored for the past five years and will continue until the samples are 10 years old. Cowan believes that he can zero in on those changes, even in blood that has been stored for just a few months.

Yeah, I don’t fully understand it, either, and Cowan was less-than-specific about his work when he spoke in Bradford. He did say he’s going to be working on the test for the months leading up to the Games, adding that his talk was essentially “a warning shot” across the collective bows of potential drug cheats.

Indeed, the threat of a test may actually accomplish the same result, since there are few things more embarrassing than to have that picture of yourself biting a gold medal splashed across news stories about how you’ve been stripped of that very same medal when lab results come back.

If you couple that test — or the threat — with the UCI’s Biological Passport program, Cowan may be right when characterizing the upcoming Olympics as “the riskiest ever” for potential cheats.

Let’s hope he’s right.

One thing is becoming clear. Back in the day, the old adage was that there was a constant race between cheaters and testers and the cheaters were always one step ahead of the testers. That was largely due to the fact that the benefits of doping outweighed the risks, because there was a helluva lot more money in cheating than there was in testing. Well, it’s been more than 12 years since the idea of the World Anti-Doping Agency was hatched at the 1999 World Conference on Doping in Sport in Lausanne, Switzerland. That conference also triggered an infusion of cash and grant monies into the work of detection. It’s a much tighter race and I sense that the testers may finally be in the lead. Chapeau!
― Charles


In my column dated September 22, I suggested that a Therapeutic Use Exemption is required for Beta2-agonists like salbutamol, which are used to treat the symptoms of asthma, a disease which affects a remarkably large number of cyclists.

Within an hour or two of posting that story, I received a note from my old friend, Prentice Steffen, the team doctor at Garmin-Cervélo, pointing out that I may have been working with old information.

“A TUE is no longer required for the inhaled beta-agonists salbutamol and salmeterol,” Steffen noted. “I understand formoterol is being added to that short list for 2012. Not even a DOU is required. Simply declaring when tested. Same for inhaled corticos which bothers a lot of people, myself included to some extent.”

Thanks, doc. I stand corrected … and a little disappointed that those rules have been loosened up.

Oh, and one more thing …

It was never my intention to turn The Explainer into a steady stream of columns about doping, doping rules and dopers. We’ve covered a lot of topics over the years, including occasional looks at the history of the sport, immigration issues, insurance questions and, of course, my favorite topic: drunk, stupid and insane drivers. While doping is admittedly an area of interest and the bulk of the questions I have received lately have focused on the subject, I welcome your questions about any topic related to the sport and cycling in general and especially those not related to drug use.

Like our hope for cycling in general, maybe we can get off the dope for a while and discuss other topics of interest (well, at least until the Contador decision comes down or there are indictments issued from that grand jury in Los Angeles).

If you have any comments, suggestions or questions even peripherally related to cycling, drop me a line at I welcome your emails and will do my best to answer your questions, either in a future column or directly.
― Charles