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NCT Number: NCT04227665

Identifying Biological Markers for Altitude Exposure and Use of Recombinant Human Erythropoietin (rHuEPO)

The project represents a well powered study of the human response to altitude exposure combined with rHuEPO treatment. A total of 20 male and 20 female non-competing athletes will participate. The participants will be exposed to a period of hypobaric hypoxia at 2.320 m for four weeks and a sea-level intervention period of four weeks. The participants will be blinded and randomly allocated to intra venous injection with 20 IU per kg body weight of recombinant human erythropoietin or placebo every second day for the initial three weeks of each intervention. Included subjects will be runners due to the good possibility of recruitment and conduction of training at altitude. Samples are collected weekly for four weeks prior to each intervention period, during the four week intervention and four weeks after. This approach yields a highly valuable biobank for identification of markers sensitive to initiation of rHuEPO injections as well as termination of injections.

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Key information

Conditions

Age range

18 year–35 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

University of Copenhagen

Copenhagen, Copenhagen Ø, 2200, Denmark

About this study

The main hypothesis for this study is that metabolomics and proteomics methods can identify biomarkers that are sensitive to altitude exposure and recombinant human erythropoietin treatment, respectively. Secondarily, the hypothesis is that the identified biomarkers can distinguish between altitude exposure and abuse of rHuEPO.

We will include 20 Danish men and 20 Danish women aged 18-35 years. The inclusion criteria are a maximum oxygen uptake rate (VO2max) > 48 ml / kg / min for men and > 43 ml / kg / min for women. All trial participants must have > 2 years of history in regular exercise including running (> 2 times a week; > 30 min per session) and capable of performing a 5 km run in 22 min for men and 25 min for women at sea level on a level surface in dry conditions and a temperature between 10 and 20 degrees C. Furthermore, the participants must not have experienced running related injuries within the past two years.

The experimental protocol consists of two experimental periods, both of which must be performed by all participants. Both periods contain a baseline period of four weeks followed by four weeks training camp and four weeks follow up. The training camp in one period of experiments is performed at sea level while the training camp in the other period is performed at 2320 m above sea level. Each period is separated by a minimum of two months to ensure that the participants have returned to baseline values. During the two intervention periods, the participants will be transported by air and car to the destination of the respective training camp. It is expected that the participants train for 1-2 hours a day on average and that the time spent for the measurements described is ~ 5-7 hours a week.

To investigate whether the described methods can identify sensitive biomarkers for the physiological response due to rHuEPO treatment, the participants will be treated with rHuEPO.

The distribution of participants allows the following:

  • 28 participants receive rHuEPO at sea level, thereby identifying biomarkers sensitive for use of rHuEPO
  • 28 participants receive placebo under altitude exposure, whereby biomarkers sensitive to altitude exposure can be identified
  • 12 participants receive placebo at sea level, whereby random fluctuations of the identified biomarkers can be determined.
  • 12 participants receive rHuEPO under altitude exposure, whereby the identified rhuEPO biomarkers and altitude exposure can be tested for whether they can be used to separate individuals receiving rHuEPO under altitude exposure from individuals receiving placebo under altitude exposure.
  • 8 participants receive placebo at sea level and altitude exposure, whereby natural and random individual fluctuations can be determined over a longer period (> 6 months). Since random individual fluctuations can be determined at n = 1, n = 8 will be sufficient to determine this.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Male: VO2max > 48 ml/min/kg bodyweight and 5km run < 22 min, Female: VO2max > 43ml/min/kg bodyweight and 5km run < 25 min A minimum of 2 years injury running training

Exclusion criteria

  • Age, insufficient fitness or injury

Treatment and study plan

Sea level

Other

Sea level exposure / sea level exposure combined with microdoses of rHuEPO

Altitude

Other

Altitude exposure / altitude exposure Iron metabolism

Primary outcomes

  1. Identification of metabolites in urine for rHuEPO and altitude exposure

    Time frame: 5 years

    Urine is analyzed by metabolomics and the metabolites for rHuEPO and altitude are verified using an exploratory design.

    More specifically, the aim is to identify the resulting metabolites from altitude exposure and treatment with rHuEPO as these are not yet known In this WADA-supported research project, the aim is to identify high sensitivity biomarkers for altitude exposure through a metabolomics methods, as 'omics' methods have previously shown promising results in other exposure contexts. However, being the first of its kind in antidoping the resulting metabolites from rHuEPO misuse and altitude have not yet been identified. Thus, an exact description of these is not possible

  2. Identification of human metabolites in serum for rHuEPO and altitude exposure

    Time frame: 5 years

    Human serum is analyzed by metabolomics and the metabolites for rHuEPO and altitude are verified using an exploratory design.

Secondary outcomes

  1. Reticulocyte percentage

    Time frame: Up to 24 weeks

    Reticulocyte percentage, will be measured to determine variation as a result of either 12 weeks exposure to altitude or sea-level (24 weeks in total).

  2. Hemoglobin concentration

    Time frame: Up to 24 weeks

    [hemoglobin] will be measured to determine variation as a result of either 12 weeks exposure to altitude or sea-level.

  3. OFF-score

    Time frame: Up to 24 weeks

    OFF-score (computed from reticulocyte perscentage and hemoglobin concentration), will be measured to determine variation as a result of either 12 weeks exposure to altitude or sea-level.

  4. Maximal oxygen uptake (VO2max)

    Time frame: Up to 24 weeks

    VO2max (ml/min) measured by incremental work load on a treadmill

  5. Iron metabolism

    Time frame: Up to 24 weeks

    Markers of iron metabolism such as hepcidin and erythroferrone are collected analyzed for evaluation of iron metabolism during and after a training camp at 2300m above sea level

  6. Work economy

    Time frame: Up to 24 weeks

    Running efficiency (%) measured by energy expenditure on a treadmill

  7. Sustainable workload

    Time frame: Up to 24 weeks

    Lactate threshold (mmol/L) measured on a treadmill

  8. Running performance

    Time frame: Up to 24 weeks

    5000m time trial performance (time) measured on a 400m running track

  9. Muscle oxygenation

    Time frame: Up to 24 weeks

    Muscle oxygenation measured by near-infrared spectroscopy during running on a treadmill

  10. Total hemoglobin mass

    Time frame: Up to 24 weeks

    Total hemoglobin mass will be measured by two-minute carbon-monoxide re-breathing to determine variation as a result of either 12 weeks exposure to altitude or sea-level.

Sponsors and collaborators

Lead sponsor

University of Copenhagen

Other

Collaborators

  • German Sport University, Cologne
  • Oslo University Hospital
  • Universidad de Granada
  • World Anti-Doping Agency

Registry information

Official study title

Identification of Biological Markers for Hypoxic Exposure and Use of Recombinant Human Erythropoietin

Important dates

Study start
2018
Primary completion
2019
Study completion
2027
First posted
Jan 14, 2020
Registry last updated
May 5, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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