Circulating hematopoietic stem cells (cHSC) in elite athletes: an antidoping perspective.

Hematopoietic stem cells (HSC) are multipotent progenitor cells, resident primarily in human bone marrow. Their main function is the continuous renewal of all hematopoietic cells. A small fraction of HSC is also circulating in peripheral blood (cHSC) where they can be possibly detected thanks to the application of the new very sensitive flow cytometry methodologies. In recent times it has been debated whether the utilization of several different types of stem cells can be abused by athletes for doping purposes. Moreover, there is growing knowledge that the dynamic and turnover of circulating HSC may reflect changes affecting the physiologic processes at the erythropoietic level; also, cHSC and other circulating hematopoietic progenitors (cHP) resulted to give different responses in athletes engaged in endurance and maximal exercise sports. If it is true that the use of stem cells (mainly mesenchymal stem cells) to allow a rapid recover from an injury is not considered a doping practice, it is also true that the 2022 WADA list of prohibited substances and methods forbids "the use of normal or genetically modified cells" as well as "any form of intravascular manipulation of the blood or blood components by physical or chemical means". In this context, HSC and hematopoietic erythroid progenitors may be a potential threat and the possibility of their abuse needs to be exploited in sport antidoping. In view of the above, we have preliminarily assessed the possibility of detecting circulating hematopoietic stem cells by flow cytofluorimetry. In details, we applied two flow cytofluorimetric protocols for the accurate and precise counting of circulating HSC, also discussing the potential applicability in a potential antidoping scenario. We concluded that i) flow cytofluorimetry is a pratical and rapid platform for the identification and the counting of cHSC and other erythroid progenitors in peripheral human whole blood, ii) the correlation between CD34+ circulating progenitors and standard haematological parameters may be an effective new tool to be exploited as in direct markers of blood doping and, iii) accurate baseline levels of HSC and erythroid progenitors need to be determined in order to identify abuses of HSC and/or conventional blood doping.