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Diaz-Garzon J, Itkonen O, Aarsand AK, Sandberg S, Coskun A, Carobene A, Jonker N, Bartlett WA, Buño A, Fernandez-Calle P. Biological variation of inflammatory and iron metabolism markers in high-endurance recreational athletes; are these markers useful for athlete monitoring? Clin Chem Lab Med 2024; 62:844-852. [PMID: 38062926 DOI: 10.1515/cclm-2023-1071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/21/2023] [Indexed: 04/05/2024]
Abstract
OBJECTIVES To deliver biological variation (BV) data for serum hepcidin, soluble transferrin receptor (sTfR), erythropoietin (EPO) and interleukin 6 (IL-6) in a population of well-characterized high-endurance athletes, and to evaluate the potential influence of exercise and health-related factors on the BV. METHODS Thirty triathletes (15 females) were sampled monthly (11 months). All samples were analyzed in duplicate and BV estimates were delivered by Bayesian and ANOVA methods. A linear mixed model was applied to study the effect of factors related to exercise, health, and sampling intervals on the BV estimates. RESULTS Within-subject BV estimates (CVI) were for hepcidin 51.9 % (95 % credibility interval 46.9-58.1), sTfR 10.3 % (8.8-12) and EPO 27.3 % (24.8-30.3). The mean concentrations were significantly different between sex, but CVI estimates were similar and not influenced by exercise, health-related factors, or sampling intervals. The data were homogeneously distributed for EPO but not for hepcidin or sTfR. IL-6 results were mostly below the limit of detection. Factors related to exercise, health, and sampling intervals did not influence the BV estimates. CONCLUSIONS This study provides, for the first time, BV data for EPO, derived from a cohort of well-characterized endurance athletes and indicates that EPO is a good candidate for athlete follow-up. The application of the Bayesian method to deliver BV data illustrates that for hepcidin and sTfR, BV data are heterogeneously distributed and using a mean BV estimate may not be appropriate when using BV data for laboratory and clinical applications.
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Affiliation(s)
- Jorge Diaz-Garzon
- Laboratory Medicine Department, La Paz University Hospital, Madrid, Spain
| | - Outi Itkonen
- Endocrinology and Metabolism Laboratory, Helsinki University Hospital, Helsinki, Finland
| | - Aasne K Aarsand
- Department of Medical Biochemistry and Pharmacology, Norwegian Porphyria Centre, Haukeland University Hospital, Bergen, Norway
- Norwegian Organization for Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- Department of Medical Biochemistry and Pharmacology, Norwegian Porphyria Centre, Haukeland University Hospital, Bergen, Norway
- Norwegian Organization for Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Abdurrahman Coskun
- Department of Medical Biochemistry Atasehir, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Türkiye
| | - Anna Carobene
- Laboratory Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Niels Jonker
- Certe, Wilhelmina Ziekenhuis Assen, Assen, The Netherlands
| | - William A Bartlett
- Undergraduate Teaching, School of Medicine, University of Dundee, Dundee, Scotland
| | - Antonio Buño
- Laboratory Medicine Department, La Paz University Hospital, Madrid, Spain
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2
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Krumm B, Saugy JJ, Botrè F, Donati F, Faiss R. Indirect biomarkers of blood doping: A systematic review. Drug Test Anal 2024; 16:49-64. [PMID: 37160638 DOI: 10.1002/dta.3514] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/13/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
The detection of blood doping represents a current major issue in sports and an ongoing challenge for antidoping research. Initially focusing on direct detection methods to identify a banned substance or its metabolites, the antidoping effort has been progressively complemented by indirect approaches. The longitudinal and individual monitoring of specific biomarkers aims to identify nonphysiological variations that may be related to doping practices. From this perspective, the identification of markers sensitive to erythropoiesis alteration is key in the screening of blood doping. The current Athlete Biological Passport implemented since 2009 is composed of 14 variables (including two primary markers, i.e., hemoglobin concentration and OFF score) for the hematological module to be used for indirect detection of blood doping. Nevertheless, research has continually proposed and investigated new markers sensitive to an alteration of the erythropoietic cascade and specific to blood doping. If multiple early markers have been identified (at the transcriptomic level) or developed directly in a diagnostics' kit (at a proteomic level), other target variables at the end of the erythropoietic process (linked with the red blood cell functions) may strengthen the hematological module in the future. Therefore, this review aims to provide a global systematic overview of the biomarkers considered to date in the indirect investigation of blood doping.
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Affiliation(s)
- Bastien Krumm
- REDs, Research & Expertise in AntiDoping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Jonas J Saugy
- REDs, Research & Expertise in AntiDoping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Francesco Botrè
- REDs, Research & Expertise in AntiDoping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Francesco Donati
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Raphael Faiss
- REDs, Research & Expertise in AntiDoping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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Breenfeldt Andersen A, Nordsborg NB, Bonne TC, Bejder J. Contemporary blood doping-Performance, mechanism, and detection. Scand J Med Sci Sports 2024; 34:e14243. [PMID: 36229224 DOI: 10.1111/sms.14243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 10/17/2022]
Abstract
Blood doping is prohibited for athletes but has been a well-described practice within endurance sports throughout the years. With improved direct and indirect detection methods, the practice has allegedly moved towards micro-dosing, that is, reducing the blood doping regime amplitude. This narrative review evaluates whether blood doping, specifically recombinant human erythropoietin (rhEpo) treatment and blood transfusions are performance-enhancing, the responsible mechanism as well as detection possibilities with a special emphasis on micro-dosing. In general, studies evaluating micro-doses of blood doping are limited. However, in randomized, double-blinded, placebo-controlled trials, three studies find that infusing as little as 130 ml red blood cells or injecting 9 IU × kg bw-1 rhEpo three times per week for 4 weeks improve endurance performance ~4%-6%. The responsible mechanism for a performance-enhancing effect following rhEpo or blood transfusions appear to be increased O2 -carrying capacity, which is accompanied by an increased muscular O2 extraction and likely increased blood flow to the working muscles, enabling the ability to sustain a higher exercise intensity for a given period. Blood doping in micro-doses challenges indirect detection by the Athlete Biological Passport, albeit it can identify ~20%-60% of the individuals depending on the sample timing. However, novel biomarkers are emerging, and some may provide additive value for detection of micro blood doping such as the immature reticulocytes or the iron regulatory hormones hepcidin and erythroferrone. Future studies should attempt to validate these biomarkers for implementation in real-world anti-doping efforts and continue the biomarker discovery.
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Affiliation(s)
- Andreas Breenfeldt Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, Section for Sport Science, Aarhus University, Aarhus, Denmark
| | | | - Thomas Christian Bonne
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Bejder
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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4
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Breenfeldt Andersen A, Bejder J, Bonne TC, Graae J, Seier S, Nordsborg NB. Changes in Immature Reticulocytes Aid the Indirect Detection of Microdose Recombinant Erythropoietin Use in Men and Women. Med Sci Sports Exerc 2023; 55:1695-1705. [PMID: 37095637 DOI: 10.1249/mss.0000000000003197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
PURPOSE We investigated whether immature reticulocyte fraction (IRF) and the immature reticulocytes to red blood cells ratio (IR/RBC) are sensitive and specific biomarkers for microdose recombinant human erythropoietin (rHuEPO) and whether the inclusion of reticulocyte percentage (RET%) and the algorithm "abnormal blood profile score (ABPS)" increased the athlete biological passport (ABP) sensitivity compared with hemoglobin concentration ([Hb]) and the OFF-hr score ([Hb]-60 × √RET%). METHODS Forty-eight (♀ = 24, ♂ = 24) participants completed a 2-wk baseline period followed by a 4-wk intervention period with three weekly intravenous injections of 9 IU·kg -1 ·bw -1 epoetin β (♀ = 12, ♂ = 12) or saline (0.9% NaCl, ♀ = 12, ♂ = 12) and a 10-d follow-up. Blood samples were collected weekly during baseline and intervention as well as 3, 5, and 10 d after treatment. RESULTS The rHuEPO treatment increased [Hb] (time-treatment, P < 0.001), RET% (time-treatment, P < 0.001), IRF (time-treatment, P < 0.001) and IR/RBC (time-treatment, P < 0.001). IRF and IR/RBC were up to ~58% ( P < 0.001) and ~141% ( P < 0.001) higher compared with placebo, and calculated thresholds provided a peak sensitivity across timepoints of 58% and 54% with ~98% specificity, respectively. To achieve >99% specificity for IRF and IR/RBC, sensitivity was reduced to 46% and 50%, respectively. Across all timepoints, the addition of RET% and ABPS to the ABP increased sensitivity from 29% to 46%. Identification of true-positive outliers obtained via the ABP and IRF and IR/RBC increased sensitivity across all timepoints to 79%. CONCLUSIONS In summary, IRF, IR/RBC, RET% and ABPS are sensitive and specific biomarkers for microdose rHuEPO in both men and women and complement the ABP.
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Affiliation(s)
| | - Jacob Bejder
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, DENMARK
| | | | - Jonathan Graae
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, DENMARK
| | - Søren Seier
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, DENMARK
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5
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Dragcevic D, Jaksic O. Blood doping — physiological background, substances and techniques used, current and future detection methods. Sci Sports 2023. [DOI: 10.1016/j.scispo.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Breenfeldt Andersen A, Graae J, Bejder J, Bonne TC, Seier S, Debertin M, Eibye K, Hostrup M, Nordsborg NB. Microdoses of Recombinant Human Erythropoietin Enhance Time Trial Performance in Trained Males and Females. Med Sci Sports Exerc 2023; 55:311-321. [PMID: 36317927 DOI: 10.1249/mss.0000000000003052] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE We investigated the effects of recombinant human erythropoietin (rHuEPO) administration on exercise endurance, maximal aerobic performance, and total hemoglobin mass (tHb). We hypothesized that frequent, small intravenous injections of epoetin β would increase time trial performance, peak oxygen uptake (V̇O 2peak ), and tHb in both males and females. METHODS We included 48 healthy, recreational to trained males ( n = 24, mean ± SD V̇O 2peak = 55 ± 5 mL O 2 ·kg -1 ⋅min -1 ) and females ( n = 24; V̇O 2peak of 46 ± 4 mL O 2 ·kg -1 ⋅min -1 ) in a counterbalanced, double-blind, randomized, placebo-controlled study design stratified by sex. Time trial performance, V̇O 2peak , and tHb were determined before and after intravenous injections of either rHuEPO (9 IU·kg bw -1 epoetin β) or saline (0.9% NaCl) three times weekly for 4 wk. RESULTS A time-treatment effect ( P < 0.05) existed for time trial performance. Within the rHuEPO group, mean power output increased by 4.1% ± 4.2% ( P < 0.001). Likewise, a time-treatment effect ( P < 0.001) existed for V̇O 2peak , where the rHuEPO group improved V̇O 2peak and peak aerobic power by 4.2% ± 6.1% ( P < 0.001) and 2.9% ± 4.0% ( P < 0.01), respectively. A time-treatment effect ( P < 0.001) existed for tHb, where the rHuEPO group increased tHb by 6.7% ± 3.4% ( P < 0.001). A main effect of "sex" alone was also evident ( P < 0.001), but no sex-specific interactions were found. No changes were observed in the placebo group for mean power output, V̇O 2peak , peak aerobic power, or tHb. CONCLUSIONS Microdoses with intravenous rHuEPO provide a sufficient erythropoietic stimuli to augment tHb and enhance aerobic-dominated performance in both trained males and females.
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Affiliation(s)
| | - Jonathan Graae
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | - Jacob Bejder
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | - Thomas C Bonne
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | - Søren Seier
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | - Maren Debertin
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | - Kasper Eibye
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | - Morten Hostrup
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | - Nikolai B Nordsborg
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
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Reichel C, Erceg D, Lorenc B, Scheiblhofer V, Farmer L, Zanitzer K, Geisendorfer T, Gmeiner G, Thevis M. Data from a microdosed recombinant human erythropoietin administration study applying the new biotinylated clone AE7A5 antibody and a further optimized sarcosyl polyacrylamide gel electrophoresis protocol. Drug Test Anal 2023; 15:163-172. [PMID: 33450134 DOI: 10.1002/dta.2989] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/23/2020] [Accepted: 12/01/2020] [Indexed: 01/07/2023]
Abstract
Erythropoietin (EPO) is a hormone, which stimulates the production of red blood cells. Due to its performance-enhancing effect, it is prohibited by the World Anti-Doping Agency (WADA). In order to reduce the detection window of EPO doping, athletes have been applying low doses of recombinant EPO (e.g., <10 IU/kg body weight, daily or every second day) instead of larger doses twice or more per week (e.g., 30 IU/kg). Microdoses of Retacrit (epoetin zeta), an EPO biosimilar, were administered intravenously and subcutaneously to human males and females. Urine and serum samples were collected and analysed applying the new biotinylated clone AE7A5 EPO antibody and a further optimized sarcosyl polyacrylamide gel electrophoresis (SAR-PAGE) protocol. With the improved protocol, microdosed Retacrit (7.5 IU/kg body weight [BW]) was detectable for at least 52 h after intravenous administration. Detection windows were approximately the same for serum and urine and doubled after subcutaneous administration (~104 h). Previous studies applying different electrophoretic techniques and the not further optimized SAR-PAGE protocol revealed considerably shorter detection windows for recombinant human erythropoietin (rhEPO) microdoses. Because the new biotinylated antibody performed significantly more sensitive than the nonbiotinylated version, the new protocol will improve the sensitivity and hence detectability of recombinant EPO in doping control.
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Affiliation(s)
- Christian Reichel
- Doping Control Laboratory Seibersdorf, Seibersdorf Labor GmbH, Seibersdorf, Austria.,European Monitoring Center for Emerging Doping Agents, German Sport University Cologne, Cologne, Germany
| | - Damir Erceg
- Clinical Trial Unit, 'Srebrnjak' Children's Hospital, Zagreb, Croatia.,Faculty of Dental Medicine and Health, University of Osijek 'Josip Juraj Strossmayer', Osijek, Croatia.,School of Medicine, University of Osijek 'Josip Juraj Strossmayer', Osijek, Croatia.,Personalized Medicine, 'St. Catherine' Hospital, Zagreb, Croatia.,Nursing Department, Catholic University of Croatia, Zagreb, Croatia
| | - Barbara Lorenc
- Doping Control Laboratory Seibersdorf, Seibersdorf Labor GmbH, Seibersdorf, Austria
| | | | - Letizia Farmer
- Doping Control Laboratory Seibersdorf, Seibersdorf Labor GmbH, Seibersdorf, Austria
| | - Katharina Zanitzer
- Doping Control Laboratory Seibersdorf, Seibersdorf Labor GmbH, Seibersdorf, Austria
| | - Thomas Geisendorfer
- Doping Control Laboratory Seibersdorf, Seibersdorf Labor GmbH, Seibersdorf, Austria
| | - Günter Gmeiner
- Doping Control Laboratory Seibersdorf, Seibersdorf Labor GmbH, Seibersdorf, Austria
| | - Mario Thevis
- Institute of Biochemistry/Center for Preventive Doping Research, German Sport University Cologne, Cologne, Germany.,European Monitoring Center for Emerging Doping Agents, German Sport University Cologne, Cologne, Germany
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8
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Saugy JJ, Schmoutz T, Botrè F. Altitude and Erythropoietin: Comparative Evaluation of Their Impact on Key Parameters of the Athlete Biological Passport: A Review. Front Sports Act Living 2022; 4:864532. [PMID: 35847455 PMCID: PMC9282833 DOI: 10.3389/fspor.2022.864532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
The hematological module of the Athlete's Biological Passport (ABP) identifies doping methods and/or substances used to increase the blood's capacity to transport or deliver oxygen to the tissues. Recombinant human erythropoietin (rhEPOs) are doping substances known to boost the production of red blood cells and might have an effect on the blood biomarkers of the ABP. However, hypoxic exposure influences these biomarkers similarly to rhEPOs. This analogous impact complicates the ABP profiles' interpretation by antidoping experts. The present study aimed to collect and identify, through a literature search, the physiological effects on ABP blood biomarkers induced by these external factors. A total of 43 studies were selected for this review. A positive correlation (R2 = 0.605, r = 0.778, p < 0.001) was identified between the hypoxic dose and the increase in hemoglobin concentration (HGB) percentage. In addition, the change in the reticulocyte percentage (RET%) has been identified as one of the most sensitive parameters to rhEPO use. The mean effects of rhEPO on blood parameters were greater than those induced by hypoxic exposure (1.7 times higher for HGB and RET% and 4 times higher for hemoglobin mass). However, rhEPO micro-doses have shown effects that are hardly distinguishable from those identified after hypoxic exposure. The results of the literature search allowed to identify temporal and quantitative evolution of blood parameters in connection with different hypoxic exposure doses, as well as different rhEPOs doses. This might be considered to provide justified and well-documented interpretations of physiological changes in blood parameters of the Athlete Biological Passport.
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Affiliation(s)
- Jonas J. Saugy
- Institute of Sport Sciences, University of Lausanne (ISSUL), Lausanne, Switzerland
- Research and Expertise in anti-Doping Sciences (REDs), University of Lausanne, Lausanne, Switzerland
- *Correspondence: Jonas J. Saugy
| | - Tania Schmoutz
- Institute of Sport Sciences, University of Lausanne (ISSUL), Lausanne, Switzerland
| | - Francesco Botrè
- Institute of Sport Sciences, University of Lausanne (ISSUL), Lausanne, Switzerland
- Research and Expertise in anti-Doping Sciences (REDs), University of Lausanne, Lausanne, Switzerland
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9
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Cox HD, Miller GD, Manandhar A, Husk JD, Crouch AK, Eichner D. Tracking immature reticulocyte proteins for improved detection of recombinant human erythropoietin (rhEPO) abuse. Am J Hematol 2021; 96:1621-1629. [PMID: 34626008 DOI: 10.1002/ajh.26368] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/12/2022]
Abstract
Athletes abuse recombinant human erythropoietin (rhEPO) and erythropoiesis stimulating agents to increase hemoglobin mass and improve performance. To evade detection, athletes have developed sophisticated blood doping regimens, which often include rhEPO micro-dosing. Detection of these methods requires biomarkers with increased sensitivity and a sample matrix that is more amenable to frequent testing in the field. We have developed a method to measure two immature reticulocyte proteins, CD71 and ferrochelatase (FECH), and one total erythrocyte protein, Band 3, in dried blood spots (DBS). This method was tested in response to rhEPO administration after low doses, 40 IU/kg, micro-doses, 900 IU, or saline injection in 20 healthy subjects. During administration of low-dose rhEPO, the mean CD71/Band 3 and FECH/Band 3 ratio increased by 412 ± 197% and 250 ± 44%, respectively. The mean response for the current biomarker, RET%, increased by 195 ± 35%. During administration of rhEPO micro-doses, CD71/Band 3 increased to 127 ± 25% on day 35 and 139 ± 36% on day 39, while no increase was observed in RET%. After rhEPO administration, during the washout phase, mean values decreased to a minimum of 64 ± 4% and 64 ± 11% for CD71/Band 3 and RET%, respectively. However, CD71/Band 3 remained below 75% of baseline for at least 4 weeks after rhEPO injection, while RET% returned to baseline levels. The results demonstrate that immature reticulocyte proteins have a larger response to rhEPO administration than the current biomarker, RET%, and can be monitored in the DBS matrix.
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Affiliation(s)
- Holly D. Cox
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
| | | | | | - Jacob D. Husk
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
| | - Andre K. Crouch
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
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Krumm B, Faiss R. Factors Confounding the Athlete Biological Passport: A Systematic Narrative Review. SPORTS MEDICINE - OPEN 2021; 7:65. [PMID: 34524567 PMCID: PMC8443715 DOI: 10.1186/s40798-021-00356-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/28/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Through longitudinal, individual and adaptive monitoring of blood biomarkers, the haematological module of the athlete biological passport (ABP) has become a valuable tool in anti-doping efforts. The composition of blood as a vector of oxygen in the human body varies in athletes with the influence of multiple intrinsic (genetic) or extrinsic (training or environmental conditions) factors. In this context, it is fundamental to establish a comprehensive understanding of the various causes that may affect blood variables and thereby alter a fair interpretation of ABP profiles. METHODS This literature review described the potential factors confounding the ABP to outline influencing factors altering haematological profiles acutely or chronically. RESULTS Our investigation confirmed that natural variations in ABP variables appear relatively small, likely-at least in part-because of strong human homeostasis. Furthermore, the significant effects on haematological variations of environmental conditions (e.g. exposure to heat or hypoxia) remain debatable. The current ABP paradigm seems rather robust in view of the existing literature that aims to delineate adaptive individual limits. Nevertheless, its objective sensitivity may be further improved. CONCLUSIONS This narrative review contributes to disentangling the numerous confounding factors of the ABP to gather the available scientific evidence and help interpret individual athlete profiles.
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Affiliation(s)
- Bastien Krumm
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Raphael Faiss
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.
- Center of Research and Expertise in Anti-Doping Sciences - REDs, University of Lausanne, Lausanne, Switzerland.
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11
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Chang WCW, Wang CY, Liu WY, Tsai CC, Wu YT, Hsu MC. Chinese Herbal Medicine Significantly Impacts the Haematological Variables of the Athlete Biological Passport. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9533. [PMID: 34574458 PMCID: PMC8469363 DOI: 10.3390/ijerph18189533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022]
Abstract
In the fight against sports doping, the Athlete Biological Passport (ABP) system aims to indirectly unveil the doping incidents by monitoring selected biomarkers; however, several unexplored extrinsic factors may dampen a fair interpretation of ABP profiles. Chinese herbal medicine (CHM) plays a pivotal role in the health care system, and some remedies have a long history of being used to treat anaemia. In this study, we addressed the concerns of whether the CHM administration could yield a measurable effect on altering the ABP haematological variables. Forty-eight healthy volunteers were randomly assigned to receive two-week oral administration of one of the six selected CHM products that are commonly prescribed in Taiwan (eight subjects per group). Their blood variables were determined longitudinally in the phases of baseline, intervention, and recovery over 5 weeks. Blood collection and analyses were carried out in strict compliance with relevant operating guidelines. In the groups receiving Angelicae Sinensis Radix, Astragali Radix, and Salviae Miltiorrhizae Radix et Rhizoma, a significant increased reticulocyte percentage and decreased OFF-hr Score were manifested during the intervention, and such effects even sustained for a period of time after withdrawal. All other variables, including haemoglobin and Abnormal Blood Profile Score, did not generate statistical significance. Our results show that the use of CHM may impact the ABP haematological variables. As a consequence, we recommend athletes, particularly those who have been registered in the testing pool, should be aware of taking specific Chinese herbal-based treatment or supplementation, and document any of its usage on the anti-doping forms.
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Affiliation(s)
- William Chih-Wei Chang
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (W.C.-W.C.); (C.-Y.W.); (W.-Y.L.)
- Master Degree Program in Toxicology, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chih-Yuan Wang
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (W.C.-W.C.); (C.-Y.W.); (W.-Y.L.)
| | - Wan-Yi Liu
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (W.C.-W.C.); (C.-Y.W.); (W.-Y.L.)
| | - Chin-Chuan Tsai
- School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung 840, Taiwan;
- Chinese Medicine Department, E-Da Hospital, Kaohsiung 824, Taiwan
| | - Yu-Tse Wu
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (W.C.-W.C.); (C.-Y.W.); (W.-Y.L.)
- Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Mei-Chich Hsu
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
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12
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Kayser B, De Block A. Would Relaxation of the Anti-doping Rule Lead to Red Queen Effects? SPORT, ETHICS AND PHILOSOPHY 2021. [DOI: 10.1080/17511321.2020.1770846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Bengt Kayser
- Institute of Sport Sciences, University of Lausanne, Synathlon, Uni-Centre, Lausanne, Switzerland
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13
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An Abductive Inference Approach to Assess the Performance-Enhancing Effects of Drugs Included on the World Anti-Doping Agency Prohibited List. Sports Med 2021; 51:1353-1376. [PMID: 33811295 DOI: 10.1007/s40279-021-01450-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 12/18/2022]
Abstract
Some have questioned the evidence for performance-enhancing effects of several substances included on the World Anti-Doping Agency's Prohibited List due to the divergent or inconclusive findings in randomized controlled trials (RCTs). However, inductive statistical inference based on RCTs-only may result in biased conclusions because of the scarcity of studies, inter-study heterogeneity, too few outcome events, or insufficient power. An abductive inference approach, where the body of evidence is evaluated beyond considerations of statistical significance, may serve as a tool to assess the plausibility of performance-enhancing effects of substances by also considering observations and facts not solely obtained from RCTs. Herein, we explored the applicability of an abductive inference approach as a tool to assess the performance-enhancing effects of substances included on the Prohibited List. We applied an abductive inference approach to make inferences on debated issues pertaining to the ergogenic effects of recombinant human erythropoietin (rHuEPO), beta2-agonists and anabolic androgenic steroids (AAS), and extended the approach to more controversial drug classes where RCTs are limited. We report that an abductive inference approach is a useful tool to assess the ergogenic effect of substances included on the Prohibited List-particularly for substances where inductive inference is inconclusive. Specifically, a systematic abductive inference approach can aid researchers in assessing the effects of doping substances, either by leading to suggestions of causal relationships or identifying the need for additional research.
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14
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Bejder J, Breenfeldt Andersen A, Bonne TC, Linkis J, Olsen NV, Huertas JR, Nordsborg NB. Hematological adaptations and detection of recombinant human erythropoietin combined with chronic hypoxia. Drug Test Anal 2020; 13:360-368. [PMID: 32955164 DOI: 10.1002/dta.2931] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 01/26/2023]
Abstract
This study evaluated whether recombinant human erythropoietin (rhEpo) treatment combined with chronic hypoxia provided an additive erythropoietic response and whether the athlete biological passport (ABP) sensitivity improved with hypoxia. Two interventions were completed, each containing 4 weeks baseline, 4 weeks exposure at sea level or 2,320 m of altitude, and 4 weeks follow-up. Participants were randomly assigned to 20 IU·kg bw-1 rhEpo or placebo injections every second day for 3 weeks during the exposure period at sea level (rhEpo n = 25, placebo n = 9) or at altitude (rhEpo n = 12, placebo n = 27). Venous blood was analyzed weekly. Combining rhEpo and hypoxia induced larger changes compared with rhEpo or hypoxia alone for [Hb] (p < 0.001 and p > 0.05, respectively), reticulocyte percentage (p < 0.001), and OFF-hr score (p < 0.01 and p < 0.001, respectively). The most pronounced effect was observed for reticulocyte percentage with up to ~35% (p < 0.001) and ~45% (p < 0.001) higher levels compared with rhEpo or hypoxia only, respectively. The ABP sensitivity for the combined treatment was 54 and 35 percentage points higher for [Hb] (p < 0.05) and reticulocyte percentage (p < 0.05), respectively, but similar for OFF-hr score, compared with rhEpo at sea level. Across any time point, [Hb] and OFF-hr score combined identified 14 unique true-positive participants (56%) at sea level and 12 unique true-positive participants (100%) at altitude. However, a concurrent reduction in specificity existed at altitude. In conclusion, rhEpo treatment combined with hypoxic exposure provided an additive erythropoietic response compared with rhEpo or hypoxic exposure alone. Correspondingly, ABP was more sensitive to rhEpo at altitude than at sea level, but a compromised specificity existed with hypoxic exposure.
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Affiliation(s)
- Jacob Bejder
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | | | - Thomas Christian Bonne
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | - Jesper Linkis
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | - Niels Vidiendal Olsen
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Jesús Rodríguez Huertas
- Department of Physiology, Faculty of Sport Sciences, Institute of Nutrition and Food Technology, Biomedical Research Centre, University of Granada, Granada, Spain
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15
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Martin L, Martin JA, Collot D, Hoang O, Audran M, Ericsson M, Marchand A. Improved detection methods significantly increase the detection window for EPO microdoses. Drug Test Anal 2020; 13:101-112. [PMID: 32737925 DOI: 10.1002/dta.2904] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 12/11/2022]
Abstract
To reproduce a potential doping scenario, a 2 week administration of recombinant erythropoietin (rEPO) microdoses alone or in combination with growth hormone (GH) microdoses (three times a week) was performed on healthy and athletic male subjects. The aim of this study was to evaluate the identification capability of rEPO in samples obtained during and post treatment. Detection was tested in urine and blood using the antidoping techniques for rEPO detection (iso-electric focusing (IEF)-, sodium-dodecyl-sulfate (SDS)-polyacrylamide gel electrophoresis (PAGE) and for some urine samples the sarcosyl (SAR)-PAGE method) with some improvements: for blood samples, instead of a simple concentration step, immuno-extraction of EPO was performed for all urines to limit protein contamination that can affect migration. In addition, elution buffer modifications also improved the quality of migration. The use of a recently validated biotinylated anti-EPO antibody simplified the protocols, allowing a single transfer step instead of a double-blot even by IEF with a lowered background. The criteria for suspicious blood and urine samples by IEF were also re-evaluated. While endogenous EPO was not decreased over the course of the study, EPO microdoses were detectable in blood and urine between 24 h and 72 h after an administration. Detection in urine in combination with SDS-PAGE was the most sensitive combination for prolonged detection (100% identification after 48 h, 91% after 72 h), slightly better than IEF. Urine samples also tested by SAR-PAGE indicated a similar sensitivity of detection to SDS-PAGE. GH co-administration had no impact on rEPO elimination/detection.
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Affiliation(s)
- Laurent Martin
- Analysis Department - Agence Française de Lutte contre le Dopage (AFLD), Châtenay-Malabry, France
| | - Jean-Antoine Martin
- Analysis Department - Agence Française de Lutte contre le Dopage (AFLD), Châtenay-Malabry, France
| | - David Collot
- Analysis Department - Agence Française de Lutte contre le Dopage (AFLD), Châtenay-Malabry, France
| | - Olivier Hoang
- Analysis Department - Agence Française de Lutte contre le Dopage (AFLD), Châtenay-Malabry, France
| | - Michel Audran
- Analysis Department - Agence Française de Lutte contre le Dopage (AFLD), Châtenay-Malabry, France
| | - Magnus Ericsson
- Analysis Department - Agence Française de Lutte contre le Dopage (AFLD), Châtenay-Malabry, France
| | - Alexandre Marchand
- Analysis Department - Agence Française de Lutte contre le Dopage (AFLD), Châtenay-Malabry, France
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16
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Mullen J, Bækken L, Bergström H, Björkhem Bergman L, Ericsson M, Ekström L. Fluctuations in hematological athlete biological passport biomarkers in relation to the menstrual cycle. Drug Test Anal 2020; 12:1229-1240. [DOI: 10.1002/dta.2873] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/11/2020] [Accepted: 06/01/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Jenny Mullen
- Department of Laboratory Medicine, Division of Clinical Pharmacology Karolinska Institutet Karolinska University Hospital, Stockholm Sweden
| | - Lasse Bækken
- Nordic Athlete Passport Management Unit Anti‐Doping Norway, Sognsveien Oslo Norway
| | - Helena Bergström
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics Karolinska Institutet Stockholm Sweden
| | - Linda Björkhem Bergman
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics Karolinska Institutet Stockholm Sweden
| | - Magnus Ericsson
- Department of Laboratory Medicine, Division of Clinical Pharmacology Karolinska Institutet Karolinska University Hospital, Stockholm Sweden
| | - Lena Ekström
- Department of Laboratory Medicine, Division of Clinical Pharmacology Karolinska Institutet Karolinska University Hospital, Stockholm Sweden
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17
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Bejder J, Robach P, Lundby A, Cornu C, Sallet P, Cairo G, Lundby C. Low doses of recombinant human erythropoietin does not affect C‐terminal FGF23 in healthy men. Drug Test Anal 2020; 12:975-979. [DOI: 10.1002/dta.2795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Jacob Bejder
- Department of Nutrition, Exercise and Sports (NEXS) University of Copenhagen Copenhagen Denmark
| | - Paul Robach
- National School of Mountain Sports Chamonix France
| | - Anne‐Kristine Lundby
- Center for Physical Activity Research University Hospital of Copenhagen Copenhagen Denmark
| | - Catherine Cornu
- Hospices Civils de Lyon INSERM CIC1407/UMR5558, Hôspital Louis Pradel Bron France
| | | | - Gaetano Cairo
- Department of Biomedical Sciences for Health University of Milan Italy
| | - Carsten Lundby
- Center for Physical Activity Research University Hospital of Copenhagen Copenhagen Denmark
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18
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Thevis M, Walpurgis K, Thomas A. Analytical Approaches in Human Sports Drug Testing: Recent Advances, Challenges, and Solutions. Anal Chem 2019; 92:506-523. [DOI: 10.1021/acs.analchem.9b04639] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Mario Thevis
- Center for Preventive Doping Research, Institute of Biochemistry, German Sport University Cologne, Am Sportpark Müngersdorf 6, Cologne 50933, Germany
- European Monitoring Center for Emerging Doping Agents (EuMoCEDA), Cologne 50933, Germany
| | - Katja Walpurgis
- Center for Preventive Doping Research, Institute of Biochemistry, German Sport University Cologne, Am Sportpark Müngersdorf 6, Cologne 50933, Germany
| | - Andreas Thomas
- Center for Preventive Doping Research, Institute of Biochemistry, German Sport University Cologne, Am Sportpark Müngersdorf 6, Cologne 50933, Germany
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19
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Marchand A, Martin J, Collot D, Hoang O, Roulland I, Semence F, Sottas P, Audran M, Varlet‐Marie E. Combined administration of microdoses of growth hormone and erythropoietin: Effects on performance and evaluation of GH detection capability using anti‐doping methods. Drug Test Anal 2019; 11:1698-1713. [DOI: 10.1002/dta.2674] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/01/2019] [Accepted: 07/04/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Alexandre Marchand
- Analyses Department ‐ Agence Française de Lutte contre le Dopage (AFLD) Châtenay‐Malabry France
| | - Jean‐Antoine Martin
- Analyses Department ‐ Agence Française de Lutte contre le Dopage (AFLD) Châtenay‐Malabry France
| | - David Collot
- Analyses Department ‐ Agence Française de Lutte contre le Dopage (AFLD) Châtenay‐Malabry France
| | - Olivier Hoang
- Analyses Department ‐ Agence Française de Lutte contre le Dopage (AFLD) Châtenay‐Malabry France
| | - Ingrid Roulland
- Analyses Department ‐ Agence Française de Lutte contre le Dopage (AFLD) Châtenay‐Malabry France
| | - Florian Semence
- Analyses Department ‐ Agence Française de Lutte contre le Dopage (AFLD) Châtenay‐Malabry France
| | | | - Michel Audran
- Analyses Department ‐ Agence Française de Lutte contre le Dopage (AFLD) Châtenay‐Malabry France
- Laboratoire de Biophysique et Bio‐Analyses, Institut des BiomoléculesMax Mousseron (IBMM), UMR 5247,CNRS‐ENSCM‐Université Montpellier France
| | - Emmanuelle Varlet‐Marie
- Laboratoire de Biophysique et Bio‐Analyses, Institut des BiomoléculesMax Mousseron (IBMM), UMR 5247,CNRS‐ENSCM‐Université Montpellier France
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20
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Heuberger JAAC, van Eenoo P, Rotmans JI, Gal P, Stuurman FE, Post TE, Daniels JMA, Ram H, de Hon O, Burggraaf J, Cohen AF. Sensitivity and specificity of detection methods for erythropoietin doping in cyclists. Drug Test Anal 2019; 11:1290-1301. [PMID: 31232530 PMCID: PMC6790592 DOI: 10.1002/dta.2665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 11/12/2022]
Abstract
Recombinant human erythropoietin (rHuEPO) is used as doping a substance. Anti‐doping efforts include urine and blood testing and monitoring the athlete biological passport (ABP). As data on the performance of these methods are incomplete, this study aimed to evaluate the performance of two common urine assays and the ABP. In a randomized, double‐blinded, placebo‐controlled trial, 48 trained cyclists received a mean dose of 6000 IU rHuEPO (epoetin β) or placebo by weekly injection for eight weeks. Seven timed urine and blood samples were collected per subject. Urine samples were analyzed by sarcosyl‐PAGE and isoelectric focusing methods in the accredited DoCoLab in Ghent. A selection of samples, including any with false presumptive findings, underwent a second sarcosyl‐PAGE confirmation analysis. Hematological parameters were used to construct a module similar to the ABP and analyzed by two evaluators from an Athlete Passport Management Unit. Sensitivity of the sarcosyl‐PAGE and isoelectric focusing assays for the detection of erythropoietin abuse were 63.8% and 58.6%, respectively, with a false presumptive finding rate of 4.3% and 6%. None of the false presumptive findings tested positive in the confirmation analysis. Sensitivity was highest between 2 and 6 days after dosing, and dropped rapidly outside this window. Sensitivity of the ABP was 91.3%. Specificity of the urine assays was high; however, the detection window of rHuEPO was narrow, leading to questionable sensitivity. The ABP, integrating longitudinal data, is more sensitive, but there are still subjects that evade detection. Combining these methods might improve performance, but will not resolve all observed shortcomings.
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Affiliation(s)
| | | | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, Netherlands
| | | | - Titiaan E Post
- Centre for Human Drug Research, Leiden, Netherlands.,Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, Netherlands
| | - Herman Ram
- Anti-Doping Authority the Netherlands, Capelle aan den IJssel, Netherlands
| | - Olivier de Hon
- Anti-Doping Authority the Netherlands, Capelle aan den IJssel, Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, Netherlands.,Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, Netherlands.,Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
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21
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Heuberger JAAC, Cohen AF. Review of WADA Prohibited Substances: Limited Evidence for Performance-Enhancing Effects. Sports Med 2019; 49:525-539. [PMID: 30411235 PMCID: PMC6422964 DOI: 10.1007/s40279-018-1014-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The World Anti-Doping Agency is responsible for maintaining a Prohibited List that describes the use of substances and methods that are prohibited for athletes. The list currently contains 23 substance classes, and an important reason for the existence of this list is to prevent unfair competition due to pharmacologically enhanced performance. The aim of this review was to give an overview of the available evidence for performance enhancement of these substance classes. We searched the scientific literature through PubMed for studies and reviews evaluating the effects of substance classes on performance. Findings from double-blind, randomized controlled trials were considered as evidence for (the absence of) effects if they were performed in trained subjects measuring relevant performance outcomes. Only 5 of 23 substance classes show evidence of having the ability to enhance actual sports performance, i.e. anabolic agents, β2-agonists, stimulants, glucocorticoids and β-blockers. One additional class, growth hormone, has similar evidence but only in untrained subjects. The observed effects all relate to strength or sprint performance (and accuracy for β-blockers); there are no studies showing positive effects on reliable markers of endurance performance. For 11 classes, no well-designed studies are available, and, for the remaining six classes, there is evidence of an absence of a positive effect. In conclusion, for the majority of substance classes, no convincing evidence for performance enhancement is available, while, for the remaining classes, the evidence is based on a total of only 266 subjects from 11 studies.
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Affiliation(s)
| | - Adam F Cohen
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
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22
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23
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Thevis M, Kuuranne T, Geyer H. Annual banned-substance review: Analytical approaches in human sports drug testing. Drug Test Anal 2019; 11:8-26. [DOI: 10.1002/dta.2549] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/18/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Mario Thevis
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Cologne Germany
- European Monitoring Center for Emerging Doping Agents; Cologne Germany
| | - Tiia Kuuranne
- Swiss Laboratory for Doping Analyses; University Center of Legal Medicine, Genève and Lausanne, Centre Hospitalier Universitaire Vaudois and University of Lausanne; Epalinges Switzerland
| | - Hans Geyer
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Cologne Germany
- European Monitoring Center for Emerging Doping Agents; Cologne Germany
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24
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Reverter-Branchat G, Ventura R, Ezzel Din M, Mateus J, Pedro C, Segura J. Detection of erythropoiesis-stimulating agents in a single dried blood spot. Drug Test Anal 2018; 10:1496-1507. [DOI: 10.1002/dta.2418] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/18/2018] [Accepted: 05/28/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Gemma Reverter-Branchat
- Integrative Pharmacology and Systems Neuroscience Research Group, Neurosciences Research Program; IMIM - Hospital del Mar Medical Research Institute; Barcelona Spain
| | - Rosa Ventura
- Catalonian Antidoping Laboratory, Doping Control Research Group, Neurosciences Research Programme; IMIM - Hospital del Mar Medical Research Institute; Barcelona Spain
| | - Mohammed Ezzel Din
- Integrative Pharmacology and Systems Neuroscience Research Group, Neurosciences Research Program; IMIM - Hospital del Mar Medical Research Institute; Barcelona Spain
| | - Julián Mateus
- Integrative Pharmacology and Systems Neuroscience Research Group, Neurosciences Research Program; IMIM - Hospital del Mar Medical Research Institute; Barcelona Spain
| | - Carme Pedro
- Department of Hematology; Hospital del Mar-IMIM; Barcelona Spain
| | - Jordi Segura
- Integrative Pharmacology and Systems Neuroscience Research Group, Neurosciences Research Program; IMIM - Hospital del Mar Medical Research Institute; Barcelona Spain
- Catalonian Antidoping Laboratory, Doping Control Research Group, Neurosciences Research Programme; IMIM - Hospital del Mar Medical Research Institute; Barcelona Spain
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25
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Puchowicz MJ, Mizelman E, Yogev A, Koehle MS, Townsend NE, Clarke DC. The Critical Power Model as a Potential Tool for Anti-doping. Front Physiol 2018; 9:643. [PMID: 29928234 PMCID: PMC5997808 DOI: 10.3389/fphys.2018.00643] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/11/2018] [Indexed: 11/13/2022] Open
Abstract
Existing doping detection strategies rely on direct and indirect biochemical measurement methods focused on detecting banned substances, their metabolites, or biomarkers related to their use. However, the goal of doping is to improve performance, and yet evidence from performance data is not considered by these strategies. The emergence of portable sensors for measuring exercise intensities and of player tracking technologies may enable the widespread collection of performance data. How these data should be used for doping detection is an open question. Herein, we review the basis by which performance models could be used for doping detection, followed by critically reviewing the potential of the critical power (CP) model as a prototypical performance model that could be used in this regard. Performance models are mathematical representations of performance data specific to the athlete. Some models feature parameters with physiological interpretations, changes to which may provide clues regarding the specific doping method. The CP model is a simple model of the power-duration curve and features two physiologically interpretable parameters, CP and W′. We argue that the CP model could be useful for doping detection mainly based on the predictable sensitivities of its parameters to ergogenic aids and other performance-enhancing interventions. However, our argument is counterbalanced by the existence of important limitations and unresolved questions that need to be addressed before the model is used for doping detection. We conclude by providing a simple worked example showing how it could be used and propose recommendations for its implementation.
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Affiliation(s)
- Michael J Puchowicz
- Department of Health Services, Arizona State University, Tempe, AZ, United States
| | - Eliran Mizelman
- Department of Biomedical Physiology and Kinesiology and Sports Analytics Group, Simon Fraser University, Burnaby, BC, Canada
| | - Assaf Yogev
- School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada
| | - Michael S Koehle
- School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada.,Division of Sport and Exercise Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Nathan E Townsend
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - David C Clarke
- Department of Biomedical Physiology and Kinesiology and Sports Analytics Group, Simon Fraser University, Burnaby, BC, Canada.,Canadian Sport Institute Pacific, Victoria, BC, Canada
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26
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Sgrò P, Sansone M, Sansone A, Romanelli F, Di Luigi L. Effects of erythropoietin abuse on exercise performance. PHYSICIAN SPORTSMED 2018; 46:105-115. [PMID: 29113535 DOI: 10.1080/00913847.2018.1402663] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The present review provides a comprehensive overview on the erythropoietic and non-erythropoietic effects of rHuEpo on human sport performance, paying attention to quantifying numerically how rHuEpo affects exercise performance and describing physiological changes regarding the most important exercise variables. Much attention has been paid to treatment schedules, in particular, to assess the effects of microdoses of rHuEpo and the prolonged effects on sport performance following withdrawal. Moreover, the review takes into account non-erythropoietic ergogenic effects of rHuEpo, including cognitive benefits of rHuEpo. A significant increase in both Vo2max and maximal cycling power was evidenced in studies taken into account for this review. rHuEpo, administered at clinical dosage, may have significant effects on haematological values, maximal and submaximal physiological variables, whereas few reports show positive effects on exercise perfomance. However, the influence of micro-dose rHuEpo on endurance performance in athletes is still unclear and further studies are warranted.
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Affiliation(s)
- Paolo Sgrò
- a Department of Movement, Human and Health Sciences, Unit of Endocrinology , Università degli Studi di Roma "Foro Italico" Piazza Lauro de Bosis , Rome , Italy
| | - Massimiliano Sansone
- b Department of Experimental Medicine , "Sapienza" Università di Roma , Rome , Italy
| | - Andrea Sansone
- b Department of Experimental Medicine , "Sapienza" Università di Roma , Rome , Italy
| | - Francesco Romanelli
- b Department of Experimental Medicine , "Sapienza" Università di Roma , Rome , Italy
| | - Luigi Di Luigi
- a Department of Movement, Human and Health Sciences, Unit of Endocrinology , Università degli Studi di Roma "Foro Italico" Piazza Lauro de Bosis , Rome , Italy
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27
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Garvican-Lewis LA, Vuong VL, Govus AD, Schumacher YO, Hughes D, Lovell G, Eichner D, Gore CJ. Influence of combined iron supplementation and simulated hypoxia on the haematological module of the athlete biological passport. Drug Test Anal 2017; 10:731-741. [PMID: 28929623 DOI: 10.1002/dta.2303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/13/2017] [Accepted: 09/13/2017] [Indexed: 01/01/2023]
Abstract
The integrity of the athlete biological passport (ABP) is underpinned by understanding normal fluctuations of its biomarkers to environmental or medical conditions, for example, altitude training or iron deficiency. The combined impact of altitude and iron supplementation on the ABP was evaluated in endurance-trained athletes (n = 34) undertaking 3 weeks of simulated live-high: train-low (14 h.d-1 , 3000 m). Athletes received either oral, intravenous (IV) or placebo iron supplementation, commencing 2 weeks prior and continuing throughout hypoxic exposure. Venous blood was sampled twice prior, weekly during, and up to 6 weeks after altitude. Individual ABP thresholds for haemoglobin concentration ([Hb]), reticulocyte percentage (%retic), and OFF score were calculated using the adaptive model and assessed at 99% and 99.9% specificity. Eleven athletes returned values outside of the calculated reference ranges at 99%, with 8 at 99.9%. The percentage of athletes exceeding the thresholds in each group was similar, but IV returned the most individual occurrences. A similar frequency of abnormalities occurred across the 3 biomarkers, with abnormal [Hb] and OFF score values arising mainly during-, and %retic values mainly post- altitude. Removing samples collected during altitude from the model resulted in 10 athletes returning abnormal values at 99% specificity, 2 of whom had not triggered the model previously. In summary, the abnormalities observed in response to iron supplementation and hypoxia were not systematic and mostly in line with expected physiological adaptations. They do not represent a uniform weakness in the ABP. Nevertheless, altitude training and iron supplementation should be carefully considered by experts evaluating abnormal ABP profiles.
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Affiliation(s)
- Laura A Garvican-Lewis
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,Australian Institute of Sport, Canberra, Australia
| | | | - Andrew D Govus
- Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
| | | | - David Hughes
- Australian Institute of Sport, Canberra, Australia
| | - Greg Lovell
- Australian Institute of Sport, Canberra, Australia
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory, Salt Lake City, Utah, USA
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