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Krumm B, Lundby C, Hansen J, Bejder J, Sørensen H, Equey T, Saugy J, Botrè F, Faiss R. Yearly intrasubject variability of hematological biomarkers in elite athletes for the Athlete Biological Passport. Drug Test Anal 2024. [PMID: 38291831 DOI: 10.1002/dta.3645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024]
Abstract
Confounding factors including exercise and environments challenge the interpretation of individual Athlete Biological Passports (ABPs). This study aimed to investigate the natural variability of hematological ABP parameters over 1 year in elite athletes compared with healthy control subjects and the validity of a multiparametric model estimating plasma volume (PV) shifts to correct individual ABP thresholds. Blood samples were collected monthly with full blood counts performed by flow cytometry (Sysmex XN analyzers) in 20 elite xc-skiers (ELITE) and 20 moderately trained controls. Individual ABP profiles were generated through Anti-Doping Administration & Management System Training, a standalone version of the ABP's adaptive model developed by the World Anti-Doping Agency. Additionally, eight serum parameters were computed as volume-sensitive biomarkers to run a multiparametric model to estimate PV. Variability in ELITE compared with controls was significantly higher for the Abnormal Blood Profile Scores (P = 0.003). Among 12 Atypical Passport Findings (ATPF) initially reported, six could be removed after correction of PV shifts with the multiparametric modeling. However, several ATPF were additionally generated (n = 19). Our study outlines a larger intraindividual variability in elite athletes, likely explained by more frequent exposure to extrinsic factors altering hematological biomarkers. PV correction for individual ABP thresholds allowed to explain most of the atypical findings while generating multiple new ATPF occurrences in the elite population. Overall, accounting for PV shifts in elite athletes was shown to be paramount in this study outlining the opportunity to consider PV variations with novel approaches when interpreting individual ABP profiles.
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Affiliation(s)
- Bastien Krumm
- REDs, Research & Expertise in antiDoping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Carsten Lundby
- Section for Health and Exercise Physiology, Inland University of Applied Sciences, Lillehammer, Norway
- Department of Nutrition, Exercise and Sport, University of Copenhagen, Copenhagen, Denmark
| | - Joar Hansen
- Section for Health and Exercise Physiology, Inland University of Applied Sciences, Lillehammer, Norway
| | - Jacob Bejder
- Department of Nutrition, Exercise and Sport, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Sørensen
- Department of Nutrition, Exercise and Sport, University of Copenhagen, Copenhagen, Denmark
| | - Tristan Equey
- Athlete Biological Passport, Science Department, WADA, World Anti-Doping Agency, Montréal, Quebec, Canada
| | - Jonas 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
| | - Raphael Faiss
- REDs, Research & Expertise in antiDoping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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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: 4] [Impact Index Per Article: 4.0] [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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Moreillon B, Krumm B, Saugy JJ, Saugy M, Botrè F, Vesin JM, Faiss R. Prediction of plasma volume and total hemoglobin mass with machine learning. Physiol Rep 2023; 11:e15834. [PMID: 37828664 PMCID: PMC10570407 DOI: 10.14814/phy2.15834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
Hemoglobin concentration ([Hb]) is used for the clinical diagnosis of anemia, and in sports as a marker of blood doping. [Hb] is however subject to significant variations mainly due to shifts in plasma volume (PV). This study proposes a newly developed model able to accurately predict total hemoglobin mass (Hbmass) and PV from a single complete blood count (CBC) and anthropometric variables in healthy subject. Seven hundred and sixty-nine CBC coupled to measures of Hbmass and PV using a CO-rebreathing method were used with a machine learning tool to calculate an estimation model. The predictive model resulted in a root mean square error of 33.2 g and 35.6 g for Hbmass, and 179 mL and 244 mL for PV, in women and men, respectively. Measured and predicted data were significantly correlated (p < 0.001) with a coefficient of determination (R2 ) ranging from 0.76 to 0.90 for Hbmass and PV, in both women and men. The Bland-Altman bias was on average 0.23 for Hbmass and 4.15 for PV. We herewith present a model with a robust prediction potential for Hbmass and PV. Such model would be relevant in providing complementary data in contexts such as the epidemiology of anemia or the individual monitoring of [Hb] in anti-doping.
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Affiliation(s)
- B. Moreillon
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
- Union Cycliste InternationaleWorld Cycling CentreAigleSwitzerland
| | - B. Krumm
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
| | - J. J. Saugy
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
| | - M. Saugy
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
| | - F. Botrè
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
- Laboratorio AntidopingFederazione Medico Sportiva ItalianaRomeItaly
| | - J. M. Vesin
- Signal Processing Laboratory 2Swiss Federal Institute of TechnologyLausanneSwitzerland
| | - R. Faiss
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
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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: 3] [Impact Index Per Article: 3.0] [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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Moreillon B, Salamin O, Krumm B, Iannella L, Molaioni F, Kuuranne T, Nicoli R, Saugy JJ, Botrè F, Faiss R. Variability of the urinary and blood steroid profiles in healthy and physically active women with and without oral contraception. Drug Test Anal 2023; 15:324-333. [PMID: 36414566 DOI: 10.1002/dta.3412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
The steroidal module of the athlete biological passport (ABP) targets the use of pseudo-endogenous androgenous anabolic steroids in elite sport by monitoring urinary steroid profiles. Urine and blood samples were collected weekly during two consecutive oral contraceptive pill (OCP) cycles in 15 physically active women to investigate the low urinary steroid concentrations and putative confounding effect of OCP. In urine, testosterone (T) and epitestosterone (E) were below the limit of quantification of 1 ng/ml in 62% of the samples. Biomarkers' variability ranged between 31% and 41%, with a significantly lesser variability for ratios (except for T/E [41%]): 20% for androsterone/etiocholanolone (p < 0.001) and 25% for 5α-androstane-3α,17β-diol/5ß-androstane-3α,17β-diol (p < 0.001). In serum, markers' variability (testosterone: 24%, androstenedione: 23%, dihydrotestosterone: 19%, and T/A4: 16%) was significantly lower than in urine (p < 0.001). Urinary A/Etio increased by >18% after the first 2 weeks (p < 0.05) following withdrawal blood loss. In contrast, serum T (0.98 nmol/l during the first week) and T/A4 (0.34 the first week) decreased significantly by more than 25% and 17% (p < 0.05), respectively, in the following weeks. Our results outline steroidal variations during the OCP cycle, highlighting exogenous hormonal preparations as confounder for steroid concentrations in blood. Low steroid levels in urine samples have a clear negative impact on the subsequent interpretation of steroid profile of the ABP. With a greater analytical sensitivity and lesser variability for steroids in healthy active women, serum represents a complementary matrix to urine in the ABP steroidal module.
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Affiliation(s)
- Basile Moreillon
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Olivier Salamin
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bastien Krumm
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Loredana Iannella
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Francesco Molaioni
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Tiia Kuuranne
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Raul Nicoli
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jonas J Saugy
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Francesco Botrè
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.,Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Raphael Faiss
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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Thevis M, Kuuranne T, Geyer H. Annual banned-substance review-Analytical approaches in human sports drug testing 2021/2022. Drug Test Anal 2023; 15:5-26. [PMID: 36369629 DOI: 10.1002/dta.3408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 11/13/2022]
Abstract
Also in 2021/2022, considerable efforts were invested into advancing human sports drug testing programs, recognizing and taking into account existing as well as emerging challenges in anti-doping, especially with regard to substances and methods of doping specified in the World Anti-Doping Agency's 2022 Prohibited List. In this edition of the annual banned-substance review, literature on recent developments published between October 2021 and September 2022 is summarized and discussed. Focus is put particularly on enhanced analytical approaches and complementary testing options in human doping controls, appreciating the exigence and mission in anti-doping and, equally, the contemporary "new normal" considering, for example, the athlete's exposome versus analytical sensitivity and applicable anti-doping regulations for result interpretation and management.
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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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Krumm B, Botrè F, Saugy JJ, Faiss R. Future opportunities for the Athlete Biological Passport. Front Sports Act Living 2022; 4:986875. [PMID: 36406774 PMCID: PMC9666424 DOI: 10.3389/fspor.2022.986875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/18/2022] [Indexed: 01/25/2023] Open
Abstract
The Athlete Biological Passport (ABP) was introduced to complement the direct anti-doping approach by indirectly outlining the possible use of prohibited substances or methods in sports. The ABP proved its effectiveness, at least through a deterrent effect, even though the matrices used for longitudinal monitoring (urine and blood) are subject to many intrinsic (e.g., genetic) and extrinsic (e.g., environmental conditions) confounding factors. In that context, new and more specific biomarkers are currently under development to enhance both the sensitivity and the specificity of the ABP. Multiple strategies are presently being explored to improve this longitudinal monitoring, with the development of the current modules, the investigation of new strategies, or the screening of new types of doping. Nevertheless, due to the variability induced by indirect biomarkers, the consideration of confounding factors should continuously support this research. Beyond tremendous advances in analytical sensitivity, machine learning-based approaches seem inevitable to facilitate an expert interpretation of numerous biological profiles and promote anti-doping efforts. This perspective article highlights the current innovations of the Athlete Biological Passport that seem the most promising. Through different research axes, this short manuscript provides an opportunity to bring together approaches that are more widely exploited (e.g., omics strategies) and others in the early stages of investigation (e.g., artificial intelligence) seeking to develop the ABP.
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Affiliation(s)
- Bastien Krumm
- Research and Expertise in Anti-Doping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Francesco Botrè
- Research and Expertise in Anti-Doping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland,Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Jonas J. Saugy
- Research and Expertise in Anti-Doping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Raphael Faiss
- Research and Expertise in Anti-Doping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland,*Correspondence: Raphael Faiss
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BREENFELDT ANDERSEN ANDREAS, BEJDER JACOB, BONNE THOMASC, SØRENSEN HENRIK, SØRENSEN HELLE, JUNG GRACE, GANZ TOMAS, NEMETH ELIZABETA, SECHER NIELSH, JOHANSSON PÄRI, NORDSBORG NIKOLAIBAASTRUP. Hepcidin and Erythroferrone Complement the Athlete Biological Passport in the Detection of Autologous Blood Transfusion. Med Sci Sports Exerc 2022; 54:1604-1616. [DOI: 10.1249/mss.0000000000002950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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