Detection of doping with rhGH: Excretion study with WADA-approved kits

A Review of Recent Progress in Drug Doping and Gene Doping Control Analysis

The illicit utilization of performance-enhancing substances, commonly referred to as doping, not only infringes upon the principles of fair competition within athletic pursuits but also poses significant health hazards to athletes. Doping control analysis has emerged as a conventional approach to ensuring equity and integrity in sports. Over the past few decades, extensive advancements have been made in doping control analysis methods, catering to the escalating need for qualitative and quantitative analysis of numerous banned substances exhibiting diverse chemical and biological characteristics. Progress in science, technology, and instrumentation has facilitated the proliferation of varied techniques for detecting doping. In this comprehensive review, we present a succinct overview of recent research developments within the last ten years pertaining to these doping detection methodologies. We undertake a comparative analysis, evaluating the merits and limitations of each technique, and offer insights into the prospective future advancements in doping detection methods. It is noteworthy that the continual design and synthesis of novel synthetic doping agents have compelled researchers to constantly refine and innovate doping detection methods in order to address the ever-expanding range of covertly employed doping agents. Overall, we remain in a passive position for doping detection and are always on the road to doping control.

Gender- and Sport-Specific Associations Between Religiousness and Doping Behavior in High-Level Team Sports

Religiousness is known to be specifically associated with substance abuse, but there is an evident lack of studies investigating the association between religiousness and doping behavior as a specific type of substance abuse in athletes. This study aimed to provide evidence for possible gender- and sport-specific associations between religiousness and doping behavior among team-sport athletes of both genders. The participants were 886 athletes (21.9 ± 3.8 years of age; 352 females) involved in four sports: volleyball (n = 154; 78 females), handball (n = 206; 68 females), soccer (n = 316; 110 females) and basketball (n = 230; 96 females) from Croatia and Slovenia (all traditionally Roman Catholics). The data were collected using a previously validated structured questionnaire that examined sociodemographic, sport- and doping-related factors. In addition, religiousness was captured by the Santa Clara Strength of Religious Faith questionnaire (SCSRF). Gender-stratified simple logistic regressions were applied to determine associations between covariates and doping behavior (criterion). There was no significant difference in potential doping behavior between males and females (OR 1.06, 95 % CI 0.76-1.46), while females reported higher religiousness (SCSRF: 23.11 ± 3.23 and 25.46 ± 7.2 for males and females, respectively; t test = 1.82, p < 0.05). Younger female athletes and those with higher SCSRF score are found to be less prone to doping behavior. When models were adjusted for personal opinion about doping presence in sport and age, the SCSRF remained a significant predictor of potential doping behavior (OR 0.95, 95 % CI 0.91-0.99). For males, the belief that doping was present in sport was strongly associated with a higher likelihood of doping. Our results suggest that highly religious females involved in three of the studies sports (i.e., volleyball, handball and basketball) show a weaker tendency toward doping. Meanwhile, there is no evidence that religiousness influences doping behavior among male team-sport athletes. Therefore, sport-specific and gender-specific approach in studying possible relationships that exist between religiousness and different types of misusing substances in sport is warranted.

Determination of Recent Growth Hormone Abuse Using a Single Dried Blood Spot

BACKGROUND

Although it is being increasingly applied, blood collection for drug testing in sport presents some logistic issues that complicate full applicability on a large scale. The use of dried blood spots (DBS) could benefit compliant blood testing considerably owing to its simplicity, minimal invasiveness, analyte stability, and reduced costs. The aim of this study was to evaluate the applicability of DBS to the methodology approved by the World Anti-Doping Agency (WADA) for detection of doping by recombinant human growth hormone (rhGH) in serum.

METHODS

A protocol for a single DBS analysis using the hGH isoforms differential immunoassays (kit 1 and kit 2) was developed and validated. A clinical study with healthy volunteers injected for 3 consecutive days with a low subcutaneous dose (0.027 mg · kg−1 · day−1 · person−1) of rhGH was conducted. Finger prick DBS and paired-time serum samples from arm venipuncture were compared.

RESULTS

The analysis of the DBS-based protocol indicated that with only a single blood spot it was possible to detect positivity for growth hormone abuse. In spite of the low rhGH dose administered and independently of the kit used, the window of detection for DBS was confirmed in all analyzed samples up to 8 h after rhGH administration and extended up to 12 h in 50% of the cases. Serum positivity was detected in all studied samples for 12 h after administration.

CONCLUSIONS

These results support the usefulness of DBS as a biological matrix for testing recent growth hormone abuse.

hGH isoform differential immunoassays applied to blood samples from athletes: decision limits for anti-doping testing

OBJECTIVE

To detect hGH doping in sport, the World Anti-Doping Agency (WADA)-accredited laboratories use the ratio of the concentrations of recombinant hGH ('rec') versus other 'natural' pituitary-derived isoforms of hGH ('pit'), measured with two different kits developed specifically to detect the administration of exogenous hGH. The current joint compliance decision limits (DLs) for ratios derived from these kits, designed so that they would both be exceeded in fewer than 1 in 10,000 samples from non-doping athletes, are based on data accrued in anti-doping labs up to March 2010, and later confirmed with data up to February-March 2011. In April 2013, WADA asked the authors to analyze the now much larger set of ratios collected in routine hGH testing of athletes, and to document in the peer-reviewed literature a statistical procedure for establishing DLs, so that it be re-applied as more data become available.

DESIGN

We examined the variation in the rec/pit ratios obtained for 21,943 screened blood (serum) samples submitted to the WADA accredited laboratories over the period 2009-2013. To fit the relevant sex- and kit-specific centiles of the logs of the ratios, we classified 'rec/pit' ratios based on low 'rec' and 'pit' values as 'negative' and fitted statistical distributions to the remaining log-ratios. The flexible data-driven quantile regression approach allowed us to deal with the fact that the location, scale and shape of the distribution of the modeled 'rec/pit' ratios varied with the concentrations of the 'rec' and 'pit' values. The between-kit correlation of the ratios was included in the fitting of the DLs, and bootstrap samples were used to quantify the estimation error in these limits. We examined the performance of these limits by applying them to the data obtained from investigator-initiated hGH administration studies, and in athletes in a simulated cycling stage race.

RESULTS

The mean and spread of the distribution of the modeled log-ratios depended in different ways on the magnitude of the rec and pit concentrations. Ultimately, however, the estimated limits were almost invariant to the concentrations, and similar to those obtained by fitting simpler (marginal) log-normal and Box-Cox transformed distributions. The estimated limits were similar to the (currently-used) limits fitted to the smaller datasets analyzed previously. In investigator-initiated instances, the limits distinguished recent use of rec-hGH from non-use.

CONCLUSIONS

The distributions of the rec/pit ratios varied as a function of the rec and pit concentrations, but the patterns in their medians and spreads largely canceled each other. Thus, ultimately, the kit- and sex-specific ratio DL obtained from the simpler model was very close to the 'curve of DLs' obtained from the more complex one. Both were close to previously established limits.