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Biasini GM, Botrè F, de la Torre X, Donati F. Age-Markers on the Red Blood Cell Surface and Erythrocyte Microparticles may Constitute a Multi-parametric Strategy for Detection of Autologous Blood Transfusion. SPORTS MEDICINE - OPEN 2023; 9:113. [PMID: 38038869 PMCID: PMC10692063 DOI: 10.1186/s40798-023-00662-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Autologous blood transfusion is one of the illicit strategies, banned by the World Anti-Doping Agency, to increase the levels of hemoglobin, with a consequent improvement in the delivery of oxygen to tissues. At present, this practice is detectable exclusively by the individual, longitudinal monitoring of hematological biomarkers, as in the hematological module of the Athlete Biological Passport; but this indirect approach may suffer from different confounding factors. We are presenting a multi-parametric, analytical strategy to detect autologous blood transfusions by targeting the modification of the red blood cells during storage. We focused on the assessment of "storage lesions", targeting (i) membrane proteins: Glycophorin-A and Band 3 complex, (ii) biomarkers of oxidative stress: Peroxiredoxin-2, (iii) biomarkers of senescence: CD47 and Phosphatidylserine, (iv) erythrocytes microparticles. RESULTS All of the above markers were monitored, by immunological and flow cytofluorimetric methods, on samples of stored whole blood collected at different time intervals, and on fresh blood samples, collected for official doping control tests, mixed "ex vivo" to simulate an autotransfusion. Although anonymized before the delivery to the laboratory, it was possible to mix samples belonging to the same subject based on the "athlete biological passport" code. Our results showed that the irreversible alteration of RBCs morphology, the loss of membrane integrity, the occurrence of hemolysis phenomena, and, more in general, the "aging" of the erythrocytes during storage are closely related to: (i) the reduced concentration, on the erythrocyte membrane, of Band 3 protein (decrease of 19% and of 39% after 20 and 40 days of storage respectively) and of glycophorin A (- 47% and - 63% respectively); (ii) the externalization of phosphatidyl serine (with a five-fold increase after 20 days and a further 2× increase after 40 days); (iii) the reduced concentration of CD47; and (iv) increased levels of erythrocyte microparticles. CONCLUSIONS The most promising method to detect the presence of transfused blood in whole blood samples can be based on a multi-parametric strategy, considering jointly both protein expression on RBCs membranes and micro-vesiculation phenomena.
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Affiliation(s)
- Giorgia M Biasini
- Sapienza University of Rome, Rome, Italy
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Francesco Botrè
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy.
- REDs - Research and Expertise in anti-Doping Sciences, ISSUL - Institute of Sport Sciences University of Lausanne, Lausanne, Switzerland.
| | - Xavier de la Torre
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Francesco Donati
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy.
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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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3
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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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The Influence of Floorball on Hematological Parameters: Consequences in Health Assessment and Antidoping Testing. JOURNAL OF SPORTS MEDICINE 2020; 2020:6109308. [PMID: 32802889 PMCID: PMC7403938 DOI: 10.1155/2020/6109308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/06/2020] [Indexed: 02/04/2023]
Abstract
Assessment of hematological parameters is common in sports medicine. Although physical exercise is an important preanalytical variable, data about acute hematological changes after high-intensity intermittent exercise are scarce. This study aimed to examine floorball as a potential preanalytical variable for hematological parameters used in health assessment and antidoping testing. Twenty-three professional male floorball players participated in a floorball game. Hematological parameters including hemoglobin, erythrocyte count and erythrocyte indices, reticulocytes, white blood cells (WBC), platelets, reticulocytes, and OFF-hr score were assessed at baseline, immediately postgame, and at 2 h postgame. Median hemoglobin concentration decreased significantly from 146 g/L pregame to 141 g/L immediately postgame (p < 0.001). WBC count increased from 7.2 × 109/L pregame to 10.1 × 109/L 2 h postgame (p < 0.001). The median OFF-hr score decreased from 99.5 to 94.2 immediately postgame and remained significantly lower than baseline at 2 h postgame (94.4, p=0.030). Looking at individual results, the highest OFF-hr score increased from 120 at baseline to 124 at 2 h postgame. Our findings suggest that participation in a floorball game affects several hematological parameters and consequently can affect health assessment and antidoping testing.
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Abstract
The Athlete Biological Passport programme was initiated in 2009 by the World Anti-Doping Agency for making the anti-doping programme more effective and stronger. There are three modules in this ABP programme: haematological, steroidal and endocrinological. Currently, the first two modules have been implemented. The newer products such as recombinant human erythropoietin, recombinant proteins, and peptides are similar to those produced naturally. Hence, detection of these substances even with advanced techniques is difficult. Therefore, the concept of ABP came into existence which is based on longitudinal monitoring of biological markers and their variations over a period of time. The ABP does not rely upon the detection of a particular prohibited substance but it reflects the changes in biological markers collated over an athlete's career. Hence, athletes can be monitored through constant interpretation of the passport data. There are many advantages with the implementation of this programme; however, there are various issues which may lead to false interpretation of passport data that must be taken into consideration.
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Sutehall S, Muniz-Pardos B, Lima G, Wang G, Malinsky FR, Bosch A, Zelenkova I, Tanisawa K, Pigozzi F, Borrione P, Pitsiladis Y. Altitude Training and Recombinant Human Erythropoietin: Considerations for Doping Detection. Curr Sports Med Rep 2019; 18:97-104. [PMID: 30969231 DOI: 10.1249/jsr.0000000000000577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The benefit of training at altitude to enhance exercise performance remains equivocal although the most widely accepted approach is one where the athletes live and perform lower-intensity running at approximately 2300 m with high-intensity training at approximately 1250 m. The idea is that this method maintains maximal augmentations in total hemoglobin mass while reducing the performance impairment of high-intensity sessions performed at moderate altitude and thus preventing any detraining that can occur when athletes live and train at moderate altitude. This training regimen, however, is not universally accepted and some argue that the performance enhancement is due to placebo and training camp effects. Altitude training may affect an athlete's hematological parameters in ways similar to those observed following blood doping. Current methods of detection appear insufficient to differentiate between altitude training and blood doping making the interpretation of an athlete's biological passport difficult. Further research is required to determine the optimal method for altitude training and to enhance current detection methods to be able to differentiate better blood doping and altitude exposure.
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Affiliation(s)
- Shaun Sutehall
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, SOUTH AFRICA
| | - Borja Muniz-Pardos
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, SPAIN
| | - Giscard Lima
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UNITED KINGDOM.,Centre for Exercise Science and Sports Medicine, University of Rome "Foro Italico", Rome, ITALY
| | - Guan Wang
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UNITED KINGDOM
| | | | - Andrew Bosch
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, SOUTH AFRICA
| | | | - Kumpei Tanisawa
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, JAPAN
| | - Fabio Pigozzi
- Centre for Exercise Science and Sports Medicine, University of Rome "Foro Italico", Rome, ITALY
| | - Paolo Borrione
- Centre for Exercise Science and Sports Medicine, University of Rome "Foro Italico", Rome, ITALY
| | - Yannis Pitsiladis
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UNITED KINGDOM
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7
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Salamin O, Kuuranne T, Saugy M, Leuenberger N. Erythropoietin as a performance-enhancing drug: Its mechanistic basis, detection, and potential adverse effects. Mol Cell Endocrinol 2018; 464:75-87. [PMID: 28119134 DOI: 10.1016/j.mce.2017.01.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 02/01/2023]
Abstract
Erythropoietin (EPO) is the main hormone regulating red blood cell (RBC) production. The large-scale production of a recombinant human erythropoietin (rHuEPO) by biotechnological methods has made possible its widespread therapeutic use as well as its misuse in sports. Since the marketing of the first epoetin in 1989, the development has progressed to the third-generation analogs. However, the production of rHuEPO is costly, and the frequent administration of an injectable formula is not optimal for compliance of therapeutic patients. Hence, pharmaceutical industries are currently developing alternative approaches to stimulate erythropoiesis, which might offer new candidates for doping purposes. The hypoxia inducible factors (HIF) pathway is of particular interest. The introduction of new erythropoiesis-stimulating agents (ESAs) for clinical use requires subsequent development of anti-doping methods for detecting the abuse of these substances. The detection of ESAs is based on two different approaches, namely, the direct detection of exogenous substances and the indirect detection, for which the effects of the substances on specific biomarkers are monitored. Omics technologies, such as ironomics or transcriptomics, are useful for the development of new promising biomarkers for the detection of ESAs. Finally, the illicit use of ESAs associates with multiple health risks that can be irreversible, and an essential facet of anti-doping work is to educate athletes of these risks. The aim of this review is to provide an overview of the evolution of ESAs, the research and implementation of the available detection methods, and the side effects associated with the misuse of ESAs.
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Affiliation(s)
- Olivier Salamin
- Center for Research and Expertise in Anti-Doping Sciences - REDs, University of Lausanne, Switzerland
| | - Tiia Kuuranne
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | - Martial Saugy
- Center for Research and Expertise in Anti-Doping Sciences - REDs, University of Lausanne, Switzerland
| | - Nicolas Leuenberger
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
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8
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Lobigs LM, Sharpe K, Garvican-Lewis LA, Gore CJ, Peeling P, Dawson B, Schumacher YO. The athlete's hematological response to hypoxia: A meta-analysis on the influence of altitude exposure on key biomarkers of erythropoiesis. Am J Hematol 2018; 93:74-83. [PMID: 29027252 DOI: 10.1002/ajh.24941] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 11/11/2022]
Abstract
Altitude training is associated with changes in blood markers, which can confound results of the Athlete?s Biological Passport (ABP). This meta-analysis aims to describe the fluctuations during- and post-altitude in key ABP variables; hemoglobin concentration ([Hb]), square-root transformed reticulocyte percentage (sqrt(retic%)) and the OFF-score. Individual de-identified raw data were provided from 17 studies. Separate linear mixed effects analyses were performed for delta values from baseline for [Hb], sqrt(retic%) and OFF-score, by altitude phase (during and post). Mixed models were fitted with the hierarchical structure: study and subject within study as random effects. Delta values as response variables and altitude dose (in kilometer hours; km.hr = altitude (m) / 1000 x hours), sex, age, protocol and baseline values as fixed effects. Allowances were made for potential autocorrelation. Within two days at natural altitude [Hb] rapidly increased. Subsequent delta [Hb] values increased with altitude dose, reaching a plateau of 0.94 g/dL [95%CI (0.69, 1.20)] at ~1000 km.hr. Delta sqrt(retic%) and OFF-score were the first to identify an erythrocyte response, with respective increases and decreases observed within 100 to 200 km.hr. Post-altitude, [Hb] remained elevated for two weeks. Delta sqrt(retic%) declined below baseline, the magnitude of change was dependent on altitude dose. Baseline values were a significant covariate (p<0.05). The response to altitude is complex resulting in a wide range of individual responses, influenced primarily by altitude dose and baseline values. Improved knowledge of the plausible hematological variations during- and post-altitude provides fundamental information for both the ABP expert and sports physician.
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Affiliation(s)
- Louisa M. Lobigs
- School of Human Sciences (Exercise and Sports Science); University of Western Australia; Perth WA 6009 Australia
- Aspetar Sports Medicine Hospital, PO Box 29222; Doha Qatar
| | - Ken Sharpe
- Statistical Consulting Centre, School of Mathematics and Statistics; University of Melbourne; Vic 3010 Australia
| | - Laura A. Garvican-Lewis
- Australian Institute of Sport; Canberra 2617 Australia
- Mary Mackillop Institute for Health Research, Australian Catholic University; Melbourne Australia
| | | | - Peter Peeling
- School of Human Sciences (Exercise and Sports Science); University of Western Australia; Perth WA 6009 Australia
- Western Australian Institute of Sport, Mt Claremont; WA 6010 Australia
| | - Brian Dawson
- School of Human Sciences (Exercise and Sports Science); University of Western Australia; Perth WA 6009 Australia
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9
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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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10
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Wang G, Durussel J, Shurlock J, Mooses M, Fuku N, Bruinvels G, Pedlar C, Burden R, Murray A, Yee B, Keenan A, McClure JD, Sottas PE, Pitsiladis YP. Validation of whole-blood transcriptome signature during microdose recombinant human erythropoietin (rHuEpo) administration. BMC Genomics 2017; 18:817. [PMID: 29143667 PMCID: PMC5688496 DOI: 10.1186/s12864-017-4191-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recombinant human erythropoietin (rHuEpo) can improve human performance and is therefore frequently abused by athletes. As a result, the World Anti-Doping Agency (WADA) introduced the Athlete Biological Passport (ABP) as an indirect method to detect blood doping. Despite this progress, challenges remain to detect blood manipulations such as the use of microdoses of rHuEpo. METHODS Forty-five whole-blood transcriptional markers of rHuEpo previously derived from a high-dose rHuEpo administration trial were used to assess whether microdoses of rHuEpo could be detected in 14 trained subjects and whether these markers may be confounded by exercise (n = 14 trained subjects) and altitude training (n = 21 elite runners and n = 4 elite rowers, respectively). Differential gene expression analysis was carried out following normalisation and significance declared following application of a 5% false discovery rate (FDR) and a 1.5 fold-change. Adaptive model analysis was also applied to incorporate these markers for the detection of rHuEpo. RESULTS ALAS2, BCL2L1, DCAF12, EPB42, GMPR, SELENBP1, SLC4A1, TMOD1 and TRIM58 were differentially expressed during and throughout the post phase of microdose rHuEpo administration. The CD247 and TRIM58 genes were significantly up- and down-regulated, respectively, immediately following exercise when compared with the baseline both before and after rHuEpo/placebo. No significant gene expression changes were found 30 min after exercise in either rHuEpo or placebo groups. ALAS2, BCL2L1, DCAF12, SLC4A1, TMOD1 and TRIM58 tended to be significantly expressed in the elite runners ten days after arriving at altitude and one week after returning from altitude (FDR > 0.059, fold-change varying from 1.39 to 1.63). Following application of the adaptive model, 15 genes showed a high sensitivity (≥ 93%) and specificity (≥ 71%), with BCL2L1 and CSDA having the highest sensitivity (93%) and specificity (93%). CONCLUSIONS Current results provide further evidence that transcriptional biomarkers can strengthen the ABP approach by significantly prolonging the detection window and improving the sensitivity and specificity of blood doping detection. Further studies are required to confirm, and if necessary, integrate the confounding effects of altitude training on blood doping.
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Affiliation(s)
- Guan Wang
- Centre of Sports Medicine for Anti-Doping Research, University of Brighton, Eastbourne, UK.,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Jérôme Durussel
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Martin Mooses
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Noriyuki Fuku
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Georgie Bruinvels
- School of Sport, Health and Applied Science, St Mary's University, Twickenham, London, UK
| | - Charles Pedlar
- School of Sport, Health and Applied Science, St Mary's University, Twickenham, London, UK
| | - Richard Burden
- School of Sport, Health and Applied Science, St Mary's University, Twickenham, London, UK
| | - Andrew Murray
- Centre for Sports and Exercise, University of Edinburgh, Edinburgh, UK
| | | | - Anne Keenan
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - John D McClure
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Yannis P Pitsiladis
- Centre of Sports Medicine for Anti-Doping Research, University of Brighton, Eastbourne, UK. .,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
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11
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Lobigs LM, Sottas PE, Bourdon PC, Nikolovski Z, El-Gingo M, Varamenti E, Peeling P, Dawson B, Schumacher YO. A step towards removing plasma volume variance from the Athlete's Biological Passport: The use of biomarkers to describe vascular volumes from a simple blood test. Drug Test Anal 2017; 10:294-300. [PMID: 28548390 DOI: 10.1002/dta.2219] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/01/2017] [Accepted: 05/22/2017] [Indexed: 02/04/2023]
Abstract
The haematological module of the Athlete's Biological Passport (ABP) has significantly impacted the prevalence of blood manipulations in elite sports. However, the ABP relies on a number of concentration-based markers of erythropoiesis, such as haemoglobin concentration ([Hb]), which are influenced by shifts in plasma volume (PV). Fluctuations in PV contribute to the majority of biological variance associated with volumetric ABP markers. Our laboratory recently identified a panel of common chemistry markers (from a simple blood test) capable of describing ca 67% of PV variance, presenting an applicable method to account for volume shifts within anti-doping practices. Here, this novel PV marker was included into the ABP adaptive model. Over a six-month period (one test per month), 33 healthy, active males provided blood samples and performed the CO-rebreathing method to record PV (control). In the final month participants performed a single maximal exercise effort to promote a PV shift (mean PV decrease -17%, 95% CI -9.75 to -18.13%). Applying the ABP adaptive model, individualized reference limits for [Hb] and the OFF-score were created, with and without the PV correction. With the PV correction, an average of 66% of [Hb] within-subject variance is explained, narrowing the predicted reference limits, and reducing the number of atypical ABP findings post-exercise. Despite an increase in sensitivity there was no observed loss of specificity with the addition of the PV correction. The novel PV marker presented here has the potential to improve the ABP's rate of correct doping detection by removing the confounding effects of PV variance.
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Affiliation(s)
- Louisa M Lobigs
- Department of Sport Science, Exercise and Health, School of Human Sciences, University of Western Australia, Perth, WA, Australia.,Aspetar Sports Medicine Hospital, Doha, Qatar
| | | | - Pitre C Bourdon
- Sports Science Department, Aspire Academy, Doha, Qatar.,School of Health Sciences, University of South Australia, Adelaide, South Austalia, Australia
| | | | | | | | - Peter Peeling
- Department of Sport Science, Exercise and Health, School of Human Sciences, University of Western Australia, Perth, WA, Australia.,Western Australian Institute of Sport, Mt Claremont, WA, Australia
| | - Brian Dawson
- Department of Sport Science, Exercise and Health, School of Human Sciences, University of Western Australia, Perth, WA, Australia
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12
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Gleaves J. Biometrics and Antidoping Enforcement in Professional Sport. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:77-79. [PMID: 27996899 DOI: 10.1080/15265161.2016.1251644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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13
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Abstract
Limits to athletic performance have long been a topic of myth and debate. However, sport performance appears to have reached a state of stagnation in recent years, suggesting that the physical capabilities of humans and other athletic species, such as greyhounds and thoroughbreds, cannot progress indefinitely. Although the ultimate capabilities may be predictable, the exact path for the absolute maximal performance values remains difficult to assess and relies on technical innovations, sport regulation, and other parameters that depend on current societal and economic conditions. The aim of this literature review was to assess the possible plateau of top physical capabilities in various events and detail the historical backgrounds and sociocultural, anthropometrical, and physiological factors influencing the progress and regression of athletic performance. Time series of performances in Olympic disciplines, such as track and field and swimming events, from 1896 to 2012 reveal a major decrease in performance development. Such a saturation effect is simultaneous in greyhound, thoroughbred, and frog performances. The genetic condition, exhaustion of phenotypic pools, economic context, and the depletion of optimal morphological traits contribute to the observed limitation of physical capabilities. Present conditions prevailing, we approach absolute physical limits and endure a continued period of world record scarcity. Optional scenarios for further improvements will mostly depend on sport technology and modification competition rules.
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Sample stability for complete blood cell count using the Sysmex XN haematological analyser. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:576-82. [PMID: 26057491 DOI: 10.2450/2015.0007-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/12/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Sample stability is a crucial aspect for the quality of results of a haematology laboratory. This study was conducted to investigate the reliability of haematological testing using Sysmex XN in samples stored for up to 24 h at different temperatures. MATERIALS AND METHODS Haematological tests were performed on whole blood samples collected from 16 ostensibly healthy outpatients immediately after collection and 3 h, 6 h or 24 h afterwards, with triple aliquots kept at room temperature, 4 °C or 37 °C. RESULTS No meaningful bias was observed after 3 h under different storage conditions, except for red blood cell distribution width (RDW) and platelet count (impedance technique, PLT-I) at 37 °C. After 6 h, meaningful bias was observed for mean corpuscular haemoglobin (MCH) and mean corpuscular volume (MCV) at room temperature, red blood cell (RBC) count, mean corpuscular haemoglobin concentration (MCHC), MCH, MCV and PLT-I at 4 °C, and RBC, RDW, MCHC, MCH and PLT-I at 37 °C. After 24 h, a meaningful bias was observed for MCHC, MCV, platelet count (fluorescent technique, PLT-F) and mean platelet volume (MPV) at room temperature, MCHC, MCV, PLT-I and MPV at 4 °C, and all parameters except RBC count and MPV at 37 °C. DISCUSSION Great caution should be observed when analysing results of haematological tests conducted more than 3 h after sample collection.
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Bonne TC, Lundby C, Lundby AK, Sander M, Bejder J, Nordsborg NB. Altitude training causes haematological fluctuations with relevance for the Athlete Biological Passport. Drug Test Anal 2014; 7:655-62. [DOI: 10.1002/dta.1757] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/15/2014] [Accepted: 11/01/2014] [Indexed: 11/10/2022]
Affiliation(s)
| | - Carsten Lundby
- Zurich Center of Integrative Human Physiology; Institute of Physiology, University of Zürich; Switzerland
| | - Anne Kristine Lundby
- Department of Cardiology; Copenhagen University Hospital at Hvidovre; Copenhagen Denmark
| | - Mikael Sander
- Department of Cardiology; Copenhagen University Hospital at Hvidovre; Copenhagen Denmark
| | - Jacob Bejder
- Department of Nutrition, Exercise and Sport Sciences; University of Copenhagen; Denmark
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16
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Schumacher YO, Garvican LA, Christian R, Lobigs LM, Qi J, Fan R, He Y, Wang H, Gore CJ, Ma F. High altitude, prolonged exercise, and the athlete biological passport. Drug Test Anal 2014; 7:48-55. [DOI: 10.1002/dta.1717] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/10/2014] [Accepted: 08/10/2014] [Indexed: 11/12/2022]
Affiliation(s)
| | - Laura A. Garvican
- Australian Institute of Sports; Department of Physiology; Canberra Australia
- Research Institute for Sport and Exercise; University of Canberra; ACT Australia
| | - Ryan Christian
- Aspetar Orthopedic & Sports Medicine Hospital; PO Box 29222 Doha Qatar
| | - Louisa M. Lobigs
- Aspetar Orthopedic & Sports Medicine Hospital; PO Box 29222 Doha Qatar
| | - Jiliang Qi
- Qinghai Institute of Sports Science (QISS); Duoba National Altitude Training Base; Xining City Qinghai China
| | - Rongyun Fan
- Qinghai Institute of Sports Science (QISS); Duoba National Altitude Training Base; Xining City Qinghai China
| | - Yingying He
- Qinghai Institute of Sports Science (QISS); Duoba National Altitude Training Base; Xining City Qinghai China
| | - Hailing Wang
- Qinghai Institute of Sports Science (QISS); Duoba National Altitude Training Base; Xining City Qinghai China
| | - Christopher J. Gore
- Australian Institute of Sports; Department of Physiology; Canberra Australia
| | - Fuhai Ma
- Qinghai Institute of Sports Science (QISS); Duoba National Altitude Training Base; Xining City Qinghai China
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Saugy M, Lundby C, Robinson N. Monitoring of biological markers indicative of doping: the athlete biological passport. Br J Sports Med 2014; 48:827-32. [DOI: 10.1136/bjsports-2014-093512] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Pitsiladis YP, Durussel J, Rabin O. An integrative ‘Omics’ solution to the detection of recombinant human erythropoietin and blood doping. Br J Sports Med 2014; 48:856-61. [DOI: 10.1136/bjsports-2014-093529] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Sanchis-Gomar F, Pareja-Galeano H, Brioche T, Martinez-Bello V, Lippi G. Altitude exposure in sports: the Athlete Biological Passport standpoint. Drug Test Anal 2013; 6:190-3. [DOI: 10.1002/dta.1539] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 08/14/2013] [Accepted: 08/14/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Fabian Sanchis-Gomar
- Faculty of Medicine, Department of Physiology; University of Valencia; Spain
- Fundación Investigación Hospital Clínico Universitario/INCLIVA; Spain
| | - Helios Pareja-Galeano
- Faculty of Medicine, Department of Physiology; University of Valencia; Spain
- Fundación Investigación Hospital Clínico Universitario/INCLIVA; Spain
| | - Thomas Brioche
- Faculty of Medicine, Department of Physiology; University of Valencia; Spain
- Fundación Investigación Hospital Clínico Universitario/INCLIVA; Spain
- Laboratory M2S (Movement, Sport and Health Sciences); UFR-APS Rennes Cedex France
| | - Vladimir Martinez-Bello
- Faculty of Teaching, Department of Teaching of Musical, Visual and Corporal Expression; University of Valencia; Spain
| | - Giuseppe Lippi
- Clinical Chemistry and Hematology Laboratory, Department of Pathology and Laboratory Medicine; Academic Hospital of Parma; Italy
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20
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Hoffmann JJ. Laboratory hematology in the history of Clinical Chemistry and Laboratory Medicine. Clin Chem Lab Med 2013; 51:119-27. [DOI: 10.1515/cclm-2012-0464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 07/26/2012] [Indexed: 11/15/2022]
Abstract
Abstract
Background: For the occasion of the 50th anniversary of the journal Clinical Chemistry and Laboratory Medicine (CCLM), an historic overview of papers that the journal has published in the field of laboratory hematology (LH) is presented.
Methods: All past volumes of CCLM were screened for papers on LH and these were categorized. Bibliographic data of these papers were also analyzed.
Results:
CCLM published in total 387 LH papers. The absolute number of LH papers published annually showed a significant increase over the years since 1985. Also the share of LH papers demonstrated a steady increase (overall mean 5%, but mean 8% over the past 4 years). The most frequent category was coagulation and fibrinolysis (23.5%). Authors from Germany contributed the most LH papers to the journal (22.7%), followed by the Netherlands and Italy (16.3 and 13.2%, respectively). Recent citation data indicated that other publications cited LH review papers much more frequently than other types of papers.
Conclusions: The history of the journal reflects the emergence and development of laboratory hematology as a separate discipline of laboratory medicine.
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Affiliation(s)
- Johannes J.M.L. Hoffmann
- Abbott Diagnostics Division, Abbott GmbH & Co. KG , Max-Planck-Ring 2, 65205 Wiesbaden-Delkenheim , Germany
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21
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Abstract
Abstract
Clinical laboratories play an important role in improving patient care. The past decades have seen unbelievable, often unpredictable improvements in analytical performance. Although the seminal concept of the brain-to-brain laboratory loop has been described more than four decades ago, there is now a growing awareness about the importance of extra-analytical aspects in laboratory quality. According to this concept, all phases and activities of the testing cycle should be assessed, monitored and improved in order to decrease the total error rates thereby improving patients’ safety. Clinical Chemistry and Laboratory Medicine (CCLM) not only has followed the shift in perception of quality in the discipline, but has been the catalyst for promoting a large debate on this topic, underlining the value of papers dealing with errors in clinical laboratories and possible remedies, as well as new approaches to the definition of quality in pre-, intra-, and post-analytical steps. The celebration of the 50th anniversary of the CCLM journal offers the opportunity to recall and mention some milestones in the approach to quality and patient safety and to inform our readers, as well as laboratory professionals, clinicians and all the stakeholders of the willingness of the journal to maintain quality issues as central to its interest even in the future.
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Affiliation(s)
- Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padua, 35128 , Padua , Italy
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Abstract
The current anti-doping policy (‘war on doping’) resembles the ‘war on drugs’ in several aspects, including a zero-tolerance approach, ideology encroaching on human rights and public health principles, high cost using public money for repression and control, and attempts to shape internationally harmonized legal frameworks to attain its aim. Furthermore, even if for different reasons, both wars seem not to be able to attain their objectives, and possibly lead to more harm to society than they can prevent. The Olympic buzz is mounting and we can expect multiple headlines in the media on doping and anti-doping stories related to this event. In this article we describe current anti-doping policy, reflect on its multiple unplanned consequences, and end with a discussion, if lessons learned from harm reduction experiences in the illicit drugs field could be applied to anti-doping.
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Affiliation(s)
- Bengt Kayser
- Institute of movement sciences and sports medicine, University of Geneva, 10, rue du Conseil Général, 1205, Geneva, Switzerland.
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Lippi G, Plebani M, Sanchis-Gomar F, Banfi G. Current limitations and future perspectives of the Athlete Blood Passport. Eur J Appl Physiol 2012; 112:3693-4. [PMID: 22441832 DOI: 10.1007/s00421-012-2386-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/12/2012] [Indexed: 11/26/2022]
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24
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Thevis M, Kuuranne T, Geyer H, Schänzer W. Annual banned-substance review: analytical approaches in human sports drug testing. Drug Test Anal 2012; 4:2-16. [DOI: 10.1002/dta.415] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Tiia Kuuranne
- Doping Control Laboratory; United Medix Laboratories; Helsinki; Finland
| | - Hans Geyer
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Germany
| | - Wilhelm Schänzer
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Germany
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