Anti-Doping Research: A Conversation with the Partnership for Clean Competition.

At Drug Free Sport, we believe that a balanced approach to sports drug testing and anti-doping involves testing and education. However, there are several elements that factor into the development of such testing and education, like proper research. With scientific advancements happening both for doping and anti-doping efforts, it’s important to be on top of developments to protect the integrity of sport. 

We recently exchanged with Jenna Celmer at the Partnership for Clean Competition about their work toward improving the detection of performance-enhancing drugs. Our organizations share the spirit of fair and safe sport. It was a great conversation that we’re proud to share with you. 

How did the Partnership for Clean Competition (PCC) come to be? 

Back in 2008, Major League Baseball, the National Football League, the United States Olympic Committee, and the United States Anti-Doping Agency came together to discuss how to better deter and detect performance-enhancing drugs (PEDs) and encourage a culture of clean sport.

These organizations understood that what the anti-doping movement needed was the collaboration and commitment of leading sport organizations willing to fund scientific breakthroughs which advance anti-doping policy. The initial (and subsequent) financial contributions of these four founding PCC members catalyzed the anti-doping research collaborative known as the Partnership for Clean Competition.

The decision was a vocal stand for sporting integrity, and an investment in clean sport and in the health of athletes worldwide.

Tell us more about your focus on “the science of doping.”

While a robust approach to anti-doping policy involves several aspects (such as the education that Drug Free Sport provides), the PCC focuses on advancing the science and technology surrounding anti-doping sample collection, detection, and analysis. Our science varies based on emerging priorities, but could involve the creation of new testing methods that are less invasive and expensive, reference materials for WADA-accredited labs, or innovative tests for new substances. With new doping agents and methods being created every day to try and evade current testing capabilities, it’s paramount that the PCC continues to fund the research that produces sound responses to imminent anti-doping challenges.

What is something that you’d like the public to know about the PCC? 

The PCC funds PhD scientists all over the world (we currently have projects ongoing in 14 different countries), and we are always looking for additional investigators to contribute their unique acumen and scientific perspective to anti-doping challenges. A common misconception is that only dedicated ‘anti-doping scientists’ advance technology in this domain. The truth is, while there are certainly some incredible researchers who have devoted their careers to clean sport, many of the investigators we fund are taking the important work they develop or study in their scientific discipline and applying it to an anti-doping context. We have chemists, biologists, endocrinologists, pathologists, physiologists, food scientists, toxicologists, exercise scientists, and many others currently working on new and exciting developments. There are truly few areas of science that do not play a role, and we’re happy to talk through projects with scientists who aren’t certain if their work is a good fit.

What are some of the research-related findings that the PCC has contributed toward recently?

The PCC has granted over $18 million in research to 100+ investigators around the world; many recent advancements in PED detection and analysis are due to PCC funding. To understand how important this is, newly-found positives during reanalysis of samples from past Olympic games are possible, thanks to the more precise scientific methods developed by scientists.

While this type of research will always be a priority, the PCC has recently invested significant amounts of funding in alternative matrices – or new ways to collect and analyze samples. Currently, most drug testing is done on blood or urine, but two emerging technologies are on our radar:

      1. Breath testing. The PCC has invested in SensaBues breath tests as a quick, easy, and low-cost alternative to current in-competition testing. Athletes simply breathe into the device, which has been proven to detect not only drugs of abuse, but many classes of anti-doping substances, with lab analysis using existing WADA approved methods. PCC investment in the tests is ongoing, and we hope to do a pilot study in 2018.

      2. Dried Plasma Spot Card Testing. While current blood tests involves the use of phlebotomists to  draw blood (a process which may be perceived as invasive by athletes), the PCC has developed cards that require only a finger prick of blood to perform several different analyses. Not only is sample collection quick and easy, but the cards are easy to store, analyze, and transport, potentially providing a significant cost savings over blood testing.

We believe that developing lower-cost, less invasive sample collection methods may increase overall testing, thus enhancing overall deterrence. The PCC is investing in the scientific validation that would be required to protect clean athletes at the same level as blood and urine matrices currently used.

As an organization that funds research, you have a grant cycle deadline coming up. Care to talk about your grant processes and programs?

Absolutely! To begin a PCC grant, investigators must first fill out our 1 – 2 page “Pre-Application”, designed to gather high-level information about the intended project to ensure it fits the PCC mission and priorities. We do this so that investigators presenting research outside of our scope don’t spend time filling out our (lengthy) full application. For instance, the PCC does not currently fund social science research, even on the topic of anti-doping. We always encourage interested researchers to review our research priorities before submitting a pre-application. 

Pre-applications are due March 1^st, July 1^st, and November 1^st of each year.

As soon as pre-applications are approved (and most are), investigators are invited to submit the full PCC application, now available to them via their project site on our website. This application ranges in length from around 10 pages, to upwards of 75 pages, depending on the level of detail the investigators provide, the complexity of their research, and the amount of supplemental information they provide (for instance preliminary studies and data). Hint: the more experimental detail provided in an application, the more likely it is to be approved.

Full applications are due April 1^st, August 1^st, and December 1^st of each year (one month after the pre-application of that cycle).

Once full applications are received, they are reviewed by two members of our 10-member Scientific Advisory Board (SAB), which consists of scientific experts representing a diverse array of disciplines (from endocrinology to exercise physiology). The SAB meets every cycle to then collectively discuss the applications, and the feedback provided by each reviewer. As a unit, the SAB then makes funding recommendations for each application submitted during the cycle to our Board of Governors (consisting of a representative from each of our Founding Members) for final approval before successful investigators are notified.

At this point, the PCC will negotiate terms and conditions with the researcher’s host institution. Unsuccessful investigators will receive feedback on their application, and may be invited to re-submit their project with changes (often more detail is required). The entire process from pre-application to funding and/or feedback takes 3-5 months.

What has research shown that may be next, in terms of doping to gain an athletic advantage?

This is a difficult question to answer and one that is constantly changing. The PCC does get applications from scientists and lab directors who have concerns about specific substances and propose research on those substances. We also incorporate input from our sponsors, who are often on the front lines with regards to new perforamnce-enhancing substances. If researchers from labs, academia, or the private sector believe they have identified a need in the anti-doping community, we would encourage them to apply for a grant or micro-grant. 

Meldonium (Mildronate): What is it and What does it do?

In light of recent media attention surrounding meldonium and its detection in elite athletes, we thought it best to share reliable information about the drug, its intended purpose, and potential use as a performance-enhancing substance.

Blog Article Contributed by Eric Smith, PharmD.

Expert Consultant for the Resource Exchange Center (REC), Powered by Drug Free Sport™

The World Anti-Doping Agency (WADA) added meldonium (Mildronate) to their 2016 Prohibited List in late September 2015. This modification—among others­­—went into effect January 1, 2016. WADA added meldonium as a prohibited substance due to “evidence of its use by athletes with the intention of enhancing performance.”

A Latvian pharmaceutical company with primary distribution in Eastern Europe and Russia manufactures meldonium under the brand name Mildronate. In the 1970s, Mildronate was developed to promote the growth of livestock. Currently, the drug is marketed to treat a variety of medical conditions including ischemic heart disease, heart failure, stroke, peripheral artery disease, and alcohol withdrawal.  Also indicated for use in healthy individuals experiencing physical and mental stress, Mildronate targets athletes as well.

Recent studies identified Mildronate as having anti-ischemic properties. Ischemia is a medical term used to describe a decrease in blood supply to certain parts of the body. A reduction in blood circulation minimizes the delivery and availability of oxygen and sugars needed by the body’s cells. Having anti-ischemic properties makes Mildronate beneficial for treating situations associated with decreased blood supply.   

The drug primarily functions to increase oxygen efficiency in certain body tissues. This makes sense when you reconsider that decreased blood supply (ischemia) reduces oxygen delivery to the tissues. Mildronate works to optimize energy production by interfering with energy pathways that use more oxygen (less efficient) and alternatively promoting pathways that use less oxygen (more efficient).

Mildronate achieves this by blocking pathways involved in carnitine production. Carnitine is an amino acid derivative used in the process of breaking fats down into fatty acids and converting them into energy.  Mildronate creates lower levels of carnitine thereby reducing the body’s ability to breakdown fats for energy.

The body adjusts by increasing the use of an alternative energy pathway called glycolysis.  Glycolysis is more efficient than fatty acid metabolism because it not only uses less oxygen, but also decreases the amount of toxins (such as lactic acid) that build up in cells during energy production.

For athletes, taking this medication could potentially increase muscle and nervous system oxygen efficiency. Using oxygen more effectively in working tissues may lead to performance enhancing benefits such as improved exercise tolerance, improved recovery, stress protection, and improved central nervous system functions. 

Isn’t biochemistry and pharmacology fun?

Mildronate is not approved by the Food and Drug Administration (FDA) for sale in the United States.

Blood Testing for Prohibited Substances in Sport

Welcome to the restored Drug Free Sport Blog, Perspectives! 

After a three-year hiatus, we are eager to begin sharing our expertise, stories, and trending news related to sport drug testing and athlete health. We hope to reengage our followers and expand our reach to new audiences to provide valuable “perspectives” about our company, staff, and the sport drug testing industry. Thank you for reading and sharing!

To kick-off our reentry into the blogosphere, we explore blood testing for prohibited substances in sport, current trends related to phlebotomy testing, and other fun facts from the industry.

To gain insight into the use of blood for drug testing athletes we sat down for a Q&A with our own Ben Mosier, Director of Professional Sports Drug Testing, Ryan Willis, Director of NFL PED Drug Testing, and Sarah Ziegelmann, Phlebotomy Services Program Manager.

Q: Drug Free Sport has been conducting blood drug testing in professional sports since 2004. Has anything significant changed in this area of drug testing?

A: Blood testing continues to expand in professional sports through the continuous addition of certified phlebotomists and an increased understanding of the process and specificity of testing. Currently, there is increasing interest in blood biomarkers and the athlete’s biological passport. Biomarker testing serves to monitor variables over time that may reveal the effect of doping, and the biological passport uses longitudinal profiling to test an athlete’s blood for initial testosterone levels. These levels are held on a file and reviewed in the future to determine if the athlete has used testosterone boosting substances. The World Anti-Doping Agency (WADA) will begin biomarker testing in the near future.

Q: So instead of testing for testosterone at a single test, you’re comparing the athlete’s own blood levels of testosterone from one sample to another over a period of time?

A:  Exactly. That would be an example of using the Athlete Biological Passport. The Athlete Biological Passport (ABP) provides a longitudinal study that monitors a panel of biomarkers within the athlete’s blood that will indirectly show the effects of doping over a period of time. Instead of searching for a specific performance-enhancing substance, a positive test can result from inconsistencies measured in the athlete’s biomarker levels. This is called a Non-Analytical Positive. Blood testing in sport can also identify and accurately detect two other categories of performance enhancement that other matrices cannot: Blood Doping and Human Growth Hormone (hGH).  

Q: Tell us about these other categories. What makes them different?

A:  There are several substances or methods used for blood doping in sports. Erythropoiesis Stimulating Agents (ESA), also known as recombinant erythropoietin (rEPO),work by stimulating the production of more red blood cells. Hemoglobin-based Oxygen Carriers (HBOC) and Homologous Blood Transfusions (HBT) are other blood doping methods. All three methods are used in various manners to increase an athlete’s red blood cell count, resulting in an increase of stamina and performance. Blood passport testing is used to target and identify these different doping methodologies. 

Human growth hormone (hGH) is a naturally occurring substance in the body produced by the pituitary gland. hGH is most often attributed to blood drug testing in sports. Synthetic hGH is used as a Performance Enhancing Drug (PED) to enhance the growth of bone, muscle and organ tissues within the body.  The Isoforms Test and Biomarkers Test can be used to determine whether the hGH levels in an athlete are naturally occurring or synthetically altered.

Q: How accurate are the results of these blood tests?

A: When conducted according to the specified collection procedures and protocols, blood testing provides less than a 0.01% error—higher accuracy than provided by urine drug tests.

Q: Are blood test results produced quicker than urine tests?

A: The speed of receiving results from a blood test is primarily dependent on the drug-testing laboratories’ volume at the time. The average timeframe for a result is 10 – 14 days, but for an additional fee the process can be expedited. A benefit of blood testing is the ability to test 20 samples at a time which can speed the process compared to urine testing. Urine testing has a 14 day result turn around.  

Q: How do athletes feel about blood testing compared to urine testing?

A: The average blood draw takes about 10 minutes, which most athletes prefer due to the quickness of the test and the ability to perform a test on demand as opposed to waiting to produce and validate a urine sample. On the other hand, some athletes have a fear of needles, making this type of testing less desirable. Under most circumstances, trained phlebotomists administering the tests are skilled at calming the athlete and successfully collecting a sample.

Q: What would be good information for athletes to know about what to expect from a blood test?

The average blood draw takes 10 minutes, 
and collects 10mL of blood.

10mL is one-third of a standard shot of espresso. 
Photo credit: by Sandstein (Own work) [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons 

A: Well, the notification of a blood test to an athlete is dependent on if the sport is in-season or off-season. Also, to ensure accuracy, blood tests require specific amounts of time between when an athlete last engaged in physical activity/exercise and the blood collection. When being tested for hGH, the athlete must wait at least 30 minutes after exercise to produce a blood sample. For ESA blood testing, the athlete has to wait a minimum of two hours after engaging in physical activity.

Similar to urine-based drug tests, the athletes are able to select their testing devices and custody and control forms for testing. Trained phlebotomists ensure that clients have a full scope of knowledge in regards to the blood collection process; this also protects the health and safety of the athletes. Prior to testing, the phlebotomist will ask about the athlete’s history with providing blood samples along with potential complications. Once athlete identification and demographic information is confirmed, the blood draw begins. Blood tests are administered using a small needle and collect 10 milliliters (mL) of blood in a test tube. (Consider: The human body has approximately 5,500 mL of blood and a standard shot of espressoholds 30 mL of fluid.) The collection tube is then secured into transport kits, stored, and shipped in temperature controlled containers. Both the athlete and collector confirm the validity of the procedure with affidavits and if feeling well, the athlete is dismissed.

Blood testing collections continue to expand in professional sports and new scientific advancements and innovations further protect the integrity and landscape of the sport drug testing industry. Drug Free Sport oversees the collection of 5,000 blood tests annually. Our experts are here to answer questions and assist you through the process. Feel free to leave comments or reach out to us directly with any questions.