Blood doping

[Barrus]

First let me put out a disclaimer:
This thread is not about the Contador case

Out of the preliminary reports by the media it appears as though a test is ready to find out whether a rider has taken a blood transfusion. My question is what info do all of you have about this test.

I have a few questions in particular

1 How long has this test existed

2 does anyone know how the test works

3 what are the approximate chances of getting caught with this test

4 what are the chances of false positives

5 how many labs are able to do this test

6 and perhaps most importantly, is this test accredited in such a way that it would be possible to base a ban on the evidence provided for by this test

 

[Benotti69]

i would add a question or 2.

When a rider gives blood for later transfusion, do they take a sample to test to make sure it will be 'clean' there and then or do they take a sample at a later date to ensure it was clean going in?

do they add anything to the blood?

what has the blood got to boost performance, high red cell count? anything else?

what kind of labs do this and do they know they are testing for illegal PEDs?
(i kind of think the answer is yes and there are unscrupulous people all over the world)

 

[ingsve]

There seems to be a test that checks the amount of DEHP metabolites in urine. DEHP is a plasticizer used in IV-bags and a study has shown that patients undergoing blood transfusions show significantly higher amounts of DEHP metabolites than in a control group and in patients undergoing medical care involving other plastics.

This seems to be a test that could potentially be positive proof of blood transfusion but it is still very early.

The study this is based on can be found here:

http://onlinelibrary.wiley.com/doi/10.1111/j.1537-2995.2009.02352.x/full

 

[Barrus]

Great article you found Ingsve, but I don't know if everyone can read that, as I think you need a subscription for it.

However what I find really good, is the fact that you can see the effects up to 48 hours later, which does increase the cance of getting caught.

Also interesting is that in the case of pro athletes the results would be even more outspoken, as a regular pro athlete has a significant lower concentration. However the study does indicate that there needs to be a long term investigation to assess the regular level of these concentration, which could be used in combination with the bio passport.

But I think this is one of the most important passages in the article:

The approach could be applicable to all urine samples submitted to doping control in any accredited laboratory being a useful tool to alert on any potential cheater in any antidoping program. Compared to other tests that are performed for blood doping detection, such as flow cytometry, the method proposed here is cheaper, less time-consuming, and easy to perform because it is based on liquid chromatography coupled to tandem mass spectrometry technology, nowadays available in all antidoping control laboratories. Moreover, it is worth remembering that the actual situation, even for allogeneic transfusion, is limited by the collection of blood samples only on a low percentage of subjects. Thus, compared with the noncomprehensive present limitation, all those urine samples collected annually in sports drug testing (more than 220,000 samples in 2007) could be screened for such undesirable and prohibited practice in sport, allowing for placing special focus and target confirmation on those subjects potentially practicing blood doping.

 

[theswordsman]

Considering the incomes of athletes and teams (across sports, not just cycling), and the willingness to adapt cheaters seem to have, wouldn't it seem likely that someone would come up with a different material for blood storage? I don't know what the limiting factors are in terms of safe collection, storage and transportation, but I imagine one of them is cost. Someone like the Red Cross, or hospitals, would need to keep the cost down. But a professional athlete who might have a victory and new contract tied to one bag of stored blood would be willing to invest a lot more for a container that won't fail a test. And a doctor who had a supply of such things could do a steady business.

I've been trained as a pro cycling fan to believe that if a test for something is imminent, a way around it is already in the works.

 

[ingsve]

Considering the incomes of athletes and teams (across sports, not just cycling), and the willingness to adapt cheaters seem to have, wouldn't it seem likely that someone would come up with a different material for blood storage? I don't know what the limiting factors are in terms of safe collection, storage and transportation, but I imagine one of them is cost. Someone like the Red Cross, or hospitals, would need to keep the cost down. But a professional athlete who might have a victory and new contract tied to one bag of stored blood would be willing to invest a lot more for a container that won't fail a test. And a doctor who had a supply of such things could do a steady business.

I've been trained as a pro cycling fan to believe that if a test for something is imminent, a way around it is already in the works.

Yes, that was my first thought as well. I don't know enough about blood storage to know if there are any other viable options out there.

 

[Squares]

Considering the incomes of athletes and teams (across sports, not just cycling), and the willingness to adapt cheaters seem to have, wouldn't it seem likely that someone would come up with a different material for blood storage? I don't know what the limiting factors are in terms of safe collection, storage and transportation, but I imagine one of them is cost. Someone like the Red Cross, or hospitals, would need to keep the cost down. But a professional athlete who might have a victory and new contract tied to one bag of stored blood would be willing to invest a lot more for a container that won't fail a test. And a doctor who had a supply of such things could do a steady business.

I've been trained as a pro cycling fan to believe that if a test for something is imminent, a way around it is already in the works.

The companies that make blood collections and storage bags, like Baxter International, spent millions on R&D to find a suitable material for blood storage bags and demonstrating that they were safe and effective. A cyclig team would have to have several dozen employees, millions of dollars worth of lab equipment, and a million dollar budget just to find and test alternatives.

The biggest problem in finding an alternative material is finding one that wouldn't contain DEHP (or whatever the acronym) but is still soft and flexible enough and yet is hemocompatible. By hemocompatible, I mean that it cannot trigger red blood cell lysis, it can't have components that leach out and harm the recipient donor, and it can't allow activation of the blood clotting cascade or the blood becomes one big clot.

This means that they are likely stuck with commercial bags.

If they have a budget that is big enough, they would be better off spending their money on recombinant DNA technologies to enable genetic doping.

 

[Barrus]

If they have a budget that is big enough, they would be better off spending their money on recombinant DNA technologies to enable genetic doping.

Or just buy the UCI

But really, great insight in this subject by you Squares.

So this would mean that if the test is accredited blood doping could be considered to be history?

 

[Escarabajo]

Or just buy the UCI

But really, great insight in this subject by you Squares.

So this would mean that if the test is accredited blood doping could be considered to be history?

Great info here. Thanks for the article ingsve.

That agrees with what was said in Lequipe today.

The question now is: If by some reason they approve it, can we retroactively test some samples from 2009 and 2008 tours? Just more ammunition to nail the big guns.

I doubt the UCI will accept that, otherwise they would have done the same thing for the test for CERA from the 2007 Tour.

 

[Benotti69]

Or just buy the UCI

But really, great insight in this subject by you Squares.

So this would mean that if the test is accredited blood doping could be considered to be history?

until they find something to eliminate the traces of plastic and it takes years to find out and test for it

 

[Cobblestones]

Thanks to Ingsve and Squares for the information. After reading through it, I think it'll be a great way to test for transfusions. The best thing, really, is that it's a urine based test and most likely, it can be administered retroactively.

 

[Barrus]

until they find something to eliminate the traces of plastic and it takes years to find out and test for it

What I understand from the article of Ingsve is that this could not be possible, as the blood takes these traces up whenever it is stored in it, and the traces cannot be masked

 

[python]

Yes, that was my first thought as well. I don't know enough about blood storage to know if there are any other viable options out there.

of course there are.

and they could be as simple as a sterilized one pint jar after the pickles were consumed - not a perfect true but almost...

the real question is what are the mass commercial alternatives vs those relatively rare custom schemes that would be suitable for a cheating athlete.

a cheater will not necessarily depend on the commercial product.

another important point is that besides the test for plasticizers, there are several alternatives ideas (some are well advanced) that are in the pipe for autologous blood transfusion test.

plasticizer is but one of them.

google and use the other academic searches are full of the references but i'm speaking from memory and gotta run.

 

[Winterfold]

Isn't this plasticiser used in many many everyday products though - I would have there is a lot of scope for legal wrangling unless they have a very clear understanding of the effects and parameters

 

[Merckx index]

The companies that make blood collections and storage bags, like Baxter International, spent millions on R&D to find a suitable material for blood storage bags and demonstrating that they were safe and effective. A cyclig team would have to have several dozen employees, millions of dollars worth of lab equipment, and a million dollar budget just to find and test alternatives.

The biggest problem in finding an alternative material is finding one that wouldn't contain DEHP (or whatever the acronym) but is still soft and flexible enough and yet is hemocompatible. By hemocompatible, I mean that it cannot trigger red blood cell lysis, it can't have components that leach out and harm the recipient donor, and it can't allow activation of the blood clotting cascade or the blood becomes one big clot.

This means that they are likely stuck with commercial bags.

If they have a budget that is big enough, they would be better off spending their money on recombinant DNA technologies to enable genetic doping.

This assumes that a doping athlete will be highly safety conscious, when in fact we know they are anything but. While it might be very difficult and expensive to find an alternative blood storage material that was demonstrably safe, this would likely not deter a lot of transfusers.

While the article is very interesting, it raises a couple of questions for me:

1) how long do the elevated metabolite levels persist? They tested up to 48 hours. Given all the blood doping that occurs during training, out of competition, one would want to demonstrate that these levels persist for more than two days. One of the metabolites in the transfused patients showed about as high levels after 48 hours as 24 hours, which suggests that in this one case, significantly high levels might be found for several days.

2) why did some athletes have very high values? Maybe they were transfusing, but an alternative is that they obtained DHEP from some other source related to their sport, e.g., drinking excess amounts of water from plastic bottles. One of the groups was aquatic sports, which I would think do not drink that much water, but is it possible these substances are in, e.g., swimming pools? I gather only one athlete from each sport was tested??, so can't really draw any conclusions either way.

 

[Cobblestones]

Isn't this plasticiser used in many many everyday products though - I would have there is a lot of scope for legal wrangling unless they have a very clear understanding of the effects and parameters

In the article it says the concentration of metabolites of this plasticizer in the urine jumps up tenfold. Yes, there is a non-zero concentration which comes from everyday exposure, but getting a transfusion really sticks out like a sore thumb.

 

[Cobblestones]

This assumes that a doping athlete will be highly safety conscious, when in fact we know they are anything but. While it might be very difficult and expensive to find an alternative blood storage material that was demonstrably safe, this would likely not deter a lot of transfusers.

While the article is very interesting, it raises a couple of questions for me:

1) how long do the elevated metabolite levels persist? They tested up to 48 hours. Given all the blood doping that occurs during training, out of competition, one would want to demonstrate that these levels persist for more than two days. One of the metabolites in the transfused patients showed about as high levels after 48 hours as 24 hours, which suggests that in this one case, significantly high levels might be found for several days.

2) why did some athletes have very high values? Maybe they were transfusing, but an alternative is that they obtained DHEP from some other source related to their sport, e.g., drinking excess amounts of water from plastic bottles. One of the groups was aquatic sports, which I would think do not drink that much water, but is it possible these substances are in, e.g., swimming pools? I gather only one athlete from each sport was tested??, so can't really draw any conclusions either way.

1) The detection window is what it is. If the concentrations go back to normal after, say 2-4 days, then that's what you have to work with. It's actually not worse than for some other tests. It just means you have to test often. The great thing is that's a urine test, not a blood test. Sample taking is simple and cheap.

2) No, the biggest test group (127) was actually athletes. Out of these 127, they found 4 'outliers' (one from cycling, one aquatic, and two soccer players). They also tested other hospitalized patients who did not receive a transfusion (but who were likely hooked up to IV's and whatnot). Not much of a signal from there.

 

[Winterfold]

In the article it says the concentration of metabolites of this plasticizer in the urine jumps up tenfold. Yes, there is a non-zero concentration which comes from everyday exposure, but getting a transfusion really sticks out like a sore thumb.

I can imagine it might well be the case - they will just need to be very clear about what constitutes a positive (accepting a few marginal cases might be inconclusive ie get away with it).

Else I can see 'my client eat 1000 rice cakes that had been wrapped in clingfilm last year and drank 5000 litres of energy drink from bottles containing this plasticiser etc etc'

 

[Cobblestones]

I can imagine it might well be the case - they will just need to be very clear about what constitutes a positive (accepting a few marginal cases might be inconclusive ie get away with it).

Else I can see 'my client eat 1000 rice cakes that had been wrapped in clingfilm last year and drank 5000 litres of energy drink from bottles containing this plasticiser etc etc'

Actually, the obstacle is bigger than that:

First of all, the plasticizer itself is not on the list of banned substances and it probably never will be, because by itself, it does not have any performance enhancing effect. The only way this test might be used is as potential evidence for getting a transfusion (getting a transfusion IS a forbidden practice). So, maybe, the test can be performed very fast and might help select whom to target for the more expensive blood test/profiling.

 

[Merckx index]

Actually, the obstacle is bigger than that:

First of all, the plasticizer itself is not on the list of banned substances and it probably never will be, because by itself, it does not have any performance enhancing effect. The only way this test might be used is as potential evidence for getting a transfusion (getting a transfusion IS a forbidden practice). So, maybe, the test can be performed very fast and might help select whom to target for the more expensive blood test/profiling.

Looks like this theory is being tested: http://sports.yahoo.com/sc/news;_ylt=AsD8jJkpp0LiVeOjX8BC0UM5nYcB?slug=ap-contador-doping

Vidarte said the World Anti-Doping Agency has not validated a method for detecting plastic from blood transfusion bags.
WADA director general David Howman, however, told the AP that a method was “fully validated and has been used in the food industry for years.”
“Its use for anti-doping purposes is partially validated and evidence from it, among others, can be used before tribunals,” Howman said.

 

[Cobblestones]

Looks like this theory is being tested: http://sports.yahoo.com/sc/news;_ylt=AsD8jJkpp0LiVeOjX8BC0UM5nYcB?slug=ap-contador-doping

Interesting. It seems what WADA is saying is that the test for DEHP metabolites is a well established method to detect exposure to DEHP. What is probably less clear is how exposure to DEHP can be related to transfusions and how to rule out other conceivable (or less conceivable) ways of contamination. Apparently wearing certain types of vinyl gloves could give you some exposure (I wonder about other, uhm, vinyl products, which you use to cover, uhm, other body parts.)

 

[Race Radio]

There is also another test being worked on that focuses on 2,3-bisphosphoglycerate levels

 

[Cobblestones]

There is also another test being worked on that focuses on 2,3-bisphosphoglycerate levels

I remember it. We discussed it last year.

 

[biokemguy]

references?

There is also another test being worked on that focuses on 2,3-bisphosphoglycerate levels

That sounds like a much more sound approach. I'd love to read about it. Do you have any references, or is this something you heard from someone 'in the know'?

As far as testing for DEHP goes, it seems pretty obvious that long term profiling of that chemical in each athletes urine would make a transfusion easy to spot.

Money and political will on the other hand probably don't exist for such testing.

 

[Barrus]

That sounds like a much more sound approach. I'd love to read about it. Do you have any references, or is this something you heard from someone 'in the know'?

As far as testing for DEHP goes, it seems pretty obvious that long term profiling of that chemical in each athletes urine would make a transfusion easy to spot.

Money and political will on the other hand probably don't exist for such testing.

The fun thing is, if you look at the article posted by Ingsve is that this test would cost close to nothing, as every lab already has the equipment and that it is a relatively easy test to administer