Practical experience with the implementation of an athlete's biological profile in athletics, cycling, football and swimming.

The introduction of the athlete's biological passport (ABP) has been a milestone in the fight against doping. The ABP is a collection of measurements of different biological parameters influenced by the administration of doping agents through the time and for each athlete. Two different modules have been developed and validated so far: the haematological module, which aims to identify enhancement of oxygen transport, including use of erythropoiesis-stimulating agents and any form of blood transfusion or manipulation, which became effective in 2010; and the steroidal module, which intends to detect the use of endogenous anabolic androgenic steroids when administered exogenously and other anabolic agents, which was introduced in 2014. Prior to the implementation of the haematological module, it is important to define an athlete's testing pool on whom to collect blood and/or urine in-competition and out-of-competition (for the steroidal module, this is irrelevant because all collected urine samples will be subjected to analysis for the steroidal variables) and to be compliant with the strict requirements of the World Anti-Doping Agency ABP Operating Guidelines. The established individual profile can be used either to target traditional antidoping tests (recombinant erythropoietins, or homologous blood transfusion tests for the haematological module; isotope ratio mass spectrometry (IRMS) for the steroidal module) or to support an antidoping rule violation due to the use of a forbidden substance or method. In this article, we present the experience of four major International Federations which have implemented an ABP programme, focusing on the haematological module. They constitute examples which could be followed by other antidoping organisations wishing to introduce this new, efficient and innovative antidoping tool.

Why glucocorticosteroids should remain in the list of prohibited substances: a sports medicine viewpoint.

In addition to their therapeutic applications, glucocorticosteroids have been widely used and abused in the belief that these substances may enhance athletic performance. Analysis of athlete urine samples by antidoping laboratories around the world support this conclusion. It is commonly accepted in medical practice to use local glucocorticosteroid injections in the treatment of non-infectious local musculotendinous inflammatory conditions conveying symptom relief and often a speedier return to sporting activity. This practice is not to be considered illicit, but sports physicians must accept that such an intervention is not in itself an immediate cure and that an athlete will still require a period of recuperation before continuing sporting activity. How long such a period of recuperation should last is a matter of conjecture and there is little concrete data to support what is, or what is not, an acceptable period of inactivity. In the interest of athlete safety, we would propose to maintain systemic glucocorticosteroids on the World Anti-Doping Agency's (WADA) list of prohibited substances, both in and out-of-competition as well as a mandatory period of 48 hours of rest from play after receiving a local glucocorticosteroid injection.

Haematological analysis conducted at the departure of the Tour de France 2001.

Since the introduction of blood analysis performed before major cycling events in 1997, there have been discussions concerning the quality of the results. The aim of our study therefore was to measure blood samples and compare the results obtained on the field with those obtained in the laboratory. For this it was necessary to have blood samples analysed with different instruments to determine the exactness of the results and evaluate the performances of these instruments in order to validate the haematological testing used to reveal athletes abusing recombinant erythropoietin. We report on the haematological analysis of 177 professional cyclists who took part in the Tour de France 2001. All the blood samples were withdrawn in the morning between 7 and 9 am in Dunkerque (France) and were analysed immediately with a transportable analyser. Then the samples were flown to Lausanne (Switzerland) and were reanalysed in two independent ISO 17 025 accredited laboratories with three different analysers. The results confirmed that the most effective haematological follow-up should be performed under standardized pre-analytical conditions and with identical analysers of the same manufacturer to avoid too many variations notably on the haematocrit level and the reticulocyte count. Furthermore, this study suggests that analyses performed on the site are good and could enable the federations to perform a urinary test to detect rhEPO abuse right after the blood analysis. This time saving is essential to fight efficiently recombinant erythropoietin doping, because the half life of the hormone is very short.

Abnormally high serum ferritin levels among professional road cyclists.

BACKGROUND: An international, longitudinal medical follow up examination of male professional road cyclists revealed excessively elevated serum ferritin levels. OBJECTIVE: To evaluate the importance of elevated ferritin values among professional cyclists, their relationship with age and nationality, and their evolution over 3 years. METHODS: Over 1000 serum ferritin values were collected. Other parameters were included in order to exclude conditions which might have increased ferritin levels without changing body iron stores. RESULTS: In 1999, over 45% of riders displayed ferritin values above 300 ng/ml and one fourth levels over 500 ng/ml. These percentages had decreased to 27% and 9%, respectively, 3 years later, while the overall average, which was above the normal limits in 1999, had decreased by 33% in 3 years. Older cyclists had higher ferritin values than younger cyclists. There was also a relationship between ferritin levels and the nationality of the cyclists. Analysis of 714 riders in 2000 and 2002 showed only a slight and insignificant decrease in the mean ferritin value although those with initially elevated iron stores had a much greater decrease. CONCLUSION: Professional road cyclists used excessive iron supplementation leading to high serum ferritin levels correlating with increased body iron stores. Although the situation progressively improved over 3 years, it remains worrying as increased body iron stores are related to health complications. Therefore, prevention in addition to the fight against doping should be a main goal of the UCI. Aggressive therapy for athletes with excessive ferritin values should be carried out at or before the end of their careers.