Explore the vast range of titles available.

In recent years, increasing concerns have emerged regarding athletes being exposed to various sources of contamination that could result in an adverse analytical finding (AAF), which is considered a positive doping test and may lead to the athlete's sanction. This review aims to examine the potential sources of contamination. Firstly, exogenous sources such as food, water, supplements, and medications will be described, along with endogenous sources, primarily arising from the athlete’s physiological condition via the biotransformation of Medications. Finally, other hypothetical contaminations arising from sample collection procedures, poor transport or storage, and laboratory conditions will be discussed. Despite some legislative efforts to regulate the production of food and supplements, contamination remains a significant concern in the context of anti-doping, necessitating athletes to stay vigilant against the risks of inadvertent uptake of illicit products. Increased knowledge of the potential sources of contamination is essential for all parties involved in the fight against doping, including athletes, support personnel, legitimate supplement product manufacturers, and the anti-doping and scientific community. Such insights can contribute to developing the most effective strategy for preventing contamination and, most importantly, reducing the risk of inadvertent AAFs. •Differentiation of inadvertent exposure of athletes to prohibited substance from doping.•Potential contamination sources are presented in this review.•Scientific studies supporting the potential contamination are summarised.•The importance of increasing knowledge about sources of contamination is discussed.

Currently, urine and blood are the only matrices authorized for antidoping testing by the World Anti-Doping Agency (WADA). Although the usefulness of urine and blood is proven, issues remain for monitoring some drug classes and for drugs prohibited only in competition. The alternative matrix oral fluid (OF) may offer solutions to some of these issues. OF collection is easy, noninvasive, and sex neutral and is directly observed, limiting potential adulteration, a major problem for urine testing. OF is used to monitor drug intake in workplace, clinical toxicology, criminal justice, and driving under the influence of drugs programs and potentially could complement urine and blood for antidoping testing in sports. This review outlines the present state of knowledge and the advantages and limitations of OF testing for each of the WADA drug classes and the research needed to advance OF testing as a viable alternative for antidoping testing. Doping agents are either prohibited at all times or prohibited in competition only. Few OF data from controlled drug administration studies are available for substances banned at all times, whereas for some agents prohibited only in competition, sufficient data may be available to suggest appropriate analytes and cutoffs (analytical threshold concentrations) to identify recent drug use. Additional research is needed to characterize the disposition of many banned substances into OF; OF collection methods and doping agent stability in OF also require investigation to allow the accurate interpretation of OF tests for antidoping monitoring.

Multi-ingredient pre-workout supplements are a popular class of dietary supplements which are purported to improve exercise performance. However, the composition of these products varies substantially between formulations, thus making comparisons challenging. Therefore, the purpose of this study was to identify a common ingredient profile of top-selling pre-workout supplements and to compare ingredient dosages to established efficacious values. The top 100 commercially available pre-workout products were analyzed for listed ingredients and amounts, if available, from the supplement facts panel. The mean ± SD number of ingredients per supplement (n = 100) was 18.4 ± 9.7 with 8.1 ± 9.9 of these ingredients included in a proprietary blend at undisclosed quantities. Relative prevalence and average amounts of the top ingredients amounted to: Beta-alanine (87%; 2.0 ± 0.8 g), Caffeine (86%; 254.0 ± 79.5 mg), Citrulline (71%; 4.0 ± 2.5 g), Tyrosine (63%; 348.0 ± 305.7 mg), Taurine (51%; 1.3 ± 0.6 g), and Creatine (49%; 2.1 ± 1.0 g). Nearly half (44.3%) of all ingredients were included as part of a proprietary blend with undisclosed amounts of each ingredient. The average amount of beta-alanine per serving size was below the recommended efficacious dose. The average caffeine content was near the low end for an effective relative dose for a 70 kg individual (3–6 mg·kg−1 of bodyweight).

The Athlete Blood Passport is the most recent tool adopted by anti-doping authorities to detect athletes using performance-enhancing drugs such as recombinant human erythropoietin (rhEPO). This strategy relies on detecting abnormal variations in haematological variables caused by doping, against a background of biological and analytical variability. Ten subjects were given twice weekly intravenous injections of rhEPO for up to 12 weeks. Full blood counts were measured using a Sysmex XE-2100 automated haematology analyser, and total haemoglobin mass via a carbon monoxide rebreathing test. The sensitivity of the passport to flag abnormal deviations in blood values was evaluated using dedicated Athlete Blood Passport software. Our treatment regimen elicited a 10% increase in total haemoglobin mass equivalent to approximately two bags of reinfused blood. The passport software did not flag any subjects as being suspicious of doping whilst they were receiving rhEPO. We conclude that it is possible for athletes to use rhEPO without eliciting abnormal changes in the blood variables currently monitored by the Athlete Blood Passport.

[...]the performance-enhancing effect of caffeine is believed to be dependent on a variety of factors, such as individual genetics [14,15], microbiome [16], nutrition [17], combination with other substances [12] and also the nature of performance [13]. [...]it is likely that the uptake of caffeine may not result in all athletes in an enhancement of performance, and this could explain the moderate increase in the total of all analyzed samples. [...]the high sugar concentrations may result in a higher thirstiness resolution in a higher consumption of such drinks and a least in a high uptake of caffeine [12]. [...]the risk of higher concentrations of caffeine in combination with physical activity is uncertain and there is a variety of safety concerns in relation to several physiological and pathologic scenarios [18]. [...]it is very likely that individuals consuming caffeine with the aim to enhance performance consume much higher amounts than 200 mg a day. [...]the data provided by Navarro et al., 2019, provide indications that the use of caffeine in elite sports has increased after its removal from the list of banned substances 2004.

Concern for the health of athletes and integrity of sport resulted in the banning of specific substances although many years passed before analytical testing took place. Soon doping control programmes became synonymous with urine tests and adverse analytical findings. This system has its limits due to the detection window of prohibited substances, the timing of sample collections and the sophistication of some doping regimens. There have been a number of situations where these limits were demonstrated by athletes who proclaimed innocence based on passing their analytical tests only to later confess to doping. New strategies were called for to protect clean athletes. In the current World Anti-Doping Code, there are eight means to an Anti-Doping Rule Violation (ADRV). Article 2.2 states that the use of a prohibited substance may be established by any reliable means including witness statements, documentary evidence or evaluations of longitudinal profiling. In 2006, the World Anti-Doping Agency (WADA) with the support of some International Federations (IFs) gathered a group of experts to develop a harmonised programme on longitudinal profiling, or serial analysis of indirect biomarkers of doping, that was both scientifically and legally robust. This culminated in the WADA Athlete Biological Passport (ABP) Operating Guidelines and Technical Documents, published in 2009. The ABP is a paradigm that infers the use of prohibited substance (or method) by the monitoring of discriminant biomarkers over time. The haematological module detects blood manipulation by the use of erythropoietic stimulating agents or via blood transfusions. The steroidal module aims to identify endogenous anabolic androgenic steroids when administered exogenously and other indirect steroid doping substances or methods. Other ABP modules (endocrine, ‘omics’) are being developed. The term passport, first coined in 2000, is now defined in the ABP Guidelines as the longitudinal profile and all other relevant information including training, competitions and information derived from investigations. In the 2015 World Anti-Doping Code, investigations or enquiries gathered from other sources will play an even more prominent role.

A medical and scientific multidisciplinary consensus meeting was held from 29 to 30 November 2013 on Anti-Doping in Sport at the Home of FIFA in Zurich, Switzerland, to create a roadmap for the implementation of the 2015 World Anti-Doping Code. The consensus statement and accompanying papers set out the priorities for the antidoping community in research, science and medicine. The participants achieved consensus on a strategy for the implementation of the 2015 World Anti-Doping Code. Key components of this strategy include: (1) sport-specific risk assessment, (2) prevalence measurement, (3) sport-specific test distribution plans, (4) storage and reanalysis, (5) analytical challenges, (6) forensic intelligence, (7) psychological approach to optimise the most deterrent effect, (8) the Athlete Biological Passport (ABP) and confounding factors, (9) data management system (Anti-Doping Administration & Management System (ADAMS), (10) education, (11) research needs and necessary advances, (12) inadvertent doping and (13) management and ethics: biological data. True implementation of the 2015 World Anti-Doping Code will depend largely on the ability to align thinking around these core concepts and strategies. FIFA, jointly with all other engaged International Federations of sports (Ifs), the International Olympic Committee (IOC) and World Anti-Doping Agency (WADA), are ideally placed to lead transformational change with the unwavering support of the wider antidoping community. The outcome of the consensus meeting was the creation of the ad hoc Working Group charged with the responsibility of moving this agenda forward.

With the constantly increasing sensitivity and robustness of liquid chromatography–mass spectrometry-based instruments combined with enhanced reproducibility as well as mass accuracy and resolution, LC–MS(/MS) has become an integral part of sports drug testing programs particularly concerning the detection of peptide hormones. Although several of the relevant peptidic drugs such as insulins (Humalog LisPro, Novolog Aspart, etc.), growth hormone releasing peptides (GHRPs, e.g., GHRP-2, GHRP-6, Hexarelin, etc.), and insulin-like growth factors (e.g., IGF-1, IGF-2, long-R 3-IGF-1) are currently analyzed using dedicated top-down analytical procedures, i.e. employing specifically tailored sample preparation procedures followed by targeted LC–MS(/MS) measurements focusing on intact analytes, first approaches towards multi-analyte methods have been established. These allow the determination of the prohibited substances in blood and urine doping control specimens following therapeutic applications. In addition, the use of new complementary devices such as ion mobility analyzers, e.g., in hybrid mass spectrometers yielded promising data for the differentiation of isobaric insulins, which outlines the potential to further accelerate and multiplex doping control analytical assays to meet the continuously increasing demands of rapid and unambiguous test methods. Moreover, the potential of LC–MS/MS to target recombinant peptide hormones such as human growth hormone using bottom-up approaches has been demonstrated by targeting proteotypic peptides that unambiguously differentiate the recombinant molecule from the naturally occurring and endogenously produced analog.

Some dietary supplements are spiked with drugs. Pieter Cohen is out to expose the hazards. Since 2005, when internist Pieter Cohen of the Cambridge Health Alliance in Massachusetts found that his patients were being sickened by a Brazilian weight loss supplement containing antidepressants and thyroid hormones, he has become something of a mix of Indiana Jones and Sherlock Holmes of the supplement world. With chemist colleagues in the United States, Brazil, and Europe, he hunts for drugs illegally buried in supplements. Then he goes public. Ultimately, he hopes to inspire new regulations. So far, Cohen and his collaborators have identified three hidden stimulant drugs in supplements. The discoveries also highlight a broader problem, Cohen and others contend: a dysfunctional system for policing dietary supplements.

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.