Steroids. Human growth hormone. EPO. The cast of characters implicated in major athletic doping scandals are familiar to fans who follow major sports. Nor are accusations of doping anything new to Lance Armstrong, the seven-time champion of the Tour de France and most famous American participant in a sport constantly marred by scandal.

Armstrong has always denied the doping charges, and he continues to in the wake of a major investigation published this week by Sports Illustrated. But this time around, reporters Selena Roberts and David Epstein allege something new: That Armstrong illegally acquired and took an experimental drug called HemAssist, which never got beyond clinical trials.

So what is this stuff? HemAssist, developed by Baxter Pharmaceuticals, belongs to a group of drugs called hemoglobin-based oxygen carriers, or HBOC. Simply, they are blood substitutes, ones that mimic the structure of hemoglobin—the protein in red blood cells that transports oxygen. According to a scientific source we spoke to, who researched these drugs for years but preferred to provide background anonymously, the drugs mimic the structure of hemoglobin to more than 99 percent, and can deliver oxygen the way natural hemoglobin does.

Biotech researchers have been developing HBOCs for decades because of their exciting potential applications. For example, these blood substitutes could be taken out on a battlefield where stocks of real blood could not be refrigerated and preserved, and given to wounded soldiers to send a rush of oxygen to their critical organs like the brain and the heart. That ability to pack an oxygen punch is what makes HBOCs a tempting target for a doper.

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After years of denial, Floyd Landis–the cyclist who was stripped of his winning title to the 2006 Tour de France after failing a drug test–admitted last week that he did take performance enhancing drugs. And his confession is causing a stir, partly because he also implicated former teammate Lance Armstrong, seven-time-winner of the Tour de France (Armstrong denies the accusation), and partly because of the particular drugs he fessed up to taking:

Mr. Landis said in [several emails to cycling officials] that during his career, he and other American riders learned how to conduct blood transfusions, take the synthetic blood booster Erythropoietin, or EPO, and use steroids. All these practices are banned in cycling. Mr. Landis said he started using testosterone patches, then progressed to blood transfusions, EPO, and a liquid steroid taken orally. [Wall Street Journal]

EPO shook the cycling community in the 1990s, when police raids during the 1998 Tour de France (dubbed the “Tour de Dopage“) found that several riders were using EPO. It looks like the drug, believed to be thwarted by drug tests, has returned.

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As we slowly slide out of the steroid era in baseball, human growth hormone (HGH) lingers as the next doping trend in major sports. Players like the New York Yankees’ Andy Pettitte have been implicated as HGH users already, and teammate Alex Rodriguez in currently one of many players being questioned in a federal investigation into the substance. However, until now there was no hard evidence that athletes gained a competitive edge by taking it. Researchers say a new study changes that.

“This is the first demonstration that growth hormone improves performance and justifies its ban in sport,” said Dr. Ken Ho, who led the study [AP].

The new research shows that the gains for athletes cheating with HGH could be staggering—but uneven and fraught with side effects. In the study published in the Annals of Internal Medicine, researchers divided 96 athletes into groups that received either placebo, HGH, testosterone, or a testosterone/HGH mix:

After eight weeks, researchers found that growth hormone improved sprint capacity in men and women by an average of 3.9% over the placebo group — which would trim 0.4 of a second from a 10-second time in the 100-meter dash, said study lead author Dr. Kenneth Ho at St. Vincent’s Hospital in Sydney, Australia. In the 2008 Olympics, the top three male finishers had times of 9.69, 9.89 and 9.91 seconds.

That same 3.9% improvement could cut 1.2 seconds from a 30-second time in a 50-meter swim, Ho said [Los Angeles Times].

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We’re only a week away from the 2010 Winter Olympics opening in Vancouver, and the return of the games brings with it the return of crazy stories about how far world-class athletes will go to get even the tiniest edge, legal or illegal. In the journal Science this week, researchers led by geneticist Theodore Friedmann take the opportunity to warn about gene doping, the next looming crisis in cheating at high-stakes athletics.

Genetic doping isn’t new to the headlines—the International Olympic Committee banned it in 2003. But its prevalence is growing, especially since improving testing is starting to weed out more standard forms of cheating like steroids and EPO, a hormone that boosts red blood cell production. Three years ago, German track coach Thomas Springstein was busted after unsuccessfully trying to score Repoxygen, an experimental gene therapy drug that boosts red blood cell production, for his runners. At the Olympics in Beijing, an unidentified Chinese doctor offered stem cell injections to a German journalist posing as a swim coach [Wired.com].

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As 80beats reported back in March, the World Anti-Doping Agency (WADA) has been experimenting with so-called biological passports to curb cheating in sports. Biological passports are electronic records for individual athletes that provide baseline measurements of substances in their blood and urine that officials can track to catch juiced athletes, since a sudden deviation from the baseline would suggest funny business.

Now, the WADA has released a new set of guidelines to monitor athletes’ blood profiles for evidence of performance enhancing substances. The guidelines take effect immediately and provide advice to antidoping agencies on how to put programs in place to collect and store athletes’ blood samples and monitor them for any variations that could indicate doping—without an actual positive test [The New York Times]. The new guidelines are necessary to keep pace with increasingly sophisticated cheating techniques, such as hormone injections, self-blood transfusions, and potentially gene doping.

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A gene therapy treatment intended to reverse muscle weakness appears to restore muscle mass in monkeys, raising hopes that doctors may soon be able to treat this condition in humans with degenerative diseases like multiple sclerosis and muscular dystrophy. Scientists injected a gene into the monkeys’ thighs that causes cells to produce human follistatin, which interferes with another compound called myostatin. Myostatin breaks down muscle, so in theory adding follistatin should encourage muscles to grow [Reuters].

And grow they did. Within three months the monkeys’ thigh muscle mass increased, and the effect lasted for 15 months, according to the research published in the journal Science Translational Medicine. (Not quite the same effect as the whippet turned hugely muscular by a natural genetic defect.) The relatively long-lasting effect is promising for researchers looking to treat lifelong conditions such as multiple sclerosis and muscular dystrophy. The researchers say the treatment was safe and that no other organs were affected.

But there could be a downside to this promising work–some experts are asking whether this therapeutic technique could be used by unscrupulous athletes looking to tweak their genetics and to build stronger muscles. The drugs companies Amgen and Wyeth have already begun testing myostatin inhibitors in humans and such studies have already prompted fears about the potential for myostatin inhibitors to be abused by athletes hoping to gain the competitive edge. If gene therapy can achieve similar outcomes in humans, such modifications will be even harder to detect [New Scientist]. The World Anti-Doping Authority has banned gene doping in athletic competitions for obvious reasons, even though there’s no evidence that any athletes are tinkering with their genes.

Of course there wouldn’t be: If some jock were gene doping, there would be no way to detect it.

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Image: Wikimedia Commons / Muhammad Mahdi Karim

Unscrupulous athletes may soon find it much harder to get away with juicing. Anti-doping agencies are trying out “biological passports,” electronic records for individual athletes which provide baseline measurements of substances in their blood and urine. The record is built up over time through repeated sampling, and later tests can look for suspicious changes that may indicate the use of performance enhancing substances. As cycling has been particularly hammered by allegations of doping athletes, the International Cycling Agency has lead the charge on biological passports. Over a year, it took around 8300 blood samples from 804 cyclists. It recently revealed that a small number of these athletes’ profiles are “under further scrutiny” [New Scientist].

Doping has gone far beyond obvious substances like steroids; in recent years athletes have been caught injecting hormones for a competitive edge, and even getting transfusions of their own blood to discreetly boost their red blood cell counts. The biological passport would combat this increasingly sophisticated arsenal of tricks. Rather than ordinary spot-testing approaches, which look for unnatural ratios between biological constituents in a single sample or for direct chemical evidence of known doping agents, the passport allows investigators to see the big picture—any deviations from the rider’s test-established norm that might result from doping, even if the specific drug or tactic remains unknown [Scientific American].

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In the first major doping scandal of the Beijing Olympics, a North Korean pistol shooter has been stripped of his silver and bronze medals after testing positive for the drug propranolol. The drug, which belongs to a class called beta-blockers, would not be considered a performance-enhancing drug in most sports; it works by blocking the action of adrenaline, and therefore lowers blood pressure and heart rate.

Cardiologist Sandeep Jauhar explains that while propranolol is used to treat high blood pressure, it has additional uses: “It’s also used to treat other conditions that are mediated by high adrenaline levels, such as tremor and performance anxiety. Beta blockers don’t lower the anxiety level, but they lower manifestations of the anxiety, such as fast heart rate, sweating, and tremor” [Scientific American]. Anti-doping officials from the International Olympic Committee (IOC) believe that the shooter, Kim Jong Su, used the drug to keep his hands from shaking during the competition.

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Researchers have developed two drugs that mimic some of the effects of exercise in mice, leading to rampant speculation that people may soon be able to take a dose of “exercise in a pill.” The dramatic study showed that the drugs built fat-burning muscles in mice and increased their endurance on an exercise wheel. Four years ago researchers bred genetically engineered mice that could run much further than normal, but this is the first test to prove that drugs can have the same effect [Telegraph].

“It’s tricking the muscle into ‘believing’ it’s been exercised daily,” said the study’s lead researcher, Ronald Evans…. “It’s basically the couch potato experiment, and it proves you can have a pharmacologic equivalent to exercise” [Wired News]. One drug proved effective for mice that were already exercising regularly, increasing their running time by 68 percent and distance by 70 percent. The other drug worked on mice that hadn’t been trained to exercise; that compound increased their running time by 23 percent and distance by 44 percent.

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Despite the International Olympic Committee’s vow to vigilantly test for performance enhancing drugs at the Summer Olympics in Beijing, some scientists and sports doctors say that athletes are likely to cheat at the games, and get away with it.

The focus is on erythropoietin (EPO), a hormone naturally produced by the kidneys which regulates red blood cell production. When extra EPO is injected before a competition, it boosts performance by increasing the amount of red blood cells in an athlete’s body; those blood cells then carry more oxygen to the hard-working muscles.

Anti-doping agencies regularly test athletes for EPO, but some researchers say the agencies can’t develop tests fast enough to keep up with new “copycat” versions of EPO, often produced by pharmaceutical companies in India, Cuba, and China. These cheap versions of EPO, often called biosimilars, can be easily bought over the internet…. Some scientists who track and monitor the development of copycat EPO drugs say there could be up to 80 different versions now being manufactured in different parts of the world [BBC News].

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