Genetic doping has been on the list of prohibited substances since 2003 and its use has been suspected for almost as long. However, until today no method for gene doping detection has been implemented by the World Anti-doping Agency. By developing and demonstrating a proof-of-principle of our method, ADOPE, we can be the first to this niche market. Our analysis and market research lead us to a distinct value proposition canvas revealing the needs of our main stakeholders, the anti-doping agencies.
We also identified applications beyond our current scope. The method is highly valuable to the Dutch Trotting and Flatracing Association, who would like to see our method implemented in horse racing doping tests. In addition, the Dutch National Bloodbank Sanquin would like to apply the method for less invasive prenatal screening, and the Dutch Research Department for Food Safety at Wageningen University and Research (RIKILT) for food safety applications.
We have taken significant steps to ensure the future implementation of our idea. By writing a grant application to the Partnership for Clean Competition and a collaboration proposal with Oxford Nanopore Technologies, we are in the starting blocks to demonstrate the applicability of ADOPE in the field. A second grant application is in preparation by the Brouns lab (TU Delft), our supervising lab, involving the Delft Sports Engineering Institute. The institute would further support the development of our ideas financially and connect with an extensive network in the world of professional sports. Oxford Nanopore Technologies indicated that our proposal is of interest to them and it would fit well within their plans.
Based on our network consisting of companies and institutions, we see an ideal basis to achieve a demonstration of our technology. We aim to become the first and best gene doping detection method to be implemented in doping detection laboratories worldwide.
To the best of our knowledge, no method for gene doping detection is currently implemented by the world anti-doping agency for testing on real athlete samples. This does not mean the problem is new: the World anti-doping agency (WADA) banned gene doping already in 2003, and rumors, accusations and initial tests have been dotting the gene doping timeline (figure 1) since then.
The World Anti Doping Agency (WADA) puts gene doping on the list of prohibited substances.
2004: Marathon mice
Geneticists at Howard Highes Medical Institute engineered so-called marathon mice that could run twice as far as normal mice by changing only a single gene, PPARdelta. (Wang et al. 2004)
2006: German Coach (Thomas Springstein) Suspected of Genetic Doping.
Thomas Springstein was a one-time coach of the German Athletics Association (DLV). He was convicted partly based on e-mail conversations, which were aquired by the police during a raid on his home. These e-mails brought up references to Repoxygen, a banned substance meant to be used in gene therapy to treat patients with anemia. Repoxygen helps to induce a controlled release of erythropoietin (EPO), a substance that stimulates the production of red blood cells, thereby increasing the amount of oxygen the blood can deliver to the muscles. It was under preclinical development by Oxford Biomedica as a possible treatment for anaemia but was abandoned in 2003. (Michael Reinsch, 28 January 2006).
2008: Chinese Doctor Offers Gene Doping to Athletes
A German television report was brought out on the availability of gene doping in China shortly before the Beijing Olympics. In this documentary produced by ARD television, a Chinese doctor offers stem cell therapy to a reporter posing as an American swimming coach in return for $24,000, according to a translation provided by the ARD television. The documentary broadcast does not offer evidence that the hospital has provided gene doping to other athletes, but it does provide a shocking insight into the doping development scene (NBC News 2008).
2010: Gene Doping Detection: Evaluation of Approach for Direct Detection of Gene Transfer using Erythropoietin as a Model System
In two mouse studies, blood was positive for a plasmid in some animals for 1–2 days and up to 1 or 4 weeks after intramuscular or intravenous administration. The sensitivity of PCR methods used in these studies was 100 or 1000 vector copies per mg of gDNA. In another study with mice injected rAAV intramuscularly, 12 whole blood samples from a high-dose group tested positive foxr viral DNA until day 28, but viral DNA in plasma was cleared within 3–4 days. The sensitivity of the method for vector detection in this study is comparable to that for the assays developed here. (Baoutina et al. 2010)
2016: Officials Fear Some Olympic Athletes Might Be Altering Their Genes To Cheat In Rio
Sarah Everts reported for Chemical and Engineering News that officials planned to test 2016 Rio athletes' tissue samples for markers of gene doping. The most likely subject of a genetic hack appears to be the gene that codes for EPO. Therefore, this gene became what the officials planned to test for. (Letzter et al. 2016)
Athletes at Rio Olympics Face Advanced Antidoping Technology
According to the International Olympic Committee’s medical and scientific director, Richard Budgett, samples collected in Rio will be tested for gene doping at some point after the games, even though the test hasn’t been run during the Olympics itself. (Everts, 2016)
2017: Doping Control Analysis at the Rio 2016 Olympic and Paralympic Games
The EPO gene is mostly expressed in renal cells, from where the EPO protein is secreted into the bloodstream. The identification of any concentration of EPO DNA sequences in blood however, are considered a positive result for gene doping within current detection methods. Considering the growing concern over gene doping, as well as the EPO availability of new molecular biology tools, the Brazilian Doping Control Laboratory (LBCD) implemented, improved, and validated 2 amplification assays for EPO cDNA using the real-time PCR instrument QuantStudio12K (Thermo Fisher, São Paulo, Brazil). All work was performed with WADA-certified reference material for EPO gene doping within a range of 1 to 4000 copies of reference material spikes and EPO gene-doping-positive samples. However, in view of the absence of interlaboratory tests among the laboratories accredited by WADA, the analysis was not performed on the Olympic samples; it was only performed on samples selected exclusively for research. (Pereira, et al. 2017)
Our enthusiastic team set out to tackle gene doping to promote responsible use of synthetic biology. Read more about our project here.
Because the niche market for gene doping detection method is still empty of tests that are actually implemented, a market analysis of this niche is hard to make. We can however analyze the doping detection field as a whole. We spoke with Mr. Olivier de Hon from the Dutch anti-doping authority on how to enter this market. “ What matters in the doping world is this: is it effective and scientifically validated? If the answer is two times “yes”, laboratories can use your method or will even have to use it obligatory. You need to convince the WADA, and more specifically the Laboratory Expert Group.” This is the way to realize implementation.
Olivier De Hon, Dutch Doping authority
Before we can start convincing the WADA, we will need to pass two important first hurdles. We need to have enough funding to continue development, and we need to ensure that once we have convinced the WADA, we remain their detection method of choice. As a first mover, this is an important consideration. We need to continue being the best gene doping detection method even after others enter the market. This is important: by being the best we can be, we force other methods in development to be even better, thus helping the field advance more rapidly.
The steps then, to enter the gene doping detection market, are clear:
- Identify how we can develop the best possible detection method.
- Gather enough funding to complete development.
- Demonstrate a method that is efficient.
- Demonstrate a method that is properly scientifically validated.
- Implementation by convincing the WADA Laboratory Expert Group of the efficiency and scientific validation of the method.
This is the road to letting our detection method have a positive impact in the doping world.
We have started taking the steps needed to reach our final goal of convincing the WADA Laboratory Expert group and creating a positive impact in the doping world.
Our first step
Our first step is to identify the best possible detection method.
For this, we need two important sources of knowledge. We need to know our customer, and we need to gather expert knowledge on our process. This step has been completed as part of our integrated human practices.
We analysed our key customers, the anti-doping agencies, via a value proposition canvas (figure 2). This value proposition canvas is a tool to investigate and map the added value of the product you want to sell, to ensure that it is a product that best suits your users needs. It is distributed into the segment Value (left) and Customer (right). For this canvas, we have chosen our main user, the (human) anti-doping agencies, and linked the way the agencies will benefit from our detection method and related services.
Customer: Anti-doping agencies
The main customers for our gene doping detection method are anti-doping agencies. The national anti-doping agencies are all given directive by the World anti-doping agency (WADA), leader in stimulating research into anti-doping measures. Their jobs are to protect the spirit of sports, prevent unnatural performance enhancement and protect athletes' health. These three criteria are used to evaluate if a substance will be added to the list of banned substances, after which a detection method will have to be developed to enforce the ban.
Thus, they benefit from an implemented detection method for the substances which are on the list, in this case gene doping. In these tests, they profit from high data processing speed, making the analysis of doping tests faster so they might prevent doping users from starting a race as the results are in before then. In addition, it is advantageous for them to have high-throughput tests, allowing for the testing of many samples at the same time. Athlete privacy is also an important advantage, since this is in compliance with data protection laws. They also benefit from a test that is >accessible to all WADA-accredited laboratories and that fits within the current testing framework. This means that tissue sampling cannot be considered for doping tests (Haisma and De Hon, 2004) and that new doping tests can be implemented within the current testing practices and times. Finally, a method would be easily adaptable to new developments in the doping world, keeping up with the rat race of doping user versus doping detector.
In contrast to these benefits, there are a few outcomes that doping authorities strive to prevent. False positive test outcomes must be prevented at all costs. A single false positive result could ruin an athletes career unjustly, so everything possible must be done to prevent such an outcome. Finally, they strive to lower the costs of detection methods as much as possible.
Value: Advanced Detection of Performance enhancement
The product we present is ADOPE, which stands for advanced detection of performance enhancement. The result is not a single kit, rather, it is a comprehensive step-by step method, including products (adapted kits and newly developed proteins), as well as services for more efficient testing and data analysis. The result includes a model for selecting the proper detection time, a sample preparation method for isolating trace elements of gene doping DNA from the blood, a pre-screening method to quickly screen and rule out many samples, an unique test based on targeted sequencing using a newly developed fusion protein, and finally a sophisticated, self-learning algorithm for data analysis to group the sequencing output in a reliable manner.
These products and services answer the needs from the anti-doping agencies in several ways. Our efficient pre-screen reduces costs and increases throughput. The screen rules out most of the samples, leaving only a fraction to the relatively more expensive sequencing step.
Due to our highly specific fusion protein, our method sequences only a low amount of DNA. This reduces data-processing time greatly compared to methods based on whole genome sequencing. The sequencing step reduces false positive test outcomes, delivering a DNA sequence from the athletes blood as definitive proof of doping use. Thanks to the versatility of the target sequences we use to find doping DNA as well as our self-learning algorithm, our test is easily adaptable to new developments in the doping world. In addition, our test does not require expensive or rare laboratory equipment apart from the consumables supplied with the test, making it accessible to all WADA-accredited laboratories.
The products and services also relieve pain for our user by fitting within the current testing framework. Thanks to our detection window analysis, testing can be done at the frequency of regular inter-competition testing as executed by local doping authorities. Our test also facilitates compliance with data laws and athlethe privacy. Due to targeting specific DNA, only the data that is needed for a reliable test outcome is collected.
We have gathered expert knowledge on our process during our whole project. For a more in-depth analysis on which experts we spoke with and how they influenced our project, please see our integrated human practices page. We have written a collaboration proposal to Oxford Nanopore Technologies, as we are currently using their next generation sequencing platform as part of our detection workflow. Our proposal was received warmly. The relevant research department indicated that our proposal is of interest tothem and would fit well within their plans.
Our second step
Our second step is to gather enough funding to continue development.
In our project thus far, we have been supported by many institutions and companies who have made development up to this point a reality.
To cover future development costs, we can apply for a grant, or we can request backing from other funding sources, such as companies and institutes with budgets for research. We choose to apply for a grant of 20.000 euros from the Partnership of Clean Competition (PCC). The PCC has supported anti-doping research since 2008, spending more than 17 Million US Dollars in support of innovative science. They received our application enthusiastically, and advised us to aim for the larger grant with an average of $225.000 without maximum. This second application is in preparation by the Brouns lab (TU Delft), our supervising lab, whose members are eager to continue our work. The Delft Sports Engineering Institute is willing to support us in this effort with their vast network in the professional sports world as well as with a financial contribution.
Our third and fourth steps
Our third and fourth steps are to develop and demonstrate a method that is efficient and properly scientifically validated. We have experienced great progress during the course of our project. Please see our results page for more information on our scientific achievements. What remains is to ensure that development will be continued in the future. After iGEM, our project will be continued by the group supervising us (the Brouns lab, TU Delft), with a perspective for funding through the Partnership for Clean Competition collaborative. Regardless of this grant, they will continue with one highly important part of our method: the targeted sequencing method based on our innovative Transposase-dxCas9 fusion protein. With this method effective and validated, a complete method for gene doping detection is possible.
Our final step
Our final step is implementation by convincing the WADA Laboratory Expert Group of the efficiency and scientific validation of the method. Taking into account the time needed to be awarded the PCC grant and to optimize our experimental protocols, we aim to convince this group to implement our method within three years.
During our customer discovery process, we spoke with other parties that could be interested in implementing (part of) our project. We investigated both doping use in the equestrian sports with the Dutch Trotting and Flatracing Association and application of our targeted sequencing approach outside of the anti-doping field with Dutch Blood bank Sanquin, exploring opportunities for less invasive prenatal screening, and the Dutch Research Department for Food Safety at Wageningen University and Research (RIKILT) for food safety applications.
We investigated the need for and interest in a gene doping detection method for equestrian sports with the Dutch Trotting and Flatracing Association (Nederlandse Draf- en Rensport, or NDR). We spoke with Mr. Camiel Mellegers of the NDR, who is in charge of doping testing for the Dutch matches in Trotting and Flatracing. He has explained to us that anti-doping policies differ in quite a few ways between human and equestrian sports. We will shortly discuss the differences that are relevant to the case of gene doping.
- The threat of gene doping is a worrying topic in equestrian anti-doping. It is one of the topics discussed on October 8th of 2018 in the 52nd International Conference of Horseracing Authorities in Paris, France (Chesser, 2018).
- The anti-doping criteria in horse racing are stricter than in humans. The human anti-doping list consist of substances that check two of the three criteria of increasing performance enhancement, endangering athlete or community health and being against the spirit of sports. Equestrian sports are stricter; they do not allow any substance that is not naturally present in the body of the horse or that is present in elevated concentrations. Mellegers explained to us that this is because horses are never consenting parties when it comes to doping use, and so they must be protected more strictly.
- EPO is not a suitable target gene for equestrian gene doping, as it does not have a performance enhancing effect in horses. Other genes have been identified, that e.g. enhance muscle mass and strength, regulate oxygen, help overcoming pain, enhance injury repair or are involved with angiogenesis and the energy metabolism (Wilkin et al, 2017). Due to the versatility of our method, detection of other genes is easily achievable. Our model on the determination of the detection window will have to be adapted drastically, since it will have to take into account equestrian physiology as well as regulation cycles for the genes in question. All other components of our detection method will be easily convertible to horse racing.
- Doping testing in equestrian sports works via an A-B-C system. First, the A sample is tested for doping. If the result is positive, the horse owner or trainer can decide to appeal. As part of this appeal, the B sample is tested with a more thorough detection method. The C sample is stored for (anonymous) research purposes. “Your pre-screen and screen fits with this model well.” Mellegers assured us. Since the appealing party pays for the testing of the B sample, cost is also less of an issue.
- Testing speed is important in applying a detection method. “The time between placement matches and registration closing of the main match is often only one week,” Mellegers explains, “so a doping sample should be shipped to testing facilities abroad and analyzed in less than one week. Most of our tests take two to three days.” Herein lies the strength of our fast detection method compared to methods without pre-screen or efficient data-processing.
- Blood will probably always be collected as a sample in the future. Currently, a doping official has 20 minutes with a horse to collect a sample. They initially try to receive an urine sample, but if the horse does not comply they take a blood sample. “In the future, we are planning to collect both samples always so that we have enough sample material to do advanced testing in cases of appeal.” according to Mellegers. For ADOPE, this means that blood sampling will remain relevant in equestrian testing.
- Finally, we learned that transparency is incredibly important in equestrian sports. “Horse racing is built upon dreams” Mellegers says. If you are not completely transparent, people will mistrust any outcome and this will damage the sport greatly. All doping test results must be published immediately. Since transparency and being open source are values ADOPE embodies, we believe that our test will be a good match to the equestrian anti-doping policies.
Camiel Mellegers, Doping official at the Dutch Trotting and Flatracing Association
To conclude, we will shortly discuss the potential of our detection method in the equestrian sports, motivated by the topics above. The threat of gene doping is real in equestrian sports (Chesser, 2018) and no detection method is currently in place (Wilkin et al, 2017). A continued ban of gene doping is highly probable based on the anti-doping values in equestrian sports. Adapting ADOPE to fit within the equestrian anti-doping policies is fairly uncomplicated. The current model gene EPO will need to be changed to a gene more relevant in horse physiology, which is what our versatile detection method was developed to do. The detection window analysis will need to be adapted to the new target genes. Our method is a good match to the equestrian anti-doping policies due to our fast result, stemming from our targeted sequencing approach. The distinction we make in an inexpensive and fast pre-screen and more expensive, highly precise screen fits well within the A-B sample method in equestrian testing. Our approach of complete transparency fits with the core values of the sport, ensuring that the dream of horseracing remains intact.
We initially visited Dutch National Bloodbank Saunquin to learn more about our sample preparation method, and there met Ms Aïcha Ait Soussan, who’s main research interest is fetal DNA in maternal plasma. When discussing our detection method with her and her colleagues Onno Verhagen and Professor Ellen (C. E.) van der Schoot from the experimental immunohematology department, it became apparent that they are struggling with many of the same problems in isolating fetal DNA from the mother blood as were are with isolating gene doping DNA from an athletes blood. They are both present in only little amounts compared to an enormous background of genomic DNA. A targeted sequencing approach as we are developing would be precisely what they need.
The Dutch Research Department for Food Safety at Wageningen University and Research (RIKILT) reached out to our supervisory group because of their real interest in the application of our gene detection method, with a specific focus on our targeted or selective sequencing based on the fusion protein we have developed. They see many applications for this technology, and have invited us to discuss with us and our supervisory group after the jamboree.
One recommendation from the doping authority is to expand our research to urine. While blood samples are also taken for doping tests, these are not implemented in all human sports and are also more invasive than urine samples. Urine sampling is prefered by athletes as well. A sample preparation method including urine would be a promising extension to ADOPE. However, with the current method our test is already applicable to be used in many athletic disciplines.
- Baoutina, A. et al. (2010). Gene Doping Detection: Evaluation of Approach for Direct Detection of Gene Transfer using Erythropoietin as a Model System. Gene Therapy 17(8): 1022-32. Doi: 10.1038/gt.2010.49.
- Chesser, A., (2018, September 20). IFHA Conference to Cover Topics Ranging from Wagering to Jockey Health and Safety. Retrieved October 12, 2018, from https://www.ifhaonline.org/Default.asp?section=Resources&area=0&story=1017
- Europa Commission (n.d.). Rules for business and organisations Retrieved October 11, 2018, from https://ec.europa.eu/info/law/law-topic/data-protection/reform/rules-business-and-organisations_en
- Everts, S. (8 August 2016). Athletes at Rio Olympics face advanced antidoping technology. C&en Vol. 94, Iss. 32, pp. 25-26. Retrieved on 5 July 2018 from: https://cen.acs.org/articles/94/i32/Athletes-Rio-Olympics-face-advanced.html?platform=hootsuite.
- Haisma, H. J., & De Hon, O. (2006). Gene doping. International journal of sports medicine, 27(04), 257-266.
- Letzter, R. et al. (8 August 2016). Officials Fear some Olympic Athletes might be altering their genes to cheat in Rio. Business Insider. Retrieved on 5 July 2018 from: https://www.businessinsider.com/wada-test-rio-olympic-athletes-gene-doping-2016-8?international=true&r=U&IR=T.
- NBC News (23 July 2008). China caught offering gene doping to athletes. Retrieved on 5 July 2018 from http://www.nbcnews.com/id/25816605/ns/beijing_olympics-beijing_olympics_news/t/china-caught-offering-gene-doping-athletes/
- Partnership for clean competition (2018, June 27). Application Center | PCC - Global Anti-Doping Research Grants for Scientists. Retrieved October 12, 2018, from https://cleancompetition.org/application-center/
- Pereira, H.M.G. et al. (2017). Doping control analysis at the Rio 2016 Olympic and Paralympic Games. Wiley Online Library. DOI 10.1002/dta.2329.
- Reinsch, M. (28 January 2006). Springstein-Prozeß: Das Zeitalter des Gendopings hat begonnen. In: Frankfurter Allgemeine Zeitung.
- RIKILT (n.d.). RIKILT - WUR. Retrieved October 12, 2018, from https://www.wur.nl/en/Research-Results/Research-Institutes/rikilt.htm
- Strategyzer AG (n.d.) Value Proposition Canvas. Retrieved October 11, 2018, from https://strategyzer.com/canvas/value-proposition-canvas
- Wang Y-X., et al. (2004). Regulation of Muscle Fiber Type and Running Endurance by PPARδ. PLoS Biology 3(1):e61. https://doi.org/10.1371/journal.pbio.0030061.
- Wilkin, T., Baoutina, A., & Hamilton, N. (2017). Equine performance genes and the future of doping in horseracing. Drug testing and analysis, 9(9), 1456-1471.