Serum IGF-I and IGF binding proteins 2 and 3 as potential markers of doping with human GH

The Proteomic Signature of Recombinant Growth Hormone in Recreational Athletes

OBJECTIVE

Administration of human growth hormone (hGH) is prohibited in competitive sport and its detection in an athlete's sample triggers an adverse analytical finding. However, the biological processes that are modulated by recombinant hGH are not well characterized and associated blood serum proteins may constitute new biomarkers for hGH misuse.

METHODS

Thirty-five recreational athletes were enrolled in a study to investigate the time- and dose-dependent response of serum protein levels to recombinant hGH administration. Participants were randomly assigned to 4 groups, receiving 1 of 3 different doses of recombinant hGH or a placebo. Bio samples were collected at 22 time points over a period of 13 weeks, starting 4 weeks before treatment, during 3 weeks of treatment, and at 6 weeks' follow-up. A total of 749 serum samples were analyzed for 1305 protein markers using the SOMAscan proteomics platform.

RESULTS

We identified 66 proteins that significantly associated with recombinant hGH administration and dosage, including well known hGH targets, such as IGF1, but also previously unknown hGH-related proteins (eg, protease inhibitors, WFIKKN1, and chemokines, CCL2). Network analysis revealed changes in specific biological pathways, mainly related to the immune system and glucose metabolism.

CONCLUSION

Our analysis suggests that hGH administration affects biological processes more strongly than previously acknowledged. Some of the proteins were dysregulated even after hGH treatment and could potentially be developed into biomarkers for hGH misuse. Moreover, our findings suggest new roles for hGH-associated proteins in the etiology of hGH-related diseases and may indicate new risks that may be associated with hGH misuse.

Procollagen type III amino-terminal propeptide and insulin-like growth factor I as biomarkers of growth hormone administration

The acceptance in 2012 by the World Anti‐Doping Agency (WADA) of the biomarker test for human growth hormone (hGH) based on procollagen type III amino‐terminal propeptide (P‐III‐NP) and insulin‐like growth factor I (IGF‐I) was perhaps the first time that such a method has been used for forensic purposes. Developing a biomarker test to anti‐doping standards, where the strict liability principle applies, is discussed. An alternative WADA‐accepted approach is based on the measurement of different hGH isoforms, a method that suffers from the very short half‐life of hGH limiting the detection period. Modification or withdrawal of the immunoassays, on which the biomarker measurements largely depend, has necessitated revalidation of the assays, remeasurement of samples and adjustment of the decision limits above which an athlete will be assumed to have administered hGH. When a liquid chromatography coupled mass spectrometry (LC–MS) method became a reality for the measurement of IGF‐I, more consistency of results was assured. Measurement of P‐III‐NP is still dependent on immunoassays although work is underway to develop an LC–MS method. The promised long‐term detection time for the biomarker assay does not appear to have been realised in practice, and this is perhaps partly the result of decision limits being set too high. Nevertheless, more robust assays are needed before a further adjustment of the decision limit is warranted. In the meantime, WADA is considering using P‐III‐NP and IGF‐I as components of a biomarker passport system recording data from an individual athlete, rather than the population. Using this approach, smaller perturbations in the growth hormone (GH) score would mandate an investigation and possible action for hGH administration.

Sex-Specific Control of Muscle Mass: Elevated IGFBP Proteolysis and Reductions of IGF-1 Levels Are Associated with Substantial Loss of Carcass Weight in Male DU6PxIGFBP-2 Transgenic Mice

In farmed animals, carcass weight represents an important economic trait. Since we had demonstrated that IGFBP-2 represents a potent inhibitor of muscle accretion in inbred mice, we wanted to quantify the inhibitory effects of IGFBP-2 under conditions of elevated protein mass in growth selected non-inbred mice (DU6P). Therefore, we crossed male DU6P mice with female IGFBP-2 transgenic mice. Male IGFBP-2 transgenic offspring (DU6P/IGFBP-2) were characterized by more than 20% reductions of carcass mass compared to male non-transgenic littermates. The carcass mass in males was also significantly lower (p < 0.001) than in transgenic female DU6P/IGFBP-2 mice, which showed a reduction of less than 10% (p < 0.05) compared to non-transgenic female DU6P/IGFBP-2 mice. Although transgene expression was elevated in the muscle of both sexes (p < 0.001), serum levels were normal in female, but significantly reduced in male transgenic DU6P/IGFBP-2 mice (p < 0.001). In this group, also IGFBP-3 and IGFBP-4 were significantly reduced in the circulation (p < 0.01). Particularly in male transgenic mice, we were able to identify proteolytic activity against recombinant IGFBP-2 included in diluted serum. IGFBP-proteolysis in males correlated with massive reductions of IGF-1 in serum samples and the presence of elevated levels of IGFBP-2 fragments. From our data, we conclude that elevated tissue expression of IGFBP-2 is an essential effector of muscle accretion and may block more than 20% of carcass mass. However, in the circulation, intact IGFBP-2 contained no reliable biomarker content. Notably, for the estimation of breeding values in meat-producing animal species, monitoring of IGFBP-2 expression in muscle appears to be supported by the present study in a model system.

Endocrine profiles in 693 elite athletes in the postcompetition setting

OBJECTIVE

To measure a profile of hormones in a group of elite athletes. Increasing awareness of the widespread use of hormones as performance-enhancing agents focusses attention on what may be considered as normal in this unusual group.

DESIGN

Blood samples were obtained from 813 volunteer elite athletes from a cross-section of 15 sporting categories. An endocrine profile was measured on a subset of 693.

PARTICIPANTS

Volunteer elite athletes. Samples were drawn within two hours of an event at a major national or international competition.

MEASUREMENTS

Demographics and hormone profiles were obtained on 454 male and 239 female elite athletes.

RESULTS

Hormone profiles showed significant differences in 19 of the 24 measured variables between sexes and between all of the 15 sporting disciplines in men and 11 out of 24 in women. 16.5% of men had low testosterone levels, whereas 13.7% of women had high levels with complete overlap between the sexes. Women had a lean body mass 85% that of men - sufficient to account for sex differences in performance. There were highly significant correlations between many of the measured hormones.

CONCLUSIONS

Hormone profiles from elite athletes differ from usual reference ranges. Individual results are dependent on a number of factors including age, gender and physique. Differences in profiles between sports suggest that an individual's profile may contribute to his/her proficiency in a particular sport. The IOC definition of a woman as one who has a 'normal' testosterone level is untenable.

Multiplex flow cytometric immunoassay for serum biomarker profiling of recombinant bovine somatotropin

Recombinant bovine somatotropin (rbST) is licensed for enhancing milk production in dairy cows in some countries, for instance the United States, but is banned in Europe. Serum biomarker profiling can be an adequate approach to discriminate between treated and untreated groups. In this study a multiplex screening tool of a small set of biomarkers for pinpointing recombinant bovine somatotropin (rbST) (ab)use was developed and evaluated: insulin-like growth factor 1 (IGF-1), IGF binding protein 2 (IGFBP2) and rbST-induced antibodies were selected as rbST dependent markers and combined in one parallel assay format. For this, the color-encoded microspheres were used in a suspension array, with a dedicated flow cytometer. Serum samples obtained from an animal experiment with rbST-treated and untreated dairy cows were measured with the developed triplex immunoassay and biomarker responses on rbST treatment were evaluated. This resulted in characteristic treatment-dependent responses for all three individual biomarkers. Combining these results with the statistical prediction model k-nearest neighbours (kNN), resulted in good discrimination of treated and untreated animals: an overall sensitivity (true positive rate) of 89.1% and an overall specificity (true negative rate) of 97.7% were reached. Therefore, this is the first multiplex method which can be applied with high confidence for screening of unknown herds of cattle pinpointing at rbST (ab)use.

Control of IGFBP-2 Expression by Steroids and Peptide Hormones in Vertebrates

IGFBP-2 (1) has been described as a brain tumor oncogene (2) and is widely expressed in cancers from different origins (3-8). IGFBP-2 alone cannot cause malignant transformation, yet progression of brain tumors to higher grade (9) and also has been provided as a protective element in earlier stages of multistage colon carcinogenesis (10). Therefore, it is crucial to understand the factors that determine expression patterns of IGFBP-2 under normal and malignant conditions. The present review provides a comprehensive update of known factors that have an impact on expression of IGFBP-2.

Multiple protein biomarker assessment for recombinant bovine somatotropin (rbST) abuse in cattle

Biomarker profiling, as a rapid screening approach for detection of hormone abuse, requires well selected candidate biomarkers and a thorough in vivo biomarker evaluation as previously done for detection of growth hormone doping in athletes. The bovine equivalent of growth hormone, called recombinant bovine somatotropin (rbST) is (il)legally administered to enhance milk production in dairy cows. In this study, first a generic sample pre-treatment and 4-plex flow cytometric immunoassay (FCIA) were developed for simultaneous measurement of four candidate biomarkers selected from literature: insulin-like growth factor 1 (IGF-1), its binding protein 2 (IGFBP2), osteocalcin and endogenously produced antibodies against rbST. Next, bovine serum samples from two extensive controlled rbST animal treatment studies were used for in vivo validation and biomarker evaluation. Finally, advanced statistic tools were tested for the assessment of biomarker combination quality aiming to correctly identify rbST-treated animals. The statistical prediction tool k-nearest neighbours using a combination of the biomarkers osteocalcin and endogenously produced antibodies against rbST proved to be very reliable and correctly predicted 95% of the treated samples starting from the second rbST injection until the end of the treatment period and even thereafter. With the same biomarker combination, only 12% of untreated animals appeared false-positive. This reliability meets the requirements of Commission Decision 2002/657/EC for screening methods in veterinary control. From the results of this multidisciplinary study, it is concluded that the osteocalcin - anti-rbST-antibodies combination represent fit-for-purpose biomarkers for screening of rbST abuse in dairy cattle and can be reliably measured in both the developed 4-plex FCIA as well as in a cost-effective 2-plex microsphere-based binding assay. This screening method can be incorporated in routine veterinary monitoring programmes: in the European Union for detection of rbST abuse and in the control of rbST-free dairy farms in the United States of America and other countries.

Immunological screening and characterization of highly specific monoclonal antibodies against 20 kDa hGH

Background: hGH has been widely abused as a doping agent in sports for many years. There are some important approaches for the detection of hGH doping, and the ratio of 22:20 kDa GH was considered one of the most suitable detection indicators of GH abuse. Currently, effective anti-GH antibodies and related reagents are needed to develop a detection method, in particular, highly specific anti-20 kDa hGH monoclonal antibodies are a prerequisite. Herein we constructed the expression vector of 20 kDa hGH and prepared the corresponding antibodies by the immunization of the recombinant human 20 kDa into mice. Positive clones that can specifically recognize 20 kDa hGH were screened and characterized by enzyme immunoassay, Dot-ELISA and surface plasmon resonance. In total, 14 specific monoclonal cell lines were screened out. Results: By a series of characterization, it was found that the 6C8, 44H3, 12G7 and 33Y19 clones were showing much higher specificity and affinity to 20 kDa hGH, and P3H9 could recognize both 20 and 22 kDa hGH isoforms. 6C8 and 44H3 matched well with P3H9 in the surface plasmon resonance testing. The 12G7 clone had the best surface properties with an association constant of 3.4 × 109 M-1 and a dissociation constant of 2.95 × 1010 M. Conclusion: Highly specific monoclonal antibodies against 20 kDa hGH were generated, and also two paired antibodies (P3H9 and 6C8 or P3H9 and 44H3) were characterized, which can serve as the potential components for 22:20 kDa detection kit.

Development of a flow cytometric immunoassay for recombinant bovine somatotropin-induced antibodies in serum of dairy cows

Administration of recombinant bovine somatotropin (rbST) to enhance milk production in dairy cows is banned within the European Union. Therefore, methods for pinpointing rbST abuse are required. Due to the problematic detection of rbST itself in serum, methods are also focused on detecting changes in rbST-related biomarkers. In this study, a fast and easy-to-perform microsphere-based flow cytometric immunoassay (FCIA) for detection of rbST-induced antibodies in serum was developed. Until now, detection of rbST-induced antibodies was also problematic due to non-specific binding of serum proteins resulting in a high rate of false positive results. Therefore, five different sample preparation methods, i.e. dilution, octanoic acid precipitation, filtration, protein G purification, and a previously described generic FCIA sample preparation were critically compared to overcome non-specific binding to the microspheres. Only the generic FCIA sample pretreatment was effective in reducing non-specific binding. As a result, an absolute decision level for detecting rbST antibodies in serum of dairy cows was determined and its applicability was demonstrated. In accordance with biological expectations from literature, rbST antibodies were induced in three out of four rbST-treated dairy cows. These rbST-induced antibodies were successfully detected for up to 4 weeks after the last rbST treatment, whereas no false positive results were obtained for 27 untreated dairy cows. This is the first method, able to overcome the interference of serum proteins and therefore, can be applied with high confidence for screening unknown herds of cattle for rbST antibodies, an important biomarker for pinpointing at rbST abuse in cattle.

Biomarkers: unrealized potential in sports doping analysis

The fight against doping in sport using analytical chemistry is a mature area with a history of approximately 100 years in horse racing and at least 40 years in human sport. Over that period, the techniques used and the breadth of coverage have developed significantly. These improvements in the testing methods have been matched by the increased sophistication of the methods, drugs and therapies available to the cheat and, as a result, testing has been a reactive process constantly adapting to meet new threats. Following the inception of the World Anti-Doping Agency, research into the methods and technologies available for human doping control have received coordinated funding on an international basis. The area of biomarker research has been a major beneficiary of this funding. The aim of this article is to review recent developments in the application of biomarkers to doping control and to assess the impact this could make in the future.

The International Olympic Committee (IOC) and GH-2000

The IOC recognised growth hormone (GH) as a drug of abuse in 1992 and recruited me as an expert to advise them on the development of a test to detect its abuse. After a long gestation period where the IOC gradually changed their attitude to research they co-funded the GH-2000 project with the European Union (EU). GH-2000 was a unique consortium of Europe's best endocrinologists and scientists in partnership with two GH manufacturers and the IOC with a greater than two million dollar budget. GH-2000 selected a method based on the measurement of GH-dependent markers and selected IGF-I and P-III-P as the most suitable markers and demonstrated that they could detect 100% of men taking GH with a false-positive rate better than 1:10,000; sensitivity was reduced however in women. GH-2000 reported back to EU and IOC in January 1999 in time to have the test available for the 2000 Olympic Games. Results were quality assured by an expert workshop. Politics has prevented this from happening however, some reasons are discussed as to why 9 years later it still has not been introduced.

Detection of doping with recombinant human growth hormone

Detection of doping with recombinant human growth hormone is one of the challenges for antidoping analysis. This review focuses on the most important relevant publications that provide insight into the laboratory measurement of human growth hormone (hGH), antibodies and standards, the isoform approach and the biomarker approach. The isoform approach monitors the changes of hGH molecular isoform composition in serum and was applied at the Olympic Games in Athens in 2004, Turin in 2006 and Beijing in 2008. The markers approach detects a formula score, which reflects the changes in concentration of IGF-1 and P-III-P. All these methodologies measure the concentrations of growth hormone and its isoforms for isoform approach, or the concentrations of IGF-1 and P-III-P. All factors that affect these measurements should be taken into account for the development of methods to detect doping with recombinant hGH.

Growth hormone, IGF-I and insulin and their abuse in sport

There is widespread anecdotal evidence that growth hormone (GH) is used by athletes for its anabolic and lipolytic properties. Although there is little evidence that GH improves performance in young healthy adults, randomized controlled studies carried out so far are inadequately designed to demonstrate this, not least because GH is often abused in combination with anabolic steroids and insulin. Some of the anabolic actions of GH are mediated through the generation of insulin-like growth factor-I (IGF-I), and it is believed that this is also being abused. Athletes are exposing themselves to potential harm by self-administering large doses of GH, IGF-I and insulin. The effects of excess GH are exemplified by acromegaly. IGF-I may mediate and cause some of these changes, but in addition, IGF-I may lead to profound hypoglycaemia, as indeed can insulin. Although GH is on the World Anti-doping Agency list of banned substances, the detection of abuse with GH is challenging. Two approaches have been developed to detect GH abuse. The first is based on an assessment of the effect of exogenous recombinant human GH on pituitary GH isoforms and the second is based on the measurement of markers of GH action. As a result, GH abuse can be detected with reasonable sensitivity and specificity. Testing for IGF-I and insulin is in its infancy, but the measurement of markers of GH action may also detect IGF-I usage, while urine mass spectroscopy has begun to identify the use of insulin analogues.

Detection of growth hormone abuse in sport

OBJECTIVE

To develop a test for GH abuse in sport.

DESIGN

A double blind placebo controlled study of one month's GH administration to 102 healthy non-competing but trained subjects. Blood levels of nine markers of GH action were measured throughout the study and for 56 days after cessation of GH administration. Blood samples were also taken from 813 elite athletes both in and out of competition.

RESULTS

GH caused a significant change in the nine measured blood markers. Men were more sensitive to the effects of GH than women. IGF-I and N-terminal extension peptide of procollagen type III were selected to construct formulae which gave optimal discrimination between the GH and placebo groups. Adjustments were made to account for the fall in IGF-I and P-III-P with age and the altered distribution seen in elite athletes. Using a cut-off specificity of 1:10,000 these formulae would allow the detection of up to 86% of men and 60% of women abusing GH at the doses used in this study.

CONCLUSIONS

We report a methodology that will allow the detection of GH abuse. This will provide the basis of a robust and enforceable test identifying those who are already cheating and provide a deterrent to those who may be tempted to do so.

Development of an absolute quantification method targeting growth hormone biomarkers using liquid chromatography coupled to isotope dilution mass spectrometry

A method to perform absolute quantification of two biomarkers (IGF-1 and IGFBP-3) of growth hormone abuse has been developed. Isotope dilution is used with synthetically labelled peptides as internal standards. Peptide selection and multiple reaction monitoring design are discussed. A simple sample preparation based on the reduction and alkylation of cysteine residues followed by tryptic digestion provides a sufficient digestion of proteins. Serum samples fortified with increasing amounts of target proteins are analysed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) on a triple quadrupole mass spectrometer. Specificity is ensured by the selection of sequences with no homology in BLAST, as well as retention time deviation check, and ion ratio monitoring. Linearity is studied in terms of calibration curves. These curves for IGFBP-3 and IGF-1 are generated with mean slopes of 0.055 and 0.065, intercepts of 0.107 and -0.011, and with coefficients of correlation of 0.95 and 0.98, respectively. These curves result from the addition of proteins to the serum. Risks of variations related to potential matrix effects are therefore reduced, as well as probable variations related to the digestion steps. The working concentration ranges are 4-10 ng/microl for IGFBP-3 and 2-8 ng/microl for IGF-1. Preliminary data regarding repeatability show that relative standard deviations (RSDs) range between 13 and 32% for IGFBP-3 and between 7 and 29% for IGF-1.

Effect of training on GH and IGF-1 responses to a submaximal exercise in football players

To study the effects of regular football training on basal and exercise induced levels of growth hormone (GH) and insulin-like growth factor (IGF-1), 13 young football players were investigated by a submaximal exercise at the beginning of the sporting season in October (S1), at the middle of the season in January (S2) and at the end in May (S3). At each session, an exercise test on an ergogycle was performed for 25 min, beginning with an incremental exercise to reach 90% of theoretical maximal heart, which was maintained for the last 10 min of the test. Venous blood samples were collected at rest, at the end of the exercise and at 30 and 60 min during the recovery period. Plasma lactate and glucose concentrations increased during exercise with no difference found between sessions. GH level increased with exercise at each session but the response was significantly higher in S1 than in S2 and S3 (P<0.01). The GH area under the curve decreased significantly all along the football season (P<0.01); the IGF-1 level did not significantly change during exercise nor with training. Basal insulin-like growth factor binding protein-3 (IGFBP3) remained stable during the three sessions. Football training decreased significantly the exercise-stimulated GH levels all along the football season but did not have any significant effect on IGF-1 levels or on basal IGFBP3 levels.

Challenges in Detecting the Abuse of Growth Hormone in Sport

Background: Growth hormone (GH) is reputed to be in widespread use in the sporting arena as a performance-enhancing agent and is on the list of banned substances published by the World Anti-Doping Agency. The detection of GH abuse poses many challenges. Unlike many substances of abuse, such as synthetic anabolic steroids, GH is a naturally occurring substance; therefore, demonstration of exogenous administration must rely on detecting concentrations in excess of an established reference interval. The purpose of this review is to discuss the methodologies being developed to detect GH abuse.

Methods: We undertook a comprehensive search using multiple electronic databases and hand searches of reference lists of articles. The data for this review reflect our academic interests and experience through work on the GH-2000 and GH-2004 projects.

Results: Two approaches have been taken to detect GH abuse. The first is based on assessment of the effect of exogenous GH on pituitary GH isoforms, and the second is based on measurement of markers of GH action. The advantages of each approach and the difficulties encountered with each technique, as well as future concepts in detection, are discussed.

Conclusion: Although there are substantial challenges for the detection of GH, methodologies now exist to detect GH abuse with reasonable sensitivity and specificity.

Growth hormone abuse: methods of detection

In the past two decades, growth hormone (GH) has been considered as a performance-enhancing drug in the sport world, certainly favoured by the awareness that there is not yet an approved method for detecting its abuse. Because resting or random measurements of plasma GH concentrations per se are meaningless, new methods have been devised to evaluate plasma levels of GH-sensitive substances that are more stable, and hence detectable, than the hormone itself. This review discusses some of the most recently proposed approaches, including a diagnostic algorithm, based on the timed application of different tests, which, collectively, would have a high diagnostic capability.

Combined evaluation of resting IGF-I, N-terminal propeptide of type III procollagen (PIIINP) and C-terminal cross-linked telopeptide of type I collagen (ICTP) levels might be useful for detecting inappropriate GH administration in athletes: a preliminary report

OBJECTIVE

To verify whether combined measurements of GH-dependent parameters might be useful in detecting exogenous recombinant GH (rGH) administration in male athletes from different disciplines.

METHODS

Sixty-six athletes (control group) were sampled for the evaluation of resting IGF-I, N-terminal propeptide of type III procollagen (PIIINP) and telopeptide type I collagen (ICTP). Cut-off values (mean + 2 SD) for IGF-I, PIIINP and ICTP were calculated and arbitrary scores (1.5, 2.0) were assigned to abnormal parameters. By using the sum of individual parameter scores, positive (> or = 3) or negative (< 3) scores were obtained. In addition, a subgroup of six athletes was treated for 3 weeks with rGH (0.09 IU/kg body weight, 6 days/week) and was similarly evaluated at the end of the 1st, 2nd and 3rd week (i.e. 18 samples).

RESULTS

Abnormal IGF-I, or PIIINP or ICTP levels were found, respectively, in one, two and four subjects (1.5-6.1%) of the control group (in the younger athletes); only one 19-year-old subject of this group obtained a positive score. Abnormal IGF-I, PIIINP and ICTP levels were found in 61.1-66.7% samples of the treated group. Positive cases were 3/6 at the 1st and 2nd week and 6/6 at the 3rd week. The sensitivity of the screening approach was 50-100% (at the 1st-2nd and 3rd week, respectively) and specificity was 98.5%.

CONCLUSION

This 'first level' screening test is safe, acceptable and relatively inexpensive. Further additional investigations of 'second level' (i.e. GH secretory profile, GH response to a GH-releasing peptide) can be retained to validate or exclude rGH administration or for the early diagnosis of infrequent endogenous GH hypersecretion.

IGF-I, IGFBP-2, and -3: do they have a role in detecting rhGH abuse in trained men?

PURPOSE

Although the illegal use of recombinant human growth hormone (rhGH) to enhance performance is increasing among athletes, no official test for its detection has yet been implemented. The aim of this work was to study how prolonged rhGH administration in trained subjects influences the insulin-like growth factor (IGF) system, in order to evaluate new methods in antidoping tests.

METHODS

Morning serum growth hormone (GH), IGF-I, IGF binding protein (BP)-2, IGFBP-3, IGF-I/IGFBP-2, and IGFBP-3/IGFBP-2 ratios were evaluated before, during (8th and 15th days), and at the end and after cessation (+3, +6, +9, +12, and +15 d) of a 3-wk treatment with different doses of rhGH (0.09 IU.kg BW(-1).d(-1) for 6 or 3 d a week, i.e., the A and B trials, respectively) in seven well-trained subjects not involved in competitive sports. The blood collections pre- and during treatment were performed immediately before the daily rhGH dose.

RESULTS

In both trials, significant increases of IGF-I (higher in the A trial) and IGFBP-3 serum concentrations during rhGH administration were observed. Serum IGFBP-3 remained significantly increased in the A trial 3 d after treatment cessation. In the A trial only, two subjects had IFG-I concentrations exceeding the upper limit of the reference range. No modifications of serum GH, IGFBP-2 and IGF-I/IGFBP-2, and IGFBP-3/IGFBP-2 ratios were observed. The z-score evaluation for IGFBP-3 detected GH exposure in 100% of subjects only at end treatment in A trial.

CONCLUSION

Although IGF-I and IGFBP-3 seem potentially the most specific markers of rhGH assumption, our data suggest that for antidoping purposes a single evaluation of their absolute serum concentration is not a sufficiently secure method to detect rhGH abuse in all subjects, especially in the case of low rhGH doses.

IGF -I plasma concentrations in non-treated horses and horses administered with methionyl equine somatotropin

Insulin-like growth factor-I (IGF -I) is likely to be an indicator of somatotropin (ST) administration in the horse. To investigate the different ways ST administration may be detected, the following aspects of IGF -I concentrations in plasma were studied: (i) the daily variation; (ii) variation following a treadmill test; (iii) concentrations at rest and after exercise; and (iv) concentrations in plasma from two young horses and two adults treated with methionyl equine somatotropin (e ST). In the population of horses at rest, IGF -I mean concentration (SEM) was 261 (104) ng ml(-1). In post race samples, IGF -I mean concentration was 187 (100) ng ml(-1). All of these data indicate that exercise does not modify IGF -I concentration in plasma. The magnitude of the increase in IGF -I following administration of e ST differed according to the age of the horses. The critical value of 700 ng ml(-1)was exceeded for 1 day in adult horses and for at least 11 days in young horses. These results show that IGF -I has potential as an indirect marker of ST administration in horses.

Growth hormone and exercise: physiology, use and abuse

This review summarizes the interactions between growth hormone (GH) and exercise. Exercise has profound effects upon the GH-insulin-like growth factor I axis per se. In addition, there is increasing evidence that such physiological perturbations might be influential in the performance responses to repeated training. However, the ergogenic effects of systemic administration of recombinant human GH by athletes and bodybuilders remain unproven. What is certain is that the prevalence of GH abuse by sportspeople will increase, not least because it is currently undetectable. The frequent and potentially severe side-effects associated with such 'doping' will be of increasing relevance to endocrinologists.

Overnight responses of the circulating IGF-I system after acute, heavy-resistance exercise

This study evaluated the individual components of the insulin-like growth factor I (IGF-I) system [i.e., total and free IGF-I, insulin-like growth factor binding protein (IGFBP)-2 and -3, and the acid-labile subunit (ALS)] in 10 young, healthy men (age: 22 +/- 1 yr, height: 177 +/- 2 cm, weight: 79 +/- 3 kg, body fat: 11 +/- 1%) overnight for 13 h after two conditions: a resting control (Con) and an acute, heavy-resistance exercise protocol (Ex). The Ex was a high-volume, multiset exercise protocol that alternated between 10- and 5-repetition maximum sets with 90-s rest periods between sets. The Ex was performed from 1500 to 1700; blood was obtained immediately postexercise and sampled throughout the night (every 10 min for the first hour and every hour thereafter) until 0600 the next morning. For the first hour, significant differences (P < or = 0.05) were only observed for IGFBP-3 (Ex: 3,801 > Con: 3,531 ng/ml). For the overnight responses, no differences were observed for total or free IGF-I or IGFBP-3, whereas IGFBP-2 increased (Ex: 561 > Con: 500 ng/ml) and ALS decreased (Ex: 35 < Con: 39 microg/ml) after exercise. The results from this study suggest that the impact that resistance exercise exerts on the circulating IGF-I system is not in the alteration of the amount of IGF-I but rather of the manner in which IGF-I is partitioned among its family of binding proteins. Thus acute, heavy-resistance exercise can lead to alterations in the IGF-I system that can be detected in the systemic circulation.

Correlations of growth hormone (GH) and insulin-like growth factor I (IGF-I): effects of exercise and abuse by athletes

The importance of hormones on body metabolism when physical exercise is carried out has been established for a long time. Growth hormone (GH) is crucial in energy metabolism as well as in body anabolism. Recent studies have increased our knowledge of GH's mechanisms of action. In particular, insulin-like growth factor I (IGF-I), the main hormone mediating the principal GH effects and other protein structures (i.e. the binding proteins related to these two hormones), has been recognized as playing a crucial role. The biochemical aspects relating to the molecules of the GH/IGF-I axis have been described here. Furthermore, the belief that GH and IGF-I enhance performance has induced an 'abuse' of GH (and possibly of IGF-I) by competitive sports athletes and amateurs. The present study outlines the best methods available to uncover abuse, as well as a series of potential research projects to recognize doping. The review also underlines the principal variables measurable in the laboratory and summarizes published reference ranges of these parameters. These biochemical and laboratory profiles describe principal experimental approaches, with the hope that this will stimulate new ideas on the subject of detecting doping practices.

Growth hormone and exercise

This review summarizes the interactions between GH and exercise. Not only does exercise have profound effects upon the GH/IGF-I axis per se, but there is increasing evidence that such physiological perturbations might be influential in the performance responses to repeated training. However, the effects of systemic administration of rGH in restoring exercise capability and muscle strength in GH deficient adults and the ergogenic benefits of GH doping amongst athletes remain unproven. What is certain is that these issues will be of increasing relevance to clinical endocrinologists.

Growth hormone induced increase in serum IGFBP-3 level is reversed by anabolic steroids in substance abusing power athletes

OBJECTIVE

Body builders may use growth hormone (GH) and anabolic steroids to increase fitness and muscle mass. GH increases serum concentrations of IGF-I and IGFBP-3. The combined effects of GH and anabolic androgenic steroids on IGFBP-3 and IGF-I levels are not known under authentic substance-abusing conditions. The aim of this study was to investigate this in substance-abusing power athletes.

DESIGN AND PATIENTS

Nine healthy, non-obese and non-competing male power athletes, all aggressive substance abusers, used GH and/or anabolic steroids independently of this study. Blood samples were taken both during and between the drug intake. Sixteen substance non-abusing wrestlers served as controls.

MEASUREMENTS

Serum IGF-I concentration was measured by radioimmunoassay and the IGFBP-3 concentration was measured by two immunofluorometric assays, one detecting proteolytic fragments of IGFBP-3. The capacity of serum to proteolytically cleave IGFBP-3 was studied by the proteolysis assay.

RESULTS

While growth hormone increased the IGFBP-3 and IGF-I concentrations, anabolic steroids decreased the same. Concomitant use of growth hormone and anabolic steroids decreased the IGFBP-3 concentration in five out of six abuse periods in spite of the fact that the IGF-I concentration remained elevated in four of them. However, in two men who were on low calorie diet both the IGF-I and IGFBP-3 concentrations decreased during combined GH/anabolic steroid abuse. No proteolytic fragmentation of IGFBP-3 was observed.

CONCLUSION

Massive abuse of anabolic steroids decreases both the basal and GH-stimulated IGFBP-3 concentrations, whereas its effects on serum IGF-I concentration are variable and affected by low calorie diet. This study demonstrates that detection of GH doping by measuring the IGF-I and/or IGFBP-3 levels has notable confounding factors.