How the Ace Program Works

ACE’s program is a comprehensive anti-doping program that tests for three categories of abuse – blood doping, anabolic steroid use and hormone use, such as hGH.  The program is unlike any other anti-doping program in both scope and nature.  ACE’s Pure Sport program involves year round testing of every athlete in the program and each athlete will be subject to a minimum of 26 collections of blood, serum and urine each year.  The key to ACE’s testing is a combination of this high volume of testing and the longitudinal analysis of the data.

Longitudinal Analysis

The extensive use of longitudinal analysis is a sharp departure from traditional anti-doping techniques and it allows ACE to detect possible doping earlier, longer after administration has stopped and doping in much small quantities when compared to traditional anti-doping.  Additionally, and perhaps most importantly, it also allows the detection of doping by means and substances currently completely undetectable by traditional anti-doping.

The reason for all this is that relevant biological parameters (described in detail, below) have a great variation between individuals but relatively much smaller variation within an individual.  As one example, the Stimulation Index (or “Off-Score”) is used by the UCI to present a possibility of doping when it exceeds 133.  This is over five standard deviations from the mean of the general population and needs to be so insensitive because even though it is over five standard deviations from the norm for the general population, in some individuals it could be as little as two standard deviations from that individual’s normal value.

As an overly simple example, using longitudinal analysis, where each individual has dozens of data points, ACE is able state, for example, for an individual with a mean Off-Score of 90 and a Standard Deviation of 8 that if that individual recorded an Off-Score over 106 that there would be only a five percent chance that the result was from normal variation and at 114 there would be less than one-half of one percent.  Both of those examples would be completely normal under traditional anti-doping, but in the ACE program both would be an indication of possible doping, with the Off-Score of 114 in that case being a very strong indication.

Blood Doping Detection

To detect blood doping, ACE’s Pure Sport program measures Hemoglobin, Hematocrit, Recticulocyte count and MCV as it’s main biological markers.  It also uses the Stimulation Index (an indexed relationship between Hemoglobin and Recticulocytes) as part of its primary analysis.  ACE also measures several other blood factors to provide secondary clues into blood manipulation including MCH, MCHC, RBC and Platelet Count.  For 2008, ACE is looking to incorporate Blood Volume testing as part of its biological matrix testing for blood manipulation.
Using the relationships between these biological parameters, ACE can gain a very good indication of possible doping with even very small variations.  The extensive number of parameters monitored also allows ACE to gain a very good picture of what reasons might exist for any particular noted movement in a parameter.  It is this comprehensive testing combined with more real experience interpreting results in elite athletes than any other program that allows ACE to detect doing better than other programs, including traditional anti-doping.

Using the example above, blood doping is readily detected by ACE when traditional anti-doping would miss it.  Additionally, because ACE’s program involves frequent, year-round testing, it is difficult for such doping to escape detection.  For example, using blood doping and the hypothetical subject above, traditional anti-doping would not detect the doping at all.  But, even if the subject were to have an Off-Score above the UCI limit of 133, because of the bodies feedback mechanisms traditional anti-doping still might fail to detect the doping simply out of luck, because the testing is not frequent enough.  If a person has a natural mean Off-Score of 90 and on day 1 administers a blood doping agent that causes his day 2 off score to go to 135.  Within less than a week it would be reasonable that this person’s Off-Score would be below 133 (though still quite high).  Thus, under traditional anti-doping a person blood doping on day 1 might be detectable for 2-6 days.  Under ACE’s program, however, this doping would remain detectable for over 4-6 weeks – e.g. far longer than the testing interval.

Steroid Use Detection

As with blood, ACE measures an extensive number of biological parameters – in both urine and serum – to help detect possible steroid use.  Additionally, ACE screens in urine for the direct detection of over 70 substances on the WADA banned substances list, with more being added every day.  In urine, ACE measures testosterone, epitestosterone, androsterone, eitocholanolone, 5- and 5β-androstanediol.  Using these six biological measurements, ACE has developed a highly sensitive proprietary index for monitoring steroid use.  ACE backs this detection method up with its serum measurement of LH and FSH.

The longitudinal analysis of these markers is similar in kind to the blood cell analysis described above.  When a person takes an anabolic androgenic steroid (“AAS” or “steroid”) that person immediately alters his body’s steroid profile.  LH and FSH are immediately suppressed.  This in turn suppresses the body’s own steroid production.  Altering for a substantial time and in a predictable manner the biological markers listed above.

As an example, in traditional anti-doping, the use of the T/E ratio is well known.  Because this ratio of biological markers is performed on a single measurement, rather than a longitudinal measurement of dozens of data points, and because this traditional marker looks at only one marker – the ratio of testosterone to epitestosterone – the test is too insensitive and too infrequent to detect the vast majority of steroid abuse.

WADA defines as suspect a T/E ratio of 4:1.  This is over six standard deviations for the expected norm of 1:1 in the general population.  Using a smaller ratio, however, would be impractical.  For example, using publicly available figure, only 3 of nearly 500 cases since 2004 where the T/E ratio was between 4:1 and 6:1 resulted in a confirmed adverse analytical finding under the WADA system.  The reason for this is the lack of frequent, longitudinal testing.  In the ACE system, again, variation from an individual athlete’s  norm in excess of two standard deviations is considered suspect, with a deviation of three standard deviations being highly suspect.

Also as with blood, the frequency of testing with the ACE program allows far greater reliability.  If, for example, an individual took oral testosterone, his T/E ratio might not exceed 4:1 at all, but if it did and even if it went as high as 30:1 or more, once the athlete stopped administration his T/E ratio could be back below 4:1 within a day, possibly sooner.  His use of testosterone under traditional anti-doping would be detectable for several more days using IRMS, but without the elevated T/E ratio, the WADA lab would have no reason to think it should perform IRMS.  Using ACE’s longitudinal analysis, oral testosterone use is easily detectable out to seven days and likely detectable out to 14 days, depending on the individual and dose.  With ACE testing occurring randomly at a minimum of once every 14 days, the ability for athletes to escape detection is remote.

hGH testing

ACE monitors hGH as part of its serum testing.  hGH is extraordinarily difficult to detect because it returns to normal so quickly after administration.  However, ACE has had some success in detecting hGH use because of its combination of high frequency testing and longitudinal analysis.  Currently, hGH use is undetectable with traditional means of anti-doping.

For every case that a result indicates the possibility of a doping violation, ACE has a protocol. The specific measures taken vary based on the nature of the result.

A rider that tests provably positive for a specific doping agent or method will be dismissed from his team.

A rider that has a bio-maker go out of normal such that there is a reasonable likelihood of doping is not permitted to race while an investigation takes place. This investigation includes follow-up testing and can also include additional testing designed to isolate the cause of the movement in the bio-marker.

Below are two examples of a rider's blood profile. Similar analyses are performed on a rider's hormone profile, including an endogenous steroid profile and a growth hormone profile. Because the body responds in predictable and consistent ways when performance enhancing drugs and methods are used, tracking these profiles gives ACE the ability to detect earlier, detect at smaller doses and detect for a longer period of time after administration has ceased when compared to traditional anti-doping methods.

Examples:



Above is the blood chemistry of a clean rider, tracking his Hemoglobin, Hematocrit and Off-Score.



In this image, you can note the spike in Off-score as well as a suddenly rising Hemoglobin and Hematocrit. This is an indicator of a possible doping violation. In the case above, the blood profile shows a reasonable possibility of the rider having used a prohibited substance or mmethod. In this case the rider would not be permitted to race while he undergoes additional testing on his blood profile. The rider's suspension would continue until such time as his blood profile returned to normal. Additionally, the rider may be subject to tests for exogenous EPO and Homologous Blood Transfusion.