Proliferation Of Orthobiologics Within A Professional Sport

Abstract

The popularity of regenerative medicine has recently increased, with many athletes turning to orthobiologic therapies that utilize complex milieus of biological substances, such as stem cells and natural growth factors, to heal sports injuries faster. Commonly derived from donor and non-donor harvested tissues, these include umbilical cord blood, amniotic fluid, placental allografts, connective and adipose tissue. Many of these products are not well characterized and their safety and efficacy has not been proven. Orthobiologics, generally are not prohibited in sport if no exogenous growth factors or other prohibited substances are added after harvesting or during the administration process, and as long as they only return normal functioning of the affected area and do not enhance it. Use of these treatments by professional athletes, presents an ethical dilemma for anti-doping governance due to the unproven efficacy, possible health risks and potential to contravene the Spirit of Sport. The US Anti-doping Agency (USADA) adopted an orthobiologics Declaration of Use (DOU) policy in 2020 for the Ultimate Fighting Championship (UFC). PURPOSE: Document the use of orthobiologics within the UFC in order to assist in evaluating such products and provide an anti-doping status to athletes. METHODS: DOU were submitted to USADA in advance of treatment, including: Date of procedure, Product, Injury, and Course of treatment and reviewed by USADA. RESULTS: Over 50 stem cell DOU were submitted in 1y including over 15 individual products. Treatment was requested primarily for joint injuries sustained during competition or arising from overuse. The most common orthobiologic was umbilical cord derived Wharton’s Jelly following or in conjunction with surgical intervention. Despite the high amounts of growth factors and cytokines present, all but one DOU was approved since growth factors were not added post-harvesting. No adverse analytical findings were associated with orthobiologic use. CONCLUSIONS: The use of orthobiologics has exploded in UFC athletes. USADA continues to monitor the evolving field through a DOU process. More detailed studies are needed to characterize these products, ensure that the constituents lack the potential for performance enhancement, evaluate treatment efficacy and monitor their safety.