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Quest’s DTC Biomarker Service Aims to Improve Athletic Performance

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NEW YORK (360Dx) — Quest Diagnostics is giving amateur and professional athletes an option to analyze levels of fitness from within the body using a biomarker-based diagnostic service. 

Blueprint for Athletes, a sports performance testing service from Quest, enables fitness enthusiasts to track biomarker values in human blood that shed light on the body’s levels of vitamin D, creatine kinase, glucose, and other biological entities that influence protein synthesis, energy levels, and wellness.

The test's diagnostics report provides information about the effects of biomarkers on performance and health, and it provides guidance on how to improve upon fitness and health through insights into training, recovery, and nutrition. 

The biomarkers include white blood cell and lymphocyte counts as indications of immune-system health, and levels of alkaline phosphatase for bone health, eGFR for kidney health, and total cortisol for muscle health, among many other markers. 

“It's one of the few instances where committed athletes who are training in the margins of their days and available time — in the morning, at night, and on the weekends — have access to something that professional athletes are using to prepare for their sports,” Richard Schwabacher, executive director of Quest Diagnostics Sports and Human Performance, told 360Dx. 

In developing the test, Quest drew from its capabilities in medical and wellness lab testing, and added insights from professional athletes and sports science researchers. 

The service is a result of a sports-science collaboration that began in 2013 between the New York Giants and Quest to develop new uses for diagnostic lab information. 

In working together, both organizations believed that it would be possible to develop new ways to improve athletes' health and performance, Schwabacher said. “Importantly, professional athletes on the New York Liberty and the New York Giants are getting the exact same report and the same level of information that you or I would get,” he added. 

At the New York Giants, Blueprint for Athletes baseline screening has become part of each player’s annual physical, and Giants players can volunteer to work with Quest in the research and application of the service. 

The New York Liberty, Miami Dolphins, and other professional and collegiate sports teams, as well as competitive athletes across the country, are also using the service. In August, Seattle Sounders FC became the first Major League Soccer team to incorporate it into training to enhance player performance. 

The trend toward consumers tracking daily progress through quantitative tools and apps may provide momentum for the uptake of Blueprint for Athletes, Schwabacher said. 

"The pervasive nature of trackers and collection of health data are at the heart of why this is a great time for Quest to launch its service," he said. "But the bottom line is that you can only glean so much information from aggregating information that's outside the body. It's important to start to understand physiological adaptations from inside the body in training and preparing for competition." 

Shawn Arent, an exercise science professor and researcher at Rutgers University who is also a member of the medical and scientific board for Blueprint for Athletes, applied the biomarker-based service to track progress of the Rutgers University women's soccer team in 2015.

Around midseason, the team exhibited a dip in form, losing two games and tying two games. "We looked at the biomarker data and, sure enough, everybody's cortisol and inflammation was climbing," Arent told 360Dx. "It had started in preseason, but it had exacerbated," he added. "And, on top of the issues with cortisol and inflammation, nutritional markers, especially for iron and omega 3s, were also following [the same trend]." 

As a remedy, the team's coaches altered training intensity and volume along with the players' nutrition and sleep profiles, he said. 

"Over the course of the next month, all marker levels started to move back to where they were at baseline," he added. "The team reached the Final Four for the first time in its history, and many of the players attributed it to the biomarker testing, because it showed them what they needed to do and how to better manage the season." 

The research, "Biomarkers Changes in Collegiate Female Power-Endurance Athletes: The Role of Fitness as a Predictor," was a poster presentation at the ACSM Annual Meeting in Boston- in June. 

Rescuing fit athletes from themselves

The researchers also discovered the "fit athlete paradox." Results from biomarker monitoring showed higher levels in fitter athletes of IL6, cortisol, prolactin, and creatine kinase through the first half of the competitive season, he said, suggesting increased muscle breakdown, inflammation, and stress as a body enters a more catabolic state.

"We saw that fitness was a predictor of biomarker changes, but not in the way most people would think," Arent said. Because the fittest players do far more work than unfit players, they had greater endocrine and dietary disruption, which was not something that you could readily recognize by observing training sessions, he said. 

"Sometimes, you have to rescue the fit players from themselves," he added. 

Users order Blueprint for Athletes through a website portal and select from performance packages that provide information that aligns with their training objectives. 

Six package options are available for Quest's service so that users can tailor a blueprint most suited to their objectives and training protocols. After purchasing a package, the athlete has blood drawn at a Quest location. 

Within a week or two, a user receives a hard copy report that consists of biomarker data. Results can be viewed through Quest’s interactive patient portal or a mobile app, MyQuest. 

The diagnostic report also provides trend data that tracks movement of biomarkers over time if it's the second or third time a user has taken the test. 

"We provide them with definitions of biomarkers, what it means if levels are high, what it means if levels are deficient, how values are going to impact performance, and what the athletes can do to make positive changes," Schwabacher said. 

Prices for the service range from $225 to $500 per package, depending on the selected configuration. And fitness enthusiasts can purchase the service in California, Colorado, Florida, Illinois, Minnesota, New Jersey, and Texas. Quest expects to launch the service in additional states through the remainder of this year. 

As this market develops for measuring sports and performance through direct-to-consumer testing, Quest can expect to encounter multiple competitors. And some are already on the market offering services based on genetics test platforms. 

London-based DNAFit, for example, screens gene variants linked to a body's response to training and nutrition, and uses a computer algorithm to generate a report informing customers about how well they are likely to respond to specific exercise and nutrition regimens. 

At the core of the test is a panel of 15 genes identified from scientific literature that link to an athlete's potential to respond to power or endurance training. The company is conducting studies to validate an endurance and power algorithm among other algorithms it has developed. 

In September, Copenhagen-based AthGene said it had launched a subscription-based genetics platform through which users pay €30 ($33) per month to "unlock new information about how to meet your body’s preferences in the best possible way." 

The firm said that it tests for 240,000 gene variants in providing personalized fitness, lifestyle, and nutrition services. 

Not all scientific researchers view genetic testing for athletes favorably. A consensus statement published in the British Journal of Sports Medicine last year raised doubts about the value of direct-to-consumer genetic testing for athletes. The authors bemoaned the lack of clarity over which specific genes or variants are being tested and the absence of "appropriate genetic counselling for the interpretation of the genetic data to consumers." They concluded that "no child or young athlete should be exposed to DTC genetic testing to define or alter training or for talent identification aimed at selecting gifted children or adolescents." 

In the broader, nascent direct-to-consumer test space, Laboratory Corporation of America may emerge as one of Quest's primary competitors. David King, LabCorp chairman and CEO, said during a conference call to discuss Q3 earnings results, "As part of our commitment to consumer engagement, we expect to launch our consumer-initiated, lab-test offering before year end, giving consumers access to certain lab tests online in an expeditious, compliant, and responsible manner." 

In June, Quest announced that it will provide diagnostic testing services in company-branded Patient Services Centers adjacent to 12 Safeway in-store pharmacies in California, Colorado, Texas, Virginia, and Maryland. Among the test options are lipid panels, STI and HIV screenings, and diabetes risk and management panels. 

And in October, the direct-to-consumer test space had one less competitor when beleaguered startup Theranos said it would close its clinical labs and wellness centers, and focus instead on developing a miniaturized, automated instrument capable of small-volume sample testing.