The world of sport was left reeling once again this week as yet another high-profile athlete failed a drug test. However, unlike previous doping cheats such as Lance Armstrong and Justin Gatlin, Maria Sharapova apparently did not know that the substance she had taken was illegal in sport. Known as meldonium, the drug has been in the spotlight this week, but what exactly is it?
Also known as mildronate, meldonium was first developed in Latvia in the early 2000s as a treatment for a condition called ischemia, which results from a reduction in blood flow to body tissues. This can be caused by physical blockages to blood vessels or by a fall in blood pressure, and leads to a decrease in the amount of oxygen reaching cells.
This, in turn, causes muscles to tire during exercise, as they rapidly use up their oxygen supply. To prevent this, meldonium inhibits the biosynthesis of an amino acid called carnitine, which plays a key role in transferring fatty acids across membranes in order to allow them to be metabolized. Since this process uses up a great deal of oxygen, inhibiting it ensures more oxygen remains available to muscle cells for the combustion of glucose in order to release energy.
According to some reports, the drug was originally trialled back in the 1980s as a secret weapon designed to create Soviet "super soldiers," capable of operating in high-altitude, low-oxygen environments. Because of these performance-enhancing effects, WADA placed meldonium on its “watch list” in 2015, before transferring it to the prohibited substances list on January 1, 2016. To qualify for inclusion on this list, drugs must display at least two of three key criteria: the ability to enhance athletic performance, pose a threat to athletes’ health, and violate the “spirit of sport.”
Meldonium, seen here for sale under the trademark Mildronate. Donat Sorokin / Getty Images
Exactly which two of these benchmarks mildronate has been deemed by WADA to have failed is not publicly known, although the first and third are the most likely candidates, since the substance is often prescribed for medicinal purposes, and is thought to have beneficial effects on users’ mood and energy levels.
According to Sharapova, her family doctor had been prescribing mildronate to her for a range of health issues over the past 10 years, during which time it was not illegal. She also claims to have been unaware of the drug’s alternative name of meldonium, under which it is listed on WADA’s banned substances catalog.
While the Russian tennis star has become the first to be caught out publicly for using the drug, the possibility of more athletes following suit remains high, with the New York Times reporting that more than 60 other professional sportsmen and women have tested positive for meldonium this year.