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Kutchy NA, Palermo A, Ma R, Li Z, Ulanov A, Callen S, Siuzdak G, Roy S, Buch S, Hu G. Changes in Plasma Metabolic Signature upon Acute and Chronic Morphine Administration in Morphine-Tolerant Mice. Metabolites 2023; 13:metabo13030434. [PMID: 36984873 PMCID: PMC10053579 DOI: 10.3390/metabo13030434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
Morphine administration causes system-level metabolic changes. Here, we show that morphine-tolerant mice exhibited distinct plasma metabolic signatures upon acute and chronic administration. We utilized a mouse model of morphine tolerance by exposing mice to increasing doses of the drug over 4 days. We collected plasma samples from mice undergoing acute or chronic morphine or saline injections and analyzed them using targeted GC–MS-based metabolomics to profile approximately 80 metabolites involved in the central carbon, amino acid, nucleotide, and lipid metabolism. Our findings reveal distinct alterations in plasma metabolite concentrations in response to acute or chronic morphine intake, and these changes were linked to the development of tolerance to morphine’s analgesic effects. We identified several metabolites that had been differentially affected by acute versus chronic morphine use, suggesting that metabolic changes may be mitigated by prolonged exposure to the drug. Morphine-tolerant mice showed a restoration of amino acid and glycolytic metabolites. Additionally, we conducted reconstructed metabolic network analysis on the first 30 VIP-ranked metabolites from the PLSDA of the saline, acute, and morphine-tolerant mice groups, which uncovered four interaction networks involving the amino acid metabolism, the TCA cycle, the glutamine-phenylalanine-tyrosine pathway, and glycolysis. These pathways were responsible for the metabolic differences observed following distinct morphine administration regimens. Overall, this study provides a valuable resource for future investigations into the role of metabolites in morphine-induced analgesia and associated effects following acute or chronic use in mice.
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Affiliation(s)
- Naseer A. Kutchy
- Department of Animal Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA (S.B.); (G.H.)
- Correspondence: (N.A.K.); (A.P.)
| | - Amelia Palermo
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Correspondence: (N.A.K.); (A.P.)
| | - Rong Ma
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA (S.B.); (G.H.)
- Department of Pharmacology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhong Li
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC 27710, USA
- Roy J. Carver Biotechnology Center, University of Illinois, Urbana, IL 61801, USA
| | - Alexandria Ulanov
- Roy J. Carver Biotechnology Center, University of Illinois, Urbana, IL 61801, USA
| | - Shannon Callen
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA (S.B.); (G.H.)
| | - Gary Siuzdak
- Center for Metabolomics and Mass Spectrometry, Scripps Research Institute, La Jolla, CA 92037, USA
| | - Sabita Roy
- Department of Surgery, University of Miami, Miami, FL 33136, USA
| | - Shilpa Buch
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA (S.B.); (G.H.)
| | - Guoku Hu
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA (S.B.); (G.H.)
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An approach for identifying in silico peptides against authentic metabolites: in vitro characterization of thymosin β4 metabolites. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2022. [DOI: 10.1007/s40005-022-00581-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Iannone M, Alberti F, Braganò MC, de la Torre X, Molaioni F, Botrè F. Influence of synthetic isoflavones on selected urinary steroid biomarkers: Relevance to doping control. Steroids 2021; 174:108900. [PMID: 34391799 DOI: 10.1016/j.steroids.2021.108900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/25/2021] [Accepted: 08/01/2021] [Indexed: 11/27/2022]
Abstract
In this work we have investigated the influence of the intake of two synthetic isoflavones, methoxyisoflavone and ipriflavone, on the urinary concentration of endogenous steroids, and on their relative ratios, of doping relevance. Specifically, the concentrations of testosterone (T), epitestosterone (E), androsterone (A), etiocholanolone (Etio), 5α-androstan-3α,17α-diol (5αAdiol), 5β-androstan-3α,17α-diol (5βAdiol), and the ratios T/E, A/T, A/Etio, 5αAdiol/5βAdiol, 5αAdiol/E, were considered, in the framework of the Steroidal Module of the Athlete Biological Passport (ABP). The above set of parameters were complemented by the urinary levels of luteinizing hormone (total LH) and the ratio between T and LH (T/total LH), to assess the possible effects on the biosynthesis of the mentioned steroids. Five healthy Caucasian male volunteers were selected for the study. Urine samples were collected before and during the administration of (i) methoxyisoflavone (Methoxyisoflavone, MyProtein) and (ii) ipriflavone (Osteofix ®, Chiesi Farmaceutici). For the analysis of the urinary steroid profile, after enzymatic hydrolysis with β-glucuronidase from Escherichia Coli (E. Coli) and liquid-liquid extraction with tert-buthylmethyl ether, all samples were analyzed by gas chromatography coupled to tandem mass spectrometry (GC-MS/MS), while for the determination of total LH all urine samples were directly analyzed by a chemiluminescent immunometric assay technique (Siemens Immulite 2000 LH). Our results show that the administration of either methoxyisoflavone or ipriflavone causes an alteration of the urinary concentrations and concentration ratios of the investigated steroids, in the range 55-80% from the baseline values. Furthermore, an oversecretion of LH after the daily intake of methoxyisoflavone or ipriflavone was also recorded in all volunteers, corresponding to an increase in the biosynthesis and excretion of T and some of its metabolites. These changes trigger a disregulation in the pattern of urinary excretion of the steroids included in the Steroidal Module of the ABP, which makes more difficult the interpretation of the longitudinal steroid profile based on the definition of individual normality ranges for each athlete. Our data are also consistent with previous evidence regarding the in vitro effects of natural and synthetic isoflavones, suggesting that their monitoring in doping control routine analysis would be very beneficial for the result management activities.
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Affiliation(s)
- Michele Iannone
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Onesti 1, 00197 Rome, Italy
| | - Francesca Alberti
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Onesti 1, 00197 Rome, Italy
| | - Maria Cristina Braganò
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Onesti 1, 00197 Rome, Italy
| | - Xavier de la Torre
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Onesti 1, 00197 Rome, Italy
| | - Francesco Molaioni
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Onesti 1, 00197 Rome, Italy
| | - Francesco Botrè
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Onesti 1, 00197 Rome, Italy; REDs - Research and Expertise in antiDoping Sciences, ISSUL - Institute of Sport Sciences, University of Lausanne, Synathlon, Quartier Centre, 1015 Lausanne, Switzerland.
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Mazzarino M, Comunità F, de la Torre X, Molaioni F, Botrè F. Effects of the administration of miconazole by different routes on the biomarkers of the "steroidal module" of the Athlete Biological Passport. Drug Test Anal 2021; 13:1712-1726. [PMID: 34212529 PMCID: PMC8597009 DOI: 10.1002/dta.3121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022]
Abstract
This article reports the results obtained from the investigation of the influence of miconazole administration on the physiological fluctuation of the markers of the steroid profile included in the “steroidal module” of the Athlete Biological Passport. Urines collected from male Caucasian subjects before, during, and after either systemic (i.e., oral and buccal) or topical (i.e., dermal) treatment with miconazole were analyzed according to validated procedures based on gas chromatography coupled to tandem mass spectrometry (GC–MS/MS) (to determine the markers of the steroid profile) or liquid chromatography coupled to MS/MS (LC–MS/MS) (to determine miconazole urinary levels). The results indicate that only after systemic administration, the markers of the steroid profile were significantly altered. After oral and buccal administration, we have registered (i) a significant increase of the 5α‐androstane‐3α,17β‐diol/5β‐androstane‐3α,17β‐diol ratio and (ii) a significant decrease of the concentration of androsterone, etiocholanolone, 5β‐androstane‐3α,17β‐diol, and 5α‐androstane‐3α,17β‐diol and of the androsterone/etiocholanolone, androsterone/testosterone, and 5α‐androstane‐3α,17β‐diol/epitestosterone ratios. Limited effects were instead measured after dermal intake. Indeed, the levels of miconazole after systemic administration were in the range of 0.1–12.5 μg/ml, whereas after dermal administration were below the limit of quantification (50 ng/ml). Significant alteration started to be registered at concentrations of miconazole higher than 0.5 μg/ml. These findings were primarily explained by the ability of miconazole in altering the kinetic/efficacy of deglucuronidation of the endogenous steroids by the enzyme β‐glucuronidase during the sample preparation process. The increase of both incubation time and amount of β‐glucuronidase was demonstrated to be effective countermeasures in the presence of miconazole to reduce the risk of uncorrected interpretation of the results.
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Affiliation(s)
- Monica Mazzarino
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Fabio Comunità
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Xavier de la Torre
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Francesco Molaioni
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Francesco Botrè
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy.,REDs-Research and Expertise on Anti-Doping Sciences, ISSUL-Institute des Sciences du Sport, Université de Lausanne, Lausanne, Switzerland
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Iannone M, Botrè F, Parenti S, Jardines D, de la Torre X. An investigation on the metabolic pathways of synthetic isoflavones by gas chromatography coupled to high accuracy mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2019; 33:1485-1493. [PMID: 31132805 DOI: 10.1002/rcm.8490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 06/09/2023]
Abstract
RATIONALE Isoflavones are a group of flavonoids that may be of interest in sport doping because they can be used by athletes in the recovery periods after the administration of anabolic steroids, with the aim of increasing the natural production of luteinizing hormone (LH) and, consequently, the biosynthesis of endogenous androgens. METHODS The in vivo metabolism of methoxyisoflavone (5-methyl-7-methoxyisoflavone) and ipriflavone (7-isopropoxyisoflavone), respectively present in a dietary supplement and in a pharmaceutical preparation, was investigated. The study was carried out by the analysis of urinary samples collected from male Caucasian subjects before, during and after the oral administration of methoxyisoflavone or ipriflavone. After enzymatic hydrolysis and liquid-liquid extraction, all urinary samples were analyzed by gas chromatography/quadrupole time-of-flight (qTOF MS system/qTOF) electron ionization mass spectrometry (EI-MS). RESULTS Eight metabolites of methoxyisoflavone and six metabolites of ipriflavone were isolated. The corresponding accurate mass spectra are specific for isoflavone structures and revealed also a retro-Diels-Alder fragmentation. CONCLUSIONS When excreted in large amounts, the urinary metabolites of methoxyisoflavone and ipriflavone can be traced to potential confounding factors in doping analysis. As methoxyisoflavone and ipriflavone have been shown to inhibit the enzyme aromatase, thus interfering with the normal metabolic pathways of testosterone, the detection of their intake, by screening for the presence of their main metabolites in urine, might be helpful in routine doping control analysis.
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Affiliation(s)
- Michele Iannone
- Laboratorio Antidoping FMSI, Largo Onesti 1, 00197, Rome, Italy
| | - Francesco Botrè
- Laboratorio Antidoping FMSI, Largo Onesti 1, 00197, Rome, Italy
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 291, 00161, Rome, Italy
| | - Silvia Parenti
- Laboratorio Antidoping FMSI, Largo Onesti 1, 00197, Rome, Italy
| | - Daniel Jardines
- Laboratorio Antidoping FMSI, Largo Onesti 1, 00197, Rome, Italy
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Li Y, Liao Y, Huang Y, Ye Z, Huang X. Dual functional monomers modified magnetic adsorbent for the enrichment of non-steroidal anti-inflammatory drugs in water and urine samples. Talanta 2019; 201:496-502. [PMID: 31122456 DOI: 10.1016/j.talanta.2019.04.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/05/2019] [Accepted: 04/17/2019] [Indexed: 01/05/2023]
Abstract
According to the molecular properties of non-steroidal anti-inflammatory drugs (NSADs), a new adsorbent for magnetic solid phase extraction (MSPE) was designed and synthesized. Triethyl-(4-vinylbenzyl)aminium chloride and 4-vinylbenzeneboronic acid were utilized as dual functional monomers to copolymerize with divinylbenzene on the surface of pre-modified Fe3O4 nanoparticles. The prepared magnetic adsorbent (Fe3O4@TCVA) was characterized by elemental analysis, Fourier transform infrared, scanning electron microscopy, transmission electron microscopy and vibrating sample magnetometer. Due to the abundant boronic acid, quaternary amine and phenyl groups, the Fe3O4@TCVA displayed satisfactory extraction performance for target NSADs (diclofenac acid, ibuprofen and mefenamic acid) by means of B-N coordination, anion-exchange, π-π and hydrophobic interactions. Under the optimized conditions, the Fe3O4@TCVA/MSPE was combined with high-performance liquid chromatography with diode array detection (HPLC-DAD) to sensitively analyze NSADs in water and human urine samples. Results indicated that the limits of detection for water and urine samples were in the ranges of 0.014-0.031 μg/L and 0.029-0.11 μg/L, respectively. The relative standard deviations for the intra-day and inter-day assay variability were below 10%. The applicability of the proposed Fe3O4@TCVA/MSPE-HPLC-DAD method was demonstrated by the successful extraction and quantification of trace levels of NSADs in real water and human urine samples. Satisfactory spiked recovery and reproducibility were achieved.
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Affiliation(s)
- Yang Li
- Key Laboratory of the Ministry of Education for Coastal and Wetland Ecosystems, Fujian Provincial Key Laboratory for Coastal Ecology and Environmental Studies, College of the Environment and Ecology, Xiamen University, Xiamen 361005, China
| | - Yingmin Liao
- Department of Environmental Science & Engineering, Tan Kah Kee College, Zhangzhou 363105, China.
| | - Youfang Huang
- Key Laboratory of the Ministry of Education for Coastal and Wetland Ecosystems, Fujian Provincial Key Laboratory for Coastal Ecology and Environmental Studies, College of the Environment and Ecology, Xiamen University, Xiamen 361005, China
| | - Ziwen Ye
- Key Laboratory of the Ministry of Education for Coastal and Wetland Ecosystems, Fujian Provincial Key Laboratory for Coastal Ecology and Environmental Studies, College of the Environment and Ecology, Xiamen University, Xiamen 361005, China
| | - Xiaojia Huang
- Key Laboratory of the Ministry of Education for Coastal and Wetland Ecosystems, Fujian Provincial Key Laboratory for Coastal Ecology and Environmental Studies, College of the Environment and Ecology, Xiamen University, Xiamen 361005, China.
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Mazzarino M, Khevenhüller-Metsch FL, Fiacco I, Parr MK, de la Torre X, Botrè F. Drug-drug interaction and doping: Effect of non-prohibited drugs on the urinary excretion profile of methandienone. Drug Test Anal 2018; 10:1554-1565. [DOI: 10.1002/dta.2406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Monica Mazzarino
- Laboratorio Antidoping; Federazione Medico Sportiva Italiana; Rome Italy
| | | | - Ilaria Fiacco
- Laboratorio Antidoping; Federazione Medico Sportiva Italiana; Rome Italy
| | - Maria Kristina Parr
- Department of Biology Chemistry and Pharmacy; Freie Universität Berlin; Germany
| | - Xavier de la Torre
- Laboratorio Antidoping; Federazione Medico Sportiva Italiana; Rome Italy
| | - Francesco Botrè
- Laboratorio Antidoping; Federazione Medico Sportiva Italiana; Rome Italy
- Dipartimento di Medicina Sperimentale; “Sapienza” Università di Roma; Rome Italy
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Ambrosio G, de la Torre X, Mazzarino M, Parr MK, Botrè F. Effect of non-prohibited drugs on the phase II metabolic profile of morphine. An in vitro investigation for doping control purposes. Drug Test Anal 2018; 10:984-994. [DOI: 10.1002/dta.2344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/12/2017] [Accepted: 11/12/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Gabriella Ambrosio
- Laboratorio Antidoping; Federazione Medico Sportiva Italiana; Rome Italy
| | - Xavier de la Torre
- Laboratorio Antidoping; Federazione Medico Sportiva Italiana; Rome Italy
| | - Monica Mazzarino
- Laboratorio Antidoping; Federazione Medico Sportiva Italiana; Rome Italy
| | - Maria K. Parr
- Department of Biology Chemistry and Pharmacy; Freie Universität Berlin; Germany
| | - Francesco Botrè
- Laboratorio Antidoping; Federazione Medico Sportiva Italiana; Rome Italy
- Dipartimento di Medicina Sperimentale; “Sapienza” Università di Roma; Rome Italy
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Mazzarino M, Buccilli V, de la Torre X, Fiacco I, Palermo A, Ughi D, Botrè F. Characterization of the phase I and phase II metabolic profile of tolvaptan by in vitro studies and liquid chromatography–mass spectrometry profiling: Relevance to doping control analysis. J Pharm Biomed Anal 2017; 145:555-568. [DOI: 10.1016/j.jpba.2017.06.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/19/2017] [Accepted: 06/23/2017] [Indexed: 01/14/2023]
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Drug-drug interactions and masking effects in sport doping: influence of miconazole administration on the urinary concentrations of endogenous anabolic steroids. Forensic Toxicol 2016. [DOI: 10.1007/s11419-016-0325-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Palonek E, Ericsson M, Gårevik N, Rane A, Lehtihet M, Ekström L. Atypical excretion profile and GC/C/IRMS findings may last for nine months after a single dose of nandrolone decanoate. Steroids 2016; 108:105-11. [PMID: 26853157 DOI: 10.1016/j.steroids.2016.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/29/2016] [Accepted: 02/03/2016] [Indexed: 11/28/2022]
Abstract
The use of the anabolic androgenic steroid nandrolone and its prohormones is prohibited in sport. A common route of nandrolone administration is intramuscular injections of a nandrolone ester. Here we have investigated the detection time of nandrolone and 19-norandrosterone and 19-noretiocholanolone metabolites in eleven healthy men after the administration of a 150 mg dose of nandrolone decanoate. The urinary concentrations of nandrolone and the metabolites were monitored by GC-MS/MS for nine months and in some samples the presence of 19-norandrosterone was confirmed by GC/C/IRMS analysis. The participants were genotyped for polymorphisms in PDE7B1 and UGT2B15 genes previously shown to influence the activation and inactivation of nandrolone decanoate. There were large inter-individual variations in the excretion rate of nandrolone and the metabolites, although not related to genetic variations in the UGT2B15 (rs1902023) and PDE7B1 (rs7774640) genes. After the administration, 19-norandrosterone was found at 2-8-fold higher concentrations than 19-noretiocholanolone. We showed that nandrolone doping can be identified 4 and 9 months after the injection of only one single dose in six and three individuals, respectively. We also noted that GC/C/IRMS confirms the presence of exogenous 19-norandrosterone in the urine samples, showing δ13 values around -32 ‰. This was true even in a sample that was not identified as an atypical finding after the GC-MS/MS analysis further showing the power of using GC/C/IRMS in routine anti-doping settings.
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Affiliation(s)
- Elzbieta Palonek
- Doping Control Laboratory, Division of Clinical Pharmacology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, SE-14186 Stockholm, Sweden
| | - Magnus Ericsson
- Doping Control Laboratory, Division of Clinical Pharmacology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, SE-14186 Stockholm, Sweden
| | - Nina Gårevik
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, SE-14186 Stockholm, Sweden
| | - Anders Rane
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, SE-14186 Stockholm, Sweden
| | - Mikael Lehtihet
- Department of Medicine/Huddinge, Karolinska Institutet and Centre for Andrology and Sexual Medicine, Karolinska University Hospital C2:84, SE 141 86 Stockholm, Sweden
| | - Lena Ekström
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, SE-14186 Stockholm, Sweden.
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