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Ekroos S, Karregat J, Toffol E, Castrén J, Arvas M, van den Hurk K. Menstrual blood loss is an independent determinant of hemoglobin and ferritin levels in premenopausal blood donors. Acta Obstet Gynecol Scand 2024. [PMID: 38856303 DOI: 10.1111/aogs.14890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION To prevent blood donors from developing iron deficiency (ferritin <15 μg/L) and subsequent anemia (hemoglobin <120 g/L), blood services rely on information about known risk factors, including the donor's sex and age. For example, while Finnish women are able to donate whole blood with a minimum donation interval of 91 days, women in the 18 to 25-year-old age group are recommended to donate no more than once per year. Menstrual blood loss is not accounted for in blood donation interval recommendations, despite being a known risk factor of iron deficiency. We aim to investigate to what extent menstrual bleeding is associated with ferritin and hemoglobin levels in female blood donors, and quantify the association of other menstruation-related variables not currently accounted for by blood services (i.e., use of hormonal contraception, heavy menstrual bleeding) with iron deficiency or anemia. MATERIAL AND METHODS The study population consisted of 473 premenopausal and 491 postmenopausal Dutch whole blood donors. Exclusion criteria were current pregnancy, BMI ≥50, ferritin ≥200, pictorial blood assessment chart (PBAC) ≥400, and age <18 or ≥70 years. Menstrual blood loss was quantified using a PBAC, a semiquantitative method to evaluate the number of used menstrual products and the degree of staining. We identified predictors of log(ferritin)/hemoglobin and iron deficiency/anemia using Bayesian linear and logistic regression models and quantified the average percentage of variance in log(ferritin) and hemoglobin explained by the covariates. RESULTS Menstrual blood loss accounted for most of the explained variance in hemoglobin (8%) and second only to the number of days since last donation for ferritin (8%). Heavy menstrual bleeding (PBAC ≥150, OR = 3.56 [1.45-8.85], prevalence 13%) was associated with anemia, and use of levonorgestrel-releasing intrauterine device was negatively associated with iron deficiency (OR = 0.06 [0.01-0.44]). After statistical control for menstrual blood loss, age was not associated with iron status. CONCLUSIONS Menstrual blood loss and blood donation were the most important determinants of iron status in premenopausal women. Thus, results suggest that accounting for menstrual blood loss in donation interval guidelines may benefit blood donors.
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Affiliation(s)
- Sofie Ekroos
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jan Karregat
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, the Netherlands
| | - Elena Toffol
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Johanna Castrén
- Finnish Red Cross, Blood Service (FRCBS), Research and Development, Helsinki, Finland
| | - Mikko Arvas
- Finnish Red Cross, Blood Service (FRCBS), Research and Development, Helsinki, Finland
| | - Katja van den Hurk
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, the Netherlands
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Dragčević D, Pandžić Jakšić V, Jakšić O. Athlete biological passport: longitudinal biomarkers and statistics in the fight against doping. Arh Hig Rada Toksikol 2024; 75:24-31. [PMID: 38548376 PMCID: PMC10978099 DOI: 10.2478/aiht-2024-75-3793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/01/2023] [Accepted: 02/01/2024] [Indexed: 04/01/2024] Open
Abstract
As novel substances, short time windows, and limits of detection increasingly challenge direct methods of doping detection in sports, indirect tools inevitably take a greater role in the fight against it. One such tool is the athlete biological passport (ABP) - a longitudinal profiling of the measured haematological and biochemical biomarkers, combined with calculated scores, against the background of epidemiological data crucial for doping detection. In both of its modules, haematological and steroidal, ABP parameters are analysed with the Bayesian adaptive model, which individualises reference and cut-off values to improve its sensitivity. It takes into account the confounding factors with proven and potential influence on the biomarkers, such as race and altitude exposure. The ABP has already changed the fight against doping, but its importance will further grow with the new modules (e.g., endocrinological), parameters (e.g., plasma volume-independent parameters), and complementing indirect methods (e.g., transcriptomic).
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Affiliation(s)
- Dora Dragčević
- University Hospital Merkur, Department of Haematology, Zagreb, Croatia
| | - Vlatka Pandžić Jakšić
- University Hospital Dubrava, Department of Endocrinology, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Ozren Jakšić
- University of Zagreb School of Medicine, Zagreb, Croatia
- University Hospital Dubrava, Department of Haematology, Zagreb, Croatia
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3
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Raberin A, Burtscher J, Citherlet T, Manferdelli G, Krumm B, Bourdillon N, Antero J, Rasica L, Malatesta D, Brocherie F, Burtscher M, Millet GP. Women at Altitude: Sex-Related Physiological Responses to Exercise in Hypoxia. Sports Med 2024; 54:271-287. [PMID: 37902936 PMCID: PMC10933174 DOI: 10.1007/s40279-023-01954-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/01/2023]
Abstract
Sex differences in physiological responses to various stressors, including exercise, have been well documented. However, the specific impact of these differences on exposure to hypoxia, both at rest and during exercise, has remained underexplored. Many studies on the physiological responses to hypoxia have either excluded women or included only a limited number without analyzing sex-related differences. To address this gap, this comprehensive review conducted an extensive literature search to examine changes in physiological functions related to oxygen transport and consumption in hypoxic conditions. The review encompasses various aspects, including ventilatory responses, cardiovascular adjustments, hematological alterations, muscle metabolism shifts, and autonomic function modifications. Furthermore, it delves into the influence of sex hormones, which evolve throughout life, encompassing considerations related to the menstrual cycle and menopause. Among these physiological functions, the ventilatory response to exercise emerges as one of the most sex-sensitive factors that may modify reactions to hypoxia. While no significant sex-based differences were observed in cardiac hemodynamic changes during hypoxia, there is evidence of greater vascular reactivity in women, particularly at rest or when combined with exercise. Consequently, a diffusive mechanism appears to be implicated in sex-related variations in responses to hypoxia. Despite well-established sex disparities in hematological parameters, both acute and chronic hematological responses to hypoxia do not seem to differ significantly between sexes. However, it is important to note that these responses are sensitive to fluctuations in sex hormones, and further investigation is needed to elucidate the impact of the menstrual cycle and menopause on physiological responses to hypoxia.
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Affiliation(s)
- Antoine Raberin
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Johannes Burtscher
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Tom Citherlet
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Giorgio Manferdelli
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Bastien Krumm
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Bourdillon
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Juliana Antero
- Institut de Recherche Bio-Médicale Et d'Épidémiologie du Sport (EA 7329), French Institute of Sport, Paris, France
| | - Letizia Rasica
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Davide Malatesta
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Franck Brocherie
- Laboratory Sport, Expertise and Performance (EA 7370), French Institute of Sport, Paris, France
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Grégoire P Millet
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
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Hassanpour M, Salybekov AA. Whispers in the Blood: Leveraging MicroRNAs for Unveiling Autologous Blood Doping in Athletes. Int J Mol Sci 2023; 25:249. [PMID: 38203416 PMCID: PMC10779309 DOI: 10.3390/ijms25010249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
The prevalence of autologous blood transfusions (ABTs) presents a formidable challenge in maintaining fair competition in sports, as it significantly enhances hemoglobin mass and oxygen capacity. In recognizing ABT as a prohibited form of doping, the World Anti-Doping Agency (WADA) mandates stringent detection methodologies. While current methods effectively identify homologous erythrocyte transfusions, a critical gap persists in detecting autologous transfusions. The gold standard practice of longitudinally monitoring hematological markers exhibits promise but is encumbered by limitations. Despite its potential, instances of blood doping often go undetected due to the absence of definitive verification processes. Moreover, some cases remain unpenalized due to conservative athlete-sanctioning approaches. This gap underscores the imperative need for a more reliable and comprehensive detection method capable of unequivocally differentiating autologous transfusions, addressing the challenges faced in accurately identifying such prohibited practices. The development of an advanced detection methodology is crucial to uphold the integrity of anti-doping measures, effectively identifying and penalizing instances of autologous blood transfusion. This, in turn, safeguards the fairness and equality essential to competitive sports. Our review tackles this critical gap by harnessing the potential of microRNAs in ABT doping detection. We aim to summarize alterations in the total microRNA profiles of erythrocyte concentrates during storage and explore the viability of observing these changes post-transfusion. This innovative approach opens avenues for anti-doping technologies and commercialization, positioning it as a cornerstone in the ongoing fight against doping in sports and beyond. The significance of developing a robust detection method cannot be overstated, as it ensures the credibility of anti-doping efforts and promotes a level playing field for all athletes.
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Breenfeldt Andersen A, Bejder J, Bonne TC, Graae J, Seier S, Nordsborg NB. Changes in Immature Reticulocytes Aid the Indirect Detection of Microdose Recombinant Erythropoietin Use in Men and Women. Med Sci Sports Exerc 2023; 55:1695-1705. [PMID: 37095637 DOI: 10.1249/mss.0000000000003197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
PURPOSE We investigated whether immature reticulocyte fraction (IRF) and the immature reticulocytes to red blood cells ratio (IR/RBC) are sensitive and specific biomarkers for microdose recombinant human erythropoietin (rHuEPO) and whether the inclusion of reticulocyte percentage (RET%) and the algorithm "abnormal blood profile score (ABPS)" increased the athlete biological passport (ABP) sensitivity compared with hemoglobin concentration ([Hb]) and the OFF-hr score ([Hb]-60 × √RET%). METHODS Forty-eight (♀ = 24, ♂ = 24) participants completed a 2-wk baseline period followed by a 4-wk intervention period with three weekly intravenous injections of 9 IU·kg -1 ·bw -1 epoetin β (♀ = 12, ♂ = 12) or saline (0.9% NaCl, ♀ = 12, ♂ = 12) and a 10-d follow-up. Blood samples were collected weekly during baseline and intervention as well as 3, 5, and 10 d after treatment. RESULTS The rHuEPO treatment increased [Hb] (time-treatment, P < 0.001), RET% (time-treatment, P < 0.001), IRF (time-treatment, P < 0.001) and IR/RBC (time-treatment, P < 0.001). IRF and IR/RBC were up to ~58% ( P < 0.001) and ~141% ( P < 0.001) higher compared with placebo, and calculated thresholds provided a peak sensitivity across timepoints of 58% and 54% with ~98% specificity, respectively. To achieve >99% specificity for IRF and IR/RBC, sensitivity was reduced to 46% and 50%, respectively. Across all timepoints, the addition of RET% and ABPS to the ABP increased sensitivity from 29% to 46%. Identification of true-positive outliers obtained via the ABP and IRF and IR/RBC increased sensitivity across all timepoints to 79%. CONCLUSIONS In summary, IRF, IR/RBC, RET% and ABPS are sensitive and specific biomarkers for microdose rHuEPO in both men and women and complement the ABP.
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Affiliation(s)
| | - Jacob Bejder
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, DENMARK
| | | | - Jonathan Graae
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, DENMARK
| | - Søren Seier
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, DENMARK
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Diaz-Garzon J, Fernandez-Calle P, Aarsand AK, Sandberg S, Coskun A, Equey T, Aikin R, Soto AB. Long-Term Within- and Between-Subject Biological Variation Data of Hematological Parameters in Recreational Endurance Athletes. Clin Chem 2023; 69:500-509. [PMID: 36786725 DOI: 10.1093/clinchem/hvad006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/28/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND Hematological parameters have many applications in athletes, from monitoring health to uncovering blood doping. This study aimed to deliver biological variation (BV) estimates for 9 hematological parameters by a Biological Variation Data Critical Appraisal Checklist (BIVAC) design in a population of recreational endurance athletes and to assess the effect of self-reported exercise and health-related variables on BV. METHODS Samples were drawn from 30 triathletes monthly for 11 months and measured in duplicate for hematological measurands on an Advia 2120 analyzer (Siemens Healthineers). After outlier and homogeneity analysis, within-subject (CVI) and between-subject (CVG) BV estimates were delivered (CV-ANOVA and log-ANOVA, respectively) and a linear mixed model was applied to analyze the effect of exercise and other related variables on the BV estimates. RESULTS CVI estimates ranged from 1.3% (95%CI, 1.2-1.4) for mean corpuscular volume to 23.8% (95%CI, 21.6-26.3) for reticulocytes. Sex differences were observed for platelets and OFF-score. The CVI estimates were higher than those reported for the general population based on meta-analysis of eligible studies in the European Biological Variation Database, but 95%CI overlapped, except for reticulocytes, 23.9% (95%CI, 21.6-26.5) and 9.7% (95%CI, 6.4-11.0), respectively. Factors related to exercise and athletes' state of health did not appear to influence the BV estimates. CONCLUSIONS This is the first BIVAC-compliant study delivering BV estimates that can be applied to athlete populations performing high-level aerobic exercise. CVI estimates of most parameters were similar to the general population and were not influenced by exercise or athletes' state of health.
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Affiliation(s)
- Jorge Diaz-Garzon
- Laboratory Medicine Department, La Paz University Hospital, Madrid, Spain
| | | | - Aasne K Aarsand
- Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.,Norwegian Organization for Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.,Norwegian Organization for Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Abdurrahman Coskun
- School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Tristan Equey
- Athlete Biological Passport, World Anti-Doping Agency (WADA), Montréal, Canada
| | - Reid Aikin
- Athlete Biological Passport, World Anti-Doping Agency (WADA), Montréal, Canada
| | - Antonio Buno Soto
- Laboratory Medicine Department, La Paz University Hospital, Madrid, Spain
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BREENFELDT ANDERSEN ANDREAS, BEJDER JACOB, BONNE THOMASC, SØRENSEN HENRIK, SØRENSEN HELLE, JUNG GRACE, GANZ TOMAS, NEMETH ELIZABETA, SECHER NIELSH, JOHANSSON PÄRI, NORDSBORG NIKOLAIBAASTRUP. Hepcidin and Erythroferrone Complement the Athlete Biological Passport in the Detection of Autologous Blood Transfusion. Med Sci Sports Exerc 2022; 54:1604-1616. [DOI: 10.1249/mss.0000000000002950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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8
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Moreillon B, Equey T, Astolfi T, Salamin O, Faiss R. Removal of the influence of plasma volume fluctuations for the athlete biological passport and stability of haematological variables in active women taking oral contraception. Drug Test Anal 2022; 14:1004-1016. [PMID: 34994063 PMCID: PMC9306693 DOI: 10.1002/dta.3218] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 01/06/2023]
Abstract
The haematological module of the athlete biological passport (ABP) monitors longitudinal haematological variations that could be indicative of blood manipulation. This study applied a multi‐parametric model previously validated in elite cyclists to compare inferred and actual PV variations, whereas the potential influence of the oral contraceptive pill (OCP) cycle on the ABP blood biomarkers and plasma volume (PV) in 14 physically active women taking OCPs was also investigated. Blood and serum samples were collected each week for 8 weeks, and the ABP haematological variables were determined according to the World Anti‐Doping Agency guidelines. Transferrin (sTFN), ferritin (FERR), albumin (ALB), calcium (Ca), creatinine (CRE), total protein (TP) and low‐density lipoprotein (LDL) were additionally computed as ‘volume‐sensitive’ variables in a multivariate analysis to determine individual estimations of PV variations. Actual PV variations were indirectly measured using a validated carbon monoxide rebreathing method. We hypothesised ABP markers to be stable during a standard OCP cycle and estimated PV variations similar to measured PV variations. Measured PV variations were in good agreement with the predictions and allowed to explain an atypical passport finding (ATPF). The ABP biomarkers, Hbmass and PV were stable over 8 weeks. Significant differences occurred only between Week 7 and Week 1, with lower levels of haemoglobin concentration ([Hb]), haematocrit (HCT) and red blood cell count (RBC)(−4.4%, p < 0.01; −5.1%, p < 0.01; −5.2%, p < 0.01) and higher levels of PV at week 7 (+9%, p = 0.05). We thus concluded that estimating PV variations may help interpret individual ABP haematological profiles in women.
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Affiliation(s)
- Basile Moreillon
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | | | - Tiffany Astolfi
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.,Research and Expertise in anti-Doping sciences (REDs), University of Lausanne, Lausanne, Switzerland
| | - Olivier Salamin
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.,Research and Expertise in anti-Doping sciences (REDs), University of Lausanne, Lausanne, Switzerland
| | - Raphael Faiss
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.,Research and Expertise in anti-Doping sciences (REDs), University of Lausanne, Lausanne, Switzerland
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Bergström H, Lindahl A, Warnqvist A, Diczfalusy U, Ekström L, Björkhem‐Bergman L. Studies on CYP3A activity during the menstrual cycle as measured by urinary 6β-hydroxycortisol/cortisol. Pharmacol Res Perspect 2021; 9:e00884. [PMID: 34664787 PMCID: PMC8525181 DOI: 10.1002/prp2.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/29/2021] [Accepted: 09/29/2021] [Indexed: 11/26/2022] Open
Abstract
The 6β-OH-cortisol/cortisol ratio (6β-OHC/C) in urine is an endogenous marker of drug-metabolizing enzyme cytochrome P450 3A (CYP3A). The primary aim of this single center, prospective, non-interventional cohort study, was to investigate the variability of 6β-OHC/C during the menstrual cycle. In addition, possible associations between the CYP3A activity and sex hormones, gut microbiota metabolite trimethylamine-N-Oxide (TMAO) and microRNA-27b, respectively, were investigated. Serum and urinary samples from healthy, regularly menstruating women followed for two menstrual cycles were analyzed. Twenty-six complete menstrual cycles including follicular, ovulatory, and luteal phase were defined based on hormone analyses in serum. 6β-OHC/C were analyzed in urine and sex hormones, TMAO and miRNA-27b were analyzed in serum at the same time points. 6β-OHC/C did not vary between the follicular, ovulatory, or luteal phases. There was a difference in the relative miRNA-27b expression between the follicular and ovulatory phase (p = .03). A significant association was found between 6β-OHC/C and progesterone during the follicular (p = .005) and ovulatory (p = .01) phases (n = 26 for each phase). In addition, a significant association was found between the ratio and TMAO during the ovulatory (p = .02) and luteal (p = .002) phases. 6β-OHC/C and gut microbiota TMAO were significantly associated (p = .003) when evaluating all values, for all phases (n = 78). Interestingly, the finding of an association between 6β-OHC/C in urine and levels of TMAO in serum suggest that gut microbiota may affect CYP3A activity.
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Affiliation(s)
- Helena Bergström
- Department of NeurobiologyCare Sciences and Society (NVS)Division of Clinical GeriatricsKarolinska InstitutetHuddingeSweden
| | - Anna Lindahl
- Department of Laboratory MedicineDivision of Clinical ChemistryKarolinska InstitutetStockholmSweden
- Department of Clinical ChemistryKarolinska University LaboratoryKarolinska University HospitalStockholmSweden
| | - Anna Warnqvist
- Department of Environmental MedicineDivision of BiostatisticsKarolinska InstitutetStockholmSweden
| | - Ulf Diczfalusy
- Department of Laboratory MedicineDivision of Clinical ChemistryKarolinska InstitutetStockholmSweden
- Department of Clinical ChemistryKarolinska University LaboratoryKarolinska University HospitalStockholmSweden
| | - Lena Ekström
- Department of Laboratory MedicineDivision of Clinical PharmacologyKarolinska InstitutetKarolinska University HospitalStockholmSweden
| | - Linda Björkhem‐Bergman
- Department of NeurobiologyCare Sciences and Society (NVS)Division of Clinical GeriatricsKarolinska InstitutetHuddingeSweden
- Department of Palliative MedicineStockholms SjukhemStockholmSweden
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Cox HD, Miller GD, Manandhar A, Husk JD, Crouch AK, Eichner D. Tracking immature reticulocyte proteins for improved detection of recombinant human erythropoietin (rhEPO) abuse. Am J Hematol 2021; 96:1621-1629. [PMID: 34626008 DOI: 10.1002/ajh.26368] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/12/2022]
Abstract
Athletes abuse recombinant human erythropoietin (rhEPO) and erythropoiesis stimulating agents to increase hemoglobin mass and improve performance. To evade detection, athletes have developed sophisticated blood doping regimens, which often include rhEPO micro-dosing. Detection of these methods requires biomarkers with increased sensitivity and a sample matrix that is more amenable to frequent testing in the field. We have developed a method to measure two immature reticulocyte proteins, CD71 and ferrochelatase (FECH), and one total erythrocyte protein, Band 3, in dried blood spots (DBS). This method was tested in response to rhEPO administration after low doses, 40 IU/kg, micro-doses, 900 IU, or saline injection in 20 healthy subjects. During administration of low-dose rhEPO, the mean CD71/Band 3 and FECH/Band 3 ratio increased by 412 ± 197% and 250 ± 44%, respectively. The mean response for the current biomarker, RET%, increased by 195 ± 35%. During administration of rhEPO micro-doses, CD71/Band 3 increased to 127 ± 25% on day 35 and 139 ± 36% on day 39, while no increase was observed in RET%. After rhEPO administration, during the washout phase, mean values decreased to a minimum of 64 ± 4% and 64 ± 11% for CD71/Band 3 and RET%, respectively. However, CD71/Band 3 remained below 75% of baseline for at least 4 weeks after rhEPO injection, while RET% returned to baseline levels. The results demonstrate that immature reticulocyte proteins have a larger response to rhEPO administration than the current biomarker, RET%, and can be monitored in the DBS matrix.
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Affiliation(s)
- Holly D. Cox
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
| | | | | | - Jacob D. Husk
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
| | - Andre K. Crouch
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
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Krumm B, Faiss R. Factors Confounding the Athlete Biological Passport: A Systematic Narrative Review. SPORTS MEDICINE - OPEN 2021; 7:65. [PMID: 34524567 PMCID: PMC8443715 DOI: 10.1186/s40798-021-00356-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/28/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Through longitudinal, individual and adaptive monitoring of blood biomarkers, the haematological module of the athlete biological passport (ABP) has become a valuable tool in anti-doping efforts. The composition of blood as a vector of oxygen in the human body varies in athletes with the influence of multiple intrinsic (genetic) or extrinsic (training or environmental conditions) factors. In this context, it is fundamental to establish a comprehensive understanding of the various causes that may affect blood variables and thereby alter a fair interpretation of ABP profiles. METHODS This literature review described the potential factors confounding the ABP to outline influencing factors altering haematological profiles acutely or chronically. RESULTS Our investigation confirmed that natural variations in ABP variables appear relatively small, likely-at least in part-because of strong human homeostasis. Furthermore, the significant effects on haematological variations of environmental conditions (e.g. exposure to heat or hypoxia) remain debatable. The current ABP paradigm seems rather robust in view of the existing literature that aims to delineate adaptive individual limits. Nevertheless, its objective sensitivity may be further improved. CONCLUSIONS This narrative review contributes to disentangling the numerous confounding factors of the ABP to gather the available scientific evidence and help interpret individual athlete profiles.
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Affiliation(s)
- Bastien Krumm
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Raphael Faiss
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.
- Center of Research and Expertise in Anti-Doping Sciences - REDs, University of Lausanne, Lausanne, Switzerland.
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12
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Chang WCW, Wang CY, Liu WY, Tsai CC, Wu YT, Hsu MC. Chinese Herbal Medicine Significantly Impacts the Haematological Variables of the Athlete Biological Passport. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9533. [PMID: 34574458 PMCID: PMC8469363 DOI: 10.3390/ijerph18189533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022]
Abstract
In the fight against sports doping, the Athlete Biological Passport (ABP) system aims to indirectly unveil the doping incidents by monitoring selected biomarkers; however, several unexplored extrinsic factors may dampen a fair interpretation of ABP profiles. Chinese herbal medicine (CHM) plays a pivotal role in the health care system, and some remedies have a long history of being used to treat anaemia. In this study, we addressed the concerns of whether the CHM administration could yield a measurable effect on altering the ABP haematological variables. Forty-eight healthy volunteers were randomly assigned to receive two-week oral administration of one of the six selected CHM products that are commonly prescribed in Taiwan (eight subjects per group). Their blood variables were determined longitudinally in the phases of baseline, intervention, and recovery over 5 weeks. Blood collection and analyses were carried out in strict compliance with relevant operating guidelines. In the groups receiving Angelicae Sinensis Radix, Astragali Radix, and Salviae Miltiorrhizae Radix et Rhizoma, a significant increased reticulocyte percentage and decreased OFF-hr Score were manifested during the intervention, and such effects even sustained for a period of time after withdrawal. All other variables, including haemoglobin and Abnormal Blood Profile Score, did not generate statistical significance. Our results show that the use of CHM may impact the ABP haematological variables. As a consequence, we recommend athletes, particularly those who have been registered in the testing pool, should be aware of taking specific Chinese herbal-based treatment or supplementation, and document any of its usage on the anti-doping forms.
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Affiliation(s)
- William Chih-Wei Chang
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (W.C.-W.C.); (C.-Y.W.); (W.-Y.L.)
- Master Degree Program in Toxicology, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chih-Yuan Wang
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (W.C.-W.C.); (C.-Y.W.); (W.-Y.L.)
| | - Wan-Yi Liu
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (W.C.-W.C.); (C.-Y.W.); (W.-Y.L.)
| | - Chin-Chuan Tsai
- School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung 840, Taiwan;
- Chinese Medicine Department, E-Da Hospital, Kaohsiung 824, Taiwan
| | - Yu-Tse Wu
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (W.C.-W.C.); (C.-Y.W.); (W.-Y.L.)
- Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Mei-Chich Hsu
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
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13
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Astolfi T, Crettaz VON Roten F, Kayser B, Saugy M, Faiss R. Hematological variables in recreational breath-hold divers: a longitudinal study. J Sports Med Phys Fitness 2021; 62:1103-1109. [PMID: 34498826 DOI: 10.23736/s0022-4707.21.12918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The influence of regular breath-hold training on hematological variables is not fully understood. We monitored hematological variables in breath-hold divers' (BHDs) and active controls over a year expecting both breath-hold training and seasonal effects. METHODS In 11 recreational BHDs (36 ± 9 yrs, 177 ± 8 cm, 72 ± 9 kg) and 12 active controls (22 ± 2 yrs, 174 ± 8 cm, 70 ± 13 kg) monthly blood samples were analyzed with the hematological module of WADA's athlete biological passport. Hemoglobin mass and plasma volume were measured indirectly by the CO-rebreathing method for the last eight months of the study. Breath-hold training sessions were recorded online. Days without breath-hold training, or the number of hours prior to blood sampling when training was realized within the last 24 h, were recorded. RESULTS Hematology did not differ significantly between BHDs and controls over the study time (P > 0.05). However, hematological values varied significantly over time for both groups suggesting seasonal effects. Blood sampling 19h or more after a breath hold training did not indicate any acute effects of breath holding training. CONCLUSIONS In comparison with a physically active lifestyle, regular breath-hold training does not induce significant variations over one year for the hematological module of the ABP.
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Affiliation(s)
- Tiffany Astolfi
- REDs, Research and Expertise in antiDoping sciences, University of Lausanne, Lausanne, Switzerland.,ISSUL, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | | | - Bengt Kayser
- ISSUL, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Martial Saugy
- REDs, Research and Expertise in antiDoping sciences, University of Lausanne, Lausanne, Switzerland.,ISSUL, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Raphael Faiss
- REDs, Research and Expertise in antiDoping sciences, University of Lausanne, Lausanne, Switzerland - .,ISSUL, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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14
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Castanier C, Bougault V, Teulier C, Jaffré C, Schiano-Lomoriello S, Vibarel-Rebot N, Villemain A, Rieth N, Le-Scanff C, Buisson C, Collomp K. The Specificities of Elite Female Athletes: A Multidisciplinary Approach. Life (Basel) 2021; 11:622. [PMID: 34206866 PMCID: PMC8303304 DOI: 10.3390/life11070622] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/19/2022] Open
Abstract
Female athletes have garnered considerable attention in the last few years as more and more women participate in sports events. However, despite the well-known repercussions of female sex hormones, few studies have investigated the specificities of elite female athletes. In this review, we present the current but still limited data on how normal menstrual phases, altered menstrual phases, and hormonal contraception affect both physical and cognitive performances in these elite athletes. To examine the implicated mechanisms, as well as the potential performances and health risks in this population, we then take a broader multidisciplinary approach and report on the causal/reciprocal relationships between hormonal status and mental and physical health in young (18-40 years) healthy females, both trained and untrained. We thus cover the research on both physiological and psychological variables, as well as on the Athlete Biological Passport used for anti-doping purposes. We consider the fairly frequent discrepancies and summarize the current knowledge in this new field of interest. Last, we conclude with some practical guidelines for eliciting improvements in physical and cognitive performance while minimizing the health risks for female athletes.
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Affiliation(s)
- Carole Castanier
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | | | - Caroline Teulier
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | | | - Sandrine Schiano-Lomoriello
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Nancy Vibarel-Rebot
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Aude Villemain
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Nathalie Rieth
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Christine Le-Scanff
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Corinne Buisson
- Département des Analyses, AFLD, 92290 Chatenay-Malabry, France;
| | - Katia Collomp
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
- Département des Analyses, AFLD, 92290 Chatenay-Malabry, France;
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15
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Bergström H, Ekström L, Warnqvist A, Bergman P, Björkhem-Bergman L. Variations in biomarkers of dyslipidemia and dysbiosis during the menstrual cycle: a pilot study in healthy volunteers. BMC WOMENS HEALTH 2021; 21:166. [PMID: 33879161 PMCID: PMC8058971 DOI: 10.1186/s12905-021-01306-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/14/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dyslipidemia in metabolic syndrome may introduce an underestimation of the risk for cardiovascular disease (CVD) using Low-Density Lipoprotein-Cholesterol (LDL-C) as a surrogate marker. Recently, non-High-Density Lipoprotein-Cholesterol (non-HDL-C), Apolipoprotein B (ApoB) and remnant-Cholesterol (remnant-C) have been suggested as better biomarkers for dyslipidemia. In addition, the microbial metabolites trimethylamine-N-oxide (TMAO), betaine and choline have been associated with CVD and suggested as markers for dysbiosis. There is a lack of knowledge on potential alterations in these biomarkers during the menstrual cycle. The aim of this single center, prospective non-interventional study, was to investigate variations in biomarkers of dyslipidemia and dysbiosis in healthy volunteers during the menstrual cycle. METHOD Serum samples were collected from 17 healthy, regularly menstruating women during two menstrual cycles, including the follicular, ovulatory and luteal phases. Levels of lipoproteins, lipoprotein ratios and microbial metabolites were analyzed in a total of 90 samples (30 complete menstrual cycles). RESULTS ApoB, ApoB/HDL and non-HDL-C/HDL ratios were significantly higher in the follicular phase compared to the ovulatory and luteal phases (p < 0.05). Remnant-C were higher during the luteal phase (p < 0.05). TMAO did not vary during the different phases and did not correlate with estrogen levels. CONCLUSION Our data support that biomarkers for dyslipidemia vary during the menstrual cycle. Thus, to avoid an underestimation of cardiovascular risk, sampling during the follicular phase, when levels of pro-atherogenic lipids are higher, may be considered.
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Affiliation(s)
- Helena Bergström
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Blickagången 16, Neo floor 7, 141 83, Huddinge, Sweden.
| | - Lena Ekström
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, and Karolinska University Laboratory, Karolinska University Hospital, 141 83, Huddinge, Sweden
| | - Anna Warnqvist
- Division of Biostatistics, Department of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 77, Stockholm, Sweden
| | - Peter Bergman
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, ANA Futura, Alfred Nobels Allé 8, 141 52, Huddinge, Sweden.,Department of Infectious Diseases, Immunodeficiency Unit, Karolinska University Hospital, 141 83, Huddinge, Sweden
| | - Linda Björkhem-Bergman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Blickagången 16, Neo floor 7, 141 83, Huddinge, Sweden.,Stockholms Sjukhem, Palliative Medicine, Mariebergsgatan 22, 112 19, Stockholm, Sweden
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16
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Astolfi T, Crettaz von Roten F, Kayser B, Saugy M, Faiss R. The Influence of Training Load on Hematological Athlete Biological Passport Variables in Elite Cyclists. Front Sports Act Living 2021; 3:618285. [PMID: 33817634 PMCID: PMC8012815 DOI: 10.3389/fspor.2021.618285] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
The hematological module of the Athlete Biological Passport (ABP) is used in elite sport for antidoping purposes. Its aim is to better target athletes for testing and to indirectly detect blood doping. The ABP allows to monitor hematological variations in athletes using selected primary blood biomarkers [hemoglobin concentration (Hb) and reticulocyte percentage (Ret%)] with an adaptive Bayesian model to set individual upper and lower limits. If values fall outside the individual limits, an athlete may be further targeted and ultimately sanctioned. Since (Hb) varies with plasma volume (PV) fluctuations, possibly caused by training load changes, we investigated the putative influence of acute and chronic training load changes on the ABP variables. Monthly blood samples were collected over one year in 10 male elite cyclists (25.6 ± 3.4 years, 181 ± 4 cm, 71.3 ± 4.9 kg, 6.7 ± 0.8 W.kg-1 5-min maximal power output) to calculate individual ABP profiles and monitor hematological variables. Total hemoglobin mass (Hbmass) and PV were additionally measured by carbon monoxide rebreathing. Acute and chronic training loads-respectively 5 and 42 days before sampling-were calculated considering duration and intensity (training stress score, TSSTM). (Hb) averaged 14.2 ± 0.0 (mean ± SD) g.dL-1 (range: 13.3-15.5 g·dl-1) over the study with significant changes over time (P = 0.004). Hbmass was 1030 ± 87 g (range: 842-1116 g) with no significant variations over time (P = 0.118), whereas PV was 4309 ± 350 mL (range: 3,688-4,751 mL) with a time-effect observed over the study time (P = 0.014). Higher acute-but not chronic-training loads were associated with significantly decreased (Hb) (P <0.001). Although individual hematological variations were observed, all ABP variables remained within the individually calculated limits. Our results support that acute training load variations significantly affect (Hb), likely due to short-term PV fluctuations, underlining the importance of considering training load when interpreting individual ABP variations for anti-doping purposes.
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Affiliation(s)
- Tiffany Astolfi
- REDs, Research and Expertise in Anti-Doping Sciences, University of Lausanne, Lausanne, Switzerland.,ISSUL, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | | | - Bengt Kayser
- ISSUL, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Martial Saugy
- REDs, Research and Expertise in Anti-Doping Sciences, University of Lausanne, Lausanne, Switzerland.,ISSUL, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Raphael Faiss
- REDs, Research and Expertise in Anti-Doping Sciences, University of Lausanne, Lausanne, Switzerland.,ISSUL, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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17
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Salamin O, Nicoli R, Langer T, Boccard J, Grundisch CS, Xu C, Rudaz S, Kuuranne T, Pitteloud N, Saugy M. Longitudinal evaluation of multiple biomarkers for the detection of testosterone gel administration in women with normal menstrual cycle. Drug Test Anal 2021; 14:833-850. [PMID: 33817997 DOI: 10.1002/dta.3040] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 01/08/2023]
Abstract
In women, hormonal fluctuations related to the menstrual cycle may impose a great source of variability for some biomarkers of testosterone (T) administration, which can ultimately disrupt the sensitivity of their longitudinal monitoring. In this study, the sensitivity of the current urinary and haematological markers of the Athlete Biological Passport (ABP), as well as serum steroid biomarkers, was investigated for the monitoring of a 28-day T gel treatment combined with endogenous fluctuation of the menstrual cycle in 14 healthy female subjects. Additionally, the analysis of urinary target compounds was performed on a subset of samples for endogenous/exogenous origin via isotope ratio mass spectrometry (IRMS). In serum, concentrations of T and dihydrotestosterone (DHT) increased significantly during the treatment, whereas in urine matrix the most affected biomarkers were found to be the ratios of testosterone/epitestosterone (T/E) and 5α-androstane-3α,17β-diol/epitestosterone (5αAdiol/E). The detection capability of both urinary biomarkers was heavily influenced by [E], which fluctuated depending on the menstrual cycle, and resulted in low sensitivity of the urinary steroidal ABP module. On the contrary, an alternative approach by the longitudinal monitoring of serum T and DHT concentrations with the newly proposed T/androstenedione ratio showed higher sensitivity. The confirmatory IRMS results demonstrated that less than one third of the tested urine samples fulfilled the criteria for positivity. Results from this study demonstrated that the 'blood steroid profile' represents a powerful complementary approach to the 'urinary module' and underlines the importance of gathering bundle of evidence to support the scenario of an endogenous prohibited substance administration.
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Affiliation(s)
- Olivier Salamin
- Center of Research and Expertise in Anti-Doping Sciences-REDs, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.,Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Raul Nicoli
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tobias Langer
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julien Boccard
- School of Pharmaceutical Sciences, University of Geneva, University Medical Centre, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), University of Geneva, Geneva, Switzerland.,Division of Biomedical and Metabolomic Analyses, Swiss Centre for Applied Human Toxicology (SCAHT), Basel, Switzerland
| | - Carine Schweizer Grundisch
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Cheng Xu
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Serge Rudaz
- School of Pharmaceutical Sciences, University of Geneva, University Medical Centre, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), University of Geneva, Geneva, Switzerland.,Division of Biomedical and Metabolomic Analyses, Swiss Centre for Applied Human Toxicology (SCAHT), Basel, Switzerland
| | - Tiia Kuuranne
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nelly Pitteloud
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Martial Saugy
- Center of Research and Expertise in Anti-Doping Sciences-REDs, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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18
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Badenhorst CE, Goto K, O'Brien WJ, Sims S. Iron status in athletic females, a shift in perspective on an old paradigm. J Sports Sci 2021; 39:1565-1575. [PMID: 33583330 DOI: 10.1080/02640414.2021.1885782] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Iron deficiency is a common nutrient deficiency within athletes, with sport scientists and medical professionals recognizing that athletes require regular monitoring of their iron status during intense training periods. Revised considerations for athlete iron screening and monitoring have suggested that males get screened biannually during heavy training periods and females require screening biannually or quarterly, depending on their previous history of iron deficiency. The prevalence of iron deficiency in female athletes is higher than their male counterparts and is often cited as being a result of the presence of a menstrual cycle in the premenopausal years. This review has sought to revise our current understanding of female physiology and the interaction between primary reproductive hormones (oestrogen and progesterone) and iron homoeostasis in females. The review highlights an apparent symbiotic relationship between iron metabolism and the menstrual cycle that requires additional research as well as identifying areas of the menstrual cycle that may be primed for nutritional iron supplementation.
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Affiliation(s)
- Claire E Badenhorst
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Kazushige Goto
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Wendy J O'Brien
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Stacy Sims
- Te Huataki Waiora - School of Health, the University of Waikato, Hamilton, New Zealand
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19
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Thevis M, Kuuranne T, Geyer H. Annual banned-substance review: Analytical approaches in human sports drug testing 2019/2020. Drug Test Anal 2020; 13:8-35. [PMID: 33185038 DOI: 10.1002/dta.2969] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/08/2020] [Indexed: 12/18/2022]
Abstract
Analytical chemistry-based research in sports drug testing has been a dynamic endeavor for several decades, with technology-driven innovations continuously contributing to significant improvements in various regards including analytical sensitivity, comprehensiveness of target analytes, differentiation of natural/endogenous substances from structurally identical but synthetically derived compounds, assessment of alternative matrices for doping control purposes, and so forth. The resulting breadth of tools being investigated and developed by anti-doping researchers has allowed to substantially improve anti-doping programs and data interpretation in general. Additionally, these outcomes have been an extremely valuable pledge for routine doping controls during the unprecedented global health crisis that severely affected established sports drug testing strategies. In this edition of the annual banned-substance review, literature on recent developments in anti-doping published between October 2019 and September 2020 is summarized and discussed, particularly focusing on human doping controls and potential applications of new testing strategies to substances and methods of doping specified the World Anti-Doping Agency's 2020 Prohibited List.
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Affiliation(s)
- Mario Thevis
- Center for Preventive Doping Research - Institute of Biochemistry, German Sport University Cologne, Cologne, Germany.,European Monitoring Center for Emerging Doping Agents, Cologne, Germany
| | - Tiia Kuuranne
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Genève and Lausanne, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Epalinges, Switzerland
| | - Hans Geyer
- Center for Preventive Doping Research - Institute of Biochemistry, German Sport University Cologne, Cologne, Germany.,European Monitoring Center for Emerging Doping Agents, Cologne, Germany
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20
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Schulze J, Suominen T, Bergström H, Ericsson M, Björkhem Bergman L, Ekström L. Urinary steroid profile in relation to the menstrual cycle. Drug Test Anal 2020; 13:550-557. [PMID: 33142032 PMCID: PMC7984021 DOI: 10.1002/dta.2960] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/19/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022]
Abstract
The interpretation of the steroidal module of the Athlete Biological Passport (ABP) in female athletes is complex due to the large variation of the endogenous urinary steroids. The menstrual cycle seems to be one of the largest confounders of the steroid profile. The duration of the different phases in the menstrual cycle differs between women and is difficult to predict only by counting days after menstruation. Here, we have determined the follicle, ovulation, and luteal phases, by assessing the menstrual hormones in serum samples collected from 17 healthy women with regular menses. Urine samples were collected three times per week during two consecutive cycles to measure the urinary steroid concentrations used in the ABP. The metabolite that was mostly affected by the menstrual phases was epitestosterone (E), where the median concentration was 133% higher in the ovulation phase compared to the follicle phase (p < 0.0001). The women with a large coefficient of variation (CV) in their first cycle also had a large CV in their second cycle and vice versa. The inter-individual difference was extensive with a range of 11%-230% difference between the lowest and the highest T/E ratio during a cycle. In conclusion, E and ratios with E as denominator are problematic biomarkers for doping in female athletes. The timing of the sample collection in the menstrual cycle will have a large influence on the steroid profile. The results of this study highlight the need to find additional biomarkers for T doping in females.
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Affiliation(s)
- Jenny Schulze
- Karolinska Institute, Department of Laboratory Medicine, Division of Clinical Pharmacology C1:68Karolinska University HospitalStockholmSweden
| | - Tina Suominen
- Helsinki Doping Control Laboratory, Forensic Toxicology UnitFinnish Institute for Health and Welfare (THL)HelsinkiFinland
| | - Helena Bergström
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical GeriatricsKarolinska InstituteStockholmSweden
| | - Magnus Ericsson
- Karolinska Institute, Department of Laboratory Medicine, Division of Clinical Pharmacology C1:68Karolinska University HospitalStockholmSweden
- French Doping Control Laboratory, Agence Française de lutte contre le dopage (AFLD) Département des AnalysesFrance
| | - Linda Björkhem Bergman
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical GeriatricsKarolinska InstituteStockholmSweden
| | - Lena Ekström
- Karolinska Institute, Department of Laboratory Medicine, Division of Clinical Pharmacology C1:68Karolinska University HospitalStockholmSweden
- Department of Clinical Pharmacology C1:68Karolinska University Laboratory, Karolinska HospitalStockholmSweden
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21
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Ericsson M, Bhuiyan H, Yousif B, Lehtihet M, Ekström L. The intra-individual stability of GH biomarkers IGF-I and P-III-NP in relation to GHRH administration, menstrual cycle, and hematological parameters. Drug Test Anal 2020; 12:1620-1628. [PMID: 33125822 DOI: 10.1002/dta.2953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/29/2022]
Abstract
The intra-individual stability of growth hormone (GH) biomarkers IGF-I, P-III-NP, calculated GH-2000 score in relation to growth hormone-releasing hormone (GHRH) (Somatorelin) administration, menstrual cycle, and hematological parameters were investigated in four men and eight women, respectively. Moreover, the hematological parameters hemoglobin (Hb) and percentage of reticulocyte (RET%) were statistically analyzed in relation to the GH biomarker parameters for the GHRH administration study and the menstrual cycle study. Longitudinal monitoring of IGF-I and/or GH-2000 score proved to be a viable approach to detect the GHRH intake in men, as all four participants show values above individually calculated thresholds (calculated as mean ± 3SD from three baseline samples). The intra-individual variation for IGF-I, P-III-NP, and calculated GH-2000 score in women, over two consecutive menstrual cycles, was investigated and established to be higher (coefficients variations [CVs] between 12% and 186%) than in men (CVs between 3% and 12%). The GHRH administration did not influence the hematological parameters. A strong positive correlation between Hb and IGF-I (Rs = 0.73, p < 0.0001) and a borderline weak correlation between RET% and IGF-I (Rs = 0.28, p = 0.054) were noticed in the women. No correlation for the P-III-NP and the hematological parameters was seen for the females in the menstrual cycle study. The results fortify previous studies that longitudinal monitoring of IGF-I and/or GH-2000 score may be a promising method to detect doping with GH and GH stimulating agents in men, whereas the large intra-individual variation noted in women indicates that longitudinal monitoring of these biomarker may be harder to evaluate in women.
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Affiliation(s)
- Magnus Ericsson
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.,Département des analyses, AFLD, Châtenay-Malabry, France
| | - Hasanuzzaman Bhuiyan
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Basam Yousif
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Lehtihet
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Lena Ekström
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
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