Prevalence of legal and illegal stimulating agents in sports

Selenium alleviates modafinil-induced neurobehavioral toxicity in rat via PI3K/Akt/mTOR/GSK3B signaling pathway and suppression of oxidative stress and apoptosis: in vivo and in silico study

Nonmedical use of modafinil (MOD) led to increased rates of overdose toxicity, road accidents, addiction, withdrawal, suicide, and mental illnesses. The current study aims to determine the probable MOD brain toxicity and elucidate the possible role of selenium (Se) in ameliorating the neurotoxicity in rat models. Fifty-four male Albino rats were randomly assigned into nine groups. The groups were G1 (control negative), G2 (Se0.1), G3 (Se0.2), G4 (MOD300), G5 (MOD600), G6 (Se0.1 + MOD300), G7 (Se0.2 + MOD300), G8 (Se0.1 + MOD600), and G9 (Se0.2 + MOD600). After finishing the experiment, blood and brain tissue were harvested for biochemical and histological investigation. Neurobehavior parameters were assessed. Tissue neurotransmitter levels and oxidative stress markers were assessed. Gene expression of PI3K/Akt/mTOR-GSK3B, orexin, and orexin receptor2 was measured by qRT-PCR. Histological and immunohistochemistry assessments, as well as molecular docking, were carried out. MOD-induced neurobehavioral toxicity exhibited by behavioral and cognitive function impairments, which are associated with decreased antioxidant activities, increased MDA levels, and decreases in neurotransmitter levels. Brain levels of mRNA expression of PI3K, Akt, and mTOR were decreased, while GS3K, orexin, and orexin receptors were significantly elevated. These disturbances were confirmed by histopathological brain changes with increased silver and Bax immunostaining and decreased crystal violet levels. MOD induced neurotoxic effects in a dose-dependent manner. Compared with the MOD groups, SE coadministration significantly attenuates MOD-induced toxic changes. Docking study shows the protective role of Se as an apoptosis inhibitor and inflammation inhibitor. In conclusion, Se could be used as a biologically effective antioxidant compound to protect from MOD neurobehavioral toxicity in Wistar rats by reversing behavioral alterations, inflammation, apoptosis, and oxidative injury.

Challenges in Reporting Adverse Events from Dietary Supplements

In 2008, the Institute of Medicine (IOM) Committee on Dietary Supplement Use by Military Personnel recommended the development of service wide military policies (e.g., education or regulations) to guide commanders in management practices for safe use of dietary supplements (DS). This review summarizes the activities the military has undertaken to advance the safe use of DS by Service Members and develop best practices on reporting adverse events across the Department of Defense (DoD). In March 2022, the Department of Defense issued a DoD Instruction (DoDI) regarding the use of DS by members of the U S. military. This DoDI provides guidelines to establish an official list of prohibited substances. The DoDI also identifies Operation Supplement Safety (OPSS) at CHAMP as DoD's "go to" program for DS use and information about DS and ingredients. Noted are a number of gaps in the reporting of adverse events from DS that need to be addressed by multiple constituencies.

Spectroscopic and molecular modeling methods to investigate the interaction between psycho-stimulant modafinil and calf thymus DNA using ethidium bromide as a fluorescence probe

Interaction type of modafinil with calf thymus DNA (ct-DNA) was examined systematically using ethidium bromide (EB) as a fluorescence probe by fluorescence spectroscopy, UV-Vis spectroscopy, viscosity and molecular docking method. The fluorescence quenching mechanism of ct-DNA-EB by modafinil can be combination of static and dynamic quenching. Results of UV-Vis absorption, competitive binding with Hoechst 33258, ionic strength effect studies, viscosity measurements were confirmed that the interaction type of modafinil with ct-DNA was intercalation. According to docking studies R-modafinil showed better interaction with ct-DNA which is consistent with known pharmacological properties of modafinil. The calculated thermodynamic parameters, enthalpy and entropy change, suggested that the driven forces are hydrogen bonding or van der Walls forces. Results of the docking studies were compatible with the experimental results and confirmed the hydrogen bond formation between modafinil and ct-DNA.

Over a century since ephedrine discovery: an updated revisit to its pharmacological aspects, functionality and toxicity in comparison to its herbal extracts

Ephedrine, a sympathomimetic amine that exhibits several adrenaline actions, is a plant alkaloid that is a common ingredient in several cold, asthma and narcolepsy treatment preparations, and in obesity management and sport medicine. Its principal action mechanism relies on its direct adrenergic actions as well as indirect role that involves the release of epinephrine and norepinephrine, thus increasing the activity of epinephrine and norepinephrine at the postsynaptic α and β receptors. Nevertheless, its serious side effects, including stroke, heart attack, drug abuse and interactions, have never been comprehensively reviewed. We conducted a systematic review of data on ephedrine, including its occurrence in functional foods, pharmacological aspects, metabolism, pharmaco/toxicokinetics and clinical features. Furthermore, a review of ephedrine natural structural analogues with regards to their differential adrenergic receptor binding affinities, food interaction, and their impact on the pharmacokinetics and effects relative to ephedrine are presented for the first time, and in comparison to its action when present in herbs.

Online Turbulent Flow Extraction and Column Switching for the Confirmatory Analysis of Stimulants in Urine by Liquid Chromatography-Mass Spectrometry

Stimulants are often used to treat attention deficit disorders and nasal congestion. As they can be misused and overdosed, the detection of stimulants is relevant in the toxicological field as well as in the doping control field. The effects of stimulants can indeed be beneficial for athletes. Therefore, their in-competition use is prohibited by the World Anti-Doping Agency (WADA). As stimulants represent one of the most detected categories of prohibited substances, automation of methods to detect and confirm their presence is desirable. Previous work has shown the advantages of using turbulent flow online solid-phase extraction liquid chromatography-tandem mass spectrometry (online SPE LC-MS-MS) for the detection and confirmation of diuretics and masking agents. Hence, a turbulent flow online SPE LC-MS-MS method, compliant with the WADA's identification criteria, was developed and validated for the detection and confirmation of 80 stimulants or metabolites with limits of identification varying between 10 (or possibly lower) and 100 ng/mL. As several metabolites are common metabolites for multiple administered stimulants, this means that with this method, misuse of well over 100 compounds can be detected. As the developed method uses the same columns and mobile phases as our turbulent flow online SPE LC-MS-MS method for the confirmation of diuretics and masking agents, there is no need to change the configuration of the instrument when switching between the diuretics method and the developed stimulants method.

Dietary Supplement and Food Contaminations and Their Implications for Doping Controls

A narrative review with an overall aim of indicating the current state of knowledge and the relevance concerning food and supplement contamination and/or adulteration with doping agents and the respective implications for sports drug testing is presented. The identification of a doping agent (or its metabolite) in sports drug testing samples constitutes a violation of the anti-doping rules defined by the World Anti-Doping Agency. Reasons for such Adverse Analytical Findings (AAFs) include the intentional misuse of performance-enhancing/banned drugs; however, also the scenario of inadvertent administrations of doping agents was proven in the past, caused by, amongst others, the ingestion of contaminated dietary supplements, drugs, or food. Even though controversial positions concerning the effectiveness of dietary supplements in healthy subjects exist, they are frequently used by athletes, anticipating positive effects on health, recovery, and performance. However, most supplement users are unaware of the fact that the administration of such products can be associated with unforeseeable health risks and AAFs in sports. In particular anabolic androgenic steroids (AAS) and stimulants have been frequently found as undeclared ingredients of dietary supplements, either as a result of cross-contaminations due to substandard manufacturing practices and missing quality controls or an intentional admixture to increase the effectiveness of the preparations. Cross-contaminations were also found to affect therapeutic drug preparations. While the sensitivity of assays employed to test pharmaceuticals for impurities is in accordance with good manufacturing practice guidelines allowing to exclude any physiological effects, minute trace amounts of contaminating compounds can still result in positive doping tests. In addition, food was found to be a potential source of unintentional doping, the most prominent example being meat tainted with the anabolic agent clenbuterol. The athletes’ compliance with anti-doping rules is frequently tested by routine doping controls. Different measures including offers of topical information and education of the athletes as well as the maintenance of databases summarizing low- or high-risk supplements are important cornerstones in preventing unintentional anti-doping rule violations. Further, the collection of additional analytical data has been shown to allow for supporting result management processes.

Pharmacokinetic and pharmacodynamic of the cognitive enhancer modafinil: Relevant clinical and forensic aspects

Modafinil is a nonamphetamine nootropic drug with an increasingly therapeutic interest due to its different sites of action and behavioral effects in comparison to cocaine or amphetamine. A review of modafinil (and of its prodrug adrafinil and its R-enantiomer armodafinil) chemical, pharmacokinetic, pharmacodynamic, toxicological, clinical and forensic aspects was performed, aiming to better understand possible health problems associated to its unconscious and unruled use. Modafinil is a racemate metabolized mainly in the liver into its inactive acid and sulfone metabolites, which undergo primarily renal excretion. Although not fully clarified, major effects seem to be associated to inhibition of dopamine reuptake and modulation of several other neurochemical pathways, namely noradrenergic, serotoninergic, orexinergic, histaminergic, glutamatergic and GABAergic. Due its wake-promoting effects, modafinil is used for the treatment of daily sleepiness associated to narcolepsy, obstructive sleep apnea and shift work sleep disorder. Its psychotropic and cognitive effects are also attractive in several other pathologies and conditions that affect sleep structure, induce fatigue and lethargy, and impair cognitive abilities. Additionally, in health subjects, including students, modafinil is being used off-label to overcome sleepiness, increase concentration and improve cognitive potential. The most common adverse effects associated to modafinil intake are headache, insomnia, anxiety, diarrhea, dry mouth and raise in blood pressure and heart rate. Infrequently, severe dermatologic effects in children, including maculopapular and morbilliform rash, erythema multiforme and Stevens-Johnson Syndrome have been reported. Intoxication and dependence associated to modafinil are uncommon. Further research on effects and health implications of modafinil and its analogs is steel needed to create evidence-based policies.

Sport-Specific Use of Doping Substances: Analysis of World Anti-Doping Agency Doping Control Tests between 2014 and 2017

Background: In recent years, there has been a solid effort across all sports organizations to reduce the prevalence and incidence of doping in sport. However, the efficacy of current strategies to fight against doping might be improved by using anti-doping polices tailored to the features of doping in each sport. Objectives: The aim of this investigation was to analyze the substances more commonly found in doping control tests in individual and team sports. Material and Methods: The publicly accessible Testing Figures Reports made available by the World Anti-Doping Agency, were analyzed from 2014 to 2017. Results: The most commonly detected groups of banned substances were anabolic agents and stimulants but the distribution of adverse findings per drug class was very different depending on the sports discipline. Weightlifting, athletics, rugby, hockey and volleyball presented abnormally high proportions of anabolic agents (p = 2.8 × 10^-11). Cycling, athletics and rugby presented atypically elevated proportions of peptide hormones and growth factors (p = 1.4 × 10^-1). Diuretics and masking agents were more commonly found in boxing, wrestling, taekwondo, judo, shooting, and gymnastics than in other sports (p = 4.0 × 10^-68). Cycling, rowing, aquatics, tennis, gymnastics and ice hockey presented abnormally high proportions of stimulants (p = 1.8 × 10^-5). Conclusions: These results indicate that the groups of banned substances more commonly detected in anti-doping control tests were different depending on the sports discipline. These data suggest the prohibited substances used as doping agents might be substantially different depending on the type of sport and thus, sports-specific anti-doping policies should be implemented to enhance the efficacy of anti-doping testing.

[Doping in elite and popular sport : What orthopedic and trauma surgeons should know]

The spectacular doping raid during the Nordic World Ski Championships in Seefeld in winter this year is not the first time that illegal performance enhancement by taking drugs is in the spotlight of public interest. Kicked off by the so-called Festina scandal of the 1998 Tour de France, the serial exposure of further doping offences continues up to the present day. Less well-known to the general public is the high prevalence of doping under hobby and amateur athletes. Physicians are confronted by this group of patients in the practice much more frequently than by elite athletes, who are mostly treated in closed medical networks. The aim of the article is to provide an overview of the medical aspects including the most frequent substance classes and the current legal foundations of the anti-doping movement. Furthermore, the official definition of doping and the structure of the anti-doping agencies are presented.

A Novel Liquid Chromatography Tandem Mass Spectrometry Technique using Multi-Period-Multi-Experiment of MRM-EPI-MRM3 with Library Matching for Simultaneous Determination of Amphetamine Type Stimulants Related Drugs in Whole Blood, Urine and Dried Blood Stain (DBS)—Application to Forensic Toxicology Cases in Malaysia

A novel mass spectrometry detection technique based on a multi-period and multi- experiment (MRM-EPI-MRM3) with library matching in a single run for fast and rapid screening and identification of amphetamine type stimulants (ATS) related drugs in whole blood, urine and dried blood stain was developed and validated. The ATS-related drugs analyzed in this study include ephedrine, pseudoephedrine, amphetamine, methamphetamine, MDMA (3,4-Methylenedioxymethamphetamine), MDA (3,4-Methylenedioxyamphetamine), MDEA (3,4-Methylenedioxy-N-ethylamphetamine) and phentermine. The relative standard deviation for inter and intraday was less than 15% while recoveries ranged from 80% to 120% for all three matrices, i.e., whole blood, urine and dried blood stain. All compounds gave library matching percentage of more than 85% based on the purity. This method was proven to be simple and robust, and provide high confident results complemented with library matching confirmation.

Noble metal nanostructures in optical biosensors: Basics, and their introduction to anti-doping detection

Nanotechnology has illustrated significant potentials in biomolecular-sensing applications; particularly its introduction to anti-doping detection is of great importance. Illicit recreational drugs, substances that can be potentially abused, and drugs with dosage limitations according to the prohibited lists announced by the World Antidoping Agency (WADA) are becoming of increasing interest to forensic chemists. In this review, the theoretical principles of optical biosensors based on noble metal nanoparticles, and the transduction mechanism of commonly-applied plasmonic biosensors are covered. We review different classes of recently-developed plasmonic biosensors for analytic determination and quantification of illicit drugs in anti-doping applications. The important classes of illicit drugs include anabolic steroids, opioids, stimulants, and peptide hormones. The main emphasis is on the advantages that noble metal nano-particles bring to optical biosensors for signal enhancement and the development of highly sensitive (label-free) biosensors. In the near future, such optical biosensors may be an invaluable substitute for conventional anti-doping detection methods such as chromatography-based approaches, and may even be commercialized for routine anti-doping tests.

The Consumption of Energy Drinks Among a Sample of College Students and College Student Athletes

To assess energy drink (ED) consumption, potential ED correlates, and ED-related motivations among a sample of college students to determine differences based on athlete status (student athlete vs. non-athlete). Six hundred and ninety-two college students completed surveys at a large private university in the United States. Participants completed a paper based questionnaire assessing ED and ED-related variables. Over thirty-six percent (197 non-athletes, 58 student athletes) of participants reported ED consumption in the preceding 30 days. Multivariately, there was no difference in ED consumption based on athlete status. Heavy episodic drinking and prescription stimulant misuse were both correlated with increased ED consumption. ED motivations differed based on the frequency of ED consumption. ED use was common among student athletes and non-athletes in our sample. It is important to be aware of the correlation between heavy episodic drinking, prescription stimulant misuse, and ED consumption among college student populations because of the adverse consequences associated with these behaviors.

N,N-dimethyl-2-phenylpropan-1-amine quantification in urine: application to excretion study following single oral dietary supplement dose

N,N-dimethyl-2-phenylpropan-1-amine (NN-DMPPA) is a new designer stimulant prohibited in sport in-competition according to the List of Prohibited Substances and Methods published by the World Anti-Doping Agency (WADA). The first published data on the excretion study of NN-DMPPA to support the knowledge of NN-DMPPA in routine anti-doping control have been presented. The reliable gas chromatography-mass spectrometry quantitative method (GC-MS) has been validated and applied to the excretion study of NN-DMPPA. The validation parameters of the GC-MS method for determination of NN-DMPPA in human urine were the linear calibration range of 100 to 7500 ng/mL, the LOD of 13.9 ng/mL and the LOQ of 42.2 ng/mL. According to the obtained repeatability, intermediate precision, and trueness, the applied GC-MS method was precise and accurate. Urine samples from three volunteers in the excretion study were collected for 5 days after single oral administration of the supplement NOXPUMP containing NN-DMPPA. The obtained results showed the maximum concentration of NN-DMPPA (189-303 ng/mL) in urine samples at a time of 2-3 h post-administration. The NN-DMPPA concentration in urine samples was higher than 50 ng/mL until 22-23 h after the dietary supplement ingestion. This means that according to the WADA rules the use of a supplement containing NN-DMPPA may be related to a positive case when athletes took this supplement in-competition. Moreover, excretion results demonstrate also that NN-DMPPA may be detected in urine samples by the applied GC-MS method till 46 h after supplement administration. Additionally, the excretion study of β-methylphenethylamine as the second prohibited substance present in the supplement NOXPUMP has been investigated. Graphical Abstract Excretion study of new designer stimulant, N,N-dimethyl-2-phenylpropan-1-amine, and β-methylphenethylamine following single oral NOXPUMP supplement dose.

Introduction to In Vitro Diagnostic Devices

Healthcare investment keeps on increasing substantially in recent years. Such investment has also focused on fighting major diseases, enabled by the novel invention of cost-effective and valid drug development for treatment and side effect reduction, along with improved vector control. In addition, the demand for diagnostics that is essential in determining prognosis, identifying disease stages, monitoring treatment, and assessing the spreading as health services has expanded. Molecular-based diagnostics is critical for prevention, identification, and treatment of disease. Current laboratory analyses support correct diagnosis in over 70 % of all diseases and can be used to aid the continuous monitoring of drug therapy. However, classic diagnostic technologies are not completely well suited to meeting the expanded testing requirement because they rely on complicated sample purification and sophisticated instruments which are labor-intensive, timely, and expensive and require well-trained operators. One of the main challenges for industry is to develop fast, relatively accurate, easy-to-use, and inexpensive devices. In addition to the improved efficiency in laboratory diagnostics, there has been a trend toward a more decentralized diagnostics which occurs directly at patients’ bedside, in outpatient clinics, or at the sites of accidents, so-called point-of-care (POC) systems. The concept of POC testing is mainly for the patient, so short turnaround time, minimum sample preparation, reagent storage and transferring, user-friendly analytical instruments, and digital or visible quantitative or semiquantitative single readout are required. POC test is a great option of potential in vitro diagnostics (IVD) for resource-limited settings. It is clear that on-site or minimum sample preparation and on-chip storage limit the delays that caused by transport and preparation of clinical samples. Shorter turnaround time leads to rapid clinical decision-making and may save fatal consequences. No previous knowledge in sample analysis should be required, so elders can perform the tests at home with minimum training to improve health outcome. Lateral-flow immunoassay (LFIA) devices, for example, which were originally proposed in the 1980s, remain popular largely because of their design simplicity. The purpose of this article is to introduce readers with basic information regarding the LFIA approach that we think the most representative product of IVD test for solving global health issues.

Misuse of prescription stimulant medication in a sample of college students: examining differences between varsity athletes and non-athletes

BACKGROUND

The misuse of prescription stimulants (MPS) has been identified as an adverse health behavior among college students. Because stimulant medication is often taken to increase focus and decrease reaction time, these substances have the potential to enhance athletic performance. However, the role that athlete status (varsity athlete vs. non-athlete) has on MPS has rarely been examined in the college student population.

OBJECTIVES

To examine whether there are differences in past-year MPS and MPS-related motivations between college varsity athletes and non-athletes.

METHODS

A sample of 682 (482 non-athletes; 200 athletes) college students between the ages of 18 and 25 completed a paper-based questionnaire to assess MPS, MPS-related motivations, and other potential MPS correlates (e.g., gender, energy drink consumption, tobacco use, heavy episodic drinking). Then, we conducted bivariate and multivariate analyses to examine potential correlates of MPS, including athlete status. Finally, we examined differences in MPS-related motivations between varsity athletes and non-athletes.

RESULTS

Overall, 98 (13.9%; 16.6% non-athletes v. 7.5% varsity athletes) respondents reported past-year MPS and varsity athletes were significantly less likely (p<0.05) to do so. Past-year MPS was also significantly associated with energy drink consumption, tobacco use, and heavy episodic drinking in our sample. Concerning MPS-related motivations, athletes more often cited a need to enhance athletic performance as the impetus for their misuse.

CONCLUSIONS

MPS was prevalent among the sample. Varsity athletes were significantly less likely to engage in past-year MPS and were motivated to do so for different reasons.

Doping in sport and exercise: anabolic, ergogenic, health and clinical issues

The use of doping agents is evident within competitive sport in senior and junior age groups, where they are taken by non-elite as well as elite participants. They are also taken in non-sporting contexts by individuals seeking to ‘improve’ their physique through an increase in muscle and/or decrease in fat mass. While attaining accurate data on the prevalence of their use has limitations, studies suggest the illicit use of doping agents by athletes and non-athletes may be 1–5% in the population and greater than 50% in some groups; with the prevalence being higher in males. There is conclusive evidence that some doping agents are anabolic and ergogenic. There is also evidence that the use of doping agents such as anabolic androgenic steroids, growth hormone and other anabolic agents, erythropoietin and stimulants conveys considerable health risks that include, but are not limited to: cardiovascular disease, diabetes, cancer, mental health issues, virilisation in females and the suppression of naturally produced androgens in males. This review will outline the anabolic, ergogenic and health impacts of selected doping agents and methods that may be used in both the sporting and physique development contexts. It also provides a brief tabulated overview of the history of doping and how doping agents may impact upon the analyses of clinical samples.

Stimulant doping agents used in Brazil: prevalence, detectability, analytical implications, and challenges

This article presents the prevalence of stimulant doping among Brazilian athletes, the analytical approaches used, as well as a general evolution of the detectability of the stimulants being used. Results from the Brazilian accredited doping control laboratory are compared with the global statistics disclosed by the World Anti-Doping Agency. The high prevalence of stimulant doping in Brazil can be attributed to several reasons, including "self-administration," a "body-shaping" culture, and the use of nutritional supplements.

Detection of β-methylphenethylamine, a novel doping substance, by means of UPLC/MS/MS

Novel substances of expected doping activity are constantly introduced to the market. β-Methylphenethylamine (BMPEA) is classified as a doping agent by the World Anti-Doping Agency as it is a positional isomer of amphetamine. In this work, the development and application of a simple and rapid analytical procedure that enables discrimination between both isomers is described. The analytes of interest were extracted from urine by a two-step liquid–liquid extraction and then analyzed by UPLC/MS/MS under isocratic conditions. The entire analytical procedure was validated by evaluating its selectivity, discrimination capabilities, carry-over, sensitivity, and influence of matrix effects on its performance. Application of the method resulted in detection of BMPEA in eight anti-doping samples, including the first report of adverse analytical finding regarding its use. Further analysis showed that BMPEA may be eliminated unchanged along with its phase II conjugates, the hydrolysis of which may considerably improve detection capabilities of the method. Omission of the hydrolysis step may therefore, produce false-negative results. Testing laboratories should also carefully examine their LC/MS/MS-based amphetamine and BMPEA findings as both isomers fragment yielding comparable collision-induced dissociation spectra and their insufficient chromatographic separation may result in misidentification. This is of great importance in case of forensic analyses as BMPEA is not controlled by the public law, and its manufacturing, distribution, and use are legal.

Recent developments in MS for small molecules: application to human doping control analysis

Recent developments in MS for the detection of small molecules in the context of doping control analysis are reviewed. Doping control analysis is evolving together with MS, which is the technique of choice in order to accomplish the analytical requirements in this field. Since these analytical requirements for the detection of a doping agent depend on the substance, in the first section we review the different scenarios. The commonly established approaches, together with their achievements and drawbacks are described. New developments in hyphenated MS techniques (both GC–MS/MS and LC–MS/MS) concerning interfaces and analyzers are mentioned. The use (or potential use) of these developments in order to minimize the limitations of the commonly established approaches in the doping control field is discussed. Finally, a brief discussion about trends and remaining limitations is presented.