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Bressan C, Alechaga É, Monfort N, Ventura R. Evaluation of sulfate metabolites as markers of topical testosterone administration in Caucasian and Asian populations. Drug Test Anal 2023. [PMID: 38012839 DOI: 10.1002/dta.3615] [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: 06/14/2023] [Revised: 10/28/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
Sulfate metabolites of endogenous anabolic androgenic steroids (EAAS) have been shown to prolong the detection times compared with the conventional urinary markers of the steroid profile for oral and intramuscular administrations of testosterone (T). In this work, the sensitivity of sulfate EAAS markers for the detection of T gel administration has been evaluated in six Caucasian and six Asian male volunteers. Fourteen sulfate metabolites were measured in basal and post-administration samples after multiple doses of T gel (100 mg/day, three consecutive days), and the detection times based on individual thresholds for each volunteer were evaluated. Sulfate concentrations did not show adequate sensitivity, but the results of sulfate ratios were much more promising. Androsterone sulfate/testosterone sulfate (A-S/T-S), epiandrosterone sulfate/epitestosterone sulfate (epiA-S/E-S), epiA-S/T-S, and etiocholanolone sulfate/epitestosterone sulfate (Etio-S/E-S) provided the most consistent detectability for all volunteers and populations, with detection times ranging from 60 to 96 h since the first dose. Additional ratios improved detectability to up to 7 days, but only in particular volunteers. In general, sensitivity was similar to or better than the conventional testosterone/epitestosterone ratio (T/E) of the steroid profile, which further reinforces the conclusion that sulfate EAAS metabolites can be a good complement for the current steroid profile.
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Affiliation(s)
- Claudia Bressan
- Catalonian Antidoping Laboratory, Doping Control Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Élida Alechaga
- Catalonian Antidoping Laboratory, Doping Control Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Nuria Monfort
- Catalonian Antidoping Laboratory, Doping Control Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Rosa Ventura
- Catalonian Antidoping Laboratory, Doping Control Research Group, Hospital del Mar Research Institute, Barcelona, Spain
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2
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Equey T, Salamin O, Ponzetto F, Nicoli R, Kuuranne T, Saugy J, Saugy M, Aikin R, Baume N. Longitudinal Profiling of Endogenous Steroids in Blood Using the Athlete Biological Passport Approach. J Clin Endocrinol Metab 2023; 108:1937-1946. [PMID: 36794909 DOI: 10.1210/clinem/dgad085] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
CONTEXT Detection of endogenous anabolic androgenic steroids (EAAS), like testosterone (T), as doping agents has been improved with the launch of the Steroidal Module of the Athlete Biological Passport (ABP) in urine samples. OBJECTIVE To target doping practices with EAAS, particularly in individuals with low level of biomarkers excreted in urine, by including new target compounds measured in blood. DESIGN T and T/androstenedione (T/A4) distributions were obtained from 4 years of anti-doping data and applied as priors to analyze individual profiles from 2 T administration studies in female and male subjects. SETTING Anti-doping laboratory. Elite athletes (n = 823) and male and female clinical trials subjects (n = 19 and 14, respectively). INTERVENTION(S) Two open-label administration studies were carried out. One involved a control phase period followed by patch and then oral T administration in male volunteers and the other followed female volunteers during 3 menstrual cycles with 28 days of daily transdermal T application during the second month. MAIN OUTCOME MEASURE(S) Serum samples were analyzed for T and A4 and the performance of a longitudinal ABP-based approach was evaluated for T and T/A4. RESULTS An ABP-based approach set at a 99% specificity flagged all female subjects during the transdermal T application period and 44% of subjects 3 days after the treatment. T showed the best sensitivity (74%) in response to transdermal T application in males. CONCLUSIONS Inclusion of T and T/A4 as markers in the Steroidal Module can improve the performance of the ABP to identify T transdermal application, particularly in females.
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Affiliation(s)
- Tristan Equey
- World Anti-Doping Agency (WADA), Montreal, Quebec H4Z 1B7, Canada
| | - Olivier Salamin
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Genève and Lausanne, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1066 Epalinges, Switzerland
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, 1015 Lausanne, Switzerland
| | - Federico Ponzetto
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, 10126 Turin, Italy
| | - Raul Nicoli
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Genève and Lausanne, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1066 Epalinges, Switzerland
| | - Tiia Kuuranne
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Genève and Lausanne, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1066 Epalinges, Switzerland
| | - Jonas Saugy
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, 1015 Lausanne, Switzerland
| | - Martial Saugy
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, 1015 Lausanne, Switzerland
| | - Reid Aikin
- World Anti-Doping Agency (WADA), Montreal, Quebec H4Z 1B7, Canada
| | - Norbert Baume
- World Anti-Doping Agency (WADA), Montreal, Quebec H4Z 1B7, Canada
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3
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Moreillon B, Salamin O, Krumm B, Iannella L, Molaioni F, Kuuranne T, Nicoli R, Saugy JJ, Botrè F, Faiss R. Variability of the urinary and blood steroid profiles in healthy and physically active women with and without oral contraception. Drug Test Anal 2023; 15:324-333. [PMID: 36414566 DOI: 10.1002/dta.3412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
The steroidal module of the athlete biological passport (ABP) targets the use of pseudo-endogenous androgenous anabolic steroids in elite sport by monitoring urinary steroid profiles. Urine and blood samples were collected weekly during two consecutive oral contraceptive pill (OCP) cycles in 15 physically active women to investigate the low urinary steroid concentrations and putative confounding effect of OCP. In urine, testosterone (T) and epitestosterone (E) were below the limit of quantification of 1 ng/ml in 62% of the samples. Biomarkers' variability ranged between 31% and 41%, with a significantly lesser variability for ratios (except for T/E [41%]): 20% for androsterone/etiocholanolone (p < 0.001) and 25% for 5α-androstane-3α,17β-diol/5ß-androstane-3α,17β-diol (p < 0.001). In serum, markers' variability (testosterone: 24%, androstenedione: 23%, dihydrotestosterone: 19%, and T/A4: 16%) was significantly lower than in urine (p < 0.001). Urinary A/Etio increased by >18% after the first 2 weeks (p < 0.05) following withdrawal blood loss. In contrast, serum T (0.98 nmol/l during the first week) and T/A4 (0.34 the first week) decreased significantly by more than 25% and 17% (p < 0.05), respectively, in the following weeks. Our results outline steroidal variations during the OCP cycle, highlighting exogenous hormonal preparations as confounder for steroid concentrations in blood. Low steroid levels in urine samples have a clear negative impact on the subsequent interpretation of steroid profile of the ABP. With a greater analytical sensitivity and lesser variability for steroids in healthy active women, serum represents a complementary matrix to urine in the ABP steroidal module.
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Affiliation(s)
- Basile Moreillon
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Olivier Salamin
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bastien Krumm
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Loredana Iannella
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Francesco Molaioni
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Tiia Kuuranne
- 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
| | - Jonas J Saugy
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Francesco Botrè
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.,Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Raphael Faiss
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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Dhurjad P, Jaiswal P, Gupta K, Wanjari P, Sonti R. Mass spectrometry: A key tool in anti‐doping. SEPARATION SCIENCE PLUS 2022. [DOI: 10.1002/sscp.202200058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Pooja Dhurjad
- Department of Pharmaceutical Analysis National Institute of Pharmaceutical Education and Research (NIPER) Hyderabad India
| | - Pooja Jaiswal
- Department of Pharmaceutical Analysis National Institute of Pharmaceutical Education and Research (NIPER) Hyderabad India
| | - Kajal Gupta
- Department of Pharmaceutical Analysis National Institute of Pharmaceutical Education and Research (NIPER) Hyderabad India
| | - Parita Wanjari
- Department of Pharmaceutical Analysis National Institute of Pharmaceutical Education and Research (NIPER) Hyderabad India
| | - Rajesh Sonti
- Department of Pharmaceutical Analysis National Institute of Pharmaceutical Education and Research (NIPER) Hyderabad India
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5
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de la Torre X, Jardines D, Botrè F. Evaluation of longitudinal 13 C IRMS data in antidoping analysis. Drug Test Anal 2022; 14:1877-1890. [PMID: 35738893 DOI: 10.1002/dta.3339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/07/2022]
Abstract
The detection of testosterone and its precursors' abuse in Antidoping sports analysis, is based on the longitudinal evaluation of markers of the urinary endogenous steroid profile. A Bayesian statistical approach is applied, allowing the establishment of credible intervals of the selected parameters for every athlete. Samples showing values outside the acceptable boundaries are selected for additional confirmation by isotope ratio mass spectrometric (IRMS) analysis. The alterations of the IRMS values last longer than the alterations of the steroid profile. Then the application of IRMS to a larger number of samples, at a screening level, would presumably allow detection of additional positive cases. The steroid profile and IRMS data can be treated using the same Bayesian inference procedure. In non-sports population, we have demonstrated the stability of IRMS data. In this work, we studied the variability of these data in real conditions, in samples collected on athletes subjected to anti-doping analyses over the years. The data obtained confirmed previous observations and the applicability of the proposed approach. The results of cases where confounding factors of the steroid profile were reported are discussed, showing that in most of the cases no significant changes are observed over the absolute delta values. Changes in diet may significantly change the absolute delta values but not the ones relative to endogenous reference compounds. Finally, a case that could have been evaluated as normal with the current approach without a thorough review of the data, was detected as positive by the proposed approach, demonstrating the benefit of its application.
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Affiliation(s)
- Xavier de la Torre
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Daniel Jardines
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Francesco Botrè
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy.,Center of Research and Expertise in Anti-Doping Sciences - REDs; ISSUL - Institute of Sport Sciences, University of Lausanne, Synathlon - Quartier Centre, Lausanne, Switzerland
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6
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Jing J, Shan Y, Liu Z, Yan H, Xiang P, Chen P, Xu X. Automated online dried blood spot sample preparation and detection of anabolic steroid esters for sports drug testing. Drug Test Anal 2022; 14:1040-1052. [DOI: 10.1002/dta.3226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/27/2021] [Accepted: 01/13/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Jing Jing
- Shanghai Anti‐doping Laboratory Shanghai University of Sport Shanghai China
| | - Yuanhong Shan
- Shanghai Anti‐doping Laboratory Shanghai University of Sport Shanghai China
| | - Zhao Liu
- Chromatography Mass Spectrometry Department, Thermo Fisher Scientific Shanghai China
| | - Hui Yan
- Department of Forensic Toxicology Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine Shanghai China
| | - Ping Xiang
- Department of Forensic Toxicology Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine Shanghai China
| | - Peijie Chen
- Shanghai Anti‐doping Laboratory Shanghai University of Sport Shanghai China
| | - Xin Xu
- Shanghai Anti‐doping Laboratory Shanghai University of Sport Shanghai China
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Abstract
The areas of application of modern bioanalytical chromatography–mass spectrometry are so extensive that any attempt to systematize them becomes subjective. It would be more correct to say that there is no such area of biology and medicine where chromatography–mass spectrometry would not find application. This article focuses on the areas of application of this technique that are either relatively new or insufficiently covered in recent reviews. State-of-the-art bioanalytical techniques have become multitargeted in terms of analytes and standardized in terms of matrices. The ability to detect trace concentrations of analytes in the presence of a huge number of biomatrix macrocomponents using chromatography–mass spectrometry is especially important for bioanalytical chemistry. In the target-oriented determination of persistent organic pollutants by chromatography–mass spectrometry, the main problem is the expansion of the list of analytes, including isomers. In the detection of exposures to unstable toxicants, the fragmented adducts of xenobiotics with biomolecules become target biomarkers along with hydrolytic metabolites. The exposome reflects the general exposure of a human being to total xenobiotics and the metabolic status reflects the physiological state of the body. Chromatography–mass spectrometry is a key technique in metabolomics. Metabolomics is currently used to solve the problems of clinical diagnostics and anti-doping control. Biological sample preparation procedures for instrumental analysis are being simplified and developed toward increasing versatility. Proteomic technologies with the use of various versions of mass spectrometry have found application in the development of new methods for diagnosing coronavirus infections.
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Affiliation(s)
- E. I. Savelieva
- Research Institute of Hygiene, Occupational Pathology, and Human Ecology, Federal Medical Biological Agency, 188663 pos. Kuz’molovskii, Vsevolozhskii region, Leningrad oblast Russia
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8
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Eklund E, Andersson A, Ekström L, Hirschberg AL. Urinary Steroid Profile in Elite Female Athletes in Relation to Serum Androgens and in Comparison With Untrained Controls. Front Physiol 2021; 12:702305. [PMID: 34526910 PMCID: PMC8435769 DOI: 10.3389/fphys.2021.702305] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction In female athletes, the interpretation of doping tests is complex due to hormonal variations during the menstrual cycle and hormonal contraceptive use, both influencing the urinary steroid profile. Exercise is suggested to affect circulating steroid hormone levels, and in women, the urinary steroid profile differs between in competition testing and out of competition testing. No previous study has investigated the relationship between amount of exercise and the urinary steroid profile in female elite athletes. Purpose To compare the urinary steroid profile between female Olympic athletes and age- and BMI-matched untrained controls, and to study the urinary steroid profile in relation to serum hormones and amount of exercise. Methods In this cross-sectional study conducted at the Women’s Health Research Unit, Karolinska University Hospital, Stockholm, 94 female elite athletes and 86 untrained controls were included. Serum estrogens and testosterone and the urinary steroid profile were analyzed by liquid chromatography–tandem mass spectrometry and gas chromatography-tandem mass spectrometry, respectively. Exercise hours/week were evaluated by questionnaire. Results Although serum steroid hormones were comparable between groups, the athletes demonstrated approximately 30% lower urinary steroid metabolites of testosterone, epitestosterone, androsterone, etiocholanolone, 5α-androstan-3α, 17β-diol, and 5β-androstan-3α, 17β-diol compared to the controls. The urinary steroid metabolites correlated positively with serum steroid hormones. In the athletes, urinary steroid metabolites: androsterone (rs = −0.28, p = 0.007), epitestosterone (rs = −0.22, p = 0.034), 5αAdiol (rs = −0.31, p = 0.002) and testosterone (rs = −0.24, p = 0.026), were negatively correlated with amount of training (hours per week). Conclusion The urinary concentrations of steroid metabolites were lower in elite athletes than in sedentary controls, although serum steroids were comparable between groups. Moreover, exercise time was negatively associated with the urinary concentrations. Our findings suggest alternative excretion routes of androgens in the athletes related to training.
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Affiliation(s)
- Emma Eklund
- Department of Women's and Children's Health, Division of Neonatology, Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Andersson
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Ekström
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Division of Neonatology, Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden.,Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
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9
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Piper T, Geyer H, Haenelt N, Huelsemann F, Schaenzer W, Thevis M. Current Insights into the Steroidal Module of the Athlete Biological Passport. Int J Sports Med 2021; 42:863-878. [PMID: 34049412 PMCID: PMC8445669 DOI: 10.1055/a-1481-8683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/07/2021] [Indexed: 12/25/2022]
Abstract
For decades, the class of anabolic androgenic steroids has represented the most frequently detected doping agents in athletes' urine samples. Roughly 50% of all adverse analytical findings per year can be attributed to anabolic androgenic steroids, of which about 2/3 are synthetic exogenous steroids, where a qualitative analytical approach is sufficient for routine doping controls. For the remaining 1/3 of findings, caused by endogenous steroid-derived analytical test results, a more sophisticated quantitative approach is required, as their sheer presence in urine cannot be directly linked to an illicit administration. Here, the determination of urinary concentrations and concentration ratios proved to be a suitable tool to identify abnormal steroid profiles. Due to the large inter-individual variability of both concentrations and ratios, population-based thresholds demonstrated to be of limited practicability, leading to the introduction of the steroidal module of the Athlete Biological Passport. The passport enabled the generation of athlete-specific individual reference ranges for steroid profile parameters. Besides an increase in sensitivity, several other aspects like sample substitution or numerous confounding factors affecting the steroid profile are addressed by the Athlete Biological Passport-based approach. This narrative review provides a comprehensive overview on current prospects, supporting professionals in sports drug testing and steroid physiology.
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Affiliation(s)
- Thomas Piper
- Center for Preventive Doping Research – Institute of
Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Hans Geyer
- Center for Preventive Doping Research – Institute of
Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Nadine Haenelt
- Center for Preventive Doping Research – Institute of
Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Frank Huelsemann
- Center for Preventive Doping Research – Institute of
Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Wilhelm Schaenzer
- Center for Preventive Doping Research – Institute of
Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Mario Thevis
- Center for Preventive Doping Research – Institute of
Biochemistry, German Sport University Cologne, Cologne, Germany
- European Monitoring Center for Emerging Doping Agents (EuMoCEDA)
Cologne/Bonn Germany
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10
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Paris A, Labrador B, Lejeune FX, Canlet C, Molina J, Guinot M, Mégret A, Rieu M, Thalabard JC, Le Bouc Y. Metabolomic signatures in elite cyclists: differential characterization of a seeming normal endocrine status regarding three serum hormones. Metabolomics 2021; 17:67. [PMID: 34228178 DOI: 10.1007/s11306-021-01812-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 06/10/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Serum phenotyping of elite cyclists regarding cortisol, IGF1 and testosterone is a way to detect endocrine disruptions possibly explained by exercise overload, non-balanced diet or by doping. This latter disruption-driven approach is supported by fundamental physiology although without any evidence of any metabolic markers. OBJECTIVES Serum samples were distributed through Low, High or Normal endocrine classes according to hormone concentration. A 1H NMR metabolomic study of 655 serum obtained in the context of the longitudinal medical follow-up of 253 subjects was performed to discriminate the three classes for every endocrine phenotype. METHODS An original processing algorithm was built which combined a partial-least squares-based orthogonal correction of metabolomic signals and a shrinkage discriminant analysis (SDA) to get satisfying classifications. An extended validation procedure was used to plan in larger size cohorts a minimal size to get a global prediction rate (GPR), i.e. the product of the three class prediction rates, higher than 99.9%. RESULTS Considering the 200 most SDA-informative variables, a sigmoidal fitting of the GPR gave estimates of a minimal sample size to 929, 2346 and 1408 for cortisol, IGF1 and testosterone, respectively. Analysis of outliers from cortisol and testosterone Normal classes outside the 97.5%-confidence limit of score prediction revealed possibly (i) an inadequate protein intake for outliers or (ii) an intake of dietary ergogenics, glycine or glutamine, which might explain the significant presence of heterogeneous metabolic profiles in a supposedly normal cyclists subgroup. CONCLUSION In a next validation metabolomics study of a so-sized cohort, anthropological, clinical and dietary metadata should be recorded in priority at the blood collection time to confirm these functional hypotheses.
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Affiliation(s)
- Alain Paris
- Unité Molécules de Communication et Adaptation des Microorganismes (MCAM), Muséum national d'Histoire naturelle, CNRS, Paris, France.
| | - Boris Labrador
- Institut du Cerveau et de la Moelle épiniere (ICM), Sorbonne Université, Inserm U 1127, CNRS UMR 7225, Hôpital Pitié Salpêtrière, Paris, France
| | - François-Xavier Lejeune
- Institut du Cerveau et de la Moelle épiniere (ICM), Sorbonne Université, Inserm U 1127, CNRS UMR 7225, Hôpital Pitié Salpêtrière, Paris, France
| | - Cécile Canlet
- Axiom, Toxalim, INRAE, ENVT, INPT-EI Purpan, Université Paul Sabatier, Toulouse, France
| | - Jérôme Molina
- Axiom, Toxalim, INRAE, ENVT, INPT-EI Purpan, Université Paul Sabatier, Toulouse, France
- Dynamiques et écologie des paysages agriforestiers (DYNAFOR), INRAE, INPT-ENSAT, INPT-EI Purpan, Auzeville, Castanet-Tolosan Cedex, France
| | - Michel Guinot
- CHU Grenoble-Alpes, UM Sports et Pathologies, Grenoble, France
- Hypoxia and Pathophysiology Unit, INSERM U 1042, Université Grenoble-Alpes, Grenoble, France
- UM Sports et Pathologies, CHU Sud, Echirolles, France
| | - Armand Mégret
- Fédération française de Cyclisme, 1 rue Laurent Fignon, Montigny le Bretonneux, France
| | - Michel Rieu
- Agence Française de Lutte contre le Dopage (AFLD), Paris, France
| | | | - Yves Le Bouc
- Sorbonne Université, INSERM, UMR S 938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
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Mazzarino M, Comunità F, de la Torre X, Molaioni F, Botrè F. Effects of the administration of miconazole by different routes on the biomarkers of the "steroidal module" of the Athlete Biological Passport. Drug Test Anal 2021; 13:1712-1726. [PMID: 34212529 PMCID: PMC8597009 DOI: 10.1002/dta.3121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022]
Abstract
This article reports the results obtained from the investigation of the influence of miconazole administration on the physiological fluctuation of the markers of the steroid profile included in the “steroidal module” of the Athlete Biological Passport. Urines collected from male Caucasian subjects before, during, and after either systemic (i.e., oral and buccal) or topical (i.e., dermal) treatment with miconazole were analyzed according to validated procedures based on gas chromatography coupled to tandem mass spectrometry (GC–MS/MS) (to determine the markers of the steroid profile) or liquid chromatography coupled to MS/MS (LC–MS/MS) (to determine miconazole urinary levels). The results indicate that only after systemic administration, the markers of the steroid profile were significantly altered. After oral and buccal administration, we have registered (i) a significant increase of the 5α‐androstane‐3α,17β‐diol/5β‐androstane‐3α,17β‐diol ratio and (ii) a significant decrease of the concentration of androsterone, etiocholanolone, 5β‐androstane‐3α,17β‐diol, and 5α‐androstane‐3α,17β‐diol and of the androsterone/etiocholanolone, androsterone/testosterone, and 5α‐androstane‐3α,17β‐diol/epitestosterone ratios. Limited effects were instead measured after dermal intake. Indeed, the levels of miconazole after systemic administration were in the range of 0.1–12.5 μg/ml, whereas after dermal administration were below the limit of quantification (50 ng/ml). Significant alteration started to be registered at concentrations of miconazole higher than 0.5 μg/ml. These findings were primarily explained by the ability of miconazole in altering the kinetic/efficacy of deglucuronidation of the endogenous steroids by the enzyme β‐glucuronidase during the sample preparation process. The increase of both incubation time and amount of β‐glucuronidase was demonstrated to be effective countermeasures in the presence of miconazole to reduce the risk of uncorrected interpretation of the results.
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Affiliation(s)
- Monica Mazzarino
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Fabio Comunità
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Xavier de la Torre
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Francesco Molaioni
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Francesco Botrè
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy.,REDs-Research and Expertise on Anti-Doping Sciences, ISSUL-Institute des Sciences du Sport, Université de Lausanne, Lausanne, Switzerland
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12
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Narduzzi L, Buisson C, Morvan ML, Marchand A, Audran M, Le Bouc Y, Varlet-Marie E, Ericsson M, Le Bizec B, Dervilly G. Coupling Complete Blood Count and Steroidomics to Track Low Doses Administration of Recombinant Growth Hormone: An Anti-Doping Perspective. Front Mol Biosci 2021; 8:683675. [PMID: 34179089 PMCID: PMC8222787 DOI: 10.3389/fmolb.2021.683675] [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: 03/21/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
Growth Hormone (GH) under its human recombinant homologue (rhGH), may be abused by athletes to take advantage of its well-known anabolic and lipolytic properties; hence it is prohibited in sports by the World Anti-Doping Agency. Due to the rapid turnover of rhGH, anti-doping screening tests have turned to monitor two endocrine biomarkers (IGF-I and P-III-NP), but unfortunately, they show population-wise variability, limiting the identification rate of rhGH users. Previous studies have evidenced the numerous effects of GH on human physiology, especially in hematopoiesis and steroidogenesis. In this work, aiming to discover novel physiological rhGH biomarkers, we analyzed the complete blood count and the steroidomics profile of healthy, physically active, young males treated either with EPO + rhGH or EPO + placebo. The time-trends of these two physiological routes have been analyzed through geometric trajectory analysis (GTA) and OPLS-DA. Individuals supplemented with micro-doses of rhGH exhibited different leukopoietic and steroidal profiles compared to the control population, suggesting a role of the rhGH in both pathways. In the article, hypotheses on the observed differences are discussed according to the most recent literature and compared to results in animal models. The use of leukopoietic and steroidal biomarkers together with endocrine biomarkers (IGF-1 and P-III-NP) allows to correctly classify over 98% of samples with no false positives, miss-classifying only one single sample (false negative) over a total of 56; a promising result, if compared to the current rhGH detection strategies.
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Affiliation(s)
- Luca Narduzzi
- Laboratoire D’Etude des Résidus et Contaminants Dans Les Aliments (LABERCA), Oniris, INRΑe, Nantes -44307, France
| | - Corinne Buisson
- Département des Analyzes, Agence Française de Lutte Contre le Dopage (AFLD), Châtenay-Malabry, French Anti-Doping Agency, Paris, France
| | - Marie-Line Morvan
- Laboratoire D’Etude des Résidus et Contaminants Dans Les Aliments (LABERCA), Oniris, INRΑe, Nantes -44307, France
| | - Alexandre Marchand
- Département des Analyzes, Agence Française de Lutte Contre le Dopage (AFLD), Châtenay-Malabry, French Anti-Doping Agency, Paris, France
| | - Michel Audran
- Département des Analyzes, Agence Française de Lutte Contre le Dopage (AFLD), Châtenay-Malabry, French Anti-Doping Agency, Paris, France
| | - Yves Le Bouc
- Sorbonne Université, INSERM, Centre de Recherche St-Antoine (CRSA), Paris, France
| | - Emmanuelle Varlet-Marie
- Institut des Biomolécules Max Mousseron (IBMM), Centre Hospitalier Universitaire de Montpellier, Montpellie, France
| | - Magnus Ericsson
- Département des Analyzes, Agence Française de Lutte Contre le Dopage (AFLD), Châtenay-Malabry, French Anti-Doping Agency, Paris, France
| | - Bruno Le Bizec
- Laboratoire D’Etude des Résidus et Contaminants Dans Les Aliments (LABERCA), Oniris, INRΑe, Nantes -44307, France
| | - Gaud Dervilly
- Laboratoire D’Etude des Résidus et Contaminants Dans Les Aliments (LABERCA), Oniris, INRΑe, Nantes -44307, France
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13
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De Wilde L, Van Renterghem P, Van Eenoo P. Long-term stability study and evaluation of intact steroid conjugate ratios after the administration of endogenous steroids. Drug Test Anal 2021; 14:851-863. [PMID: 33982451 DOI: 10.1002/dta.3096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/26/2022]
Abstract
The most frequently detected substances prohibited by the World Anti-Doping Agency (WADA) belong to the anabolic steroids class. The most challenging compounds among this class are the endogenous anabolic steroids, which are detected by quantitative measurement of testosterone (T) and its metabolites with a so-called "steroid profiling" method. The current steroid profile is based on the concentrations and ratios of the sum of free and glucuronidated steroids. Recently, our group developed a steroid profiling method for the detection of three free steroids and 14 intact steroid conjugates, including both the glucuronic acid conjugated and sulfated fraction. The study aimed at evaluating the long-term stability of steroid conjugate concentrations and ratios, and the influence of different endogenous steroids on this extended steroid profile. A single dose of oral T undecanoate (TU), topical T gel, topical dihydrotestosterone (DHT) gel, and oral dehydroepiandrosterone (DHEA) was administered to six healthy male volunteers. One additional volunteer with a homozygote deletion of the UGT2B17 gene (del/del genotype) received a single topical dose of T gel. An intramuscular dose of TU was administered to another volunteer. To avoid fluctuation of steroid concentrations caused by variations in urinary flow rates, steroid ratios were calculated and evaluated as possible biomarkers for the detection of endogenous steroid abuse with low doses. Overall, sulfates do not have substantial additional value in prolonging detection times for the investigated endogenous steroids and administration doses. The already monitored glucuronides were overall the best markers and were sufficient to detect the administered steroids.
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Affiliation(s)
- Laurie De Wilde
- Department Diagnostic Sciences, Doping Control Laboratory (DoCoLab), Ghent University (UGent), Ghent, Belgium
| | - Pieter Van Renterghem
- Department Diagnostic Sciences, Doping Control Laboratory (DoCoLab), Ghent University (UGent), Ghent, Belgium
| | - Peter Van Eenoo
- Department Diagnostic Sciences, Doping Control Laboratory (DoCoLab), Ghent University (UGent), Ghent, Belgium
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14
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Schulze J, Pettersson-Bohlin K, Thörngren JO, Ekström L. Re-evaluation of combined ((ES/EG)/(TS/TG)) ratio as a marker of testosterone intake in men. Drug Test Anal 2021; 13:1576-1579. [PMID: 33864421 DOI: 10.1002/dta.3045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 11/08/2022]
Abstract
To detect doping with pseudo-endogenous anabolic steroids in sports, a urinary steroid profile with glucuronidated plus unconjugated androgens is used. In addition to analyze androgen glucuronide metabolites, it can be of interest to also include sulfate metabolites in the urinary steroid profile. The combined ratios of epitestosterone sulfate/epitestosterone glucuronide to the ratios of testosterone sulfate/testosterone glucuronide ((ES/EG)/(TS/TG)) have previously been investigated as a complementary biomarker for testosterone doping. In this restudy, the aim was to evaluate this biomarker in a larger study sample population. A single dose of 500-mg testosterone enanthate was administered to 54 healthy male volunteers. Urine was collected prior to (Day 0) administration and throughout 15 days and analyzed for the sulfate and glucuronide conjugates of testosterone and epitestosterone. The results show that the combined ratio increased to a larger extent than the traditional T/E ratio in all subjects. This increase was independent on UGT2B17 gene polymorphism. Moreover, a delayed peak of the combined ratio was observed in ~60% of the participants. The results confirm that complementary analyses of the sulfate metabolites may be a useful approach to detect testosterone doping in men.
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Affiliation(s)
- Jenny Schulze
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Kim Pettersson-Bohlin
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - John-Olof Thörngren
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Ekström
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
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15
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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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16
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Nair VS, Sharpe K, Husk J, Miller GD, Van Eenoo P, Crouch A, Eichner D. Evaluation of blood parameters by linear discriminant models for the detection of testosterone administration. Drug Test Anal 2021; 13:1270-1281. [PMID: 33629499 DOI: 10.1002/dta.3017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/09/2022]
Abstract
The steroidal module of the Athlete Biological Passport (ABP) has been used since 2014 for the longitudinal monitoring of urinary testosterone and its metabolites to identify samples suspicious for the use of synthetic forms of Endogenous Anabolic Androgenic Steroids (EAAS). Multiple recent studies have suggested that monitoring of blood parameters may provide enhanced detectability of exogenous testosterone administration. Transdermal and intramuscular testosterone administration studies were carried out in 15 subjects, and the effect on blood steroidal levels, hematological parameters, and gonadotropins was evaluated. Serum testosterone and dihydrotestosterone levels increased while gonadotropin levels were suppressed after administration. A modest increase in reticulocytes was also observed. The blood parameters that were responsive to the administrations were combined into several linear discriminant models targeting both administration (on) and washout (off) phases. The models were effective in detecting the large dose intramuscular administration but were less successful in the detection of the lower dose transdermal application. The blood profiling models may provide complementary value but do not appear to be substantially more advantageous than longitudinal urinary profiling.
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Affiliation(s)
- Vinod S Nair
- Sports Medicine Research and Testing Laboratory, South Jordan, Utah, USA.,DoCoLab, Department of Diagnostic Science, Ghent University, Ghent, Belgium
| | - Ken Sharpe
- Statistical Consulting Centre, School of Mathematics and Statistics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jacob Husk
- Sports Medicine Research and Testing Laboratory, South Jordan, Utah, USA
| | - Geoffrey D Miller
- Sports Medicine Research and Testing Laboratory, South Jordan, Utah, USA
| | - Peter Van Eenoo
- DoCoLab, Department of Diagnostic Science, Ghent University, Ghent, Belgium
| | - Andre 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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17
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Roshan D, Ferguson J, Pedlar CR, Simpkin A, Wyns W, Sullivan F, Newell J. A comparison of methods to generate adaptive reference ranges in longitudinal monitoring. PLoS One 2021; 16:e0247338. [PMID: 33606821 PMCID: PMC7894906 DOI: 10.1371/journal.pone.0247338] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/05/2021] [Indexed: 11/18/2022] Open
Abstract
In a clinical setting, biomarkers are typically measured and evaluated as biological indicators of a physiological state. Population based reference ranges, known as 'static' or 'normal' reference ranges, are often used as a tool to classify a biomarker value for an individual as typical or atypical. However, these ranges may not be informative to a particular individual when considering changes in a biomarker over time since each observation is assessed in isolation and against the same reference limits. To allow early detection of unusual physiological changes, adaptation of static reference ranges is required that incorporates within-individual variability of biomarkers arising from longitudinal monitoring in addition to between-individual variability. To overcome this issue, methods for generating individualised reference ranges are proposed within a Bayesian framework which adapts successively whenever a new measurement is recorded for the individual. This new Bayesian approach also allows the within-individual variability to differ for each individual, compared to other less flexible approaches. However, the Bayesian approach usually comes with a high computational cost, especially for individuals with a large number of observations, that diminishes its applicability. This difficulty suggests that a computational approximation may be required. Thus, methods for generating individualised adaptive ranges by the use of a time-efficient approximate Expectation-Maximisation (EM) algorithm will be presented which relies only on a few sufficient statistics at the individual level.
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Affiliation(s)
- Davood Roshan
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland.,CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland, Galway, Ireland.,Prostate Cancer Institute, National University of Ireland Galway, Galway, Ireland
| | - John Ferguson
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - Charles R Pedlar
- Faculty of Sport, Health and Applied Science, St Mary's University, Twickenham, United Kingdom
| | - Andrew Simpkin
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland
| | - William Wyns
- The Lambe Institute for Translational Medicine, National University of Ireland, Galway, Ireland
| | - Frank Sullivan
- Prostate Cancer Institute, National University of Ireland Galway, Galway, Ireland
| | - John Newell
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland.,CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland, Galway, Ireland
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18
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Badrick T. Biological variation: Understanding why it is so important? Pract Lab Med 2021; 23:e00199. [PMID: 33490349 PMCID: PMC7809190 DOI: 10.1016/j.plabm.2020.e00199] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/23/2020] [Indexed: 12/19/2022] Open
Abstract
This Review will describe the increasing importance of the concepts of biological variation to clinical chemists. The idea of comparison to 'reference' is fundamental in measurement. For the biological measurands, that reference is the relevant patient population, a clinical decision point based on a trial or an individual patient's previous results. The idea of using biological variation to set quality goals was then realised for setting Quality Control (QC) and External Quality Assurance (EQA) limits. The current phase of BV integration into practice is using Patient-Based Real-Time Quality Control (PBRTQC) and Patient Based Quality Assurance (PBQA) to detect a change in assay performance. The challenge of personalised medicine is to determine an individual reference interval. The Athletes Biological Passport may provide the solution.
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Affiliation(s)
- Tony Badrick
- Royal College of Pathologists of Australasia Quality Assurance Programs, St Leonards Sydney, NSW, 2065, Australia
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19
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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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20
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Influence of Indomethacin on Steroid Metabolism: Endocrine Disruption and Confounding Effects in Urinary Steroid Profiling of Anti-Doping Analyses. Metabolites 2020; 10:metabo10110463. [PMID: 33202527 PMCID: PMC7698016 DOI: 10.3390/metabo10110463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022] Open
Abstract
Anabolic androgenic steroids (AAS) are prohibited as doping substances in sports by the World Anti-Doping Agency. Concentrations and concentration ratios of endogenous AAS (steroid profile markers) in urine samples collected from athletes are used to detect their administration. Certain (non-prohibited) drugs have been shown to influence the steroid profile and thereby sophisticate anti-doping analysis. It was shown in vitro that the non-steroidal anti-inflammatory drug (NSAID) indomethacin inhibits selected steroid-biotransformations catalyzed by the aldo-keto reductase (AKR) 1C3, which plays a key role in the endogenous steroid metabolism. Kinetic parameters for the indomethacin-mediated inhibition of the AKR1C3 catalyzed reduction in etiocholanolone were determined in vitro using two comparing methods. As NSAIDs are very frequently used (not only) by athletes, the inhibitory impact of indomethacin intake on the steroid metabolism was evaluated, and steroid profile alterations were detected in vivo (one male and one female volunteer). Significant differences between samples collected before, during or after the intake of indomethacin for selected steroid profile markers were observed. The presented results are of relevance for the interpretation of results from doping control analysis. Additionally, the administration of NSAIDs should be carefully reconsidered due to their potential as endocrine disruptors.
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21
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Development and application of analytical procedures for the GC–MS/MS analysis of the sulfates metabolites of anabolic androgenic steroids: The pivotal role of chemical hydrolysis. J Chromatogr B Analyt Technol Biomed Life Sci 2020; 1155:122280. [DOI: 10.1016/j.jchromb.2020.122280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 11/17/2022]
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22
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Nair VS, Husk J, Miller GD, Eenoo P, Crouch A, Eichner D. Evaluation of longitudinal steroid profiling with the ADAMS adaptive model for detection of transdermal, intramuscular, and subcutaneous testosterone administration. Drug Test Anal 2020; 12:1419-1431. [DOI: 10.1002/dta.2885] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Vinod S. Nair
- Sports Medicine Research and Testing Laboratory South Jordan UT USA
- DoCoLab, Department of Diagnostic Science Ghent University Ghent Belgium
| | - Jacob Husk
- Sports Medicine Research and Testing Laboratory South Jordan UT USA
| | | | - Peter Eenoo
- DoCoLab, Department of Diagnostic Science Ghent University Ghent Belgium
| | - Andre Crouch
- Sports Medicine Research and Testing Laboratory South Jordan UT USA
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory South Jordan UT USA
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23
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De Wilde L, Roels K, Van Renterghem P, Van Eenoo P, Deventer K. Steroid profiling in urine of intact glucuronidated and sulfated steroids using liquid chromatography-mass spectrometry. J Chromatogr A 2020; 1624:461231. [DOI: 10.1016/j.chroma.2020.461231] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 02/05/2023]
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24
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Development and validation of an UHPLC–MS/MS method for extended serum steroid profiling in female populations. Bioanalysis 2020; 12:753-768. [DOI: 10.4155/bio-2020-0046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: Quantitative endogenous steroid profiling in blood appears as a complementary approach to the urinary module of the World Anti-Doping Agency's Athlete Biological Passport Steroidal Module for the detection of testosterone doping. To refine this approach further, a UHPLC–MS/MS method was developed for the simultaneous determination of 14 free and 14 conjugated steroids in serum. Results: The method was validated for quantitative purposes with satisfactory results in terms of selectivity, linearity range, trueness, precision and combined uncertainty (<20%). The validated method was then applied to serum samples from both healthy women and women diagnosed with mild hyperandrogenism. Conclusion: The UHPLC–MS/MS method showed promising capability in quantifying free and conjugated steroids in serum and determining variations of their concentration/distribution within serum samples from different populations.
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25
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Forsdahl G, Zanitzer K, Erceg D, Gmeiner G. Quantification of endogenous steroid sulfates and glucuronides in human urine after intramuscular administration of testosterone esters. Steroids 2020; 157:108614. [PMID: 32097612 DOI: 10.1016/j.steroids.2020.108614] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/23/2020] [Accepted: 02/17/2020] [Indexed: 12/22/2022]
Abstract
For an effective detection of doping with pseudo-endogenous anabolic steroids, the urinary steroid profile is of high value. In this work, the aim was to investigate steroid metabolism disruption after exogenous intramuscular administration of different testosterone esters. The investigation focused on both sulfo - and glucoro conjugated androgens. A single intramuscular injection of either 1000 mg testosterone undecanoate (Nebido®) or a mixture of 30 mg testosterone propionate, 60 mg testosterone phenylpropionate, 60 mg testosterone isocaproate, and 100 mg testosterone decanoate (Sustanone®), was given to six healthy volunteers. Urine was collected throughout a testing period of 60 days. A LC-MS method was developed and validated for the analysis of eight conjugated steroids in their intact form. The results show that urinary changes in both sulfo - and glucuro conjugated steroid levels are prominent after the injection of testosterone esters. A promising potential marker for the intake of exogenous testosterone is the combined ratio of epitestosterone sulfate/epitestosterone glucuronide to testosterone sulfate/testosterone glucuronide ((ES/EG)/(TS/TG)) as a complementary biomarker for testosterone abuse. This represents a new piece of evidence to detect testosterone doping, representing a new approach and being independent from the metabolic connections of the markers in the steroid passport.
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Affiliation(s)
- Guro Forsdahl
- Doping Control Laboratory, Seibersdorf Labor GmbH, Seibersdorf, Austria; Department of Pharmacy, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.
| | | | - Damir Erceg
- Childrens Hospital Srebrnjak, Clinical Trials Unit, Zagreb, Croatia; St. Catherine Specialty Hospital, Zabok/Zagreb, Croatia; Medical School, University "Josip Juraj Strossmayer", Osijek, Croatia; Faculty of Dental Medicine and Health, University "Josip Juraj Strossmayer", Zagreb, Croatia; Croatian Catholic University, Zagreb, Croatia
| | - Günter Gmeiner
- Doping Control Laboratory, Seibersdorf Labor GmbH, Seibersdorf, Austria
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26
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Narduzzi L, Dervilly G, Marchand A, Audran M, Le Bizec B, Buisson C. Applying metabolomics to detect growth hormone administration in athletes: Proof of concept. Drug Test Anal 2020; 12:887-899. [DOI: 10.1002/dta.2798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/29/2020] [Accepted: 03/29/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Luca Narduzzi
- Laboratoire d’Etude des Résidus et Contaminants dans les Aliments (LABERCA), Oniris INRAE Nantes F‐44307 France
| | - Gaud Dervilly
- Laboratoire d’Etude des Résidus et Contaminants dans les Aliments (LABERCA), Oniris INRAE Nantes F‐44307 France
| | - Alexandre Marchand
- Département des analyses Agence Française de Lutte contre le Dopage (AFLD) Châtenay‐Malabry France
| | - Michel Audran
- Département des analyses Agence Française de Lutte contre le Dopage (AFLD) Châtenay‐Malabry France
| | - Bruno Le Bizec
- Laboratoire d’Etude des Résidus et Contaminants dans les Aliments (LABERCA), Oniris INRAE Nantes F‐44307 France
| | - Corinne Buisson
- Département des analyses Agence Française de Lutte contre le Dopage (AFLD) Châtenay‐Malabry France
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27
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Börjesson A, Lehtihet M, Andersson A, Dahl M, Vicente V, Ericsson M, Ekström L. Studies of athlete biological passport biomarkers and clinical parameters in male and female users of anabolic androgenic steroids and other doping agents. Drug Test Anal 2020; 12:514-523. [DOI: 10.1002/dta.2763] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/30/2019] [Accepted: 01/07/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Annica Börjesson
- Division of Clinical Pharmacology, Department of Laboratory MedicineKarolinska Institutet Stockholm Sweden
- Clinical Pharmacology, Karolinska University LaboratoryKarolinska University Hospital Stockholm Sweden
| | - Mikael Lehtihet
- Department of MedicineKarolinska Institutet and St Görans Hospital Stockholm Sweden
| | - Alexander Andersson
- Anti‐Doping Laboratory, Clinical Pharmacology, Karolinska University LaboratoryKarolinska University Hospital Stockholm Sweden
- Clinical Pharmacology, Karolinska University LaboratoryKarolinska University Hospital Stockholm Sweden
| | - Marja‐Liisa Dahl
- Division of Clinical Pharmacology, Department of Laboratory MedicineKarolinska Institutet Stockholm Sweden
- Clinical Pharmacology, Karolinska University LaboratoryKarolinska University Hospital Stockholm Sweden
| | - Veronica Vicente
- Ambulance Medical Service in Stockholm [Ambulanssjukvården i Storstockholm AB]Academic EMS Stockholm Sweden
- Department of Clinical Science and Education, Karolinska Institutet, StockholmSödersjukhuset Stockholm Sweden
| | - Magnus Ericsson
- Division of Clinical Pharmacology, Department of Laboratory MedicineKarolinska Institutet Stockholm Sweden
- Anti‐Doping Laboratory, Clinical Pharmacology, Karolinska University LaboratoryKarolinska University Hospital Stockholm Sweden
- Clinical Pharmacology, Karolinska University LaboratoryKarolinska University Hospital Stockholm Sweden
| | - Lena Ekström
- Division of Clinical Pharmacology, Department of Laboratory MedicineKarolinska Institutet Stockholm Sweden
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Narduzzi L, Dervilly G, Audran M, Le Bizec B, Buisson C. A role for metabolomics in the antidoping toolbox? Drug Test Anal 2020; 12:677-690. [DOI: 10.1002/dta.2788] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/30/2020] [Accepted: 03/05/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Luca Narduzzi
- Laboratoire d’Etude des Résidus et Contaminants dans les Aliments (LABERCA)Oniris, INRAE Nantes France
| | - Gaud Dervilly
- Laboratoire d’Etude des Résidus et Contaminants dans les Aliments (LABERCA)Oniris, INRAE Nantes France
| | - Michel Audran
- Département des analysesAgence Française de Lutte contre le Dopage (AFLD) Châtenay‐Malabry France
| | - Bruno Le Bizec
- Laboratoire d’Etude des Résidus et Contaminants dans les Aliments (LABERCA)Oniris, INRAE Nantes France
| | - Corinne Buisson
- Département des analysesAgence Française de Lutte contre le Dopage (AFLD) Châtenay‐Malabry France
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29
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Mullen J, Bækken LV, Törmäkangas T, Ekström L, Ericsson M, Hullstein IR, Schulze JJ. Inter‐individual variation of the urinary steroid profiles in Swedish and Norwegian athletes. Drug Test Anal 2020; 12:720-730. [DOI: 10.1002/dta.2778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Jenny Mullen
- Department of Laboratory Medicine, Division of Clinical PharmacologyKarolinska Institutet Sweden
| | | | - Timo Törmäkangas
- Health Sciences, Faculty of Sport and Health SciencesUniversity of Jyväskylä Finland
| | - Lena Ekström
- Department of Laboratory Medicine, Division of Clinical PharmacologyKarolinska Institutet Sweden
| | - Magnus Ericsson
- Department of Laboratory Medicine, Division of Clinical PharmacologyKarolinska Institutet Sweden
- French Doping Control LaboratoryAgence Française de lutte contre le dopage (AFLD) Département des Analyses France
| | | | - Jenny J. Schulze
- Department of Laboratory Medicine, Division of Clinical PharmacologyKarolinska Institutet Sweden
- The Swedish National Anti‐Doping OrganisationSwedish Sports Confederation Sweden
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30
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Iannone M, Palermo A, de la Torre X, Romanelli F, Sansone A, Sansone M, Lenzi A, Botrè F. Effects of transdermal administration of testosterone gel on the urinary steroid profile in hypogonadal men: Implications in antidoping analysis. Steroids 2019; 152:108491. [PMID: 31499075 DOI: 10.1016/j.steroids.2019.108491] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/20/2019] [Accepted: 09/01/2019] [Indexed: 12/11/2022]
Abstract
Testosterone is one of the most abused pseudo-endogenous anabolic steroids in sport doping. The current method adopted to detect the abuse of testosterone and other pseudo-endogenous steroids (endogenous steroids when administered exogenously) is first based on the longitudinal monitoring of several urinary biomarkers, which constitute the so called "steroidal module" of the Athlete Biological Passport (ABP): atypical samples undergo a confirmation analysis based on the measurement of the 13C/12C isotopic ratio of selected target compounds, to distinguish their endogenous or exogenous origin. At the same time, testosterone administration can be allowed in athletes diagnosed with hypogonadism, provided they are granted a therapeutic use exemption by the relevant medical authority. In this pilot study we have investigated whether the approach based on the preliminary determination of the urinary steroid profile, in the format considered in the steroidal module of the ABP, also integrated with the inclusion of the sulfo-conjugates and of additional target steroids, can retain its validity also in the case of hypogonadal athletes. We have studied the effects of a single low dose (40 mg) of testosterone gel (T-gel) on the urinary concentration of the markers of steroidal module of the ABP, as well as on some additional steroid markers. The study was based on the analysis of urinary samples from 19 non-hospitalized hypogonadal men, 10 of them with late-onset hypogonadism (LOH), collected before, after 4 h and after 24 h the transdermal self-administration of 40 mg of T-gel. None of the patient had any co-morbidities possibly affecting the urinary excretion of the steroidal markers. The steroidal markers were quantified by gas chromatography coupled to tandem mass spectrometry (GC-MS/MS) after the enzymatic hydrolysis of the respective glucuro-conjugates and the chemical hydrolysis of the respective sulfo-conjugates. Targeted GC-MS/MS analysis was carried out operating in electron impact (EI) ionization mode, with acquisition in multiple reaction monitoring (MRM) mode. Our preliminary results show that, as expected, the treatment with T-gel leads, in all hypogonadal men, to an increase of the urinary concentration of the glucuro-conjugate metabolites of testosterone and its main metabolites, with special relevance to those with 5α-reduction. Furthermore, samples collected from non-LOH hypogonadal men showed an increase also in the levels of epitestosterone glucuronide, testosterone sulfate and epitestosterone sulfate. Apart from their biochemical and pharmacological relevance, these outcomes could be leveraged to refine the analytical strategy currently followed in the antidoping field for the analysis of the urinary steroidal markers, with potential implications also in other forensic and/or clinical investigations.
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Affiliation(s)
- Michele Iannone
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Onesti 1, 00197 Rome, Italy
| | - Amelia Palermo
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Onesti 1, 00197 Rome, Italy
| | - Xavier de la Torre
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Onesti 1, 00197 Rome, Italy
| | - Francesco Romanelli
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161 Roma, Italy
| | - Andrea Sansone
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161 Roma, Italy
| | - Massimiliano Sansone
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161 Roma, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161 Roma, Italy
| | - Francesco Botrè
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Onesti 1, 00197 Rome, Italy; Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161 Roma, Italy.
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31
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Saad K, Vonaparti A, Athanasiadou I, Saleh A, Abushareeda W, Alwahaibi A, Khan BFA, Aguilera R, Kraiem S, Horvatovich PL, Al-Muraikhi AE, Al Maadheed M, Georgakopoulos C. Population reference ranges of urinary endogenous sulfate steroids concentrations and ratios as complement to the steroid profile in sports antidoping. Steroids 2019; 152:108477. [PMID: 31446013 DOI: 10.1016/j.steroids.2019.108477] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 08/06/2019] [Accepted: 08/14/2019] [Indexed: 02/05/2023]
Abstract
The population based Steroid Profile (SP) ratio of testosterone (T) and epitestosterone (E) has been considered as a biomarker approach to detect testosterone abuse in '80s. The contemporary Antidoping Laboratories apply the World Antidoping Agency (WADA) Technical Document (TD) for Endogenous Androgenic Anabolic Steroids (EAAS) in the analysis of SP during their screening. The SP Athlete Biological Passport (ABP) adaptive model uses the concentrations of the total of free and glucuronide conjugated forms of six EAASs concentrations and ratios measured by GC/MS. In the Antidoping Lab Qatar (ADLQ), the routine LC/MS screening method was used to quantitatively estimate the sulfate conjugated EAAS in the same analytical run as for the rest qualitative analytes. Seven sulfate EAAS were quantified for a number of routine antidoping male and female urine samples during screening. Concentrations, statistical parameters and selected ratios for the 6 EAAS, the 6 sulfate EAAS and 29 proposed ratios of concentrations from both EAAS and sulfate EAAS, which potentially used as SP ABP biomarkers, population reference limits and distributions have been estimated after the GC/MSMS analysis for EAAS and LC/Orbitrap/MS analysis for sulfate EAAS.
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Affiliation(s)
- Khadija Saad
- Anti-Doping Lab Qatar, Sports City, P.O. Box 27775, Doha, Qatar
| | | | | | - Amal Saleh
- Anti-Doping Lab Qatar, Sports City, P.O. Box 27775, Doha, Qatar
| | | | - Aisha Alwahaibi
- Anti-Doping Lab Qatar, Sports City, P.O. Box 27775, Doha, Qatar
| | | | | | - Souheil Kraiem
- Anti-Doping Lab Qatar, Sports City, P.O. Box 27775, Doha, Qatar
| | - Peter L Horvatovich
- University of Groningen, Groningen Research Institute of Pharmacy, P.O. Box 196, 9700 AD Groningen, the Netherlands
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32
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Amante E, Pruner S, Alladio E, Salomone A, Vincenti M, Bro R. Multivariate interpretation of the urinary steroid profile and training-induced modifications. The case study of a Marathon runner. Drug Test Anal 2019; 11:1556-1565. [PMID: 31307117 DOI: 10.1002/dta.2676] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/04/2019] [Accepted: 07/07/2019] [Indexed: 12/11/2022]
Abstract
The steroidal module of the athlete biological passport (ABP) introduced by the World Anti-Doping Agency (WADA) in 2014 includes six endogenous androgenic steroids and five of their concentration ratios, monitored in urine samples collected repeatedly from the same athlete, whose values are interpreted by a Bayesian model on the basis of intra-individual variability. The same steroid profile, plus dihydrotestosterone (DHT) and DHEA, was determined in 198 urine samples collected from an amateur marathon runner monitored over three months preceding an international competition. Two to three samples were collected each day and subsequently analyzed by a fully validated gas chromatography-mass spectrometry protocol. The objective of the study was to identify the potential effects of physical activity at different intensity levels on the physiological steroid profile of the athlete. The results were interpreted using principal component analysis and Hotelling's T2 vs Q residuals plots, and were compared with a profile model based on the samples collected after rest. The urine samples collected after activity of moderate or high intensity, in terms of cardiac frequency and/or distance run, proved to modify the basal steroid profile, with particular enhancement of testosterone, epitestosterone, and 5α-androstane-3α,17β-diol. In contrast, all steroid concentration ratios were apparently not modified by intense exercise. The alteration of steroid profiles seemingly lasted for few hours, as most of the samples collected 6 or more hours after training showed profiles compatible with the "after rest" model. These observations issue a warning about the ABP results obtained immediately post-competition.
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Affiliation(s)
- Eleonora Amante
- Dipartimento di Chimica, Università degli Studi di Torino, Via P. Giuria 7, 10125, Torino, Italy.,Centro Regionale Antidoping e di Tossicologia "A. Bertinaria", Regione Gonzole 10/1, 10043, Orbassano, Torino, Italy
| | - Serena Pruner
- Dipartimento di Chimica, Università degli Studi di Torino, Via P. Giuria 7, 10125, Torino, Italy
| | - Eugenio Alladio
- Dipartimento di Chimica, Università degli Studi di Torino, Via P. Giuria 7, 10125, Torino, Italy.,Centro Regionale Antidoping e di Tossicologia "A. Bertinaria", Regione Gonzole 10/1, 10043, Orbassano, Torino, Italy
| | - Alberto Salomone
- Dipartimento di Chimica, Università degli Studi di Torino, Via P. Giuria 7, 10125, Torino, Italy.,Centro Regionale Antidoping e di Tossicologia "A. Bertinaria", Regione Gonzole 10/1, 10043, Orbassano, Torino, Italy
| | - Marco Vincenti
- Dipartimento di Chimica, Università degli Studi di Torino, Via P. Giuria 7, 10125, Torino, Italy.,Centro Regionale Antidoping e di Tossicologia "A. Bertinaria", Regione Gonzole 10/1, 10043, Orbassano, Torino, Italy
| | - Rasmus Bro
- Department of Food Science, Faculty of Science, University of Copenhagen, Rolighedsvej 30 - 1958, Frederiksberg, Denmark
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33
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Steroidomics for highlighting novel serum biomarkers of testosterone doping. Bioanalysis 2019; 11:1171-1187. [DOI: 10.4155/bio-2019-0079] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Aim: Quantification of testosterone (T) and 5α-dihydrotestosterone serum concentrations proved to be an efficient alternative to urinary steroid profiling for the detection of T doping. In this context, additional serum markers could be discovered by exploratory untargeted steroidomics studies. Results: Endogenous steroid metabolites were monitored by ultra high-performance liquid chromatography coupled to high-resolution mass spectrometry in serum samples collected during a T administration clinical trial. A three-step workflow for accurate review of annotation was used and multifactorial data analysis allowed highlighting promising serum biomarkers. Longitudinal monitoring of selected compounds was performed to assess T abuse detection capabilities. Conclusion: Application of serum steroidomics showed high potential for biomarker discovery of T doping, suggesting longitudinal monitoring of steroid hormones in serum as a significant improvement in detection of endogenous steroids abuse.
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34
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Esquivel A, Alechaga É, Monfort N, Yang S, Xing Y, Moutian W, Ventura R. Evaluation of sulfate metabolites as markers of intramuscular testosterone administration in Caucasian and Asian populations. Drug Test Anal 2019; 11:1218-1230. [PMID: 30932347 DOI: 10.1002/dta.2598] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/07/2019] [Accepted: 03/22/2019] [Indexed: 01/29/2023]
Abstract
The introduction of alternative markers to the steroid profile can be an effective approach to improving the screening capabilities for the detection of testosterone (T) misuse. In this work, endogenous steroid sulfates were evaluated as potential markers to detect intramuscular (IM) T administration. Fourteen sulfate metabolites were quantified using mixed-mode solid-phase extraction and analysis by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Urine samples after a single IM injection (100 mg) of T cypionate to six Caucasian and six Asian healthy male volunteers were analyzed. Principal component analysis (PCA) was used to characterize the sample cohort and to obtain the most useful markers for discrimination between pre- and post-administration samples. For Caucasian volunteers, a separation between pre- and post-administration samples was observed in PCA, whereas for Asian volunteers no separation was obtained. Seventeen ratios between sulfate metabolites were selected and further considered. Detection times (DTs) of each marker were evaluated using individual thresholds for each volunteer. The best results were obtained using ratios involving T and epitestosterone (E) sulfates in the denominator. The best marker was the ratio androsterone sulfate/testosterone sulfate (A-S/T-S) which prolonged the DT 1.2-2.1 times in respect to those obtained using T/E ratio in all Caucasian volunteers and 1.3-1.5 times in two Asian volunteers. Other ratios between A-S or etiocholanolone sulfate and E-S, and sulfates of etiocholanolone, dehydroandrosterone or epiandrosterone, and T-S were also found adequate. These ratios improve the DT after IM T administration and their incorporation to complement the current steroid profile is recommended.
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Affiliation(s)
- Argitxu Esquivel
- Catalonian Antidoping Laboratory, Doping Control Research Group, Fundació IMIM, Doctor Aiguader 88, 08003, Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Doctor Aiguader 88, 08003, Barcelona, Spain
| | - Élida Alechaga
- Catalonian Antidoping Laboratory, Doping Control Research Group, Fundació IMIM, Doctor Aiguader 88, 08003, Barcelona, Spain
| | - Nuria Monfort
- Catalonian Antidoping Laboratory, Doping Control Research Group, Fundació IMIM, Doctor Aiguader 88, 08003, Barcelona, Spain
| | - Sheng Yang
- National Anti-Doping Laboratory, China Anti-Doping Agency, 100029, Beijing, China
| | - Yanyi Xing
- National Anti-Doping Laboratory, China Anti-Doping Agency, 100029, Beijing, China
| | - Wu Moutian
- China Anti-Doping Agency, 100029, Beijing, China
| | - Rosa Ventura
- Catalonian Antidoping Laboratory, Doping Control Research Group, Fundació IMIM, Doctor Aiguader 88, 08003, Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Doctor Aiguader 88, 08003, Barcelona, Spain.,Barcelona Antidoping Laboratory, Doping Control Research Group, IMIM, Hospital del Mar Medical Research Institute, Doctor Aiguader 88, 08003, Barcelona, Spain
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35
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Rogol AD, Pieper LP. The Interconnected Histories of Endocrinology and Eligibility in Women's Sport. Horm Res Paediatr 2019; 90:213-220. [PMID: 30336491 DOI: 10.1159/000493646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/11/2018] [Indexed: 11/19/2022] Open
Abstract
This report illustrates the links between history, sport, endocrinology, and genetics to show the ways in which historical context is key to understanding the current conversations and controversies about who may compete in the female category in elite sport. The International Association of Athletics Federations (IAAF) introduced hyperandrogenemia regulations for women's competitions in 2011, followed by the International Olympic Committee (IOC) for the 2012 Olympics. The policies concern female athletes who naturally produce higher-than-average levels of testosterone and want to compete in the women's category. Hyperandrogenemia guidelines are the current effort in a long series of attempts to determine women's eligibility scientifically. Scientific endeavors to control who may participate as a woman illustrate the impossibility of neatly classifying competitors by sex and discriminate against women with differences of sex development (also called intersex by some).
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Affiliation(s)
- Alan D Rogol
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Lindsay Parks Pieper
- Department of Sport Management, University of Lynchburg College, Lynchburg, Virginia,
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36
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Christou GA, Christou MA, Žiberna L, Christou KA. Indirect clinical markers for the detection of anabolic steroid abuse beyond the conventional doping control in athletes. Eur J Sport Sci 2019; 19:1276-1286. [DOI: 10.1080/17461391.2019.1587522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Georgios A. Christou
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria A. Christou
- Department of Endocrinology, Medical School, University of Ioannina, Ioannina, Greece
| | - Lovro Žiberna
- Faculty of Medicine, Institute of Pharmacology and Experimental Toxicology, University of Ljubljana, Ljubljana, Slovenia
- Slovenian Anti-Doping Organization (SLOADO), Ljubljana, Slovenia
| | - Konstantinos A. Christou
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece
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37
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Martín-Escudero P, Muñoz-Guerra JA, García-Tenorio SV, Garde ES, Soldevilla-Navarro AB, Galindo-Canales M, Prado N, Fuentes-Ferrer ME, Fernández-Pérez C. Impact of the UGT2B17 polymorphism on the steroid profile. Results of a crossover clinical trial in athletes submitted to testosterone administration. Steroids 2019; 141:104-113. [PMID: 30503386 DOI: 10.1016/j.steroids.2018.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 10/12/2018] [Accepted: 11/12/2018] [Indexed: 11/27/2022]
Abstract
This article studies the genetic influence of polymorphism of the UGT2B17 gen on the urinary steroid profile and its implications for the anti-doping field. The study presents the results of a triple-blind randomized placebo-controlled crossover trial with healthy athletes submitted to a single dose of 250 mg of testosterone cypionate. Forty urine samples were collected from each participant. Mass spectrometry-based techniques commonly used in Anti-Doping laboratories, were employed to measure the urinary concentration and the Δδ13C values of a selection of target compounds for testosterone (T) administration together with LH. Twelve volunteers were included in the study; the polymorphism was evenly distributed among them. After T administration, the most meaningful change affected the Testosterone/Epitestosterone ratio (T/E) and the urinary concentration of LH. In relation with T/E, the wild type homozygous (ins/ins) group there was a mean relative increase of 30 (CI 95%: 25.2 to 36.7); in the heterozygous mutant (del/ins) group it was 19.8 (CI 95%:15.9 to 24.7); and in the homozygous mutant (del/del) group it was 19.7 (CI 95% 14.9 to 26.2). In the case of LH, it́s observed how LH values decrease significantly after the administration of Testex homogeneously among the three groups. The main outcome was related to the (del/del) group (homozygous mutant), where due to the depressed basal level of the steroid profile, if the longitudinal steroid profile of the athlete was not available, the analysis by GC/MS would not produce an "atypical" result according to the WADA TD2016EAAS despite the T administration. However, the genotyping of the UGT2B17 polymorphism, the follow up of LH and the use of GC-C-IRMS makes it possible to identify most of these samples as Adverse.
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Affiliation(s)
- Pilar Martín-Escudero
- Professional School of Sports Medicine, Faculty of Medicine, University Complutense of Madrid, Madrid, Spain.
| | | | | | - Ester Serrano Garde
- Doping Control Laboratory of Madrid and Anti-Doping State Agency, AEPSAD, Madrid, Spain
| | | | - Mercedes Galindo-Canales
- Professional School of Sports Medicine, Faculty of Medicine, University Complutense of Madrid, Madrid, Spain
| | - Nayade Prado
- Preventive Medicine Service, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel E Fuentes-Ferrer
- Preventive Medicine Service, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Fernández-Pérez
- Preventive Medicine Service, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria IdISSC, Hospital Clínico San Carlos, Madrid, Spain
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38
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Esquivel A, Alechaga É, Monfort N, Ventura R. Sulfate metabolites improve retrospectivity after oral testosterone administration. Drug Test Anal 2018; 11:392-402. [PMID: 30362276 DOI: 10.1002/dta.2529] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/16/2022]
Abstract
The detection of testosterone (T) misuse is performed using the steroid profile that includes concentrations of T and related metabolites excreted free and glucuronoconjugated, and the ratios between them. In this work, the usefulness of 14 endogenous steroid sulfates to improve the detection capabilities of oral T administration has been evaluated. Quantitation of the sulfate metabolites was performed using solid-phase extraction and analysis by liquid chromatography-tandem mass spectrometry. Urine samples were collected up to 144 hours after a single oral dose of T undecanoate (120 mg) to five Caucasian male volunteers. Detection times (DTs) of each marker were estimated using reference limits based on a population study and also monitoring the individual threshold for each volunteer. High inter-individual variability was observed for sulfate metabolites and, therefore, better DTs were obtained using individual thresholds. Using individual threshold limits, epiandrosterone sulfate (epiA-S) improved the DT with respect to testosterone/epitestosterone (T/E) ratio in all volunteers. Androsterone, etiocholanolone, and two androstanediol sulfates also improved DTs for some volunteers. Principal component analysis was used to characterize the sample cohort, obtaining 13 ratios useful for discrimination. These ratios as well as the ratio epiA-S/dehydroepiandrosterone sulfate were further examined. The most promising results were obtained using ratios between sulfates of epiA, androsterone, or androstanediol 1 and E, and also sulfates of epiA or androstanediol 1, and dehydroandrosterone. These selected ratios prolonged the DT of oral T administration up to 144 hours, which corresponded to a significantly higher retrospectivity compared to those obtained using concentrations or the conventional T/E ratio.
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Affiliation(s)
- Argitxu Esquivel
- Doping Control Research Group, Catalonian Antidoping Laboratory, Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Élida Alechaga
- Doping Control Research Group, Catalonian Antidoping Laboratory, Barcelona, Spain
| | - Nuria Monfort
- Doping Control Research Group, Catalonian Antidoping Laboratory, Barcelona, Spain
| | - Rosa Ventura
- Doping Control Research Group, Catalonian Antidoping Laboratory, Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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Puchowicz MJ, Mizelman E, Yogev A, Koehle MS, Townsend NE, Clarke DC. The Critical Power Model as a Potential Tool for Anti-doping. Front Physiol 2018; 9:643. [PMID: 29928234 PMCID: PMC5997808 DOI: 10.3389/fphys.2018.00643] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/11/2018] [Indexed: 11/13/2022] Open
Abstract
Existing doping detection strategies rely on direct and indirect biochemical measurement methods focused on detecting banned substances, their metabolites, or biomarkers related to their use. However, the goal of doping is to improve performance, and yet evidence from performance data is not considered by these strategies. The emergence of portable sensors for measuring exercise intensities and of player tracking technologies may enable the widespread collection of performance data. How these data should be used for doping detection is an open question. Herein, we review the basis by which performance models could be used for doping detection, followed by critically reviewing the potential of the critical power (CP) model as a prototypical performance model that could be used in this regard. Performance models are mathematical representations of performance data specific to the athlete. Some models feature parameters with physiological interpretations, changes to which may provide clues regarding the specific doping method. The CP model is a simple model of the power-duration curve and features two physiologically interpretable parameters, CP and W′. We argue that the CP model could be useful for doping detection mainly based on the predictable sensitivities of its parameters to ergogenic aids and other performance-enhancing interventions. However, our argument is counterbalanced by the existence of important limitations and unresolved questions that need to be addressed before the model is used for doping detection. We conclude by providing a simple worked example showing how it could be used and propose recommendations for its implementation.
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Affiliation(s)
- Michael J Puchowicz
- Department of Health Services, Arizona State University, Tempe, AZ, United States
| | - Eliran Mizelman
- Department of Biomedical Physiology and Kinesiology and Sports Analytics Group, Simon Fraser University, Burnaby, BC, Canada
| | - Assaf Yogev
- School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada
| | - Michael S Koehle
- School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada.,Division of Sport and Exercise Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Nathan E Townsend
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - David C Clarke
- Department of Biomedical Physiology and Kinesiology and Sports Analytics Group, Simon Fraser University, Burnaby, BC, Canada.,Canadian Sport Institute Pacific, Victoria, BC, Canada
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Devriendt T, Chokoshvili D, Favaretto M, Borry P. Do athletes have a right to access data in their Athlete Biological Passport? Drug Test Anal 2018. [PMID: 29524351 DOI: 10.1002/dta.2380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The Athlete Biological Passport (ABP) refers to the collection of data related to an individual athlete. The ABP contains the Haematological Module and the Steroidal Module, which are used for the longitudinal monitoring of variables in blood and urine, respectively. Based on changes in these variables, a statistical model detects outliers which indicate doping use and guide further targeted testing of the athlete. Presently, athletes can access their data of the Haematological Module in the Anti-Doping Administration and Management System (ADAMS). However, granting athletes access to this data has been a matter of debate within the anti-doping community. This article investigates whether an athlete has a right to access the contents of their ABP profile. We approached this discussion by comparing the nature of ABP data with that of forensic and medical data and touched on important concerns with ABP data disclosure to athletes such as potentially allowing for the development of alternative doping techniques to circumvent detection; and making athletes vulnerable to pressure by the media to publicly release their data. Furthermore, given that ABP data may contain medically relevant information that can be used to diagnose disease, athletes may over-interpret its medical significance and wrongly see it as a free health check. We argue that safeguarding the integrity of the ABP system must be seen as the most essential element and thus a departure from immediate data disclosure is necessary. Two different strategies for delayed data disclosure are proposed which diminish the chances of ABP data being misused to refine doping techniques.
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Affiliation(s)
- Thijs Devriendt
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Belgium
| | - Davit Chokoshvili
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Belgium
| | - Maddalena Favaretto
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Belgium
| | - Pascal Borry
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Belgium
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41
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Roli L, De Vincentis S, Rocchi MBL, Trenti T, De Santis MC, Savino G. Testosterone, cortisol, hGH, and IGF-1 levels in an Italian female elite volleyball team. Health Sci Rep 2018; 1:e32. [PMID: 30623067 PMCID: PMC6266423 DOI: 10.1002/hsr2.32] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/12/2017] [Accepted: 02/01/2018] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To assess the transferability of the reference intervals (RI) of testosterone (T), cortisol (C), human growth hormone (hGH), and insulin-like growth factor (IGF)-1, calculated on a normal healthy population, to a population of female elite volleyball players. Secondary aim of this study is the evaluation of the T/C ratio as predictive tool of overtraining during the annual regular season. METHODS A retrospective, longitudinal, observational study was performed, enrolling 58 professional female volleyball players periodically evaluated during the regular sportive season, which lasts from September to May. RESULTS Statistically significant differences between the volleyball players and reference populations for T (P = .010), C (P < .001), and IGF-1 (P < .001) were found. Three different statistical approaches to calculate the RI in the athlete group showed a high degree of concordance and pointed out a shift upwards of both lower and upper reference limits. The T/C ratio significantly changed among visits (P = .009). In particular, an overall decrease of about 30% was observed for this ratio during the season, suggesting a state of overtraining. CONCLUSION T, C, hGH, and IGF-1 reference values calculated on elite volleyball female players are higher than those of the reference population used in normal clinical practice, suggesting that the health status of highly trained subjects needs the definition of tailored RI for these variables. Moreover, the utility of T/C ratio in the evaluation of overtraining is confirmed.
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Affiliation(s)
- Laura Roli
- Department of Laboratory Medicine and PathologyAzienda USL of ModenaItaly
| | - Sara De Vincentis
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaItaly
- Department of Medicine, Endocrinology, Metabolism and GeriatricsAzienda Ospedaliero‐Universitaria of ModenaItaly
| | | | - Tommaso Trenti
- Department of Laboratory Medicine and PathologyAzienda USL of ModenaItaly
| | | | - Gustavo Savino
- Department of Public Healthcare, Sport Medicine ServiceAzienda USL of ModenaItaly
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42
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Alquraini H, Auchus RJ. Strategies that athletes use to avoid detection of androgenic-anabolic steroid doping and sanctions. Mol Cell Endocrinol 2018; 464:28-33. [PMID: 28130115 DOI: 10.1016/j.mce.2017.01.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 01/19/2017] [Indexed: 11/29/2022]
Abstract
Androgenic-anabolic steroids (AAS) are potent and widely used performance-enhancing substances (PES). Since the International Olympic Committee (IOC) began testing athletes for AAS in the 1970s, athletes and their teams have endeavored to beat the system to avoid doping violations and/or sanctions derived from positive test results. This review will discuss the strategies used to avoid detection based on the pharmacology, biochemistry, and genetics of AAS metabolism and testing principles. Another strategy used is to dope with testosterone under the guise that the athlete has a true medical condition that requires testosterone treatment, using the therapeutic use exemption (TUE) mechanism. Misrepresentation in TUE applications is extending to amateur athletes, as testosterone prescription outside of FDA guidance increases and sport organizations broaden their efforts to police doping at all levels of competition. Strict criteria are enforced under which a TUE for testosterone use may be granted, to maintain the integrity of sport. The challenge of upholding a zero-tolerance policy for AAS abuse, despite popular misconceptions of androgen physiology and pervasive attempts to dope among athletes and physicians, remains a daunting and evolving task for the anti-doping community.
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Affiliation(s)
- Hussain Alquraini
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Richard J Auchus
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; Department of Pharmacology, University of Michigan, Ann Arbor, MI 48109, USA.
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Mullen J, Gadot Y, Eklund E, Andersson A, J Schulze J, Ericsson M, Lindén Hirschberg A, Rane A, Ekström L. Pregnancy greatly affects the steroidal module of the Athlete Biological Passport. Drug Test Anal 2018; 10:1070-1075. [PMID: 29349906 DOI: 10.1002/dta.2361] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/06/2018] [Accepted: 01/10/2018] [Indexed: 02/28/2024]
Abstract
Concentrations of urinary steroids are measured in anti-doping test programs to detect doping with endogenous steroids. These concentrations are combined into ratios and followed over time in the steroidal module of the Athlete Biological Passport (ABP). The most important ratio in the ABP is the testosterone/epitestosterone (T/E) ratio but this ratio is subject to intra-individual variations, especially large in women, which complicates interpretation. In addition, there are other factors affecting T/E. Pregnancy, for example, is known to affect the urinary excretion rate of epitestosterone and hence the T/E ratio. However, the extent of this variation and how pregnancy affect other ratios has not been fully evaluated. Here we have studied the urinary steroid profile, including 19-norandrosterone (19-NA), in 67 pregnant women and compared to postpartum. Epitestosterone was higher and, consequently, the T/E and 5αAdiol/E ratios were lower in the pregnant women. Androsterone/etiocholanolone (A/Etio) and 5αAdiol/5βAdiol, on the other hand, were higher in the first trimester as compared to postpartum (p<0.0001 and p=0.0396, respectively). There was no difference in A/T during pregnancy or after. 19-NA was present in 90.5% of the urine samples collected from pregnant women. In this study, we have shown that the steroid profile of the ABP is affected by pregnancy, and hence can cause atypical passport findings. These atypical findings would lead to unnecessary confirmation procedures, if the patterns of pregnancy are not recognized by the ABP management units.
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Affiliation(s)
- Jenny Mullen
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Yifat Gadot
- St Michaels Hospital and Clinical Pharmacology and Toxicology Unit, Hospital for Sick Children, Toronto, Canada
| | - Emma Eklund
- Department of Women's and Children's Health, Karolinska Institutet, and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander Andersson
- Doping Control Laboratory, Division of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Jenny J Schulze
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Ericsson
- Doping Control Laboratory, Division of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Rane
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Ekström
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Xing Y, Liu X, Yan M, Chen T, Lu F, Xu B, Gong Y, Chu F, Lei H. Impact of nonsteroidal aromatase inhibitors on steroid profile in a Chinese population. Medicine (Baltimore) 2017; 96:e7411. [PMID: 28700478 PMCID: PMC5515750 DOI: 10.1097/md.0000000000007411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Steroid profiling was introduced to determine the endogenous steroid misuse in sports. Thus, screening for the exogenous use of these prohibited substances can be established by monitoring a range of endogenous steroids, which constitute the steroid profile and evaluate their concentrations and ratios against reference values. The steroid profiling is currently based on population statistics. As large interindividual variations exist, athlete biological passport (ABP) analysis is ongoing. This study aimed to identify new biomarker(s) for aromatase inhibitor detection in sports using statistical analysis and adapt the model into ABP analysis.Forty-one Chinese nonathlete volunteers (21 males and 20 females) were administered 3 nonsteroidal aromatase inhibitors (aminoglutethimide, letrozole, and anastrozole) independently. Statistical analysis was performed on 16 steroid profile parameters.After administration, the concentrations of endogenous androgen biomarkers including testosterone (T), epitestosterone, androsterone (AN), etiocholanolone (ETIO), 5α-diol, 5β-diol, and dehydroepiandrosterone were increased, while the level of estrogen was decreased. These biomarkers returned to the baselines levels within 1 month. In females, the concentrations of endogenous biomarkers were affected by nonsteroidal aromatase inhibitors, without a common trend. Three new endogenous biomarkers (AN/estrone, ETIO/estrone, and T/estrone) elevated significantly after treatment. The 3 new models were more sensitive than the World Anti-Doping Agency ratio biomarkers. They were also effective in exponentially weighted moving average chart analysis.Verification experiment demonstrated that the biomarker T/estrone was valid in judging the steroidal aromatase inhibitor abuse. The screening of these new endogenous biomarkers can provide additional parameters to support ABP monitoring and specific information regarding the administered steroids.
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Affiliation(s)
- Yanyi Xing
- School of Chinese Pharmacy, Beijing University of Chinese Medicine
- National Anti-Doping Laboratory, China Anti-Doping Agency
| | - Xin Liu
- National Anti-Doping Laboratory, China Anti-Doping Agency
| | - Mengmeng Yan
- School of Chinese Pharmacy, Beijing University of Chinese Medicine
| | - Tianqi Chen
- College of Applied Statistics, Beijing University of Technology, Beijing, China
| | - Fei Lu
- School of Chinese Pharmacy, Beijing University of Chinese Medicine
| | - Bing Xu
- School of Chinese Pharmacy, Beijing University of Chinese Medicine
| | - Yan Gong
- School of Chinese Pharmacy, Beijing University of Chinese Medicine
| | - Fuhao Chu
- School of Chinese Pharmacy, Beijing University of Chinese Medicine
| | - Haimin Lei
- School of Chinese Pharmacy, Beijing University of Chinese Medicine
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45
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Palermo A, Botrè F, de la Torre X, Zamboni N. Non-targeted LC-MS based metabolomics analysis of the urinary steroidal profile. Anal Chim Acta 2017; 964:112-122. [PMID: 28351627 DOI: 10.1016/j.aca.2017.01.055] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 01/28/2023]
Abstract
The urinary steroidal fraction has been extensively explored as non-invasive alternative to monitor pathological conditions as well as to unveil the illicit intake of pseudo-endogenous anabolic steroids in sport. However, the majority of previous approaches involved the a priori selection of potentially relevant target analytes. Here we describe the non-targeted analysis of the urinary steroidal profiles. The workflow includes minimal sample pretreatment and normalization according to the specific gravity of urine, a 20 min reverse phase ultra-performance liquid chromatographic separation hyphenated to electrospray time-of-flight mass spectrometry. As initial validation, we analyzed a set of quality control urines spiked with glucurono- and sulfo-conjugated steroids at physiological ranges. We then applied the method for the analysis of samples collected after single transdermal administration of testosterone in hypogonadal men. The method allowed profiling of approximately three thousand metabolic features, including steroids of clinical and forensic relevance. It successfully identified metabolic pathways mostly responsible for groups clustering even in the context of high inter-individual variability and allowed the detection of currently unknown metabolic features correlating with testosterone administration. These outcomes set the stage for future studies aimed at implementing currently monitored urinary steroidal markers both in clinical and forensic analysis.
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Affiliation(s)
- Amelia Palermo
- Institute of Molecular Systems Biology, ETH Zurich, Switzerland; Department of Chemistry and Pharmaceutical Technologies, Sapienza University of Rome, Italy; Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Italy
| | - Francesco Botrè
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Italy; Department of Experimental Medicine, Sapienza University of Rome, Italy
| | | | - Nicola Zamboni
- Institute of Molecular Systems Biology, ETH Zurich, Switzerland.
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Kotronoulas A, Gomez-Gomez A, Segura J, Ventura R, Joglar J, Pozo OJ. Evaluation of two glucuronides resistant to enzymatic hydrolysis as markers of testosterone oral administration. J Steroid Biochem Mol Biol 2017; 165:212-218. [PMID: 27328448 DOI: 10.1016/j.jsbmb.2016.06.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/11/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
Abstract
Testosterone (T) has traditionally been the most commonly reported doping agent by doping control laboratories. The screening of T misuse is performed by the quantification of six endogenous androgenic steroids and the ratio T/E included in the Athlete Biological Passport (ABP). The inclusion of additional metabolites can improve the screening capabilities of ABP. In this study, the potential of 3α-glucuronide-6β-hydroxyandrosterone (6OH-Andros3G) and 3α-glucuronide-6β-hydroxyetiocholanolone (6OH-Etio3G) as markers of T oral administration was evaluated. These glucuronides have been shown to be resistant to enzymatic hydrolysis and their quantification by means of liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) was reported as the only way to obtain feasible results. Urine samples were collected from five volunteers before and after the oral administration of 40mg of T undecanoate and were analyzed by a LC-MS/MS method recently developed. Concentration of 6OH-Andros3G and 6OH-Etio3G compounds and those of the glucuronides of T (TG), epitestosterone (EG), androsterone and etiocholanolone were established and different concentration ratios were calculated. The detection windows (DWs) for the T administration obtained by each selected ratio were compared to the one of TG/EG. The results showed that four out of the nine tested markers presented DWs much larger for all volunteers than those obtained by the World Anti-Doping Agency established T/E marker or other alternative markers. The 6OH-Andros3G/EG, 6OH-Etio3G/EG, 6OH-Andros3G/TG and 6OH-Etio3G/TG markers were able to identify the T abuse up to 96h after the administration, extending our detection capability for the misuse up to 84h more than the classic marker. The importance of these markers was also highlighted by their prolonged capacity to detect the T misuse in the case of one volunteer whose TG/EG barely exceeded his individual threshold. As a consequence, the four markers presented in this study seem to have an exceptional potential as biomarkers of T oral administration.
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Affiliation(s)
- Aristotelis Kotronoulas
- Bioanalysis Research Group, IMIM, Hospital del Mar, Doctor Aiguader 88, 08003 Barcelona, Spain; Department of Biological Chemistry and Molecular Modelling, Institute of Advanced Chemistry of Catalonia, Spanish Council for Scientific Research (IQAC-CSIC), Jordi Girona 18-26, 08034 Barcelona, Spain
| | - Alex Gomez-Gomez
- Bioanalysis Research Group, IMIM, Hospital del Mar, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Jordi Segura
- Bioanalysis Research Group, IMIM, Hospital del Mar, Doctor Aiguader 88, 08003 Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Rosa Ventura
- Bioanalysis Research Group, IMIM, Hospital del Mar, Doctor Aiguader 88, 08003 Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Jesús Joglar
- Department of Biological Chemistry and Molecular Modelling, Institute of Advanced Chemistry of Catalonia, Spanish Council for Scientific Research (IQAC-CSIC), Jordi Girona 18-26, 08034 Barcelona, Spain
| | - Oscar J Pozo
- Bioanalysis Research Group, IMIM, Hospital del Mar, Doctor Aiguader 88, 08003 Barcelona, Spain.
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Jardines D, Botrè F, Colamonici C, Curcio D, Procida G, de la Torre X. Longitudinal evaluation of the isotope ratio mass spectrometric data: towards the ‘isotopic module’ of the athlete biological passport? Drug Test Anal 2016; 8:1212-1221. [DOI: 10.1002/dta.2118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/07/2016] [Accepted: 10/11/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Daniel Jardines
- Laboratorio Antidoping FMSI; Largo Onesti 1 00197 Rome Italy
| | - Francesco Botrè
- Laboratorio Antidoping FMSI; Largo Onesti 1 00197 Rome Italy
- Department of Experimental Medicine; “Sapienza” University of Rome; Viale Regina Elena, 291 00161 Roma Italy
| | | | - Davide Curcio
- Laboratorio Antidoping FMSI; Largo Onesti 1 00197 Rome Italy
| | - Gemma Procida
- Laboratorio Antidoping FMSI; Largo Onesti 1 00197 Rome Italy
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48
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Miller GD, Nair V, Morrison MS, Summers M, Willick SE, Eichner D. Intranasal delivery of Natesto® testosterone gel and its effects on doping markers. Drug Test Anal 2016; 8:1197-1203. [DOI: 10.1002/dta.2106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Geoffrey D. Miller
- Sports Medicine Research and Testing Laboratory; 560 Arapeen Drive, Suite 150A Salt Lake City Utah 84108-1293 USA
- Division of Physical Medicine and Rehabilitation; University of Utah School of Medicine; Salt Lake City Utah USA
| | - Vinod Nair
- Sports Medicine Research and Testing Laboratory; 560 Arapeen Drive, Suite 150A Salt Lake City Utah 84108-1293 USA
| | - M. Scott Morrison
- Sports Medicine Research and Testing Laboratory; 560 Arapeen Drive, Suite 150A Salt Lake City Utah 84108-1293 USA
| | - Maggie Summers
- Sports Medicine Research and Testing Laboratory; 560 Arapeen Drive, Suite 150A Salt Lake City Utah 84108-1293 USA
| | - Stuart E. Willick
- Division of Physical Medicine and Rehabilitation; University of Utah School of Medicine; Salt Lake City Utah USA
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory; 560 Arapeen Drive, Suite 150A Salt Lake City Utah 84108-1293 USA
- Division of Physical Medicine and Rehabilitation; University of Utah School of Medicine; Salt Lake City Utah USA
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49
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Alladio E, Caruso R, Gerace E, Amante E, Salomone A, Vincenti M. Application of multivariate statistics to the Steroidal Module of the Athlete Biological Passport: A proof of concept study. Anal Chim Acta 2016; 922:19-29. [PMID: 27154828 DOI: 10.1016/j.aca.2016.03.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/24/2016] [Accepted: 03/29/2016] [Indexed: 11/27/2022]
Abstract
The Technical Document TD2014EAAS was drafted by the World Anti-Doping Agency (WADA) in order to fight the spread of endogenous anabolic androgenic steroids (EAAS) misuse in several sport disciplines. In particular, adoption of the so-called Athlete Biological Passport (ABP) - Steroidal Module allowed control laboratories to identify anomalous EAAS concentrations within the athletes' physiological urinary steroidal profile. Gas chromatography (GC) combined with mass spectrometry (MS), indicated by WADA as an appropriate technique to detect urinary EAAS, was utilized in the present study to develop and fully-validate an analytical method for the determination of all EAAS markers specified in TD2014EAAS, plus two further markers hypothetically useful to reveal microbial degradation of the sample. In particular, testosterone, epitestosterone, androsterone, etiocholanolone, 5α-androstane-3α,17β-diol, 5β-androstane-3α,17β-diol, dehydroepiandrosterone, 5α-dihydrotestosterone, were included in the analytical method. Afterwards, the multi-parametric feature of ABP profile was exploited to develop a robust approach for the detection of EAAS misuse, based on multivariate statistical analysis. In particular, Principal Component Analysis (PCA) was combined with Hotelling T(2) tests to explore the EAAS data obtained from 60 sequential urine samples collected from six volunteers, in comparison with a reference population of single urine samples collected from 96 volunteers. The new approach proved capable of identifying anomalous results, including (i) the recognition of samples extraneous to each of the individual urine series and (ii) the discrimination of the urine samples collected from individuals to whom "endogenous" steroids had been administrated with respect to the rest of the samples population. The proof-of-concept results presented in this study will need further extension and validation on a population of sport professionals.
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Affiliation(s)
- Eugenio Alladio
- Centro Regionale Antidoping e di Tossicologia "A. Bertinaria", Regione Gonzole 10/1, 10043 Orbassano, Torino, Italy; Dipartimento di Chimica, Università degli Studi di Torino, Via P. Giuria 7, 10125 Torino, Italy.
| | - Roberto Caruso
- Dipartimento di Chimica, Università degli Studi di Torino, Via P. Giuria 7, 10125 Torino, Italy.
| | - Enrico Gerace
- Centro Regionale Antidoping e di Tossicologia "A. Bertinaria", Regione Gonzole 10/1, 10043 Orbassano, Torino, Italy.
| | - Eleonora Amante
- Dipartimento di Chimica, Università degli Studi di Torino, Via P. Giuria 7, 10125 Torino, Italy.
| | - Alberto Salomone
- Centro Regionale Antidoping e di Tossicologia "A. Bertinaria", Regione Gonzole 10/1, 10043 Orbassano, Torino, Italy.
| | - Marco Vincenti
- Centro Regionale Antidoping e di Tossicologia "A. Bertinaria", Regione Gonzole 10/1, 10043 Orbassano, Torino, Italy; Dipartimento di Chimica, Università degli Studi di Torino, Via P. Giuria 7, 10125 Torino, Italy.
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50
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Analytical challenges and solutions in doping control: a perspective from the Swedish Doping Control Laboratory. Bioanalysis 2016; 8:735-9. [DOI: 10.4155/bio-2016-0037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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