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Kumari S, Pal B, Sahu SK, Prabhakar PK, Tewari D. Adverse events of clenbuterol among athletes: a systematic review of case reports and case series. Int J Legal Med 2023:10.1007/s00414-023-02996-1. [PMID: 37062796 DOI: 10.1007/s00414-023-02996-1] [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: 11/23/2022] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
Clenbuterol is a potent beta-2 agonist widely misused by professional athletes and bodybuilders. Information on clenbuterol associated adverse events is present in case reports and case series, though it may not be readily available. This systematic review aimed to critically evaluate the evidence of adverse events associated with clenbuterol among athletes. The search strategy was in accordance with PRISMA guidelines. Databases such as PubMed, Science Direct, Scopus, and Google Scholar were searched from 1990 to October 2021 to find out the relevant case reports and case series. There were 23 included studies. Using a suitable scale, the included studies' methodological quality analysis was evaluated. In total, 24 athletes experienced adverse events. Oral ingestion of clenbuterol was the most preferred route among them. The daily administered dose of clenbuterol was ranging from 20 µg to 30 mg. Major adverse events experienced by athletes were supraventricular tachycardia, atrial fibrillation, hypotension, chest pain, myocardial injury, myocarditis, myocardial ischemia, myocardial infarction, cardiomyopathy, hepatomegaly, hyperglycemia, and death. The cardiac-related complications were the most commonly occurring adverse events. Clenbuterol is notorious to produce life-threatening adverse events including death. Lack of evidence regarding the performance-enhancing effects of clenbuterol combined with its serious toxicities questions the usefulness of this drug in athletes.
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Affiliation(s)
- Sweta Kumari
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India
| | - Biplab Pal
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India
| | - Sanjeev Kumar Sahu
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India
| | - Pranav Kumar Prabhakar
- School of Allied Medical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India
| | - Devesh Tewari
- Department of Pharmacognosy and Phytochemistry, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, 110017, India.
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Du Y, Demillard LJ, Ren J. Catecholamine-induced cardiotoxicity: A critical element in the pathophysiology of stroke-induced heart injury. Life Sci 2021; 287:120106. [PMID: 34756930 DOI: 10.1016/j.lfs.2021.120106] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 01/20/2023]
Abstract
Cerebrovascular diseases such as ischemic stroke, brain hemorrhage, and subarachnoid hemorrhage provoke cardiac complications such as heart failure, neurogenic stress-related cardiomyopathy and Takotsubo cardiomyopathy. With regards to the pathophysiology of stroke-induced heart injury, several mechanisms have been postulated to contribute to this complex interaction between brain and heart, including damage from gut dysbiosis, immune and systematic inflammatory responses, microvesicle- and microRNA-mediated vascular injury and damage from a surge of catecholamines. All these cerebrovascular diseases may trigger pronounced catecholamine surges through diverse ways, including stimulation of hypothalamic-pituitary adrenal axis, dysregulation of autonomic system, and secretion of adrenocorticotropic hormone. Primary catecholamines involved in this pathophysiological response include norepinephrine (NE) and epinephrine. Both are important neurotransmitters that connect the nervous system with the heart, leading to cardiac damage via myocardial ischemia, calcium (Ca2+) overload, oxidative stress, and mitochondrial dysfunction. In this review, we will aim to summarize the molecular mechanisms behind catecholamine-induced cardiotoxicity including Ca2+ overload, oxidative stress, apoptosis, cardiac hypertrophy, interstitial fibrosis, and inflammation. In addition, we will focus on how synchronization among these pathways evokes cardiotoxicity.
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Affiliation(s)
- Yuxin Du
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Laurie J Demillard
- School of Pharmacy, University of Wyoming College of Health Sciences, Laramie, WY 82071, USA
| | - Jun Ren
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai 200032, China; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA.
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3
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(Doping, dietary supplements, and cardiovascular system). COR ET VASA 2020. [DOI: 10.33678/cor.2020.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Moriarty N, Attar N. Clenbuterol-Induced Myocarditis: A Case Report. Eur J Case Rep Intern Med 2020; 7:001662. [PMID: 32908823 DOI: 10.12890/2020_001662] [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: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/05/2022] Open
Abstract
Objective We present a case of a 22-year-old bodybuilder diagnosed with myocarditis secondary to clenbuterol use. Results The patient was primarily managed conservatively by the discontinuation of clenbuterol and the temporary use of dual anti-platelets, beta-blockers and nitrates. Conclusion Clenbuterol is a long-acting beta-2 agonist primarily used in veterinary medicine. In recent years, it has been illegally marketed as a weight loss supplement because of its anabolic properties and is popular among fitness enthusiasts. It is our aim to use this case to underscore the adverse effects of this drug with hopes that tighter regulations will be instituted to stem its illegal distribution. LEARNING POINTS Clenbuterol is primarily a veterinary drug with bronchodilator and tocolytic properties.It is illegally used as a performance enhancer by athletes and bodybuilders because of its anabolic properties.Clenbuterol misuse can result in myocardial injury.
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Affiliation(s)
- Natassja Moriarty
- Department of Medicine, Furness General Hospital, Barrow-in-Furness, United Kingdom
| | - Nadeem Attar
- Department of Cardiology, Furness General Hospital, Barrow-in-Furness, United Kingdom
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Tester AA, Logan S, Pollock L, McKie A. Clenbuterol: a new toxic substance in paediatrics. BMJ Case Rep 2020; 13:13/3/e233180. [PMID: 32169984 DOI: 10.1136/bcr-2019-233180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A 13-year-old girl presented to the emergency department with acute onset of chest pain, nausea and tremor. The patient denied drug ingestion, and urine toxicology was negative. ECG demonstrated sinus tachycardia, prolonged QTc (541 ms) and ST depression. Laboratory testing demonstrated metabolic acidosis, hypokalaemia, hypophosphataemia and hyperglycaemia. She was commenced on continuous cardiac monitoring and treated with intravenous fluids and electrolyte replacement. Presenting features and laboratory abnormalities resolved within 48 hours. The National Poisons Information Service and Clinical Biochemistry were integral to her management, advising the clinical team on the likeliest aetiology. Five weeks after discharge, urine toxicology, using mass spectrometry, identified clenbuterol. Clenbuterol is an oral β2-agonist with anabolic and lipolytic effects that is misused as a performance and image enhancing drug. Clinicians must be aware of the increasing availability of these drugs and their potential for causing harm in children and adolescents.
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Affiliation(s)
- Andrew A Tester
- Emergency Department, Royal Hospital for Children, Glasgow, Scotland, UK
| | - Sheena Logan
- Emergency Department, Royal Hospital for Children, Glasgow, Scotland, UK
| | - Louisa Pollock
- Emergency Department, Royal Hospital for Children, Glasgow, Scotland, UK
| | - Allison McKie
- Emergency Department, Royal Hospital for Children, Glasgow, Scotland, UK
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Lehmann S, Thomas A, Schiwy-Bochat KH, Geyer H, Thevis M, Glenewinkel F, Rothschild MA, Andresen-Streichert H, Juebner M. Death after misuse of anabolic substances (clenbuterol, stanozolol and metandienone). Forensic Sci Int 2019; 303:109925. [DOI: 10.1016/j.forsciint.2019.109925] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/18/2019] [Accepted: 08/02/2019] [Indexed: 02/06/2023]
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Bonney CF, Hatten B, Wang GS. Toxicity From Unintentional Pediatric Ingestion of a Performance-Enhancing Drug: A Case Report With Review of Clenbuterol Toxicity and Treatment. J Emerg Med 2019; 57:e105-e108. [DOI: 10.1016/j.jemermed.2019.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/03/2019] [Accepted: 06/15/2019] [Indexed: 11/29/2022]
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Anabolic steroid users' misuse of non-traditional prescription drugs. Res Social Adm Pharm 2019; 15:949-952. [DOI: 10.1016/j.sapharm.2018.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/06/2018] [Accepted: 07/02/2018] [Indexed: 11/18/2022]
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Dolores HM, Villaseñor A, Piña OS, Mercado Márquez C, Bejarano BV, Bonaparte MEG, López-Arellano R. Evaluation of R- (-) and S- (+) Clenbuterol enantiomers during a doping cycle or continuous ingestion of contaminated meat using chiral liquid chromatography by LC-TQ-MS. Drug Test Anal 2019; 11:1238-1247. [PMID: 31069953 DOI: 10.1002/dta.2612] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/12/2019] [Accepted: 05/03/2019] [Indexed: 11/07/2022]
Abstract
Clenbuterol is known to improve competition resistance and muscular growth in athletes. Although it is an illegal drug, its use by farmers is widely spread to induce growth of their cattle. Thus, when clenbuterol is found in the urine of an athlete, there is doubt whether it was consumed with doping purposes or if it is due to the consumption of meat from a clenbuterol-fed animal. Previous studies suggest that enantiomeric relationship of clenbuterol may be different according to the intake source. However, the enantiomeric relationship throughout a doping cycle or a continuous intake of contaminated meat has not yet been explored. In this first approximation, our aim was the development and validation of a sensitive and rapid method for the determination of S- (+) and R- (─) clenbuterol enantiomers to be used in a controlled study in rats fed for one week with contaminated meat or simulating a doping cycle. Enantiomers were measured using liquid chromatography coupled to mass spectrometry with a triple quadrupole analyzer (LC-TQ-MS) and were separated on an AGP Chiralpak column. The method was fully validated following the VICH (Veterinary International Conference on Harmonization guidelines) and was linear in the range of 12.5-800 pg/mL with a correlation coefficient of ≥0.98 for each enantiomer, and with a limit of quantitation and detection (LOQ and LOD) of 12.5 pg/mL and 6.5 pg/mL, respectively, for both enantiomers. The application of this method pointed out the shift of the enantiomeric relationship in urine from rats during the first five days of the doping cycle compared to those fed with contaminated meat. This finding can be of substantial importance in further doping studies.
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Affiliation(s)
- Hernández Mariana Dolores
- Laboratory of Pharmaceutical Development Tests, Multidisciplinary Research Unit, Faculty of Higher Education Cuautitlán, National Autonomous University of Mexico, Cuautitlán Izcalli, Mexico state
| | - Alma Villaseñor
- Institute of Applied Molecular Medicine, Faculty of Medicine, San Pablo CEU University, Madrid, Spain
| | - Olmos Sofia Piña
- Laboratory of Cellular Toxicology, Multidisciplinary Research Unit, National Autonomous University of Mexico, Cuautitlán Izcalli, Mexico state
| | - Crisóforo Mercado Márquez
- Multidisciplinary Research Unit, National Autonomous University of Mexico, Cuautitlán Izcalli, Mexico State, Mexico
| | - Benjamín Velasco Bejarano
- Department of Chemical Sciences, Section of Organic Chemistry, National Autonomous University of Mexico, Cuautitlán Izcalli, State of Mexico, Mexico
| | - María Eugenia Gonsebatt Bonaparte
- Genomic Medicine and Environmental Toxicology Research, Biomedical Institute, National Autonomous University of Mexico, University Exterior Circuit, Mexico City, Mexico
| | - Raquel López-Arellano
- Laboratory of Pharmaceutical Development Tests, Multidisciplinary Research Unit, Faculty of Higher Education Cuautitlán, National Autonomous University of Mexico, Cuautitlán Izcalli, Mexico state
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Moreira FX, Carmo H, Melo A, André MB, Silva R, Azevedo Z, Bastos ML, de Pinho PG. The Use of Feathers from Racing Pigeons for Doping Control Purposes. J Anal Toxicol 2018; 43:307-315. [DOI: 10.1093/jat/bky088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 09/11/2018] [Accepted: 10/22/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Fernando X Moreira
- REQUIMTE/UCIBIO, Laboratório de Toxicologia, Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, R. Jorge de Viterbo Ferreira 228, Porto, Portugal
- Departamento de Medicina Legal e Ciências Forenses, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, Porto, Portugal
| | - Helena Carmo
- REQUIMTE/UCIBIO, Laboratório de Toxicologia, Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, R. Jorge de Viterbo Ferreira 228, Porto, Portugal
| | - Armindo Melo
- LAQV/REQUIMTE/ Departamento de Ciências Químicas, Laboratório de Bromatologia e Hidrologia, Faculdade de Farmácia, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, Porto, Portugal
- Departamento de Saúde Ambiental, Instituto Nacional de Saúde Doutor Ricardo Jorge, Rua Alexandre Herculano, 321, Porto, Portugal
| | - Maria B André
- REQUIMTE/UCIBIO, Laboratório de Toxicologia, Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, R. Jorge de Viterbo Ferreira 228, Porto, Portugal
| | - Renata Silva
- REQUIMTE/UCIBIO, Laboratório de Toxicologia, Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, R. Jorge de Viterbo Ferreira 228, Porto, Portugal
| | - Zélia Azevedo
- ICETA/REQUIMTE/LAQV – Laboratório Associado para a Química Verde, Faculdade de Ciências, Universidade do Porto, Rua do Campo Alegre, Porto, Portugal
| | - Maria L Bastos
- REQUIMTE/UCIBIO, Laboratório de Toxicologia, Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, R. Jorge de Viterbo Ferreira 228, Porto, Portugal
| | - Paula G de Pinho
- REQUIMTE/UCIBIO, Laboratório de Toxicologia, Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, R. Jorge de Viterbo Ferreira 228, Porto, Portugal
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Mladěnka P, Applová L, Patočka J, Costa VM, Remiao F, Pourová J, Mladěnka A, Karlíčková J, Jahodář L, Vopršalová M, Varner KJ, Štěrba M. Comprehensive review of cardiovascular toxicity of drugs and related agents. Med Res Rev 2018; 38:1332-1403. [PMID: 29315692 PMCID: PMC6033155 DOI: 10.1002/med.21476] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/20/2017] [Accepted: 11/16/2017] [Indexed: 12/12/2022]
Abstract
Cardiovascular diseases are a leading cause of morbidity and mortality in most developed countries of the world. Pharmaceuticals, illicit drugs, and toxins can significantly contribute to the overall cardiovascular burden and thus deserve attention. The present article is a systematic overview of drugs that may induce distinct cardiovascular toxicity. The compounds are classified into agents that have significant effects on the heart, blood vessels, or both. The mechanism(s) of toxic action are discussed and treatment modalities are briefly mentioned in relevant cases. Due to the large number of clinically relevant compounds discussed, this article could be of interest to a broad audience including pharmacologists and toxicologists, pharmacists, physicians, and medicinal chemists. Particular emphasis is given to clinically relevant topics including the cardiovascular toxicity of illicit sympathomimetic drugs (e.g., cocaine, amphetamines, cathinones), drugs that prolong the QT interval, antidysrhythmic drugs, digoxin and other cardioactive steroids, beta-blockers, calcium channel blockers, female hormones, nonsteroidal anti-inflammatory, and anticancer compounds encompassing anthracyclines and novel targeted therapy interfering with the HER2 or the vascular endothelial growth factor pathway.
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Affiliation(s)
- Přemysl Mladěnka
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Lenka Applová
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Jiří Patočka
- Department of Radiology and Toxicology, Faculty of Health and Social StudiesUniversity of South BohemiaČeské BudějoviceCzech Republic
- Biomedical Research CentreUniversity HospitalHradec KraloveCzech Republic
| | - Vera Marisa Costa
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of PharmacyUniversity of PortoPortoPortugal
| | - Fernando Remiao
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of PharmacyUniversity of PortoPortoPortugal
| | - Jana Pourová
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Aleš Mladěnka
- Oncogynaecologic Center, Department of Gynecology and ObstetricsUniversity HospitalOstravaCzech Republic
| | - Jana Karlíčková
- Department of Pharmaceutical Botany and Ecology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Luděk Jahodář
- Department of Pharmaceutical Botany and Ecology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Marie Vopršalová
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Kurt J. Varner
- Department of PharmacologyLouisiana State University Health Sciences CenterNew OrleansLAUSA
| | - Martin Štěrba
- Department of Pharmacology, Faculty of Medicine in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
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Guzzoni V, Cunha TS, das Neves VJ, Briet L, Costa R, Moura MJCS, Oliveira V, Franco MDCP, Novaes PD, Marcondes FK. Nandrolone combined with strenuous resistance training reduces vascular nitric oxide bioavailability and impairs endothelium-dependent vasodilation. Steroids 2018; 131:7-13. [PMID: 29317256 DOI: 10.1016/j.steroids.2017.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 12/11/2017] [Accepted: 12/20/2017] [Indexed: 01/04/2023]
Abstract
Anabolic Androgenic Steroids (AASs) misuse has increased among adolescents and recreational athletes due to their potential effects on muscle hypertrophy. On the other hand, AAS might induce alterations on cardiovascular system, although some controversies regarding AAS on vascular properties remain unknown. To address this question, we aimed to investigate the effects of high doses of nandrolone combined with strenuous resistance training (RT) on function and structure of thoracic aorta. Rats were randomized into four groups: non-trained vehicle (NTV), trained vehicle (TV), non-trained nandrolone (NTN), and trained nandrolone (TN), and submitted to 6 weeks of treatment with nandrolone (5 mg/kg, twice a week) and/or resistance training. In vitro response of thoracic aorta to acetylcholine (ACh) was analyzed. Vascular nitric oxide (NO) and reactive oxygen species (ROS) synthesis were evaluated using 4,5-diaminofluorescein diacetate (DAF-2) and hydroethidine fluorescent techniques, respectively. Thoracic aorta was processed for microscopy analyses and tunica media thickness was measured. ACh-mediated relaxation response was impaired in endothelium intact aortic rings isolated from trained rats (TV and TN) as compared with their matched non-trained groups. TN rats showed reduced ACh-mediated vasodilatation than NTN rats. NO production and bioavailability decreased in thoracic aorta of nandrolone-treated rats in relation to their matched non-trained group (NTN vs. NTV; TN vs. TV). ROS production and tunica media thickness were increased in TN rats when compared with TV rats. These findings indicate that high doses of nandrolone combined with strenuous RT affect NO bioavailability and might induce endothelial dysfunction and arterial morphological alterations.
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Affiliation(s)
- Vinicius Guzzoni
- Department of Oral Physiology, Piracicaba Dental School, University of Campinas - FOP/UNICAMP, Piracicaba, SP, Brazil
| | - Tatiana Sousa Cunha
- Science and Technology Institute, Federal University of São Paulo, São José dos Campos, Brazil
| | - Vander José das Neves
- Department of Oral Physiology, Piracicaba Dental School, University of Campinas - FOP/UNICAMP, Piracicaba, SP, Brazil
| | - Larissa Briet
- Department of Oral Physiology, Piracicaba Dental School, University of Campinas - FOP/UNICAMP, Piracicaba, SP, Brazil
| | - Rafaela Costa
- Department of Oral Physiology, Piracicaba Dental School, University of Campinas - FOP/UNICAMP, Piracicaba, SP, Brazil
| | | | - Vanessa Oliveira
- Nephrology Division, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | | | - Pedro Duarte Novaes
- Department of Oral Physiology, Piracicaba Dental School, University of Campinas - FOP/UNICAMP, Piracicaba, SP, Brazil
| | - Fernanda Klein Marcondes
- Department of Oral Physiology, Piracicaba Dental School, University of Campinas - FOP/UNICAMP, Piracicaba, SP, Brazil.
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Santos RP, Pereira A, Guedes H, Lourenço C, Azevedo J, Pinto P. Anabolic drugs and myocardial infarction - a clinical case report. Arq Bras Cardiol 2016; 105:316-9. [PMID: 26466073 PMCID: PMC4592181 DOI: 10.5935/abc.20150111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 01/12/2015] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rui Pontes Santos
- Serviço de Cardiologia, Centro Hospitalar Tâmega e Sousa, Penafiel, PT
| | - Adriana Pereira
- Serviço de Cardiologia, Centro Hospitalar Tâmega e Sousa, Penafiel, PT
| | - Henrique Guedes
- Serviço de Cardiologia, Centro Hospitalar Tâmega e Sousa, Penafiel, PT
| | - Carolina Lourenço
- Serviço de Cardiologia, Centro Hospitalar Tâmega e Sousa, Penafiel, PT
| | - João Azevedo
- Serviço de Cardiologia, Centro Hospitalar Tâmega e Sousa, Penafiel, PT
| | - Paula Pinto
- Serviço de Cardiologia, Centro Hospitalar Tâmega e Sousa, Penafiel, PT
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Börjesson A, Gårevik N, Dahl ML, Rane A, Ekström L. Recruitment to doping and help-seeking behavior of eight female AAS users. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:11. [PMID: 26945991 PMCID: PMC4779574 DOI: 10.1186/s13011-016-0056-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/02/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Doping with anabolic androgenic steroids in sports has now developed to a widespread use of these agents among young people outside the sport. This is of major concern to the society. The purpose of the use is mainly for aesthetic reasons and is seen as a male phenomenon. But use also occurs in women where the knowledge is scarce. Our aim was to identify the pattern of doping agents in eight female cases and compare them with similar data from men. METHODS Eight female users were recruited through Anti-Doping Hot-Line, a national telephone counseling service on doping issues during the years 1998-2004. The use was confirmed with urine doping analysis at the Doping Laboratory. The characteristic of use, co-use of narcotics/other doping agents, exercise pattern, adverse-side effects, family history and reason to begin was evaluated. RESULTS The women used on average 1.9 different anabolic androgenic steroids and clenbuterol preparations. Ephedrine and growth hormone were co-used in five and one of the women, respectively. Three women reported co-use of narcotics (cannabis and cocaine). The average duration of anabolic agent use before contacting health care was 58 weeks (range 7-104). Side effects for anabolic androgenic steroids (n = 5) included voice changes, clitoral enlargement, body hair growth, whereas women using clenbuterol (n = 2) reported tachycardia and depression. All women except one had a man in close relationship encouraging them to begin with the doping agents. CONCLUSIONS The use of doping agents in our eight women was different from that in male users. The women used less doping agents and were more prone to contact the health care, at an earlier stage, probably due to the adverse effects. The co-use with ephedrine, growth hormone and cannabis appeared to be in the same range as in men. This is the first study showing that a man in close relationship may motivate a woman to use anabolic agents.
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Affiliation(s)
- Annica Börjesson
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
| | - Nina Gårevik
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
| | - Marja-Liisa Dahl
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
| | - Anders Rane
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
| | - Lena Ekström
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
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Grimmer NM, Gimbar RP, Bursua A, Patel M. Rhabdomyolysis Secondary to Clenbuterol Use and Exercise. J Emerg Med 2016; 50:e71-4. [DOI: 10.1016/j.jemermed.2015.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/11/2015] [Accepted: 09/04/2015] [Indexed: 12/18/2022]
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Quinley KE, Chen HY, Yang HS, Lynch KL, Olson KR. Clenbuterol causing non-ST-segment elevation myocardial infarction in a teenage female desiring to lose weight: case and brief literature review. Am J Emerg Med 2016; 34:1739.e5-7. [PMID: 26873408 DOI: 10.1016/j.ajem.2015.12.086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Kelly E Quinley
- Department of Emergency Medicine, Highland Hospital Alameda Health System, Oakland, CA 94602.
| | - Hsien-Yi Chen
- Department of Emergency Medicine, Chang-Gung Memorial Hospital, Taoyuan, Taiwan; San Francisco Division of California Poison Control System,San Francisco, CA.
| | - He S Yang
- Department of Laboratory Medicine, University of California San Francisco, 1001 Potrero Ave, NH2M16, San Francisco, CA 94110.
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California San Francisco, 1001 Potrero Ave, NH2M16, San Francisco, CA 94110.
| | - Kent R Olson
- San Francisco Division of the California Poison Control System, University of California San Francisco, San Francisco, CA 94143-1369.
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Bartus RT, Bétourné A, Basile A, Peterson BL, Glass J, Boulis NM. β2-Adrenoceptor agonists as novel, safe and potentially effective therapies for Amyotrophic lateral sclerosis (ALS). Neurobiol Dis 2015; 85:11-24. [PMID: 26459114 DOI: 10.1016/j.nbd.2015.10.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/25/2015] [Accepted: 10/08/2015] [Indexed: 02/04/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a chronic and progressive neuromuscular disease for which no cure exists and better treatment options are desperately needed. We hypothesize that currently approved β2-adrenoceptor agonists may effectively treat the symptoms and possibly slow the progression of ALS. Although β2-agonists are primarily used to treat asthma, pharmacologic data from animal models of neuromuscular diseases suggest that these agents may have pharmacologic effects of benefit in treating ALS. These include inhibiting protein degradation, stimulating protein synthesis, inducing neurotrophic factor synthesis and release, positively modulating microglial and systemic immune function, maintaining the structural and functional integrity of motor endplates, and improving energy metabolism. Moreover, stimulation of β2-adrenoceptors can activate a range of downstream signaling events in many different cell types that could account for the diverse array of effects of these agents. The evidence supporting the possible therapeutic benefits of β2-agonists is briefly reviewed, followed by a more detailed review of clinical trials testing the efficacy of β-agonists in a variety of human neuromuscular maladies. The weight of evidence of the potential benefits from treating these diseases supports the hypothesis that β2-agonists may be efficacious in ALS. Finally, ways to monitor and manage the side effects that may arise with chronic administration of β2-agonists are evaluated. In sum, effective, safe and orally-active β2-agonists may provide a novel and convenient means to reduce the symptoms of ALS and possibly delay disease progression, affording a unique opportunity to repurpose these approved drugs for treating ALS, and rapidly transforming the management of this serious, unmet medical need.
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Affiliation(s)
| | | | | | | | - Jonathan Glass
- Dept Neurology and Emory ALS Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Nicholas M Boulis
- Dept Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
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Spiller HA, James KJ, Scholzen S, Borys DJ. A descriptive study of adverse events from clenbuterol misuse and abuse for weight loss and bodybuilding. Subst Abus 2014; 34:306-12. [PMID: 23844963 DOI: 10.1080/08897077.2013.772083] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Clenbuterol is a β2-agonist approved in the United States for veterinary use in nonfood animals. Clenbuterol use is emerging among bodybuilders and fitness enthusiasts attracted to the hypertrophic and lipolytic effects. CASES This was a retrospective chart review of clenbuterol exposures reported to 2 poison control centers. Misuse of clenbuterol for weight loss and bodybuilding was reported in 11 of 13 clenbuterol users. Reported clinical effects included tachycardia, widened pulse pressure, tachypnea, hypokalemia, hyperglycemia, ST changes on electrocardiogram (ECG), elevated troponin, elevated creatine phosphokinase (CPK), palpitations, chest pain, and tremor. Measured serum clenbuterol concentration was 2983 pg/mL post 4.5 mg ingestion. Co-ingestants included T3 and anabolic steroids. Treatments included activated charcoal, benzodiazepines, β-blockers, potassium replacement, and intravenous (IV) fluid. CONCLUSIONS There is an increasing use of the Internet for illicit drug use for bodybuilding and weight loss purposes. These patients may not present as the stereotype of illicit drug abusers, but as healthy athletic low-risk patients. Clinical effects persisted greater than 24 hours with evidence of myocardial injury in 2 patients. Clenbuterol is increasingly being abused within the bodybuilding subculture. These cases illustrate the hidden dangers of clenbuterol abuse among bodybuilders and fitness enthusiasts.
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Affiliation(s)
- Henry A Spiller
- Central Ohio Poison Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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19
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Brett J, Dawson AH, Brown JA. Clenbuterol toxicity: a NSW poisons information centre experience. Med J Aust 2014; 200:219-21. [PMID: 24580525 DOI: 10.5694/mja13.10982] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 10/01/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the epidemiology and toxicity of clenbuterol in exposures reported to the NSW Poisons Information Centre (NSWPIC). DESIGN AND SETTING Retrospective observational study analysing data from all calls about clenbuterol exposure recorded in the NSWPIC database from 1 January 2004 to 31 December 2012. The NSWPIC coversthe Australian jurisdictions New South Wales, Tasmania and the Australian Capital Territory 24 hours a day and provides after-hours cover for the rest of Australia for 7 nights each fortnight. MAIN OUTCOME MEASURES Total number of exposures, source of call (hospital, health care worker, member of the public), time from exposure to call, reasons for drug use, clinical features and advice given. RESULTS Callers reported 63 exposures to clenbuterol, with a dramatic increase from three in 2008 to 27 in 2012. Of the 63 calls, 35 were from hospital, two from paramedics, one from general practice and 21 direct from the public. At least 53 patients (84%) required hospitalisation. The commonest reasons for use were bodybuilding and slimming. The most common features were tachycardia (24 patients), gastrointestinal disturbance (16) and tremor (11). Exposure was also associated with cardiotoxicity including one cardiac arrest in a 21-year-old man. CONCLUSION Although a well recognised doping issue among elite athletes, clenbuterol use has spread out into the general public, especially during 2012, and should be considered in patients using bodybuilding or slimming products who present with protracted sympathomimetic features. The potential for misuse of this substance requires reconsideration of its current poison schedule registration and its availability.
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Affiliation(s)
- Jonathan Brett
- Drug Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Andrew H Dawson
- NSW Poisons Information Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Jared A Brown
- NSW Poisons Information Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia
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20
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Hepworth‐Warren KL, Alcott CJ. Treatment and resolution of zilpaterol hydrochloride toxicity in a
Q
uarter
H
orse gelding. EQUINE VET EDUC 2013. [DOI: 10.1111/eve.12092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K. L. Hepworth‐Warren
- Lloyd Veterinary Medical CenterCollege of Veterinary MedicineIowa State University Ames Iowa USA
| | - C. J. Alcott
- Lloyd Veterinary Medical CenterCollege of Veterinary MedicineIowa State University Ames Iowa USA
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21
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22
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Myocardial Ischemia Associated with Clenbuterol Abuse: Report of Two Cases. J Emerg Med 2013; 44:444-9. [DOI: 10.1016/j.jemermed.2012.02.057] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 11/30/2011] [Accepted: 02/25/2012] [Indexed: 11/17/2022]
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23
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Drake S, Hansen L, Harris C, Lewis W, Miller E, Moranville B, Blyzka M, Bergen W, McKeever K, Hausman G, Dodson M. Effects of clenbuterol on horses. COMPARATIVE EXERCISE PHYSIOLOGY 2013. [DOI: 10.3920/cep13022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Clenbuterol was intended as a treatment for respiratory diseases in horses, but has been used in multiple species, including humans, for its repartitioning of fat to lean effects (free fatty acids are released from adipose tissue to be used by tissues of higher priority). In the horse industry clenbuterol application is restricted to the treatment of chronic obstructive pulmonary disease and reactive airway disease (heaves). Negative effects of clenbuterol exposure include a decrease in maximum oxygen intake and increased muscle fatigue upon exercise. As a result of these and other negative effects, clenbuterol remains strictly controlled by the US Food and Drug Administration.
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Affiliation(s)
- S.D. Drake
- Department of Animal Sciences, Washington State University, 139 Clark Hall, Pullman, WA 99164, USA
| | - L.E. Hansen
- Department of Animal Sciences, Washington State University, 139 Clark Hall, Pullman, WA 99164, USA
| | - C. Harris
- Department of Animal Sciences, Washington State University, 139 Clark Hall, Pullman, WA 99164, USA
| | - W.C. Lewis
- Department of Animal Sciences, Washington State University, 139 Clark Hall, Pullman, WA 99164, USA
| | - E. Miller
- Department of Animal Sciences, Washington State University, 139 Clark Hall, Pullman, WA 99164, USA
| | | | | | - W.G. Bergen
- Program in Cellular and Molecular Biosciences/Department of Animal Sciences, Auburn University, Auburn, AL 36849, USA
| | - K.H. McKeever
- Department of Animal Science, Rutgers the State University of New Jersey, New Brunswick, NJ 08901-8525, USA
| | - G.J. Hausman
- Department of Animal Science, University of Georgia, Athens, GA 30602-2771, USA
| | - M.V. Dodson
- Department of Animal Sciences, Washington State University, 139 Clark Hall, Pullman, WA 99164, USA
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Levine M, Brooks DE, Truitt CA, Wolk BJ, Boyer EW, Ruha AM. Toxicology in the ICU. Chest 2011; 140:795-806. [DOI: 10.1378/chest.10-2548] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Hoffman JR, Kraemer WJ, Bhasin S, Storer T, Ratamess NA, Haff GG, Willoughby DS, Rogol AD. Position stand on androgen and human growth hormone use. J Strength Cond Res 2009; 23:S1-S59. [PMID: 19620932 DOI: 10.1519/jsc.0b013e31819df2e6] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hoffman, JR, Kraemer, WJ, Bhasin, S, Storer, T, Ratamess, NA, Haff, GG, Willoughby, DS, and Rogol, AD. Position stand on Androgen and human growth hormone use. J Strength Cond Res 23(5): S1-S59, 2009-Perceived yet often misunderstood demands of a sport, overt benefits of anabolic drugs, and the inability to be offered any effective alternatives has fueled anabolic drug abuse despite any consequences. Motivational interactions with many situational demands including the desire for improved body image, sport performance, physical function, and body size influence and fuel such negative decisions. Positive countermeasures to deter the abuse of anabolic drugs are complex and yet unclear. Furthermore, anabolic drugs work and the optimized training and nutritional programs needed to cut into the magnitude of improvement mediated by drug abuse require more work, dedication, and preparation on the part of both athletes and coaches alike. Few shortcuts are available to the athlete who desires to train naturally. Historically, the NSCA has placed an emphasis on education to help athletes, coaches, and strength and conditioning professionals become more knowledgeable, highly skilled, and technically trained in their approach to exercise program design and implementation. Optimizing nutritional strategies are a vital interface to help cope with exercise and sport demands (). In addition, research-based supplements will also have to be acknowledged as a strategic set of tools (e.g., protein supplements before and after resistance exercise workout) that can be used in conjunction with optimized nutrition to allow more effective adaptation and recovery from exercise. Resistance exercise is the most effective anabolic form of exercise, and over the past 20 years, the research base for resistance exercise has just started to develop to a significant volume of work to help in the decision-making process in program design (). The interface with nutritional strategies has been less studied, yet may yield even greater benefits to the individual athlete in their attempt to train naturally. Nevertheless, these are the 2 domains that require the most attention when trying to optimize the physical adaptations to exercise training without drug use.Recent surveys indicate that the prevalence of androgen use among adolescents has decreased over the past 10-15 years (). The decrease in androgen use among these students may be attributed to several factors related to education and viable alternatives (i.e., sport supplements) to substitute for illegal drug use. Although success has been achieved in using peer pressure to educate high school athletes on behaviors designed to reduce the intent to use androgens (), it has not had the far-reaching effect desired. It would appear that using the people who have the greatest influence on adolescents (coaches and teachers) be the primary focus of the educational program. It becomes imperative that coaches provide realistic training goals for their athletes and understand the difference between normal physiological adaptation to training or that is pharmaceutically enhanced. Only through a stringent coaching certification program will academic institutions be ensured that coaches that they hire will have the minimal knowledge to provide support to their athletes in helping them make the correct choices regarding sport supplements and performance-enhancing drugs.The NSCA rejects the use of androgens and hGH or any performance-enhancing drugs on the basis of ethics, the ideals of fair play in competition, and concerns for the athlete's health. The NSCA has based this position stand on a critical analysis of the scientific literature evaluating the effects of androgens and human growth hormone on human physiology and performance. The use of anabolic drugs to enhance athletic performance has become a major concern for professional sport organizations, sport governing bodies, and the federal government. It is the belief of the NSCA that through education and research we can mitigate the abuse of androgens and hGH by athletes. Due to the diversity of testosterone-related drugs and molecules, the term androgens is believed to be a more appropriate term for anabolic steroids.
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Affiliation(s)
- Jay R Hoffman
- Department of Health and Exercise Science, The College of New Jersey, Ewing, 08628, USA.
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26
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Ryall JG, Lynch GS. The potential and the pitfalls of β-adrenoceptor agonists for the management of skeletal muscle wasting. Pharmacol Ther 2008; 120:219-32. [DOI: 10.1016/j.pharmthera.2008.06.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 06/04/2008] [Indexed: 01/08/2023]
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27
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Dimaano JQ, Burda AM, Korah JE, Wahl M. Street Drugs Possibly Tainted With Clenbuterol. J Emerg Nurs 2008; 34:582-3. [DOI: 10.1016/j.jen.2008.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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A Descriptive Study of an Outbreak of Clenbuterol-Containing Heroin. Ann Emerg Med 2008; 52:548-53. [DOI: 10.1016/j.annemergmed.2008.04.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2007] [Revised: 03/16/2008] [Accepted: 04/22/2008] [Indexed: 11/20/2022]
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Ramos BP, Colgan LA, Nou E, Arnsten AF. Beta2 adrenergic agonist, clenbuterol, enhances working memory performance in aging animals. Neurobiol Aging 2008; 29:1060-9. [PMID: 17363115 PMCID: PMC3154024 DOI: 10.1016/j.neurobiolaging.2007.02.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2006] [Revised: 01/29/2007] [Accepted: 02/05/2007] [Indexed: 11/29/2022]
Abstract
Previous studies using a mixed beta1 and beta2 adrenergic antagonist, propanolol, have indicated that beta adrenoceptors have little effect on the cognitive functioning of the prefrontal cortex. However, recent studies have suggested that endogenous stimulation of beta1 adrenoceptors impairs working memory in both rats and monkeys. Since propanolol has no effect on cognition, we hypothesized that activation of beta2 adrenoceptors might improve performance in a working memory task. We tested this hypothesis by observing the effects of the beta2 agonist, clenbuterol, on spatial working memory performance. Clenbuterol was either infused directly into the prefrontal cortex (rats) or administered systemically (monkeys). Results demonstrated that clenbuterol improved performance in many young and aged rats and monkeys who performed poorly under control conditions. Actions at beta2 adrenoceptors were confirmed by challenging the clenbuterol response with the beta2 adrenergic antagonist, ICI 118,551. The effects of clenbuterol were not universal and depended on the cognitive status of the animal: the drug moderately improved only a subset of animals with working memory impairment.
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Affiliation(s)
- Brian P. Ramos
- Yale University School of Medicine, Department of Neurobiology, SHM C-300, 333 Cedar Street, New Haven, CT 06510, USA
| | - Leslie A. Colgan
- Yale University School of Medicine, Department of Neurobiology, SHM C-300, 333 Cedar Street, New Haven, CT 06510, USA
| | - Eric Nou
- Yale University School of Medicine, Department of Neurobiology, SHM C-300, 333 Cedar Street, New Haven, CT 06510, USA
| | - Amy F.T. Arnsten
- Yale University School of Medicine, Department of Neurobiology, SHM C-300, 333 Cedar Street, New Haven, CT 06510, USA
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30
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Lynch GS, Ryall JG. Role of beta-adrenoceptor signaling in skeletal muscle: implications for muscle wasting and disease. Physiol Rev 2008; 88:729-67. [PMID: 18391178 DOI: 10.1152/physrev.00028.2007] [Citation(s) in RCA: 295] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The importance of beta-adrenergic signaling in the heart has been well documented, but it is only more recently that we have begun to understand the importance of this signaling pathway in skeletal muscle. There is considerable evidence regarding the stimulation of the beta-adrenergic system with beta-adrenoceptor agonists (beta-agonists). Although traditionally used for treating bronchospasm, it became apparent that some beta-agonists could increase skeletal muscle mass and decrease body fat. These so-called "repartitioning effects" proved desirable for the livestock industry trying to improve feed efficiency and meat quality. Studying beta-agonist effects on skeletal muscle has identified potential therapeutic applications for muscle wasting conditions such as sarcopenia, cancer cachexia, denervation, and neuromuscular diseases, aiming to attenuate (or potentially reverse) the muscle wasting and associated muscle weakness, and to enhance muscle growth and repair after injury. Some undesirable cardiovascular side effects of beta-agonists have so far limited their therapeutic potential. This review describes the physiological significance of beta-adrenergic signaling in skeletal muscle and examines the effects of beta-agonists on skeletal muscle structure and function. In addition, we examine the proposed beneficial effects of beta-agonist administration on skeletal muscle along with some of the less desirable cardiovascular effects. Understanding beta-adrenergic signaling in skeletal muscle is important for identifying new therapeutic targets and identifying novel approaches to attenuate the muscle wasting concomitant with many diseases.
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Affiliation(s)
- Gordon S Lynch
- Basic and Clinical Myology Laboratory, Department of Physiology, The University of Melbourne, Victoria, Australia.
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31
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32
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Schechter E, Hoffman RS, Stajic M, McGee MP, Cuevas S, Tarabar A. Pulmonary edema and respiratory failure associated with clenbuterol exposure. Am J Emerg Med 2007; 25:735.e1-3. [PMID: 17606110 DOI: 10.1016/j.ajem.2006.12.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2006] [Accepted: 12/24/2006] [Indexed: 11/29/2022] Open
Affiliation(s)
- Elissa Schechter
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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33
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Guilbeau-Frugier C, Rambaud C, Dedouit F, Telmon N, Rougé D, Delisle MB. [Interest of post mortem analysis in diagnosis and etiopathogeny of ischemic myocardial infarction]. Ann Pathol 2007; 26:427-34. [PMID: 17255902 DOI: 10.1016/s0242-6498(06)70751-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The discovery of an ischaemic myocardial infarction during forensic or scientific autopsy is sometimes surprising when found in a young subject. It is therefore important to find out the etiology of vascular lesions to take preventive measures in the family. In post mortem, some complementary analysis can be performed to determine the diagnosis of ischaemic myocardial infarction and its etiopathogeny. Such analyses, routinely made in forensic practice, are rarely used by pathologists during scientific autopsy. Some biological mediums are stable enough to be used for biological, biochemical and even genetical analyses. We will study the different post mortem analyses, and see their interest and reliability.
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Affiliation(s)
- Céline Guilbeau-Frugier
- Service d'Anatomie Pathologique, CHU Rangueil, Av du Professeur J. Poulhès, 31059 Toulouse cedex 9.
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Burniston JG, Tan LB, Goldspink DF. Relative myotoxic and haemodynamic effects of the beta-agonists fenoterol and clenbuterol measured in conscious unrestrained rats. Exp Physiol 2006; 91:1041-9. [PMID: 16973691 PMCID: PMC1828613 DOI: 10.1113/expphysiol.2006.035014] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The beta(2)-adrenoceptor (beta(2)-AR) agonists clenbuterol and fenoterol have similar beneficial effects in animal models of heart failure. However, large doses of clenbuterol can induce cardiomyocyte death, and it is not known which of these agents has the most favourable therapeutic profile. We have investigated the cardiotoxicity of clenbuterol and fenoterol alongside that of isoprenaline, and compared their haemodynamic effects. Wistar rats (n = 6 per group) were subcutaneously injected with each beta-agonist (0.003-3 mmol kg(-1)) or saline, and cardiomyocyte apoptosis was detected by caspase 3 immunohistochemistry. In a separate experiment, rats (n = 4) were given equivalent doses to those used in the myotoxicity studies, in a randomized cross-over design, and their blood pressure recorded via radiotelemetry. Injection of 0.3 mmol kg(-1) fenoterol or isoprenaline, but not clenbuterol, induced significant cardiomyocyte apoptosis (0.4 +/- 0.05%; P < 0.05). At 3 mmol kg(-1), all agonists induced apoptosis (fenoterol, 1.1 +/- 0.1%; isoprenaline, 0.9 +/- 0.8%; and clenbuterol, 0.4 +/- 0.07%; P < 0.05). beta(1)-Adrenoceptor antagonism (10 mg kg(-1) bisoprolol) prevented 92% (P < 0.05) of apoptosis induced by all three agonists, but clenbuterol-induced apoptosis could also be prevented by 96% (P < 0.05) by beta(2)-AR antagonism (10 mg kg(-1) ICI 118 551). Clenbuterol decreased diastolic (1.3- to 1.6-fold; P < 0.05) and systolic blood pressure (1.3-fold; P < 0.05), and doses > 0.3 mmol kg(-1) increased heart rate (1.4-fold; P < 0.05). Fenoterol increased heart rate (1.2- to 1.4-fold; P < 0.05), and doses > 0.3 mmol kg(-1) decreased diastolic blood pressure (1.3-fold; P < 0.05). In conclusion, the cardiotoxicity of fenoterol was similar to isoprenaline and greater than clenbuterol, and fenoterol had less desirable haemodynamic effects.
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Affiliation(s)
- Jatin G Burniston
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Webster Street, Liverpool L3 2ET, UK.
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