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Goodrum JM, Moore C, Crouch AK, Eichner D, Miller GD. Influence of multiple human chorionic gonadotropin administrations on serum and urinary steroid Athlete Biological Passport profiles in males. Drug Test Anal 2023; 15:1371-1381. [PMID: 37749856 DOI: 10.1002/dta.3579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/27/2023]
Abstract
The Athlete Biological Passport (ABP) is a longitudinal tool used in anti-doping to monitor biological parameters known to change with performance-enhancing drug use. The ABP consists of multiple modules, including two aimed at detecting the use of endogenous anabolic androgenic steroids: the urinary and serum steroid modules. Human chorionic gonadotropin (hCG) is a protein hormone potentially abused by male athletes to increase the production of endogenous testosterone. To date, no studies have investigated the impact of extended hCG administration on the urinary and serum steroid modules of the ABP. The goal of this study was to identify the impact of multiple hCG administrations on the parameters tracked as part of the urinary and serum steroid modules of the ABP. Ten recreationally active, healthy male individuals self-administered seven 250 μg hCG injections over 3 weeks. Serum and urine samples were collected before, during, and 2 weeks following the final injection. All ABP parameters were quantified in the respective matrix, and steroid profiles were created with Anti-Doping Administration and Management System adaptive model upper and lower limits for both matrices. In both serum and urine profiles, testosterone increased; however, the testosterone/epitestosterone ratio in urine and the testosterone/androstenedione ratio in serum showed minimal changes. Additionally, serum luteinizing hormone (LH) was quantified using an immunoassay, and a serum testosterone/LH ratio was generated. Serum LH values decreased during administration causing large increases in the serum T/LH ratio, indicating this ratio may be a more sensitive parameter for detecting hCG abuse than urinary testosterone/epitestosterone or serum testosterone/androstenedione.
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Affiliation(s)
- Jenna M Goodrum
- Sports Medicine Research and Testing Laboratory, South Jordan, Utah, USA
| | - Chad Moore
- Sports Medicine Research and Testing Laboratory, South Jordan, Utah, USA
| | - Andre K Crouch
- Sports Medicine Research and Testing Laboratory, South Jordan, Utah, USA
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory, South Jordan, Utah, USA
| | - Geoffrey D Miller
- Sports Medicine Research and Testing Laboratory, South Jordan, Utah, USA
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Goodrum JM, Nair VS, Moore C, Crouch AK, Eichner D, Miller GD. Impact of Biotin Supplementation on Human Chorionic Gonadotropin Immunoassays Utilizing Biotin-Streptavidin Binding Methods in Urine. Clin Chem 2023:7186580. [PMID: 37253044 DOI: 10.1093/clinchem/hvad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/01/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Human chorionic gonadotropin (hCG) detection is indicative of pregnancy and can be indicative of some forms of cancerous tumors. The hCG drug itself, however, is a performance enhancing substance used by male athletes to increase testosterone production. Antidoping testing for hCG is conducted in urine, often on immunoanalyzer platforms, many of which utilize biotin-streptavidin dependent immunoassays in which the presence of biotin in samples is a known confounding factor. While biotin interference in serum has been well-studied, the extent of biotin interference in urine has not. METHODS Ten active male individuals underwent a 2-week hCG administration protocol concurrent with supplementation with biotin (20 mg/day) or placebo. Urine and serum samples were collected throughout the study and analyzed for hCG and biotin concentrations. RESULTS Urinary biotin levels in the hCG + biotin group increased 500-fold over baseline and 29-fold over corresponding serum biotin levels after biotin supplementation. When using a biotin-dependent immunoassay, the hCG + placebo group produced hCG-positive results (hCG ≥ 5 mIU/mL) in 71% of urine samples, while the hCG + biotin group produced positive results in only 19% of samples. Both groups had elevated hCG values in serum measurements by a biotin-dependent immunoassay and in urine when using a biotin-independent immunoassay. Urinary hCG measurements and biotin levels from the hCG + biotin group showed a negative correlation (Spearman r = -0.46, P < 0.0001) when measured using a biotin-dependent immunoassay. CONCLUSIONS Biotin supplementation can severely suppress urinary hCG values in assays utilizing biotin-streptavidin binding methods and therefore these types of assays are not recommended for use in urine samples containing high levels of biotin. Clinicaltrials.gov Registration Number: NCT05450900.
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Affiliation(s)
- Jenna M Goodrum
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT, United States
| | - Vinod S Nair
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT, United States
| | - Chad Moore
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT, United States
| | - Andre K Crouch
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT, United States
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT, United States
| | - Geoffrey D Miller
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT, United States
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Miller GD, Husk J, Crouch AK, Eichner D. EPO AND THE ATHLETE BIOLOGICAL PASSPORT: HEMATOLOGICAL RESULTS FROM A PLACEBO‐CONTROLLED, BOOSTING AND MICRODOSE EPO ADMINISTRATION IN MALE RECREATIONAL ATHLETES. Drug Test Anal 2022; 14:1962-1973. [DOI: 10.1002/dta.3370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jacob Husk
- Sports Medicine Research and Testing Laboratory Salt Lake City UT USA
| | - Andre K. Crouch
- Sports Medicine Research and Testing Laboratory Salt Lake City UT USA
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory Salt Lake City UT USA
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Marchand A, Miller G, Martin L, Gobbo C, Crouch AK, Eichner D, Ericsson M. Detection of erythropoiesis stimulating agent Luspatercept after administration to healthy volunteers for antidoping purposes. Drug Test Anal 2022; 14:1952-1961. [PMID: 35789123 PMCID: PMC10084338 DOI: 10.1002/dta.3341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 01/02/2023]
Abstract
Luspatercept (Reblozyl®) is a newly approved anti-anemic drug prohibited by the World Anti-Doping Agency. It promotes erythropoiesis by limiting apoptosis of immature erythroblasts and the risk of misuse by athletes for doping is high. Proposed detection methods have been published recently but only evaluated in vitro. The objective of this study was to perform the first administration of luspatercept in healthy volunteers for antidoping purpose and to evaluate the detectability in serum, dried capillary blood spots (DBS, collected using TASSO M20 device), and urine. Indirect detection was also evaluated by analyzing hematological parameters for the Athlete Biological Passport. Four volunteers (two males, two females) received one subtherapeutic dose of luspatercept (0.25 mg/kg) followed 3 weeks after by a second dose. Samples were collected from before administration until 7 weeks after the second dose. After immunopurification, electrophoretic separation SDS-/SAR-/IEF- polyacrylamide gel electrophoresis (PAGE), and immunodetection, luspatercept was detected at high levels in serum until the end of the collection, sign of a very slow elimination and similarly detected unchanged at lower levels in urine from 2 days after the first administration until 7 weeks postadministration. DBS showed also the same long window of detection. Luspatercept effects were however of limited amplitude on hematological markers, and only two subjects presented atypical points outside the physiological limits during the study. The direct detection method was very efficient, and change of electrophoretic method and detection antibody can be used for confirmation of suspicious samples.
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Affiliation(s)
- Alexandre Marchand
- Laboratoire Antidopage Français (LADF), Université Paris-Saclay, Châtenay-Malabry, France
| | - Geoff Miller
- Sports Medicine Research and Testing Laboratory (SMRTL), South Jordan, Utah, USA
| | - Laurent Martin
- Laboratoire Antidopage Français (LADF), Université Paris-Saclay, Châtenay-Malabry, France
| | - Coralie Gobbo
- Laboratoire Antidopage Français (LADF), Université Paris-Saclay, Châtenay-Malabry, France
| | - Andre K Crouch
- Sports Medicine Research and Testing Laboratory (SMRTL), South Jordan, Utah, USA
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory (SMRTL), South Jordan, Utah, USA
| | - Magnus Ericsson
- Laboratoire Antidopage Français (LADF), Université Paris-Saclay, Châtenay-Malabry, France
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Miller GD, Husk J, Crouch AK, Eichner D. Growth hormone isoform testing in capillary dried blood spots: results from single and multiple dose administration studies and large‐scale field collections. Drug Test Anal 2022; 14:1255-1263. [DOI: 10.1002/dta.3248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | - Jacob Husk
- Sports Medicine Research and Testing Laboratory Salt Lake City UT USA
| | - Andre K. Crouch
- Sports Medicine Research and Testing Laboratory Salt Lake City UT USA
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory Salt Lake City UT USA
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Cox HD, Miller GD, Manandhar A, Husk JD, Crouch AK, Eichner D. Tracking immature reticulocyte proteins for improved detection of recombinant human erythropoietin (rhEPO) abuse. Am J Hematol 2021; 96:1621-1629. [PMID: 34626008 DOI: 10.1002/ajh.26368] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/12/2022]
Abstract
Athletes abuse recombinant human erythropoietin (rhEPO) and erythropoiesis stimulating agents to increase hemoglobin mass and improve performance. To evade detection, athletes have developed sophisticated blood doping regimens, which often include rhEPO micro-dosing. Detection of these methods requires biomarkers with increased sensitivity and a sample matrix that is more amenable to frequent testing in the field. We have developed a method to measure two immature reticulocyte proteins, CD71 and ferrochelatase (FECH), and one total erythrocyte protein, Band 3, in dried blood spots (DBS). This method was tested in response to rhEPO administration after low doses, 40 IU/kg, micro-doses, 900 IU, or saline injection in 20 healthy subjects. During administration of low-dose rhEPO, the mean CD71/Band 3 and FECH/Band 3 ratio increased by 412 ± 197% and 250 ± 44%, respectively. The mean response for the current biomarker, RET%, increased by 195 ± 35%. During administration of rhEPO micro-doses, CD71/Band 3 increased to 127 ± 25% on day 35 and 139 ± 36% on day 39, while no increase was observed in RET%. After rhEPO administration, during the washout phase, mean values decreased to a minimum of 64 ± 4% and 64 ± 11% for CD71/Band 3 and RET%, respectively. However, CD71/Band 3 remained below 75% of baseline for at least 4 weeks after rhEPO injection, while RET% returned to baseline levels. The results demonstrate that immature reticulocyte proteins have a larger response to rhEPO administration than the current biomarker, RET%, and can be monitored in the DBS matrix.
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Affiliation(s)
- Holly D. Cox
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
| | | | | | - Jacob D. Husk
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
| | - Andre K. Crouch
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
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Nair VS, Doman CE, Morrison MS, Miller GD, Husk J, Eenoo P, Crouch AK, Eichner D. Evaluation of epiandrosterone as a long‐term marker of testosterone use. Drug Test Anal 2020; 12:1554-1560. [DOI: 10.1002/dta.2903] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Vinod S. Nair
- Sports Medicine Research and Testing Laboratory, South Jordan UT USA
| | | | | | | | - Jacob Husk
- Sports Medicine Research and Testing Laboratory, South Jordan UT USA
| | - Peter Eenoo
- DoCoLab, Department of Chemical Biology, Microbiology and Immunology Ghent University Ghent Belgium
| | - Andre K. 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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McIntosh SE, Crouch AK, Dorais A, McDevitt M, Wilson C, Harmston CH, Radwin MI, Grissom CK. Effect of head and face insulation on cooling rate during snow burial. Wilderness Environ Med 2014; 26:21-8. [PMID: 25281588 DOI: 10.1016/j.wem.2014.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/19/2014] [Accepted: 07/08/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Avalanche victims are subjected to a number of physiological stressors during burial. We simulated avalanche burial to monitor physiological data and determine whether wearing head and face insulation slows cooling rate during snow burial. In addition, we sought to compare 3 different types of temperature measurement methods. METHODS Nine subjects underwent 2 burials each, 1 with head and face insulation and 1 without. Burials consisted of a 60-minute burial phase followed by a 60-minute rewarming phase. Temperature was measured via 3 methods: esophageal probe, ingestible capsule, and rectal probe. RESULTS Cooling and rewarming rates were not statistically different between the 2 testing conditions when measured by the 3 measurement methods. All temperature measurement methods correlated significantly. CONCLUSIONS Head and face insulation did not protect the simulated avalanche victim from faster cooling or rewarming. Because the 3 temperature measurement methods correlated, the ingestible capsule may provide an advantageous noninvasive method for snow burial and future hypothermia studies if interruptions in data transmission can be minimized.
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Affiliation(s)
- Scott E McIntosh
- Division of Emergency Medicine, University of Utah Health Care, Salt Lake City, UT (Drs McIntosh and McDevitt).
| | - Andre K Crouch
- Department of Emergency Medicine, Intermountian Medical Center, Murray, UT (Drs Crouch and Dorais)
| | - Andrew Dorais
- Department of Emergency Medicine, Intermountian Medical Center, Murray, UT (Drs Crouch and Dorais)
| | - Marion McDevitt
- Division of Emergency Medicine, University of Utah Health Care, Salt Lake City, UT (Drs McIntosh and McDevitt)
| | - Courtney Wilson
- Department of Emergency Medicine, Rogue Regional Medical Center, Medford, OR (Dr Wilson)
| | | | | | - Colin K Grissom
- Shock Trauma ICU, Intermountain Medical Center, and Department of Medicine, University of Utah, Murray, UT (Dr Grissom)
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Crouch AK, Dawson M, Long D, Allred D, Madsen T. Perceived confidence in the FAST exam before and after an educational intervention in a developing country. Int J Emerg Med 2010; 3:49-52. [PMID: 20414382 PMCID: PMC2850974 DOI: 10.1007/s12245-009-0144-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 11/23/2009] [Indexed: 11/28/2022] Open
Abstract
Background Trauma care in developing countries suffers from many limitations related to equipment shortages, disrepair, quality assurance, and lack of training. Health care providers in the three principal hospitals in Cusco, Peru have ultrasound machines, but they do not utilize this for the focused assessment of sonography in trauma (FAST) scan (only one of the three hospitals has a computed tomography scanner). Aims The goal of this study was to assess the confidence of physicians in a developing country to conduct a FAST exam after an educational intervention. Methods Participants were Peruvian health care workers who attended a 2-day conference on trauma. Participants completed a questionnaire based on a 5-point Likert scale (1 = no confidence, 5 = high confidence) to assess comfort with the FAST scan before and after a FAST teaching workshop, which included hands-on ultrasound training. Thirteen individuals, eight of whom were physicians, completed the training and survey. Results were analyzed using paired t test statistics and are reported as pre- and post-training mean scores (± standard error), with p < 0.05 considered statistically significant. Results Participants rated their confidence in using the FAST exam on a trauma patient with an average score of 3.3 (± 0.3) pre-training and 4.5 (± 0.2) post-training (p = 0.007). When asked about their comfort level in making clinical decisions based on the FAST scan, pre-training average score was 3.5 (± 0.4) and post-training was 4.5 (± 0.2), p = 0.016. Participants also answered questions about their comfort with the technical aspects of using the ultrasound machine: ability to choose the correct probe (pre: 3.9, post: 4.6, p = 0.011), choosing the correct probe orientation (pre: 3.9, post: 4.6, p = 0.008), and adjusting the depth and gain (pre: 3.1, post: 4.4, p = 0.001). Finally, participants rated their comfort with the specific views of the FAST scan: ability to find the correct subcostal view (pre: 3.3, post: 4.9, p < 0.001), right upper quadrant view (pre: 3.2, post: 4.6, p < 0.001), left upper quadrant view (pre: 3.2, post: 4.4, p = 0.001), and the pelvic view (pre: 3.2, post: 4.5, p < 0.001). Conclusion After a training session in the use of ultrasound in trauma, health care workers in Cusco, Peru reported increased confidence in their FAST scan ability and in their comfort in using this exam for clinical decision-making. Future research should include objective testing of participants’ skill as well as longitudinal follow-up to determine the extent to which the FAST scan has been incorporated into participants’ evaluations of trauma patients.
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Affiliation(s)
- Andre K Crouch
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT 84132, USA
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