Caffeine and Theobromine Identifications in Post
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MEDICINE—EXERCISE Caffeine and Theobromine Identifications in Post- Race Urines: Threshold Levels and Regulatory Significance of Such Identifications Amit Budhraja, BVSc, AH; Fernanda C. Camargo, DVM, PhD; Charlie Hughes, BS, MS; Andreas F. Lehner, BS, MS, PhD; Kent Stirling, BBA; Noel Brennan, BSc; Mark Dowling, BSc; and Thomas Tobin, MVB, MSc, PhD, MRCVS, Diplomate ABT* Caffeine is a widespread environmental substance, and testing for caffeine is now highly sensi- tive. Currently, many authorities in North America are not concerned about plasma caffeine concentrations of Ͻ100 ng/ml, equivalent to ϳ300 ng/ml in urine. This is because such low caffeine concentrations are likely to be associated with environmental exposure to caffeine and are also unlikely to be associated with pharmacological responses. Authors’ addresses: Gradu- ate Center for Toxicology, Health Sciences Research Building, University of Kentucky, Lexington, KY 40536 (Budhraja); Maxwell Gluck Equine Research Center, Farm Lane and Nicholasville Road, University of Kentucky, Lexington, KY 40546 (Camargo, Hughes, Tobin); U.K. Livestock Disease Diagnostic Center, 1490 Bull Lea Road, Lexington, KY 40512 (Lehner); Florida Horse- men’s Benevolent and Protective Association, PO Box 1808 Calder race course, Opa-Locka, FL 33056 (Stirling); and Connolly’s Redmills, Goresbridge, Kilkenny, Ireland (Brennan, Dowling); e-mail: [email protected] (Tobin). © 2007 AAEP. *Presenting author. 1. Introduction In horses, caffeine is metabolized to theophylline, Caffeine and theobromine are commonly found in theobromine, and paraxanthine. These metabo- equine feeds and environments. They are well lites are excreted at high concentrations in equine absorbed and may appear at microgram concen- urine. Caffeine identifications in the absence of trations in equine blood and urine; enzyme-linked these metabolites suggest post-collection entry of immunosorbent assay (ELISA) tests can detect caffeine into the sample. low nanogram per milliliter (ppb) concentrations. Behavioral studies suggest that performance- Therefore, low-concentration identifications of caf- threshold plasma and urinary concentrations of caf- ϳ feine and theobromine are not unusual and are feine are 2000 and 10,000 ng/ml, respectively. most likely caused by environmental exposure or Regulatory thresholds or “cut-offs” for caffeine and feed. Between 2000 and 2006, ϳ67 caffeine “pos- theobromine are in place in a number of jurisdic- itives” were called in the United States, and 2 tions worldwide. For caffeine, reported “cut-offs” were called in Canada. vary from 10 ng/ml in plasma to 1000 ng/ml in urine. NOTES AAEP PROCEEDINGS ր Vol. 53 ր 2007 87 MEDICINE—EXERCISE Theobromine is both a metabolite of caffeine and a medication in its own right. Theobromine is also a common component of equine feed, and there is a long established international threshold of 2000 ng/ml in urine of theobromine, although this thresh- old may be relatively conservative. Theophylline is another metabolite of caffeine and a therapeutic medication in its own right. The Ca- nadian urinary “withdrawal time” for theophylline is 96 h after therapeutic administration. The equivalent urinary cut-off seems to be ϳ1000 ng/ml. 2. Background Caffeine is a central nervous-system stimulant and the most widely consumed psychoactive substance Fig. 1. Urinary concentrations of caffeine and its metabolites in the world. In humans, caffeine-containing bev- after administration of2gofcaffeine orally to a horse. Repro- erages, at a dose rate of ϳ80–200 mg per cup of duced with permission from the Canadian Pari-Mutuel Agency’s coffee1,2 (special coffee brands may contain higher Analytical Methodology for Detection and Confirmation of Drugs amounts), ward off drowsiness and restore alert- in Body Fluids, vol. 2. ness. Common human beverages containing caf- feine include coffee, tea, soft drinks, and especially, 1–3 “energy drinks.” Its actions are largely terminated by metabolism, and In nature, caffeine is a plant alkaloid that func- the decline of plasma concentrations follows simple tions as a natural pesticide against insect predators. first-order kinetics.1,3 In the horse, the plasma half- The most widely cultivated caffeine-containing life of caffeine is relatively long (ϳ19 h).4,5 plants are Coffea arabica (coffee), Camellia sinensis (tea), and to a lesser extent, Theobroma cacao (Co- Caffeine in the Horse coa). The primary source of caffeine is the coffee Caffeine, at doses of up to 2 g/day, seems to produce bean. The coffee plant is native to Africa. It was broadly similar pharmacological affects in horses first introduced to Europe in about 1600 A.D., and and humans. Orally administered caffeine is well the first cup of coffee consumed in England was in absorbed, and urinary concentrations peak at Balliol College, Oxford in 1637.1 Tea is another ϳ21,000 ng/ml at ϳ1 h post-administration; it then common source of caffeine. The tea plant is origi- declines to 1000 ng/ml at 96 h post-administration. nally native to Burma, reaching China by 300 A.D. Of considerable forensic significance, the concentra- and Japan by 1000 A.D.. In Europe, tea arrived as tions of its metabolites, paraxanthine, theophylline, a medicinal in 1500 A.D. and became a common and theobromine, are always higher than those of beverage by 1600 A.D. caffeine by 24 h after administration and at least Caffeine is now inextricably associated with hu- 10-fold higher at 96 h post-administration (Fig. 1).6 mans and can be found in many unexpected places. For example, bee pollen has been found to contain Caffeine and Its Metabolites in the Horse sufficient caffeine to trigger “positive” identifications Caffeine, a trimethylxanthine, is metabolized in the in racing dogs and horses in Florida in the 1990s. liver to yield three dimethylxanthines (Fig. 2), and each of these metabolites has a different spectrum of 3. General Pharmacology pharmacological effects on the body. Theophylline In humans, caffeine is a central nervous-system and (1,3-dimethylxanthine) is a bronchodilator; theobro- metabolic stimulant and is widely used to restore mine (3,7-dimethylxanthine) is a less potent di- mental alertness and alleviate physical fatigue. uretic, but there are no reports of significant Caffeine produces these effects by virtue of its pu- pharmacological activity for paraxanthine rine structure acting on some of the same receptors (1,7-dimethylxanthine). as adenosine-related nucleosides and nucleotides, such as the cell surface G protein-coupled receptors 4. Sensitivity of ELISA Testing for Caffeine, (GPCRs) as well as the intracellular ryanodine re- Theophylline, and Theobromine ceptor (RyR).1 Physiologically, however, caffeine’s Routine post-race testing for these agents is now action is unlikely to be caused by increased RyR highly sensitive. Commercially available ELISA opening, since this would likely require a lethal tests have an I-50 of about 10 ng/ml for caffeine; as plasma concentration of caffeine; as such, its effects such,a1mg/horse dose of caffeine has the potential are most likely due to its actions on adenosine to give rise to detectable (10 ng/ml) plasma and receptors. urinary concentrations of caffeine. The IC-50s (i.e., After oral administration, caffeine is rapidly and the concentrations for one-half maximal inhibition completely absorbed from the stomach and small of the tests) are caffeine at 10 ng/ml, theophylline at intestine and distributed to all tissues of the body. 7 ng/ml, and theobromine at 25 ng/ml (Figs. 3 and 88 2007 ր Vol. 53 ր AAEP PROCEEDINGS MEDICINE—EXERCISE Fig. 2. Chemical structures of caffeine and its metabo- lites. Note that caffeine has three methyl groups, and its me- tabolites have two methyl groups each. 4).7 Review of the urinary excretion concentrations of these agents after the administration of pharma- cologically effective doses shows that concentrations in the low g/ml range (1000 ng/ml) are readily Fig. 4. ELISA standard curves for theobromine in several attained urinary concentrations of these substances. equine matrixes, such as urine, plasma, and serum and also, in These findings give rise to the following general EIA buffer. The IC-50 represents the sensitivity of the test, guidelines with reference to caffeine. If the concen- which is ϳ20 ng/ml for serum and plasma and ϳ70 ng/ml for tration is Ͻ100 ng/ml in plasma or 300 ng/ml in equine urine. Adapted with permission from Neogen Corp. urine, the finding is pharmacologically ineffective and of no forensic interest; if the expected metabo- lites of caffeine, theophylline, theobromine, and parax- anthine are not present, then it is unlikely that the caffeine in question “passed through the horse.” Therefore, the caffeine identification is most likely caused by post-collection contamination, which is also the case if caffeine is not detectable in the blood. With respect to post-collection contamination, caf- feine may be present in unexpected places, including as a “binder” in pH test strips. In Australia ϳ20 yr ago, a laboratory was testing the pH of post-race urine samples by dipping pH strips into the urine samples, a violation of good laboratory procedure. The strips’ caffeine binder contaminated many sam- ples. This matter was eventually sorted out but not before a very large number of caffeine identifications were made and called in the absence of any metab- olite or blood-caffeine information.8 Finally, these data also show a considerable re- serve of detection sensitivity with regard to concen- trations of these agents likely to be found in association with pharmacological administrations. As such, there is a clear need for “limitations” on the sensitivity of testing for these agents, and indeed, the first international horse-racing “threshold” ever introduced was for theobromine in horse urine. Fig. 3. ELISA standard curves for caffeine in several equine 5. Theobromine matrixes, such as urine, plasma and serum and also, in EIA buffer. The IC-50 represents the sensitivity of the test, which is The caffeine metabolite theobromine is also a plant ϳ9–10 ng/ml for serum and plasma and ϳ10–20 ng/ml for equine alkaloid and a medication in its own right.