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Anabolic Agents: Recent Strategies for Their Detection and Protection from Inadvertent Doping Hans Geyer,1,2 Wilhelm Schänzer,1 Mario Thevis1,2

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Anabolic Agents: Recent Strategies for Their Detection and Protection from Inadvertent Doping Hans Geyer,1,2 Wilhelm Schänzer,1 Mario Thevis1,2 Review Br J Sports Med: first published as 10.1136/bjsports-2014-093526 on 14 March 2014. Downloaded from Anabolic agents: recent strategies for their detection and protection from inadvertent doping Hans Geyer,1,2 Wilhelm Schänzer,1 Mario Thevis1,2 1Institute of Biochemistry, ABSTRACT such as clenbuterol and selective androgen receptor Center for Preventive Doping According to the World Anti-Doping Agency (WADA) modulators (SARMs).2 Research, German Sport University Cologne, Cologne, Prohibited List, anabolic agents consist of exogenous Analytical challenges for the detection of the Germany anabolic androgenic steroids (AAS), endogenous AAS misuse of anabolic agents result from various differ- 2European Monitoring Center and other anabolic agents such as clenbuterol and ent facts, among which a few are of major concern. for Emerging Doping Agents selective androgen receptor modulators (SARMs). These include the growing problem of the adminis- (EuMoCEDA), Cologne/Bonn, Currently employed strategies for their improved tration of unapproved and/or new designer sub- Germany detection include the prolongation of the detection stances, the evidently increasing use of endogenous Correspondence to windows for exogenous AAS, non-targeted and indirect substances, the constantly decreasing concentrations Dr Hans Geyer, Institute of analytical approaches for the detection of modified of the analytes detected in positive doping control Biochemistry, Center for steroids (designer steroids), the athlete’s biological samples (most probably due to the use of micro- Preventive Doping Research, German Sport University passport and isotope ratio mass spectrometry for the doses or to an earlier cessation of the drug regimen Cologne, Am Sportpark detection of the misuse of endogenous AAS, as well as before doping controls are expected), and genetic Müngersdorf 6, Cologne preventive doping research for the detection of SARMs. polymorphisms that lead to different metabolic pat- 50933, Germany; h.geyer@ The recent use of these strategies led to 4–80-fold terns in the tested individuals. Besides, major pro- biochem.dshs-koeln.de increases of adverse analytical findings for exogenous blems in connection with anabolic agents arise ‘ ’ Accepted 20 February 2014 AAS, to the detection of the misuse of new designer from doping traps , which can lead to inadvertent Published Online First steroids, to adverse analytical findings of different doping cases. Candidates for such traps are, for 14 March 2014 endogenous AAS and to the first adverse analytical example, nutritional supplements adulterated with findings of SARMs. The strategies of the antidoping endogenous or exogenous AAS, food contaminated research are not only focused on the development of with clenbuterol and animal tissues used in trad- methods to catch the cheating athlete but also to itional medicine therapeutics that contain endogen- protect the clean athlete from inadvertent doping. Within ous AAS, etc. Here, the challenge obviously is to the past few years several sources of inadvertent doping identify such sources of inadvertent doping to be with anabolic agents have been identified. Among these able to warn and protect athletes. are nutritional supplements adulterated with AAS, meat Recent strategies to manage such challenges in products contaminated with clenbuterol, mycotoxin connection with anabolic agents are presented. (zearalenone) contamination leading to zeranol findings, and natural products containing endogenous AAS. The Prolongation of the detection window for http://bjsm.bmj.com/ protection strategy consists of further investigations in exogenous AAS case of reasonable suspicion of inadvertent doping, The detection of exogenous AAS is commonly publication of the results, education of athletes and based on the detection of their urinary phase-I and development of methods to differentiate between phase-II metabolites. Owing to the long lasting intentional and unintentional doping. effects of AAS on athletic performance, the recent strategy of antidoping research is mainly focused on the search for long-term metabolites (LTMs) of on October 2, 2021 by guest. Protected copyright. exogenous AAS. The implementation of LTMs into INTRODUCTION the analytical screening procedures allows the pro- Since years anabolic agents are the most frequently longation of the detection window and an detected doping substances in sports. This is also increased retrospectivity for AAS. In 1996 the first valid for 2012. Of 4500 adverse analytical and publications focused on LTMs of exogenous AAS atypical findings reported by the World were published.34 Anti-Doping Agency (WADA) accredited laborator- The prolongation of the detection windows is ies via the Anti-Doping Administration and not only due to the implementation of their LTMs Open Access Management System (ADAMS), about 50% are into sports drug testing but also to the use of Scan to access more 1 free content anabolic agents (figure 1). Anabolic agents are highly sensitive detection methods employing chro- detected in all sports1 and they are mainly misused matographic/mass spectrometric techniques (eg, because of their anabolic effects such as muscle LC-MS/MS, GC-MS/MS, HRMS) in screening pro- growth, increase of strength, accelerated recovery cedures. The most recent methods, which combine and anticatabolic effects under strenuous exercise. LTMs and new sophisticated mass spectrometric According to the WADA Prohibited List, anabolic methods are compiled in table 1. These strategies agents consist of exogenous anabolic androgenic of exploiting new analytical technologies and alter- To cite: Geyer H, steroids (AAS) including for instance stanozolol, native target compounds have led to an enormous Schänzer W, Thevis M. Br J metandienone, oxandrolone, etc, endogenous AAS increase of adverse analytical findings (AAFs) in the Sports Med 2014;48: such as testosterone, dehydroepiandrosterone, past. For instance, the implementation of the LTM – 820 826. androstenedione, etc and other anabolic agents for metandienone (18-nor-17β-hydroxymethyl, Geyer H, et al. Br J Sports Med 2014;48:820–826. doi:10.1136/bjsports-2014-093526 1 of 8 Review Br J Sports Med: first published as 10.1136/bjsports-2014-093526 on 14 March 2014. Downloaded from Figure 1 Adverse analytical findings and atypical findings of all World Anti-Doping Agency (WADA) accredited laboratories in 2012 reported via Anti-Doping Administration and Management System (ADAMS).1 17α-methyl-androst-1,4,13-trien-3-one) in the screening proced- one or two of these 82 cases would have been detected with the ure of the WADA accredited laboratory Cologne in 2006 methods used till the end of 2012 in the Cologne laboratory. resulted in an increase of AAFs with metandienone of more Another substantial increment in the number of AAFs was than 400% from approximately 12–15 AAFs in the years 2003– observed for the exogenous AAS stanozolol, also resulting from 2005 to 68 AAFs in 2006, although the number and origin of expanding the detection window for some of its metabolites (see the analysed samples was nearly constant (figure 2). As Cologne table 1). Here, the use of high-resolution/high-accuracy mass spec- was the first WADA accredited laboratory in the world to screen trometry was considered decisive, which allowed for the detection for this new metabolite, the number of AAFs for metandienone of the stanozolol metabolite 3´-hydroxystanozolol-O-glucuronide in Cologne in 2006 was higher than the sum of AAFs for in initial test methods at concentrations as low as 20 pg/mL; metandienone of all other WADA accredited laboratories.5 This moreover, a pattern of other established as well as new stanozolol effect of the implementation of new LTMs was even more pro- metabolites corroborated the findings, which included stanozolol- nounced with regard to the detection of AAFs for dehydro- N-glucuronide, stanozolol-O-glucuronide, 16β-hydroxystanozolol- chloromethyltestosterone. In January 2013, three new LTMs for O-glucuronide, and 4β-hydroxystanozolol-glucuronide and the dehydrochloromethyltestosterone were implemented in the new LTM 17-epistanozolol-N-glucuronide. This screening method screening procedures of the Cologne laboratory (see table 1). was implemented at the beginning of December 2012 in the This led to an increase of AAFs from an annual average number Cologne laboratory and led to an increase of AAFs for stanozolol of 1–82 cases in the first 11 months of 2013 (figure 3). Only from an annual average of about 23 cases to 182 cases from early http://bjsm.bmj.com/ Table 1 Recent methods for the prolonged detection of exogenous AAS by the combination of the implementation of LTMs in screening procedures and the use of sensitive mass spectrometric methods Exogenous AAS LTMs References on October 2, 2021 by guest. Protected copyright. Metandienone 18-nor-17β-hydroxymethyl,17α-methyl-androst-1,4,13-trien-3-one 10, 59, 60 18-nor-17β-hydroxymethyl,17α-methyl-androst-1,4,13-trien-3-one-sulfate Oxandrolone 17β-hydroxymethyl-17α-methyl-18-nor-2-oxa-5α-androsta-13-en-3-one 61 17α-hydroxymethyl-17β-methyl-18-nor-2-oxa-5α-androsta-13-en-3-one Oxymetholone 18-nor-2x, 17β-hydroxymethyl-17α-methyl-5α-androst-13-en-3α-ol 7 18-nor-17β-hydroxymethyl-17α-2x-methyl-5α-androst-13-en-3-one Desoxymethyltestosterone 18-nor-17,17-dimethyl-5α-androst-13-en-2x, 3α-diol 7 Dehydrochloromethyltestosterone 4-chloro-17-methyl-5β-androstane-3,16,17-triol 6 4-chloro-17-hydroxymethyl-17-methyl-18-nor-5β-androst-1,13-diene-3-ol 4-chloro-17-hydroxymethyl-17-methyl-18-nor-5β-androst-13-ene-3-ol
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