The occurrence of non-anatomical therapeutic chemical-international nonproprietary name molecules in suspected illegal or illegally traded health products in Europe: A retrospective and prospective study

Acteoside-Loaded Self-Healing Hydrogel Enhances Skin Wound Healing through Modulation of Hair Follicle Stem Cells

Background

Skin wound healing is a complex biological process involving cellular, molecular, and physiological events. Traditional treatments often fail to provide optimal outcomes, particularly for chronic wounds.

Objectives

This study aimed to develop a self-healing hydrogel loaded with Acteoside, a bioactive compound with antioxidant and anti-inflammatory properties, to enhance skin wound healing.

Methods

Using transcriptomic analysis, Rab31 was identified as a key target of Acteoside in regulating hair follicle stem cells (HFSCs). In vitro assays demonstrated that Acteoside promotes HFSC proliferation, migration, and differentiation by upregulating Rab31 expression. The self-healing hydrogel was prepared using quaternized chitosan derivatives, which exhibited excellent mechanical properties, antibacterial, and antioxidant activities.

Results

In vivo studies in a mouse model showed that Acteoside-loaded hydrogel significantly accelerated wound healing, promoting skin regeneration and improving wound closure.

Conclusions

This research highlights the potential of Acteoside-loaded self-healing hydrogels as an innovative therapeutic strategy for enhancing skin wound healing. By modulating HFSC activity, this hydrogel offers a promising solution for improving healing outcomes in challenging wound environments.

Graphical Abstract

Schematic representation of an injectable self-healing hydrogel loaded with the phenylethanoid compound acteoside for regulating the proliferation and differentiation of HFSCs to mediate the healing of skin wounds.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12195-025-00845-2.

Illegal and falsified medicines self-administrated in not approved post-cycle therapy after the cessation of anabolic-androgenic steroids - qualitative analysis

Background

The term post-cycle therapy (PCT) often appears in bodybuilding forums in the context of anabolic-androgenic steroids (AAS) cessation. To reduce the negative impact of AAS on the hormonal system, unapproved PCT is used, which consist of medications that help restore hormonal balance. The most used medicinal products are selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs), and preparations containing human chorionic gonadotropin (hCG). These substances are prohibited in sports by the World Anti-Doping Agency.

Methods

Between January 2020 and the end of August 2024, 601 samples seized by the police and prosecutor's office from the illegal market, intended for use as performance-enhancing drugs (PEDs), were tested at the Polish Official Medicines Control Laboratory. Samples were analyzed using accredited methods, including liquid chromatography coupled with high-resolution hybrid mass spectrometry and X-ray powder diffraction, to estimate PCT drug prevalence among other PED samples. In total, 411 (68.4%) samples declaring to contain AAS, 63 (10.5%) declaring to contain substances used in PCT, and 127 (21.1%) other PEDs were tested.

Results

Among the PCT drug samples, 33.3%, 25.4%, and 41.3% indicated the presence of SERMs (tamoxifen and clomiphene), AIs (anastrozole, letrozole, and exemestane), and other substances (hCG, cabergoline, and mesterolone), respectively according to the label. However, not all samples were consistent with the declarations. In 65.1% of the samples, the declared active pharmaceutical ingredients (APIs) were present, whereas in 34.9%, they were not. Furthermore, among the samples in which the declared API was found, 58.7% contained only the declared API, while 6.4% included an additional undeclared API. Conversely, among the samples without the declared API, 20.6% contained neither a declared API nor any API, while 14.3% had other undeclared APIs.

Conclusion

We have shown that illicit drugs used in PCT may be substituted, adulterated, or contain no active ingredients. Our results indicate that in view of the high prevalence of illicit AAS use, the self-administration of unapproved PCT using illegal and falsified medicines is dangerous and can be considered a potential threat to consumer health.

Cross-Analytical Strategies to Tackle "Medicines in Disguise" Presented as Food Supplements, a New Threat for Human Health

Plant-based food supplements (FS) of doubtful traceability have now emerged as a new threat to human health. Food supplements adulterated with pharmaceutical ingredients are considered "medicines in disguise" by regulatory authorities, which is a sub-category of falsified medicines. In the context of illegal manufacture and trade, as well as in the absence of an official phyto- and/or pharmacovigilance system, emergency departments and poison control centers constitute a early warning system for detecting ingested suspect FS. In the present investigation, we set up efficient workflows for the systematic characterization of adulterated plant-based FS in the context of an original local early warning alert system (i.e., FalsiMedTrack) involving an emergency department, a poison center, and academic analytical chemistry laboratories. Fit-for-purpose cross-analytical methods were employed, including sophisticated methods such as liquid chromatography coupled to high-resolution mass spectrometry, nuclear magnetic resonance, X-ray powder diffraction, as well as the most accessible and affordable HPLC method with UV/DAD detection. The strategy was applied successfully to typical cases of suspect plant-based health products, i.e., sample incriminated in patients experiencing side effects and herbal products currently commercialized for their "amazing health benefits". The samples contained active pharmaceutical ingredients, including diclofenac, piroxicam, dexamethasone 21-acetate, and sibutramine. We provided evidence of "medicines in disguise" presented as food supplements, which raises concerns about their quality and safety.

Athlete Selective Androgen Receptor Modulators Abuse: A Systematic Review

BACKGROUND

Selective androgen receptor modulators (SARMs) are small-molecule compounds that exert agonist and antagonist effects on androgen receptors in a tissue-specific fashion. Because of their performance-enhancing implications, SARMs are increasingly abused by athletes. To date, SARMs have no Food and Drug Administration approved use, and recent case reports associate the use of SARMs with deleterious effects such as drug-induced liver injury, myocarditis, and tendon rupture.

PURPOSE

(1) To provide a comprehensive synthesis of the literature pertaining to SARMs from a sports medicine perspective and (2) to provide a better understanding of the clinical effects, treatment protocols, prevalence, and potential contamination associated with athlete-consumed SARMs.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

A systematic review of the English-language literature from PubMed, Cochrane, and Embase databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles relevant to SARM clinical outcomes, elimination profiles, contamination, safety profiles, prevalence, and doping control were included.

RESULTS

A total of 72 articles from 2003 to 2022 were identified for inclusion. The prevalence of SARM use among athletes is estimated to be 1% to 3%. SARM preclinical and clinical studies reported significant increases in lean body mass and side effects-including bone remodeling, testosterone suppression, and kidney, liver, and prostate enlargement. Thirteen case reports described 15 cases of SARM abuse. All described patients were men, with a median age of 32 years (range, 19-52 years), more than half were identified as athletes (8/15), and all ingested SARMs orally for a mean course of 8 weeks. Five patients described in the case reports explicitly denied "illicit drug use," implying patients may believe their use to be legal. Athletes most commonly purchased SARMs online, and most of these compounds have been shown to be contaminated with other substances, contributing to adverse effects. Athletes reported consuming SARMs at much higher doses than clinically studied, which may increase the risk of the reported side effects, such as liver injury, impaired insulin sensitivity, cardiovascular events, and tendon damage.

CONCLUSION

The results of this systematic review serve to educate sports medicine clinicians and researchers on how to better identify, diagnose, and treat athlete SARM abuse. SARM use is associated with increased muscle mass, hepatotoxicity, cardiotoxicity, tendon damage, and androgenic side effects throughout the body-including prostate enlargement and serum testosterone suppression. Identifying and treating SARM abuse requires taking a thorough substance and supplement use history with open communication, providing literature-supported patient education, negotiating SARM discontinuation, and performing multidisciplinary treatment of adverse events. Athlete SARM abuse is increasingly widespread and unsafe, and public health oversight bodies should advocate for regulation of these gray-market compounds.

Illegal products containing selective androgen receptor modulators purchased online from Italy: health risks for consumers

Background

Selective androgen receptor modulators (SARMs) are small synthetic drug molecules that are still not approved as medicine in Europe or the United States but are sold on illegal websites to improve sport performance, particularly bodybuilding.

Aim

To address the quality issues of illegal SARM products and their increasing diffusion in Italy with their potential health risks for consumers.

Methods

Web-based tools were used to investigate retail websites, trending searches, and information exchange via social media. Thirteen SARM products, purchased on retail websites accessible from Italy, were subject to visual inspection and chemical analysis by mass spectrometry and quantitative nuclear magnetic resonance.

Outcomes

The primary outcome was demonstration of additional health risks due to the illicit presence of other active ingredients, contamination, and misdosage in SARM products sold on the internet. The secondary outcome was to show the increasing trend of interest in Italy for these products.

Results

Most websites reported misleading information; specifically, the statement "for research only" was reported notwithstanding indications on dosage and training phases. The trending search showed that interest toward SARMs increased in Italy in the last years. The use of these products is clearly encouraged by the emerging phenomenon of "broscience" as revealed in socials. Visual inspection evidenced nonconform labeling. Qualitative analysis confirmed the presence of the stated SARM in about 70% of samples. In 23% of samples, the expected SARM was not detected but a different one instead, and in 1 sample, no SARMs were detected. Other undeclared pharmaceutical substances (tamoxifen, clomifene, testosterone, epimethandienone, tadalafil) were measured in 30% of samples. The copresence of >1 active substance was observed in >60% of samples. Quantitative nuclear magnetic resonance data showed nonuniform content ranging from 30% to 90% of the label claim.

Clinical Implications

The use of SARMs, in the presence of unexpected life-threatening reactions in persons using the products to increase sport performance, should be assessed.

Strengths and Limitations

This investigation involved an integrated approach to study SARM products and related sociologic aspects. The main shortcomings are the limited number of samples and retail websites in the clear web investigated.

Conclusion

SARMs sold online as food supplement-like products represent a health hazard due to the presence of unapproved and undeclared active substances. The presence of contaminants clearly indicates the absence of good manufacturing practices in the production, which increases the health risks.

Facing Counterfeit Medications in Sexual Medicine. A Systematic Scoping Review on Social Strategies and Technological Solutions

INTRODUCTION

The counterfeit phenomenon is a largely under-reported issue, with potentially large burden for healthcare. The market for counterfeit drugs used in sexual medicine, most notably type 5 phosphodiesterase inhibitors (PDE5i), is rapidly growing.

AIMS

To report the health risks associated with the use of counterfeit medications, the reasons driving their use, and the strategies enacted to contain this phenomenon.

METHODS

A systematic scoping review of the literature regarding counterfeit PDE5i was carried between January and June 2021, then updated in August 2021.

MAIN OUTCOME MEASURE

We primarily aimed to clarify the main drivers for counterfeit PDE5i use, the health risks associated, and the currently available strategies to fight counterfeiters.

RESULTS

One hundred thirty-one records were considered for the present scoping review. Production of fake PDE5i is highly lucrative and the lacking awareness of the potential health risks makes it a largely exploitable market by counterfeiters. Adulteration with other drugs, microbial contamination and unreliable dosages make counterfeit medications a cause of worry also outside of the sexual medicine scope. Several laboratory techniques have been devised to identify and quantify the presence of other compounds in counterfeit medications. Strategies aimed at improving awareness, providing antitampering packaging and producing non-falsifiable products, such as the orodispersible formulations, are also described.

CLINICAL IMPLICATIONS

Improving our understanding of the PDE5i counterfeit phenomenon can be helpful to promote awareness of this issue and to improve patient care.

STRENGTHS & LIMITATIONS

Despite the systematic approach, few clinical studies were retrieved, and data concerning the prevalence of counterfeit PDE5i use is not available on a global scale.

CONCLUSION

The counterfeit phenomenon is a steadily growing issue, with PDE5i being the most counterfeited medication with potentially large harmful effects on unaware consumers. Sansone A, Cuzin B, and Jannini EA. Facing Counterfeit Medications in Sexual Medicine. A Systematic Scoping Review on Social Strategies and Technological Solutions. Sex Med 2021;9:100437.