Body fluid contamination in the context of an adverse analytical finding in doping: About a case involving ostarine

Interest of hair tests to discriminate a tail end of a doping regimen from a possible unpredictable source of a prohibited substance in case of challenging an anti-doping rule violation

The presence of letrozole, an aromatase inhibitor, in an athlete's sample constitutes one of the more frequent anti-doping rules violation. It is possible to challenge this violation but it is the athletes who have to demonstrate their innocence. The conditions to evidence/establish the absence of fault or negligence hinge on two points: 1. the athletes or their legal representatives have to present verified circumstances of contamination and the source of contamination has to be identified; and 2. there have to be verified claims by the athlete about the fact that the intake of the prohibited substance was not known, i.e. that the violation was not intentional. This corresponds to the suggested shift terminology from "contaminated product" to "unpredictable source of a prohibited substance". In the recent years, several top athletes challenged their ADRV with a low urine letrozole concentration and requested a hair test. In three cases, letrozole concentration in segmented hair, particularly in the segment corresponding to the urine AAF was significantly lower than 1 pg/mg, which is the limit of quantification of the method. Considering that a ¼ of a 2.5 mg therapeutic dose of letrozole produces a hair concentration of approximately 30 pg/mg, it is easy to establish that the dose that entered in the body of these athletes was incidental. Nevertheless, all three athletes were sentenced a 2-years ban as the source of contamination was not identified. In that sense, the WADA dogma contradicts scientific evidence, and from a forensic perspective, this appears difficult to understand.

Annual Banned-Substance Review 17th Edition-Analytical Approaches in Human Sports Drug Testing 2023/2024

The 17th edition of the annual banned-substance review on analytical approaches in human sports drug testing is dedicated to literature published between October 2023 and September 2024. As in previous years, focus is put particularly on new or enhanced analytical options in human doping controls as well as investigations into the metabolism and elimination of compounds of interest, which represent central (while not exclusive) cornerstones of the global anti-doping mission. New information published within the past 12 months on established doping agents as well as new potentially relevant substances are reviewed and discussed in the context of the World Anti-Doping Agency's 2024 Prohibited List. Thereby, analytical challenges, especially with regard to the continuously growing number of target compounds and potentially relevant drug classes as well as the exigency (and consequences) of utmost analytical retrospectivity, are thematized and contextualized. Investigations especially into anabolic agents, peptide hormones, and strategies for the detection of gene doping were identified as core areas of anti-doping research in the reviewed period.

Case Report: A case study of positive doping control by animal-to-human drug transfer after an athlete administered medicine in spray format, containing clostebol acetate, to a pet dog

The presence of a doping substance in an athlete's biological sample may not be only related to intentional pharmacological support. The unintended use of a prohibited substance may be due various reasons. This paper describes the case of a Polish canoeist preparing for the 2024 Summer Olympics in Paris who presented a positive doping test result, as a consequence of administering medication to her injured dog. The athlete used a Trofodermin cutaneous spray (containing clostebol acetate) for pet treatment, which resulted in human transfer during close contact and subsequent detection by doping authorities. To bolster the athlete's defense, it was essential to substantiate the scenario of an unconscious violation of anti-doping rules with scientific evidence. Hence, the decision was made to analyze and compare samples of the athlete's hair and her dog's fur. This investigation confirmed that clostebol absorption occurred through the skin of the hands, transfer during sleeping with the dog on the same bedding and/or inhalation (during the application of the medication, which was dispensed to the animal's paws). This defense was accepted by the Court of Arbitration for the Sport Anti-Doping Division, which subsequently found that the athlete committed an anti-doping rule violation, but under circumstances that amounted to a "no fault" scenario.

Knowing the minimal detectable dose can facilitate the interpretation of a hair test result: Case example with chlortalidone

In case of an adverse analytical finding, a low (estimate) urine concentration can be the consequence of 2 very different situations: it can be the tail end of a drug voluntarily consumed to enhance athletic performance, even by microdosing (which is not effective for all drugs), or it can be the result of a contamination, irrespective of its source. For numerous doping agents, a hair test can allow discriminating doping from contamination based on the measured concentration or even the absence of the target drug. Given hair produces incremental concentrations, its analysis offers the possibility of establishing a pattern of drug use and thus, verifying self-reported histories of exposure. In order to provide a retrospective calendar of drug use, segmental analysis of the hair strand can be performed. In doping, the usual practice is to test the substance in short segments, such as 1 cm to avoid drug dilution when using larger segments. During the last months, seven athletes have returned an adverse analytical finding for the diuretic chlortalidone, with reported urine concentrations in the range 20 to 50 ng/mL. All these athletes submitted, via their legal team, their hair for establishing a pattern of exposure. Results were always consistent with incidental contamination (hair concentration lower than 5 pg/mg), although the source of contamination was never identified. The interpretation of the findings was established in the light of the limited literature, including hair tests after microdosing and therapeutic use.

Evidence of ostarine cross-contamination via sweat in 2 athletes sharing the same neoprene hamstring sleeves. An original situation of drug transfer where the anti-doping rule violation was suspended by the sport authorities

The presence of ostarine, a selective androgen receptor modulator (SARM) in an athlete's sample constitutes one of the most frequent anti-doping rules violation. It is possible to challenge this violation but it is the athlete who has to demonstrate he / she is innocent. The conditions to evidence no fault or negligence are mostly based on 2 points: 1. the athlete or his/her legal representative must present verified circumstances of contamination and the source of contamination must be identified; and 2. there must be verified claims by the athlete about the fact that he / she did not knowingly take the prohibited substance, i.e. that the violation was not intentional. During a 2-weeks period, a male athlete tested two times positive for ostarine in urine (<0.1 ng/ml) and he challenged these results. His hair and nail tests returned negative (LOQ at 0.5 pg/mg). He admitted using two neoprene hamstring sleeves of another athlete who confessed abusing ostarine. This was confirmed in his hair (190 pg/mg), his fingernail clippings (780 pg/mg) and his toenail clippings (45 pg/mg). To document the presence of ostarine in the hamstring sleeves and therefore possible drug transfer, the hamstring sleeves were analysed. Ostarine was identified in 12 different selected pieces (about 1 g) of the sleeves at concentrations ranging from 3 to 142 pg/g. Sport authorities (USADA) agreed that the most likely source of contamination was the hamstring sleeves, thus confirming the scenario of drug transfer and gave the athlete a no fault.

Evidence of ostarine excretion in oral fluid after a single controlled oral administration

The presence of ostarine, a selective androgen receptor modulator (SARM) in an athlete's urine specimen constitutes one of the most frequent anti-doping rules violation as the drug is listed as a member of the S1.2 class "other anabolic agents" of the World Anti-doping Agency Prohibited List, forbidden in- and out-competition. It is possible to challenge this violation but it is at the charge of the athlete to prove innocence. The conditions to evidence no fault or negligence are mostly based on 2 points: 1. the athlete must present verified circumstances of contamination and the source of contamination must be identified; and 2. there must be verified claims by the athlete that the violation was not intentional. Some months before the Olympic games, a female athlete was suspended by a national anti-doping agency because of an adverse analytical finding for ostarine. She claimed that her violation was due to drug transfer when kissing her boyfriend, who did not inform her about his ostarine daily intake. To document this claim (excretion of ostarine in oral fluid in sufficient amounts), a male volunteer ingested 17.3 mg of ostarine (dose verified by 1H NMR). Oral fluid was collected over 8 h using the NeoSal™ collection device and was tested by liquid chromatography coupled to tandem mass spectrometry. Maximal ostarine concentration was 468 ng/mL at T + 15 min, which can also be partially attributed to mouth contamination. Ostarine was detectable during the whole period of test, with concentrations at 1-2 ng/mL after T + 4 h. These results support drug transfer during kissing and subsequent possible contamination of the partner.