Forensic Post-Mortem Investigation in AAS Abusers : Investigative Diagnostic Protocol. A Systematic Review / Massimiliano Esposito, Gabriele Licciardello, Federico Privitera, Salvatore Iannuzzi, Aldo Liberto, Francesco Sessa, Monica Salerno. - (Diagnostics 11 (2021) 8 (21 July); 1307)

• PMID: 34441242
• PMCID: PMC8393338
• DOI: 10.3390/diagnostics11081307

Abstract

Anabolic-androgenic steroids (AASs) are a group of synthetic molecules derived from testosterone and its precursors. AASs are widely used illicitly by adolescents and athletes, especially by bodybuilders; AASs are among the most used drugs for improving physical performance, as well as for aesthetic purposes. The use of AASs by professional and recreational athletes is increasing worldwide. This review focused on deaths related to AAS abuse and to investigation of the autopsy results and histopathological findings using a rigorous methodology protocol covering: a complete autopsy, histological analysis, and a broad toxicological investigation. Moreover, we aimed to define an investigative diagnostic protocol supporting forensic pathologists during the post-mortem investigation of AAS abusers. This review was conducted using PubMed Central and Google Scholar databases to find articles published between 1 January 1968 and 30 June 2021, using the following key terms: "(anabolic-androgenic steroids) AND (autopsy); (anabolic-androgenic steroids) AND (forensic)". A total of 939 articles were screened and 926 did not meet the inclusion criteria. In conclusion, 14 articles were included in this systematic review, reporting 137 fatal cases of AAS abuse in total. The histopathologic studies showed myocardial damage characterized by myocyte hypertrophy, focal myocyte damage with myofibrillar loss, interstitial fibrosis, mostly subepicardial, and small vessel disease. Indeed, in AAS-related cases, autopsy plays a pivotal role in the study of AAS adverse effects and organ damage related to their use or abuse. This systematic review aimed to define a specific workflow in death cases related to AASs, suggesting important future insights to better clarify sudden deaths related to AASs, such as the use of miRNAs. The forensic community needs a unified approach in cases of suspected death related to the use of AASs. There are several occasions to apply this workflow, for example in cases of death of bodybuilders and of young people who die in gymnasiums or during sports activities.

Severe Cardiac and Metabolic Pathology Induced by Steroid Abuse in a Young Individual / Adrian Tirla, Cosmin Mihai Vesa, Simona Cavalu. - (Diagnostics 11 (2021) 8 (21 July); p. 1-13)

• PMID: 34441248
• PMCID: PMC8394374
• DOI: 10.3390/diagnostics11081313

Abstract

Androgenic-Anabolic Steroids (AAS) abuse is known to play an important role in causing the systemic inflammatory response and multiple-organ dysfunction in healthy individuals. Although many of the undesirable effects of steroid abuse have been reported, at present, little is known about the effect of anabolic supplements and the correlation between cardiac and metabolic pathology. This paper presents a case of a 25 year old patient with a complex medical history after 6 months of steroid administration. Myocardial infraction, dyslipidemia, obesity, hyperuricemia, secondary diabetes, and chronic renal disease were identified after clinical and para-clinical examinations. The particularities of this case were interpreted in the context of a literature review, highlighting the effect of multi-organ damage as a result of the uncontrolled use of anabolic steroid supplements.

Dealing with doping. A plea for better science, governance and education / Jules A.A. Heuberger, April Henning, Adam F. Cohen, Bengt Kayser. - (British Journal of Clinical Pharmacology (2021) 22 July)

• PMID: 34291479
• DOI: 10.1111/bcp.14998

Abstract

The creation of WADA contributed to harmonization of anti-doping and changed doping behavior and prevalence in the past 22 years. However, the system has developed important deficiencies and limitations that are causing harm to sports, athletes and society. These issues are related to the lack of evidence for most substances on the Prohibited List for performance or negative health effects, a lack of transparency and accountability of governance and decision-making by WADA and the extension of anti-doping policies outside the field of professional sports. This article tries to identify these deficiencies and limitations and presents a plea for more science, better governance and more education. This should lead to a discussion for reform among stakeholders, which should cover support of a new Prohibited List by actual research and evidence and introduce better governance with accountable control bodies and regulation. Finally, comprehensive education for all stakeholders will be the basis of all future positive improvements.

CAS OG 20/04 Maxim Agapitov v. International Olympic Committee

Mr. Maxim Agapitov is a retired weightlifter and currently the acting President of the European Weightlifting Federation and President of the Russian Weightlifting Federation. As an Athlete he was sanctioned in 1994 for committing an anti-doping rule violation, 27 years ago.

After recent revelations on widespread doping practices at the International Weightlifiting Federation (IWF) the IOC rendered in June 2021 conditions for the accreditation for IWF officials for the Tokyo 2020 Olympic Games.

In July 2021 the IOC decided to withdraw the accreditation for the Tokyo 2020 Olympic Games due to Mr. Agapitov did not meet the criteria for IWF officials as he had “a personal history linked to any anti-doping rule violation and/or sanction”.

Hereafter on 21 July 2021 Mr. Agapitov filed an application with the CAS Ad Hoc Division against the IOC with respect to the withdrawal of his accreditation for the Tokyo 2020 Olympic Games.

Mr. Agapitov requested the Panel to set aside the IOC Decision regarding the withdrawal of his accreditation, to approve his participation and to reinstate his accreditation for the Tokyo 2020 Olympic Games.

The IOC argued that there there were 3 grounds for the withdrawal of Mr. Agapitov's accreditation:

• his 1994 anti-doping rule violation;
• the presence of his name in the IWF independent investigation report drafted by Professor Richard McLaren;
• the official functions of Mr. Agapitov within weightlifting federations at the Russian or European level.

The CAS ad Hoc Panel finds that the Mr. Agapitov's application is admissble, that it has jurisdiction of the present dispute whereas it shall review this matter de novo.

The Panel assessed the IOC criteria in question and concludes that the absence of any limitation in time with respect to the expression of “a personal history linked to any anti-doping rule violation and/or sanction”, 27 years is far beyond the time that could be reasonably considered as being part of a “personal history” likely to adversely affect the reputation of the sport of weightlifting at the Tokyo 2020 Olympic Games.

Furthermore, the Panel finds that the 1994 violation was committed by Mr. Agapitov during his athlete’s life while he is now exercising new functions as a sports official.

Finally, the Panel deems that Mr. Agapitov’s 1994 violation is not even relevant or related to the IWF’s governance problems and its officials’ reprehensible conducts towards doping, which have generated the issuance of the IOC’s criteria.

Quite to the contrary, Prof. McLaren, certainly the best positioned person to make any finding in this respect, has convincingly testified that Mr. Agapitov had an affirmative approach in fighting against doping and in restructuring the governance of the IWF.

As such, in the opinion of the Panel, the withdrawal of Mr. Agapitov's accreditation does not actually serve the purpose pursued by the IOC and could even be perceived as counterproductive in that respect.

Therefore the CAS Ad Hoc Panel decides on 24 July 2021:

1. The application filed by Mr Maxim Agapitov 21 July 2021 is admissible and upheld.
2. The decision of the IOC to withdraw the accreditation of Mr. Maxim Agapitov is set aside.
3. The accreditation delivered to Mr. Maxim Agapitov in June 2021 for the Games of the XXXII Olympiad in Tokyo shall be reinstated in full.

• CAS OG 20/06 World Athletics v. Alex Wilson, Swiss Anti-Doping & Swiss Olympic
• CAS OG 20/08 WADA v. Alex Wilson, Swiss Anti-Doping & Swiss Olympic
  
  
• CAS ad hoc Division (OG Tokyo) 20/006 & 20/008 World Athletics (WA) & World Anti-Doping Agency (WADA) v. Alex Wilson, Swiss Anti-Doping & Swiss Olympic

• Athletics (sprint)
• Doping (epitrenbolone)
• Jurisdiction ratione temporis of the CAS ad hoc Division
  Conditions to lift a mandatory provisional suspension

1. The CAS ad hoc Division only has jurisdiction to deal with disputes which arise during the Olympic Games or during a period of ten days preceding the Opening Ceremony. In general, the date when a dispute arises is the date of the decision with which the applicant disagrees. However, such a date can arise later, in some cases, if, for example, it is necessary for the applicant to wait until the full case file and necessary documentation is received in order to enable it to determine whether there is a dispute concerning the decision.

2. Pursuant to Article 7.4.1 of the World Anti-Doping Code (WADC), a mandatory provisional suspension may be eliminated if the athlete demonstrates to the hearing panel that the anti-doping rule violation (ADRV) is likely to have involved a contaminated product. Article 7.4.1 of the Swiss Anti-Doping Rules (Swiss ADR) reflecting the WADC provides that the mandatory provisional suspension can only be lifted if the athlete demonstrates that it was probable that the ADRV was caused by a contaminated product. Thus, the test for the hearing panel is not only whether the positive finding could have been caused by a contaminated product. The two tests are not the same and that they impose very different burdens on the athlete and necessitate very different analyses of the evidence.

In April 2021 Antidoping Switzerland reported an anti-doping rule violation against the Swiss Athlete Alex Wilson after his A and B samples tested positive for the prohibited substance Trenbolone.

After notification a provisional suspension was ordered which was callenged by the Athlete in May 2021. The Athlete requested the Disciplinary Chamber of Swiss Olympic to lift the provisional suspension in order to participate in the outdoor season and the Tokyo Olympic Games.

The Athlete argued that the source of the positive test was  contaminated meat he had ingested in a restaurant in Las Vegas, USA, in March 2021. On 2 July 2021 the Disciplinary Chamber of Swiss Olympic decided to lift the provisional suspension imposed on the Athlete.

Hereafter on 22 and 24 July 2021 both World Athletics and WADA appealed the decision of the Disciplinary Chamber with the CAS Ad Hoc Division. They requested the Panel to set aside the Appealed Decision and for the imposition of the provisional suspension with immediate effect.

The Athlete raised a number of challenges to jurisdiction of the CAS Ad Hoc Division. However the Panel deems that it has jurisdiction to hear the filed applications and that they are admissible.

Based on the evidence the Panel concludes that the Athlete has not satisfied it that, on the balance of probabilities, it is likely or probable that the Trenbolone came from contaminated meat in the circumstances presently described by the Athlete.

The Panel finds that the evidence available so far clearly shows that the provisional suspension imposed on the Athlete should not have been lifted by the Disciplinary Chamber. It follows that the decision of the Disciplinary Chamber of 2 July 2021 should not be reinstated and, thus, the mandatory provisional suspension shall be reinstated with immediate effect.

Therefore the CAS Ad Hoc Panel decides on 27 July 2021:

1. The Ad Hoc Division of the Court of Arbitration for Sport has jurisdiction to entertain the Application filed by World Athletics on 22 July 2021 and by WADA on 24 July 2021.
2. The applications filed by World Athletics and by WADA on 22 and, respectively, 24 July 2021 are upheld.
3. The Decision rendered on 2 July 2021 by the Disciplinary Chamber of Swiss Olympic is set aside.
4. The provisional suspension imposed on Mr Alex Wilson by Antidoping Switzerland on 28 April 2021 shall be reinstated with immediate effect.
5. Each Party shall bear its own legal costs and other expenses incurred by this procedure.

Multidimensional Separations of Intact Phase II Steroid Metabolites Utilizing LC-Ion Mobility-HRMS / Don E. Davis Jr, Katrina L. Leaptrot, David C. Koomen, Jody C. May, Gustavo de A. Cavalcanti, Monica C. Padilha, Henrique M.G. Pereira, John A. McLean. - (Analytical Chemistry 93 (2021) 31 (10 August); p. 10990-10998)

• PMID: 34319704
• DOI: 10.1021/acs.analchem.1c02163

Abstract

The detection and unambiguous identification of anabolic-androgenic steroid metabolites are essential in clinical, forensic, and antidoping analyses. Recently, sulfate phase II steroid metabolites have received increased attention in steroid metabolism and drug testing. In large part, this is because phase II steroid metabolites are excreted for an extended time, making them a potential long-term chemical marker of choice for tracking steroid misuse in sports. Comprehensive analytical methods, such as liquid chromatography-tandem mass spectrometry (LC-MS/MS), have been used to detect and identify glucuronide and sulfate steroids in human urine with high sensitivity and reliability. However, LC-MS/MS identification strategies can be hindered by the fact that phase II steroid metabolites generate nonselective ion fragments across the different metabolite markers, limiting the confidence in metabolite identifications that rely on exact mass measurement and MS/MS information. Additionally, liquid chromatography-high-resolution mass spectrometry (LC-HRMS) is sometimes insufficient at fully resolving the analyte peaks from the sample matrix (commonly urine) chemical noise, further complicating accurate identification efforts. Therefore, we developed a liquid chromatography-ion mobility-high resolution mass spectrometry (LC-IM-HRMS) method to increase the peak capacity and utilize the IM-derived collision cross section (CCS) values as an additional molecular descriptor for increased selectivity and to improve identifications of intact steroid analyses at low concentrations.

Russia Taskforce Report to Council Meeting of 28 July 2021 / Rune Andersen. - Monaco : World Athletics, 2021

In its report to the Council, the Russia Taskforce confirmed that the suspended Russian Federation (RusAF) was making satisfactory progress against the milestones and KPIs set out in the Reinstatement Plan and had paid the latest invoice of US$431,848 for the reinstatement costs incurred by World Athletics in the quarter ending 31 March 2021. 

The Taskforce is hopeful that, under the guidance of Acting President Irina Privalova, and with the assistance of the three international experts appointed to assist in the Reinstatement Plan, RusAF will continue to meet the remaining milestones and KPIs to satisfy all of the conditions set for its reinstatement to membership of World Athletics.

Consequently, the Council resolved that the Authorised Neutral Athlete (ANA) process would remain in effect and that the Council would consider in November whether the ANA quota of 10 athletes that applied to certain competitions in 2021 should be maintained or revised for competitions staged in 2022.

It further decided that the status of RusAF’s membership would be put on the agenda for the 53rd World Athletics Congress to be held in November, where the congress will be asked to vote on the following resolution:

Congress resolves, in exercise of its powers under Article 13.7 of the World Athletics Constitution, that the suspension of RusAF’s membership of World Athletics will continue until Council decides that all of the conditions set by Council from time to time for the revocation of RusAF’s suspension and the consequent reinstatement of RusAF’s membership have been met.

However the Taskforce warned that if RusAF stopped making satisfactory progress against the KPIs and milestones in the Reinstatement Plan, or failed to reimburse World Athletics' reinstatement costs on a timely basis in this period, it would recommend that the Council withdraw the proposed resolution to Congress, and propose instead that Congress resolves to expel RusAF from membership with immediate effect. The Taskforce trusts that this will not be necessary.

Related cases:

• CAS 2019_A_6319 Maria Guadalupe Gonzalez Romero vs IAAF
  July 2, 2020
• IAAF 2018 IAAF vs María Guadalupe González Romero
  May 9, 2019
• CAS 2021_A_8311 María Guadalupe González Romero vs IAAF
  December 29, 2023
  
  

On 9 May 2019 the IAAF (now: World Athletics) Disciplinary Tribunal decided to impose a 4 year period of ineligibility on the Mexican Athlete María Guadalupe González Romero after her A and B samples tested positive for the prohibited substance Trenbolone.

In First Instance the Sole Arbitrator deemed that the explanation together with the evidence produced by the Athlete were not convincing, contradicting and unreliable. Consequently her explanation was rejected for lack of credibility since she failed to establish that her violation was not intentional.

The Athlete appealed in June 2020 with the Court of Arbitration for Sport (CAS). However on 2 July 2020 the CAS Panel confirmed the Appealed IAAF Decision of 9 May 2019. During the CAS hearing the Athlete acknowledged that she had provided false statements and evidence.

Hereafter in July 2020 the Athletics Integrity Unit (AIU) for World Athletics reported a new anti-doping rule violation against the Athlete for Tampering because of the false statements, fabricated evidence and false documents she had provided to the AIU.

Regarding the Athlete's Tampering the AIU contended that:

• the Athlete provided two contradictory sets of facts with regards to her consumption of meat in the days before the sample collection;
• the hospital report submitted by the Athlete was forged;
• the receipts for the restaurants in question were also forged;
• the Athlete acknowledged that she had asked her friend to provide false testimony to support her story about eating beef at the restaurant in question.

The Athlete argued that she never had the intention to manipulate evidence or to lie during the proceedings neither before the First Instance Proceedings before the Disciplinary Tribunal, nor before CAS. Indeed, the Athlete discharged any possible responsibility on her first lawyers, who did not disclose or inform her about any falsification or manipulation of documents and even forged her signature.

The Sole Arbitrator finds the conclusions reached by both, the First Decision and the CAS decision of the utmost relevance, since they are convincing and persuasive enough to conclude that the Athlete indeed lied and presented fabricated evidence during the First Instance Proceedings.

The Sole Arbitrator rejects the Athletes arguments alleging that she was unaware of the content, evidence and documents filed in her defence. Whereas he concludes that the Athlete's conduct shall be qualified as Tampering pursuant to the definition established in the ADR.

Considering the principle of lex mitior and the application of Article 10.9.3(c) of the ADR 2021 the Sole Arbitrator deems that the Athlete committed a stand-alone first violation with the imposition of a 4 year period of ineligibility (instead of 8 years).

Therefore on 30 July 2021 the Sole Arbitrator decides that the Athlete has committed an anti-doping rule violation for Tampering and to impose a 4 year period of ineligibility.

This new sanction shall run consecutively to the period of ineligibility already imposed on the Athlete unitl 15 November 2022, thus starting on 16 November 2022 until 15 November 2026.

Anabolic-Androgenic Steroid Use in Sports, Health, and Society / Shalender Bhasin, Disa L. Hatfield, Jay R. Hoffman, William J. Kraemer, Michele Labotz, Stuart M. Phillips, Nicholas A. Ratamess. - (Medicine & Science in Sports & Exercise 50 (2021) 8 (August); p. 1778-1794)

• PMID: 34261998
• DOI: 10.1249/MSS.0000000000002670

Abstract

This consensus statement is an update of the 1987 American College of Sports Medicine (ACSM) position stand on the use of anabolic-androgenic steroids (AAS). Substantial data have been collected since the previous position stand, and AAS use patterns have changed significantly. The ACSM acknowledges that lawful and ethical therapeutic use of AAS is now an accepted mainstream treatment for several clinical disorders; however, there is increased recognition that AAS are commonly used illicitly to enhance performance and appearance in several segments of the population, including competitive athletes. The illicit use of AAS by competitive athletes is contrary to the rules and ethics of many sport governing bodies. Thus, the ACSM deplores the illicit use of AAS for athletic and recreational purposes. This consensus statement provides a brief history of AAS use, an update on the science of how we now understand AAS to be working metabolically/biochemically, potential side effects, the prevalence of use among athletes, and the use of AAS in clinical scenarios.

Voetbal en doping / Herman Ram. - (Voetbal- & Sportjuridische Zaken (2021) 1; p. 10-16)

• doi: 10.5553/VSZ/277267382021001001003

Samenvatting:

Anders dan veel anekdotiek doet vermoeden worden in het voetbal relatief veel dopingcontroles uitgevoerd, maar worden daarbij betrekkelijk weinig dopingovertredingen vastgesteld. De wel vastgestelde overtredingen worden op dezelfde basis afgehandeld als in andere sporten gebeurt. Tuchtrechtelijke uitspraken worden echter zelden gepubliceerd, wat het verzamelen van objectieve data bemoeilijkt.