Ligandrol (LGD-4033)-Induced Liver Injury / Mary Barbara, Sadhna Dhingra, Ayse Mindikoglu / (ACG Case Reports Journal 7 (2020) 6 (June); p. 1-3)

• PMID: 32637435
• PMCID: PMC7304490
• DOI: 10.14309/crj.0000000000000370

Abstract

We described a 32-year-old man who developed severe drug-induced liver injury after using Ligandrol (LGD-4033). The diagnosis was confirmed by a liver biopsy that showed cholestatic hepatitis with a mild portal, periportal, and perisinusoidal fibrosis. Ligandrol is a selective androgen receptor modulator that is available over the counter and via the internet.

In September 2019 the International Equestrian Federation (FEI) has reported an anti-doping rule violation against the Czech jumping rider Emma Augier de Moussac after her sample tested positive for the prohibited substance Hydrochlorothiazide. After notification the Athlete gave a prompt admission, accepted a provisional suspension and the sanction proposed by FEI. 

The parties in this case reached an agreement and requested the FEI Tribunal to issue a Decision incorporating the terms of this agreement. The parties agreed that the violation was not intentional and the result of the Athlete’s use of contaminated supplement for weight loss while there are grounds for No Significant Fault or Negligence. 

The Panel considers that the violation was not intentional, that the Athlete gave a prompt admission, explained how the prohibited substance entered her system and established grounds for No Significant Fault or Negligence.

Therefore the FEI Tribunal decides on 16 June 2020 in accordance with the mutual consent of the Parties to impose a fine and a 12 month period of ineligibility on the Athlete starting on the date of the sample collection, i.e. on 28 June 2019.

In July 2018 the National Anti Doping Agency of Germany (NADA) has reported an anti-doping rule violation against the German jumping rider Jan-Philipp Weichert after his A and B samples tested positive for the prohibited substance Cocaine and Amfetamine.

NADA notified the Athlete in July 2018 and ordered a provisional suspension which was lifted in October 2018. Hereafter the International Equestrian Federation (FEI) notified the Athlete and imposed a provisional suspension in November 2018. 

The parties in this case reached an agreement in June 2020 and requested the FEI Tribunal to issue a Decision incorporating the terms of this agreement. The parties agreed that the violation was not intentional since the substances were consumed out-of-competition in a context unrelated to sport. The Athlete admitted the violation, he accepted that he acted negligently and explained how the prohibited substances entered his system. 

Therefore the FEI Tribunal decides on 13 July 2020 in accordance with the mutual consent of the Parties to impose a fine and a 2 year period of ineligibility on the Athlete starting on the date of the first provisional suspension, i.e. 2 July 2018.

In March 2020 the the Athletics Integrity Unit (AIU) of World Athletics reported an anti-doping rule violation against the Bahrain Athlete Hassan Chani after an AIU Expert Panel concluded unanimously in January 2020 in their Joint Expert Opinion that the Athlete’s hematological profile “highly likely” showed that he used a prohibited substance or a prohibited method: the use of EPO or Blood doping.

This conclusion of the AIU Expert Panel was based on assessment of blood samples, collected in the period from 11 August 2016 until 4 October 2019 reported in the Athlete’s Biological Passport (ABP). 

After notification the Athlete submitted an explanation to the AIU about the circumstances surrounding the collected samples. However after consideration the Expert Panel rejected the Athlete’s explanations in March 2020 in their second joint report. A provisional suspension was ordered and the Athlete was heard for the World Athletics Disciplinary Tribunal. 

The AIU contended that the Athlete’s ABP profile constitutes reliable evidence of blood doping and accordingly that the Athlete committed an anti-doping rule violation under the Rules. The Athlete denied the violation, disputed the reliablility of the ABP and asserted that the values in his ABP could be explained as a result of high altitude and his training regime. 

Based on the evidence the Panel deems that Athlete’s ABP is highly abnormal and none of the Athlete's explanations or allegations can refute that conclusion. The Panel is comfortably satisfied that the doping scenario presented by the AIU and the Expert Panel caused the abnormalities in the Athlete’s ABP and that the Athlete committed an anti-doping rule violation. 

Therefore on 10 September 2020 the Disciplinary Tribunal decides to impose a 4 year period of ineligibility on the Athlete starting on the date of the provisional suspension, i.e. on 16 March 2020.

In March 2020 the the Athletics Integrity Unit (AIU) of World Athletics has reported an an anti-doping rule violation against the Kenyan Athlete Patrick Siele for evading sample collection on 18 December 2019. Here the Doping Control Officers reported that when selected the Athlete ran away from testing at a training camp in Kenya.

After notification the Athlete gave a prompt admission, waived his right for a hearing, accepted a provisional suspension and the sanction proposed by the AIU.

The AIU considered that for the 23 years old Athlete this was his first experience of out-of-competition testing and that his lack of anti-doping education may have contributed to his conduct.

Therefore the AIU decides on 18 September 2020 to impose a 3 year and 6 month period of ineligibility on the Athlete starting on 16 March 2020.

CAS 2018_A_5619 WADA vs UWW & Anzor Boltukaev

Related case:

UWW 2017 UWW vs Anzor Boltukaev
February 2, 2018

On 2 February 2018 the UWW Anti-Doping Panel decided to impose a 10 month period of ineligibility on the Russian wrestler Anzor Boltukaev after he tested positive for the prohibited substance Higenamine. Here the UWW Panel accepted that the postive test was te result of contaminated nutritional supplements he had used. It concluded that the violation was not intentional and that he established No Significant Fault or Negligence.

Hereafter in March 2018 the World Anti-Doping Agency (WADA) appealed the UWW decision of 2 February 2019 with the Court of Arbitration for Sport (CAS). WADA requested the Panel to set aside the UWW decision and to impose a 2 year period of ineligibility on the Athlete.

WADA does not dispute that the violation was not intentional but contended that the Athlete failed to establish the origin of
the prohibited substance on the balance of probabilities, and therefore that a standard sanction of two years should be imposed.

The Athlete denied the intentional use of the substance, that he had established that the positive test was caused by the use of coffee or a contaminated supplement and that he bore no significant fault or negligence.

While the violation is deemed to be not intentional the Panel finds the Athlete's explanations not convincing. They appear to the Panel to amount to mere speculations and are unsupported by sufficient evidence.

As a result the Panel concludes that the Athlete failed to establish, by a balance of probability, that the consumption of coffee or of a nutritional supplement was the origin of the positive test.

Therefore the Court of Arbitration for Sport decides on 3 October 2018 that:

1.) The appeal filed by the World Anti-Doping Agency on 12 March 2018 against the decision rendered on 2 February 2018 by the Anti-Doping Panel of the United Wrestling Federation is upheld.

2.) The decision rendered on 2 February 2018 by the Anti-Doping Panel of the United Wrestling Federation is set aside.

3.) Mr Anzor Boltukaev is declared ineligible for a period of two years from the date of the present award, with credit given for the period of ineligibility already served between 6 June 2017 and 5 April 2018.

4.) All competitive results obtained by Mr Anzor Boltukaev between 3 May 2017, including the results of 3 May 2017, and 6 June 2017 are disqualified, with all of the resulting consequences, including forfeiture of any medals, points and prizes.

5.) The award is pronounced without costs, except for the Court Office fee of CHF 1,000 paid by the World Anti-Doping Agency which is retained by the CAS.

6.) Mr Anzor Boltukaev and the United Wrestling Federation shall pay to the World AntiDoping Agency an amount of CHF 1,000 ( one thousand Swiss Francs) each towards the legal costs and expenses incurred by the World Anti-Doping Agency in connection with the present proceedings.

7.) All other motions or prayers for relief are dismissed.

CAS 2019/A/6443 Canadian Centre for Ethics in Sport (CCES) v. Dominika Jamnicky

CAS 2019/A/6593 Dominika Jamnicky v. Canadian Centre for Ethics in Sport (CCES)

Related cases:

SDRCC 2018 CCES vs Dominika Jamnicky & Triathlon Canada - Final Award
August 16, 2019

SDRCC 2018 CCES vs Dominika Jamnicky & Triathlon Canada - Partial Award
May 31, 2019

In May 2018 the Canadian Centre for Ethics in Sport (CCES) has reported an anti-doping rule violation against the Triathlon Athlete Dominika Jamnicky after her sample tested positive for the prohibited substance Clostebol allegedly as a result of her use of a contaminated product. 

In two Awards rendered by the SDRCC Doping Tribunal on 31 May 2019 and on 16 August 2019 the Arbitrator deemed that the Athlete failed to establish the source of the anti-doping rule violation. However she established that the violation was not intentional and although she committed an anti-doping rule violation only a reprimand was imposed on the Athlete. 

Hereafter in September 2019 the CCES and the Athlete in October 2019 appealed the SDRCC decision of 16 August 2019 with the Court of Arbitration for Sport (CAS).

The CCES requested the Panel to set aside the SDRCC decision and to impose a 2 year period of ineligibility on the Athlete. It did not dispute that the violation was not intentional but contended that there were no grounds to impose a reduced sanction based on the principle of proportionality.

CCES regarded that the Athlete’s evidence in support of her Meat Contamination theory clearly was insufficient to meet te required standard of proof. It regarded it extremely unlikely that the positive test was the result of contaminated meat in Australia or Canada. She failed to investigate her theory of meat contamination nor did she identify all possible sources of Clostebol. 

The Athlete requested the Panel to dismiss the CCES appeal and to set aside the SDRCC Decision of 6 August 2019. She asserted that the source of the positive test was contamined meat; she bears No Fault; alternative she bears No Significant Fault; or the imposition of a reprimand should be confirmed. She testified that she was in Australia and in Canada in April 2018 and there she had consumed a numer of animal food products that possible illegally was treated with Clostebol.

Supported by expert witnesses and with circumstancial evidence the Athlete demonstrated that Clostebol is a well-known and effective growth promoter for animal food products while the monitoring authorities for domestic and imported livestock products in both Australia and Canada do not test for Clostebol, creating incentives for producers who might wish to enhance production without fear of being caught.

She excluded the possibility of supplement contamination since she was tested before without issues and she handled and checked with utmost care her supplements before using. 

The Panel considers that the Athlete had accepted the test result and that the CCES had accepted that the violation was not intentional. After having more closely examined the entirety of the evidence in respect of the Meat Contamination, and when combined with other inferences made, the Panel is unanimously of the view that the Meat Contamination is the only reasonably possible and credible explanation for the Athlete’s positive test and is more likely than not to have occurred. 

In reaching this conclusion the Panel deems that it applied the rules and standards that govern triers of fact in assessing circumstantial evidence. In weighing both the inferences to be drawn and the weight of all of the inferences when balanced together, it is satisfied that their conclusion meets the standard of being logical "in light of human experience and common sense".

The Panel holds that the Athlete has established on a balance of probability how Clostebol entered her system, that she bears No Fault in relation to her anti-doping rule violation and that the otherwise applicable 2 year sanction is eliminated. 

Therefore the Court of Arbitration for Sport decides on 9 July 2020 that: 

1.) The (a) appeal filed by the Canadian Centre for Ethics in Sport against Ms. Dominika Jamnicky and (b) cross-appeal filed by Ms. Dominika Jamnicky against the Canadian Centre for Ethics in Sport concerning the decision rendered by the doping tribunal of the Sport Dispute Resolution Centre of Canada on 16 August 2019 are partially upheld.

2.) The decision dated 16 August 2019 by the doping tribunal constituted and administered by the Sport Dispute Resolution Centre of Canada on 16 August 2019 is set aside.

3.) Ms. Dominika Jamnicky is found to have committed an Anti-Doping Rule Violation but bears no fault or negligence and no period of ineligibility shall be imposed on her.

4.) All other prayers for relief in the Appeal and the Cross-Appeal are denied.

5.) (…).

6.) (…).

Related cases:

CAS 2019_A_6443 CCES vs Dominika Jamnicky | Dominika Jamnicky vs CCES
July 9, 2020

SDRCC 2018 CCES vs Dominika Jamnicky & Triathlon Canada - Partial Award
May 31, 2019

In June 2018 the Canadian Centre for Ethics in Sport (CCES) has reported an anti-doping rule violation against the Triathlon Athlete Dominika Jamnicky after her sample tested positive for the prohibited substance Clostebol.

After notification a provisional suspension was ordered. The Athlete filed a statement with evidence in her defence and she was heard for the SDRCC Doping Tribunal.

The Athlete accepted the test result and denied the intentional use of the substance. She argued that the positive test was the result of contaminated meat in Australia or Canada.

The CCES contended that the Athlete failed to establish the source of Clostebol nor that the violation was not intentional.

On 31 May 2019 the SDRCC Doping Tribunal in the Partial Award decided that the Athlete has not discharged her burden of proving the source of her positive test. However the Arbitrator deemed that the Athlete indeed has discharged her burden of proving that her positive test was not intentional.

Hereafter the Parties filed their submissions as to the consequences that should follow from this Partial Award.

Considering the submissions of the Parties the Arbitrator concludes that the Athlete had committed an anti-doping rule violation. However with application of the principle of proportionality as to the seriousness of the violation the Arbitrator deems that a 2 year period of ineligibility would be wholly unfair and an excessively severe sanction.

Therefore the SDRCC Doping Tribunal decides on 16 August 2019 that the Athlete has committed an anti-doping rule violation and that the Athlete's sanction is reduced to a reprimand.

Related cases:

CAS 2019_A_6443 CCES vs Dominika Jamnicky | Dominika Jamnicky vs CCES
July 9, 2020

SDRCC 2018 CCES vs Dominika Jamnicky & Triathlon Canada - Final Award
August 16, 2019

In June 2018 the Canadian Centre for Ethics in Sport (CCES) has reported an anti-doping rule violation against the Triathlon Athlete Dominika Jamnicky after her sample tested positive for the prohibited substance Clostebol.

After notification a provisional suspension was ordered. The Athlete filed a statement with evidence in her defence and she was heard for the SDRCC Doping Tribunal.

The Athlete accepted the test result and denied the intentional use of the substance. She argued that the positive test was the result of contaminated meat in Australia or Canada.

The CCES contended that the Athlete failed to establish the source of Clostebol nor the that the violation was not intentional.

On 31 May 2019 the SDRCC Doping Tribunal in this Partial Award decides that the Athlete has not discharged her burden of proving the source of her positive test. However the Arbitrator deemed that the Athlete indeed has discharged her burden of proving that her positive test was not intentional.

Hereafter, as agreed by the Parties, they made submissions as to the consequences that should follow from this Partial Award.

In April 2020 the Canadian Centre for Ethics in Sport (CCES) has reported an anti-doping rule violation against the U Sports wrestler Jasonpreet Bains after his sample tested positive for the prohibited substannce Dehydrochlormethyltestosterone (Turinabol). After notification a provisional suspension was ordered. The Athlete filed a statement in his defence and he was heard for the SDRCC Doping Tribunal.

The Athlete denied the intentional use of the substance and believed that he acted without significant fault or negligence. He testified that at his home's kitchen he had used his brother's protein powder when he run out of his supply while he was unaware that his brother's protein powder contained the prohibited substance. He took this protein powder 2 or 3 days before testing and it never occurred to him to move his supplements out of the kitchen and away from his brother.

The Montreal Lab reported that based on the test result the last administration of the substance would have been probably several weeks before and not 2 or 3 days before testing as alleged by the Athlete. The Athlete maintained that he took the protein powder 3 days before testing.

The CCES contended that the Athlete failed to establish that the violation was not intentional and that the Athlete's and his brother's evidence is not credible.

Considering the evidence in this case the Arbitrator is willing to accept that the violation was the result of a contaminated protein powder. However the Athlete failed to demonstrate that his actions were not intentional.

Therefore the SDRCC Doping Tribunal decides on 1 September 2020 to impose a 4 year period of ineligibility on the Athlete starting on the date of the provisional suspension, i.e. on 3 April 2020.