Re-exploring testosterone metabolism : new insights for doping control

The detection of endogenous anabolic androgenic steroids (EAAS) is one of the most difficult analytical challenges in the doping control field. The main problem for their detection is to distinguish between normally endogenous concentrations and those observed after the exogenous administration of an EAAS. The screening methods for EAAS are currently based on the determination of the steroid profile and the application of the athlete biological passport. The inclusion of new steroid metabolites can improve the screening capabilities of the steroid profile. Thus, the objective of the thesis is to elucidate and characterize new testosterone metabolites that can be implemented to the current steroid profile and to evaluate their usefulness for doping control analysis. Four unreported testosterone metabolites were detected and characterized by using liquid chromatography coupled to tandem mass spectrometry approaches. These compounds were demonstrated to come from degradation of cysteine conjugates. The formation of these conjugates implies an addition of a double bond as a phase I metabolism followed by conjugation with glutathione and the subsequent transformation to cysteine conjugates in urine. In order to determinate the usefulness of the cysteinyl compounds for doping control purposes, a quantitative method for the indirect determination of these compounds was developed and validated. Using this method, reference population limits were established by the analysis of 174 urine samples. Additionally, different factors that can potentially influence the excretion of these compounds were evaluated. Finally, the usefulness of these cysteinyl metabolites for the detection of EAAS misuse was evaluated by the analysis of samples collected after different EAAS administration. The use of these metabolites seems to improve in some cases the detection capabilities of the current marker used in routine analysis.La detecció d’esteroides androgènics anabolitzants endògens (EAAE) és un dels reptes analítics més difícils en la lluita contra el dopatge. El problema més important per a la seva detecció és distingir entre concentracions endògenes i aquelles que s’observen després de l’administració exògena d’un EAAE. Els mètodes de cribatge per a la detecció d’EAAE estan basats en la determinació del perfil esteroïdal i la introducció d’aquest en el passaport biològic de l’atleta. La inclusió de nous metabòlits d’esteroides pot ajudar a millorar les capacitats de cribatge del perfil esteroïdal. Per tant, l’objectiu d’aquesta tesis és detectar i caracteritzar nous metabòlits d’EAAE que puguin implementar-se en l’actual perfil esteroïdal i l’avaluació de la seva utilitat en la lluita contra el dopatge. Quatre metabòlits desconeguts de la testosterona van ser detectats i caracteritzats mitjançant la utilització de la cromatografia líquida acoblada a l’espectrometria de masses en tàndem. L’origen d’aquests compostos es va demostrar que provenia de la degradació de conjugats amb cisteïna. La formació d’aquests conjugats implica l’addició d’un doble enllaç com a reacció metabòlica de fase I acompanyat per la conjugació amb glutationa i la subseqüent degradació d’aquesta a cisteïna en orina. Per tal de poder veure la seva aplicació en el camp del dopatge, es va desenvolupar i validar un mètode per la quantificació indirecta d’aquests compostos en orina. Utilitzant aquest mètode es van establir límits de referència basats en l’anàlisi de 174 mostres de orina. Addicionalment, diferents factors descrits que poden afectar l’excreció en orina d’aquests compostos també van ser estudiats en detall. Finalment, es va avaluar la utilitat d’aquests metabòlits conjugats amb cisteïna per a la detecció de l’abús d’EAAE mitjançant l’ anàlisis de mostres després de l’administració de diferents EAAE. L’ús d’aquests metabòlits va millorar (en alguns casos) els temps de detecció comparant-los amb els actuals marcadors utilitzats en rutina

Adrenal hormonal imbalance in acute intermittent porphyria patients: results of a case control study

Background: Acute Intermittent Porphyria (AIP) is a rare disease that results from a deficiency of hydroxymethylbilane synthase, the third enzyme of the heme biosynthetic pathway. AIP carriers are at risk of presenting acute life-threatening neurovisceral attacks. The disease induces overproduction of heme precursors in the liver and long-lasting deregulation of metabolic networks. The clinical history of AIP suggests a strong endocrine influence, being neurovisceral attacks more common in women than in men and very rare before puberty. To asses the hypothesis that steroidogenesis may be modified in AIP patients with biochemically active disease, we undertook a comprehensive analysis of the urinary steroid metabolome. Methods: A case–control study was performed by collecting spot morning urine from 24 AIP patients and 24 healthy controls. Steroids in urine were quantified by liquid chromatography-tandem mass spectrometry. Parent steroids (17-hydroxyprogesterone; deoxycorticosterone; corticoesterone; 11-dehydrocorticosterone; cortisol and cortisone) and a large number of metabolites (N = 55) were investigated. Correlations between the different steroids analyzed and biomarkers of porphyria biochemical status (urinary heme precursors) were also evaluated. The Mann–Whitney U test and Spearman’s correlation with a two tailed test were used for statistical analyses. Results: Forty-one steroids were found to be decreased in the urine of AIP patients (P  0.51, P < 0.01). Conclusions: Comprehensive study of the urinary steroid metabolome showed that AIP patients present an imbalance in adrenal steroidogenesis, affecting the biosynthesis of cortisol and resulting in decreased out-put of cortisol and metabolites. This may result from alterations of central origin and/or may originate in specific decreased enzymatic activity in the adrenal gland. An imbalance in steroidogenesis may be related to the maintenance of an active disease state among AIP patients.This work was supported by grants from Instituto de Salud Carlos III FEDER, (CP/10/00576) and the Spanish “Fondo de Investigación Sanitaria” (PI11/00767) to Jordi To-Figuera

Adrenal hormonal imbalance in acute intermittent porphyria patients: results of a case control study

Background: Acute Intermittent Porphyria (AIP) is a rare disease that results from a deficiency of hydroxymethylbilane synthase, the third enzyme of the heme biosynthetic pathway. AIP carriers are at risk of presenting acute life-threatening neurovisceral attacks. The disease induces overproduction of heme precursors in the liver and long-lasting deregulation of metabolic networks. The clinical history of AIP suggests a strong endocrine influence, being neurovisceral attacks more common in women than in men and very rare before puberty. To asses the hypothesis that steroidogenesis may be modified in AIP patients with biochemically active disease, we undertook a comprehensive analysis of the urinary steroid metabolome. Methods: A case–control study was performed by collecting spot morning urine from 24 AIP patients and 24 healthy controls. Steroids in urine were quantified by liquid chromatography-tandem mass spectrometry. Parent steroids (17-hydroxyprogesterone; deoxycorticosterone; corticoesterone; 11-dehydrocorticosterone; cortisol and cortisone) and a large number of metabolites (N = 55) were investigated. Correlations between the different steroids analyzed and biomarkers of porphyria biochemical status (urinary heme precursors) were also evaluated. The Mann–Whitney U test and Spearman’s correlation with a two tailed test were used for statistical analyses. Results: Forty-one steroids were found to be decreased in the urine of AIP patients (P  0.51, P < 0.01). Conclusions: Comprehensive study of the urinary steroid metabolome showed that AIP patients present an imbalance in adrenal steroidogenesis, affecting the biosynthesis of cortisol and resulting in decreased out-put of cortisol and metabolites. This may result from alterations of central origin and/or may originate in specific decreased enzymatic activity in the adrenal gland. An imbalance in steroidogenesis may be related to the maintenance of an active disease state among AIP patients.This work was supported by grants from Instituto de Salud Carlos III FEDER, (CP/10/00576) and the Spanish “Fondo de Investigación Sanitaria” (PI11/00767) to Jordi To-Figuera