Kintz Pascal
X-Pertise Consulting, Mittelhausbergen, France.
Institut de Médecine Légale, Strasbourg, France.
Clin Chem Lab Med. 2025 Jan 21;63(6):1075-1079. doi: 10.1515/cclm-2024-1407. Print 2025 May 26.
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.
运动员样本中出现芳香化酶抑制剂来曲唑是较为常见的违反反兴奋剂规则的情况之一。可以对这种违规行为提出质疑,但运动员必须证明自己的清白。证明不存在过错或疏忽的条件取决于两点:1. 运动员或其法定代表人必须提供经核实的污染情况,且必须确定污染源;2. 运动员必须提供经核实的声明,表明对摄入违禁物质不知情,即违规行为并非故意。这与建议的术语转变相对应,从“受污染产品”转变为“违禁物质的不可预测来源”。近年来,几位顶级运动员以尿液中低浓度来曲唑为由对其违反反兴奋剂规则的行为提出质疑,并要求进行毛发检测。在三个案例中,分段毛发中的来曲唑浓度,特别是与尿液中AAF相对应的分段中的浓度,显著低于1 pg/mg,这是该方法的定量限。考虑到来曲唑2.5 mg治疗剂量的四分之一会产生约30 pg/mg的毛发浓度,很容易确定进入这些运动员体内的剂量是偶然的。然而,由于未确定污染源,这三名运动员均被禁赛两年。从这个意义上说,世界反兴奋剂机构的教条与科学证据相矛盾,从法医角度来看,这似乎难以理解。