Exposome - Doping(?) and the Athletes' Exposome

first published: 25.10.2021

Thevis M, Kuuranne T, Fedoruk M. Geyer H. Sports drug testing and the athletes' exposome. Drug Test Anal. 2021;13(11-12):1814-1821. doi:10.1002/dta.3187

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Abstract
Similar to the general population, elite athletes are exposed to a complex set of environmental factors including chemicals and radiation and also biological and physical stressors, which constitute an exposome that is, unlike for the general population, subjected to specific scrutiny for athletes due to applicable antidoping regulations and associated (frequent) routine doping controls.
Hence, investigations into the athlete's exposome and how to distinguish between deliberate drug use and different contamination scenarios has become a central topic of antidoping research, as a delicate balance is to be managed between the vital and continually evolving developments of sensitive analytical techniques on the one hand, and the risk of the athletes' exposome potentially causing adverse analytical findings on the other.

INTRODUCTION

The multifaceted and interconnected pathways, transmission routes, sources, and (bio)transformations of synthetic as well as natural substances has exponentially increased the complexity of the human exposome. Derived from “exposure,” the term and concept of the exposome was introduced in 2005¹ and has since been the subject of numerous research projects and detailed considerations as to how the entirety of a human's lifetime exposure to environmental factors (including chemicals and radiation and also biological and physical stressors) can be monitored and conceptualized.^2-4 The exposome as such is of paramount importance in a broad context, for example, in acute and long-term toxicological evaluations,^5-6 medical and pathological considerations,^7-9 and, while from a different perspective, also in athlete doping controls. The latter features unique aspects with, among others, potential sanctions associated with adverse analytical findings (AAFs) of drug or drug metabolite residues at any detectable level (depending on the sample matrix, type of sample collection, i.e., in- vs. out-of-competition, and the identified drug/drug metabolite), combined with a comparably high testing frequency of the athletes. The exposome may also be considered a known or unknown confounder of direct detection of drugs or drug residues or indirect biomarkers that can be evidence of doping. Further, the analysis of athletes' urine and/or blood samples is conducted with comparably harmonized and standardized methods, targeting a constantly growing, diversifying, and comprehensive set of drugs and chemicals considered relevant in antidoping.¹⁰ Consequently, in view of the exposome's extent that athletes are subjected to today, the possibility of AAFs through scenarios other than doping necessitates research, data, and strategies to support result management authorities in identifying and differentiating the inadvertent exposure to prohibited substances from findings resulting from the intentional administration for performance-enhancing purposes.
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