Effects of the administration of miconazole by different routes on the biomarkers of the steroidal module of the Athlete Biological Passport

This article reports the results obtained from the investigation of the influence of miconazole administration on the physiological fluctuation of the markers of the steroid profile included in the steroidal module of the Athlete Biological Passport. Urines collected from male Caucasian subjects before, during, and after either systemic (i.e., oral and buccal) or topical (i.e., dermal) treatment with miconazole were analyzed according to validated procedures based on gas chromatography coupled to tandem mass spectrometry (GC-MS/MS) (to determine the markers of the steroid profile) or liquid chromatography coupled to MS/MS (LC-MS/MS) (to determine miconazole urinary levels). The results indicate that only after systemic administration, the markers of the steroid profile were significantly altered. After oral and buccal administration, we have registered (i) a significant increase of the 5 alpha-androstane-3 alpha,17 beta-diol/5 beta-androstane-3 alpha,17 beta-diol ratio and (ii) a significant decrease of the concentration of androsterone, etiocholanolone, 5 beta-androstane-3 alpha,17 beta-diol, and 5 alpha-androstane-3 alpha,17 beta-diol and of the androsterone/etiocholanolone, androsterone/testosterone, and 5 alpha-androstane-3 alpha,17 beta-diol/epitestosterone ratios. Limited effects were instead measured after dermal intake. Indeed, the levels of miconazole after systemic administration were in the range of 0.1-12.5 mu g/ml, whereas after dermal administration were below the limit of quantification (50 ng/ml). Significant alteration started to be registered at concentrations of miconazole higher than 0.5 mu g/ml. These findings were primarily explained by the ability of miconazole in altering the kinetic/efficacy of deglucuronidation of the endogenous steroids by the enzyme beta-glucuronidase during the sample preparation process. The increase of both incubation time and amount of beta-glucuronidase was demonstrated to be effective countermeasures in the presence of miconazole to reduce the risk of uncorrected interpretation of the results.

Automated summary

This study found that systemic administration of miconazole significantly altered the markers of the steroid profile, while limited effects were observed after dermal intake. This was primarily due to miconazole's ability to alter the kinetics/efficacy of deglucuronidation of endogenous steroids by beta-glucuronidase during sample preparation.