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International Journal of Legal Medicine
Published in: International Journal of Legal Medicine 6/2017

01-11-2017 | Original Article

Ventricular androgenic-anabolic steroid-related remodeling: an immunohistochemical study

Authors: Rossana Cecchi, Barbara Muciaccia, Costantino Ciallella, Natale Mario Di Luca, Akihiko Kimura, Cristina Sestili, Mizuho Nosaka, Toshikazu Kondo

Published in: International Journal of Legal Medicine | Issue 6/2017

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Abstract

Background

Several fatal cases of bodybuilders, following a myocardial infarction after long exposure to androgenic-anabolic steroids (AAS), are reported. In recent years, evidence has emerged of cases of heart failure related to AAS consumption, with no signs of coronary or aorta atherosclerosis. This study aims to further investigate the pathogenesis of the ventricular AAS-related remodeling performing immunohistochemistry (IHC).

Method

In order to examine innate immunity activity and myocytes and endothelial cell apoptosis, IHC analyses were performed on heart tissue of two cases of bodybuilders who died after years of supratherapeutic use of metelonone and nandrolone and where no atherosclerosis or thrombosis were found, using the following antibodies: anti-CD68, anti-iNOS, anti-CD163, anti-CD 15, anti-CD8, anti-CD4, anti-HIF1 α, and in situ TUNEL staining.

Results

Results confirm the experimental findings of recent research that, in the absence of other pathological factors, if intensive training is combined with AAS abuse, myocytes and endothelial cells undergo apoptotic alterations. The absence of inflammatory reactions and the presence of an increased number of M2 macrophages in the areas of fibrotic remodeling confirm that the fibrotic changes in the heart are apoptosis-related and not necrosis-related.

Conclusions

In conclusion, the study indicates that, in very young subjects with chronic hypoxia-related alterations of the heart, signs of a heart failure in the other organs and a history of AAS abuse, death can be ascribed to progressive heart failure due to the direct apoptotic cardiac and endothelial changes produced by AAS.
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Metadata
Title
Ventricular androgenic-anabolic steroid-related remodeling: an immunohistochemical study
Authors
Rossana Cecchi
Barbara Muciaccia
Costantino Ciallella
Natale Mario Di Luca
Akihiko Kimura
Cristina Sestili
Mizuho Nosaka
Toshikazu Kondo
Publication date
01-11-2017
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Legal Medicine / Issue 6/2017
Print ISSN: 0937-9827
Electronic ISSN: 1437-1596
DOI
https://doi.org/10.1007/s00414-017-1589-3

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