Screening of aflatoxin M1, a metabolite of aflatoxin B1 in human urine samples in Malaysia: A preliminary study

Aflatoxin M1 levels in urine and breast milk of lactating mothers in Kuala Lumpur, Malaysia

Aflatoxins are carcinogens that can contaminate food and affect various body organs especially liver and kidney. When consumed, aflatoxin B1 (AFB1) is partially metabolised into aflatoxin M1 (AFM1), which is excreted in the urine.Breast milk may also contain AFM1 due to maternal dietary intake from contaminated food. This cross-sectional study aimed to determine the levels of AFM1 in both urine and breast milk among breastfeeding mothers (n = 256). The mother's demographic information was collected during recruitment. Mothers were then scheduled for an appointment to provide a morning urine sample along with five to ten mL samples of breast milk. AFM1 levels in both samples were analysed using an enzyme-linked immunosorbent assay (ELISA). Spearman's rho and Chi-square were used to determine the associations between mean levels of AFM1 in urine and breast milk. Findings show 68.0% of urine samples were contaminated with AFM1 (mean levels = 0.08 ± 0.04 ng/mL), while 14.8% of breast milk samples had AFM1 (mean levels = 5.94 ± 1.81 ng/kg). Urine AFM1 levels were not significantly associated with AFM1 levels in breast milk (p > 0.05). This study can act as a baseline for future research examining long-term aflatoxin exposure among both mothers and infants.

Assessment of aflatoxin M1 exposure and associated determinants in children from Lahore, Pakistan

Aflatoxins are potent carcinogenic and immunomodulatory mycotoxins, and exposure may lead to deleterious effects on human health. This study aimed to detect aflatoxin M₁ (AFM₁) as biomarker of exposure and determine associated risk factors in children attending a specialized-childcare hospital in Lahore. Urine samples collected from 238 children (1-11 years) during winter (January-mid-March 2020) and hot-humid summer (August-September 2020) were tested for AFM₁ presence using ELISA. Data on potential risk factors were also collected. Of 238 samples, 156 (65.5%) were positive for urinary AFM₁. Season was significantly associated (OR = 2.64; 95% CI = 1.49-4.79; p = 0.001) with AFM₁ positivity; prevalence was higher in hot-humid months (74.6%) than winter (57.3%). The place of living was also significantly associated (OR = 2.21; 95% CI = 1.25-3.97; p = 0.007), and urinary AFM₁ positivity was higher in urban children (71.1%) compared to rural (58.3%). Median value for creatinine-adjusted AFM₁ was 1.9 ng/mg creatinine (Q1-Q3 = 0.82-6.0 ng/mg creatinine), while non-creatinine-adjusted AFM₁ was 0.57 ng/mL (Q1-Q3 = 0.23-1.4 ng/mL). Significantly higher urinary AFM₁ levels were detected in children; age ≤2 years (p = 0.037), who consumed more milk (p = 0.048), and who presented to the nutrition clinic (p = 0.003). These findings highlight the need for an effective control program to reduce the AFM₁ burden in children.

Evaluation of detoxification of aflatoxin-b1 by using Ag nanoparticles of oil extracts user prepared by using some medical herbs

Introduction: Herbs or plants are used for a variety of purposes, including nutrition, medicinal and in the beverage industry, beverages, coloring, food preservatives, insect repellants and cosmetics.

Methods: Many plants were obtained from local markets and the oil was extracted with hexane at a concentration of 75%. Green silver nanoparticles were prepared. The nanoparticles were characterized using various techniques, including scanning electron microscopy, UV visible spectroscopy, Fourier transform infra-red, energy dispersive spectroscopy, and zeta potential analyzer.

Results: The results showed small, smooth spherical nanoparticles, ranging between 57.41–88.00 nm, as well as the distribution of electric charges evenly on the surface of the nanoparticles, which acquired effective agents for nanoparticles against aflatoxin-b1. The effectiveness of green nanoparticles against aflatoxin-b1 by using high-performance liquid chromatography technology detected its concentration. The standard concentration of aflatoxin-b1 was (20) ppb. The results of the activity of plant oil extracts of T-thyme, rosemary-R, mint-M and eucalyptus-E reached (0.104, 1.586, 1.083 and 1.067) ppb, while it appears in the nanoparticle activity of T, R, M and E were as (0.065, 0.226, 0.377 and 0.702) ppb respectively.

Conclusion: We concluded that green Ag nanoparticles are efficient in processing or eliminating aflatoxin-b1 and can be produced at very low concentrations compared to the concentrations of plant extracts prepared.

Dual effects of zearalenone on aflatoxin B1-induced liver and mammary gland toxicity in pregnant and lactating rats

Food and feed are frequently co-contaminated with aflatoxin B1 (AFB1) and zearalenone (ZEN). This study investigated the effects of ZEN on the AFB1-induced liver and mammary gland toxicity in pregnant and lactating rats. AFB1 and ZEN co-exposure inhibited the growth of rats and caused oxidative stress and inflammatory responses in the liver and mammary gland. Compared with the AFB1-only group, damage was aggravated in the AFB1 + 10 mg/kg ZEN group, and the AFB1 + 1 mg/kg ZEN group showed a reduction in some metrics. The metabolomic results of the mammary gland showed that metabolite changes were mainly in lipid, amino acid, and glucose metabolism. Compared with the AFB1 + 0 mg/kg ZEN group, the AFB1 + 1 mg/kg ZEN group had the most metabolite changes. Moreover, AFB1 and ZEN co-exposure reduced the levels of sex hormones and RNA m⁶A methylation in the mammary gland. We speculate that ZEN affects the toxicity of AFB1 to the liver and mammary gland by interfering with the function of sex hormones, regulating cell proliferation and metabolic processes.

Biochemical investigation of human exposure to aflatoxin M1 and its association with risk factors of diabetes mellitus

Recently, aflatoxin M1 (AFM1) has emerged as a major health concern owing to its exposure to human being via consumption of milk, dairy products, and food commodities, and this has a strong association with risk factors that may lead to the onset of type 2 diabetes mellitus (T2DM) and various other associated metabolic disorders. This study was conducted to investigate the exposure to AFM1 and its association with sociodemographic features and risk factors of T2DM. Urine and blood samples from 672 participants were collected to investigate the concentration of AFM1 in urine and glucose, glycosylated hemoglobin (HbA1c), insulin, α-amylase, dipeptidyl peptidase-IV (DPP-IV), free fatty acids (FFAs), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-chol), interleukine-6 (IL-6), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), creatinine, uric acid, blood urea nitrogen (BUN), aspartate aminotransferase (AST), and alanine transaminase (ALT) from the blood of study participants. Association of exposure to AFM1 with sociodemographic features and risk factors of T2DM was determined using person correlation coefficient (r), coefficient of determination (R²), and 95% confidence interval, and the level of significance (P<0.05) was measured by Student's unpaired t-test. Among the participants in which AFM1 was detected, 62.91% of participants were found to be diabetic and 37.09% of participants were found to be non-diabetic. Further to this, it was also found that concentration of AFM1 in the urine of diabetic participants was found to be higher (P<0.05) as compared to that in non-diabetic participants. Association of AFM1 exposure with risk factors of T2MD exhibits that exposure to AFM1 was responsible for the induction of inflammatory responses and oxidative stress that may lead to the onset of impaired insulin secretion and metabolism of carbohydrates and ultimately the onset of T2DM and associated metabolic disorders. Hence, it can be summarized that exposure to AFM1 is one of the causative factors that may lead to potentiate the several risk factors notably inflammatory responses and oxidative stress that ultimately induce the pathogenesis of T2DM and associated metabolic disorders. The key findings of this study suggest that human population who are at greater risk of AFM1 exposure can develop T2DM and other associated metabolic risk factors.

Screening of the aflatoxin M1 metabolite in urine samples of residents in Terengganu, Malaysia

A study was conducted to screen the occurrence and level of aflatoxin M₁ (AFM₁) in urine samples of 206 urban and rural residents in Terengganu, Malaysia. The level of AFM₁ was quantified by competitive enzyme-linked immune-absorbent assay (ELISA). Of the 206 samples, 84 were positive for AFM₁ (40.8%) in a range of 0.07-5.53 ng/ml (mean = 0.589 ng/ml). Residents of Terengganu are moderately exposed to AFM₁. Age, ethnicity, marital status and employment status were associated with urinary level of AFM₁. Subjects aged 30 years and above, non-Malays, married, and those unemployed had significantly higher levels of urinary AFM₁ (p < 0.05)_. Since aflatoxin is recognised as a potent-carcinogen for liver cancer and a continuous exposure to this toxin can be fatal, the present findings could provide a baseline for future studies where larger samples and more advanced techniques might be used to find the possible effects of the exposure of this toxin on the community's health.

Oral administration of Lactobacillus casei Shirota can ameliorate the adverse effect of an acute aflatoxin exposure in Sprague Dawley rats

Aflatoxin B₁(AFB₁) is a toxic compound commonly found in some crops with an adverse health effect on human and animals. Some beneficial microorganisms (or probiotics) such as lactic acid bacteria have shown the ability to reduce the bioavailability of aflatoxins and its intestinal absorption. However, the dose and duration of aflatoxins exposure and probiotic treatment can influence the ability of probiotics to remove aflatoxins. Therefore, this research aimed to investigate the efficacy of oral probiotic Lactobacillus casei Shirota strain (LcS) induction in an acute exposure to AFB₁ in rats. Experimentally, Sprague Dawley rats were divided into three groups: AFB₁ only (n = 9); AFB₁ treated with LcS (n = 9); and control (no AFB₁ exposure) (n = 6) groups. The blood AFB₁ level of rats treated with LcS was slightly lower than the untreated AFB₁ induced rats (11.12 ± 0.71 vs 10.93 ± 0.69 ng g^-1). Also, LcS treatment slightly moderated the liver and kidney biomarkers in AFB₁ induced rats. However, a trend for a significant difference was only observed in ALT of AFB₁ induced rats treated with LcS compared to their counterparts (126.11 ± 36.90 vs 157.36 ± 15.46, p = 0.06). Rats' body weight decreased in all animals force-fed with AFB₁ with no significant difference between LcS treatment compared to the counterpart. In conclusion, this experiment indicated that probiotic LsC was able to slightly ameliorate the adverse effect of an acute exposure to AFB₁ in rats. However, future studies with longer probiotics treatment or higher probiotics dose is required to confirm these findings.

Determination of Aflatoxin M1 concentration in volunteers from rural and urban areas of Cochabamba-Bolivia

Aflatoxins are produced by toxigenic strains of Aspergillus fungi and include the subtypes: B1, B2, G1, and G2. Once ingested, aflatoxin is metabolized to aflatoxin M1 found in the urine. Because of the importance of aflatoxins on human health, we analyzed 550 urine samples collected from farmers and city volunteers from Cochabamba. The level of aflatoxin M1 was determined using the Helica Aflatoxin M1 ELISA Kit specific for urine. 216 volunteer farmers had an aflatoxin M1 range of 0.02-1.21 ng/ml, while 334 urine city volunteers had a range of 0.03-1.27 ng/ml, indicating a risk for exposure to aflatoxin contamination for both populations.

Association between Urinary Aflatoxin (AFM₁) and Dietary Intake among Adults in Hulu Langat District, Selangor, Malaysia

Aflatoxin is a food contaminant and its exposure through the diet is frequent and ubiquitous. A long-term dietary aflatoxin exposure has been linked to the development of liver cancer in populations with high prevalence of aflatoxin contamination in foods. Therefore, this study was conducted to identify the association between urinary aflatoxin M₁ (AFM₁), a biomarker of aflatoxin exposure, with the dietary intake among adults in Hulu Langat district, Selangor, Malaysia. Certain food products have higher potential for aflatoxin contamination and these were listed in a Food Frequency Questionnaire, which was given to all study participants. This allowed us to record consumption rates for each food product listed. Concomitantly, urine samples were collected, from adults in selected areas in Hulu Langat district, for the measurement of AFM₁ levels using an ELISA kit. Of the 444 urine samples collected and tested, 199 were positive for AFM₁, with 37 of them exceeding the limit of detection (LOD) of 0.64 ng/mL. Cereal products showed the highest consumption level among all food groups, with an average intake of 512.54 g per day. Chi-square analysis showed that consumption of eggs (X² = 4.77, p = 0.03) and dairy products (X² = 19.36, p < 0.01) had significant associations with urinary AFM₁ but both food groups were having a phi and Cramer’s V value that less than 0.3, which indicated that the association between these food groups’ consumption and AFM₁ level in urine was weak.

Protective effects of curcumin against aflatoxicosis: A comprehensive review

Aflatoxicosis is a deleterious medical condition that results from aflatoxins (AFs) or ochratoxins (OTs). Contamination with these toxins exerts detrimental effects on the liver, kidneys, reproductive organs, and also on immunological and cardiovascular systems. Aflatoxicosis is closely associated with overproduction of reactive oxygen species (ROS) as key contributors to oxidative and nitrosative stress responses, and subsequent damages to lipids, proteins, RNA, and DNA. The main target organ for AF toxicity is the liver, where DNA adducts, degranulation of endoplasmic reticulum, increased hepatic lipid peroxide, GSH depletion, mitochondrial dysfunction, and reduction of enzymatic and non-enzymatic antioxidants are manifestations of aflatoxicosis. Curcuma longa L. (turmeric) is a medicinal plant widely utilized all over the world for culinary and phytomedical purposes. Considering the antioxidant characteristic of curcumin, the main active component of turmeric, this review is intended to critically summarize the available evidence supporting possible effectiveness of curcumin against aflatoxicosis. Curcumin can serve as a promising candidate for attenuation of the adverse consequences of aflatoxicosis, acting mainly through intrinsic antioxidant effects aroused from its structure, modulation of the immune system as reflected by interleukin-1β and transforming growth factor-β, and interfering with AF's biotransformation by cytochrome P450 isoenzymes CYP1A, CYP3A, CYP2A, CYP2B, and CYP2C.

Intra-laboratory Development and Evaluation of a Quantitative Method for Measurement of Aflatoxins B1, M1 and Q1 in Animal Urine by High Performance Liquid Chromatography with Fluorescence Detection

Mycotoxins negatively impact animal health. Aflatoxins (AFs) are the most common mycotoxins affecting both large and small animals and are a common cause of toxin-related pet food recalls. Definitive diagnosis of aflatoxicosis is constrained by a lack of validated ante-mortem analytical methods for detection and quantitation of AFs and their metabolites in biological specimens. Herein, we developed and evaluated a urine-based quantitative method for measurement of aflatoxin B1 (AFB1) and its metabolites aflatoxin M1 (AFM1) and aflatoxin Q1 (AFQ1) in animal urine. (Some of the results have been presented at 59th AAVLD conference, Greensboro, North Carolina, October 13-19th, 2016.) This method uses an immuno-affinity column for clean-up and pre-column derivatization followed by high performance liquid chromatography analysis with fluorescence detection. The method has high selectivity, recovery (>81%) and sensitivity with an instrument limit of detection of 0.20-1.02 pg; instrument limit of quantitation of 0.77-4.46 pg; and a method lower limit of quantitation of 0.30-2.5 ng/mL. The method has high accuracy, repeatability, and is rugged against minor changes. However, because of poor sensitivity of AFQ1 at low concentrations we recommend this method for quantitative determination of AFB1 and AFM1, and for qualitative measurement of AFQ1 in animal urine for diagnosis of aflatoxicosis.

Effect of dietary macronutrients on aflatoxicosis: a mini-review

Aflatoxin is a toxin produced by Aspergillus species of fungi. The main route of aflatoxin exposure is through the diet. Indeed, long-term aflatoxin exposure is linked to the development of hepatocellular carcinoma (HCC). Aflatoxin causes aflatoxicosis, which can be affected by several factors and is prevalent in many developing Asian and African countries. This mini-review discusses the effects of carbohydrate, fat and protein on aflatoxicosis based on findings from animal and human studies. It was found that high carbohydrate intake enhanced aflatoxicosis occurrence, while low ingestion of carbohydrate with caloric restriction slowed the symptoms associated with aflatoxicosis. Additionally, diets with low protein content worsened the symptoms related to HCC due to aflatoxin exposure. Nevertheless, a study reported that a high-protein diet favored detoxification of aflatoxin in vivo. There were also conflicting results on the influence of dietary fat, as high ingestion of fat enhanced aflatoxicosis development as compared with a low-fat diet. Moreover, the type of fat also plays a significant role in influencing aflatoxin toxicity. In regard to food safety, understanding the influence of macronutrients toward the progression of aflatoxicosis can improve preventive measures against human and animal exposure to aflatoxin. © 2017 Society of Chemical Industry.

Detection of trace aflatoxin M1 in human urine using a commercial ELISA followed by HPLC

Aflatoxin is a liver carcinogen, and rapid, inexpensive methods to detect its urinary biomarkers are needed. We used a commercial enzyme-linked immuno-sorbent assay (ELISA) for aflatoxin M1 in urine (Helica Biosystems) to test 52 Haitian samples. Using this ELISA, we detected traces above the limit of detection (0.2 ng/ml urine) but below the limit of quantitation (0.4 ng/ml) in 14 samples. Liquid chromatography of all 52 Haitian urine samples revealed that only 11 had quantifiable AFM1 (mean: 29.5 pg/ml, standard error: 10.8, range: 2.94-96.5 pg/ml). The Helica ELISA may have detected forms of aflatoxin other than AFM1 in the Haitian samples, or matrix enhancement may have affected results at low AFM1 concentrations. This ELISA may serve as an initial, qualitative indicator of aflatoxin exposure for epidemiological purposes. But this method's utility as a precise and specific indicator of AFM1 concentrations will require additional refinement and validation.

Effect of supplementation of fermented milk drink containing probiotic Lactobacillus casei Shirota on the concentrations of aflatoxin biomarkers among employees of Universiti Putra Malaysia: a randomised, double-blind, cross-over, placebo-controlled study

Human exposure to aflatoxin is through the diet, and probiotics are able to bind aflatoxin and prevent its absorption in the small intestine. This study aimed to determine the effectiveness of a fermented milk drink containing Lactobacillus casei Shirota (LcS) (probiotic drink) to prevent aflatoxin absorption and reduce serum aflatoxin B1-lysine adduct (AFB1-lys) and urinary aflatoxin M1 concentrations. The present study was a randomised, double-blind, cross-over, placebo-controlled study with two 4-week intervention phases. In all, seventy-one subjects recruited from the screening stage were divided into two groups--the Yellow group and the Blue group. In the 1st phase, one group received probiotic drinks twice a day and the other group received placebo drinks. Blood and urine samples were collected at baseline, 2nd and 4th week of the intervention. After a 2-week wash-out period, the treatments were switched between the groups, and blood and urine samples were collected at the 6th, 8th and 10th week (2nd phase) of the intervention. No significant differences in aflatoxin biomarker concentrations were observed during the intervention. A within-group analysis was further carried out. Aflatoxin biomarker concentrations were not significantly different in the Yellow group. Nevertheless, ANOVA for repeated measurements indicated that AFB1-lys concentrations were significantly different (P=0·035) with the probiotic intervention in the Blue group. The 2nd week AFB1-lys concentrations (5·14 (SD 2·15) pg/mg albumin (ALB)) were significantly reduced (P=0·048) compared with the baseline (6·24 (SD 3·42) pg/mg ALB). Besides, the 4th week AFB1-lys concentrations were significantly lower (P<0·05) with probiotic supplementation than with the placebo. Based on these findings, a longer intervention study is warranted to investigate the effects of continuous LcS consumption to prevent dietary aflatoxin exposure.

Ultra-high performance liquid chromatographic determination of aflatoxin M1 in urine

The development of analytical methods to detect aflatoxin B1 (AFB1) in foodstuffs and its metabolites in human biological samples is useful for risk assessment. The latter methodology, i.e. the measurement of AFB1 biomarkers, has become important to assess human aflatoxin exposure. AFB1-lysine adduct, AFB1-DNA adduct and urinary aflatoxin M1 (AFM1) are some of the AFB1 biomarkers that can be measured by several analytical methods, such as enzyme-linked immunosorbent assay, radioimmunoassay, and high performance liquid chromatography (HPLC). HPLC coupled to a fluorescence detector is useful and preferable due to its high degree of sensitivity, but the analysis may take time and consume large amount of solvents. Therefore, the present study extrapolated the HPLC method to ultra-HPLC for the determination of urinary AFM1. After the extraction procedure with an immunoaffinity column, chromatographic separation was done using a high performance 1.8 μm microparticulate C18 column. The mean recovery from urine samples spiked with 0.5, 1.0 and 2.0 ng/ml AFM1 was 84.4±4.0%, with acceptable recovery values, interday (6.0±5.3%) and intraday (2.6±0.6%) coefficients of variation. The retention time was 5.7 min. This method was used to measure urinary AFM1 in 71 subjects, of which 13 had AFM1 levels above the limit of detection (0.018 ng/ml). The mean urinary AFM1 level of the positive samples was 18.8±28.6 pg/ml, ranging from 2.4 to 100.4 pg/ml. As this is one of the few studies investigating the occurrence of aflatoxin biomarkers in human biological samples in Malaysia, a study with a larger sample size is necessary to investigate the magnitude of aflatoxin exposure among the population.

Detection of serum AFB1-lysine adduct in Malaysia and its association with liver and kidney functions

Aflatoxin is ubiquitously found in many foodstuffs and produced by Aspergillus species of fungi. Of many aflatoxin metabolites, AFB1 is classified by the International Agency for Research on Cancer (IARC) as group one carcinogen and linked to the development of hepatocellular carcinoma (HCC). The study on molecular biomarker of aflatoxin provides a better assessment on the extent of human exposure to aflatoxin. In Malaysia, the occurrences of aflatoxin-contaminated foods have been documented, but there is a lack of data on human exposure to aflatoxin. Hence, this study investigated the occurrence of AFB1-lysine adduct in serum samples and its association with liver and kidney functions. 5ml fasting blood samples were collected from seventy-one subjects (n=71) for the measurement of AFB1-lysine adduct, albumin, total bilirubin, AST (aspartate aminotransferase), ALT (alanine transaminase), ALP (alkaline phosphatase), GGT (gamma-glutamyl transpeptidase), creatinine and BUN (blood urea nitrogen). The AFB1-lysine adduct was detected in all serum samples (100% detection rate) with a mean of 6.85±3.20pg/mg albumin (range: 1.13-18.85pg/mg albumin). Male subjects (mean: 8.03±3.41pg/mg albumin) had significantly higher adduct levels than female subjects (mean: 5.64±2.46pg/mg albumin) (p<0.01). It was noteworthy that subjects with adduct levels greater than average (>6.85pg/mg albumin) had significantly elevated level of total bilirubin (p<0.01), GGT (p<0.05) and creatinine (p<0.01). Nevertheless, only the level of total bilirubin, (r=0.347, p-value=0.003) and creatinine (r=0.318, p-value=0.007) showed significant and positive correlation with the level of AFB1-lysine adduct. This study provides a valuable insight on human exposure to aflatoxin in Malaysia. Given that aflatoxin can pose serious problem to the health, intervention strategies should be implemented to limit/reduce human exposure to aflatoxin. Besides, a study with a big sample size should be warranted in order to assess aflatoxin exposure in the general population of Malaysia.