Individual and combined effects of mycotoxins from typical indoor moulds

First evidence on the occurrence of multi-mycotoxins and dietary risk exposure to AFB1 along the cassava value chain in Uganda

This study investigated the occurrence and distribution of multiple mycotoxins (aflatoxin B1, B2, G1, G2, fumonisins B1, B2, ochratoxin A (OTA), deoxynivalenol (DON), zearalenone (ZEN), and citrinin (CIT)) in cassava products and as assessed the potential risk of aflatoxin B1 (AFB1) exposure among cassava consumers. A total of 192 samples of cassava products (96 flour and 96 chips, each with 48 samples from farmer and 48 from wholesaler) were analysed using LC/MS-MS. All positive samples irrespective of their origin (flour or chips) exhibited AFB1 levels exceeding the EU regulatory threshold of 5 µg/kg. The sum of fumonisins (FB1 + FB2), ZEN, and DON were significantly (P < 0.05) higher in cassava flour (14.3 µg/kg; 3.71 µg/kg; 25.1 µg/kg) compared to chips (6.54 µg/kg; 1.25 µg/kg; 0.25 µg/kg), respectively. Aflatoxins G2 was not detected in any of 192 samples. Cassava flour samples from farmers exhibited significantly (P < 0.05) higher mean concentrations of AFB1 (27.1 µg/kg), total aflatoxins (78.2 µg/kg), and ochratoxin A (79.6 µg/kg) in contrast to wholesalers, whose mean levels were notably lower at 8.91, 5.79 µg/kg, and 2.44 µg/kg, respectively, pointing the likely critical source of mycotoxin contamination. Cassava consumers in Northern Uganda are at a higher risk, with an estimated 2.06 cancer cases per 100,000 individuals per year compared to those in Eastern Uganda at 0.25. This study underscores the urgent need for interventions to manage aflatoxins in cassava flour, particularly at farm level in Northern Uganda. It accentuates a shift market to household-level sampling and the need for analytical methods targeting multiple mycotoxins.

Mycotoxins Exposure of Lactating Women and Its Relationship with Dietary and Pre/Post-Harvest Practices in Rural Ethiopia

Mycotoxins can be transferred to breast milk during lactation. Hence, the presence of multiple mycotoxins (aflatoxins B1, B2, G1, G2, and M1, alpha and beta zearalanol, deoxynivalenol, fumonisins B1, B2, B3, and hydrolyzed B1, nivalenol, ochratoxin A, ochratoxin alpha, and zearalenone) in breast milk samples was assessed in our study. Furthermore, the relationship between total fumonisins and pre/post-harvest and the women's dietary practices was examined. Liquid chromatography coupled with tandem mass spectrometry was used to analyze the 16 mycotoxins. An adjusted censored regression model was fitted to identify predictors of mycotoxins, i.e., total fumonisins. We detected only fumonisin B2 (15% of the samples) and fumonisin B3 (9% of the samples) while fumonisin B1 and nivalenol were detected only in a single breast milk sample. No association between total fumonisins and pre/post-harvest and dietary practices was found (p < 0.05). The overall exposure to mycotoxins was low in the studied women, although fumonisins contamination was not negligible. Moreover, the recorded total fumonisins was not associated with any of the pre/post-harvest and dietary practices. Therefore, to better identify predictors of fumonisin contamination in breast milk, longitudinal studies with food samples in addition to breast milk samples and with larger sample sizes are needed for the future.

Airborne mycotoxins in waste recycling and recovery facilities: Occupational exposure and health risk assessment

Mycotoxins are metabolites secreted by certain types of moulds, and some of them can be harmful to health. The objective of this study was to estimate the level of exposure to airborne aflatoxin B1, ochratoxin A, gliotoxin and sterigmatocystin in waste recycling and recovery facilities. An additional goal was to assess the related health risks for workers. Targeted mycotoxins were analysed quantitatively in 94 air samples collected in five sites using ultra-performance liquid chromatography coupled with high resolution mass spectrometry. The level of exposure to mycotoxin during working day scenarios was compared to benchmark values, either health-based guidelines when available or the concentration of no toxicological concern (CoNTC) when not. Eleven per cent of samples showed quantifiable measurement results. Aflatoxin B1 and sterigmatocystin were quantified at the mechanical separation area in mechanical-biological treatment (MBT) facilities and in the materials recovery facility (MRF), but not in composting plants and composting units in MBT facilities. The levels of exposure were all below 1 ng m^-3. This is the first time exposure to sterigmatocystin in waste management facilities is reported and quantified. Ochratoxin A and gliotoxin were not quantified in any of the air samples. Health risk assessment approaches did not suggest a significant threat to workers' health. These data do not suggest the need for specific prevention measures in addition to those against other airborne biological agents.

Toxicological and Medical Aspects of Aspergillus-Derived Mycotoxins Entering the Feed and Food Chain

Due to Earth's changing climate, the ongoing and foreseeable spreading of mycotoxigenic Aspergillus species has increased the possibility of mycotoxin contamination in the feed and food production chain. These harmful mycotoxins have aroused serious health and economic problems since their first appearance. The most potent Aspergillus-derived mycotoxins include aflatoxins, ochratoxins, gliotoxin, fumonisins, sterigmatocystin, and patulin. Some of them can be found in dairy products, mainly in milk and cheese, as well as in fresh and especially in dried fruits and vegetables, in nut products, typically in groundnuts, in oil seeds, in coffee beans, in different grain products, like rice, wheat, barley, rye, and frequently in maize and, furthermore, even in the liver of livestock fed by mycotoxin-contaminated forage. Though the mycotoxins present in the feed and food chain are well documented, the human physiological effects of mycotoxin exposure are not yet fully understood. It is known that mycotoxins have nephrotoxic, genotoxic, teratogenic, carcinogenic, and cytotoxic properties and, as a consequence, these toxins may cause liver carcinomas, renal dysfunctions, and also immunosuppressed states. The deleterious physiological effects of mycotoxins on humans are still a first-priority question. In food production and also in the case of acute and chronic poisoning, there are possibilities to set suitable food safety measures into operation to minimize the effects of mycotoxin contaminations. On the other hand, preventive actions are always better, due to the multivariate nature of mycotoxin exposures. In this review, the occurrence and toxicological features of major Aspergillus-derived mycotoxins are summarized and, furthermore, the possibilities of treatments in the medical practice to heal the deleterious consequences of acute and/or chronic exposures are presented.

Mycotoxins co-contamination: Methodological aspects and biological relevance of combined toxicity studies

Mycotoxins are secondary fungal metabolites produced mainly by Aspergillus, Penicillium, and Fusarium. As evidenced by large-scale surveys, humans and animals are simultaneously exposed to several mycotoxins. Simultaneous exposure could result in synergistic, additive or antagonistic effects. However, most toxicity studies addressed the effects of mycotoxins separately. We present the experimental designs and we discuss the conclusions drawn from in vitro experiments exploring toxicological interactions of mycotoxins. We report more than 80 publications related to mycotoxin interactions. The studies explored combinations involving the regulated groups of mycotoxins, especially aflatoxins, ochratoxins, fumonisins, zearalenone and trichothecenes, but also the "emerging" mycotoxins beauvericin and enniatins. Over 50 publications are based on the arithmetic model of additivity. Few studies used the factorial designs or the theoretical biology-based models of additivity. The latter approaches are gaining increased attention. These analyses allow determination of the type of interaction and, optionally, its magnitude. The type of interaction reported for mycotoxin combinations depended on several factors, in particular cell models and the tested dose ranges. However, synergy among Fusarium toxins was highlighted in several studies. This review indicates that well-addressed in vitro studies remain valuable tools for the screening of interactive potential in mycotoxin mixtures.

Health Risks Associated with Exposure to Filamentous Fungi

Filamentous fungi occur widely in the environment, contaminating soil, air, food and other substrates. Due to their wide distribution, they have medical and economic implications. Regardless of their use as a source of antibiotics, vitamins and raw materials for various industrially important chemicals, most fungi and filamentous fungi produce metabolites associated with a range of health risks, both in humans and in animals. The association of filamentous fungi and their metabolites to different negative health conditions in humans and animals, has contributed to the importance of investigating different health risks induced by this family of heterotrophs. This review aims to discuss health risks associated with commonly occurring filamentous fungal species which belong to genera Aspergillus, Penicillium and Fusarium, as well as evaluating their pathogenicity and mycotoxic properties.

Inflammation-associated gene expression in RAW 264.7 macrophages induced by toxins from fungi common on damp building materials

Most fungi that grow on damp building materials produce low molecular weight compounds, some of which are known to be toxic. In this study, we tested the hypothesis that exposure to some metabolites of fungi common on damp building materials would result in time-, dose-, and compound-specific responses in the production of various chemokines by RAW 264.7 cells. Cell cultures were exposed to a 10^-7M or 10^-8M metabolite dose for 2, 4, 8 or 24h. Metabolite concentrations used were based on those that might be expected in alveolar macrophages due to inhalation exposure from living or working in a damp building. Compared to controls, exposure provoked significant time-, dose- and compound-specific responses manifest as differentially elevated secretion of three of nine cytokines tested in culture supernatant of treated cells. The greatest number of cytokines produced in response to the metabolites tested were in andrastin A-treated cells (GM-CSF, TGFβ1, Tnf-α) followed by koninginin A (TGFβ1 and Tnf-α) and phomenone (GM-CSF, TGFβ1). Chaetoglobosin A, chaetomugilin D and walleminone exposures each resulted in significant time-specific production of Tnf-α only. This investigation adds to a body of evidence supporting the role of low molecular weight compounds from damp building materials as pathogen associated molecular patterns (PAMPs). Along with fungal glucan and chitin, these compounds contribute to the non-allergy based respiratory outcomes for people living and working in damp buildings.

Synergistic proinflammatory interactions of microbial toxins and structural components characteristic to moisture-damaged buildings

Indoor exposure to microbes and their structural and metabolic compounds is notoriously complex. To study proinflammatory interactions between the multiple microbial agents, macrophages derived from human THP-1 monocytic cells were exposed to several concentrations of microbial toxins alone (emodin, enniatin B, physcion, sterigmatocystin, valinomycin) and in combination with microbial structural components (bacterial lipopolysaccharide [LPS] or fungal β-glucan). While the expression of proinflammatory cytokines TNFα and IL-1β to single toxins alone was modest, low-dose co-exposure with structural components increased the responses of emodin, enniatin B, and valinomycin synergistically, both at the mRNA and protein level, as measured by RT-qPCR and ELISA, respectively. Co-exposure of toxins and β-glucan resulted in consistent synergistically increased expression of several inflammation-related genes, while some of the responses with LPS were also inhibitory. Co-exposure of toxins with either β-glucan or LPS induced also mitochondrial damage and autophagocytosis. The results demonstrate that microbial toxins together with bacterial and fungal structural components characteristic to moisture-damaged buildings can have drastic synergistic proinflammatory interactions at low exposure levels.

Challenges in risk assessment of multiple mycotoxins in food

Most fungi are able to produce several mycotoxins simultaneously and, consequently, to contaminate a wide variety of foodstuffs. Therefore, the risk of human co-exposure to multiple mycotoxins is real, raising a growing concern about their potential impact on human health. Besides, government and industry regulations are usually based on individual toxicities, and do not take into account the complex dynamics associated with interactions between co-occurring groups of mycotoxins. The present work assembles, for the first time, the challenges posed by the likelihood of human co-exposure to these toxins and the possibility of interactive effects occurring after absorption, towards knowledge generation to support a more accurate human risk assessment. Regarding hazard assessment, a physiologically-based framework is proposed in order to infer the health effects from exposure to multiple mycotoxins in food, including knowledge on the bioaccessibility, toxicokinetics and toxicodynamics of single and combined toxins. The prioritisation of the most relevant mixtures to be tested under experimental conditions that attempt to mimic human exposure and the use of adequate mathematical approaches to evaluate interactions, particularly concerning the combined genotoxicity, were identified as the main challenges for hazard assessment. Regarding exposure assessment, the need of harmonised food consumption data, availability of multianalyte methods for mycotoxin quantification, management of left-censored data, use of probabilistic models and multibiomarker approaches are highlighted, in order to develop a more precise and realistic exposure assessment. To conclude, further studies on hazard and exposure assessment of multiple mycotoxins, using harmonised methodologies, are crucial towards an improvement of data quality and a more reliable and robust risk characterisation, which is central for risk management and, consequently, to prevent mycotoxins-associated adverse effects. A deep understanding of the nature of interactions between multiple mycotoxins will contribute to draw real conclusions on the health impact of human exposure to mycotoxin mixtures.

Indoor fungi: companions and contaminants

This review discusses the role of fungi and fungal products in indoor environments, especially as agents of human exposure. Fungi are present everywhere, and knowledge for indoor environments is extensive on their occurrence and ecology, concentrations, and determinants. Problems of dampness and mold have dominated the discussion on indoor fungi. However, the role of fungi in human health is still not well understood. In this review, we take a look back to integrate what cultivation-based research has taught us alongside more recent work with cultivation-independent techniques. We attempt to summarize what is known today and to point out where more data is needed for risk assessment associated with indoor fungal exposures. New data have demonstrated qualitative and quantitative richness of fungal material inside and outside buildings. Research on mycotoxins shows that just as microbes are everywhere in our indoor environments, so too are their metabolic products. Assessment of fungal exposures is notoriously challenging due to the numerous factors that contribute to the variation of fungal concentrations in indoor environments. We also may have to acknowledge and incorporate into our understanding the complexity of interactions between multiple biological agents in assessing their effects on human health and well-being.

The identification of complex interactions in epidemiology and toxicology: a simulation study of boosted regression trees

BACKGROUND

There is a need to evaluate complex interaction effects on human health, such as those induced by mixtures of environmental contaminants. The usual approach is to formulate an additive statistical model and check for departures using product terms between the variables of interest. In this paper, we present an approach to search for interaction effects among several variables using boosted regression trees.

METHODS

We simulate a continuous outcome from real data on 27 environmental contaminants, some of which are correlated, and test the method's ability to uncover the simulated interactions. The simulated outcome contains one four-way interaction, one non-linear effect and one interaction between a continuous variable and a binary variable. Four scenarios reflecting different strengths of association are simulated. We illustrate the method using real data.

RESULTS

The method succeeded in identifying the true interactions in all scenarios except where the association was weakest. Some spurious interactions were also found, however. The method was also capable to identify interactions in the real data set.

CONCLUSIONS

We conclude that boosted regression trees can be used to uncover complex interaction effects in epidemiological studies.