Ochratoxin A levels in plasma from inhabitants of northern Paraná, Brazil

Ochratoxin A (OTA), a mycotoxin produced by some fungi like Aspergillus ochraceus, Aspergillus niger, Aspergillus carbonarius and Penicillium viridicatum, is a natural contaminant of many foods worldwide. The intake of OTA is associated with deleterious effects to humans and animals, such as nephro- and hepatotoxicity. Although there are some data about food contamination, there is lack of data about human exposure to OTA in Brazil. Therefore, current research aimed to determine the level of human exposure to OTA and, additionally, identify possible associations with biomarkers of liver and kidney damage. OTA levels were evaluated in plasma samples from 149 individuals living in the state of Paraná, Brazil, by indirect competitive ELISA using monoclonal antibody anti-OTA (cell line OTA.7). Plasma levels of OTA, alanine aminotransferase, aspartate aminotransferase, urea and creatinine were submitted to Pearson's correlation test. It was possible to measure OTA levels in 54.4% of the samples (mean 734±296 pg/ml; maximum 1,585 pg/ml), with an estimated daily intake of 983-1,445 pg/kg body weight. There was no correlation between OTA plasma levels and biochemical parameters, possibly due to the low level of contamination. This is one of the first studies concerning the contamination of humans by OTA in Brazil and we conclude that the plasma levels of the evaluated population indicate an estimated weekly intake below the tolerable weekly intake derived by the EFSA Panel on Contaminants in the Food Chain. Nevertheless, additional longitudinal studies with greater regional coverage and at different seasonal periods are necessary.

Ochratoxin A: 50 Years of Research

Since ochratoxin A (OTA) was discovered, it has been ubiquitous as a natural contaminant of moldy food and feed. The multiple toxic effects of OTA are a real threat for human beings and animal health. For example, OTA can cause porcine nephropathy but can also damage poultries. Humans exposed to OTA can develop (notably by inhalation in the development of acute renal failure within 24 h) a range of chronic disorders such as upper urothelial carcinoma. OTA plays the main role in the pathogenesis of some renal diseases including Balkan endemic nephropathy, kidney tumors occurring in certain endemic regions of the Balkan Peninsula, and chronic interstitial nephropathy occurring in Northern African countries and likely in other parts of the world. OTA leads to DNA adduct formation, which is known for its genotoxicity and carcinogenicity. The present article discusses how renal carcinogenicity and nephrotoxicity cause both oxidative stress and direct genotoxicity. Careful analyses of the data show that OTA carcinogenic effects are due to combined direct and indirect mechanisms (e.g., genotoxicity, oxidative stress, epigenetic factors). Altogether this provides strong evidence that OTA carcinogenicity can also occur in humans.

Ochratoxin A and human health risk: a review of the evidence

Ochratoxin A (OTA) is a mycotoxin produced by several fungal species including Aspergillus ochraceus, A. carbonarius, A. niger, and Penicillium verrucosum. OTA causes nephrotoxicity and renal tumors in a variety of animal species; however, human health effects are less well-characterized. Various studies have linked OTA exposure with the human diseases Balkan endemic nephropathy (BEN) and chronic interstitial nephropathy (CIN), as well as other renal diseases. This study reviews the epidemiological literature on OTA exposure and adverse health effects in different populations worldwide, and assesses the potential human health risks of OTA exposure. Epidemiological studies identified in a systematic review were used to calculate unadjusted odds ratios for OTA associated with various health endpoints. With one exception, there appears to be no statistically significant evidence for human health risks associated with OTA exposure. One Egyptian study showed a significantly higher risk of nephritic syndrome in those with very high urinary OTA levels compared with relatively unexposed individuals; however, other potential risk factors were not controlled for in the study. Larger cohort or case-control studies are needed in the future to better establish potential OTA-related human health effects, and further duplicate-diet studies are needed to validate biomarkers of OTA exposure in humans.

Evaluating weight of evidence in the mystery of Balkan endemic nephropathy

Balkan endemic nephropathy (BEN) is a chronic, progressive wasting disease of the kidneys, endemic in certain rural regions of the Balkan nations Croatia, Serbia, Bulgaria, and Romania. It is irreversible and ultimately fatal. Though this disease was first described in the 1950s, its causes have been a mystery and a source of much academic and clinical contention. Possible etiologic agents that have been explored include exposure to metals and metalloids, viruses and bacteria, and the dietary toxins aristolochic acid (AA) and ochratoxin A (OTA). AA is a toxin produced by weeds of the genus Aristolochia, common in Balkan wheat fields. Aristolochia seeds may intermingle with harvested grains and thus inadvertently enter human diets. OTA is a mycotoxin (fungal toxin) common in many foods, including cereal grains. In this study, we analyzed the weight of evidence for each of the suspected causes of BEN using the Bradford Hill criteria (BHC): nine conditions that determine weight of evidence for a causal relationship between an agent and a disease. Each agent postulated to cause BEN was evaluated using the nine criteria, and for each criterion was given a rating based on the strength of the association between exposure to the substance and BEN. From the overall available scientific evidence for each of these suspected risk factors, AA is the agent with the greatest weight of evidence in causing BEN. We describe other methods for testing causality from epidemiological studies, which support this conclusion of AA causing BEN.

Ochratoxin A exposure biomarkers in the Czech Republic and comparison with foreign countries

Among ochratoxins, ochratoxin A (OTA) occupies a dominant place and represents significant risk for human and animal health which also implies economic losses around the world. OTA is nephrotoxic, hepatotoxic, teratogenic and immunotoxic mycotoxin. OTA exposure may lead to formation of DNA adducts resulting to genotoxicity and carcinogenicity (human carcinogen of 2B group). Now it seems that OTA could be "a complete carcinogen" which obliges to monitor its presence in biological materials, especially using the suitable biomarkers. In this article, OTA findings in urine, blood, serum, plasma and human kidneys (target dose) in the Czech Republic and comparison with foreign countries are presented.

Review. Ochratoxin A: Presence in Human Plasma and Intake Estimation

Ochratoxin A (OTA) is a fungal toxic secondary metabolite that can be found in several foodstuffs and thereby ingested by humans. One way to assess exposure of humans to OTA is the determination of the levels of this mycotoxin in blood plasma from a certain population. Such studies have been done in many countries, both in healthy people and nephropathy patients. Relationships with individual characteristics were investigated in several cases. Thus, most studies found no correlation with age, either with gender. However, the few studies that found correlation between OTA plasma levels and gender showed that men presented the highest values. When sampling was done over more than one season, the highest OTA plasma levels were found mostly in summer. Differences within regions of a country were related to dietary habits of each area. OTA levels of group populations showed variations from year to year, whereas intraindividual repetitions showed no specific trend. Daily intake of the toxin can be estimated from OTA plasma concentrations by the Klaassen equation. OTA toxicokinetics are considered in this review. Calculated daily intake of OTA by different studies did not overpass the proposed tolerable daily intakes of OTA.

Ochratoxin A: An overview on toxicity and carcinogenicity in animals and humans

Ochratoxin A (OTA) is a ubiquitous mycotoxin produced by fungi of improperly stored food products. OTA is nephrotoxic and is suspected of being the main etiological agent responsible for human Balkan endemic nephropathy (BEN) and associated urinary tract tumours. Striking similarities between OTA-induced porcine nephropathy in pigs and BEN in humans are observed. International Agency for Research on Cancer (IARC) has classified OTA as a possible human carcinogen (group 2B). Currently, the mode of carcinogenic action by OTA is unknown. OTA is genotoxic following oxidative metabolism. This activity is thought to play a central role in OTA-mediated carcinogenesis and may be divided into direct (covalent DNA adduction) and indirect (oxidative DNA damage) mechanisms of action. Evidence for a direct mode of genotoxicity has been derived from the sensitive 32P-postlabelling assay. OTA facilitates guanine-specific DNA adducts in vitro and in rat and pig kidney orally dosed, one adduct comigrates with a synthetic carbon (C)-bonded C8-dG OTA adduct standard. In this paper, our current understanding of OTA toxicity and carcinogenicity are reviewed. The available evidence suggests that OTA is a genotoxic carcinogen by induction of oxidative DNA lesions coupled with direct DNA adducts via quinone formation. This mechanism of action should be used to establish acceptable intake levels of OTA from human food sources.

Monitoring the mycotoxins in food and their biomarkers in the Czech Republic

Testing of the presence of toxigenic microfungi and mycotoxins in foodstuffs in the food chain is an important part of the food safety strategy in The Czech Republic. At the national level, control of their presence in the entire food chain is assured by Public Health Protection Agencies, by the Veterinary Administration and by the Czech Agriculture and Food Inspection Authority. This article summarizes surveillance activities of Public Health Protection Agencies and mycotoxins findings in dietary raw materials and foodstuffs from the 1990s to 2004 in the Czech Republic. At present, the health risk from the mycotoxins exposure from foodstuffs is assessed to be relatively low in the Czech Republic, especially as far as the foodstuffs of the Czech origin are concerned. It may result in late toxic effects (e. g., carcinogenic risk) following a single or repeated ingestion of low mycotoxins doses from foodstuffs. Nevertheless, the overall situation may change due to the globalization of the food market. In order to minimize the risk associated with mycotoxins and eliminate their impact on Czech public health, continuous monitoring of the presence of toxigenic moulds, mycotoxins, and their biomarkers is necessary, in conjunction with strict respect to European Union legislation.

Biomarkers of human exposure to ochratoxin A

Low blood serum/plasma concentrations of ochratoxin A (OTA) have been reported for healthy persons in more than 20 countries. Epidemiology studies in Bulgaria, Romania, Spain, the Czech Republic, Turkey, Italy, Egypt, Algeria and Tunisia have found significantly higher serum or plasma levels of OTA in patients with certain kidney disorders compared to healthy people, although the association may not be a causal one. Regional variations within one country, seasonal differences and variation within one person were found in some studies. Correlations with age and gender have not usually been detected. Detection limits using liquid chromatographic methods are about 0.02-0.1 ng ml(-1) plasma/serum so that incidences of positives often are 50-100%, reflecting widespread and continuous exposure of humans to OTA. In a study in the UK, OTA in urine was found to be a better indicator of OTA consumption than OTA in plasma. Nevertheless, blood plasma concentrations have been widely used to estimate dietary intake of OTA, using equations relating it with plasma concentration, plasma clearance and bioavailability. A further source of human exposure is airborne dust. OTA has been detected in human milk in several countries and comparisons with serum/blood levels have been made in Germany and Sweden.

New data on the occurrence of ochratoxin A in human sera from patients affected or not by renal diseases in Tunisia

Ochratoxin A is often found in the sera of people exposed to this mycotoxin in their food (cereals such as barley, coffee, wines, fruit juices, spices, products of animal origin such as pig and poultry offal). Ochratoxin A is suspected of playing a role in the Balkan Endemic Nephropathy, a nephropathology described in Balkan areas where ochratoxin A is often found in cereals and in pork-derived products. In North Africa like Tunisia where high incidence of chronic interstitial nephropathies of unknown aetiology are pointed out, the involvement of ochratoxin A was suspected but contradictory studies on the degree of human exposure did not succeed in evidencing the role of ochratoxin A. In the present work, sera from 47 volunteers hospitalised for nephropathic damages including bladder tumours (21 people), and from 62 patients hospitalised for disorders other than nephropathic ones, were analysed for ochratoxin A contents. The determination of ochratoxin A in sera was done by a validated immunoaffinity-HPLC method. Sera from unaffected population exhibited percentages of 74.2%, 22.6% and 3.2% containing ranges of ochratoxin A as <0.10-0.5 microg/l, 0.51-1.0 microg/l and above 1.0 microg/l respectively. For patients affected with renal diseases, percentages were 59.5%, 25.5% and 14.9% on the same ranges of ochratoxin A levels respectively. The average ochratoxin A concentration for patients with urinary tract disease excluding cancer patients was 0.99+/-1.28 microg/l while that for the non-nephropathic patients was 0.53+/-1.00 microg/l. However the average levels in the cancer patients was only 0.26+/-0.20 microg/l. Those results are in line with most of previously published works and did not confirm very high ochratoxin A contents found in other reports from same regions.