Risk Assessment of RYR Food Supplements: Perception vs. Reality

Coordinated Synthesis of Pigments Differing in Side Chain Length in Monascus purpureus and Investigation of Pigments and Citrinin Relation

The Monascus fungi have traditionally been used in Asia for food coloring. Unfortunately, the most well-known species, Monascus purpureus, very often produce mycotoxin citrinin in addition to pigments, which poses a significant problem for the use of pigments in foods. There is a step in pigment biosynthesis where a side chain of five or seven carbons is attached to the tetraketide, the product of polyketide synthase, resulting in the formation of pigments in pairs. Further, it is still unclear whether pigment and citrinin biosyntheses are related or independent. Therefore, this study is focused on the relationship between pigment and citrinin production and pigment analogues that differ in side chain length, all evaluated by the Spearman correlation test. To generate sufficient data, Monascus purpureus DBM 4360 was cultivated with different carbon and nitrogen sources and under osmotic stress induced by glucose and/or sodium chloride. The study reveals a very strong correlation between the production of five- and seven-carbon side chain pigments under all culture conditions tested for all three groups, yellow, orange, and red pigments. The correlation between pigments and citrinin depended on the group assessed and ranged from fair to very strong. While the coordinated synthesis of pigment analogues in pairs has been clearly confirmed, the relationship between pigment and citrinin production was unfortunately neither confirmed nor refuted and must be the subject of further research.

Subclinical acute tubular necrosis potentially associated with red yeast rice consumption unexpectedly detected in a patient with membranous nephropathy

In March 2024, a significant public health issue involving red yeast rice supplements emerged in Japan, which may have been associated with several health problems, including kidney dysfunction. A 74-year-old man without a history of urinary abnormalities developed nephrotic syndrome 10 weeks after starting "Beni-Koji Choleste Help®," a red yeast rice supplement. Electron microscopy showed subepithelial and intramembranous dense deposits with abnormality of the glomerular basement membrane, which led to the diagnosis of long-standing membranous nephropathy. The diagnosis of phospholipase A2 receptor (PLA2R)-positive primary membranous nephropathy was confirmed via PLA2R-positive immunostaining. Furthermore, there were findings of focal tubular necrosis without unexplained cellular infiltration. Based on previous reports, it was suggested that red yeast rice-related products have triggered the acute tubular necrosis in the patient. His nephrotic syndrome reached partial remission with oral administration of prednisolone at an initial dose of 40 mg/day. This case indicates that membranous nephropathy was coincidentally accompanied by acute tubular necrosis that was potentially associated with red yeast rice-related health foods. It may be reasonable to state that individuals consuming red yeast rice-related health products may develop subclinical focal tubular necrosis even in the absence of overt clinical symptoms or laboratory abnormalities. The currently recognized health issues associated with red yeast rice-related health foods may only represent a small portion of the overall risks.

Citrinin disrupts microtubule assembly in cardiac cells: Impact on mitochondrial organization and function

Citrinin (CTN) is a mycotoxin commonly present in various foods and feeds worldwide, as well as dietary supplements in Asian countries, but the risks and cellular mechanisms associated with its cardiotoxicity remains unclear. In this study, RNA-seq analysis of CTN-treated H9c2 cardiac cells demonstrated significant perturbations in pathways related to microtubule cytoskeleton and mitochondrial network organization. CTN disrupted microtubule polymerization and downregulated mRNA levels of microtubule-assembling genes, Map2 and Tpx2, in H9c2 cardiac cells. Additionally, CTN interfered with the distribution of mitochondrial network along the microtubules, leading to the accumulation of dysfunctional mitochondria characterized by elevated superoxide levels and reduced membrane potential. This disruption also caused the buildup of lysosomes and ubiquitinated proteins, which hindered waste clearance in microtubule-disassembled H9c2 cells. Molecular docking analysis indicated that CTN could bind to the colchicine binding site on β-tubulin, thereby mimicking the microtubule-disrupting effect of colchicine. This study provides morphological, transcriptomic, and mechanistic evidence to elucidate the cardiotoxic mechanisms of CTN, which involve the dysregulated microtubule network, subsequent mitochondrial mislocalization, and impaired proteolysis of damaged proteins/organelles in cardiac cells. Our findings may enhance the fundamental understanding and facilitate future risk assessment of CTN.

Quality Control and Safety Assessment of Online-Purchased Food Supplements Containing Red Yeast Rice (RYR)

Dietary supplements containing red yeast rice (RYR), a fermentation product of the fungus Monascus purpureus grown on white rice, remain popular in Europe as proclaimed cholesterol-lowering aids. The cholesterol-lowering effects are due to the occurrence of monacolin K, which is often present as a mixture of monacolin K lactone (MK) and as monacolin K hydroxy acid (MKA). MK is structurally similar to the cholesterol-lowering medicine lovastatin. Recently, due to safety concerns linked to the use of statins, the European Commission prohibited RYR supplements with a maximum serving exceeding 3 mg of total monacolins per day. Moreover, the amount of the mycotoxin citrinin, potentially produced by M. purpureus, was also reduced to 100 µg/kg. Evidently, manufacturers that offer their products on the European market, including the online market, must also be compliant with these limits in order to guarantee the safety of their products. Therefore, thirty-five different RYR supplements, purchased from an EU-bound e-commerce platform or from registered online pharmacies, were screened for their compliance to the European legislation for citrinin content and the amount of total monacolin K. This was conducted by means of a newly developed LC-MS/MS methodology that was validated according to ISO 17025. Moreover, these supplements were also screened for possible adulteration and any contamination by micro-organisms and/or mycotoxins. It was found that at least four of the thirty-five RYR supplements (≈11%) might have reason for concern for the safety of the consumer either due to high total monacolin K concentrations exceeding the European predefined limits for total monacolins or severe bacterial contamination. Moreover, three samples (≈9%) were likely adulterated, and the labeling of six of the seventeen samples (≈35%) originating from an EU-based e-commerce platform was not compliant, as either the mandatory warning was missing or incomplete or the total amount of monacolins was not mentioned.

Mycotoxins and pyrrolizidine alkaloids in herbal dietary supplements

The market demand for herbal dietary supplements is rapidly growing and such products are becoming more common and accessible to consumers. However, the knowledge about their safety remains incomplete. Herbal dietary supplements are one of the food groups that can contribute significantly to human health concerns arising from chronic exposure to pyrrolizidine alkaloids and mycotoxins. This study aimed to simultaneously determine 79 natural contaminants, including mycotoxins, as well as pyrrolizidine and tropane alkaloids in herbal dietary supplements in one analytical run. Exposure assessment and human health risks were assessed for all compounds included in this study. The total concentration of naturally occurring contaminants in herbal dietary supplements reached 5.3 mg kg-1 and the most frequently detected mycotoxins were tentoxin and alternariol monomethyl ether. The latter was detected with the highest frequency, reaching concentrations up to 2.5 mg kg-1. The obtained results indicate a potential risk to public health related to herbal dietary supplement consumption.

Occurrence, Risk Implications, Prevention and Control of CIT in Monascus Cheese: A Review

Monascus is a filamentous fungus that has been used in the food and pharmaceutical industries. When used as an auxiliary fermenting agent in the manufacturing of cheese, Monascus cheese is obtained. Citrinin (CIT) is a well-known hepatorenal toxin produced by Monascus that can harm the kidneys structurally and functionally and is frequently found in foods. However, CIT contamination in Monascus cheese is exacerbated by the metabolic ability of Monascus to product CIT, which is not lost during fermentation, and by the threat of contamination by Penicillium spp. that may be introduced during production and processing. Considering the safety of consumption and subsequent industrial development, the CIT contamination of Monascus cheese products needs to be addressed. This review aimed to examine its occurrence in Monascus cheese, risk implications, traditional control strategies, and new research advances in prevention and control to guide the application of biotechnology in the control of CIT contamination, providing more possibilities for the application of Monascus in the cheese industry.

The Impact of Red Yeast Rice Extract Use on the Occurrence of Muscle Symptoms and Liver Dysfunction: An Update from the Adverse Event Reporting Systems and Available Meta-Analyses

Red yeast rice (RYR) has a cholesterol-lowering effect due to the presence of bioactive components (monacolins, mainly monacolin K) that act by inhibiting the activity of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. The European Food Safety Authority (EFSA) assessed the use of RYR and, while pointing out several uncertainties regarding the available data, raised a warning related to the safety of RYR when used as a food supplement at a dose of monacolin as low as 3 mg/day. In their decision in June 2023, EFSA approved the use of monacolins from RYR at doses less than 3 mg/day. We therefore decided to interrogate the different adverse event reporting systems (FAERS and CAERS) and analyse the characteristics of the cases reported to be associated with RYR supplements, and we reviewed the most recent meta-analyses with a focus on the occurrence of muscle symptoms and liver dysfunction. In terms of all musculoskeletal disorders from September 2013 (when the first case related to RYR consumption was recorded) to 30 September 2023, 363,879 cases were reported in the FAERS, with the number of cases related to RYR consumption being very small and accounting for 0.008% of cases. In the same time frame, 27,032 cases of hepatobiliary disorders were reported, and the cases attributable to RYR ingestion accounted for 0.01% of all cases. A low rate of muscle symptoms and liver dysfunction attributed to RYR ingestion was also observed in the CAERS database, where only 34 cases of adverse muscle events and 10 cases of adverse liver events reported RYR as the suspect product, while 19 cases of both muscle events and 10 cases of adverse liver events reported it as a concomitant product. This profile mirrors that of meta-analyses of randomised clinical trials of RYR, in which RYR use was not associated with either liver dysfunction or muscular adverse symptoms.

Exposure to Mycotoxin Citrinin Promotes Carcinogenic Potential of Human Renal Cells

Mycotoxin citrinin (CTN), commonly found in food and health supplements, may induce chromosomal instability. In this study, human renal proximal tubule epithelial cells (hRPTECs) that were exposed to CTN (10 and 20 μM) over 3 days exhibited numerical chromosomal aberrations. Short-term (3 days) and long-term (30 days) exposures to CTN significantly promoted mitotic spindle abnormalities, wound healing, cell migration, and anchorage-independent growth in human embryonic kidney 293 (HEK293) cells. Short-term exposure to 10 and 20 μM CTN increased the number of migrated cells on day 10 by 1.7 and 1.9 times, respectively. The number of anchorage-independent colonies increased from 2.2 ± 1.3 to 7.8 ± 0.6 after short-term exposure to 20 μM CTN and from 2.0 ± 1.0 to 12.0 ± 1.2 after long-term exposure. The transcriptomic profiles of CTN-treated HEK293 were subjected to over-representative analysis (ORA), gene set enrichment analysis (GSEA), and Ingenuity pathway analysis (IPA). Short-term exposure to CTN promoted the RTK/KRAS/RAF/MAPK cascade, while long-term exposure altered the extracellular matrix organization. Both short- and long-term CTN exposure activated cancer and cell cycle-related signaling pathways. These results demonstrate the carcinogenic potential of CTN in human cells and provide valuable insights into the cancer risk associated with CTN.

Combined toxicity assessment of a naturally occurring toxin and a triazole fungicide on different biological processes through toxicogenomic data mining with mixtures

Fungicides are widely used to prevent fungal growth and reduce mycotoxin contamination in food, which provides the opportunity for the co-occurrence of mycotoxins and fungicide residues in food and poses a greater risk to human health. To assess the combined effects of a naturally occurring mycotoxin, citrinin (CIT), and a widely used triazole fungicide, triadimefon (TAD) on different biological processes, the comparative toxicogenomics database was used to obtain phenotypes and response genes for CIT or TAD exposure. Then individual and combined exposure models were developed with zebrafish embryos, and the interaction between CIT and TAD was analyzed using the 2 × 2 factorial design approach to observe the toxic effects. Through data mining analysis, our results showed that CIT or TAD exposure is related to different biological phenotypes, such as cell death, regulation of antioxidant systems, and thyroid hormone metabolism. Our results also showed that CIT (4-day LC₅₀ value of 12.7 mg/L) exposure possessed higher toxicity to zebrafish embryos compared with TAD (4-day LC₅₀ value of 29.6 mg/L). Meanwhile, individual exposure to CIT and TAD altered the expression levels of biomarkers related to oxidative stress, inflammation, apoptosis and hypothalamic-pituitary-thyroid (HPT) axis. Notably, combined exposure to CIT and TAD induced changes in the mentioned biological processes and had an interactive effect on the expression of multiple biomarkers. In conclusion, we evaluated the toxic effects of CIT and TAD in isolation and combination by in-vivo experiments, which provide a new methodological basis and reference for future risk assessment and setting of safety limits for foodborne toxicants.

Red Yeast Rice for the Improvement of Lipid Profiles in Mild-to-Moderate Hypercholesterolemia: A Narrative Review

Reducing low-density lipoprotein cholesterol (LDL-C) levels is a key target for lowering cardiovascular risk and preventing atherosclerotic cardiovascular disease (ASCVD). Red yeast rice (RYR) is a nutraceutical widely used as a lipid-lowering dietary supplement. The main cholesterol-lowering components of RYR are monacolins, particularly monacolin K, which is structurally identical to lovastatin and targets the same key enzyme of cholesterol biosynthesis. RYR supplementation reduces LDL-C levels by approximately 15-34% versus placebo, with a similar effect to low-dose, first-generation statins in subjects with mild-to-moderate dyslipidemia. RYR has also demonstrated beneficial reductions of up to 45% versus placebo in the risk of ASCVD events in secondary prevention studies. RYR at a dose that provides about 3 mg/d of monacolin K is well tolerated, with an adverse event profile similar to that of low-dose statins. RYR is therefore a treatment option for lowering LDL-C levels and ASCVD risk for people with mild-to-moderate hypercholesterolemia who are ineligible for statin therapy, particularly those who are unable to implement lifestyle modifications, and also for people who are eligible for statin therapy but who are unwilling to take a pharmacologic therapy.

Identification and Transcriptional Profiling of SNARE Family in Monascus ruber M7 Reveal Likely Roles in Secondary Metabolism

Soluble N-ethylmaleimide-sensitive factor attachment protein receptors (SNAREs) are the core components that mediate vesicle fusion, and they play an important role in secondary metabolism of filamentous fungi. However, in Monascus spp., one of the traditional medicinal and edible filamentous fungi, the members and function of SNAREs remain unknown. Here, twenty SNAREs in M. ruber M7 were systematically identified based on the gene structure, amino acid structure and phylogenetic analysis and were classified into four subfamilies. We also compared the expression profiles of twenty MrSNAREs in M. ruber M7 and its deletion mutants, ΔmrpigA and ΔpksCT, which could not produce Monascus pigment and citrinin, respectively. The results indicated that these MrSNAREs showed distinct expression patterns in the three strains. Compared to M. ruber M7, the expression levels of Mrtlg2, Mrbet1, Mrgos1 and Mrsec22 remained higher in ΔmrpigA but lower in ΔpksCT, which could be reason to consider them as potential candidate genes involved in secondary metabolism for further functional characterization. Further, the significant upregulation of Mrpep12 and Mrvtil in ΔpksCT is worthy of attention for further research. Our results provide systematic identification and expression profiling of the SNARE family in Monascus and imply that the functions of MrSNAREs are specific to different secondary metabolic processes.