Presence of Mycotoxins in Milk Thistle (Silybum marianum) Food Supplements: A Review

A patient-centered approach to dietary supplements for patients with chronic liver disease

The use of dietary supplements by patients with chronic liver disease is prevalent and rising. Despite the known risks of dietary supplements, including hepatotoxicity, adulteration, and contamination, patients with chronic liver disease often turn to dietary supplements to support their liver and/or overall health but are not necessarily empowered with the information or guidance from their liver practitioner to do so. This article provides practitioners with a framework for balancing the risks and benefits of dietary supplements in patients with chronic liver disease, offering examples of independent resources and certifications to use this framework in clinical practice. We offer 3 common clinical scenarios to highlight how the use of this framework can improve communication and decision-making in clinical practice. By adapting principles from Integrative Medicine, this article advocates for a patient-centered approach to dietary supplements in patients with chronic liver disease, encouraging open dialogue between clinicians and their patients to facilitate informed decision-making and personalized care.

The spinal consequences of HT-2 toxin and selenium deficiency during bone maturation in mice

In our investigation, we probed the ramifications of low selenium diets and HT-2 mycotoxin exposure on spinal development and structural fidelity in murine models. A cohort of 48 male mice was segregated into six groups: a control set, a singular low selenium diet group, two cohorts exposed to distinct concentrations of HT-2 toxin (1.6 and 3.2 mg/kg·bw·d), and two assemblies subjected to a confluence of low selenium intake and each designated HT-2 dosage. Across an 8-week investigative period, parameters such as body mass, markers of bone metabolism, and cellular vigor were assiduously monitored. Analytical techniques encompassed biomechanical assessments, X-ray scrutiny, and micro-computed tomography (micro-CT) evaluations. Our results unveiled a dose-dependent diminution in the body mass of mice exclusively exposed to HT-2 toxin, whereas concurrent exposure to both low selenium and HT-2 toxins elicited a synergistic effect. Pertinent shifts were observed in calcium, phosphorus, and vitamin D concentrations, as well as in the operational dynamics of osteoblasts and osteoclasts, aligning with toxin dosage and combined exposure. Variations in biomechanical attributes were also discerned, mirroring the levels of toxin exposure. Micro-CT and X-ray examinations further corroborated the extensive detrimental impact on the cortical and trabecular architecture of the mice's spinal columns. This inquiry elucidates the complex synergistic interactions between low selenium and HT-2 mycotoxin on murine spinal development and integrity under co-exposure conditions. These findings accentuate the exigency of comprehensively understanding the solitary and joint effects of these toxins on osseous health, providing pivotal insights for future toxicological research and public health strategies.

Promising Phytogenic Feed Additives Used as Anti-Mycotoxin Solutions in Animal Nutrition

Mycotoxins are a major threat to animal and human health, as well as to the global feed supply chain. Among them, aflatoxins, fumonisins, zearalenone, T-2 toxins, deoxynivalenol, and Alternaria toxins are the most common mycotoxins found in animal feed, with genotoxic, cytotoxic, carcinogenic, and mutagenic effects that concern the animal industry. The chronic negative effects of mycotoxins on animal health and production and the negative economic impact on the livestock industry make it crucial to develop and implement solutions to mitigate mycotoxins. In this review, we summarize the current knowledge of the mycotoxicosis effect in livestock animals as a result of their contaminated diet. In addition, we discuss the potential of five promising phytogenics (curcumin, silymarin, grape pomace, olive pomace, and orange peel extracts) with demonstrated positive effects on animal performance and health, to present them as potential anti-mycotoxin solutions. We describe the composition and the main promising characteristics of these bioactive compounds that can exert beneficial effects on animal health and performance, and how these phytogenic feed additives can help to alleviate mycotoxins' deleterious effects.

Comprehensive Review of Aflatoxin and Ochratoxin A Dynamics: Emergence, Toxicological Impact, and Advanced Control Strategies

Filamentous fungi exhibit remarkable adaptability to diverse substrates and can synthesize a plethora of secondary metabolites. These metabolites, produced in response to environmental stimuli, not only confer selective advantages but also encompass potentially deleterious mycotoxins. Mycotoxins, exemplified by those originating from Alternaria, Aspergillus, Penicillium, and Fusarium species, represent challenging hazards to both human and animal health, thus warranting stringent regulatory control. Despite regulatory frameworks, mycotoxin contamination remains a pressing global challenge, particularly within cereal-based matrices and their derived by-products, integral components of animal diets. Strategies aimed at mitigating mycotoxin contamination encompass multifaceted approaches, including biological control modalities, detoxification procedures, and innovative interventions like essential oils. However, hurdles persist, underscoring the imperative for innovative interventions. This review elucidated the prevalence, health ramifications, regulatory paradigms, and evolving preventive strategies about two prominent mycotoxins, aflatoxins and ochratoxin A. Furthermore, it explored the emergence of new fungal species, and biocontrol methods using lactic acid bacteria and essential mustard oil, emphasizing their efficacy in mitigating fungal spoilage and mycotoxin production. Through an integrative examination of these facets, this review endeavored to furnish a comprehensive understanding of the multifaceted challenges posed by mycotoxin contamination and the emergent strategies poised to ameliorate its impact on food and feed safety.

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.

T-2 toxin metabolism and its hepatotoxicity: New insights on the molecular mechanism and detoxification

T-2 toxin, a type A trichothecene, is a secondary metabolite produced by Fusarium poae, Fusarium sporotrichioides, and Fusarium tricinctum. As the most toxic trichothecenes, T-2 toxin causes severe damage to multiple organs, especially to liver. However, the contamination of T-2 toxin covers a wide range of plants, including nuts, grains, fruits and herbs globally. And due to chemical stability of T-2 toxin, it is difficult to be completely removed from the food and feeds, which poses a great threat to human and animal health. Liver is the major detoxifying organ which also makes it the main target of T-2 toxin. After being absorbed by intestine, the first pass effect will reduce the level of T-2 toxin in blood indicating that liver is the main metabolic site of T-2 toxin in vivo. In this review, updated researches on the hepatotoxicity of T-2 toxin were summarized. The metabolic characteristic of T-2 toxin in vivo was introduced. The main hepatotoxic mechanisms of T-2 toxin are oxidative stress, mitochondrial damage, deoxyribonucleic acid (DNA) methylation, autophagy and apoptosis. Recent research of the main hepatotoxic mechanisms of T-2 toxin and the interactions between these mechanisms were summarized. The remission of the hepatotoxicity induced by T-2 toxin was also studied in this review followed by new findings on the detoxification of hepatotoxicity induced by T-2 toxin. The review aimed to offer a comprehensive view and proposes new perspectives in the field of hepatotoxicity induced by T-2 toxin.

Impact of Enniatin and Deoxynivalenol Co-Occurrence on Plant, Microbial, Insect, Animal and Human Systems: Current Knowledge and Future Perspectives

Fusarium mycotoxins commonly contaminate agricultural products resulting in a serious threat to both animal and human health. The co-occurrence of different mycotoxins in the same cereal field is very common, so the risks as well as the functional and ecological effects of mycotoxins cannot always be predicted by focusing only on the effect of the single contaminants. Enniatins (ENNs) are among the most frequently detected emerging mycotoxins, while deoxynivalenol (DON) is probably the most common contaminant of cereal grains worldwide. The purpose of this review is to provide an overview of the simultaneous exposure to these mycotoxins, with emphasis on the combined effects in multiple organisms. Our literature analysis shows that just a few studies on ENN-DON toxicity are available, suggesting the complexity of mycotoxin interactions, which include synergistic, antagonistic, and additive effects. Both ENNs and DON modulate drug efflux transporters, therefore this specific ability deserves to be explored to better understand their complex biological role. Additionally, future studies should investigate the interaction mechanisms of mycotoxin co-occurrence on different model organisms, using concentrations closer to real exposures.

Detecting and Profiling of Milk Thistle Metabolites in Food Supplements: A Safety-Oriented Approach by Advanced Analytics

Milk thistle (Silybum marianum (L.) Gaertn.) is among the top-selling botanicals used as a supportive treatment for liver diseases. Silymarin, a mixture of unique flavonolignan metabolites, is the main bioactive component of milk thistle. The biological activities of silymarin have been well described in the literature, and its use is considered safe and well-tolerated in appropriate doses. However, commercial preparations do not always contain the recommended concentrations of silymarin, failing to provide the expected therapeutic effect. While the poor quality of raw material may explain the low concentrations of silymarin, its deliberate removal is suspected to be an adulteration. Toxic contaminants and foreign matters were also detected in milk thistle preparations, raising serious health concerns. Standard methods for determination of silymarin components include thin-layer chromatography (TLC), high-performance thin-layer chromatography (HPTLC), and high-performance liquid chromatography (HPLC) with various detectors, but nuclear magnetic resonance (NMR) and ultra-high-performance liquid chromatography (UHPLC) have also been applied. This review surveys the extraction techniques of main milk thistle metabolites and the quality, efficacy, and safety of the derived food supplements. Advanced analytical authentication approaches are discussed with a focus on DNA barcoding and metabarcoding to complement orthogonal chemical characterization and fingerprinting of herbal products.

Illumina-Based Analysis Yields New Insights Into the Fungal Contamination Associated With the Processed Products of Crataegi Fructus

Crataegi Fructus, a medicinal and edible herb in China, has been considered a popular dietary supplement globally. It is used for the treatment of dyspepsia and chronic heart failure according to the Chinese Pharmacopoeia (2020). However, fungal contamination in Crataegi Fructus affects its quality and safety, thus preventing its global promotion. In this study, we comprehensively studied the fungal community in processed products of Crataegi Fructus by high-throughput sequencing. A total of 21 Crataegi Fructus samples were collected from five provinces in China, and the samples were divided into five groups based on collection areas, as well as into three groups based on processing methods. We then targeted the internal transcribed spacer 2 sequence through the Illumina Miseq PE300 platform to investigate fungal composition and diversity. Results showed that all 21 samples were detected with fungal contamination, and Ascomycota was dominant at the phylum level. In the groups based on collection areas, Dothideomycetes, Pleosporaceae, and Alternaria were dominant at the class, family, and genus levels, respectively. In the groups based on processing methods, Dothideomycetes, Aspergillaceae, and Alternaria were the most abundant at the class, family, and genus levels, respectively. Differences in fungal communities between various groups were also observed. Furthermore, a total of 115 species were identified, among which seven were potential toxigenic, namely, Trichothecium roseum, Alternaria tenuissima, Aspergillus carbonarius, Penicillium brevicompactum, Aspergillus fumigatus, Rhizopus microspores, and Pichia fermentans. In conclusion, this study reveals great fungal richness and diversity of Crataegi Fructus, providing references for the prevention and control of fungal contamination of Crataegi Fructus in practical production.

The occurrence of fungi on the commercial dietary supplements based on the milk thistle (Silybum marianum (L.) Gaertn.) available on Polish market

Introduction: Milk thistle (Silybum marianum (L.) Gaertn.) is an important medicinal plant, its achenes contain a silymarin, which has a regenerating and stabilizing effect on liver cells. The milk thistle based dietary supplements are among the best-selling plant pharmaceuticals in the US and the UE.

Objective: The goal of the experiment was to determine which – if any – fungi contaminated either the whole or ground milk thistle achenes, available on the Polish market.

Methods: The mycological analyses were performed on 200 achenes, using deep-freeze blotter method. Ground material was assessed using agar test method. For each sample, 10 Petri dishes were used. The material was applied in five places per one Petri dish, with a micro scoop laboratory spatula. Then, Petri dishes with achenes and ground material were incubated at 20°C under alternating cycles of 12 h NUV light and 12 h darkness. The identification of fungi was performed using stereo microscope and compound microscope, if necessary.

Results: The milk thistle achenes were infested with following fungi: Alternaria alternata, Alternaria sp., Aspergillus flavus, Aspergillus spp., Bipolaris sp., Cladosporium spp., Epicoccum nigrum, Fusarium spp., Melanospora simplex, Mucor spp., Penicillium spp., Phoma sp., Rhizopus stolonifer, Sarocladium strictum, Stemphylium botryosum, Trichothecium roseum, Ulocladium consortiale and Verticillium sp. Among them A. alternata predominated. Whereas, milled milk thistle achenes were occupied by Aspergillus flavus, A. niger, Aspergillus spp., Fusarium sp., Mortierella spp., Mucor spp., Penicillium spp. and R. stolonifer.

Conclusion: Considering the significant fungal contamination of milk thistle achenes-based dietary supplements, it seems reasonable to introduce a system of achene control due to possible microbiological contamination.

Mycotoxins in raw materials, beverages and supplements of botanicals: A review of occurrence, risk assessment and analytical methodologies

Over recent years, consumer interest in natural products, such as botanicals has increased considerably. One of the factors affecting their quality is the presence of mycotoxins. This review focuses on exploring the mycotoxin occurrence in botanicals (raw material and ready-to-eat forms such as infusions or tablets) and the risk assessment due to their ingestion. Aflatoxins, Ochratoxin A, and Fumonisins are the most commonly studied mycotoxins and data in the literature report levels ranging from traces to 1000 μg/kg in raw materials. In general, the highest contents observed in raw materials decreased to unconcerning levels after the preparation of the infusions, reaching values that generally do not exceed 100 μg/L. Regarding botanical dietary supplements, the levels observed were lower than those reported for other matrices, although higher levels (of up to 1000 μg/kg) have been reported in some cases. Risk assessment studies in botanicals revealed a higher risk when they are consumed as tablets compared to infusions. Analytical methodologies implied in mycotoxin determination have also been contemplated. In this sense, liquid chromatography coupled to fluorescence detection has been the most frequently employed analytical technique, although in recent years tandem mass spectrometry has been widely used.

Determination of T-2 and HT-2 Toxins in Seed of Milk Thistle [Silybum marianum (L.) Gaertn.] Using Immunoaffinity Column by UPLC-MS/MS

Milk thistle [Silybum marianum (L.) Gaertn.] achieved a significant increase in interest over the past few years from local and foreign pharmaceutical corporations. The silymarin complex of constituents extracted from milk thistle achenes provides compelling health benefits primarily thanks to antioxidant activities and hepatoprotective effects. However, consuming mycotoxin-contaminated plant material can cause immunosuppression and hepatotoxic problems. The aim of this study was to develop and validate a method for the determination of mycotoxin content in milk thistle. Fusarium toxins as T-2 and HT-2 toxins in grown milk thistle harvested from a breeding station in the Czech Republic during 2020-2021 were studied. The analysis of T-2 and HT-2 toxins was performed by UPLC-MS/MS after immunoaffinity columns EASI-EXTRACT® T-2 & HT-2 clean up. All analysed samples of milk thistle were contaminated with T-2 toxin and HT-2 toxin. The content of T-2 toxin in the samples from 2020 was in the range of 122.7-290.2 µg/kg and HT-2 toxin 157.0-319.0 µg/kg. In 2021, the content of T-2 toxin was in the range of 28.8-69.9 µg/kg and HT-2 toxin was 24.2-75.4 µg/kg. The results show that the climatic conditions of the year of harvesting have a highly statistically significant effect on the content of T-2 and HT-2 toxins in milk thistle.

Multiclass and multi-residue screening of mycotoxins, pharmacologically active substances, and pesticides in infant milk formulas through ultra-high-performance liquid chromatography coupled with high-resolution mass spectrometry analysis

Infant milk formulas are designed to substitute human milk when breastfeeding is unavailable. In addition to human milk and milk-derived products, these formulas can be a vehicle of contaminants. In this work, a multiclass method based on the QuEChERS (quick, easy, cheap, effective, rugged, and safe) approach was developed for the simultaneous determination of contaminants (n = 45), including mycotoxins and veterinary drug residues, occurring in infant milk formulas. By using an ultra-high-performance liquid chromatography quadrupole-Orbitrap coupled with high-resolution mass spectrometry analysis (UHPLC-Q-Orbitrap HRMS; Thermo Fisher Scientific), further retrospective analysis of 337 contaminants, including pesticides, was achieved. The method was validated in accordance with European regulations and applied for the analysis of 54 infant milk samples. Risk assessment was also performed. Dexamethasone was detected in 16.6% of samples (range: 0.905-1.131 ng/mL), and procaine benzyl penicillin in 1 sample at a concentration of 0.295 ng/mL. Zearalenone was found in 55.5% of samples (range: 0.133-0.638 ng/mL) and α-zearalenol in 16.6% of samples (range: 1.534-10.408 ng/mL). Up to 49 pesticides, 11 veterinary drug residues, and 5 mycotoxins were tentatively identified via retrospective analysis based on the mass spectral library. These findings highlight the necessity of careful evaluation of contaminants in infant formulas, considering that they are intended for a vulnerable part of the population.

Effect of herbal cream containing Fumaria officinalis and silymarin for treatment of eczema: A randomized double-blind controlled clinical trial

Objective

Atopic dermatitis (AD) is a common skin disorder with symptoms including severe pruritus and eczematous lesions. AD affects between 5 and 20% of people in their life. Silymarin (SM) is a polyphenolic flavonoid from Silybum marianum L. and has several therapeutic characteristics including antiallergic, anticancer, and anti-inflammatory properties. Fumaria officinalis is a small plant that has a high antioxidant power and modulating effects on the immune system. Therefore, the current study intended to examine the influence of these two herbs extract on severity and symptoms of AD in patients.

Materials and Methods

40 patients with mild to moderate eczema randomly received mometasone 0.1% or the herbal cream. Treatment course was 2 weeks and patients were examined before and after 2 weeks of treatment using the SCORAD system.

Results

The reduction of SCORAD score was significant in both groups (p=0.04 in the herbal group and p=0.03 in the mometasone group) but no significant difference was observed between the groups. Mean SCORAD score was 27.66±5.9 before therapy and 4.77±1.6 after therapy in the mometasone group and mean SCORAD score was 26.05±7.1 before therapy and 6.944±2.6 after therapy in the herbal group.

Conclusion

The current study indicated the impact of these two herbs extract on severity and symptoms of AD in patients; these plants may be a new treatment in reducing eczema symptoms and its problems.

Risk Assessment of RYR Food Supplements: Perception vs. Reality

Thirty-seven red yeast rice (RYR) food supplements were screened for their mycotoxin and natural statin content. Products included pure RYR capsules and multi-ingredient formulations with standardized amounts of monacolin K (MK), marketed both online and retail in the European Union. In terms of mycotoxins, citrinin (CIT) was found in all the monitored products. As CIT content ranged from 100 to 25100 μg/kg, only four products were compliant with maximum EU levels in force until April 2020, while a single product was compliant with the limit of 100 μg/kg introduced after that date. Four contaminated products were labeled as "citrinin free". In terms of natural statins, nine products had a lower content vs. label statements (from -30 to -83%), while for 24 a larger MK amount (from 10 to 266%) was noticed. Three products had a negligible MK content and only 19 offered a daily dosage exceeding 10 mg as dictated by the health claim granted by EFSA in the EU. No sample had label values compliant with pharmaceutical Good Manufacturing Practices requirements (95-105% content of active constituent). Variable, but small amounts of simvastatin (0.1-7.5 μg per daily dose) were found in 30 samples. These results suggest that limited efficacy and reported safety issues may stem from an under-regulated and undercontrolled market, weakening both effectiveness and risk assessment evaluations.

Natural Bioactive Compounds from Food Waste: Toxicity and Safety Concerns

Although synthetic bioactive compounds are approved in many countries for food applications, they are becoming less and less welcome by consumers. Therefore, there has been an increasing interest in replacing these synthetic compounds by natural bioactive compounds. These natural compounds can be used as food additives to maintain the food quality, food safety and appeal, and as food supplements or nutraceuticals to correct nutritional deficiencies, maintain a suitable intake of nutrients, or to support physiological functions, respectively. Recent studies reveal that numerous food wastes, particularly fruit and vegetables byproducts, are a good source of bioactive compounds that can be extracted and reintroduced into the food chain as natural food additives or in food matrices for obtaining nutraceuticals and functional foods. This review addresses general questions concerning the use of fruit and vegetables byproducts as new sources of natural bioactive compounds that are being addressed to foods as natural additives and supplements. Those bioactive compounds must follow the legal requirements and evaluations to assess the risks for human health and their toxicity must be considered before being launched into the market. To overcome the potential health risk while increasing the biological activity, stability and biodistribution of the supplements' technological alternatives have been studied such as encapsulation of bioactive compounds into micro or nanoparticles or nanoemulsions. This will allow enhancing the stability and release along the gastrointestinal tract in a controlled manner into the specific tissues. This review summarizes the valorization path that a bioactive compound recovered from an agro-food waste can face from the moment their potentialities are exhibited until it reaches the final consumer and the safety and toxicity challenges, they may overcome.