Literature review and evaluation of biomarkers, matrices and analytical methods for chemicals selected in the research program Human Biomonitoring for the European Union (HBM4EU)

Humans are potentially exposed to a large amount of chemicals present in the environment and in the workplace. In the European Human Biomonitoring initiative (Human Biomonitoring for the European Union = HBM4EU), acrylamide, mycotoxins (aflatoxin B1, deoxynivalenol, fumonisin B1), diisocyanates (4,4'-methylenediphenyl diisocyanate, 2,4- and 2,6-toluene diisocyanate), and pyrethroids were included among the prioritized chemicals of concern for human health. For the present literature review, the analytical methods used in worldwide biomonitoring studies for these compounds were collected and presented in comprehensive tables, including the following parameter: determined biomarker, matrix, sample amount, work-up procedure, available laboratory quality assurance and quality assessment information, analytical techniques, and limit of detection. Based on the data presented in these tables, the most suitable methods were recommended. According to the paradigm of biomonitoring, the information about two different biomarkers of exposure was evaluated: a) internal dose = parent compounds and metabolites in urine and blood; and b) the biologically effective = dose measured as blood protein adducts. Urine was the preferred matrix used for deoxynivalenol, fumonisin B1, and pyrethroids (biomarkers of internal dose). Markers of the biological effective dose were determined as hemoglobin adducts for diisocyanates and acrylamide, and as serum-albumin-adducts of aflatoxin B1 and diisocyanates. The analyses and quantitation of the protein adducts in blood or the metabolites in urine were mostly performed with LC-MS/MS or GC-MS in the presence of isotope-labeled internal standards. This review also addresses the critical aspects of the application, use and selection of biomarkers. For future biomonitoring studies, a more comprehensive approach is discussed to broaden the selection of compounds.

Biomonitoring of Multiple Mycotoxins in Urine by GC-MS/MS: A Pilot Study on Patients with Esophageal Cancer in Golestan Province, Northeastern Iran

A pilot study to investigate the occurrence of 10 mycotoxins (deoxynivalenol, DON; 3-acetyldeoxynivalenol, 3-ADON; 15-acetyldeoxynivalenol, 15-ADON; fusarenon-X, FUS-X; diacetoxyscirpenol, DAS; nivalenol, NIV; neosolaniol, NEO; zearalenone, ZON; zearalanone, ZAN; T-2 toxin, T-2; and HT-2 toxin, HT-2) in esophageal cancer patients was performed with the urinary biomarkers approach in Golestan, Iran. Urine multimycotoxin analysis was performed by dispersive liquid–liquid microextraction and gas chromatography–tandem mass spectrometry (GC–MS/MS) analysis, and values were normalized with urinary creatinine (μg/g). Four mycotoxins, namely NEO (40%), HT-2 (17.6%), DON (10%), and HT-2 (5.8%), were detected in the analyzed urine samples. DON was only detected in the control group (5.09 μg/g creatinine), while T-2 (44.70 μg/g creatinine) was only present in the esophageal cancer group. NEO and HT-2 were quantified in both control and case groups, showing average of positive samples of 9.09 and 10.45 μg/g creatinine for NEO and 16.81 and 29.09 μg/g creatinine for HT-2, respectively. Mycotoxin co-occurrence was observed in three samples as binary (NEO/HT-2 and T-2/HT-2) and ternary (DON/NEO/HT-2) combinations, reaching total concentrations of 44.58, 79.13, and 30.04 µg/g creatinine, respectively. Further investigations are needed to explore a causal association between mycotoxin contamination and esophageal cancer. For this pilot study in Golestan, the low sample size was a very limiting factor.

Dried urine spots as sampling technique for multi-mycotoxin analysis in human urine

A simple and effective approach for HPLC-MS/MS based multi-mycotoxin analysis in human urine samples was developed by application of dried urine spots (DUS) as alternative on-site sampling strategy. The newly developed method enables the detection and quantitation of 14 relevant mycotoxins and mycotoxin metabolites, including citrinin (CIT), dihydrocitrinone (DH-CIT), deoxynivalenol (DON), fumonisin B₁ (FB₁), T-2 Toxin (T-2), HT-2 Toxin (HT-2), ochratoxin A (OTA), 2′R-ochratoxin A (2′R-OTA), ochratoxin α (OTα), tenuazonic acid and allo-tenuazonic acid (TeA + allo-TeA), zearalenone (ZEN), zearalanone (ZAN), α-zearalenol (α-ZEL), and β-zearalenol (β-ZEL). Besides the spotting procedure, sample preparation includes enzymatic cleavage of glucuronic acid conjugates and stable isotope dilution analysis. Method validation revealed low limits of detection in the range of pg/mL urine and excellent apparent recovery rates for most analytes. Stability investigation of DUS displayed no or only slight decrease of the analyte concentration over a period of 28 days at room temperature. The new method was applied to the analysis of a set of urine samples (n = 91) from a Swedish cohort. The four analytes, DH-CIT, DON, OTA, and TeA + allo-TeA, could be detected and quantified in amounts ranging from 0.06 to 0.97 ng/mL, 3.03 to 136 ng/mL, 0.013 to 0.434 ng/mL and from 0.36 to 47 ng/mL in 38.5%, 70.3%, 68.1%, and 94.5% of the samples, respectively. Additional analysis of these urine samples with an established dilute and shoot (DaS) approach displayed a high consistency of the results obtained with both methods. However, due to higher sensitivity, a larger number of positive samples were observed using the DUS method consequently providing a suitable approach for human biomonitoring of mycotoxin exposure.

Improved methods for biomarker analysis of the big five mycotoxins enables reliable exposure characterization in a population of childbearing age women in Rwanda

Of the five agriculturally important mycotoxins, AFB₁, FB₁, DON, ZEA and OTA, a well-characterized biomarker of exposure in blood is only available for aflatoxin. Working with a population of 139 women of childbearing age in Rwanda, we undertook a comprehensive assessment of their dietary mycotoxin exposure. Using high-resolution LC-MS/MS with stable isotope dilution analysis, the albumin-aflatoxin adduct was quantitated in plasma. Similarly, AFM₁, AFB₁, AFG₁, FB₁ and B₂, OTA, zearalenone, α-zearalenol, deoxynivalenol, deoxynivalenol-15-glucuronide and deoxynivalenol-3-glucuronide were quantitated in urine. AFB₁-Lys was detected in plasma from 81% of the women, indicative of exposures 1-2 orders of magnitude above current guidance. Zearalenone and/or α-zearalenol were detected in the urine of 61% of the women, the majority of whom had estimated exposures 2-5 times the PMTDI, with one third more than an order of magnitude above. Urinary deoxynivalenol or the two glucuronide conjugates were found in 77% of the participants. Of these, 60% were below the PMTDI, 28% were twice and 12% were >10x the PMTDI. Fumonisin B₁ (30%) and ochratoxin A (71%) were also detected in urine. Exposures observed in these Rwandan women raise serious food safety concerns and highlight the need for authorities to help manage multiple mycotoxins in their diet.

Deoxynivalenol exposure assessment through a modelling approach of food intake and biomonitoring data - A contribution to the risk assessment of an enteropathogenic mycotoxin

Deoxynivalenol (DON), an enteropathogenic mycotoxin produced by Fusarium species, is usually associated with adverse health outcomes such as gastrointestinal diseases and immunotoxicity. To estimate DON exposure of the Portuguese population at national level, a modelling approach, based on data from 94 Portuguese volunteers, was developed considering the inputs of the food consumption data generated within the National Food and Physical Activity Survey and the human biomonitoring data used to assess the exposure to DON. Ten models of association between DON urinary biomarkers and food items (pasta, cookies, biscuits, sweets, bread, rusks, nuts, oilseeds, beer, meat, milk) were established. Applying the most adequate model to the consumption data (n = 5811) of the general population, the exposure estimates of the Probable Daily Intake revealed that a fraction (0.1%) of the Portuguese population might exceed the Tolerable Daily Intake defined for DON. The analysis stratified by age revealed children (3.2%) and adolescents (6.0%) are more likely to exceed the Tolerable Daily Intake for DON. Although the unavoidable uncertainties, these results are important contributions to understand the exposure to this mycotoxin in Portugal, to assess the associated risk and the potential public health consequences.

Human dietary and internal exposure to zearalenone based on a 24-hour duplicate diet and following morning urine study

Zearalenone is a widespread mycotoxin with high estrogenic activity. This study aimed to characterize the exposure of ZEN in a Chinese population during harvest season in 2016. Exposure to ZEN was measured using both duplicate diet method and human biomonitoring approaches. Duplicate diet samples from 199 individuals (4-80 years old) and their following morning urine samples were collected and analyzed using LC-MS/MS methods sensitive for ZEN, ZAN, α/β-ZEL and α/β-ZAL. ZEN was detected in 59.8% of the food samples at a mean level of 1.21 ± 2.15 μg/kg. The estimated daily intake (EDI) of ZEN was calculated from food contamination and consumption data at a mean level of 25.6 ± 38.6 ng/kg bw/day, representing 10.2% of the tolerable daily intake (TDI) set by EFSA and 5.1% of the provisional maximum tolerable daily intake (PMTDI) set by JECFA, respectively. Wheat appears to be the main diet source of ZEN exposure, contributing over 80% of the mean EDI. Children had the highest EDI at 37.5 ± 56.3 ng/kg bw/day (p < 0.05). Urine samples were analyzed both before and after enzymatic hydrolysis to determine the free and total amounts of ZEN biomarkers. The majority of ZEN was excreted as conjugates with the mean fZEN/tBM ratio of 25.4%. Adolescents had the highest excretion of ZEN biomarkers among all age groups (p < 0.05). Probable daily intake (PDI) was calculated from ZEN biomarkers and an excretion rate of 36.8%, giving a mean value of 41.6 ± 65.5 ng/kg bw/day. Significant correlation between internal and external exposure measurement was evidenced in this study (r = 0.344, p < 0.01). Although the mean PDI was approximately 1.6 times the mean EDI, these two approaches resulted in similar calculated degrees of ZEN exposure, both markedly below the health-based guidance value. This study is the first to compare ZEN exposure in a same population based on both diet study and human biomonitoring approaches. Significant differences of PDI/EDI ratios were found in different age groups (p < 0.05), possibly indicative of diversified excretion capabilities and metabolism patterns within the population.

Mycotoxins in blood and urine of Swedish adolescents-possible associations to food intake and other background characteristics

The exposure to mycotoxins of Swedish adolescents is currently unknown. The aim of the present study was to investigate the exposure to mycotoxins and their association with food intake, and background characteristics in adolescents of a national dietary survey. About 3000 school students (1000 from the 5th, 8th and 11th school years) were recruited for the survey. The participants completed Web-based questionnaires on food propensity, sociodemography and health, and a Web-based dietary recall. Spot urine and blood samples were collected from 1105 of the participants for mycotoxin biomarker analysis. Mycotoxins were analysed with multibiomarker methods in urine (HPLC-MS/MS) and serum (HPLC-MS/MS). Of the 35 different analytes in urine, the frequency of positive samples were the following: deoxynivalenol (DON, 4.8%), DON-15-β-D-O-glucuronide (DON-15GlcA, 9.1%), dihydro-citrinone (DH-CIT, 0.5%), HT-2-glucuronide (HT-2-3-GlcA, 0.1%) and ochratoxin A (OTA, 0.1%). Of the 27 different analytes in serum, OTA was detected in all samples, while 2'R-ochratoxin A (2'R-OTA) was found in 8.3% and enniatin B (EnB) in 99.2% of the samples. Exposure assessment calculations were performed on OTA from the serum concentration and on DON equivalents (DON eqv) from the urine concentration. All probable daily intake (PDI) estimates were below tolerable daily intakes, except for 1.6% of the participants for DON. The maximum PDI was 4.3 μg DON eqv/kg body weight and day. Consumption of cereal grain commodities was associated with levels of DON, EnB or OTA in biofluids. Serum OTA was also associated with intakes of raisins and coffee. Furthermore, coffee consumption correlated well with 2'R-OTA concentration in serum. In conclusion, exposure to mycotoxins in Swedish adolescents is common, but fortunately, high exposure was rare.

Multimycotoxin Exposure Assessment in UK Children Using Urinary Biomarkers-A Pilot Survey

Cereal foods are commonly contaminated with multiple mycotoxins resulting in frequent human mycotoxin exposure. Children are at risk of high-level exposure because of their high cereal intake relative to body weight. Hence, this study aims to assess multimycotoxin exposure in UK children using urinary biomarkers. Spot urines (n = 21) were analyzed for multimycotoxins (deoxynivalenol, DON; nivalenol, NIV; ochratoxin A, OTA; zearalenone, ZEN; α-zearalenol, α-ZEL; β-zearalenol, β-ZEL; T-2 toxin, T-2; HT-2 toxin, HT-2; and aflatoxin B₁ and M_1, AFB₁, AFM₁) using liquid chromatography-coupled tandem mass spectrometry. Urine samples frequently contained DON (13.10 ± 12.69 ng/mL), NIV (0.36 ± 0.16 ng/mL), OTA (0.05 ± 0.02 ng/mL), and ZEN (0.09 ± 0.07 ng/mL). Some samples (1-3) contained T-2, HT-2, α-ZEL, and β-ZEL but not aflatoxins. Dietary mycotoxin estimation showed that children were frequently exposed to levels exceeding the tolerable daily intake (52 and 95% of cases for DON and OTA). This demonstrates that UK children are exposed to multiple mycotoxins through their habitual diet.

Biomonitoring Study of Deoxynivalenol Exposure in Chinese Inhabitants

Objective: To investigate the levels of a deoxynivalenol (DON) biomarker in the urine of subjects living in two China provinces with different geographic locations and dietary patterns, and estimate their dietary DON exposures and health risks. Methods: First morning urine samples were collected on three consecutive days from 599 healthy subjects-301 from Henan province and 298 from Sichuan province-to analyze the total DON concentrations (tDON) after β-glucuronidase hydrolysis using a high-performance liquid chromatography tandem mass spectrometry-based method. The consumption of cereal foods in the previous 24 h before each urine collection was recorded using a duplicate diet method. DON exposure levels were estimated based on the urinary tDON concentrations. Results: Total DON were detected in 100% and 92% of the urine samples from Henan and Sichuan, respectively. Mean urinary tDON concentrations were 52.83 ng/mL in Henan subjects and 12.99 ng/mL in Sichuan subjects, respectively. The tDON levels were significantly higher in the urine of Henan subjects than that of the Sichuan subjects (p < 0.001). Urinary tDON levels were significantly different among age groups in both areas (Henan: p < 0.001; Sichuan: p = 0.026) and were highest in adolescents aged 13-17 years, followed by children aged 7-12 years. Based on the DON biomarker and exposure conversion reported by the European Food Safety Authority (EFSA), the mean estimated dietary intakes of DON were 1.82 μg/kg bw/day in Henan subjects and 0.45 μg/kg bw/day in Sichuan subjects. A total of 56% of Henan subjects and 12% of Sichuan subjects were estimated to exceed the PMTDI of 1 μg/kg bw/day. Consistent with urinary tDON levels, the highest estimated dietary DON intakes were also in children and adolescents aged 7-17 years. For all kinds of wheat-based foods except dumplings, the consumptions were significantly higher in Henan than those in Sichuan. The mean consumption of steamed buns was 8.4-fold higher in Henan (70.67 g/d) than that in Sichuan (8.45 g/d). The mean consumption of noodles in Henan (273.91 g/d) was 3.6-fold higher than that in Sichuan (75.87 g/d). Conclusions: The levels of urinary DON biomarker and the estimated dietary DON intakes in Henan province were high and concerning, especially for children and adolescents. The overall exposure level of Sichuan inhabitants was low.

Extended evaluation of urinary multi-biomarker analyses of mycotoxins in Swedish adults and children

Biomarker-based methods are being more and more used to assess dietary exposure of mycotoxins in a population. The aim of the present study was to perform an extended analysis of urinary multiple mycotoxin levels and associations with background characteristics and food groups. Exposure assessment calculations were performed on three urine mycotoxins as described below and the probable daily intake (PDI) was compared with the established tolerable daily intake (TDI) to uncover potential exposure risks. The study population consisted of 250 adults and 50 school children in grade five from two surveys conducted by the Swedish National Food Agency. Six mycotoxins (deoxynivalenol (DON), zearalenone (ZEA), fumonisin B1 (FB1), fumonisin B2 (FB2), ochratoxin A (OTA), and nivalenol (NIV) and four metabolites (deepoxy-deoxynivalenol (DOM-1), aflatoxin M1 (AFM1), α-zearalenol (α-ZOL) and β-zearalenol (β-ZOL) were measured by an ultra-performance liquid chromatography tandem mass spectrometry based method (LC-MS/MS). OTA and DON were the most commonly occurring mycotoxins in urine of both adults and children, 51 and 63%, respectively in adults and 96 and 94%, respectively in children. A positive correlation was found between urinary NIV and total cereal consumption among adults. ZEA, α-ZOL, β-ZOL and FB2 were significantly higher in females than males (P<0.01 for all). Adjusted OTA levels were inversely correlated with income in men. In children, the percentage DOM-1 positive samples were much higher compared to adults, 76 and 8% respectively, indicating a higher capacity to detoxify DON. The small sample size among children made it difficult to study associations between urine mycotoxins levels and food group intake. All PDI estimates [DON (with and without DOM-1), ZEA (with and without α-ZOL and β-ZOL) and FB1] were below the TDI values except for DON exposure in adults, as reported previously, 1.3% of the volunteers were above the TDI.

Risk assessment of deoxynivalenol in high-risk area of China by human biomonitoring using an improved high throughput UPLC-MS/MS method

A risk assessment of deoxynivalenol (DON) was recently conducted for the residents in Henan province, China, where wheat as the staple food are highly consumed. A high-throughput sensitive UPLC-MS/MS method following 96-well μElution solid-phase extraction (SPE) were developed and validated for the determination of DON biomarkers in human urine. Isotope labelled internal standard, 13C-DON, was used for accurate quantification. Urinary samples collected from 151 healthy Chinese aged 2-78 years were processed with and without enzyme hydrolysis to determine total and free biomarkers, respectively. DON, and de-epoxy-deoxynivalenol (DOM-1) to a lesser extent, can be frequently detected in these samples both with and without enzyme hydrolysis. Free DOM-1 was detected at low level in human urine for the first time. Total DON was detected in all samples with a mean concentration at 47.6 ng mL-1. The mean and median probable daily intakes (PDI) for the whole participants, estimated to be 1.61 μg/kg bw and 1.10 μg/kg bw, both exceeded the PMTDI (1 μg/kg bw/day), indicating a potential risk for the residents in this area, especially for children and adolescents.

Risks to human and animal health related to the presence of deoxynivalenol and its acetylated and modified forms in food and feed

Deoxynivalenol (DON) is a mycotoxin primarily produced by Fusarium fungi, occurring predominantly in cereal grains. Following the request of the European Commission, the CONTAM Panel assessed the risk to animal and human health related to DON, 3-acetyl-DON (3-Ac-DON), 15-acetyl-DON (15-Ac-DON) and DON-3-glucoside in food and feed. A total of 27,537, 13,892, 7,270 and 2,266 analytical data for DON, 3-Ac-DON, 15-Ac-DON and DON-3-glucoside, respectively, in food, feed and unprocessed grains collected from 2007 to 2014 were used. For human exposure, grains and grain-based products were main sources, whereas in farm and companion animals, cereal grains, cereal by-products and forage maize contributed most. DON is rapidly absorbed, distributed, and excreted. Since 3-Ac-DON and 15-Ac-DON are largely deacetylated and DON-3-glucoside cleaved in the intestines the same toxic effects as DON can be expected. The TDI of 1 μg/kg bw per day, that was established for DON based on reduced body weight gain in mice, was therefore used as a group-TDI for the sum of DON, 3-Ac-DON, 15-Ac-DON and DON-3-glucoside. In order to assess acute human health risk, epidemiological data from mycotoxicoses were assessed and a group-ARfD of 8 μg/kg bw per eating occasion was calculated. Estimates of acute dietary exposures were below this dose and did not raise a health concern in humans. The estimated mean chronic dietary exposure was above the group-TDI in infants, toddlers and other children, and at high exposure also in adolescents and adults, indicating a potential health concern. Based on estimated mean dietary concentrations in ruminants, poultry, rabbits, dogs and cats, most farmed fish species and horses, adverse effects are not expected. At the high dietary concentrations, there is a potential risk for chronic adverse effects in pigs and fish and for acute adverse effects in cats and farmed mink.

Comparison of Data from a Single-Analyte and a Multianalyte Method for Determination of Urinary Total Deoxynivalenol in Human Samples

Deoxynivalenol (DON) exposure is estimated by the combined measures of urinary DON and DON-glucuronides. In this study, data from single-mycotoxin (SM) and a multimycotoxin (MM) methods were compared for 256 Swedish adult urine samples. Both methods included β-glucuronidase predigestion, immunoaffinity enrichment, and LC-MS/MS. However, the specific reagents, apparatus, and conditions were not identical in part because the MM method measures additional mycotoxins. DON was detected in 88 and 63% of samples using the SM and MM methods, respectively, with the following mean and median concentrations: SM, mean = 5.0 ng/mL, SD = 7.4, range of positives = 0.5-60.2 ng/mL, median = 2.5 ng/mL, IQR = 1.0-5.5 ng/mL; MM, mean = 4.4 ng/mL, SD = 12.9, range of positives = 0.5-135.2 ng/mL, median = 0.8 ng/mL, IQR = 0.3-3.5. Linear regression showed a significant, albeit modest, correlation between the two measures (p = 0.0001, r = 0.591). The differences observed may reflect subtle handling differences in DON extraction and quantitation between the methods.

Deoxynivalenol Exposure in Norway, Risk Assessments for Different Human Age Groups

Deoxynivalenol (DON) is the most common mycotoxin in Norwegian cereals, and DON is detected in most samples of crude cereal grain and cereal food commodities such as flour, bran, and oat flakes. The Norwegian Scientific Committee for Food Safety assessed the risk for adverse effects of deoxynivalenol (DON) in different age groups of the domestic population. This review presents the main results from the risk assessment, supplemented with some recently published data. Impairment of the immune system together with reduced feed intake and weight gain are the critical effects of DON in experimental animals on which the current tolerable daily intake was established. Based on food consumption and occurrence data, the mean exposure to DON in years with low and high levels of DON in the flour, respectively, were in the range of or up to two times the Tolerable Daily Intake (TDI) in 1-year-old infants and 2-year-old children. In years with high mean DON concentration, the high (95th-percentile) exposure exceeded the TDI by up to 3.5 times in 1-, 2- , 4-, and 9-year-old children. The assessment concluded that exceeding the TDI in infants and children is of concern. The estimated dietary DON intakes in adolescent and adult populations are in the range of the TDI or below, and are not a health concern. Acute human exposure to DON is not of concern in any age group.

Strategies for estimating human exposure to mycotoxins via food

In this review, five strategies to estimate mycotoxin exposure of a (sub-)population via food, including data collection, are discussed with the aim to identify the added values and limitations of each strategy for risk assessment of these chemicals. The well-established point estimate, observed individual mean, probabilistic and duplicate diet strategies are addressed, as well as the emerging human biomonitoring strategy. All five exposure assessment strategies allow the estimation of chronic (long-term) exposure to mycotoxins, and, with the exception of the observed individual mean strategy, also acute (short-term) exposure. Methods for data collection, i.e. food consumption surveys, food monitoring studies and total diet studies are discussed. In food monitoring studies, the driving force is often enforcement of legal limits, and, consequently, data are often generated with relatively high limits of quantification and targeted at products suspected to contain mycotoxin levels above these legal limits. Total diet studies provide a solid base for chronic exposure assessments since they provide mycotoxin levels in food based on well-defined samples and including the effect of food preparation. Duplicate diet studies and human biomonitoring studies reveal the actual exposure but often involve a restricted group of human volunteers and a limited time period. Human biomonitoring studies may also include exposure to mycotoxins from other sources than food, and exposure to modified mycotoxins that may not be detected with current analytical methods. Low limits of quantification are required for analytical methods applied for data collection to avoid large uncertainties in the exposure due to high numbers of left censored data, i.e. with levels below the limit of quantification.

Multidetection of urinary ochratoxin A, deoxynivalenol and its metabolites: pilot time-course study and risk assessment in Catalonia, Spain

The presence of two main mycotoxins, ochratoxin A (OTA) and deoxynivalenol (DON), is widespread in cereal-based foodstuffs marketed in Europe. The objectives of this study were to develop and validate a multi-detection analytical methodology to simultaneously assess the urinary concentrations of OTA, DON and their metabolites, and to apply this methodology in a preliminary follow-up trial in Catalonia (Spain). Hence, an ultra-performance liquid chromatography with tandem mass spectrometry method was developed to simultaneously assess the urinary levels of OTA, DON, deoxynivalenol-3-glucoside (DON-3-glucoside), deoxynivalenol-3-glucuronide (DON-3-glucuronide), 3-acetyldeoxynivalenol (3-ADON) and de-epoxy-deoxynivalenol (DOM-1). Urine mycotoxins levels and food dietary intake were prospectively monitored in a group of volunteers throughout a restriction period followed by a free-diet period. The proposed multi-detection methodology for urinary OTA and DON metabolites was validated, providing suitable recovery, linearity and precision. The results from the pilot trial showed that urinary OTA, DON and its metabolites were detected in most background samples, displaying moderate reductions after the restriction period and subsequently recovering the background levels. Despite the restriction period, some DON metabolites, such as 3-ADON or DOM-1, were still found in urine samples, placing alternative sources of DON exposure other than the ones considered in the study under suspicion. DON and DON-3-glucuronide were significantly associated with consumption of bread, pasta and pastries, while OTA was only associated with consumption of wine and breakfast cereals. The urinary levels of OTA were significantly correlated with plasmatic levels of OTA and ochratoxin α, supporting the results from the multidetection method in urine. The results also showed that the high exposure to DON could be held throughout the time by the same person, exceeding the tolerable daily intake systematically instead of eventually. The estimates of OTA exposure through urine are largely higher than those obtained with the dietary approach. The background levels found in urine revealed that the exposure to DON and OTA could be of concern for the Catalonian population, thus, further studies applying this biomonitoring methodology in a larger sample of Catalonian population are needed to accurately characterise the human health risks at population level.

Biomonitoring of Mycotoxins in Urine: Pilot Study in Mill Workers

Contamination of grains with mycotoxins results in a dietary background exposure of the general population. In occupational settings such as during processing of raw materials as in milling, an additional mycotoxin exposure by inhalation is possible. Biomonitoring is an integrative approach to assess human exposure from various sources and by all routes. To investigate possible workplace exposure to mycotoxins, a pilot study was conducted that compared levels of urinary biomarkers in mill workers to those in a control group with dietary mycotoxin intake alone. Workers (n = 17) from three grain mills in North Rhine Westphalia, Germany, provided spot urines during shift; volunteers (n = 13, IfADo staff) with matched age structure served as control group. The mycotoxins selected for biomarker analysis were citrinin (CIT) deoxynivalenol (DON), ochratoxin A (OTA), and zearalenone (ZEN). Immunoaffinity columns (CIT, DON, ZEN) or liquid-liquid extraction (OTA) was employed for urine sample cleanup prior to targeted analysis by liquid chromatography with tandem mass spectrometry (LC-MS/MS) or by high-performance liquid chromatography (HPLC). In addition, mycotoxin metabolites that may be formed in the organism were analyzed, including deepoxy-deoxynivalenol (DOM-1), ochratoxin alpha (OTα), dihydrocitrinone (DH-CIT), and α- and β-zearalenol (α- and β-ZEL), as well as phase II metabolites that were hydrolyzed with β-glucuronidase/arylsulfatase prior to sample cleanup. All analyte concentrations were adjusted for creatinine (crea) content in the spot urine samples. Citrinin, DON, OTA, and ZEN were detected in nearly all urine samples from mill workers and controls. Interestingly, DH-CIT was found at higher mean levels than the parent compound (~0.14 and 0.045 µg/g crea, respectively), suggesting an effective metabolism of CIT in humans. Other metabolites DOM-1, OTα, and α- and β-ZEL were detected less frequently in urine. Deoxynivalenol was detected at the highest concentrations (mean ~6 µg/g crea), followed by OTA (mean ~0.08 µg/g crea); ZEN (mean ~0.03 µg/g crea) and its metabolites appeared in urine at lower levels. Mycotoxin biomarker levels in urine from mill workers and controls were not significantly different. From these results it is concluded that biomarker levels measured in urine samples from the two cohorts reflect mainly dietary mycotoxin exposure. An additional occupational (inhalational) exposure of mill workers, if any, is apparently low at the investigated workplaces.

Human biomonitoring of multiple mycotoxins in the Belgian population: Results of the BIOMYCO study

Mycotoxins are important food contaminants responsible for health effects such as cancer, nephrotoxicity, hepatotoxicity or immunosuppression. The assessment of mycotoxin exposure is often based on calculations combining mycotoxin occurrence data in food with population data on food consumption. Because of limitations inherent to that approach, the direct measurement of biomarkers of exposure in biological fluids has been proposed as a suitable alternative to perform an accurate mycotoxin exposure assessment at individual level. For this reason, the BIOMYCO study was designed to assess mycotoxin exposure in Belgian adults and children using urinary biomarkers of exposure. Morning urine was gathered in a representative part of the Belgian population according to a standardised study protocol, whereby 155 children (3-12 years old) and 239 adults (19-65 years old) were selected based on random cluster sampling. These urine samples were analysed for the presence of 33 potential biomarkers with focus on aflatoxins, citrinin (CIT), fumonisins, trichothecenes, ochratoxin A (OTA), zearalenone and their metabolites using two validated LC-MS/MS methods. Nine out of the 33 analysed mycotoxins were detected whereby deoxynivalenol (DON), OTA, CIT and their metabolites were the most frequently detected. Deoxynivalenol-15-glucuronide was the main urinary DON biomarker and was found in all urine samples in the ng/mL range. Furthermore deoxynivalenol-3-glucuronide was quantified in 91% of the urine samples collected from children and in 77% of the samples collected from adults. Deoxynivalenol was detected in 70% and 37% of the samples of children and adults respectively. For the first time deepoxy-deoxynivalenol-glucuronide was detected in children's urine (17%). In the samples collected by adults, the prevalence was 22%. Whereas all these mycotoxins contaminated the urine samples in the ng/mL range, CIT and OTA were present in much lower concentrations (pg/mL). OTA contaminated 51% and 35% of the samples collected by children and adults respectively. CIT and its metabolite were present in 72% and 6% of children's urine, whereas they contaminated 59% and 12% of adult's urine. Finally, α-zearalenol and β-zearalenol-14-glucuronide were found in respectively one and two samples from adults. The exposure to DON, OTA and CIT was compared between subgroups and urinary mycotoxin concentrations differed significantly among age and gender. Based on the urinary levels, the daily intake of DON and OTA was estimated and evaluated whereby, depending on the used method, 16-69% of the population possibly exceeded the tolerable daily intake for DON and 1% for OTA. The BIOMYCO study is the first study whereby a multi-toxin approach was applied for mycotoxin exposure assessment in adults and children on a large-scale. Moreover, it is the first study that described the exposure to an elaborated set of mycotoxins in the Belgian population. Biomarker analysis showed a clear exposure of a broad segment of the Belgian population to DON, OTA and CIT. The risk assessment based on these data indicates a potential concern for a number of individuals whereby young children need special attention because of the relatively higher food intake per kg body weight.

Deoxynivalenol Exposure Assessment for Pregnant Women in Bangladesh

The trichothecene mycotoxin deoxynivalenol (DON) is a contaminant of crops worldwide and known to cause adverse health effects in exposed animals and humans. A small survey reported the presence of DON in maize samples in Bangladesh, but these data are insufficient to assess human exposure, and also, biomonitoring data are still scarce. The present study applied biomarker analysis to investigate the DON exposure of pregnant women in Bangladesh. Urine samples were collected from pregnant women living in a rural (n = 32) and in a suburban (n = 22) area of the country. Urines were subjected to enzymatic hydrolysis of glucuronic acid conjugates and to immunoaffinity column clean-up prior to LC-MS/MS analysis of DON and its de-epoxy metabolite DOM-1. The limits of detection (LOD) for DON and DOM-1 in urine were 0.16 ng/mL and 0.10 ng/mL, respectively. DOM-1 was not detected in any of the urines, whilst DON was detectable in 52% of the samples at levels ranging from 0.18–7.16 ng/mL and a mean DON concentration of 0.86 ± 1.57 ng/mL or 2.14 ± 4.74 ng/mg creatinine. A significant difference in mean urinary DON levels was found between the rural (0.47 ± 0.73 ng/mL) and suburban (1.44 ± 2.20 ng/mL) cohort, which may be related to different food habits in the two cohorts. Analysis of food consumption data for the participants did not show significant correlations between their intake of typical staple foods and DON levels in urine. The biomarker concentrations found and published urinary excretion rates for DON were used to estimate daily mycotoxin intake in the cohort: the mean DON intake was 0.05 µg/kg b.w., and the maximum intake was 0.46 µg/kg b.w., values lower than the tolerable daily intake of 1 µg/kg b.w. These first results indicate a low dietary exposure of pregnant women in Bangladesh to DON. Nonetheless, further biomonitoring studies in children and in adult cohorts from other parts of the country are of interest to gain more insight into DON exposure in the population of Bangladesh.

Mycotoxin exposure in rural residents in northern Nigeria: a pilot study using multi-urinary biomarkers

A pilot, cross-sectional, correlational study was conducted in eight rural communities in northern Nigeria to investigate mycotoxin exposures in 120 volunteers (19 children, 20 adolescents and 81 adults) using a modern LC-MS/MS based multi-biomarker approach. First morning urine samples were analyzed and urinary biomarker levels correlated with mycotoxin levels in foods consumed the day before urine collection. A total of eight analytes were detected in 61/120 (50.8%) of studied urine samples, with ochratoxin A, aflatoxin M1 and fumonisin B1 being the most frequently occurring biomarkers of exposure. These mycotoxin biomarkers were present in samples from all age categories, suggestive of chronic (lifetime) exposures. Rough estimates of mycotoxin intake suggested some exposures were higher than the tolerable daily intake. Overall, rural consumer populations from Nasarawa were more exposed to several mixtures of mycotoxins in their diets relative to those from Kaduna as shown by food and urine biomarker data. This study has shown that mycotoxin co-exposure may be a major public health challenge in rural Nigeria; this calls for urgent intervention.

Assessment of multi-mycotoxin exposure in southern Italy by urinary multi-biomarker determination

Human exposure assessment to deoxynivalenol (DON), aflatoxin B1 (AFB1), fumonisin B1 (FB1), zearalenone (ZEA) and ochratoxin A (OTA) can be performed by measuring their urinary biomarkers. Suitable biomarkers of exposure for these mycotoxins are DON + de-epoxydeoxynivalenol (DOM-1), aflatoxin M1 (AFM1), FB₁, ZEA + α-zearalenol (α-ZOL) + β-zearalenol (β-ZOL) and OTA, respectively. An UPLC-MS/MS multi-biomarker method was used to detect and measure incidence and levels of these biomarkers in urine samples of 52 volunteers resident in Apulia region in Southern Italy. The presence of ZEA + ZOLs, OTA, DON, FB1 and AFM1 were detected in 100%, 100%, 96%, 56% and 6%, of samples, respectively. All samples contained biomarkers of two or more mycotoxins. The mean concentrations of biomarkers ranged from 0.055 ng/mL (FB1) to 11.89 ng/mL (DON). Urinary biomarker concentrations were used to estimate human exposure to multiple mycotoxin. For OTA and DON, 94% and 40% of volunteers, respectively exceeded the tolerable daily intake (TDI) for these mycotoxins. The estimated human exposure to FB1 and ZEA was largely below the TDI for these mycotoxins for all volunteers.