Assessment of mycotoxin exposure and risk characterization using occurrence data in foods and urinary biomarkers in Brazil

Recent Progress of Mycotoxin in Various Food Products-Human Exposure and Health Risk Assessment

Mycotoxins, as prevalent contaminants in the food chain, exhibit diverse toxicological effects on both animals and humans. Chronic dietary exposure to mycotoxin-contaminated foods may result in the bioaccumulation of these toxins, posing substantial public health risks. This review systematically examines the contamination patterns of mycotoxins across major food categories, including cereals and related products, animal-derived foods, fruits, and medical food materials. Furthermore, we critically evaluated two methodological frameworks for assessing mycotoxin exposure risks: (1) dietary exposure models integrating contamination levels and consumption data and (2) human biomonitoring approaches quantifying mycotoxin biomarkers in biological samples. A key contribution lies in the stratified analysis of exposure disparities among population subgroups (adults, teenagers, children, and infants). Additionally, we summarize current research on the relationship between human mycotoxin biomonitoring and associated health impacts, with a particular emphasis on vulnerable groups such as pregnant women and infants. By elucidating the challenges inherent in existing studies, this synthesis provides a roadmap for advancing risk characterization and evidence-based food safety interventions.

Deoxynivalenol and Alternaria Toxin Exposure and Health Effects Assessment of Pregnant Shanghai Women

Deoxynivalenol (DON) and Alternaria toxins (ATs) are two common types of mycotoxins in food. Although they are physiologically toxic to animals and various cell lines, data related to the exposure risks and health effects in the human population were still limited, especially for ATs. In this study, we combined food consumption data and human biomonitoring data of 200 pregnant volunteers from different districts of Shanghai to assess the exposure to DON and ATs. In addition, correlations between food consumption and urinary DON and ATs levels, urine biomarkers, and blood indexes were analyzed by regression analysis. For DON, the exposure assessment of the probable daily intake (PDI) indicated that a portion (37.5%) of all participants exceeded the Tolerable Daily Intake (TDI) proposed for DON. For ATs, the PDI values estimated based on the urinary concentrations indicated that 2-100% of all participants exceeded the threshold of toxicological concern (TTC) values for ATs. In addition, we innovatively found some associations between exposure to ATs and abnormal uric acid and high-density lipoprotein cholesterol indexes by regression analysis. Despite the inevitable uncertainties, these results make an important contribution to the understanding of DON and ATs exposure risks and potential health hazards in the pregnant women population.

Cross-sectional biomonitoring of urinary deoxynivalenol, T-2 and HT-2 toxins, and zearalenone in Japanese adults

BACKGROUND

Among the more than 300 mycotoxins that are known to have toxic effects on animals and humans, Fusarium toxins deoxynivalenol (DON), T-2 and HT-2 toxins (T2/HT2), and zearalenone (ZEN) are frequently detected in domestic agricultural products. This study aimed to assess DON, T2/HT2, and ZEN exposure in Japanese adults by measuring urinary mycotoxins, observing their distributions, and making comparisons with data from other countries.

METHODS

A total of 201 individuals participated in the study. Twenty-four-hour urine samples were collected from young adults (34 men and 35 women) in the Tokai region (urban area) and spot urine samples were collected from middle-aged and elderly adults (64 men and 68 women) in the Donan area of Hokkaido Prefecture (rural area). Urinary DON, T2/HT2, and ZEN levels were measured using a validated liquid chromatography-tandem mass spectrometry method.

RESULTS

For DON, T2/HT2, and ZEN, the detection frequencies above the limit of detection (LOD) level (0.15, 0.13, and 0.01 µg/L, respectively) in all the samples were 53%, 26%, and 71%, respectively. The median concentrations (95th percentile) of urinary DON, HT2, and ZEN were 0.19 (3.93),

CONCLUSIONS

This study represents the first comprehensive exposure assessment for DON, T2/HT2, and ZEN in Japanese adults using human biomonitoring methods. These data provide valuable information for a better understanding of mycotoxin exposure in Japan.

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Key Words

• Human biomonitoring
• Japanese adults
• Liquid chromatography–tandem mass spectrometry
• Mycotoxin
• Urine

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MESH Headings

• Humans
• Zearalenone/urine
• Japan
• Male
• Female
• Trichothecenes/urine
• T-2 Toxin/analogs & derivatives
• T-2 Toxin/urine
• Biological Monitoring
• Adult
• Middle Aged
• Aged
• Cross-Sectional Studies
• Young Adult
• Mycotoxins/urine
• Environmental Exposure/analysis
• East Asian People

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Affiliation(s)

Toshiki Tajima Department of Biomolecular Sciences, Field of Omics Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya 461-8673, Japan
Tomohiko Isobe Health and Environmental Risk Division, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba 305-8506, Japan
Isao Saito Department of Biomolecular Sciences, Field of Omics Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya 461-8673, Japan
Takaaki Kondo Department of Biomolecular Sciences, Field of Omics Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya 461-8673, Japan
Koji Suzuki Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
Ryosuke Fujii Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
Yoshiki Tsuboi Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
Yoshiko Sugita-Konishi Faculty of Applied Biosciences, Tokyo University of Agriculture, 1-1-1 Sakuragaoka, Setagaya-ku, Tokyo 156-8502, Japan
Jun Ueyama Department of Biomolecular Sciences, Field of Omics Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya 461-8673, Japan

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Biomonitoring and determinants of mycotoxin exposures from pregnancy until post-lactation in HIV-infected and HIV-uninfected women from Harare, Zimbabwe

The human immunodeficiency virus (HIV) heavily affects women from resource-limited settings who are vulnerable to potentially harmful mycotoxins including aflatoxin B1 (AFB1), fumonisin B1 (FB1) and ochratoxin A (OTA). We aimed to conduct biomonitoring and ascertain the determinants of maternal mycotoxin exposure in pregnancy, lactation and post-lactation periods. We conducted a retrospective longitudinal study in HIV-infected and HIV-uninfected women from Harare, Zimbabwe. 175 and 125 random urine samples in pregnancy and 24 months after delivery (post-lactation) respectively were analysed for aflatoxin M1 (AFM1) and FB1 by ELISA. 6 weeks after delivery (lactation), 226 and 262 breast milk (BM) samples were analysed for AFM1 and OTA respectively by ELISA. The association of demographics and food consumption with mycotoxins was evaluated using multivariable logistic regression. In HIV-infected, urinary AFM1 was detected in 46/94 (Median: 0.05; Range: 0.04-0.46 ng mL-1) in pregnancy and 47/66 (Median: 0.05; Range: 0.04-1.01 ng mL-1) post-lactation. Urinary FB1 was detected in 86/94 (Median: 1.39; Range: 0.17-6.02 ng mL-1) in pregnancy and 56/66 (Median: 0.72; Range: 0.20-3.81 ng mL-1) post-lactation. BM AFM1 was detected in 28/110 (Median: 7.24; Range: 5.96-29.80 pg mL-1) and OTA in 11/129 (Median: 0.20; Range: 0.14-0.65 ng mL-1). In HIV-uninfected, urinary AFM1 was detected in 48/81 (Median: 0.05; Range: 0.04-1.06 ng mL-1) in pregnancy and 41/59 (Median: 0.05; Range: 0.04-0.52 ng mL-1) post-lactation. Urinary FB1 was detected in 74/81 (Median: 1.15; Range: 0.17-6.16 ng mL-1) in pregnancy and 55/59 (Median: 0.96; Range: 0.20-2.82 ng mL-1) post-lactation. BM AFM1 was detected in 38/116 (Median: 7.70; Range: 6.07-31.75 pg mL-1) and OTA in 4/133 (Median: 0.24; Range: 0.18-0.83 ng mL-1). Location, wealth, and peanut butter consumption were determinants of AFB1 exposure. HIV infection, BMI, location, rainy season, unemployment, and age were determinants of FB1 exposure. Women especially those pregnant and/or HIV-infected are at risk of adverse effects of mycotoxins.

Exposure to mycotoxins from the consumption of corn-based breakfast cereals in the United Arab Emirates

Corn-based breakfast cereals, known as cornflakes, have become a common breakfast choice worldwide, recognized for their convenience and versatility. However, mycotoxins can contaminate these products, adversely affecting human health. This study assessed the occurrence of major mycotoxins (AFB1, OTA, DON, ZEA, and FUM) in cornflake stock-keeping units (SKUs) marketed in the United Arab Emirates (UAE). It also evaluated the effect of different independent variables (country of origin, temperature on the production day, storage time, presence of chocolate, bran, and nut ingredients) and estimated the exposure levels of the UAE population to these mycotoxins and the associated risk factors. Seventy-six distinct cornflake SKUs were identified through a market screening and tested for mycotoxins using the Enzyme-Linked Immunosorbent Assay (ELISA) technique. AFB1, OTA, ZEA, FUM, and DON were detected in 23.7, 48.7, 27.6, 9.2 and 88.2% of the samples, respectively. The mean concentrations among positive samples were 2.0, 1.0, 10.14, 584.9, and 90.6 μg/kg, respectively. Except for AFB1, the average mycotoxin levels in samples were below the established limits by the European Union (EU). Among positive samples, none exceeded the US FDA limits for all mycotoxins, and only one exceeded the CODEX limit for FUM. On the other hand, four (5.3%), one (1.3%), one (1.3%), and one (1.3%) SKU exceeded EU limits for AFB1, OTA, FUM, and ZEA, respectively. The country of origin (developing vs. developed countries) exhibited a significant effect on AFB1 presence (p < 0.0001). Furthermore, higher temperature on the production day was associated with significantly higher AFB1 occurrence (p = 0.009). Moreover, the presence of chocolate ingredient had a borderline significant effect on AFB1 (p = 0.05) and a significant effect on OTA (p = 0.002), with higher percentages observed in SKUs containing chocolate. However, no significant effects were found for storage time or the presence of bran and nut ingredients in the cornflakes. On the other hand, the HQ values were below 1 for all mycotoxins, indicating low risk. MoE values exceeded 10,000 among regular cornflake consumers, except for FUM, suggesting minimal risk. Liver cancer risk was 0.0032 cases per 100,000 people per year. Weekly OTA exposure was 0.133 ng/kg BW, below PTWI (Provisional Tolerable Weekly Intake).

Assessment of Mycotoxin Exposure and Associated Risk in Pregnant Dutch Women: The Human Biomonitoring Approach

Mycotoxins are toxic secondary metabolites produced by various fungi that can contaminate food crops, which, in turn, may lead to human exposure. Chronic exposure to mycotoxins can cause adverse health effects including reproductive and developmental toxicity. Pregnant women and their foetuses present a vulnerable group for exposure to mycotoxins that can cross the placenta. Human biomonitoring of mycotoxins provides a real-life approach to estimate internal exposure. In this pilot study, 24-h urine samples from 36 pregnant Dutch women were analysed for aflatoxin M1 (AFM1), total deoxynivalenol (DON), de-epoxy-deoxynivalenol (DOM-1), total zearalenone (ZEN), total α-zearalenol (α-ZEL), total β-zearalenol (β-ZEL) and total zearalanone (ZAN), where 'total' refers to mycotoxins and their conjugated forms. Serum samples from these women were analysed for fumonisin B1 (FB1) and ochratoxin A (OTA). All samples were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The most prevalent mycotoxins were total DON, total ZEN and OTA, with a detection frequency of 100%. DOM-1, total α-ZEL and total β-ZEL were detected but to a lesser extent, while AFM1, total ZAN and FB1 were undetected. Median concentrations were 4.75 μg total DON/L, 0.0350 μg DOM-1/L, 0.0413 μg total ZEN/L, 0.0379 μg total α-ZEL/L, 0.0189 μg total β-ZEL/L, and 0.121 μg OTA/L. The calculated median concentration for total ZEN and its metabolites was 0.105 μg/L. Based on two separate risk assessment approaches, total DON exposure in this group was considered to be of low concern. Similarly, exposure to total ZEN and its metabolites in this group was of low concern. For OTA, the risk of non-neoplastic effects was of low concern based on exposure in this group, and the risk of neoplastic effects was of low concern in the majority of participants in this group. The findings of this pilot study confirm the presence of mycotoxins in the urine and serum of pregnant Dutch women, with total DON, total ZEN, and OTA most frequently detected. Exposure to all measured mycotoxins was considered to be of low concern in this group, except for exposure to OTA, which was of low concern for the majority of participants. The study's findings offer valuable insights but should be confirmed using a larger and more diverse sample of the Dutch general population.

Exposure assessment of children to dietary mycotoxins: A pilot study conducted in Ribeirão Preto, São Paulo, Brazil

Exposure to mycotoxins through food is a major health concern, especially for youngsters. This study performed a preliminary investigation on children's exposure to dietary mycotoxins in Ribeirão Preto, Brazil. Sampling procedures were conducted between August and December 2022, to collect foods (N = 213) available for consumption in the households of children (N = 67), including preschoolers (aged 3-6 years, n = 21), schoolers (aged 7-10 years, n = 15), and adolescents (aged 11-17 years, n = 31) cared in the Vila Lobato Community Social Medical Center of Ribeirão Preto. Ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS) was used to determine concentrations of the mycotoxins in foods. Mycotoxins measured in all foods comprised aflatoxins (AFs), fumonisins (FBs), zearalenone (ZEN), T-2 toxin, deoxynivalenol (DON) and ochratoxin A (OTA). Higher incidence and levels were found for FBs, ZEN, and DON in several commonly consumed foods. Furthermore, 32.86 % foods had two to four quantifiable mycotoxins in various combinations. The mean estimated daily intake (EDI) values were lower than the tolerable daily intake (TDI) for AFs, FBs, and ZEN, but higher than the TDI (1.0 µg/kg bw/day) for DON, hence indicating a health risk for all children age groups. Preschoolers and adolescents were exposed to DON through wheat products (EDIs: 2.696 ± 7.372 and 1.484 ± 2.395 µg/kg body weight (bw)/day, respectively), while schoolers were exposed through wheat products (EDI: 1.595 ± 1.748 µg/kg bw/day) and rice (EDI: 1.391 ± 1.876 µg/kg bw/day). The results indicate that wheat-based foods and rice may be risky to children, implying the need for stringent measures to avoid DON contamination in these products.

Assessment of quality and safety aspects of homemade and commercial baby foods

Dietary Guidelines in some countries recommend avoiding commercially processed baby food, while others encourage the consultation of ingredients and nutritional information. Therefore, the objective of this study was to systematically analyze different baby foods obtained from commercial market and "homemade" produced, in order to verify whether comercial products have low nutritional and unsafety attributes. The samples were analyzed for chemical composition, physicochemical aspects, texture, microbiological and mycotoxin contamination, and pesticide residues. Results showed that, in general, commercial samples have a higher energy density and better ratio of macronutrients. The sodium, pH, and texture of both products were in accordance with the recommendations. None of the baby foods evaluated were contaminated with yeast and molds, total coliforms, or Escherichia coli; however, Salmonella sp. was confirmed in one homemade sample. Pesticide residues were detected in all analyzed baby food samples; however, at lower levels than the limit of quantification. Ochratoxin A was detected in one homemade baby food sample (5.76 µg /kg). Considering the samples evaluated, commercial baby food samples appeared to be safer in relation to microbiological, pesticide residue standards, and mycotoxin contamination. Therefore, it could be concluded that the quality of commercial and homemade baby foods still needs to be improved, as well as more studies related to a critical analyses of both types of processes used.

Efficacy of Two Commercially Available Adsorbents to Reduce the Combined Toxic Effects of Dietary Aflatoxins, Fumonisins, and Zearalenone and Their Residues in the Tissues of Weaned Pigs

Mycotoxins present a significant health concern within the animal-feed industry, with profound implications for the pig-farming sector. The objective of this study was to evaluate the efficacy of two commercial adsorbents, an organically modified clinoptilolite (OMC) and a multicomponent mycotoxin detoxifying agent (MMDA), to ameliorate the combined adverse effects of dietary aflatoxins (AFs: sum of AFB1, AFB2, AFG1, and AFG2), fumonisins (FBs), and zearalenone (ZEN) at levels of nearly 0.5, 1.0, and 1.0 mg/kg, on a cohort of cross-bred female pigs (N = 24). Pigs were randomly allocated into six experimental groups (control, mycotoxins (MTX) alone, MTX + OMC 1.5 kg/ton, MTX + OMC 3.0 kg/ton, MTX + MMDA 1.5 kg/ton, and MTX + MMDA 3.0 kg/ton), each consisting of four individuals, and subjected to a dietary regimen spanning 42 days. The administration of combined AFs, FBs, and ZEN reduced the body-weight gain and increased the relative weight of the liver, while there was no negative influence observed on the serum biochemistry of animals. The supplementation of OMC and MMDA ameliorated the toxic effects, as observed in organ histology, and provided a notable reduction in residual AFs, FBs, and ZEN levels in the liver and kidneys. Moreover, the OMC supplementation was able to reduce the initiation of liver carcinogenesis without any hepatotoxic side effects. These findings demonstrate that the use of OMC and MMDA effectively mitigated the adverse effects of dietary AFs, FBs, and ZEN in piglets. Further studies should explore the long-term protective effects of the studied adsorbent supplementation to optimize mycotoxin management strategies in pig-farming operations.

Longitudinal follow-up of zearalenone and deoxynivalenol mycotoxins in breast milk in the first five months of life

OBJECTIVES

There is a possibility for exposed lactating mammalians to transfer some contaminants to their milk. This study aimed to determine the levels and changes of Zearalenone (ZEN), Deoxynivalenol (DON) mycotoxins for the first five months in human milk.

METHODS

Voluntary lactating mothers having infants with gestational length ≥ 37 weeks were enrolled between August 2017 and June 2018 in Şanlıurfa. Mothers and infants with chronic health problems were not included in the study. Human milk samples were taken at three different times; on enrollment (Day 6-10, visit 1), between 4 and 6 weeks postpartum (visit 2), and between 14 and 19 weeks postpartum (visit 3). Mycotoxin levels in human milk were measured utilizing Helica brand commercial kit.

RESULTS

Nineteen voluntary mothers and their breastfed infants with three human milk samples completed the study. The mean ages of mothers and infant (± SD) were 27.4 (± 5.4) years and 7.6 (± 0.9) days on enrollment. Median levels of ZEN and DON in human milk samples were 0.39 and 16.7 ng/mL, respectively. None of the cases had a ZEN daily intake higher than 250 ng/kg bw per day. However, three fourth of the cases had DON intake higher than > 1000 ng/kg bw per day. When adjusted for infant weight for age and sex, both ZEN levels and daily intake were decreased progressively from visit 1 to visit 3 (p < 0.001). DON levels and daily intake at visit 2 were found to be significantly lower in samples of visit 3 than that taken in visit 2 (p = 0.004 and p < 0.001, respectively).

CONCLUSIONS

Breast milk monitoring study revealed that ZEN and DON mycotoxins were present in the mother-infant environment. Contamination levels changed during the lactation period.

Multi-mycotoxin determination in plant-based meat alternatives and exposure assessment

The aim of this study was to fill in the gap regarding the occurrence of mycotoxins in plant-based meat alternatives. Hence, a multi-mycotoxin method (aflatoxins, ochratoxin A, fumonisins, zearalenone, and mycotoxins from the Alternaria alternata genera) was developed followed by an exposure assessment for the Italian consumers' exposure to mycotoxins. A total of 13 meat alternatives samples based on soy, pea, chickpea, lupin, and seitan were analysed. With the exception of seitan, all of the remaining samples were contaminated with one mycotoxin or mixtures of up to seven mycotoxins. The level of contamination was as low as 0.2 μg/kg alternariol methyl ether and as high as 66.9 μg/kg fumonisin B1. To analyse the exposure to mycotoxins due to plant-based meat alternatives consumption we used the consumption meat data from the Food and Agriculture Organization for Italian adult consumers and simulated a full replacement of meat with plant-based meat alternatives. Based on our model, consumption of plant-based meat alternatives led to a non-tolerable exposure to alternariol (hazard index (HI) > 1) in pea-based burger and soy + wheat-based steak, while samples contaminated with aflatoxins, respectively ochratoxin A, indicated a health concern related to liver and renal cancer (margin of exposure (MOE) < 10,000). This is the first study that presents the co-occurrence of mycotoxins in multiple plant-based meat alternatives. Moreover, these results indicate that there is a need for policymakers to consider the regulation of mycotoxins in plant-based meat alternatives in order to ensure consumers' safety.

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.

Assessment of occupational and dietary exposures of feed handling workers to mycotoxins in rural areas from São Paulo, Brazil

In the current study, the occupational and dietary exposures of feed handling workers (N = 28) to aflatoxins (AFs), fumonisins (FBs), ochratoxin A (OTA), deoxynivalenol (DON), zearalenone (ZEN), toxins T-2 and HT-2 were assessed for the first time in animal-producing farms and feed factories from São Paulo, Brazil. Mycotoxins in food (n = 244) and airborne dust (n = 27), as well as biomarkers in urine (n = 97) samples were determined by liquid chromatography coupled with tandem mass spectrometry. FBs were detected in all airborne dust samples, with concentrations ranging from 7.85 to 16,839 ng/m³. The mean probable daily intake (PDI) based on food data were 0.005, 0.769, 0.673 and 0.012 μg/kg of body weight (bw)/day for AFs, FBs, DON and ZEN, respectively. Mean PDI values obtained through urinary biomarkers were 0.29, 0.10, 0.50, 9.72 and 0.10 μg/kg body weight/day for AFB₁, DON, OTA, FB₁ and ZEN, respectively. The analyses based on urinary biomarkers revealed a potential health concern for OTA and FBs, although no potential health concern was observed with PDI calculated through food data. Results of this trial stress the need for preventive measures to avoid health risks of workers in Brazilian animal-producing farms and feed industries.

Co-occurrence of mycotoxins: A review on bioanalytical methods for simultaneous analysis in human biological samples, mixture toxicity and risk assessment strategies

Mycotoxins are the toxic chemical substances that are produced by various fungal species and some of these are harmful to humans. Mycotoxins are ubiquitous in nature and humans could be exposed to multiple mycotoxins simultaneously. Unfortunately, exposure to mixed mycotoxins is not very well studied. Various studies have demonstrated the capacity of mycotoxins to show synergistic effect in the presence of other mycotoxins, thus, increasing the risk of toxicity. Hence, it is important to monitor mixed mycotoxins in human biological samples which would serve as a crucial information for risk assessment. Through this review paper, we aim to summarize the mixture toxicity of mycotoxins and the various bio-analytical techniques that are being used for the simultaneous analysis of mixed mycotoxins in human biological samples. Different sample preparation and clean-up techniques employed till date for eliminating the interferences from human biological samples without affecting the analyses of the mycotoxins are also discussed. Further, a brief introduction of risk assessment strategies that have been or could be adopted for multiple mycotoxin risk assessments is also mentioned. To the best of our knowledge, this is the first review that focuses solely on the occurrence of multiple mycotoxins in human biological samples as well as their risk assessment strategies.

Risk Assessment of Hepatocellular Carcinoma with Aflatoxin B1 Exposure in Edible Oils

Contamination of edible oils with aflatoxins (AFs) is a universal issue due to the detrimental effects of aflatoxins on human health and the fact that edible oils are a major source of fungal growth, particularly storage fungi (Aspergillus sp.). The objective of this study was to assess aflatoxin B1 (AFB1) in edible oil used in fried food in order to determine the risk of cancer from AFB1 exposure through cooked food using the FAO/WHO’s and EFSA’s margin of exposure (MOE) quantitative liver cancer risk approaches. Using Mycosep 226 columns and HPLC-FLD, 100 samples of cooking oils (soybean, canola, and sunflower oil) from different food points were analyzed for contamination with aflatoxins. Of all the samples tested, 89% were positive for total aflatoxins and AFB1, with 65% indicating AF concentrations beyond permitted levels. Canola oil was found to contain higher levels of AFB1 and AFs than soybean and sunflower oil. Almost 71 percent of canola oil samples (range of 54.4–281.1 µg/kg) were contaminated with AF levels higher than the proposed limits of the European Union (20 µg/kg). The consumption of canola oil samples used in fried foods had MOE values that were significantly lower as compared to sunflower and soybean oils, indicating that risk reduction is feasible. Additionally, compared to soybean and sunflower oil, canola oil exhibited a greater threat of liver cancer cases linked to AFB1 exposure (17.13 per 100,000 males over 35 and 10.93 per 100,000 females over 35). Using a quantitative liver cancer approach, health risk valuation demonstrated that males and females over the age of 35 are at significant risk of developing liver cancer. The health risk assessment exposed that the males and female over the age of 35 are at considerable risk of liver cancer by using a quantitative liver cancer approach. The innovation of this study lies in the fact that no such study is reported related to liver cancer risk evaluation accompanied with AFB1 exposure from consumed edible oil. As a result, a national strategy must be developed to solve this problem so that edible oil products are subjected to severe regulatory examination.

Exposure assessment of urinary deoxynivalenol in pregnant women in Wuhan, China

Deoxynivalenol (DON) is a ubiquitous trichothecene mycotoxin in food. DON and its modified forms can cross the placental barrier and influence the foetus' health. Limited information is available on exposure of dietary DON intake of pregnant women in China recently. We estimated the exposure of dietary DON intake of pregnant women in a large sample size (n = 2534) from China. The total DON (tDON) and free DON (fDON) biomarkers in urine were detected by liquid chromatography-tandem mass spectrometry. The mean concentration of tDON was 34.8 ng/mg creatinine, and the fDON was 15.9 ng/mg creatinine. The estimated exposure of dietary DON intake was 0.96-1.91 μg/kg bw/day, and the difference in exposure of DON between the first and second trimesters was statistically insignificant. Approximately 26%-60% of individuals exceeded the provisional maximum tolerable daily intake (PMTDI). The age, pre-pregnancy BMI, and the sampling seasons may be the risk factor for the occurrence of exceeding PMTDI. This survey is the first exposure biomarker for DON in a large sample size from pregnant women in China. We found that the dietary DON exposure in pregnant women was relatively high and particular concern should be paid to the DON exposure during pregnancy.

Dietary Exposure and Risk Assessment of Mycotoxins in Thyme and Thyme-Based Products Marketed in Lebanon

This study aimed at evaluating the incidence of aflatoxin B1 (AFB1) and ochratoxin A (OTA) in thyme and thyme-based products, related dietary exposure, and cancer risk for regular and high consumption. A total of 160 samples were collected, and 32 composite samples were analyzed. AFB1 and OTA were respectively found in 84% (27/32) and 38% (12/32) of the samples. AFB1 exceeded the limits in 41% (13/32) and 25% (8/32) of the samples according to the Lebanese and European standards, respectively. OTA was unacceptable in only 6% (2/32) and 3% (1/32) of the samples according to the Lebanese and European standards, respectively. AFB1 and OTA daily exposure was shown to be 4.270 and 1.345 ng/kg bw/day, respectively. AFB1 was shown to be associated with 0.41 and 0.35 additional cancer cases per 100,000 persons per year for regular consumption, respectively; while for high consumption, an increase of 0.911 and 0.639 cancer cases per 100,000 person per year was noted, respectively. The margin of exposure (MOE) for OTA was >10,000 for the non-neoplastic effect and >200 for the neoplastic effect, representing no toxicological concerns for consumers.

Assessment of Human Mycotoxin Exposure in Hungary by Urinary Biomarker Determination and the Uncertainties of the Exposure Calculation: A Case Study

Urinary biomarkers of mycotoxin exposure were evaluated in the case of healthy people (n = 41) and coeliac patients (n = 19) by using a multi-biomarker LC-MS/MS immunoaffinity based method capable to analyse biomarkers of nine mycotoxins, i.e., fumonisin B1 (FB1), fumonisin B2 (FB2), deoxynivalenol (DON), zearalenone (ZEN), ochratoxin A (OTA), Aflatoxin B1 (AFB1), T-2 toxin, HT-2 toxin and Nivalenol (NIV). Urinary biomarker concentrations were used to calculate the probable daily intake (PDI) of fumonisin B1, deoxynivalenol, zearalenone and ochratoxin A and compared with their tolerable daily intake (TDI). The human urinary excretion rate values reported in the literature and the 24 h excretion rate measured in piglets were used to estimate and compare the PDI values of the four mycotoxins. The highest mean biomarker concentrations were found for DON (2.30 ng/mL for healthy people and 2.68 ng/mL for coeliac patients). Mean OTA concentration was significantly higher (p < 0.001) in healthy people compared to coeliac patients. PDI calculated with piglets excretion data exceeded the TDI values by a much smaller percentage than when they were calculated from human data, especially for FB₁. The uncertainties arising from the different calculations can be well perceived on the basis of these data.

Assessment of Dietary Exposure to Ochratoxin A in Lebanese Students and Its Urinary Biomarker Analysis

The present study investigated the dietary and urinary OTA occurrence among 44 Lebanese children. Relying on HPLC-FLD analysis, OTA was found in all the urine samples and in 46.5% and 25% of the 24 h duplicate diet and dinner samples, respectively. The means of OTA levels in positive samples were 0.32 ± 0.1 ng/g in 24 h diet, 0.32 ± 0.18 ng/g in dinner and 0.022 ± 0.012 ng/mL in urines. These values corresponded to margin of exposure (MOE) means of 7907 ± 5922 (neoplastic) and 2579 ± 1932 (non-neoplastic) calculated from positive 24 h diet, while 961 ± 599 (neoplastic) and 313 ± 195 (non-neoplastic) calculated from the urine. Since the MOE levels for the neoplastic effect were below the limit (10,000), a major health threat was detected and must be addressed as a health institutions' priority. Besides, the wide difference between PDIs and MOEs calculated from food and urine suggests conducting further OTA's toxicokinetics studies before using urine to measure OTA exposure.

Assessment of Human Exposure to Five Alternaria Mycotoxins in China by Biomonitoring Approach

This biomonitoring study was conducted to investigate the concentration levels of five Alternaria mycotoxins in urine samples from 269 healthy volunteers living in the Yangtze River Delta, China. Alternariol (AOH), alternariol monomethyl ether (AME), tenuazonic acid (TeA) and tentoxin (TEN) were detected in 38.3%, 48.7%, 63.9% and 23.4% of urine samples with the concentrations ranging from 0.057 to 45.8 ng/mL, 0.020 to 0.802 ng/mL, 0.050 to 80.6 ng/mL and 0.021 to 0.939 ng/mL, respectively. Altenuene (ALT) was not detected in any urine sample. Based on the urinary concentrations, the probable daily intake (PDI) values of Alternaria mycotoxins were calculated, and 100%, 99.2-100%, 0.372% and 1.12% of participants exceeded the threshold of toxicological concern (TTC) values for AOH, AME, TeA and TEN, respectively. This study revealed high potential health risks related to the contaminations of major Alternaria mycotoxins in China and highlighted the necessity for more toxicological studies to provide better basis for further comprehensive risk assessments.

Risk assessment of multiple-mycotoxin exposure for consumers of chestnuts in Shandong Province markets in China

In this study, 321 chestnut samples from Shandong Province in China were analysed for the presence of mycotoxins. We screened for 14 mycotoxins including aflatoxins (AFs: AFB₁, AFB₂, AFG₁, AFG₂), deoxynivalenol (DON), 3-acetyldeoxynivalenol (3-ADON), 15-acetyldeoxynivalenol (15-ADON), T-2 toxin (T-2), zearalenone (ZEA), ochratoxin A (OTA), fumonisins (FB₁, FB₂, FB₃), and penicillic acid (PeA). Mycotoxins were detected in 56.4% of the samples, and 11 of these mycotoxins were found. Thirty samples from the Shandong Province markets were deemed positive for AFs (9.3%) and had an AFB₁ level of >2 μg/kg or a sum of AFB₁, AFB₂, AFG₁, and AFG₂ that was >4 μg/kg, which exceed the maximum tolerable level of the European regulations standards (EC/188/2006). The contamination level for total mycotoxins found in chestnuts was in the range of 0.6-2,791.0 μg/kg. The estimated daily intake (EDI) values for each individual mycotoxin and for all of the mycotoxins collectively were calculated by both a deterministic approach and a probabilistic approach. For risk characterisation, dietary exposure to DON, ZEA, FBs, and OTA through consumption of chestnuts, analysed according to both approaches, showed no health risk to Chinese adolescents and adults from exposure to either individual mycotoxins or in combination, but more concern should be paid to the AFs for adolescents and adults at a high consumption level. This is believed to be the first work performing risk assessment of multiple mycotoxins specifically for adolescents, including the recently isolated FBs and PeA, which have recently emerged as mycotoxins of concern, in chestnuts of Shandong Province in China.

Aflatoxin contamination in maize: occurrence and health implications in Latin America

According to the United Nations Food and Agriculture Organisation, mycotoxicoses constitute the second most pressing food safety problem worldwide, with most cases occurring in developing countries. Maize (Zea mays L.), the main staple for many Latin Americans, is one of the best suitable substrates for mycotoxigenic Aspergillus fungi. Aflatoxins (AFs) produced primarily by Aspergillus flavus, are of significant concern, especially in developing countries. While AFs production occurs mainly in warmer, tropical, and subtropical environments, recent evidence suggests that global climate change favours their presence in regions with little or no awareness of this issue. AFs interfere with metabolic processes, causing cancer and other health disorders resulting in health hazards and even death. The setting of national acceptable regulatory levels of AFs is necessary for Latin American countries. Unfortunately, no estimates of the economic impact of AFs in this region are currently available nor the cost of regulatory programs designed to reduce health risks to animals and humans. This review explores relevant data about incidence of AFs in maize produced in the region and the adverse effects of the consumption of contaminated foods and the associated health consequences for Latin American consumers. Regulations aimed to mitigate AFs exposure to consumers are also reviewed and identified gaps for researchers and actors of the maize value chain are also proposed.

Biomonitoring aflatoxin B1 exposure of residents from the Amazon region: a pilot study

The present study was a pilot study that aimed to evaluate the occurrence of aflatoxins (AF) in the human diets and its presence in human urine as a metabolite (aflatoxin M1; AFM1). Volunteers from the Amazon region were evaluated before and after the consumption of 2 Brazil nuts/day for thirty days. At the end of 30 days (t=30) without the consumption of Brazil nuts, 9 samples (30%) were positive for AFM1. After 30 days (t=30) consuming 2 Brazil nuts per day, there was a reduction to 2 positive samples (7%). Questionnaires were also applied to volunteers, and the foods most often cited as consumed in their normal diet were cereals and bovine milk. However, there was no statistical relationship between these foods and the levels of AFM1 in the urine or in relation to those who already consumed Brazil nuts in culinary preparations or derived products. Despite the reduction of positive samples for AFM1 after 30 days of Brazil nut consumption, we suggest further studies regarding the clinical condition and genetics of individuals from the Amazon region, as well as the nutrient levels of the diet, e.g. for selenium, and which may protect the human body against aflatoxins.

Assessment of Human Exposure to Deoxynivalenol, Ochratoxin A, Zearalenone and Their Metabolites Biomarker in Urine Samples Using LC-ESI-qTOF

Human are exposed to a wide range of mycotoxins through dietary food intake, including processed food. Even most of the mycotoxin exposure assessment studies are based on analysis of foodstuffs, and evaluation of dietary intake through food consumption patterns and human biomonitoring methods are rising as a reliable alternative to approach the individual exposures, overcoming the limitations of the indirect dietary assessment. In this study, human urine samples were analyzed, seeking the presence of deoxynivalenol (DON), ochratoxin A (OTA), zearalenone (ZEA), and their metabolites. For this purpose, 40 urine samples from female and male adult residents in the city of Valencia (Spain) were evaluated by liquid chromatography quadrupole time-of-flight mass spectrometry (LC-ESI-qTOF) after salting-out liquid–liquid extraction. Analytical data showed that 72.5% of analyzed samples were contaminated by at least one mycotoxin at variable levels. The most prevalent mycotoxins were de-epoxy DON (DOM-1) (53%), ZEA (40%), and α-zearalenol (αZOL) (43%), while OTA was only detected in one sample. The mean concentrations in positive samples were DON (9.07 ng/mL), DOM-1 (20.28 ng/mL), ZEA (6.70 ng/mL), ZEA-14 glucoside (ZEA-14-Glc) (12.43 ng/mL), αZOL (27.44 ng/mL), αZOL-14 glucoside (αZOL-14-Glc) (12.84 ng/mL), and OTA (11.73 ng/mL). Finally, probable daily intakes (PDIs) were calculated and compared with the established tolerable daily intakes (TDIs) to estimate the potential risk of exposure to the studied mycotoxins. The calculated PDI was below the TDI value established for DON in both female and male adults, reaching a percentage up to 30%; however, this percentage increased up to 92% considering total DON (DON + DOM-1). On the other hand, the PDI obtained for ZEA and its metabolites were higher than the TDI value fixed, but the low urine excretion rate (10%) considered should be highlighted. Finally, the PDI calculated in the detected positive sample for OTA exceeded the TDI value. The findings of the present study confirm the presence of the studied mycotoxins and their metabolites as some of the most prevalent in urine.

Mycotoxin Co-Occurrence in Milks and Exposure Estimation: A Pilot Study in São Paulo, Brazil

The aim of this study was to conduct a first evaluation on the co-occurrence of aflatoxins (AF) M1, B1, B2, G1 and G2; fumonisins (F) B1 and B2; deoxynivalenol (DON); de-epoxydeoxinivalenol (DOM-1); ochratoxin A (OTA); zearalenone (ZEN); α-zearalenol (α-ZEL); and β-zearalenol (β-ZEL) in 68 samples of fluid milk consumed in Pirassununga, São Paulo, Brazil. The probable daily intake (PDI) was also calculated for each mycotoxin evaluated. Mycotoxins were determined by liquid chromatography coupled to mass spectrometry. Sixty-two (91.2%) samples contained at least one type of mycotoxin. AFM1 was found in 6 samples (8.8%), and none of them presented concentrations above the Brazilian maximum permitted level in milk (500 ng/L). Low levels of non-regulated mycotoxins DOM-1, OTA, FB1, FB2, α-ZEL and β-ZEL were found in 6 (8.8%), 17 (25%), 10 (14.7%), 3 (4.4%), 39 (57.4%) and 28 (41.2%) samples of milk, respectively. None of the PDIs calculated for the quantified mycotoxins were above recommended values, indicating low exposure through milk consumption in the area studied. However, 21 samples (30.9%) contained 2-4 types of mycotoxins, which warrants concern about the potential adverse effects of mycotoxin mixtures in milks.

Assessment of Mycotoxin Exposure in a Rural County of Chile by Urinary Biomarker Determination

Aflatoxin B1 (AFB1), ochratoxin A (OTA), zearalenone (ZEN), and deoxynivalenol (DON) are frequent mycotoxins that may cause carcinogenic, mutagenic, estrogenic, or gastrointestinal effects. The aim of this study was to assess the exposure to and risk from AFB1, OTA, ZEN, and DON in 172 participants of the Maule Cohort (MAUCO) by a biomarker analysis in urine and to associate their exposure with food consumption and occupation. Mycotoxins in the first morning urine were analyzed by solid-phase extraction and quantified by Ultra-High-Performance Liquid Chromatography with a mass-mass detector. Participants' information regarding food consumption, occupation, and other characteristics was obtained from a baseline and 2-year follow-up survey of the cohort. The prevalence and mean levels of mycotoxins in the urine were as follows: DON 63%, 60.7 (±78.7) ng/mL; AFB1 8%, 0.3 (±0.3) ng/mL; α-zearalenol (α-ZEL) 4.1%, 41.8 (±115) ng/mL; β-ZEL 3.5%, 17.4 (±16.1) ng/mL; AFM1 2%, 1.8 (±1.0) ng/mL; OTA 0.6% (1/172), 1.3 ng/mL; and ZEN 0.6%, 1.1 ng/mL. These results were translated into exposures of DON, ZEN, and aflatoxins of public health concern. Participants who consumed coffee and pepper the day before had a significantly greater presence of DON (OR: 2.3, CI95 1.17-4.96) and total ZEL (OR: 14.7, CI95 3.1-81.0), respectively, in their urine. Additionally, we observed associations between the habitual consumption of beer and DON (OR: 2.89, CI95 1.39-6.42). Regarding the levels of mycotoxins and the amount of food consumed, we found correlations between DON and nuts (p = 0.003), total ZEL and cereals (p = 0.01), and aflatoxins with capsicum powder (p = 0.03) and walnuts (p = 0.03). Occupation did not show an association with the presence of mycotoxins in urine.

Mycotoxin occurrence in breast milk and exposure estimation of lactating mothers using urinary biomarkers in São Paulo, Brazil

In this study, the occurrence of aflatoxins (AFs), fumonisins (FBs), ochratoxin A (OTA), deoxynivalenol (DON), zearalenone (ZEN) and some of their metabolites were assessed in breast milk and urine of lactating women (N = 74) from Pirassununga, São Paulo, Brazil. Exposure estimations through urinary mycotoxin biomarkers was also performed. Samples were collected in four sampling times (May and August 2018, February and July 2019) and analyzed by liquid chromatography coupled to tandem mass spectrometry. Aflatoxin M₁ (AFM₁) was not detected in breast milk. However, two samples (3%) presented FB₁ at 2200 and 3400 ng/L, while 4 samples (5%) had OTA at the median level of 360 ng/L. In urine, AFM₁ and aflatoxin P₁ (AFP₁) were found in 51 and 11% of samples, respectively (median levels: 0.16 and 0.07 ng/mg creatinine, respectively). Urinary DON (median level: 38.59 ng/mg creatinine), OTA (median level: 2.38 ng/mg creatinine) and ZEN (median level: 0.02 ng/mg of creatinine) were quantified in 18, 8 and 10% of the samples, respectively. Mean probable daily intake (PDI) values based on urinary biomarkers were 1.58, 1.09, 5.07, and 0.05 μg/kg body weight/day for AFM₁, DON, OTA, and ZEN, respectively. Although a low mycotoxin occurrence was detected in breast milk, the PDI for the genotoxic AFs was much higher than those reported previously in Brazil, while PDI values obtained for OTA and DON were higher than recommended tolerable daily intakes. These outcomes warrant concern on the exposure of lactating women to these mycotoxins in the studied area.

Impact of Fusarium-Derived Mycoestrogens on Female Reproduction: A Systematic Review

Contamination of the world's food supply and animal feed with mycotoxins is a growing concern as global temperatures rise and promote the growth of fungus. Zearalenone (ZEN), an estrogenic mycotoxin produced by Fusarium fungi, is a common contaminant of cereal grains and has also been detected at lower levels in meat, milk, and spices. ZEN's synthetic derivative, zeranol, is used as a growth promoter in United States (US) and Canadian beef production. Experimental research suggests that ZEN and zeranol disrupt the endocrine and reproductive systems, leading to infertility, polycystic ovarian syndrome-like phenotypes, pregnancy loss, and low birth weight. With widespread human dietary exposure and growing experimental evidence of endocrine-disrupting properties, a comprehensive review of the impact of ZEN, zeranol, and their metabolites on the female reproductive system is warranted. The objective of this systematic review was to summarize the in vitro, in vivo, and epidemiological literature and evaluate the potential impact of ZEN, zeranol, and their metabolites (commonly referred to as mycoestrogens) on female reproductive outcomes. We conducted a systematic review (PROSPERO registration CRD42020166469) of the literature (2000-2020) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources were primary literature published in English obtained from searching PubMed, Web of Science, and Scopus. The ToxR tool was applied to assess risk of bias. In vitro and in vivo studies (n = 104) were identified and, overall, evidence consistently supported adverse effects of mycoestrogens on physiological processes, organs, and tissues associated with female reproduction. In non-pregnant animals, mycoestrogens alter follicular profiles in the ovary, disrupt estrus cycling, and increase myometrium thickness. Furthermore, during pregnancy, mycoestrogen exposure contributes to placental hemorrhage, stillbirth, and impaired fetal growth. No epidemiological studies fitting the inclusion criteria were identified.

Prevalence and concentration of fumonisins in cereal-based foods: a global systematic review and meta-analysis study

Cereal-based foods are utilized as an essential food segment worldwide. Nevertheless, their contamination by mycotoxins, also fumonisins, could pose a critical health risk. The present research provides the first systematic review regarding the prevalence and concentration of fumonisins in cereal-based food with the aid of a meta-analysis. In this regard, some international databases PubMed, Web of Science, Google Scholar, and Scopus were explored during the last 30 years. Among 9729 screened articles, 73 articles (which meet the proposed inclusion criteria), including 11,132 data, were incorporated in the performed meta-analysis. The overall rank order regarding the concentration of fumonisins in cereal-based foods was corn-based foods > wheat-based foods > other cereal foods > barley-based foods > rice-based foods > oat-based foods. Based on the prevalence of fumonisins, the overall rank order was other cereal foods > corn-based foods > rice-based foods > wheat-based foods > oat-based foods > barley-based food. The present meta-analysis results can be a beneficial database for risk assessment model progress, which can help industries and organizations decrease the presence of fumonisins in cereal-based food.

Effect of Lactic Acid Bacteria Strains on the Growth and Aflatoxin Production Potential of Aspergillus parasiticus, and Their Ability to Bind Aflatoxin B1, Ochratoxin A, and Zearalenone in vitro

The increased consumption of plant-based foods has intensified the concern related to mycotoxin intoxication. This study aimed to investigate the effect of selected lactic acid bacteria (LAB) strains on the growth of Aspergillus parasiticus NRRL 2999 and its production of aflatoxin (AF). The ability of the heat-killed (100°C for 1 h) LAB strains to bind aflatoxin M1 (AFM1) in milk and aflatoxin B1 (AFB1), ochratoxin A (OTA), and zearalenone (ZEN) in potassium phosphate buffer (PPB) was also evaluated in vitro. Ten LAB strains were tested individually, by inoculating them simultaneously with the fungus or after incubation of the fungus for 24 or 48 h at 25°C. Double layer yeast extract sucrose (YES) agar, de Man Rogosa and Sharpe (MRS) agar, and YES broth were incubated for 7 days at 25°C to follow the development of the fungus. Levilactobacillus spp. 3QB398 and Levilactobacillus brevis 2QB422 strains were able to delay the growth of A. parasiticus in YES broth, even when these strains were inoculated 24 h after the fungus. The inhibitory effect of these LAB strains was confirmed by the reduction of fungus colony size, suggesting dominance of LAB by competition (a Lotka-Voltera effect). The production of AFB1 by A. parasiticus was inhibited when the fungus was inoculated simultaneously with Lactiplantibacillus plantarum 3QB361 or L. plantarum 3QB350. No AFB1 was found when Levilactobacillus spp. 2QB383 was present, even when the LAB was inoculated 48 h after the fungus. In binding studies, seven inactivated LAB strains were able to promote a reduction of at least 50% the level of AFB1, OTA, and ZEN. This reduction varied depending on the pH of the PPB. In milk, however, only two inactivated LAB strains were able to reduce AFM1, with a reduction of 33 and 45% for Levilactobacillus spp. 3QB398 (Levilactobacillus spp.) and L. brevis 2QB422, respectively. Nevertheless, these results clearly indicate the potential of using LAB for mycotoxin reduction.

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.

Herbs and herbal infusions: Determination of natural contaminants (mycotoxins and trace elements) and evaluation of their exposure

Herbal infusions are amongst the world's most popular and widely enjoyed beverages, due to both large variety and convenience. However, natural contaminants, such as mycotoxins and trace elements can accumulate in aromatic herbs, which may have serious food safety and public health implications. In this study, the presence of mycotoxins, as well as the content of trace elements was evaluated in herbs and herbal infusions commercialized in Brazil. For the determination of fourteen mycotoxins, including the emerging mycotoxins enniatins (EN), beauvericin (BEA), and sterigmatocystin (STE), a liquid-chromatography tandem mass spectrometry (LC-MS/MS) method was validated. Overall, 42 out of 58 herb samples (72%) were contaminated, being BEA the most usual mycotoxin, present in 43% of the samples, followed by STE and HT-2 toxin, present in 37% and 24% of the samples, respectively. In herbal infusions, the occurrence of mycotoxins was 88% lesser than those verified in raw products. Despite these low levels, the hazard quotient (HQ) calculated revealed a potential health concern for HT-2 in infusions. The margin of exposure values for aflatoxins (AF), and ochratoxin A (OTA) from six herbal infusions were below 10,000, indicating also potential health risks. The twenty-one trace elements comprising toxic elements such as arsenic (As), cadmium (Cd), and lead (Pb) were determined in herb raw materials by inductively coupled plasma-mass spectrometry (ICP-MS). The levels of trace elements in herbs were very varied, with aluminum (Al) presenting the highest amount. The levels of legislated elements (As, Cd, Pb) analyzed in herbs were lower than 3.03 µg g^-1 (Pb), thus not exceeding the legal limits defined for herbal medicinal by both European and Brazilian pharmacopeia.

Exposure Assessment of Multiple Mycotoxins and Cumulative Health Risk Assessment: A Biomonitoring-Based Study in the Yangtze River Delta, China

The extensive exposure to multiple mycotoxins has been demonstrated in many countries; however, realistic assessments of the risks related to cumulative exposure are limited. This biomonitoring study was conducted to investigate exposure to 23 mycotoxins/metabolites and their determinants in 227 adults (aged 20-88 years) in the Yangtze River Delta, China. Eight mycotoxins were detected in 110 urine samples, and multiple mycotoxins co-occurred in 51/227 (22.47%) of urine samples, with deoxynivalenol (DON), fumonisin B1 (FB1), and zearalenone (ZEN) being the most frequently occurring. For single mycotoxin risk assessment, FB1, ZEN, aflatoxin B1 (AFB1), and ochratoxin A (OTA) all showed potential adverse effects. However, for the 12 samples containing DON and ZEN, in which none had a hazard risk, the combination of both mycotoxins in two samples was considered to pose potential endocrine disrupting risks to humans by hazard index (HI) method. The combined margin of exposure (MOET) for AFB1 and FB1 could constitute a potential health concern, and AFB1 was the main contributor. Our approach provides a blueprint for evaluating the cumulative risks related to different types of mycotoxins and opens a new horizon for the accurate interpretation of epidemiological health outcomes related to multi-mycotoxin exposure.

Fumonisins and zearalenone fed at low levels can persist several days in the liver of turkeys and broiler chickens after exposure to the contaminated diet was stopped

Previous studies using zearalenone (ZEN) and fumonisins (FB) revealed alpha-zearalanol (α-ZOL) and FB1 in the liver of turkeys and chickens with no sign of toxicity. The aim of the present study was to determine whether contamination persists after distribution of a mycotoxin-free diet for several days. Turkeys and broilers were fed for 14 days with a diet containing respectively, 7.5 and 0.6 mg/kg of FB and ZEN, then fed for 0, 2 or 4 days with a mycotoxin-free diet. FB1 and total α-ZOL were the most abundant metabolites found, and their concentration decreased with time. The decrease was linear for FB1 (P < 0.001) and exponential for α-ZOL. Mean concentrations of FB1 on days 0, 2, and 4 were respectively, 4.9, 4, and 2.9 ng/g in turkeys, and respectively, 5, 2.3, and 1.3 ng/g in chickens. The decrease in concentration of FB1 with time was modeled by linear regression (P < 0.001). Mean concentrations of α-ZOL on days 0, 2 and 4, were respectively, 4.8, 0.8, and 0.5 ng/g in turkeys, whereas α-ZOL was only quantified in chickens on day 0 at 0.3 ng/g. A strong correlation was found between α-ZOL and β-zearalenol (P < 0.001).

Mycotoxins in cereals and cereal-based products: Incidence and probabilistic dietary risk assessment for the Brazilian population

A probabilistic dietary risk assessment on mycotoxins was conducted using the Monte Carlo Risk Assessment software, with consumption data from the 2008/2009 Brazilian Household Budget Survey for individuals who were at least 10 years old and occurrence data for 646 samples of rice, maize, wheat, and their products, collected in the Federal District and in the state of Rio Grande do Sul, Brazil. Processing factors were estimated and applied to concentration data. Chronic exposure was estimated for fumonisins (free and bound/hidden), deoxynivalenol (DON) (including the acetylated forms) and zearalenone (ZON) (including alfa-zearalenol) and acute exposure was estimated for DON. For the general population, the chronic exposure exceeded the safe exposure levels at the 95P for DON and at the 99P for fumonisins. Additionally, safe level exceedance occurred at the 97.5P for fumonisins and at the 95P for DON for teenagers, as well as at the 99P for fumonisins for women of child-bearing-age. No exceedances were found for chronic exposure to ZON and acute exposure to DON. Maize couscous contributed most of the total fumonisins (91%) and ZON intakes (~40%) and bread to total intake of DON (~30%). Further studies should be conducted with updated Brazilian consumption data, which should include information for individuals aged less than 10 years old.

Dilute-and-Shoot HPLC-UV Method for Determination of Urinary Creatinine as a Normalization Tool in Mycotoxin Biomonitoring in Pigs

A simple, rapid, and accurate HPLC-UV method was developed for the determination of creatinine in pig urine. Usually, it is determined in urine in biomonitoring of xenobiotics to correct for variations in dilutions of urine samples. The colorimetric method (based on Jaffe reaction), which was mainly used for this purpose in mycotoxin biomonitoring, is not a reliable approach for pig urine. Therefore, a novel and accurate HPLC method for creatinine determination was developed. The sample preparation was based on the dilute and shoot approach. An HPLC separation was performed with a porous graphitic carbon column with an aqueous mobile phase to achieve satisfactory retention time for creatinine. The method has been successfully validated, applied for the determination of creatinine in pig urine, and compared with other methods commonly used for that purpose—a colorimetric method based on Jaffe reaction and commercial ELISA test. The developed HPLC method shows the highest precision and accuracy for pig urine samples. Finally, the method was applied as a normalization tool in LC-MS/MS mycotoxin biomarkers analysis. The standardization to a constant creatinine level (0.5 mg/mL) enables similar matrix effects for eleven mycotoxin biomarkers for pig urine samples with different creatinine levels.

Dietary exposure assessment and risk characterization of mycotoxins in lactating women: Case study of São Paulo state, Brazil

The exposure and risk characterization of lactating women to aflatoxins (AFs), fumonisins (FBs), ochratoxin A (OTA) and zearalenone (ZEN) due to consumption of different types of food products in Pirassununga, São Paulo, Brazil, was assessed. Lactating women (N = 74) provided samples of foods stored and available at their households between April-August/2018, totaling 184 samples. Mycotoxins were determined in food samples by liquid chromatography-tandem mass spectrometry. According to findings, 20% (n = 36) of all food samples were contaminated with AFs at median concentrations ranging from 9.2 to 18.5 µg/kg, while OTA was detected only in three samples (rice, bread and pasta) at concentrations of 22.3, 23.8 and 48.7 µg/kg, respectively. ZEN was detected in 34 samples (18%) at median levels of 62-195 µg/kg, and FBs at median levels of 58-1546 µg/kg was observed in 22 samples (12%). Moreover, the concentration of AFs, OTA, ZEN and FBs exceeded their respective maximum permitted levels in 11 (6%), 3 (2%), 8 (4%) and 5 (3%) from total samples, respectively. Twenty-eight samples (15%) were contaminated with two or three types of mycotoxins. Corn products contributed for the highest mean probable daily intakes (PDI) of AFs (0.119 ± 0.193 µg/kg body weight (bw)/day), ZEN (0.325 ± 0.097 µg/kg bw/day) and FBs (2.936 ± 1.541 µg/kg bw/day), while wheat-based products contributed for the highest PDI of OTA (0.035 ± 0.028 µg/kg bw/day). The Margin of Exposure (MoE) value for AFs (3.72) demonstrated a high cancer risk (MoE < 10,000), and the Hazard Quotient (HQ) obtained for OTA (24.66), ZEN (4.24) and total FBs (5.01) also resulted in a non-tolerable risk (HQ > 1) via consumption of the investigated food products. Results of this trial indicate high exposure levels of lactating women to dietary mycotoxins in the studied area, which warrant concern about the possible transfer of residual mycotoxins into breast milk.

Burden of disease associated with dietary exposure to carcinogenic aflatoxins in Portugal using human biomonitoring approach

Human biomonitoring is an important tool to assess human exposure to chemicals, contributing to describe trends of exposure over time and to identify population groups that could be under risk. Aflatoxins are genotoxic and carcinogenic food contaminants causing hepatocellular carcinoma, the third leading cause of cancer deaths worldwide. In Portugal, scarce data are available regarding exposure to aflatoxins and no previous study used human biomonitoring data to comprehensively characterize the associated burden of disease. 24 h urine and first-morning urine paired samples were collected by 94 participants and were analyzed by liquid chromatography-tandem mass spectrometry for the quantitative determination of aflatoxins (B₁, B₂, G₁, G₂ and M₁). Deterministic and probabilistic models were developed to assess the Portuguese exposure to aflatoxins and to estimate the health impact of this exposure, estimating the attributed Disability-Adjusted Life Years (DALYs). Aflatoxins were detected in a maximum of 13% (AFB₁), 16% (AFB₂), 1% (AFG₁), 2% (AFG₂) and 19% (AFM₁) of the urine samples. Data obtained through the probabilistic approach revealed an estimated mean probable daily intake of 13.43 ng/kg body weight per day resulting in 0.13 extra cases of hepatocellular carcinoma, corresponding to mean annual DALYs of 172.8 for the Portuguese population (10291027 inhabitants). The present study generated for the first time and within a human biomonitoring study, reliable and crucial data to characterize the burden associated to the exposure to aflatoxins of the Portuguese population. The obtained results constitute an imperative support to risk managers in the establishment of preventive policy measures that contribute to ensure public health protection.

Development of a Sensitive and Reliable UHPLC-MS/MS Method for the Determination of Multiple Urinary Biomarkers of Mycotoxin Exposure

A variety of mycotoxins from different sources frequently contaminate farm products, presenting a potential toxicological concern for animals and human. Mycotoxin exposure has been the focus of attention for governments around the world. To date, biomarkers are used to monitor mycotoxin exposure and promote new understanding of their role in chronic diseases. The goal of this research was to develop and validate a sensitive UHPLC-MS/MS method using isotopically-labeled internal standards suitable for accurate determination of 18 mycotoxin biomarkers, including fumonisins, ochratoxins, Alternaria and emerging Fusarium mycotoxins (fumonisin B1, B2, and B3, hydrolyzed fumonisin B1 and B2, ochratoxin A, B, and alpha, alternariol, alternariol monomethyl ether, altenuene, tentoxin, tenuazonic acid, beauvericin, enniatin A, A1, B, and B1) in human urine. After enzymatic digestion with β-glucuronidase, human urine samples were cleaned up using HLB solid phase extraction cartridges prior to instrument analysis. The multi-mycotoxin and analyte-specific method was validated in-house, providing satisfactory results. The method provided good linearity in the tested concentration range (from LOQ up to 25-500 ng/mL for different analytes), with R2 from 0.997 to 0.999. The limits of quantitation varied from 0.0002 to 0.5 ng/mL for all analytes in urine. The recoveries for spiked samples were between 74.0% and 133%, with intra-day precision of 0.5%-8.7% and inter-day precision of 2.4%-13.4%. This method was applied to 60 urine samples collected from healthy volunteers in Beijing, and 10 biomarkers were found. At least one biomarker was found in all but one of the samples. The high sensitivity and accuracy of this method make it practical for human biomonitoring and mycotoxin exposure assessment.

Human Mycotoxin Biomonitoring: Conclusive Remarks on Direct or Indirect Assessment of Urinary Deoxynivalenol

Deoxynivalenol is one of the most ubiquitous mycotoxins in the Western diet through its presence in cereals and cereal products. A vast amount of studies indicate the worrying level of exposure to this toxin, while even high percentages of the population exceed the tolerable daily intake. To evaluate and assess dietary exposure, analysis of urinary levels of deoxynivalenol and its glucuronides has been proposed as a reliable methodology. An indirect preliminary method was used based on the cleavage of deoxynivalenol glucuronides through the use of enzymes (β-glucuronidase) and subsequent determination of "total deoxynivalenol" (sum of free and released mycotoxins by hydrolysis). Next, a direct procedure for quantification of deoxynivalenol-3-glucuronide and deoxynivalenol-15-glucuronide was developed. As deoxynivalenol glucuronides reference standards are not commercially available, the indirect method is widely applied. However, to not underestimate the total deoxynivalenol exposure in urine, the direct and indirect methodologies need to be compared. Urinary samples (n = 96) with a confirmed presence of deoxynivalenol and/or deoxynivalenol glucuronides were analysed using both approaches. The indirect method clarified that not all deoxynivalenol glucuronides were transformed to free deoxynivalenol during enzymatic treatment, causing an underestimation of total deoxynivalenol. This short communication concludes on the application of direct or indirect assessment of urinary deoxynivalenol.

Food Consumption Data as a Tool to Estimate Exposure to Mycoestrogens

Zearalenone and alternariol are mycotoxins produced by Fusarium and Alternaria species, respectively, that present estrogenic activity and consequently are classified as endocrine disruptors. To estimate the exposure of the Portuguese population to these two mycotoxins at a national level, a modelling approach, based on data from 94 Portuguese volunteers, was developed considering as inputs: i) the food consumption data generated within the National Food and Physical Activity Survey; and ii) the human biomonitoring data used to assess the exposure to the referred mycotoxins. Six models of association between mycoestrogens urinary levels (zearalenone, total zearalenone and alternariol) and food items (meat, cheese, and fresh-cheese, breakfast cereals, sweets) were established. Applying the obtained models to the consumption data (n = 5811) of the general population, the median estimates of the probable daily intake revealed that a fraction of the Portuguese population might exceed the tolerable daily intake defined for zearalenone. A reference intake value for alternariol is still lacking, thus the characterization of risk due to the exposure to this mycotoxin was not possible to perform. Although the unavoidable uncertainties, these results are important contributions to understand the exposure to endocrine disruptors in Portugal and the potential Public Health consequences.

Advances in Occurrence, Importance, and Mycotoxin Control Strategies: Prevention and Detoxification in Foods

Mycotoxins are toxic substances that can infect many foods with carcinogenic, genotoxic, teratogenic, nephrotoxic, and hepatotoxic effects. Mycotoxin contamination of foodstuffs causes diseases worldwide. The major classes of mycotoxins that are of the greatest agroeconomic importance are aflatoxins, ochratoxins, fumonisins, trichothecenes, emerging Fusarium mycotoxins, enniatins, ergot alkaloids, Alternaria toxins, and patulin. Thus, in order to mitigate mycotoxin contamination of foods, many control approaches are used. Prevention, detoxification, and decontamination of mycotoxins can contribute in this purpose in the pre-harvest and post-harvest stages. Therefore, the purpose of the review is to elaborate on the recent advances regarding the occurrence of main mycotoxins in many types of important agricultural products, as well as the methods of inactivation and detoxification of foods from mycotoxins in order to reduce or fully eliminate them.

Ochratoxin A and Portuguese children: Urine biomonitoring, intake estimation and risk assessment

Ochratoxin A (OTA) is a mycotoxin detected worldwide. Urine biomonitoring is a more realistic and non-invasive way to assess exposure when compared to traditional methods based on food occurrence and consumption data. Few studies have investigated children's exposure to OTA, although it is a more susceptible population. Our main goal was the OTA biomonitoring in urine of Portuguese children to better characterize the health risk of this population. The validated analytical methodology was based on an immunoaffinity clean-up, followed by LC-FD. First morning samples were collected, between 2018 and 2019, from 85 healthy children, 41 boys and 44 girls, aging between 2 and 13 years old. Overall, from the 85 analysed samples 79 (92.94%) were found positive. The average OTA concentration level was of 0.020 ng/mL (29.41 ng/g of creatinine), with a maximum value of 0.052 ng/mL (114.45 ng/g of creatinine). No statistical differences were found between the OTA contamination levels, the anthropometric data and dietary habits considered. Depending on the excretion rate considered for the PDI calculation, the risk assessed for the average OTA contamination varied from 10% to 194%, indicating a potential concern. This is the first study regarding OTA exposure in Portuguese children, showing their clear exposure.