Acute renal failure from inhalation of mycotoxins

An Immunoenzymatic Method for the Determination of Ochratoxin A in Biological Liquids (Colostrum and Cow's Milk)

Ochratoxins are mycotoxins that have been extensively studied lately due to the multiple toxic effects such as nephrotoxicity, hepatotoxicity, and carcinogenicity. These toxins contaminate plant and animal foods and after ingestion they reach into body fluids. The method of competitive direct enzyme immunoassay, in the solid phase, was validated through the determination of specific parameters (performance, linearity, recovery percentage, limit of detection, limit of quantification). The validated method was used to determine ochratoxin A in colostrum and cow’s milk. The method applied for the determination of ochratoxin A was linear for the concentration range of 0.0–0.5 ng/mL, the value for the regression coefficient (r) was 0.9838. Ochratoxin A was present in 91.67% of the colostrum and in 93.33% of cow’s milk samples. The linearity of the method, demonstrated for very low concentrations of analyte, the detection limit as well as the limit of quantification recommend the method for the determinations of micro-pollutants from foods, including biological fluids.

Ochratoxin A Levels in Tissues of Wild Boars (Sus scrofa) from Northern Italy

Ochratoxin A (OTA) is a mycotoxin produced by Aspergillus and Penicillium, capable of contaminating several foodstuffs. OTA damages primarily the kidneys, and is suspected to be a carcinogenic substance, thus maximum levels for OTA in foodstuffs have been established in the EU. Italian Ministry of Health suggested a maximum level of 1 μg/kg OTA in pork meat and derived products. In this study, OTA concentrations in liver, kidney, and muscle of 64 wild boars (Sus scrofa) killed in two areas (area A and B) of Parma province (northern Italy), characterized by different habitat types, were assessed by HPLC-FLD technique. OTA was detected in 54% liver, 52% kidney, and 16% muscle samples. OTA levels were significantly higher in liver and kidney compared with muscle, and were above 1 μg/kg in 19 liver, 17 kidney, and 4 muscle samples. OTA levels in wild boars from area A resulted significantly higher with respect to those from area B, suggesting an environmental influence on OTA contamination in wild boars. This study seems to confirm that wild boar meat is a potential source of OTA, thus monitoring the presence of this mycotoxin in game meat might be recommended to prevent risks for human health.

Unravelling the Aptamer-Analyte Interaction Dynamics through Fluorescence Quenching in Graphene Quantum Dots (GQDs) Based Homogeneous Assays

Graphene quantum dots (GQDs) are used here as a biosensing platform for the recognition of the major food contaminant ochratoxin A (OTA), with a fluorescently labelled DNA aptamer (FAM OTA aptamer) functioning as the biorecognition element. The detection principle lies in the formation of noncovalent interactions between the FAM OTA aptamer and the GQD surface, and the consequent fluorescence quenching. The further change in the fluorescence signal, induced by the formation of the FAM OTA Aptamer/OTA conjugate during the detection step, could then be correlated to the presence and concentration of the target analyte. Upon tuning the concentration of GQDs, a switch in the biorecognition mechanism occurred. Specifically, while a lower GQD concentration (0.060 mg/mL) resulted in a restoration of the fluorescence intensity upon incubation with OTA, a higher GQD concentration (0.150 mg/mL) provided a further quenching of the final fluorescence intensity. Upon further calibration study, it was discovered that the latter mechanism provided a better option in terms of linearity of response, detection limit and selectivity.

Astaxanthin Protects OTA-Induced Lung Injury in Mice through the Nrf2/NF-κB Pathway

The aim of this research was to evaluate the potential protective mechanism of astaxanthin (ASTA) against oxidative damage and inflammation caused by ochratoxin (OTA) in mouse lung. We divided mice into a control group (CG), an OTA group (PG), an astaxanthin group (AG), and an OTA+ASTA group (JG). Oxidative indices (malondialdehyde (MDA), total superoxide dismutase (T-SOD), and reduced glutathione (GSH)) and inflammatory markers (interleukin 1β (IL-1β), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α)) were assayed in the lung, and the lung-weight-to-body-weight ratio was calculated. Apoptosis was detected in pathological sections by the TdT-mediated dUTP nick-end labeling (TUNEL) assay. Oxidative damage and inflammation were detected in the lung of mice after exposure to OTA. Besides, Nrf2- and NF-κB-pathway-associated proteins were detected by Western blot. In contrast with OTA, ASTA significantly raised the expression of Nrf2, HO-1, and MnSOD, while the expression of other proteins (Keap1, TLR4, and NF-κB) was significantly decreased. These results indicate that ASTA exerted protective effects against OTA-induced oxidative damage and inflammation in the lung by regulating the Nrf2 and NF-κB pathways.

Mycotoxins as human carcinogens-the IARC Monographs classification

Humans are constantly exposed to mycotoxins (e.g. aflatoxins, ochratoxins), mainly via food intake of plant and animal origin. The health risks stemming from mycotoxins may result from their toxicity, in particular their carcinogenicity. In order to prevent these risks, the International Agency for Research on Cancer (IARC) in Lyon (France)-through its IARC Monographs programme-has performed the carcinogenic hazard assessment of some mycotoxins in humans, on the basis of epidemiological data, studies of cancer in experimental animals and mechanistic studies. The present article summarizes the carcinogenic hazard assessments of those mycotoxins, especially aflatoxins (aflatoxin B1, B2, G1, G2 and M1), fumonisins (fumonisin B1 and B2) and ochratoxin A (OTA). New information regarding the genotoxicity of OTA (formation of OTA-DNA adducts), the role of OTA in oxidative stress and the identification of epigenetic factors involved in OTA carcinogenesis-should they indeed provide strong evidence that OTA carcinogenicity is mediated by a mechanism that also operates in humans-could lead to the reclassification of OTA.

Ochratoxin A: 50 Years of Research

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

Occupational exposure to mould and microbial metabolites during onion sorting--insights into an overlooked workplace

Manual sorting of onions is known to be associated with a bioaerosol exposure. The study aimed to gain an initial indication as to what extent manual sorting of onions is also associated with mycotoxin exposure. Twelve representative samples of outer onion skins from different onion origins were sampled and analyzed with a multimycotoxin method comprising 40 mycotoxins using a single extraction step followed by liquid chromatography with electrospray ionization and triple quadrupole mass spectrometry. Six of the 12 samples were positive for mycotoxins. In those samples, deoxynivalenol, fumonisin B1, and B2 were observed in quantitatively detectable amounts of 3940 ng/g for fumonisin B1 and in the range of 126-587 ng/g for deoxynivalenol and 55-554 ng/g for fumonisin B2. Although the results point to a lower risk due to mycotoxins, the risk should not be completely neglected and has to be considered in the risk assessment.

Acute kidney injury associated with smoking synthetic cannabinoid

CONTEXT AND OBJECTIVES

Synthetic cannabinoids are illegal drugs of abuse known to cause adverse neurologic and sympathomimetic effects. They are an emerging health risk: 11% of high school seniors reported smoking them during the previous 12 months. We describe the epidemiology of a toxicologic syndrome of acute kidney injury associated with synthetic cannabinoids, review the toxicologic and public health investigation of the cluster, and describe clinical implications of the cluster investigation.

MATERIALS AND METHODS

Case series of nine patients affected by the toxicologic syndrome in Oregon and southwestern Washington during May-October 2012. Cases were defined as acute kidney injury (creatinine > 1.3 mg/dL) among persons aged 13-40 years without known renal disease who reported smoking synthetic cannabinoids. Toxicology laboratories used liquid chromatography and time-of-flight mass spectrometry to test clinical and product specimens for synthetic cannabinoids, their metabolites, and known nephrotoxins. Public health alerts informed clinicians, law enforcement, and the community about the cluster and the need to be alert for toxidromes associated with emerging drugs of abuse.

RESULTS

Patients were males aged 15-27 years (median, 18 years), with intense nausea and flank or abdominal pain, and included two sets of siblings. Peak creatinine levels were 2.6-17.7 mg/dL (median, 6.6 mg/dL). All patients were hospitalized; one required dialysis; none died. No alternate causes of acute kidney injury or nephrotoxins were identified. Patients reported easily purchasing synthetic cannabinoids at convenience, tobacco, and adult bookstores. One clinical and 2 product samples contained evidence of a novel synthetic cannabinoid, XLR-11 ([1-(5-fluoropentyl)-1H-indol-3-yl](2,2,3,3-tetramethylcyclopropyl)methanone).

DISCUSSION AND CONCLUSION

Whether caused by direct toxicity, genetic predisposition, or an as-yet unidentified nephrotoxin, this association between synthetic cannabinoid exposure and acute kidney injury reinforces the need for vigilance to detect new toxicologic syndromes associated with emerging drugs of abuse. Liquid chromatography and time-of-flight mass spectrometry are useful tools in determining the active ingredients in these evolving products and evaluating them for toxic contaminants.

Current asthma in schoolchildren is related to fungal spores in classrooms

BACKGROUND

The presence of visible mold in households is associated with asthma. However, the role of "classroom fungus" in the development of childhood asthma, as well as the fungal species that may lead to asthma, remains controversial. This nationwide school survey was conducted to investigate the correlation between fungal spores in classrooms and asthma in schoolchildren.

METHODS

From April to May 2011, a cross-sectional survey was conducted to assess allergic/asthmatic conditions in schoolchildren aged 6 to 15 years old in 44 schools across Taiwan. Personal histories and current asthmatic conditions were collected using a modified International Study of Asthma and Allergies in Childhood questionnaire. Fungal spores in classroom were collected using a Burkard Personal Air Sampler and counted under light microscopy. Three-level hierarchical modeling was used to determine the complex correlation between fungal spores in classrooms and childhood asthma.

RESULTS

The survey was completed by 6,346 out of 7,154 parents (88.7%). The prevalences of physician-diagnosed asthma, current asthma, and asthma with symptoms reduced on holidays or weekends (ASROH) were 11.7%, 7.5%, and 3.1%, respectively. The geometric mean spore concentrations of total fungi, Aspergillus/Penicillium, and basidiospores were 2,181, 49, and 318 spores/m3. Aspergillus/Penicillium and basidiospores were significantly correlated with current asthma and ASROH after adjusting for personal and school factors. Of those with current asthma, 41% reported relief of symptoms during weekends.

CONCLUSIONS

Classroom Aspergillus/Penicillium and basidiospores are significantly associated with childhood asthma and ASROH. Government health policy should explore environmental interventions for the elimination of fungal spores in classrooms to reduce the prevalence of childhood asthma.

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The results support the view that apart from the pathogenic and allergological relevance of microbial emissions from garbage, secondary fungal metabolites, and thus toxicological aspects, deserve further attention.

Tools for investigating workplace-related risks from mycotoxin exposure

There is growing recognition and interest in the role of mycotoxins as health hazards in the workplace. Examples will illustrate what we know about certain mycotoxins in some occupational settings and what we need to know to make further progress in assessing their impact on human health. A range of mycotoxins has been detected in different workplaces, e.g. in agricultural and food processing facilities, greenhouses, and the waste management sector. Their occurrence, mainly in dust from different raw materials or processed products, is indicative of a potential health hazard. However, assessing risks for workplace-related mycotoxin exposures remains a challenging task for several reasons, including uncertainties with regard to the transfer from contaminated material into air (inhalable mycotoxin concentrations) and/or the toxin fraction absorbed upon dermal contact or after respiratory intake. Human biomonitoring studies can considerably reduce these uncertainties, and serve to assess workplace-related exposures (in addition to dietary mycotoxin intake). These studies require not only sensitive methods for analysis of mycotoxins and/or their metabolites in blood or urine (biomarkers of exposure) in a cohort of workers, but also data on the levels/range of these biomarkers in non-occupationally exposed persons to account for exposures resulting from oral intake of mycotoxin-contaminated food (dietary 'background'). Biomonitoring methods were first developed for aflatoxin B1, then for ochratoxin A, and more recently for deoxynivalenol and for fumonisin B. But, there are no such methods for many other important mycotoxins. So far, only a small number of biomonitoring studies have addressed the question whether occupational mycotoxin exposures (by inhalation) add significantly to those from dietary exposure to mycotoxins, as observed in the general population. Therefore, a risk assessment is hampered by major uncertainties regarding the true impact of occupational mycotoxin exposures. Human biomonitoring (with biomarkers of exposure and/or effect) is considered a valuable instrument, and should be developed further for mycotoxins of relevance in the workplace.

Ochratoxins-food contaminants: impact on human health

Ochratoxins are secondary metabolites of Aspergillus and Penicillium, that are hazardous to health through contamination of dietary foods. Ochratoxin A (OTA) remains the single most potent member of this group of mycotoxins. OTA has a long half-life in humans and is thus easily detected in serum. Dietary intake studies have confirmed link between endemic nephrotoxicity in humans to their daily household intake of OTA. OTA has been reported to contribute to endemic nephrotoxicity and carcinogenicity in humans and animals. OTA produces renal tumours, DNA adducts and chromosomal aberrations in kidneys. OTA may be embryotoxic, teratogenic, and immunotoxic only at doses higher than those causing nephrotoxicity. The incidence of endemic nephrotoxicity has been mostly reported in northeast Europe since the early fifties. Recent studies however have warned that OTA and other toxins, such as aristolochic acid, show very similar renal pathology. There is thus the need for thorough co-occurrence studies on toxin incidence.

Molds, mycotoxins, and sick building syndrome

The following is a review of some of the work we have done since 2004 regarding the importance of molds and their mycotoxins in the phenomenon of sick building syndrome (SBS). In these studies we showed that the macrocyclic trichothecene mycotoxins (MTM) of Stachybotrys chartarum (SC) are easily dissociated from the surface of the organism as it grows and could therefore be consequently spread in buildings as the fungus experiences additional water events. We then showed that SC and Penicillium chrysogenum (PC) colonies remain viable long after a water source has been removed, and the MTM produced by SC remain toxic over extended periods of time. We next showed that PC when inhaled, can release in vivo, a protease allergen that can cause a significant allergic inflammatory reaction in the lungs of mice. We then showed, in a laboratory study, that the MTM of SC can become airborne attached to spores or SC particulates smaller than spores. Following that study, we next showed that the same phenomenon actually occurred in SC infested buildings where people were complaining of health problems potentially associated with SBS. Finally, we were able to demonstrate the presence of MTM in the sera of individuals who had been exposed to SC in indoor environments. This last study was done with enough mold exposed individuals to allow for the statistical significance of SC exposure to be evaluated.

The concentration of no toxicologic concern (CoNTC) and airborne mycotoxins

The threshold of toxicologic concern (TTC) concept was developed as a method to identify a chemical intake level that is predicted to be without adverse human health effects assuming daily intake over the course of a 70-yr life span. The TTC values are based on known structure-activity relationships and do not require chemical-specific toxicity data. This allows safety assessment (or prioritization for testing) of chemicals with known molecular structure but little or no toxicity data. Recently, the TTC concept was extended to inhaled substances by converting a TTC expressed in micrograms per person per day to an airborne concentration (ng/m(3)), making allowance for intake by routes in addition to inhalation and implicitly assuming 100% bioavailability of inhaled toxicants. The resulting concentration of no toxicologic concern (CoNTC), 30 ng/m(3), represents a generic airborne concentration that is expected to pose no hazard to humans exposed continuously throughout a 70-yr lifetime. Published data on the levels of mycotoxins in agricultural dusts or in fungal spores, along with measured levels of airborne mycotoxins, spores, or dust in various environments, were used to identify conditions under which mycotoxin exposures might reach the CoNTC. Data demonstrate that airborne concentrations of dusts and mold spores sometimes encountered in agricultural environments have the potential to produce mycotoxin concentrations greater than the CoNTC. On the other hand, these data suggest that common exposures to mycotoxins from airborne molds in daily life, including in the built indoor environment, are below the concentration of no toxicologic concern.

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

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

Ochratoxins: a global perspective

Ochratoxins have been overshadowed by better-known mycotoxins, but they are gaining importance. Here we consider ochratoxins in the context of aflatoxins, which are better understood than ochratoxins on many levels. We review recent work on taxonomic distribution, contamination of commodities, biosynthesis, toxicity and regulatory aspects of ochratoxins. We focus on ochratoxins in coffee, since coffee is becoming a key commodity in ochratoxin research and regulation.

Melatonin counteracts oxidative stress in rats fed an ochratoxin A contaminated diet

The mycotoxin ochratoxin A (OTA) is a widespread contaminant in human and animal food products. It induces a wide range of toxic effects including lipid peroxidation through the generation of free radicals. The aim of this work was to evaluate the antioxidant effects of melatonin against OTA-induced oxidative stress in liver and kidney in rats. Treated animals were fed OTA-contaminated diet (3 mg/kg) for 15 days before, during and after melatonin administration (20 mg/kg bw). The results indicate that OTA caused severe effects typical to those reported in the literature for ochratoxicosis. Melatonin alone was effective in the improving food intake, body weight gain, serum total protein, albumin, the activities of alkaline phosphatase, G-glutamyl transferase and creatinine kinase and liver and kidney glutathione peroxidase, superoxide dismutase and malondialdehyde. Rats fed OTA-contaminated diet before, during or after melatonin administration showed a significant improvement in all tested parameters toward the normal values of the controls. This improvement was most pronounced in the group pretreated with melatonin. It is concluded that melatonin exhibits a preventive effect against OTA-induced oxidative stress through its role in the scavenging of free radicals and/or the prevention of lipid peroxidation.

Health Effects of Mycotoxins: A Toxicological Overview

Diseases caused by fungi are spread by direct implantation or inhalation of spores. Fungi can cause adverse human health effects to many organ systems. In addition to infection and allergy, fungi can produce mycotoxins and organic chemicals that are responsible for various toxicologic effects. We reviewed the published literature on important mycotoxins and systemic effects of mycotoxins. Scientific literature revealed a linkage between ingesting mycotoxin contaminated food and illness, especially hepatic, gastrointestinal, and carcinogenic diseases. Issues related to mycotoxin exposure, specific diseases, and management are discussed. Although there is agreement that diet is the main source of mycotoxin exposure, specific health effects and risk assessment from indoor nonagricultural exposure are limited by the paucity of scientific evidence currently available. Further research on the health effects of inhaling mycotoxins in indoor settings is needed.

Saliva secretory IgA antibodies against molds and mycotoxins in patients exposed to toxigenic fungi

Upper respiratory exposure to different environmental antigens results first in the activation of mucosal immunity and production of IgA antibodies in different secretions including saliva. Despite this there is no study, which addresses secretory antibodies against molds and mycotoxins. The purpose of this study was to evaluate mold-specific salivary IgA in individuals exposed to molds and mycotoxins in a water-damaged building environment. Saliva IgA antibody levels against seven different molds and two mycotoxins were studied in 40 patients exposed to molds and in 40 control subjects. Mold-exposed patients showed significantly higher levels of salivary IgA antibodies against one or more mold species. A majority of patients with high IgA antibodies against molds exhibited elevation in salivary IgA against mycotoxins, as well. These IgA antibodies against molds and mycotoxins are specific, since using molds and mycotoxins in immune absorption could reduce antibody levels, significantly. Detection of high counts of molds in water-damaged buildings, strongly suggests the existence of a reservoir of mold spores in the environment. This viable microbial activity with specific mold and mycotoxin IgA in saliva may assist in the diagnosis of mold exposure. Whether mold and mycotoxin specific IgA antibodies detected in saliva are indicative of the role of IgA antibodies in the late phase of type-1 hypersensitivity reaction or in type-2 and type-3 delayed sensitivities is a matter that warrants further investigation.

Indoor mold, toxigenic fungi, and Stachybotrys chartarum: infectious disease perspective

Damp buildings often have a moldy smell or obvious mold growth; some molds are human pathogens. This has caused concern regarding health effects of moldy indoor environments and has resulted in many studies of moisture- and mold-damaged buildings. Recently, there have been reports of severe illness as a result of indoor mold exposure, particularly due to Stachybotrys chartarum. While many authors describe a direct relationship between fungal contamination and illness, close examination of the literature reveals a confusing picture. Here, we review the evidence regarding indoor mold exposure and mycotoxicosis, with an emphasis on S. chartarum. We also examine possible end-organ effects, including pulmonary, immunologic, neurologic, and oncologic disorders. We discuss the Cleveland infant idiopathic pulmonary hemorrhage reports in detail, since they provided important impetus for concerns about Stachybotrys. Some valid concerns exist regarding the relationship between indoor mold exposure and human disease. Review of the literature reveals certain fungus-disease associations in humans, including ergotism (Claviceps species), alimentary toxic aleukia (Fusarium), and liver disease (Aspergillys). While many papers suggest a similar relationship between Stachybotrys and human disease, the studies nearly uniformly suffer from significant methodological flaws, making their findings inconclusive. As a result, we have not found well-substantiated supportive evidence of serious illness due to Stachybotrys exposure in the contemporary environment. To address issues of indoor mold-related illness, there is an urgent need for studies using objective markers of illness, relevant animal models, proper epidemiologic techniques, and examination of confounding factors.

Chemistry and toxicology of molds isolated from water-damaged buildings

There is increasing evidence of health risks associated with damp buildings and homes in which high levels of microbes are found. Although concerns have traditionally centered on microbial pathogens and allergenic effects, recent work has suggested that fungi pose the more serious risk. Evidence is accumulating that certain toxigenic molds are particularly a risk for human health through exposure, via inhalation, of fungal spores. Many of these fungi produce toxins (mycotoxins) some of which have been shown to cause animal and human intoxications, usually in an agricultural setting. The fungus, Stachybotrys chartarum (S. atra) is considered to be one of the more serious threats to people living and working in water-damaged buildings. This mold has a long history of being responsible for animal toxicoses, and in recent years, being associated with infant pulmonary hemosiderosis (bleeding in the lungs) of infants exposed to spores of this fungus in their homes. S. atra produces a variety of potent toxins and immunosuppressant agents, including a novel class of diterpenes (atranones) of unusual structure. More research is needed to determine the impact to health resulting from inhalation of toxigenic mold spores.

Balkan endemic nephropathy and associated urinary tract tumours: a review on aetiological causes and the potential role of mycotoxins

A series of publications in the 1950s described a kidney disease in Bulgaria, the former Yugoslavia and Romania that became known as Balkan endemic nephropathy (BEN). The disease was qualified by World Health Organisation (WHO) experts as 'progressive and very gradually developing renal failure with insidious onset.... The last stage shows marked fibrosis...'. BEN is characterized by tubular degeneration, interstitial fibrosis and hyalinization of glomeruli accompanied by enzymuria and impaired renal function without nephrotic syndrome. Later, an association between BEN and tumours of the kidney pelvis and ureter was recognized, so that the problem of BEN became not only nephrological, but also oncological. There may also be an association with increased urinary bladder cancer incidence, although many confounding factors may interfere in the analysis of data for this organ. In view of the very intimate association between BEN and the urinary tract tumours (UTT), the term 'endemic uropathy' has been proposed. Several hypothesis concerning the aetiology of these diseases has been investigated, which include: predisposing genes factors, environmental factors (heavy metals, minerals, bacteria, leptospira, viruses, fungal toxins and, most recently, pliocene lignites). This paper reviews the different hypotheses about the aetiology of endemic uropathy and pays particular attention to the role of fungal toxins.

Ochratoxin A in airborne dust and fungal conidia

Farm workers are often exposed to high concentrations of airborne organic dust and fungal conidia, especially when working with plant materials. The purpose of this investigation was to study the possibility of exposure to the mycotoxin ochratoxin A (OTA) through inhalation of organic dust and conidia. Dust and aerosol samples were collected from three local cowsheds. Aerosol samples for determination of total conidia and dust concentrations were collected by stationary sampling on polycarbonate filters. Total dust was analysed by gravimetry, and conidia were counted using scanning electron microscopy. A method was developed for extraction and determination of OTA in small samples of settled dust. OTA was extracted with a mixture of methanol, chloroform, HCl, and water, purified on immunoaffinity column, and analysed by ion-pair HPLC with fluorescence detection. Recovery of OTA from spiked dust samples (0.9-1.0 microg/kg) was 74% (quantitation limit 0.150 microg/kg). OTA was found in 6 out of 14 settled dust samples (0.2-70 microg/kg). The total concentration of airborne conidia ranged from < 1.1 x 10(4) to 3.9 x 15(5) per m3, and the airborne dust concentration ranged from 0.08 to 0.21 mg/m3. Conidia collected from cultures of Penicillium verrucosum and Aspergillus ochraceus contained 0.4-0.7 and 0.02-0.06 pg OTA per conidium, respectively. Testing of conidial extracts from these fungi in a Bacillus subtilis bioassay indicated the presence of toxic compounds in addition to OTA. The results show that airborne dust and fungal conidia can be sources of OTA. Peak exposures to airborne OTA may be significant, e.g., in agricultural environments.

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Two toxicity tests (pollen tube growth test and methylen blue-assay) were examined regarding their sensitivity towards certain chosen mycotoxins. The IC50 values of the PTGT were in a concentration range between 0,01 μg/ml and 11,18 μg/ml, of the MB-assay in a concentration range between 0,003 μg/ml and 17,91 μg/ml. Both tests can be used to record toxigenic fungal wild strains in mould-infested apartments. Independently from the well-known immunochemical methods or HPLC/GC-MS analysis must be used for an exact determination of the kind and the content of the mycotoxins.

Presence of ochratoxin A in human milk in relation to dietary intake

Individual and geographical variations in ochratoxin A (OA) levels in human blood and milk samples may be due to differences in dietary habits. The purpose of this study was to examine the relationship between OA contamination of human milk and dietary intake. Human milk samples were collected from 80 Norwegian women. The usual food intake during the last year was recorded using a quantitative food frequency questionnaire. The concentration of OA in the human milk was determined by HPLC (detection limit 10 ng/l). Seventeen (21%) out of 80 human milk samples contained OA in the range 10-182 ng/l. The women with a high dietary intake of liver paste (liverwurst, liver pâté) and cakes (cookies, fruitcakes, chocolate cakes, etc.) were more likely to have OA-contaminated milk. The risk of OA contamination was also increased by the intake of juice (all kinds). In addition, the results indicate that breakfast cereals, processed meat products, and cheese could be important contributors to dietary OA intake. OA contamination of the milk was unrelated to smoking, age, parity, and anthropometric data other than body weight.

The occurrence of ochratoxin A in dust collected from a problem household

Accumulated dust samples were collected from the heating ducts in a household where signs resembling ochratoxin poisoning in animals occurred. Several Penicillium spp. and Aspergillus ochraceous had been identified previously from air samples taken from this house. A composite sample from six collected samples was examined by HPLC, and it was determined that 58 ppb of ochratoxin A was present in this sample. A second set of six samples was collected and determinations were made by HPLC of the ochratoxin content in each sample. All samples, including one sample of dirt from a crawl space, yielded at least a trace of ochratoxin A; however, one sample of dust collected from the heating ducts yielded over 1500 ppb of ochratoxin A, and another sample of dust from a different heating duct yielded 306 ppb of ochratoxin A. Ochratoxin A was confirmed in all samples by LC-MS, and ochratoxin was evident in the samples by TLC analysis. This is believed to be the first report of finding ochratoxin in house dust.

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Ochratoxin A (OTA) is an important food and feed contaminant with potential adverse effects in humans and animals. In view of present discussions on limit values for OTA in foods, essential elements of a toxicological risk assessment are outlined. The exposure situation in Europe is now well documented. The data base, with respect to a characterization of hazard and dose-response relationships, allowed to calculate a provisional tolerable daily intake for OTA suited to protect the consumer against undesirable toxic effects. Nonetheless, further research on OTA is indicated in view of unresolved issues regarding the following points: 1. mechanisms of action (mode of genotoxicity, role of bioactivation/metabolism, identification of DNA-adducts and dose-dependency); 2. combinations of OTA and other mycotoxins (studies of relevant mixtures/conditions); 3. individual susceptibility and/or situation-based vulnerability. Better information on mechanistic aspects of mycotoxin-induced toxicities will further improve our knowledge on the "margin of safety" between a given exposure and a potential impairment of human health.

Roles of cyclooxygenase and lipoxygenases in ochratoxin A genotoxicity in human epithelial lung cells

The roles of constitutive prostaglandin-H-synthetase (PGHS) and lipoxygenases in ochratoxin A (OTA) genotoxicity, as reflected by DNA adduct formation, have been investigated in vitro: (1) in culture of human epithelial cells and (2) by incubation in presence of pig seminal vesicle microsomes. Indomethacin (0.1 μM), which inhibits PGHS and significantly increases leukotriene C(4) production by enhancement of lipoxygenases, enhanced formation of OTA-DNA adducts tenfold. At highest dose of 10 μM, indomethacin inhibited all pathways (PGHS and lipoxygenases) and thus prevented OTA-DNA adduct formation. Nordihydroguaiaretic acid, which inhibits lipoxygenases, suppressed OTA-DNA adduct formation. The OTA metabolites formed were analysed by HPLC. OTα, 4[R]- and 4[S]-hydroxy-OTA and a unidentified derivative were formed in control cells. After pre-incubation with indomethacin (0.1 μM), further unidentified metabolites were obtained. They were similar to those obtained in presence of pig seminal vesicle microsomes. These data demonstrate that OTA is biotransformed into genotoxic metabolites via a lipoxygenase, whereas PGHS decreases OTA genotoxicity.

The mitochondrial toxin produced by Streptomyces griseus strains isolated from an indoor environment is valinomycin

Actinomycete isolates from indoor air and dust in water-damaged schools and children's day care centers were tested for toxicity by using boar spermatozoa as an indicator. Toxicity was detected in extracts of four strains which caused a loss of sperm motility, and the 50% effective concentrations (EC50) were 10 to 63 ng (dry weight) ml of extended boar semen-1. The four strains were identified as Streptomyces griseus strains by 16S ribosomal DNA and chemotaxonomic methods. The four S. griseus strains had similar effects on sperm cells, including loss of motility and swelling of mitochondria, but we observed no loss of plasma membrane integrity or depletion of cellular ATP. None of the effects was observed with sperm cells exposed to extracts of other indoor actinomycete isolates at concentrations of >/=5,000 to 72,000 ng ml-1. The toxin was purified from all four strains and was identified as a dodecadepsipeptide, and the fragmentation pattern obtained by tandem mass spectrometry was identical to that of valinomycin. Commercial valinomycin had effects in sperm cells that were identical to the effects of the four indoor isolates of S. griseus. The EC50 of purified toxin from the S. griseus strains were 1 to 3 ng ml of extended boar semen-1, and the EC50 of commercial valinomycin was 2 ng ml of extended boar semen-1. To our knowledge, this is the first report of the presence of ionophoric toxin producers in an indoor environment and the first report of valinomycin-producing strains identified as S. griseus.

Health and immunology study following exposure to toxigenic fungi (Stachybotrys chartarum) in a water-damaged office environment

There is growing concern about adverse health effects of fungal bio-aerosols on occupants of water-damaged buildings. Accidental, occupational exposure in a nonagricultural setting has not been investigated using modern immunological laboratory tests. The objective of this study was to evaluate the health status of office workers after exposure to fungal bio-aerosols, especially Stachybotrys chartarum (atra) (S. chartarum) and its toxigenic metabolites (satratoxins), and to study laboratory parameters or biomarkers related to allergic or toxic human health effects. Exposure characterization and quantification were performed using microscopic, culture, and chemical techniques. The study population (n = 53) consisted of 39 female and 14 male employees (mean age 34.8 years) who had worked for a mean of 3.1 years at a problem office site; a control group comprised 21 persons (mean age 37.5 years) without contact with the problem office site. Health complaints were surveyed with a 187-item standardized questionnaire. A comprehensive test battery was used to study the red and white blood cell system, serum chemistry, immunology/antibodies, lymphocyte enumeration and function. Widespread fungal contamination of water-damaged, primarily cellulose material with S. chartarum was found. S. chartarum produced a macrocyclic trichothecene, satratoxin H, and spirocyclic lactones. Strong associations with exposure indicators and significant differences between employees (n = 53) and controls (n = 21) were found for lower respiratory system symptoms, dermatological symptoms, eye symptoms, constitutional symptoms, chronic fatigue symptoms and several enumeration and function laboratory tests, mainly of the white blood cell system. The proportion of mature T-lymphocyte cells (CD3%) was lower in employees than in controls, and regression analyses showed significantly lower CD3% among those reporting a history of upper respiratory infections. Specific S. chartarum antibody tests (IgE and IgG) showed small differences (NS). It is concluded that prolonged and intense exposure to toxigenic S. chartarum and other atypical fungi was associated with reported disorders of the respiratory and central nervous systems, reported disorders of the mucous membranes and a few parameters pertaining to the cellular and humoral immune system, suggesting a possible immune competency dysfunction.

Toxicokinetics of ochratoxin A in rat following intratracheal administration

The toxicokinetic parameters of ochratoxin A in rat following intratracheal administration of 50 ng ochratoxin A/g body weight were studied. The absorption of ochratoxin A from the lungs was very efficient. The elimination pattern of the toxin was studied by the analysis of blood samples. The biological half-life of ochratoxin A was 127 h and the calculated apparent volume of distribution equalled 168 ml/kg. The bioavailability of the toxin was very high, 98%. The plasma clearance of the toxin was 0.92 ml/kg.h.