Aflatoxin and the Etiology of Liver Cancer and Its Implications for Guatemala

Profound primary prevention of liver cancer following a natural experiment in China: A 50-year perspective and public health implications

Liver cancer causes upwards of 1 million cancer deaths annually and is projected to rise by at least 55% over the next 15 years. Two of the major risk factors contributing to liver cancer have been well documented by multiple epidemiologic studies and the hepatitis B virus (HBV) and aflatoxin show a synergy that increases by more than 8-fold the risk of liver cancer relative to HBV alone. Using the population-based cancer registry established by the Qidong Liver Cancer Institute in 1972 and aflatoxin-specific biomarkers, we document that reduction of aflatoxin exposure has likely contributed to a nearly 70% decline in age-standardized liver cancer incidence over the past 30 years despite an unchanging prevalence of HBV infection in cases. A natural experiment of economic reform in the 1980s drove a rapid switch from consumption of heavily contaminated corn to minimally, if any, contaminated rice and subsequent dietary diversity. Aflatoxin consumption appears to accelerate the time to liver cancer diagnosis; lowering exposure to this carcinogen adds years of life before a cancer diagnosis. Thus, in 1990 the median age of diagnosis was 48 years, while increasing to 67 years by 2021. These findings have important translational public health implications since up to 5 billion people worldwide might be routinely exposed to dietary aflatoxin, especially in societies using corn as the staple food. Interventions against aflatoxin are an achievable outcome leading to a reduction in liver cancer incidence and years of delay of its nearly always fatal diagnosis.

Environmental exposures and the risk of hepatocellular carcinoma

The global epidemiology of HCC is shifting due to changes in both established and emerging risk factors. This transformation is marked by an emerging prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes, alongside traditional risks such as viral hepatitis (HBV and HCV), and exposure to chemical agents like aflatoxin, alcohol, tobacco, and air pollution. This review examines how environmental exposures and evolving liver pathology, exacerbated by lifestyle and metabolic conditions, are contributing to the rising worldwide incidence of HCC. Effective prevention strategies must not only address traditional risk factors through vaccination and therapeutic measures but also confront metabolic and socioeconomic disparities through comprehensive public health efforts. As the burden of liver cancer continues to grow, particularly in resource-limited settings, an expansive and inclusive approach is vital for mitigating its impact across diverse populations.

Liver Cancer Mortality Rates in Peru: Trend Analysis from 2003 to 2017

BACKGROUND

Liver cancer is one of the leading causes of cancer-related death in Peru, and some reports have indicated an increase in mortality rates among the largest cities. To our knowledge, no study has been carried out at a national level or by geographic area in recent years. Thus, our objective was to examine overall, regional and sex-specific liver cancer mortality rates in Peru between 2003-2017.

METHODS

We retrieved data on liver cancer deaths between 2003 and 2017 from the mortality database of the Peruvian Ministry of Health.  Age-standardized mortality rates (ASMR) were estimated per 100,000 person-years using the world standard SEGI population. We analyzed mortality trends using Joinpoint regression Program Version 4.7.0. To examine the spatial distribution of the mortality rates, we used GeoDa software.

RESULTS

Between 2003 and 2017, 31,473 deaths from liver cancer were reported in Peru. Overall, liver cancer mortality rates have decreased significantly among Peruvian women since 2005 (-3.1% annually) with decreases in the coastal and highland regions ranging from 2.8% to 3.5%. In Arequipa, Cusco, La Libertad, Lima, and Moquegua, rates decreased bewteen 2003 and 2017. Among men in Ancash a significant increase (+12.5 annually) was observed from 2003-2011, followed by a sharpdecline (-10.5 annually) between  2011 and  2017.  In contrast, rates in Cajamarca, Junin, and Ucayali  decreased between  2003 and 2017.

CONCLUSIONS

Although decreases in liver cancer mortality rates were observed in some  regions of Peru, these trends were not statistically significant. In addition, some provinces experienced  increases in rates. Effective interventions, such as expanding access to healthcare and controlling the various risk factors for liver cancer, remains a key challenge for the country.

The prevalence and concentration of aflatoxins in beers: a global systematic review and meta-analysis and probabilistic health risk assessment

Mycotoxins have been identified as considerable contaminants in beer. The current investigation's concentration and prevalence of aflatoxins (AFs) in beer were meta-analyzed. The health risk of consumers was estimated through MOEs in the Monte Carlo simulation (MCS) model. The rank order of AFs in beer based on pooled prevalence was AFB1 (26.00%) > AFG1 (14.93%) > AFB2 (7.69%) > AFG2 (7.52%), In addition, the rank order of AFs in beer based on their pooled concentration was AFG1 (0.505 µg/l) > AFB1 (0.469 µg/l) > AFB2 (0.134 µg/l) > AFG2 (0.071 µg/l). The prevalence and concentration of AFs in beer in Malawi were higher than in other countries. The health risk assessment shows consumers in all countries, especially Malawi, Brazil, and Cameroon, are exposed to unacceptably health risks (MOEs <10,000). It is recommended to monitor levels of AFs in beer efficiently and implement control plans in order to decrease health risk of exposed population.

Exploring a new chapter in traditional Chinese medicine: The potential of Calculus bovis in liver cancer treatment

In the ongoing quest for new treatments in medicine, traditional Chinese medicine offers unique insights and potential. Recently, studies on the ability of Calculus bovis to inhibit M2-type tumour-associated macrophage polarisation by modulating the Wnt/β-catenin signalling pathway to suppress liver cancer have undoubtedly revealed new benefits and hope for this field of research. The purpose of this article is to comment on this study and explore its strengths and weaknesses, thereby providing ideas for the future treatment of liver cancer.

Liver Cancer Etiology: Old Issues and New Perspectives

PURPOSE OF REVIEW

This review aims to synthesize the old issues and current understandings of the etiology of liver cancer, focusing on the diverse causative factors influenced by geographical, socioeconomic, and lifestyle variations across different regions.

RECENT FINDINGS

We highlight significant geographic disparities in liver cancer risk factors. While hepatitis B and C viruses, aflatoxin exposure, and alcohol consumption remain globally established contributors; metabolic dysfunction-associated steatotic liver disease and metabolic syndromes are increasingly prominent in the West. Chronic HBV and aflatoxin continue to dominate as risk factors in Asia and Africa. Dietary factors, metabolic diseases like diabetes and obesity, genetic predispositions, environmental risk factors and lifestyle choices such as smoking and alcohol use play substantial roles in specific populations. Protective factors like coffee and tea consumption, along with aspirin use, vegetables and fruits have shown potential in reducing HCC risk, although findings vary by population and dietary habits. Liver cancer etiology is influenced by various factors that differ by region. Established risk factors include hepatitis B and C, aflatoxin, and alcohol. Emerging risks, such as metabolic dysfunction-associated steatotic liver disease, are more prevalent in Western countries, while aflatoxin and HBV remains significant in Asia and Africa. Diet, metabolic conditions like diabetes and obesity, genetic predispositions, and lifestyle choices also play crucial roles. Coffee, tea, aspirin, vegetables, and fruits may reduce HCC risk, but effectiveness varies. Future research should integrate epidemiology, genetics, and nutrition, with global cooperation and data sharing essential for effective cancer control strategies.

Liver Cancer: Progress and Priorities

Liver cancer, the sixth most frequently occurring cancer in the world and the third most common cause of cancer mortality, has wide geographical variation in both incidence and mortality rates. At the end of the 20th century, incidence rates began declining in some high-rate areas and increasing in some lower-rate areas. These trends were undoubtedly driven by the shifting contributions of both well-established and more novel risk factors. While notable strides have been made in combating some major risk factors, such as hepatitis B virus and hepatitis C virus, the emergence of metabolic conditions as important drivers of liver cancer risk indicates that much work remains to be done in prevention. As liver cancer is strongly associated with economic and social deprivation, research, early-diagnosis, and treatment among disadvantaged populations are of paramount importance.

Zanthoxylum zanthoxyloides (Lam.) B. Zepernick & Timler alkaloidal extract exerts hepatoprotective effects in rats with a CCl4/olive oil-induced hepatocellular carcinoma-like phenotype

Objective

This study assessed the prophylactic anti-HCC effects of a combined stem and root alkaloidal extract of Zanthoxylum zanthoxyloides (Z. zanthoxyloides) (SRAEZZ) in rats with a CCl4/olive oil-induced HCC-like phenotype.

Methods

SRAEZZ was prepared from dried stems and roots of Z. zanthoxyloides in a 1:1 proportion and chemically characterized. A total of 30 healthy male Wistar rats (weighing 210-280 g) were randomly assigned to six groups (control, model, capecitabine, and SRAEZZ [50, 100, or 200 mg/kg]). All groups except the control received CCl4/olive oil (3 mL/kg, po) in the morning, whereas in the afternoon of the same dosing day, the model group received normal saline (5 mL/kg, po), the capecitabine group received capecitabine (50 mg/kg, po), and the SRAEZZ groups received SRAEZZ (50, 100, or 200 mg/kg, po, respectively) once per week for 36 days. Survival rate, serum α-fetoprotein (AFP), and C-reactive protein (CRP) were monitored. Gross liver anatomy, liver histology, liver enzymes (ALP, AST, and ALT), bilirubin, creatinine, urea, albumin, globulins, and hematological parameters were assessed.

Results

SRAEZZ yield was 0.58% from the initial stem and root sample (520 g). Quaternary phenanthridin alkaloids were detected in SRAEZZ. Control rats had a 100% survival rate compared with rats in the model group. SRAEZZ treatment improved the survival rate with respect to that in the model group. Serum AFP, CRP, and bilirubin levels were greater in the model group than the control group. SRAEZZ decreased serum AFP, CRP, and bilirubin below the levels observed in the model group. ALP, AST, and AST were higher in the model group, but lower in SRAEZZ-treated group, than the control group.

Conclusion

SRAEZZ demonstrated prophylactic anti-HCC effects against CCl4/olive oil-induced HCC-like phenotypes in rats. These findings highlight the potential of crude alkaloids from Z. zanthoxyloides as natural templates for semi-synthesis of anti-HCC pharmacotherapeutics.

DNA modifications: Biomarkers for the exposome?

The concept of the exposome is the encompassing of all the environmental exposures, both exogenous and endogenous, across the life course. Many, if not all, of these exposures can result in the generation of reactive species, and/or the modulation of cellular processes, that can lead to a breadth of modifications of DNA, the nature of which may be used to infer their origin. Because of their role in cell function, such modifications have been associated with various major human diseases, including cancer, and so their assessment is crucial. Historically, most methods have been able to only measure one or a few DNA modifications at a time, limiting the information available. With the development of DNA adductomics, which aims to determine the totality of DNA modifications, a far more comprehensive picture of the DNA adduct burden can be gained. Importantly, DNA adductomics can facilitate a "top-down" investigative approach whereby patterns of adducts may be used to trace and identify the originating exposure source. This, together with other 'omic approaches, represents a major tool for unraveling the complexities of the exposome and hence allow a better a understanding of the environmental origins of disease.

Nitidine chloride inhibits G2/M phase by regulating the p53/14-3-3 Sigma/CDK1 axis for hepatocellular carcinoma treatment

Background

Liver cancer had become the sixth most common cancer. Nitidine chloride (NC) has demonstrated promising anti-HCC properties; however, further elucidation of its mechanism of action is necessary.

Methods

The anti-HCC targets of NC were identified through the utilization of multiple databases and ChIPs data analysis. The GO and KEGG analyses to determine the specific pathway affected by NC. The Huh 7 and Hep G2 cells were subjected to a 24-h treatment with NC, followed by evaluating the impact of NC on cell proliferation and cell cycle. The involvement of the p53/14-3-3 Sigma/CDK1 axis in HCC cells was confirmed by qPCR and WB analysis of the corresponding genes and proteins.

Results

The GO and KEGG analysis showed the targets were related to cell cycle and p53 signaling pathways. In vitro experiments showed that NC significantly inhibited the proliferation of HCC cells and induced G2/M phase arrest. In addition, qPCR and WB experiments showed that the expression of p53 in HCC cells increased after NC intervention, while the expression of 14-3-3 Sigma and CDK1 decreased.

Conclusion

NC can inhibit the proliferation of HCC cells and induce G2/M cell cycle arrest, potentially by regulating the p53/14-3-3 Sigma/CDK1 axis.

Genetic Diversity of Aspergillus flavus on Maize in Guatemala

Aflatoxin contamination of maize is a leading threat to health in Guatemala. This contamination is the result of infection from Aspergillus flavus and has been effectively reduced in other countries through application of nonaflatoxigenic, indigenous strains of A. flavus. We collected 82 maize samples from throughout Guatemala in two years and isolated 272 A. flavus from these samples, including 126 unique genotypes. We provide here a phenotypic and simple sequence repeat (SSR)-based genotypic description of these isolates, as well as an analysis of the diversity of this population. High levels of genetic diversity were observed with the nonaflatoxigenic isolates in this study, but this information contributes to the development of indigenous aflatoxin biocontrol products.

Aflatoxin exposure in a population of HIV patients at risk of hepatocellular carcinoma North-Central, Nigeria

Background

Aflatoxin B1causes damage to the DNA by the alkylation of bases and P53 mutation. Exposure to this mycotoxin is associated with the development of liver cancer. Measures to reduce grain and cereal contamination have been a focus however, the effects of these measures are still lagging behind and exposure continues to occur even in populations at risk of developing liver cancer.

Objective

To quantify aflatoxin B1 exposure in a population of HIV infected patients with and without HCC.

Method

This was a cross-sectional study among 196 patients with HIV and or HCC. We evaluated the exposure to aflatoxin B1 using the Aflatoxin M1 metabolite by ELISA on urine samples.

Results

A total of 196 participants consisting of 163 (83.2%) HIV positive and 28 (14.3%) HCC. Mean age is 46.64±10.8 years. The median aflatoxin (IQR) aflatoxin M1level is 177.3(112.5-272) pg/ml. Only 8(4.1%) of the participant had no exposure to aflatoxin B1. The median (IQR) aflatoxin for fibrosis score ≥ 13kpa (178.7(112.9-286.8) pg/ml) VS < 13kpa (173.5(107.9-250.4)), p = 0.046.

Conclusion

There is high prevalence of aflatoxin B1 exposure in this population. Concerted efforts must be put in place to mitigate exposure because of the potential effects of short- and long-term exposure to aflatoxin.

Cancer Incidence in Merida, Mexico 2015-2018: First Report from the Population-based Cancer Registry

BACKGROUND

Cancer registries are essential for monitoring cancer burden and patterns, and document changes in time for cancer control. Hereby, we present the first results of four years of the Merida population-based cancer registry in Mexico.

METHODS

The registry collects data on all new cancers diagnosed since 2015 using both active and passive methods including a total of 104 information sources. Definitions and coding follow international standards. Using CanReg5 software, age-standardized incidence rates (ASR/100,000 person years) were computed by direct method using the world standard population.

RESULTS

A total of 5684 new cancer cases were registered during 2015-2018, 2321 in males and 3363 in females corresponding to age-adjusted incidence rates (ASR per 100,000) of 128.5, and 153.1, respectively. Most frequent cancers among males were prostate cancer (ASR 29.8), lymphomas (ASR 10.9) and colorectal cancer (ASR 9.7) while among females it was breast cancer (ASR 49.3), cervical cancer (ASR 17.5) and corpus uteri (ASR 11.5). Childhood cancers (0-14 year) represented 2.9% of all cancers, with leukemias accounting for 52% of the new cases. Overall, 87.6% of new cases were microscopically verified.

CONCLUSIONS

The data reported provide information on the cancer profile in Merida. Prostate and breast cancer are the main incident cancers. Cervical cancers present high rates among women, while lymphomas and liver cancer data merit further exploration. Efforts to support the Merida cancer registry as well as other registries in Mexico need to be pursued in order to have locally recorded data to support cancer control measures.

Heart failure and cancer: From active exposure to passive adaption

The human body seems like a "balance integrator." On the one hand, the body constantly actively receives various outside stimuli and signals to induce changes. On the other hand, several internal regulations would be initiated to adapt to these changes. In most cases, the body could keep the balance in vitro and in vivo to reach a healthy body. However, in some cases, the body can only get to a pathological balance. Actively exposed to unhealthy lifestyles and passively adapting to individual primary diseases lead to a similarly inner environment for both heart failure and cancer. To cope with these stimuli, the body must activate the system regulation mechanism and face the mutual interference. This review summarized the association between heart failure and cancer from active exposure to passive adaption. Moreover, we hope to inspire researchers to contemplate these two diseases from the angle of overall body consideration.

Foreword

First and foremost, let me wish you a healthy, lucky and prosperous 2022! Let us hope that this year brings a change for the better, as more than five million human lives were lost due to COVID-19 already (Adam, 2022). While the pandemic continues to affect our daily life more than we would have ever thought, research must continue and maybe it is more important than ever. So even during difficult times, some great scientific achievements were made, and that includes mycotoxins.

Foreword – special issue Mycotoxins in Latin America

Latin America with its considerable North-South extent is subject to climate that varies from tropical, subtropical and warm temperate to temperate. Different agricultural products are produced in the area including cereals, oilseeds, beans, fruits and nuts together with animal production including cattle for beef and milk, pigs, poultry and fish. The heterogeneity of agriculture in Latin America is reflected in the diversity of the region’s farm structures. While agriculture in the Southern Cone is dominated by large, commercial and export-oriented farms, particularly in Argentina and Brazil, besides increasingly in other countries like Uruguay, much of the rest of the region is characterised by smallholder and family agriculture. The contamination of agricultural products with mycotoxins has impact both human and animal health, as well as the economy due to losses related to rejections of agricultural products and by-products during trade. The economic burden related to the consumption of mycotoxins by animals is especially important, causing productivity losses up to the death of animals. The relevant mycotoxins are fumonisins, deoxynivalenol (DON) and zearalenone (ZEN) in cereals and cereal-based products, aflatoxins in cereals, oily seeds and nuts, aflatoxin M1 in milk and dairy products as well as ochratoxin A (OTA) in coffee, grapes and raisins. Co-occurrence of mycotoxins has also been observed mainly with aflatoxins and fumonisins in different Latin American countries (Torres et al., 2015). Advances on legislation in different countries including Argentina, Brazil, Chile, Mexico and Uruguay have been done to establish maximum limits for mycotoxins including aflatoxins, DON, ZEN, OTA, patulin and ergot alkaloids (ANVISA, 2011/2017; CAA, 2019/2021, Norma Oficial Mexicana, N.-243-S., 2010/2010; Reglamento Sanitario de los Alimentos, 2013).