Mycotoxins in Food and Feed
Mycotoxins in Food and Feed
Mycotoxins in Food and Feed
ABSTRACT: Disease outbreaks due to the consumption of contaminated food and feedstuff are a recurring problem worldwide. The major factor contributing to contamination are microorganisms, especially fungi, which produce low-molecular-weight compounds as secondary metabolites, with confirmed toxic properties referred to as mycotoxins. Several mycotoxins reported to date are cosmopolitan in distribution and incur severe health-associated risks (including cancer and neurological disorders). Hence, creating awareness among consumers, as well as developing new methods for detection and inactivation is of great importance for food safety. In this review, the focus is on the occurrence of various types of mycotoxins in food and feed associated with risks to humans and livestock, as well as legislation put forth by various authorities, and on presently practiced detoxification methods. Brief descriptions on recent developments in mycotoxin detection methodology are also inlcuded. This review is meant to be informative not only for health-conscious consumers but also for experts in the field to pave the way for future research to fill the existing gaps in our knowledge with regard to mycotoxins and food safety.
Introduction
Contamination of food and agricultural commodities by various types of toxigenic molds (fungi) is a serious and a widely neglected problem. Regardless of decades of extensive research, mold infection still remains a challenging problem (Munkvold 2003). It has been estimated by FAO that worldwide approximately 25% of the crops get contaminated by molds and are affected by mycotoxins (CAST 1989; Rice and Ross 1994), and the estimated loss extends to billions of dollars (Trail and others 1995). Molds have been designated to rank second only to insect pests as a cause of damage during the storage of grains (CAST 1989). Poor harvesting practices, improper drying, handling, packaging, storage, and transport conditions contribute to fungal growth and increase the risk of mycotoxin production. Major loss of fresh harvest that renders it to be an impediment for safe consumption can be attributed mainly to 3 factors: biological (storage pests), microbial (bacteria, fungi), and chemical (insecticide, fungicide residues). These 3 factors, singly or in combination, can readily react with the substrate or the raw material leading to the production of off-avors, discoloration of the product, and reduction in nutritional value. Today, in most of the cases, chemical fumigants or chemical-based protective agents are used for the safe preservation of fresh produce. HowMS 20090721 Submitted 7/28/2009, Accepted 8/27/2009 . Authors Bhat and Karim are with Food Technology Div., School of Industrial Technology, Univ. Sains Malaysia, 11800 Penang, Malaysia. Author Rai is with Dept. of Microbiology, Univ. of Mysore, Manasagangotri, Mysore 570 006, India. Direct inquiries to author Bhat (E-mail: rajeevbhat1304@gmail.com).
ever, increasing concern and demand by consumers for safe and high-quality foods have made it mandatory to look for better alternatives to chemicals. In this regard, it has been a major challenge for the scientic community around the world, as some of the chemical fumigants (like ethylene dioxide, methyl bromide), which are routinely used for postharvest preservation purposes, have been reported to be highly toxic. Some of these chemicals are either banned in developed countries or are likely to be banned in developing countries (by 2015) (Anonymous 1995; FAO 2005). Worldwide, it is generally claimed that natural products are safe. However, contamination of human or animal food (or feed) via natural biotoxins produced by microbes might result in outbreaks of several diseases. Among the microbes, fungal toxins assume more importance due to their worldwide distribution. The colonizing fungi are capable of producing toxins, and can cause deleterious health effects in humans or in livestock consuming the contaminated products. Such cases of fungal poisoning may cause death in animals, but are rarely fatal to humans (PfohlLeszkowicz 2000). As there is an increasing concern among consumers regarding food safety, as well as demand for high-quality foods with minimal bio or chemical contaminants, frequent occurrence of these toxins will denitely have a negative impact on the economy of the affected region/country. Fungal toxins have been detected in various food commodities from many parts of the world and have been recognized to be one of the most dangerous contaminants of food and feed (CAST 1989). The production of toxins by a fungus does not correlate directly with its growth, but is also dependent on the fungistatic and fungicidal compounds that might affect the invasion and
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Table 1 --- Some of the recent methods developed/adapted for the detection of mycotoxins. Raw material Groundnut Peanut Raw and pasteurized sheep, cow and goat milk, egg, and beef samples Chilli Red chilli powder Rice Corn Maize and barley Nuts, cereals, dried fruits, and spices Milk Egg Immunoafnity pre-concentration combined with on-column visual detection LCMS/MS Vicam immunoafnity column for the clean-up procedure and with bromine derivatizaton with an electrochemical cell Rapid FT-NIR method Signal-amplied electrochemical immunosensor ELIME-array (based on an indirect competitive ELISA format) Near-infrared spectroscopy (NIR) In-tube solid-phase micro-extraction (SPME) coupled with LC-MS. Tripathi and Mishra (2009) Tan and others (2009) Piermarini and others (2009) Fernandez-Iba nez and others (2009) Nonaka and others (2009) Goryacheva and others (2009) Jestoi and others (2009) HPLC using UV and uorescent detectors Herzallah (2009) Class-specic monoclonal antibody-based ELISA Li and others (2009) Adsorptive cathodic stripping voltammetry Hajian and Ensa (2009) Detection method Reference
Mycotoxin
Aatoxin (B1, B2) Aatoxin (B1, B2,G1, G2, M1) Aatoxin (B1, B2, G1, G2, M1, M2) O Riordan and Wilkinson (2009)
Fusarium toxins (beauvericin and enniatins [A, A1, B, B1]) Fumonisin B1 DON Bovine milk --Cereals, fruit, and coffee products Tunisian foods Cheese --Corn breakfast and infant cereals Sweet pepper LC-MS/MS Molecular imprint polymer technology
Gazzotti and others (2009) Weiss and others (2003) Tabata and others (2008) Ghali and others (2009) Zhang and others (2009b) Huang and others (2009) Shim and others (2009) Zinedine and others (2009) Monbaliu and others (2009)
OTA
High-performance liquid chromatography with uorescence detection (HPLC-FL) using LC/MS/MS HPLC technique preceded by an immunoafnity clean-up step Solid-phase micro extraction coupled to liquid chromatography-tandem mass spectrometry. Dual-label time-resolved uoroimmunoassay One-step simultaneous immunochromatographic strip test Pressurized liquid extraction coupled to liquid chromatography Multi-mycotoxin liquid chromatography/tandem mass spectrometry method
OTA and ZEN OTA Multi mycotoxinstrichothecenes, aatoxin (B1,B2, G1, G2), Alternaria toxins, fumonisins (B1, B2, B3), ochratoxin A, ZEN, beauvericin, and sterigmatocystin ZEN ZEN and fumonisins Patulin
Fluorescence polarization immunoassay (FPIA) Immunoafnity clean-up and detection by liquid chromatography GC-MS
Chun and others (2009) Manova and Mladenova (2009) Cunha and others (2009)
Patulin
Corn Cereals Apple fruit and apple products including juice, cider, and baby food, and also in quince fruit and quince jam Apple juice Fruit juice and dried fruit
Patulin
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Single-laboratory validation of a liquid chromatography liquid chromatograph (with a C18 column and diode array detector) In-tube solid-phase microextraction coupled with liquid chromatographymass spectrometry
individual. Populations residing in developed countries are generally considered to be less exposed to mycotoxins than those in developing countries. This might be attributed to various factors: execution and practice of modern food handling/preservation technology, as well as successful governmental regulation and commercial control over food quality and safety. The presence of mycotoxin-producing fungi in a substrate (cereals, grains, and other sources) has been well dened and accepted as a natural bio-contaminant in many of the EU countries, the U.S., Canada, Russia, and in most of the Asian countries (Smith and Moss 1985). However, even monitoring and exercising of good agricultural and manufacturing practices (GAP and GMP) along with an effective Hazard Analysis and Critical Control Point (HACCP) approach might not completely avoid or eliminate mycotoxins in the food chain. Mycotoxins can enter the food chain directly via plant products such as cereal grains, coffee, oil seeds, spices, fruit
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juices, and beverages (wine and beer), and indirectly from animal diets (pastures, feeds) contaminated with mycotoxins, which can leave residues in milk, meat, and other products.
Types of Mycotoxins
Aatoxins
Aatoxins are highly toxic, mutagenic, teratogenic, and carcinogenic compounds that are produced as secondary metabolites by fungi belonging to several Aspergillus species, mainly A. avus and A. parasiticus (Groopman and others 1988; Massey and others 1995; Romagnoli and others 2007; ORiordan and Wilkinson 2008). Aatoxins have a high presence in tropical and subtropical regions where humidity and temperature conditions are optimal for toxin production. The name aatoxin has Historical Perspectives been derived from the combination of a for the Aspergillus Earlier reports have clearly indicated the devastating risks as- genus and a for the species avus, and toxin meaning poison sociated with the consumption of mold-contaminated products. (Ellis and others 1991). Discovery of aatoxins dates back to the Death due to ergotism has been described in the Old Testament 1960s following the severe outbreak of turkey X disease (in the
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and others 1993; Barrios and others 1997; Sarimehmetoolu and others 2003; Driehuis and others 2008; Sugiyama and others 2008). However, it should be noted that aatoxin M1 is a metabolite of aatoxin B1, and therefore the possibilities of any direct carryover of AFM1 from feed to milk could be ruled out. It is generally recognized that contamination of milk and milk products with AFM1 varies according to geographical location (dry or wet) and season (hot or cold). Lafont and others (1980) reported that the carryover of aatoxins from animal feed to milk is less than 1% in cows and varies between 0.14% and 0.95%, which is dependent not only on the individual animal but also on the lactation stage of the animal. Aatoxins in raw drugs. Even though considerable advances have been achieved in modern medicine, there has been a renewed interest in the use of traditional plant-based products for a variety of therapeutic purposes (Rates 2001). Currently, a large share in the health care market has been taken over by products based on the popularity of health foods (nutraceuticals/functional foods) of plant origin (Johnson 1997). Contamination of crude drugs of plant origin (as in Ayurvedic and Chinese medicine, and others) incurs heavy economic losses in the tropics and subtropics. The conventional methods of collection, storage, and marketing usually promote the association with several toxigenic molds (Roy and others 1987). Several reports are available on aatoxins contaminating raw drugs of plant origin. The potential of producing aatoxins (AFB1) by some 20 strains of Aspergillus avus contaminating raw drugs has been reported by Chourasia (1990) who reported levels ranging between 0.09 and 0.88 g/mL of the culture ltrate. Roy and others (1988) analyzed common drug plants to detect aatoxin contamination. Out of 15 samples analyzed, 14 were positive for aatoxins ranging between 0.09 g/g in Acacia catechu and 1.20 g/g in Piper nigrum. The researchers also reported that out of 158 isolates of A. avus from the drugyielding plants 49 were toxigenic in nature and the amount of AFB1 produced by the toxigenic isolates ranged between 0.86 and 5.24 g/mL. Similar observations on the contamination of medicinal plant samples have been reported by Aziz and others (1998). They examined a total of 84 medicinal plants and spices and reported 17 samples to be contaminated by AFB1 which ranged between 10 and 160 g/kg. Ali and others (2005) evaluated 23 commercial samples of traditional herbal medicines from Malaysia and Indonesia and found the presence of aatoxin in most of the samples. The mean levels of AFB1, AFB2, and AFG1 in positive samples were 0.26 (70%), 0.07 (61%), and 0.10 (30%) g/kg, respectively, and one of the samples was positive for AFG2 at a level of 0.03 (4%) g/kg. Though these are just a few of the examples to cite, an alarming increase among consumers relying on food of plant origin, renders it a necessity to undertake safety measures against fungal contamination and mycotoxins that might be present in raw materials possessing nutraceutical value. Aatoxins in eggs. Consumption of egg as a rich source of protein is well known. Reports available on aatoxin contamination in eggs are scarce (Micco and others 1987; Pandey and Chauhan 2007; Aly and Anwer 2009; Herzallah 2009). Micco and others (1987) reported that AFB1 bio-transformation in the liver of hens could generate a variety of toxic hydroxylated metabolites that can be transferred to eggs. Hens that are fed with contaminated feeds with more than 3300 mg/kg of AFB1 over a period of 28 d were reported to produce contaminated eggs (Wolzak and others 1985). Also, reports are available on the presence of aatoxin residues transmitted into eggs (Qureshi and others 1998). However, since 1974 the EC has set a limit of 20 g AFB1/kg of layer feed. A study by Pietri and others (2001a) indicated that if this ofcial limit is respected, then no trace of AFB1 or its metabolites can be detected in eggs.
Ochratoxin-A (OTA; molecular weight 403.8) is the 2nd most important mycotoxin; it is produced by the fungi Aspergillus ochraceus and Penicillium verrucosum. It has also been reported that isolates of Aspergillus niger as well as A. carbonarius are capable of producing OTA (Varga and others 1996; Heenan and others 1998). OTA generally appears during storage of fresh produce (in cereals, coffee, cocoa, dried fruit, spices, and also in
pork) and occasionally in the eld on grapes. It may also be present in some of the internal organs (particularly blood and kidneys) of animals that have been fed on contaminated feeds. In temperate climates OTA is produced by Penicillium verrucosum, while a number of Aspergillus spp. (A. ochraceous, A. niger, A. sulphureus, A. sclerotiorum, and A. melleus) are known to be responsible for its production in tropical and pan-tropical regions of the world. Moss (1996) isolated Petromyces alliaceus from onion and has shown it to be a good OTA producer under laboratory conditions. OTA has also been shown to be biosynthesized by Aspergillus carbonarius in apple and grape juices (Pitt 2000). OTA in milk. OTA contaminations in human milk are common in the temperate and cool areas of the world, including Italy (Micco and others 1995; Miraglia and others 1995; Galvano and others 2001), Switzerland (Zimmerli and Dick 1995), Germany (Gareis and others 1988), and France (Boudra and others 2007). OTA levels in milk from cows in Norway were sufcient to cause a higher intake of OTA than the suggested tolerable daily intake of 5 ng/kg body weight/d (Skaug 1999). OTA contamination in milk from tropical/ hot regions have also been reported in India (Rastogi and others 2004), Egypt (El-Sayed Abd Alla and others 2000), and Brazil (Shundo and others 2009). High levels of OTA in human milk have been reported by Jonsyn and others (1995) wherein, in some instances, infants in Sierra Leone were being exposed to OTA levels that exceeded the permissible limits in animal feed in some of the developed countries. In Norway, Skaug and others (1998, 2001) examined the relationship between OTA contamination of human milk and dietary intake and concluded that the risk of OTA was related to dietary intakes (cereals, processed meat products, cheese, cakes, cookies, and juices). OTA in wine, coffee, tea, cocoa, and herbs. Zimmerli and Dick (1996) in a survey of 133 wines obtained from retail outlets in Switzerland reported, for the 1st time, the occurrence of OTA in wine. OTA was higher in red wines than in white and rose wines. Also, Otteneder and Majerus (2000) have shown OTA to be more common in red wines than in rose and white wines and attributed this to the differences in the winemaking procedure. Impact of geographical effects on the occurrence of OTA in red wines has been reported by Otteneder and Majerus (2000) in Germany; Pietri and others (2001b) in Italy; Stefanaki and others (2003) in Greece; Ratola and others (2004) in Portuguese wines; and in Chilean vineyards (D az and other 2009). The occurrence and the concerns pertaining to OTA in grapes and wine have been extensively reviewed (Battilani and others 2006; Leong and others 2006; Hocking and others 2007). Recently, Flajs and others (2009) employed the enzyme-linked immunosorbent assay (ELISA) and high-performance liquid chromatography (HPLC) for OTA analysis in must and in wine samples collected in Croatia. Their results revealed that OTA concentrations in must (range 19 to 50 ng/L) were higher than in the wines (range 0 to 21 ng/L). The CEC (2002) has xed an OTA limit of 10 g/kg in dried wine fruits. Except for Italian red wines, the mean concentration of OTA in wine in the EU countries does not exceed 100 ng/L (Varga and Kozakiewicz 2006). With regard to coffee and cocoa, the occurrence of OTA is of main concern as the populations dependent on these products are present worldwide. In one of the recent reports, both the wet and dry methods of coffee processing have been reported to represent high levels of OTA (up to 5 g/kg) (Batista and others 2009). Contamination of cocoa beans by OTA has been reported (Jrgensen 2005; Vecchio and Finoli 2007; Am ezqueta and others 2008a). Cocoa bean powder is also known to contain OTA wherein it was in lower levels in cocoa butter than in the nonfat fraction (powder or cake) (Beckett 1994). A 1998 survey in
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Fungi belonging to the genus Fusarium are associated with the production of fusariotoxins. There are 2 types of toxins produced by these fungi, namely, metabolites that have properties similar to the hormone estrogen such as ZEN (F-2 toxin) and other ones that are the nonestrogenic trichothecenes. There are several synonyms related to fusariotoxin poisoning: fusario-mycotoxicosis, trichothecene mycotoxicosis, T-2 toxicosis, vomitoxicosis, and ZEN toxicosis.
Fumonisins
Fumonisins (synonym: Macrofusine, molecular weight 721.8) are the most recently isolated mycotoxins (rst discovered in 1988) that are known to possess high cancer-inducing properties (Gelderblom and others 1988; Bennett and Klich 2003). This toxin was originally isolated from Fusarium moniliforme (present name: F. verticillioides Sheldon.) and from Fusarium proliferatum, a common fungal contaminant of corn (maize) throughout the world (Gelderblom and others 1988; Castelo and others 1998). Of late, 6 different types of fumonisins (FA1, FA2, FB1, FB2, FB3, and FB4) have been reported, wherein the A series is the amides and the B series possesses a free amine (Gelderblom and others 1992). Even FC1 has also been reported in the C series. Fumonisins are also known to be produced by F. proliferatum and other related species, especially on maize that has been previously infected during its preharvest stages. Reports are available on the presence of fumonisins in several agricultural products like corn, cornour, dried milled maize fractions, dried gs, herbal tea, medicinal plants, bovine milk, and others (Omurtag and Yazi and cio glu 2004; Gazzotti and others 2009; Karbancioglu-Guler Heperkan 2009; Pietri and others 2009; Seo and others 2009), indicating high risks to public health. It has been estimated that consumption of fumonisin B1 (FB1) by humans in the U.S. is about 80 ng/kg/d (WHO 2002). Occurrence of fusarial toxins in ensiled grass or hay, originating mainly from preharvest contamination, has been reported by Baath and others (1990). Associated health risks of fumonisins. Consumption of fumonisin-contaminated foods by humans has been correlated with increased incidence of esophageal cancer in various parts of South Africa, Central America, Asia (Chelule and others 2001; Marasas and others 2004), and among the black population in Charleston, South Carolina (Sydenham and others 1991). Similar observations have been reported from China (Abnet and others 2001), Italy (Franceschi and others 1990), and Brazil (Van der Westhuizen and others 2003). This toxin has also been reported to be immunosuppressive (WHO 2002). The IARC (International Agency for Research on Cancer 1993c) has classied fumonisins under group 2B (possibly carcinogenic to humans). Among the various types, FB1 is known as a cancer promoter and plays an important role in carcinogenesis in humans (Chu and Li 1994). Fumonisin consumption has also been related to neural tube defects in human babies as they (especially FB1) reduce the uptake of folate in different cell lines (Marasas and others 2004). In the concluding report of the recent task force of the U.S. Council for Agricultural Sciences and Technology (CAST 2003), additional research into the relationship between fumonisin, sphingolipid metabolism disruption, and apoptosis has been asked for to understand the potential carcinogenicity of fumonisins in human health. In a preliminary evaluation report, experts from Nordic countries (Denmark, Norway, Sweden, Finland, and Iceland) have concluded that human daily intake of fumonisins should be less than 1 g/kg body weight/d (Petersen and Thorup 2001). According to Miller and others (1996), the recommended levels of fumonisin concentration in animal feed is: 5 g/g for horses and other equine species, 10 g/g for porcine species, 50 g/g for cattle, and 50 g/g for poultry.
swine and mink, but rather acted as an estrogen agonist. Enlarged mammae and atrophied testes were exhibited due to ZEN intake in boars (Flannigan 1991). Consumption of contaminated feed by dairy cows did not result in any of the health hazards to humans (Wood 1992). The Joint FAO/WHO Expert Committee on Food Additives (JECFA) has established a provisional maximum tolerable daily intake for ZEN to be 0.5 g/kg of body weight (JECFA 2000).
Vomitoxin (DON) and associated risks
ZEN (molecular weight: 318.4) and zearalenol are estrogenic resorcylic acid lactone compounds produced by Fusarium species (Diekman and Green 1992). Among the human population, children are the most affected due to consumption of ZEN-contaminated foods (mainly cereals and cereal-based food products). This toxin has worldwide distribution and can contaminate most of the cereals like barley, maize, oats, sorghum, and others. ZEN has also been detected in wheat and in bread (Tanaka and others 1988; Aziz and others 1997). Associated health risks. This toxin has been implicated in several incidents of precocious pubertal changes (Kuiper-Goodman and others 1987). In domestic animals, ZEN poisoning has been associated with hyperestrogenic or feminizing syndromes. Pigs are generally the most affected and it causes genital/urinary prob lems (Zollner and others 2002; D anicke and others 2005). The major symptoms of ZEN poisoning include hyperemia and edematous swelling of the vulva in prepubertal gilts and in severe cases prolapse of the vagina and rectum. In some cases, atrophy of the testes in male pigs occurred with decreased libido and hypertrophy of the mammary glands (Marasas and others 1984). In general, poultry are the least affected after ingestion of ZEN. However, swine showed acute symptoms in prepubertal gilts that included enlarged mammae, swelling of uterus and vulva, and atrophy of the ovaries. In severe cases, prolapse of the vulva and rectum have occurred. Effects of ZEN and/or tamoxifen (TAM) on swine and mink reproduction have been studied by Yang and others (1995). Results of their study indicated that TAM was not effective in ameliorating the hyperestrogenic effects of ZEN in
DON (12, 13-epoxy-3,4,15-trihydroxytrichothec-9-en-8-one; molecular weight: 240.26) is commonly known as alphamethyl phenethylamine, amphetamine deoxynivalenol, 4deoxynivalenol (DON), or as RD-toxin. Vomitoxin is commonly encountered in food products and feeds prepared from contaminated corn and wheat (Rotter and others 1996). This toxin is the most frequently detected Fusarium toxin produced by Fusarium graminearum. DON has been reported in most parts of the world (Canady and others 2001) and in the U.S. alone computer simulations have shown annual costs for DON to be 637 million dollars in crop losses of wheat and corn and 18 million in feed losses (CAST 2003). Vomitoxin is considered to be highly stable and can survive various food processing methods (such as milling, powdering). DON and its metabolite de-epoxyDON have also been reported to be present in low amounts in eggs (Sypecka and others 2004; Valenta and Danicke 2005) and in beer at low levels (Scott 1996). Recently, low levels of deoxynivalenol (2.6 to 17.9 ng/g) and its metabolite deepoxy-DON (2.4 to 23.7 ng/g) have been reported in 20 homeproduced egg samples collected in Belgium (Tangnia and others 2008). Consumption of vomitoxin-contaminated products has been correlated with reduced milk production in dairy cattle, vomiting in swine, inhibition of reproductive performance and immune function in several animal species, along with induction of apoptosis in mice (Jones and others 1994; Zhou and others 2000). Maximum limit of 1 ppm of DON for bran, our, and germ meant to be used for human consumption has been set by the U.S. Food and Drug Administration (FDA) (Proctor and others 1995). Maximum tolerated levels in the range of 500 to 1000 g/kg (0.05 to 0.1 ppm) for DON in most other food products have also been set (van Egmond and Jonker 2004). The maximum level of DON in raw cereals allowed by the European Union is 1250 g/kg (Food Safety Authority of Ireland, http://www.fsai.ie). In humans, the effects of DON on health are not completely understood. However, some toxicity information after consumption of DON-contaminated cereals, grains, and other products has been reported (Yoshizawa 1983; Luo 1994; Meky and others 2001; Sun and others 2002).
Trichothecenes and associated health risks
Similar to ZEN and vomitoxin, trichothecenes are also produced by Fusarium species. Trichothecenes are also known to be produced by other fungal genera like Trichoderma, Trichotecium, Myrothecium, and Stachybotrys (IPCS 1990). Trichothecenes are sesquiterpenoid mycotoxins that accumulate in kernels of infected spikelets rendering the grain unsuitable for human or animal consumption (Harris and others 1999; Langevin and others 2004). Trichothecenes are usually found to be contaminants of cereals and their derivatives (Foroud and Eudes 2009). Nearly 160 trichothecenes have been identied and are classied into 4 groups depending on their chemical structure. The major ones are T-2 and HT-2 toxins (group A) and nivalenol (NIV) (group B).
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sic environmental factors as variations in temperature and water activity (Northolt and others 1996). Associated health risks of Patulin. Patulin toxin is reported to affect the functions of gastrointestinal tissue, kidney, liver, and the overall immune system (Escoula and others 1988; Speijers and others 1988; Wichmann and others 2002). This toxin is regarded to be genotoxic, carcinogenic, can induce oxidative stress response in mammalian cells, generate reactive oxygen species (ROS), and induce apoptosis in human leukemia cells (HL-60) (Barhoumi and Burghardt 1996; Schumacher and others 2006; Liu and others 2007; Wu and others 2008). Contradictorily, Wouters and Speijers (1996) have reported patulin to be noncarcinogenic. However, the IARC has classied patulin as category 3; not classiable as to its carcinogenicity in humans (IARC 1993b). The permissible limit for patulin in apples and their products in the U.S. and EU has been set at 50 ppb (FDA, http://www.fda.gov/ora/compliance ref/cpg; EUROPA, http://europa.eu.int/eur-lex/en/archive/2004). A permissible limit of patulin content in apple juice, and as juice ingredients in other beverages, has been set at 50 g/kg, in solid apple products at 25 g/kg, and in baby food of 10 g/kg (Mycotoxin Certication Standard 2008, www.mycotoxin-certication.eu).
Citrinin
Generally, fruits and vegetables are easily contaminated by toxigenic molds leading to quality deterioration (Drusch and Ragab 2003; Moss 2008). Agronomic practices employed during fruit cultivation and juice making have been reported to signicantly inuence the occurrence and production of patulin and citrinin (Martins and others 2002). Patulin (molecular weight: 145.1) is a mycotoxin that forms the smallest group of toxic metabolites referred to as polyketides, and is reported to be produced by fungi belonging to Aspergillus spp., Penicillium expansum, and Paecilomyces and Byssochlamys spp. (Byssochlamys nivea, B. fulva) (Dutton and others 1984; Fuchs and others 2008; Moss 2008; Cunha and others 2009). Patulin is being considered as a possible toxin in Europe and New Zealand (Lacey 1991) and is regarded as the most dangerous mycotoxin in fruits, particularly apples, pears, and their products (Frisvad and Thrane 1996; Kabak and others 2006; Murillo-Arbizu and others 2009). Patulin is mainly associated with surface-injured fruits, which renders them vulnerable to fungal infection, mainly by Penicillium spp. (Sewram and others 2000). Patulin is also reported to be present in silage/feeds intended for ruminants; and it has been reported to be responsible for the deaths of cattle in France (Moreau 1979). Schneweis and others (2000) reported that lower concentrations of patulin found in silage will rarely cause the typical neurotoxic signs in animals, but might exert detrimental effects on the rumen microora, mainly because of its antimicrobial activity. The occurrence of patulin in a raw material has been directly related to some of such extrin66
Citrinin (molecular weight: 250.25) is the secondary metabolite produced by Penicillium expansum and some of the Aspergillus and Monascus spp. (Kurata 1990; Vinas and others 1993; Li and others 2003; Kim and others 2007; Abramson and others 2009). Citrinin often occurs as a common contaminant of food and feed (fruits, barley, maize, cheese, dietary supplements) (Manabe 2001; Schneweis and others 2001; Bailly and others 2002; Bennett and Klich 2003; Meister 2004). Barley, as well as other cereals employed for producing beer, has been reported to be a good substrate for the growth of many toxigenic fungi capable of producing citrinin (Galvano and others 2005). Associated health risks of citrinin. In humans, reported health risks due to citrinin are scarce. Some reports do indicate citrinins association with mycotoxic nephropathy in swine and Balkan endemic nephropathy in humans (IARC 1986; Chernozemsky 1991; Hald 1991). However, details available on the toxic effects of citrinin in animals show its nephrotoxic nature as well as teratogenic effects in rabbits, poultry, dogs, and rats and mice along with induction of apoptosis (Kogika and others 1993; Bennett and Klich 2003; Yu and others 2006; Chan 2007; Kumar and others 2007; Singh and others 2007).
Alternaria toxins
Mycotoxins produced by fungi belonging to Alternaria species are referred to as Alternaria toxins. Alternaria species commonly occur during the pre- and postharvest stages of fruits and vegetables. These fungi are capable of producing a range of mycotoxins and other less toxic metabolites. The most important toxinproducing species is Alternaria alternate, which usually contaminates cereals, sunower seeds, rapeseed, olives, and fruits. Among the various Alternaria toxins, alternariol (AOH) and alternariol monomethyl ether (AME) are reported to be the most toxic (Combe and others 1970; Pero and others 1973). The toxins AOH and AME have been detected in sorghum (Ansari and Shrivastava 1990), sunower seeds (Chulze and others 1995), barley, wheat, oats (Gruber-Schley and Thalmann 1988; Azcarate and others 2008), olives, tomatoes, mandarin oranges, peppers, and melons (Logrieco and others 1988). Also, apart from AOH and AME, other naturally occurring Alternaria toxins include tenuazonic acid, altenuene, and altertoxin. The signicance of tenuazonic acid in fresh tomatoes used for the production of tomato sauce has been detailed by
Sclerotia of fungi belonging to the genus Claviceps produce ergot alkaloids. A sclerotium is a dark-colored, hard mycelial mass that establishes itself on the seed or kernel of the plant. Usually, wild grass species are considered to favor the crosscontamination of C. purpurea onto the cultivated grass (Poo and Araya 1989). Apart from Claviceps, ergot alkaloids are also produced as secondary metabolites by fungal species belonging to Penicillium, Aspergillus, and Rhizopus (Flieger and others 1997). The human disease ergotism is entirely inuenced by the type of alkaloids present (Burfening 1973) (The term ergotism has occassionally also been used to denote the plant disease). Associated health risks of ergot toxins. The Claviceps purpurea toxin is of not much signicance today and human ergotism is extremely rare, which might be attributed to 2 reasons: primarily, due to the recent improvements in the cleaning and milling processes that are able to remove most of the ergots leaving very low levels of the alkaloids in the our, and, second, these alkaloids might be relatively unstable and can be destroyed easily by conventional processing (baking, cooking, milling). However, it is necessary to cover a few aspects on C. purpurea toxins. Earlier reports are available on ergot poisoning of domestic animals by ingestion of feeds containing Claviceps purpurea sclerotia (Groger 1972; van Rensburg and Altenkirk 1974). Ergot alkaloids have been reported in sleepy grass (Stipa robusta) which is common in the South-Western parts of the U.S. (Cheeke 1995). The most common intoxications associated with ergot alkaloids is fescue toxicosis wherein the tall fescue (Festuca arundinacea) pasture grass common to the U.S. was infected by Claviceps spp. that produced ergovaline (an alkaloid), which proved to be toxic to animals (Botha and others 2004). These ergot alkaloids have also been reported in pasture grasses of Northern Europe (FinkGremmels 2005). Toxicity symptoms of Claviceps toxins include delirium, prostration, violent head pain, abscesses, and gangrene of the extremities. The toxin most likely acts as a vasoconstrictor. Some of the secondary metabolites of fungi that were used as antibiotics in earlier years are now considered toxins (Peraica and others 1999). However, with regard to ergot alkaloids, they are still being used in the treatment of Parkinsons disease, as prolactin inhibitors, in cerebrovascular insufciency, and in migraine treatments. Ergotamine, a major alkaloid involved, possesses greater biological activity than the other components of ergot and is used in human medicine (mainly as a vasoconstrictor and an oxytoxic) (van Rensburg and Altenkirk 1974).
Cyclopiazonic acid and associated health risks
Cyclopiazonic acid (CPA) (molecular weight: 336.4) is a toxic secondary metabolite that was originally isolated from Penicillium cyclopium and later on from other fungal species like: P. griseofulvum, Aspergillus avus, A. versicolor, and A. tamarii. Chemically, it is an indole tetramic acid. The signicance of CPA is obscure;
however, it is reported to naturally occur in peanuts (Urano and others 1992), corn (Lee and Hagler 1991), and in cheese (LeBars 1979). The health risks associated with CPA is very minimal, but in high concentrations it may be acutely toxic, especially to animals. This toxin is usually encountered on consumption of contaminated cereals. It is generally claimed to be a co-contaminant with AFB1 in North America. However, due to its co-occurrence, it is believed to reduce the danger of aatoxins by contributing towards their metabolic inhibition. Morrissey and others (1984) have assessed the potential effects of CPA on pregnancy and fetal development in Fischer-344 rats, which were given daily doses of CPA (0, 1, 5, or 10 mg CPA/kg body weight). The researchers reported a signicant decrease in feed consumption (at high dose) and the animals that died had histologic lesions in the liver, spleen, kidney, and other organs. Signicant differences in skeletal development were also observed that showed retardation of ossication of cervical centra and caudal vertebrae. Toxic effects of CPA in broiler chicks have been reported earlier (Cullen and others 1988; Kubena and others 1994; Balachandran and Parthasarathy 1996). CPA is also being assumed to induce mycotoxicoses in quail in Indonesia (Stoltz and others 1988). Only a few signicant ndings are discussed in the subsequent text. Smith and others (1992) evaluated the individual and combined effects of aatoxins and CPA in day-old Petersen x Hubbard broiler chickens to 3 wk of age. The treatments included supplementation with levels of 0 and 3.5 mg aatoxins/kg of feed, and 0 and 50 mg CPA/kg of feed. They recorded a signicant reduction in the body weight by aatoxins, CPA, and the aatoxins-CPA combination at the end of 3 wk. Toxicity of CPA indicated increase in weights of the liver, kidney, and proventriculus with enhancement in the levels of uric acid and cholesterol. A signicant decrease in serum phosphorus was also recorded. Activities of aatoxins and CPA combination showed an increase in weight of the liver, kidney, pancreas, and proventriculus with a decrease in concentrations of serum albumin and phosphorus. An increase in concentrations of serum glutamic oxalacetic transaminase and blood urea nitrogen, and decreases in the relative weight of the bursa of Fabricius were also observed. The postmortem results showed that chickens fed with CPA and the aatoxin-CPA combination had thickened mucosa and dilated proventricular lumens, hard brotic spleen, and atrophy of the gizzard. Kubena and others (1994) studied the effects of feeding 6 mg T-2 toxin and 34 mg CPA/kg of diet singly and in combination in male broiler chicks from 1 d to 3 wk of age. They found that the body weights were depressed by T-2 or CPA singly or after the combination of T-2 and CPA. A signicant synergistic interaction between T-2 and CPA with regard to liver and kidney weights and serum cholesterol and triglyceride concentrations was recorded. However, the efciency of feed utilization or mortality was not affected by dietary treatments. Oral lesions were observed in chicks fed diets containing CPA. Gentles and others (1999) evaluated the individual and combined effects of OTA and CPA in Petersen x Hubbard broiler chickens from 1 d to 3 wk of age, wherein treatments of 0 and 2.5 mg OTA/kg feed and 0 and 34 mg CPA/kg feed were administered. Results showed a decrease in the body weight gain by OTA, CPA, and OA-CPA in combination at the end of 3 wk. Increased relative weights of the proventriculus and activity of creatine kinase were the main toxic symptoms of CPA. The researchers reported that exposure to OA-CPA was characterized by increased relative weights of the liver, kidney, pancreas, and proventriculus, decreased concentrations of serum albumin, total protein, and cholesterol, and with increased activity of creatine kinase and
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Aatoxin M1
Bhat and others (2007), Ogbadu (1980), Temcharoen and Thilly (1982) McKenzie and others (1997) Staron and others (1980) Alderman and Marth (1976), Kensler and others (2004), Peterson and others (2006), Reddy and others (2009) Doyle and others (1982), Devegowda (2000),
phosphateethanol extraction Fermentative bacteria, thermal treatments Alkaline treatments, thermal treatments, genetic modication of plant Radiation processing Thermal treatments Polishing and milling By use of bentonite, modied bentonites, and chitosan Lactic acid bacteria Fermentation, heat treatments Chicken intestinal microbes
Kiermeier and Mashaley (1977), Yousef and Marth (1985); Lee and others (2007) Niderkorn and others (2007), Young and others (1987) Duvick (2001), Hendrich and others (1993), Jackson and others (1996) Paster and others (1985) Boudra and others (1995), Scudamore (2005), La Pera and others (2008) Osborne and others (1996) Kurtbay and others (2008) Del Prete and others (2007) Kadakal and Nas (2003), Ough and Corison (1980) Young and others (2007)
also been reported (Nony and others 1999). A delayed dystonia syndrome in children subsequent to initial gastrointestinal symptoms and acute noninammatory encephalopathy on ingestion of mildewed sugarcane containing 3-nitropropionic acid (3-NPA) has been reported by He and others (1995). Onyalai disease. Onyalai, an endemic disease of Africa (southern Sahara region) is caused by the mycotoxin produced by isolates of Phoma sorghina, which often contaminates millet. Onyalai has also been reported in a few black populations of central southern Africa (Kavango, Namibia) with a recorded incidence of 1 in 660 inhabitants/year (Hesseling 1992). The disease is known to be produced in rats fed with intentionally contaminated maize and wheat. This disease is characterized by hemorrhaging lesions in the mouth (Rabie and others 1975). Information on the possible pathways of the toxin is scarce.
Pre- and postharvest methods adapted to control mycotoxins
Increasing knowledge and awareness on the consumption of food and feeds contaminated with mycotoxins has turned the focus towards development of inactivation procedures. Reports are available wherein inactivation or removal of some of the common mycotoxins (like aatoxins, OTA, fumonisins) have been explored, and in certain cases have been successful. However, a wide gap still persists with regard to exploring the possibilities of removal or inactivation of other commonly occurring mycotoxins (both in food and feed), which have been described previously. Even though good agricultural practice and good manufacturing practice (GAP and GMP, respectively) are the best available option to minimize mycotoxins at the eld level, certain reports are available wherein various processing methodologies have been
adapted to eliminate these toxins. Table 2 highlights some of the recent postharvest methods adapted for removal of mycotoxins in human food, while Table 3 details on the maximum tolerable limits set for certain mycotoxins in food and feed. In the following text, a few are being discussed with regard to aatoxins, OTA, and Fusarium toxins. Removal or inactivation of aatoxins. Cotty and Bhatnagar (1994) proposed a new method that involves isolation of A. avus and A. parasiticus (nonvirulent strains that do not produce aatoxins), to compete with the natural toxin-producing strains. These strains occupied the same ecological niche as toxin-producing strains and they decreased the level of contamination with toxinproducing molds. Fungal co-occurrence in any product indicates the possible competition and succession or antagonism among the colonizing fungi. Co-occurrence of fungal species has been shown to inhibit or reduce the toxin concentration in a substrate (Mann and Rehm 1976). Co-inoculation of A. niger and Trichoderma viride onto maize or peanuts contaminated with A. avus has been shown to reduce aatoxin production (Wicklow and others 1980; Aziz and Shahin 1997). Reports are available (El-Nemazi and others 1998; Yoon and Baeck 1999) wherein specic strains of lactic acid bacteria (such as propionibacteria and bidobacteria) possessing typical cell wall structures can bind aatoxins and limit their bioavailability. These toxins could then be eliminated in the feces/excreta without any negative impact on the animals or any risk for toxic residues to be found in edible animal products. Also, some of the microbes (for example, Corynebacterium rubrum) have been shown to metabolize mycotoxins (aatoxins) in contaminated feed or to bio-transform them (Nakazato and others 1990).
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Table 3 --- Maximum tolerable limits set for certain mycotoxins in food and feed. Products 2ppb for AFB1 and 4 ppb for AF B1+B2+G1+G2 50 ng/kg 5 ng/kg body weight/d 10 g/kg 120 ng/kg body weight Limits set Reference
Mycotoxin
Aatoxins
Moss (2002), Stroka and Anklam (2002) EC (European Commission) (2006) Anonymous (2001) Skaug (1999) CEC (2002) EU Commission Regulation (2006a) WHO (2002) EU Commission Regulation (2006a) WHO (2002) Miller and others (1996) Creppy (2002), JECFA (2000) JECFA (2001) JECFA (2001) EU Commission Regulation (2006b) www.mycotoxin-certication.eu (accessed on 24 July 2009) Anonymous (1996)
Fumonisins
in milk in milk in dried wine fruits cereals, cereal products, raisins, roasted coffee, wine, grape juice, and food for children from all food source 2 g/kg body weight (bw)/d for fumonisins 200 g/kg (infants and young children) 80 ng/kg/d 5 to 50 g/g for horses 0.5 g/kg of body weight 1250 g/kg 1 g/kg body weight 0.061 g/kg body weight 0.4 g/kg body weight. 10 g/kg body weight 50 g/kg and 25 g/kg, respectively 5 ng/g
ZEN DON Trichothecenes (T-2 toxin ) Trichothecenes (HT-2 toxin) Patulin Patulin
maize-based formulae maize and other cereals animal feed for horses and other equine species, and for cattle in food and feed in raw cereals in food & feed
Patulin Phomopsins
overall reductions in total fumonisin levels (between 26.2% and 69.4%) and recommended that initial removal of nes from bulk shipments of maize, prior to further processing, can serve as an initial step for fumonisin decontamination. Signicant reduction in fumonisin concentrations on heating aqueous solutions (150 C and above) have been reported by Jackson and others (1996). Heating moist maize kernels were also successful in reducing this toxin (Murphy and others 1996). Other thermal treatments usually employed during conventional food processing like baking and frying has been shown to reduce fumonisin levels in corn. Mufns prepared by baking corn batter at around 175 to 200 C (for 20 min) reduced fumonisin levels up to 30%. Further decrease was observed with an increase in temperature. Reductions in fumonisin levels were higher on the surface of mufns, which has been attributed to better heat penetration corresponding to enhanced baking temperatures (Jackson and others 1997). Heating results in the hydrolysis of the primary amine of the fumonisins. Also, autoclaving at 121 C (1 h) in the presence of 8.33% aqueous sodium bisulte has been shown to reduce DON levels in corn by 95% (Young and others 1987). Transformation of DON to a lesser toxic metabolite (de-epoxyDON) by microbes in the large intestine of chickens has been reported by He and others (1992). Hendrich and others (1993) have reported reduction in fumonisin levels by alkaline processing, wherein the ester bonds of the toxin were hydrolyzed to release its tricarballylic groups and yield aminopentol (Hendrich and others 1993). The application of chemical methods has been unsuccessful for the elimination of fumonisins. Wang and others (1991) used the commercially available enzymes and tested their ability for detoxifying fumonisins; however, the reduction in the fumonisins was not signicant. However, to date no reliable and effective methods have been developed for the removal of fusario-toxins in food, a gap that needs to be lled at the earliest to reduce further economic losses, as well as for safety purpose. Inactivation/removal of Patulin. Even though removal of the rotten and injured portion of the fruits has been recommended for minimizing patulin concentrations, this does not completely ensure the elimination of the toxin (Beretta and others 2000). Ough and Corison (1980) have reported that fermentation can destroy patulin during cider production. Filtration employed to clarify apple juice and concentrates has been reported to decrease patulin levels up to 40% (Bissessur and others 2001). Also, a pasteurization or evaporation condition, wherein the temperature is between 70 and 100 C, has been shown to reduce patulin (by 25%) in naturally contaminated apple juice (Kadakal and Nas 2003). The adoption of various control methods for patulin in food products has been well reviewed by Moake and others 2005.
Mycotoxinsmode of action
Generally, understanding the chemical structure and basic mechanism of action of an individual mycotoxin can provide sufcient base to develop protocols or methods to efciently manage the mycotoxins associated problems, as well as to understand their biological effects. Even though several mycotoxins have been identied to date, the basic mechanism of action has been workedout for only a few of them (aatoxins, OTA, fumonisins) indicating a wide gap to persist. Of late, several excellent studies are available wherein the basic mechanisms of action of certain mycotoxins have been discussed in detail (like aatoxins, DON, fumonisin, OTA) (Kiessling 1986; Ueno 1991; Riley and Norred 1996; Riley 1998; Tashiro 2000).
Methods of mycotoxin detection
For qualitative, quantitative, and accurate determinations of mycotoxins in foods and feeds, several analytical methods have
Of late, use of electronic nose and soft X-ray imaging for the detection of fungi in food commodities have received positive attention (Perkowski and others 2008; Concina and others 2009; Narvankar and others 2009). However, these techniques might be useful for the rapid detection of the fungal pathogens only rather than a mycotoxin itself. It is highly imperative to develop newer detection methods for the rapid analysis of mycotoxins in food, particularly considering the new open global market under the new World Trade Organization (WTO) regime. The new analytical tools developed would be more useful if several mycotoxins could be screened simultaneously within a fraction of minutes in a large number of samples. For example, Gachok and others (2008) have reported the development of a uorescence polarization immunoassay, which could detect mycotoxins like OTA, AFB1, and ZEN in the samples present in low amounts up to 1 ng/mL, much lower than maximum residue limits (MRL) set for mycotoxins in food (from 10 to 100 ppb for different mycotoxins and in different foods).
Prevention and future outlook
Prevention of fungal contamination and thereby toxin production can be achieved either during preharvest stages by good crop husbandry and appropriate cultural practices and the use of a HACCP plan, as well as during postharvest stages by the application of proper drying, storage, and transport procedures (FAO 2006a, 2006b). Application of fungicides at eld levels might reduce mold growth resulting in the reduction of production of mycotoxins. However, it has been opined that the stress generated by the fungicides on the molds can also result in increased mycotoxin production (Gareis and Ceynowa 1994). Hence, further studies have to be initiated to look for a better and environmentally friendly alternative at the eld level rather than relying on chemicals. Development of resistant plant varieties with the application of modern biotechnological methods would prove to be benecial up to certain extent. Some studies in this regard are already being reported. For example, biotechnologically developed corn (Bt corn) has been reported to possess lower levels of contamination with fumonisin and aatoxin. A total prot of 23 million dollars annually due to Bt corns reduction of fumonisin and aatoxin in the U.S. has been estimated (Wu 2006). Even though organic farming is well established and has been forecast to reduce mycotoxin contamination in the food chain, it has not yet been possible to establish major differences in this regard when comparing it to conventional farming. However implementation of GAP in organic elds might denitely have a good impact on the contamination and production levels of mycotoxins. Removal of crop residues and undertaking crop rotation is a better option considering the fact that some viable pathogenic fungal spores might be present in the old crops after harvest. As the detoxication of human food and animal feeds (during postharvest stages) is performed mostly by employing chemical methods, safety, and efcacy along with handling, costs should be taken into consideration. Care should be taken to see that the preservatives or the chemicals employed do not degrade the overall nutritional, sensory, and functional properties of the food product. Hence, development of newer physical methods of preservation is a necessity in the near future. Of late, nonionizing radiation, like ultraviolet rays (UV), has been shown to be successful in reducing the microbial load and thereby toxin production. However, the penetration of UV rays is not deep at all. Application of UV in combination with heat treatment has been reported to be successful in the inactivation of conidia of Botrytis cinerea and Monilinia fructigena, which are the 2 major postharvest spoilage fungi of strawberries and cherries (Marquenie and others 2002). Successful prevention of the germination
Conclusions
The occurrence of mycotoxins in the food chain is an unavoidable and serious problem the world is facing. Apart from practicing good sanitary measures, awareness has to be created to indicate the toxic effects associated with mycotoxin poisonings in humans and livestock. Wide gaps still exist on the toxicological effects of feeding animals mycotoxin-contaminated feeds. Research in this eld is a necessity as there is every possibility that the toxins will enter the human food chain. Further research also needs to be focused on the generation of data dealing with epidemiological and toxicity effects, especially in humans. Implementation of strict quarantine rules with regard to mycotoxin contamination has to be made mandatory worldwide. Emphasis should be laid towards development of newer low-cost mycotoxin detection instruments, which are portable, reliable, and easy to handle at eld levels. Development of new genetically modied plants by the application of genetic engineering that might be resistant to fungal invasion might also prove to be a good option. Developing new protocols and strategies to compare the costs and benets of various controlling agents against fungal pathogens and mycotoxin production might be benecial for economic stability of a commodity or an agricultural area.
Acknowledgments
The authors gratefully acknowledge the scientic editor, Prof. Dr. Manfred Kroger, and the anonymous referees for comments and constructive suggestions provided for improving the manuscript.
References
Abdulrazzaq YM, Osman N, Yousif ZM, Al-Falahi S. 2003. Aatoxin M1 in breast-milk of UAE women. Ann Trop Paediatr 23:1739. Abnet CC, Borkowf CB, Qiao Y-L, Albert PS, Wang E, Merrill AH Jr, Mark SD, Dong Z-W, Taylor PR, Dawsey SM. 2001. Sphingolipids as biomarkers of fumonisin exposure and risk of esophageal squamous cell carcinoma in China. Cancer Causes Cont 12:8218. Abramson D, Lombaert G, Clear RM, Sholberg P, Trelka R, Rosin E. 2009. Production of patulin and citrinin by Penicillium expansum from British Columbia (Canada) apples. Mycotoxin Res 25:858. Adhikari M, Ramjee G, Berjak P. 1994. Aatoxin, kwarshiorkor and morbidity. J Nat Tox 2:13.
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