# Aflatoxin/Aflatoxin in Detail
### Exposure to Aflatoxin

Children are particularly affected by aflatoxin exposure, which is associated with stunted growth, delayed development, liver damage, and liver cancer. An association between childhood stunting and aflatoxin exposure has been reported in some studies but could not be detected in all. Furthermore, a causal relationship between childhood stunting and aflatoxin exposure has yet to be conclusively shown by epidemiological studies, though such investigations are under way. Adults have a higher tolerance to exposure, but are also at risk. No animal species is immune. Aflatoxins are among the most carcinogenic substances known. After entering the body, aflatoxins may be metabolized by the liver to a reactive epoxide intermediate or hydroxylated to become the less harmful aflatoxin M$_1$.
Aflatoxin poisoning most commonly results from ingestion, but the most toxic aflatoxin compound, B$_1$, can permeate through the skin.
The United States Food and Drug Administration (FDA) action levels for aflatoxin present in food or feed is 20 to 300 ppb. The FDA has had occasion to declare both human and pet food recalls as a precautionary measure to prevent exposure.
The term "aflatoxin" is derived from the name of the species Aspergillus flavus, in which some of the compounds first were discovered. The word was coined around 1960 after its discovery as the source of "Turkey X disease". Aflatoxins form one of the major groupings of mycotoxins, and apart from Aspergillus flavus various members of the group of compounds occur in species such as: Aspergillus parasiticus, Aspergillus pseudocaelatus, Aspergillus pseudonomius", and Aspergillus nomius".

## Major types and their metabolites

Aflatoxin B$_1$ is considered the most toxic and is produced by both Aspergillus flavus and Aspergillus parasiticus. Aflatoxin M$_1$ is present in the fermentation broth of Aspergillus parasiticus, but it and aflatoxin M$_2$ are also produced when an infected liver metabolizes aflatoxin B$_1$ and B$_2$.
* Aflatoxin B$_1$ and B$_2$ (AFB), produced by Aspergillus flavus and A. parasiticus
* Aflatoxin G$_1$ and G$_2$ (AFG), produced by some Group II A. flavus and Aspergillus parasiticus
* Aflatoxin M$_1$ (AFM$_1$), metabolite of aflatoxin B$_1$ in humans and animals (exposure in ng levels may come from a mother's milk)
* Aflatoxin M$_2$, metabolite of aflatoxin B$_2$ in milk of cattle fed on contaminated foods
* Aflatoxicol (AFL): metabolite produced by breaking down the lactone ring
* Aflatoxin Q$_1$ (AFQ$_1$), major metabolite of AFB$_1$ in in vitro liver preparations of other higher vertebrates
AFM, AFQ, and AFL retain the possibility to become an epoxide. Nevertheless, they appear much less capable of causing mutagenesis than the unmetabolized toxin.

## Contamination conditions

Aflatoxins are produced by both Aspergillus flavus and Aspergillus parasiticus, which are common forms of 'weedy' molds widespread in nature. The presence of those molds does not always indicate that harmful levels of aflatoxin are present, but does indicate a significant risk. The molds can colonize and contaminate food before harvest or during storage, especially following prolonged exposure to a high-humidity environment, or to stressful conditions such as drought.
The native habitat of Aspergillus is in soil, decaying vegetation, hay, and grains undergoing microbiological deterioration, but it invades all types of organic substrates whenever conditions are favorable for its growth. Favorable conditions for production of aflatoxins include high moisture content (at least 7%) and temperatures from 55 °F (13 °C) to 104 °F (40 °C) [optimum 27 to 30 °C (81 to 86 °F)]. Aflatoxins have been isolated from all major cereal crops, and from sources as diverse as peanut butter and cannabis. The staple commodities regularly contaminated with aflatoxins include cassava, chilies, corn, cotton seed, millet, peanuts, rice, sorghum, sunflower seeds, tree nuts, wheat, and a variety of spices intended for human or animal consumption. Aflatoxin transformation products are sometimes found in eggs, milk products, and meat when animals are fed contaminated grains.
A study conducted in Kenya and Mali found that the predominant practices for drying and storage of maize were inadequate in minimizing exposure to aflatoxins.
Organic crops, which are not treated with fungicides, may be more susceptible to contamination with aflatoxins.

## Prevention

A primary means of limiting risk from aflatoxins in the food supply is food hygiene in the commercial commodity supply chain, such as rejecting moldy grain for use in food processing plants and testing of batches of ingredients for aflatoxin levels before adding them to the mix. Regulatory agencies such as the FDA set limits on acceptable levels. Grain drying itself, which is necessary for viable combine harvesting in many regions, lays the fundamentals for this effort by preventing stored grain from being too damp in the first place.
There is very limited evidence to show that agricultural and nutritional education can reduce exposure to aflatoxin in low to middle income countries.

## Pathology

No animal species is known to be immune to the acute toxic effects of aflatoxins. Adult humans have a high tolerance for aflatoxin exposure and rarely succumb to acute aflatoxicosis, but children are particularly affected, and their exposure can lead to stunted growth and delayed development, in addition to all the symptoms mentioned below.
High-level aflatoxin exposure produces an acute hepatic necrosis (acute aflatoxicosis), resulting later in cirrhosis or carcinoma of the liver. Acute liver failure is made manifest by bleeding, edema, alteration in digestion, changes to the absorption and/or metabolism of nutrients, and mental changes and/or coma.
Chronic, subclinical exposure does not lead to symptoms so dramatic as acute aflatoxicosis. Chronic exposure increases the risk of developing liver and gallbladder cancer, as aflatoxin metabolites may intercalate into DNA and alkylate the bases through epoxide moiety. This is thought to cause mutations in the p53 gene, an important gene in preventing cell cycle progression when there are DNA mutations, or signaling apoptosis (programmed cell death). These mutations seem to affect some base pair locations more than others, for example, the third base of codon 249 of the p53 gene appears to be more susceptible to aflatoxin-mediated mutations than nearby bases. As with other DNA-alkylating agents, Aflatoxin B$_1$ can cause immune suppression, and exposure to it is associated with an increased viral load in HIV positive individuals.
The expression of aflatoxin-related diseases is influenced by factors such as species, age, nutrition, sex, and the possibility of concurrent exposure to other toxins. The main target organ in mammals is the liver, so aflatoxicosis primarily is a hepatic disease. Conditions increasing the likelihood of aflatoxicosis in humans include limited availability of food, environmental conditions that favour mould growth on foodstuffs, and lack of regulatory systems for aflatoxin monitoring and control.
A regular diet including apiaceous vegetables, such as carrots, parsnips, celery, and parsley may reduce the carcinogenic effects of aflatoxin.
There is no specific antidote for aflatoxicosis. Symptomatic and supportive care tailored to the severity of the liver disease may include intravenous fluids with dextrose, active vitamin K, B vitamins, and a restricted, but high-quality protein diet with adequate carbohydrate content.

### In other animals

In dogs, aflatoxin has potential to lead to liver disease. Low levels of aflatoxin exposure require continuous consumption for several weeks to months in order for signs of liver dysfunction to appear. Some articles have suggested the toxic level in dog food is 100–300 ppb and requires continuous exposure or consumption for a few weeks to months to develop aflatoxicosis. No information is available to suggest that recovered dogs will later succumb to an aflatoxin-induced disease.
Turkeys are extremely susceptible to aflatoxicosis. Recent studies have revealed that this is due to the efficient cytochrome P450 mediated metabolism of aflatoxin B$_1$ in the liver of turkeys and deficient glutathione-S-transferase mediated detoxification.
Some studies on pregnant hamsters showed a significant relationship between exposure of aflatoxin B$_1$ (4 mg/kg, single dose) and the appearance of developmental anomalies in their offspring.
In 2005, Diamond Pet Foods discovered aflatoxin in a product manufactured at their facility in Gaston, South Carolina. In 23 states, Diamond voluntarily recalled 19 products formulated with corn and manufactured in the Gaston facility. Testing of more than 2,700 finished product samples conducted by laboratories confirmed that only two date codes of two adult dog formulas had the potential to be toxic.
In December 2020 and January 2021, Midwestern Pet Foods recalled dog food that contained fatal levels of aflatoxin. As many as 70 dogs had died from aflatoxin poisoning by January 12, 2021.

## Detection in humans

There are two principal techniques that have been used most often to detect levels of aflatoxin in humans.
The first method is measuring the AFB$_1$-guanine adduct in the urine of subjects. The presence of this breakdown product indicates exposure to aflatoxin B$_1$ during the past 24 hours. This technique measures only recent exposure, however. Due to the half-life of this metabolite, the level of AFB$_1$-guanine measured may vary from day to day, based on diet, it is not ideal for assessing long-term exposure.
Another technique that has been used is a measurement of the AFB$_1$-albumin adduct level in the blood serum. This approach provides a more integrated measure of exposure over several weeks or months.
* ↑ "Aflatoxins and growth impairment: a review". Critical Reviews in Toxicology 41 (9): 740–55. October 2011. doi:10.3109/10408444.2011.575766. PMID 21711088.
* 1 2
* ↑ "The Potential Role of Mycotoxins as a Contributor to Stunting in the SHINE Trial". Clinical Infectious Diseases 61 Suppl 7: S733–7. December 2015. doi:10.1093/cid/civ849. PMID 26602301. PMC 4657594. //www.ncbi.nlm.nih.gov/pmc/articles/PMC4657594/.
* ↑ "Association of aflatoxin exposure and height-for-age among young children in Guatemala". International Journal of Environmental Health Research 28 (3): 280–292. April 2018. doi:10.1080/09603123.2018.1468424. PMID 29706087.
* ↑ "Aflatoxin exposure in utero causes growth faltering in Gambian infants". International Journal of Epidemiology 36 (5): 1119–25. October 2007. doi:10.1093/ije/dym122. PMID 17576701.
* ↑ "Aflatoxin exposure during the first 36 months of life was not associated with impaired growth in Nepalese children: An extension of the MAL-ED study". PLOS ONE 12 (2): e0172124. 2017. doi:10.1371/journal.pone.0172124. PMID 28212415. PMC 5315312. //www.ncbi.nlm.nih.gov/pmc/articles/PMC5315312/.
* ↑ "Exposure to aflatoxin and fumonisin in children at risk for growth impairment in rural Tanzania". Environment International 115: 29–37. March 2018. doi:10.1016/j.envint.2018.03.001. PMID 29544138. PMC 5989662. //www.ncbi.nlm.nih.gov/pmc/articles/PMC5989662/.
* ↑ "The Potential Role of Mycotoxins as a Contributor to Stunting in the SHINE Trial". Clinical Infectious Diseases 61 Suppl 7 (Suppl 7): S733–7. December 2015. doi:10.1093/cid/civ849. PMID 26602301. PMC 4657594. //www.ncbi.nlm.nih.gov/pmc/articles/PMC4657594/.
* ↑ Hoffmann, V.; Jones, K.; Leroy, J. L. (2018). "The impact of reducing dietary aflatoxin exposure on child linear growth: a cluster randomised controlled trial in Kenya". BMJ Global Health 3: e000983. doi:10.1136/bmjgh-2018-000983. PMID 30588341. https://doi.org/10.1136/bmjgh-2018-000983.
* ↑ "Mitigating aflatoxin exposure to improve child growth in Eastern Kenya: study protocol for a randomized controlled trial". Trials 16: 552. December 2015. doi:10.1186/s13063-015-1064-8. PMID 26634701. PMC 4669614. //www.ncbi.nlm.nih.gov/pmc/articles/PMC4669614/.
* ↑ J. Varga, J.C. Frisvad, R.A. Samson: "Two new aflatoxin producing species, and an overview of Aspergillus section Flavi", Stud Mycol. 2011 Jun 30; 69(1): 57–80. doi: 10.3114/sim.2011.69.05
* ↑ "The phylogenetics of mycotoxin and sclerotium production in Aspergillus flavus and Aspergillus oryzae". Fungal Genetics and Biology 31 (3): 169–79. December 2000. doi:10.1006/fgbi.2000.1215. PMID 11273679. https://naldc-legacy.nal.usda.gov/naldc/download.xhtml?id=35468&content=PDF.
* ↑ "Metabolism and toxicity of aflatoxins M1 and B1 in human-derived in vitro systems". Toxicology and Applied Pharmacology 151 (1): 152–8. July 1998. doi:10.1006/taap.1998.8440. PMID 9705898.
* ↑ "Risk of aflatoxin contamination increases with hot and dry growing conditions | Integrated Crop Management". crops.extension.iastate.edu. Retrieved 2021-06-13.
* ↑ "Storing nuts at a low temperature (refrigeration) reduces aflatoxin levels and mold and yeast counts for 3-6 months | News | Postharvest - Fruits, Vegetables and Ornamentals". www.postharvest.biz. Retrieved 2021-06-13.
* ↑ Pradeepkiran, Jangampalli Adi (December 2018). "Analysis of aflatoxin B1 in contaminated feed, media, and serum samples of Cyprinus carpio L. by high-performance liquid chromatography". Food Quality and Safety 2 (4): 199–204. doi:10.1093/fqsafe/fyy013.
* ↑ "Agricultural and nutritional education interventions for reducing aflatoxin exposure to improve infant and child growth in low- and middle-income countries". The Cochrane Database of Systematic Reviews 4: CD013376. April 2020. doi:10.1002/14651858.cd013376.pub2. PMID 32270495. PMC 7141997. //www.ncbi.nlm.nih.gov/pmc/articles/PMC7141997/.
* 1 2
* ↑ "Association of aflatoxin with gallbladder cancer in Chile". JAMA 313 (20): 2075–7. May 2015. doi:10.1001/jama.2015.4559. PMID 26010638. PMC 7169945. //www.ncbi.nlm.nih.gov/pmc/articles/PMC7169945/.
* ↑ "Aflatoxin B1 induces the transversion of G-->T in codon 249 of the p53 tumor suppressor gene in human hepatocytes". Proceedings of the National Academy of Sciences of the United States of America 90 (18): 8586–90. September 1993. doi:10.1073/pnas.90.18.8586. PMID 8397412. PMC 47402. //www.ncbi.nlm.nih.gov/pmc/articles/PMC47402/.
* ↑ FDA Inspection Report-Diamond Gaston SC Plant 12/21/2005-1/19/2006.
* ↑ 2005 Recall, FDA
* ↑ AKC Standard Article Contaminated Diamond Pet Food Products and 'Best By' Dates Narrowed Akcstandard.com Archived July 7, 2011, at the Wayback Machine
* ↑ Medicine, Center for Veterinary (2021-01-12). "FDA Alert: Certain Lots of Sportmix Pet Food Recalled for Potentially Fatal Levels of Aflatoxin". FDA. https://www.fda.gov/animal-veterinary/outbreaks-and-advisories/fda-alert-certain-lots-sportmix-pet-food-recalled-potentially-fatal-levels-aflatoxin.
* ↑ Tyko, Kelly. "Dog food recall expands: More than 70 dogs have died and 80 pets sick after eating Sportsmix pet food". USA TODAY. Retrieved 2021-01-13.