Applications of Mycotoxin Biomarkers in Human Biomonitoring for Exposome-Health Studies: Past, Present, and Future

Abstract This publication reviews the state-of-the-art human biological monitoring (HBM) of mycotoxin biomarkers in breast milk, plasma, serum, and whole blood samples with a focus on the past two decades (2000–2011 and 2011–2021). Three aspects have been analyzed and summarized: (a) the biomarkers detected and their levels found, (b) the analytical methodologies developed and employed, and (c) the exposome concept and the significance of omics tools. From the literature reviewed, aflatoxins (AFs) and ochratoxin A (OTA) in human breast milk, plasma and serum were the most widely studied mycotoxin biomarkers for HBM. Regarding analytical methodologies, a clear increase in the development and implementation of mass spectrometry methods for simultaneous determination of multiple mycotoxins was observed. For this purpose, use of liquid chromatography (LC) methodologies, especially when coupled with tandem mass spectrometry (MS/MS) or high-resolution mass spectrometry (HRMS) has grown substantially and are now the methods of choice. A high percentage of the samples analyzed for various mycotoxins in the literature reviewed were found to contain biomarkers, demonstrating a combination of targeted sampling and high levels of human exposure to mycotoxins within the target populations. Also, most HBM investigations only examined exposure to one or a few mycotoxins at a given period. Human exposome studies undertake a wider evaluation of the exposure as part of epidemiological studies through the discovery of novel biomarkers that exist as potential indicators of environmental influences on human health. However, guidelines are required for analytical method validation, as well as algorithms to establish the relationship between the levels of biomarkers detected in human biofluids and mycotoxin intake.