hrvatski

Uloga mikotoksina u etiologiji endemske nefropatije : (u povodu nedavno održanog simpozija o etiopatogenezi i ranoj dijagnostici endemske nefropatije)

One of the main arguments of the International Symposium on Endemic Nephropathy held in Zagreb from 7 to 9 November 1996 was the etiology of endemic nephropathy (EN). Several participanst of the Symposium suggested that the most plausible theory as to the etiology was the one that pinpointed the mycotoxin ochratoxin A (OA) as a causative agent of the disease. The involvment of ochratoxin A in the etiology of EN has been investigated for a long time in the Laboratory of toxicology within the Institute for Medical Research and Occupational Health in Zagreb. The obtained laboratory results, independently confirmed by other authors, speak in favor of this hypothesis. OA was found in the serum of persons from an endemic region in Croatia. It has been determined that OA is nephrotoxic for all animal species tested so far, and that hardly is there a reason not to consider it nephrotoxic for humans just as well. Its immunotoxic, mutagenic, genotoxic, carcinogenic properties have been proved on laboratory animals. Epidemiological studies of the endemic areas have revealed unusually high incidence of uro-epithelial carcinomas with rather specific features, different from carcinomas of the same localization in persons from nonendemic areas. The most serious argument against the theory of involvment of OA in the development of EN is that this mycotoxin is ubiquitous and was found in the human serum in several countries where EN is not known. However, the incidence of OA positive samples as well as its quantity in the sera of persons from endemic villages were higher than from control villages where EN was not found. The toxicity of compounds is dose- and time- related and depends on their bioavailability. Therefore, it is possible that OA reveals nephrotoxic properties only after a longer (or continous) exposure to higher doses that these found in control villages. Some improvement in socio-hygienic measures introduced to the endemic region of Croatia may explain the decrease in the incidence of EN and the change in the age distribution (in the last 20 years, EN peak incidence has shifted to older population, the patients are in better general conditions when the disease is diagnosed, and the survival period is longer). The role of OA causation of EN has not been firmly established as yet, and other factors should not be dismissed. However, further investigation should focus on the involvment of mycotoxins, as the most plausible etiological hypothesis.

mikotoksini; okratoksin A; endemska nefropatija

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