1. Introduction
The confinement buildings used for swine production are recognized for their high levels of contamination with fungi and their metabolites [
1,
2,
3,
4,
5,
6]. Previous studies performed in swine farms demonstrated that this environment could be considered an occupational setting with high levels of exposure to dust aerosolization [
4,
7,
8,
9], and consequently it results in the widespread presence of fungi and their metabolites, such as volatile organic compounds and mycotoxins [
1,
2,
4,
9,
10,
11]. Therefore, it is expected that swine production workers are exposed simultaneously to multiple contaminants, as demonstrated previously by some authors [
5,
8]. Besides, the swine feed contamination by mycotoxins is also a well-known and frequently reported issue in Portugal [
12] and all over the world [
13,
14,
15,
16].
Occupational exposure to aflatoxin B
1 (AFB
1) in Portuguese swine production farms has been reported [
17]. However, data regarding fungal contamination showed that exposure to other mycotoxins besides AFB
1 could be expected in this setting. Indeed, in addition to the
Aspergillus section
Flavi, other fungal species recognized as mycotoxin producers were found in this occupational environment [
5,
10]. The most prevalent found in air (20.9%) and surface (26.6%) samples was the
Aspergillus section
Versicolores. However, other
Aspergillus sections were also found, namely
Nigri,
Circumdati and
Fumigati [
5,
10], and all of them have recognized toxigenic potential [
18], besides the clinical relevance of
Fumigati section [
19].
Occupational exposure to mycotoxins is considered a complex process since it is associated with co-exposure to several mycotoxins by different exposure routes. In this context, human biomonitoring is of particular importance, characterizing the workers exposure to multiple mycotoxins and taking advantage of already available analytical methods that cover the detection and quantification of several mycotoxins and metabolites simultaneously in different biological samples [
20,
21,
22,
23]. Therefore, biomonitoring has an important role in the determination of the real human exposure to mycotoxins [
17,
20,
22,
24,
25,
26,
27]. Biomonitoring covers not only mycotoxin intake from all dietary sources, but also exposure by other routes, such as inhalation of mycotoxins at the workplace [
28]. Nowadays, the use of biomarkers has become more common, and research to discover new and more specific biomarkers has been proposed since the use of biomarkers is proven to be a successful method to assess exposure to xenobiotics. However, some challenges have to be addressed, such as the deep knowledge about the toxicokinetics and the possible metabolites for all relevant mycotoxins [
29]. Other challenges include the frequent discovery of new metabolites for a specific mycotoxin and the need for understanding their possible use for biomonitoring studies, considering the measuring feasibility and the representativeness of the information regarding exposure to that mycotoxin [
30]. Few studies have been performed with the use of biomarkers to study occupational exposure to mycotoxins [
23,
27,
28].
Whether workplace-related exposure could represent a significant exposure source to mycotoxins as compared to exposure through ingestion of contaminated food constitutes a critical issue. As suggested by Reference [
28], the comparison of results from workers and from non-occupationally exposed individuals (controls) should shed light on this issue contributing to the clarification of the importance of some occupational settings to multiple mycotoxins exposure in humans. The control group includes workers from administrative companies from the same locality and where the workplace environment does not have conditions to promote exposure to mycotoxins. This enables us to take into account the exposure by food intake and to have a better understanding of the role of the working environment in the total burden of mycotoxin exposure [
4,
24].
The present study aims to characterize the occupational exposure to multiple mycotoxins, including aflatoxin M1 (AFM1), aflatoxin B1 (AFB1), aflatoxin B2 (AFB2), aflatoxin G1 (AFG1), aflatoxin G2 (AFG2), patulin (PAT), nivalenol (NIV), deoxynivalenol (DON), deoxynivalenol-3-glucoside (DON-3-G), 15-acetyldeoxynivalenol (15-AcDON), 3-acetyldeoxynivalenol (3-AcDON), deepoxy-deoxynivalenol (DOM-1), deoxynivalenol-glucuronide (DON-GlcA), fusarenon-X (FUS-X), α-zearalanol (α-ZAL), β-zearalanol (β-ZAL), α-zearalenol (α-ZEL), β-zearalenol (β-ZEL), zearalenone (ZAN), zearalenone (ZEN), toxin T-2 (T-2), toxin HT-2 (HT-2), toxin HT-2-4-glucuronide (HT-2-4-GlcA), T-2 tetraol, T-2 triol, neosolaniol (NEO), monoacetoxyscirpenol (MAS), diacetoxyscirpenol (DAS), fumonisin B1 (FB1), fumonisin B2 (FB2), fumonisin B3 (FB3), roquefortine C (ROQ-C), griseofulvin (GRIS), ochratoxin A (OTA), ochratoxin B (OTB), ochratoxin alpha (OTα), mycophenolic acid (MPA), mevinolin (MEV), sterigmatocystin (STER), citrinin (CIT), dihydrocitrinone (DH-CIT), Enniatin B (EnB), of workers of swine production, in addition to the previously documented exposure to AFB1.
3. Discussion
This study is the result of previous work related to occupational exposure to mycotoxins and the need to identify the contribution of specific occupational settings to total mycotoxins exposure. At the same time, this study and previous ones [
27,
31] allow us to recognize mycotoxins as real and common occupational risk factors in specific occupational settings. Indeed, as in previous reports, results showed that the occupational environment and probably specific work tasks developed by the workers implicate exposure to mycotoxins by inhalation. Although no statistical significance was obtained in some tests, results demonstrated that only workers presented quantifiable levels of DON-GlcA (a biomarker of exposure to DON), AFM
1 (the hydroxylated metabolite of AFB
1, EnB (also a Fusarium toxin)), DH-CIT (the main metabolite of CIT) and OTA (the most-abundant food-contaminating mycotoxin). One possible reason for the absence of statistical significance in some tests could be due to the small sample size in both groups. Additionally, the type of urine samples used for this study (spot samples) might be responsible since 24 h urine (or first-morning void) are more concentrated with mycotoxins than one spot urine sample [
32]. For instance, in the case of DON, previous studies showed that there is clear evidence that urinary DON excretion varies at different times of the day, and spot samples cannot describe these differences [
33,
34,
35].
Consequently, the results were mainly discussed in the context of their values and not their statistical significance. However, and despite the small number, results indicate that even if workers are exposed through food consumption to some of these mycotoxins, occupational exposure is adding and contributing to the total exposure. This is not difficult to understand if we consider that, besides air samples, all the other environmental samples collected presented high and diverse levels of contamination, and DON was, like in the biomonitoring results, the most prominent mycotoxin. Additionally, the almost null results regarding air samples can be explained by the fact that mycotoxins are not volatile, and for the workers, exposure by inhalation occurs when exposure to organic dust happens in specific tasks since dust functions as a mycotoxins carrier and enters respiratory systems. A previous work developed by Reference [
36] identified in swine farms the predictors for dust exposure being associated with tasks involving intense animal handling, such as castrating, ear tagging, and teeth cutting, as well as activities related to feeding, floor sweeping, and removal of dry manure. If we consider the results obtained in the current study concerning the high contamination found in the litter and feed samples, it is possible to estimate that feeding, floor sweeping, and removal/change of litter will be responsible for the workers’ dust and mycotoxins exposure. Furthermore, dust particles containing mycotoxins can be deposited in the skin, leading to dermal absorption, or work surfaces contaminated with dust particles can also be touched, generating the opportunity for additional skin contact [
4,
37]. Consequently, this exposure route is also possible in this occupational setting since workers do not use gloves and most of the workers were using short leaves when performing their working tasks. Unfortunately, there is a lack of information on the adsorption rates from lungs and skin for mycotoxins in humans.
The results obtained regarding feed contamination (between 9–17 mycotoxins in the same sample) demonstrate that feed has a relevant role in workplace environment contamination with mycotoxins and the handling of feed is probably one of the tasks that implicates exposure. An important preventive action will be the choice of the raw materials used during feed formulation, avoiding the use of materials with high mycotoxin contaminations. Considering this aspect, it seems of interest to highlight the influence that the geographic origin of the raw material can have on the mycotoxin contamination of feed at different stages of production [
38]. Previously, and similarly to our findings, DON has been reported as the more prevalent mycotoxin in the different types of raw materials used to produce feed, since it is common to find DON, for instance, in maize, wheat, soybean meal, and others [
38]. This contamination has several consequences for pig health, such as increased susceptibility to infectious diseases, reactivation of chronic infection, and a decreased vaccine efficacy, with a huge economic impact on pig production [
39]. Other mycotoxins present in all the feed samples analyzed, although in lower concentrations, such as ZEN, fumonisins (FB
1, FB
2, and FB
3), and type A trichothecenes (T-2 and HT-2) are also commonly reported as contaminants of feed and have several health consequences for the animals [
38,
39]. Therefore, preventive actions taken to avoid feed contamination will result in preventing/reducing workers exposure to mycotoxins and, at the same time, guarantee better production results.
Exposure to mycotoxins mixtures was also once more revealed in this biomonitoring study. Both group results in workers and controls showed that this is a common aspect. This is understandable since, besides the presence of multiple mycotoxins in the occupational environment, this is also a common feature of food commodities. Even the most frequent combination found in biological samples from workers and controls (DON and OTA) were already reported in several foods from European countries such as beer, pasta, cereals, and cereal-based foods [
26,
40].
A previous paper developed by Reference [
41] assessed DON and OTA interactions using two different model systems appropriate for the evaluation of intestinal or liver toxicity and an experimental design that included realistic doses of each mycotoxin. The authors found that Caco-2 and HepG2 cells were more sensitive to DON alone than to OTA. Moreover, when combined, OTA-DON showed the most toxic combinations for Caco-2 and HepG2, respectively, having both synergistic effects at all inhibition levels [
41]. The same trend was found for the combination AFB
1-DON, a mixture also observed in our study. Therefore, the results obtained in the present study, even if exposure route is mainly via inhalation, suggest that exposure to DON occurs in combination with other mycotoxins and this should be considered when performing risk assessment.
Regarding the high prevalence of OTA in the samples of both groups, previous studies developed in the Portuguese population found OTA in biologic fluids [
40,
42,
43,
44] relating to the consumption of some food commodities. Additionally, Reference [
43] concluded that the estimated daily intake values in the Portuguese populations are higher than other European populations. Indeed, our results are probably explained once again by the fact that this mycotoxin is one of the most-abundant food-contaminating mycotoxins [
44]. In Portugal, the bread is the major cereal-derived product consumed, and it is probably the main factor responsible for OTA exposure, also due to the contamination levels. Other products such as wine and pork also contribute to exposure but are more related to the high consumption rate of these products and not so much due to their contamination levels [
44].
One aspect relevant to the analysis is the fact that in all environmental samples, including air samples, STER was detected, with a high frequency and concentration in the feed samples. STER synthesis is restricted to species in four sections in
Aspergillus (
Ochraceorosei,
Versicolores,
Nidulantes, and
Flavi) [
45]. However, most of the
Aspergillus species from the section
Versicolores are able to produce STER, and this was the most prevalent species on air and surface samples from the swine farms engaged in this study. Therefore, besides the feed contaminated with STER that has already been reported [
45], it seems that the swine farm environment can promote this mycotoxin production by the
Versicolores section. STER is extensively metabolized essentially by glucuronidation but the identification of the glucuronide forms in human biological samples has not been accomplished until now [
29]. Further studies should be developed to determine the most suitable STER biomarkers for identifying exposure.
This study demonstrates once more the usefulness of biomonitoring tools. These tools not only allowed us to identify that the occupational environment is contributing to the swine workers’ total exposure to mycotoxins but also it revealed that exposure occurs as a mixture of mycotoxins. Furthermore, and considering that some mycotoxin mixtures could lead to additive or synergistic effects, a significant threat to human and animal health could occur. However, most studies have been carried out over less than three days and at concentrations above the legal limits available in the context of food safety. There is therefore a lack of data about chronic exposure at sub-toxic mycotoxin concentrations, closer to real food and feed consumption habits [
46]. This implies also the availability of enough sensitive analytical techniques for the quantification of biomarkers of multiple co-occurring mycotoxins [
47]. Likewise, and concerning occupational exposure, probably we are dealing with intermittent exposures linked with very high concentrations within a short duration of time. This exposure is in addition to the exposure occurring via food intake (chronic exposure to low amounts). Subsequently, there is a gap in the knowledge concerning the approach which should be used to accomplish a suitable risk assessment methodology. Toxicokinetics and toxicodynamics data from exposure sources other than ingestion, as well as human biomonitoring guidance values, are needed in order to anticipate the associated risk. This implies that the involved stakeholders need to extend the dialogue across different chemical sectors (food safety vs. occupational health) in order to come to more overarching and harmonized approaches [
48].
Moreover, the exposure scenario found in this occupational setting can suffer variations due to climate change that will affect cereals (used for feed), agricultural practices, and the ecological niches of mycotoxigenic fungi in a particular area. In the future, mycotoxin producers in temperate climates will be replaced by better-adapted species or mutants which may produce new secondary metabolites [
49,
50]. Therefore, monitoring programs considering biological and environmental samples should be developed continuously to allow for a better and more detailed exposure scenario. In addition to this, adequate health surveillance programs should be applied.