title: Dietary BMAA exposure in an amyotrophic lateral sclerosis cluster from southern France.
abstract: BACKGROUND
  Dietary exposure to the cyanotoxin BMAA is suspected to be the cause of amyotrophic lateral sclerosis in the Western Pacific Islands. In Europe and North America, this toxin has been identified in the marine environment of amyotrophic lateral sclerosis clusters but, to date, only few dietary exposures have been described.
  
  
  OBJECTIVE
  We aimed at identifying cluster(s) of amyotrophic lateral sclerosis in the Hérault district, a coastal district from Southern France, and to search, in the identified area(s), for the existence of a potential dietary source of BMAA.
  
  
  METHODS
  A spatio-temporal cluster analysis was performed in the district, considering all incident amyotrophic lateral sclerosis cases identified from 1994 to 2009 by our expert center. We investigated the cluster area with serial collections of oysters and mussels that were subsequently analyzed blind for BMAA concentrations.
  
  
  RESULTS
  We found one significant amyotrophic lateral sclerosis cluster (p = 0.0024), surrounding the Thau lagoon, the most important area of shellfish production and consumption along the French Mediterranean coast. BMAA was identified in mussels (1.8 µg/g to 6.0 µg/g) and oysters (0.6 µg/g to 1.6 µg/g). The highest concentrations of BMAA were measured during summer when the highest picocyanobacteria abundances were recorded.
  
  
  CONCLUSIONS
  While it is not possible to ascertain a direct link between shellfish consumption and the existence of this ALS cluster, these results add new data to the potential association of BMAA with sporadic amyotrophic lateral sclerosis, one of the most severe neurodegenerative disorder.
authors.affiliation: Ecologie des Systèmes Marins Côtiers, Unité Mixte de Recherche 5119, Institut de Recherche pour le Développement, Ifremer, Université Montpellier 2, Montpellier, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Masseret
authors.affiliation: Institute for Ethnomedicine, Jackson, Wyoming, United States of America.
authors.forename: Sandra
authors.initials: S
authors.lastname: Banack
authors.affiliation: Net, Unité Mixte de Recherche 1094, Université de Limoges, Limoges, France.
authors.forename: Farid
authors.initials: F
authors.lastname: Boumédiène
authors.affiliation: Laboratoire Environnement Ressources/Languedoc Roussillon, Ifremer, Sète, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Abadie
authors.affiliation: Unité Mixte de Recherche 6553, Eco-bio, Université de Rennes I, Rennes, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Brient
authors.affiliation: Ifremer-Laboratoire Environnement Ressource Languedoc-Roussillon, Sète, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Pernet
authors.affiliation: Amyotrophic Lateral Sclerosis Center, Centre Hospitalier Universitaire Gui de Chauliac and Institut National de la Santé et de la Recherche Médicale U1051, Montpellier University 1, Montpellier, France.
authors.forename: Raoul
authors.initials: R
authors.lastname: Juntas-Morales
authors.affiliation: Amyotrophic Lateral Sclerosis Center, Centre Hospitalier Universitaire Gui de Chauliac and Institut National de la Santé et de la Recherche Médicale U1051, Montpellier University 1, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pageot
authors.affiliation: Institute for Ethnomedicine, Jackson, Wyoming, United States of America.
authors.forename: James
authors.initials: J
authors.lastname: Metcalf
authors.affiliation: Institute for Ethnomedicine, Jackson, Wyoming, United States of America.
authors.forename: Paul
authors.initials: P
authors.lastname: Cox
authors.affiliation: Amyotrophic Lateral Sclerosis Center, Centre Hospitalier Universitaire Gui de Chauliac and Institut National de la Santé et de la Recherche Médicale U1051, Montpellier University 1, Montpellier, France.
authors.forename: William
authors.initials: W
authors.lastname: Camu
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000453:epidemiology / Q000209:etiology; D000818:Animals; D001427:Bacterial Toxins / Q000633:toxicity*; D049872:Bivalvia; D000458:Cyanobacteria; D005260:Female; D005506:Food Contamination; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012758:Shellfish / Q000009:adverse effects*
chemical_list: D001427:Bacterial Toxins