title: Toxicology of microcystins with reference to cases of human intoxications and epidemiological investigations of exposures to cyanobacteria and cyanotoxins.
abstract: Blooms of cyanobacteria have been documented throughout history, all over the world. Mass populations of these organisms typically present hazards to human health and are known for the production of a wide range of highly toxic metabolites-cyanotoxins, of which among the most common and most investigated are the microcystins. The toxicity of the family of microcystin congeners to animal and cell models has received much attention; however, less is known about their negative effects on human health, whether via acute or chronic exposure. Useful information may be acquired through epidemiological studies since they can contribute to knowledge of the relationships between cyanotoxins and human health in environmental settings. The aim of this review is to compile and evaluate the available published reports and epidemiological investigations of human health incidents associated with exposure to mass populations of cyanobacteria from throughout the world and to identify the occurrence and likely role of microcystins in these events. After an initial screening of 134 publications, 42 publications (25 on the chronic and 17 on the acute effects of cyanotoxins) describing 33 cases of poisonings by cyanobacterial toxins in 11 countries were reviewed. The countries were Australia, China, Sri Lanka, Namibia, Serbia, Sweden, UK, Portugal, Brazil, USA, and Canada. At least 36 publications link cyanobacteria/cyanotoxins including microcystins to adverse human health effects. The studies were published between 1960 and 2016. Although the scattered epidemiological evidence does not provide a definitive conclusion, it can serve as additional information for the medical assessment of the role of microcystins in cancer development and other human health problems. This paper discusses the major cases of cyanotoxin poisonings as well as the strengths, weaknesses, and importance of the performed epidemiological research. This study also proposes some recommendations for future epidemiological work.
authors.affiliation: Laboratory for Paleoenvironmental Reconstruction, Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovića 3, Novi Sad, 21000, Serbia. zorica.svircev@dbe.uns.ac.rs.|Biochemistry, Faculty of Science and Engineering, Åbo Akademi University, Tykistökatu 6 A, 20520, Turku, Finland. zorica.svircev@dbe.uns.ac.rs.
authors.forename: Zorica
authors.identifier: http://orcid.org/0000-0001-8355-7661
authors.initials: Z
authors.lastname: Svirčev
authors.affiliation: Laboratory for Paleoenvironmental Reconstruction, Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovića 3, Novi Sad, 21000, Serbia.
authors.forename: Damjana
authors.initials: D
authors.lastname: Drobac
authors.affiliation: Laboratory for Paleoenvironmental Reconstruction, Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovića 3, Novi Sad, 21000, Serbia.
authors.forename: Nada
authors.initials: N
authors.lastname: Tokodi
authors.affiliation: Institute of Public Health, dr Veselina Marinkovića 4, Užice, 31000, Serbia.|Medical Faculty Foca, University of East Sarajevo, Studentska 3, 58000, Foca, Republic of Srpska, Bosnia and Herzegovina.
authors.forename: Biljana
authors.initials: B
authors.lastname: Mijović
authors.affiliation: Biological and Environmental Sciences, University of Stirling, Stirling, FK9 4LA, Scotland, UK.|College of Life Sciences, University of Dundee, Dundee, DD1 5EH, Scotland, UK.
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Codd
authors.affiliation: Laboratory for Paleoenvironmental Reconstruction, Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovića 3, Novi Sad, 21000, Serbia.|Biochemistry, Faculty of Science and Engineering, Åbo Akademi University, Tykistökatu 6 A, 20520, Turku, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Meriluoto
mesh_terms: D000284:Administration, Oral; D001427:Bacterial Toxins / Q000506:poisoning / Q000633:toxicity*; D000458:Cyanobacteria; D000087522:Cyanobacteria Toxins; D004781:Environmental Exposure / Q000009:adverse effects / Q000032:analysis* / Q000706:statistics & numerical data; D057097:Harmful Algal Bloom; D006801:Humans; D008387:Marine Toxins / Q000506:poisoning / Q000633:toxicity*; D052998:Microcystins / Q000008:administration & dosage / Q000506:poisoning / Q000633:toxicity*; D011041:Poisoning / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D001427:Bacterial Toxins; D000087522:Cyanobacteria Toxins; D008387:Marine Toxins; D052998:Microcystins
keywords: Cyanobacteria; Epidemiology; Human health; Microcystins