Evaluating Weight of Evidence in the Mystery of Balkan Endemic Nephropathy
Identifieur interne : 000137 ( Pmc/Checkpoint ); précédent : 000136; suivant : 000138Evaluating Weight of Evidence in the Mystery of Balkan Endemic Nephropathy
Auteurs : Travis Bui-Klimke [États-Unis] ; Felicia Wu [États-Unis]Source :
- Risk analysis : an official publication of the Society for Risk Analysis [ 0272-4332 ] ; 2014.
Abstract
Balkan Endemic Nephropathy (BEN) is a chronic, progressive wasting disease of the kidneys, endemic in certain rural regions of the Balkan nations Croatia, Serbia, Bulgaria, and Romania. It is irreversible, and ultimately fatal. Though this disease was first described in the 1920s, its causes have been a mystery and a source of much academic and clinical contention. Possible etiologic agents that have been explored include exposure to metals and metalloids, viruses and bacteria, and the environmental toxins aristolochic acid (AA) and ochratoxin A (OTA). Aristolochic acid is a toxin produced by weeds of the genus
Url:
DOI: 10.1111/risa.12239
PubMed: 24954501
PubMed Central: 4199864
Affiliations:
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<front><div type="abstract" xml:lang="en"><p id="P1">Balkan Endemic Nephropathy (BEN) is a chronic, progressive wasting disease of the kidneys, endemic in certain rural regions of the Balkan nations Croatia, Serbia, Bulgaria, and Romania. It is irreversible, and ultimately fatal. Though this disease was first described in the 1920s, its causes have been a mystery and a source of much academic and clinical contention. Possible etiologic agents that have been explored include exposure to metals and metalloids, viruses and bacteria, and the environmental toxins aristolochic acid (AA) and ochratoxin A (OTA). Aristolochic acid is a toxin produced by weeds of the genus <italic>Aristolochia</italic>
, common in Balkan wheat fields. <italic>Aristolochia</italic>
seeds may intermingle with harvested grains and thus inadvertently enter human diets. Ochratoxin A is a mycotoxin (fungal toxin) common in many foods, including cereal grains. In this study, we analyzed the weight of evidence for each of the suspected causes of BEN using the Bradford Hill Criteria (BHC): nine conditions that determine weight of evidence for a causal relationship between an agent and a disease. Each agent postulated to cause BEN was evaluated using the nine criteria, and for each criterion was given a rating based on the strength of the association between exposure to the substance and BEN. From the overall available scientific evidence for each of these suspected risk factors, aristolochic acid is the agent with the greatest weight of evidence in causing BEN. We describe other methods for testing causality from epidemiological studies, which support this conclusion of AA causing BEN.</p>
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Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, USA</aff>
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Michigan State University, Department of Food Science and Human Nutrition, East Lansing, MI 48824, USA</aff>
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Address correspondence to: Felicia Wu, 2Michigan State University, Department of Food Science and Human Nutrition, East Lansing, MI 48824, USA; tel: 517-355-8474; <email>fwu@msu.edu</email>
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<pmc-comment>elocation-id from pubmed: 10.1111/risa.12239</pmc-comment>
<abstract><p id="P1">Balkan Endemic Nephropathy (BEN) is a chronic, progressive wasting disease of the kidneys, endemic in certain rural regions of the Balkan nations Croatia, Serbia, Bulgaria, and Romania. It is irreversible, and ultimately fatal. Though this disease was first described in the 1920s, its causes have been a mystery and a source of much academic and clinical contention. Possible etiologic agents that have been explored include exposure to metals and metalloids, viruses and bacteria, and the environmental toxins aristolochic acid (AA) and ochratoxin A (OTA). Aristolochic acid is a toxin produced by weeds of the genus <italic>Aristolochia</italic>
, common in Balkan wheat fields. <italic>Aristolochia</italic>
seeds may intermingle with harvested grains and thus inadvertently enter human diets. Ochratoxin A is a mycotoxin (fungal toxin) common in many foods, including cereal grains. In this study, we analyzed the weight of evidence for each of the suspected causes of BEN using the Bradford Hill Criteria (BHC): nine conditions that determine weight of evidence for a causal relationship between an agent and a disease. Each agent postulated to cause BEN was evaluated using the nine criteria, and for each criterion was given a rating based on the strength of the association between exposure to the substance and BEN. From the overall available scientific evidence for each of these suspected risk factors, aristolochic acid is the agent with the greatest weight of evidence in causing BEN. We describe other methods for testing causality from epidemiological studies, which support this conclusion of AA causing BEN.</p>
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