By: Matt Pratt-Hyatt, PhD
Welcome back to the RTL blog. I know it is a trying time for all of us with the coronavirus pandemic. However, mold induced illness and other illnesses aren’t taking a break while we are concerned about COVID-19. The staff here at RTL are looking to help in any way we can. We have worked with the CDC to implement COVID-19 testing in our facility.
Today I decided to discuss clinical testing for mycotoxins and then next month I will discuss testing your home, office, children’s school, etc. Testing patients for mold exposure can be a tricky subject and there is a lot of misleading information out there. I will try to be as thorough as I can be in this post and try to explain all of the differences in testing.
Mycotoxins are metabolites or by products from mold. These mycotoxins have a wide range of toxicity and effects that they can cause to the human body. There are over 300 different species of mold that produce mycotoxins, however, many of these mold species produce the same mycotoxins. This means that a panel much smaller than 300 can determine if a person has been exposed to mold and if they still have mycotoxins in their system. Mycotoxins can enter the body through many different routes. They can be absorbed through the skin, they can enter through breathing or ingestion, or they can be produced inside the body in patients that have mold colonization. These mycotoxins can be stored in the adipose tissue in the body and could stay there for months. The body attempts to modify the mycotoxins to make them more water soluble so they can be removed. The mycotoxins that any test measures are those that the bodies removed at any single time, and unfortunately this removal is not uniform from day to day, which will lead to some variations if testing is done day to day.
I know that testing for mycotoxins can be scary and I’ve met a lot of people that have avoided doing the testing because they don’t want to know the answer. However, it is almost always better to have this information to not have it. Not everyone exhibits symptoms from exposure to mold immediately and sometimes only certain members of a family will start before others. This is because everyone detoxes at different rates and some individuals are far more susceptible to mold toxicity than others. However, building up mycotoxins in your system could predispose you to serious chronic health issues down the line. Diseases that arise from mold exposure are quite varied and I don’t think we know every disease linked to mold exposure. Here are some of the diseases, but not a complete list, dementia, ADHD, Parkinson’s, rashes, depression, chronic fatigue, cancer, COPD, and many more.
There are three main types of testing for mycotoxins for clinical results, which are ELISA testing, LC/MS testing/ and blood antibody tests. The first two are adequate types of clinical tests while the third has not been proven useful and I would not recommend it. Mycotoxin tests have been in development since the late 90’s and the technology has been improving ever since. I will discuss details of all three tests and why you should use one test over another.
The gold standard for the last 15 years for mycotoxin tests has been the Realtime Labs ELISA test. With their patented technology they have brought routine mycotoxin to patients in order to help solve chronic health issues that have been brought about by mold exposure. They have published multiple papers in medical journals (LINK). ELISA testing works by developing antibodies to certain molecules (mycotoxins) in this case. The antibody is coated on the bottom of 96 well plates (See Figure 1). Samples are then added to the wells along with labeled
mycotoxins (mycotoxins which are chemically bonded to agents which will cause a color change). The mycotoxins in the samples compete with the labeled mycotoxins for a limited number of antibody binding sites on the bottom of the wells. The wells are then washed to eliminate mycotoxins not bound to antibodies on the plate. Finally, an agent is added that will interact with the labeled mycotoxins to cause a color change. There is then a reverse correlation between the color in the well versus the amount of mycotoxins in the sample. The antibodies in this test is what separates it from other tests for mycotoxins, and the reason why is that mycotoxins are modified in multiple different ways (See Figure 2)
This is just one example of zearalenone metabolism demonstrates how mycotoxins are modified inside the human body. There are many different enzymes that modify mycotoxins inside the body. Some of these enzymes include P450s, Glutathione S-transferases, UDP-glucuronosyltransferases, and sulfur-transferases. There isn’t a lot of data in humans about the percent of mycotoxins are modified inside the body. There are reports showing some mycotoxins can be modified between 50-90% of the total entering the body. However, I think (with no hard data to back this up) that there is quite a bit of variation in the capacity of different patients to detoxify mycotoxins. I don’t want to make conclusions without more data, but I think that patients that are most susceptible to mold illness have genetic factors that predispose them, and a lot of these factors may be differences in detoxifying genes. So, why is this important to what type of testing you decide on? The important part is that every other type of testing cannot see modified mycotoxins. They are designed to look at the parent (original) molecule most of the time so when the molecular mass changes the instrument won’t be able to see it.
The type of testing that this is most relevant for is Liquid chromatography mass spectrometry (LC/MS). Now, I love LC/MS, and it is a great tool for measuring small molecules. The way LC/MS works is that you inject samples into a sample tube which drives the samples from a HPLC/UPLC column. The sample then enters the mass spec which measures the samples by size and then fragments the molecules. The fragments sizes are then measured which produces a spectrum which can be used like a fingerprint (see figure 3). This is where the problem with LC/MS lies. If you don’t have standards for the metabolites, then you can’t teach
the instrument what spectrums to look for and you won’t be able to measure those molecules. So, all of the labs that measure mycotoxins by LC/MS could have a lot of variation or completely miss mycotoxins because of the modifications done to the mycotoxins by the detoxification systems in the body.
The third and final test type is the blood antibody test, which looks for the presence of immunoglobulin G (IgG) and E (IgE) antibodies to mycotoxins in the blood. IgG and IgE are antibodies produced by the body when a foreign antigen is present. IgG makes up about 75% of serum antibodies in humans. They are created by plasma B cells and their main roles are to activate the complement system to eliminate pathogens and to neutralize toxins. However, there are multiple reasons why measuring for these antibodies is noninformative. First, this technique is not used by experts in the field that measure mycotoxins. There are only a handful of clinical labs that utilize this method. Second, mycotoxins can lead to the production of these antibodies. However, these antibodies will remain in the body long after the mycotoxins are removed. This makes them uninformative when you are trying to determine if a treatment regimen is helping the patient. Third, it has been shown that many mycotoxins can interfere with how the body’s immune system functions. There are no studies to prove that you can’t get false negatives using this type of testing because of lack of an immune response.
Those are the simplified facts on testing. I know I presented a lot of information, but I wanted to make sure that I included all of the data you would need to produce an informed decision. If you have any questions, please let us know. We are here to help. Remember to come back next month when I will discuss environmental testing.
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