Chronic exposure to cereal mycotoxin likely citreoviridin may be a trigger for Keshan disease mainly through oxidative stress mechanism.

The origin of Keshan disease (KD), an endemic cardiomyopathy particularly affected children and young women in China, has been a controversial and difficult problem in academics over the past decades. We hypothesize that mycotoxins likely citreoviridin may initiate KD mainly through oxidative stress mechanism by long-term consumption of mouldy cereals due to food shortage lifestyle. Dietary deficiency of selenium, proteins, Vitamin C, E, etc., may act as enhancing factors to exacerbate the pathological damage. This speculation can perfectly explain the features of KD and has received strong supporting evidences. If the hypothesis were to be confirmed, it is of very important value in monitoring and blocking the incidence of KD. Thus, future efforts are needed to investigate specific biomarkers of exposure to citreoviridin in KD cases.