The Clinically Silent Pandemic: A Review of Aflatoxin B1 Exposure and its Role in Hepatocellular Carcinoma and Immune Suppression

Abstract

Aflatoxin B1 (AFB1) exposure represents a pervasive yet underrecognized global health threat, contributing significantly to the burden of hepatocellular carcinoma (HCC) and widespread immune dysfunction, necessitating a comprehensive review to consolidate current knowledge and guide public health action. This review provides evidence on the molecular mechanisms of AFB1-induced hepatocarcinogenesis, including deoxyribonucleic acid (DNA) adduct formation, p53 mutations, and endoplasmic reticulum stress, as well as its immunosuppressive effects via oxidative stress, cytokine dysregulation, and impaired immune cell function. It further examines the synergistic interactions between AFB1 and other risk factors such as hepatitis viral infections and explores potential therapeutic targets and intervention strategies derived from recent preclinical and clinical studies. Future research should prioritize standardized biomarker assessments, longitudinal human studies, and the development of integrated intervention frameworks that combine dietary safety measures, vaccination programs, and novel therapeutics to mitigate the multifaceted health impacts of AFB1 exposure globally.