Ochratoxin A (OTA) is a mycotoxin produced by fungi of two genera: Penicillium and Aspergillus. OTA has been shown to be nephrotoxic, hepatotoxic, teratogenic and immunotoxic to several species of animals and to cause kidney and liver tumours in mice and rats. Because of differences in the physiology of animal species, wide variations are seen in the toxicokinetic patterns of absorption, distribution and elimination of the toxin. Biotransformation of OTA has not been entirely elucidated. At present, data regarding OTA metabolism are controversial. Several metabolites have been characterized in vitro and/or in vivo, whereas other metabolites remain to be characterized. Several major mechanisms have been shown as involved in the toxicity of OTA: inhibition of protein synthesis, promotion of membrane peroxidation, disruption of calcium homeostasis, inhibition of mitochondrial respiration and DNA damage. The contribution of metabolites in OTA genotoxicity and carcinogenicity is still unclear. The genotoxic status of OTA is still controversial because contradictory results were obtained in various microbial and mammalian tests, notably regarding the formation of DNA adducts. More recent studies are focused on the OTA ability to disturb cellular signalling and regulation, to modulate physiological signals and thereby to influence cells viability and proliferation. The present paper offers an update on these different issues. In addition since humans and animals are likely to be simultaneously exposed to several mycotoxins, especially through their diet, the little information available on the combined effects of OTA and other mycotoxins has also been reviewed.