A review of the pathways of human exposure to poly- and perfluoroalkyl substances (PFASs) and present understanding of health effects

Sociodemographic and behavioral determinants of serum concentrations of per- and polyfluoroalkyl substances in a community highly exposed to aqueous film-forming foam contaminants in drinking water

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are a chemical class widely used in industrial and commercial applications because of their unique physical and chemical properties. Between 2013 and 2016 PFAS were detected in public water systems and private wells in El Paso County, Colorado. The contamination was likely due to aqueous film forming foams used at a nearby Air Force base.

OBJECTIVE

To cross-sectionally describe the serum concentrations of PFAS in a highly exposed community, estimate associations with drinking water source, and explore potential demographic and behavioral predictors.

METHODS

In June 2018, serum PFAS concentrations were quantified and questionnaires administered in 213 non-smoking adult (ages 19-93) participants residing in three affected water districts. Twenty PFAS were quantified and those detected in >50% of participants were analyzed: perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorononanoate (PFNA) and perfluoroheptane sulfonate (PFHpS). Unadjusted associations were estimated between serum PFAS concentrations and several predictors, including water consumption, demographics, personal behaviors and employment. A multiple linear regression model estimated adjusted associations with smoking history.

RESULTS

Study participants' median PFHxS serum concentration (14.8 ng/mL) was approximately 12 times as high as the U.S. national average. Median serum concentrations for PFOS, PFOA, PFNA and PFHpS were 9.7 ng/mL, 3.0 ng/mL, 0.4 ng/mL and 0.2 ng/mL, respectively. Determinants of PFHxS serum concentrations were water district of residence, frequency of bottled water consumption, age, race/ethnicity, and smoking history. Determinants of serum concentrations for the other four PFAS evaluated included: water district of residence, bottled water consumption, age, sex, race/ethnicity, smoking history, and firefighter or military employment.

CONCLUSIONS

Determinants of serum concentrations for multiple PFAS, including PFHxS, included water district of residence and frequency of bottled water consumption. Participants' dominant PFAS exposure route was likely consumption of PFAS-contaminated water, but certain demographic and behavioral characteristics also predicted serum concentrations.

Modern water: A biocultural approach to water pollution at the Akwesasne Mohawk Nation

OBJECTIVES

The goal of this article is to review a body of research around water contamination conducted in the Akwesasne Mohawk Nation between 1995 and 2016, place these findings in a biocultural context, and consider implications for a human biology of water.

METHODS

This review draws on research projects conducted in partnership with the Akwesasne Mohawk Nation living along the St. Lawrence River as well as published research by others on water contamination at Akwesasne. Quantitative and qualitative methods including toxicological and epidemiological methods, surveys, and ethnographic studies are included.

RESULTS

Pollution of a river with polychlorinated biphenyls (PCBs) contaminated local fish, a major, traditional, food source. Following health advisories to avoid consuming local fish, consumption and PCB levels decreased. PCB levels were negatively associated with health outcomes. In adolescents, higher PCB levels were associated with advanced sexual maturation in females, reduced testosterone in males and reduced thyroxine levels in young adults. Avoiding fish consumption altered traditional dietary patterns and social interactions, generational transmission of knowledge, and relations between generations, all of which impacted cultural forms and may have added to the perceived injustices in this Native American community. Items substituted for fish may have contributed to increasing rates of obesity as well.

CONCLUSIONS

Water pollution has immediate direct health consequences as well as cultural impacts related to changed food consumption and altered patterns of social interaction.

Isomers of per- and polyfluoroalkyl substances and uric acid in adults: Isomers of C8 Health Project in China

BACKGROUND

Greater levels of serum per- and polyfluoroalkyl substances (PFAS) are known to be associated with higher uric acid which itself leads to a number of chronic diseases. However, whether this association varies across PFAS isomers which recently have been found to be associated with human health remains unknown.

OBJECTIVES

To address this research gap, we explored isomer-specific associations between serum PFAS and uric acid in Chinese adults.

METHODS

We conducted a cross-sectional study of associations between serum PFAS isomer and serum uric acid in 1612 participants from the Isomer of C8 Health Project. We used multivariable linear and logistic regression models to analyze serum isomers of perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), and other PFASs as continuous and categorical predictors of uric acid, adjusted for confounders. The association was also stratified by kidney function stage based on estimated glomerular filtration rate (GF-1, GF-2, GF-3a, and GF-3b/4).

RESULTS

We found positive associations between serum PFAS isomer concentrations and uric acid. Uric acid levels were greater for each log-unit increase in branched PFOA (β = 0.30, 95% CI: 0.21, 0.40), linear PFOA (β = 0.18, 95% CI: 0.09, 0.26), branched PFOS (β = 0.09, 95% CI: 0.02, 0.17) and linear PFOS (β = 0.06, 95% CI: -0.01, 0.14) concentration. The associations between PFAS and uric acid showed an inverted 'U' shaped pattern across kidney function stages. For example, uric acid level was greater with each log-unit increase in total-PFOA among GF-1 (β = 0.21, 95% CI: 0.06, 0.37), this relationship was greater in GF-3a (β = 0.49, 95% CI: 0.09, 0.89) and decreased in GF-3b/4 (β = -0.22, 95% CI: -0.83, 0.39). We also found the odds of hyperuricemia increased linearly with increasing branched PFOA in quartiles (odds ratio = 2.67, 95% CI: 1.86, 3.85 at the highest quartile).

CONCLUSION

We report novel results in which PFAS associations with uric acid varied according to isomer and adult kidney function. Besides, our findings are consistent with previous epidemiologic studies in finding a positive association between serum PFAS concentrations and serum uric acid, especially for PFOA. Our results indicate that more research is needed to more clearly assess the impact of PFAS isomers on human health, which will help to refine regulation policies for PFAS.

Perfluorooctane Sulfonate (PFOS) Produces Dopaminergic Neuropathology in Caenorhabditis elegans

Perfluorooctane sulfonate (PFOS) has been widely utilized in numerous industries. Due to long environmental and biological half-lives, PFOS is a major public health concern. Although the literature suggests that PFOS may induce neurotoxicity, neurotoxic mechanisms, and neuropathology are poorly understood. Thus, the primary goal of this study was to determine if PFOS is selectively neurotoxic and potentially relevant to specific neurological diseases. Nematodes (Caenorhabditis elegans) were exposed to PFOS or related per- and polyfluoroalkyl substances (PFAS) for 72 h and tested for evidence of neuropathology through examination of cholinergic, dopaminergic, gamma-amino butyric acid (GABA)ergic, and serotoninergic neuronal morphologies. Dopaminergic and cholinergic functional analyses were assessed through 1-nonanol and Aldicarb assay. Mechanistic studies assessed total reactive oxygen species, superoxide ions, and mitochondrial content. Finally, therapeutic approaches were utilized to further examine pathogenic mechanisms. Dopaminergic neuropathology occurred at lower exposure levels (25 ppm, approximately 50 µM) than required to produce neuropathology in GABAergic, serotonergic, and cholinergic neurons (100 ppm, approximately 200 µM). Further, PFOS exposure led to dopamine-dependent functional deficits, without altering acetylcholine-dependent paralysis. Mitochondrial content was affected by PFOS at far lower exposure level than required to induce pathology (≥1 ppm, approximately 2 µM). Perfluorooctane sulfonate exposure also enhanced oxidative stress. Further, mutation in mitochondrial superoxide dismutase rendered animals more vulnerable. Neuroprotective approaches such as antioxidants, PFAS-protein dissociation, and targeted (mitochondrial) radical and electron scavenging were neuroprotective, suggesting specific mechanisms of action. In general, other tested PFAS were less neurotoxic. The primary impact is to prompt research into potential adverse outcomes related to PFAS-induced dopaminergic neurotoxicity in humans.

Association between prenatal exposure to perfluoroalkyl substances and asthma in 5-year-old children in the Odense Child Cohort

BACKGROUND

Asthma is the most common non-communicable disease in children. Prenatal exposure to perfluoroalkyl substances (PFASs), a group of persistent environmental chemicals with endocrine disrupting abilities, has been associated with immunomodulation and may contribute to the aetiology of asthma. We investigated the associations between prenatal exposure to five PFASs and asthma in 5-year-old children.

METHODS

We studied 981 mother-child pairs within the Odense Child Cohort (OCC), Denmark. We measured perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA) and perfluorodecanoic acid (PFDA) in maternal serum donated in early pregnancy. A standardized questionnaire based on the International Study of Asthma and Allergies in Childhood (ISAAC) was used to assess wheeze, self-reported asthma and doctor-diagnosed asthma among children at age 5 years. Associations were examined using logistic regression analyses adjusting for parity, maternal educational level, maternal pre-pregnancy BMI, asthma predisposition and child sex.

RESULTS

Among the 5-year-old children 18.6% reported wheeze and 7.1% reported asthma. We found no association between prenatal exposure to PFAS and doctor-diagnosed asthma or wheeze. Prenatal PFAS exposure was associated with self-reported asthma, although only significant for PFNA (OR = 1.84, 95% CI 1.03,3.23).

CONCLUSION

Our findings support the suggested immunomodulatory effects of PFASs, however, additional studies are warranted. In order to verify our findings, it is important to re-examine the children with postnatal measurements of serum PFAS concentrations and additional clinical diagnostic testing at an older age where an asthma diagnosis is more valid.

Poly- and Perfluoroalkyl Substances in Seawater and Plankton from the Northwestern Atlantic Margin

The ocean is thought to be the terminal sink for poly- and perfluoroalkyl substances (PFAS) that have been produced and released in large quantities for more than 60 years. Regulatory actions have curbed production of legacy compounds such as perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA), but impacts of regulations on PFAS releases to the marine environment are poorly understood. Here, we report new data for 21 targeted PFAS in seawater and plankton from the coast, shelf, and slope of the Northwestern Atlantic Ocean. We find strong inverse correlations between salinity and concentrations of most PFAS, indicating that ongoing continental discharges are the major source to the marine environment. For legacy PFAS such as PFOS and PFOA, a comparison of inland and offshore measurements from the same year (2014) suggests that there are ongoing releases to the marine environment from sources such as submarine groundwater discharges. Vertical transport of most PFAS associated with settling particles from the surface (10 m) to deeper waters is small compared to advective transport except for perfluorodecanoic acid (PFDA; 35% of vertical flux) and precursor compounds to PFOS (up to 86%). We find higher than expected bioaccumulation factors (BAFs = Cplankton/Cwater) for perfluorinated carboxylic acids (PFCAs) with five and six carbons (log BAF = 2.9-3.4) and linear PFOS (log BAF = 2.6-4.3) in marine plankton compared to PFCAs with 7-11 carbons. We postulate that this reflects additional contributions from precursor compounds. Known precursor compounds detected here have among the highest BAFs (log BAF > 3.0) for all PFAS in this study, suggesting that additional research on the bioaccumulation potential of unknown organofluorine compounds is urgently needed.

Themed issues on per- and polyfluoroalkyl substances

Guest editors Lutz Ahrens, Jonathan Benskin, Ian Cousins, Michelle Crimi and Christopher Higgins introduce the “Per- and polyfluoroalkyl substances (PFASs)” themed issue.

The use of high resolution graphite furnace molecular absorption spectrometry (HR -MAS) for total fluorine determination in extractable organofluorines (EOF)

The determination of total fluorine content using high-resolution graphite furnace continuum source molecular absorption spectrometry (HR- MAS) has been employed in a variety of samples for over 10 years. However, most of the samples analysed by HR- MAS are rich in fluoride, with negligible levels of organic fluorinated species. With an increase in concern surrounding per- and polyfluoroalkyl substances (PFASs), new methods to measure total fluorine of organofluorine using different techniques have been developed. However, no studies focused on PFASs behaviour in HR-MAS have been performed. As these compounds encompass a wide range of different structures, boiling points, decomposition temperatures and matrix interactions, a loss of accuracy can occur when an aqueous external calibration is performed using only one compound. To overcome this issue, an investigation into permanent modifiers for the graphite furnace was performed. After optimisation similar sensitivity for different PFCA was achieved when 400 μg of W was used as a permanent modifier together with an optimised temperature program. The relative deviation between the different PFCA standard slopes relative to the PFOA slope was lower than 15%. The instrumental limit of detection and quantification (LOD and LOQ, respectively) of total fluorine as total PFCA was 0.1 mg L^-1 and 0.3 mg L^-1, respectively, while the method LOD and LOQ (using solid phase extraction) was 0.3 μg L^-1 and 1.0 μg L^-1, respectively. The developed method gave satisfactory recoveries for the spiked PFCA into seawater, river water and effluent using PFOA calibration standards. The optimised method is useful for measuring extractable organofluorines (EOF) when only ionic PFASs such as PFCA are expected. When other organofluorines are expected, the results using HR GF-MAS should be taken with caution.

Legacy and alternative per- and polyfluoroalkyl substances in the U.S. general population: Paired serum-urine data from the 2013-2014 National Health and Nutrition Examination Survey

Concerns are heightened from detecting environmentally persistent man-made per- and polyfluoroalkyl substances (PFAS) in drinking water systems around the world. Many PFAS, including perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA), remain in the human body for years. Since 1999-2000, assessment of exposure to PFOS, PFOA, and other select PFAS in the U.S. general population has relied on measuring PFAS serum concentrations in participants of the National Health and Nutrition Examination Survey (NHANES). Manufacturers have replaced select chemistries ("legacy" PFAS) with PFAS with shorter biological half-lives (e.g., GenX, perfluorobutanoate [PFBA]) which may efficiently eliminate in urine. However, knowledge regarding exposure to these compounds is limited. We analyzed 2682 urine samples for 17 legacy and alternative PFAS in 2013-2014 NHANES participants ≥6 years of age. Concentrations of some of these PFAS, measured previously in paired serum samples from the same NHANES participants, suggested universal exposure to PFOS and PFOA, and infrequent or no exposure to two short-chain PFAS, perfluorobutane sulfonate and perfluoroheptanoate. Yet, in urine, PFAS were seldom detected; the frequency of not having detectable concentrations of any of the 17 PFAS was 67.5%. Only two were detected in >1.5% of the population: PFBA (13.3%) and perfluorohexanoate (PFHxA, 22.6%); the 90th percentile urine concentrations were 0.1 μg/L (PFBA), and 0.3 μg/L (PFHxA). These results suggest that exposures to short-chain PFAS are infrequent or at levels below those that would result in detectable concentrations in urine. As such, these findings do not support biomonitoring of short-chain PFAS or fluorinated alternatives in the general population using urine, and highlight the importance of selecting the adequate biomonitoring matrix.

Human exposure to per- and polyfluoroalkyl substances (PFAS) through drinking water: A review of the recent scientific literature

Per- and polyfluoroalkyl substances (PFAS) are a group of water-soluble chemical compounds with an important number of applications, which have been widely used during the last 60 years. Two of them, perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA), are the most known and well investigated. As for many other organic substances that are of environmental concern, the diet is the main route of human exposure to PFAS. However, in certain cases drinking water may also mean a significant contribution to human exposure, and to a lesser extent, dust and air (indoor exposure). In recent years, the environmental persistence of PFAS, their biomagnification in food webs, as well as their potential accumulation and toxicity, have generated a notable interest, which has been evidenced by the considerable number of publications in this regard. Recently, we carried out a wide revision on the levels of PFAS in food and human dietary intake. In the current review, we have summarized the recent information (last 10 years) published in the scientific literature (Scopus and PubMed) on the concentrations of PFAS in drinking water and the human health risks derived from the regular water consumption, when available. A large amount of data belongs to PFOS and PFOA and corresponds to studies mainly conducted in countries of the European Union, USA and China, although no information is available for most countries over the world. According to the toxicological information about PFAS that is so far available, the current health risks for the regular consumers of municipal/tap water do not seem to be of concern according to the levels considered as acceptable for various regulatory institutions.

Level and determinants of serum perfluoroalkyl acids (PFAAs) in a population in Klang Valley, Malaysia

For decades, perfluoroalkyl acids (PFAAs) have been commonly used for industrial and commercial purposes due to their water- and stain-resistant properties. Persistent pollutants that contain PFAAs have been associated with adverse health effects in humans, and many studies have documented dietary intake, indoor air inhalation, and dermal contact as the potential routes for human exposure to PFAAs. The aim of this study was to assess the level of PFAAs in the serum samples of a general population in a specific region in Malaysia. Using 219 serum samples collected from residents of Klang Valley, Malaysia, the levels of nine PFAAs were analyzed using liquid chromatography-tandem mass spectrometry. In addition, questionnaire surveys on the dietary habits and lifestyles of the subjects were conducted. The results showed that PFAA concentrations of up to 32.57 ng/mL were detected in all serum samples. In 82.6% of the participants, at least seven PFAAs were detected in the serum samples, with perfluorooctanesulfonic acid being the predominant PFAA (median = 8.79 ng/mL). In the adjusted regression model, the concentrations of most PFAAs were higher in men than in women and positively correlated with age, although body mass index and smoking were not significantly associated with the serum PFAA concentrations. Taking into consideration the lifestyle variables, significant associations were found between nonstick cookware and perfluorononanoic acid, between dental floss and cosmetics and perfluorodecanoic acid (PFDA), and between leather sofa and perfluoroundecanoic acid (PFUnDA). Besides, consumption of beef was significantly associated with increased levels of serum PFUnDA, whereas consumption of lamb and chicken eggs was negatively associated with the serum levels of PFUnDA and PFDA, respectively.

Universal Basic Income and Inclusive Capitalism: Consequences for Sustainability

Over the past forty years, income growth for the middle and lower classes has stagnated, while the economy (and with it, economic inequality) has grown significantly. Early automation, the decline of labor unions, changes in corporate taxation, the financialization and globalization of the economy, deindustrialization in the U.S. and many OECD countries, and trade have contributed to these trends. However, the transformative roles of more recent automation and digital technologies/artificial intelligence (AI) are now considered by many as additional and potentially more potent forces undermining the ability of workers to maintain their foothold in the economy. These drivers of change are intensifying the extent to which advancing technology imbedded in increasingly productive real capital is driving productivity. To compound the problem, many solutions presented by industrialized nations to environmental problems rely on hyper-efficient technologies, which if fully implemented, could further advance the displacement of well-paid job opportunities for many. While there are numerous ways to address economic inequality, there is growing interest in using some form of universal basic income (UBI) to enhance income and provide economic stability. However, these approaches rarely consider the potential environmental impact from the likely increase in aggregate demand for goods and services or consider ways to focus this demand on more sustainable forms of consumption. Based on the premise that the problems of income distribution and environmental sustainability must be addressed in an integrated and holistic way, this paper considers how a range of approaches to financing a UBI system, and a complementary market solution based on an ownership-broadening approach to inclusive capitalism, might advance or undermine strategies to improve environmental sustainability.

Determinants of per- and polyfluoroalkyl substances (PFAS) in midlife women: Evidence of racial/ethnic and geographic differences in PFAS exposure

BACKGROUND

Per- and poly-fluoroalkyl substances (PFAS) are public health concerns because of widespread exposure through contaminated foods/drinking water. Although some determinants of PFAS exposure have been suggested, the role of geographic location and race/ethnicity in PFAS exposure has not been well characterized.

OBJECTIVES

We examined potential determinants of PFAS from the Study of Women's Health Across the Nation (SWAN).

METHODS

This study includes 1302 women aged 45-56 years from 5 SWAN sites where white women and women from one minority group were recruited (black from Southeast Michigan, Pittsburgh, Boston; Chinese from Oakland; Japanese from Los Angeles). We determined concentrations of 11 PFAS in serum samples collected in 1999-2000 and examined 7 PFAS detected in most women (>97%). Linear regression with backward elimination was used to identify important determinants of PFAS serum concentrations among a set of pre-specified variables (age, body mass index, site, race/ethnicity, education, financial hardship, occupation, born outside the United States (US), parity, menstrual bleeding within the past year, smoking status, alcohol consumption, and consumption of fish, dairy, pizza, salty snack, and French fries).

RESULTS

Site and race/ethnicity were two major determinants of PFAS. White women had higher concentrations of linear perfluorooctanoic acid (PFOA) compared with the Chinese in Oakland (p < 0.0001) and blacks in Pittsburgh (p = 0.048). Black women in Southeast Michigan and Boston (vs. white women) had higher concentrations of linear (p < 0.001 for Southeast Michigan; p < 0.0001 for Boston) and total perfluorooctane sulfonic acid (PFOS) (p < 0.001 for both Southeast Michigan and Boston) and 2-(N-methyl-perfluorooctane sulfonamido) acetic acid (p = 0.02 for Southeast Michigan; p < 0.001 for Boston). Chinese (Oakland) and Japanese (Los Angeles) women had higher concentrations of perfluorononanoic acid (PFNA) compared with white women in each site (p < 0.01 for both). Within white women, those in Pittsburgh had relatively higher concentrations of PFAS. Within Chinese and Japanese women, those who were born outside the US had significantly lower concentrations of most PFAS but significantly higher PFNA concentrations. Menstrual bleeding and parity were significantly associated with lower PFAS concentrations. Higher intake of salty snacks including popcorn was significantly associated with higher concentrations of linear PFOA, PFOS and 2-(N-ethyl-perfluorooctane sulfonamido) acetic acid.

DISCUSSION

Geographic locations and race/ethnicity play an important role in differential exposure to PFAS, with racial/ethnic burdens differing between PFOS, PFOA and PFNA. Menstruation and parity were also determinants of PFAS concentrations possibly as an elimination route.

Tap Water Contributions to Plasma Concentrations of Poly- and Perfluoroalkyl Substances (PFAS) in a Nationwide Prospective Cohort of U.S. Women

BACKGROUND

Between 2013 and 2015, concentrations of poly- and perfluoroalkyl substances (PFAS) in public drinking water supplies serving at least six million individuals exceeded the level set forth in the health advisory established by the U.S. Environmental Protection Agency. Other than data reported for contaminated sites, no systematic or prospective data exist on the relative source contribution (RSC) of drinking water to human PFAS exposures.

OBJECTIVES

This study estimates the RSC of tap water to overall PFAS exposure among members of the general U.S.

POPULATION

METHODS

We measured concentrations of 15 PFAS in home tap water samples collected in 1989-1990 from 225 participants in a nationwide prospective cohort of U.S. women: the Nurses' Health Study (NHS). We used a one-compartment toxicokinetic model to estimate plasma concentrations corresponding to tap water intake of PFAS. We compared modeled results with measured plasma PFAS concentrations among a subset of 110 NHS participants.

RESULTS

Tap water perfluorooctanoic acid (PFOA) and perfluorononanoic acid (PFNA) were statistically significant predictors of plasma concentrations among individuals who consumed [Formula: see text] cups of tap water per day. Modeled median contributions of tap water to measured plasma concentrations were: PFOA 12% (95% probability interval 11%-14%), PFNA 13% (8.7%-21%), linear perfluorooctanesulfonic acid (nPFOS) 2.2% (2.0%-2.5%), branched perfluorooctanesulfonic acid (brPFOS) 3.0% (2.5%-3.2%), and perfluorohexanesulfonic acid (PFHxS) 34% (29%-39%). In five locations, comparisons of PFASs in community tap water collected in the period 2013-2016 with samples from 1989-1990 indicated increases in quantifiable PFAS and extractable organic fluorine (a proxy for unquantified PFAS).

CONCLUSIONS

Our results for 1989-1990 compare well with the default RSC of 20% used in risk assessments for legacy PFAS by many agencies. Future evaluation of drinking water exposures should incorporate emerging PFAS. https://doi.org/10.1289/EHP4093.

Phospholipid Levels Predict the Tissue Distribution of Poly- and Perfluoroalkyl Substances in a Marine Mammal

Exposure to poly- and perfluoroalkyl substances (PFASs) has been linked to many negative health impacts in humans and wildlife. Unlike neutral hydrophobic organic pollutants, many PFASs are ionic and have been hypothesized to accumulate in both phospholipids and protein-rich tissues. Here we investigate the role of phospholipids for PFAS accumulation by analyzing associations among concurrent measurements of phospholipid, total protein, total lipid and 24 PFASs in the heart, muscle, brain, kidney, liver, blubber, placenta and spleen of North Atlantic pilot whales (Globicephala melas). The sum of 24 PFASs ( ∑ 24 PFAS ) was highest in the liver (median 260 ng g^-1; interquartile range (IQR) 216-295 ng g^-1) and brain (86.0; IQR 54.5-91.3 ng g^-1), while phospholipid levels were highest in brain. The relative abundance of PFASs in the brain greatly increases with carbon chain lengths of 10 or greater, suggesting shorter-chained compounds may cross the blood-brain barrier less efficiently. Phospholipids were significant predictors of the tissue distribution of the longest-chained PFASs: perfluorodecanesulfonate (PFDS), perfluorododecanoate (PFDoA), perfluorotridecanoate (PFTrA), and perfluorotetradecanoic acid (PFTA) (r_s = 0.5-0.6). In all tissues except the brain, each 1 mg g^-1 increase in phospholipids led to a 12%-25% increase in the concentration of each PFAS. We conclude that partitioning to phospholipids is an important mechanism of bioaccumulation for long-chained PFASs in marine mammals.

Environmental perfluoroalkyl acid exposures are associated with liver disease characterized by apoptosis and altered serum adipocytokines

Exposures to perfluoroalkyl substances (PFAS) including perfluoroalkyl acids (PFAAs) are associated with increased liver enzymes in cohort studies including the C8 Health Study. In animal models, PFAAs disrupt hepatic lipid metabolism and induce apoptosis to cause nonalcoholic fatty liver disease (NAFLD). PFAAs are immunotoxic and inhibit pro-inflammatory cytokine release from stimulated leukocytes in vitro. This cross-sectional study tests the hypothesis that environmental PFAAs are associated with increased hepatocyte apoptosis and decreased pro-inflammatory cytokines in serum. Biomarkers previously associated with PFAS exposures and/or NAFLD were evaluated as secondary endpoints. Two hundred adult C8 Health Study participants were included. Measured serum biomarkers included: perfluorohexane sulfonate (PFHxS); perfluorooctanoic acid (PFOA); perfluorooctane sulfonate (PFOS); perfluorononanoic acid (PFNA); cytokeratin 18 M30 (CK18 M30, hepatocyte apoptosis); adipocytokines; insulin; and cleaved complement 3 (C3a). Confounder-adjusted linear regression models determined associations between PFAS and disease biomarkers with cut-offs determined by classification and regression tree analysis. CK18 M30 was positively associated with PFHxS (β = 0.889, p = 0.042); PFOA (β = 2.1, p = 0.005); and PFNA (β = 0.567, p = 0.03). Tumor necrosis factor α (TNFα) was inversely associated with PFHxS (β = -0.799, p = 0.001); PFOA (β = - 1.242, p = 0.001); and PFOS (β = -0.704, p < 0.001). Interleukin 8 was inversely associated with PFOS and PFNA. PFAAs were also associated with sexually dimorphic adipocytokine and C3a responses. Overall, PFAA exposures were associated with the novel combination of increased biomarkers of hepatocyte apoptosis and decreased serum TNFα. These data support previous findings from cohorts and experimental systems that PFAAs may cause liver injury while downregulated some aspects of the immune response. Further studies of PFAAs in NAFLD are warranted and should evaluate sex differences.