Immune responses in the aquatic gastropod Lymnaea stagnalis under short-term exposure to pharmaceuticals of concern for immune systems: Diclofenac, cyclophosphamide and cyclosporine A

Metabolic network and proteomic expression perturbed by cyclosporine A to model microbe Escherichia coli

Cyclosporine A (CsA) is a model drug that has caused great concern due to its widespread use and abuse in the environment. However, the potential harm of CsA to organisms also remains largely unknown, and this issue is exceptionally important for the health risk assessment of antibiotics. To address this concern, the crosstalk between CsA stress and cellular metabolism at the proteomic level in Escherichia coli was investigated and dissected in this study. The results showed that CsA inhibited E. coli growth in a time-dependent manner. CsA induced reactive oxygen species (ROS) overproduction in a dose- and time-dependent manner, leading to membrane depolarization followed by cell apoptosis. In addition, translation, the citric acid cycle, amino acid biosynthesis, glycolysis and responses to oxidative stress and heat were the central metabolic pathways induced by CsA stress. The upregulated proteins, including PotD, PotF and PotG, controlled cell growth. The downregulated proteins, including SspA, SspB, CstA and DpS, were regulators of self-feedback during the starvation process. And the up- and downregulated proteins, including AtpD, Adk, GroS, GroL and DnaK, controlled energy production. These results provide an important reference for the environmental health risk assessment of CsA.

Nabumetone and flufenamic acid pose a serious risk to aquatic plants: A study with Chlamydomonas reinhardtii as a model organism

The aquatic environment is constantly under threat due to the release of numerous pollutants. Among them, pharmaceuticals constitute a huge and diverse group. Non-steroidal anti-inflammatory drugs (NSAIDs) are increasingly found in water bodies, but knowledge about their potential toxicity is still low. In particular, there is a lack of information about their influences on aquatic plants and algae. We estimated the susceptibility of the microalgae Chlamydomonas reinhardtii to nabumetone (NBT) and flufenamic acid (FFA), focusing on photosynthesis. Due to the differences in the structures of these compounds, it was assumed that these drugs would have different toxicities to the tested green algae. The hypothesis was confirmed by determining the effective concentration values, the intensity of photosynthesis, the intensity of dark respiration, the contents of photosynthetic pigments, the fluorescence of chlorophyll a in vivo (OJIP test), and cell ultrastructure analysis. Assessment of the toxicity of the NSAIDs was extended by the calculation of an integrated biomarker response index (IBR), which is a valuable tool in ecotoxicological studies. The obtained results indicate an over six times higher toxicity of NBT compared to FFA. After analysis of the chlorophyll a fluorescence in vivo, it was found that NBT inhibited electron transport beyond the PS II. FFA, unlike NBT, lowered the intensity of photosynthesis, probably transforming some reaction centers into "silent centers", which dissipate energy as heat. The IBR estimated based on photosynthetic parameters suggests that the toxic effect of FFA results mainly from photosynthesis disruption, whereas NBT significantly affects other cellular processes. No significant alteration in the ultrastructure of treated cells could be seen, except for changes in starch grain number and autophagic vacuoles that appeared in FFA-treated cells. To the best of our knowledge, this is the first work reporting the toxic effects of NBT and FFA on unicellular green algae.

Review of warming and acidification effects to the ecotoxicity of pharmaceuticals on aquatic organisms in the era of climate change

An increase in the temperature and the acidification of the aquatic environment are among the many consequences of global warming. Climate change can also negatively affect aquatic organisms indirectly, by altering the toxicity of pollutants. Models of climate change impacts on the distribution, fate and ecotoxicity of persistent pollutants are now available. For pharmaceuticals, however, as new environmental pollutants, there are no predictions on this issue. Therefore, this paper organizes the existing knowledge on the effects of temperature, pH and both stressors combined on the toxicity of pharmaceuticals on aquatic organisms. Besides lethal toxicity, the molecular, physiological and behavioral biomarkers of sub-lethal stress were also assessed. Both acute and chronic toxicity, as well as bioaccumulation, were found to be affected. The direction and magnitude of these changes depend on the specific pharmaceutical, as well as the organism and conditions involved. Unfortunately, the response of organisms was enhanced by combined stressors. We compare the findings with those known for persistent organic pollutants, for which the pH has a relatively low effect on toxicity. The acid-base constant of molecules, as assumed, have an effect on the toxicity change with pH modulation. Studies with bivalves have been were overrepresented, while too little attention was paid to producers. Furthermore, the limited number of pharmaceuticals have been tested, and metabolites skipped altogether. Generally, the effects of warming and acidification were rather indicated than explored, and much more attention needs to be given to the ecotoxicology of pharmaceuticals in climate change conditions.

Sublethal cadmium exposure in the freshwater snail Lymnaea stagnalis meets a deficient, poorly responsive metallothionein system while evoking oxidative and cellular stress

The Great Pond snail Lymnaea stagnalis (Gastropoda, Hygrophila) is a wide-spread freshwater gastropod, being considered as a model organism for research in many fields of biology, including ecotoxicology. The aim of the present study was to explore the Cd sensitivity of L. stagnalis through the measurement of a biomarker battery for oxidative, toxic and cellular stress. The interpretation of biomarker parameters occurred against the background of a truncated metallothionein protein with a limited Cd-binding capacity. Individuals of L. stagnalis were exposed through 14 days to uncontaminated water (controls) or to low (30 μg · L^-1) or high (50 μg · L^-1) Cd concentrations. The digestive gland of control and low-Cd exposed snails was processed for transcriptional analysis of the Metallothionein (MT) gene expression, and for determination of biomarkers for oxidative stress, toxicity and cellular stress. Digestive gland supernatants of high-Cd exposed snails were subjected to chromatography and subsequent analysis by spectrophotometry. It was shown that the MT system of L. stagnalis is functionally deficient, with a poor Cd responsiveness at both, the transcriptional and the protein expression levels. Instead, L. stagnalis appears to rely on alternative detoxification mechanisms such as Cd binding by phytochelatins and metal inactivation by compartmentalization within the lysosomal system. In spite of this, however, traces of Cd apparently leak out of the pre-determined detoxification pathways, leading to adverse effects, which is clearly indicated by biomarkers of oxidative and cellular stress.

Long-term stability of diclofenac and 4-hydroxydiclofenac in the seawater and sediment microenvironments: Evaluation of biotic and abiotic factors

Studies in recent years have shown that significant amounts of diclofenac (DCF) and its metabolites are present in marine coastal waters. Their continuous flow into the environment may be associated with numerous negative effects on both fauna and flora. Although more and more is known about the effects of pharmaceuticals on marine ecosystems, there are still many issues that have not received enough attention, but are essential for risk assessment, such as long term stability. Furthermore, interaction of pharmaceuticals with sediments, which are inhabited by rich microbial, meiofaunal and macrobenthic communities need investigation. Therefore, we undertook an analysis of the stability of DCF and its metabolite, 4-hydroxy diclofenac, in seawater and sediment collected from the brackish environment of Puck Bay. Our 29-day experiment was designed to gain a better understanding of the fate of these compounds under experimental conditions same as near the seafloor. Diclofenac concentration decreased by 31.5% and 20.4% in the tanks with sediment and autoclaved sediment, respectively during 29-day long experiment. In contrast, the concentration of 4-OH diclofenac decreased by 76.5% and 90.2% in sediment and autoclaved sediment, respectively. The concentration decrease of both compounds in the sediment tanks resulted from their sorption in the sediment and biodegradation. Obtained results show that marine sediments favour DCF and 4-OH DCF removal from the water column.

Antioxidant and Immunostimulatory Activities of Fermented Sour Soybean Milk Added With Polypeptides From Pleurotus eryngii

The improved quality of sour soybean milk by adding polypeptide from Pleurotus eryngii was investigated in this study, and the immunomodulatory effect of sour soybean milk fermented with polypeptides from P. eryngii was also evaluated in immunosuppressed mice induced by cyclophosphamide. Results showed the physicochemical property of sour soybean milk fermented with small-molecular-weight polypeptide (<3 kDa) were superior to the others including the decrease of pH, and increase of acidity, water-holding capacity and lactic acid bacteria count. The animal experiment demonstrated that sour soybean milk with polypeptide could effectively reverse the decreasing trend of thymus/spleen index and hematological parameters, enhance murine immune functions including serum hemolysin and splenic lymphocyte proliferation, and inhibit oxidative stress. In addition, sour soybean milk fermented with polypeptide could increase the diversity of intestinal flora, and increase the abundances of Firmicutes, Bacteroides, and Lactobacillus. Taken together, it could provide a theoretical basis for developing an immunomodulatory agent or functional food additives with antioxidant activity.

Long-term exposure to environmental diclofenac concentrations impairs growth and induces molecular changes in Lymnaea stagnalis freshwater snails

As pharmaceutical substances are highly used in human and veterinary medicine and subsequently released in the environment, they represent emerging contaminants in the aquatic compartment. Diclofenac (DCF) is one of the most commonly detected pharmaceuticals in water and little research has been focused on its long-term effects on freshwater invertebrates. In this study, we assessed the chronic impacts of DCF on the freshwater gastropod Lymnaea stagnalis using life history, behavioral and molecular approaches. These organisms were exposed from the embryo to the adult stage to three environmentally relevant DCF concentrations (0.1, 2 and 10 μg/L). The results indicated that DCF impaired shell growth and feeding behavior at the juvenile stage, yet no impacts on hatching, locomotion and response to light stress were noted. The molecular findings (metabolomics and transcriptomic) suggested that DCF may disturb the immune system, energy metabolism, osmoregulation and redox balance. In addition, prostaglandin synthesis could potentially be inhibited by DCF exposure. The molecular findings revealed signs of reproduction impairment but this trend was not confirmed by the physiological tests. Combined omics tools provided complementary information and enabled us to gain further insight into DCF effects in freshwater organisms.

Mechanism of action and toxicological evaluation of engineered layered double hydroxide nanomaterials in Biomphalaria alexandrina snails

Layered double hydroxide (LDH) nanomaterials have recently become immense research area as it is used widely in industries. So, it's chance of their release into natural environment and risk assessment to nontarget aquatic invertebrate increasing. So, the present study aimed to synthesize and confirm the crystalline formation of Co-Cd-Fe LDHs and Co-Cd-Fe/PbI₂ (LDH) and then to investigate the toxic impact of the two LDH on the adult freshwater snails (Biomphalaia alexandrina). Results showed that Co-Cd-Fe/PbI₂ LDH has more toxic effect to adult Biomphalaria than Co-Cd-Fe LDHs (LC₅₀ was 56.4 and 147.7 mg/L, 72 h of exposure, respectively). The effect of LC₂₅ (117.1 mg/L) of Co-Cd-Fe LDHs exposure on the embryo showed suppression of embryonic development and induced embryo malformation. Also, it showed alterations in the tegmental architectures of the mantle-foot region of B. alexandrina snails as declared in scanning electron micrograph. Also, exposure to this sublethal concentration caused abnormalities in hemocyte shapes and upregulated IL-2 level in soft tissue. In addition, it decreased levels of nonenzymatic reduced glutathione (GSH), catalase (CAT), superoxide dismutase (SOD), caspase-3 activity, and total protein content in significant manner. Glutathione S-transferase (GST) activity was not affected by LDH exposure. It caused histopathological damages in both glands of snails and also caused a genotoxic effect in their cells. The results from the present study indicated that LDH has risk assessment on aquatic B. alexandrina snails and that it can be used as a biological indicator of water pollution with LDH.

The effects of the chemotherapy drug cyclophosphamide on the structure and functioning of freshwater communities under sub-tropical conditions: A mesocosm study

Cyclophosphamide (CP) is a chemotherapy drug which is widely used in the treatment of neoplastic diseases and have often been detected in urban and hospital wastewater, and surface waters. However, at present the effects of CP on aquatic organisms and ecosystems are poorly understood. The main objective of the present study was to assess the effect of CP on the structure and functioning of a sub-tropical freshwater ecosystem (macroinvertebrates, zooplankton and phytoplankton) at environmental relevant concentrations. CP (0, 0.5, 5 and 50 μg/L) was applied weekly to 13,600 L mesocosms over a period of four weeks followed by a one month post exposure period. CP was found to dissipate much faster than previous reported in literature and the half-dissipation times were treatment dependent, being 2.2, 21.3 and 23.6 days in the lowest, middle and highest treatments respectively. Only treatment related effects were observed on the community structure at individual samplings with zooplankton (NOEC_community = 0.5 μg/L) responding at lower concentrations than phytoplankton (NOEC_community = 5 μg/L) and macroinvertebrates (NOEC_community ≥ 50 μg/L). The dissolved organic carbon concentration was consistently higher in the 2 highest treatments, indicating a potential effect on food web interactions and/or the microbial loop. At the population level, consistent adverse effects were observed for the plankton taxa Pleuroxus laevis, Dissotrocha sp. and Oscillatoria sp. at all CP concentrations (NOEC <0.5 μg/L). Additionally, at the highest CP treatments 7% of all the taxa showed a clear short-term adverse effect. Based on comparison with literature data it can be concluded that these taxa have the highest CP sensitivity ever recorded and these findings indicate a potential CP risk to aquatic ecosystems at environmental relevant concentrations.

Four scenarios of environmental risk of diclofenac in European groundwater ecosystems

Groundwater is the largest source of liquid freshwater on Earth. Groundwater ecosystems harbor a rich biodiversity, mainly consisting of microbes and invertebrates that provide substantial ecological services. Despite its importance, groundwater is affected by several anthropic pressures, including pollution from pharmaceutical compounds. Diclofenac is the non-steroidal drug most widely detected in freshwaters, both in surface waters (e.g., rivers, streams, lakes etc.) and groundwaters. Unlike surface waters, the environmental risk of diclofenac in European groundwaters has not yet been assessed by the competent Authorities. The environmental risk assessment refers to the analysis of the potential risk that a chemical compound poses to a given environment by comparing its measured environmental concentrations to its predicted no-effect concentration. In this study, we explored four environmental risk scenarios in European groundwaters using different methodologies. We obtained diverse risk expectations, some indicative of a moderately diffuse environmental risk for concentrations of diclofenac ≥42 ng/L and others indicative of a widespread environmental risk for concentrations ≥5 ng/L. The difference among the four scenarios mainly related to the methods of calculating the predicted no-effect concentration of diclofenac. We discussed the four scenarios in order to identify the most realistic risk expectations posed by diclofenac to European groundwater ecosystems.

Can Ultrasound Therapy Be an Environmental-Friendly Alternative to Non-Steroidal Anti-Inflammatory Drugs in Knee Osteoarthritis Treatment?

The non-steroidal anti-inflammatory drugs (NSAIDs) are the most used drugs in knee OA (osteoarthritis) treatment. Despite their efficiency in pain and inflammation alleviation, NSAIDs accumulate in the environment as chemical pollutants and have numerous genetic, morphologic, and functional negative effects on plants and animals. Ultrasound (US) therapy can improve pain, inflammation, and function in knee OA, without impact on environment, and with supplementary metabolic beneficial effects on cartilage compared to NSAIDs. These features recommend US therapy as alternative for NSAIDs use in knee OA treatment.

Toxicity of engineered nanomaterials to aquatic and land snails: A scientometric and systematic review

The emerging growth of nanotechnology has attracted great attention due to its application in the parasite and intermediate host control. However, the knowledge concerning the mechanism of action (MoA) and toxicity of nanomaterials (NMs) to snails remain unclear. In this context, the present study revised the historical use of snails as experimental models in nanotoxicological studies and summarized the MoA and toxicity of NMs in aquatic and land snails. The data concerning the bioaccumulation, reproductive and transgenerational toxicity, embryotoxicity, genotoxicity and potential molluscicidal activity of NMs were revised. Furthermore, the data about the experimental conditions, such as exposure time, concentrations, cell and tissue-specific responses, snail species and nanoparticle types are discussed. Revised data showed that the toxic effects of NMs were reported for 21 snail species with medical, veterinary and ecological importance. The NM toxicity to snails is dependent on the physical and chemical properties of NMs, as well as their environmental transformation and experimental design. The NM bioaccumulation on snails was related to several toxic effects, such as reactive oxygen species (ROS) production, oxidative stress, following by oxidative damage to DNA, lipids and proteins. The NM metabolism in snails remains unknown. Results showed the potential use of NMs in the snail control program. Also, significant research gaps and recommendations for future researches are indicated. The present study confirms that snails are suitable invertebrate model system to assess the nanotoxicity.

Toxic effects of NSAIDs in non-target species: A review from the perspective of the aquatic environment

The presence of pharmaceuticals in the aquatic environment, both in marine and freshwater reservoirs, is a major concern of global environmental protection. Among the drugs that are most commonly used, NSAIDs tend to dominate. Currently, being aware of the problem caused by drug contamination, it is extremely important to evaluate the scale and the full spectrum of its consequences, from short-term to long-term effects. The influence on non-target aquatic animals can take place at many levels, and the effects can be seen both in behaviour and physiology, but also in genetic alterations or reproduction disorders, affecting the development of entire populations. This review summarises all the advances made to estimate the impact of NSAIDs on aquatic animals. Multicellular animals from all trophic levels, inhabiting both inland waters, seas and oceans, have been considered. Particular attention has been paid to chronic studies, conducted at low, environmentally-relevant concentrations, to estimate the real effects of the present pollution. The number of such studies has indeed increased in recent years, allowing for a better insight into the possible consequences of pharmaceutical pollution. It should be stressed, however, that our knowledge is still limited to a few model species, while there are many groups of organisms completely unexplored regarding the effects of drugs. Therefore, the main aim of this paper was to summarise the current state of knowledge on the toxicity of NSAIDs in aquatic animals, also identifying important gaps and major issues requiring further analysis.

Toxicity of the Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) acetylsalicylic acid, paracetamol, diclofenac, ibuprofen and naproxen towards freshwater invertebrates: A review

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) represent one of the main therapeutic classes of molecules contaminating aquatic ecosystems worldwide. NSAIDs are commonly and extensively used for their analgesic, antipyretic and anti-inflammatory properties to cure pain and inflammation in human and veterinary therapy. After use, NSAIDs are excreted in their native form or as metabolites, entering the aquatic ecosystems. A number of monitoring surveys has detected the presence of different NSAIDs in freshwater ecosystems in the ng/L - μg/L concentration range. Although the concentrations of NSAIDs in surface waters are low, the high biological activity of these molecules may confer them a potential toxicity towards non-target aquatic organisms. The present review aims at summarizing toxicity, in terms of both acute and chronic toxicity, induced by the main NSAIDs detected in surface waters worldwide, namely acetylsalicylic acid (ASA), paracetamol (PCM), diclofenac (DCF), ibuprofen (IBU) and naproxen (NPX), both singularly and in mixture, towards freshwater invertebrates. Invertebrates play a crucial role in ecosystem functioning so that NSAIDs-induced effects may result in hazardous consequences to the whole freshwater trophic chain. Acute toxicity of NSAIDs occurs only at high, unrealistic concentrations, while sub-lethal effects arise also at low, environmentally relevant concentrations of all these drugs. Thus, further studies represent a priority in order to improve the knowledge on NSAID toxicity and mechanism(s) of action in freshwater organisms and to shed light on their real ecological hazard towards freshwater communities.

Ecotoxicological assessment of chemotherapeutic agents using toxicity tests with embryos of Mellita quinquiesperforata

The consumption of anticancer agents has increased in the recent decades, and these substances may be present in sewage. Consequently, they may reach the environment when sanitation infrastructure is ineffective. This study evaluated the toxicity of three anticancer agents-Tamoxifen (TAM), Cisplatin (CisPt), and Cyclophosphamide (CP)-on the development of embryos of the sand-dollar Mellita quinquiesperforata. Adult individuals were collected in sandy beaches, and gametes were obtained. Freshly-fertilized eggs were exposed to increasing sets of concentrations of each compound, and the effective concentrations needed to cause a 50% effect in the organisms (EC50) were calculated. The three compounds were toxic, and their EC50 values were 16.78 ± 2.42 ng·L^-1 (TAM), 27.20 ± 38.26 ng·L^-1 (CisPt), and 101.82 ± 70.96 ng·L^-1 (CP). There is no information on the environmental levels of these compounds in Brazil, but as they were already detected in ng·L^-1 levels worldwide, it can be expected that these substances pose environmental risks to the marine biota.

Antineoplastic Agents: Environmental Prevalence and Adverse Outcomes in Aquatic Organisms

Cancer is the second leading cause of death worldwide, with 9.6 million cancer-related deaths in 2018. Cancer incidence has increased over time, and so has the prescription rate of chemotherapeutic drugs. These pharmaceuticals, known as antineoplastic agents, enter the aquatic environment via human excretion and wastewater. The objectives of the present critical review were to investigate the risk of antineoplastics to aquatic species and to summarize the current state of knowledge regarding their levels in the environment, because many antineoplastics are not adequately removed during wastewater treatment. We conducted 2 separate literature reviews to synthesize data on the global environmental prevalence and toxicity of antineoplastics. The antineoplastics most frequently detected in the environment included cyclophosphamide, ifosfamide, tamoxifen, methotrexate, and 5-fluorouracil; all were detectable in multiple water sources, including effluent and surface waters. These antineoplastics span 3 different mechanistic classes, with cyclophosphamide and ifosfamide classified as alkylating agents, tamoxifen as a hormonal agent, and methotrexate and 5-fluorouracil as antimetabolites. Studies that characterize the risk of antineoplastics released into aquatic environments are scarce. We summarize the biological impacts of the most environmentally prevalent antineoplastics on aquatic organisms and propose an adverse outcome pathway for cyclophosphamide and ifosfamide, 2 widely prescribed drugs with a similar immunotoxic mode of action. Acute and chronic ecotoxicity studies using aquatic models are needed for risk characterization of antineoplastics. Environ Toxicol Chem 2020;39:967-985. © 2020 SETAC.

Environmental relevant levels of the cytotoxic drug cyclophosphamide produce harmful effects in the polychaete Nereis diversicolor

Cytotoxic drugs applied in chemotherapy enter the aquatic environment after patient's metabolism and excretion, in both main compounds and their respective metabolites. The increased consumption and discharge of these drugs raise concern on the genotoxic burden to non-target aquatic species, due to their unselective action on DNA. Settlement and adsorption of cytotoxic drugs to aquatic sediments pose risks to benthic species through chronic exposure. The aim of the present study was to assess the effects induced by the anticancer drug cyclophosphamide (CP) on the polychaete Nereis diversicolor, after 14 days of exposure to environmental relevant concentrations (10, 100, 500 and 1000 ng L^-1). Burrowing impairment, neurotoxicity (Acetylcholinesterase - AChE activity), oxidative stress (superoxide dismutase - SOD; catalase - CAT; glutathione peroxidases - GPXs activities), biotransformation (glutathione-S-transferases - GST), oxidative damage (lipid peroxidation - LPO) and genotoxicity (DNA damage) were assessed. Burrowing impairments were higher at the lowest CP concentrations tested. The higher CP levels tested (500 and 1000 ng L^-1) induced a significant inhibition on the enzymatic antioxidant system (SOD, GPx) and on GST activity. DNA damage was also significant at these concentrations as an outcome of CP metabolism, and high levels of oxidative damage occurred. The results showed that the prodrug CP was metabolically activated in the benthic biological model N. diversicolor. In addition to the potential cytotoxic impact likely to be caused in aquatic species with similar metabolism, N. diversicolor proved to be reliable and vulnerable to the cytotoxic mode of action of CP, even at the lower doses.

Integrated multi-biomarker responses of juvenile seabass to diclofenac, warming and acidification co-exposure

Pharmaceutical drugs, such as diclofenac (DCF), are frequently detected in the marine environment, and recent evidence has pointed out their toxicity to non-target marine biota. Concomitantly, altered environmental conditions associated with climate change (e.g. warming and acidification) can also affect the physiology of marine organisms. Yet, the underlying interactions between these environmental stressors (pharmaceutical exposure and climate change-related stressors) still require a deeper understanding. Comprehending the influence of abiotic variables on chemical contaminants' toxicological attributes provides a broader view of the ecological consequences of climate change. Hence, the aim of this study was to assess the ecotoxicological responses of juvenile seabass Dicenthrachus labrax under the co-exposure to DCF (from dietary sources, 500 ± 36 ng kg^-1 dw), warming (ΔTºC = +5 °C) and acidification (ΔpCO₂ ∼1000 μatm, equivalent to ΔpH = -0.4 units), using an "Integrated Biomarker Response" (IBR) approach. Fish were exposed to these three stressors, acting alone or combined, for 28 days in a full cross-factorial design, and blood, brain, liver and muscle tissues were subsequently collected in order to evaluate: i) animal/organ fitness; ii) hematological parameters and iii) molecular biomarkers. Results not only confirmed the toxicological attributes of dietary exposure to DCF in marine fish species at the tissue (e.g. lower HSI), cellular (e.g. increased ENAs and lower erythrocytes viability) and molecular levels (e.g. increased oxidative stress, protein degradation, AChE activity and VTG synthesis), but also showed that such attributes are altered by warming and acidification. Hence, while acidification and/or warming enhanced some effects of DCF exposure (e.g. by further lowering erythrocyte viability, and increasing brain GST activity and Ub synthesis in muscle), the co-exposure to these abiotic stressors also resulted in a reversion/inhibition of some molecular responses (e.g. lower CAT and SOD inhibition and VTG synthesis). IBRs evidenced that an overall higher degree of stress (i.e. high IBR index) was associated with DCF and warming co-exposure, while the effects of acidification were less evident. The distinct responses observed when DCF acted alone or the animals were co-exposed to the drug together with warming and acidification not only highlighted the relevance of considering the interactions between multiple environmental stressors in ecotoxicological studies, but also suggested that the toxicity of pharmaceuticals can be aggravated by climate change-related stressors (particularly warming), thus, posing additional biological challenges to marine fish populations.