Occurrence and distribution of per- and polyfluoroalkyl substances (PFASs) in human livers with liver cancer

PFHpA alters lipid metabolism and increases the risk of metabolic dysfunction-associated steatotic liver disease in youth-a translational research framework

To address the growing epidemic of liver disease, particularly in pediatric populations, it is crucial to identify modifiable risk factors for the development and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). Per- and polyfluoroalkyl substances (PFAS) are persistent ubiquitous chemicals and have emerged as potential risk factors for liver damage. However, their impact on the etiology and severity of MASLD remains largely unexplored in humans. This study aims to bridge the gap between human and in vitro studies to understand how exposure to perfluoroheptanoic acid (PFHpA), one of the emerging PFAS replacements which accumulates in high concentrations in the liver, contributes to MASLD risk and progression. First, we showed that PFHpA plasma concentrations were significantly associated with increased risk of MASLD in obese adolescents. Further, we examined the impact of PFHpA on hepatic metabolism using 3D human liver spheroids and single-cell transcriptomics to identify major hepatic pathways affected by PFHpA. Next, we integrated the in vivo and in vitro multi-omics datasets with a novel statistical approach which identified signatures of proteins and metabolites associated with MASLD development triggered by PFHpA exposure. In addition to characterizing the contribution of PFHpA to MASLD progression, our study provides a novel strategy to identify individuals at high risk of PFHpA-induced MASLD and develop early intervention strategies. Notably, our analysis revealed that the proteomic signature exhibited a stronger correlation between both PFHpA exposure and MASLD risk compared to the metabolomic signature. While establishing a clear connection between PFHpA exposure and MASLD progression in humans, our study delved into the molecular mechanisms through which PFHpA disrupts liver metabolism. Our in vitro findings revealed that PFHpA primarily impacts lipid metabolism, leading to a notable increase of lipid accumulation in human hepatocytes after PFHpA exposure. Among the pathways involved in lipid metabolism in hepatocytes, regulation of lipid metabolism by PPAR-a showed a remarkable activation. Moreover, the translational research framework we developed by integrating human and in vitro data provided us biomarkers to identify individuals at a high risk of MASLD due to PFHpA exposure. Our framework can inform policies on PFAS-induced liver disease and identify potential targets for prevention and treatment strategies.

Exposure to per- and polyfluoroalkyl substances in lung cancer patients and their associations with clinical health indicators

Per- and polyfluoroalkyl substances (PFASs) have potential carcinogenicity, immunotoxicity, and hepatotoxicity. Research has been conducted on PFAS exposure in people to discuss their potential health effects, excluding lung cancer. In this study, we recruited participants (n = 282) with lung cancer from Heilongjiang Province, northeast China. The PFAS concentrations were measured in their serum to fill the data gap of exposure, and relationships were explored in levels between PFASs and clinical indicators of tumor, immune and liver function. Ten PFASs were found in over 80 % of samples and their total concentrations were 5.27-152 ng/mL, with the highest level for perfluorooctanesulfonate (median: 12.4 ng/mL). Long-chain PFASs were the main congeners and their median concentration (20.5 ng/mL) was nearly three times to that of short-chain PFASs (7.61 ng/mL). Significantly higher concentrations of perfluorobutanoic acid, perfluorononanoic acid and perfluorohexanesulfonate were found in males than in females (p < 0.05). Serum levels of neuro-specific enolase were positively associated with perfluoropentanoic acid in all participants and were negatively associated with perfluorononanesulfonate in females (p < 0.05, multiple linear regression models). Exposure to PFAS mixture was significantly positively associated with the lymphocytic absolute value (difference: 0.224, 95% CI: 0.018, 0.470; p < 0.05, quantile g-computation models) and serum total bilirubin (difference: 2.177, 95% CI: 0.0335, 4.33; p < 0.05). Moreover, PFAS exposure can affect γ-glutamyl transpeptidase through several immune markers (p < 0.05, mediating test). Our results suggest that exposure to certain PFASs could interfere with clinical indicators in lung cancer patients. To our knowledge, this is the first study to detect serum PFAS occurrence and check their associations with clinical indicators in lung cancer patients.

Effect of liver cancer on the accumulation and hepatobiliary transport of per- and polyfluoroalkyl substances

In this study, we examined the distribution of per- and polyfluoroalkyl substances (PFASs) in liver and bile tissues from the patients with liver cancer (n = 202) and healthy controls (n = 30), and calculated the hepatobiliary transport efficiency (TB-L) of PFASs. Among 21 PFASs, 13 PFASs were frequently detected in the liver (median: 8.80-16.3 ng/g) and bile (median: 11.03-14.26 ng/mL) samples. PFAS concentrations in liver were positively correlated with age, with higher levels of PFASs in the older. Variance analysis showed that gender and BMI (Body Mass Index) have an important impact on the distribution of PFASs. A U-shaped trend in TB-L of PFASs with the increasing of carbon chain length was found for the first time, and the TB-L of most PFASs in the control was higher than that of those in cases (p < 0.05), suggesting that hepatic injury would affect their transport. PFASs were positively associated with liver injury biomarkers, including γ-glutamyl transferase (GGT), alanine aminotransferase (ALT), and total bilirubin (TB) levels (p < 0.05). This is the first study on examining the hepatobiliary transport characteristics of PFASs, which may help understand the connection between PFAS accumulation and liver cancer risk.

Inequities in primary liver cancer in Europe: The state of play

Given the increasing burden of liver cancer in Europe, it is crucial to investigate how social determinants of health (SDoH) affect liver cancer risk factors and access to care in order to improve health outcomes equitably. This paper summarises the available evidence on the differential distribution of liver cancer risk factors, incidence, and health outcomes in the European Economic Area and the United Kingdom from an SDoH perspective. Vulnerable and marginalised populations have low socio-economic and educational levels and are the most affected by liver cancer risk factors. Reasons for this include varied access to hepatitis B virus vaccination and limited access to viral hepatitis B and C screening, harm reduction, and treatment. Additionally, alcohol-related liver disease remains highly prevalent among individuals with low education, insecure employment, economic instability, migrants, and deprived populations. Moreover, significant variation exists across Europe in the proportion of adults with steatotic liver disease, overweight/obesity, and diabetes, based on geographical area, gender, socio-economic and educational background, and density of ultra-processed food outlets. Inequities in cirrhosis mortality rates have been reported, with the highest death rates among individuals living in socio-economically disadvantaged areas and those with lower educational levels. Furthermore, insufficient healthcare access for key populations with primary liver cancer is influenced by complex healthcare systems, stigmatisation, discrimination, low education, language barriers, and fear of disclosure. These challenges contribute to inequities in liver cancer care pathways. Future studies are needed to explore the different SDoH-interlinked effects on liver cancer incidence and outcomes in European countries. The ultimate goal is to develop evidence-based multilevel public health interventions that reduce the SDoH impact in precipitating and perpetuating the disproportionate burden of liver cancer in specific populations.

Comparative hepatotoxicity of novel lithium bis(trifluoromethanesulfonyl)imide (LiTFSI, ie. HQ-115) and legacy Perfluorooctanoic acid (PFOA) in male mice: Insights into epigenetic mechanisms and pathway-specific responses

Lithium Bis(trifluoromethanesulfonyl)imide (LiTFSI ie. HQ-115), a polymer electrolyte used in energy applications, has been detected in the environment, yet its health risks and environmental epigenetic effects remain unknown. This study aims to unravel the potential health risks associated with LiTFSI, investigate the role of DNA methylation-induced toxic mechanisms in its effects, and compare its hepatotoxic impact with the well-studied Perfluorooctanoic Acid (PFOA). Using a murine model, six-week-old male CD1 mice were exposed to 10 and 20 mg/kg/day of each chemical for 14 days as 14-day exposure and 1 and 5 mg/kg/day for 30 days as 30-day exposure. Results indicate that PFOA exposure induced significant hepatotoxicity, characterized by liver enlargement, and elevated serum biomarkers. In contrast, LiTFSI exposure showed lower hepatotoxicity, accompanied by mild liver injuries. Despite higher bioaccumulation of PFOA in serum, LiTFSI exhibited a similar range of liver concentrations compared to PFOA. Reduced Representative Bisulfite Sequencing (RRBS) analysis revealed distinct DNA methylation patterns between 14-day and 30-day exposure for the two compounds. Both LiTFSI and PFOA implicated liver inflammatory pathways and lipid metabolism. Transcriptional results showed that differentially methylated regions in both exposures are enriched with cancer/disease-related motifs. Furthermore, Peroxisome proliferator-activated receptor alpha (PPARα), a regulator of lipid metabolism, was upregulated in both exposures, with downstream genes indicating potential oxidative damages. Overall, LiTFSI exhibits distinct hepatotoxicity profiles, emphasizing the need for comprehensive assessment of emerging PFAS compounds.

Per- and polyfluoroalkyl substance (PFAS) mixtures induce gut microbiota dysbiosis and metabolic disruption in silkworm (Bombyx mori L.)

Mixed legacy and emerging per- and polyfluoroalkyl substances (PFASs) are commonly found in soil and dust; however, the potential toxicity of PFAS mixtures (mPFASs) in insects is unknown. Using 16S rRNA gene sequencing and transcriptome sequencing (RNA-Seq), we evaluated the adverse effects of mPFASs on silkworms, a typical lepidopteran insect. After exposure to mPFASs, the silkworm midgut was enriched with high levels of PFASs, which induced histopathological changes. The composition of the midgut microbiota was significantly affected by mPFAS exposure, and functional predictions revealed significant disruption of some metabolic pathways. RNA-seq analysis revealed that mPFASs significantly changed the transcription profiles. Functional enrichment analysis of the differentially expressed genes also revealed that biological processes related to metabolic pathways and the digestive system were significantly affected, similar to the results of the gut microbiota analysis, suggesting that mPFAS exposure had an adverse effect on the metabolic function of silkworms and may further affect their normal growth. Finally, the significant correlation between abundance changes in the gut microbiota and metabolism/digestion-related genes further highlighted the role of the gut microbiota in mPFAS-related processes affecting the metabolic functions of silkworms. To our knowledge, this study is the first to evaluate the toxic effects of mPFASs in insects and provide basic data for further PFAS toxicity investigations in insects and comprehensive ecological risk assessments of mPFASs.

Dietary exposure to per- and polyfluoroalkyl substances: Potential health impacts on human liver

Per- and polyfluoroalkyl substances (PFAS), dubbed "forever chemicals", are widely present in the environment. Environmental contamination and food contact substances are the main sources of PFAS in food, increasing the risk of human dietary exposure. Numerous epidemiological studies have established the link between dietary exposure to PFAS and liver disease. Correspondingly, PFAS induced-hepatotoxicity (e.g., hepatomegaly, cell viability, inflammation, oxidative stress, bile acid metabolism dysregulation and glycolipid metabolism disorder) observed from in vitro models and in vivo rodent studies have been extensively reported. In this review, the pertinent literature of the last 5 years from the Web of Science database was researched. This study summarized the source and fate of PFAS, and reviewed the occurrence of PFAS in food system (natural and processed food). Subsequently, the characteristics of human dietary exposure PFAS (population characteristics, distribution trend, absorption and distribution) were mentioned. Additionally, epidemiologic evidence linking PFAS exposure and liver disease was alluded, and the PFAS-induced hepatotoxicity observed from in vitro models and in vivo rodent studies was comprehensively reviewed. Lastly, we highlighted several critical knowledge gaps and proposed future research directions. This review aims to raise public awareness about food PFAS contamination and its potential risks to human liver health.

Hepatotoxic response of perfluorooctane sulfonamide (PFOSA) in early life stage zebrafish (Danio rerio) is greater than perfluorooctane sulfonate (PFOS)

Perfluorooctane sulfonamide (PFOSA), a typical perfluorooctane sulfonate precursor (PreFOS), has been detected in the aquatic environment globally. However, the effects of PFOSA at levels measured in the environment have not been well characterized in aquatic organisms. In this study, we evaluated the transcriptional, biochemical, histopathological, and morphological effects of PFOSA to characterize the underlying mechanisms of toxicity by using a universal model in aquatic ecotoxicology, zebrafish (Danio rerio). Transcriptional changes in PFOSA-exposed zebrafish predicted hepatic fibrosis and associated immune function. Subsequent, sublethal impacts were observed, which included significant alterations in liver-specific protein levels, increased immune cell numbers, and liver pathological structural damage. In addition, we compared the effects caused by PFOSA and perfluorooctane sulfonate (PFOS) at the same exposure concentration and found a greater hepatotoxic effect of PFOSA relative to PFOS, indicating that the adverse impacts of PFOSA may be more severe. This was the first study to comparatively explore the hepatotoxic response of PFOSA and PFOS in aquatic organisms, which can be used for ecological risk assessments of PreFOS compounds.

Associations between per- and polyfluoroalkyl substances, liver function, and daily alcohol consumption in a sample of U.S. adults

BACKGROUND AND AIM

Per- and polyfluoroalkyl substances (PFAS) are ubiquitous in the environment and in the serum of the U.S.

POPULATION

We sought to evaluate the association of PFAS independently and jointly with alcohol intake on liver function biomarkers in a sample of the U.S. general population.

METHODS

Using data from the National Health and Nutrition Examination Survey (2003-2016; N = 11,794), we examined the five most historically prevalent PFAS with >75% detection rates. We estimated odds ratios (OR) and 95% confidence intervals (CI) for the association between PFAS (quartiles and log-transformed continuous, ng/mL) and high levels (>95th percentile) of liver injury biomarkers using logistic regression models adjusted for key confounders. We evaluated interactions between PFAS and alcohol consumption and sex via stratified analyses and conducted sub-analyses adjusting for daily alcohol intake among those with available drinking history (N = 10,316).

RESULT

Serum perfluorooctanoic acid (PFOA) was positively associated with high levels of alanine transferase (ALT) without monotonic trend (ORQ4vsQ1 = 1.45, CI: 0.99-2.12; p-trend = 0.18), and with increased aspartate transaminase when modeled continuously (OR = 1.15, CI: 1.02-1.30; p-trend = 0.03). Perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonate (PFHxS) were both inversely associated with alkaline phosphatase while a trend was evident only for PFHxS (p = 0.02). A non-monotonic inverse association was observed with PFOA (p-trend = 0.10). The highest quartile of PFOS was associated with high total bilirubin (TB; ORQ4vsQ1 = 1.57, CI: 1.01-2.43, p-trend = 0.02). No significant associations were found between any PFAS and γ-glutamyl transpeptidase. We found no associations for perfluorodecanoic acid and perfluorononanoic acid. We observed some suggestive interactions with alcohol intake, particularly among heavy drinkers.

CONCLUSION

Consistent with other studies, serum levels of PFOA, PFHxS and PFNA were positively associated with high levels of ALT, and we also observed weak positive associations between some PFAS and TB. Associations observed among heavy drinkers warrant additional evaluation.

Paired Liver:Plasma PFAS Concentration Ratios from Adolescents in the Teen-LABS Study and Derivation of Empirical and Mass Balance Models to Predict and Explain Liver PFAS Accumulation

Animal studies have pointed at the liver as a hotspot for per- and polyfluoroalkyl substances (PFAS) accumulation and toxicity; however, these findings have not been replicated in human populations. We measured concentrations of seven PFAS in matched liver and plasma samples collected at the time of bariatric surgery from 64 adolescents in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. Liver:plasma concentration ratios were perfectly explained (r2 > 0.99) in a multilinear regression (MLR) model based on toxicokinetic (TK) descriptors consisting of binding to tissue constituents and membrane permeabilities. Of the seven matched plasma and liver PFAS concentrations compared in this study, the liver:plasma concentration ratio of perfluoroheptanoic acid (PFHpA) was considerably higher than the liver:plasma concentration ratio of other PFAS congeners. Comparing the MLR model with an equilibrium mass balance model (MBM) suggested that complex kinetic transport processes are driving the unexpectedly high liver:plasma concentration ratio of PFHpA. Intratissue MBM modeling pointed to membrane lipids as the tissue constituents that drive the liver accumulation of long-chain, hydrophobic PFAS, whereas albumin binding of hydrophobic PFAS dominated PFAS distribution in plasma. The liver:plasma concentration data set, empirical MLR model, and mechanistic MBM modeling allow the prediction of liver from plasma concentrations measured in human cohort studies. Our study demonstrates that combining biomonitoring data with mechanistic modeling can identify underlying mechanisms of internal distribution and specific target organ toxicity of PFAS in humans.

Exposure to perfluoroalkyl and polyfluoroalkyl substances and estimated glomerular filtration rate in adults: a cross-sectional study based on NHANES (2017-2018)

Perfluoroalkyl and polyfluoroalkyl substances (PFASs) may be important environmental risk factors affecting renal function. This study aimed to investigate the relationships between PFASs and estimated glomerular filtration rate (eGFR) in univariate exposure and multivariate co-exposure models of PFASs. A total of 1700 people over 18 years from National Health and Nutrition Examination Survey (NHANES) in 2017-2018 were selected as subjects to explore the relationships between eGFR and six PFASs (perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFUA), perfluorodecanoic acid (PFDeA), and perfluorohexane sulfonate (PFHxS)). First, multiple linear regression was used to estimate the association of each PFAS with eGFR, and the joint effect of PFAS mixtures was evaluated by Bayesian kernel machine regression (BKMR). Multiple linear regression analysis showed PFOS (β =  - 0.246, p = 0.026) and PFHxS (β = 0.538, p = 0.049) were significantly associated with eGFR in total population. In BKMR analysis, there was joint effect between PFOS and PFHxS for eGFR. And there were the joint effects of multiple PFAS on eGFR, especially the significant joint effect between PFHxS and PFDeA/PFNA/PFUA. Future cohort studies need to explore the association of multiple PFASs and health.

Recent trends in degradation strategies of PFOA/PFOS substitutes

The global elimination and restriction of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS), respectively, have urged manufacturers to shift production to their substitutes which still pose threat to the environment with their bioaccumulation, toxicity and migration issues. In this context, efficient technologies and systematic mechanistic studies on the degradation of PFOA/PFOS substitutes are highly desirable. In this review, we summarize the progress in degrading PFOA/PFOS substitutes, including four kinds of mainstream methods. The pros and cons of the present technologies are analyzed, which renders the discussion of future prospects on rational optimizations. Additional discussion is made on the differences in the degradation of various kinds of substitutes, which is compared to the PFOA/PFOS and derives designing principles for more degradable F-containing compounds.

Perfluoroalkyl and polyfluoroalkyl substances (PFASs) crossing the blood-cerebrospinal fluid barrier: Their occurrence in human cerebrospinal fluid

Data remain scarce regarding the occurrence of per- and polyfluoroalkyl substances (PFASs) in the human brain for better understanding the cerebral disorders. In this study, we measured the concentrations and profiles of 26 traditional and emerging PFASs in cerebrospinal fluid (CSF), which is a preferred matrix to monitor pollutants in the human brain. Our results indicated perfluorooctanesulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorohexanesulfonate (PFHxS) and n-methylperfluorooctanesulfonamidoacetic acid were the most frequently detected congeners (detection frequency >90%). As the predominant congeners, PFOA and PFOS contributed 27.7% and 14.5% of the total amount of PFASs (ΣPFASs), with respective mean concentration of 221 and 115 pg mL^-1. In addition, the concentrations of ΣPFASs in CSF of males were generally higher than those of females, which may be related to the different half-lives of PFASs in different sexes. Interestingly, the concentrations of ΣPFASs and several individual congeners (e.g., perfluorohexanoic acid, perfluorodecanoic acid, perfluorononanoic acid, PFHxS and PFOS) increased with age. The highest concentration of ΣPFASs was found in the elderly compared with other age groups, which may be due to the decreased CSF output as age increased. Our data are valuable for further studies regarding the toxic effects of PFASs on the human brain.

Glioma is associated with exposure to legacy and alternative per- and polyfluoroalkyl substances

Data on the occurrences of legacy and alternative per- and polyfluoroalkyl substances (PFASs) in glioma are scarce. It remains unclear if PFASs exposure is related to the prevalence of glioma. A total of 137 glioma and 40 non-glioma brain tissue samples from patients recruited from the Nanfang Hospital, South China were analyzed for 17 PFAS compounds. Perfluorohexanoic acid, perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorooctane sulfonamide (FOSA), and 6:2 chlorinated polyfluorinated ether sulfonate were frequently detected (> 60 %) in glioma. The total concentrations (range; median) of 17 PFASs in glioma (0.20-140; 3.1 ng g^-1) were slightly higher than those in non-glioma (0.35-32; 2.2 ng g^-1), but without statistical significance. The PFAS concentrations in males were statistically higher (p < 0.05) than those in females. Elevated glioma grades were associated with higher concentrations of PFOA, PFOS, and FOSA. Positive correlations were observed between PFAS concentrations (especially for PFOA) and Ki-67 or P53 expression, pathological molecular markers of glioma. Our findings suggested that exposure to PFASs might increase the probability to develop glioma. This is the first case study demonstrating associations between PFASs exposure and brain cancer. More evidences and potential pathogenic mechanisms warranted further investigations.

Integration of metabolomics and proteomics reveals the underlying hepatotoxic mechanism of perfluorooctane sulfonate (PFOS) and 6:2 chlorinated polyfluoroalkyl ether sulfonic acid (6:2 Cl-PFESA) in primary human hepatocytes

Perfluorooctane sulfonate (PFOS) and its alternative 6:2 chlorinated polyfluorinated ether sulfonate (6:2 Cl-PFESA) are ubiquitous in various environmental and human samples. They have been reported to have hepatotoxicity effects, but the potential mechanisms remain unclear. Herein, we integrated metabolomics and proteomics analysis to investigate the altered profiles in metabolite and protein levels in primary human hepatocytes (PHH) exposed to 6:2 Cl-PFESA and PFOS at human exposure relevant concentrations. Our results showed that 6:2 Cl-PFESA exhibited higher perturbation effects on cell viability, metabolome and proteome than PFOS. Integration of metabolomics and proteomics revealed that the alteration of glycerophospholipid metabolism was the critical pathway of 6:2 Cl-PFESA and PFOS-induced lipid metabolism disorder in primary human hepatocytes. Interestingly, 6:2 Cl-PFESA-induced cellular metabolic process disorder was associated with the cellular membrane-bounded signaling pathway, while PFOS was associated with the intracellular transport process. Moreover, the disruption effects of 6:2 Cl-PFESA were also involved in inositol phosphate metabolism and phosphatidylinositol signaling system. Overall, this study provided comprehensive insights into the hepatic lipid toxicity mechanisms of 6:2 Cl-PFESA and PFOS in human primary hepatocytes.

Challenges of fluoride pollution in environment: Mechanisms and pathological significance of toxicity - A review

Fluoride is an important trace element in the living body. A suitable amount of fluoride has a beneficial effect on the body, but disproportionate fluoride entering the body will affect various organs and systems, especially the liver, kidneys, nervous system, endocrine system, reproductive system, bone, and intestinal system. In recent years, with the rapid development of agriculture and industry, fluoride pollution has become one of the important factors of environmental pollution, and fluoride pollution in any form is becoming a serious problem. Although countries around the world have made great breakthroughs in controlling fluoride pollution, however fluorosis still exists. A large amount of fluoride accumulated in animals will not only produce the toxic effects, but it also causes cell damage and affect the normal physiological activities of the body. There is no systematic description of the damage mechanism of fluoride. Therefore, the study on the toxicity mechanism of fluoride is still in progress. This review summarizes the existing information of several molecular mechanisms of the fluoride toxicity comprehensively, aiming to clarify the toxic mechanism of fluoride on various body systems. We have also summerized the pathological changes of those organ systems after fluoride poisoning in order to provide some ideas and solutions to the reader for the prevention and control of modern fluoride pollution.