Joint effects of per- and polyfluoroalkyl substance alternatives and heavy metals on renal health: A community-based population study in China

Combined Toxicity Assessment of Deoxynivalenol and Pb2+ on HK-2 Cells Involved in Excessive ROS-Induced Ferroptosis

The cocontamination of food by several mycotoxins and heavy metals poses significant health risks, and their combined toxic effects remain poorly understood. Particularly, specific studies exploring their combined impact on ferroptosis remain limited. In this work, we investigated the combined toxic effects of a mycotoxin, called deoxynivalenol (DON), and a heavy metal, called plumbum (Pb), and explored the potential mechanisms of DON and Pb co-occurrence via excessive ROS-induced ferroptosis in HK-2 cells. It was found that combined toxicity of DON and Pb2+ showed a synergism at low concentrations and an antagonism at high concentrations. The increase of the ROS level and iron content as well as the change expression of four ferroptosis marker proteins were observed in DON and Pb2+ individual and combined groups. Furthermore, the addition of ferroptosis inhibitor Fer-1 could mitigate the imbalance of oxidative stress and ferroptosis. Our results suggest that the co-occurrence of DON and Pb2+ might pose a slight threat to the nephrotoxicity due to the interactions related to the excessive ROS-induced ferroptosis, which would provide valuable insights into their potential combined toxic impacts to human and animal health.

Increased health risk from co-exposure to polycyclic aromatic hydrocarbons, phthalates, and per- and polyfluoroalkyl substances: Epidemiological insight from e-waste workers in Hong Kong

The alarming surge in electronic waste (e-waste) in Hong Kong has heightened concerns regarding occupational exposure to a myriad of pollutants. Among these, polycyclic aromatic hydrocarbons (PAHs), phthalates (PAEs), and per- and polyfluoroalkyl substances (PFASs) are prevalent and known for their harmful effects, including the induction of oxidative stress and DNA damage, thereby contributing to various diseases. This study addresses gaps in knowledge by investigating exposure levels of these pollutants-measured via hydroxylated PAHs (OH-PAHs), phthalate metabolites (mPAEs), and PFASs-in urine from 101 e-waste workers and 100 office workers. E-waste workers exhibited higher concentrations of these substances compared to office workers. Elevated urinary levels of OH-PAHs, mPAEs, and PFASs correlated significantly with increased 8-hydroxy-2-deoxyguanosine (8-OHdG) levels (β = 2.53, 95 % CI: 2.12-3.02). The association between short-chain PFASs (Perfluoropentanoic acid, PFPeA) and DNA damage was discovered for the first time. Despite most participants (95 %) showing hazard index (HI) values below non-carcinogenic risk thresholds for PAHs and PAEs, certain pollutants posed higher risks among e-waste workers, necessitating enhanced protective measures. Moreover, the 95th percentile of carcinogenic risk associated with diethylhexyl phthalate (DEHP) exceeded 10-4 in both groups, highlighting the urgent need for regulatory measures to mitigate DEHP exposure risks in Hong Kong.

F-53B stimulated vascular smooth muscle cell phenotypic switch and vascular remodeling via ferroptosis-related pathway

The compound 6:2 chlorinated polyfluorinated ether sulfonate (F53B), an alternative to perfluorooctane sulfonate (PFOS), has been widely utilized in China. Although the connection between the exposure and toxicity of F53B is established, the role and mechanisms of the compound in promoting vascular remodeling are yet to be elucidated. Thus, the present study investigated the impact of F53B on the function of vascular smooth muscle cells (VSMCs) and vascular remodeling. The data exhibited that F53B stimulates vascular morphological alterations in vivo, and exposure to the compound caused excessive VSMCs ferroptosis and phenotype switching, as determined using phenotype and molecular assays. Moreover, Fer-1 reversed F-53B-induced VSMC dysfunction and vascular remodeling. Furthermore, F53B activated the ferroptosis-related pathway, encompassing ATR expression and LOC101929922/miR-542-3p/ACSL4 pathway. Thus, the current results elaborated on the multifaceted toxicities of F53B that induce vascular remodeling, thereby necessitating the assessment of vasotoxicity risks associated with the compound.

Clinical, histological, molecular, and toxicokinetic renal outcomes of per-/polyfluoroalkyl substances (PFAS) exposure: Systematic review and meta-analysis

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals present in the environment that can negatively affect health. Kidney is the major target organ of PFAS exposure, yet the renal impact of PFAS is not completely understood. Here we review the effects of PFAS exposure on kidney health to identify gaps in our understanding and mark potential avenues for future research.

METHODS

PubMed and SCOPUS databases were searched for studies that examined the association between PFAS exposure and kidney-related outcomes. We included all epidemiological, animal, and cell studies and categorized outcomes into four categories: clinical, histological, molecular and toxicokinetic.

RESULTS

We identified 169 studies, including 51 on clinical outcomes, 28 on histological changes, 42 on molecular mechanisms, and 68 on toxicokinetics. Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) exposure were associated with kidney dysfunction, chronic kidney diseases, and increased risk of kidney cancer. Various histological changes were reported, especially in tubular epithelial cells, and the etiology of PFAS-induced kidney injury included various molecular mechanisms. Although PFOA and PFOS are not considered genotoxic, they exhibit several characteristics of carcinogens. Toxicokinetics of PFOA and PFOS differed significantly between species, with renal elimination influenced by various factors such as sex, age, and structure of the compound.

CONCLUSION

Evidence suggests that PFAS, especially PFOA and PFOS, negatively affects kidney health, though gaps in our understanding of such effects call for further research.

Association of coexposure to perfluoroalkyl and polyfluoroalkyl compounds and heavy metals with pregnancy loss and reproductive lifespan: The mediating role of cholesterol

Previous studies have demonstrated the toxic effects of per- and polyfluoroalkyl substances (PFASs) and heavy metals on the reproductive system. However, the interactions and combined effects of these substances remain unexplored. This study utilizes data from the National Health and Nutrition Examination Survey to investigate the associations between coexposure to four types of PFASs, lead (Pb), mercury (Hg) and self-reported pregnancy loss and reproductive lifespan in females. Genes associated with these substances and abortion were identified via the Comparative Toxicogenomics Database. The results revealed that Ln-PFOA (IRR=1.88, 95 % CI=1.42-2.50, Ln--: log transformed), Ln-PFOS (IRR=1.58, 95 % CI=1.12-2.22), Ln-PFHxS (IRR=1.99, 95 % CI=1.57-2.52), and Ln-Hg (IRR=1.92, 95 % CI=1.41-2.43) were positively associated with the risk of pregnancy loss. Ln-PFOA (β=1.27, 95 % CI=0.28-2.27), Ln-PFOS (β=1.01, 95 % CI=0.39-1.63), Ln-PFHxS (β=0.71, 95 % CI=0.12-1.63), Ln-PFNA (β=1.15, 95 % CI=0.23-2.08), Ln-Pb (β=3.87, 95 % CI=2.58-5.15), and Ln-Hg (β=1.01, 95 % CI=0.39-1.64) exposures were positively associated with reproductive lifespan. The mixed and overall effects of coexposure to PFASs and heavy metals were positively correlated with the risk of pregnancy loss and reproductive lifespan. Cholesterol partially mediated the association with the risk of pregnancy loss, whereas delay in menopause fully mediated the association with reproductive lifespan. Significant additive interactions were observed between PFOA and Pb and between PFOS, PFHxS, PFNA and Hg at high levels of coexposure. Thirty-nine overlapping genes associated with abortion were identified for these substances, and further analyses revealed that these genes significantly interact and may contribute to abortion through oxidative stress.

Associations between multi-metal joint exposure and decreased estimated glomerular filtration rate (eGFR) in solar greenhouse workers: A study of a unique farmer group

BACKGROUND

Solar greenhouse workers, a unique farmer group, have been reported to have a higher risk of chronic kidney disease (CKD) compared to the general population, possible due to exposure to multiple metals.

OBJECTIVE

This study aimed to investigate the associations between exposure to multiple metals and the estimated glomerular filtration rate (eGFR).

METHODS

A cross-sectional study was conducted in the Northwest China. Urine samples were tested for concentration of 14 metals, including chromium, manganese, iron et al. Blood creatinine was measured to calculate eGFR, which was to evaluate the kidney function. Linear model and the Bayesian Kernel Machine Regression (BKMR) models were used to evaluate the associations between metals exposure and eGFR.

RESULT

The study included 281 solar greenhouse workers, with 128 (45.6%) males and 153 (54.4%) females. The highest median concentrations of metals were zinc (418.55 μg/L), strontium (368.77 μg/L), and iron (55.73 μg/L), respectively. The linear model analysis showed that urinary levels of copper and zinc were negatively associated with eGFR [β = -0.021, 95% CI (-0.048, -0.007); β = -0.018, 95% CI (-0.068, -0.005)] considering a false discovery rate. BKMR results indicated a significant overall negative effect of 14 metals exposure on the eGFR when all metal levels were above the 50th percentile compared to the median value.

CONCLUSIONS

The decrease in eGFR among solar greenhouse workers was related to mixed metal exposure. Reducing exposure to the metals of copper, zinc, and lead could effectively protects kidney function. Further prospective studies are needed to resolve concerns about reverse causality.

Association of co-exposure to organophosphate esters and per- and polyfluoroalkyl substances and mixture with cardiovascular-kidney-liver-metabolic biomarkers among Chinese adults

BACKGROUND

Organophosphate esters (OPEs) and Per- and polyfluoroalkyl substances (PFAS) are ubiquitous environmental contaminants with common exposure sources, leading to their widespread presence in human body. However, evidence on co-exposure to OPEs and PFAS and its impact on cardiovascular-kidney-liver-metabolic biomarkers remains limited.

METHODS

In this cross-sectional study, 467 adults were enrolled from January to May 2022 during physical visits in Shijiazhuang, Hebei province. Eleven types of OPEs and twelves types of PFAS were detected, among which eight OPEs and six PFAS contaminants were detected in more than 60% of plasma samples. Seventeen biomarkers were assessed to comprehensively evaluate the cardiovascular-kidney-liver-metabolic function. Multiple linear regression, multipollutant models with sparse partial least squares, and Bayesian kernel machine regression (BKMR) models were applied to examine the associations of individual OPEs and PFAS and their mixtures with organ function and metabolism, respectively.

RESULTS

Of the over 400 exposure-outcome associations tested when modelling, we observed robust results across three models that perfluorohexanoic acid (PFHxS) was significantly positively associated with alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), and indirect bilirubin (IBIL). Perfluorononanoic acid was significantly associated with decreased AST/ALT and increased very-low-density lipoprotein cholesterol levels. Besides, perfluorodecanoic acid was correlated with increased high lipoprotein cholesterol and perfluoroundecanoic acid was consistently associated with lower glucose level. BKMR analysis showed that OPEs and PFAS mixtures were positively associated with IBIL and TBIL, among which PFHxS was the main toxic chemicals.

CONCLUSIONS

Our findings suggest that exposure to OPEs and PFAS, especially PFHxS and PFNA, may disrupt organ function and metabolism in the general population, providing insight into the potential pathophysiological mechanisms of OPEs and PFAS co-exposure and chronic diseases.

Association of Combined Per- and Polyfluoroalkyl Substances and Metals with Chronic Kidney Disease

Background: Exposure to environmental pollutants such as metals and Per- and Polyfluoroalkyl Substances (PFAS) has become common and increasingly associated with a decrease in the estimated Glomerular Filtration Rate (eGFR), which is a marker often used to measure chronic kidney disease (CKD). However, there are limited studies involving the use of both eGFR and the urine albumin creatinine ratio (uACR), which are more comprehensive markers to determine the presence of CKD and the complexity of pollutant exposures and response interactions, especially for combined metals and PFAS, which has not been comprehensively elucidated. Objective: This study aims to assess the individual and combined effects of perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), Cadmium (Cd), Mercury (Hg), and Lead (Pb) exposure on CKD using data from the National Health and Nutritional Examination Survey (NHANES) 2017-2018. Methods: We employed the use of bivariate logistic regression and Bayesian Kernel Machine Regression (BKMR) in our analysis of the data. Results: Logistic regression results revealed a positive association between PFOA and CKD. Our BKMR analysis revealed a non-linear and bi-phasic relationship between the metal exposures and CKD. In our univariate exposure-response function plot, Cd and Hg exhibited a U and N-shaped interaction, which indicated a non-linear and non-additive relationship with both low and high exposures associated with CKD. In addition, the bivariate exposure-response function between two exposures in a mixture revealed that Cd had a U-shaped relationship with CKD at different quantiles of Pb, Hg, PFOA, and PFOS, indicating that both low and high levels of Cd is associated with CKD, implying a non-linear and complex biological interaction. Hg's interaction plot demonstrated a N-shaped association across all quantiles of Cd, with the 75th quantile of Pb and the 50th and 75th quantiles of PFOA and PFOS. Furthermore, the PIP results underscored Cd's consistent association with CKD (PIP = 1.000) followed by Hg's (PIP = 0.9984), then PFOA and PFOS with a closely related PIP of 0.7880 and 0.7604, respectively, and finally Pb (PIP = 0.6940), contributing the least among the five environmental pollutants on CKD, though significant. Conclusions: Our findings revealed that exposure to environmental pollutants, particularly Hg and Cd, are associated with CKD. These findings highlight the need for public health interventions and strategies to mitigate the cumulative effect of PFAS and metal exposure and elucidate the significance of utilizing advanced statistical methods and tools to understand the impact of environmental pollutants on human health. Further research is needed to understand the mechanistic pathways of PFAS and metal-induced kidney injury and CKD, and longitudinal studies are required to ascertain the long-term impact of these environmental exposures.

Relationship of single and co-exposure of per-and polyfluoroalkyl substances and their alternatives with uric acid: A community-based study in China

Numerous studies have suggested per-and polyfluoroalkyl substances (PFASs) are related to uric acid levels, but evidence related to PFAS alternatives is limited. Moreover, the effect of the combined exposure to PFASs and their alternatives on uric acid has not been reported. Hence, we conducted a cross-sectional study involving 1312 adults in Guangzhou, China. Generalized linear regression model was adopted to explore the effect of single PFAS exposure on serum uric acid levels. Further, multi-pollutant models such as Bayesian kernel machine regression, weighted quantile sum, and quantile G-computation were employed to investigate the combined association of PFASs and alternatives with serum uric acid levels. We performed molecular docking to understand the potential interaction of PFAS with Organic Anion Transporters (OATs), involved in the secretion of uric acid. Per log serum 6:2 Cl-PFESA and PFOA increases were accompanied with an increase of serum uric acid with statistical significance (for 6:2 Cl-PFESA: beta: 0.19 ng/mL, 95% CI 0.11-0.26 and for PFOA: beta: 0.43 ng/mL, 95% CI 0.34-0.52). The associations were strongest among overweight and elderly. Multi-pollutant models also revealed a positive association. These positive associations may be PFASs can competitively combine with OAT1 and OAT3, leading to the increase of serum uric acid.

Associations of maternal exposure to multiple plasma trace elements with the prevalence of fetal congenital heart defects: A nested case-control study

BACKGROUND

Scanty knowledge prevails regarding the combined impact of multiple plasma trace elements and main contributors on the prevalence of congenital heart defects (CHDs) in offspring. Thus, we performed a nested case-control analysis in a neonates cohort to investigate this important public health issue.

METHODS

We selected 164 pairs of cases and non-malformed controls from live births registered in the parent cohort (n = 11,578) at the same hospital. Plasma levels of 14 trace elements were determined by inductively coupled plasma-mass spectrometry. The odds ratios (ORs) of exposure were compared between cases and controls. Bayesian Kernel Machine Regression (BKMR) and Quantile g-Computation (QgC) models were employed to assess the cumulative effect of exposure to trace elements.

RESULTS

We found positive associations and linear dose-response relationships between plasma Pb and Sn and CHD. BKMR models indicated that the overall effect of the trace element mixture was associated with CHDs below the 45th percentile or above the 50th percentile, and the combined effect was primarily attributed to Sn and Pb. The QgC model indicated significantly increased odds of CHD with simultaneous exposure to all studied trace elements (OR: 2.19, 95%CI: 1.44-3.33).

CONCLUSIONS

This study is the first to report an association between elevated levels of mixed trace elements in maternal plasma with an increased prevalence of fetal CHDs, particularly in the case of Pb and Sn. Findings from this study provide further evidence of the important of heavy metal pollution to human health, and can help stakeholders prioritize policies and develop interventions to target the leading contributors to human exposure.

Association between multiple metal(loid)s exposure and renal function: a cross-sectional study from southeastern China

In the real world, humans are exposed to multiple metal(loid)s (designated hereafter metals) that contain essential metals as well as toxic metals. Exposure to the metal mixture was assumed to be associated with renal function impairment; however, there is no consensus on available studies. Therefore, we here explored the association between multiple metals exposure and indicators of renal function in the general population from southeastern China. A total of 11 metals with 6 human essential metals and 5 toxic metals were determined in the selected 720 subjects. In addition, serum uric acid (SUA), serum creatinine (SCR), and the estimated glomerular filtration rate (eGFR) were measured or calculated as indicators of renal function. Using multiple flexible statistical models of generalized linear model, elastic net regression, and Bayesian kernel machine regression, the joint as well as the individual effect of metals within the mixture, and the interactions between metals were explored. When exposed to the metal mixture, the statistically non-significantly increased SUA, the significantly increased SCR, and the significantly declined eGFR were observed. In addition, the declined renal function may be primarily attributed to lead (Pb), arsenic (As), and nickel (Ni) exposure. Finally, interactions, such as the synergistic effect between Pb and Mo on SUA, whereas the antagonistic effect between Ni and Cd on SCR and eGFR were identified. Our finding suggests that combined exposure to multiple metals would impair renal function. Therefore, reducing exposure to toxic heavy metals of Pb, As, and Cd and limiting exposure to the human essential metal of Ni would protect renal function.

Antagonistic Toxic Effects of Surfactants Mixtures to Bacteria Pseudomonas putida and Marine Microalgae Phaeodactylum tricornutum

Surfactants can be found in an ever-widening variety of products and applications, in which the combination of several types of surfactants is used to reinforce their properties, looking for synergistic effects between them. After use, they tend to be discarded into wastewater, ending up in aquatic bodies with concerning harmful and toxic effects. The aim of this study is the toxicological assessment of three anionic surfactants (ether carboxylic derivative, EC) and three amphoteric surfactants (amine-oxide-based, AO), individually and in binary mixtures of them (1:1 w/w), to bacteria Pseudomonas putida and marine microalgae Phaeodactylum tricornutum. Critical Micelle Concentration (CMC) was determined to demonstrate the capacity to reduce surface tension and the toxicity of the surfactants and mixtures. Zeta potential (ζ-potential) and micelle diameter (MD) were also determined to confirm the formation of mixed surfactant micelles. The Model of Toxic Units (MTUs) was used to quantify the interactions of surfactants in binary mixtures and to predict if the concentration addition or response addition principle can be assumed for each mixture. The results showed a higher sensitivity of microalgae P. tricornutum to the surfactants tested and their mixtures than bacteria P. putida. Antagonism toxic effects have been detected in the mixture of EC + AO and in one binary mixture of different AOs; this is to say, the mixtures showed lower toxicity than expected.