Perfluoroalkyl substances are inversely associated with coronary heart disease in adults with diabetes

Single-cell RNA sequencing reveals the role of mitochondrial dysfunction in the cardiogenic toxicity of perfluorooctane sulfonate in human embryonic stem cells

Perfluorooctane sulfonate (PFOS), an endocrine-disrupting chemical pollutant, affects embryonic heart development; however, the mechanisms underlying its toxicity have not been fully elucidated. Here, Single-cell RNA sequencing (scRNA-seq) was used to investigate the overall effects of PFOS on myocardial differentiation from human embryonic stem cells (hESCs). Additionally, apoptosis, mitochondrial membrane potential, and ATP assays were performed. Downregulated cardiogenesis-related genes and inhibited cardiac differentiation were observed after PFOS exposure in vitro. The percentages of cardiomyocyte and cardiac progenitor cell clusters decreased significantly following exposure to PFOS, while the proportion of primitive endoderm cell was increased in PFOS group. Moreover, PFOS inhibited myocardial differentiation and blocked cellular development at the early- and middle-stage. A Gene Ontology analysis and pseudo-time trajectory illustrated that PFOS disturbed multiple processes related to cardiogenesis and oxidative phosphorylation in the mitochondria. Furthermore, PFOS decreased mitochondrial membrane potential and induced apoptosis. These results offer meaningful insights into the cardiogenic toxicity of PFOS exposure during heart formation as well as the adverse effects of PFOS on mitochondria.

Per- and polyfluoroalkyl substances and cardiometabolic diseases: A review

Per- and polyfluoroalkyl substances (PFAS) are a group of persistent and widespread environmental pollutants that represent a high concern for human health. They have been shown to be associated with several important physiological processes such as lipid metabolism and the immune system. Consequently, PFAS are suspected to play a role in cardiometabolic disease development. However, the evidence regarding associations between PFAS and overt cardiovascular disease and type 2 diabetes remains limited and inconsistent. To address this, we conducted a review of the epidemiological evidence. A deeper understanding of potential underlying molecular mechanisms may help to explain inconsistencies in epidemiological findings. Thus, to gain more mechanistic insight, we also summarized evidence from omics and laboratory studies into an adverse outcome pathway framework. Our observations indicate the potential for associations of PFAS with multiple molecular pathways that could have opposite associations with disease risk, which could be further modified by mixture composition, lifestyle factors or genetic polymorphisms. This identifies the need for exposome studies considering mixture effects, the use of multi-omics data to gain insight in relevant pathways and the integration of epidemiological and laboratory studies to enhance mechanistic understanding and causal inference. Improved comprehension is essential for environmental health risk assessments.

Decreased levels of perfluoroalkyl substances in patients receiving hemodialysis treatment

Perfluoroalkyl substances (PFAS) have been reported to be harmful to multiple organs in the human body. Based on a previous study suggesting that hemodialysis (HD) may be a means of eliminating PFAS from the human body, we aimed to compare the serum PFAS concentrations of patients undergoing regular HD, patients with chronic kidney disease (CKD) and controls. Additionally, we also investigated the correlation between PFAS and biochemical data, as well as concurrent comorbidities. We recruited 301 participants who had been on maintenance dialysis for >90 days, 20 participants with stage 5 non-dialysis CKD, and 55 control participants who did not have a diagnosis of kidney disease, with a mean creatinine level of 0.77 mg/dl. Eight different PFAS, namely perfluorooctanoic acid (PFOA), total and linear perfluorooctanesulfonic acid (PFOS), perfluoroheptanoic acid (PFHpA), perfluorohexanesulfonic acid (PFHxS), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA), were measured using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Spearman correlation and multivariable linear regression with 5 % false discovery rate were used to evaluate the relationships between PFAS and clinical parameters in HD patients and controls. Circulating concentrations of seven PFAS, including total and linear PFOS (T-PFOS and L-PFOS) PFDA, PFNA, PFHxS, PFOA, and PFUnDA, were significantly lower in the HD group compared to the CKD and control group. For the interplay between biochemical data and PFAS, all of the studied PFAS were positively correlated with aspartate aminotransferase, alanine aminotransferase, glucose, blood urea nitrogen, ferritin, and vitamin D in the controls, while in HD patients, the PFAS were all positively correlated with albumin, uric acid, iron, and vitamin D. These findings may offer valuable insights for future studies seeking to eliminate PFAS.

Environmental pollutant pre- and polyfluoroalkyl substances are associated with electrocardiogram parameters disorder in adults

Environmental pollutants exposure might disrupt cardiac function, but evidence about the associations of per- and polyfluoroalkyl substances (PFASs) exposure and cardiac conduction system remains sparse. To explore the associations between serum PFASs exposure and electrocardiogram (ECG) parameters changes in adults, we recruited 1229 participants (mean age: 55.1 years) from communities of Guangzhou, China. 13 serum PFASs with detection rate > 85% were analyzed finally. We selected 6 ECG parameters [heart rate (HR), PR interval, QRS duration, Bazett heart rate-corrected QT interval (QTc), QRS electric axis and RV5 + SV1 voltage] as outcomes. Generalized linear models (GLMs) and Bayesian kernel machine regression (BKMR) model were conducted to explore the associations of individual and joint PFASs exposure and ECG parameters changes, respectively. We detected significant associations of PFASs exposure with decreased HR, QRS duration, but with increased PR interval. For example, at the 95th percentile of 6:2 Cl-PFESA, HR and QRS duration were - 6.98 [95% confidence interval (CI): - 9.07, - 4.90] and - 6.54(95% CI: -9.05, -4.03) lower, but PR interval was 7.35 (95% CI: 3.52, 11.17) longer than those at the 25th percentile. Similarly, significant joint associations were observed in HR, PR interval and QRS duration when analyzed by BKMR model.

Per- and polyfluoroalkyl substances, gestational weight gain, postpartum weight retention and body composition in the UPSIDE cohort

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals found in drinking water and consumer products, resulting in ubiquitous human exposure. PFAS have been linked to endocrine disruption and altered weight gain across the lifespan. A limited and inconsistent body of research suggests PFAS may impact gestational weight gain (GWG) and postpartum body mass index (BMI), which are important predictors of overall infant and maternal health, respectively.

METHODS

In the Understanding Pregnancy Signals and Infant Development (UPSIDE/UPSIDE-MOMs) study (n = 243; Rochester, NY), we examined second trimester serum PFAS (PFOS: perfluorooctanesulfonic acid, PFOA: perfluorooctanoic acid, PFNA: perfluorononanoic acid, PFHxS: perfluorohexanesulfonic acid, PFDA: perfluorodecanoic acid) in relation to GWG (kg, and weekly rate of gain) and in the postpartum, weight retention (PPWR (kg) and total body fat percentage (measured by bioelectrical impedance)). We fit multivariable linear regression models examining these outcomes in relation to log-transformed PFAS in the whole cohort as well as stratified by maternal pre-pregnancy BMI (< 25 vs. =  > 25 kg/m2), adjusting for demographics and lifestyle factors. We used weighted quantile sum regression to find the combined influence of the 5 PFAS on GWG, PPWR, and body fat percentage.

RESULTS

PFOA and PFHxS were inversely associated with total GWG (PFOA: ß = -1.54 kg, 95%CI: -2.79, -0.30; rate ß = -0.05 kg/week, 95%CI: -0.09, -0.01; PFHxS: ß = -1.59 kg, 95%CI: -3.39, 0.21; rate ß = -0.05 kg/week, 95%CI: -0.11, 0.01) and PPWR at 6 and 12 months (PFOA 6 months: ß = -2.39 kg, 95%CI: -4.17, -0.61; 12 months: ß = -4.02 kg, 95%CI: -6.58, -1.46; PFHxS 6 months: ß = -2.94 kg, 95%CI: -5.52, -0.35; 12 months: ß = -5.13 kg, 95%CI: -8.34, -1.93). PFOA was additionally associated with lower body fat percentage at 6 and 12 months (ß = -1.75, 95%CI: -3.17, -0.32; ß = -1.64, 95%CI: -3.43, 0.16, respectively) with stronger associations observed in participants with higher pre-pregnancy BMI. The PFAS mixture was inversely associated with weight retention at 12 months (ß = -2.030, 95%CI: -3.486, -0.573) amongst all participants.

CONCLUSION

PFAS, in particular PFOA and PFHxS, in pregnancy are associated with altered patterns of GWG and postpartum adiposity with potential implications for fetal development and long-term maternal cardiometabolic health.

Associations of perfluoroalkyl substances (PFAS) with lipid and lipoprotein profiles

BACKGROUND

Perfluoroalkyl substances (PFAS) are man-made chemicals with unique properties that are widely distributed in humans and the environment. Recent studies suggest that PFAS are involved in cholesterol metabolism, however, the mechanisms underlying the associations are poorly understood.

OBJECTIVE

We aimed to evaluate associations of plasma PFAS with detailed lipid and lipoprotein subfractions in an adult population of men and women.

METHODS

We measured concentrations of cholesterol and triglycerides in lipoprotein subfractions, apolipoprotein subclasses, as well as fatty acid and different phospholipid measures, using serum proton nuclear magnetic resonance (1H-NMR), and four plasma PFAS using liquid chromatography-mass spectrometry (UHPLC-MS/MS). Measurements were available for 493 participants (all aged 50 years, 50% female). Multivariable linear regression was used to estimate the association of four PFAS with 43 different 1H-NMR measures, with adjustment for body mass index (BMI), smoking, education, and physical activity.

RESULTS

We found that perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorodecanoic acid (PFDA), but not perfluorohexanesulfonate (PFHxS), concentrations were consistently positively associated with concentrations of cholesterol in lipoprotein subfractions, apolipoproteins, as well as composite fatty acid- and phospholipid profiles. The most consistent associations were found for the relationship of PFAS with total cholesterol in intermediate-density lipoprotein (IDL), across all low-density lipoprotein (LDL) subfractions and small high-density lipoprotein (HDL). Moreover, we found weak to null evidence for an association of any of the measured 13 triglyceride lipoprotein subfractions with PFAS.

CONCLUSIONS

Our results suggest that plasma PFAS concentrations are associated with cholesterol in small HDL, IDL and all LDL subfractions, as well as apolipoproteins and composite fatty acid and phospholipid profiles but to a lesser extent with triglycerides in lipoproteins. Our findings draw attention to the need for more detailed measurements of lipids across various lipoprotein subfractions and subclasses in assessing the role of PFAS in lipid metabolism.

IMPACT

By performing an in-depth characterization of circulating cholesterol and triglycerides in lipoprotein subfractions, apolipoprotein, fatty acid, and phospholipid concentrations, this study has expanded upon the limited literature available on the associations of plasma PFAS concentrations beyond clinical routine laboratory testing for lipids.

Associations between Per- and Polyfluoroalkyl Substances Exposures and Blood Lipid Levels among Adults-A Meta-Analysis

BACKGROUND

Associations between per- and polyfluoroalkyl substances (PFAS) and blood lipid levels in humans were mixed.

OBJECTIVES

The objective of this meta-analysis was to summarize associations between PFAS and blood lipids in adults.

METHODS

A literature search was conducted on PubMed and Web of Science for articles published through 13 May 2022 that examined associations between PFAS and blood lipids, including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triacylglycerols (TGs). Inclusion criteria included the presence of associations between five PFAS (PFOA, PFOS, PFHxS, PFDA, and PFNA) and four blood lipid measures (TC, HDL-C, LDL-C, and TGs) in adults. Data on study characteristics and PFAS-lipid associations were extracted. Assessments of individual study quality were performed. Associations of changes of blood lipid levels corresponding to 1 interquartile range (IQR)-unit increase of blood PFAS levels were pooled using random effects models. Dose-response relationships were examined.

RESULTS

Twenty-nine publications were included in the present analyses. Every IQR increase of PFOA was significantly associated with a 2.1 -mg / dL increase in TC (95% CI: 1.2, 3.0), a 1.3 -mg / dL increase in TGs (95% CI: 0.1, 2.4), and a 1.4 -mg / dL increase in LDL-C (95% CI: 0.6, 2.2). PFOS was also significantly associated with TC and LDL-C levels, and the corresponding values were 2.6 (95% CI: 1.5, 3.6) and 1.9 (95% CI: 0.9, 3.0), respectively. Associations of PFOS and PFOA with HDL-C levels were largely null. For minor PFAS species, PFHxS was significantly associated with higher levels of HDL-C [0.8 (95% CI: 0.5, 1.2)]. Inverse associations were observed between PFDA and TGs [- 5.0 (95% CI: - 8.1 , - 1.9 )] and between PFNA and TGs [- 1.7 (95% CI: - 3.5 , - 0.02 )], whereas a positive association was observed between PFDA and HDL-C [1.4 (95% CI: 0.1, 2.7)]. Nonsignificant nonlinear dose-response relationships were identified for associations of PFOA and PFOS with certain blood lipids.

DISCUSSION

PFOA and PFOS were significantly associated with TC and LDL-C levels in adults. Whether these findings may translate into an elevated cardiovascular disease risk associated with PFAS exposure warrants further investigation. https://doi.org/10.1289/EHP11840.

A review of cardiovascular effects and underlying mechanisms of legacy and emerging per- and polyfluoroalkyl substances (PFAS)

Cardiovascular disease (CVD) poses the leading threats to human health and life, and their occurrence and severity are associated with exposure to environmental pollutants. Per- and polyfluoroalkyl substances (PFAS), a group of widely used industrial chemicals, are characterized by persistence, long-distance migration, bioaccumulation, and toxicity. Some PFAS, particularly perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA) and perfluorohexanesulfonic acid (PFHxS), have been banned, leaving only legacy exposure to the environment and human body, while a number of novel PFAS alternatives have emerged and raised concerns, such as polyfluoroalkyl ether sulfonic and carboxylic acid (PFESA and PFECA) and sodium p-perfluorous nonenoxybenzene sulfonate (OBS). Overall, this review systematically elucidated the adverse cardiovascular (CV) effects of legacy and emerging PFAS, emphasized the dose/concentration-dependent, time-dependent, carbon chain length-dependent, sex-specific, and coexposure effects, and discussed the underlying mechanisms and possible prevention and treatment. Extensive epidemiological and laboratory evidence suggests that accumulated serum levels of legacy PFAS possibly contribute to an increased risk of CVD and its subclinical course, such as cardiac toxicity, vascular disorder, hypertension, and dyslipidemia. The underlying biological mechanisms may include oxidative stress, signaling pathway disturbance, lipid metabolism disturbance, and so on. Various emerging alternatives to PFAS also play increasingly prominent toxic roles in CV outcomes that are milder, similar to, or more severe than legacy PFAS. Future research is recommended to conduct more in-depth CV toxicity assessments of legacy and emerging PFAS and explore more effective surveillance, prevention, and treatment strategies, accordingly.

Association of exposure to perfluoroalkyl substances and risk of the acute coronary syndrome: A case-control study in Shijiazhuang Hebei Province

Exposures to perfluoroalkyl substances (PFAS) have been reported to increase the risk of atherosclerosis. Therefore, PFAS exposure may be linked to the risk of acute coronary syndrome (ACS), but this association remains uncertain. The objective of the present study was to investigate the association between PFAS exposure and ACS risk through a case-control study. The study included 355 newly diagnosed ACS cases and 355 controls matched by age (within 5 years) and sex. Twelve PFAS were measured in plasma by ultra-high-performance liquid chromatography-tandem mass spectrometry. The conditional logistic regression models were performed to investigate the association between the single and multiple PFAS and ACS risk. Furthermore, we investigated the association of PFAS mixture exposure with ACS risk using a quantile-based g-computation (qgcomp) approach. A mediating effect model was used to assess the mediating effect of platelet indices on the association between PFAS and ACS risk. The results showed that perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) were significantly positively associated with ACS risk in the multiple-PFAS model 2, and this effect was not significant in females. The odds ratios (95% confidence intervals) for PFAS (z-score PFAS) and ACS risk were 1.51 (1.07, 2.15) for PFOA and 1.77 (1.15, 2.72) for PFOS. The dose-response relationships revealed an increasing trend for ACS risk with PFOA and PFOS and decreasing trend for perfluorohexane sulfonic acid (PFHxS) and perfluorodecanoic acid (PFDA). There was no significant correlation between PFAS mixture exposure and ACS risk. Analysis of mediation indicated that platelet count mediated the relationship between PFOS and ACS risk. Our study suggests that higher levels of PFOA and PFOS, and lower levels of PFHxS and PFDA may increase the risk of ACS. However, the reported negative associations should not be considered as protective, and uncertain unresolved confounding may contribute to this result.

Exposure to per- and polyfluoroalkyl substances and glycemic control in older US adults with type 2 diabetes mellitus

BACKGROUND

Perfluoroalkyl substances (PFAS) have been associated with impaired glucose homeostasis. We aimed to examine associations of serum concentrations of PFAS with poor glycemic control (PGC) in US adults aged ≥65 years with type 2 diabetes mellitus (T2DM).

METHODS

We abstracted data from the 1999 to 2018 NHANES examination. In main analyses, we defined PGC as glycated haemoglobin A1C ≥ 8.0% in adults aged ≥75 years and A1C ≥ 7.0% (in main analyses) or A1C ≥ 7.5% (in sensitivity analyses) in those aged 65-74 years. We considered PFAS detected in >80% of the US population: perfluorodecanoic acid (PFDeA), perfluorononanoic acid (PFNA), perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), and perfluorohexane sulfonic acid (PFHxS). We estimated the adjusted odds ratio (aOR) and 95% confidence intervals (95% CI) of PGC across quartiles of PFAS concentrations using generalized linear mixed models, with the logit link.

RESULTS

Of the 4575 adults included, 42.2% were ≥75 years of age and men represented 53.2%. Compared to adults in the bottom quartile, the odds of PGC was lower in the third quartile of PFDeA (aOR = 0.46, 95% CI: 0.29-0.77; P = 0.0026) and PFHxS (aOR = 0.56, 95% CI: 0.32-0.96; P = 0.0368), the second quartile of PFNA (aOR = 0.41, 95% CI: 0.23-0.71), the upper quartile of PFOA (aOR = 0.29, 95% CI: 0.12-0.73; P = 0.0017), and higher in the second quartile of ΣPFAS (aOR = 1.85, 95% CI: 1.16-2.95; P = 0.0102). In sensitivity analyses, likelihood for PGC was higher in the upper quartile of PFNA (aOR = 2.30, 95% CI: 1.25-4.21; P = 0.0071) and PFHxS (aOR = 2.87, 95% CI: 1.56-5.30; P = 0.0007), the second quartile of PFOS (aOR = 2.81, 95% CI: 1.11-7.14; P = 0.0297), PFHxS (aOR = 1.90, 95% CI: 1.09-3.32; P = 0.0240) and ΣPFAS (aOR = 2.29, 95% CI: 1.40-3.77; P = 0.0010).

CONCLUSIONS

In US adults aged ≥65 years with known T2DM, PGC is more likely to be observed in those with high serum levels of PFNA and PFHxS (independent of sex) and PFDeA (in men), after controlling for confounders.

Associations between Per- and Polyfluoroalkyl Substances (PFAS) and Cardiometabolic Biomarkers in Adults of Czechia: The Kardiovize Study

Even though there is evidence of decreasing trends of per- and polyfluoroalkyl substances (PFAS) in Czechia, there are still major sources of PFAS pollution. Regarding the still-inconsistent results of the relationship between cardiometabolic health and PFAS, the present study sought to determine the association between PFAS levels and the presence of cardiometabolic biomarkers, including blood pressure and dysglycemia drivers in the Czech population. A cross-sectional study with 479 subjects (56.4% women, median: 53 years, range: 25-89) was conducted. Four PFAS were measured in serum: perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluorooctane sulfonate (PFOS). The associations between natural log (ln)-transformed PFAS and cardiometabolic biomarkers were assessed through generalized additive models using linear regression and smoothing thin plate splines, adjusted for potential confounders. There were positive and significant (p < 0.05) associations between the ln-transformed PFOA and glucose (β = 0.01), systolic (β = 0.76) and diastolic blood pressure (β = 0.65); total cholesterol (β = 0.07) and LDL-c (β = 0.04); and PFOS with glucose (β = 0.03), BMI (β = 2.26), waist circumference (β = 7.89), systolic blood pressure (β = 1.18), total cholesterol (β = 0.13), and HDL-c (β = 0.04). When significant, the correlations of PFNA and PFDA were negative. Of the four PFAS, only PFOA and PFOS showed a positive association, even in serum levels not as high as the values from the literature.

Integrative omics analysis reveals the protective role of vitamin C on perfluorooctanoic acid-induced hepatoxicity

Introduction

Perfluorooctanoic acid (PFOA) is a compound used as an industrial surfactant in chemical processes worldwide. Population and cross-sectional studies have demonstrated positive correlations between PFOA levels and human health problems.

Objectives

Many studies have focused on the hepatotoxicity and liver problems caused by PFOA, with little attention to remediation of these problems. As an antioxidant, vitamin C is frequently utilized as a supplement for hepatic detoxification.

Methods

In this study, we use a mouse model to study the possible role of vitamin C in reducing PFOA-induced liver damage. Based on comparative transcriptomic and metabolomic analysis, we elucidate the mechanisms underlying the protective effect of vitamin C.

Results

Our results show that vitamin C supplementation reduces signs of PFOA-induced liver damage including total cholesterol and triglyceride levels increase, liver damage markers aspartate, transaminase, and alanine aminotransferase elevation, and liver enlargement. Further, we show that the protective role of vitamin C is associated with signaling networks control, suppressing linoleic acid metabolism, reducing thiodiglycolic acid, and elevating glutathione in the liver.

Conclusion

The findings in this study demonstrate, for the first time, the utility of vitamin C for preventing PFOA-induced hepatotoxicity.

Metabolome-wide association study of serum exogenous chemical residues in a cohort with 5 major chronic diseases

BACKGROUND

Chronic diseases have become main killers affecting the health of human, and environmental pollution is a major health risk factor that cannot be ignored. It has been reported that exogenous chemical residues including pesticides, herbicides, fungicides, veterinary drugs and persistent organic pollutants are associated with chronic diseases. However, the evidence for their relationship is equivocal and the underlying mechanisms are unclear.

OBJECTIVES

We aim to investigate the linkages between serum exogenous chemical residues and 5 main chronic diseases including obesity, hyperuricemia, hypertension, diabetes and dyslipidemia, and further reveal the metabolic perturbations of chronic diseases related to exogenous chemical residue exposure, then gain potential mechanism insight at the metabolic level.

METHODS

LC-MS-based targeted and nontargeted methods were respectively performed to quantify exogenous chemical residues and acquire metabolic profiling of 496 serum samples from chronic disease patients. Non-parametric test, correlation and regression analyses were carried out to investigate the association between exogenous chemical residues and chronic diseases. Metabolome-wide association study combined with the meeting-in-the-middle strategy and mediation analysis was performed to reveal and explain exposure-related metabolic disturbances and their risk to chronic diseases.

RESULTS

In the association analysis of 106 serum exogenous chemical residues and 5 chronic diseases, positive associations of serum perfluoroalkyl substances (PFASs) with hyperuricemia were discovered while other associations were not significant. 240 exposure markers of PFASs and 84 disease markers of hyperuricemia were found, and 47 of them were overlapped and considered as putative effective markers. Serum uric acid, amino acids, cholesterol, carnitines, fatty acids, glycerides, glycerophospholipids, ceramides, and a part of sphingolipids were positively correlated with PFASs and associated with increased risk for hyperuricemia. Creatine, creatinine, glyceryl monooleate, phosphatidylcholine 36:6, phosphatidylethanolamine 40:6, cholesterol and sphingolipid 36:1;2O were significant markers which mediated the associations of the residues with hyperuricemia.

CONCLUSIONS

Our study demonstrated a significantly positive association between PFASs exposure and hyperuricemia. The most significant metabolic abnormality was lipid metabolism which not only was positively associated with PFASs, but also increased the risk of hyperuricemia.

Interference of C6O4 on platelet aggregation pathways: Cues on the new-generation of perfluoro-alkyl substance

BACKGROUND

Health concerns associated with the exposure to legacy perfluoro-alkyl substances (PFAS) led to the development of new-generation PFAS, such as C6O4. Here we investigated the possible effects of C6O4 on the platelet's activation profile, by incubating human platelets from healthy donors with C6O4 at different concentrations and evaluating the effects on activation, production and phenotype of platelets micro-particles (MPV) and aggregation under-flow. Based on the eventual platelet pro-aggregation profile detected, the preventive effect of acetylsalicylic acid (ASA) was also explored.

METHODS

Adhesion-induced platelet aggregation of platelet rich plasma (PRP) under flow was evaluated on collagen-coated microchip at a shear stress of 10 Dyne. The turbidimetric method was used to investigate platelet aggregation. Finally, the in vitro generation of pro-coagulant MPV in PRP was evaluated by flow cytometry, as characterized by CD41 and annexin V positive events, under resting conditions and after stimulation with agonists at low shear stress.

RESULTS

The generation of platelet aggregates under flow was significantly increased by the pretreatment of PRP with 100-200 ng/mL C6O4, compared to both the control condition and the experiment performed in presence of ASA. Arachidonic acid (AA), ADP and collagen induced an higher maximal aggregation, at turbidimetric evaluation, when PRP was pretreated with 100-500 ng/mL C6O4. In addition, PRP stimulated with AA also showed a steeper slope of the aggregation curve. The aggregation induced by the tested agonists was almost abolished by ASA. Finally, pretreatment with C6O4 increased the number of MPV in resting conditions and in presence of ADP and TRAP. ASA tended to reduce MPV generation.

CONCLUSIONS

Exposure to C6O4 associates with an increased platelet response to agonists, translating into a possible increased risk of cardiovascular events. Pending a further clarification on the toxicokinetics of this compound, our results claim the possible prophylactic use of ASA.

Impact of kidney hyperfiltration on concentrations of selected perfluoroalkyl acids among US adults for various disease groups

Data from the National Health and Nutrition Examination Survey (N = 6141) for the years 2003-2016 for US adults were analyzed to evaluate the impact of glomerular hyperfiltration on the observed concentrations of perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorodecanoic acid, perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA) for several disease groups. Hyperfiltrators were defined as having an estimated glomerular filtration rate (eGFR) ≥ 110 mL/min/1.73 m², and normal filtrators were defined as those having an eGFR between 90 and 110 mL/min/1.73 m². The seven disease groups for which the data were analyzed were as follows: those (i) without any diseases; (ii) with hypertension only; (iii) with albuminuria only; (iv) with anemia only; (v) with diabetes only; (vi) with hypertension and one or more of diabetes, anemia, and albuminuria; and (vii) with two or more of diabetes, anemia, and albuminuria without hypertension. For almost every PFAA, for all seven disease groups except the albuminuria only group, hyperfiltrators had lower adjusted geometric means (AGM) than normal filtrators. For example, for the disease group with hypertension only, for PFOS, the AGMs for hyperfiltrators and normal filtrators were 8.3 and 10.6 ng/mL, respectively, for the total population. For the group with albuminuria only, normal filtrators were found to have higher AGMs than hyperfiltrators for the total population and males. For example, for PFHxS, the AGMs for normal and hyperfiltrators were 0.98 and 1.05 ng/mL, respectively, for the total population. For females, these AGMs for normal and hyperfiltrators were 0.96 and 0.86 ng/mL respectively. Males usually had higher AGMs than females, but the reverse was also true occasionally. Usually, male-female differences were substantially narrower for normal filtrators than hyperfiltrators. Irrespective of the filtration status, the disease group with hypertension only had the highest AGMs for every PFAA. AGMs for the anemia only group were the lowest for every PFAA as compared with other disease groups among hyperfiltrators.

Perfluoroalkyl acids and their isomers, diabetes, anemia, and albuminuria: Variabilities with deteriorating kidney function

Data for US adults aged ≥20 years from National Health and Nutrition Examination Survey for the years 2003-2014 were analyzed to evaluate how adjusted (N = 8481) and unadjusted (N = 9080) levels of selected perfluoroalkyl acids (PFAA) vary across the different stages of glomerular function (GF) among those who did not have diabetes, anemia, or albuminuria as compared to those who had diabetes only, anemia only, and albuminuria only. PFAAs selected for analyses were: perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorodecanoic acid (PFDA), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA). Irrespective of GF stage, there was no noticeable evidence to suggest that adjusted levels of PFAA for those with diabetes only are any lower than those with no diabetes, no anemia, and no albuminuria. Those who had anemia only were found to have lower adjusted levels of at least PFOA, PFOS, PFDA, and PFHxS than those who had no diabetes, no anemia, and no albuminuria. These results were seen in the presence (eGFR < 60 mL/min/1.73 m²) as well as the absence of chronic kidney disease. For GF-1 (eGFR > 90 mL/min/1.73 m²), GF-2 (60 ≤ eGFR ≤ 90 mL/min/1.73 m²), and GF-3B/4 (15 < eGFR ≤ 45 mL/min/1.73 m²), those who had albuminuria only had lower adjusted levels of PFOA, PFOS, and PFHxS than those who had no diabetes, no anemia, and no albuminuria. In general, adjusted levels of those who had albuminuria only were lower than those who had anemia only at GF-3 and more often than not at GF-1 and GF-2. Rise in adjusted levels of PFAA from GF-1 to GF-3A (45 < eGFR < 60 mL/min/1.73 m²) was faster for those with anemia only than any other comparison group for the total population and females.

Perfluoroalkyl substances and likelihood of stroke in persons with and without diabetes

OBJECTIVE

The main objective of this study is to evaluate the relationship of perfluoroalkyl substances with stroke and any modifying influence of diabetes.

METHODS

Data on 3921 adults aged ⩾20 years with and 44,285 without diabetes were drawn from the C8 Health Project. Four perfluoroalkyl substances were investigated: perfluorohexane sulphate, C8 - perfluorooctanoic acid, perfluoroctane sulfonate and perfluorononaoic acid.

RESULTS

There were 238 cases of stroke among those with and 643 among those without diabetes. In analyses controlled for age, sex, race, diabetes duration, body mass index, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, C-reactive protein, kidney function and a history of smoking, a history of stroke was significantly inversely associated with serum perfluorohexane sulphate (odds ratio = 0.75, 0.64-0.88) and perfluoroctane sulfonate (odds ratio = 0.81, 0.70-0.90), but not perfluorooctanoic acid (odds ratio = 1.04, 0.94-1.15) or perfluorononaoic acid (odds ratio = 0.89, 0.70-1.14) among those with diabetes. Perfluoroalkyl substances demonstrated no association with stroke among those without diabetes (p interaction = 0.006 and 0.01 for perfluorohexane sulphate and perfluorooctanoic acid, respectively).

CONCLUSION

In this large cross-sectional study, serum levels of perfluorohexane sulphate and perfluoroctane sulfonate were inversely associated with stroke among those with diabetes. Although mechanisms and implications for this diabetes-specific inverse relationship need to be further explored, our data suggest that perfluoroalkyl substances do not increase risk of stroke among persons with or without diabetes.