Environmental risk assessment of widely used anticancer drugs (5-fluorouracil, cisplatin, etoposide, imatinib mesylate)

Toxicity toward freshwater and marine water organisms of the cytostatic drugs bleomycin and vincristine and their binary mixture

Antineoplastic drugs are not effectively removed by wastewater treatment plants, ending up in surface waters. Since these drugs can interfere with the structure and functions of DNA, they pose a potential threat to aquatic biota. Unfortunately, many chemotherapeutic agents have not been studied in an environmental context. Additionally, there is a significant lack of information about the impact of anticancer drugs on marine organisms compared to freshwater species, and most studies only focus on the toxicity of single compounds rather than considering their occurrence as complex mixtures in the environment. Therefore, the aim of this study was to evaluate the ecotoxicity of two commonly used cytostatics, bleomycin and vincristine, toward six biomodels: Pseudokirchneriella subcapitata, Phaeodactylum tricornutum, Brachionus plicatilis, Brachionus calyciflorus, Thamnocephalus platyurus, and Artemia franciscana. These selected aquatic organisms are representatives of both freshwater and marine environments and belong to different trophic levels. The pharmaceuticals were investigated both individually and in combination. Binary mixture toxicity predictions were performed according to the Response Additivity and Independent Action models. Additionally, the toxicity data obtained from these experiments were utilized for risk assessment in the context of the drugs' environmental occurrence. The results indicated that freshwater species were generally more sensitive to both tested compounds than marine organisms, with T. platyurus being the most sensitive. Based on the tests performed on this biomodel, bleomycin was categorized as extremely toxic, while vincristine was considered moderately toxic. Neither of the applied models suitably predicted binary mixture toxicity, as the combination of drugs showed additive, synergistic, and antagonistic effects, suggesting that single compound toxicity data are insufficient for predicting the aquatic toxicities of cytostatics mixtures. The environmental risk of vincristine ranged from low to high, and for bleomycin varied from moderate to high, depending on the matrices examined. Therefore, further research on drug removal is recommended.

The male reproductive toxicity after 5-Fluorouracil exposure: DNA damage, oxidative stress, and mitochondrial dysfunction in vitro and in vivo

5-Fluorouracil (5-FU), a chemotherapeutic drug used to treat a variety of cancers, can enter the environment through different routes, causing serious public health and environmental concerns. It has been reported that 5-FU exposure adversely affects male reproductive function, and its effects on this system cannot be avoided. In this study, using western blotting and quantitative polymerase chain reaction studies, we found that 5-FU promoted testicular injury by inducing oxidative stress, which was accompanied by the inhibition of nuclear factor erythroid 2-related factor 2/antioxidant response element signaling. Accumulation of reactive oxygen species (ROS) aggravated 5-FU-mediated mitochondrial dysfunction and apoptosis in murine cell lines and testes, indicating oxidative stress and mitochondrial-dependent apoptotic signaling play crucial roles in the damage of spermatogenic cells caused. N-Acetyl-L-cysteine, an antioxidant that scavenges intracellular ROS, protected spermatogenic cells from 5-FU-induced oxidative damage and mitochondrial dysfunction, revealing the important role of ROS in testicular dysfunction caused by 5-FU. We found that 5-FU exposure induces testicular cell apoptosis through ROS-mediated mitochondria pathway in mice. In summary, our findings revealed the reproductive toxicological effect of 5-FU on mice and its mechanism, provided basic data reference for adverse ecological and human health outcomes associated with 5-FU contamination or poisoning.

Acyclovir eco-geno-toxicity in freshwater organisms

This study explores the eco-geno-toxic impact of Acyclovir (ACV), a widely used antiviral drug, on various freshwater organisms, given its increasing detection in surface waters. The research focused on non-target organisms, including the green alga Raphidocelis subcapitata, the rotifer Brachionus calyciflorus, the cladoceran crustacean Ceriodaphnia dubia, and the benthic ostracod Heterocypris incongruens, exposed to ACV to assess both acute and chronic toxicity. The results indicate that while acute toxicity occurs at environmentally not-relevant concentrations, a significant chronic toxicity for C. dubia (EC50 = 0.03 µg/L, NOEC = 0.02·10-2 µg/L), highlighted substantial environmental concern. Furthermore, DNA strand breaks and reactive oxygen species detected in C. dubia indicate significant increase at concentrations exceeding 200 µg/L. Regarding environmental risk, the authors identified chronic exposures to acyclovir causing inhibitory effects on reproduction in B. calyciflorus at hundreds of µg/L and hundredths of µg/L for C. dubia as environmentally relevant environmental concentrations. The study concludes by quantifying the toxic and genotoxic risks of ACV showing a chronic risk quotient higher than the critical value of 1and a genotoxic risk quotient reaching this threshold, highlighting the urgent need for a broader risk assessment of ACV for its significant implications for aquatic ecosystems.

Waterborne exposure to the antineoplastic 5-fluorouracil alters lipid composition in larval zebrafish (Danio rerio)

Antineoplastic medications are present in aquatic environments and are measured at relatively high concentrations in hospital sewage effluent. Thus, it is important to characterize risk associated with waterborne exposures to anticancer drugs. The drug 5-fluorouracil (5-FU) is used to treat several types of cancers, acting to inhibit cell division and cellular metabolism. The objectives of this study were to determine the effects of 5-FU on developmental endpoints and lipid composition in zebrafish. 5-FU did not negatively affect development nor survival in developing zebrafish at concentrations up to 1000 μg/L. However, 5-FU increased neutral lipid content in zebrafish larvae, indicating potential for lipid dysregulation. To further discern effects on lipids, lipidomics was conducted and a total of 164 lipids belonging to 14 lipid classes were identified. Significant changes (false discovery rate < 0.05) in abundance were detected for 19 lipids including some ceramides, ether-linked phosphatidylethanolamines, and sphingomyelins among others. We also measured the expression levels of 14 lipid-related enzymes and transporters (e.g., acox3, dgat1, fads2, fasn, elovl2) using real-time PCR; however, mRNA abundance levels were not affected, suggesting transcriptional changes may not be a primary mechanism underlying lipid dysregulation. Locomotor activity was measured in zebrafish as lipids are needed for swimming activity in larvae. Exposure to 5-FU did not affect locomotor activity up to 1000 μg/L. We conclude that lipids accumulate in larval zebrafish with exposure to 5-FU, which can subsequently affect lipid composition. These data reveal potential lipid signatures of 5-FU exposure and contribute to risk assessments for antineoplastic exposure in aquatic environments.

Trace cisplatin adsorption by thiol-functionalized sponge (TFS) and Sn/SnO2-coated TFS: Adsorption study and mechanism investigation

To remove trace cisplatin from aqueous solution, commercial sponges were functionalized by esterification with 3-mercaptopropionic acid, followed by reduction with Na2S·9H2O or SnCl2·2H2O. The resulting thiol-functionalized sponges (TFSs), TFS_1 and TFS_2, were tested for the removal of cisplatin (235 μg L-1) achieving maximum removal of 95.5 ± 0.8% and 99.5 ± 0.1% respectively, which were significantly higher than the non-functionalized counterpart. The successful grafting of thiol groups, verified through FTIR, elemental analysis, SEM-EDS, and XPS characterization, facilitated Pt-S complexation during adsorption. The aqua-derivatives of cisplatin, formed through hydration, complexed with thiol sites through ligand displacement. Additionally, the presence of Sn/SnO2 coating on TFS_2 further enhanced the adsorption process. The rapid adsorption process conformed to pseudo-second-order kinetic model, involving both diffusion and chemisorption. While the Langmuir isotherm model generally described the monolayer adsorption behavior of cisplatin, the aggregation of Sn/SnO2 onto TFS_2 at 343 K introduced surface heterogeneity, rendering the Freundlich model a better fit for the adsorption isotherm. Differential pH dependence and the evaluation of mean free energy, derived from the Dubinin-Radushkevich isotherm model, indicated that cisplatin adsorption onto TFS_1 involved physisorption, including electrostatic attraction, while chemisorption predominated for TFS_2. Increasing the temperature notably promoted adsorption by facilitating the thermal-favored formation of Pt-S bonds.

Degradation and mineralization of anti-cancer drugs Capecitabine, Bicalutamide and Irinotecan by UV-irradiation and ozone

The degradation of three anti-cancer drugs (ADs), Capecitabine (CAP), Bicalutamide (BIC) and Irinotecan (IRI), in ultrapure water by ozonation and UV-irradiation was tested in a bench-scale reactor and AD concentrations were measured through ultra-high-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS). A low-pressure mercury UV (LP-UV) lamp was used and degradation by UV (λ = 254 nm) followed pseudo-first order kinetics. Incident radiation in the reactor was measured via chemical actinometry using uridine. The quantum yields (φ) for the degradation of CAP, BIC and IRI were 0.012, 0.0020 and 0.0045 mol Einstein-1, respectively. Ozone experiments with CAP and IRI were conducted by adding ozone stock solution to the reactor either with or without addition of tert-butanol (t-BuOH) as radical quencher. Using this experimental arrangement, no degradation of BIC was observed, so a semi-batch setup was employed for the ozone degradation experiments of BIC. Without t-BuOH, apparent second order reaction rate constants for the reaction of the ADs with molecular ozone were determined to be 3.5 ± 0.8 ∙ 103 L mol-1 s-1 (CAP), 7.9 ± 2.1 ∙ 10-1 L mol-1 s-1 (BIC) and 1.0 ± 0.3 ∙ 103 L mol-1 s-1 (IRI). When OH-radicals (∙OH) were quenched, rate constants were virtually the same for CAP and IRI. For BIC, a significantly lower constant of 1.0 ± 0.5 ∙ 10-1 L mol-1 s-1 was determined. Of the tested substances, BIC was the most recalcitrant, with the slowest degradation during both ozonation and UV-irradiation. The extent of mineralization was also determined for both processes. UV irradiation was able to fully degrade up to 80% of DOC, ozonation up to 30%. Toxicity tests with Daphnia magna (D. magna) did not find toxicity for fully degraded solutions of the three ADs at environmentally relevant concentrations.

Recent Trends in Nanomaterial Based Electrochemical Sensors for Drug Detection: Considering Green Assessment

An individual's therapeutic drug exposure level is directly linked to corresponding clinical effects. Rapid, sensitive, inexpensive, portable and reliable devices are needed for diagnosis related to drug exposure, treatment, and prognosis of diseases. Electrochemical sensors are useful for drug monitoring due to their high sensitivity and fast response time. Also, they can be combined with portable signal read-out devices for point-of-care applications. In recent years, nanomaterials such as carbon-based, carbon-metal nanocomposites, noble nanomaterials have been widely used to modify electrode surfaces due to their outstanding features including catalytic abilities, conductivity, chemical stability, biocompatibility for development of electrochemical sensors. This review paper presents the most recent advances about nanomaterials-based electrochemical sensors including the use of green assessment approach for detection of drugs including anticancer, antiviral, anti-inflammatory, and antibiotics covering the period from 2019 to 2023. The sensor characteristics such as analyte interactions, fabrication, sensitivity, and selectivity are also discussed. In addition, the current challenges and potential future directions of the field are highlighted.

Hazard assessment of antineoplastic drugs and metabolites using cytotoxicity and genotoxicity assays

Antineoplastic drugs are among the most toxic pharmaceuticals. Their release into the aquatic ecosystems has been reported, giving rise to concerns about the adverse effects, including cytotoxicity and genotoxicity, that they may have on exposed organisms. In this study, we analyzed the cytotoxicity and genotoxicity of 5-fluorouracil (5-FU) and its metabolite alpha-fluoro-beta-alanine (3-NH2-F); gemcitabine (GEM) and its metabolite 2'-deoxy-2',2'-difluorouridine (2-DOH-DiF); as well as cyclophosphamide (CP) on the HepG2 cell line. Drug concentrations were based on those previously observed in the effluent of a major cancer hospital in Brazil. The study found that GEM, 2-DOH-DiF and 5-FU resulted in reduced cell viability. No reduction in cell viability was observed for CP and 3-NH2-F. Genotoxic assessment revealed damage in the form of nucleoplasmic bridges for CP and 3-NH2-F. The tested concentrations of all compounds resulted in significantly increased MNi and NBUDs. The results showed that these compounds induced cytotoxic and genotoxic effects in HepG2 cells at concentrations found in the environment. To the best of our knowledge, this study is the first to report on the cytogenotoxic impacts of the metabolites 3-NH2-F and 2-DOH-DiF in HepG2 cells. These findings may help in the development of public policies that could minimize potential environmental contamination.

Diclofenac eco-geno-toxicity in freshwater algae, rotifers and crustaceans

This study assessed the eco-genotoxic impact of diclofenac (DCF) in sentinel species of the freshwater ecosystem. DCF residues are found in freshwater from few ng/L to tens of μg/L due to the inability of conventional wastewater treatment plants to ensure removal efficiency of the drug. An ample body of literature reports on the acute toxicity of DCF in non-target organisms without addressing potential chronic long-term effects on organisms at actual, environmental concentrations. Herein, assessment for acute and chronic toxicity was performed on organisms in vivo exposed to DCF, specifically on the green alga Raphidocelis subcapitata, the rotifer Brachionus calyciflorus and the crustacean Ceriodaphnia dubia. Furthermore, potential DNA damage and expression of antioxidant genes (MnSOD, Cu/ZnSOD and CAT) were evaluated in crustacean neonates. The toxicological risk of DCF was assessed as well as its. GENOTOXIC RISK: The acute toxicity was observed at concentrations far from those of environmental concern. Rotifers and crustaceans were much more chronically sensitive than the algae to DCF, observing besides, the median effect concentrations at tens of μg/L. In crustaceans, DNA damage was noted at units of μg/L, revealing concentrations of environmental concern. The dysregulated activity of SOD and CAT also showed the ability of DCF to provoke oxidative stress. On assessment of environmental risk, the chronic Risk Quotient (RQ) was above the threshold value of 1. Nevertheless, the genotoxic RQ was significantly greater than the chronic RQ, thus, the need of regulatory bodies to acknowledge the genotoxic impact as an environmental risk factor. To our knowledge, this study is the first investigation to perform environmental genotoxic risk assessment of DCF.

Enantioseparation and ecotoxicity evaluation of ibrutinib by Electrokinetic Chromatography using single and dual systems

In this work, two chiral methods enabling the separation of ibrutinib enantiomers were developed by Electrokinetic Chromatography. A cyclodextrin (CD) or a mixture of the CD and a chiral ionic liquid (CIL) was used as chiral selector. Using the single CD system, seven neutral and six anionic CDs were tested in a formate buffer at pH 3.0 working in positive and negative polarity, respectively. The use of sulfated-γ-CD (S-γ-CD) and negative polarity originated the best results considering analysis time and enantioresolution. The optimization of the experimental conditions allowed obtaining the separation of ibrutinib enantiomers in an analysis time of 4.2 min with an enantioresolution value of 1.5. The effect of the addition of fifteen CILs on the enantioresolution was evaluated showing that both analysis time and enantioresolution were generally increased. A mixture of S-γ-CD and [TMA][L-Lys] was selected which provided the separation of ibrutinib enantiomers in 8.1 min with an enantioresolution value of 3.3 under the same experimental conditions as in the case of using the single CD system. The enantiomeric impurity (S-ibrutinib) was the first-migrating isomer when using the single CD and the combined CD/CIL systems, as corresponds to the most desirable situation. Both chiral methods allowed the detection of the enantiomeric impurity up to a 0.1% as established by the International Council on Harmonization. After establishing the analytical characteristics of both chiral methodologies developed, they were applied to the enantiomeric determination of ibrutinib in a pharmaceutical formulation for hospital use marketed as pure enantiomer (R-ibrutinib) and to evaluate the stability and ecotoxicity of racemic ibrutinib and R-ibrutinib on Daphnia magna. The developed methodologies enabled, for the first time, the rapid chiral quantitation of ibrutinib in abiotic and biotic matrices.

Alginate/geopolymer hybrid beads as an innovative adsorbent applied to the removal of 5-fluorouracil from contaminated environmental water

Water contaminated by cytostatic drugs has many negative impacts on the ecosystems. In this work, cross-linked adsorbent beads based on alginate and a geopolymer (prepared from an illito-kaolinitic clay) were developed for a promising decontamination of the 5-fluorouracil (5-FU) cytostatic drug from water samples. The characterization of the prepared geopolymer and its hybrid derivative was performed by scanning electron microscopy, X-ray diffraction, Fourier transform infrared and termogravimetric analysis. Batch adsorption experiments indicated that alginate/geopolymer hybrid beads (AGHB) allow an excellent 5-FU removal efficiency of up to 80% for a dosage adsorbent/water of 0.002 g/mL and a concentration of 5-FU of 2.5 mg/L. The adsorption isotherms data follow well the Langmuir model. The kinetics data favor the pseudo-second-order model. The maximum adsorption capacity (q_max) was 6.2 mg/g. The optimal adsorption pH was 4. Besides pore filling sorption process, the carboxyl and hydroxyl groups from alginate immobilized onto the geopolymer matrix favored the retention of 5-FU ions by hydrogen bonds. Common competitors, such as dissolved organic matter, do not significantly affected the adsorption. In addition, this material has not only eco-friendly and cost-effective advantages but also excellent efficiency when applied to real environmental samples such as wastewater and surface water. This fact suggests that it could have a great application in the purification of contaminated water.

Assessing the risks of capecitabine and its active metabolite 5-fluorouracil to freshwater biota

Capecitabine (CAP, prodrug) and 5-fluorouracil (5-FU, its active metabolite) are two of the most prominent cytostatics, for which no clear picture can be drawn regarding potential concentrations of effect for freshwater biota, with CAP being grouped in the least studied cytostatic, whereas 5-FU has been classified as of no and of high environmental risk. Accordingly, the present work aimed to assess the ecotoxicity of CAP and 5-FU in three freshwater species, which included a 72-h assay with the producer Raphidocelis subcapitata; a 96-h assay with the invertebrate secondary consumer Hydra viridissima; and a 96-h assay with embryos of the vertebrate secondary consumer Danio rerio. The following endpoints were monitored: yield and population growth rate for the algae; mortality, morphological alterations, and post-exposure feeding rates for the cnidarian; and mortality, hatching, and malformations for the fish. Overall, organisms' sensitivity to CAP decreased in the following order: R. subcapitata > H. viridissima > D. rerio, whereas for 5-FU, it decreased in the following order: H. viridissima > D. rerio > R. subcapitata. For CAP, no median lethal effective concentrations (LC/EC₅₀) were possible to compute for D. rerio, with no significant mortality or malformations registered in embryos exposed at concentrations up to 800 mg L^-1. For R. subcapitata, the EC₅₀s were 0.077 and 0.63 mg L^-1 for yield and growth rate, respectively, and for H. viridissima, the EC_50,30 min for feeding was 22.0 mg L^-1. For 5-FU, no EC_50s could be computed for R. subcapitata, whilst the EC_50s for H. viridissima mortality and feeding were 55.4 and 67.9 mg L^-1, respectively, and for D. rerio, the LC_50,96 h and EC_50,96 h (hatching and abnormalities) were 4546, 4100, and 2459 mg L^-1, respectively. Assuming similar modes of action for both compounds and their co-occurrence, the combined risk quotient of the two chemicals was determined to be 7.97, which represents a risk for freshwater biota. Anticipating the increased consumption of these compounds and cancer development trends worldwide, these impacts may be further aggravated.

Adverse Toxic Effects of Tyrosine Kinase Inhibitors on Non-Target Zebrafish Liver (ZFL) Cells

Over the past 20 years, numerous tyrosine kinase inhibitors (TKIs) have been introduced for targeted therapy of various types of malignancies. Due to frequent and increasing use, leading to eventual excretion with body fluids, their residues have been found in hospital and household wastewaters as well as surface water. However, the effects of TKI residues in the environment on aquatic organisms are poorly described. In the present study, we investigated the cytotoxic and genotoxic effects of five selected TKIs, namely erlotinib (ERL), dasatinib (DAS), nilotinib (NIL), regorafenib (REG), and sorafenib (SOR), using the in vitro zebrafish liver cell (ZFL) model. Cytotoxicity was determined using the MTS assay and propidium iodide (PI) live/dead staining by flow cytometry. DAS, SOR, and REG decreased ZFL cell viability dose- and time-dependently, with DAS being the most cytotoxic TKI studied. ERL and NIL did not affect viability at concentrations up to their maximum solubility; however, NIL was the only TKI that significantly decreased the proportion of PI negative cells as determined by the flow cytometry. Cell cycle progression analyses showed that DAS, ERL, REG, and SOR caused the cell cycle arrest of ZFL cells in the G0/G1 phase, with a concomitant decrease of cells in the S-phase fraction. No data could be obtained for NIL due to severe DNA fragmentation. The genotoxic activity of the investigated TKIs was evaluated using comet and cytokinesis block micronucleus (CBMN) assays. The dose-dependent induction of DNA single strand breaks was induced by NIL (≥2 μM), DAS (≥0.006 μM), and REG (≥0.8 μM), with DAS being the most potent. None of the TKIs studied induced micronuclei formation. These results suggest that normal non-target fish liver cells are sensitive to the TKIs studied in a concentration range similar to those previously reported for human cancer cell lines. Although the TKI concentrations that induced adverse effects in exposed ZFL cells are several orders of magnitude higher than those currently expected in the aquatic environment, the observed DNA damage and cell cycle effects suggest that residues of TKIs in the environment may pose a hazard to non-intentionally exposed organisms living in environments contaminated with TKIs.

Imidacloprid: Comparative toxicity, DNA damage, ROS production and risk assessment for aquatic non-target organisms

Imidacloprid is a neonicotinoid systemic insecticide used worldwide. Despite its hazardous impact on non-target organisms, few studies have been conducted concerning the potential eco-genotoxic effects in invertebrates of surface waters where this pesticide is detected from units of ng/L to tens of μg/L. The aim of the present work was to determine the acute, the sub-chronic and the chronic toxicity of imidacloprid in producers and primary consumers of the freshwater trophic chain. The organisms under investigation were the green alga Raphidocelis subcapitata, the rotifer Brachionus calyciflorus, the cladoceran crustacean Ceriodaphnia dubia and the benthic ostracod Heterocypris incongruens. In addition, potential DNA damage and ROS production were evaluated in C. dubia. Furthermore, in accordance with European guidelines, toxicological risk assessment of imidacloprid was performed for all continents considering its global occurrence in surface waters. In addition, we assessed the genotoxicological risk and median inhibition of reproduction was observed at units of mg/L for rotifers and daphnids. Algae showed the lowest level of sensitivity to the pesticide with effective concentrations from units to hundreds of mg/L. DNA lesions were marked from 7 μg/L with a significant increase in damage as concentrations increased. Chronic toxicity risk quotient values were generally below to a threshold value of 1, with no consequential environmental concern other than for the Canadian areas. On the contrary, the genotoxicological risk quotient values were found higher than the threshold value in all continents.

Amelioration of 5-Fluorouracil Induced Nephrotoxicity by Acacia catechu through Overcoming Oxidative Damage and Inflammation in Wistar Rats

AIM

The research intended to explore the possible nephroprotective potential of the ethyl acetate fraction derived from Acacia catechu leaves against nephrotoxicity brought about by 5-fluorouracil (5-FU) in Wistar rats.

BACKGROUND

While possessing strong anticancer properties, 5-FU is hindered in its therapeutic application due to significant organ toxicity linked to elevated oxidative stress and inflammation.

OBJECTIVE

The study is undertaken to conduct an analysis of the ethyl acetate fraction of A. catechu leaves both in terms of quality and quantity, examining its impact on different biochemical and histopathological parameters within the context of 5-FU-induced renal damage in rats and elucidation of the mechanism behind the observed outcomes.

METHODOLOGY

Intraperitoneal injection of 5-FU at a dosage of 20 mg/kg/day over 5 days was given to induce nephrotoxicity in rats. The evaluation of nephrotoxicity involved quantifying serum creatinine, urea, uric acid, and electrolyte concentrations. Furthermore, superoxide dismutase, catalase antioxidant enzymes, and TNF-α concentration in serum were also measured.

RESULTS

5-FU injection led to the initiation of oxidative stress within the kidneys, leading to modifications in renal biomarkers (including serum creatinine, urea, uric acid, and Na+, K+ levels), and a reduction in antioxidant enzymes namely superoxide dismutase and catalase. Notably, the presence of the inflammatory cytokine TNF-α was significantly elevated due to 5-FU. Microscopic examination of renal tissue revealed tubular degeneration and congestion. However, treatment involving the ethyl acetate fraction derived from A. catechu leaves effectively and dose-dependently reversed the changes observed in renal biomarkers, renal antioxidant enzymes, inflammatory mediators, and histopathological features, bringing them closer to normal conditions. The observed recuperative impact was mainly attributed to the antioxidant and antiinflammatory properties of the fraction.

CONCLUSION

The ethyl acetate fraction of A. catechu leaves exhibited a mitigating influence on the renal impairment caused by 5-FU, showcasing its potential as a nephroprotective agent capable of preventing and ameliorating 5-FU-induced nephrotoxicity.

Top2a promotes the development of social behavior via PRC2 and H3K27me3

Little is understood about the embryonic development of sociality. We screened 1120 known drugs and found that embryonic inhibition of topoisomerase IIα (Top2a) resulted in lasting social deficits in zebrafish. In mice, prenatal Top2 inhibition caused defects in social interaction and communication, which are behaviors that relate to core symptoms of autism. Mutation of Top2a in zebrafish caused down-regulation of a set of genes highly enriched for genes associated with autism in humans. Both the Top2a-regulated and autism-associated gene sets have binding sites for polycomb repressive complex 2 (PRC2), a regulatory complex responsible for H3K27 trimethylation (H3K27me3). Moreover, both gene sets are highly enriched for H3K27me3. Inhibition of the PRC2 component Ezh2 rescued social deficits caused by Top2 inhibition. Therefore, Top2a is a key component of an evolutionarily conserved pathway that promotes the development of social behavior through PRC2 and H3K27me3.

Photocatalytic Activity of TiO2 for the Degradation of Anticancer Drugs

To prevent water pollution, photocatalysis is often used to remove small molecules such as drugs by generating reactive species. This study aimed to determine the photocatalytic activity of two anticancer drugs, imatinib and crizotinib, and to investigate various influences that may alter the kinetic degradation rate and ultimately the efficacy of the process. In order to obtain optimal parameters for the removal of drugs with immobilized TiO₂, the mutual influence of the initial concentration of the contaminant at environmentally relevant pH values was investigated using the response surface modeling approach. The faster kinetic rate of photocatalysis was obtained at pH 5 and at the smallest applied concentration of both drugs. The photocatalytic efficiency was mostly decreased by adding various inorganic salts and organic compounds to the drug mixture. Regarding the degradation mechanism of imatinib and crizotinib, hydroxyl radicals and singlet oxygen showed a major role in photochemical reactions. The formation of seven degradation products for imatinib and fifteen for crizotinib during the optimal photocatalytic process was monitored by high-resolution mass spectrometry (HPLC-QqTOF). Since the newly formed products may pose a hazard to the environment, their toxicity was studied using Vibrio fischeri, where the significant luminescence inhibition was assessed for the mixture of crizotinib degradants during the photocatalysis from 90 to 120 min.

Transcriptomic responses to cytotoxic drug cisplatin in water flea Daphnia magna

Cytotoxic drugs have been recognized by the European Union as the potential threat in the aquatic environment. As a typical cytotoxic drug, effects of long-term exposure to cisplatin at the environmentally relevant concentrations on the crustacean health and its molecular mechanism remain undetermined. In this study, the growth and reproduction of Daphnia magna resulting from cisplatin exposure were initially assessed. While the phenotypes were not altered in 2 μg L^-1, 20 μg L^-1, and 200 μg L^-1 treatment groups, cisplatin at 500 µg L^-1 significantly reduced the offspring number to 8-13 neonates in each brood, which was lower than 13-27 neonates in the control group. In addition to the delay in the time of first pregnancy, the body length was decreased by approximate 12.13% at day 7. Meanwhile, all daphnids died after exposure to 500 µg L^-1 cisplatin for 17 days. Transcriptome profiling bioassays were performed for 10 days to explore the alternation at the molecular level. Briefly, 980 (257 up- and 723 down-regulated), 429 (182 up- and 247 down-regulated) and 1984 (616 up-regulated and 1368 down-regulated) genes were differentially expressed (adj p < 0.05) in low (2 μg L^-1), medium (200 μg L^-1) and high (500 μg L^-1) cisplatin treatment groups, respectively. Differentially expressed genes were primarily enriched in the digestion and absorption, nerve conduction, endocrine interference, and circulatory related pathways. Specifically, the down-regulated digestive secretion and nutrient absorption and neuronal conduction pathways may lead to insufficient energy supply involved in growth and reproduction, and hinder ovarian development and cell growth. Down-regulation of ovarian steroids and relaxin signaling pathways may be related to the reduction of offspring number and delayed pregnancy, and reduced body length of D. magna may attribute to the enrichment of insulin secretion pathway. In addition, the death of D. magna may result from the reduced expression of genes in cardiomyocyte contraction and apoptosome processes. Taken together, this study revealed the potential toxic mechanism of cisplatin in a model water flea.

Zebrafish embryos as an in vivo model to investigate cisplatin-induced oxidative stress and apoptosis in mitochondrion-rich ionocytes

Pharmaceuticals and personal care products are emerging environmental pollutants. Cisplatin, one of the most widely used platinum-based chemotherapeutic agents, has been found to contaminate aquatic environments. Using zebrafish embryos as a model, cisplatin was previously found to impair skin ionocytes and ion regulation. The purpose of this study was to further investigate how cisplatin damages ionocytes. Zebrafish embryos were exposed to cisplatin (0, 50, and 100 μM) for 96 h (4-100 h post-fertilization) and then stained with fluorescent dyes to reveal mitochondrial activity (rhodamine123), apoptosis (acridine orange), and oxidative stress (CellROX/MitoSOX) in ionocytes of living embryos. Results showed that cisplatin exposure decreased rhodamine 123-labeled ionocytes, induced oxidative stress in ionocytes, and promoted apoptosis in a concentration-dependent manner. Quantitative PCR analysis showed that mRNA levels of antioxidative genes (sod1, sod2, gpx1a, and cat) and an apoptotic gene (caps3a) were induced. In the time-course experiment at 96-98 h post-fertilization, cisplatin increased oxidative stress and apoptosis in ionocytes in a time-dependent manner. In conclusion, this study demonstrates that cisplatin exposure induces oxidative stress, mitochondrial damage, and apoptosis in ionocytes of zebrafish embryos.

Active-chlorine-mediated oxidation of 5-fluorouracil on a hierarchically ordered macroporous RuO2 electrode

A hierarchically ordered macroporous RuO₂ electrode (HOM-RuO₂) was fabricated to enhance in situ active chlorine production in an electrochemical system intended for treatment of pharmaceutical active compounds (PhACs). The unique structure of HOM-RuO₂ resulted in a decrease of the chlorine evolution potential, a large electro-active area available for in situ conversion of Cl^- to active chlorine, and hence improved the active chlorine production by 40%. 5-Fluorouracil (5-FU) was used as a target pollutant to explore the performance of the HOM-RuO₂ for PhACs degradation based on the in situ generated active chlorine. The results showed that the reaction rate of active-chlorine-mediated oxidation of 5-FU produced using the HOM-RuO₂ was 18.4 times higher than that in the case of hydroxyl radicals (OH)-initiated oxidation using a PbO₂ electrode at 30 mA cm^-2. The effects of current density and initial solution pH on the 5-FU removal were investigated. The mechanism of 5-FU degradation was proposed taking into accounts both active chlorine production, and change of the speciation of 5-FU caused by pH variations. The dominant degradation products observed for the degradation of 5-FU using the HOM-RuO₂ were lactic acid, propanol, acetic acid, urea and other small molecules, but no chlorinated products were detected. These study demonstrates the promise of the HOM-RuO₂-based electrochemical systems for the active-chlorine-mediated treatment of recalcitrant pharmaceuticals found in wastewater.

Ozonation and UV photolysis for removing anticancer drug residues from hospital wastewater

The present study investigates the use of UV light and the ozone process for doxorubicin, daunorubicin, epirubicin, and irinotecan degradation. The process was carried out using different pH values in hospital wastewater. The use of UV radiation reduces the concentration of anticancer drugs, but in all cases, this technology was not able enough to remove on the whole these contaminants from hospital wastewater. The best condition was achieved when using pH 9 for most of the analytes. Doxorubicin, daunorubicin, and epirubicin were degraded at 97.3%, 88.3%, and 99.0%, respectively. Irinotecan showed the lowest degradation, just 55.6%; a slightly higher degradation (63.8%) was obtained when pH 5 was used. Complete removal of doxorubicin, daunorubicin, epirubicin, and irinotecan was achieved when ozone treatment was used for all the pH studied. The results indicated that UV light and the ozone process can be used as a tertiary treatment to reduce the concentration of anticancer drugs in the effluents. Ozonation, therefore, proved to be more efficient than the photolysis process, when considering the percentual degradation of the original compounds in shorter timespans.

Evaluation of uptake of the cytostatic methotrexate in Elliptio complanata mussels by LC-MS/MS

Aquatic organisms are continuously exposed to emerging contaminants coming from urban effluents of wastewater treatment plants. The contamination of surface water by those effluents poses a number of environmental risks, and pharmaceuticals are part of this class of effluent contaminants. Various classes of pharmaceuticals are not treated by wastewater treatment plants and anticancer drugs are part of them. The chemotherapy drug methotrexate (MTX) is an emerging contaminant and its growing use with the increase in cancer cases worldwide raises potential risk to aquatic organisms exposed to effluent discharges. However, chemical analyses in exposed freshwater aquatic organisms for ecotoxicological studies are rarely available and no studies have been done yet to accompany ecotoxicological data of exposed filter-feeding organisms. The purpose of this study was to develop a specific and sensitive analytical LC-MS/MS method for the quantification of methotrexate uptake in mussels exposed at different concentrations of the drug. A solid/liquid extraction followed by solid phase extraction (SPE) using an MCX phase purification scheme was optimized. The optimal recovery of 65% and matrix effect of 38% allowed to achieve a limit of quantification of 0.25 ng g^-1, with an accuracy of 99-106%, a precision of no more than 3% RSD, and linearity ranging from 0.25 to 25 ng g^-1. This methodology was tested with mussels exposed for 96 h at different concentrations (4 to 100 µg L^-1) of MTX. The data revealed tissue uptake at concentrations ranging from 0 to 2.53 ng g^-1. This suggests that this drug has low uptake potential and this methodology could be used to examine tissue levels of this drug in organisms continuously exposed to urban pollution.

Environmental Toxicity Assessment of Sodium Fluoride and Platinum-Derived Drugs Co-Exposure on Aquatic Organisms

Pharmaceuticals are widely acknowledged to be a threat to aquatic life. Over the last two decades, the steady use of biologically active chemicals for human health has been mirrored by a rise in the leaking of these chemicals into natural environments. The aim of this work was to detect the toxicity of sodium fluoride (NaF) exposure and platinum-derived drugs in an ecological setting on aquatic organism development. From 24 to 96 h post-fertilization, zebrafish embryos were treated to dosages of NaF 10 mg/L⁻¹ + cisplatin (CDDP) 100 μM, one with NaF 10 mg/L⁻¹ + carboplatin (CARP) 25 μM, one with NaF 10 mg/L⁻¹ + CDDP 100 μM + CARP 25 μM. Fluoride exposure in combination with Cisplatin and Carboplatin (non-toxic concentration) had an effect on survival and hatching rate according to this study. Additionally, it significantly disturbed the antioxidant defense system and increased ROS in zebrafish larvae. NaF 10 mg/L⁻¹ associated with CDDP 100 μM and CARP 25 μM, increased the production of apoptosis-related proteins (caspase 3, bax, and bcl-2) and the downregulation of acetylcholinesterase (AChE) activity, while no effect was seen for the single exposure.

Study of the DNA binding mechanism and in vitro activity against cancer cells of iron(III) and aluminium(III) kojic acid derivative complexes

Metal ions have unique electrochemical and spectroscopical properties that cannot be attained by purely organic compounds. Most of the metal ions are toxic to humans, but paradoxically, metallodrugs are used in medicine as therapeutics and theranostics. Metallodrugs are eliminated in urine and faeces, and therefore release toxic metals and ligands into aquatic ecosystems, thereby raising concerns regarding environmental risks. The use of metallodrugs based on essential metal ions (i.e., iron, copper and zinc), instead of toxic ions, is a new alternative with minor hazards. Kojic acid is an Asperigillus oryzae metabolite of low toxicity used in the food and cosmetics industries. Its derivatives form stable complexes with iron(III) ions, which bind effectively to DNA and inhibit DNA polymerization. The iron(III)/S2 ligand complexes reduce in vitro colon carcinoma (Caco₂) cell viability and significantly decrease the cell number. The kojic acid derivative complexes with iron(III) presented here are an alternative to the currently used platinum complexes in cancer therapy.

Comparative degradation of 5-fluorouracil in aqueous solution by using H2O2-modified subcritical water, photocatalytic oxidation and electro-Fenton processes

This study investigated the degradation of the antineoplastic agent 5-fluorouracil (5-FU) widely applied to treat different cancers using different advanced oxidation processes such as electro-Fenton (EF), photocatalysis with TiO_2, and H₂O₂-modified subcritical water oxidation. The treatment with the EF process was the most efficient compared to others. Interestingly, in the EF process, the oxidative degradation of 5-FU behaved differently depending on the anode used. At low currents (20 and 40 mA), Pt and DSA anodes performed better than BDD and Ti₄O₇ anodes. In contrast, at the higher current of 120 mA, the production of heterogeneous hydroxyl radicals (M(^•OH)) became important and contributed significantly to the oxidation of 5-FU in addition to homogeneous ^•OH generated in the bulk solution. These latter have high O₂-evolution overpotential leading to the high amount of physisorbed M(^•OH) compared to Pt and DSA. The oxidative degradation of 5-FU was then performed by titanium dioxide-based photocatalytic oxidation and subcritical water oxidation processes, both of which showed a lower degradation efficiency and failed to achieve complete mineralization. Finally, a comparison was performed in laboratory-scale, taking into account the following performance indicators: the degradation efficiency, the mineralization power, the cost of equipment and reagents, and the energy required for the treatment of 5-FU.

One-Pot Thermal Synthesis of g-C3N4/ZnO Composites for the Degradation of 5-Fluoruracil Cytostatic Drug under UV-LED Irradiation

Graphitic carbon nitride (g-C₃N₄) was used to enhance the photocatalytic activity of ZnO nanoparticles for the degradation of 5-fluorouracil (5-FU) cytostatic drug under UV-LED irradiation. CN/ZnO composites were synthetized by an easy one-pot thermal method, varying the g-C₃N₄ loading, i.e., from 10 to 67 wt% and a post-thermal exfoliation in air. The physicochemical and optical properties of the materials were analyzed by several techniques. CN/ZnO composites showed a coral-like structure of spherical ZnO wurtzite particles on the g-C₃N₄ structure. In general, the synergism and heterojunction interface between both phases allowed the enhancement of the mesoporosity, light absorption ability, and the aromaticity of the corresponding composites. Moreover, the photocatalytic activity of the CN/ZnO composites was increased with the addition of g-C₃N₄ in comparison with pristine ZnO. The highest activity was found for the composite containing 25 wt% of g-C₃N₄ (i.e., CN25/ZnO), reaching the total degradation of 5-FU and a mineralization of 48% at 180 min, as well as a good photostability during four reuse cycles. Experiments with different pH solutions and scavengers allowed for the assessment of the reactive oxygen species (ROS) involved in the 5-FU degradation pathway, with radicals and non-radical species as the main responsible active species. Furthermore, a tentative photocatalytic mechanism was proposed for CN/ZnO composites.

Mixture predicted no-effect concentrations derived by independent action model vs concentration addition model based on different species sensitivity distribution models

In the hazard assessment of mixtures, the mixture predicted no-effect concentration (mPNEC) is always derived by the concentration addition (CA) model (mPNEC_CA) to assess the risk of mixtures combined with exposure assessment. However, the independent action (IA) model, which is also widely used as the CA model in the prediction and evaluation of mixture toxicity, is always used to calculate the population fraction showing a predefined effect, not mPNEC, and this limits the application of IA model in the mixture risk assessment. In this study, we explored the process of mPNEC derived by the IA method (mPNEC_IA) based on the species sensitivity distribution (SSD) and compared mPNEC_IA with mPNEC_CA. Taking two common pesticides, dimethoate (DIM) and dichlorvos (DIC), exposed in the actual water environment as an example, their SSD models were constructed separately using nine distribution functions after toxicity data screening and quality testing. For both DIC and DIM, all different nine models had passed the Kolmogorov-Smirnov test. Then, the PNECs of two pesticides were derived based on SSD models. Finally, mPNEC_IA with different concentration ratios was derived and compared to mPNEC_CA based on 81 combinations of nine SSD models. Most mPNEC values derived by IA model were more conservative than those by CA. It is worth noting that the mPNEC_IA is more conservative than mPNEC_CA for the commonly used log-logit distribution (function 7), log-normal distribution (8), and log-Weibull distribution (9). This study provides a new direction for the application of IA in the risk assessment and enriches the framework of mixture risk assessment.

Aquatic ecotoxicology of anticancer drugs: A systematic review

Anticancer drugs in the aquatic environment have drawn a lot of attention in the last decade. Since wastewater treatment plants are inefficient at fully eliminating trace concentrations of anticancer drugs, these compounds are continuously discharged into the aquatic environment. Subsequently, non-target organisms such as the aquatic biota are directly exposed to a variety of anticancer drugs. To understand the potential impact on the aquatic organisms, a systematic review was conducted in compliance with the PRISMA guidelines. The results acquired from the 152 included studies were analysed and sorted into four categories: the impact of each included anticancer drug, the effect of metabolites, the effect of a mixture of drugs, and risk assessment. Findings showed that risk to the aquatic biota was unlikely to occur as the concentrations needed to induce effects were much higher than those detected in the environment. However, these data were based on acute toxicity and included only basic toxicity endpoints. The concentrations that produced significant effects were much lower when tested in the long-term or in multi-generational studies. Heterogeneity in results was also observed; this depended on the organism tested, the assessment adopted, and the endpoints selected. In this systematic review, an overall view of the research studies was generated by which all the variability factors to be considered were reported and recommendations to guide future studies were proposed.

A novel workflow utilizing open-source software tools in the environmental fate studies: The example of imatinib biotransformation

The aim of this study is to utilize novel and powerful workflows with publicly available tools to efficiently process data and facilitate rapid acquisition of knowledge on environmental fate studies. Taking imatinib (IMA) as an example, we developed an efficient workflow to describe IMA biodegradation with activated sludge (AS) from wastewater treatment plants (WWTP). IMA is a cytostatic pharmaceutical; a selective tyrosine kinase inhibitor used to treat chronic myeloid leukemia. Its reported ecotoxic, endocrine and genotoxic effects imply high risk for aquatic wildlife and human health, however its fate in the environment is not yet well known. The study was conducted in a batch biotransformation setup, at two AS concentration levels and in presence and absence of carbon source. Degradation profiles and formation of IMA transformation products (TPs) were investigated using UHPLC-QqOrbitrap-MS/MS which showed that IMA is readily biodegradable. TPs were determined using multivariate statistical analysis. Eight TPs were determined and tentatively identified, six of them for first time. Hydrolysis of amide bond, oxidation, demethylation, deamination, acetylation and succinylation are proposed as major biodegradation pathways. TP235, the product of amide bond hydrolysis, was detected and quantified in actual wastewaters, at levels around 1 ng/L. This calls for more studies on the environmental fate of IMA in order to properly asses the environmental risk and hazard associated to IMA and its TPs.

Treatment-driven removal efficiency, product formation, and toxicity evolution of antineoplastic agents: Current status and implications for water safety assessment

Antineoplastic compounds, designed for chemotherapeutic anticancer therapy, have become emerging contaminants of global concern over the past decade due to their ubiquitous occurrence, environmental persistence, and multiple adverse effects on aquatic ecosystems. Increasing efforts have been devoted to developing efficient strategies for remediating water containing these micropollutants. In this study, the physicochemical properties, natural attenuation, and chemical reactivity with aqueous oxidizing species of five antineoplastic drugs with the highest environmental prevalence (i.e., tamoxifen, cyclophosphamide, ifosfamide, 5-fluorouracil, and methotrexate) were summarized. The removal performance, transformation products (TPs) of varying structures, overall reaction pathways, and toxicity evolution during different treatments were evaluated and discussed. Additionally, the biodegradability and multi-endpoint toxicity of each TP were predicted using in silico QSAR software. Depending on their distinct inherent structures, the reactivity of the antineoplastics with oxidizing species varied, with hydroxyl radicals exhibiting unparalleled merits in rapid oxidation. Complete elimination of these contaminants was observed during oxidative treatments, but with inadequate mineralization. Notably, the increase in toxicity within multiple processes was determined based on both experimental bioassays and theoretical predictions. This may be attributed to the adverse effects induced by the large number of identified and unknown TPs individually and in combination. Together with the environmental persistence and low biodegradability of most TPs, these results necessitate the application of efficient post-treatments in conjunction with a more thorough water safety evaluation (e.g., using high-throughput screening) of the mixtures of treated water and wastewater.

The Dark Side of Platinum Based Cytostatic Drugs: From Detection to Removal

The uncontrolled release of pharmaceutical drugs into the environment raised serious concerns in the last decades as they can potentially exert adverse effects on living organisms even at the low concentrations at which they are typically found. Among them, platinum based cytostatic drugs (Pt CDs) are among the most used drugs in cancer treatments which are administered via intravenous infusion and released partially intact or as transformation products. In this review, the studies on environmental occurrence, transformation, potential ecotoxicity, and possible treatment for the removal of platinum cytostatic compounds are revised. The analysis of the literature highlighted the generally low total platinum concentration values (from a few tens of ng L−1 to a few hundred μg L−1) found in hospital effluents. Additionally, several studies highlighted how hospitals are sources of a minor fraction of the total Pt CDs found in the environment due to the slow excretion rate which is longer than the usual treatment durations. Only some data about the impact of the exposure to low levels of Pt CDs on the health of flora and fauna are present in literature. In some cases, adverse effects have been shown to occur in living organisms, even at low concentrations. Further ecotoxicity data are needed to support or exclude their chronic effects on the ecosystem. Finally, fundamental understanding is required on the platinum drugs removal by MBR, AOPs, technologies, and adsorption.

Risk management in an anticancer drug preparation unit: use of Preliminary Risk Analysis method and application to the preparation process

Objectives

Preparation of injectable anticancer drugs in hospital pharmacies, in particular of cytotoxics, is a high-risk activity. We used Preliminary Risk Analysis (PRA) to analyse the risks in the different steps of our anticancer drug circuit, including the preparation step (PRA1). Then, to prepare an important change in management of the circuit with the software Chimio® (pooling of three databases for subcontracting), we repeated the analysis of preparation step (PRA2). PRA is known to be time and resource consuming. To overcome this, we developed a strict organisational framework to perform the analysis within a reasonable amount of time. We present the PRA method including its practical implementation, and its application to the anticancer drug preparation process, before and after pooling of Chimio® databases.

Methods

PRA has two main stages, PRA “system” and PRA “scenario”. A multidisciplinary working group is created for the entire PRA process. PRA “system” is an exploratory and qualitative stage. PRA “scenario” requires the creation of risk assessment tools and decision tools before actually developing, analysing and treating scenarios, with risk reduction actions structured in an action plan. For PRA2 we used the same working group, assessment and decision tools as for PRA1 and we only analysed dangerous situations (DS) that appeared or changed towards more risk, requiring a new action plan. The different PRA only required four 2 h meetings thanks to the investment of a coordinator who is expert in the method.

Results

In PRA1, the riskiest phase was production while it was the verification and delivery of the finished product in PRA2. The risks were mainly related to management, human and technical dangers in PRA1. Human danger was found to be the main danger in PRA2, followed by organisational danger. Among the 264 scenarios described in PRA1, six of criticality 3 and 69 of criticality 2 have been associated with risk reduction actions. These actions mainly involved managing the risk of human error, with the control system Drugcam® and the standardisation of the pharmaceutical assistants’ training program. In PRA2, 11 scenarios were analysed, including three of criticality 3 and 4 of criticality 2 for which risk reduction measures were taken.

Conclusions

PRA allowed us to perform an in depth analysis of the highly specific and technical process of anticancer drug preparation. Human danger was one of the most important dangers identified, and it should always be taken into consideration, whatever the measures taken to prevent it. PRA2 was extremely useful to plan the organisation that would result from the new Chimio® database, while involving the team and winning its commitment. It allowed an exhaustive and structured anticipation of this major change. Practical aspects of PRA method implementation we have adopted facilitate its application and can help to deploy it on many areas in our hospitals. Indeed, besides an exhaustive analysis of the risks, this approach promotes collaboration, develops a quality culture and is an excellent tool for team and project management, as well as communication.

The antineoplastic drugs cyclophosphamide and cisplatin in the aquatic environment - Review

Cyclophosphamide (CP) and Cisplatin (CDDP) are antineoplastic drugs widely used in the treatment of neoplastic diseases that have been detected in the aquatic environment. This review summarizes the current knowledge on the presence in the aquatic environment of these two drugs and their effects on freshwater and marine invertebrates, which includes good model species in ecotoxicology and risk assessment programs. The consumption levels, occurrence in freshwater and marine ecosystems, and the impacts exerted on aquatic organisms, even at low concentrations, justifies this review and the selection of these two drugs. Both pharmaceuticals were detected in different aquatic environments, with concentrations ranging from ng L^-1 up to 687.0 μg L^-1 (CP) and 250 μg L^-1 (CDDP). The available studies showed that CP and CDDP induce individual and sub-individual impacts on aquatic invertebrate species. The most common effects reported were changes in the reproductive function, oxidative stress, genotoxicity, cytotoxicity and neurotoxicity. The literature used in this review supports the need to increase monitoring studies concerning the occurrence of antineoplastic drugs in the aquatic environment since negative effects have been reported even at trace concentrations (ng L^-1). Furthermore, marine ecosystems should be considered as a priority since less is known on the occurrence and effects of antineoplastic drugs in this environment comparing to freshwater ecosystems.

Deregulation of whole-transcriptome gene expression in zebrafish (Danio rerio) after chronic exposure to low doses of imatinib mesylate in a complete life cycle study

Imatinib mesylate (IM) is an anticancer drug that belongs to tyrosine kinase inhibitors. We report the results of the first investigation of the chronic exposure of zebrafish (Danio rerio) to IM. The exposure to IM (0.01, 1 and 100 μg/L) was initiated in adult fish and continued through hatching and the offspring generation for seven months. In addition to standard toxicological endpoints, induction of genotoxic effects and whole-genome transcriptome of liver samples of offspring generation of zebrafish were analysed. Exposure to IM did not affect the survival and growth of zebrafish, did not cause any histopathological changes, but it induced a marginal increase in the chromosomal damage in blood cells. The whole-genome transcriptome analyses demonstrated dose-dependent increase in the number of differentially expressed genes with a significantly higher number of deregulated genes in female fish compared to male. Differentially expressed genes included genes involved in response to DNA damage, cell cycle control and regulation of circadian rhythm. Based on the low genotoxic activity and the pattern of the changes in DNA damage responsive genes we consider that at current environmental exposure levels, IM represents low risk for genotoxic effects in aquatic organisms. Exposure to IM also induced deregulation of the expression of genes associated with steroidogenesis and hormone metabolism and function, which indicates hormone-disrupting activity of IM that has not been studied so far. The study provide new information on the potential consequences of chronic exposure to the residues of tyrosine kinase inhibitors, which remain to be further explored.

Threat and sustainable technological solution for antineoplastic drugs pollution: Review on a persisting global issue

In the past 20 years, the discharge of pharmaceuticals and their presence in the aquatic environment have been continuously increasing and this has caused serious public health and environmental concerns. Antineoplastic drugs are used in chemotherapy, in large quantities worldwide, for the treatment of continuously increasing cancer cases. Antineoplastic drugs also contaminate water sources and possess mutagenic, cytostatic and eco-toxicological effects on microorganisms present in the aquatic environment as well as on human health. Due to the recalcitrant nature of antineoplastic drugs, the commonly used wastewater treatment processes are not able to eliminate these drugs. Globally, various anticancer drugs are being consumed during chemotherapy in hospitals and households by out-patients. These anti-cancer agents enter the water bodies in their original form or as metabolites via urine and faeces of the out-patients or the patients admitted in hospitals. Due to its high lipid solubility, the antineoplastic drugs accumulate in the fatty tissues of the organisms. These drugs enter through the food chain and cause adverse health effects on humans due to their cytotoxic and genotoxic properties. The United States Environmental Protection Agency (US-EPA) and the Organization for Economic Cooperation and Development (OECD) elucidated new regulations for the management of hazardous pharmaceuticals in the water environment. In this paper, the role of antineoplastic agents as emerging water contaminants, its transfer through the food chain, its eco-toxicological properties and effects, technological solutions and management aspects were reviewed.

Detection of anti-cancer drugs and metabolites in the effluents from a large Brazilian cancer hospital and an evaluation of ecotoxicology

The use of chemotherapy agents has been growing worldwide, due to the increase number of cancer cases. In several countries, mainly in Europe countries, these drugs have been detected in hospitals and municipal wastewaters. In Brazil this issue is poorly explored. The main goal of this study was to assess the presence of three anti-cancer drugs, 5-fluorouracil (5-FU), gemcitabine (GEM) and cyclophosphamide (CP), and two metabolites, alpha-fluoro-beta-alanine (3-NH₂-F) and 2'-deoxy-2',2'-difluorouridine (2-DOH-DiF), in effluents from a large cancer hospital, in the municipal wastewater treatment plant (WWTP) influent and effluent, and also to evaluate toxicity of the mixtures of these compounds by ecotoxicological testing in zebrafish. The sample collections were performed in Barretos Cancer Hospital of the large cancer center in Brazil. After each collection, the samples were filtered for subsequent Liquid Chromatography Mass Spectrometry analysis. The presence of CP, GEM, and both metabolites (3-NH₂-F and 2-DOH-DiF) were detected in the hospital wastewater and the WWTP influent. Three drugs, GEM, 2-DOH-DiF and CP, were detected in the WWTP effluent. Two drugs were detected below the limit of quantification, 2-DOH-DiF: <LOQ (above 1400 ng L^-1) and CP: <LOQ (above 300 ng L^-1), and GEM was quantified at 420 ng L^-1. Furthermore, 2-DOH-DiF (116,000 ng L^-1) was detected at the highest level in the hospital wastewater. There were no zebrafish deaths at any of the concentrations of the compounds used. However, we observed histological changes, including aneurysms and edema in the gills and areas of necrosis of the liver. In summary, we found higher concentrations of CP, GEM and both metabolites (3-NH₂-F and 2-DOH-DiF) were detected for the first time. There is currently no legislation regarding the discharge of anti-cancer drugs in effluents in Brazil. This study is first to focus on effluents from specific treatments from a large cancer hospital located in small city in Brazil.

Ecotoxic interactions between pharmaceuticals in mixtures: Diclofenac and sulfamethoxazole

The objective of this study was to investigate the impact of two pharmaceuticals, diclofenac and sulfamethoxazole, and their binary mixture on aquatic organisms, marine bacteria Aliivibrio fischeri, crustacean Daphnia magna, and vascular plant Lemna minor. The binary mixture of the drugs showed the highest toxicity towards the model organisms. Diclofenac had an average toxicity which posed a high environmental risk to aquatic organisms, while sulfamethoxazole was characterized by a low toxicity with low environmental risk. The organism most sensitive to diclofenac was A. fischeri (IC₅₀ = 8.72 ± 1.14 mg L^-1) and for sulfamethoxazole and the binary mixture, it was L. minor (IC₅₀ = 12.56 ± 4.48 and 4.83 ± 0.43 mg L^-1, respectively). The toxicity of the mixture was predicted using the Concentration Addition and Independent Action models, and the results were compared with the experimental data. None of the models suitably predicted the real toxicity of the pharmaceutical mixture. Interactions between the mixture components were confirmed by calculating the mixture toxicity index values which showed that the pharmaceuticals displayed synergistic or partial additive effects which depended on the selected test organism and test duration. When added as a complex matrix to wastewater (at a concentration of 2 mg L^-1 each), the pharmaceuticals did not display increased toxicity. This observation confirms that the presence of micro-contaminants in aquatic environments may cause interactions between different compounds, the results of which are difficult to predict and model.

Genomic instability in peripheral blood lymphocytes of patients diagnosed with high-grade squamous intraepithelial lesions: CIN 2 versus CIN 3

Cancer is a genomic disease associated with accumulation of genetic damage. Cancer-initiating events, such as chromosome breakage, loss and rearrangement, can be used as biomarkers to evaluate individual cancer risk. Cytokinesis-block micronucleus cytome (CBMN - Cyt) assay parameters in peripheral blood lymphocytes (PBL) of thirty four patients diagnosed with high-grade squamous intraepithelial lesions (HSIL) and fifteen healthy women were measured. The genomic instability of patients diagnosed with HSIL were investigated in order to compare differences between the two subgroups of HSIL (CIN 2 and CIN 3). The micronucleus (MN) frequencies in PBL, as well as the frequencies of nucleoplasmic bridges (NPB) and nuclear buds (NBUD) were higher in patients than in controls (Mann- Whitney test, p < 0.05). These results provide evidence that CBMN cytome assay in peripheral blood lymphocytes may be used to identify individuals who are at high risk of developing cervical cancer. Since the extent of DNA damage varies between CIN 2 and CIN 3, these findings support the CIN grading system.

Evaluation of toxic effects of platinum-based antineoplastic drugs (cisplatin, carboplatin and oxaliplatin) on green alga Chlorella vulgaris

Platinum-based antineoplastic drugs (PBADs) enter the environment via hospital and municipal wastes as reactive and highly toxic molecules. Chlorella vulgaris is a freshwater microalgae and is used as an excellent aquatic model for toxicity assessment. In the present study, the toxicity of PBADs to C. vulgaris was investigated for better understanding of PBADs environmental toxicity. The algae were cultured in Bold´s Basal Medium (BBM) and exposed to different concentrations of PBADs for 48, 72 and 96 h. Then, cell proliferation, the synthesis of photosynthetic pigments, protein content, malondialdehyde (MDA) release and antioxidant potential were determined. IC₅₀ s of cisplatin, carboplatin and oxaliplatin for 96 h of exposure were 106.2, 124.3 and 153.9 mg/L respectively. Cell proliferation, synthesis of chlorophyll a, chlorophyll b and algal protein content significantly decreased in a time and dose-dependent manner. The release of MDA to culture media significantly increased and antioxidant potential decreased. Cisplatin showed more toxic effects on C. vulgaris compared to carboplatin and oxaliplatin indicating its severe toxicity for marine organisms. PBADs induce their toxic effects in algal cells via the interaction with DNA, production of free radicals (such as reactive oxygen species), lipid peroxidation and cell wall damages. Due to these toxic effects of PBADs for various environmental organisms, there must be severe restriction on their release into the environment.

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.

Ecotoxicological study of six drugs in Aliivibrio fischeri, Daphnia magna and Raphidocelis subcapitata

The presence of drugs in the environment is an emerging issue in the scientific community. It has been shown that these substances are active chemicals that consequently affect aquatic organisms and, finally, humans as end users. To evaluate the toxicity of these compounds and how they affect the environment, it is important to perform systematic ecotoxicological and physicochemical studies. The best way to address this problem is to conduct studies on different aquatic trophic levels. In this work, an ecotoxicological study of six drugs (anhydrous caffeine, diphenhydramine hydrochloride, gentamicin sulphate, lidocaine hydrochloride, tobramycin sulphate and enalapril maleate) that used three aquatic biological models (Raphidocelis subcapitata, Aliivibrio fischeri and Daphnia magna) was performed. Additionally, the concentration of chlorophyll in the algae R. subcapitata was measured. Furthermore, EC50 values were analysed using the Passino and Smith classification (PSC) method, which categorized the compounds as toxic or relatively toxic. All of the studied drugs showed clear concentration-dependent toxic effects. The toxicity of the chemicals depended on the biological model studied, with Raphidocelis subcapitata being the most sensitive species and Aliivibrio fischeri being the least sensitive. The results indicate that the most toxic compound, for all the studied biological models, was diphenhydramine hydrochloride. Graphical abstract.

Cisplatin affects locomotor activity and physiological endpoints of Daphnia magna

Cisplatin (CPL) is a common antineoplastic drug used in human medicine for treatment of various cancer types. Since the knowledge about its effects on crustacean behavioral and physiological parameters is very scarce, the aim of our study was to determine the influence of CPL at concentrations of 125 μg/L, 200 μg/L, 500 μg/L and 1000 μg/L on swimming behavior (swimming speed, distance travelled, hopping frequency, propelling efficiency index - a novel parameter) and physiological parameters (heart rate, thoracic limb activity) of Daphnia magna with the use of video digital analysis. The results showed that distance travelled, swimming speed, hopping frequency and propelling efficiency were inhibited as early as after 24 h in concentration- and time-dependent manner. On the other hand, heart rate was stimulated in the animals treated with 125 μg/L of CPL after 48 h, 72 h and 120 h of the exposure, however it was decreased at the higher concentrations. Although thoracic limb activity was considerably increased in daphnids exposed to 125 μg/L and 200 μg/L after 72 h, it was inhibited at the higher concentrations of the drug. The study suggests that since CPL affected daphnid parameters at the environmental concentration, it should be considered as hazardous to zooplankton.