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Schlezinger JJ, Gokce N. Perfluoroalkyl/Polyfluoroalkyl Substances: Links to Cardiovascular Disease Risk. Circ Res 2024; 134:1136-1159. [PMID: 38662859 PMCID: PMC11047059 DOI: 10.1161/circresaha.124.323697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Conservative estimates by the World Health Organization suggest that at least a quarter of global cardiovascular diseases are attributable to environmental exposures. Associations between air pollution and cardiovascular risk have garnered the most headlines and are strong, but less attention has been paid to other omnipresent toxicants in our ecosystem. Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are man-made chemicals that are extensively used in industrial and consumer products worldwide and in aqueous film-forming foam utilized in firefighting. As such, our exposure to PFAS is essentially ubiquitous. Given the long half-lives of these degradation-resistant chemicals, virtually, all people are carrying a body burden of PFAS. Health concerns related to PFAS are growing such that the National Academies of Sciences, Engineering and Medicine has recommended standards for clinical follow-up of individuals with high PFAS blood levels, including prioritizing screening for dyslipidemia. The link between PFAS and dyslipidemia has been extensively investigated, and evidence for associations is compelling. However, dyslipidemia is not the only cardiovascular risk factor with which PFAS is associated. Here, we review the epidemiological evidence for links between PFAS of concern identified by the National Academies of Sciences, Engineering and Medicine and risk factors for cardiovascular disease, including overweight/obesity, glucose intolerance, hypertension, dyslipidemia, and hyperuricemia. Moreover, we review the potential connections of PFAS with vascular disease and atherosclerosis. While observational data support associations between the National Academies of Sciences, Engineering and Medicine PFAS and selected cardiac risk factors, additional research is needed to establish causation and better understand how exposure to PFAS leads to the development of these conditions.
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Affiliation(s)
| | - Noyan Gokce
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
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2
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Weatherly LM, Shane HL, Jackson LG, Lukomska E, Baur R, Cooper MP, Anderson SE. Systemic and immunotoxicity induced by topical application of perfluorohexane sulfonic acid (PFHxS) in a murine model. Food Chem Toxicol 2024; 186:114578. [PMID: 38458531 DOI: 10.1016/j.fct.2024.114578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
Per- and polyfluoroalkyl substances (PFAS) are a large group of stable synthetic surfactants that are incorporated into numerous products for their water and oil resistance and have been associated with adverse health effects. The present study evaluated the systemic and immunotoxicity of sub-chronic 28- or 10-day dermal exposure of PFHxS (0.625-5% or 15.63-125 mg/kg/dose) in a murine model. Elevated levels of PFHxS were detected in the serum and urine, suggesting that absorption is occurring through the dermal route. Liver weight (% body) significantly increased and spleen weight (% body) significantly decreased with PFHxS exposure, which was supported by histopathological changes. Additionally, PFHxS significantly reduced the humoral immune response and altered immune subsets in the spleen, suggesting immunosuppression. Gene expression changes were observed in the liver, skin, and spleen with genes involved in fatty acid metabolism, necrosis, and inflammation. Immune-cell phenotyping identified significant decreases in B-cells, NK cells, and CD11b+ monocyte/macrophages in the spleen along with increases in CD4+ and CD8+ T-cells, NK cells, and neutrophils in the skin. These findings support dermal PFHxS-induced liver damage and immune suppression. Overall, data support PFHxS absorption through the skin and demonstrate immunotoxicity via this exposure route, suggesting the need for further examination.
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Affiliation(s)
- Lisa M Weatherly
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA.
| | - Hillary L Shane
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Laurel G Jackson
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Ewa Lukomska
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Rachel Baur
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Madison P Cooper
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Stacey E Anderson
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
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3
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Nematollahi AJ, Fisher JM, Furlong MA, Beamer PI, Goodrich JM, Graber JM, Calafat AM, Botelho JC, Beitel SC, Littau SR, Gulotta JJ, Wallentine DD, Burgess JL. Comparison of Serum Per- and Polyfluoroalkyl Substances Concentrations in Incumbent and Recruit Firefighters and Longitudinal Assessment in Recruits. J Occup Environ Med 2024; 66:202-211. [PMID: 38013397 PMCID: PMC10916718 DOI: 10.1097/jom.0000000000003020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Firefighters are occupationally exposed to per- and polyfluoroalkyl substances (PFAS). This study objective was to compare serum PFAS concentrations in incumbent and recruit firefighters and evaluate temporal trends among recruits. METHODS Serum PFAS concentrations were measured in 99 incumbent and 55 recruit firefighters at enrollment in 2015-2016, with follow-up 20 to 37 months later for recruits. Linear and logistic regression and linear mixed-effects models were used for analyses. Fireground exposure impact on PFAS concentrations was investigated using adjusted linear and logistic regression models. RESULTS Incumbents had lower n-PFOA and PFNA than recruits and most PFAS significantly decreased over time among male recruits. No significant links were found between cumulative fireground exposures and PFAS concentrations. CONCLUSIONS Serum PFAS concentrations were not increased in incumbent firefighters compared with recruits and were not associated with cumulative fireground exposures.
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Affiliation(s)
- Amy J. Nematollahi
- Environmental Health Sciences, Mel and Enid Zuckerman School of Public Health, The University of Arizona, Tucson, Arizona, USA
| | - Julia M. Fisher
- BIO5 Institute, Statistics Consulting Laboratory, The University of Arizona, Tucson, Arizona, USA
| | - Melissa A. Furlong
- Environmental Health Sciences, Mel and Enid Zuckerman School of Public Health, The University of Arizona, Tucson, Arizona, USA
| | - Paloma I. Beamer
- Environmental Health Sciences, Mel and Enid Zuckerman School of Public Health, The University of Arizona, Tucson, Arizona, USA
| | - Jaclyn M. Goodrich
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Judith M. Graber
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julianne Cook Botelho
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shawn C. Beitel
- Environmental Health Sciences, Mel and Enid Zuckerman School of Public Health, The University of Arizona, Tucson, Arizona, USA
| | - Sally R. Littau
- Environmental Health Sciences, Mel and Enid Zuckerman School of Public Health, The University of Arizona, Tucson, Arizona, USA
| | | | | | - Jefferey L. Burgess
- Environmental Health Sciences, Mel and Enid Zuckerman School of Public Health, The University of Arizona, Tucson, Arizona, USA
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4
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Christensen BT, Calkins MM. Occupational exposure to per- and polyfluoroalkyl substances: a scope review of the literature from 1980-2021. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:673-686. [PMID: 36977833 PMCID: PMC10533727 DOI: 10.1038/s41370-023-00536-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) comprise a large group of chemicals that have been integrated into a wide variety of industrial processes and consumer products since the 1950s. Due to their profuse usage and high persistence in human serum, understanding workplace exposures to PFAS is critical. OBJECTIVE We aimed to characterize the PFAS exposure profiles of relevant occupational populations, elucidate trends in the PFAS exposure characterization process, and identify major research gaps that remain within the occupational PFAS exposure literature. METHODS A systematic search of four literature databases for peer-reviewed articles published between 1980 and 2021 on PFAS exposure in occupational settings was conducted. RESULTS Of the 2574 articles identified, 92 met the inclusion criteria. Fluorochemical workers were the target population in most early exposure assessment research; however, studies conducted within the last 10 years have evaluated a wider range of occupational populations and settings. The highest exposures were reported in fluorochemical workers, but, in comparison to reference populations, one or more PFAS were elevated in most workers and in most workplaces that were assessed. PFAS was most frequently assessed in worker serum using a discrete analytical panel of PFAS, with earlier studies restricted to a few long-alkyl chain PFAS while more recent studies have included more expansive panels due to more robust methods. SIGNIFICANCE Characterization of occupational exposure to PFAS is limited but expanding. Current analytical methods are not robust enough to fully capture the potential range of PFAS present across different workers and workplaces. While exposures to PFAS for certain occupational groups have been studied in detail, exposure information for other occupational groups with high potential for exposure are limited. This review highlights substantial findings and major research gaps within the occupational literature.
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Affiliation(s)
- Brian T Christensen
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, 45213, USA.
| | - Miriam M Calkins
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, 45213, USA
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5
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Purdue MP, Rhee J, Denic-Roberts H, McGlynn KA, Byrne C, Sampson J, Botelho JC, Calafat AM, Rusiecki J. A Nested Case-Control Study of Serum Per- and Polyfluoroalkyl Substances and Testicular Germ Cell Tumors among U.S. Air Force Servicemen. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:77007. [PMID: 37458713 PMCID: PMC10351502 DOI: 10.1289/ehp12603] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are a component of firefighting foams used at military installations. Although high PFAS exposures have been related to cancer risks among civilian populations, the effects for military personnel are unclear. OBJECTIVES We investigated associations between serum PFAS concentrations and testicular germ cell tumors (TGCT) among U.S. Air Force servicemen. METHODS This nested case-control study involved active-duty Air Force servicemen with sera from the Department of Defense Serum Repository. We selected 530 cases and 530 controls individually matched on birth date, race and ethnicity, year entered the service, and year of sample collection, with prediagnostic serum samples collected between 1988 and 2017. A second prediagnostic sample, collected a median of 4 y after the first, was selected for 187 case-control pairs. Seven PFAS were quantified using isotope-dilution tandem mass spectrometry. Odds ratios (ORs) and 95% confidence intervals (CIs) from conditional logistic regression adjusting for military grade, number of deployments, and, in some models, other PFAS, estimated associations between PFAS concentrations (categorized using quartiles among controls) and TGCT. RESULTS Elevated concentrations of some PFAS were observed for military employment in firefighting [perfluorooctanesulfonic acid (PFOS), perfluorohexanesulfonic acid (PFHxS), perfluorooctanoic acid] and service at a base with high PFAS concentrations in drinking water (PFHxS). Elevated PFOS concentrations in the second sample were positively associated with TGCT [OR for fourth vs. first quartile ( OR Q 4 ) = 2.6 , 95% CI: 1.1, 6.4; p trend = 0.02 ], including after adjustment for other PFAS (OR Q 4 = 4.6 , 95% CI: 1.4, 15.1; p trend = 0.009 ). Associations with PFOS in the first/only samples were weak and not statistically significant. Elevated concentrations of perfluorononanoic acid were inversely associated with TGCT, whereas results were null for other PFAS. DISCUSSION We identified service-related predictors of PFAS concentrations and increased TGCT relative risks with elevated PFOS concentrations among Air Force servicemen. These findings warrant further investigation in other populations and military service branches. https://doi.org/10.1289/EHP12603.
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Affiliation(s)
- Mark P Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Jongeun Rhee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Hristina Denic-Roberts
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Celia Byrne
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Joshua Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Julianne Cook Botelho
- Division of Laboratory Sciences, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Rusiecki
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Barros B, Oliveira M, Morais S. Biomonitoring of firefighting forces: a review on biomarkers of exposure to health-relevant pollutants released from fires. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2023; 26:127-171. [PMID: 36748115 DOI: 10.1080/10937404.2023.2172119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Occupational exposure as a firefighter has recently been classified as a carcinogen to humans by International Agency for Research on Cancer (IARC). Biomonitoring has been increasingly used to characterize exposure of firefighting forces to contaminants. However, available data are dispersed and information on the most relevant and promising biomarkers in this context of firefighting is missing. This review presents a comprehensive summary and critical appraisal of existing biomarkers of exposure including volatile organic compounds such as polycyclic aromatic hydrocarbons, several other persistent other organic pollutants as well as heavy metals and metalloids detected in biological fluids of firefighters attending different fire scenarios. Urine was the most characterized matrix, followed by blood. Firefighters exhaled breath and saliva were poorly evaluated. Overall, biological levels of compounds were predominantly increased in firefighters after participation in firefighting activities. Biomonitoring studies combining different biomarkers of exposure and of effect are currently limited but exploratory findings are of high interest. However, biomonitoring still has some unresolved major limitations since reference or recommended values are not yet established for most biomarkers. In addition, half-lives values for most of the biomarkers have thus far not been defined, which significantly hampers the design of studies. These limitations need to be tackled urgently to improve risk assessment and support implementation of better more effective preventive strategies.
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Affiliation(s)
- Bela Barros
- REQUIMTE-LAQV,Instituto Superior de Engenharia do Porto, Instituto Politécnico do Porto, Porto, Portugal
| | - Marta Oliveira
- REQUIMTE-LAQV,Instituto Superior de Engenharia do Porto, Instituto Politécnico do Porto, Porto, Portugal
| | - Simone Morais
- REQUIMTE-LAQV,Instituto Superior de Engenharia do Porto, Instituto Politécnico do Porto, Porto, Portugal
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Rosenfeld PE, Spaeth KR, Remy LL, Byers V, Muerth SA, Hallman RC, Summers-Evans J, Barker S. Perfluoroalkyl substances exposure in firefighters: Sources and implications. ENVIRONMENTAL RESEARCH 2023; 220:115164. [PMID: 36584840 DOI: 10.1016/j.envres.2022.115164] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
Firefighters are at risk of occupational exposure to long-chain per- and poly-fluoroalkyl substances (PFASs), most notably from PFASs present in Class B aqueous film-forming foam (AFFF). Firefighters have been found to have elevated serum levels of long-chain PFASs. Due to the persistence of PFAS chemicals in the human body and their ability to bioaccumulate, firefighters experience the latent and cumulative effects of PFAS-containing AFFF exposure that occurs throughout their careers. This article summarizes the history of AFFF use by firefighters and current AFFF use practices. In addition, this paper describes PFAS levels in firefighter serum, PFAS serum removal pathways, PFAS exposure pathways, and occupational factors affecting PFAS levels in firefighters. International, national, and state agencies have concluded that PFOA, a long-chain PFAS, is potentially carcinogenic and that carcinogens have an additive effect. From the cancer types that may be associated with PFAS exposure, studies on cancer risk among firefighters have shown an elevated risk for thyroid, kidney, bladder, testicular, prostate, and colon cancer. Thus, exposure to PFAS-containing AFFF may contribute to firefighter cancer risk and warrants further research.
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Affiliation(s)
- Paul E Rosenfeld
- Soil Water Air Protection Enterprise (SWAPE), 2656 29th Street, Suite 201, Santa Monica, CA, 90405, USA.
| | - Kenneth R Spaeth
- Division of Occupational and Environmental Medicine, Zucker School of Medicine at Hofstra/Northwell, NY, USA.
| | - Linda L Remy
- Family Health Outcomes Project, Family and Community Medicine, School of Medicine, University of California San Francisco, 500 Parnassus Ave. Room MU-337, San Francisco, CA, 94143-0900, USA.
| | - Vera Byers
- Immunology Inc. PO Box 4703, Incline Village, NV, 89450, USA.
| | - Stuart A Muerth
- Soil Water Air Protection Enterprise (SWAPE), 2656 29th Street, Suite 201, Santa Monica, CA, 90405, USA.
| | - Ryan C Hallman
- Soil Water Air Protection Enterprise (SWAPE), 2656 29th Street, Suite 201, Santa Monica, CA, 90405, USA.
| | - Jasmine Summers-Evans
- University of California, Los Angeles, Institute of the Environment and Sustainability. LaKretz Hall, 619 Charles E Young Dr E #300, Los Angeles, CA, 90024, USA.
| | - Sofia Barker
- Soil Water Air Protection Enterprise (SWAPE), 2656 29th Street, Suite 201, Santa Monica, CA, 90405, USA.
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Nilsson S, Smurthwaite K, Aylward LL, Kay M, Toms LM, King L, Marrington S, Kirk MD, Mueller JF, Bräunig J. Associations between serum perfluoroalkyl acid (PFAA) concentrations and health related biomarkers in firefighters. ENVIRONMENTAL RESEARCH 2022; 215:114370. [PMID: 36174755 DOI: 10.1016/j.envres.2022.114370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Firefighters who used aqueous film forming foam in the past have experienced elevated exposures to perfluoroalkyl acids (PFAAs). The objective of this study was to examine the associations between clinical chemistry endpoints and serum concentrations of perfluorooctanoic acid (PFOA), perfluorohexane sulfonate (PFHxS), perfluoroheptane sulfonate (PFHpS) and perfluorooctane sulfonate (PFOS) in firefighters. Multiple linear regression was used to assess relationships between PFAA serum concentrations and biochemical markers for cardiovascular disease, kidney-, liver- and thyroid function, in a cross-sectional survey of 783 firefighters with elevated levels of PFHxS, PFHpS and PFOS in relation to the most recently reported levels in the general Australian population. Linear logistic regression was used to assess the odds ratios for selected self-reported health outcomes. Repeated measures linear mixed models were further used to assess relationships between PFAAs and biomarkers for cardiovascular disease and kidney function longitudinally in a subset of the firefighters (n = 130) where serum measurements were available from two timepoints, five years apart. In the cross-sectional analysis, higher levels of all PFAAs were significantly associated with higher levels of biomarkers for cardiovascular disease (total-cholesterol, and LDL-cholesterol). For example, doubling in PFOS serum concentration were associated with increases in total cholesterol (β:0.111, 95% confidence interval (95%CI): 0.026, 0.195 mmol/L) and LDL-cholesterol (β: 0.104, 95%CI:0.03, 0.178 mmol/L). Doubling in PFOA concentration, despite not being elevated in the study population, were additionally positively associated with kidney function marker urate (e.g., β: 0.010, 95%CI; 0.004, 0.016 mmol/L) and thyroid function marker TSH (e.g., β: 0.087, 95%CI: 0.014, 0.161 mIU/L). PFAAs were not associated with any assessed self-reported health conditions. No significant relationships were observed in the longitudinal analysis. Findings support previous studies, particularly on the association between PFAAs and serum lipids.
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Affiliation(s)
- Sandra Nilsson
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102, QLD, Australia.
| | - Kayla Smurthwaite
- National Centre for Epidemiology and Population Health, The Australian National University, Cnr of Eggleston and Mills Roads Acton 2600, Australia
| | - Lesa L Aylward
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102, QLD, Australia; Summit Toxicology, LLP, La Quinta, 92253, CA, USA
| | - Margaret Kay
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Health Sciences Building, RBWH Complex, Herston, 4029, QLD, Australia
| | - Leisa-Maree Toms
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Musk Avenue, Kelvin Grove, 4059, QLD, Australia
| | - Leisa King
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102, QLD, Australia
| | - Shelby Marrington
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102, QLD, Australia
| | - Martyn D Kirk
- National Centre for Epidemiology and Population Health, The Australian National University, Cnr of Eggleston and Mills Roads Acton 2600, Australia
| | - Jochen F Mueller
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102, QLD, Australia
| | - Jennifer Bräunig
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102, QLD, Australia
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Ho SH, Soh SXH, Wang MX, Ong J, Seah A, Wong Y, Fang Z, Sim S, Lim JT. Perfluoroalkyl substances and lipid concentrations in the blood: A systematic review of epidemiological studies. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 850:158036. [PMID: 35973530 DOI: 10.1016/j.scitotenv.2022.158036] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/19/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Perfluoroalkyl substances (PFAS) are widely used synthetic aliphatic compounds. This systematic review aims to assess PFAS associations with low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), total cholesterol (TC) and total triglyceride (TG) concentrations in human populations. METHOD We systematically searched four online databases, PubMed, Scopus, Embase, and Cochrane Library for relevant peer-reviewed English language articles published until July 2021. Additional relevant articles identified were also included in the search results. We categorised populations into adults (≥18 years old) and children. Primary findings were the associations between PFAS concentrations and LDL, HDL, TC, and TG concentrations in the serum, plasma, or whole blood; secondary findings were the associations between PFAS concentrations and the odds of lipid-related health outcomes. Quantitative synthesis was done by vote counting of the effect directions between concentrations of PFAS and lipids/health outcomes, repeated on articles with sample size >1000. Sign tests were performed to assess the statistical significance of the differences between positive and negative associations. Sensitivity analysis was performed by separating out articles with populations having high concentrations of perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS). Quality was assessed with the STROBE checklist and NHBLI Study Quality Assessment Tool. RESULTS A total of 58 articles were included for review. There was evidence that PFAS exposure is associated with higher concentrations of LDL, HDL, and TC, particularly for PFOA-LDL, PFOA-TC, PFOS-TC, and PFNA-LDL. Associations between PFAS and TG tended to be negative, especially for perfluoroundecanoic acid (PFUnDA). Associations between PFAS concentration and the odds of secondary outcomes generally supported a positive association between PFAS and cholesterol concentrations. CONCLUSION We found evidence of associations between the concentrations of some PFAS-lipid pairs in human populations. Future research should be conducted on the less well-studied PFAS to explore their effects on human health and in regions where such studies are currently lacking. (300 words).
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Affiliation(s)
- Soon Hoe Ho
- Environmental Health Institute, National Environment Agency, 11 Biopolis Way, #06-05/08 Helios Block, Singapore 138667, Singapore.
| | - Stacy Xin Hui Soh
- Environmental Health Institute, National Environment Agency, 11 Biopolis Way, #06-05/08 Helios Block, Singapore 138667, Singapore
| | - Min Xian Wang
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - Janet Ong
- Environmental Health Institute, National Environment Agency, 11 Biopolis Way, #06-05/08 Helios Block, Singapore 138667, Singapore
| | - Annabel Seah
- Environmental Health Institute, National Environment Agency, 11 Biopolis Way, #06-05/08 Helios Block, Singapore 138667, Singapore
| | - Yvonne Wong
- Environmental Health Institute, National Environment Agency, 11 Biopolis Way, #06-05/08 Helios Block, Singapore 138667, Singapore
| | - Zhanxiong Fang
- Environmental Health Institute, National Environment Agency, 11 Biopolis Way, #06-05/08 Helios Block, Singapore 138667, Singapore
| | - Shuzhen Sim
- Environmental Health Institute, National Environment Agency, 11 Biopolis Way, #06-05/08 Helios Block, Singapore 138667, Singapore
| | - Jue Tao Lim
- Environmental Health Institute, National Environment Agency, 11 Biopolis Way, #06-05/08 Helios Block, Singapore 138667, Singapore; Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University Novena Campus, 11 Mandalay Road, Singapore 308232, Singapore
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10
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Nilsson S, Smurthwaite K, Aylward LL, Kay M, Toms LM, King L, Marrington S, Barnes C, Kirk MD, Mueller JF, Bräunig J. Serum concentration trends and apparent half-lives of per- and polyfluoroalkyl substances (PFAS) in Australian firefighters. Int J Hyg Environ Health 2022; 246:114040. [PMID: 36162311 DOI: 10.1016/j.ijheh.2022.114040] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/29/2022] [Accepted: 09/06/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFASs) are persistent manmade compounds used in aqueous film forming foam (AFFF). The extensive use of AFFF has led to widespread environmental PFAS contamination and exposures of firefighters. OBJECTIVES To determine PFAS blood serum concentration trends and apparent serum half-lives in firefighters after the replacement of AFFF. METHODS Current and former employees of an Australian corporation providing firefighting services, where AFFF formulations had been used since the 1980s up until 2010, were recruited in 2018-2019 to participate in this study. Special focus was put on re-recruiting participants who had provided blood samples five years prior (2013-2014). Participants were asked to provide a blood sample and fill in a questionnaire. Serum samples were analysed for 40 different PFASs using HP LC-MS/MS. RESULTS A total of 799 participants provided blood samples in 2018-2019. Of these, 130 previously provided blood serum in 2013-2014. In 2018-2019, mean (arithmetic) serum concentrations of perfluorooctane sulfonate (PFOS, 27 ng/mL), perfluoroheptane sulfonate (PFHpS, 1.7 ng/mL) and perfluorohexane sulfonate (PFHxS, 14 ng/mL) were higher than the levels in the general Australian population. Serum concentrations were associated with the use of PFOS/PFHxS based AFFF. Participants who commenced service after the replacement of this foam had serum concentrations similar to those in the general population. Mean (arithmetic) individual apparent half-lives were estimated to be 5.0 years (perfluorooctanoic acid (PFOA)), 7.8 years (PFHxS), 7.4 years (PFHpS) and 6.5 years (PFOS). CONCLUSION This study shows how workplace interventions such as replacement of AFFF can benefit employees at risk of occupational exposure.
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Affiliation(s)
- S Nilsson
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102, QLD, Australia.
| | - K Smurthwaite
- National Centre for Epidemiology and Population Health, The Australian National University, Cnr of Eggleston and Mills Roads Acton, 2600, Australia
| | - L L Aylward
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102, QLD, Australia; Summit Toxicology, LLP, La Quinta, 92253, CA, USA
| | - M Kay
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Health Sciences Building, RBWH Complex, Herston, 4029, QLD, Australia
| | - L M Toms
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Musk Avenue, Kelvin Grove, 4059, QLD, Australia
| | - L King
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102, QLD, Australia
| | - S Marrington
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102, QLD, Australia
| | - C Barnes
- Airservices Australia, 25 Constitution Ave, Canberra, 2601, ACT, Australia
| | - M D Kirk
- National Centre for Epidemiology and Population Health, The Australian National University, Cnr of Eggleston and Mills Roads Acton, 2600, Australia
| | - J F Mueller
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102, QLD, Australia
| | - J Bräunig
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102, QLD, Australia
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Burgess JL, Fisher JM, Nematollahi A, Jung AM, Calkins MM, Graber JM, Grant CC, Beitel SC, Littau SR, Gulotta JJ, Wallentine DD, Hughes RJ, Popp C, Calafat AM, Botelho JC, Coleman AD, Schaefer-Solle N, Louzado-Feliciano P, Oduwole SO, Caban-Martinez AJ. Serum per- and polyfluoroalkyl substance concentrations in four municipal US fire departments. Am J Ind Med 2022; 66:411-423. [PMID: 35864570 PMCID: PMC9859935 DOI: 10.1002/ajim.23413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/05/2022] [Accepted: 07/08/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Firefighters have occupational and environmental exposures to per- and polyfluoroalkyl substances (PFAS). The goal of this study was to compare serum PFAS concentrations across multiple United States fire departments to National Health and Nutrition Examination Survey (NHANES) participants. METHODS Nine serum PFAS were compared in 290 firefighters from four municipal fire departments (coded A-D) and three NHANES participants matched to each firefighter on sex, ethnicity, age, and PFAS collection year. Only Departments A and C had sufficient women study participants (25 and six, respectively) to compare with NHANES. RESULTS In male firefighters compared with NHANES, geometric mean perfluorohexane sulfonate (PFHxS) was elevated in Departments A-C, sum of branched perfluoromethylheptane sulfonate isomers (Sm-PFOS) was elevated in all four departments, linear perfluorooctane sulfonate (n-PFOS) was elevated in Departments B and C, linear perfluorooctanoate (n-PFOA) was elevated in Departments B-D, and perfluorononanoate (PFNA) was elevated in Departments B-D, but lower in A. In male firefighters compared with NHANES, perfluoroundecanoate (PFUnDA) was more frequently detected in Departments B and D, and 2-(N-methyl-perfluorooctane sulfonamido) acetate (MeFOSAA) was less frequently detected in Departments B-D. In female firefighters compared with NHANES, PFHxS and Sm-PFOS concentrations were elevated in Departments A and C. Other PFAS concentrations were elevated and/or reduced in only one department or not significantly different from NHANES in any department. CONCLUSIONS Serum PFHxS, Sm-PFOS, n-PFOS, n-PFOA, and PFNA concentrations were increased in at least two of four fire departments in comparison to NHANES.
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Affiliation(s)
- Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Julia M. Fisher
- Statistics Consulting Laboratory, BIO5 Institute, University of Arizona, Tucson, Arizona, USA
| | - Amy Nematollahi
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Alesia M. Jung
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Miriam M. Calkins
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Judith M. Graber
- Rutgers the State University of New Jersey, Piscataway, New Jersey, USA
| | - Casey C. Grant
- D&S Research Associates & Engineers, LLC, Belmont, Massachusetts, USA
| | - Shawn C. Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Sally R. Littau
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | | | | | - Charles Popp
- Boston Fire Department, Boston, Massachusetts, USA
| | - Antonia M. Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julianne C. Botelho
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alissa D. Coleman
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | | | - Simi O. Oduwole
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
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12
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Per- and Polyfluoroalkyl Substance and Cardio Metabolic Markers in Firefighters: Erratum. J Occup Environ Med 2022; 64:182. [DOI: 10.1097/jom.0000000000002498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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13
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Legacy and Emerging Per- and Polyfluoroalkyl Substances: Analytical Techniques, Environmental Fate, and Health Effects. Int J Mol Sci 2021; 22:ijms22030995. [PMID: 33498193 PMCID: PMC7863963 DOI: 10.3390/ijms22030995] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 01/24/2023] Open
Abstract
Due to their unique chemical properties, per- and polyfluoroalkyl substances (PFAS) have been used extensively as industrial surfactants and processing aids. While several types of PFAS have been voluntarily phased out by their manufacturers, these chemicals continue to be of ecological and public health concern due to their persistence in the environment and their presence in living organisms. Moreover, while the compounds referred to as “legacy” PFAS remain in the environment, alternative compounds have emerged as replacements for their legacy predecessors and are now detected in numerous matrices. In this review, we discuss the historical uses of PFAS, recent advances in analytical techniques for analysis of these compounds, and the fate of PFAS in the environment. In addition, we evaluate current biomonitoring studies of human exposure to legacy and emerging PFAS and examine the associations of PFAS exposure with human health impacts, including cancer- and non-cancer-related outcomes. Special focus is given to short-chain perfluoroalkyl acids (PFAAs) and ether-substituted, polyfluoroalkyl alternatives including hexafluoropropylene oxide dimer acid (HFPO-DA; tradename GenX), 4,8-dioxa-3H-perfluorononanoic acid (DONA), and 6:2 chlorinated polyfluoroethersulfonic acid (6:2 Cl-PFESA; tradename F-53B).
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