Risk to human health related to the presence of perfluoroalkyl substances in food

A systematic review of evidence that environmental contaminant exposure impedes weight loss and glycemic control during calorie-restricted diets in humans

Calorie-restricted diets cause weight loss and can drive type 2 diabetes remission. However, many patients struggle to achieve clinically relevant weight loss, and the reasons are not well understood. Chemical exposure is associated with obesity and type 2 diabetes development, and some evidence from preclinical experiments suggests it can limit the clinical benefits of calorie restriction. We systematically reviewed the evidence for the effects of environmental chemical exposure on mass loss and glycemic control during diet-induced weight management in humans (PROSPERO: CRD42022339993). Of 222 unique citations, only six papers directly examined this question. Only one targeted people with type 2 diabetes. One linked phthalates and parabens, but not bisphenols, with slower fat loss. Two showed per- and polyfluoroalkyl substances were not associated with mass loss, but with faster subsequent mass regain. One linked impaired adiposity improvements with air pollutants. Two papers reported weight loss-induced elevation in plasma organochlorines associated with altered glycemic control. The risk of bias largely arose from the potential for deviation from the intended diet, and statistics and reporting. The role of chemical exposure in impeding the effectiveness of weight management programs needs to be better understood to provide suitable support to people living with obesity and type 2 diabetes.

Current understanding of human bioaccumulation patterns and health effects of exposure to perfluorooctane sulfonate (PFOS)

Perfluorooctane sulfonate (PFOS) is a persistent organic pollutant of global concern due to its environmental presence,bioaccumulative potential and toxicological impacts. This review synthesizes current knowledge regarding PFOS exposure, bioaccumulation patterns and adverse health outcomes in human population. Analysis of worldwide biomonitoring data, and epidemiological studies reveals PFOS systemic effects, including immunological dysfunction (decreased vaccine response), developmental toxicity (reduced birth weight), hepatic metabolic disruption, potential carcinogenogenicity, and reproductive abnormalities. At the molecular level, PFOS induces toxicity through multiple pathways, including PI3K/AKT/mTOR pathway inhibition, PPARα activation, NF-κB signaling modulation, and oxidative stress induction. Recent advances in analytical methodologies have enhanced our understanding of PFOS distribution and fate, while evolving egulatory frameworks attempts to address its risk. This review identifies critical research gaps and emphasized the need for coordinated multidisciplinary approaches to address this persistent environmental contaminant.

Constitutive androstane receptor, liver pathophysiology and chemical contaminants: current evidence and perspectives

Introduction

The Constitutive Androstane Receptor (CAR) (NR1I3), a pivotal member of the xenosensor family, plays a key role in the hepatic detoxification of xenobiotic and endobiotic chemicals through the induction of the expression of drug-metabolizing enzymes and transporters. CAR's involvement extends beyond detoxification, influencing gluconeogenesis, lipogenesis, bile acid regulation, and cellular processes such as proliferation, tissue regeneration, and carcinogenesis. This review explores CAR regulation by various factors, highlighting its role in mediating metabolic changes induced by environmental contaminants.

Methods

A literature search was conducted to identify all articles on the PubMed website in which the CAR-contaminant and CAR-hepatic steatosis relationship is analyzed in both in vitro and in vivo models.

Results

Numerous contaminants, such as perfluorooctanoic acid (PFOA), Zearalenone mycotoxin, PCB, triazole fungicide propiconazole can activate hepatic nuclear receptors contributing to the development of steatosis through increased de novo lipogenesis, decreased fatty acid oxidation, increased hepatic lipid uptake, and decreased gluconeogenesis. Indirect CAR activation pathways, particularly involving PFOA, are discussed in the context of PPARα-independent mechanisms leading to hepatotoxicity, including hepatocellular hypertrophy and necrosis, and their implications in nonalcoholic steatohepatitis (NASH) and nonalcoholic fatty liver disease (NAFLD). The prevalence of NAFLD, a significant component of metabolic syndrome, underscores the importance of understanding CAR's role in its pathogenesis.

Conclusions

Experimental and epidemiological data suggest that endocrine disruptors, especially pesticides, play a significant role in NAFLD's development and progression via CAR-regulated pathways. This review advocates for the inclusion of modern toxicological risk assessment tools, such as New Approach Methodologies (NAMs), Adverse Outcome Pathways (AOPs), and Integrated Approaches to Testing and Assessment (IATA), to elucidate CAR-mediated effects and enhance regulatory frameworks.

New insights into the effects of PFOS exposure on rat lung development: morphological, functional, and single-cell sequencing analysis

Perfluorooctane sulfonate (PFOS), a widely persistent environmental pollutant, has been demonstrated to disrupt lung development in animal models. However, its cellular and molecular mechanisms remain insufficiently understood. This study examines the effects of prenatal PFOS exposure on lung development and function in offspring rats. Pregnant rats were exposed to PFOS at concentrations relevant to both environmental and occupational exposures, with doses of 0, 0.01, 0.1, and 1 mg/kg/day from gestational day 11-20. We primarily evaluated morphological changes, pulmonary function, bronchoalveolar lavage fluid composition, and alterations in trace element and fatty acid metabolism at postnatal days 0, 4, 14, 21, and 60. Single-cell RNA sequencing was employed to profile cellular and molecular responses in the lungs. Our results show that PFOS exposure leads to dose-dependent reductions in alveolar development, increased pulmonary injury, fibrosis, and impaired lung function. PFOS also changes lung cell composition, particularly affecting structural and immune cells, and shifts immune responses from innate to adaptive immunity. Differential gene expression analyses revealed the upregulation of Fam111a and downregulation of Stk35, implicating these genes in PFOS-induced lung injury and repair processes. In addition, pathway analyses demonstrated suppression of immune-related signaling pathways and disruption of cell adhesion and phagocytosis, which may exacerbate lung tissue injury. These findings provide novel insights into the developmental toxicity of PFOS and highlight its potential long-term health risks.

Combination of suspect and nontarget screening with exposure assessment for per- and polyfluoroalkyl substance prioritization in Chinese municipal wastewater

Municipal wastewater treatment plants (WWTPs) are significant sources of per- and polyfluoroalkyl substances (PFASs) in aquatic environments, making their identification and priority rank crucial for risk control. Wastewater samples were collected from 148 municipal WWTPs in China to determine the occurrence and risk prioritization of PFASs. A total of 61 PFASs were identified, including 14 legacy and 47 emerging PFASs, using machine learning prediction-enhanced suspect and nontarget screening techniques. PFASs were detected in all wastewater samples, with perfluorocarboxylic acid (PFCA), perfluorosulfonic acid (PFSA), fluoromeric sulfonic acid (FTSA), and perfluoroalkyl sulfonamide-like (PFSM) substances being the predominant classes. The exposure loads of legacy and emerging PFASs to the Chinese population were 71.8 and 52.9 μg·day-1·people-1, respectively, and textile and clothing products might be the primary PFAS exposure pathways. Through a risk prioritization method integrating toxicity and exposure data, ten legacy and five emerging PFASs were flagged as high-priority substances requiring additional attention. As the PFAS risk removal efficiency by conventional biological treatment processes was only 0.7 %, the PFAS risk priority patterns in influent and effluent were similar (r = 0.86, p < 0.01). In addition, there were significant regional differences in the PFAS risk distribution, and the PFAS risk in eastern China was higher than that in other regions. This study offers novel insights for the identification and priority control assessment of PFASs and other emerging environmental contaminants.

Selection of the critical effect size alters hazard characterization - a retrospective analysis of key studies used for risk assessments of PFAS

Regulatory values for per- and polyfluoroalkyl substances (PFAS) vary widely across agencies, creating inconsistencies that challenge effective risk management and public health communication. These differences often stem from methodological choices in determining points of departure (PoDs), the selection of critical effect size (CES) and the modeling framework for benchmark dose (BMD) analysis. This study investigates the impact of CES selection on hazard characterization by analyzing how variations in CES influence resulting PoDs and health-based guidance values. A retrospective analysis of key studies from four regulatory PFAS risk assessments was conducted, covering both animal and epidemiological data (thyroid hormone, cholesterol, and vaccine response). CES options compared included 5%, 10%, one standard deviation from background, and a generalized effect size theory, using both frequentist and Bayesian statistics. The findings show that CES selection and statistical approach substantially affect BMD estimates such as the lower bound BMD (BMDL) of the respective confidence interval or credible interval; with larger CES values and Bayesian modeling yielding more biologically relevant, stable results. For instance, Bayesian methods provided narrower credible intervals, compared to frequentist methods at lower CES levels, minimizing overly conservative assessments. However, in comparison to the PoD previously derived by the European Food Safety Authority the results generally suggest lower values. In conclusion, this study supports the use of a flexible, endpoint-specific CES with Bayesian model averaging, which may enhance the accuracy and consistency of PFAS guidance values, offering a more robust foundation for regulatory risk assessments.

Mitigating the environmental effects of healthcare: the role of the endocrinologist

Human health depends on planetary health, and yet healthcare provision can have unintended consequences for the health of the planet. Emissions from the healthcare sector include greenhouse gases, air pollution and plastic pollution, alongside chemical contamination. Chemical pollution resulting in endocrine disruption has been associated with plastics, which are a source of concerning additives such as phthalates, bisphenols, perfluoroalkyl and polyfluoroalkyl substances, and flame retardants (all routinely found in healthcare products). Many endocrine-disrupting chemicals are persistent and ubiquitous in the environment (including water and food sources), with potential secondary harms for human health, including disrupting reproductive, metabolic and thyroid function. Here we review evidence-based strategies for mitigating environmental effects of healthcare delivery. We focus on what endocrinologists can do, including reducing demand for healthcare services through better preventative health, focusing on high-value care and improving sustainability of medical equipment and pharmaceuticals through adopting circular economy principles (including reduce, reuse and, as a last resort, recycle). The specific issue of endocrine-disrupting chemicals might be mitigated through responsible disposal and processing, alongside advocating for the use of alternative materials and replacing additive chemicals with those that have lower toxicity profiles, as well as tighter regulations. We must work to urgently transition to sustainable models of care provision, minimizing negative effects on human and planetary health.

Research Progress in Current and Emerging Issues of PFASs' Global Impact: Long-Term Health Effects and Governance of Food Systems

Per- and polyfluoroalkyl substances (PFASs) are found everywhere, including food, cosmetics, and pharmaceuticals. This review introduces PFASs comprehensively, discussing their nature and identifying their interconnection with microplastics and their impacts on public health and the environment. The human cost of decades of delay, cover-ups, and mismanagement of PFASs and plastic waste is outlined and briefly explained. Following that, PFASs and long-term health effects are critically assessed. Risk assessment is then critically reviewed, mentioning different tools and models. Scientific research and health impacts in the United States of America are critically analyzed, taking into consideration the Center for Disease Control (CDC)'s PFAS Medical Studies and Guidelines. PFAS impact and activities studies around the world have focused on PFAS levels in food products and dietary intake in different countries such as China, European countries, USA and Australia. Moreover, PFASs in drinking water and food are outlined with regard to risks, mitigation, and regulatory needs, taking into account chemical contaminants in food and their impact on health and safety. Finally, PFAS impact and activities briefings specific to regions around the world are discussed, referring to Australia, Vietnam, Canada, Europe, the United States of America (USA), South America, and Africa. The PFAS crisis is a multifaceted issue, exacerbated by mismanagement, and it is discussed in the context of applying the following problem-solving analytical tools: the Domino Effect Model of accident causation, the Swiss Cheese Theory Model, and the Ishikawa Fish Bone Root Cause Analysis. Last but not least, PFASs' impacts on the Sustainable Development Goals (SDGs) of 2030 are rigorously discussed.

Integrated computational analysis of molecular mechanisms underlying perfluorooctane sulfonic acid induced thyroid toxicity

Perfluorooctane sulfonic acid (PFOS), a persistent organic pollutant, significantly disrupts thyroid function. This study presented an integrated computational approach, combining network toxicology, molecular docking, and molecular dynamics simulations to systematically elucidate the molecular mechanisms underlying PFOS induced thyroid toxicity. Through integrated analysis of the Comparative Toxicogenomics Database (CTD), GeneCards, and Online Mendelian Inheritance in Man (OMIM) databases, we identified 205 potential thyroid toxicity-related targets. Protein-protein interaction network analysis revealed 34 hub targets, with TP53, JUN, ESR1, AKT1, and CTNNB1 emerging as central nodes in the toxicity network. Functional enrichment analysis demonstrated significant enrichment in the PPAR signaling pathway, fatty acid metabolism, AGE-RAGE pathway, and AMPK pathway, indicating that PFOS influences thyroid function through multiple signaling pathways. Molecular docking studies showed that PFOS forms stable complexes with core target proteins, with binding energies ranging from - 4.9 to -9.7 kcal/mol. Molecular dynamics simulations further validated the structural stability of these complexes, with PFOS-AKT1 and PFOS-TP53 exhibiting the highest conformational stability. This study revealed the multi-target and multi-pathway characteristics of PFOS-induced thyroid toxicity, providing novel insights into its toxicological mechanisms.

Application of a quantitative uncertainty assessment to develop ranges of plausible toxicity values when using observational data in risk assessment: a case study examining associations between PFOA and PFOS exposures and vaccine response

Traditional approaches for quantitatively characterizing uncertainty in risk assessment require adaptation to accommodate increased reliance on observational (vs experimental) studies in developing toxicity values. Herein, a case study with perfluorooctanoic acid (PFOA) and PFOS and vaccine response explores approaches for qualitative and-where possible-quantitative assessments of uncertainty at each step in the toxicity value development process when using observational data, including review and appraisal of individual studies, candidate study selection, dose-response modeling, and application of uncertainty factors. Each of the 15 studies identified had uncertainties due to risk of bias in confounding, outcome, and exposure ascertainment, likely contributing to the observed inconsistencies within and across studies, and resulting in lack of candidacy for dose-response assessment. Nonetheless, 2 representative studies were selected to demonstrate possible methods to quantify uncertainty in the remaining steps. Data simulations indicated lack of a clear dose-response relationship; dose-response models fit to representative simulations indicated high uncertainty in both the magnitude and direction of effect with simulated benchmark dose and its lower limit values varying at least 66- and 86-fold for PFOA and PFOS. Uncertainty factor application added minimal uncertainty. Combined, a high level of uncertainty was observed, precluding the ability to confidently assess causal dose-response relationships with the observational data, alone. This case study highlights the need for quantitative uncertainty analysis when developing toxicity values with observational data and, importantly, emphasizes the need for application of additional techniques to directly assess causality and the specificity of dose-response when relying on studies of association in quantitative risk assessment.

Bone cell differentiation and mineralization in wild-type and osteogenesis imperfecta zebrafish are compromised by per- and poly-fluoroalkyl substances (PFAS)

Perfluorinated compounds (PFAS) are well recognized toxic pollutants for humans, but if their effect is equally harmful for healthy and fragile people is unknown. Addressing this question represents a need for ensuring global health and wellbeing to all individuals in a world facing the progressive increase of aging and aging related diseases. This study aimed to evaluate the impact of perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA) and perfluorohexanoic acid (PFHxA) exposure on development and skeletal phenotype using the osteogenesis imperfecta (OI) zebrafish model Chihuahua (Chi/+), carrying a dominant glycine substitution in the α1 chain of collagen I and their wild-type (WT) littermates. To this purpose Chi/+ and WT zebrafish expressing the green fluorescent protein under the early osteoblast marker osterix were exposed from 1 to 6 days post fertilization to 0.36, 1.5 and 3.0 mg/L PFOS, 0.005 and 0.5 mg/L PFOA and 0.01, 0.48 and 16.0 mg/L PFHxA, and their development and skeletal phenotype investigated. Morphometric measurements, confocal microscopy evaluation of operculum area delimited by the fluorescent preosteoblasts and mineral deposition analysis following alizarin red staining were employed. PFOS and the highest concentration of PFHxA significantly impaired standard length in both genotypes. Osteoblast differentiation was significantly compromised by PFOS and by PFOA only in Chi/+. Limited to WT exposed to PFOA a reduced mineralization was also observed. No effect was detected after PFHxA exposure. Apoptosis was only activated by PFOA, specifically in Chi/+ mutant operculum osteoblasts. Interestingly, an altered lipid distribution in both WT and mutant fish was revealed after exposure to both pollutants. In conclusion, our data demonstrate that PFAS impair operculum development mainly compromising cell differentiation in mutant fish whereas alter lipid hepatic distribution in both genotypes with a more severe effect on Chi/+ preosteoblast survival. These results represent a first warning sign of the negative impact of PFAS exposure in presence of genetically determined skeletal fragility.

Current trends and patterns of PFAS in agroecosystems and environment: A review

Per- and polyfluoroalkyl substances (PFASs) are one of the more well-known highly persistent organic pollutants with potential risks to agroecological systems. These compounds are of global concern due to their persistence and mobility, and they often lead to serious impacts on environmental, agricultural, and human health. In the past 20 years, the number of science publications on PFAS has risen; despite this, certain fundamental questions about PFAS occurrence, sources, mechanism of transport, and impacts on agroecosystems and the societies dependent on them are still open and evolving. There is a lack of systematic and comprehensive analysis of these concerns in agroecosystems. Therefore, we reviewed the current literature on PFAS with a focus on agroecosystems; our review suggests that PFASs are nearly ubiquitous in agricultural systems. We found the current research has limitations in analyzing PFAS in complex matrices because of their small size, distribution, and persistence within various environmental systems. There is consistency in the properties and composition of PFAS in and around agroecosystems, suggesting evidence of shared sources and similar components within different tropic levels. The introduction of new and varied sources of PFAS appear to be growing, adding to their residual accumulation in environmental matrices and leading to possible new types of chemical compounds that are difficult to assess accurately. This review determines existing research trends, understands mechanisms and incidence of PFAS within agroecosystems and their impact on human health, and thereby recommends further studies to remedy research gaps.

From wastewater to feed: Understanding per- and polyfluoroalkyl substances occurrence in wastewater-irrigated crops

Reusing treated wastewater for irrigation is a sustainable way to recycle nutrients and reduce freshwater use. However, wastewater irrigation inadvertently introduces per- and polyfluoroalkyl substances (PFAS) into agroecosystems, causing concerns regarding potential adverse effects to ecosystem, animal, and human health. Therefore, a better understanding of the pathways by which PFAS accumulate in forage crops is needed. A greenhouse study was conducted to (1) quantify the contribution of root uptake versus foliar sorption of PFAS in corn (Zea mays) and orchard grass (Dactylis glomerata), (2) assess effects of PFAS-impacted wastewater irrigation on plant health, and (3) determine the potential implications for bioaccumulation. The greenhouse study was composed of four treatments for each forage crop to isolate the relative contribution of two uptake pathways. Results suggested that foliar sorption was an unlikely contributor to PFAS concentrations observed in crop tissue. Root uptake was identified as the predominant uptake pathway. PFAS were detected more frequently in orchard grass samples compared to corn silage samples. Additionally, corn exhibited a lower uptake of long-chain PFAS compared to grass. Overall, no plant health effects on growth attributable to PFAS concentrations were observed. Forage data suggest cattle exposure to PFAS would be largely short-chain PFAS or long-chain "replacement" compounds (>50%). However, cattle may still be exposed to potentially harmful long-chain PFAS; levels in the forage crops exceeded the tolerable weekly intake set by the European Food Safety Authority. This study provides insights on PFAS entry into the food chain and potential implications for livestock and human health.

Microplastics: Omnipresent and an ongoing challenge for medical science

Micro- and nanoplastics are omnipresent not only in the environment, but have also been detected in human body fluids and tissue. The subsequent commentary provides a perspective about potential risks for human health as well as resulting challenges for medical science.

Associations between maternal per- and polyfluoroalkyl substances exposure and lipid levels in maternal and cord blood: The Japan environment and Children's study

Despite numerous studies, the associations between per- and polyfluoroalkyl substances (PFAS) exposure and various lipid levels in pregnant women remain ambiguous, especially concerning the association with cord blood lipids. This analysis included 20,960 pregnant women enrolled in the Japan Environment and Children's Study, recruited between 2011 and 2014. Non-fasting plasma samples collected before 22 weeks of gestation were examined for PFAS concentrations. Additionally, non-fasting serum samples collected before, at and after 22 weeks of gestation, at birth, and from cord blood were used to measure total cholesterol (TC) and triglycerides (TG). Linear regression models were applied to quantify the association between each PFAS and various lipid metrics. Among the 28 PFAS analyzed, 7 were quantifiable in more than 80% of participants. Of these, 6 PFAS showed positive associations with TC in maternal blood before 22 weeks of gestation, a trend that remained mostly consistent for maternal blood samples in later stages. However, no associations were found with TC levels in cord blood. Regarding TG, 3 PFAS demonstrated a negative association with TG levels in maternal blood before 22 weeks of gestation, with these relationships generally persisting in later stages, while 4 PFAS were positively associated with TG in cord blood. In summary, this study identified associations between PFAS concentrations in maternal blood and lipid levels in both maternal and cord blood, with differing patterns observed between the two.

A novel high-throughput quantitative method for the determination of per- and poly-fluoroalkyl substances in human plasma based on UHPLC-Q/Orbitrap HRMS coupled with isotope internal standard

A novel method for the quantitative analysis of 56 per- and polyfluoroalkyl substances (PFASs) in human plasma was established on the basis of ultrahigh performance liquid chromatography tandem quadrupole Orbitrap high-resolution mass spectrometry (UHPLC-Q/Orbitrap HRMS) in combination with accurate customized mass databases and isotopic internal standards. A streamlined, high-throughput, and high-recovery (RE) sample pretreatment method was developed. The method's performance was evaluated in terms of linearity, limit of quantification, RE, repeatability, reproducibility, and matrix effect. The proposed method was applied in the simultaneous analysis of 56 PFASs in human plasma, and its results demonstrated high sensitivity, accuracy, and precision. The optimized method was implemented to analyze PFASs in 135 plasma samples, and 12 components were detected. The comparative analysis of the results from 135 plasma samples with domestic and international studies revealed elevated contents of PFOA, PFOS, PFBA, and PFTrDA, the moderate amounts of PFHxS, PFUdA, PFBS, and PFHpS, and the low concentrations of PFNA and PFDA. Notably, GenX was detected in human plasma for the first time. This finding suggests that the study region is contaminated with this substance. Correlation analysis revealed a strong relationship among PFNA, PFDA, and PFUdA, implying that these substances may have similar exposure sources.

Per- and polyfluoroalkyl substances (PFAS): Trends in mass spectrometric analysis for human biomonitoring and exposure patterns from recent global cohort studies

Per- and polyfluoroalkyl substances (PFAS) are widespread environmental contaminants that have been shown to contribute to human exposure, thereby raising a range of health concerns. In this context, human biomonitoring is essential for linking exposure levels of PFAS with their potential health risks. Mass spectrometry-based analytical techniques have been extensively adopted for the evaluation of PFAS levels across various cohorts. However, challenges arising from the use of biological samples (e.g., plasma, serum, urine, etc.) necessitate ongoing research and refinement of analytical methodologies. This review provides an overview of current trends in mass spectrometry-based approaches for human biomonitoring of PFAS, including sample collection and preparation, and instrumental techniques. We also explore analytical strategies to overcome challenges in obtaining PFAS-free blank matrices and address the risk of background contamination. Moreover, this review examines differing PFAS exposure patterns across regions by analyzing recent international cohort studies, specifically those conducted in the US and China over the past five years. Accordingly, several key research gaps in biomonitoring studies that need to be addressed moving forward are highlighted.

Decreases in serum PFAS are associated with decreases in serum lipids: A longitudinal study on a highly exposed population

INTRODUCTION

Perfluoroalkyl substances (PFAS) are widely used, ubiquitous and highly persistent man-made chemicals. Previous cross-sectional studies have consistently linked PFAS exposure to alterations in lipid profiles. However, longitudinal investigations are preferred to mitigate issues related to reverse causation and confounding. Hence, we aimed to investigate the association between changes in serum PFAS and changes in serum lipids, while shedding light on potential modifiers of the examined relationships.

METHODS

We used data from a health surveillance program offered to residents of a vast area of the Veneto Region (North-Eastern Italy), who had been exposed to PFAS via contaminated drinking water until 2013. We included subjects aged ≥20 years who provided two blood samples over an average 4-year interval (n = 8101). We examined the relationships between changes in PFOA, PFOS and PFHxS and changes in total cholesterol (TC), high-density lipoprotein cholesterol (HDLC) and low-density lipoprotein cholesterol (LDL-C). Linear models were fitted for change in the natural logarithm (ln) of each lipid in relation to the change in the ln of PFAS. From the estimated regression coefficients, we calculated the predicted percentage change in the response for a ln-decrease in PFAS serum concentrations.

RESULTS

Overall concentrations of PFOA, PFOS, PFHxS fell by 62.1 %, 24.4 % and 35.4 % from baseline, while small increases in lipids were observed. Declines in PFAS concentrations were associated with decreases in all lipids. For a ln-decrease in PFOA HDL-C decreased by 1.99 % (95 % CI: 1.28, 2.70), TC by 1.49 % (95 % CI: 0.88, 2.10), and LDL-C by 1.40 % (95 % CI: 0.45, 2.37).

CONCLUSIONS

We found a positive association between changes in PFAS concentrations and changes in cholesterol levels, observing the most marked contrasts across sexes and age groups. Our findings support the reversibility of the associations identified in cross-sectional analyses, emphasizing the importance of water treatment measures in mitigating adverse health effects.

Advancing PFAS risk assessment: Integrative approaches using agent-based modelling and physiologically-based kinetic for environmental and health safety

Per- and polyfluoroalkyl substances (PFAS), ubiquitous in a myriad of consumer and industrial products, and depending on the doses of exposure represent a hazard to both environmental and public health, owing to their persistent, mobile, and bio accumulative properties. These substances exhibit long half-lives in humans and can induce potential immunotoxic effects at low exposure levels, sparking growing concerns. While the European Food Safety Authority (EFSA) has assessed the risk to human health related to the presence of PFAS in food, in which a reduced antibody response to vaccination in infants was considered as the most critical human health effect, a comprehensive grasp of the molecular mechanisms spearheading PFAS-induced immunotoxicity is yet to be attained. Leveraging modern computational tools, including the Agent-Based Model (ABM) Universal Immune System Simulator (UISS) and Physiologically Based Kinetic (PBK) models, a deeper insight into the complex mechanisms of PFAS was sought. The adapted UISS serves as a vital tool in chemical risk assessments, simulating the host immune system's reactions to diverse stimuli and monitoring biological entities within specific adverse health contexts. In tandem, PBK models unravelling PFAS' biokinetics within the body i.e. absorption, distribution, metabolism, and elimination, facilitating the development of time-concentration profiles from birth to 75 years at varied dosage levels, thereby enhancing UISS-TOX's predictive abilities. The integrated use of these computational frameworks shows promises in leveraging new scientific evidence to support risk assessments of PFAS. This innovative approach not only allowed to bridge existing data gaps but also unveiled complex mechanisms and the identification of unanticipated dynamics, potentially guiding more informed risk assessments, regulatory decisions, and associated risk mitigations measures for the future.

Advancing understanding of human variability through toxicokinetic modeling, in vitro-in vivo extrapolation, and new approach methodologies

The merging of physiology and toxicokinetics, or pharmacokinetics, with computational modeling to characterize dosimetry has led to major advances for both the chemical and pharmaceutical research arenas. Driven by the mutual need to estimate internal exposures where in vivo data generation was simply not possible, the application of toxicokinetic modeling has grown exponentially in the past 30 years. In toxicology the need has been the derivation of quantitative estimates of toxicokinetic and toxicodynamic variability to evaluate the suitability of the tenfold uncertainty factor employed in risk assessment decision-making. Consideration of a host of physiologic, ontogenetic, genetic, and exposure factors are all required for comprehensive characterization. Fortunately, the underlying framework of physiologically based toxicokinetic models can accommodate these inputs, in addition to being amenable to capturing time-varying dynamics. Meanwhile, international interest in advancing new approach methodologies has fueled the generation of in vitro toxicity and toxicokinetic data that can be applied in in vitro-in vivo extrapolation approaches to provide human-specific risk-based information for historically data-poor chemicals. This review will provide a brief introduction to the structure and evolution of toxicokinetic and physiologically based toxicokinetic models as they advanced to incorporate variability and a wide range of complex exposure scenarios. This will be followed by a state of the science update describing current and emerging experimental and modeling strategies for population and life-stage variability, including the increasing application of in vitro-in vivo extrapolation with physiologically based toxicokinetic models in pharmaceutical and chemical safety research. The review will conclude with case study examples demonstrating novel applications of physiologically based toxicokinetic modeling and an update on its applications for regulatory decision-making. Physiologically based toxicokinetic modeling provides a sound framework for variability evaluation in chemical risk assessment.

Study of Endocrine-Disrupting Chemicals in Infant Formulas and Baby Bottles: Data from the European LIFE-MILCH PROJECT

Exposure to endocrine-disrupting chemicals (EDCs) is inevitable, and growing scientific evidence indicates that even very low doses can negatively impact human health, particularly during pregnancy and the neonatal period. As part of the European project LIFE18 ENV/IT/00460, this study aims to identify the presence of EDCs in 20 infant formulas (both powdered and liquid) and the release from baby bottles and teats. Particularly, sensitization of young people and future parents towards the potential harmful effects of EDCs could significantly help to reduce exposure. Seven different UPLC-MS/MS methodologies and one ICP-AES were set up to quantify already assessed and suspected EDCs among 85 different chemicals (bisphenols, parabens, PAHs, phthalates, pesticides, herbicides and their main metabolites, PFAS, and metals). Results showed that in 2 out of 14 baby bottles, only anthracene and phenanthrene of the group of PAHs were released (10.68-10.81 ng/mL). Phthalates such as mono-ethyl phthalate (MEP) were found in 9 of 14 samples (0.054-0.140 ng/mL), while mono(2-ethyl-5-oxohexyl) phthalate (MeOHP) appeared in 2 samples (0.870-0.930 ng/mL). In accordance with current EU regulations, other chemicals were not detected in baby bottles and teats. However, bisphenols, parabens, PAHs, phthalates, PFAS, and metals were detected in infant formula, emphasizing the need for continued monitoring and public health interventions.

Efficient Online TurboFlow Method for Simultaneous Determination of 60 Emerging Per- and Polyfluoroalkyl Substances in Milk

Emerging perfluoroalkyl and polyfluoroalkyl substances (PFASs) have received much attention in recent years. Milk has usually low concentrations of PFASs, but it remains an important PFAS exposure route due to its high consumption. In this study, a method for simultaneous determination of 60 PFASs in milk was developed by online TurboFlow liquid chromatography-tandem mass spectrometry. A pH-dependent cold-induced liquid-liquid extraction was developed for precleanup and enrichment. Method quantification limits ranged from 0.003 to 0.500 ng/mL. For PFASs without corresponding isotope-labeled internal standards, Tanimoto coefficient and logP were introduced for the selection of internal standards. The matrix spiked recoveries ranged from 47 to 190%. The method was applied for PFAS analysis in 35 milk samples. PFBS, perfluorohexanesulfonic acid, perfluorooctanesulfonic acid, PFNS, PFPeA, perfluorooctanoic acid, PFNA, and 6:2 FTS were detected. The developed online TurboFlow method was simple, reliable, efficient, and applicable for trace analysis of PFASs in milk.

Transport of perfluoroalkyl substances across human induced pluripotent stem cell-derived intestinal epithelial cells in comparison with primary human intestinal epithelial cells and Caco-2 cells

Humans can be exposed to per- and polyfluoroalkyl substances (PFASs) via many exposure routes, including diet, which may lead to several adverse health effects. So far, little is known about PFAS transport across the human intestinal barrier. In the current study, we aimed to assess the transport of 5 PFASs (PFOS, PFOA, PFNA, PFHxS and HFPO-DA) in a human induced pluripotent stem cell (hiPSC)-derived intestinal epithelial cell (IEC) model. This model was extensively characterized and compared with the widely applied human colonic adenocarcinoma cell line Caco-2 and a human primary IEC-based model, described to most closely resemble in vivo tissue. The hiPSC-derived IEC layers demonstrated polarized monolayers with tight junctions and a mucus layer. The monolayers consisted of enterocytes, stem cells, goblet cells, enteroendocrine cells, and Paneth cells that are also present in native tissue. Transcriptomics analysis revealed distinct differences in gene expression profiles, where the hiPSC-derived IECs showed the highest expression of intestinal tissue-specific genes relative to the primary IEC-based model and the Caco-2 cells clustered closer to the primary IEC-based model than the hiPSC-derived IECs. The order of PFAS transport was largely similar between the models and the apparent permeability (Papp) values of PFAS in apical to basolateral direction in the hiPSC-derived IEC model were in the following order: PFHxS > PFOA > HFPO-DA > PFNA > PFOS. In conclusion, the hiPSC-derived IEC model highly resembles human intestinal physiology and is therefore a promising novel in vitro model to study transport of chemicals across the intestinal barrier for risk assessment of chemicals.

Monitoring of per- and polyfluoroalkyl substances (PFAS) in human blood samples collected in three regions with known PFAS releases in the environment and three control regions in South Germany

Per- and polyfluoroalkyl substances (PFAS) are known as persistent and bioaccumulative chemicals. The present paper describes the analysis of 969 human blood samples collected in South Germany aiming to determine whether there are statistic significant differences in internal PFAS burden between three regions with known PFAS releases in the environment (study regions) and three regions without known PFAS releases in the environment (control regions). Nine environmental relevant PFAS were analyzed, including the perfluorooctanoic acid (PFOA) substitute 3H-perfluoro-3-[(3-methoxy-propoxy)propanoic acid] ammonium salt (ADONA). We found that concentrations of PFOA and perfluorooctane sulfonate (PFOS) were higher than for all other PFAS in all of the six regions, but all medians of PFOA (between 0.8 and 0.9 ng/ml for the study and control regions) and PFOS (between 1.3 and 1.5 ng/ml for the study regions and between 1.4 and 1.5 ng/ml for the control regions) were below the human biomonitoring values (HBM) I for PFOA (2 ng/ml) und for PFOS (5 ng/ml) derived by the German HBM Commission. Concentrations of ADONA were below the limit of quantification in all samples. Minor differences were observed in PFAS blood levels between study and control regions. Especially for PFOS and PFOA the medians for women are slightly lower compared to men. In summary, individuals living in regions with known environmental PFAS contaminations show no higher internal PFAS exposure to controls and in comparison to other studies in the literature.

Prioritization of chemical food safety hazards in the European feed supply chain

Extensive monitoring programs of chemical hazards in the animal feed chain are in place, both organized by public and private organizations. The objective of this review was to prioritize chemical hazards for monitoring in the European animal feed supply chain. A step-wise approach was designed for the prioritization, based on: historical occurrence of the chemicals in animal feed ingredients and animal feeds (in relation to European guidance values or maximum limits in feed); information on transfer of the chemical to edible animal products, and; the extent of human dietary intake of the products and possible adverse human health effects of the chemical. Possible prioritization outcomes were: high (H), medium (M), or low (L) priority for monitoring, or classification not possible (NC) because of limited available data on the transfer of the chemical to edible animal tissues. The selection of chemicals included (with results in parentheses): dioxins and polychlorinated biphenyls (H); brominated flame retardants (H); per- and polyfluorinated alkyl substances (H); the heavy metals arsenic (H) and cadmium (H) as well as lead (M) and mercury (M); aflatoxins (H), ochratoxin A (NC), and other mycotoxins (L); pyrrolizidine alkaloids (H) and other plant toxins (NC); organochlorine pesticides (H) and other pesticides (L); pharmaceutically active substances (M); hormones (NC); polycyclic aromatic hydrocarbons (L), heat-induced processing contaminants (NC), and mineral oils (NC). Results of this study can be used to support risk-based monitoring by food safety authorities and feed-producing companies in Europe.

Considerations and challenges in support of science and communication of fish consumption advisories for per- and polyfluoroalkyl substances

Federal, state, tribal, or local entities in the United States issue fish consumption advisories (FCAs) as guidance for safer consumption of locally caught fish containing contaminants. Fish consumption advisories have been developed for commonly detected compounds such as mercury and polychlorinated biphenyls. The existing national guidance does not specifically address the unique challenges associated with bioaccumulation and consumption risk related to per- and polyfluoroalkyl substances (PFAS). As a result, several states have derived their own PFAS-related consumption guidelines, many of which focus on one frequently detected PFAS, known as perfluorooctane sulfonic acid (PFOS). However, there can be significant variation between tissue concentrations or trigger concentrations (TCs) of PFOS that support the individual state-issued FCAs. This variation in TCs can create challenges for risk assessors and risk communicators in their efforts to protect public health. The objective of this article is to review existing challenges, knowledge gaps, and needs related to issuing PFAS-related FCAs and to provide key considerations for the development of protective fish consumption guidance. The current state of the science and variability in FCA derivation, considerations for sampling and analytical methodologies, risk management, risk communication, and policy challenges are discussed. How to best address PFAS mixtures in the development of FCAs, in risk assessment, and establishment of effect thresholds remains a major challenge, as well as a source of uncertainty and scrutiny. This includes developments better elucidating toxicity factors, exposures to PFAS mixtures, community fish consumption behaviors, and evolving technology and analytical instrumentation, methods, and the associated detection limits. Given the evolving science and public interests informing PFAS-related FCAs, continued review and revision of FCA approaches and best practices are vital. Nonetheless, consistent, widely applicable, PFAS-specific approaches informing methods, critical concentration thresholds, and priority compounds may assist practitioners in PFAS-related FCA development and possibly reduce variability between states and jurisdictions. Integr Environ Assess Manag 2024;20:1839-1858. © 2024 The Author(s). Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Development, validation, and clinical assessment of a liquid chromatography-tandem mass spectrometry serum assay for per- and polyfluoroalkyl substances (PFAS) recommended by the National Academies of Science, Engineering, and Medicine (NASEM)

Per- and polyfluoroalkyl substances (PFAS) are widely used in industry, residential, and consumer products. Studies have shown associations between high PFAS exposure and adverse health effects. In 2022, the National Academies of Science, Engineering, and Medicine (NASEM) published Guidance on PFAS Exposure, Testing, and Clinical Follow-up providing laboratory and clinical direction. The Guidance suggests nine PFAS should be measured in serum or plasma specimens and summed to provide a total PFAS concentration using a NASEM-recommended method. Follow-up clinical recommendations are based on the calculated PFAS NASEM summation. We developed and validated a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method in accordance with NASEM recommendations but distinguished by the ability to separate closely related structural isomers. As part of our validation, PFAS prevalence was evaluated in a population survey comprised of clinical donor and remnant specimens (n = 1023 in total). In this study, 82.2% of the specimens had PFAS NASEM summations of 2 to < 20 ng/mL and 2.5% had a summation ≥ 20 ng/mL. The median PFAS NASEM summation was 4.65 ng/mL in this study, lower than the 7.74 ng/mL median observed in the 2017-2020 Centers for Disease Control and Prevention, National Health and Nutrition Examination Survey (n = 3072). This lower median PFAS NASEM summation may reflect a decline in PFAS population levels over time or sample population exposure differences.

The impact of high exposure to perfluoroalkyl substances and risk for hormone receptor-positive breast cancer - A Swedish cohort study

INTRODUCTION

Perfluoroalkyl substances (PFAS) are persisting chemicals with endocrine disruptive and carcinogenic properties. Previous studies involving cohorts with high PFAS exposure have not shown an increased risk of breast cancer. Research on PFAS and breast cancer according to hormone receptor status is limited. This study aims to investigate the association between PFAS exposure and hormone receptor-positive breast cancer.

MATERIALS AND METHODS

In 2013, high levels of PFAS (sum of PFAS >10,000 ng/L), dominated by perfluorooctane sulfonic acid (PFOS) and perfluorohexane sulfonic acid (PFHxS) were found in the drinking water from one of the two waterworks in Ronneby, Sweden. Breast cancer diagnoses and information of adjuvant endocrine therapy were retrieved from the Swedish Cancer Register and The Prescribed Drug Register 2006-2016 for a cohort of women residing in the municipality between 1985 and 2013 (n=24,509). Individual exposure was assessed based on municipality waterworks distribution data linked to annual residential addresses. Cox proportional hazards models were used in the analysis. The highest achieved educational level was used as an indicator of socioeconomic position. Sensitivity and subgroup analysis were performed for prepubertal exposure and diagnosis before or after age 50 (assumed menopause).

RESULTS

There were 313 cases of malignant breast cancer among women ≤85 years between 2006 and 2016. Of these, 224 cases (72%) were considered hormone receptor-positive based on the first prescription of adjuvant endocrine therapy, antiestrogens (40%) or aromatase inhibitor (60%). Among women ever living at a residential address with high PFAS exposure, the hazard ratio (HR) for breast cancer classified as hormone receptor-positive was 0.84; 95% confidence interval (CI) 0.61, 1.14. Findings were similar before and after menopause.

CONCLUSION

High PFAS exposure from drinking water, dominated by PFOS and PFHxS, was not associated with an elevated risk of hormone receptor-positive breast cancer.

Kinetics of 15 per- and polyfluoroalkyl substances (PFAS) after single oral application as a mixture - A pilot investigation in a male volunteer

Per- and polyfluoroalkyl substances (PFAS) are ubiquitous environmental contaminants with half-lives in humans in the range of years in case of the long-chain compounds, leading to accumulation and measurable levels in plasma. In contrast, short-chain and "alternative" PFAS have lower levels or are not detectable in humans with background exposure. This may be due to lower exposure, but also due to much shorter half-lives compared to long-chain compounds. To get better data on kinetics, a healthy volunteer orally ingested a mixture of fifteen predominantly 13C-labeled PFAS ("MPFAS") in a pilot investigation (MPFBA, MPFPeA, MPFHxA, MPFHpA, MPFOA, MPFNA, MPFDA, MPFUdA, MPFDoA, PFBS, MPFHxS, MPFOS, DONA, HFPO-DA, 6:2FTS). After application, concentrations were measured over 450 days in plasma, urine and feces, using UHPLC-MS/MS analysis after extraction. The compounds were absorbed quickly and almost completely. Data analysis revealed volumes of distribution between 110 and 177 mL/kg bw for most compounds, but higher values for MPFDA, MPFUdA and MPFDoA (maximum of 354 mL/kg bw). Half-lives were found to vary extremely, from 0.5 days (MPFPeA) and 1.5 days (MPFHxA) to 51 days (PFBS) and 152 days (MPFHpA) in case of the short-chain and "alternative" compounds. For the long-chain compounds, half-lives in the range of several years were confirmed for MPFOA, MPFNA, MPFHxS and MPFOS, but with even higher chain-lengths of the carboxylic acids, the half-lives were found to decrease, with the shortest half-life for MPFDoA (295 days). Elimination from the body was completely explained by the urinary losses in case of the short-chain and "alternative" PFAS, and in part by the fecal losses in case of the long-chain PFCA. Overall, elimination kinetics seem to be determined by several different renal and gastrointestinal factors (fraction unbound in plasma, binding affinity to organic anion transporters causing netto secretion or reabsorption, fecal loss with mechanisms to be clarified).

Characterizing the Areal Extent of PFAS Contamination in Fish Species Downgradient of AFFF Source Zones

Most monitoring programs next to large per- and polyfluoroalkyl substances (PFAS) sources focus on drinking water contamination near source zones. However, less is understood about how these sources affect downgradient hydrological systems and food webs. Here, we report paired PFAS measurements in water, sediment, and aquatic biota along a hydrological gradient away from source zones contaminated by the use of legacy aqueous film-forming foam (AFFF) manufactured using electrochemical fluorination. Clustering analysis indicates that the PFAS composition characteristic of AFFF is detectable in water and fishes >8 km from the source. Concentrations of 38 targeted PFAS and extractable organofluorine (EOF) decreased in fishes downgradient of the AFFF-contaminated source zones. However, PFAS concentrations remained above consumption limits at all locations within the affected watershed. Perfluoroalkyl sulfonamide precursors accounted for approximately half of targeted PFAS in fish tissues, which explain >90% of EOF across all sampling locations. Suspect screening analyses revealed the presence of a polyfluoroketone pharmaceutical in fish species, and a fluorinated agrochemical in water that likely does not accumulate in biological tissues, suggesting the presence of diffuse sources such as septic system and agrochemical inputs throughout the watershed in addition to AFFF contamination. Based on these results, monitoring programs that consider all hydrologically connected regions within watersheds affected by large PFAS sources would help ensure public health protection.

Comprehensive analysis of PFAS presence from environment to plate

Per- and polyfluoroalkyl substances (PFAS) pose an emerging environmental risk impacting food products and ecosystems. This study analyzes over 150,000 entries from food safety authorities and scientific publications from 2017 onwards. Our findings show that fish & seafood, and biota have the highest PFAS concentrations due to environmental contamination and bioaccumulation. Surface water samples also frequently contain PFAS, raising concerns about long-term ecological and human health effects. Comprehensive strategies are essential to mitigate these risks.

Silicone Wristbands as a Personal Passive Sampler to Evaluate Indoor Exposure to Volatile and Non-volatile PFASs

Exposure to per- and polyfluoroalkyl substances (PFASs) primarily occurs via consumption of contaminated drinking water and food; however, individuals can also be exposed dermally and via inhalation indoors. This study developed an analytical method for measuring volatile PFASs in silicone wristbands and used them to assess personal exposure in a Midwestern community (n = 87). Paired samples of blood and wristbands were analyzed for PFASs using LC-MS/MS and GC-HRMS to monitor both non-volatile and volatile PFASs. The most frequently detected PFASs in wristbands were: 6:2 diPAP, 6:2 FTOH, MeFOSE and EtFOSE. Females had a 4-fold higher exposure to 6:2 diPAP compared to males and age-dependent differences in exposure to 6:2 FTOH, MeFOSE and EtFOSE were observed. Exposure to MeFOSE and EtFOSE differed based on the average time spent in the home. Frequently detected PFASs in blood were: PFOA, PFOS, PFHxS, PFHpS, and N-MeFOSAA. A strong correlation was found between MeFOSE in the wristbands and N-MeFOSAA in serum (rs = 0.90, p-value <0.001), suggesting exposure to this PFAS was primarily via inhalation and dermal exposure. These results demonstrate that wristbands can provide individual level data on exposure to some polyfluoroalkyl precursors present indoors that reflect serum levels of their suspected biotransformation products.

Exposure to Per- and Polyfluoroalkyl Substances and Timing of Puberty in Norwegian Boys: Data from the Bergen Growth Study 2

Per- and polyfluoroalkyl substances (PFAS) are widespread environmental contaminants with endocrine-disruptive properties. Their impact on puberty in boys is unclear. In this cross-sectional study, we investigated the association between PFAS exposure and pubertal timing in 300 Norwegian boys (9-16 years), enrolled in the Bergen Growth Study 2 during 2016. We measured 19 PFAS in serum samples and used objective pubertal markers, including ultrasound-measured testicular volume (USTV), Tanner staging of pubic hair development, and serum levels of testosterone, luteinizing hormone, and follicle-stimulating hormone. In addition to logistic regression of single pollutants and the sum of PFAS, Bayesian and elastic net regression were used to estimate the contribution of the individual PFAS. Higher levels of the sum of perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorohexanesulfonic acid (PFHxS) were associated with later pubertal onset according to USTV (age-adjusted odds ratio (AOR): 2.20, 95% confidence interval (CI): 1.29, 3.93) and testosterone level (AOR: 2.35, 95% CI: 1.34, 4.36). Bayesian modeling showed that higher levels of PFNA and PFHxS were associated with later pubertal onset by USTV, while higher levels of PFNA and perfluoroundecanoic acid (PFUnDA) were associated with later pubertal onset by testosterone level. Our findings indicate that certain PFAS were associated with delay in male pubertal onset.

Determination of regulated perfluoroalkyl substances (PFAS) in drinking water according to Directive 2020/2184/EU

Perfluoroalkyl substances (PFAS) are chemical compounds that have been widely used in industry and manufacture. Occurrence, together with persistence and recent toxicological effects data, has promoted the regulation of 20 PFAS (carboxylic and sulfonic) acids in drinking water through the recent Directive 2020/2184/EU. This Regulation included PFAS with different carbon chain lengths (from C4 to C13) and limited the total PFAS concentration (as sum) to a maximum of 0.1 µg/L, for which law-enforcement analytical methods are required. In this work, three different methodologies have been developed and evaluated as regards their performance to determine those 20 PFAS in tap and bottled water, based on on-line and off-line solid-phase extraction (SPE) and direct injection. In all cases, ultra-high pressure liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) was used as a determination technique. Off-line SPE with Oasis Weak Anion Exchange (WAX) cartridges provided the best results in terms of limits of quantification (LOQ ≤ 0.3 ng/L) and accuracy (R ≥ 70%) in drinking water samples. On-line SPE and direct injection presented some drawbacks such as background contamination problems and lower accuracies for the least polar compounds. This off-line SPE methodology was then applied to the analysis of 46 drinking water samples (11 commercial bottled samples, 23 Spanish and 12 international tap water samples). Ten PFAS were quantified in such samples at concentrations and detection frequencies ranging from 0.1 to 20.1 ng/L and 2 to 91%, respectively. However, the sum concentration did not surpass the established limit in any sample.

Exploring Perfluoroalkyl and Polyfluoroalkyl Substance Presence and Potential Leaching from Reverse Osmosis Membranes: Implications for Drinking Water Treatment

Reverse osmosis (RO) is increasingly used in drinking water production to effectively remove micropollutants, such as perfluoroalkyl and polyfluoroalkyl substances (PFAS). However, RO membranes themselves may contain PFAS, which can potentially leach into treated drinking water. Leaching experiments and direct total oxidizable precursor assays revealed the presence and leaching potential of PFOS (branched and linear), PFBA, PFHxA, PFNA, and PFOA in five selected commercial RO membranes. This resulted in the release of tens of milligrams of ΣPFAS per membrane element used in drinking water production. Depending on assumptions made regarding leaching kinetics and volume of produced water per membrane element, predicted concentrations of ΣPFAS in the produced water ranged from less than one up to hundreds of pg/L. These concentrations are two to four orders of magnitude lower than those currently observed in Dutch drinking waters. The origin of PFAS in the membranes remains unclear. Further research is needed to bridge the gap between the laboratory conditions as used in this study and the real-world conditions and for a full understanding of potential leaching scenarios. Such an understanding is critical for water producers using RO technologies to proactively manage and mitigate potential PFAS contamination.

Occurrence and health risk assessment of PFAS and possible precursors: a case study in a drinking water treatment plant and bottled water (south Catalonia, Spain)

The presence of PFAS in drinking water may pose a serious threat to human health. This study aims to determine the levels of these compounds and their precursors in water samples from a drinking water treatment plant (DWTP) located in l'Ampolla (Spain) and to assess their fate. Additionally, ten Spanish bottled waters were analyzed to compare the occurrence of PFAS in the mentioned matrices and in drinking water. Off-line solid phase extraction (SPE) followed by liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was applied to determine 26 PFAS and PFAS precursors after a total oxidizable precursor assay. The analytical method presents low quantification limits (0.25-5 ng/L). A total PFAS concentration of up to 16 ng/L in all the DWTP samples was obtained, and 6:2 FTS was the only precursor detected. Results are close to the quantification limits, resulting in a high degree of uncertainty, and for this, it is difficult to evaluate the DWTP PFAS removal efficiency. Regarding bottled water, total PFAS concentration found was up to 12 ng/L in one of ten samples, with no precursors detected. Exposure assessment revealed that there is no risk associated with the ingestion of the samples analyzed. Moreover, there were no differences in terms of risk between drinking water from l'Ampolla DWTP and bottled water.

Thermal desorption - gas chromatography - mass spectrometry (TD-GC-MS) analysis of PFAS used in food contact materials

Per- and polyfluoroalkyl substances (PFAS) are used in food contact materials (FCMs), e.g. as production aids in the fabrication of PTFE based coatings for kitchenware or as additives in paper and board. Growing concerns about the environment and health related to PFAS have led to an increasing interest in monitoring PFAS levels in FCMs as well as their migration into food. In this study, method development for the analysis of PFAS by thermal desorption - gas chromatography - mass spectrometry (TD-GC-MS) was done. In addition to fluorotelomer alcohols (FTOHs), which are the only PFAS commonly analysed by GC-MS, it was proven that perfluorocarboxylic acids (PFCAs) and per- and polyfluoroether carboxylic acids (PFECAs) as well as their thermolysis products, perfluoroethers (PFEs) and perfluoroalkenes, can be analysed by GC-MS without prior derivatization. Screening for PFCAs and FTOHs was possible by electron impact ionization (EI) using group specific SIM fragments. Confirmation of identity has been done by EI scans as well as chemical ionization (CI) SIM measurements. LODs (limits of detection) of PFCAs, FTOHs and PFECAs in the TD-GC-MS instrument were in the low pg range. Thermal degradation of PFCAs and PFECAs during TD-GC-MS measurement was investigated.

Development and Application of a Liquid Chromatography-Tandem Mass Spectrometry Method for the Analysis of 20 Perfluoroalkyl Substances in Fruit and Vegetables at Sub-Parts-per-Trillion Levels

In response to the European Food Safety Authority's establishment of a tolerable weekly intake (TWI) for the sum of PFOA, PFNA, PFHxS, and PFOS, a method was developed to quantify and confirm 20 PFASs at the sub-parts-per-trillion level in fruit and vegetables. Improved sensitivity was achieved by (i) increasing the sample intake, (ii) decreasing the solvent volume in the final extract, and (iii) using a highly sensitive mass spectrometer. Except for PFTrDA, target PFASs could be quantitatively determined with an apparent recovery of 90-119%, limits of quantitation down to 0.5 ng/kg, and a relative standard deviation under within-laboratory reproducibility conditions of <28%. The method was successfully applied to 215 fruit and vegetable samples obtained from local grocery stores and markets. Leafy vegetables prove to be the main vegetable category responsible to PFAS exposure, mainly of PFOA, followed by PFHpA and PFHxA.

Zürich II Statement on Per- and Polyfluoroalkyl Substances (PFASs): Scientific and Regulatory Needs

Per- and polyfluoroalkyl substances (PFASs) are a class of synthetic organic chemicals of global concern. A group of 36 scientists and regulators from 18 countries held a hybrid workshop in 2022 in Zürich, Switzerland. The workshop, a sequel to a previous Zürich workshop held in 2017, deliberated on progress in the last five years and discussed further needs for cooperative scientific research and regulatory action on PFASs. This review reflects discussion and insights gained during and after this workshop and summarizes key signs of progress in science and policy, ongoing critical issues to be addressed, and possible ways forward. Some key take home messages include: 1) understanding of human health effects continues to develop dramatically, 2) regulatory guidelines continue to drop, 3) better understanding of emissions and contamination levels is needed in more parts of the world, 4) analytical methods, while improving, still only cover around 50 PFASs, and 5) discussions of how to group PFASs for regulation (including subgroupings) have gathered momentum with several jurisdictions proposing restricting a large proportion of PFAS uses. It was concluded that more multi-group exchanges are needed in the future and that there should be a greater diversity of participants at future workshops.

Prenatal Exposure of PFAS in Cohorts of Pregnant Women: Identifying the Critical Windows of Vulnerability and Health Implications

Cohorts of pregnant women in 2018 and 2020 were selected to explore prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances (PFAS). Maternal serum during the whole pregnancy (first to third trimesters) and matched cord serum were collected for the analysis of 50 PFAS. Perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), and 6:2 fluorotelomer sulfonic acid (6:2 FTS) were the dominant PFAS in both the maternal and cord serum. The median ∑PFAS concentration was 14.18 ng/mL, and the ∑PFAS concentration was observed to decline from the first trimester to the third trimester. The transplacental transfer efficiencies (TTE) of 29 PFAS were comprehensively assessed, and a "U"-shaped trend in TTE values with increasing molecular chain length of perfluoroalkyl carboxylic acid (PFCA) was observed in this study. Moreover, the maternal concentrations of 9-chlorohexadecafluoro-3-oxanonane-1-sulfonic acid (6:2 Cl-PFESA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUdA), perfluorododecanoic acid (PFDoA), PFOS, and hexafluoropropylene oxide dimer acid (HFPO-DA) in the 2020 cohort were significantly lower than those in the 2018 cohort, declining by about 23.85-43.2% from 2018 to 2020 (p < 0.05). Higher proportions of emerging PFAS were observed in fetuses born in 2020. This birth cohort was collected during the COVID-19 epidemic period. The change in the PFAS exposure scene might be in response to the different exposure profiles of the 2018 and 2020 cohorts, which are attributed to the impact of COVID-19 on the social activities and environment of pregnant women. Finally, by application of a multiple informant model, the third trimester was identified as the critical window of vulnerability to PFAS exposure that affects birth weight and birth length.

Association Between Prenatal Exposure to Per- and Poly-Fluoroalkyl Substances From Electronic Waste Disassembly Areas and Steroid Hormones in Human Milk Samples

Per- and poly-fluoroalkyl substances (PFAS), which are long-lasting environmental contaminants that are released into the environment during the e-waste disassembly process, pose a threat to human health. Human milk is a complex and dynamic mixture of endogenous and exogenous substances, including steroid hormones and PFAS. Therefore, in this study, we aimed to investigate the association between PFAS and steroid hormones in human milk from women living close to an e-waste disassembly area. In 2021, we collected milk samples from 150 mothers within 4 weeks of delivery and analyzed them via liquid chromatography-tandem mass spectrometry to determine the levels of 21 perfluorinated compounds and five steroid hormones (estrone, estriol, testosterone, progesterone, and androstenedione [A-dione]). We also performed multiple linear regression analysis to clarify the association between maternal PFAS exposure and steroid hormone concentrations. Our results indicated that PFOA and PFOS were positively associated with estrone (β, 0.23; 95% CI, 0.08-0.39) and A-dione (β, 0.186; 95% CI, 0.016-0.357) concentrations in human milk, respectively. Further, the average estimated daily intake of PFOA and PFOS were 36.5 ng/kg bw/day (range, 0.52-291.7 ng/kg bw/day) and 5.21 ng/kg bw/day (range, 0.26-32.3 ng/kg bw/day), respectively. Of concern, the PFAS intake of breastfeeding infants in the study area was higher than the recommended threshold. These findings suggested that prenatal exposure to PFAS from the e-waste disassembly process can influence steroid hormones levels in human milk. Increased efforts to mitigate mother and infant exposure to environmental pollutants are also required.

Effects of Perfluorohexane Sulfonate Exposure on Immune Cell Populations in Naive Mice

Perfluorohexane sulfonate (PFHxS) is a member of the per- and polyfluoroalkyls (PFAS) superfamily of molecules, characterized by their fluorinated carbon chains and use in a wide range of industrial applications. PFHxS and perfluorooctane sulfonate are able to accumulate in the environment and in humans with the approximated serum elimination half-life in the range of several years. More recently, some PFAS compounds have also been suggested as potential immunosuppressants. In this study, we analyze immune cell numbers in mice following 28-d repeated oral exposure to potassium PFHxS at 12, 120, 1,200, and 12,000 ng/kg/d, with resulting serum levels ranging up to ∼1,600 ng/ml, approximating ranges found in the general population and at higher levels in PFAS workers. The immunosuppressant cyclophosphamide was analyzed as a positive control. B cells, T cells, and granulocytes from the bone marrow, liver, spleen, lymph nodes, and thymus were evaluated. We found that at these exposures, there was no effect of PFHxS on major T or B cell populations, macrophages, dendritic cells, basophils, mast cells, eosinophils, neutrophils, or circulating Ab isotypes. By contrast, mice exposed to cyclophosphamide exhibited depletion of several granulocyte and T and B cell populations in the thymus, bone marrow, and spleen, as well as reductions in IgG1, IgG2b, IgG2c, IgG3, IgE, and IgM. These data indicate that exposures of up to 12,000 ng/kg of PFHxS for 28 d do not affect immune cell numbers in naive mice, which provides valuable information for assessing the risks and health influences of exposures to this compound.

Accumulation of Per- and Polyfluoroalkyl Substances (PFAS) in Coastal Sharks from Contrasting Marine Environments: The New York Bight and The Bahamas

Per- and polyfluoroalkyl substances (PFAS) enter the marine food web, accumulate in organisms, and potentially have adverse effects on predators and consumers of seafood. However, evaluations of PFAS in meso-to-apex predators, like sharks, are scarce. This study investigated PFAS occurrence in five shark species from two marine ecosystems with contrasting relative human population densities, the New York Bight (NYB) and the coastal waters of The Bahamas archipelago. The total detected PFAS (∑PFAS) concentrations in muscle tissue ranged from 1.10 to 58.5 ng g-1 wet weight, and perfluorocarboxylic acids (PFCAs) were dominant. Fewer PFAS were detected in Caribbean reef sharks (Carcharhinus perezi) from The Bahamas, and concentrations of those detected were, on average, ∼79% lower than in the NYB sharks. In the NYB, ∑PFAS concentrations followed: common thresher (Alopias vulpinus) > shortfin mako (Isurus oxyrinchus) > sandbar (Carcharhinus plumbeus) > smooth dogfish (Mustelus canis). PFAS precursors/intermediates, such as 2H,2H,3H,3H-perfluorodecanoic acid and perfluorooctanesulfonamide, were only detected in the NYB sharks, suggesting higher ambient concentrations and diversity of PFAS sources in this region. Ultralong-chain PFAS (C ≥ 10) were positively correlated with nitrogen isotope values (δ15N) and total mercury in some species. Our results provide some of the first baseline information on PFAS concentrations in shark species from the northwest Atlantic Ocean, and correlations between PFAS, stable isotopes, and mercury further contextualize the drivers of PFAS occurrence.

Per- and poly-fluoroalkyl substances (PFAS) effects on lung health: a perspective on the current literature and future recommendations

Per- and poly-fluoroalkyl substances (PFAS) are a broad class of synthetic compounds widely used in commercial applications. The persistent nature of PFAS in the environment has earned them the epithet "forever chemicals." Concerns arise from widespread exposure to PFAS from occupational, household, and environmental sources. This widespread use of PFAS is particularly concerning, as emerging epidemiological evidence highlights their adverse effects on lung health. Such adverse impacts include impaired fetal lung development, reduced immune function in children, and potential links to lung cancer. Both in vivo and in vitro studies illuminate potential mechanisms underlying such adverse health outcomes subsequent to PFAS inhalation exposure, which may include immunomodulation, oxidative stress, and disruptions to epithelial barriers. However, evidence-based information focusing on the mechanisms of PFAS-mediated lung injury is lacking. Additionally, the discrepancies between data collected from animal and epidemiological studies highlight the need for improved approaches to better understand the toxicity results of PFAS exposure. To address these gaps, we recommend leveraging route-to-route extrapolation for risk assessment, prioritizing research on understudied PFAS, and adopting physiologically relevant, high-throughput approaches. These strategies are aimed at enhancing our understanding of PFAS inhalation effects, aiding in more informed risk management decisions. In this review, we summarize the current literature on PFAS exposure, emphasizing its adverse effects on lung health, particularly through inhalation. We then discuss the current knowledge on mechanisms underlying tissue- and cellular-level adverse outcomes caused by PFAS.

Association of diet with per- and polyfluoroalkyl substances in plasma and human milk in the New Hampshire Birth Cohort Study

Per- and polyfluoroalkyl substances (PFAS) are related to various adverse health outcomes, and food is a common source of PFAS exposure. Dietary sources of PFAS have not been adequately explored among U.S. pregnant individuals. We examined associations of dietary factors during pregnancy with PFAS concentrations in maternal plasma and human milk in the New Hampshire Birth Cohort Study. PFAS concentrations, including perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorononanoate (PFNA), and perfluorodecanoate (PFDA), were measured in maternal plasma collected at ∼28 gestational weeks and human milk collected at ∼6 postpartum weeks. Sociodemographic, lifestyle and reproductive factors were collected from prenatal questionnaires and diet from food frequency questionnaires at ∼28 gestational weeks. We used adaptive elastic net (AENET) to identify important dietary variables for PFAS concentrations. We used multivariable linear regression to assess associations of dietary variables selected by AENET models with PFAS concentrations. Models were adjusted for sociodemographic, lifestyle, and reproductive factors, as well as gestational week of blood sample collection (plasma PFAS), postpartum week of milk sample collection (milk PFAS), and enrollment year. A higher intake of fish/seafood, eggs, coffee, or white rice during pregnancy was associated with higher plasma or milk PFAS concentrations. For example, every 1 standard deviation (SD) servings/day increase in egg intake during pregnancy was associated with 4.4 % (95 % CI: 0.6, 8.4), 3.3 % (0.1, 6.7), and 10.3 % (5.6, 15.2) higher plasma PFOS, PFOA, and PFDA concentrations respectively. Similarly, every 1 SD servings/day increase in white rice intake during pregnancy was associated with 7.5 % (95 % CI: -0.2, 15.8) and 12.4 % (4.8, 20.5) greater milk PFOS and PFOA concentrations, respectively. Our study suggests that certain dietary factors during pregnancy may contribute to higher PFAS concentrations in maternal plasma and human milk, which could inform interventions to reduce PFAS exposure for both birthing people and offspring.

Insights into the Enhanced Bioavailability of Per- and Polyfluoroalkyl Substances in Food Caused by Chronic Inflammatory Bowel Disease

Understanding the bioavailability of per- and polyfluoroalkyl substances (PFAS) in food is essential for accurate human health risk assessment. Given the rising incidence of inflammatory bowel disease (IBD), this study aimed to investigate the impacts of IBD on the bioavailability of PFAS in food using mice models. The relative bioavailability (RBA) of PFAS was the highest in the chronic IBD mice (64.3-144%), followed by the healthy (60.8-133%) and acute IBD mice (41.5-121%), suggesting that chronic IBD enhanced the PFAS exposure risk. In vitro tests showed that the intestinal micelle stability increased as a result of reduced content of short-chain fatty acids, thus promoting the PFAS bioaccessibility in the digestive fluid of chronic IBD. Additionally, increased pathogenic and decreased beneficial bacteria in the gut of IBD groups facilitated the intestinal permeability, thus enhancing PFAS absorption. These together explained the higher RBA of PFAS in the chronic IBD. However, remarkably lower enzymatic activities suggested severely impaired digestive ability in the acute IBD, which facilitated the excretion of PFAS from feces, thus lowering the RBA. Conversely, PFAS exposure might exacerbate IBD by changing the gut microbiota structures. This study hints that individuals with chronic intestinal inflammation might have higher PFAS exposure risk than the healthy population.

Childhood PFAS exposure and immunotoxicity: a systematic review and meta-analysis of human studies

BACKGROUND

Exposure to poly- and perfluoroalkyl substances (PFAS) may affect infant and childhood health through immunosuppression. However, the findings of epidemiological literature examining relationships between prenatal/childhood PFAS exposure and vaccine response and infection in humans are still inconclusive. The aim of this review was to examine the effects of PFAS exposure on vaccine antibody response and infection in humans.

METHODS

The MEDLINE/Pubmed database was searched for publications until 1 February 2023 to identify human studies on PFAS exposure and human health. Eligible for inclusion studies had to have an epidemiological study design and must have performed logistic regression analyses of gestational or childhood exposure to PFAS against either antibody levels for pediatric vaccines or the occurrence of children's infectious diseases. Information on baseline exposure to PFAS (in ng/mL), the age of PFAS exposure (gestational or in years), and the outcome was measured, potentially leading to multiple exposure-outcome comparisons within each study was collected. Percentage change and standard errors of antibody titers and occurrence of infectious diseases per doubling of PFAS exposure were calculated, and a quality assessment of each study was performed.

RESULTS

Seventeen articles were identified matching the inclusion criteria and were included in the meta-analysis. In general, a small decrease in antibody response and some associations between PFAS exposure and childhood infections were observed.

CONCLUSIONS

This meta-analysis summarizes the findings of PFAS effects on infant and childhood immune health. The immunosuppression findings for infections yielded suggestive evidence related to PFAS exposure, particularly PFOS, PFOA, PFHxS, and PFNA but moderate to no evidence regarding antibody titer reduction.

SYSTEMATIC REVIEW REGISTRATION

The research protocol of this systematic review is registered and accessible at the Open Science Framework ( https://doi.org/10.17605/OSF.IO/5M2VU ).

Plant-based food contact materials: presence of hazardous substances

As a result of the European Single Use Plastic Directive and as part of the transition to a circular economy, plastic food contact materials (FCMs) are being replaced, often by renewable plant-based materials. This research aimed to identify which chemical substances are present in plant-based materials. In 2022 a total of 28 samples of the latter materials from the Dutch market were analysed for 313 active substances from plant protection products, 47 per- and polyfluoralkyl substances (PFASs) and 27 heavy metals and other elements. Ten samples contained plant protection products that are not authorised in the EU. Most materials contained PFASs at trace or even high levels. Three out of four investigated sugar cane materials contained 6:2 fluorotelomer alcohol at levels up to 1.7 mg/kg. High contents of aluminium, manganese, iron, zinc, and barium were found. Other heavy metals, such as arsenic, lead and mercury were found in relatively low contents. A broad GC-MS screening was performed, which revealed the presence of plant extractable, plasticisers, antioxidants and hydrocarbons, which were not all authorised for FCMs, but may be present as non-intentionally added substances.