[Wastewater-based epidemiology: applications towards the estimation of drugs of abuse consumption and public health in general. The Spanish network ESAR-Net]

This manuscript introduces Wastewater-Based Epidemiology (WBE) and its potential in the assessment of diverse aspects related to public health. This methodology can provide data in a relatively short temporal and local scale (typically dialy-weekly at the municipal level) on consumption patterns of illicit drugs (e.g. cocaine or cannabis), licit substances of abuse (e.g. alcohol) by measuring their consumption biomarkers (i.e. the original unmetabolized substance or some of its metabolite) in wastewater. Besides discussing the fundaments, advantages and shortcomings of WBE, it reviews some of the main precedents at international level and most remarkable activities that have been taken place in this field in Spain. Finally, the Spanish Network of Wastewater-Based Epidemiology (ESAR-Net) as is presented. ESAR-Net is an Excellence Network that sums up the efforts of the most relevant Spanish researchers in the field of WBE, aiming to investigate future perspectives of this methodology and its impact on Public Health competences in Spain.

Assessing drugs of abuse distribution in Turia River based on geographic information system and liquid chromatography mass spectrometry

Drugs of abuse are continuously discharged into wastewaters as part of their elimination process. Pollution at very low concentrations appears to be broad in environmental compartments near populated areas. A total of 42 drugs of abuse and metabolites were analysed in surface water samples collected in 2012 and 2013 by solid phase extraction and liquid chromatography coupled to mass spectrometry. Analytical results of target compounds were georeferenced and integrated into a geographical information systems (GIS). Ecotoxicological risk of drugs of abuse detected in the Turia River was evaluated in this study by calculating risk quotient (RQ). In 2012, 6 compounds were detected in a total of 22 points. In 2013, 7 compounds were found in a total of 31 sampling sites, 4 of them also detected in 2012. The most frequent compound was benzoylecgonine, detected in 9 sampling points in 2012 and 8 in 2013, at an average concentration of 25.4ng/L and 14.02ng/L. Codeine reached the maximum concentration of detected compounds (101ng/L) in 2013. GIS provided the spatial incidence of drugs of abuse along the Turia River basin. The distribution of these compounds in 2012 and 2013 shows that the highest concentrations and frequency of drugs of abuse run into places with the highest population density. The RQ obtained from measured concentrations of detected drugs predict that no short-term environmental risk might be expected. Further research including multi-stressors studies with more potentially persistent or pseudo-persistent organic pollutants in surface waters is needed to establish relationships with human pressure in a river basin.

Estimating population size in wastewater-based epidemiology. Valencia metropolitan area as a case study

Wastewater can provide a wealth of epidemiologic data on common drugs consumed and on health and nutritional problems based on the biomarkers excreted into community sewage systems. One of the biggest uncertainties of these studies is the estimation of the number of inhabitants served by the treatment plants. Twelve human urine biomarkers -5-hydroxyindoleacetic acid (5-HIAA), acesulfame, atenolol, caffeine, carbamazepine, codeine, cotinine, creatinine, hydrochlorothiazide (HCTZ), naproxen, salicylic acid (SA) and hydroxycotinine (OHCOT)- were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS) to estimate population size. The results reveal that populations calculated from cotinine, 5-HIAA and caffeine are commonly in agreement with those calculated by the hydrochemical parameters. Creatinine is too unstable to be applicable. HCTZ, naproxen, codeine, OHCOT and carbamazepine, under or overestimate the population compared to the hydrochemical population estimates but showed constant results through the weekdays. The consumption of cannabis, cocaine, heroin and bufotenine in Valencia was estimated for a week using different population calculations.

Analysis of cannabinoids by liquid chromatography-mass spectrometry in milk, liver and hemp seed to ensure food safety

A method for determining cannabinoids, Δ9-tetrahidrocannabinol (THC), 11-nor-9-carboxy-Δ⁹-THC (THC-COOH) and 11-hidroxy-Δ⁹-THC (THC-OH) in milk, liver and hemp seeds based on liquid chromatography tandem mass spectrometry has been optimized and validated. Analytes were extracted with methanol and the extracts cleaned-up by solid-phase extraction using Oasis HLB (60mg). The developed method was validated according to the Commission Decision 2002/657/EC. The decision limit (CCα) and detection capability (CCβ) ranged from 3.10-10.5ngg^-1 and 3.52-11.5ngg^-1, the recoveries were 76-118% and matrix effect ranged from -17.8% to 19.9% in the three matrices studied. The method was applied to food samples obtaining positive results for THC in hemp seeds (average 0.82μgg^-1) and three brands of junior formula milk at concentrations from 4.76 to 56.11ngg^-1. The developed method was suitable achieving identification and quantification of cannabinoids in food matrices.

Estimation of alcohol consumption during "Fallas" festivity in the wastewater of Valencia city (Spain) using ethyl sulfate as a biomarker

Alcohol consumption has been increasing in the last years and it has become a sociological problem due its derived health and safety problems. Ethyl sulfate is a secondary metabolite of the alcohol degradation that is excreted through the urine (0.010-0.016%) after alcohol ingestion and it is quite stable in water. In this study, a new methodology to determine ethyl sulfate by ion-pair liquid chromatography-tandem mass spectrometry (LC-MS/MS) was developed. Different ion-pairs and additives were tested directly in the sample extracts or in the mobile phase. The best ion-pair was set up adding 0.5M of tributylamine and 0.1% of formic acid to the sample. The limit of quantification was 0.3 μg L(-1) and the intra-day and inter-day precision of the method were ≤ 2.8 and ≤ 3.0%, respectively. Good linearity (r(2)<0.999) and low matrix effect (<30% corrected by using internal isotopically labelled internal standard) were achieved. The sampling campaign was from 4th to 20th March of 2014 covering the festivity of Fallas (15th to 19th March). Ethyl sulfate was determined in all influents of the 3 wastewater treatment plants (Pinedo I, Pinedo II and Quart-Benàger) belonging to Valencia and surrounding area. Ethyl sulfate concentrations ranged from 1.46 to 19.85 μg L(-1) and alcohol consumption ranged from 1.07 to 56.11 mL day(-1) inhab(-1), being the highest value of alcohol consumption determined during Fallas. This study presents a reliable and alternative method to traditional ones to determine alcohol consumption by population that provides real-time information of alcohol consumption.

Occurrence and removal of drugs of abuse in Wastewater Treatment Plants of Valencia (Spain)

The occurrence of 8 drugs of abuse and metabolites in the influent and effluent of the 3 Wastewater Treatment Plants (WWTP) that treat wastewater from Valencia was studied in 2011, 2012 and 2013. Target drugs except 6-monoacetylmorphine (6-ACMOR) were detected in 100% of the influents. The WWTPs eliminate cocaine (COC), amphetamine (AMP), methamphetamine (MAMP) and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH). Benzoylecgonine (BECG) was also efficiently eliminated (93-98%), whereas 3,4-methylenedioxymethamphetamine (MDMA) presented removal rates of 32-57% and ketamine (KET) was not eliminated. The most consumed illicit drugs, according to the estimated concentrations of each compound in the studied WWTPs, were cannabis and COC followed by KET, AMP, MAMP, MDMA and heroin. Environmental risk assessment was evaluated by calculating Risk Quotient (RQ). MDMA and KET could pose a medium risk and low risk, respectively, to the aquatic organisms. Although short-term environmental risk is not worrisome, long-term effects cannot be known exactly.

Urinary KIM-1, NGAL and L-FABP for the diagnosis of AKI in patients with acute coronary syndrome or heart failure undergoing coronary angiography

Acute kidney injury (AKI) is a common complication after coronary angiography. Early biomarkers of this disease are needed since increase in serum creatinine levels is a late marker. To assess the usefulness of urinary kidney injury molecule-1 (uKIM-1), neutrophil gelatinase-associated lipocalin (uNGAL) and liver-type fatty acid-binding protein (uL-FABP) for early detection of AKI in these patients, comparing their performance with another group of cardiac surgery patients. Biomarkers were measured in 193 patients, 12 h after intervention. In the ROC analysis, AUC for KIM-1, NGAL and L-FABP was 0.713, 0.958 and 0.642, respectively, in the coronary angiography group, and 0.716, 0.916 and 0.743 in the cardiac surgery group. Urinary KIM-1 12 h after intervention is predictive of AKI in adult patients undergoing coronary angiography, but NGAL shows higher sensitivity and specificity. L-FABP provides inferior discrimination for AKI than KIM-1 or NGAL in contrast to its performance after cardiac surgery. This is the first study showing the predictive capacity of KIM-1 for AKI after coronary angiography. Further studies are still needed to answer relevant questions about the clinical utility of biomarkers for AKI in different clinical settings.