Vascular endothelium as a target for perfluroalkyl substances (PFAs)

Association of Per- and Polyfluoroalkyl Substance Exposure with Coronary Stenosis and Prognosis in Acute Coronary Syndrome

Per- and polyfluoroalkyl substances (PFAS) have been associated with an increased risk of acute coronary syndromes (ACS), but the influence on the degree of coronary stenosis and prognosis is unclear. This study enrolled 571 newly diagnosed ACS cases and investigated the association of 12 PFAS with coronary stenosis severity and prognosis. Coronary stenosis was assessed via Gensini score (GS) and number of lesioned vessels (LVN). Prognosis was estimated by tracking major adverse cardiovascular events (MACE). Statistical analyses included ordered logistic regression, Cox regression, threshold effect models, Bayesian kernel machine regression, and quantile g-computation models. The adverse outcome pathway (AOP) framework was applied to reveal the underlying mechanism. The results showed positive association between perfluorooctanesulfonic acid (PFOS) and coronary stenosis, with an odds ratio (95% confidence interval, CI) of 1.33 (1.06, 1.67) for GS and 1.36 (1.08, 1.71) for LVN. PFOS significantly increased the incidence of poor prognosis, with hazard ratios (95% CI) of 1.96 (1.34, 2.89) for MACE. Threshold effects were observed for PFAS on coronary stenosis and prognosis, with PFOS thresholds of 4.65 ng/mL for GS, 4.54 ng/mL for LVN, and 5.14 ng/mL for MACE, and 5.03 ng/mL for nonfatal myocardial infarction. PFAS mixture exposure increased the occurrence of MACE and nonfatal myocardial infarction. The AOP framework shows that PFAS may impact protein binding, the cytoskeleton, multicellular biological processes, and heart function. In summary, our study revealed the adverse effects of PFAS on the degree of coronary stenosis and prognosis in ACS and identified potentially relevant molecular loci.

Emerging eco-friendly technologies for remediation of Per- and poly-fluoroalkyl substances (PFAS) in water and wastewater: A pathway to environmental sustainability

Per- and polyfluoroalkyl substances (PFAS) are rampant, toxic contaminants from anthropogenic sources, called forever chemicals for their recalcitrance. Although banned in several parts of the world for public health implications, including liver, kidney, and testicular diseases, PFAS are abundant in water sources due to easy dispersion. With chemical properties resulting from strong hydrophobic bonds, they defile many physicochemical removal methods. Though adsorption processes such as granular activated carbon (GAC) are widely used, they are marred by several limitations, including cost and secondary contamination. Thus, eco-friendly methods involving a synergy of the removal principles have been preferred for ease of use, cost-effectiveness, and near-zero effect on the environment. We present novel eco-friendly methods as the solution to PFAS remediation towards environmental sustainability. Current eco-friendly methods of PFAS removal from water sources, including electrocoagulation, membrane/filtration, adsorption, and phytoremediation methods, were highlighted, although with limitations. Novel eco-friendly methods such as microbial fuel cells, photoelectrical cells, and plasma treatment offer solutions to PFAS remediation and are quite efficient in terms of cost, result, and environmental sustainability. Overall, the successful integration of eco-friendly techniques in a seamless manner ensures the desired result. We also present a balanced position on the ecosystem impact of these ecofriendly methods, noting the successes towards environmental sustainability while exposing the gaps for further research.

Exposure to per- and polyfluoroalkyl substances is associated with impaired cardiovascular health: a cross-sectional study

Background

Per- and polyfluoroalkyl substance (PFAS) exposure and cardiovascular disease are controversial. We aimed to assess the association between serum PFAS exposure and cardiovascular health (CVH) in U.S. adults.

Methods

We analyzed serum PFAS concentration data of U.S. adults reported in the National Health and Nutrition Examination Survey (NHANES) study (2005-2018). We employed two weighted logistic regression models and a restricted cubic spline (RCS) to examine the association between each PFAS and impaired CVH (defined as moderate and low CVH). Quantile g-computation (Qgcomp) and weighted quantile sum (WQS) analysis were used to estimate the effects of mixed exposures to PFASs on impaired CVH.

Results

PFAS were associated with an increased risk of impaired CVH (ORPFNA: 1.40, 95% CI: 1.09, 1.80; ORPFOA: 1.44, 95% CI: 1.10, 1.88; ORPFOS: 1.62, 95% CI: 1.25, 2.11). PFOA and PFOS exhibited nonlinear relationships with impaired CVH. Significant interactions were observed for impaired CVH between race/ethnicity and PFHxS (p = 0.02), marital status and PFOA (p = 0.03), and both marital status and race/ethnicity with PFOS (p = 0.01 and p = 0.02, respectively). Analysis via WQS and Qgcomp revealed that the mixture of PFAS was positively associated with an increased risk of impaired CVH.

Conclusion

PFNA, PFOA, and PFOS exposure are associated with an increased risk of impaired CVH in U.S. adults. Race/ethnicity and marital status may influence CVH. Reducing PFAS exposure could alleviate the burden of disease associated with impaired CVH.

Platelet RNA Biomarker of Ticagrelor-Responsive Genes Is Associated With Platelet Function and Cardiovascular Events

BACKGROUND

Identifying patients with the optimal risk:benefit for ticagrelor is challenging. The aim was to identify ticagrelor-responsive platelet transcripts as biomarkers of platelet function and cardiovascular risk.

METHODS

Healthy volunteers (n=58, discovery; n=49, validation) were exposed to 4 weeks of ticagrelor with platelet RNA data, platelet function, and self-reported bleeding measured pre-/post-ticagrelor. RNA sequencing was used to discover platelet genes affected by ticagrelor, and a subset of the most informative was summarized into a composite score and tested for validation. This score was further analyzed (1) in CD34+ megakaryocytes exposed to an P2Y12 inhibitor in vitro, (2) with baseline platelet function in healthy controls, (3) in peripheral artery disease patients (n=139) versus patient controls (n=30) without atherosclerosis, and (4) in patients with peripheral artery disease for correlation with atherosclerosis severity and risk of incident major adverse cardiovascular and limb events.

RESULTS

Ticagrelor exposure differentially expressed 3409 platelet transcripts. Of these, 111 were prioritized to calculate a Ticagrelor Exposure Signature score, which ticagrelor reproducibly increased in discovery and validation cohorts. Ticagrelor's effects on platelets transcripts positively correlated with effects of P2Y12 inhibition in primary megakaryocytes. In healthy controls, higher baseline scores correlated with lower baseline platelet function and with minor bleeding while receiving ticagrelor. In patients, lower scores independently associated with both the presence and extent of atherosclerosis and incident ischemic events.

CONCLUSIONS

Ticagrelor-responsive platelet transcripts are a biomarker for platelet function and cardiovascular risk and may have clinical utility for selecting patients with optimal risk:benefit for ticagrelor use.

Per- and polyfluoroalkyl substances and cardiometabolic diseases: A review

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

Unveiling Distribution of Per- and Polyfluoroalkyl Substances in Matched Placenta-Serum Tetrads: Novel Implications for Birth Outcome Mediated by Placental Vascular Disruption

The placenta is pivotal for fetal development and maternal-fetal transfer of many substances, including per- and polyfluoroalkyl substances (PFASs). However, the intraplacental distribution of PFASs and their effects on placental vascular function remain unclear. In this study, 302 tetrads of matched subchorionic placenta (fetal-side), parabasal placenta (maternal-side), cord serum, and maternal serum samples were collected from Guangzhou, China. Eighteen emerging and legacy PFASs and five placental vascular biomarkers were measured. Results showed that higher levels of perfluorooctanoic (PFOA), perfluorooctane sulfonic acid (PFOS), and chlorinated polyfluorinated ether sulfonic acids (Cl-PFESAs) were detected in subchorionic placenta compared to parabasal placenta. There were significant associations of PFASs in the subchorionic placenta, but not in the serum, with placental vascular biomarkers (up to 32.5%) and lower birth size. Birth weight was negatively associated with PFOA (β: -103.8, 95% CI: -186.3 and -21.32) and 6:2 Cl-PFESA (β: -80.04, 95% CI: -139.5 and -20.61), primarily in subchorionic placenta. Mediation effects of altered placental angiopoietin-2 and vascular endothelial growth factor receptor-2 were evidenced on associations of adverse birth outcomes with intraplacental PFOS and 8:2 Cl-PFESA, explaining 9.5%-32.5% of the total effect. To the best of our knowledge, this study is the first to report on differential intraplacental distribution of PFASs and placental vascular effects mediating adverse birth outcomes and provides novel insights into the placental plate-specific measurement in PFAS-associated health risk assessment.