Phthalates' exposure leads to an increasing concern on cardiovascular health

The effect of endocrine disruptors on the cardiovascular system: does sex matter?

Endocrine disruptors (EDs) are environmental chemicals that interfere with hormone function, posing significant risks to human health, including the cardiovascular system. This review comprehensively examines the impact of EDs on cardiovascular health, with a specific focus on sex differences observed in various models. Utilizing in-vitro studies, in vivo animal models, and human clinical data, we delineate how sex-specific hormonal environments influence the cardiovascular effects of ED exposure. In vitro studies highlight cellular and molecular mechanisms that differ between male and female-derived cells. In vivo models reveal distinct physiological responses and susceptibilities to EDs, influenced by sex hormones. Human studies provide epidemiological evidence and clinical observations that underscore the variability in cardiovascular outcomes between men and women. This review underscores the necessity of considering sex as a critical factor in understanding the cardiovascular implications of ED exposure, advocating for gender-specific risk assessment and therapeutic strategies. The findings aim to enhance awareness and inform future research and policy-making to mitigate the adverse cardiovascular effects of EDs across different sexes.

Uptake, translocation, and biotransformation of phthalate acid esters in crop plants: A comprehensive review

Phthalate acid esters (PAEs) are prevalent emerging contaminants in agricultural environments. The uptake of PAEs by crop plants has attracted extensive attention due to the risks posed to human health through transfer in food chains. Despite its importance, the interaction between PAEs and crop plants remains poorly understood. In this critical review, the occurrence of six priority control PAEs in various food crops grown in greenhouses and conventional farms is investigated, with detected concentrations reaching up to mg/kg (dry weight) levels. PAEs enter plants through roots, foliar gas, or foliar particle uptake. After entry, PAEs exhibit acropetal translocation from the root and basipetal translocation from the leaf. PAEs are transformed into various metabolites through hydroxylation, hydrolysis, and oxidation in phase I metabolism and further conjugated with biomolecules such as amino acids or sugars in phase II metabolism. Exposure to PAEs disrupts plant homeostasis and activated antioxidant enzymes to alleviate phytotoxicity. Dietary intake of PAEs-contaminated food crops presents potential risks to human health, particularly from fruit and root vegetables consumed by children, warranting specific attention. Furthermore, current knowledge gaps and future perspectives are proposed. This review provides a comprehensive assessment of the knowledge on the uptake, translocation, and transformation of PAEs in crop plants, emphasizing the need for an integrated investigation into the full life cycle of PAEs in plants to ensure food safety.

Heavy metals and phthalate contamination in prenatal vitamins and folic acid supplements

OBJECTIVE

The goal is to characterize the contamination of prenatal vitamins and folate/folic acid supplements with lead, cadmium, and phthalates.

METHODS

The sample included 156 commercially available prenatal vitamins, 19 folate/folic acid supplements, and nine prescription prenatal supplements. Lead and cadmium were measured by inductively coupled plasma-mass spectrometry, and phthalates by liquid chromatography-tandem mass spectrometry, and quantified as μg/daily serving. Distributions of lead, cadmium, and phthalates were examined across products, as well as the proportion exceeding the California proposition 65 threshold for daily lead consumption (0.5 μg).

RESULTS

Lead exceeded the limit of quantification (LOQ) in 83% of commercially available prenatal vitamin samples (15% > 0.5 μg/serving), cadmium in 73%, DEHP in 25%, and DBP in 13%. Product characteristics associated with increased lead and cadmium contamination included calcium and iron doses, and being a caplet, capsule, or tablet. Lead and cadmium exceeded the LOQ in 7/9 prescription prenatals (33% > 0.5 μg/serving lead). Heavy metal and phthalate contamination was lower in folate/folic acid supplements.

CONCLUSIONS

Clear and enforceable regulations regarding frequent testing and restriction of lead and cadmium contamination in prenatal vitamins are needed.

Implications of plastic-derived endocrine disruptors on human health

Endocrine-disrupting chemicals (EDCs), such as bisphenol A (BPA), bisphenol S (BPS), phthalates, and micro- and nanoplastics, present substantial environmental and health hazards because of their potential to disrupt hormonal systems. Micro- and nanoplastics can release EDCs that disrupt reproductive and developmental processes, potentially affecting future generations. BPA, a common plasticizer and resin component, mimics estrogen and disrupts thyroid hormone metabolism, contributing to obesity, diabetes, and cardiovascular issues. BPS, a BPA substitute, exhibits similar endocrine-disrupting properties and persists longer in the environment. Phthalates, which are widely used as plasticizers, are associated with reproductive issues, metabolic conditions, and developmental issues in children. Combined exposure to multiple EDCs can amplify health risks, underscoring the need for further research on the synergistic impacts of these chemicals. This review underscores the urgent need for effective regulatory measures and further investigations into the health impacts of EDCs to mitigate their harmful impacts on the health of humans and the environment.

Mechanism of S-Palmitoylation in Polystyrene Nanoplastics-Induced Macrophage Cuproptosis Contributing to Emphysema through Alveolar Epithelial Cell Pyroptosis

More than microplastics, nanoplastics may pose a greater toxic effect on humans due to their unique physicochemical properties. Currently, research on lung diseases caused by respiratory exposure to nanoplastics is scarce, with epigenetic mechanisms warranting further investigation. In the present study, we exposed rats to polystyrene nanoplastics (PS-NPs) via an oral-nasal exposure system and found that PS-NPs exposure resulted in emphysema. Mechanistically, PS-NPs entered macrophages and competitively bound to sigma nonopioid intracellular receptor 1 (SIGMAR1), leading to an increase in free zDHHC palmitoyltransferase 14 (zDHHC14). This, in turn, caused elevated palmitoylation of solute carrier family 31 member 1 (SLC31A1) in macrophages, inhibiting its ubiquitination and degradation, thereby enhancing SLC31A1 expression. The increased expression of SLC31A1 promoted cuproptosis of macrophages and elevated tumor necrosis factor-α (TNF-α) secretion, which activated the NLR family pyrin domain containing 3/matrix metallopeptidase 9 (NLRP3/MMP-9) pathway in alveolar epithelial cells (AECs). This process mediated pyroptosis and degradation of extracellular matrix (ECM), resulting in the destruction of alveolar structure and development of emphysema. The findings demonstrate a previously unknown molecular mechanism by which PS-NPs induce emphysema. The findings have implications for the prevention and treatment of respiratory system damage caused by nanoparticles.

Adsorption of dibutyl phthalate by multi-walled carbon nanotubes aggravates hemogram, liver and kidney damage in rats

Studies have shown that environmental pollutants, DBP and MWCNTs, are physiologically toxic. To investigate whether MWCNTs with adsorbed DBP would aggravate this toxicity, we exposed rats to this combination via tail vein injection for two weeks. The results showed the numbers of total WBCs, LYMs, MONs, GRAs, RBCs, PLTs were significantly higher, decrease in GSH, and increase in IL-6, TNF-α, and IgE. Tissue sections revealed hepatic steatosis, sinusoidal sludge, and dilated glomerular capillaries filled with erythrocytes. Blood glucose regulation was impaired, and serum TP, ALT, Cr, and BUN levels were elevated. GO and KEGG analyses showed DEPs were mainly enriched in the catabolism of lipids and proteins, hepatobiliary system development, acute inflammatory response, and metabolic pathways. These findings demonstrate that MWCNTs with adsorbed DBP are more toxic, inducing inflammatory factor release and abnormal metabolic protein expression in the liver and kidney through oxidative damage.

Distribution of phthalic acid esters in propolis ethanolic extract and capsuled propolis

Phthalate esters (PAEs), commonly used in food packaging materials, pose a potential health risk due to their migration into food matrices. Propolis, a resinous bee product widely consumed for its health benefits, is often packaged in plastics, raising concerns about PAE contamination. However, the occurrence of PAEs within propolis has been scarcely investigated. This study quantified PAE contamination profiles in propolis ethanolic extracts (PE) and propolis capsules (PCs) from China. The GC-MS/MS analysis of 20 PAEs demonstrated high linearity, indicating the reliability of the method. The limits of quantification (LOQ) ranged from 1.3 to 26.2 µg/kg, and the limits of detection (LOD) ranged from 0.4 to 8.6 µg/kg. Matrix effects ranged between 9% and 33%. Five PAEs were detected in PE samples: dimethyl phthalate (DMP), diethyl phthalate (DEP), diisobutyl phthalate (DiBP), dibutyl phthalate (DBP) and bis(2-ethylhexyl)phthalate (DEHP). Seventeen PAEs were detected in PC samples, with 15 consistently present in all samples (100% positivity). Diallyl phthalate (DAP), dipropyl phthalate (DPrP) and di-n-octyl phthalate (DNOP) were not detected in any sample. The total mean concentration of the 17 detected PAEs (∑17 PAEs) in the capsules ranged from 0.87 mg/kg to 23.71 mg/kg. This study found that PE and PC had the highest DBP (0.24 mg/kg) and di-heptyl phthalate (DHP: 2.29 mg/kg) levels on average, respectively. While PC showed higher PAE levels than PE. Therefore, this study provides insight into PAE contamination of raw propolis extract and encapsulated propolis.

Exposure to phthalates and replacements during pregnancy in association with gestational blood pressure and hypertensive disorders of pregnancy

Exposure to endocrine-disrupting chemicals such as phthalates may increase risk of hypertensive disorders of pregnancy (HDP). Prior studies lack investigation of chemical mixtures, phthalate replacements, or key periods of susceptibility including early pregnancy. In the present study, we used a longitudinal approach to evaluate gestational exposure to phthalates and replacements, as both single-pollutants and mixtures, in association with blood pressure and diagnosis of preeclampsia or any HDP. The Human Placenta and Phthalates prospective pregnancy cohort includes 291 participants recruited from two U.S. clinics. Urinary metabolites of ten phthalates and replacements were quantified at up to 8 time points per individual and averaged to create early (12-15 weeks) and overall (12-38 weeks) pregnancy exposure biomarkers. We collected data on gestational blood pressure (mean = 6.2 measures per participant) and diagnosis of preeclampsia (n = 26 cases) or any HDP (n = 44 cases). Linear mixed effects models estimated associations between exposure biomarkers and repeated blood pressure measures. We estimated exposure biomarker associations with preeclampsia and HDP using Cox proportional hazards or logistic regression models, respectively. Quantile g-computation was used to estimate joint effects of a phthalate or replacement mixture with each outcome. Early pregnancy exposure biomarkers demonstrated greater associations with adverse outcomes compared to overall pregnancy. A one-interquartile range increase in early pregnancy di-isononyl phthalate metabolites (ƩDiNP) was associated with a 1.13 mmHg (95 % confidence interval [CI]: 0.25, 2.37) and 0.90 mmHg (CI: 0.16, 1.65) increase in systolic and diastolic blood pressure, respectively. We also found positive but nonsignificant associations of early pregnancy mono-3-carboxypropyl phthalate, di-2-ethylhexyl terephthalate metabolites, and the high molecular weight phthalate mixture with blood pressure. Early pregnancy ƩDiNP was furthermore associated with increased odds of HDP (odds ratio: 1.37, CI: 1.03, 1.82), but not preeclampsia. In sum, early gestational exposure to DiNP and other high molecular weight phthalates may contribute to HDP.

Quercetin Alleviates Pyroptosis and Necroptosis Triggered on by DEHP Exposure in Bursa of Fabricius in Chicken by the ROS/MAPK/NF-κB Pathway

Bis(2-ethylhexyl) phthalate (DEHP) is an endocrine disruptor that may cause damage to several species. Quercetin (Que), a common flavonoid, has anti-inflammation, antioxidation, and immune regulation properties. In this study, we identified DEHP-exposed or Que-antagonist groups in chicken and MSB-1 cells to explore whether Que can mitigate DEHP-caused bursa of Fabricius pyroptosis and necroptosis. The findings demonstrated that Que reduced the expression of necroptosis and pyroptosis, inhibited the mitogen-activated protein kinase (MAPK)/NF-κB pathway, and mitigated oxidative stress caused by DEHP. The addition of the reactive oxygen species activator (Sanguinarin) raised the extent of oxidative stress, and the NF-κB activator (nuclear factor-kappa-B activator1, NF-κB act1) activated the MAPK/NF-κB pathway compared to the Que + DEHP group. In conclusion, Que inhibited the MAPK/NF-κB pathway to counteract DEHP-induced bursa pyroptosis and programmed necrosis. This work adds to the toxicological consequences of DEHP on avian further theoretical justification for Que's treatment of organic toxic damage.

The sprouting angiogenesis and vascular dysfunction triggered by bisphenol S and tetrabromobisphenol S through disrupting vascular endothelial-cadherin in zebrafish

Exogenous chemical toxicants may be important inducers of pathological angiogenesis diseases. However, few studies have investigated the associations between pathological angiogenesis diseases and chemical toxicant exposures, and the specific mechanism by which chemical toxicants induce sprouting angiogenesis is unclear. In this study, zebrafish were exposed to bisphenol S (BPS, 1-100 μg/L) and tetrabromobisphenol S (TBBPS, 0.1 and 10 μg/L) from the embryonic stage to the larval stage to investigate how pollutants interfere with angiogenesis and the function of ectopic sprouting vessels. The results showed that BPS and TBBPS promoted ectopic sprouting angiogenesis in different types of vascular plexuses, including the posterior cardinal vein (PCV) and superficial choroidal vessels (SOVs), at different developmental time points. Proteomic analyses of eGFP-positive endothelial cells (ECs) isolated from Tg(flk1: eGFP) zebrafish revealed that both BPS and TBBPS induced ectopic angiogenesis by acting on vascular endothelial-cadherin (VE-cadherin) and activating downstream proangiogenic signaling. In ectopic sprouting vessels induced by BPS and TBBPS, increased endothelial permeability resulted in white blood cell recruitment. Human oxidized lipids also tended to deposit in these ectopic vessels following BPS and TBBPS exposure. These findings suggest that chemical toxicant-induced ectopic angiogenesis is an important cause of vascular dysfunction and related diseases.

Comprehensive review of phthalate exposure: Health implications, biomarker detection and regulatory standards

Phthalates are a wide family of chemicals that are used in many different industrial applications used in many different industrial applications, including the production of plastics, toys, food packaging particularly for kids, and medical equipment. Due to their various chemical and physical properties, phthalates may negatively impact humans, animals, and the environment. Thus the potential for phthalate exposure and harm to humans, animals, and the environment is high because its presence is alarming. Phthalates can be ingested, inhaled, absorbed topically, or via iatrogenic exposure in animals and humans. This article aimed to ascertain the modes of exposure, fate and detection techniques, and harmful effects of phthalates on humans, animals, and the environment. This review also shows that the intake of phthalate above the established daily limit from sources such as food, toys, and air causes serious harm, including impaired immune function, difficulties in pregnancy, loss of reproduction, and damage to the kidneys, lungs, heart, and brain in humans. Children and pregnant women are the most impacted groups and phthalates also negatively affect the environment and wildlife. A few methods to determine phthalate exposure, such as the LC and the HPLC-MS/MS methods, which employ human fluid or dust air as a biomarker, are also addressed here. Consequently, this comprehensive review aims to provide a detailed analysis of the existing evidence regarding explicit links between exposure to phthalates and subsequent health outcomes that may be directly related to this exposure. Additionally, we reviewed the developed and validated analytical methods and supplemented the literature with partial biomonitoring data on their metabolites.

Accumulation characteristics and fate modeling of phthalic acid esters in surface water from the Three Gorges Reservoir area, China

Phthalic acid esters (PAEs) are a group of compounds widespread in the environment. To investigate the occurrence and accumulation characteristics of PAEs, surface water samples were collected from the Three Gorges Reservoir area, China. The total concentrations of 11 analyzed PAEs (∑11PAEs) in the collected water samples ranging from 197.7 to 1,409.3 ng/L (mean ± IQR: 583.1 ± 308.4 ng/L). While DEHP was the most frequently detected PAE, DnBP and DnNP were the most predominant PAEs in the analyzed water samples with a mean contribution of 63.3% of the ∑11PAEs. The concentrations of the ∑11PAEs in the water samples from the upper reaches of the Yangtze River were significantly higher than those from the middle reaches. To better understand the transport and fate of the PAEs, seven detected PAEs were modeled by Quantitative Water Air Sediment Interaction (QWASI). The simulated and measured values were close for most PAEs, and differences are within one order of magnitude even for the worst one. For all simulated PAEs, water and particle inflow were main sources in the reservoir, whereas water outflow and degradation in water were important removal pathways. The contribution ratios of different sources/losses varied from PAEs, depending on their properties. The calculated risk quotients of DnNP in the Three Gorges Reservoir area whether based on monitoring or simulating results were all far exceeded the safety threshold value, implying the occurrence of this PAE compound may cause potential adverse effects for the aquatic ecology of the Three Gorges Reservoir area.

Occurrence of phthalate esters in the yellow and Yangtze rivers of china: Risk assessment and source apportionment

Phthalate esters (PAEs), recognized as endocrine disruptors, are released into the environment during usage, thereby exerting adverse ecological effects. This study investigates the occurrence, sources, and risk assessment of PAEs in surface water obtained from 36 sampling points within the Yellow River and Yangtze River basins. The total concentration of PAEs in the Yellow River spans from 124.5 to 836.5 ng/L, with Dimethyl phthalate (DMP) (75.4 ± 102.7 ng/L) and Diisobutyl phthalate (DiBP) (263.4 ± 103.1 ng/L) emerging as the predominant types. Concentrations exhibit a pattern of upstream (512.9 ± 202.1 ng/L) > midstream (344.5 ± 135.3 ng/L) > downstream (177.8 ± 46.7 ng/L). In the Yangtze River, the total concentration ranges from 81.9 to 441.6 ng/L, with DMP (46.1 ± 23.4 ng/L), Diethyl phthalate (DEP) (93.3 ± 45.2 ng/L), and DiBP (174.2 ± 67.6 ng/L) as the primary components. Concentration levels follow a midstream (324.8 ± 107.3 ng/L) > upstream (200.8 ± 51.8 ng/L) > downstream (165.8 ± 71.6 ng/L) pattern. Attention should be directed towards the moderate ecological risks of DiBP in the upstream of HH, and both the upstream and midstream of CJ need consideration for the moderate ecological risks associated with Di-n-octyl phthalate (DNOP). Conversely, in other regions, the associated risk with PAEs is either low or negligible. The main source of PAEs in Yellow River is attributed to the release of construction land, while in the Yangtze River Basin, it stems from the accumulation of pollutants in lakes and forests discharged into the river. These findings are instrumental for pinpointing sources of PAEs pollution and formulating control strategies in the Yellow and Yangtze Rivers, providing valuable insights for global PAEs research in other major rivers.

A covalent organic framework-coated steel substrate as a mass spectrometric ionization source for the effective enrichment and rapid detection of phthalates in beverages

A novel, rapid, and simple detection method is proposed to realize the simultaneous detection of seven phthalate esters (PAEs) within 1.5 min. A suitable covalent organic framework (COF) was coated on a stainless steel substrate (COFCS) to serve as both an enrichment element and a solid substrate for electrospray ionization mass spectrometry (ESI-MS). Twenty microliters of elution solvent was added dropwise to the COFCS enriched with analytes, and then high voltage electricity was applied and combined with ambient mass spectrometry (AMS) to realize the detection of PAEs. In order to investigate the reliability of the COFCS-ESI-MS method, dimethyl phthalate (DMP), diethyl phthalate (DEP), ethyl phthalate (2-methoxy) (DMEP), phthalate(2-ethoxy) ethyl ester (DEEP), dipentyl phthalate (DPP), dihexyl phthalate (DHXP), and butyl benzyl phthalate (BBP) were detected simultaneously. The proposed method showed good linearity in the range 0.1-80 μg/L with the determination coefficient (R2) > 0.9916. The limits of detection (LODs) and limits of quantification (LOQs) of the determination technology were in the ranges 0.03-0.40 μg/L and 0.1-2.0 μg/L, respectively. The results demonstrated that the simultaneous detection of the seven PAEs in beverages can be realized using the method, and the spiked recoveries were in the range 85.17-104.09% with the relative standard deviations (RSDs) < 8.32%. In addition, the COFCS has good reusability and batch-to-batch repeatability and can be re-used at least 5 times and still maintain good enrichment performance.

Association between phthalate exposure and rash eczema disease: based on NHANES 2005-2006

Phthalates are commonly found in plastic products, personal care products, and food packaging. In recent years, the relationship between phthalates and skin diseases such as eczema has been gaining attention. As endocrine disruptors, phthalates may increase the risk of eczema by affecting the immune system or skin barrier function. This study used a cross-sectional design based on data from the 2005-2006 National Health and Nutrition Examination Survey to assess the association between phthalate exposure and eczema in adults using generalized linear models, restricted cubic spline plots and weighted quantile sum regression. Eczema diagnosis was determined by participants' self-report of whether they had ever been diagnosed with eczema by doctors. Phthalate exposure was assessed by urinary concentrations of phthalates. A total of 1203 subjects, aged 18 years and over, were recruited for the study, comprising 627 males and 576 females. We found that females had significantly higher phthalate exposure concentrations than males. There was a significant positive correlation between monoisononyl phthalate (MiNP) and eczema. Mixture analysis similarly found a positive correlation between phthalates and rash eczema, and MiNP was the main contributor. Further sex-stratified analyses showed that this association occurred predominantly in females, while no significant association was found in the male population. Phthalates may have adverse effects on skin health, particularly in women. Future studies should further investigate the mechanisms of this association and focus on other types of phthalates and their effects on skin health.

Diisononyl phthalate down-regulates the expression of antioxidant genes NFE2L2, TXN, and TXNRD2, while diethyl-hexyl terephthalate up-regulates their expression including SOD-1

Phthalates, widely utilised as plasticisers to enhance the flexibility of rigid materials like polyvinyl chloride, are known for their endocrine-disrupting properties and cytotoxic effects.This study investigated the impact of Diisononyl phthalate (DINP) and Diethyl-hexyl terephthalate (DEHT) on human endothelial cells (EA.hy926).The assessment focused on cell viability, reactive oxygen species (ROS) production, and the antioxidant-responsive genes expression (NFE2L2, SOD1, TXN, and TXNRD2) following exposure to varying 1, 10, and 100 µg/mL of DINP or DEHT.Cell viability was determined using MTT and lactate dehydrogenase (LDH) release assays. ROS were measured using the DCFDA assay.Gene expression analysis was conducted via qRT-PCR after 48 h of exposure. Results revealed that DINP 100 µg/mL significantly reduced cell viability at 11 and 17% at 48 and 72 h, respectively, whereas increased LDH release by 69% at 48 h. ROS levels also rose by 19-30%, accompanied by down-regulation of NFE2L2, TXN, and TXNRD2.Conversely, DEHT had no adverse effect on cell viability or LDH levels but elevated ROS production (11-14%) and induced up-regulation of antioxidant genes, including SOD1.The findings indicate that DINP exposure could negatively affect the cellular antioxidant response, whereas DEHT leads to up-regulation of antioxidant genes without detrimental effects on viability.

Maternal phthalates exposure promotes neural stem cell differentiation into phagocytic astrocytes and synapse engulfment via IRE1α/XBP1s pathway

Humans are widely exposed to phthalates, a common chemical plasticizer. Previous cohort studies have revealed that maternal exposure to monobutyl phthalate (MBP), a key metabolite of phthalates, is associated with neurodevelopmental defects. However, the molecular mechanism remains unclear. Here, we demonstrate that maternal exposure to MBP enhances neural stem cell (NSC) differentiation into astrocytes with highly expressed C3 and LCN2 in mouse offspring, resulting in increased synapse phagocytosis and cognitive dysfunction. Mechanistically, we find that MBP exposure activates the IRE1α/XBP1s (spliced XBP1) stress response pathway, which regulates key genes involved in astrocyte differentiation (SOX9 and ATF3) and reactivity (C3 and LCN2). Conditional knockout or pharmacological inhibition of IRE1α markedly inhibits NSC differentiation into astrocytes and astrocyte reactivity, attenuates synapse phagocytosis, and improves cognitive function. This phenotype is further recapitulated in a human brain organoid model. Together, these findings unveil the molecular mechanism underlying the neurodevelopmental deficits caused by a widespread environmental pollutant.

Interaction of GPER-1 with the endocrine signaling axis in breast cancer

G Protein-Coupled Estrogen Receptor 1 (GPER-1) is a membrane estrogen receptor that has emerged as a key player in breast cancer development and progression. In addition to its direct influence on estrogen signaling, a crucial interaction between GPER-1 and the hypothalamic-pituitary-gonadal (HPG) axis has been evidenced. The novel and complex relationship between GPER-1 and HPG implies a hormonal regulation with important homeostatic effects on general organ development and reproductive tissues, but also on the pathophysiology of cancer, especially breast cancer. Recent research points to a great versatility of GPER-1, interacting with classical estrogen receptors and with signaling pathways related to inflammation. Importantly, through its activation by environmental and synthetic estrogens, GPER-1 is associated with hormone therapy resistance in breast cancer. These findings open new perspectives in the understanding of breast tumor development and raise the possibility of future applications in the design of more personalized and effective therapeutic approaches.

Physiological and multi-omics analysis revealed the mechanism of arbuscular mycorrhizal fungi to cadmium toxicity in green onion

Cadmium (Cd) is a highly toxic agricultural pollutant that inhibits the growth and development of plants. Arbuscular mycorrhizal fungi (AMF) can enhance plant tolerance to Cd, but the regulatory mechanisms in Allium fistulosum (green onion) are unclear. This study used a Cd treatment concentration of 1.5 mg·kg-1, which corresponds to the risk control threshold for soil pollution in Chinese agricultural land, to examine the effects and molecular mechanisms of AMF inoculation on the growth and physiology of green onion under Cd stress. AMF formed an effective symbiotic relationship with green onion roots under Cd stress, increased plant biomass, improved root structure and enhanced root vitality. AMF-colonized green onion had reduced Cd content in roots and leaves by 63.00 % and 46.50 %, respectively, with Cd content being higher in the roots than in the leaves. The ameliorative effect of AMF on Cd toxicity was mainly due to a reduction in malondialdehyde content in leaves (30.12 %) and an enhancement of antioxidant enzyme activities (peroxidase, catalase, superoxide dismutase, glutathione reductase and reduced glutathione) that mitigated damage from excessive reactive oxygen species. In addition, AMF induced secretion of easily extractable glomalin soil protein and total glomalin-related soil protein and inhibited the translocation of Cd to the shoots. Transcriptomic and metabolomic correlation analyses revealed that differentially expressed genes and metabolites in AMF-inoculated green onion under Cd stress were predominantly enriched in the "phenylpropanoid biosynthesis" and "phenylalanine metabolism" pathways, upregulated the expression of the HCT, PRDX6, HPD, MIF, and HMA3 genes, and accumulation of the phenylalanine, L-tyrosine, and 1-O-sinapoyl-β-glucose metabolites. Thus, AMF enhance Cd tolerance in green onions by sequestering Cd in roots, restricting its translocation, modulating antioxidant defenses and inducing the expression of genes involved in the phenylpropanoid biosynthesis and phenylalanine metabolism pathways. Collectedly, we for the first time revealed the mechanism of AMF alleviating the toxicity of Cd to green onion, providing a theoretical foundation for the safe production and sustainable cultivation of green onion in Cd-contaminated soils.

Inflammation mediates the adverse effects of urinary phthalate exposure on metabolic disease risk: Results from NHANES 2005-2016

BACKGROUND

Phthalates are a category of chemicals commonly utilized in various industrial applications and everyday products. Their associations with health issues remains a significant concern. Although some studies have suggested associations between phthalates and metabolic diseases, the current understanding of the associations is still limited, especially the lack of effects of mixed exposure.

METHODS

This cross-sectional study included information from 9217 participants in National Health and Nutrition Examination Survey (NHANES) from 2005 to 2016. Multivariate logistic regression was used to explore the associations between single phthalate exposure and obesity and its complications. Weighted quantile sum (WQS) regression and Quantile G-Computation (Qgcomp) models were used to further analyze the associations between mixed phthalate exposure and obesity and its complications. Mediated analysis was used to explore the mediating role of immune cells in the relationship between phthalate exposure and obesity and its complications.

RESULTS

MiBP, MCOP and MBzP were associated with an increased risk of obesity. MiBP and MCOP were associated with an increased risk of abdominal obesity. MCNP, MCOP, MEHHP, MEOHP and MECPP were positively associated with T2DM. Mixed phthalate exposure was positively associated with obesity and T2DM. Monocytes mediated the effects of MiBP, MEHP and MBzP on obesity, explaining 7.94 %, -2.32 % and 6.69% of the total effect, respectively.

CONCLUSIONS

This study revealed a significant association between mixed phthalate exposure and obesity and its complications, underlining the importance of considering the interactions of these compounds. The synergistic effects of multiple phthalates may exacerbate health risks.

The combination of polystyrene microplastics and di (2-ethylhexyl) phthalate promotes the conjugative transfer of antibiotic resistance genes between bacteria

Plastic pollution has become a common phenomenon. The process of plastic degradation is accompanied by the release of microplastics and plasticizers. However, the coexistence of microplastics and plasticizers on the transfer of antibiotic resistance genes (ARGs) has not been reported until now. Here, polystyrene (PS) microplastics and plasticizer di (2-ethylhexyl) phthalate (DEHP) were used for combined treatment experiment and their effects and mechanisms on the transfer of ARGs between bacteria were explored. By increasing cell membrane permeability and the expression of correlated genes, the combined treatment group showed promoting effects on the transfer of ARGs than that of control, with the highest promoting effects observed at 1 mg/L PS and 0.1 mg/L DEHP, which was 3.0 times higher in ARGs transfer rate than that of control. It was found that PS and DEHP treatment alone also led to a higher conjugative transfer frequency, and the frequency of the combined treatment was lower than that of the corresponding single treatment group. This indicated that the effects of DEHP and microplastics on ARGs transfer might be antagonistic. Transcriptome analysis indicated that the transfer of ARGs affects bacterial ion binding, oxidative stress, and energy metabolism processes, while the expression of genes related to cell membrane permeability, DNA repair, bacterial drug resistance, and quorum sensing also increase. This study may provide new insights for explaining the combined effects of various pollutants in the environment on the spread of ARGs.

Boronic acid functionalized of covalent organic framework for high performance capture of trace phthalates

In order to improve the enrichment performance of parent covalent organic frameworks (COFs), boronic acid functionalized of COF (COF-B(OH)2) was obtained by a simple standing method for the first time. The obtained COF-B(OH)2 exhibited the new characteristics that were not possessed by pure COF and was employed as the solid phase microextraction (SPME) coating material for highly efficient enrichment of trace endocrine disruptors phthalates (PAEs). Compared to pure COF, the synergistic effect of the newly emerged unique pore structure and boric acid interaction sites, and the large specific surface area and the abundant benzene ring structure inherited by original COF framework endowed COF-B(OH)2 with enhanced enrichment performance for PAEs. Combined with gas chromatography-mass spectrometry (GC-MS), COF-B(OH)2 exhibited the good linearity over a wide concentration of 0.1-3000 ng l-1 with good coefficients (R2, 0.9916-0.9998) for PAEs. The developed method was successfully employed for detection of trace PAEs in milk and water samples, demonstrating high recoveries (90.6-111.3 %). This work provides a sustainable approach to developing high-performance materials for enriching environmental pollutants.

Unveiling the environmental impact of tire wear particles and the associated contaminants: A comprehensive review of environmental and health risk

This review offers a novel perspective on the environmental fate and ecotoxicological effects of tire wear particles (TWPs), ubiquitous environmental contaminants ranging in size from micrometers to millimeters (averaging 10-100 micrometers). These particles pose a growing threat due to their complex chemical composition and potential toxicity. Human exposure primarily occurs through inhalation, ingesting contaminated food and water, and dermal contact. Our review delves into the dynamic interplay between TWP composition, transformation products (TPs), and ecological impacts, highlighting the importance of considering both individual chemical effects and potential synergistic interactions. Notably, our investigation reveals that degradation products of certain chemicals, such as diphenylguanidine (DPG) and diphenylamine (DPA), can be more toxic than the parent compounds, underscoring the need to fully understand these contaminants' environmental profile. Furthermore, we explore the potential human health implications of TWPs, emphasizing the need for further research on potential respiratory, cardiovascular, and endocrine disturbances. Addressing the challenges in characterizing TWPs, assessing their environmental fate, and understanding their potential health risks requires a multidisciplinary approach. Future research should prioritize standardized TWP characterization and leachate analysis methods, conduct field studies to enhance ecological realism, and utilize advanced analytical techniques to decipher complex mixture interactions and identify key toxicants. By addressing these challenges, we can better mitigate the environmental and health risks associated with TWPs and ensure a more sustainable future.

The Aloe vera acemannan polysaccharides inhibit phthalate-induced cell viability, metastasis, and stemness in colorectal cancer cells

Plasticizers are recognized as environmental pollutants that may be associated with a range of health concerns, including impacts on growth, development, and oncogenic risks. Previous research demonstrated that prolonged exposure to di-(2-ethylhexyl) phthalate and its metabolite mono-(2-ethylhexyl) phthalate contributes to chemotherapeutic drug resistance and stemness in colorectal cancer cells. Aloe vera, an herbaceous plant with a long-standing history in traditional medicine, has attracted considerable attention for its diverse pharmacological properties. This study aimed to investigate the therapeutic potential of polysaccharides extracted from Aloe vera, specifically focusing on their anticancer properties. We eluted polysaccharides from Aloe vera using water and ethanol, resulting in the fractions designated A50 and I50, respectively. We characterized their effects on cell viability, migration, invasion, stemness, and glycosylation of colorectal cancer cells exposed to phthalates. Comprehensive glycan analysis revealed that phthalate exposure induced alterations in glycosylation patterns in colorectal cancer cells. Treatment with A50 and I50 reversed these changes to varying degrees, indicating distinct regulatory roles of the two polysaccharide fractions in colorectal cancer cells subjected to phthalate exposure. A50 exhibited a dose-dependent reduction in cell viability induced by phthalates, whereas I50 demonstrated no such effect. Notably, I50 displayed a notable inhibitory effect on migration, invasion, and stemness induced by phthalates when compared with A50. The differing polysaccharide structures of A50 and I50 may account for their divergent effects on the malignancy of colorectal cancer cells. These findings underscore the potential of Aloe vera polysaccharides in anticancer therapy and highlight the necessity for further investigation into their clinical applications.

Thyroid hormones and oxidative stress moderated the association between urinary phthalate metabolites and cardiovascular risk factors

While previous studies suggested that phthalate exposure poses a risk to cardiovascular health, the results are mixed and indicated variability based on population characteristics and health outcomes assessed. Research that simultaneously investigates the association between urinary phthalate metabolites and multiple cardiovascular risk factors within a single study is relatively scarce. This study assessed human exposure to phthalates by determining urinary metabolite concentrations, and applied multiple statistical techniques to systematically evaluate the individual dose-response relationships and joint effects of phthalate exposure on blood lipids, blood pressure, and fasting blood glucose. The results revealed significant negative associations between urinary phthalate metabolites and low-density lipoprotein cholesterol, triglycerides, total cholesterol, diastolic blood pressure, systolic blood pressure, and fasting blood glucose. Significant nonlinear associations were obtained between specific individual metabolites and diastolic blood pressure. The oxidative stress biomarker 8-hydroxydeoxyguanosine levels in urine and thyroid hormone levels in paired serum were measured simultaneously. Then, we examined the indirect roles of thyroid hormones and oxidative stress in the association between urinary phthalate metabolites and cardiovascular risk factors by mediation and moderation analysis. While the mediation effect was not statistically significant, the negative associations of urinary phthalate metabolites with fasting blood glucose, triglyceride, and lipoprotein cholesterol were statistically significant at lower levels of thyroid hormones by moderation analysis. The association was also significant under certain levels of oxidative stress. The results demonstrated that phthalate exposure is associated with several cardiovascular risk factors, and maintaining appropriate oxidative stress levels and ensuring sufficient thyroid hormone levels may attenuate these associations.

Association between phthalates exposure and all-cause mortality among diabetic cases: A prospective study

The aim of this study was to explore the association between phthalates (PAEs) exposure and all-cause mortality among diabetic cases, and potential molecular mechanisms of the effect. We followed 2806 diabetes cases from 2008 to the end of 2018 based on the Dongfeng-Tongji study, of which 446 cases died. We measured serum levels of six PAEs (DMP, DEP, DiBP, DnBP, BBP, and DEHP). Cox models were used to investigate the associations between PAEs and all-cause mortality. Genes related to PAEs are obtained from the Comparative Toxicogenomics Database. We constructed polygenic scores for sex hormone-binding globulin (SHBG) and testosterone, and functional SNPs for IL-6, PPARG, and GPX1 from genotyping data, and further analyzed the environment-gene interactions. The positive associations of PAEs (DMP, DiBP, DnBP, DEHP) with mortality were only observed in males but not in females. Comparing with the extreme quartile 1, the HRs (95% CI) for quartile 4 were 1.63 (0.17, 2.26) for DMP, 1.82 (1.29, 2.56) for DiBP, 1.68 (1.18, 2.40) for DnBP, 1.66 (1.17, 2.36) for DEHP. Enrichment analysis showed that PAEs-related genes were mainly associated with hormones and IL-6-related pathways. Genetic variants of SHBG, testosterone, and IL-6 modified the association between PAEs mixture and all-cause mortality. PAEs exposure are associated with all-cause mortality among diabetic cases, and PAE exposure increases the risk of all-cause mortality only in males. Effects on the hormonal system and IL6-related pathways may be potential mechanisms.

Improving the Health and Environmental Health Literacy of Professionals: Evaluating the Effect of a Virtual Intervention on Phthalate Environmental Health Literacy

The American College of Obstetricians and Gynecologists provided updated guidance in 2021, recommending that reproductive health professionals should include discussion of environmental exposures with their patients. However, environmental health is seldom included in medical training, with endocrine-disrupting chemicals, such as phthalates-linked to adverse pregnancy outcomes-being among the least discussed. We developed a one-hour virtual educational intervention to train reproductive health professionals on the routes of phthalate exposure, potential associated health impacts, and suggestions on how to discuss exposure reduction with patients. The intervention was designed to include perspectives from patients, scientists, and clinicians. Using a pre/post/post design, we evaluated the impact of the intervention on reproductive health professionals' phthalate-related reproductive health literacy via a validated environmental health literacy (EHL) scale, their confidence in discussing phthalates, and the frequency of discussions about phthalates with patients. All materials, including the study questionnaires and intervention materials, were administered virtually to reproductive health professionals (n = 203) currently seeing patients working in the United States. After completing the intervention, reproductive health professionals' average EHL increased (pre-course: 22.3, post-course: 23.7, 2 months post-course: 24.0), as did their confidence in discussing phthalates with their patients (pre-course: 1% (2/203) reported being quite confident, post-course: 64% (131/203) reported being quite confident, and 2 months post course: 86% (174/203) reported being quite confident). Additionally, the reported frequency of discussions about phthalates with patients rose substantially (pre-course: 0% (0/203) reported usually discussing phthalates with patients, and 2 months post-course: 86% (175/203) reported usually discussing phthalates with patients): In line with the recommendations of the American College of Obstetricians and Gynecologists, this online phthalate educational intervention tool increased EHL among reproductive health professionals and shifted clinical care to include discussion about phthalates, a reproductive toxicant.

Association of Di(2-ethylhexyl) Phthalate Exposure with Reproductive Hormones in the General Population and the Susceptible Population: A Systematic Review and Meta-Analysis

Di(2-ethylhexyl) phthalate (DEHP), an environmental endocrine disruptor, has hormone-like activity and endocrine-disrupting effects. However, the types of reproductive hormones associated with DEHP vary across the studies. Thus, we conducted a systematic review and meta-analysis to pool existing epidemiological evidence. We searched three databases up to January 31, 2024, for eligible original studies to ultimately include 37 studies from eight countries with a total of 28 911 participants. DEHP exposure was evaluated with urinary metabolites. Since the main types, production sites, blood concentrations, and functions of reproductive hormones differ between men and women, we reported the combined effect values by gender. Subgroup analyses were conducted by age, subfertility status, and the national sociodemographic index (SDI) level. Furthermore, the effect of maternal exposure during pregnancy on children's reproductive hormone levels was analyzed separately. Overall, in general, in men, DEHP was positively correlated with sex hormone binding-globulin (SHBG) and adversely correlated with total testosterone (TT), free androgen index (FAI), and follicle-stimulating hormone (FSH). Results indicated that among men of reproductive age, DEHP exposure was associated with more significant hormonal suppression in infertile men compared with fertile men. Notably, age subgroup analysis among women revealed that postmenopausal women were more vulnerable to DEHP, which was related to lower TT and estradiol (E2). However, this study did not observe a significant association between prenatal DEHP metabolites and reproductive hormone levels in children. Our research identifies the most susceptible hormones (androgen suppression) after DEHP exposure and suggests that infertile men and postmenopausal women are in great need of more attention as sensitive populations.

Associations of exposure to phthalate with serum uric acid and hyperuricemia risk, and the mediating role of systemic immune inflammation

BACKGROUND

Previous studies found that urinary phthalates (PAEs) metabolites may be associated with increased serum uric acid concentration and hyperuricemia risk. However, no population-based study has investigated the underlying biological mechanisms.

METHODS

This nationwide cross-sectional study analyzed the data from the National Health and Nutrition Examination Survey (NHANES) 2003-2018. Urinary PAEs metabolites were measured and 8 PAEs metabolites (MCPP, MECPP, MEHHP, MEOHP, MBzP, MiBP, MBP, and MEP) were incorporated into the analysis. Serum uric acid was determined and hyperuricemia cases were identified. Multi-variable generalized linear model, exposure-response (E-R) function and weighted quantile sum (WQS) regression were utilized to investigate the relationships of PAEs metabolites with serum uric acid concentration and hyperuricemia risk. Systemic immune inflammation (SII) was assessed using the SII index and its mediation effects were explored using causal mediation effect model.

RESULTS

Data from 10,633 US adults in the NHANES 2003-2018 was analyzed. Except for MEP, individual PAEs metabolite and total PAEs metabolites were associated with increased serum uric acid concentration and hyperuricemia risk. E-R function of PAEs metabolites with serum uric acid concentration and the risk of hyperuricemia showed significantly positive associations with most curves in a nearly linear relationship. WQS regression showed that the mixture of PAEs metabolites was related to elevated serum uric acid and hyperuricemia risk, and MBzP was identified as the most contributing PAEs metabolite. The causal mediation effect model found that SII significantly mediated the relationships of PAEs metabolites with serum uric acid and hyperuricemia risk.

CONCLUSION

Individual and mixture of urinary PAEs metabolites were associated with increased serum uric acid concentration and the risk of hyperuricemia. MBzP exhibited the highest contribution to the overall effects. SII alteration may be an important biological mechanism underlining the impact of PAEs metabolites on serum uric acid concentration and hyperuricemia risk.

Association between phthalates exposure and myocardial damage in the general population: A cross-sectional study

BACKGROUND

Cardiovascular consequences of phthalates exposure have been given increasing attention, but the association of phthalates with subclinical cardiovascular disease (CVD) was unknown. Accordingly, this study aimed to investigate the association between phthalates exposure and high-sensitivity cardiac troponin I (hs-cTnI), a marker of myocardial injury, which was detectable in the subclinical stage of CVD.

METHODS

Participants aged 6 years or older with available urinary phthalates metabolites and serum hs-cTnI concentrations were included in the National Health and Nutrition Examination Survey 2003-2004 cycle. Multivariable linear regression and weighted quantiles sum (WQS) regression were used to assess the association of hs-cTnI with individual phthalates and their co-exposure. Di-2-ethylhexylphthalate (ΣDEHP), high-molecular-weight phthalate (ΣHMWP), and low-molecular-weight phthalate (ΣLMWP) were defined as the molecular sum of phthalates metabolites in urine.

RESULTS

2241 participants were finally included. The percent change of serum hs-cTnI concentrations related to per 1-standard deviation increase of logarithmic urinary phthalates concentrations was 3.4% (0.1-6.7, P = 0.04) for ΣDEHP, 3.6% (0.3-6.9, P = 0.03) for ΣHMWP, and 3.5% (0.2-6.8, P = 0.04) for ΣLMWP. Co-exposure to phthalates metabolites expressed as the WQS index also demonstrated a positive association with hs-cTnI. A similar association pattern was found in the population with no prior CVD.

CONCLUSIONS

This study indicated the potential of phthalates to myocardial injury which may occur even before clinically apparent CVD was identified, emphasizing the significance of reducing phthalates in the prevention of CVD.

Phthalate Metabolites Were Related to the Risk of High-Frequency Hearing Loss: A Cross-Sectional Study of National Health and Nutrition Examination Survey

Background

Phthalate metabolites are pervasive in the environment and linked to various health issues. This study aimed to investigate the relationship between phthalate metabolites and hearing loss.

Methods

We conducted a cross-sectional study with 1713 participants based on the National Health and Nutrition Examination Survey 2015-2018. Participants were defined as speech-frequency hearing loss (SFHL) or high-frequency hearing loss (HFHL). We analyzed the baseline characteristics of participants and assessed the detection rates of phthalate metabolites in samples. Phthalate metabolites with detection rates of >85% were enrolled. Then, restricted cubic spline and multivariable logistic regression analyses were conducted to explore the association of phthalate metabolites with hearing loss. Multi-model analysis was employed to select an optimal predictive model for HFHL based on phthalate metabolites and clinical factors.

Results

Among participants, 24.518% had SFHL and 41.998% had HFHL, associated with older age, higher BMI, male, non-Hispanic white, lower physical activity levels, higher exposure to work noise, hypertension, and diabetes. Monobenzyl phthalate (MBZP) showed a positive linear association with both SFHL and HFHL. Multivariable logistic regression revealed MBZP as a significant risk factor for HFHL (odds ratio=1.339, 95% confidence interval, 1.053-1.707). According to the area under curve (AUC) values, the logistic regression model had the best diagnostic performance of HFHL, with the highest AUC values of 0.865 in the test set. In the model, gender, diabetes, and MBZP were the top predictors of HFHL.

Conclusion

The study identified a significant association between MBZP exposure and HFHL, highlighting the need to reduce phthalate exposure.

Quercetin antagonizes apoptosis, autophagy and immune dysfunction induced by di(2-ethylhexyl) phthalate via ROS/ASK1/JNK pathway

Di(2-ethylhexyl) phthalate (DEHP) is a plasticizer that can damage various organizations and physiques through oxidative stress. Quercetin (Que) is a rich polyphenol flavonoid with good anti-inflammatory and antioxidant effects. However, the protection mechanism of Que against DEHP exposure-induced IPEC-J2 cell injury and the implication of autophagy, apoptosis and immunity are still unclear. In this experiment, we looked into the toxicity regime of DEHP exposure on IPEC-J2 cells and the antagonistic function of Que on DEHP. In the experiment, 135 μM DEHP and/or 80 μM Que were used to treat the IPEC-J2 cells for 24h. Experiments indicated that DEHP exposure can cause increased reactive oxygen species (ROS) levels leading to oxidative stress, decreased CAT, T-AOC and GSH-Px activities, increased MDA and H2O2 accumulation, activated the ASK1/JNK signalling pathway, and further increases in the levels of apoptosis markers Bax, Caspase3, Caspase9, and Cyt-c, while reduced the Bcl-2 expression. DEHP also increased the expression of genes linked to autophagy (ATG5, Beclin1, LC3), while decreasing the expression of P62. Additionally, DEHP exposure led to elevated levels of IL1-β, IL-6, MCP-1, and TNF expression. When exposed to Que alone, there were no significant changes in cellular oxidative stress level, ASK1/JNK signalling pathway expression level, apoptosis, autophagy and cellular immune function. The combination of DEHP and Que treatment remarkably decreased the proportion of autophagy and apoptosis, and recovered cellular immunity. In summary, Que can attenuate DEHP-induced apoptosis and autophagy in IPEC-J2 cells by regulating the ROS/ASK1/JNK signalling pathway and improving the immune dysfunction of IPEC-J2 cells.

The Adverse Impact of Bisphenol A Exposure on Optimal Cardiovascular Health as Measured by Life's Essential 8 in U.S. Adults: Evidence from NHANES 2005 to 2016

Background/Objectives: Cardiovascular diseases are the primary cause of global morbidity and mortality, with cardiovascular health (CVH) remaining well below the ideal level and showing minimal improvement in the U.S. population over recent years. Bisphenol A (BPA), a pervasive environmental contaminant, has emerged as a potential contributor to adverse cardiovascular outcomes. This cross-sectional study delves into the impact of BPA exposure on achieving optimal CVH, as assessed by the Life's Essential 8 metric, among U.S. adults. Methods: Analyzing data from 6635 participants in the National Health and Nutrition Examination Survey (NHANES) collected between 2005 and 2016, BPA exposure was quantified through urinary BPA levels, while optimal CVH was defined using the American Heart Association's Life's Essential 8 criteria, scoring between 80 and 100. Multivariable logistic regression and propensity score matching were employed to evaluate the association between BPA exposure and CVH. Results: This study reveals that individuals in the highest tertile of urinary BPA levels were 27% less likely to attain optimal CVH compared with those in the lowest tertile (OR, 0.73; 95% CI: 0.59-0.92). This negative association persisted across diverse demographics, including age, sex, and race, mirrored in the link between urinary BPA levels and health factor scores. Conclusions: The findings underscore the potential benefits of reducing BPA exposure in enhancing the prevalence of optimal CVH and mitigating the burden of cardiovascular disease. Given the widespread use of BPA, ongoing monitoring of BPA's impact on CVH is essential. Further studies are necessary to elucidate the long-term and causative connections between BPA and CVH. These insights contribute to understanding the complex interplay between environmental factors and CVH outcomes, informing targeted interventions to mitigate cardiovascular disease risk within the population.

Association between phthalates exposure and non-alcoholic fatty liver disease under different diagnostic criteria: a cross-sectional study based on NHANES 2017 to 2018

Purpose

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease. Phthalates have been suggested to influence the development of NAFLD due to their endocrine-disrupting properties, but studies based on nationally representative populations are insufficient, and existing studies seem to have reached conflicting conclusions. Due to changes in legislation, the use of traditional phthalates has gradually decreased, and the phthalates substitutes is getting more attention. This study aims to delve deeper into how the choice of diagnostic approach influences observed correlations and concern about more alternatives of phthalates, thereby offering more precise references for the prevention and treatment of NAFLD.

Methods

A cohort of 641 participants, sourced from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 database, was evaluated for NAFLD using three diagnostic methods: the Hepatic Steatosis Index (HSI), the US Fatty Liver Indicator (US.FLI), and Vibration Controlled Transient Elastography (VCTE). The urinary metabolite concentrations of Di-2-ethylhexyl phthalate (DEHP), Di-isodecyl phthalate (DIDP), Di-isononyl phthalate (DINP), Di-n-butyl phthalate (DnBP), Di-isobutyl phthalate (DIBP), Di-ethyl phthalate (DEP) and Di-n-octyl phthalate (DnOP) were detected. The association between NAFLD and urinary phthalate metabolites was evaluated through univariate and multivariate logistic regression analyses, considering different concentration gradients of urinary phthalates.

Results

Univariate logistic regression analysis found significant correlations between NAFLD and specific urinary phthalate metabolites, such as Mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), Mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), Mono-2-ethyl-5-carboxypentyl phthalate (MECPP), and Mono-(carboxyisoctyl) phthalate (MCiOP), across different diagnostic criteria. In a multivariate logistic regression analysis adjusting only for demographic data, MEOHP (OR = 3.26, 95% CI = 1.19-8.94, p = 0.029), MEHHP (OR = 3.98, 95% CI = 1.43-11.1, p = 0.016), MECPP (OR = 3.52, 95% CI = 1.01-12.2, p = 0.049), and MCiOP (OR = 4.55, 95% CI = 1.93-10.7, p = 0.005) were positively related to NAFLD defined by HSI and VCTE. The correlation strength varied with the concentration of phthalates, indicating a potential dose-response relationship. Adjusting for all covariates in multivariate logistic regression, only MCiOP (OR = 4.22, 95% CI = 1.10-16.2, p = 0.044), as an oxidative metabolite of DINP, remained significantly associated with NAFLD under the VCTE criterion, suggesting its potential role as a risk factor for NAFLD.

Conclusion

This research highlights a significant association between DINP and NAFLD. These findings underscore the need for further investigation into the role of the phthalates substitutes in the pathogenesis of NAFLD and the importance of considering different diagnostic criteria in research.

Vascular endothelial effects of dibutyl phthalate: In vitro and in vivo evidence

Dibutyl phthalate (DBP) is widely used in many consumer and personal care products. Here, we report vascular endothelial response to DBP in three different exposure scenarios: after short-term exposure (24 h) of human endothelial cells (ECs) EA.hy926 to 10-6, 10-5, and 10-4 M DBP, long-term exposure (12 weeks) of EA.hy926 cells to 10-9, 10-8, and 10-7 M DBP, and exposure of rats (28 and 90 days) to 100, 500, and 5000 mg DBP/kg food. We examined different vascular functions such as migration of ECs, adhesion of ECs to the extracellular matrix, tube formation, the morphology of rat aorta, as well as several signaling pathways involved in controlling endothelial function. Short-term in vitro exposure to DBP increased migration of ECs through G protein-coupled estrogen receptor, extracellular signal-regulated kinase 1/2, and nitric oxide (NO) signaling and decreased adhesion to gelatin. Long-term in vitro exposure to DBP transiently increased EC migration and had a bidirectional effect on EC adhesion to gelatin and tube formation. These effects were accompanied by a sustained increase in NO production and endothelial NO synthase (eNOS) and Akt activity. In vivo, exposure to DBP for 90 days decreased the aortic wall-to-lumen ratio and increased eNOS and Akt phosphorylation in ECs of rat aorta. This comparative investigation has shown that exposure to DBP may affect vascular function by altering EC migration, adhesion to gelatin, and tube formation after short- and long-term in vitro exposure and by decreasing the aortic wall-to-lumen ratio in vivo. The eNOS-NO and Akt signaling could be important in mediating the effects of DBP in long-term exposure scenarios.

Association between the Exposure to Phthalates and the Risk of Endometriosis: An Updated Review

Endometriosis is a chronic gynecological disease, primarily associated with pelvic pain and infertility, that affects approximately 10% of the women of reproductive age. Estrogen plays a central role in endometriosis, and there is growing evidence that endocrine disruptors, such as phthalates, may contribute to its development. This review aimed to determine whether there is a causal relationship between phthalate exposure and the development of endometriosis, as well as the possible effects of phthalates on fertility, by analyzing epidemiological data. After a literature search with a combination of specific terms on this topic, we found that although there are limitations to the current studies, there is a clear association between phthalate exposure and endometriosis. Phthalates can interfere with the cellular processes of the endometrium; specifically, they can bind to PPAR and ER-α and activate TGF-β, promoting different signaling cascades that regulate the expression of specific target genes. This may lead to inflammation, invasion, cytokine alteration, increased oxidative stress, and impaired cell viability and proliferation, culminating in endometriosis. Nevertheless, future research is important to curb the progression and development of endometriosis, and strategies for prevention, diagnosis, and treatment are a priority. In this regard, public policies and recommendations to reduce exposure to phthalates and other endocrine disruptors should be promptly implemented.

The obesogen bisphenol A promotes adipogenesis in canine adipose-derived stem cells: Potential implication in dog obesity

The growing number of companion dogs has contributed to a rapidly growing market for pet products, including dog toys. However, little is known about the hazardous substances released from dog toys. This study aims to examine the potential presence of obesogens, a subset of endocrine-disrupting chemicals (EDCs) that are widely utilized as raw materials in the manufacture of dog toy components, and their effects on dog health. To achieve this, we adapted and employed a migration method typically used for children's products to simulate obesogen exposure in dogs through sucking or chewing toys. We demonstrated that out of various obesogens, bisphenol A (BPA) was released from dog toys into synthetic saliva, whereas phthalates and azo dyes were not detected in any of the leachates. Additionally, we found that BPA induced adipogenic differentiation in canine adipose-derived stem cells (cADSCs). Our RNA sequencing experiments revealed that BPA alters the adipogenesis-related gene signature in cADSCs by elevating the expression levels of ADIPOQ, PLIN1, PCK1, CIDEC, and FABP4. The associated transcriptional changes are involved in the peroxisome proliferator-activated receptor (PPAR) signaling pathway, which may contribute to the promotion of adipogenesis by BPA. Our findings suggest that companion dogs are at risk of BPA exposure, which may contribute to obesity in dogs. Therefore, the implementation of precautionary measures is crucial.

Transcriptome-centric approach to the derivation of adverse outcome pathway networks of vascular dysfunction after long-term low-level exposure of human endothelial cells to dibutyl phthalate

Dibutyl phthalate (DBP) is an endocrine disruptor that adversely affects reproduction; however, evidence suggests it can also impact other systems, including vascular function. The mechanisms underlying DBP-induced vascular dysfunction, particularly after long-term low-level exposure of endothelial cells to this phthalate, remain largely unknown. To address this gap, we used experimentally derived data on differentially expressed genes (DEGs) obtained after 12 weeks of exposure of human vascular endothelial cells EA.hy926 to the concentrations of DBP to which humans are routinely exposed (10-9 M, 10-8 M, and 10-7 M) and various computational tools and manual data curation to build the first adverse outcome pathway (AOP) network relevant to DBP-induced vascular toxicity. DEGs were used to infer transcription factors (molecular initiating events) and molecular functions and biological processes (key events, KEs) using the Enrichr database. The AOP-helpFinder 2.0, an artificial intelligence-based web tool, was used to link genes and KEs and assign confidence scores to co-occurred terms. We constructed the AOP networks using Cytoscape and then manually arranged KEs to depict the flow of mechanistic information across different levels of network organization. An AOP network was created for each DBP concentration, revealing several distinct high-confidence subnetworks that could be involved in DBP-induced vascular toxicity: the insulin-like growth factor subnetwork for 10-7 M DBP, the CXCL8-dependent chemokine subnetwork for 10-8 M DBP, and the fatty acid subnetwork for 10-9 M DBP. We also developed an AOP network providing a mechanistic insight into the dose-dependent effects of DBP in endothelial cells leading to vascular dysfunction. In summary, we present novel putative AOP networks describing the mechanistic flow of information involved in DBP-induced vascular dysfunction in a long-term low-level exposure scenario.

AQP1 Deficiency Drives Phthalate-Induced Epithelial Barrier Disruption through Intestinal Inflammation

Di-2-ethylhexyl phthalate (DEHP) is frequently used as a plasticizer to enhance the plasticity and durability of agricultural products, which pose adverse effects to human health and the environment. Aquaporin 1 (AQP1) is a main water transport channel protein and is involved in the maintenance of intestinal integrity. However, the impact of DEHP exposure on gut health and its potential mechanisms remain elusive. Here, we determined that DEHP exposure induced a compromised duodenum structure, which was concomitant with mitochondrial structural injury of epithelial cells. Importantly, DEHP exposure caused duodenum inflammatory epithelial cell damage and strong inflammatory response accompanied by activating the TLR4/MyD88/NF-κB signaling pathway. Mechanistically, DEHP exposure directly inhibits the expression of AQP1 and thus leads to an inflammatory response, ultimately disrupting duodenum integrity and barrier function. Collectively, our findings uncover the role of AQP1 in phthalate-induced intestinal disorders, and AQP1 could be a promising therapeutic approach for treating patients with intestinal disorders or inflammatory diseases.

Association of phthalate exposure with reproductive outcomes among infertile couples undergoing in vitro fertilization: A systematic review

Human fertility is impacted by changes in lifestyle and environmental deterioration. To increase human fertility, assisted reproductive technology (ART) has been extensively used around the globe. As early as 2009, the Endocrine Society released its first scientific statement on the potential adverse effects of environmental endocrine-disrupting chemicals (EDCs) on human health and disease development. Chemicals known as phthalates, frequently employed as plasticizers and additives, are common EDCs. Numerous studies have shown that phthalate metabolites in vivo exert estrogen-like or anti-androgenic effects in both humans and animals. They are associated with the progression of a range of diseases, most notably interference with the reproductive process, damage to the placenta, and the initiation of chronic diseases in adulthood. Phthalates are ingested by infertile couples in a variety of ways, including household products, diet, medical treatment, etc. Exposure to phthalates may exacerbate their infertility or poor ART outcomes, however, the available data on phthalate exposure and ART pregnancy outcomes are sparse and contradictory. Therefore, this review conducted a systematic evaluation of 16 papers related to phthalate exposure and ART pregnancy outcomes, to provide more aggregated results, and deepen our understanding of reproductive outcomes in infertile populations with phthalate exposure.

Microplastics in human blood: Polymer types, concentrations and characterisation using μFTIR

Microplastics (MPs) are an everyday part of life, and are now ubiquitous in the environment. Crucially, MPs have not just been found within the environment, but also within human bodies, including the blood. We aimed to provide novel information on the range of MP polymer types present, as well as their size and shape characteristics, in human whole blood from 20 healthy volunteers. Twenty-four polymer types were identified from 18 out of 20 (90 %) donors and quantified in blood, with the majority observed for the first time. Using an LOQ approach, five polymer types met the threshold with a lower mean ± SD of 2466 ± 4174 MP/L. The concentrations of plastics analysed in blood samples ranged from 1.84 - 4.65 μg/mL. Polyethylene (32 %), ethylene propylene diene (14 %), and ethylene-vinyl-acetate/alcohol (12 %) fragments were the most abundant. MP particles that were identified within the blood samples had a mean particle length of 127.99 ± 293.26 µm (7-3000 µm), and a mean particle width of 57.88 ± 88.89 µm (5-800 µm). The MPs were predominantly categorised as fragments (88 %) and were white/clear (79 %). A variety of plastic additive chemicals were identified including endocrine disrupting-classed phthalates. The procedural blank samples comprised 7 polymer types, that were distinct from those identified in blood, mainly resin (25 %), polyethylene terephthalate (17 %), and polystyrene (17 %) with a mean ± SD of 4.80 ± 5.59 MP/L. This study adds to the growing evidence that MPs are taken up into the human body and are transported via the bloodstream. The shape and sizes of the particles raise important questions with respect to their presence and associated hazards in terms of potential detrimental impacts such as vascular inflammation, build up within major organs, and changes to either immune cell response, or haemostasis and thrombosis.

Phthalate exposure and subclinical carotid atherosclerosis: A systematic review and meta-analysis

Phthalates may be associated with an increased risk of cardiometabolic diseases by interfering with glucose and lipid metabolism and by promoting adipogenesis. This study aimed to perform a systematic review and meta-analysis of the association between phthalate exposure and subclinical carotid atherosclerosis, using surrogate markers such as carotid intima-media thickness (IMT) and carotid plaques. The literature search was performed using four databases (Web of Science, Medline, PubMed, and Scopus), and this systematic review includes all available observational studies until July 6th, 2023. The Joanna Briggs Institute critical appraisal tool was used to assess the risk of bias. Meta-analyses were performed, and random effects models were used. Six high-quality cross-sectional studies and 2570 participants aged 12 to 70 were included. Six phthalate metabolites showed significant associations with subclinical carotid atherosclerosis. Exposure to MBzP, ΣDEHP, and MnBP was associated with increased carotid IMT. Exposure to MEP was associated with a higher prevalence of carotid plaques, and MiBP was associated with a lower prevalence. Mixed results were observed for MMP in older adults. The meta-analyses showed a high degree of heterogeneity, and the results are based on single studies. This study accurately describes the evidence of this association to date, suggesting that phthalates are associated with increased carotid IMT and a higher prevalence of carotid plaques. Further research is needed to elucidate this association, as phthalates are still used in the manufacture of everyday products, humans continue to be exposed to them, and atherosclerosis is a public health concern.

Phthalate Exposure and Coronary Heart Disease: Possible Implications of Oxidative Stress and Altered miRNA Expression

The relationship between phthalate exposure and coronary heart disease (CHD) is still unclear. This study aimed to investigate the association between phthalate exposure and CHD and determine the possible atherogenic mechanisms of phthalates by assessing oxidative stress and altering miRNA expression. This case-control study included 110 participants (55 CHD patients and 55 healthy controls). The levels of oxidative stress markers, malondialdehyde (MDA), and superoxide dismutase (SOD), and the expression of miRNA-155 (miR-155) and miRNA-208a (miR-208a), were measured and correlated with the urinary mono-2-ethylhexyl phthalate (MEHP). Highly significant differences were detected between the CHD cases and the control group regarding MEHP, MDA, SOD, miR-155, and miR-208a (p-value < 0.001). Spearman correlations revealed a significant positive correlation between MDA and MEHP in urine (P = 0.001 and rs = 0.316) and a significant negative correlation between SOD and MEHP in urine (P < 0.001 and rs = -0.345). Furthermore, significant positive correlations were observed between miR-155 and urinary MEHP (P = 0.001 and rs = 0.318) and miR-208a and urinary MEHP (P < 0.001 and rs = -0.352). This study revealed an association between phthalate exposure, as indicated by urinary MEHP and CHD; altered expression of miR-155 and miR-208a and oxidative stress could be the fundamental mechanisms.

Dimethyl phthalate induced cardiovascular developmental toxicity in zebrafish embryos by regulating MAPK and calcium signaling pathways

Dimethyl phthalate (DMP), the lowest-molecular-weight phthalate ester (PAE), is one of the most commonly detected persistent organic pollutants in the environment, but its toxic effects, especially cardiovascular developmental toxicity, are largely unknown. In this study, zebrafish embryos were exposed to sublethal concentrations of DMP from 4 to 96 hpf. Our results showed that DMP treatment induced yolk retention, pericardial edema, and swim bladder deficiency, as well as increased SV-BA distance and decreased heart rate, stroke volume, ventricular axis shortening rate and ejection fraction. In addition, oxidative stress and apoptosis were found to be highly involved in this process. The results of transcriptome sequencing and mRNA expression of related genes indicated that MAPK and calcium signaling pathways were perturbed by DMP. These findings have the potential to provide new insights into the potential developmental toxicity and cardiovascular disease risk of DMP.

Association between urinary phthalates and phthalate metabolites and cancer risk: A systematic review and meta-analysis

Phthalates, widely utilized in industrial products, are classified as endocrine-disrupting chemicals (EDCs). Although certain phthalate and their metabolites have been implicated in cancer development, the reported findings have exhibited inconsistencies. Therefore, we conducted the comprehensive literature search to assess the association between phthalate and their metabolites and cancer risk by identifying original studies measuring phthalates or their metabolites and reporting their correlation with cancer until July 4, 2023. The Odds Ratios (ORs) and corresponding 95% confidence intervals (CIs) were extracted and analyzed to estimate the risk. Pooled data from eleven studies, including 3101 cancer patients and 6858 controls, were analyzed using a fixed- or random-effects model based on heterogeneity tests. When comparing extreme categories of different phthalates and their metabolites, we observed a significant association between urinary phthalates and phthalate metabolites (MEHHP, MECPP, DBP and MBzP) and cancer risk. The findings of our meta-analysis reinforce the existing evidence that urinary phthalates and phthalate metabolites is strongly associated with cancer development. Further investigations are warranted to elucidate the underlying mechanisms of this association. These results may offer novel insights into cancer development.

Phthalate exposure aggravates periodontitis by activating NFκB pathway

BACKGROUND

Phthalates are widely used plasticizers, which were identified as risk factors in the development of many human diseases. However, the effects of phthalates in the periodontitis are unknown. We aimed to investigated the relationship of periodontitis and phthalate exposure as well as the underlying mechanisms.

MATERIALS AND METHODS

Univariate and multivariate logistic regressions were employed to evaluate the association between phthalate metabolites and periodontitis. The generalized additive model and piecewise logistic regression were conducted to investigate the dose-response relationship. Cell and animal models were used to explore the role and mechanism of DEHP in the development of periodontitis. Transcriptome sequencing, bioinformatics analysis, western blot, immunofluorescence and mice model of periodontitis were also employed.

RESULTS

MEHP (OR 1.14, 95% CI 1.05-1.24), MCPP (OR 1.08, 95% CI 1.00-1.17), MEHHP (OR 1.18, 95% CI 1.08-1.29), MEOHP (OR 1.18, 95% CI 1.07-1.29), MiBP (OR 1.15, 95% CI 1.04-1.28), and MECPP (OR 1.20, 95% CI 1.09-1.32) were independent risk factors. And MEHHP, the metabolite of DEHP, showed the relative most important effects on periodontitis with the highest weight (0.34) among all risk factors assessed. And the increase of inflammation and the activation of NFκB pathway in the periodontitis model mice and cells were observed.

CONCLUSION

Exposure to multiple phthalates was positively associated with periodontitis in US adults between 30 and 80 years old. And DEHP aggravated inflammation in periodontitis by activating NFκB pathway.

The mitochondrial link: Phthalate exposure and cardiovascular disease

Phthalates' pervasive presence in everyday life poses concern as they have been revealed to induce perturbing health defects. Utilized as a plasticizer, phthalates are riddled throughout many common consumer products including personal care products, food packaging, home furnishings, and medical supplies. Phthalates permeate into the environment by leaching out of these products which can subsequently be taken up by the human body. It is previously established that a connection exists between phthalate exposure and cardiovascular disease (CVD) development; however, the specific mitochondrial link in this scenario has not yet been described. Prior studies have indicated that one possible mechanism for how phthalates exert their effects is through mitochondrial dysfunction. By disturbing mitochondrial structure, function, and signaling, phthalates can contribute to the development of the foremost cause of death worldwide, CVD. This review will examine the potential link among phthalates and their effects on the mitochondria, permissive of CVD development.

Association of co-exposure to polycyclic aromatic hydrocarbons and phthalates with oxidative stress and inflammation

Exposure to multiple environmental pollutants is ubiquitous and inevitable, but studies investigating their exposure effects on oxidative stress or inflammation have mainly been restricted to single-pollutant models. This study investigated the association of co-exposure to polycyclic aromatic hydrocarbons and phthalates with oxidative stress and inflammation. Using a cross-sectional study in adults, we measured urinary concentrations of metabolites of polycyclic aromatic hydrocarbons (OH-PAHs) and phthalates (mPAEs), urinary oxidative stress biomarker 8-hydroxy-2'-deoxyguanosine, and 9 inflammatory biomarkers in paired blood samples. The associations of urinary OH-PAHs and mPAEs with oxidative stress and inflammation biomarkers were evaluated by different statistical models. The Bayesian kernel machine regression and quantile g-computation was used to examine the joint effects, and increased levels of urinary concentrations of OH-PAHs and mPAEs were associated with elevated 8-hydroxy-2'-deoxyguanosine level and white blood cell counts. Exposure to polycyclic aromatic hydrocarbons contributed more significantly to inflammation, while exposure to phthalates contributed more to oxidative stress. Monoisobutyl phthalate was identified as the most significant metabolite contributing to elevated oxidative stress levels. 1-Hydroxypyrene was negatively associated with platelet, and monomethyl phthalate was significantly positively associated with interleukin 6 in multivariate linear regression. The restricted cubic spline analysis revealed non-linear patterns of 3-hydroxyfluorene with white blood cell, lymphocyte, neutrophil, and C-reactive protein. The results indicated significant associations between increased co-exposure to polycyclic aromatic hydrocarbons and phthalates with elevated oxidative stress and inflammation. Further investigation is needed to elucidate the underlying biological mechanisms and to determine the potential public health implications.

MXene-Enhanced Bi2S3/CdIn2S4 Heterojunction Photosensitive Gate for DEHP Detection in a Signal-On OPECT Aptamer Biosensor

Organic electrochemical transistors with signal amplification and good stability are expected to play a more important role in the detection of environmental pollutants. However, the bias voltage at the gate may have an effect on the activity of vulnerable biomolecules. In this work, a novel organic photoelectrochemical transistor (OPECT) aptamer biosensor was developed for di(2-ethylhexyl) phthalate (DEHP) detection by combining photoelectrochemical analysis with an organic electrochemical transistor, where MXene/Bi2S3/CdIn2S4 was employed as a photoactive material, target-dependent DNA hybridization chain reaction was used as a signal amplification unit, and Ru(NH3)63+ was selected as a signal enhancement molecule. The poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate)-based OPECT biosensor modulated by the MXene/Bi2S3/CdIn2S4 photosensitive material achieved a high current gain of nearly a thousand times at zero bias voltage. The developed signal-on OPECT sensing platform realized sensitive and specific detection of DEHP, with a detection range of 1-200 pM and a minimum detection limit of 0.24 pM under optimized experimental conditions, and its application to real water samples was also evaluated with satisfactory results. Hence, the construction of this OPECT biosensing platform not only provides a promising tool for the detection of DEHP but also reveals the great potential of the OPECT application for the detection of other environmental toxins.

Association of mono-2-ethylhexyl phthalate with adverse outcomes in chronic hemodialysis patients

Phthalate exposure is widespread and has a global impact. Growing evidence shows that mono-2-ethylhexyl phthalate (MEHP) exposure has a negative impact on human health. However, whether MEHP exposure is associated with mortality and other adverse outcomes in hemodialysis patients remains unknown. This study prospectively enrolled 217 patients on maintenance hemodialysis from June 30, 2021, to August 16, 2022. Baseline serum MEHP, di-2-ethylhexyl phthalate (DEHP), and indoxyl sulfate (IS) concentrations were measured. Primary endpoints were all-cause mortality or composite adverse outcomes, including all-cause death plus hospitalization due to cardiovascular disease, heart failure, stroke, infection, or cancer. Serum MEHP concentrations were positively associated with DEHP but not indoxyl sulfate concentrations in hemodialysis patients. Additionally, serum MEHP concentrations were significantly and independently associated with all-cause mortality and composite adverse outcomes (adjusted hazard ratios [HRs], 1.04 and 1.03 per ng/mL, 95% confidence intervals [CIs], 1.01-1.07 and 1.00-1.05; p = 0.016 and 0.015, respectively). We found a cutoff value of MEHP for predicting both endpoints. Patients with serum MEHP concentrations of ≥ 41.8 ng/mL had much higher risks for all-cause mortality and composite adverse outcomes (adjusted HRs, 39.2 and 13; 95% CIs, 2.44-65.7 and 2.74-61.4; p = 0.011 and 0.001, respectively). MEHP exposure is significantly associated with higher risks for all-cause mortality and composite adverse outcomes. Hemodialysis patients with serum MEHP concentrations above 41.8 ng/mL had much poorer prognoses regarding both outcomes.