Tissue Distribution and Whole Body Burden of the Chlorinated Polyfluoroalkyl Ether Sulfonic Acid F-53B in Crucian Carp (Carassius carassius): Evidence for a Highly Bioaccumulative Contaminant of Emerging Concern

Screening estimates of bioaccumulation factors for 4950 per- and polyfluoroalkyl substances in aquatic species

The considerable variability in bioaccumulation factors (BAFs) of per- and polyfluoroalkyl substances (PFAS) across aquatic species, driven by the diversity of PFAS, complex water conditions, and species differences, underscores the resource-intensive nature of relying on experimental data. To develop a robust and effective approach for predicting BAFs, a predictive framework using a three-level stacking deep ensemble learning model was established. Initially, we compiled a substantial dataset of BAFs, encompassing a wide variety of PFAS across both marine and freshwater species. The stacking model demonstrated strong performance, achieving R-squared (R2) values of 0.94 and 0.89, and root-mean-square errors (RMSE) of 0.88 and 1.17 for training and testing, respectively. External validation revealed that 60 % and 90 % of predictions fell within 2-fold and 4-fold differences, respectively, from the observed values. Using this model, we predicted BAFs for 4950 PFAS in 54 global edible fish species, with the predicted median BAF values ranging from 22 L/kg to 477.09 L/kg. The results indicated that PFAS with multiple functional groups (e.g., benzene rings and ketones) exhibited higher BAFs. Finally, an accessible online tool (https://pfasbaf.hhra.net/) was launched to facilitate BAF predictions. This newly released application promises to offer valuable support for environmental risk management and policymaking efforts.

Neurodevelopmental toxicity and mechanism of chlorinated polyfluoroalkyl ether sulfonate alternative F-53B in pubertal male rats

F-53B, a substitute for perfluorooctane sulfonate (PFOS), has attracted considerable concerns due to its frequent detection in environment matrices. However, the potential health risks to mammals, especially neurodevelopmental toxicity, remain unclear. In this study, 3-week-old pubertal male rats were exposed to F-53B at concentrations of 0, 0.15, 1.5, and 15 μg/kg for 3 weeks continuously. Diminished cognitive abilities were observed by morris water maze (MWM) test, F-53B exposure increased the escape latency and decreased the time spent in the target quadrant of rats. Furthermore, F-53B significantly altered neurotransmitter levels in the hippocampus. Molecular docking studies indicated that F-53B might bind to metabotropic glutamate receptor 5 (mGluR5), potentially entering neurons and causing further neurotoxicity. qRT-PCR and western blot analyses were used to assess the expression of genes and proteins related to calcium pathways. Results revealed that F-53B exposure downregulated mRNA expression of ryanodine receptors (RyRs) and the phosphorylation of inositol trisphosphate receptors (IP3Rs), while upregulating sarco/endoplasmic reticulum Ca2+-ATPase2 (SERCA2) levels. F-53B inhibits the IP3/Ca2+ signaling pathway in the rat hippocampus, which may affect ER Ca2+ storage and release functions. Additionally, F-53B reduced the phosphorylation of IP3R, Ca2+/calmodulin-dependent protein kinase II (CaMKII), extracellular signal-regulated kinase 1 and 2 (ERK1/2), and cAMP response element binding protein (CREB), potentially impairing synaptic plasticity and long-term potentiation (LTP), leading to learning and memory deficits. This study reveals that F-53B induced neurodevelopmental toxicity linked to calcium pathway disruption and provides new insight into the potential long-term hazards of F-53B.

Neurobehavioral response in zebrafish exposed to perfluorooctane sulfonate and its substitutes: Underestimated ecological risks

Perfluorooctane sulfonate (PFOS) is a persistent environmental contaminant with adverse effects. Alongside PFOS, its substitutes, such as 6:2 chlorinated polyfluorinated ether sulfonate (F-53B) and 6:2 fluorotelomer sulfonic acid (6:2 FTSA), are frequently detected in aquatic environments. While the effects of PFOS and its substitutes on the aquatic organism behavior have been observed, the underlying mechanisms of these effects remain poorly understood. In this study, an online biological monitoring system was utilized to investigate the behavioral effects of 7-day exposure to PFOS, F-53B, and 6:2 FTSA in adult zebrafish (Danio rerio), and assess alterations in neurotoxicity-related biomarker levels. Results demonstrate that exposure to PFOS, F-53B, and 6:2 FTSA significantly reduced the behavioral strength (BS) and the amplitude of circadian rhythm in zebrafish. Notably, PFOS and 6:2 FTSA exposure induced circadian rhythm phase shifts. Furthermore, acetylcholinesterase (AChE) activity and dopamine (DA)/melatonin (MT) levels showed significant reductions consistent with BS alterations across all exposure groups. Molecular docking analysis revealed that PFOS, F-53B, and 6:2 FTSA exhibited significant binding affinities to related receptors. Among the three pollutants, F-53B exerted the most pronounced effects on BS values, circadian rhythm amplitude, and levels of related biomarkers. In contrast, 6:2 FTSA displayed the most significant impact on circadian rhythm phase shifts. These findings suggest that the effects and the underlying mechanisms of PFOS and its substitutes on zebrafish behavior may vary. A comprehensive evaluation of the neurotoxicity of PFOS substitutes for aquatic organisms is required to prevent underestimation of their potential risks.

Toxicokinetic and liver proteomic study of the Chinese rare minnow (Gobiocypris rarus) exposed to F-53B

Perfluorooctane sulfonic acid (PFOS) and its alternative 6:2 chlorinated polyfluoroethersulfonate (6:2 Cl-PFESA, also known as F-53B), are frequently detected in a variety of environmental and human samples. These substances have been associated with hepatotoxic effects, including disorders in lipid metabolism and oxidative stress. However, the molecular mechanisms underlying the causal relationship between exposure to F-53B and hepatotoxicity remain inadequately understood. This study investigated the toxicokinetics and mechanisms of hepatotoxicity associated with prolonged exposure to F-53B in adult Chinese rare minnows. Specifically, 5-month-old adult Chinese rare minnow was exposed to concentrations of 10 μg/L and 200 μg/L of F-53B for a duration of 28 days for bioaccumulation assessment, followed by a 14-day period for metabolic evaluation. The findings indicated that the bioaccumulation of F-53B in the tissues was positively correlated with the exposure concentrations. The logarithmic bioconcentration factor (Log BCF28d) was determined to be 2.67 ± 0.02 for the low concentration group and 2.27 ± 0.01 for the high concentration group. The calculated half-lives (t1/2) were 18.50 ± 1.67 days and 21.38 ± 0.31 days for the respective concentration groups. F-53B protein exhibited a distinct tissue-specific distribution in adult Chinese rare minnow, with the following order of enrichment: Blood > Liver > Gonad > Gill > Intestine > Brain > Muscle. F-53B was primarily concentrated in the blood and liver, where the protein content was significantly higher. Exposure to F-53B for 28 days significantly elevated biochemical levels associated with lipid metabolism and increased the activities of the enzymes FAS, PPARα, and ACC in the liver. This exposure also resulted in impairment of the hepatic oxidative system in the Chinese rare minnow, with F-53B significantly reducing most of the measured markers related to oxidative stress (e.g., GSH, SOD, CAT, and MDA). Proteomic analysis indicated that the toxicity of F-53B regulates the expression of proteins across several functional classes. Based on the functional information of the differential proteins provided in UniProt and KEGG, they were categorized into five main categories: Cellular Processes, Environmental Information Processing, Genetic Information Processing, Metabolism, and Organismal Systems. This study indicate that F-53B is bioaccumulative and persistent in Chinese rare minnow, and can further induce oxidative stress and lipid metabolism disorders. Combined with proteomic research methods, the toxicological effects of F-53B on Chinese rare minnow can be better explained.

High-Throughput Single-Cell Mass Spectrometry Reveals Sex-Specific Metabolic Responses to 6:2 Chlorinated Polyfluoroalkyl Ether Sulfonate in Zebrafish Liver Cells

Compound 6:2 chlorinated polyfluoroalkyl ether sulfonate (6:2 Cl-PFESA) is an emerging per- and polyfluoroalkyl substance (PFAS) with potential toxicity and health risks to biosystems and ecosystems. Here, we developed a metabolomics method based on single-cell mass spectrometry to investigate the hepatotoxicity and heterogeneous responses in zebrafish exposed to 6:2 Cl-PFESA. Zebrafish were exposed to an environmentally relevant concentration (200 ng/L) of 6:2 Cl-PFESA for 14 days. The livers were dissociated and prepared as cell suspensions and then introduced to high-throughput single-cell mass spectrometry for analysis of 6:2 Cl-PFESA and endogenous metabolites in individual primary liver cells. Significant sex-specific heterogeneity in 6:2 Cl-PFESA accumulation was observed (p < 0.05). Metabolomics analysis revealed perturbations in lipid metabolism, particularly affecting unsaturated fatty acids, ether lipids, and sphingolipids in zebrafish liver cells, indicating potential hepatotoxicity. Sex-dependent metabolic responses were evident: males showed notable changes in glucose and fatty acid metabolism, whereas females experienced pronounced disruptions in glycerophospholipid and amino acid pathways. ROC analysis identified sex-specific biomarkers, including FA(18:3) and FA(16:1) in males (AUC > 0.85), as well as proline and phosphatidylcholine in females (AUC > 0.90). These findings reflect metabolic dysregulation and highlight sex-specific responses. This study demonstrates the feasibility of single-cell metabolomics to elucidate the cellular mechanisms and metabolic responses of pollutant exposure, offering insights into precise and comprehensive toxicity assessments at the single-cell level.

Impacts of Gestational F-53B Exposure on Fetal Neurodevelopment: Insights from Placental and Thyroid Hormone Disruption

It has been evidenced that chlorinated polyfluoroalkyl ether sulfonic acids (Cl-PFESAs) have strong potential cross the placental barrier, but their adverse effects on offspring remain unclear. In this study, pregnant mice received daily intraperitoneal injections of chlorinated polyfluorinated ether sulfonate (Cl-PFESA; commercially known as F-53B, primarily comprising 6:2 Cl-PFESA and 8:2 Cl-PFESA) at dosages of 40 and 200 μg/kg from gestational days 6 to 17. Following gestational exposure, distinct accumulation of 6:2 and 8:2 Cl-PFESAs was observed in both the placenta and fetal brain, confirming their penetration across the placental and fetal blood-brain barriers. Maternal exposure to F-53B disrupted the placental 11β-hydroxysteroid dehydrogenase type 2 (hsd11b2) barrier, characterized by hypermethylation of its promoter, decreased blood sinusoids in labyrinth layer, and downregulation of the nutrient transport genes, thereby severely impairing the placenta's protective and nutrient transfer functions. Concomitantly, significant fetal intrauterine growth restriction indicated by decreased fetal weight and crown-rump length was observed. Additionally, changes in thyroid hormones, along with transcriptional and DNA methylation alterations in the promoter regions of transthyretin (ttr) and deiodinase 3 (dio3) genes, were noted in the placenta. These epigenetic changes might affect the maternal-fetal transport of thyroid hormones, possibly leading to disrupted thyroid function in the F1 generation. With the decreased nutrient transport capacity of the placenta, T4 levels in the fetus are significantly reduced, resulting in significant fetal neurodevelopmental abnormalities, reduced nerve cell proliferation (Ki67), and damage to synaptic plasticity. This study reveals unveil the hidden dangers of F-53B, highlighting its neurotoxic effects on fetal development through the disruption of thyroid hormone transport across the placenta.

Co-exposure to F-53B and nanoplastics induced hepatic glucolipid metabolism disorders by the PI3K-AKT signaling pathway

Recent investigations suggest that the chemical compound F-53B (6:2 chlorinated polyfluorinated ether sulfonate) may pose risks of liver toxicity. Within environmental settings, F-53B attaches to microplastics and nanoplastics, which are capable of being consumed by diverse species. To investigate the synergistic effects on hepatotoxicity, adult male mice were subjected to F-53B at daily doses of 1, 10, and 100 μg/kg, NPs at 100 mg/kg per day, or a combination of both treatments for a duration of 2 months. The results indicated that NPs moderately increased the buildup of F-53B within both the liver and plasma. Co-exposure to F-53B (100 μg/kg/day) and NPs induced hepatocellular edema and elevated plasma ALT levels, which were rarely observed in groups exposed to F-53B or NPs alone. Additionally, we found that co-exposure decreased the concentrations of total cholesterol (TC) and triglycerides (TG) in both plasma and liver tissues, while increasing fasting plasma glucose and insulin levels. Transcriptomic analysis revealed that the PI3K-AKT signaling pathway is potentially involved in mediating hepatic metabolic disorders. Further experiments demonstrated that the combined treatment significantly suppressed the expression of FGF21, an upstream regulator of the PI3K-AKT pathway. This alteration resulted in the suppression of PI3K-regulated gene expression associated with glucose and lipid metabolism. The findings suggest that F-53B impairs hepatic glucolipid metabolism in mice by suppressing of the PI3K-AKT signaling cascade, with NPs amplifying its toxicity.

Two-layer homolog network approach for PFAS nontarget screening and retrospective data mining

The rapid increase of novel per- and polyfluoroalkyl substances (PFAS) raises concerns, while their identification remains challenging. Here, we develop a two-layer homolog network approach for PFAS nontarget screening using mass spectrometry. The first layer constructs networks between homologs, with evaluation showing that it filters 94% of false candidates. The second layer builds a network between classes to expedite the identification of PFAS. We detected 94 PFAS in twelve waterproof products and two related industrial sludges, including 36 novel PFAS not previously reported in any sample. A local dataset is constructed for retrospective analysis by re-analyzing our previous samples, revealing fifteen novel PFAS in samples collected in 2005. The retrieval of the public database MassIVE uncovers novel PFAS in samples from seven countries. Here, we reveal the historic and global presence of novel PFAS, providing guidance for the management and policy-making concerning persistent chemicals.

6:2 chlorinated polyfluoroalkyl ether sulfonate (F-53B) induced nephrotoxicity associated with oxidative stress, inflammation and fibrosis in mice

6:2 Chlorinated polyfluoroalkyl ether sulfonate (trade name F-53B) is a substitute for perfluorooctane sulfonate (PFOS) used in the plating industry, and has been found in a range of environmental matrices and livings. There are numerous ways by which it is biotoxic to mammals. The kidneys are critical for maintaining homeostasis. However, little research has been conducted on how F-53B affects the kidneys. In this work, we investigated the renal toxicity of long-term oral F-53B treatment in C57BL/6J mice. Mice were allowed to drink F-53B freely at concentrations of 0, 0.057, 0.57, and 5.7 mg/L for 8 weeks. Renal oxidative stress, inflammation, and fibrosis were detected in mice exposed to F-53B, and the expression of related biochemical markers was significantly altered. Further investigations revealed that the TGF-β1/Smad3 and NF-κB signaling pathways may be associated with F-53B-induced renal fibrotic damage and inflammation. Overall, this study suggested that F-53B causes renal injury possibly via oxidative stress, activating the TGF-β1/Smad3 and NF-κB signaling pathways. This provides a foundation for further research into the harmful mechanism of F-53B in mammals.

Tissue distribution of emerging per- and polyfluoroalkyl substances in wild fish species from Qiantang river, east China: Comparison of 6:2 Cl-PFESA with PFOS

This study argued for the first time that 6:2 chlorinated polyfluorinated ether sulfonate (6:2 Cl-PFESA) and perfluorooctanesulfonic acid (PFOS) might have different tissue distribution mechanisms in wild fish species. Nine emerging and legacy per- and polyfluoroalkyl substances (PFASs) were detected in the water and wild fish tissues samples collected from the Qiantang River. Perfluorooctanoic acid (213 ng/L) was the predominant PFAS contaminant, and the other contaminants included perfluorohexanoate (19 ng/L), perfluorobutanoate (199 ng/L) and hexafuoropropylene oxide dimer acid (55 ng/L), which are the main fluorinated alternatives used in various industries located along the Qiantang River. Furthermore, PFOS (742 ng/g) and 6:2 Cl-PFESA (9.0 ng/g) were the predominant PFAS contaminants detected in the fish tissue samples. The differences in the potential molecular mechanism of the tissue distribution of PFOS and 6:2 Cl-PFESA in wild fish species are discussed. Additionally, we hypothesize that phospholipid partitioning is the primary mechanism underlying the tissue distribution of PFOS, and that a specific protein-binding mechanism is involved in the tissue distribution of 6:2 Cl-PFESA.

F-53B stimulated vascular smooth muscle cell phenotypic switch and vascular remodeling via ferroptosis-related pathway

The compound 6:2 chlorinated polyfluorinated ether sulfonate (F53B), an alternative to perfluorooctane sulfonate (PFOS), has been widely utilized in China. Although the connection between the exposure and toxicity of F53B is established, the role and mechanisms of the compound in promoting vascular remodeling are yet to be elucidated. Thus, the present study investigated the impact of F53B on the function of vascular smooth muscle cells (VSMCs) and vascular remodeling. The data exhibited that F53B stimulates vascular morphological alterations in vivo, and exposure to the compound caused excessive VSMCs ferroptosis and phenotype switching, as determined using phenotype and molecular assays. Moreover, Fer-1 reversed F-53B-induced VSMC dysfunction and vascular remodeling. Furthermore, F53B activated the ferroptosis-related pathway, encompassing ATR expression and LOC101929922/miR-542-3p/ACSL4 pathway. Thus, the current results elaborated on the multifaceted toxicities of F53B that induce vascular remodeling, thereby necessitating the assessment of vasotoxicity risks associated with the compound.

Molecular designing of potential environmentally friendly PFAS based on deep learning and generative models

Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are widely used across a spectrum of industrial and consumer goods. Nonetheless, their persistent nature and tendency to accumulate in biological systems pose substantial environmental and health threats. Consequently, striking a balance between maximizing product efficiency and minimizing environmental and health risks by tailoring the molecular structure of PFAS has become a pivotal challenge in the fields of environmental chemistry and sustainable development. To address this issue, a computational workflow was proposed for designing an environmentally friendly PFAS by incorporating deep learning (DL) and molecular generative models. The hybrid DL architecture MolHGT+ based on heterogeneous graph neural network with transformer-like attention was applied to predict the surface tension, bioaccumulation, and hepatotoxicity of the molecules. Through virtual screening of the PFAS master database using MolHGT+, the findings indicate that incorporating the siloxane group and betaine fragment can effectively decrease both the bioaccumulation and hepatotoxicity of PFAS while preserving low surface tension. In addition, molecular generative models were employed to create a structurally diverse pool of novel PFASs with the aforementioned hit molecules serving as the initial template structures. Overall, our study presents a promising AI-driven method for advancing the development of environmentally friendly PFAS.

Adolescent F-53B exposure induces ovarian toxicity in rats: Autophagy-apoptosis interplay

As a substitute for perfluorooctane sulfonates, F-53B has permeated into the environment and can reach the human body through the food chain. Adolescent individuals are in a critical stage of development and may be more sensitive to the impacts of F-53B. In the present study, we modeled the exposure of adolescent female rats by allowing them free access to F-53B at concentrations of 0 mg/L, 0.125 mg/L, and 6.25 mg/L in drinking water, aiming to simulate the exposure in the adolescent population. Using the ovary as the focal point, we investigated the impact of developmental exposure to F-53B on female reproduction. The results indicated that F-53B induced reproductive toxicity in adolescent female rats, including ovarian lesions, follicular dysplasia and hormonal disorders. In-depth investigations revealed that F-53B induced ovarian oxidative stress, triggering autophagy within the ovaries, and the autophagy exhibited the interplay with apoptosis in turn, collectively leading to significant ovarian toxicity. Our findings provided deeper insights into the roles of the autophagy-apoptosis interplay in ovarian toxicity, and offered a new perspective on the developmental toxicity inflicted by adolescent F-53B exposure.

A combinational threat of micro- and nano-plastics (MNPs) as potential emerging vectors for per- and polyfluoroalkyl substances (PFAS) to human health

Micro- and nano-plastics (MNPs) and per- and polyfluoroalkyl substances (PFAS) are prevalent in ecosystems due to their exceptional properties and widespread use, profoundly affecting both human health and ecosystem. Upon entering the environment, MNPs and PFAS undergo various transformations, such as weathering, transport, and accumulation, potentially altering their characteristics and structural dynamics. Their interactions, governed by factors like hydrogen bonding, hydrophobic interactions, Van der Waals forces, electrostatic attractions, and environmental conditions, can amplify or mitigate their toxicity toward human health within ecological conditions. Several studies demonstrate the in vivo effects of PFAS and MNPs, encompassing growth and reproductive impairments, oxidative stress, neurotoxicity, apoptosis, DNA damage, genotoxicity, immunological responses, behavioral changes, modifications in gut microbiota, and histopathological alterations. Moreover, in vitro investigations highlight impacts on cellular uptake, affecting survival, proliferation, membrane integrity, reactive oxygen species (ROS) generation, and antioxidant responses. This review combines knowledge on the co-existence and adsorption of PFAS and MNPs in the environment, defining their combined in vivo and in vitro impacts. It provides evidence of potential human health implications. While significant research originates from China, Europe, and the USA, studies from other regions are limited. Only freshwater and marine organisms and their impacts are extensively studied in comparison to terrestrial organisms and humans. Nonetheless, detailed investigations are lacking regarding their fate, combined environmental exposure, mode of action, and implications in human health studies. Ongoing research is imperative to comprehensively understand environmental exposures and interaction mechanisms, addressing the need to elucidate these aspects thoroughly.

Rethinking alternatives to fluorinated pops in aqueous environment and corresponding destructive treatment strategies

Alternatives are being developed to replace fluorinated persistent organic pollutants (POPs) listed in the Stockholm Convention, bypass environmental regulations, and overcome environmental risks. However, the extensive usage of fluorinated POPs alternatives has revealed potential risks such as high exposure levels, long-range transport properties, and physiological toxicity. Therefore, it is imperative to rethink the alternatives and their treatment technologies. This review aims to consider the existing destructive technologies for completely eliminating fluorinated POPs alternatives from the earth based on the updated classification and risks overview. Herein, the types of common alternatives were renewed and categorized, and their risks to the environment and organisms were concluded. The efficiency, effectiveness, energy utilization, sustainability, and cost of various degradation technologies in the treatment of fluorinated POPs alternatives were reviewed and evaluated. Meanwhile, the reaction mechanisms of different fluorinated POPs alternatives are systematically generalized, and the correlation between the structure of alternatives and the degradation characteristics was discussed, providing mechanistic insights for their removal from the environment. Overall, the review supplies a theoretical foundation and reference for the control and treatment of fluorinated POPs alternatives pollution.

Development and Evaluation of Aquatic and Terrestrial Food Web Bioaccumulation Models for Per- and Polyfluoroalkyl Substances

There is a need for reliable models to predict the food web bioaccumulation and assess ecological and human health risks of per- and polyfluoroalkyl substances (PFAS). This present study presents (i) the development of novel mechanistic aquatic and terrestrial food web bioaccumulation models for PFAS and (ii) an evaluation of model performance using available laboratory and field data. Model predictions of laboratory-measured bioconcentration factors and field-based bioaccumulation factors of PFAS in fish were in good agreement with observed data as measured by the mean model bias (MB), representing systematic over- or under-estimation and the standard deviation of the MB, representing general uncertainty. The models provide a mechanistic framework for evaluating the combined effect of simultaneously occurring uptake and elimination processes and indicate food web-specific magnification of PFAS, with the highest degree of biomagnification occurring in food webs composed of air-breathing wildlife. Albumin-water, structural protein-water, membrane-water distribution coefficients, and renal clearance rate are among the most important model parameters. With further development and testing, these models may be useful for future PFAS screening and risk assessment initiatives and advance bioaccumulation studies of PFAS by providing a mechanistic framework for PFAS bioaccumulation.

Impact of the novel chlorinated polyfluorinated ether sulfonate, F-53B, on gill structure and reproductive toxicity in zebrafish

6:2 Chlorinated polyfluorinated ether sulfonate, commonly known as F-53B, is widely used as a mist suppressant in various industries and is frequently detected in the environment. Despite its prevalent presence, the adverse effects of F-53B are not well understood and require future investigation. This study utilized zebrafish embryos and adults to examine the toxic effects of F-53B. Our findings revealed that F-53B impaired gill structure and increased erythrocyte numbers in adult zebrafish. Notably, F-53B demonstrated a higher sensitivity for inducing mortality (LC50 at 96 h) in adult zebrafish compared to embryos. Additionally, F-53B disrupted the expression of critical steroidogenic genes and hindered sex hormone production, which negatively affecting egg production. In conclusion, this study underscores the detrimental impact of F-53B on gill structure and reproductive toxicity in zebrafish, providing valuable insights into its overall toxicity.

Caspase-8 promotes NLRP3 inflammasome activation mediates eye development defects in zebrafish larvae exposed to perfulorooctane sulfonate (PFOS)

Epidemiological evidence showed that serum high perfluorooctane sulfonate (PFOS) levels are associated with multiple eye related diseases, but the potential underlying molecular mechanisms remain poorly understood. Zebrafish and photoreceptor cell (661w) models were used to investigate the molecular mechanism of PFOS induced eye development defects. Our results showed a novel molecular mechanism of PFOS-induced inflammation response-mediated photoreceptor cell death associated with eye development defects. Inhibition of Caspase-8 activation significantly decreased photoreceptor cell death in PFOS exposure. Mechanistically, Toll-like receptor 4 (TLR4) mediates activation of Caspase-8 promote activation of NLR family pyrin domain-containing 3 (NLRP3) inflammasome to elicit maturation of interleukin-1 beta (IL-1β) via Caspase-1 activation, facilitating photoreceptor cell inflammation damage in PFOS exposure. In addition, we also made a novel finding that Caspase-3 activation was increased via Caspase-8 activation and directly intensified cell death. Our results show the important role of Caspase-8 activation in PFOS induced eye development defects and highlight Caspase-8 mediated activation of the NLRP3 inflammation triggers activation of Caspase-1 and promote the maturation of IL-1β in retinal inflammatory injury.

The bioaccumulation and ecotoxicity of co-exposure of per(poly)fluoroalkyl substances and polystyrene microplastics to Eichhornia crassipes

Gen X and F-53B have been popularized as alternatives to PFOA and PFOS, respectively. These per(poly)fluoroalkyl substances pervasively coexist with microplastics (MPs) in aquatic environments. However, there are knowledge gaps regarding their potential eco-environmental risks. In this study, a typical free-floating macrophyte, Eichhornia crassipes (E. crassipes), was selected for hydroponic simulation of a single exposure to PFOA, PFOS, Gen X, and F-53B, and co-exposure with polystyrene (PS) microspheres. F-53B exhibited the highest bioaccumulation followed by Gen X, PFOA, and PFOS. In the presence of PS MPs, the bioavailabilities of the four PFASs shifted and the whole plant bioconcentration factors improved. All four PFASs induced severe lipid peroxidation, which was exacerbated by PS MPs. The highest integrated biomarker response (IBR) was observed for E. crassipes (IBR of shoot: 30.01, IBR of root: 22.79, and IBR of whole plant: 34.96) co-exposed to PS MPs and F-53B. The effect addition index (EAI) model revealed that PS MPs showed antagonistic toxicity with PFOA and PFOS (EAI < 0) and synergistic toxicity with Gen X and F-53B (EAI > 0). These results are helpful to compare the eco-environmental impacts of legacy and alternative PFASs for renewal process of PFAS consumption and provide toxicological, botanical, and ecoengineering insights under co-contamination with MPs.

Multimedia distribution and release characteristics of emerging PFAS in wastewater treatment plants in Tianjin, China

Legacy and emerging PFAS in the air, wastewater, and sludge from two wastewater treatment plants (WWTPs) in Tianjin were investigated in this study. The semi-quantified nontarget PFAS accounted for up to 99 % of ƩPFAS in the gas phase, and aqueous film-forming foam (AFFF)-related PFAS were predominant in wastewater (up to 2250 ng/L, 79 % of ƩPFAS) and sludge (up to 4690 ng/g, 95 % of ƩPFAS). Furthermore, field-derived air particle-gas, air-wastewater, and wastewater particle-wastewater distribution coefficients of emerging PFAS are characterized, which have rarely been reported. The emerging substitute p-perfluorous nonenoxybenzenesulfonate (OBS) and AFFF-related cationic and zwitterionic PFAS show a stronger tendency to partition into particle phase in air and wastewater than perfluorooctane sulfonic acid (PFOS). The estimated total PFAS emissions from the effluent and sludge of WWTP A were 202 kg/y and 351 kg/y, respectively. While the target PFAS only accounted for 20-33 % of the total emissions, suggesting a significant underestimation of environmental releases of the nontarget PFAS and unknown perfluoroalkyl acid precursors through the wastewater and sludge disposal. Overall, this study highlights the importance of comprehensive monitoring and understanding the behavior of legacy and emerging PFAS in wastewater systems, and fills a critical gap in our understanding of PFAS exposure.

Integration of Nontarget Screening and QSPR Models to Identify Novel Organophosphate Esters of High Priority in Aquatic Environment

With the development of large numbers of novel organophosphate esters (OPEs) alternatives, it is imperative to screen and identify those with high priority. In this study, surface water, biofilms, and freshwater snails were collected from the flow-in rivers of Taihu Lake Basin, China. Screened by target, suspect, and nontarget analysis, 11 traditional and 14 novel OPEs were identified, of which 5 OPEs were first discovered in Taihu Lake Basin. The OPE concentrations in surface water ranged from 196 to 2568 ng/L, with the primary homologue tris(2,4-ditert-butylphenyl) phosphate (TDtBPP) being newly identified, which was likely derived from the transformation of tris(2,4-ditert-butylphenyl) phosphite. The majority of the newly identified OPEs displayed substantially higher bioaccumulation and biomagnification potentials in the biofilm-snail food chain than the traditional ones. Quantitative structure-property relationship models revealed both hydrophobicity and polarity influenced the bioaccumulation and biomagnification of the OPEs, while electrostatic attraction also had a contribution to the bioaccumulation in the biofilm. TDtBPP was determined as the utmost priority by toxicological priority index scheme, which integrated concentration, bioaccumulation, biomagnification, acute toxicity, and endocrine disrupting potential of the identified OPEs. These findings provide novel insights into the behaviors of OPEs and scientific bases for better management of high-risk pollutants in aquatic ecosystem.

Regulating the absorption and excretion of perfluorooctane sulfonate and its alternatives through influencing enterohepatic circulation

Enterohepatic circulation has been reported to play a significant role in the bioaccumulation of PFASs. In this study, the tissue distribution and excretion of PFOS and its alternatives, namely 6:2 and 8:2 fluorotelomer sulfonic acid (FTSA) was investigated using a mouse assay with a focus on role of enterohepatic circulation. Liver was the primarily accumulating organ for PFOS and 8:2 FTSA (33.4 % and 25.8 % of total doses absorbed after 14 days), whereas 65 % of 6:2 FTSA was excreted via urine within 24 h. Peak levels of 8:2 FTSA and PFOS were found in the gallbladder, implying the important role of enterohepatic circulation in PFASs reabsorption. The role of enterohepatic circulation was further evaluated through co-exposure of 8:2 FTSA and PFOS with medicines (namely metformin (MET) and ursodeoxycholic acid (UDCA)). MET reduced accumulation of 8:2 FTSA and PFOS in the liver by 68.6 % and 65.8 %, through down-regulation of bile acid transporter (Asbt) and enhancement of fecal excretion. Conversely, UDCA raised their concentrations by 21.9 % and 34.6 % compared to that exposed solely to PFASs. A strong positive correlation was identified between PFASs serum levels and Asbt expression. This study illuminated PFAS bioaccumulation mechanisms and suggested potential strategies to mitigate the exposure risks.

Spatial distribution, source, and fate of per- and polyfluoroalkyl substances in the surrounding environment of closed and converted fluorochemical factories in Fujian, China

Following the closure of perfluorooctanesulfonic acid (PFOS) production to comply with the Stockholm Convention regulations or restrictions, manufacturers have shifted to developing short-chain alternatives like perfluorobutane sulfonic acid (PFBS). However, limited research has been conducted to evaluate the impact of this transition on the surrounding environment. This study focused on the spatial distribution, source, and fate of 18 per- and polyfluoroalkyl substances (PFAS) in the surrounding environment of the closure and transformation of two PFAS manufacturing plants in Fujian, China. The total concentrations of PFAS in surface water, sediment, and fish were within the range of 48.9-72,400 ng/L, 0.930-57.6 ng/g dw, and 3.33-1245 ng/g dw, respectively. The predominant compounds were PFBS, PFOS, and perfluorooctanoic acid (PFOA) among the three matrices. Principal component analysis highlighted significant differences in PFAS profiles across different regions of the Futun River, suggesting diverse sources of PFAS. Source apportionment indicated that despite being closed or converted for almost three years, the two factories still significantly impacted the surrounding environment. The shutdown factory mainly released PFAS characterized by perfluoroalkyl sulfonic acids. In contrast, the PFAS were released from conversion plant with the fingerprint being PFBS and perfluoroalkyl carboxylic acids. The conversion of the factories has resulted in the coexistence of long-chain and short-chain PFAS, which has complicated the composition of PFAS in the environment. As sewage treatment plant could not effectively remove PFBS and perfluorobutanoic acid (PFBA) in wastewater, and due to their strong migration ability, these chemicals had a wider impact range, increasing the difficulty of environmental restoration and management. Risk assessment showed that PFAS downstream of the two factories posed high or moderate ecological risks. Specifically, PFBS, PFOS, and PFOA displayed the highest risk quotients and should be paid further attention.

Accumulation features and temporal trends (2002-2015) for legacy and emerging per- and polyfluoroalkyl substances (PFASs) in finless porpoises bycaught off Korean coasts

Legacy and emerging per- and polyfluoroalkyl substances (PFASs) were measured in livers of finless porpoises (Neophocaena asiaeorientalis; n = 167) collected in Korean waters from 2002 to 2015 to investigate their occurrence, bioaccumulation feature, temporal trends, and ecotoxicological implications. Perfulorooctane sulfonate (PFOS), perfluoroundecanoate (PFUnDA), and perfluorotridecanoate (PFTrDA) were the predominant PFASs found in the porpoises. The concentration of 6:2 chlorinated polyfluoroalkyl ether sulfonate (F-53B), an alternative to PFOS, was comparable to that of PFTrDA. Perfluorooctane sulfonamide (FOSA), a precursor of PFOS, was also detected in all the porpoises examined. All PFASs, including F-53B, accumulated to higher concentrations in immature porpoises compared with mature specimens, implying substantial maternal transfer and limited metabolizing capacity for PFASs. A significant correlation was observed between PFOS and F-53B concentrations, indicating similar bioaccumulation processes. Based on prenatal exposure and toxicity, F-53B is an emerging contaminant in marine ecosystems. Significantly increasing trends were observed in the concentrations of sulfonates, carboxylates, and F-53B between 2002/2003 and 2010, whereas the FOSA concentration significantly decreased. During 2010-2015, decreasing trends were observed in the concentrations of FOSA and sulfonates, whereas concentrations of carboxylate and F-53B increased without statistical significance, likely due to a gap for the implementation of regulatory actions between sulfonates and carboxylates. Although PFOS and PFOA were found to pose little health risk to porpoises, the combined toxicological effects of other contaminants should be considered to protect populations and to mitigate PFAS contamination in marine ecosystems.

Prenatal exposure to poly/perfluoroalkyl substances and risk for congenital heart disease in offspring

Congenital heart disease (CHD) is the most prevalent congenital malformation worldwide, and the association between per- and polyfluoroalkyl substances (PFASs) exposure and CHD in population has only received limited study. Therefore, we conducted a multicenter case-control study to explore the associations between prenatal exposure to individual PFASs, and also a PFAS mixture, and CHD risk, including 185 CHDs and 247 controls in China from 2016 to 2021. Thirteen PFASs in maternal plasma were quantified using liquid chromatography-tandem mass spectrometry. Logistic regression and two multipollutant models (Bayesian kernel machine regression [BKMR] and quantile g-computation [qgcomp]) were used to assess the potential associations between any individual PFAS, and also a PFAS mixture, and CHD risk. After adjusting for potential confounders, logistic regression indicated significant associations between elevated levels of perfluorononanoic acid (odds ratio [OR]= 1.30, 95% confidence intervals [CI]: 1.07-1.58), perfluorodecanoic acid (OR=2.07, 95%CI: 1.32-3.26), and perfluoroundecanoic acid (OR=2.86, 95%CI:1.45-5.65) and CHD risk. The BKMR model and qgcomp approach identified that a significant positive association between the PFAS mixture and risk for CHD. These findings provide essential evidence that there is indeed a health crisis associated with PFASs and that it is linked to CHD.

Angiotoxic effects of chlorinated polyfluorinated ether sulfonate, a novel perfluorooctane sulfonate substitute, in vivo and in vitro

Chlorinated polyfluorinated ether sulfonate (Cl-PFESA), a substitute for perfluorooctane sulfonate (PFOS), has been widely used in the Chinese electroplating industry under the trade name F-53B. The production and use of F-53B is keep increasing in recent years, consequently causing more emissions into the environment. Thus, there is a growing concern about the adverse effects of F-53B on human health. However, related research is very limited, particularly in terms of its toxicity to the vascular system. In this study, C57BL/6 J mice were exposed to 0.04, 0.2, and 1 mg/kg F-53B for 12 weeks to assess its impact on the vascular system. We found that F-53B exposure caused aortic wall thickening, collagen deposition, and reduced elasticity in mice. In addition, F-53B exposure led to a loss of vascular endothelial integrity and a vascular inflammatory response. Intercellular cell adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) were found to be indispensable for this process. Furthermore, RNA sequencing analysis revealed that F-53B can decrease the repair capacity of endothelial cells by inhibiting their proliferation and migration. Collectively, our findings demonstrate that F-53B exposure induces vascular inflammation and loss of endothelial integrity as well as suppresses the repair capacity of endothelial cells, which ultimately results in vascular injury, highlighting the need for a more thorough risk assessment of F-53B to human health.

Hepatic injury and ileitis associated with gut microbiota dysbiosis in mice upon F-53B exposure

Chlorinated polyfluorinated ether sulfonate (F-53B), a substitute of perfluorooctane sulfonic acid (PFOS), has attracted significant attention for its link to hepatotoxicity and enterotoxicity. Nevertheless, the underlying mechanisms of F-53B-induced enterohepatic toxicity remain incompletely understood. This study aimed to explore the role of F-53B exposure on enterohepatic injury based on the gut microbiota, pathological and molecular analysis in mice. Here, we exposed C57BL/6 mice to F-53B (0, 4, 40, and 400 μg/L) for 28 days. Our findings revealed a significant accumulation of F-53B in the liver, followed by small intestines, and feces. In addition, F-53B induced pathological collagen fiber deposition and lipoid degeneration, up-regulated the expression of fatty acid β-oxidation-related genes (PPARα and PPARγ, etc), while simultaneously down-regulating pro-inflammatory genes (Nlrp3, IL-1β, and Mcp1) in the liver. Meanwhile, F-53B induced ileal mucosal barrier damage, and an up-regulation of pro-inflammatory genes and mucosal barrier-related genes (Muc1, Muc2, Claudin1, Occludin, Mct1, and ZO-1) in the ileum. Importantly, F-53B distinctly altered gut microbiota compositions by increasing the abundance of Akkermansia and decreasing the abundance of Prevotellaceae_NK3B31_group in the feces. F-53B-altered microbiota compositions were significantly associated with genes related to fatty acid β-oxidation, inflammation, and mucosal barrier. In summary, our results demonstrate that F-53B is capable of inducing hepatic injury, ileitis, and gut microbiota dysbiosis in mice, and the gut microbiota dysbiosis may play an important role in the F-53B-induced enterohepatic toxicity.

Environmental occurrence, bioaccumulation and human risks of emerging fluoroalkylether substances: Insight into security of alternatives

Per- and polyfluoroalkyl substances (PFASs) are widely used due to their unique structure and excellent performance, while also posing threats on ecosystem, especially long-chain perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA). As the control of conventional PFASs, fluoroalkylether substances (ether-PFASs) as alternatives are constantly emerging. Subsequently, the three representative ether-PFASs, chlorinated polyfluoroalkyl ether sulfonic acid (F-53B), hexafluoropropylene oxide-dimer acid (HFPO-DA), and 4,8-Dioxa-3H-perfluorononanoicacid (ADONA) are discovered and have received more attention in the environment and ecosystem. But their security is now also being challenged. This review systematically assesses their security from six dimensions including environmental occurrence in water, soil and atmosphere, as well as bioaccumulation and risk in plants, animals and humans. High substitution level is observed for F-53B, whether in environment or living things. Like PFOS or even more extreme, F-53B exhibits high biomagnification ability, transmission efficiency from maternal to infant, and various biological toxicity effects. HFPO-DA still has a relatively low substitution level for PFOA, but its use has emerged in Europe. Although it is less detected in human bodies and has a higher metabolic rate than PFOA, the strong migration ability of HFPO-DA in plants may pose dietary safety concerns for humans. Research on ADONA is limited, and currently, it is detected in Germany frequently while remaining at trace levels globally. Evidently, F-53B has shown increasing risk both in occurrence and toxicity compared to PFOS, and HFPO-DA is relatively safe based on available data. There are still knowledge gaps on security of alternatives that need to be addressed.

Investigating mouse hepatic lipidome dysregulation following exposure to emerging per- and polyfluoroalkyl substances (PFAS)

Per- and polyfluoroalkyl substances (PFAS) are environmental pollutants that have been associated with adverse health effects including liver damage, decreased vaccine responses, cancer, developmental toxicity, thyroid dysfunction, and elevated cholesterol. The specific molecular mechanisms impacted by PFAS exposure to cause these health effects remain poorly understood, however there is some evidence of lipid dysregulation. Thus, lipidomic studies that go beyond clinical triglyceride and cholesterol tests are greatly needed to investigate these perturbations. Here, we have utilized a platform coupling liquid chromatography, ion mobility spectrometry, and mass spectrometry (LC-IMS-MS) separations to simultaneously evaluate PFAS bioaccumulation and lipid metabolism disruptions. For the study, liver samples collected from C57BL/6 mice exposed to either of the emerging PFAS hexafluoropropylene oxide dimer acid (HFPO-DA or "GenX") or Nafion byproduct 2 (NBP2) were assessed. Sex-specific differences in PFAS accumulation and liver size were observed for both PFAS, in addition to disturbed hepatic liver lipidomic profiles. Interestingly, GenX resulted in less hepatic bioaccumulation than NBP2 yet gave a higher number of significantly altered lipids when compared to the control group, implying that the accumulation of substances in the liver may not be a reliable measure of the substance's capacity to disrupt the liver's natural metabolic processes. Specifically, phosphatidylglycerols, phosphatidylinositols, and various specific fatty acyls were greatly impacted, indicating alteration of inflammation, oxidative stress, and cellular signaling processes due to emerging PFAS exposure. Overall, these results provide valuable insight into the liver bioaccumulation and molecular mechanisms of GenX- and NBP2-induced hepatotoxicity.

Deciphering behaviors of 6:2 chlorinated polyfluorinated ether sulfonate (alternative-PFOS) on anammox processes: Nitrogen removal efficiency and microbial adaptability

This study investigates the behaviors and effects of F-53B, an alternative to perfluorooctane sulfonate on anaerobic ammonium oxidation (anammox) processes. Results showed that the nitrogen removal efficiency (NRE) reached 83.8 % at a F-53B concentration of 0.5 mg·L-1, while NRE decreased to 66.9 % with 5 mg·L-1 of F-53B. The defluorination rates of 17.8 % (0.5 mg·L-1) and 9.3 % (5 mg·L-1) were observed, respectively, suggesting the occurrence of F-53B degradation. The relative abundance of Ca. Kuenenia decreased from 26.1 % to 16.2 % with the F-53B concentration increasing from 0.5 mg·L-1 to 5 mg·L-1. Meanwhile, Denitratisoma was selectively enriched with a relative abundance of 40.7 % at an F-53B concentration of 0.5 mg·L-1. Ca. Kuenenia could reduce reactive oxygen species induced by F-53B to maintain the balance of oxidative stress. This study gains insight into the behaviors and metabolic mechanisms of F-53B in anammox consortia, suggesting the feasibility of anammox processes for industrial wastewater.

Assessment of Fetal Exposure and Elimination of Perfluoroalkyl and Polyfluoroalkyl Substances: New Evidence from Paired Serum, Placenta, and Meconium Samples

Multiple pieces of evidence have shown that prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances (PFASs) is closely related to adverse birth outcomes for infants. However, difficult access to human samples limits our understanding of PFASs transport and metabolism across the human placental barrier, as well as the accurate assessment of fetal PFASs exposure. Herein, we assess fetal exposure to 28 PFASs based on paired serum, placenta, and meconium samples. Overall, 21 PFASs were identified first to be exposed to the fetus prenatally and to be metabolized and excreted by the fetus. In meconium samples, 25 PFASs were detected, with perfluorooctane sulfonate and perfluorohexane sulfonic acid being the dominant congeners, suggesting the metabolism and excretion of PFASs through meconium. Perfluoroalkyl sulfonic acids might be more easily eliminated through the meconium than perfluorinated carboxylic acids. Importantly, based on molecular docking, MRP1, OATP2B1, ASCT1, and P-gp were identified as crucial transporters in the dynamic placental transfer of PFASs between the mother and the fetus. ATSC5p and PubchemFP679 were recognized as critical structural features that affect the metabolism and secretion of PFASs through meconium. With increasing carbon chain length, both the transplacental transfer efficiency and meconium excretion efficiency of PFASs showed a structure-dependent manner. This study reports, for the first time, that meconium, which is a noninvasive and stable biological matrix, can be strong evidence of prenatal PFASs exposure.

Emerging and legacy per- and polyfluoroalkyl substances in Daling River and its estuary, Northern China

Strict restriction on legacy per- and polyfluoroalkyl substances (PFASs) has caused a dramatic increase in production and usage of emerging PFASs over the last decades. However, the environmental behaviors of emerging PFASs is largely unknown in Daling River, Northern China. In this study, the potential sources, sediment-water partitioning and substitution trends of PFASs were investigated in overlying water and sediments from Daling River and its estuary. Perfluorooctane sulfonate and 6:2 fluorotelomer sulfonic acid were major compounds, and sodium p-perfluorous nonenoxybenzene sulfonate was first detected. Firefighting foam manufacturing and fluoropolymer production were the main sources of PFASs. Compared to legacy PFASs (C8), the emerging PFASs (C6 - C9) were more incline to distribute into overlying water. Substitution trends indicated 6:2 fluorotelomer sulfonic acid and hexafluoropropylene oxide trimer acid as the important alternatives of perfluorooctane sulfonate and perfluorooctanoic acid, respectively. The results were meaningful for understanding the environmental behaviors of emerging PFASs.

Structure-Related Thyroid Disrupting Effect of Perfluorooctanesulfonate-like Substances in Zebrafish Larvae

Chlorinated polyfluorooctane ether sulfonate (6:2 Cl-PFESA), hydrogenated polyfluorooctane ether sulfonate (6:2 H-PFESA), and chlorinated polyfluorooctanesulfonate (Cl-PFOS) share structural similarities with the regulated perfluorooctanesulfonate (PFOS), but their toxic potential is rarely known. Here, the thyroid disrupting potential of these four compounds in zebrafish larvae has been comparably investigated. PFOS, Cl-PFOS, and 6:2 Cl-PFESA were accumulated in the larvae at similar levels, approximately 1.3-1.6 times higher than 6:2 H-PFESA. Additionally, PFOS, Cl-PFOS, and 6:2 Cl-PFESA exhibited stronger disruption than 6:2 H-PFESA on genetic regulation, particularly concerning thyroid hormone (TH) activation and action and on TH homeostasis in both free and total forms of thyroxine (T4) and 3,5,3'-triiodothyronine (T3). These results indicate that chlorination or oxygen insertion does not substantially alter the thyrotoxicity of PFOS, but hydrogenation mitigates it. Molecular docking analysis and the luciferase reporter gene assay provided mechanistic perspectives that the PFOS-like substances could competitively replace THs to bind with TH plasma and membrane transporters, thereby disrupting TH transport and action, respectively. Moreover, they are also potent to disrupt TH synthesis and activation through Na+/K+-dependent transport of I- or competitive binding to the sites of deiodinases.

In Vitro and In Silico Analysis of the Bindings between Legacy and Novel Per- and Polyfluoroalkyl Substances and Human Serum Albumin

Per- and polyfluoroalkyl substances (PFASs) are emerging contaminants of concern that can enter the human body through a variety of pathways and thereby cause harmful effects. Exposure of pregnant women to PFASs could even affect both the mother and the child. Human serum albumin (HSA) is considered to be the primary transport protein for a variety of substances in body fluids. It can be bound to different contaminants and might result in possible effects on human health. Yet, few studies are available on the binding affinity of legacy PFASs and their novel alternatives to HSA. In this study, the binding mechanisms of HSA to both legacy PFASs and their novel alternatives were investigated using fluorescence spectroscopy, together with further molecular docking. The results show that all the target PFASs were statically quenched against HSA with binding ratios of 1:1. The binding constants of long-chain PFASs and novel alternatives of perfluoroalkanesulfonic acids (PFSAs) were greater than 102, whereas those of short-chain PFASs alternatives and novel alternatives of perfluorocarboxylic acids (PFCAs) were less than 102. In general, the binding affinities of PFCAs on HSA were less than that of PFSAs, while the binding affinities of short-chain PFASs alternatives on HSA were smaller than those of long-chain PFASs and their novel alternatives. Therefore, bindings to HSA could be considered as an important influencing factor for the bioaccumulation of legacy and novel PFASs in the human body.

The sources and bioaccumulation of per- and polyfluoroalkyl substances in animal-derived foods and the potential risk of dietary intake

Per- and polyfluoroalkyl substances (PFAS) have attracted increasing attention due to their environmental persistence and potential toxicity. Diet is one of the main routes of human exposure to PFAS, particularly through the consumption of animal-derived foods (e.g., aquatic products, livestock and poultry, and products derived from them). This review summarizes the source, bioaccumulation, and distribution of PFAS in animal-derived foods and key influential factors. In most environmental media, perfluorooctanoic acid and perfluorooctane sulfonate are the dominant PFAS, with the levels of short-chain PFAS such as perfluorobutyric acid and perfluorohexane sulfonate surpassing them in some watersheds and coastal areas. The presence of PFAS in environmental media is mainly influenced by suspended particulate matter, microbial communities as well as temporal and spatial factors, such as season and location. Linear PFAS with long carbon chains (C ≥ 7) and sulfonic groups tend to accumulate in organisms and contribute significantly to the contamination of animal-derived foods. Furthermore, PFAS, due to their protein affinity, are prone to accumulate in the blood and protein-rich tissues such as the liver and kidney. Species differences in PFAS bioaccumulation are determined by diet, variances in protein content in the blood and tissues and species-specific activity of transport proteins. Carnivorous fish usually show higher PFAS accumulation than omnivorous fish. Poultry typically metabolize PFAS more rapidly than mammals. PFAS exposures in the processing of animal-derived foods are also attributable to the migration of PFAS from food contact materials, especially those in higher-fat content foods. The human health risk assessment of PFAS exposure from animal-derived foods suggests that frequent consumption of aquatic products potentially engender greater risks to women and minors than to adult males. The information and perspectives from this review would help to further identify the toxicity and migration mechanism of PFAS in animal-derived foods and provide information for food safety management.

Identifying priority PBT-like compounds from emerging PFAS by nontargeted analysis and machine learning models

As traditional per and polyfluoroalkyl substances (PFAS) are phased out, emerging PFAS are being developed and widely used. However, little is known about their properties, including persistence, bioaccumulation, and toxicity (PBT). Screening for emerging PFAS relies on available chemical inventory databases. Here, we compiled a database of emerging PFAS obtained from nontargeted analysis and assessed their PBT properties using machine learning models, including qualitative graph attention networks, Insubria PBT Index and quantitative EAS-E Suite, VEGA, and ProTox-II platforms. Totally 282 homologues (21.8% of emerging PFAS) were identified as PBT based on the combined qualitative and quantitative prediction, in which 140 homologues were detected in industrial and nonbiological/biological samples, belong to four categories, i.e. modifications of perfluoroalkyl carboxylic acids, perfluoroalkane sulfonamido substances, fluorotelomers and modifications of perfluoroalkyl sulfonic acids. Approximately 10.1% of prioritized emerging PFAS were matched to chemical vendors and 19.6% to patents. Aqueous film-forming foams and fluorochemical factories are the predominant sources for prioritized emerging PFAS. The database and screening results can update the assessment related to legislative bodies such as the US Toxic Substances Control Act and the Stockholm Convention. The combined qualitative and quantitative machine learning models can provide a methodological tool for prioritizing other emerging organic contaminants.

Microfluidic Chip-Based Modeling of Three-Dimensional Intestine-Vessel-Liver Interactions in Fluorotelomer Alcohol Biotransformation

Plyfluoroalkyl substance (PFAS), featured with incredible persistence and chronic toxicity, poses an emerging ecological and environmental crisis. Although significant progress has been made in PFAS metabolism in vivo, the underlying mechanism of metabolically active organ interactions in PFAS bioaccumulation remains largely unknown. We developed a microfluidic-based assay to recreate the intestine-vessel-liver interface in three dimensions, allowing for high-resolution, real-time images and precise quantification of intestine-vessel-liver interactions in PFAS biotransformation. In contrast to the scattered arrangement of vascular endothelium on the traditional d-polylysine-modified two-dimensional (2D) plate, the microtubules in our three-dimensional (3D) platform formed a dense honeycomb network through the ECM, with longer tubular structures. Additionally, the slope culture of epithelial cells in our platform exhibited a closely arranged and thicker cell layer than the planar culture. To dynamically monitor the metabolic crosstalk in the intestinal-vascular endothelium-liver interaction under exposure to fluorotelomer alcohols (FTOHs), we combined the chip with a solid-phase extraction-mass spectrometry (SPE-MS) system. Our findings revealed that endothelial cells were involved in the metabolic process of FTOHs. The transformation of intestinal epithelial and hepatic epithelial cells produces toxic metabolite fluorotelomer carboxylic acids (FTCAs), which circulate to endothelial cells and affect angiogenesis. This system shows promise as an enhanced surrogate model and platform for studying pollutant exposure as well as for biomedical and pharmaceutical research.

Maternal transfer of F-53B inhibited neurobehavior in zebrafish offspring larvae and potential mechanisms: Dopaminergic dysfunction, eye development defects and disrupted calcium homeostasis

Maternal exposure to environment toxicants is an important risk factor for neurobehavioral health in their offspring. In our study, we investigated the impact of maternal exposure to chlorinated polyfluoroalkyl ether sulfonic acids (Cl-PFESAs, commercial name: F-53B) on behavioral changes and the potential mechanism in the offspring larvae of zebrafish. Adult zebrafish exposed to Cl-PFESAs (0, 0.2, 2, 20 and 200 μg/L) for 21 days were subsequently mated their embryos were cultured for 5 days. Higher concentrations of Cl-PFESAs in zebrafish embryos were observed, along with, reduced swimming speed and distance travelled in the offspring larvae. Molecular docking analysis revealed that Cl-PFESAs can form hydrogen bonds with brain-derived neurotropic factor (BDNF), protein kinase C, alpha, (PKCα), Ca2+-ATPase and Na, K - ATPase. Molecular and biochemical studies evidenced Cl-PFESAs induce dopaminergic dysfunction, eye developmental defects and disrupted Ca2+ homeostasis. Together, our results showed that maternal exposure to Cl-PFESAs lead to behavioral alteration in offspring mediated by disruption in Ca2+ homeostasis, dopaminergic dysfunction and eye developmental defects.

6:2 Chlorinated Polyfluoroalkyl Ether Sulfonates Exert Stronger Thyroid Homeostasis Disruptive Effects in Newborns than Perfluorooctanesulfonate: Evidence Based on Bayesian Benchmark Dose Values from a Population Study

Growing toxicologic evidence suggests that emerging perfluoroalkyl substances (PFASs), like chlorinated polyfluoroalkyl ether sulfonate (Cl-PFESA), may be as toxic or more toxic than perfluorooctanesulfonate (PFOS) and perfluorooctanoic acid (PFOA). However, further investigations are needed in terms of the human health risk assessment. This study examined the effects of emerging and legacy PFAS exposure on newborn thyroid homeostasis and compared the thyroid disruption caused by 6:2 Cl-PFESA and PFOS using a benchmark dose approach. The health effects of mixture and individual exposure were estimated using the partial least-squares (PLS) model and linear regression, respectively. A Bayesian benchmark dose (BMD) analysis determined the BMD value for adverse effect comparison between 6:2 Cl-PFESA and PFOS. The median (interquartile range) concentrations of 6:2 Cl-PFESA (0.573 [0.351-0.872] ng/mL), PFOS (0.674 [0.462-1.007] ng/mL), and PFOA (1.457 [1.034, 2.405] ng/mL) were found to be similar. The PLS model ranked the PFAS variables' importance in projection (VIP) scores as follows: 6:2 Cl-PFESA > PFOS > PFOA. Linear regression showed that 6:2 Cl-PFESA had a positive association with free triiodothyronine (FT3, P = 0.006) and triiodothyronine (T3, P = 0.014), while PFOS had a marginally significant positive association with FT3 alone (P = 0.042). The BMD analysis indicated that the estimated BMD10 for 6:2 Cl-PFESA (1.01 ng/mL) was lower than that for PFOS (1.66 ng/mL) in relation to a 10% increase in FT3. These findings suggest that 6:2 Cl-PFESA, an alternative to PFOS, has a more pronounced impact on newborns' thyroid homeostasis compared to PFOS and other legacy PFASs.

Occurrence of legacy and alternative per- and polyfluoroalkyl substances in serum from high exposure population and their disrupting effects on serum lipids and thyroid function

High exposure of per- and polyfluoroalkyl substances (PFAS) has been reported in main chemical production areas in China, while epidemiological study on exposure risk of PFAS is still limited. In this study, legacy and alternative PFAS were measured in serum samples from 161 adults living in Laizhou Bay, a famous chemical production area located in Shandong province, Northern China. Based on the concentrations of serum PFAS, the disrupting effects of PFAS on serum lipids and thyroid function were further explored. The results showed that the serum perfluorooctanoic acid (PFOA) (geometric mean (GM): 60 ng/mL) in this region was even higher than serum PFOA of residents living in PFOA contaminated water districts in United States and Sweden. 100 % of the serum PFOA was higher than the reference dose for increased total cholesterol (TC). Consistently, higher serum PFOA was marginally correlated with increased TC level (p = 0.062) and low-density lipoprotein (p = 0.065). In addition, higher perfluoroisopropyl perfluorooctanesulfonate and 6:2 chlorinated polyfluoroalkyl ether sulfonates (6,2 Cl-PFESA) were significantly correlated with increased high-density lipoprotein (p = 0.040, 0.022). No significant association was observed between individual PFAS and any thyroid function biomarker. However, using the principal component analysis derived factors to represent the co-exposure patterns, co-exposure of legacy long-chain PFAS showed synergistic effects on the free thyroxine, while the mixture of alternative PFAS showed a synergistic influence on the total and free triiodothyronine.

Bioaccumulation, tissue distribution, and maternal transfer of novel PFOS alternatives (6:2 Cl-PFESA and OBS) in wild freshwater fish from Poyang Lake, China

As emerging alternatives to perfluorooctane sulfonate (PFOS), 6:2 chlorinated polyfluoroalkyl ether sulfonic acid (6:2 Cl-PFESA) and sodium p-perfluorous nonenox-benzenesulfonate (OBS) were frequently detected in the four freshwater fish species collected from Poyang Lake. Median concentrations of 6:2 Cl-PFESA and OBS in fish tissues were 0.046-6.0 and 0.46-5.1 ng/g wet weight, respectively. The highest concentrations of 6:2 Cl-PFESA was found in fish livers, whereas OBS was found in the pancreas, brain, gonads, and skin. The tissue distribution pattern of 6:2 Cl-PFESA is similar to that of PFOS. The tissue/liver ratios of OBS were higher than those of PFOS, suggesting that OBS has a greater tendency to transfer from the liver to other tissues. The logarithmic bioaccumulation factors (log BAFs) of 6:2 Cl-PFESA in three carnivorous fish species were greater than 3.7, whereas those of OBS were less than 3.7, indicating that 6:2 Cl-PFESA had a strong bioaccumulation potential. Notably, sex- and tissue-specific bioaccumulation of OBS has also been observed in catfish. Most tissues (except the gonads) exhibited higher OBS concentrations in males than in females. However, no differences were found for 6:2 Cl-PFESA and PFOS. Maternal transfer efficiency of OBS was higher than that of 6:2 Cl-PFESA and PFOS in catfish (p < 0.05), indicating that OBS presents a higher risk of exposure to males and offspring through maternal offloading.

The occurrence, tissue distribution, and PBT potential of per- and polyfluoroalkyl substances in the freshwater organisms from the Yangtze river via nontarget analysis

Numerous emerging per- and polyfluoroalkyl substances (PFASs) occur in the aquatic environment, posing a threat to aquatic ecosystems and human health. In this study, we conducted a nontarget analysis on 3 surface water samples and 92 tissue samples of 16 fish collected from the Yangtze River to investigate the patterns, tissue distribution, and environmental impacts of emerging PFASs. A total of 43 PFASs from 11 classes were identified, including 17 legacy PFASs and 26 emerging PFASs. Among the 43 PFASs, seven PFASs were reported in biota for the first time while five PFASs were reported in the environment for the first time. Chlorine substituted perfluoroalyl ether sulfonic acids were the major emerging PFASs detected in organisms. Our results showed that most emerging PFASs tended to accumulate in the liver whereas perfluorinated sulfonamides tended to accumulate in the blood, and all of the emerging PFASs accumulated less in the muscle. Methods for evaluating the persistence, bioaccumulation, and toxicity (PBT) of PFASs were developed by combining the in-silico methods and experimental methods. Long-chain PFASs were found to have extremely high PBT scores compared to short-chain PFASs. Additionally, most emerging PFASs exhibited comparable PBT characteristics with legacy PFASs, especially Cl-substituted PFASs.

Legacy and novel perfluoroalkyl substances in raw and cooked squids: Perspective from health risks and nutrient benefits

Perfluoroalkyl substance (PFAS) existed ubiquitously in the environment and could be ingested unconsciously with food which posed a disease risk to human health. Swordtip squid (Uroteuthis edulis) is one of the most popular and highly consumed seafood worldwide, with wide distribution and abundant biomass. Therefore, it is of great importance to the health of the public by reducing the health risks of squid consumption while preserving the benefits of squid to humans. In this study, the PFAS and fatty acids in squids were tested from the southeast coastal regions of China, a major habitat for squids. Relative higher concentrations of PFAS in squid were found in the subtropical zone of southern China (mean: 15.90 ng/g·dw) compared to those of the temperate zone of northern China (mean: 11.77 ng/g·dw). The digestive system had high tissue/muscle ratio (TMR) values, and the pattern of TMR among the same carbon-chain PFAS was similar. Cooking methods have a significant contribution to eliminating PFAS (in squids). PFAS were transferred from squids to other mediums after cooking, so juice and oil should be poured out to minimize PFAS exposure into body. The result showed that squids can be regarded as a healthy food by health benefits associated with fatty acids. Estimated daily intake (EDI) had the highest level in Korea via consuming squids through cooking processes compared with other countries. Based on the assessment of the hazard ratios (HRs), there was a high exposure risk of perfluoropentanoic acid (PFPeA) via taking squids for human health. This research provided the theoretical guidance of aquatic product processing in improving nutrition and reducing harmful substances.

Effects of PFOS, F-53B and OBS on locomotor behaviour, the dopaminergic system and mitochondrial function in developing zebrafish (Danio rerio)

Perfluorooctanesulfonic acid (PFOS) has widely been reported to persist in the environment and to elicit neurotoxicological effects in wildlife and humans. Following the restriction of PFOS use, 6:2 chlorinated polyfluorinated ether sulfonate (F-53B) and sodium p-perfluorous nonenoxybenzene sulfonate (OBS) have emerged as novel PFOS alternatives and have been detected in the environment. However, knowledge on the toxicological effects of these alternatives remains scarce. Using developing transgenic Tg(dat:eGFP) zebrafish, we evaluated the consequences of exposure to 0, 0.1 and 1 mg/l PFOS, F-53B and OBS on the dopaminergic system, locomotor behaviour and mitochondrial function. All compounds generally reduced locomotor activity under light conditions irrespective of exposure concentration. Exposure to OBS (at all concentrations), as well as PFOS and F-53B (at 1 mg/l), significantly reduced subpallial dopaminergic neuron abundance. PFOS also significantly reduced dat and pink1 expression irrespective of exposure concentration, while F-53B and OBS tended to reduce mitochondrial pink1 and fis1 expression across concentrations without reaching statistical significance. Mitochondrial function, in the form of reduced oxygen consumption rate and marginally inhibited ATP-linked oxygen consumption rate, was affected only in response to 1 mg/l PFOS. Together, PFOS and the emerging contaminants F-53B and OBS inhibit locomotion at similar concentrations, a finding correlated with decreased dopaminergic neuron numbers in the subpallium and decreased expression of pink1. These findings are relevant to wildlife and human health, as they suggest that PFOS as well as replacement compounds affect locomotion likely in part by negatively impacting the dopamine system.

A Review on Per- and Polyfluoroalkyl Substances in Pregnant Women: Maternal Exposure, Placental Transfer, and Relevant Model Simulation

Per- and polyfluoroalkyl substances (PFASs) are important and ubiquitous environmental contaminants worldwide. These novel contaminants can enter human bodies via various pathways, subsequently posing risks to the ecosystem and human health. The exposure of pregnant women to PFASs might pose risks to the health of mothers and the growth and development of fetuses. However, little information is available about the placental transfer of PFASs from mothers to fetuses and the related mechanisms through model simulation. In the present study, based upon a review of previously published literature, we initially summarized the exposure pathways of PFASs in pregnant women, factors affecting the efficiency of placental transfer, and mechanisms associated with placental transfer; outlined simulation analysis approaches using molecular docking and machine learning to reveal the mechanisms of placental transfer; and finally highlighted future research emphases that need to be focused on. Consequently, it was notable that the binding of PFASs to proteins during placental transfer could be simulated by molecular docking and that the placental transfer efficiency of PFASs could also be predicted by machine learning. Therefore, future research on the maternal-fetal transfer mechanisms of PFASs with the benefit of simulation analysis approaches is warranted to provide a scientific basis for the health effects of PFASs on newborns.

Insight into the binding model of per- and polyfluoroalkyl substances to proteins and membranes

Legacy per- and polyfluoroalkyl substances (PFASs) have elicited much concern because of their ubiquitous distribution in the environment and the potential hazards they pose to wildlife and human health. Although an increasing number of effective PFAS alternatives are available in the market, these alternatives bring new challenges. This paper comprehensively reviews how PFASs bind to transport proteins (e.g., serum albumin, liver fatty acid transport proteins and organic acid transporters), nuclear receptors (e.g., peroxisome proliferator activated receptors, thyroid hormone receptors and reproductive hormone receptors) and membranes (e.g., cell membrane and mitochondrial membrane). Briefly, the hydrophobic fluorinated carbon chains of PFASs occupy the binding cavities of the target proteins, and the acid groups of PFASs form hydrogen bonds with amino acid residues. Various structural features of PFAS alternatives such as chlorine atom substitution, oxygen atom insertion and a branched structure, introduce variations in their chain length and hydrophobicity, which potentially change the affinity of PFAS alternatives for endogenous proteins. The toxic effects and mechanisms of action of legacy PFASs can be demonstrated and compared with their alternatives using binding models. In future studies, in vitro experiments and in silico quantitative structure-activity relationship modeling should be better integrated to allow more reliable toxicity predictions for both legacy and alternative PFASs.

Development of a Completely New PFOS Alternative with Lower Surface Tension for Minimizing the Environmental Burden

Improving the technical performance of related industrial products is an efficient strategy to reducing the application quantities and environmental burden for toxic chemicals. A novel polyfluoroalkyl surfactant potassium 1,1,2,2,3,3,4,4-octafluoro-4-(perfluorobutoxy)butane-1-sulfonate(F404) was synthesized by a commercializable route. It had a surface tension(γ) of 18.2 mN/m at the critical micelle concentration(CMC, 1.04 g/L), significantly lower than that of perfluorooctane sulfonate(PFOS, ca. 33.0 mN/m, 0.72 g/L), and exhibited remarkable suppression of chromium-fog at a dose half that of PFOS. The half maximal inhibitory concentration(IC50) values in HepG2 cells and the lethal concentration of 50%(LC50) in zebrafish embryos after 72 hpf indicated a lower toxicity for F404 in comparison to PFOS. In a UV/sulphite system, 89.3% of F404 were decomposed after 3 h, representing a defluorination efficiency of 43%. The cleavage of the ether C-O bond during the decomposition would be expected to form a short chain·C4F9 as the position of the ether C-O in the F404 fluorocarbon chains is C4-O5. The ether unit is introduced in the perfluoroalkyl chain to improve water solubility, biocompatibility and degradation, thereby minimizing the environmental burden.

Electronic Supplementary Material

Supplementary material is available in the online version of this article at 10.1007/s40242-023-3030-4.

Integration of target, suspect, and nontarget screening with risk modeling for per- and polyfluoroalkyl substances prioritization in surface waters

Though thousands of per- and polyfluoroalkyl substances (PFAS) have been on the global market, most research focused on only a small fraction, potentially resulting in underestimated environmental risks. Here, we used complementary target, suspect, and nontarget screening for quantifying and identifying the target and nontarget PFAS, respectively, and developed a risk model considering their specific properties to prioritize the PFAS in surface waters. Thirty-three PFAS were identified in surface water in the Chaobai river, Beijing. The suspect and nontarget screening by Orbitrap displayed a sensitivity of > 77%, indicating its good performance in identifying the PFAS in samples. We used triple quadrupole (QqQ) under multiple-reaction monitoring for quantifying PFAS with authentic standards due to its potentially high sensitivity. To quantify the nontarget PFAS without authentic standards, we trained a random forest regression model which presented the differences up to only 2.7 times between measured and predicted response factors (RFs). The maximum/minimum RF in each PFAS class was as high as 1.2-10.0 in Orbitrap and 1.7-22.3 in QqQ. A risk-based prioritization approach was developed to rank the identified PFAS, and four PFAS (i.e., perfluorooctanoic acid, hydrogenated perfluorohexanoic acid, bistriflimide, 6:2 fluorotelomer carboxylic acid) were flagged with high priority (risk index > 0.1) for remediation and management. Our study highlighted the importance of a quantification strategy during environmental scrutiny of PFAS, especially for nontarget PFAS without standards.

Insights into the circadian rhythm alterations of the novel PFOS substitutes F-53B and OBS on adult zebrafish

As alternatives to perfluorooctane sulfonate (PFOS), 6:2 Cl-PFESA (F-53B) and sodium p-perfluorous nonenoxybenzene sulfonate (OBS) are frequently detected in aquatic environments, but little is known about their neurotoxicity, especially in terms of circadian rhythms. In this study, adult zebrafish were chronically exposed to 1 μM PFOS, F-53B and OBS for 21 days taking circadian rhythm-dopamine (DA) regulatory network as an entry point to comparatively investigate their neurotoxicity and underlying mechanisms. The results showed that PFOS may affect the response to heat rather than circadian rhythms by reducing DA secretion due to disruption of calcium signaling pathway transduction caused by midbrain swelling. In contrast, F-53B and OBS altered the circadian rhythms of adult zebrafish, but their mechanisms of action were different. Specifically, F-53B might alter circadian rhythms by interfering with amino acid neurotransmitter metabolism and disrupting blood-brain barrier (BBB) formation, whereas OBS mainly inhibited canonical Wnt signaling transduction by reducing cilia formation in ependymal cells and induced midbrain ventriculomegaly, finally triggering imbalance in DA secretion and circadian rhythm changes. Our study highlights the need to focus on the environmental exposure risks of PFOS alternatives and the sequential and interactive mechanisms of their multiple toxicities.

Associations between per and polyfluoroalkyl ether sulfonic acids and vitamin D biomarker levels in Chinese newborns

Skeleton develops extremely fast during fetal and neonatal stages; thus, fetuses and newborns exhibit unique vulnerabilities to vitamin D metabolism dysregulation, giving vitamin D's principal role in calcium homeostasis. Previous studies linked legacy per and polyfluoroalkyl ether sulfonic acids (PFAS) with vitamin D biomarker status in adults and children; however, how PFAS, especially emerging CI-PFESAs, influence vitamin D among newborns is unknown. This study focused on the epidemiological linkages between PFAS and vitamin D biomarkers. Eleven PFAS, including legacy PFAS and emerging CI-PFESAs, as well as two vitamin D metabolites [25-hydroxyvitamin D2 (25(OH)D2) and 25-hydroxyvitamin D3 (25(OH)D3)], were determined in cord sera of 992 newborns from a birth cohort in Wuhan, China. The cord serum levels of 25(OH)D2 and 25(OH)D3 were summed as total 25(OH)D, which is a reliable biomarker of vitamin D status. The associations of separated PFAS with vitamin D biomarker levels were analyzed via multiple linear models, whereas the mixture effect was estimated by utilizing the weighted quantile sum (WQS) regression. We observed that per doubling changes in perfluorotridecanoate (PFTrDA), perfluorohexane sulfonate (PFHxS), and perfluorooctane sulfonate (PFOS) were associated with a 6.04 to 9.05 % change in total 25(OH)D levels. PFHxS contributed over half of the PFAS mixture effect on total 25(OH)D. Stratified analysis indicated that the associations of certain PFAS with vitamin D biomarkers were more pronounced among boys. The emerging CI-PFESAs were not robustly related to vitamin D biomarker levels. The results suggested that exposure to legacy PFAS might disturb vitamin D status in newborns. Future epidemiological studies are required to confirm the association and to determine healthy implications at a later age.