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Belay MH, Robotti E, Ghignone A, Fabbris A, Brandi J, Cecconi D, Masini MA, Dondero F, Marengo E. Sensitive and accurate determination of 32 PFAS in human serum using online SPE-UHPLC-HRMS. JOURNAL OF HAZARDOUS MATERIALS 2025; 485:136780. [PMID: 39667152 DOI: 10.1016/j.jhazmat.2024.136780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Revised: 12/02/2024] [Accepted: 12/03/2024] [Indexed: 12/14/2024]
Abstract
Per- and polyfluoroalkyl substances' (PFAS) extreme persistence has been linked to many adverse effects on human health including increased risk of certain cancers. This study presents the development and validation of a new, highly sensitive method for the quantification of 32 PFAS in human serum using online solid-phase extraction (SPE) coupled with ultra-high performance liquid chromatography-high resolution mass spectrometry (UHPLC-HRMS). Legacy and emerging PFAS were targeted. Main steps of sample pretreatment include protein precipitation (PP), pellet rinsing, centrifugation, preconcentration through solvent evaporation, and online SPE using a weak anion-exchange polymeric sorbent. The PP and pellet-rinsing procedures were optimized through a comprehensive exploration of solvent combinations. Following this, a pretreatment that offers the best compromise for the targeted PFAS was identified using principal component analysis. The method demonstrated excellent linearity (R² = 0.977-0.997) with limits of quantification ranging from 8.9 to 27 ng/L, 5 to 15 times lower than previous methods. Precision (intraday 2.6-14.0 % and interday 1.3-11.0 % relative standard deviation) and accuracy (recoveries 72.7-106 %) were robust. The method was validated in accordance with ISO/IEC 17025 and successfully applied to five human serum samples, confirming its suitability for high-throughput profiling of PFAS in biomonitoring studies. This method is the first to use online SPE for the simultaneous determination of a broad range of PFAS, including ether congeners such as perfluoro(2-ethoxyethane) sulfonic acid and Nafion byproduct 2. Furthermore, control charts were employed to assess instrument performance during routine analysis and implement necessary actions.
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Affiliation(s)
- Masho Hilawie Belay
- Department of Sciences and Technological Innovation, University of Piemonte Orientale, Viale Teresa Michel 11, 15121 Alessandria, Italy; Department of Chemistry, Mekelle University, P. O. Box 231, Mekelle, Ethiopia
| | - Elisa Robotti
- Department of Sciences and Technological Innovation, University of Piemonte Orientale, Viale Teresa Michel 11, 15121 Alessandria, Italy.
| | - Arianna Ghignone
- Department of Sciences and Technological Innovation, University of Piemonte Orientale, Viale Teresa Michel 11, 15121 Alessandria, Italy
| | - Alessia Fabbris
- Department of Sciences and Technological Innovation, University of Piemonte Orientale, Viale Teresa Michel 11, 15121 Alessandria, Italy
| | - Jessica Brandi
- Department of Biotechnology, University of Verona, Strada le Grazie 15, 37134 Verona, Italy
| | - Daniela Cecconi
- Department of Biotechnology, University of Verona, Strada le Grazie 15, 37134 Verona, Italy
| | - Maria Angela Masini
- Department of Sciences and Technological Innovation, University of Piemonte Orientale, Viale Teresa Michel 11, 15121 Alessandria, Italy
| | - Francesco Dondero
- Department of Sciences and Technological Innovation, University of Piemonte Orientale, Viale Teresa Michel 11, 15121 Alessandria, Italy
| | - Emilio Marengo
- Department of Sciences and Technological Innovation, University of Piemonte Orientale, Viale Teresa Michel 11, 15121 Alessandria, Italy
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2
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Wang Z, You X, Lan L, Huang G, Zhu T, Tian S, Yang B, Zhuo Q. Electrocatalytic oxidation of hexafluoropropylene oxide homologues in water using a boron-doped diamond electrode. ENVIRONMENTAL TECHNOLOGY 2025; 46:1280-1291. [PMID: 39128835 DOI: 10.1080/09593330.2024.2382937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/03/2024] [Indexed: 08/13/2024]
Abstract
Hexafluoropropylene oxide (GenX) is a kind of substitute to PFOA, which has been listed in the Stockholm Convention. In this study, GenX was attempted to be degraded using a boron-doped diamond anode in the electrochemical oxidation system. The effects of operating parameters, including current density (0.5-10 mA/cm2), initial pH (3.0-11.49), initial concentration of GenX (20-150 mg/L), electrode distances (0.5-2 cm), electrolyte types (Na2SO4, NaCl, NaNO3 and NaHCO3) and Na2SO4 electrolyte concentration (40-80 mm), on GenX were studied. GenX can almost completely be degraded under the optimal operating parameters after 180 min of electrolysis. Free radical quenching experiments were carried out to investigate the effects of hydroxyl radicals and sulphate radicals on the degradation of GenX. The degradation intermediates were identified based on the ultra-high performance liquid chromatography equipped with a tandem mass spectrometer, and the degradation mechanisms were also proposed. Finally, the toxicities of GenX and its degradation products were evaluated using the QSAR models. The novelty is that the degradation mechanisms of the high concentration GenX (100 mg/L) were elucidated based on the free radical quenching experiments and the intermediates detected, when the degradation ratio reached 100%.
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Affiliation(s)
- Zihao Wang
- School of Environment and Civil Engineering, Dongguan University of Technology, Dongguan Key Laboratory of Emerging Contaminants, Dongguan, People's Republic of China
| | - Xiaolin You
- College of Chemistry and Environmental Engineering, Shenzhen University, Shenzhen, People's Republic of China
| | - Liying Lan
- School of Environment and Civil Engineering, Dongguan University of Technology, Dongguan Key Laboratory of Emerging Contaminants, Dongguan, People's Republic of China
| | - Gang Huang
- School of Environment and Civil Engineering, Dongguan University of Technology, Dongguan Key Laboratory of Emerging Contaminants, Dongguan, People's Republic of China
| | - Tongyin Zhu
- School of Environment and Civil Engineering, Dongguan University of Technology, Dongguan Key Laboratory of Emerging Contaminants, Dongguan, People's Republic of China
| | - Shengpeng Tian
- School of Environment and Civil Engineering, Dongguan University of Technology, Dongguan Key Laboratory of Emerging Contaminants, Dongguan, People's Republic of China
| | - Bo Yang
- College of Chemistry and Environmental Engineering, Shenzhen University, Shenzhen, People's Republic of China
| | - Qiongfang Zhuo
- School of Environment and Civil Engineering, Dongguan University of Technology, Dongguan Key Laboratory of Emerging Contaminants, Dongguan, People's Republic of China
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3
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Ren R, Zhou X, Jia T, Wang B, Liu A, Gao M, Song J, Wang L, Jing Y, Yu L, Shen H, Zhang X. Developmental exposure to perfluorooctane sulfonate(PFOS) impairs the endometrial receptivity. Sci Rep 2025; 15:1747. [PMID: 39799182 PMCID: PMC11724984 DOI: 10.1038/s41598-024-84732-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 12/26/2024] [Indexed: 01/15/2025] Open
Abstract
Perfluorooctane sulfonate (PFOS) is a widely used chemical in industrial production. It can be introduced into the environment through multiple pathways and exhibits resistance to degradation. Recent research has demonstrated a significant correlation between its exposure levels in the human body and the incidence of various diseases. The expression of genes related to endometrial receptivity and the differentiation of human endometrial stromal cells (hESCs) were assessed in this study concerning PFOS. In this study, we investigated the effect of PFOS exposure on endometrial tolerance by cell and animal experiments. The activity against endometrial mesenchymal cells was significantly reduced by PFOS intervention, and the apoptosis flow assay results showed that PFOS significantly promoted cell death in a concentration-dependent manner. Transmission electron microscopy results revealed mitochondrial damage in the PFOS-intervened group, and WB results showed that the expression levels of endometrial tolerance-related proteins Homeobox A10 (HOXA10) and integrin beta3 (ITGB3) were decreased, and the expression level of Forkhead box O1 (FOXO1) protein was increased. Animal studies have shown that PFOS exposure can change uterine morphology, cause obvious damage to pinopodes morphology, change the estrous cycle of mice, and affect endometrial receptivity In the present study, we found that PFOS may synergistically affect the viability of endometrial mesenchymal stromal cells through accumulation in vivo, and that PFOS may contribute to the failure of embryo implantation by affecting mitochondrial function and consequently endometrial permissive sites.
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Affiliation(s)
- Rui Ren
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
- The First Hospital of Lanzhou University, Lanzhou, China
- Gansu Provincial Hospital, Lanzhou, China
| | - Xinyue Zhou
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Tianyu Jia
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Bin Wang
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Ahui Liu
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Min Gao
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Ji Song
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Liyan Wang
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Yuanxue Jing
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Liulin Yu
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Haofei Shen
- The First Hospital of Lanzhou University, Lanzhou, China.
| | - Xuehong Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.
- The First Hospital of Lanzhou University, Lanzhou, China.
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4
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Lu S, Zhu X, Zeng P, Hu L, Huang Y, Guo X, Chen Q, Wang Y, Lai L, Xue A, Wang Y, Wang Z, Song W, Liu Q, Bian G, Li J, Bu Q, Cen X. Exposure to PFOA, PFOS, and PFHxS induces Alzheimer's disease-like neuropathology in cerebral organoids. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 363:125098. [PMID: 39389246 DOI: 10.1016/j.envpol.2024.125098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 09/25/2024] [Accepted: 10/08/2024] [Indexed: 10/12/2024]
Abstract
Per- and polyfluoroalkyl substances (PFASs), a class of ubiquitous synthetic organic chemicals, are widely utilized across various industrial applications. However, the long-term neurological health effects of PFAS mixture exposure in humans remain poorly understood. To address this gap, we have designed a comprehensive study to predict and validate cell-type-specific neurotoxicity of PFASs using single-cell RNA sequencing (scRNA-seq) and cerebral organoids. Cerebral organoids were exposed to a PFAS mixture at concentrations of 1 × (10 ng/ml PFOS and PFOA, and 1 ng/ml PFHxS), 30 × , and 900 × over 35 days, with a follow-up analysis at day 70. Pathological alterations and lipidomic profiles were analyzed to identify disrupted molecular pathways and mechanisms. The scRNA-seq data revealed a significant impact of PFASs on neurons, suggesting a potential role in Alzheimer's Disease (AD) pathology, as well as intellectual and cognitive impairments. PFAS-treated cerebral organoids exhibited Aβ accumulation and tau phosphorylation. Lipidomic analyses further revealed lipid disturbances in response to PFAS mixture exposure, linking PFAS-induced AD-like neuropathology to sphingolipid metabolism disruption. Collectively, our findings provide novel insights into the PFAS-induced neurotoxicity, highlighting the significance of sphingolipid metabolism in the development of AD-like neuropathology. The use of cerebral organoids and scRNA-seq offers a powerful methodology for evaluating the health risks associated with environmental contaminants, particularly those with neurotoxic potential.
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Affiliation(s)
- Shiya Lu
- Molecular Toxicology Key Laboratory of Sichuan Provincial Education office, West China School of Public Health and West China Fourth Hospital, and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China
| | - Xizhi Zhu
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Pinli Zeng
- Molecular Toxicology Key Laboratory of Sichuan Provincial Education office, West China School of Public Health and West China Fourth Hospital, and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China
| | - Linxia Hu
- Molecular Toxicology Key Laboratory of Sichuan Provincial Education office, West China School of Public Health and West China Fourth Hospital, and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China
| | - Yan Huang
- Molecular Toxicology Key Laboratory of Sichuan Provincial Education office, West China School of Public Health and West China Fourth Hospital, and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China
| | - Xinhua Guo
- Molecular Toxicology Key Laboratory of Sichuan Provincial Education office, West China School of Public Health and West China Fourth Hospital, and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China
| | - Qiqi Chen
- Molecular Toxicology Key Laboratory of Sichuan Provincial Education office, West China School of Public Health and West China Fourth Hospital, and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China
| | - Yantang Wang
- Department of Pharmacology, School of Pharmacy, Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Li Lai
- National Chengdu Center for Safety Evaluation of Drugs, State Key Lab of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Aiqin Xue
- National Chengdu Center for Safety Evaluation of Drugs, State Key Lab of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Yanli Wang
- Jinniu Maternity and Child Health Hospital of Chengdu, Chengdu, 610036, China
| | - Zhiqiu Wang
- Molecular Toxicology Key Laboratory of Sichuan Provincial Education office, West China School of Public Health and West China Fourth Hospital, and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China
| | - Wenbo Song
- National Chengdu Center for Safety Evaluation of Drugs, State Key Lab of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Qian Liu
- National Chengdu Center for Safety Evaluation of Drugs, State Key Lab of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Guohui Bian
- National Chengdu Center for Safety Evaluation of Drugs, State Key Lab of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Jiayuan Li
- Molecular Toxicology Key Laboratory of Sichuan Provincial Education office, West China School of Public Health and West China Fourth Hospital, and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China
| | - Qian Bu
- Molecular Toxicology Key Laboratory of Sichuan Provincial Education office, West China School of Public Health and West China Fourth Hospital, and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China.
| | - Xiaobo Cen
- National Chengdu Center for Safety Evaluation of Drugs, State Key Lab of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, China.
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5
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Ma H, Mustafa MA, Maashi MS, Menon SV, Sivaprasad GV, Hjazi A, Ibrahim FM, Jabbar HS, Meng X. Maternal and cord blood levels of metals and fetal liver function. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 363:125305. [PMID: 39542167 DOI: 10.1016/j.envpol.2024.125305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 10/24/2024] [Accepted: 11/11/2024] [Indexed: 11/17/2024]
Abstract
Exposure to metals during pregnancy has been associated with adverse birth outcomes, but its impact on fetal liver function remains poorly understood. This study for the first time aimed to investigate the association between maternal and umbilical cord blood Metals levels and umbilical liver enzymes. A comprehensive analysis was conducted on 450 mother-newborn pairs in 2022, measuring 13 Metals in serum samples from pregnant women during the third trimester and umbilical cord blood samples. Regression analyses were utilized to examine the relationship between levels of maternal and umbilical cord blood Metals and the levels of gamma-glutamyl transferase (GGT), umbilical alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). G-comp analyses evaluated the combined effect of metals exposure on umbilical liver enzymes. Elevated levels of certain Metals in cord blood and maternal samples were positively linked with increased umbilical GGT, ALP, ALT, and AST levels. Notably, zinc (Zn) levels in cord blood exhibited an inverse correlation with umbilical liver enzyme levels. Furthermore, g-comp analyses revealed significant positive associations between exposure to metals mixtures and umbilical liver enzyme levels. An increase of one quartile in the mixture of maternal and umbilical Metals was linked with 99.45 U/L (95% CI:37.72, 161.19, p < 0.01), 2.79 (95% CI: 0.92, 4.65, p < 0.01), and 87.17 (95% CI: 53.96, 120.38, p < 0.01) increase in ALP, ALT and GGT levels. Further examination of the weight of Metals revealed As, Cd, Ni, Pb, Hg and Cr with the highest positive effects and Zn with the highest negative effect in the mixture effect on the umbilical liver enzyme. In summary, our results underscore the potential influence of prenatal heavy metal exposure on fetal liver function.
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Affiliation(s)
- Haowei Ma
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | | | - Marwah Suliman Maashi
- Medical Laboratory Sciences Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; Regenerative Medicine Unit at King Fahad Medical Research Centre, Jeddah, Saudi Arabia
| | - Soumya V Menon
- Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), Bangalore, Karnataka, India
| | - G V Sivaprasad
- Department of Basic Science & Humanities, Raghu Engineering College, Visakhapatnam, India
| | - Ahmed Hjazi
- Clinical Medicine, Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
| | - Fatma Magdi Ibrahim
- Community Health Nursing, RAK Medical and Health Sciences University, United Arab Emirates; Geriatric nursing, Mansoura University, Egypt
| | - Hijran Sanaan Jabbar
- Department of Chemistry, College of Science, Salahaddin University-Erbil, Erbil, Kurdistan Region, Iraq
| | - Xuan Meng
- Hepatobiliary Surgery Department, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China; Zibo City Fourth People's Hospital, Zibo, 255067, China.
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6
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Bharal B, Ruchitha C, Kumar P, Pandey R, Rachamalla M, Niyogi S, Naidu R, Kaundal RK. Neurotoxicity of per- and polyfluoroalkyl substances: Evidence and future directions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 955:176941. [PMID: 39454776 DOI: 10.1016/j.scitotenv.2024.176941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 09/28/2024] [Accepted: 10/12/2024] [Indexed: 10/28/2024]
Abstract
Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals widely used in various products, including food packaging, textiles, and firefighting foam, owing to their unique properties such as amphiphilicity and strong CF bonds. Despite their widespread use, concerns have arisen due to their resistance to degradation and propensity for bioaccumulation in both environmental and human systems. Emerging evidence suggests a potential link between PFAS exposure and neurotoxic effects, spanning cognitive deficits, neurodevelopmental disorders, and neurodegenerative diseases. This review comprehensively synthesizes current knowledge on PFAS neurotoxicity, drawing insights from epidemiological studies, animal experiments, and mechanistic investigations. PFAS, known for their lipophilic nature, tend to accumulate in lipid-rich tissues, including the brain, breaching biological barriers such as the blood-brain barrier (BBB). The accumulation of PFAS within the central nervous system (CNS) has been implicated in a spectrum of neurological maladies. Neurotoxicity induced by PFAS manifests through a multitude of direct and indirect mechanisms. A growing body of research associated PFAS exposure with BBB disruption, calcium dysregulation, neurotransmitter alterations, neuroinflammation, oxidative stress, and mitochondrial dysfunction, all contributing to neuronal impairment. Despite notable strides in research, significant lacunae persist, necessitating further exploration to elucidate the full spectrum of PFAS-mediated neurotoxicity. Prospective research endeavors should prioritize developing biomarkers, delineating sensitive exposure windows, and exploring mitigation strategies aimed at safeguarding neurological integrity within populations vulnerable to PFAS exposure.
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Affiliation(s)
- Bhagyashree Bharal
- Department of Regulatory Toxicology, National Institute of Pharmaceutical Education and Research-Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow, UP 226002, India
| | - Chanda Ruchitha
- Department of Regulatory Toxicology, National Institute of Pharmaceutical Education and Research-Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow, UP 226002, India
| | - Paarth Kumar
- Department of Regulatory Toxicology, National Institute of Pharmaceutical Education and Research-Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow, UP 226002, India
| | - Rukmani Pandey
- Department of Psychiatry, Center for Molecular Biology and Genetics of Neurodegeneration, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Mahesh Rachamalla
- Department of Biology, University of Saskatchewan, Saskatoon, SK S7N 5E2, Canada
| | - Som Niyogi
- Department of Biology, University of Saskatchewan, Saskatoon, SK S7N 5E2, Canada; Toxicology Centre, University of Saskatchewan, 44 Campus Drive, Saskatoon, SK S7N 5B3, Canada
| | - Ravi Naidu
- Global Centre for Environmental Remediation (GCER), University of Newcastle, Callaghan, NSW 2308, Australia; CRC for Contamination Assessment and Remediation of the Environment (CRC CARE), University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Ravinder K Kaundal
- Department of Regulatory Toxicology, National Institute of Pharmaceutical Education and Research-Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow, UP 226002, India; Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research-Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow, UP 226002, India.
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7
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Park NY, Cho SW, Seo YE, Chae H, Lee I, Lee YA, Jun JK, Kim EN, Oh JW, Choi K, Kho Y. Exposure to and Transplacental Transfer of Per- and Polyfluoroalkyl Substances in a Twin Pregnancy Cohort in Korea. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024. [PMID: 39503683 DOI: 10.1021/acs.est.4c04915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2024]
Abstract
Twin pregnancies involving assisted reproductive technology, particularly among older women, are considered to be high risk and vulnerable to chemical exposures. Per- and polyfluoroalkyl substances (PFAS) can cross the placenta and affect the fetus, but their transplacental transfer (TPT) is not well characterized for twin pregnancies. We employed a subset of twin pregnancies from the Ideal Breast Milk (IBM) cohort and measured the levels of PFAS and related chemicals in maternal (n = 78) and cord serum (n = 156) samples. L-PFOS and PFOA were detected at higher levels in maternal serum, with geometric means of 4.22 and 2.80 ng/mL, respectively, while the level of Br-PFHxS was higher in cord serum (0.29 ng/mL). Higher maternal PFAS levels were associated with the occurrence of maternal vascular malperfusion. Greater differences in cord PFAS levels between twin newborns were associated with higher maternal PFAS levels and an asymmetrical placental perfusion. The TPT ratio exhibited a U-shaped pattern with the number of carbons of PFAS, similar to a singleton pregnancy. Moreover, those with eight carbon atoms, i.e., 9Cl-PF3ONS, PFOA, and PFOS, showed different TPT efficiencies with respect to their structure and functional group. While the twin pregnancy does not appear to influence exposure levels or TPT efficiencies of PFAS and related chemicals, the consequences of the exposure warrant further investigations in this population.
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Affiliation(s)
- Na-Youn Park
- Department of Health, Environment & Safety, Eulji University, Seongnam-si, Gyeonggi-do 13135, South Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Ye Eun Seo
- Department of Food Technology & Service, Eulji University, Seongnam-si, Gyeonggi-do 13135, South Korea
| | - Heeyeon Chae
- Department of Environmental Health Sciences, School of Public Health, and Institute of Health and Environment, Seoul National University, Seoul 08826, South Korea
| | - Inae Lee
- Department of Environmental Health Sciences, School of Public Health, and Institute of Health and Environment, Seoul National University, Seoul 08826, South Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Hospital and Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Eun Na Kim
- Department of Pathology, Seoul National University Hospital, Seoul 03080, South Korea
| | - Jeong-Won Oh
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Seoul 04401, South Korea
| | - Kyungho Choi
- Department of Environmental Health Sciences, School of Public Health, and Institute of Health and Environment, Seoul National University, Seoul 08826, South Korea
| | - Younglim Kho
- Department of Health, Environment & Safety, Eulji University, Seongnam-si, Gyeonggi-do 13135, South Korea
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8
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Li Y, Gao Y, Sun S, Zhang Y, Li X, Shi L, Zhan Y, Wang Q, Chen C, Zhang Q. Efficient Online TurboFlow Method for Simultaneous Determination of 60 Emerging Per- and Polyfluoroalkyl Substances in Milk. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2024; 72:24857-24865. [PMID: 39446904 DOI: 10.1021/acs.jafc.4c04976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2024]
Abstract
Emerging perfluoroalkyl and polyfluoroalkyl substances (PFASs) have received much attention in recent years. Milk has usually low concentrations of PFASs, but it remains an important PFAS exposure route due to its high consumption. In this study, a method for simultaneous determination of 60 PFASs in milk was developed by online TurboFlow liquid chromatography-tandem mass spectrometry. A pH-dependent cold-induced liquid-liquid extraction was developed for precleanup and enrichment. Method quantification limits ranged from 0.003 to 0.500 ng/mL. For PFASs without corresponding isotope-labeled internal standards, Tanimoto coefficient and logP were introduced for the selection of internal standards. The matrix spiked recoveries ranged from 47 to 190%. The method was applied for PFAS analysis in 35 milk samples. PFBS, perfluorohexanesulfonic acid, perfluorooctanesulfonic acid, PFNS, PFPeA, perfluorooctanoic acid, PFNA, and 6:2 FTS were detected. The developed online TurboFlow method was simple, reliable, efficient, and applicable for trace analysis of PFASs in milk.
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Affiliation(s)
- Yaoyao Li
- Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China
- State Key Laboratory of Heavy Oil Processing, State Key Laboratory of Petroleum Pollution Control, China University of Petroleum-Beijing, Beijing 102249, China
| | - Yan Gao
- Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China
- Key Laboratory of Chemical Metrology and Applications on Nutrition and Health for State Market Regulation, Beijing 100029, China
| | - Shenzheng Sun
- Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China
- College of Materials and Chemistry, China Jiliang University, Hangzhou 310018, China
| | - Yan Zhang
- Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China
| | - Xiuqin Li
- Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China
- Key Laboratory of Chemical Metrology and Applications on Nutrition and Health for State Market Regulation, Beijing 100029, China
| | - Ling Shi
- Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China
| | - Yali Zhan
- State Key Laboratory of Heavy Oil Processing, State Key Laboratory of Petroleum Pollution Control, China University of Petroleum-Beijing, Beijing 102249, China
| | - Qinghong Wang
- State Key Laboratory of Heavy Oil Processing, State Key Laboratory of Petroleum Pollution Control, China University of Petroleum-Beijing, Beijing 102249, China
| | - Chunmao Chen
- State Key Laboratory of Heavy Oil Processing, State Key Laboratory of Petroleum Pollution Control, China University of Petroleum-Beijing, Beijing 102249, China
| | - Qinghe Zhang
- Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China
- Key Laboratory of Chemical Metrology and Applications on Nutrition and Health for State Market Regulation, Beijing 100029, China
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9
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Huang Y, Jia Z, Lu X, Wang Y, Li R, Zhou A, Chen L, Wang Y, Zeng HC, Li P, Ghassabian A, Yuan N, Kong F, Xu S, Liu H. Prenatal Exposure to Per- and Polyfluoroalkyl Substances and ASD-Related Symptoms in Early Childhood: Mediation Role of Steroids. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:16291-16301. [PMID: 39226190 DOI: 10.1021/acs.est.4c04500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Previous studies regarding the associations between perfluoroalkyl and polyfluoroalkyl substances (PFAS) and autism spectrum disorder (ASD) have yielded inconsistent results, with the underlying mechanisms remaining unknown. In this study, we quantified 13 PFAS in cord serum samples from 396 neonates and followed the children at age 4 to assess ASD-related symptoms. Our findings revealed associations between certain PFAS and ASD-related symptoms, with a doubling of perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA) concentrations associated with respective increases of 1.79, 1.62, and 1.45 units in language-related symptoms and PFDA exhibiting an association with higher score of sensory stimuli. Nonlinear associations were observed in the associations of 6:2 chlorinated polyfluorinated ether sulfonate (Cl-PFAES) and 8:2 Cl-PFAES with ASD-related symptoms. Employing weighted quantile sum (WQS) regression, we observed significant mixture effects of multiple PFAS on all domains of ASD-related symptoms, with PFNA emerging as the most substantial contributor. Assuming causality, we found that 39-40% of the estimated effect of long-chain PFAS (PFUnDA and PFDoDA) exposure on sensory stimuli was mediated by androstenedione. This study provides novel epidemiological data about prenatal PFAS mixture exposure and ASD-related symptoms.
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Affiliation(s)
- Yun Huang
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Zhenxian Jia
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Xinhe Lu
- School of Environmental Science and Engineering, Hainan University, Haikou 570228, Hainan, China
| | - Yin Wang
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Ruizhen Li
- Women and Children Medical and Healthcare Center of Wuhan, Wuhan 430016, Hubei, China
| | - Aifen Zhou
- Women and Children Medical and Healthcare Center of Wuhan, Wuhan 430016, Hubei, China
| | - Lei Chen
- Women and Children Medical and Healthcare Center of Wuhan, Wuhan 430016, Hubei, China
| | - Yuyan Wang
- Department of Population Health, New York University Grossman School of Medicine, 10016 New York, New York, United States
| | - Huai-Cai Zeng
- School of Public Health, Guilin Medical University, Guilin 541199, Guangxi, China
| | - Pei Li
- Department of Physiology and Biophysics, University of New York at Buffalo, 14260 New York, New York, United States
| | - Akhgar Ghassabian
- Department of Population Health, New York University Grossman School of Medicine, 10016 New York, New York, United States
| | - Ningxue Yuan
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Fanjuan Kong
- Medical Record Management Department, Maternal and Child Health Hospital of Hunan Province, Changsha 410008, Hunan, China
| | - Shunqing Xu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- School of Environmental Science and Engineering, Hainan University, Haikou 570228, Hainan, China
| | - Hongxiu Liu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
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10
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Jia C, Li Y, Cao Y, Zhou Z, Liu Y, Guo Y, Liu W, Yang L. Association between perfluoroalkyl substances and breast cancer on the National Health and Nutrition Examination Survey Database and meta-analysis. JOURNAL OF HAZARDOUS MATERIALS 2024; 477:135219. [PMID: 39053068 DOI: 10.1016/j.jhazmat.2024.135219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 07/10/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024]
Abstract
The relationship between perfluoroalkyl substances (PFASs) and the risk of breast cancer has been controversial. Here, we used the National Health and Nutrition Examination Survey (NHANES) database and a meta-analysis to examine the association between PFASs and breast cancer incidence. From the NHANES database, we obtained data on PFASs and breast cancer from 2003 to 2014. We searched PubMed, Web of Science, Scopus and PsycINFO from the establishment of the databases to August 24, 2023, for research on PFASs related to breast cancer. A meta-analysis was performed using Stata 12.0. A total of 1430 subjects aged 20 years or older were selected from the NHANES. The logistic regression results indicated that there was no correlation between breast cancer and PFASs (P > 0.05). The meta-analysis, included nine studies with a total of 2399 breast cancer patients, included in the meta-analysis, revealed no statistically significant association between PFASs and the risk of breast cancer (odds ratio = 1.04; 95 % confidence interval, 0.88-1.21; P > 0.05). The results show that PFASs are not associated with breast cancer risk.
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Affiliation(s)
- Conghui Jia
- Department of Epidemiology and Statistics, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China
| | - Yanchao Li
- Department of Epidemiology and Statistics, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China
| | - Yuxuan Cao
- Department of Epidemiology and Statistics, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China
| | - Zilin Zhou
- Department of Epidemiology and Statistics, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China
| | - Yuan Liu
- Department of Epidemiology and Statistics, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China
| | - Yang Guo
- Department of Epidemiology and Statistics, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China
| | - Wenxuan Liu
- Department of Epidemiology and Statistics, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China.
| | - Lei Yang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China.
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11
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Ma X, Cai D, Chen Q, Zhu Z, Zhang S, Wang Z, Hu Z, Shen H, Meng Z. Hunting Metabolic Biomarkers for Exposure to Per- and Polyfluoroalkyl Substances: A Review. Metabolites 2024; 14:392. [PMID: 39057715 PMCID: PMC11278593 DOI: 10.3390/metabo14070392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Per- and polyfluoroalkyl substances (PFAS) represent a class of persistent synthetic chemicals extensively utilized across industrial and consumer sectors, raising substantial environmental and human health concerns. Epidemiological investigations have robustly linked PFAS exposure to a spectrum of adverse health outcomes. Altered metabolites stand as promising biomarkers, offering insights into the identification of specific environmental pollutants and their deleterious impacts on human health. However, elucidating metabolic alterations attributable to PFAS exposure and their ensuing health effects has remained challenging. In light of this, this review aims to elucidate potential biomarkers of PFAS exposure by presenting a comprehensive overview of recent metabolomics-based studies exploring PFAS toxicity. Details of PFAS types, sources, and human exposure patterns are provided. Furthermore, insights into PFAS-induced liver toxicity, reproductive and developmental toxicity, cardiovascular toxicity, glucose homeostasis disruption, kidney toxicity, and carcinogenesis are synthesized. Additionally, a thorough examination of studies utilizing metabolomics to delineate PFAS exposure and toxicity biomarkers across blood, liver, and urine specimens is presented. This review endeavors to advance our understanding of PFAS biomarkers regarding exposure and associated toxicological effects.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Zhen Meng
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
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12
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Zhang B, Wang Z, Zhang J, Dai Y, Ding J, Guo J, Qi X, Wu C, Zhou Z. Prenatal exposure to per- and polyfluoroalkyl substances, fetal thyroid function, and intelligence quotient at 7 years of age: Findings from the Sheyang Mini Birth Cohort Study. ENVIRONMENT INTERNATIONAL 2024; 187:108720. [PMID: 38718676 DOI: 10.1016/j.envint.2024.108720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/24/2024] [Accepted: 05/03/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Prenatal exposure to per- and polyfluoroalkyl substances (PFASs) influences neurodevelopment. Thyroid homeostasis disruption is thought to be a possible underlying mechanism. However, current epidemiological evidence remains inconclusive. OBJECTIVES This study aimed to explore the effects of prenatal PFAS exposure on the intelligence quotient (IQ) of school-aged children and assess the potential mediating role of fetal thyroid function. METHODS The study included 327 7-year-old children from the Sheyang Mini Birth Cohort Study (SMBCS). Cord serum samples were analyzed for 12 PFAS concentrations and 5 thyroid hormone (TH) levels. IQ was assessed using the Wechsler Intelligence Scale for Children-Chinese Revised (WISC-CR). Generalized linear models (GLM) and Bayesian Kernel Machine Regression (BKMR) were used to evaluate the individual and combined effects of prenatal PFAS exposure on IQ. Additionally, the impact on fetal thyroid function was examined using a GLM, and a mediation analysis was conducted to explore the potential mediating roles of this function. RESULTS The molar sum concentration of perfluorinated carboxylic acids (ΣPFCA) in cord serum was significantly negatively associated with the performance IQ (PIQ) of 7-year-old children (β = -6.21, 95 % confidence interval [CI]: -12.21, -0.21), with more pronounced associations observed among girls (β = -9.57, 95 % CI: -18.33, -0.81) than in boys. Negative, albeit non-significant, cumulative effects were noted when considering PFAS mixture exposure. Prenatal exposure to perfluorooctanoic acid, perfluorononanoic acid, and perfluorooctanesulfonic acid was positively associated with the total thyroxine/triiodothyronine ratio. However, no evidence supported the mediating role of thyroid function in the link between PFAS exposure and IQ. CONCLUSIONS Increased prenatal exposure to PFASs negatively affected the IQ of school-aged children, whereas fetal thyroid function did not serve as a mediator in this relationship.
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Affiliation(s)
- Boya Zhang
- School of Public Health/MOE Key Laboratory of Public Health Safety, Fudan University, No.130 Dong'an Road, Shanghai 200032, China
| | - Zheng Wang
- School of Public Health/MOE Key Laboratory of Public Health Safety, Fudan University, No.130 Dong'an Road, Shanghai 200032, China
| | - Jiming Zhang
- School of Public Health/MOE Key Laboratory of Public Health Safety, Fudan University, No.130 Dong'an Road, Shanghai 200032, China.
| | - Yiming Dai
- School of Public Health/MOE Key Laboratory of Public Health Safety, Fudan University, No.130 Dong'an Road, Shanghai 200032, China
| | - Jiayun Ding
- School of Public Health/MOE Key Laboratory of Public Health Safety, Fudan University, No.130 Dong'an Road, Shanghai 200032, China
| | - Jianqiu Guo
- School of Public Health/MOE Key Laboratory of Public Health Safety, Fudan University, No.130 Dong'an Road, Shanghai 200032, China
| | - Xiaojuan Qi
- School of Public Health/MOE Key Laboratory of Public Health Safety, Fudan University, No.130 Dong'an Road, Shanghai 200032, China; Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou 310051, China
| | - Chunhua Wu
- School of Public Health/MOE Key Laboratory of Public Health Safety, Fudan University, No.130 Dong'an Road, Shanghai 200032, China
| | - Zhijun Zhou
- School of Public Health/MOE Key Laboratory of Public Health Safety, Fudan University, No.130 Dong'an Road, Shanghai 200032, China.
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13
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Marchese MJ, Zhu T, Hawkey AB, Wang K, Yuan E, Wen J, Be SE, Levin ED, Feng L. Prenatal and perinatal exposure to Per- and polyfluoroalkyl substances (PFAS)-contaminated drinking water impacts offspring neurobehavior and development. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 917:170459. [PMID: 38290673 PMCID: PMC10923173 DOI: 10.1016/j.scitotenv.2024.170459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/01/2024]
Abstract
Per- and polyfluoroalkyl substances (PFAS) are persistent organic pollutants ubiquitous in the environment and humans. In-utero PFAS exposure is associated with numerous adverse health impacts. However, little is known about how prenatal PFAS mixture exposure affects offspring's neurobehavioral function. This study aims to determine the causal relationship between in-utero PFAS mixture exposure and neurobehavioral changes in Sprague-Dawley rat offspring. Dams were exposed via drinking water to the vehicle (control), an environmentally relevant PFAS mixture, or a high-dose PFAS mixture. The environmentally relevant mixture was formulated to resemble measured tap water levels in Pittsboro, NC, USA (10 PFAS compounds; sum PFAS =758.6 ng/L). The high-dose PFAS load was 3.8 mg/L (5000×), within the range of exposures in the experimental literature. Exposure occurred seven days before mating until birth. Following exposure to PFAS-laden water or the vehicle during fetal development, neurobehavioral toxicity was assessed in male and female offspring with a battery of motor, cognitive, and affective function tests as juveniles, adolescents, and adults. Just before weaning, the environmentally relevant exposure group had smaller anogenital distances compared to the vehicle and high-dose groups on day 17, and males in the environmentally relevant exposure group demonstrated lower weights than the high-dose group on day 21 (p < 0.05). Reflex development delays were seen in negative geotaxis acquisition for both exposure groups compared to vehicle-exposed controls (p = 0.009). Our post-weaning behavioral measures of anxiety, depression, and memory were not found to be affected by maternal PFAS exposure. In adolescence (week five) and adulthood (week eight), the high PFAS dose significantly attenuated typical sex differences in locomotor activity. Maternal exposure to an environmentally relevant PFAS mixture produced developmental delays in the domains of pup weight, anogenital distance, and reflex acquisition for rat offspring. The high-dose PFAS exposure significantly decreased typical sex differences in locomotor activity.
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Affiliation(s)
| | - Tianyi Zhu
- Duke University Global Health Institute, Durham, NC, USA
| | - Andrew B Hawkey
- Department of Biomedical Sciences, Midwestern University, Downers Grove, IL, USA
| | | | - Emi Yuan
- Duke University, Durham, NC, USA
| | | | | | - Edward D Levin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Liping Feng
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA.
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