Assessment of PFAS exposures and health effects in two Massachusetts communities with PFAS drinking water contamination

摘要 在美国，越来越多的饮用水供应被发现受到污染， 全氟和多氟烷基物质（PFAS）。我们首先发现，在22个州， 从超过EPA 2016年PFOS和PFOA指南的来源获得饮用水， 据估计，有100万美国人的自来水中含有PFAS。超过400个国防部站点已经知道或 疑似释放PFAS。我们的团队发现，靠近军事消防训练区和机场， 预测由于使用含有PFAS的水性成膜泡沫（AFFF） 液体燃料火灾。与PFOA和PFOS有关的健康问题包括癌症、肝毒性、高胆固醇和 生殖和发育影响。在我们的第一份免疫毒性报告之后，2016年国家 毒理学计划系统审查得出结论，全氟辛烷磺酸和全氟辛酸均被推定为免疫危害 对人类虽然总胆固醇升高与PFAS暴露有关，但我们的初步研究表明， 有证据表明，与预测心血管疾病风险的特定脂蛋白亚组分有关。 疾病尽管有越来越多的社区有记录的PFAS暴露， 在饮用水受PFAS影响的社区开展流行病学研究。 作为美国毒物与疾病登记署多地点研究与接触PFAS污染的健康影响的一部分， 饮用水，我们建议在马萨诸塞州东部的两个社区进行PFAS健康影响的研究 公共饮用水供应被附近消防训练中使用的AFFF中的PFAS污染 地区我们的建议包括根据ATSDR的协议和新的要求要素的组合 成分，如应用总可提取有机氟（VOC）和非靶向筛选方法， 提供更全面的PFAS暴露评估，并分析脂蛋白组分、体脂 测量和脂质代谢的代谢组学标志物。研究合作伙伴包括寂静的春天 研究所，哈佛T.H. Chan公共卫生学院、Eastern Research Group和社区合作伙伴 这些组织包括位于海恩尼斯的马萨诸塞州乳腺癌联盟（MBCC）和艾耶尔人民 关注环境（PACE）。主要目标是： 目标1。评估血清PFAS水平、影响的血清生物标志物和神经行为结局， 两个社区的1 000名成年人和350名儿童受到AFFF污染的公共供水。 目标2.测量血液样本中的总可提取有机氟和非靶向PFAS特征 从儿童和成人中获得的数据，以提供对PFAS总暴露量的更完整评估。 目标3：评估测量和估计的PFAS暴露量与 升高的疾病风险，如脂蛋白亚组分，脂质代谢的代谢组学标志物， 体脂测量和抗体浓度。

ABSTRACT Across the U.S., a growing number of drinking water supplies have been found to be contaminated with per- and polyfluoroalkyl substances (PFAS). We first found that at least six million Americans in 22 states receive drinking water from sources that exceeded EPA’s 2016 guideline for PFOS and PFOA, and over 100 million Americans are estimated to have PFAS in their tap water. Over 400 DoD sites have known or suspected releases of PFAS. Our team found that proximity to military fire training areas and airports strongly predicts drinking water contamination due to the use of PFAS-containing aqueous film-forming foam (AFFF) for liquid fuel fires. Health concerns related to PFOA and PFOS include cancer, liver toxicity, high cholesterol, and reproductive and developmental effects. Following our first report on immunotoxicity, a 2016 National Toxicology Program systematic review concluded that both PFOS and PFOA are presumed immune hazards to humans. While elevated total cholesterol has been associated with PFAS exposure, our preliminary evidence suggests associations with specific lipoprotein subfractions that predict risk of cardiovascular disease. Despite the growing number of communities with documented PFAS exposures, there have been few epidemiological studies in communities with PFAS-impacted drinking water. As part of ATSDR’s multi-site study of health effects associated with exposures to PFAS-contaminated drinking water, we propose a study of PFAS health effects in two communities in Eastern Massachusetts where public drinking water supplies have been contaminated by PFAS from AFFF use at nearby fire training areas. Our proposal includes a combination of required elements according to ATSDR’s protocol and novel components, such as applying total extractable organofluorine (EOF) and non-targeted screening methods to provide a more complete assessment of PFAS exposures and analyzing lipoprotein fractions, body fat measurements, and metabolomics markers of lipid metabolism. Research partners include Silent Spring Institute, Harvard T.H. Chan School of Public Health, and Eastern Research Group, and community partner organizations include Massachusetts Breast Cancer Coalition (MBCC) in Hyannis and People of Ayer Concerned about the Environment (PACE). The primary aims are: Aim 1. Evaluate serum-PFAS levels, serum biomarkers of effects, and neurobehavioral outcomes in 1,000 adults and 350 children in two communities with AFFF contamination of public water supplies. Aim 2. Measure total extractable organofluorine and non-targeted PFAS profiles in blood samples from children and adults to provide a more complete assessment of total PFAS exposures. Aim 3. Evaluate associations between measured and estimated PFAS exposures and markers of elevated disease risks, such as lipoprotein subfractions, metabolomics markers of lipid metabolism, body fat measurements, and antibody concentrations.