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

摘要 在美国各地，越来越多的饮用水供应被发现受到污染 全氟烷基和多氟烷基物质(PFAS)。我们首先发现，22个州至少有600万美国人 从超过美国环保署2016年全氟辛烷磺酸和全氟辛烷磺酸指导方针的水源获得饮用水，并超过100 据估计，有数百万美国人的自来水中含有全氟辛烷磺酸。超过400个国防部站点已经知道或 怀疑释放了全氟辛烷磺酸。我们的团队发现，距离军事消防训练区和机场很近的地方 预测因使用含全氟辛烷磺酸的水性成膜泡沫(AFFF)而造成的饮用水污染 液体燃料起火。与全氟辛烷磺酸和全氟辛烷磺酸相关的健康问题包括癌症、肝脏毒性、高胆固醇和 对生殖和发育的影响。在我们关于免疫毒性的第一份报告之后，2016年的一项国家 毒理学项目系统审查得出结论，全氟辛烷磺酸和全氟辛烷磺酸都被推定为免疫危险 对人类来说。虽然总胆固醇升高与PFAS暴露有关，但我们的初步研究 有证据表明，与预测心血管风险的特定脂蛋白亚组分有关 疾病。尽管有记录的全氟辛烷磺酸暴露的社区越来越多，但很少有 受全氟辛烷磺酸影响的饮用水社区的流行病学研究。 作为ATSDR关于接触全氟辛烷磺酸污染对健康影响的多点研究的一部分 饮用水，我们提议在马萨诸塞州东部的两个社区进行一项全氟辛烷磺酸对健康影响的研究 在附近的消防培训中使用AFFF的全氟辛烷磺酸污染公共饮用水供应 区域。我们的建议包括根据ATSDR的协议和新颖的必要元素的组合 成分，如应用全可提取有机氟(EOF)和非靶向筛选方法 提供对PFAS暴露的更完整的评估，并分析脂蛋白组分、体脂 脂肪代谢的代谢组学标记物。研究伙伴包括寂静之春 哈佛大学陈天鸿公共卫生学院和东方研究小组，以及社区伙伴 组织包括海尼斯的马萨诸塞州乳腺癌联盟(MBCC)和艾尔人 关注环境(PACE)。主要目标是： 目的1.评估血清-PFAS水平、影响的血清生物标记物和神经行为结果 两个社区的1,000名成年人和350名儿童受到AFFF污染公共供水。 目的2.测量血液样本中总的可提取有机氟和非靶向PFAS图谱 儿童和成人提供对全氟辛烷磺酸总暴露的更全面的评估。 目的3.评估测量和估计的全氟辛烷磺酸暴露与以下指标之间的关系 疾病风险增加，如脂蛋白亚组分、脂代谢的代谢组学标志、 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.