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Review
. 2019 Mar;29(2):148-156.
doi: 10.1038/s41370-018-0097-y. Epub 2018 Nov 27.

Exposure to per-fluoroalkyl and polyfluoroalkyl substances leads to immunotoxicity: epidemiological and toxicological evidence

Jamie C DeWitt  1 , Sarah J Blossom  2 , Laurel A Schaider  3
Affiliations
Review

Exposure to per-fluoroalkyl and polyfluoroalkyl substances leads to immunotoxicity: epidemiological and toxicological evidence

Jamie C DeWitt et al. J Expo Sci Environ Epidemiol. 2019 Mar.

Abstract

In this perspective, we evaluate key and emerging epidemiological and toxicological data concerning immunotoxicity of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) and seek to reconcile conflicting conclusions from two reviews published in 2016. We summarize ways that immunosuppression and immunoenhancement are defined and explain how specific outcomes are used to evaluate immunotoxicity in humans and experimental animals. We observe that different approaches to defining immunotoxicological outcomes, particularly those that do not produce clinical disease, may lead to different conclusions from epidemiological and toxicological studies. The fundamental point that we make is that aspects of epidemiological studies considered as limitations can be minimized when data from toxicological studies support epidemiological findings. Taken together, we find that results of epidemiological studies, supported by findings from toxicological studies, provide strong evidence that humans exposed to PFOA and PFOS are at risk for immunosuppression.

Keywords: Emerging contaminants; Perfluorinated chemicals; Population-based studies.

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Conflict of interest statement

Conflict of Interest

Dr. DeWitt reports that she was a protocol reviewer and a draft report reviewer for the NTP Monograph on Immunotoxicity Associated with Exposure to Perfluorooctanoic Acid or Perfluorooctane Sulfonate.

Figures

Figure 1.
Figure 1.
Serum PFOA and PFOS concentrations in epidemiological studies showing inhibited antibody responses to vaccines. (21): PFAS measured in serum of five-year-old children and antibodies measured in seven-year-old children (N=464) in the Faroe Islands; (23): PFAS measured in maternal serum at birth and antibodies measured in three-year-old children (N=56) in Norway; (24): PFAS measured in adults (N=403) from the C8 Health Project and antibodies measured after 21±3 days after vaccination; (25): PFAS measured in adults (N=1,191) in the National Health and Nutrition Examination Survey in the U.S. and antibodies to childhood vaccinations.
Figure 2.
Figure 2.
Factors used by the U.S. National Toxicology Program in assessing confidence in the body of evidence concerning the immunotoxic effects of PFOA and PFOS (adopted from 8).
See this image and copyright information in PMC

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