Perfluorochemicals and Endometriosis The ENDO Study

Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Health, Rockville, MD
Epidemiology (Cambridge, Mass.) (Impact Factor: 6.2). 09/2012; 23(6):799-805. DOI: 10.1097/EDE.0b013e31826cc0cf
Source: PubMed


: Environmental chemicals may be associated with endometriosis. No published research has focused on the possible role of perfluorochemicals (PFCs) despite their widespread presence in human tissues.
: We formulated two samples. The first was an operative sample comprising 495 women aged 18-44 years scheduled for laparoscopy/laparotomy at one of 14 participating clinical sites in the Salt Lake City or San Francisco area, 2007-2009. The second was a population-based sample comprising 131 women matched to the operative sample on age and residence within a 50-mile radius of participating clinics. Interviews and anthropometric assessments were conducted at enrollment, along with blood collection for the analysis of nine PFCs, which were quantified using liquid chromatography-tandem mass spectrometry. Endometriosis was defined based on surgical visualization (in the operative sample) or magnetic resonance imaging (in the population sample). Using logistic regression, we estimated odds ratios (ORs) and 95% confidence intervals (CIs) for each PFC (log-transformed), adjusting for age and body mass index, and then parity.
: Serum perfluorooctanoic acid (PFOA; OR = 1.89 [95% CI = 1.17-3.06]) and perfluorononanoic acid (2.20 [1.02-4.75]) were associated with endometriosis in the operative sample; findings were moderately attenuated with parity adjustment (1.62 [0.99-2.66] and 1.99 [0.91-4.33], respectively). Perfluorooctane sulfonic acid (1.86 [1.05-3.30]) and PFOA (2.58 [1.18-5.64]) increased the odds for moderate/severe endometriosis, although the odds were similarly attenuated with parity adjustment (OR = 1.50 and 1.86, respectively).
: Select PFCs were associated with an endometriosis diagnosis. These associations await corroboration.

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Available from: Kurunthachalam Kannan
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    • "Additionally, we conducted sensitivity analysis excluding maternal parity, given its uncertain relationship with PFASs (Buck Louis et al., 2012). Two-sided significance levels (p-value < 0.05) were used to assess significance without correcting for multiple comparisons , given the exploratory design of this study. "
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    ABSTRACT: Select persistent environmental chemicals have been associated with a reduction in the secondary sex ratio (SSR), or the ratio of male to female live births. We evaluated preconception maternal, paternal, and couple serum concentrations of perfluoroalkyl and polyfluoroalkyl substances (PFASs) in relation to the SSR, given the absence of previous investigation. Two hundred thirty-three couples from Michigan and Texas were enrolled prior to conception and prospectively followed through delivery of a singleton birth, 2005-2009. Maternal and paternal serum concentrations (ngmL(-1)) were measured at baseline for seven PFASs. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for a male birth, after adjusting for potential confounders. When maternal and paternal PFAS concentrations were modeled jointly, five of the seven PFASs, including the two most prominent PFASs, perfluorooctane sulfonic acid and perfluorooctanoic acid, were not significantly associated with the SSR. However, paternal N-methyl-perfluorooctane sulfonamidoacetic acid (MeFOSAA) and perfluorononanoic acid (2nd versus 1st tertile, OR, 0.43, 95% CI, 0.21-0.88) were significantly associated with an excess of female births. Meanwhile, a dose-response relation was observed only for paternal MeFOSAA (2nd versus 1st tertile, OR, 0.53, 95% CI, 0.26-1.10; 3rd versus 1st tertile, OR, 0.34, 95% CI, 0.13-0.89). This study suggests a possible dose-response relation between a less prevalent PFAS and a reversal in the SSR, though the underlying mechanisms remain unknown and the findings await corroboration to eliminate other explanations including chance. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Aug 2015 · Chemosphere
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    • "In addition to DAGs, there is also toxicokinetic data to support the exclusion of parity in models for fecundity-related outcomes (Buck Louis et al., 2012). PFCs are not lipophilic and while transfer during pregnancy and lactation has been reported in animal models (Loccisano et al., 2013) and humans (Fromme et al., 2010; Arbuckle et al., 2013a,b), the magnitude of change is minimal compared with lipophilic compounds. "
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    ABSTRACT: STUDY QUESTION What is the effect of maternal exposure to perfluorooctane sulfonate (PFOS), perflurooctanoic acid (PFOA) and perfluorohexane sulfonate (PFHxS) on female fecundity?
    Full-text · Article · Jan 2015 · Human Reproduction
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    • "A study of 158 pregnant Chinese women reported that higher serum levels of PFOA were associated with significantly shorter gestation, lower birth weights, and lower 5-minute Apgar scores as compared to pregnant women with lower serum PFOA [16]. A recent case-control study reported the finding of significantly higher PFOA and PFOS serum levels in women with surgically treated endometriosis as compared to matched control women [17]. Studies examining associations between serum PFC levels and human semen studies have been inconsistent, with some studies reporting significantly lower levels of morphologically normal sperm cells in men with higher serum PFC levels and other studies showing little relationship [18]. "
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    ABSTRACT: Background. While perfluorinated compounds (PFCs) are a family of commonly used synthetic compounds with many applications, some PFCs remain persistent within the human body due, in part, to enterohepatic recirculation and renal tubular reabsorption. With increasing recognition of potential harm to human health associated with PFC bioaccumulation, interventions to facilitate elimination of these toxicants are welcome in order to potentially preclude or overcome illness. Minimal research has been undertaken thus far on methods to accelerate human clearance of PFCs. Methods. To test for possible oral treatments to hasten PFC elimination, a group of individuals with elevated PFC levels was treated with cholestyramine (CSM) and, after a break, was subsequently treated with Chlorella pyrenoidosa (CP). Stool samples were collected from all participants (i) prior to any treatment, (ii) during treatment with CSM, and (iii) during treatment with CP. Results. With CSM treatment, significant levels of three distinct PFCs were found in all stools, while levels were mostly undetectable prior to treatment. Following treatment with oral CP, undetectable or very low levels of all PFCs were noted in each sample tested. Conclusion. CSM appears to facilitate elimination of some common PFCs and may have some role in the clinical management of patients with accrued PFCs.
    Full-text · Article · Sep 2013
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