Article Impact Level: HIGH Data Quality: STRONG Summary of Environment International, https://doi.org/10.1016/j.envint.2025.109794 Dr. Axel G. Andersso et al.
Points
- The study investigated medications like cholestyramine, colesevelam, and probenecid to accelerate PFAS elimination.
- Ten individuals from Ronneby, Sweden, highly exposed to PFHxS, PFOS, and PFOA, participated in the cross-over trial.
- Cholestyramine increased serum-adjusted fecal PFOS concentrations by twenty-three point one times compared to no intervention.
- Twelve-week colesevelam intervention resulted in a mean serum PFOS decline of thirty-eight percent versus two percent in controls.
- Bile acid sequestrants show promise for accelerating PFAS excretion in highly exposed individuals, warranting further study.
Summary
This cross-over clinical study, conducted in Ronneby, Sweden, investigated the potential of bile acid sequestrants and organic anion transporter inhibitors to accelerate the elimination of per- and polyfluoroalkyl substances (PFAS) in humans. The study enrolled ten individuals highly exposed to PFAS, primarily perfluorohexane sulfonic acid (PFHxS; mean serum: 50 ng/mL, range: 5.8–170), perfluorooctane sulfonic acid (PFOS; mean serum: 46 ng/mL, range: 9.2–130), and perfluorooctanoic acid (PFOA; mean serum: 2.2 ng/mL, range: 0.7–4.4). These substances are known for their prolonged serum half-lives, extending to several years.
Participants underwent a sequence of interventions. Initially, they received either the bile acid sequestrant cholestyramine or the organic anion transporter inhibitor probenecid for one week each, with urinary and fecal PFAS concentrations monitored before, during, and after administration. Subsequently, changes in serum PFAS concentrations were compared during a twelve-week intervention with the bile acid sequestrant colesevelam against a control period. This design aimed to assess the impact of these pharmaceutical agents on PFAS excretion pathways.
The results demonstrated that cholestyramine intervention significantly increased serum-adjusted fecal PFOS concentrations by 23.1 times (95% confidence interval [CI]: 13.6, 39.2) compared to no intervention. Probenecid was associated with 0.79 times (95% CI: 0.63, 1.0) serum-adjusted urinary PFOS concentrations. Critically, the twelve-week colesevelam intervention led to a mean serum PFOS decline of 38% (95% CI: -42, -34), markedly higher than the 2% decline (95% CI: -8, 5) observed during the control period. While declines for PFHxS and PFOA were smaller, these findings suggest that bile acid sequestrants hold promise for accelerating PFAS excretion in highly exposed individuals, though further studies are warranted to evaluate risks, costs, and benefits.
Link to the article: https://www.sciencedirect.com/science/article/pii/S0160412025005458?via%3Dihub
References
Andersson, A. G., Xu, Y., Kärrman, A., Cederlund, J., Lindh, C. H., Pineda, D., Fletcher, T., Jakobsson, K., & Li, Y. (2025). Serum, urinary and fecal concentrations of perfluoroalkyl substances after interventions with cholestyramine/colesevelam and probenecid – cross-over trials in Ronneby, Sweden. Environment International, 204, 109794. https://doi.org/10.1016/j.envint.2025.109794
