Abstract
Our studies have demonstrated that developmental exposure to perfluorinated alkylate substances (PFAS) are
associated with attenuated antibody responses to routine childhood vaccines. Our most recent findings
suggest that breastfeeding can transfer PFAS to the infant and lead to substantial elevations of serum-PFAS
concentrations, with possible adverse implications for immune system development. As blood samples from
infancy were not available to us in previous studies, we modeled the concentrations of early-life serum-PFAS
and showed that levels of early postnatal serum-PFAS are inversely associated with antibody concentrations
measured at age 5 years, more so than serum concentrations measured at age 18 months or later. The
present proposal will obtain blood samples in infancy and maternal milk for analysis of PFAS to improve the
modeling of profiles of serum-PFAS during infancy. This will allow testing of the hypothesis that early-life
exposure to immunotoxic PFAS impair the development of the adaptive immune system and negatively affects
the efficacy of routine childhood vaccines. The extended model of serum-PFAS will be used for estimation of
exposures of PFAS in infancy among >1,000 children from previous cohorts, where serum samples from
infancy were not collected. In addition to blood sampling at ages 3 and 12 months in the new cohort, we will
use novel cell phone technology to allow mothers to record breastfeeding, occurrence of infectious disease,
antibiotic treatment, and other relevant study parameters every two weeks. Our focus on vaccines will include
toxoids (diphtheria and tetanus), as these de novo protein vaccines are known to be the most reliable clinical
indicators of immune suppression. The duration of breastfeeding will be considered both as an exposure
pathway and a moderator, as breastfeeding is considered to be advantageous for the child’s immune system
development. The proposed study will be carried out at the Faroe Islands, where excellent conditions are
available to recruit the birth cohort and to ensure a high participation rate and minimal socioeconomic
confounding. Exposures of PFAS mainly originate from seafood and vary substantially, while average serum
concentrations are similar to U.S. levels. A cohort size of 600 can be recruited within 16 months and will
provide appropriate statistical power as one of the largest so far in the field. At 3 and 12 months of age,
vaccine antibodies, thymus size, and advanced differential white cell counts will be assessed. Statistical data
analysis will include multivariate analysis, assessment of mediation and/or modulation, structural equation
modeling of combined exposure of exposure associations of PFAS with immune functions, and benchmark
dose calculations. While research on immunotoxicology has traditionally focused on adverse effects in the
mature organism, this proposal aims to characterize immunotoxic risks from developmental exposure to these
priority pollutants at the most vulnerable developmental stages in early life.