Understanding PFAS toxicity through cell culture metabolomics: Current applications and future perspectives.

Per- and polyfluoroalkyl substances (PFAS), ubiquitous environmental contaminants, pose significant challenges to ecosystems and human health. While cell cultures have emerged as new approach methodologies (NAMs) in ecotoxicity research, metabolomics is an emerging technique used to characterize the small-molecule metabolites present in cells and to understand their role in various biological processes. Integration of metabolomics with cell cultures, known as cell culture metabolomics, provides a novel and robust tool to unravel the complex molecular responses induced by PFAS exposure. In vitro testing also reduces reliance on animal testing, aligning with ethical and regulatory imperatives. The current review summarizes key findings from recent studies utilizing cell culture metabolomics to investigate PFAS toxicity, highlighting alterations in metabolic pathways, biomarker identification, and the potential linkages between metabolic perturbations. Additionally, the paper discusses different types of cell cultures and metabolomics methods used for studies of environmental contaminants and particularly PFAS. Future perspectives on the combination of metabolomics with other advanced technologies, such as single-cell metabolomics (SCM), imaging mass spectrometry (IMS), extracellular flux analysis (EFA), and multi-omics are also explored, which offers a holistic understanding of environmental contaminants. The synthesis of current knowledge and identification of research gaps provide a foundation for future investigations that aim to elucidate the complexities of PFAS-induced cellular responses and contribute to the development of effective strategies for mitigating their adverse effects on human health.

Commercial compost amendments inhibit the bioavailability and plant uptake of per- and polyfluoroalkyl substances in soil-porewater-lettuce systems.

Compost is widely used in agriculture as fertilizer while providing a practical option for solid municipal waste disposal. However, compost may also contain per- and polyfluoroalkyl substances (PFAS), potentially impacting soils and leading to PFAS entry into food chains and ultimately human exposure risks via dietary intake. This study examined how compost affects the bioavailability and uptake of eight PFAS (two ethers, three fluorotelomer sulfonates, and three perfluorosulfonates) by lettuce (Lactuca sativa) grown in commercial organic compost-amended, PFAS spiked soils. After 50 days of greenhouse experiment, PFAS uptake by lettuce decreased (by up to 90.5 %) with the increasing compost amendment ratios (0-20 %, w/w), consistent with their decreased porewater concentrations (by 30.7-86.3 %) in compost-amended soils. Decreased bioavailability of PFAS was evidenced by the increased in-situ soil-porewater distribution coefficients (Kd) (by factors of 1.5-7.0) with increasing compost additions. Significant negative (or positive) correlations (R2 ≥ 0.55) were observed between plant bioaccumulation (or Kd) and soil organic carbon content, suggesting that compost amendment inhibited plant uptake of PFAS mainly by increasing soil organic carbon and enhancing PFAS sorption. However, short-chain PFAS alternatives (e.g., perfluoro-2-methoxyacetic acid (PFMOAA)) were effectively translocated to shoots with translocation factors > 2.9, increasing their risks of contamination in leafy vegetables. Our findings underscore the necessity for comprehensive risk assessment of compost-borne PFAS when using commercial compost products in agricultural lands.

Influence of Perfluorobutanoic Acid (PFBA) on the Developmental Cycle and Damage Potential of the Beet Armyworm Spodoptera exigua (Hübner) (Insecta: Lepidoptera: Noctuidae).

Perfluorobutanoic acid (PFBA), one of the short-chain replacement perfluoroalkyl substances, has been shown to accumulate in plants. The potential of PFBA to modulate the developmental cycle of the beet armyworm, Spodoptera exigua, a polyphagous pest, was investigated. Second-instar larvae were fed with PFBA-spiked artificial diets and leaves from soybean plants grown with PFBA-spiked irrigation water. Spiked PFBA concentrations were 200 µg/kg for the artificial diet, whereas 405 to 15,190 ng/kg accumulated in the soybean leaves. The larvae fed with the PFBA-spiked diet showed a significant increase in weight gain compared with the controls over a 7-day exposure period. A similar weight gain trend was observed with larvae fed with the PFBA-containing soybean leaves, with the dose-response data fitting into a Brain-Cousens hormesis model with a 57% stimulation over controls. The artificial diet treatments showed 66.7% metamorphosed larva to pupa at 9 days after exposure (dpe) compared with 33.3% of the controls. The adult emergence at 16-dpe followed a similar trend with 57.7% and 33.3%, respectively, for the exposed and control groups. The duration of transition from larvae to adults was more symmetrical and 0.5 day faster for the exposed groups over controls. The beet armyworm caused more damage on leaves from the PFBA exposed plants in a nonmonotonic dose-response manner. The results suggest PFBA may have a stimulatory impact on some hormonal signaling pathways at low doses.

Pre-clinical assessment of a water-in-fluorocarbon emulsion for the treatment of pulmonary vascular diseases.

Hypoxic pulmonary vasoconstriction (HPV) is a well-characterized vascular response to low oxygen pressures and is involved in life-threatening conditions such as high-altitude pulmonary edema (HAPE) and pulmonary arterial hypertension (PAH). While the efficacy of oral therapies can be affected by drug metabolism, or dose-limiting systemic toxicity, inhaled treatment via pressured metered dose inhalers (pMDI) may be an effective, nontoxic, practical alternative. We hypothesized that a stable water-in-perfluorooctyl bromide (PFOB) emulsion that provides solubility in common pMDI propellants, engineered for intrapulmonary delivery of pulmonary vasodilators, reverses HPV during acute hypoxia (HX). Male Sprague Dawley rats received two 10-min bouts of HX (13% O2) with 20 min of room air and drug application between exposures. Treatment groups: intrapulmonary delivery (PUL) of (1) saline; (2) ambrisentan in saline (0.1 mg/kg); (3) empty emulsion; (4) emulsion encapsulating ambrisentan or sodium nitrite (NaNO2) (0.1 and 0.5 mg/kg each); and intravenous (5) ambrisentan (0.1 mg/kg) or (6) NaNO2 (0.5 mg/kg). Neither PUL of saline or empty emulsion, nor infusions of drugs prevented pulmonary artery pressure (PAP) elevation (32.6 ± 3.2, 31.5 ± 1.2, 29.3 ± 1.8, and 30.2 ± 2.5 mmHg, respectively). In contrast, PUL of aqueous ambrisentan and both drug emulsions reduced PAP by 20-30% during HX, compared to controls. IL6 expression in bronchoalveolar lavage fluid and whole lung 24 h post-PUL did not differ among cohorts. We demonstrate proof-of-concept for delivering pulmonary vasodilators via aerosolized water-in-PFOB emulsion. This concept opens a potentially feasible and effective route of treating pulmonary vascular pathologies via pMDI.

All-in-One Theranostic Nanoplatform Based on Hollow MoSx for Photothermally-maneuvered Oxygen Self-enriched Photodynamic Therapy.

Photodynamic therapy (PDT) kills cancer cells by converting tumor-dissolved oxygen into reactive singlet oxygen (1O2) using a photosensitizer under laser irradiation. However, pre-existing hypoxia in tumors and oxygen consumption during PDT can result in an inadequate oxygen supply, which in turn hampers PDT efficacy. Herein, an O2 self-sufficient nanotheranostic platform based on hollow MoSx nanoparticles (HMoSx) with oxygen-saturated perfluorohexane (O2@PFH) and surface-modified human serum albumin (HSA)/chloride aluminium phthalocyanine (AlPc) (O2@PFH@HMoSx-HSA/AlPc), has been designed for the imaging and oxygen self-enriched photodynamic therapy (Oxy-PDT) of cancer. METHODS: The in vitro anti-cancer activity and intracellular 1O2 generation performance of the nanoparticles were examined using 4T1 cells. We also evaluated the multimodal imaging capabilities and anti-tumor efficiency of the prepared nanoparticles in vivo using a 4T1 tumor-bearing nude mouse model. RESULTS: This nanoplatform could achieve the distinct in vivo fluorescence (FL)/photoacoustic (PA)/X-ray computed tomography (CT) triple-model imaging-guided photothermally-maneuvered Oxy-PDT. Interestingly, the fluorescence and Oxy-PDT properties of O2@PFH@HMoSx-HSA/AlPc were considerably quenched; however, photothermal activation by 670 nm laser irradiation induced a significant increase in temperature, which empowered the Oxy-PDT effect of the nanoparticles. In this study, O2@PFH@HMoSx-HSA/AlPc demonstrated a great potential to image and treat tumors both in vitro and in vivo, showing complete tumor-inhibition over 16 days after treatment in the 4T1 tumor model. CONCLUSION: O2@PFH@HMoSx-HSA/AlPc is promising to be used as novel multifunctional theranostic nanoagent for triple-modal imaging as well as single wavelength NIR laser triggered PTT/Oxy-PDT synergistic therapy.

Ultrasound and magnetic resonance molecular imaging of atherosclerotic neovasculature with perfluorocarbon magnetic nanocapsules targeted against vascular endothelial growth factor receptor 2 in rats.

The aim of the present study was to investigate the feasibility of using ultrasonography (US) and magnetic resonance (MR) for bimodal molecular imaging of atherosclerotic neovasculature with liquid perfluorocarbon magnetic nanocapsules (NCs) targeted to vascular endothelial growth factor receptor 2 (VEGFR­2). By incorporating perfluorooctyl bromide (PFOB) and superparamagnetic iron oxide (SPIO) into polylactic acid, a SPIO­embedded PFOB NC was constructed; subsequently, a VEGFR­2­targeted NC (VTNC) containing dual detectable probes was created by covalently linking a VEGFR­2 antibody onto the surface of the SPIO­embedded PFOB NC. Target specificity was verified in vitro by incubating VTNC with VEGFR­2+ or VEGFR­2­ endothelial cells. Rats with vulnerable plaques were assigned to receive either an injection of VTNC (Targeted group; n=8) or an injection of NC (Nontargeted group; n=8); control rats also received an injection of VTNC (Control group; n=8). US and MR imaging of the abdominal aorta were performed to detect VTNC by measuring of the ultrasonic grayscale intensity (GSI) and MR contrast­to­noise ratio (CNR) prior to and at successive time points following VTNC and NC injections. The percent positive area (PPA) of CD31+ (PPACD31+) or VEGFR­2+ (PPAVEGFR­2+) expression was quantified by immunohistochemical staining. CD31 was used to verify the existence of endothelial cells as it is widely expressed on the surface of endothelial cells whether activated or not. The results demonstrated that VTNC was able to highly and selectively detect VEGFR­2+ endothelial cells, and GSI, CNR, PPACD31+ and PPAVEGFR­2+ were significantly increased in the targeted group compared with the nontargeted and control groups. In the control group, no atherosclerotic plaques or angiogenesis was identified, thus no expression of PPACD31+ and PPAVEGFR­2 (data not shown). There were strong correlations among GSI, CNR, PPACD31+ and PPAVEGFR­2+. In conclusion, two­probe VTNC is feasible for bimodal US and MR molecular imaging of atherosclerotic neovasculature, which may offer complementary information for the more reliable prediction of plaque vulnerability.

Editor's Highlight: Perfluorooctane Sulfonate-Choline Ion Pair Formation: A Potential Mechanism Modulating Hepatic Steatosis and Oxidative Stress in Mice.

The mechanisms underlying perfluorooctane sulfonate (PFOS)-induced steatosis remain unclear. The hypothesis that PFOS causes steatosis and other hepatic effects by forming an ion pair with choline was examined. C57BL/6 mice were fed either a control diet or a marginal methionine/choline-deficient (mMCD) diet, with and without 0.003, 0.006, or 0.012% potassium PFOS. Dietary PFOS caused a dose-dependent decrease in body weight, and increases in the relative liver weight, hepatic triglyceride concentration and serum markers of liver toxicity and oxidative stress. Some of these effects were exacerbated in mice fed the mMCD diet supplemented with 0.012% PFOS compared with those fed the control diet supplemented with 0.012% PFOS. Surprisingly, serum PFOS concentrations were higher while liver PFOS concentrations were lower in mMCD-fed mice compared with corresponding control-fed mice. To determine if supplemental dietary choline could prevent PFOS-induced hepatic effects, C57BL/6 mice were fed a control diet, or a choline supplemental diet (1.2%) with or without 0.003% PFOS. Lipidomic analysis demonstrated that PFOS caused alterations in hepatic lipid metabolism in the PFOS-fed mice compared with controls, and supplemental dietary choline prevented these PFOS-induced changes. Interestingly, dietary choline supplementation also prevented PFOS-induced oxidative damage. These studies are the first to suggest that PFOS may cause hepatic steatosis and oxidative stress by effectively reducing the choline required for hepatic VLDL production and export by forming an ion pair with choline, and suggest that choline supplementation may prevent and/or treat PFOS-induced hepatic steatosis and oxidative stress.

Effect of metabolic gases and water vapor, perfluorocarbon emulsions, and nitric oxide on tissue bubbles during decompression sickness.

In aviation and diving, fast decrease in ambient pressure, such as during accidental loss of cabin pressure or when a diver decompresses too fast to sea level, may cause nitrogen (N2) bubble formation in blood and tissue resulting in decompression sickness (DCS). Conventional treatment of DCS is oxygen (O2) breathing combined with recompression.  However, bubble kinetic models suggest, that metabolic gases, i.e. O2 and carbon dioxide (CO2), and water vapor contribute significantly to DCS bubble volume and growth at hypobaric altitude exposures. Further, perfluorocarbon emulsions (PFC) and nitric oxide (NO) donors have, on an experimental basis, demonstrated therapeutic properties both as treatment and prophylactic intervention against DCS. The effect was ascribed to solubility of respiratory gases in PFC, plausible NO elicited nuclei demise and/or N2 washout through enhanced blood flow rate. Accordingly, by means of monitoring injected bubbles in exposed adipose tissue or measurements of spinal evoked potentials (SEPs) in anaesthetized rats, the aim of this study was to: 1) evaluate the contribution of metabolic gases and water vapor to bubble volume at different barometrical altitude exposures, 2) clarify the O2 contribution and N2 solubility from bubbles during administration of PFC at normo- and hypobaric conditions and, 3) test the effect of different NO donors on SEPs during DCS upon a hyperbaric air dive and, to study the influence of  NO on tissue bubbles at high altitude exposures. The results support the bubble kinetic models and indicate that metabolic gases and water vapor contribute significantly to bubble volume at 25 kPa (~10,376 m above sea level) and constitute a threshold for bubble stabilization or decay at the interval of 47-36 kPa (~6,036 and ~7,920 m above sea level). The effect of the metabolic gases and water vapor seemed to compromise the therapeutic properties of both PFC and NO at altitude, while PFC significantly increased bubble disappearance rate at sea level following a hyperbaric airdive. We found no protective effect of NO donors during DCS from diving. On the contrary, there was a tendency towards a poorer outcome when decompression was combined with NO donor administration. This observation is seemingly contradictive to recent publications and may be explained by the multifactorial effect of NO in combination with a fast decompression profile, speeding up the N2 release from tissues and thereby aggravating the DCS symptoms.

Fate of polyfluoroalkyl phosphate diesters and their metabolites in biosolids-applied soil: biodegradation and plant uptake in greenhouse and field experiments.

Significant contamination of perfluoroalkyl acids (PFAAs) in wastewater treatment plant (WWTP) sludge implicates the practice of applying treated sludge or biosolids as a potential source of these chemicals onto agricultural farmlands. Recent efforts to characterize the sources of PFAAs in the environment have unveiled a number of fluorotelomer-based materials that are capable of degrading to the perfluoroalkyl carboxylates (PFCAs), such as the polyfluoroalkyl phosphate diesters (diPAPs), which have been detected in WWTP and paper fiber biosolids. Here, a greenhouse microcosm was used to investigate the fate of endogenous diPAPs and PFCAs present in WWTP and paper fiber biosolids upon amendment of these materials with soil that had been sown with Medicago truncatula plants. Biodegradation pathways and plant uptake were further elucidated in a separate greenhouse microcosm supplemented with high concentrations of 6:2 diPAP. Biosolid-amended soil exhibited increased concentrations of diPAPs (4-83 ng/g dry weight (dw)) and PFCAs (0.1-19 ng/g dw), as compared to control soils (nd-1.4 ng/g dw). Both plant uptake and biotransformation contributed to the observed decline in diPAP soil concentrations over time. Biotransformation was further evidenced by the degradation of 6:2 diPAP to its corresponding fluorotelomer intermediates and C4-C7 PFCAs. Substantial plant accumulation of endogenous PFCAs present in the biosolids (0.1-138 ng/g wet weight (ww)) and those produced from 6:2 diPAP degradation (100-58 000 ng/g ww) were observed within 1.5 months of application, with the congener profile dominated by the short-chain PFCAs (C4-C6). This pattern was corroborated by the inverse relationship observed between the plant-soil accumulation factor (PSAF, Cplant/Csoil) and carbon chain length (p < 0.05, r = 0.90-0.97). These results were complemented by a field study in which the fate of diPAPs and PFCAs was investigated upon application of compost and paper fiber biosolids to two farm fields. Together, these studies provide the first evidence of soil biodegradation of diPAPs and the subsequent uptake of these chemicals and their metabolites into plants.

Carryover of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) from soil to plant and distribution to the different plant compartments studied in cultures of carrots (Daucus carota ssp. Sativus), potatoes (Solanum tuberosum), and cucumbers (Cucumis Sativus).

A vegetation study was carried out to investigate the carryover of Perfluorooctanoic Acid (PFOA) and Perfluorooctane Sulfonate (PFOS) from soil mixed with contaminated sewage sludge to potato, carrot, and cucumber plants. Analysis was done by liquid-extraction using acetonitrile with dispersive SPE cleanup and subsequent HPLC-MS/MS. In order to assess the transfer potential from soil, transfer factors (TF) were calculated for the different plant compartments: TF = [PFC](plant (wet substance))/[PFC](soil (dry weight)). The highest TF were found for the vegetative plant compartments with average values for PFOS below those for PFOA: cucumber, 0.17 (PFOS), 0.88 (PFOA); potato, 0.36 (PFOS), 0.40 (PFOA); carrot, 0.38 (PFOS), 0.53 (PFOA). Transfer of PFOA and PFOS into potato peelings (average values of TF: PFOA 0.03, PFOS 0.04) exceeded the carryover to the peeled tubers (PFOA 0.01, PFOS < 0.01). In carrots, this difference did not occur (average values of TF: PFOA 0.04, PFOS 0.04). Transfer of PFOS into the unpeeled cucumbers was low and comparable to that of peeled potatoes (TF < 0.01). For PFOA, it was higher (TF: 0.03).

Simultaneous quantification of insecticides including carbaryl in drinking water by gas chromatography using dual electron-capture and nitrogen-phosphorus detection.

A rapid and simple gas chromatographic method for the simultaneous determination of malathion, parathion, fenitrothion, diazinon and carbaryl in drinking water is presented. A fused-silica SE-54 column was used for the separation of the insecticides and was split into two specific detectors; electron-capture and nitrogen-phosphorus detectors by using column switching. A water sample was extracted with methylene chloride. The organic phase was evaporated and the residue was derivatized with pentafluoropropionic acid anhydride. The detection limit was below 0.1 ng/ml and the calibration curves showed good linearity with r = 0.998 approximately 1.000. The method was sensitive, reproducible and simple enough to permit the reliable routine analysis of the pesticides in drinking water.

Quantum-chemical ab initio study on the adenine-difluorotoluene complex--a mimic for the adenine-thymine base pair.

Recent experiments have shown that difluorotoluene (F), a nonpolar isostere for thymine (T), codes efficiently and specifically for adenine (A) in DNA replication. F has almost the same shape as thymine but it is unable to form conventional hydrogen bonds with adenine. Therefore, it has been claimed that not hydrogen bonding but shape complementary may be important for the selection of the correct bases by DNA-replicating enzymes. In order to gain deeper insight into structure, charge distribution and energetics of the A-F and A-T base pairs we have performed quantum-chemical ab initio and density functional calculations at the HF, MP2 and B3LYP levels. The interaction energy of the A-F complex amounts to -3.8 kcal/mol (MP2) and is thus substantially smaller than typical ab initio interaction energies for Watson-Crick or non-canonical base pairs. The A-T and A-F complexes are planar and their overall geometries are similar (root-mean-square deviation: 0.4 A). The calculated donor acceptor atom distances in A-T are in good agreement with the experimental mean values obtained from an analysis of 21 high resolution DNA structures. However, A-F shows a base pair opening as compared to A-T. Even though the interaction energy in the A-F base pair is small, the distances for the N6-H...F and N1...H-C3 contacts are still below the sum of the van-der-Waals radii, which means that the interaction is not governed by van-der-Waals forces alone. If the experimental findings can be confirmed, then our results indicate that DNA polymerase is able to retain high fidelity with base pairs of much smaller interaction energies than found for the conventional Watson-Crick and non-canonical base pairs.

Liquid ventilation in premature lambs: uptake, biodistribution and elimination of perfluorodecalin liquid.

Perfluorochemical (PFC) liquids are biologically inert and nonbiotransformable substances that, when used as breathing medium, may be transported across the lung epithelium in small quantities, distributed throughout the body, and ultimately vapourized through the lungs and transpired through the skin. To further evaluate the uptake, biodistribution and elimination of a PFC liquid (perfluorodecalin) in the neonatal population, arterial blood, tissue and expired gas samples were obtained from preterm lambs (105-114 days gestation). Two groups of premature lambs were studied: Group I (n = 4) lambs were liquid ventilated from birth for 1 h and killed without exposure to gas ventilation (GV) and Group II (n = 5) lambs were liquid ventilated for 1 h followed by up to 2 h of GV. Samples were analysed by electron-capture gas chromatography and data were expressed in nl of PFC/ml of blood or gas and nl of PFC/gm tissue. During liquid ventilation and subsequent GV, PFC blood levels significantly increased (P < 0.001) from baseline control levels (0.007 +/- 0.001 SE nl PFC/ml blood) to a high of 2.95 +/- 1.03 SE nl PFC/ml blood. Perfluorochemical levels measured in expired gas (Group II) demonstrated a rapid decrease as a function of time of GV. Tissue levels of PFC indicated that uptake of PFC in Group I was significantly different (P < 0.001) than baseline levels and organ dependent; the highest levels were in the lungs (221 +/- 26.2 SE nl PFC/g tissue) and the lowest in the liver (2.24 +/- 1.6 SE nl PFC/g tissue). Comparison of tissue levels of PFC between groups indicated a 34.8% mean decrease across organs in Group II compared with Group I. These data indicate that PFC uptake and elimination is organ dependent and that PFC liquids can be eliminated through the lungs upon return to GV. Sustained PFC blood levels may be related to residual PFC in the organs and lung as well as regional variation in ventilation-perfusion matching upon return to GV.

Mechanochemical interactions between striated muscle cells of jellyfish and grafted extracellular matrix can induce and inhibit DNA replication and transdifferentiation in vitro.

Striated muscle tissue of jellyfish was isolated with its adhering extracellular matrix (ECM) and cultured. Without further treatment the cultured muscle cells maintain their differentiated state. If, however, the isolated tissues are combined with cell-free ECM from the jellyfish or its polyp, DNA replication and proteolytic activity are induced followed by transdifferentiation into RF-amide-positive nerve cells. Changes in the mechanochemical interactions between the cells and the grafted ECM seem to induce the signals which lead to transdifferentiation. If the isolates are combined with small floating pieces of ECM most cells will leave their own ECM and overgrow the ECM graft. All cells in the combinations will then transdifferentiate. If the isolates are grafted onto large pieces of ECM kept permanently stretched on glass, a majority of cells will migrate onto the grafted ECM where they form a flat monolayer. In this case, however, DNA replication and transdifferentiation occurs mainly in those cells which have remained on or near their own ECM. Labeling experiments with [3H]-thymidine demonstrate that initiation of DNA replication occurs first in those cells which bridge from the native ECM to the grafted ECM. On the other hand inhibition of DNA replication and transdifferentiation is generally suppressed whenever tissues are allowed to form a monolayer of well-stretched cells. From these observations we conclude that mechanochemical interactions between the muscle cells and their substrate are responsible for both activation and inhibition of DNA replication and transdifferentiation.

Toxicity and kinetics of perfluoro-octanoic acid in the Wistar rat.

Perfluoro-octanoic acid [PFO; CF3 (CF2)6 COOH] is a single chain fatty acid with surfactant properties. Thus far the kinetics and toxicity of PFO has not been studied thoroughly. PFO was administered orally 3 mg/kg, 10 mg/kg, and 30 mg/kg to 36 Wistar rats daily for 28 consecutive days. Another 12 animals received 0.5 ml/100 g saline each day. Animal behaviour, body weight, as well as, water and food consumption were observed regularly. Blood, urine, and some viscera were collected for the analysis of PFO and histopathology. Food consumption decreased with increasing dose of PFO. Serum PFO concentrations were 6-19 times higher in the males than in the females (range 48.6-83.0 micrograms/ml males, and 2.4-11.2 micrograms/ml females) (p less than 0.001). On the 7th day the mean PFO excretion in the low dose group for the males was 157 +/- 63 micrograms/24 (SD) h and 255 +/- 27 micrograms/24 h for females (p less than 0.05). In the high dose group the corresponding figures were 2476 +/- 665 micrograms/24 h (males) and 2917 +/- 493 micrograms/24 h (females). On the 28th day the PFO excretion for the low dose males was 609 +/- 87 micrograms/24 h, 671 +/- 65 micrograms/24 h for the females. In the high dose group the figures were 4619 +/- 2886 micrograms/24 h (males) and 4379 +/- 692 micrograms/24 h (females).

Current status of erythrocyte substitutes.

During the last two decades the search for alternatives to whole blood transfusions has led to promising developments in the field of erythrocyte substitutes. Hemoglobin solutions free of fragments of erythrocyte stroma and fluorocarbon emulsions are not blood-type-specific and appear likely to satisfy some proportion of our blood requirements. Both must be modified before becoming clinically useful. The oxygen affinity of the hemoglobin solution must be reduced and its intravascular persistence improved. Fluorocarbons cannot yet contribute significantly to the oxygen supply unless the patient breathes hyperbaric oxygen. Recent advances are leading to solutions for these problems.