Metabolic impacts of PFAS exposure in the cape fear basin: genx exposure study

The National Institute of Environmental Health Sciences awarded North Carolina State University $4,233,899 under the NIEHS Superfund Hazardous Substances Basic Research and Education program (CFDA 93.143) on August 1, 2026, to evaluate per- and polyfluoroalkyl substances (PFAS) exposure and associated metabolic health effects across three North Carolina communities with contaminated drinking water supplies.

The research examines PFAS-induced dyslipidemia and obesity in approximately 1,000 individuals ages six and older recruited from Pittsboro (exposed to historically used PFAS via the Cape Fear River), a private well community south of Fayetteville (exposed to novel PFAS through air transport from a manufacturing facility), and the lower Cape Fear area comprising New Hanover and Brunswick Counties (exposed to both historically used PFAS such as PFOA and PFOS and novel PFAS including GENX and Nafion byproduct 2). The study incorporates exposure reconstruction methodology to estimate health effects from past exposures to novel PFAS that are detectable in drinking water but not in human serum.

The award runs through July 31, 2030, with place of performance in Raleigh, North Carolina. Work is conducted in collaboration with community groups along the Cape Fear River. The assistance type is a Project Grant.

Abstract

(biomedical research) project 1 per- and polyfluoroalkyl substances (PFAS) are common drinking water contaminants in north carolina and around the united states. These chemicals have been detected in the drinking water of communities living along the cape fear river in NC. Working with community groups along the cape fear river, we will evaluate PFAS exposure and metabolic health effects (dyslipidemia and obesity) in people from three communities whose drinking water has been contaminated with PFAS. Disruption of lipid homeostasis and impacts on weight gain have been associated with PFAS in other populations. The three communities have exposure to different PFAS. Two of the communities (town of pittsboro and lower cape fear area -- new hanover and brunswick counties, NC) rely on the cape fear river for drinking water, while a third (the private well community south of fayetteville, NC) relies on private wells. Pittsboro, located on the HAW river in the upper region of the cape fear river, is exposed to historically used PFAS. The fayetteville private well community is located near a PFAS manufacturing plant which has discharged novel PFAS to both air and water (cape fear river) since 1980; their wells are contaminated from PFAS air transport. New hanover and brunswick counties, at the mouth of the cape fear river and downstream of the chemical plant, are exposed to both historically used PFAS (e.g., pfoa, pfos) as well as novel PFAS (e.g., genx, nafion byproduct 2). Some of these novel PFAS were found in high levels in drinking water, but not detectable in human serum (e.g., genx, pfmoaa); exposure reconstruction is necessary to estimate health effects from past exposures. We recruited ~1000 individuals ages 6 and older (200 from pittsboro, 300 from fayetteville private well community, and 500 from wilmington) into the genx study cohort in 2020-21 to follow over time to evaluate how PFAS chemicals influence human health. For this current effort, we will focus prospectively on how PFAS influence dyslipidemia and obesity. We will update the health history of this cohort annually. In years 2 & 3 we will collect new blood samples for lipid and PFAS analysis and measure body composition using bioimpedance. We will link previously collected information on residential history to estimates of historic levels of the new PFAS to create estimates for health effects analysis. Because most individuals have measurable exposure to more than 8 different PFAS and because the effects of PFAS on lipids and weight can be non-linear, we will develop new statistical methodology to evaluate both the effects of individual PFAS and all PFAS together. We will report back individual and community level results on a regular basis and will conduct community-initiated analyses. We have a community science advisory panel to provide input to the study and ensure that the study investigators are well informed about community concerns. This study with its complex mix of PFAS and geographically diverse sample will provide key insights to the human health implications of PFAS both in NC and around the world.