Rehoboth Chinyere Uwaga, Polycarp Dauda Madaki, James Owupele Ibibama, Chiara Frazzoli, Orish E Orisakwe
{"title":"Microplastics in bottled water and human health outcomes: a systematic review of multi-organ toxicity and mechanistic pathways.","authors":"Rehoboth Chinyere Uwaga, Polycarp Dauda Madaki, James Owupele Ibibama, Chiara Frazzoli, Orish E Orisakwe","doi":"10.1080/26896583.2026.2722385","DOIUrl":"https://doi.org/10.1080/26896583.2026.2722385","url":null,"abstract":"<p><p>This systematic review synthesized evidence on the health effects of microplastic exposure, with emphasis on organ-specific toxicity, molecular mechanisms, and implications for chronic disease. Following PRISMA 2020 guidelines, we searched PubMed, Scopus and Web of Science for peer-reviewed studies examining health outcomes associated with microplastic exposure relevant to bottled water consumption. Eligible studies included human observational studies, controlled animal experiments, and mechanistic <i>in vitro</i> investigations. Of 128 identified records, 15 studies met inclusion criteria: 3 human observational studies, 5 <i>in vivo</i> experiments, 4 <i>in vitro</i> investigations, and 3 mixed-design studies. Geographically, studies originated from China (40%), United States (20%), and other regions (40%). Polystyrene (10 studies), polyethylene, and polyethylene terephthalate (4 studies each) were most frequently investigated. Human biomonitoring confirmed microplastic presence in blood (3.15 ± 1.25 particles/mL), placental tissue (226-273 µg/g), and testicular samples (328 µg/g). Reproductive toxicity was the most consistently reported adverse outcome (5 studies), followed by hepatic, gastrointestinal, cardiovascular, renal, developmental, and neurological effects. Across studies, oxidative stress (reported in 12 studies), inflammatory activation (10 studies), endocrine disruption (4 studies), and mitochondrial dysfunction (4 studies) emerged as principal mechanistic pathways. Chronic exposure to microplastics from bottled water may contribute to multisystem toxicity through oxido-inflammatory mechanisms.</p>","PeriodicalId":53200,"journal":{"name":"Journal of Environmental Science and Health Part C-Toxicology and Carcinogenesis","volume":" ","pages":"1-21"},"PeriodicalIF":5.0,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"环境科学与生态学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Microplastics and nanoplastics in humans: exposure pathways, biological mechanisms, and implications for health risk assessment.","authors":"Rasha Osman, Meera Kussai, Ula Abdulrahman, Otmane Lamrabet","doi":"10.1080/26896583.2026.2707025","DOIUrl":"https://doi.org/10.1080/26896583.2026.2707025","url":null,"abstract":"<p><p>Microplastics (MPs) and nanoplastics (NPs) are ubiquitous contaminants, but their implications for human internal exposure, biological effects, and health risk assessment remain incompletely defined. Although many reviews summarize environmental occurrence and ecological impacts, fewer integrate human exposure pathways with mechanistic toxicological evidence and safety-relevant uncertainties. This review synthesizes evidence on inhalation, ingestion, and dermal exposure, emphasizing particle size, barrier interactions, translocation, and distribution. We examine experimental and clinical evidence describing oxidative stress, inflammatory signaling, epithelial barrier dysfunction, gut dysbiosis, immune activation, and endocrine interference associated with MP and NP exposure. Particular attention is given to distinguishing MPs from NPs in terms of cellular uptake, biodistribution, analytical detectability, and toxicodynamic behavior. We also discuss limitations in exposure assessment, including contamination bias, analytical detection limits, and harmonized reporting standards. Rather than focusing on environmental prevalence, this review highlights gaps in exposure quantification, dose-response relationships, chronic low-dose exposure, vulnerable populations, and co-exposure to plastic additives or adsorbed contaminants. An organ-specific risk perspective is integrated, emphasizing respiratory, digestive, immune, and systemic effects, as well as particle size, polymer type, exposure concentration, and human dose-response uncertainty. By synthesizing toxicological, analytical, and public health evidence, this review defines research priorities for risk assessment.</p>","PeriodicalId":53200,"journal":{"name":"Journal of Environmental Science and Health Part C-Toxicology and Carcinogenesis","volume":" ","pages":"1-45"},"PeriodicalIF":5.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"环境科学与生态学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel N Obot, Godswill J Udom, Omoirri M Aziakpono, Oluchi F Obilor, Nkechi J Onyeukwu, Ayodeji Aturamu, Richard D Agbana, Joseph G Omole, Ayobami J Olusola, Idara A Okon, Nita-Wills G Udom, Orish E Orisakwe
{"title":"Health implications of chronic fluoride exposure in children and young adults: a systematic review.","authors":"Daniel N Obot, Godswill J Udom, Omoirri M Aziakpono, Oluchi F Obilor, Nkechi J Onyeukwu, Ayodeji Aturamu, Richard D Agbana, Joseph G Omole, Ayobami J Olusola, Idara A Okon, Nita-Wills G Udom, Orish E Orisakwe","doi":"10.1080/26896583.2026.2697147","DOIUrl":"https://doi.org/10.1080/26896583.2026.2697147","url":null,"abstract":"<p><p>Fluoride is widely recognized for its caries-preventive benefits; however, chronic exposure, particularly in children and young adults, raises significant public health concerns. The study assessed the health implications of prolonged fluoride exposure in individuals aged 0-30 years. A systematic search was conducted across major databases (PubMed, Scopus, Web of Science) following the PRISMA guidelines and CASP tools for quality assessment. Of the 1,020 articles, 34 studies were selected. Findings showed that while low fluoride concentrations (0.1-1.5 mg/L) effectively prevent dental caries, prolonged high-dose exposure is associated with adverse outcomes. Reported associations included dental fluorosis, reproductive disturbances, cognitive and neurodevelopmental impairments; mechanistic studies provided biological plausibility for several proposed toxicity pathways. Studies linked elevated levels with reduced IQ in children, raising concerns about long-term developmental health. Although impacts on bone and endocrine systems were inconsistent/inconclusive across different populations, potential systemic toxicity is not negligible. Chronic fluoride exposure is of human pathological importance. It highlights the importance of region-specific risk assessment, particularly in areas with fluoridated water or high fluoride levels. Further research, particularly using multi-omics approaches, is critical to uncover molecular mechanisms underlying fluoride toxicity. Balancing dental benefits with systemic risks requires urgent, evidence-based public health policies and exposure control strategies.</p>","PeriodicalId":53200,"journal":{"name":"Journal of Environmental Science and Health Part C-Toxicology and Carcinogenesis","volume":" ","pages":"1-25"},"PeriodicalIF":5.0,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"环境科学与生态学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Association between long-term exposure to ambient air pollution and breast cancer risk in Mexico: a systematic review of observational studies.","authors":"Diana Evelyn Villa-Guillen, Jorge Alejandro Villa-Carrillo","doi":"10.1080/26896583.2026.2678762","DOIUrl":"https://doi.org/10.1080/26896583.2026.2678762","url":null,"abstract":"<p><p>Breast cancer remains a major public health concern in Mexico, and ambient air pollution has been proposed as a possible contributing factor. We conducted a PROSPERO-registered systematic review, following PRISMA guidance, to assess observational evidence on long-term exposure to PM<sub>2.5</sub>, PM<sub>10</sub>, NO<sub>2</sub>, SO<sub>2</sub>, O<sub>3</sub>, and polycyclic aromatic hydrocarbons (PAHs) in Mexican women. Searches of bibliographic databases and grey literature, including dissertations, institutional repositories, and scholarly networking sites, identified 35 records. Six studies met the inclusion criteria: four ecological or spatial studies and two retrospective clinical studies from Hermosillo, the Monterrey Metropolitan Area, Miguel Alemán, and Mexico City. Where pollutant concentrations were reported, PM<sub>2.5</sub> and PM<sub>10</sub> were directly assessed; other studies used residential proximity to industrial or emission sources as exposure indicators. Across studies, higher estimated exposure was consistently associated with greater breast cancer burden, less favorable prognosis, or more adverse tumor characteristics. Even so, the evidence base was limited by heterogeneity in design, indirect exposure assessment, and substantial risk of bias. Overall certainty of evidence was very low. These findings are best interpreted as preliminary and hypothesis-generating, underscoring the need for stronger, better-controlled studies before causal or policy conclusions are drawn.</p>","PeriodicalId":53200,"journal":{"name":"Journal of Environmental Science and Health Part C-Toxicology and Carcinogenesis","volume":" ","pages":"1-27"},"PeriodicalIF":2.3,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"环境科学与生态学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Johnson C Agbasi, Arinze Longinus Ezugwu, Michael Ekuru Omeka, Ifeanyi Adolphus Ucheana, Chiedozie Chukwuemeka Aralu, Kevin Emeka Agbo, Nchekwube D Nweke, Stanley Ugochukwu Nwoke, Arikpo Temple Okah, Hillary Onyeka Abugu, Johnbosco C Egbueri
{"title":"Three decades of Nigerian bottled water quality research: a systematic review of contaminants and research gaps for environmental toxicology.","authors":"Johnson C Agbasi, Arinze Longinus Ezugwu, Michael Ekuru Omeka, Ifeanyi Adolphus Ucheana, Chiedozie Chukwuemeka Aralu, Kevin Emeka Agbo, Nchekwube D Nweke, Stanley Ugochukwu Nwoke, Arikpo Temple Okah, Hillary Onyeka Abugu, Johnbosco C Egbueri","doi":"10.1080/26896583.2026.2674461","DOIUrl":"10.1080/26896583.2026.2674461","url":null,"abstract":"<p><p>Bottled water consumption is widespread in Nigeria, yet the contaminant profile of these products and the implications for human exposure remain incompletely characterized. This systematic review synthesizes Nigerian bottled water quality research published between 1992 and 2025, drawing on 58 studies from major scientific databases. Analyses include temporal trends in research activity, types of contaminants investigated, and collaboration patterns among researchers. Results show marked geographical imbalance. About 79.5% of all research output focuses on southern Nigeria, while 14 states have no published data on bottled water quality. Studies of traditional contaminants, including heavy metals and microbial indicators, dominate the literature. Investigation of Contaminants of Emerging Concern, such as pharmaceuticals, personal care products, and microplastics, began only in 2020 despite more than two decades of global research on these substances. International collaborations (22.4% of studies) enabled advanced analytical methods but also revealed limited independent capacity for comprehensive contaminant detection. Without systematic data on bottled water contaminants across all regions, population exposure assessments remain incomplete. The delayed attention to emerging contaminants limits understanding of chronic exposure to chemical mixtures. This review supports prioritizing future toxicological research and strengthening environmental health monitoring in Nigeria and similar developing regions.</p>","PeriodicalId":53200,"journal":{"name":"Journal of Environmental Science and Health Part C-Toxicology and Carcinogenesis","volume":" ","pages":"236-280"},"PeriodicalIF":5.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"环境科学与生态学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karmbir, Mansha Aggarwal, Sheikh Mohammad Faisal, Raj Kumar Narang, Balak Das Kurmi, Kirandeep Kaur, Amit Sharma
{"title":"Environmental pollutants as vascular poisons: rethinking mesenteric ischemia through the lens of heavy metal toxicity.","authors":"Karmbir, Mansha Aggarwal, Sheikh Mohammad Faisal, Raj Kumar Narang, Balak Das Kurmi, Kirandeep Kaur, Amit Sharma","doi":"10.1080/26896583.2026.2673281","DOIUrl":"10.1080/26896583.2026.2673281","url":null,"abstract":"<p><p>Mesenteric ischemia is a potentially deadly condition that occurs due to the lack of blood supply to the intestine. There is also emerging evidence that the mesenteric circulation may result in vascular dysfunction and ischemic damage caused by environmental contaminants especially heavy metals such as lead and mercury. Persistent exposure leads to endothelial dysfunction through the generation of oxidative stress, nitric oxide depletion, mitochondrial dysfunction and inflammatory signaling pathways. This hypothesis-generating narrative review integrates toxicological and vascular evidence to propose that chronic low-level exposure to these metals could represent an underrecognized etiological factor in mesenteric ischemia. The main molecular mechanisms, including oxidative stress, endothelial dysfunction, mitochondrial dysfunction, and vascular remodeling, are discussed, and the potential synergistic toxicity of the combined exposure to metals is considered. Additionally, several crucial diagnostic biomarkers are mentioned, such as intestinal fatty acid-binding protein (I-FABP), alpha-glutathione S-transferase (α-GST), C-reactive protein (CRP), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and malondialdehyde (MDA). A knowledge of the connection between mesenteric vascular injury and exposure to heavy metals may aid in the development of improved methods of diagnosis and treatment.</p>","PeriodicalId":53200,"journal":{"name":"Journal of Environmental Science and Health Part C-Toxicology and Carcinogenesis","volume":" ","pages":"198-235"},"PeriodicalIF":5.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"环境科学与生态学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Uncovering the nexus of human health hazards of nanoplastics, gut-dysbiosis and antibiotic-resistance.","authors":"Prashant Sharma, Sakshi Dagariya, Shubham Sharma, Manish Singh","doi":"10.1080/26896583.2025.2578871","DOIUrl":"10.1080/26896583.2025.2578871","url":null,"abstract":"<p><p>Nanoplastics (1-1000 nm) (NPs) represent a novel and insidious class of emerging contaminants with the potential to profoundly disrupt gut microbial ecology and accelerate the spread of antibiotic resistance two critical and converging threats to global health. While prior studies have examined the toxicokinetics of NPs and their general microbial interactions, this review provides the first comprehensive synthesis specifically focused on the nexus between NPs, gut dysbiosis, and the propagation of antibiotic resistance genes (ARGs). This review highlights how NPs alter gut microbiota composition, suppressing beneficial microbes while fostering opportunistic pathogens and how such imbalances may contribute to human health issues. Importantly, emerging evidence also suggests that NPs may serve as unrecognized vectors for horizontal gene transfer (HGT), enabling the rapid dissemination of ARGs <i>via</i> conjugation, transformation, transduction, and extracellular vesicles within the gastrointestinal tract. In addition, this review also identifies urgent methodological gaps in detecting NPs in biological matrices and the environment, as well as assessing their mechanistic impacts, calling for innovation in analytical approaches. By presenting an interdisciplinary perspective that bridges nanotoxicology, microbiome science, and antimicrobial resistance, this article sheds light on an underexplored yet urgent frontier in environmental health, offering novel insights to guide future research, risk assessment, and policy development.</p>","PeriodicalId":53200,"journal":{"name":"Journal of Environmental Science and Health Part C-Toxicology and Carcinogenesis","volume":" ","pages":"1-60"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"环境科学与生态学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Interactions between polystyrene-derived micro- and nanoplastics and the microbiota: a systematic review of multi-omics mouse studies.","authors":"Deniz Özkan Vardar, Berzan Ekmen, Abdulhamit Çalı","doi":"10.1080/26896583.2026.2636868","DOIUrl":"10.1080/26896583.2026.2636868","url":null,"abstract":"<p><p>Micro- and nanoplastics (MNPs), especially polystyrene-derived particles (PS-MPs/PS-NPs), have become a growing concern due to their increasing presence in the environment and their proven biological toxicity. Although PS particles have been identified in various human tissues, including feces, placenta, and blood, their impact on the gut microbiota and microbiota-driven metabolic pathways remains insufficiently synthesized. This systematic review aims to compile current <i>in vivo</i> evidence from mouse studies to assess how PS-MP/NP exposure influences gut microbial diversity, taxonomic composition, microbial metabolites, and subsequent physiological outcomes. A PRISMA-guided literature search identified 15 controlled mouse studies published between 2010 and 2024. Across these studies, PS exposure consistently induced gut dysbiosis, characterized by reductions or shifts in alpha-diversity, distinct beta-diversity clustering, loss of beneficial commensals such as <i>Lactobacillus</i>, <i>Bifidobacterium</i>, and members of <i>Ruminococcaceae</i>, and enrichment of opportunistic or pro-inflammatory taxa including <i>Proteobacteria</i>, <i>Helicobacter</i>, and <i>Staphylococcus</i>. Notably, MNPs particles induced more pronounced microbial disruption than micro-sized forms. Overall, current experimental evidence indicates that PS-MPs/PS-NPs induce multidimensional toxicity by simultaneously disrupting gut microbial ecology and host metabolic pathways. These findings emphasize the need for standardized methodologies in microplastic research and highlight the importance of clarifying the long-term health effects of human exposure to micro- and nanoplastics.</p>","PeriodicalId":53200,"journal":{"name":"Journal of Environmental Science and Health Part C-Toxicology and Carcinogenesis","volume":" ","pages":"141-159"},"PeriodicalIF":5.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"环境科学与生态学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Genotoxic effects of atmospheric PAH and heavy metals: Interaction and mechanistic evidence - a narrative review.","authors":"Norberto Alarcón-Herrera, Sandra Gómez-Arroyo, Saúl Flores-Maya, Paulina Abrica-González","doi":"10.1080/26896583.2026.2655995","DOIUrl":"10.1080/26896583.2026.2655995","url":null,"abstract":"<p><p>Environmental contaminants present a significant concern owing to their pervasive distribution and their capacity to induce molecular and cellular damage. Among these, polycyclic aromatic hydrocarbons and heavy metals are of particular importance, as numerous compounds within these categories are classified as carcinogenic by the International Agency for Research on Cancer (IARC). It is crucial to understand the mechanistic basis of their genotoxicity to elucidate how environmental exposures contribute to genotoxicity. In this regard, biochemical, cytogenetic, and DNA integrity biomarkers have become essential tools for detecting biological responses and unraveling toxicodynamic pathways. Despite these advancements, most existing evidence derives from studies assessing single compounds; however, real-world exposures typically involve complex mixtures in which polycyclic aromatic hydrocarbons and heavy metals frequently co-exist. Mixtures can produce interaction effects (synergistic, additive, or antagonistic) that significantly alter the extent and nature of genotoxic damage. Therefore, risk assessments based solely on isolated exposures may not adequately reflect environmentally relevant scenarios and could underestimate potential hazards. Overcoming this limitation necessitates research strategies that incorporate validated biomarkers to evaluate combined exposures. These methods improve understanding of interaction mechanisms, quantify mixture-induced DNA damage, and clarify individual roles of pollutants, enhancing human health risk assessment.</p>","PeriodicalId":53200,"journal":{"name":"Journal of Environmental Science and Health Part C-Toxicology and Carcinogenesis","volume":" ","pages":"160-197"},"PeriodicalIF":5.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"环境科学与生态学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James O Ibibama, Godswill J Udom, Rehoboth Uwaga, Unique Chukwu, Margaret Azaatse, Chinwe Leonard-Alika, Omunakwe Onu, Samuel Saka, Chiara Frazzoli, Orish Ebere Orisakwe
{"title":"Environmental determinants of therapeutic drug failure: a systematic review of heavy metal-induced inefficacy.","authors":"James O Ibibama, Godswill J Udom, Rehoboth Uwaga, Unique Chukwu, Margaret Azaatse, Chinwe Leonard-Alika, Omunakwe Onu, Samuel Saka, Chiara Frazzoli, Orish Ebere Orisakwe","doi":"10.1080/26896583.2025.2611653","DOIUrl":"10.1080/26896583.2025.2611653","url":null,"abstract":"<p><p>Therapeutic drug failure poses a significant global health burden, particularly in developing regions with high environmental toxicant exposure. While traditionally attributed to factors such as substandard drugs, genetic polymorphisms, and non-compliance, emerging evidence implicates heavy metals as under-recognized modulators of drug efficacy. This systematic review assessed how heavy metals potentially interfere with the pharmacokinetics and pharmacodynamics of drugs. Following PRISMA guidelines, peer-reviewed articles published between 1999 and 2024 were retrieved from PubMed, ScienceDirect, Web of Science, Scopus and Google Scholar. Studies investigating <i>in vivo, in vitro</i> or clinical evidence of heavy metal interference with therapeutic drug action were eligible. Out of 139 studies identified, 20 studies met the inclusion criteria. Cadmium, lead and mercury were the most implicated metals. Approximately 60% of studies demonstrated that oxidative stress could induce loss of therapeutic drug efficacy, while 40% showed enzyme inhibition (notably CYP3A4 and CYP2C9) or transporter impairment. Experimental models linked these effects to anti-hypertensives, antidiabetics, and drugs used in the management of metabolic disorders. Environmental heavy metal exposures may hinder therapeutic responses through oxidative and metabolic disruption. Integrating environmental exposure assessment into global pharmacovigilance and clinical pharmacology could enhance drug response predictability and treatment success.</p>","PeriodicalId":53200,"journal":{"name":"Journal of Environmental Science and Health Part C-Toxicology and Carcinogenesis","volume":" ","pages":"61-83"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"环境科学与生态学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}