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A new paradigm in drug use and human health risk assessment: Sewage profiling at the community level

Final Report Summary - SEWPROF (A new paradigm in drug use and human health risk assessment: Sewage profiling at the community level)

SEWPROF established inter-disciplinary and cross-sectoral research capability and trained the next generation of scientists working in the new and exciting field of wastewater-based epidemiology. SEWPROF developed and validated new, integrated tools towards public health monitoring at a community level based on innovative wastewater-based epidemiology techniques. WBE focussed on profiling of community-wide health and lifestyle through the analysis of human biomarkers in wastewater using a wide-range of methods including hyphenated mass spectrometry techniques, bioanalytical techniques and biosensors.

The main research objectives of SEWPROF were: (RO1) To develop an understanding of sampling uncertainties and to establish novel sampling techniques for sewage profiling; (RO2) To develop novel hyphenated (chromatography coupled with mass spectrometry) and bioanalytical techniques for the targeted analysis and screening of biomarkers in sewage; (RO3) To undertake sewage epidemiology studies for real-time verification of community-wide health (exposure to food and environmental toxicants), disease (cancer) and lifestyle (use of drugs); (RO4) To apply sewage epidemiology in the Europe-wide monitoring of societal health and lifestyle. The research objectives were met through 4 strongly interlinked research work packages build upon 15 individual personalised but complementary research projects. 11 Early Stage Researchers and 4 Experienced Researchers were employed in SEWPROF.

WP1 (RO1) focussed on the development of innovative sampling approaches and verified in-sewer transformation of several biomarkers. Both robust sampling approaches and good understanding of transformation of biomarkers in wastewater are key in delivering robust methodology for multi-biomarker estimation of community-wide health.

WP2 (RO2) aimed to provide new solutions to the analysis of very complex and heterogeneous environmental matrices through the development of sensitive and selective analytical techniques. Analysis of biomarkers in wastewater has been internationally studied and accepted as a complementary tool to traditional epidemiological methods. So far, the approach has mostly focused on the determination of legal or illegal drug use at the community level. However, there is large potential for wastewater-based epidemiology (WBE) approach to be extended to human health biomarkers for the assessment of community-wide health and disease. New methodologies utilizing hyphenated (mass spectrometry-based) techniques were developed in WP2 for targeted analysis, screening of unknowns and retrospective analysis of wastewater samples. These included methods using LC/MS techniques for the analysis of: (1) selected health biomarkers (e.g. oxidative stress: 8-iso-prostaglandin F2α) (2) human biomarkers reflecting exposure to environmental and food toxic chemicals (e.g. urinary metabolites of pesticides, antibiotic residues and phosphodiesterase type 5 inhibitors and their metabolites); (3) chiral biomarkers of illicit drugs and antibiotics (e.g. for mephedrone, MDMA, PMA, methadone, ketamine, benzodiazepines and their metabolites). New high resolution mass spectrometry based methods were developed for the identification, confirmation and quantification of new drugs/psychoactive compounds and their transformation products in sewage. Innovative biosensor approaches allowed for quantification of biomarkers (such as cocaine and PSA, prostate specific antigen) in complex wastewater samples.

WP3 (RO3) aimed to standardize the wastewater-based epidemiology approach and develop novel applications to assess community-wide health and lifestyle. This was achieved via: (1) Identification of new synthetic drugs of abuse in illicit drug market using various approaches including club amnesty bins, test purchasing of “legal highs” from websites and “head shops’, and pooled urine analysis. As a result several new synthetic drugs in the illicit drug market (e.g. FUB-PB-22, AL-LAD, bromo-amphetamine) were identified.; (2) Verification the abuse of prescription and illicit drugs by measuring their weekly variation in wastewater; (3) The study metabolic pathways of selected illicit drugs (parent drugs and metabolites) that can occur in wastewater by microbial metabolism; (4) Standardization of the sewage epidemiology approach to develop novel applications and compare results with those collected via socio-epidemiological studies.

Measurement of the weekly variation of prescription drugs in sewage, identification of metabolic pathways of drugs of abuse in sewage, refined estimation methods of population habits (e.g. using caffeine, nicotine and their metabolites), reliable estimation of population size and dynamics and comparison of results from sewage and social studies in a small and stable community were investigated. The outcomes of WP1-3 were applied in a Europe-wide monitoring programme (WP4) to test the efficacy of wastewater-based epidemiology and to undertake inter-laboratory comparisons of analytical protocols. Several paper outlining outcomes from SEWPROF ITN have been published and can be found on the network’s website:

The training objectives were: (TO 1) To provide the highest quality, cutting-edge, modern and flexible training environment allowing the researchers to gain specialist skills and knowledge within the chosen research area and to be able to apply them across disciplines; (TO 2) To promote transnational, interdisciplinary and intersectoral training environment; (TO 3) To enhance trainees’ confidence and communication skills across sectors; (TO 4) To promote personalized training through a Researcher Development Framework; (TO 5) To equip trainees with a wide-range of transferable skills. Sewprof achieved all TOs. The training programme in SEWPROF was undertaken through: individual research projects, secondments and visits, programme of taught training courses, project meetings and personal career development planning. SEWPROF advanced knowledge of the epidemiology of (illicit) drug use and bridged gaps in the available expertise with the ultimate goal of applying this cutting edge interdisciplinary approach within epidemiological studies of societal health. This was achieved through bringing together leaders in the field across Europe in academia, research institutes and the private sector and utilising their expertise and commitment in training a highly employable cohort of researchers who acquired advanced knowledge in the field through an interdisciplinary and cross-sectoral training programme delivered by world class research-led organisations and industrial partners.