Per- And Polyfluoroalkyl Substances (PFAS) and Public Health Impact: Current Evidence, Emerging Challenges, And Future Perspectives

Abstract

Per- and polyfluoroalkyl substances (PFAS) are a large and chemically diverse class of synthetic organofluorine compounds recognized as persistent environmental contaminants because of their exceptional chemical stability, widespread industrial applications, and resistance to biological and environmental degradation. Their extensive use in firefighting foams, food-contact materials, textiles, cosmetics, electronics, and numerous consumer products has resulted in global contamination of water, soil, air, wildlife, and human populations. Biomonitoring studies consistently detect PFAS in human serum worldwide, highlighting widespread exposure and increasing concerns regarding their long-term environmental and public health consequences. This review critically synthesizes current evidence on PFAS chemistry, environmental occurrence, exposure pathways, toxicokinetics, molecular mechanisms of toxicity, public health impacts, regulatory developments, and remediation technologies. A PRISMA-informed narrative review supported by thematic evidence synthesis was undertaken using peer-reviewed literature and authoritative regulatory reports published primarily between 2021 and 2025, while retaining landmark studies that underpin PFAS research. Evidence indicates that contaminated drinking water, dietary intake, occupational activities, indoor dust, and consumer products constitute the principal human exposure pathways. Current epidemiological and toxicological findings associate PFAS exposure with endocrine disruption, hepatotoxicity, immunotoxicity, thyroid dysfunction, metabolic disorders, reproductive and developmental toxicity, cardiovascular disease, neurodevelopmental impairment, reduced vaccine responses, and increased risks of kidney and testicular cancers. However, important uncertainties remain regarding the toxicity of replacement PFAS, mixture effects, chronic low-dose exposure, and limited biomonitoring data from low- and middle-income countries. Although international regulatory initiatives have strengthened PFAS management, disparities in environmental monitoring, policy implementation, quantitative risk assessment, and remediation capacity persist. Future priorities should emphasize harmonized global regulations, expanded biomonitoring, sustainable fluorine-free alternatives, innovative remediation technologies, and integrated public health interventions to reduce PFAS exposure and protect environmental and human health.