Kai-Fan Tsai Taiwan

Education: 1) September 2004 to June 2011, Bachelor of Medicine (Doctor of Medicine, MD) School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan 2) September 2023 to the Present, Ph. D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Medical Training: 1) July 2010 to June 2011, Internship Training (Medicine) Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 2) October 2012 to September 2013, Post-Graduate-Year Training (Medicine) Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 3) October 2013 to June 2016, Residency Training (Internal Medicine) Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 4) July 2016 to September 2018, Fellowship Training (Nephrology) Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan Professional Affiliations: 1) October 2018 to the Present, Attending Physician (Nephrology) Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 2) June 2023 to the Present, Assistant Professor Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 3) July 2022 to May 2023, Lecturer Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 4) June 2019 to August 2020, Attending Physician (Nephrology) Division of Nephrology, Department of Internal Medicine, Kaohsiung Municipal Feng-Shan Hospital (Under the Management of Kaohsiung Chang Gung Memorial Hospital), Kaohsiung, Taiwan Board Certification: 1) Taiwan Society of Internal Medicine: No. 010429 (December 2016) 2) Taiwan Society of Nephrology: No. S1520 (September 2018) Research Interest: 1) Acute Kidney Injury 2) Chronic Kidney Disease 3) Renal Replacement Therapy 4) Toxicology 5) Environmental Medicine Research Project: 1) The Impacts of Endocrine Disrupting Chemicals on the Progression and Prognosis of Chronic Kidney Disease (CMRPG8K1321–3), Co-Principal Investigator 2) The Relationship between Mercury Exposure and Chronic Kidney Disease Progression (CMRPGTM0041), Principal Investigator 3) Health impacts of exposure to endocrine-disrupting chemicals on renal transplant recipients (CMRPG8N1301), Principal Investigator 4) Investigations on the adverse impacts and its underpinning mechanisms of emerging flame retardants and phthalate on chronic kidney disease (CORPG8P0521–3), Co-Principal Investigator Honor and Award: 1) Taiwan Clinical Dialysis Association – Outstanding Paper Award, December 2022 2) Taiwan Society of Nephrology – Outstanding Paper Award, December 2023 Bibliography: Publications: (ⴕ: co-first author; *: corresponding author) 1) Chung-Hsu Lai, Wu Sun, Chen-Hsiang Lee, Jiun-Nong Lin, Ming-Huei Liao, Shyh-Shyan Liu, Tzu-Yao Chang, Kai-Fan Tsai, Yi-Chin Chang, Hsi-Hsun Lin, Yen-Hsu Chen*. The Epidemiology and Characteristics of Q fever and Co-infections with Scrub Typhus, Murine Typhus or Leptospirosis in Taiwan: A Nationwide Database Study. Zoonoses and Public Health. 2017 Nov; 64(7):517-526 (SCIE; 2023 IF = 2.4, Veterinary Sciences 24/167) 2) Kai-Fan Tsai, Lung-Chih Li*, Chien-Ning Hsu, Chih-Che Lin, Yu-Hung Lin, Yu-Fan Cheng, Chih-Chi Wang, Chao-Long Chen. Effects of Conversion From Calcineurin Inhibitors to Sirolimus or Everolimus on Renal Function and Possible Mechanisms in Liver Transplant Recipients. Journal of Clinical Pharmacology. 2019 Mar; 59(3):326-334 (SCIE; 2023 IF = 2.4, Pharmacology & Pharmacy 188/354) 3) Hua-Rong Zhong, Chiang-Chi Huang, Po-Jung Wu, Kai-Fan Tsai, Chien-Hsing Wu, Chien-Te Lee, Terry Ting-Yu Chiou*. Factors Associated With Circuit Set Lifetime in Continuous Venovenous Hemofiltration Therapy. Acta Nephrologica. 2019 Mar; 30(1):40-49 (Domestic Journal) 4) Kai-Fan Tsai, Yung-Lung Chen, Terry Ting-Yu Chiou, Tian-Huei Chu, Lung-Chih Li, Hwee-Yeong Ng, Wen-Chin Lee*, Chien-Te Lee*. Emergence of SGLT2 Inhibitors as Powerful Antioxidants in Human Diseases. Antioxidants (Basel). 2021 Jul; 10(8):1166 (SCIE; 2023 IF = 6.0, Food Sciences & Technology 20/173) 5) Kai-Fan Tsai, Pai-Chin Hsu, Chia-Te Kung, Chien-Te Lee, Huey-Ling You, Wan-Ting Huang, Shau-Hsuan Li, Fu-Jen Cheng, Chin-Chou Wang, Wen-Chin Lee*. The Risk Factors of Blood Cadmium Elevation in Chronic Kidney Disease. International Journal of Environmental Research and Public Health. 2021 Nov; 18(23):12337 (SSCI; 2021 IF = 4.614, Public, Environmental & Occupational Health 71/210) 6) Ju-Shao Yen, I-Kuan Wang, Chih-Chia Liang, Jen-Fen Fu, Yi-Chou Hou, Chih-Chun Chang, Po-Wen Gu, Kai-Fan Tsai, Cheng-Hao Weng, Wen-Hung Huang, Ching-Wei Hsu, Tzung-Hai Yen*. Cytokine Changes in Fatal Cases of Paraquat Poisoning. American Journal of Translational Research. 2021 Oct; 13(10):11571-11584 (SCIE; 2023 IF = 1.7, Medicine, Research & Experimental 135/189) 7) Kai-Fan Tsai, Pai-Chin Hsu, Chien-Te Lee, Chia-Te Kung, Yi-Chin Chang, Lung-Ming Fu,Yu-Che Ou, Kuo-Chung Lan, Tzung-Hai Yen, Wen-Chin Lee*. Association between Enzyme-Linked Immunosorbent Assay-Measured Kidney Injury Markers and Urinary Cadmium Levels in Chronic Kidney Disease. Journal of Clinical Medicine. 2021 Dec; 11(1):156 (SCIE; 2023 IF = 3.0, Medicine, General & Internal, 58/325) 8) Po-Hsun Chuang, Kai-Fan Tsai, I-Kuan Wang, Ya-Ching Huang, Lan-Mei Huang, Shou-Hsuan Liu, Cheng-Hao Weng, Wen-Hung Huang, Ching-Wei Hsu, Wen-Chin Lee, Tzung-Hai Yen*. Blood Aluminum Levels in Patients with Hemodialysis and Peritoneal Dialysis. International Journal of Environmental Research and Public Health. 2022 Mar; 19(7):3885 (SSCI; 2021 IF = 4.614, Public, Environmental & Occupational Health 71/210) 9) Pai-Chin Hsu, Chih-Han Liu, Wen-Chin Lee, Chien-Hsing Wu, Chien-Te Lee, Chien-Hao Su, Yu-Chin Lily Wang, Kai-Fan Tsai*, Terry Ting-Yu Chiou*. Predictors of Acute Kidney Disease Severity in Hospitalized Patients with Acute Kidney Injury. Biomedicines. 2022 May; 10(5):1081 (SCIE; 2023 IF = 3.9, Pharmacology & Pharmacy 85/354) 10) Yu-Hsin Liu, Kai-Fan Tsai, Pai-Chin Hsu, Meng-Hsuan Hsieh, Jen-Fen Fu, I-Kuan Wang, Shou-Hsuan Liu, Cheng-Hao Weng, Wen-Hung Huang, Ching-Wei Hsu, Tzung-Hai Yen*. Hemodialysis Treatment for Patients with Lithium Poisoning. International Journal of Environmental Research and Public Health. 2022 Aug; 19(16):10044 (SSCI; 2021 IF = 4.614, Public, Environmental & Occupational Health 71/210) 11) Chung‐Ming Fuⴕ, Kai‐Fan Tsaiⴕ, Wei‐Hung Kuo, Chien‐Hsing Wu, Ching‐I Yu, Huey‐Ling You, Chien‐Te Lee*. The Waxing, Waning, and Predictors of Humoral Responses to Vector‐Based SARS‐CoV‐2 Vaccine in Hemodialysis Patients. Vaccines (Basel). 2022 Sep; 10(9):1537 (SCIE; 2023 IF = 5.2, Medicine, Research & Experimental 39/189) 12) Kai-Fan Tsai, Fu-Jen Cheng, Wan-Ting Huang, Chia-Te Kung, Chien-Te Lee, Ben-Chung Cheng, Jin-Bor Chen, Shau-Hsuan Li, Chin-Chou Wang, Liang-Jen Wang, Yu-Che Ou, Wen-Chin Lee*. The associations between renal disease severity and exposure to organophosphate flame retardants in patients with chronic kidney disease. Environment International. 2022 Oct; 170:107573 (SCIE; 2023 IF = 10.3, Environmental Sciences 21/358) 13) Po-Chun Chen, Chiang-Chi Huang, Chung-Ming Fu, Yi-Chin Chang, Po-Jung Wu, Wen-Chin Lee, Chien-Te Lee, Kai-Fan Tsai*. Real-World Effectiveness of SARS-CoV-2 Vaccine Booster in Hemodialysis Patients with COVID-19 Receiving Molnupiravir. Viruses (Basel). 2023 Feb, 15(2):543 (SCIE; 2023 IF = 3.8, Virology 17/41) 14) Po-Yen Kuo, Kai-Fan Tsai, Po-Jung Wu, Pai-Chin Hsu, Chien-Hsing Wu, Wen-Chin Lee, Hsiu-Yu Fang, Chih-Yuan Fang, Sheng-Ying Chung, Yung-Lung Chen, and Terry Ting-Yu Chiou*. Interleukin-18 and Gelsolin Are Associated with Acute Kidney Disease after Cardiac Catheterization. Biomolecules. 2023 Mar, 13(3):487 (SCIE; 2023 IF = 4.8, Biochemistry & Molecular Biology 67/313) 15) Chi-Ang Liang, Shu-Sen Chang, Hsien-Yi Chen, Kai-Fan Tsai, Wen-Chin Lee, I-Kuan Wang, Chao-Yu Chen, Shou-Hsuan Liu, Cheng-Hao Weng, Wen-Hung Huang, Ching-Wei Hsu, Tzung-Hai Yen*. Human Poisoning with Methomyl and Cypermethrin Pesticide Mixture. Toxics. 2023 Apr, 11(4):372 (SCIE; 2023 IF = 3.9, Toxicology 23/106) 16) Yi-Chin Chang, Yi-Chun Chen, Chiang-Chi Huang, Chung-Ming Fu, Yueh-Ting Lee, Po-Jung Wu, Wen-Chin Lee, Chien-Te Lee, Shang-Chih Liao, Kai-Fan Tsai*. Clinical effectiveness of molnupiravir in patients with COVID-19 undergoing haemodialysis. International Journal of Antimicrobial Agents. 2023 Jul, 62(1):106834 (SCIE; 2023 IF = 4.9, Infectious Diseases 16/132) 17) Feng-Shun Chen, Chih-Cheng Chen, Ching-Chang Tsai, Jian-He Lu, Huey-Ling You, Ching-Mei Chen, Wan-Ting Huang, Kai-Fan Tsai, Fu-Jen Cheng, Chia-Te Kung, Shau-Hsuan Li, Chin-Chou Wang, Yu-Che Ou, Wen-Chin Lee, Yu-Ting Chang, Fahimah Hashim, How-Ran Chao*, Liang-Jen Wang*. Urinary levels of organophosphate flame retardants metabolites in a young population from Southern Taiwan and potential health effects. Frontiers in Endocrinology. 2023 Jun, 14:1173449 (SCIE, 2023 IF = 3.9, Endocrinology & Metabolism 51/186) 18) Fu-Jen Cheng, Kai-Fan Tsai, Kuo-Chen Huang, Chia-Te Kung, Wan-Ting Huang, Huey-Ling You, Shau-Hsuan Li, Chin-Chou Wang, Wen-Chin Lee, Hsiu-Yung Pan*. Association between organophosphate flame retardant exposure and lipid metabolism: data from the 2013-2014 National Health and Nutrition Examination Survey. Frontiers in Public Health. 2024 Mar, 12:1340261 (SCIE, 2023 IF = 3.0, Public, Environmental & Occupational Health 114/403) 19) Kai-Fan Tsai, Fu-Jen Cheng, Wan-Ting Huang, Chih-Chao Yang, Shau-Hsuan Li, Ben-Chung Cheng, Chin-Chou Wang, Chia-Te Kung, Liang-Jen Wang, Wen-Chin Lee *, Yu-Che Ou. Nephrotoxicity of organophosphate flame retardants in patients with chronic kidney disease: A 2-year longitudinal study. Ecotoxicology and Environmental Safety. 2024 August, 281:116625 (SCIE; 2023 IF = 6.2, Toxicology 9/106) 20) Kuan-Hung Liu, Shu-Sen Chang, Chao-Ying Tu, Hsien-Yi Chen, Wen-Chin Lee, Kai-Fan Tsai, Po-Yen Kuo, Ju-Ching Yen, I-Kuan Wang, Tzung-Hai Yen*. Human poisoning with glyphosate-surfactant herbicides: Retrospective analysis of mortality outcomes of patients treated in a poison center. Human & Experimental Toxicology. 2024 January-December, 43:9603271241297004 (SCIE; 2023 IF = 2.7, Toxicology 56/106) 21) Liang-Jen Wang, How-Ran Chao, Chih-Cheng Chen, Ching-Me Chen, Huey-Ling You, Ching-Chang Tsai, Ching-Shu Tsai, Wen-Jiun Chou, Chia-Jung Li, Kai Fan Tsai, Fu-Jen Cheng, Chia-Te Kung, Shau-Hsuan Li, Chin-Chou Wang, Yu-Che Ou, Wen-Chin Lee, Wan-Ting Huang*. Effects of urinary organophosphate flame retardants in susceptibility to attention-deficit/hyperactivity disorder in school-age children. Ecotoxicology and Environmental Safety. 2024 November, 287:117281 (SCIE; 2023 IF = 6.2, Toxicology 9/106) 22) Wen-Yu Ho, Ju-Ching Yen, Cheng-Hao Weng, Wen-Hung Huang, Li-Chung Chiu, Po-Yen Kuo, Kai-Fan Tsai, I-Kuan Wang, Tzung-Hai Yen*, Ching-Wei Hsu*. Serum Nickel Concentrations in Patients Receiving Chronic Hemodialysis. Hemodialysis International. 2025 March. doi: 10.1111/hdi.13235 (SCIE; 2023 IF = 1.2, Urology & Nephrology 91/126) 23) Chi-An Hsiao, Wen-Chin Lee, Wan-Ting Huang, Fu-Jen Cheng, Chia-Te Kung, Chien-Te Lee, Chin-Chou Wang, Kai-Fan Tsai *, Liang-Jen Wang, Shau-Hsuan, Yu-Che Ou. Associations between phthalate exposure and kidney injury in chronic kidney disease. Hygiene and Environmental Health Advances. 2026 Mar, 17:100172 (SCIE; 2024 IF = 3.5, Public, Environmental & Occupational Health 77/421) Presentations: 1) Kai-Fan Tsai, Ching-I Yu, Hwee-Yeong Ng*, Chien-Te Lee. Factors Associated with Inaccuracy of Ultrafiltration in Hemodialysis Patients. Annual Meeting of Taiwan Society of Nephrology; Taipei, Taiwan, Dec. 2016. (Poster Presentation) 2) Chi-An Hsiao, Wen-Chin Lee, Kai-Fan Tsai*. The association between exposure to organophosphate flame retardants and progression of chronic kidney disease: A one year longitudinal analysis. Annual Meeting of Taiwan Society of Internal Medicine; Taipei, Taiwan, Dec. 2022. (Poster Presentation) 3) Po-Chun Chen, Po-Jung Wu, Chiang-Chi Huang, Chung-Ming Fu, Wen-Chin Lee, Yueh-Ting Lee, Chiao-Jung Chen, Ching-I Yu, Ching-Tan Cheng, Kai-Fan Tsai*. Clinical efficacy of SARS-CoV-2 vaccine booster among hemodialysis patients with COVID 19 receiving molnupiravir. Annual Meeting of Taiwan Society of Internal Medicine; Taipei, Taiwan, Dec. 2022. (Poster Presentation) 4) Kai-Fan Tsai. Relationship between renal impairment and exposure to organophosphate flame retardants (OPFRs) in patients with chronic kidney disease: Analysis of a Taiwanese cohort. 2022 International Symposium of Precision Environmental Medicine (2022 ISPEM); Taipei, Taiwan, Oct. 2022. (Oral Presentation) 5) Chi-An Hsiao, Kai-Fan Tsai*, Chia-Te Kung, Chien-Te Lee, Wen-Chin Lee. The roles of urinary novel renal biomarkers in detecting phthalate-associated nephrotoxicity in patients with chronic kidney disease. 2023 International Symposium of Precision Environmental Medicine (2023 ISPEM); Kaohsiung, Taiwan, Apr. 2023. (Poster Presentation) 6) Kai-Fan Tsai. Novel Endocrine Disrupting Chemicals: Development and Clinical Application of OPFR and Phthalate Testing. 2023 International Symposium of Precision Environmental Medicine (2023 ISPEM); Kaohsiung, Taiwan, Apr. 2023. (Oral Presentation) 7) Kai-Fan Tsai, Chia-Te Kung, Chien-Te Lee, Wen-Chin Lee. Renal tubular toxicity of organophosphate flame retardants in patients with chronic kidney disease. 60th European Renal Association Congress (60th ERA); Milan, Italy, Jun. 2023. (e-Poster Presentation; Nephrology Dialysis Transplantation 38(Supplement_1)) 8) Wen-Chin Lee, Kai-Fan Tsai, Chien-Te Lee, Chia-Te Kung. Di(2-ethylhexyl) phthalate induces renal proximal tubular cells to undergo epithelial-mesenchymal transition via AHR signaling (60th ERA); Milan, Italy, Jun. 2023. (Focused Oral Presentation; Nephrology Dialysis Transplantation 38(Supplement_1)) 9) Kai-Fan Tsai. Health Impact of Exposure to Organophosphate Flame Retardants (OPFRs) (10th International Congress of Asian Society of Toxicology, ASIATOX-X); Taichung, Taiwan, July 2023. (Oral Presentation) 10) Kai-Fan Tsai, Chia-Te Kung, Chien-Te Lee, Wen-Chin Lee. Coexposure to organophosphate flame retardants and phthalates in patients with chronic kidney disease and the potential nephrotoxicity (2023 ISEE); Kaohsiung, Taiwan, Sep. 2023. (e-poster and poster oral discussion)

20 MARCH

Time Session
10:30
12:00
[Symposium] EDCs
Environmental Hormones
Ting-I LeeTaiwan Moderator
Yung Hsiang LinTaiwan Moderator
  • Endocrine Disrupting Chemicals Exposure and Human Health Outcomes in Different Populations
    Ching Chang LeeTaiwan Speaker Endocrine Disrupting Chemicals Exposure and Human Health Outcomes in Different PopulationsUp to now, public concerns about the impact of EDCs on human health is growing steadily. Phthalates are thyroid, reproductive and developmental toxicants. Maternal hypothyroidism during pregnancy can cause adverse effects in the fetus. Study 1 investigates the association between phthalate exposure and thyroid hormones in pregnant women. After adjusting for age, BMI and gestation, urinary MBP levels showed negative associations with FT4 and T4 (FT4:  = -0.110, P < 0.001; T4:  = -0.112, P = 0.003). Exposure to di-n-butyl phthalate (DBP) may affect thyroid activity in pregnant women. Study 2 evaluates the association between maternal urine excretion, the exposure of fetus to phthalates in amniotic fluid, and the health of newborns. We found a significant positive correlation between creatinine adjusted urinary MBP and amniotic fluid MBP (R2=0.156, P <0.05) in all infants and, only in female infants, a significantly negative correlation between amniotic fluid MBP, AGD (R = −0.31, P <0.06), and the anogenital index adjusted by birth weight (AGI-W) (R = −0.32, P <0.05). Our data clearly show that in utero exposure to phthalates in general has anti-androgenic effects on the fetus. Study 3 investigates the association between exposure to phthalates and female puberty, and assesses the effect of leuprorelin acetate treatment on kisspeptin-54 secretion in girls with CPP. All seven urinary phthalate metabolites in the CPP group were significantly higher than in prepubescent controls. Serum kisspeptin-54 level were higher (P = 0.022) in the CPP group than control group and still significantly higher after adjusting for age (P = 0.03). There was a significant increasing trend (Ptrend = 0.005) between levels of kisspeptin and the stages of puberty. Significantly positive correlation between kisspeptin-54 and urinary MBP (R2 = 0.109, P = 0.024) was found. Study 4 explores the biomarkers of altered testicular function associated with exposure to phthalates: the testosterone and INSL3 secretion of adult men with different fertility states. In multiple regression models controlled for potential confounders, there is an inverse association between urinary levels of MMP), mono-iso-butyl phthalate (MiBP), MEHP, MEHP% and serum TT (P = 0.001, 0.007, 0.042 and 0.012). The inverse associations were also found between urinary levels of MiBP, MBzP, MEHP, MEHP% and serum fT (P = 0.028, 0.017, 0.045 and 0.027). Urinary MBzP and MEHP% were negatively associated with a decrease in serum INSL3 (P = 0.049 and 0.001). We also observed a strong inverse relationship between MEHP% quartiles and serum TT, fT, the TT : LH ratio and INSL3 (Ptrend = 0.003, 0.080, 0.002 and 0.012). Serum INSL3, TT, fT and the TT : LH ratio were lower for men in the highest MEHP% quartile than in the reference group (P = 0.007, 0.002, 0.090 and 0.001). In conclusion, the present study showed that infertile men had poor Leydig cell functionality, higher levels of urinary phthalate metabolites and lower concentrations of androgens or INSL3, or both, which implied that being exposed to phthalates might affect human testicular steroidogenesis by impairing the function of Leydig cells. Study 5 investigated the active mechanisms of how being exposed to phthalates affects the imbalance of androgen and estrogen and the generation of ROS to determine whether both mediated phthalate-induced effects are involved in prostatic enlargement. DEHP metabolite levels, particularly urinary MEHP, were positively associated with androgen, estrogen, hormone ratios, inducible nitric oxide synthetase (iNOS), 8-OHdG, prostate specific antigen (PSA), and prostate volume (PV) (P < 0.05). PV and PSA were positively associated with androgen, estrogen, hormone ratios and oxidative stress markers (P < 0.05). The estimated percentages of exposure to phthalates in prostatic enlargement mediated by androgen, estrogen, and OS markers ranged from 3.5% to 63.1%. Exposure to DEHP promoted the progress of BPH by increasing dihydrotestosterone (DHT), estradiol (E2), the converted enzymes aromatase and 5 reductase, and reactive oxygen species (8-OHdG and iNOS) production. Sex hormones and OS might be important hyperplasia-promoters after a patient has been exposed to phthalates, especially to DEHP.
  • Environmental Endocrinology: Interactions Between Environment and Hormonal Systems
    Vina Yanti SusantiIndonesia Speaker Environmental Endocrinology: Interactions Between Environment and Hormonal SystemsEnvironmental Endocrinology: Interactions Between Environment and Hormonal System Vina Yanti Susanti1 1 Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Gadjah Mada University, Dr. Sardjito Hospital, Yogyakarta, Indonesia Abstract The endocrine system serves as a sophisticated regulatory network essential for maintaining homeostasis, growth, and reproductive health through precise hormonal signaling. However, increasing exposure to environmental stressors—specifically Endocrine Disrupting Chemicals (EDCs)—has been shown to interfere with these pathways, posing significant risks to human health. This review explores the complex interactions between environmental pollutants and the hormonal system by dissecting the ten key functional characteristics of EDCs. The analysis categorizes these interactions into direct and indirect mechanisms. We examine how EDCs act as receptor agonists or antagonists, blocking natural hormones, and how they modulate receptor expression and signal transduction pathways. Furthermore, the review highlights the molecular impact of EDCs on epigenetic alterations, such as DNA methylation and histone modification. At the systemic level, we discuss the disruption of hormone synthesis, transport, distribution, and clearance. Finally, the review addresses the downstream consequences on cellular fate, including dysregulated proliferation, differentiation, and apoptosis. By integrating these ten dimensions, this paper emphasizes that environmental endocrine disruption is a multifaceted process rather than a single-point failure. Elucidating these integrated mechanisms provides a profound understanding of how environmental factors interact with and fundamentally reshape the body's internal hormonal landscape. Keywords: Environmental Endocrinology, Endocrine-Disrupting Chemicals (EDCs), Key Characteristic of Endocrine Disrupting Chemicals
  • Emerging Endocrine Disrupting Chemicals and Their Impacts in Patients with Renal Disease
    Kai-Fan TsaiTaiwan Speaker Emerging Endocrine Disrupting Chemicals and Their Impacts in Patients with Renal DiseaseEnvironmental factors contribute to 22% of global mortality. In Taiwan, which has the highest prevalence of treated end-stage renal disease worldwide, approximately 10% of chronic kidney disease (CKD) cases remain of uncertain etiology. This highlights the urgent need to investigate environmental pollutants, particularly endocrine disrupting chemicals (EDCs), as potential nephrotoxins. Our study details findings from an integrated research project at Kaohsiung Chang Gung Memorial Hospital focusing on two emerging EDC classes in the CKD population: organophosphate flame retardants (OPFRs) and phthalates. Our research demonstrated a nearly 100% detection rate for OPFRs in the study population, indicating universal exposure. Cross-sectional analysis revealed that higher urinary OPFR levels were independently associated with lower eGFR and overt proteinuria, respectively. Notably, a two-year longitudinal study identified high OPFR exposure as a significant predictor for adverse renal events. Regarding phthalates, a one-year longitudinal study of patients with CKD uncovered the associations between phthalate exposure and increased renal injury biomarkers. Mediation analysis showed that exposure to phthalates might induce renal tubular injury through the mechanism of oxidative damage. In conclusion, these findings suggest that EDCs are pervasive environmental threats that might accelerate renal disease progression. Recognizing these hidden culprits is vital for developing preventive strategies and improving long-term outcomes for patients with renal disease.
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