{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:24:54Z","timestamp":1791235494035,"version":"4.1.0"},"reference-count":86,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004063","name":"Knut och Alice Wallenbergs Stiftelse","doi-asserted-by":"publisher","award":["KAW 2017.0003"],"award-info":[{"award-number":["KAW 2017.0003"]}],"id":[{"id":"10.13039\/501100004063","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004063","name":"Knut och Alice Wallenbergs Stiftelse","doi-asserted-by":"publisher","award":["KAW 2020.0239"],"award-info":[{"award-number":["KAW 2020.0239"]}],"id":[{"id":"10.13039\/501100004063","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2024-03161"],"award-info":[{"award-number":["2024-03161"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2021\\u201302814"],"award-info":[{"award-number":["2021\\u201302814"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2021\\u201302189"],"award-info":[{"award-number":["2021\\u201302189"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007435","name":"\u00c5ke Wiberg Stiftelse","doi-asserted-by":"publisher","award":["2024\\u201301410"],"award-info":[{"award-number":["2024\\u201301410"]}],"id":[{"id":"10.13039\/100007435","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100023867","name":"Swedish Stroke Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100023867","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001862","name":"Svenska Forskningsr\u00e5det Formas","doi-asserted-by":"publisher","award":["01267"],"award-info":[{"award-number":["01267"]}],"id":[{"id":"10.13039\/501100001862","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003748","name":"Svenska S\u00e4llskapet f\u00f6r Medicinsk Forskning","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003748","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011898","name":"Marcus och Amalia Wallenbergs minnesfond","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011898","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009252","name":"Science for Life Laboratory","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009252","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Environment International"],"published-print":{"date-parts":[[2026,1]]},"DOI":"10.1016\/j.envint.2025.109993","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T03:06:18Z","timestamp":1765422378000},"page":"109993","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":3,"special_numbering":"C","title":["Co-exposure to PFAS and hydroxylated PCBs is associated with increased odds of multiple sclerosis"],"prefix":"10.1016","volume":"207","author":[{"given":"Aina","family":"Vaivade","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7293-6487","authenticated-orcid":false,"given":"Akshai Parakkal","family":"Sreenivasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ida","family":"Erngren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0226-1047","authenticated-orcid":false,"given":"Eva","family":"Freyhult","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Payam","family":"Emami Khoonsari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob","family":"Siljebo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asma","family":"Al-Grety","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6748-6119","authenticated-orcid":false,"given":"Henrik","family":"Carlsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torbj\u00f6rn","family":"\u00c5kerfeldt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ola","family":"Spjuth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6612-4749","authenticated-orcid":false,"given":"Anna Karin","family":"Hedstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0867-4726","authenticated-orcid":false,"given":"Ingrid","family":"Kockum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1688-6697","authenticated-orcid":false,"given":"Lars","family":"Alfredsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Olsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7045-1806","authenticated-orcid":false,"given":"Joachim","family":"Burman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0680-1410","authenticated-orcid":false,"given":"Kim","family":"Kultima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.envint.2025.109993_b0005","doi-asserted-by":"crossref","DOI":"10.1101\/cshperspect.a028944","article-title":"Lifestyle and environmental factors in multiple sclerosis","volume":"9","author":"Alfredsson","year":"2019","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"10.1016\/j.envint.2025.109993_b0010","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.jneuroim.2019.03.002","article-title":"Perfluorinated substances, risk factors for multiple sclerosis and cellular immune activation","volume":"330","author":"Ammitzb\u00f8ll","year":"2019","journal-title":"J. Neuroimmunol."},{"key":"10.1016\/j.envint.2025.109993_b0015","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/S1474-4422(10)70086-7","article-title":"Vitamin D and multiple sclerosis","volume":"9","author":"Ascherio","year":"2010","journal-title":"Lancet Neurol."},{"key":"10.1016\/j.envint.2025.109993_b0020","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1038\/s41577-022-00718-z","article-title":"The immunology of multiple sclerosis","volume":"22","author":"Attfield","year":"2022","journal-title":"Nat. Rev. Immunol."},{"key":"10.1016\/j.envint.2025.109993_b0025","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1289\/ehp.94102464","article-title":"Selective retention of hydroxylated PCB metabolites in blood","volume":"102","author":"Bergman","year":"1994","journal-title":"Environ. Health Perspect."},{"key":"10.1016\/j.envint.2025.109993_b0030","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.envint.2012.10.010","article-title":"Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a swedish population","volume":"51","author":"Bjermo","year":"2013","journal-title":"Environ. Int."},{"key":"10.1016\/j.envint.2025.109993_b0035","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1001\/jamaneurol.2019.3238","article-title":"Serum neurofilament light chain levels in patients with presymptomatic multiple sclerosis","volume":"77","author":"Bjornevik","year":"2020","journal-title":"JAMA Neurol."},{"key":"10.1016\/j.envint.2025.109993_b0040","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12302-018-0134-4","article-title":"Short-chain perfluoroalkyl acids: environmental concerns and a regulatory strategy under REACH","volume":"30","author":"Brendel","year":"2018","journal-title":"Environ. Sci. Eur."},{"key":"10.1016\/j.envint.2025.109993_b0045","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1039\/D3EM00060E","article-title":"Combining the targeted and untargeted screening of environmental contaminants reveals associations between PFAS exposure and vitamin D metabolism in human plasma","volume":"25","author":"Carlsson","year":"2023","journal-title":"Environ. Sci. Process. Impacts"},{"key":"10.1016\/j.envint.2025.109993_b0050","doi-asserted-by":"crossref","first-page":"279","DOI":"10.3109\/10408444.2015.1122573","article-title":"A critical review of perfluorooctanoate and perfluorooctanesulfonate exposure and immunological health conditions in humans","volume":"46","author":"Chang","year":"2016","journal-title":"Crit. Rev. Toxicol."},{"key":"10.1016\/j.envint.2025.109993_b0055","doi-asserted-by":"crossref","first-page":"4483","DOI":"10.4049\/jimmunol.1101757","article-title":"The NF-\u03baB transcription factor c-Rel is required for Th17 effector cell development in experimental autoimmune encephalomyelitis","volume":"187","author":"Chen","year":"2011","journal-title":"J. Immunol."},{"key":"10.1016\/j.envint.2025.109993_b0060","doi-asserted-by":"crossref","DOI":"10.1016\/j.metabol.2020.154338","article-title":"The role of peroxisome proliferator-activated receptors (PPAR) in immune responses","volume":"114","author":"Christofides","year":"2021","journal-title":"Metabolism"},{"key":"10.1016\/j.envint.2025.109993_b0065","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1038\/nature10251","article-title":"Genetic risk and a primary role for cell-mediated immune mechanisms in multiple sclerosis","volume":"476","author":"International Multiple Sclerosis Genetics Consortium","year":"2011","journal-title":"Nature"},{"key":"10.1016\/j.envint.2025.109993_b0070","doi-asserted-by":"crossref","DOI":"10.1016\/j.envint.2023.107734","article-title":"Systematic review and meta-analysis of epidemiologic data on vaccine response in relation to exposure to five principal perfluoroalkyl substances","volume":"172","author":"Crawford","year":"2023","journal-title":"Environ. Int."},{"key":"10.1016\/j.envint.2025.109993_b0075","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pcbi.1002877","article-title":"Multi-population classical HLA type imputation","volume":"9","author":"Dilthey","year":"2013","journal-title":"PLoS Comput. Biol."},{"key":"10.1016\/j.envint.2025.109993_b0080","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1007\/s00244-012-9864-2","article-title":"Combined effects of PFOS and PFOA on zebrafish (Danio rerio) embryos","volume":"64","author":"Ding","year":"2013","journal-title":"Arch. Environ. Contam. Toxicol."},{"key":"10.1016\/j.envint.2025.109993_b0085","doi-asserted-by":"crossref","DOI":"10.1016\/j.envint.2022.107376","article-title":"Expanded assessment of xenobiotic associations with antinuclear antibodies in the United States, 1988-2012","volume":"166","author":"Dinse","year":"2022","journal-title":"Environ. Int."},{"key":"10.1016\/j.envint.2025.109993_b0090","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/ene.13819","article-title":"Multiple sclerosis - a review","volume":"26","author":"Dobson","year":"2019","journal-title":"Eur. J. Neurol."},{"key":"10.1016\/j.envint.2025.109993_b0095","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2021.570425","article-title":"Peroxisome proliferator-activated receptor-\u03b4 deficiency in microglia results in exacerbated axonal injury and tissue loss in experimental autoimmune encephalomyelitis","volume":"12","author":"Doroshenko","year":"2021","journal-title":"Front. Immunol."},{"key":"10.1016\/j.envint.2025.109993_b0100","article-title":"Common infections in children aged 6 months to 7 years after high prenatal exposure to perfluoroalkyl substances from contaminated drinking water in Ronneby","volume":"268","author":"Ebel","year":"2025","journal-title":"Sweden. Environ. Res."},{"key":"10.1016\/j.envint.2025.109993_b0105","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s12940-022-00958-5","article-title":"Consideration of pathways for immunotoxicity of per- and polyfluoroalkyl substances (PFAS)","volume":"22","author":"Ehrlich","year":"2023","journal-title":"Environ. Health"},{"key":"10.1016\/j.envint.2025.109993_b0110","doi-asserted-by":"crossref","first-page":"2385","DOI":"10.3390\/ijerph19042385","article-title":"High in utero exposure to perfluoroalkyl substances from drinking water and birth weight: a cohort study among infants in Ronneby, Sweden","volume":"19","author":"Engstr\u00f6m","year":"2022","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"10.1016\/j.envint.2025.109993_b0115","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.etap.2007.10.019","article-title":"Pcbs and tight junction expression","volume":"25","author":"Eum","year":"2008","journal-title":"Environ. Toxicol. Pharmacol."},{"key":"10.1016\/j.envint.2025.109993_b0120","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1289\/ehp.5456","article-title":"Organochlorines in swedish women: determinants of serum concentrations","volume":"111","author":"Glynn","year":"2003","journal-title":"Environ. Health Perspect."},{"key":"10.1016\/j.envint.2025.109993_b0125","doi-asserted-by":"crossref","first-page":"245","DOI":"10.3109\/10408444.2014.999365","article-title":"Metabolism and metabolites of polychlorinated biphenyls","volume":"45","author":"Grimm","year":"2015","journal-title":"Crit. Rev. Toxicol."},{"key":"10.1016\/j.envint.2025.109993_b0130","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/j.envres.2015.05.019","article-title":"Influence of contaminated drinking water on perfluoroalkyl acid levels in human serum\u2013a case study from Uppsala, Sweden","volume":"140","author":"Gyllenhammar","year":"2015","journal-title":"Environ. Res."},{"key":"10.1016\/j.envint.2025.109993_b0135","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1093\/ije\/dyu195","article-title":"Interaction between passive smoking and two HLA genes with regard to multiple sclerosis risk","volume":"43","author":"Hedstr\u00f6m","year":"2014","journal-title":"Int. J. Epidemiol."},{"key":"10.1016\/j.envint.2025.109993_b0140","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1007\/s10654-017-0250-2","article-title":"The interaction between smoking and HLA genes in multiple sclerosis: replication and refinement","volume":"32","author":"Hedstr\u00f6m","year":"2017","journal-title":"Eur. J. Epidemiol."},{"key":"10.1016\/j.envint.2025.109993_b0145","doi-asserted-by":"crossref","first-page":"e455","DOI":"10.1212\/WNL.0000000000005906","article-title":"Organic solvents and MS susceptibility: Interaction with MS risk HLA genes","volume":"91","author":"Hedstr\u00f6m","year":"2018","journal-title":"Neurology"},{"key":"10.1016\/j.envint.2025.109993_b0150","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1136\/jnnp-2020-325676","article-title":"DRB1-environment interactions in multiple sclerosis etiology: results from two swedish case-control studies","volume":"92","author":"Hedstr\u00f6m","year":"2021","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"10.1016\/j.envint.2025.109993_b0155","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1212\/WNL.0b013e3181b59c40","article-title":"Tobacco smoking, but not swedish snuff use, increases the risk of multiple sclerosis","volume":"73","author":"Hedstr\u00f6m","year":"2009","journal-title":"Neurology"},{"key":"10.1016\/j.envint.2025.109993_b0160","doi-asserted-by":"crossref","first-page":"21237","DOI":"10.1038\/s41598-021-00578-y","article-title":"The increased risk of multiple sclerosis associated with HLA-DRB1*15:01 and smoking is modified by alcohol consumption","volume":"11","author":"Hedstr\u00f6m","year":"2021","journal-title":"Sci. Rep."},{"key":"10.1016\/j.envint.2025.109993_b0165","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jaut.2015.06.010","article-title":"The immunogenetics of multiple sclerosis: a comprehensive review","volume":"64","author":"Hollenbach","year":"2015","journal-title":"J. Autoimmun."},{"key":"10.1016\/j.envint.2025.109993_b0170","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.chemosphere.2013.07.033","article-title":"Synergistic effects of perfluoroalkyl acids mixtures with J-shaped concentration-responses on viability of a human liver cell line","volume":"96","author":"Hu","year":"2014","journal-title":"Chemosphere"},{"key":"10.1016\/j.envint.2025.109993_b0175","doi-asserted-by":"crossref","DOI":"10.1016\/j.jaut.2023.103049","article-title":"The aryl hydrocarbon receptor in immune regulation and autoimmune pathogenesis","volume":"138","author":"Huang","year":"2023","journal-title":"J. Autoimmun."},{"key":"10.1016\/j.envint.2025.109993_b0180","doi-asserted-by":"crossref","DOI":"10.1016\/j.envres.2023.116222","article-title":"Endocrine-disrupting chemicals and autoimmune diseases","volume":"231","author":"Huang","year":"2023","journal-title":"Environ. Res."},{"key":"10.1016\/j.envint.2025.109993_b0185","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1038\/gene.2016.23","article-title":"GWAS analysis implicates NF-\u03baB-mediated induction of inflammatory T cells in multiple sclerosis","volume":"17","author":"Hussman","year":"2016","journal-title":"Genes Immun."},{"key":"10.1016\/j.envint.2025.109993_b0190","doi-asserted-by":"crossref","first-page":"21587","DOI":"10.1038\/s41598-020-78405-z","article-title":"Metabolic activation and toxicological evaluation of polychlorinated biphenyls in Drosophila melanogaster","volume":"10","author":"Idda","year":"2020","journal-title":"Sci. Rep."},{"key":"10.1016\/j.envint.2025.109993_b0195","doi-asserted-by":"crossref","DOI":"10.1126\/science.aav7188","article-title":"Multiple sclerosis genomic map implicates peripheral immune cells and microglia in susceptibility","volume":"365","author":"International Multiple Sclerosis Genetics Consortium","year":"2019","journal-title":"Science"},{"key":"10.1016\/j.envint.2025.109993_b0200","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/j.tiv.2009.03.004","article-title":"Mono-hydroxylated polychlorinated biphenyls are potent aryl hydrocarbon receptor ligands in recombinant yeast cells","volume":"23","author":"Kamata","year":"2009","journal-title":"Toxicol. In Vitro"},{"key":"10.1016\/j.envint.2025.109993_b0205","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.brainres.2010.12.059","article-title":"PPAR\u03b4 deficient mice develop elevated Th1\/Th17 responses and prolonged experimental autoimmune encephalomyelitis","volume":"1376","author":"Kanakasabai","year":"2011","journal-title":"Brain Res."},{"key":"10.1016\/j.envint.2025.109993_b0210","doi-asserted-by":"crossref","DOI":"10.1101\/cshperspect.a029025","article-title":"Effector T cells in multiple sclerosis","volume":"8","author":"Kaskow","year":"2018","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"10.1016\/j.envint.2025.109993_b0215","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1093\/rheumatology\/ken259","article-title":"A role for the aryl hydrocarbon receptor and the dioxin TCDD in rheumatoid arthritis","volume":"47","author":"Kobayashi","year":"2008","journal-title":"Rheumatology (Oxford)"},{"key":"10.1016\/j.envint.2025.109993_b0220","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1289\/ehp.9887","article-title":"Positive associations of serum concentration of polychlorinated biphenyls or organochlorine pesticides with self-reported arthritis, especially rheumatoid type, in women","volume":"115","author":"Lee","year":"2007","journal-title":"Environ. Health Perspect."},{"key":"10.1016\/j.envint.2025.109993_b0225","doi-asserted-by":"crossref","first-page":"22115","DOI":"10.1038\/srep22115","article-title":"Cell intrinsic role of NF-\u03baB-inducing kinase in regulating T cell-mediated immune and autoimmune responses","volume":"6","author":"Li","year":"2016","journal-title":"Sci. Rep."},{"key":"10.1016\/j.envint.2025.109993_b0230","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12940-020-00588-9","article-title":"Associations between perfluoroalkyl substances and serum lipids in a swedish adult population with contaminated drinking water","volume":"19","author":"Li","year":"2020","journal-title":"Environ. Health"},{"key":"10.1016\/j.envint.2025.109993_b0235","doi-asserted-by":"crossref","DOI":"10.1016\/j.ecoenv.2025.119237","article-title":"Perfluorooctanesulfonic acid (PFOS) exposure and multiple sclerosis: evidence of association and mechanistic insights","volume":"305","author":"Liu","year":"2025","journal-title":"Ecotoxicol. Environ. Saf."},{"key":"10.1016\/j.envint.2025.109993_b0240","article-title":"NF-\u03baB signaling in inflammation","volume":"2","author":"Liu","year":"2017","journal-title":"Signal Transduct. Target. Ther."},{"key":"10.1016\/j.envint.2025.109993_b0245","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgen.1009199","article-title":"Function of multiple sclerosis-protective HLA class I alleles revealed by genome-wide protein-quantitative trait loci mapping of interferon signalling","volume":"16","author":"Lundtoft","year":"2020","journal-title":"PLoS Genet."},{"key":"10.1016\/j.envint.2025.109993_b0250","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/j.molmed.2013.08.001","article-title":"Nuclear factor kappa B (NF-\u03baB) in multiple sclerosis pathology","volume":"19","author":"Mc Guire","year":"2013","journal-title":"Trends Mol. Med."},{"key":"10.1016\/j.envint.2025.109993_b0255","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1038\/ng.3395","article-title":"Class II HLA interactions modulate genetic risk for multiple sclerosis","volume":"47","author":"Moutsianas","year":"2015","journal-title":"Nat. Genet."},{"key":"10.1016\/j.envint.2025.109993_b0260","doi-asserted-by":"crossref","first-page":"2832","DOI":"10.1001\/jama.296.23.2832","article-title":"Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis","volume":"296","author":"Munger","year":"2006","journal-title":"J. Am. Med. Assoc."},{"key":"10.1016\/j.envint.2025.109993_b0265","doi-asserted-by":"crossref","DOI":"10.1016\/j.envpol.2020.114182","article-title":"Combined effects and toxicological interactions of perfluoroalkyl and polyfluoroalkyl substances mixtures in human liver cells (HepG2)","volume":"263","author":"Ojo","year":"2020","journal-title":"Environ. Pollut."},{"key":"10.1016\/j.envint.2025.109993_b0270","doi-asserted-by":"crossref","DOI":"10.1016\/j.jhazmat.2020.124863","article-title":"Assessing the human health risks of per- and polyfluoroalkyl substances: a need for greater focus on their interactions as mixtures","volume":"407","author":"Ojo","year":"2021","journal-title":"J. Hazard. Mater."},{"key":"10.1016\/j.envint.2025.109993_b0275","doi-asserted-by":"crossref","DOI":"10.1016\/j.jhazmat.2024.136832","article-title":"Early-life exposure to PCBs and PFAS exerts negative effects on the developing central nervous system","volume":"485","author":"Peixoto-Rodrigues","year":"2025","journal-title":"J. Hazard. Mater."},{"key":"10.1016\/j.envint.2025.109993_b0280","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1002\/ana.20703","article-title":"Diagnostic criteria for multiple sclerosis: 2005 revisions to the \u201cMcDonald Criteria.","volume":"58","author":"Polman","year":"2005","journal-title":"Ann. Neurol."},{"key":"10.1016\/j.envint.2025.109993_b0285","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1002\/ana.22366","article-title":"Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria","volume":"69","author":"Polman","year":"2011","journal-title":"Ann. Neurol."},{"key":"10.1016\/j.envint.2025.109993_b0290","unstructured":"National Toxicology Program :: NTP. NTP Monograph: Immunotoxicity Associated with Exposure to Perfluorooctanoic Acid or Perfluorooctane Sulfonate (2016). (2016)."},{"key":"10.1016\/j.envint.2025.109993_b0295","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1016\/j.chembiol.2004.10.009","article-title":"Hydroxylated polychlorinated biphenyls selectively bind transthyretin in blood and inhibit amyloidogenesis: rationalizing rodent PCB toxicity","volume":"11","author":"Purkey","year":"2004","journal-title":"Chem. Biol."},{"key":"10.1016\/j.envint.2025.109993_b0300","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s12940-024-01073-3","article-title":"Associations of per- and polyfluoroalkyl substances (PFAS) and their mixture with risk of rheumatoid arthritis in the U.S. adult population","volume":"23","author":"Qiao","year":"2024","journal-title":"Environ. Health"},{"key":"10.1016\/j.envint.2025.109993_b0305","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1038\/nature06880","article-title":"Control of T(reg) and T(H)17 cell differentiation by the aryl hydrocarbon receptor","volume":"453","author":"Quintana","year":"2008","journal-title":"Nature"},{"key":"10.1016\/j.envint.2025.109993_b0310","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing. Preprint at https:\/\/www.r-project.org\/ (2024)."},{"key":"10.1016\/j.envint.2025.109993_b0315","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1038\/s41370-025-00773-3","article-title":"Longitudinal association of perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) exposure with lipid traits, in a healthy unselected population","volume":"35","author":"Raza","year":"2025","journal-title":"J. Eposure Sci. Environ. Epidemiol."},{"key":"10.1016\/j.envint.2025.109993_b0320","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0011281","article-title":"A nested case-control study of intrauterine exposure to persistent organochlorine pollutants in relation to risk of type 1 diabetes","volume":"5","author":"Rignell-Hydbom","year":"2010","journal-title":"PLoS One"},{"key":"10.1016\/j.envint.2025.109993_b0325","doi-asserted-by":"crossref","DOI":"10.1016\/j.envres.2023.115969","article-title":"Impact of PFAS exposure on prevalence of immune-mediated diseases in adults in the Czech Republic","volume":"229","author":"Rudzanova","year":"2023","journal-title":"Environ. Res."},{"key":"10.1016\/j.envint.2025.109993_b0330","doi-asserted-by":"crossref","first-page":"87","DOI":"10.3109\/10408449409049308","article-title":"Polychlorinated biphenyls (PCBs): environmental impact, biochemical and toxic responses, and implications for risk assessment","volume":"24","author":"Safe","year":"1994","journal-title":"Crit. Rev. Toxicol."},{"key":"10.1016\/j.envint.2025.109993_b0335","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1289\/ehp.0901334","article-title":"Polychlorinated biphenyls disrupt blood-brain barrier integrity and promote brain metastasis formation","volume":"118","author":"Seelbach","year":"2010","journal-title":"Environ. Health Perspect."},{"key":"10.1016\/j.envint.2025.109993_b0340","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1289\/ehp.1206449","article-title":"Ulcerative colitis and perfluorooctanoic acid (PFOA) in a highly exposed population of community residents and workers in the mid-Ohio valley","volume":"121","author":"Steenland","year":"2013","journal-title":"Environ. Health Perspect."},{"key":"10.1016\/j.envint.2025.109993_b0345","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1038\/s41370-018-0094-1","article-title":"A review of the pathways of human exposure to poly- and perfluoroalkyl substances (PFASs) and present understanding of health effects","volume":"29","author":"Sunderland","year":"2019","journal-title":"J. Eposure Sci. Environ. Epidemiol."},{"key":"10.1016\/j.envint.2025.109993_b0350","doi-asserted-by":"crossref","first-page":"6334","DOI":"10.1007\/s11356-013-1742-6","article-title":"Hydroxylated polychlorinated biphenyls in the environment: sources, fate, and toxicities","volume":"21","author":"Tehrani","year":"2014","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"10.1016\/j.envint.2025.109993_b0355","doi-asserted-by":"crossref","first-page":"16955","DOI":"10.1073\/pnas.1902623116","article-title":"Molecular mimicry between Anoctamin 2 and Epstein-Barr virus nuclear antigen 1 associates with multiple sclerosis risk","volume":"116","author":"Tengvall","year":"2019","journal-title":"PNAS"},{"key":"10.1016\/j.envint.2025.109993_b0360","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.scitotenv.2006.12.024","article-title":"Increased liver and lupus mortalities in 24-year follow-up of the Taiwanese people highly exposed to polychlorinated biphenyls and dibenzofurans","volume":"374","author":"Tsai","year":"2007","journal-title":"Sci. Total Environ."},{"key":"10.1016\/j.envint.2025.109993_b0365","doi-asserted-by":"crossref","first-page":"2014","DOI":"10.1038\/s41467-025-57172-3","article-title":"Associations of PFAS and OH-PCBs with risk of multiple sclerosis onset and disability worsening","volume":"16","author":"Vaivade","year":"2025","journal-title":"Nat. Commun."},{"key":"10.1016\/j.envint.2025.109993_b0370","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1177\/1352458515594040","article-title":"Population attributable fractions and joint effects of key risk factors for multiple sclerosis","volume":"22","author":"van der Mei","year":"2016","journal-title":"Mult. Scler."},{"key":"10.1016\/j.envint.2025.109993_b0375","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.neuro.2006.11.002","article-title":"PCB (Aroclor 1254) enhances oxidative damage in rat brain regions: protective role of ascorbic acid","volume":"28","author":"Venkataraman","year":"2007","journal-title":"Neurotoxicology"},{"key":"10.1016\/j.envint.2025.109993_b0380","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.ijdevneu.2008.05.002","article-title":"Protective role of melatonin on PCB (Aroclor 1,254) induced oxidative stress and changes in acetylcholine esterase and membrane bound ATPases in cerebellum, cerebral cortex and hippocampus of adult rat brain","volume":"26","author":"Venkataraman","year":"2008","journal-title":"Int. J. Dev. Neurosci."},{"key":"10.1016\/j.envint.2025.109993_b0385","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2021.e08160","article-title":"Perfluoroalkyl substances exposure and immunity, allergic response, infection, and asthma in children: review of epidemiologic studies","volume":"7","author":"von Holst","year":"2021","journal-title":"Heliyon"},{"key":"10.1016\/j.envint.2025.109993_b0390","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.bbrc.2011.05.128","article-title":"Perfluorooctane sulfonate triggers tight junction \u201copening\u201d in brain endothelial cells via phosphatidylinositol 3-kinase","volume":"410","author":"Wang","year":"2011","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"10.1016\/j.envint.2025.109993_b0395","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijheh.2025.114560","article-title":"Per- and polyfluoroalkyl substances and type 2 diabetes among older adults: Synthesizing cross-sectional population study and meta-analysis","volume":"266","author":"Wang","year":"2025","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"10.1016\/j.envint.2025.109993_b0400","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.88.16_supplement.S50.002","article-title":"CHS-131, a novel once daily oral treatment, decreased lesion burden of patients with relapsing-remitting course of multiple sclerosis (RRMS) in a randomized, double-blind, phase 2b, multicenter study (S50.002)","volume":"88","author":"Weinstein","year":"2017","journal-title":"Neurology"},{"key":"10.1016\/j.envint.2025.109993_b0405","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1016\/S0140-6736(23)00621-9","article-title":"A population-based study on autoimmune disease","volume":"401","author":"Wen","year":"2023","journal-title":"Lancet"},{"key":"10.1016\/j.envint.2025.109993_b0410","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.tox.2013.12.002","article-title":"Evaluating the additivity of perfluoroalkyl acids in binary combinations on peroxisome proliferator-activated receptor-\u03b1 activation","volume":"316","author":"Wolf","year":"2014","journal-title":"Toxicology"},{"key":"10.1016\/j.envint.2025.109993_b0415","doi-asserted-by":"crossref","DOI":"10.1016\/j.envpol.2024.123937","article-title":"Association between per- and poly-fluoroalkyl substances and nonalcoholic fatty liver disease: a nested case-control study in northwest China","volume":"350","author":"Wu","year":"2024","journal-title":"Environ. Pollut."},{"key":"10.1016\/j.envint.2025.109993_b0420","article-title":"Exposure to high levels of PFAS through drinking water is associated with increased risk of type 2 diabetes-findings from a register-based study in Ronneby","volume":"225","author":"Xu","year":"2023","journal-title":"Sweden. Environ. Res."},{"key":"10.1016\/j.envint.2025.109993_b0425","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1093\/toxsci\/kfw020","article-title":"Immunomodulation by subchronic low dose 2,3,7,8-tetrachlorodibenzo-p-dioxin in experimental autoimmune encephalomyelitis in the absence of pertussis toxin","volume":"151","author":"Yang","year":"2016","journal-title":"Toxicol. Sci."},{"key":"10.1016\/j.envint.2025.109993_b0430","doi-asserted-by":"crossref","DOI":"10.1016\/j.envpol.2019.113429","article-title":"Perfluorooctane sulfonate disrupts the blood brain barrier through the crosstalk between endothelial cells and astrocytes in mice","volume":"256","author":"Yu","year":"2020","journal-title":"Environ. Pollut."}],"container-title":["Environment International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0160412025007445?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0160412025007445?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T14:55:27Z","timestamp":1782485727000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0160412025007445"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":86,"alternative-id":["S0160412025007445"],"URL":"https:\/\/doi.org\/10.1016\/j.envint.2025.109993","relation":{},"ISSN":["0160-4120"],"issn-type":[{"value":"0160-4120","type":"print"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Co-exposure to PFAS and hydroxylated PCBs is associated with increased odds of multiple sclerosis","name":"articletitle","label":"Article Title"},{"value":"Environment International","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.envint.2025.109993","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Authors. Published by Elsevier Ltd.","name":"copyright","label":"Copyright"}],"article-number":"109993"}}