title: Human Exposure to Wastewater-Derived Pharmaceuticals in Fresh Produce: A Randomized Controlled Trial Focusing on Carbamazepine.
abstract: Fresh water scarcity has led to increased use of reclaimed wastewater as an alternative and reliable source for crop irrigation. Beyond microbiological safety, concerns have been raised regarding contamination of reclaimed wastewater by xenobiotics including pharmaceuticals. This study focuses on carbamazepine, an anticonvulsant drug which is ubiquitously detected in reclaimed wastewater, highly persistent in soil, and taken up by crops. In a randomized controlled trial we demonstrate that healthy individuals consuming reclaimed wastewater-irrigated produce excreted carbamazepine and its metabolites in their urine, while subjects consuming fresh water-irrigated produce excreted undetectable or significantly lower levels of carbamazepine. We also report that the carbamazepine metabolite pattern at this low exposure level differed from that observed at therapeutic doses. This "proof of concept" study demonstrates that human exposure to xenobiotics occurs through ingestion of reclaimed wastewater-irrigated produce, providing real world data which could guide risk assessments and policy designed to ensure the safe use of wastewater for crop irrigation.
authors.affiliation: Braun School of Public Health and Community Medicine, Hadassah-Hebrew University of Jerusalem , Jerusalem 9112001, Israel.|Department of Hematology, Hadassah-Hebrew University Medical Center , Jerusalem 9112001, Israel.|The Hebrew University Center of Excellence in Agriculture and Environmental Health.
authors.forename: Ora
authors.initials: O
authors.lastname: Paltiel
authors.affiliation: The Hebrew University Center of Excellence in Agriculture and Environmental Health.|Department of Soil and Water Sciences, Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem , Rehovot 7610001, Israel.
authors.forename: Ganna
authors.initials: G
authors.lastname: Fedorova
authors.affiliation: Braun School of Public Health and Community Medicine, Hadassah-Hebrew University of Jerusalem , Jerusalem 9112001, Israel.|The Hebrew University Center of Excellence in Agriculture and Environmental Health.|Department of Soil and Water Sciences, Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem , Rehovot 7610001, Israel.
authors.forename: Galit
authors.initials: G
authors.lastname: Tadmor
authors.affiliation: Braun School of Public Health and Community Medicine, Hadassah-Hebrew University of Jerusalem , Jerusalem 9112001, Israel.|The Hebrew University Center of Excellence in Agriculture and Environmental Health.
authors.forename: Geffen
authors.initials: G
authors.lastname: Kleinstern
authors.affiliation: The Hebrew University Center of Excellence in Agriculture and Environmental Health.
authors.forename: Yehoshua
authors.initials: Y
authors.lastname: Maor
authors.affiliation: The Hebrew University Center of Excellence in Agriculture and Environmental Health.|Department of Soil and Water Sciences, Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem , Rehovot 7610001, Israel.
authors.forename: Benny
authors.initials: B
authors.lastname: Chefetz
mesh_terms: D000293:Adolescent; D000328:Adult; D057914:Agricultural Irrigation / Q000379:methods*; D002220:Carbamazepine / Q000378:metabolism / Q000652:urine*; D018556:Crops, Agricultural / Q000254:growth & development / Q000378:metabolism*; D018592:Cross-Over Studies; D005260:Female; D005506:Food Contamination; D005618:Fresh Water / Q000737:chemistry*; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method; D012989:Soil Pollutants / Q000378:metabolism / Q000652:urine*; D062065:Wastewater / Q000737:chemistry*; D055815:Young Adult
chemical_list: D002220:Carbamazepine; D012989:Soil Pollutants; D062065:Wastewater