Antiepileptic Drug Leaves Lasting Stress Signature in Freshwater Mussels

One of the world’s most frequently detected pharmaceutical pollutants has been shown to quietly rewire the immune system and cellular defenses of freshwater mussels, according to new research published in the journal Ecotoxicology. Carbamazepine, an antiepileptic drug taken by millions of people worldwide, passes through conventional wastewater treatment largely intact and ends up in rivers, lakes, and streams where filter-feeding animals can accumulate it over months or years. The new study, conducted by Göktuğ Gül of Gazi University in Ankara, Türkiye, exposes for the first time in the freshwater mussel Unio delicatus how prolonged exposure to this compound shifts both immune cell populations and the delicate balance of oxidative chemistry inside two critically important tissues: the gills and the digestive gland.

The environmental logic behind the experiment is straightforward but sobering. Carbamazepine is famously persistent in aquatic systems, resisting the biological and chemical processes that break down many other contaminants, and it is routinely found in surface waters downstream of wastewater discharges around the globe. Because mussels filter enormous volumes of water to feed, they act as living sieves for dissolved pollutants, making them ideal sentinel organisms for tracking pharmaceutical contamination. Previous work on marine and freshwater bivalves had already hinted that carbamazepine could disturb cell signaling, antioxidant defenses, and behavior in related species, but the combined immune and oxidative stress picture in Unio delicatus, a freshwater unionid mussel, remained blank until now.

To fill that gap, the researcher exposed 160 mussels to three sublethal concentrations of carbamazepine under semi-static laboratory conditions, where the water was periodically replaced to maintain consistent drug levels throughout the experiment. The concentrations were set at 199 micrograms per liter, 995 micrograms per liter, and 1.99 milligrams per liter, corresponding to one percent, five percent, and ten percent of the drug’s LC50 value of 19.9 milligrams per liter, the concentration lethal to half of the test population. The animals were sampled after 21 days and again after 45 days, allowing the study to capture both short-term and long-term responses across a realistic exposure window. Although these experimental doses exceed the concentrations typically measured in the environment, they were deliberately chosen to be far below lethal levels, so that any biological changes observed would reflect genuine physiological stress rather than outright poisoning.

The immune readout came from the mussels’ hemolymph, the circulatory fluid that in bivalves carries the cells responsible for internal defense. By counting total haemocytes, the study tracked how hard the animals’ immune systems were being pushed. The results were striking: carbamazepine exposure drove significant increases in total haemocyte counts, and, counterintuitively, the strongest immune activation appeared at the lowest doses tested. Even more telling, this response intensified with time, becoming more pronounced after 45 days than after 21. Elevated haemocyte counts are a classic sign of immunostimulation, suggesting the mussels’ defense systems recognized the drug or the cellular damage it caused as a threat and mobilized accordingly. Sustained immune activation, however, carries a metabolic cost, and chronic overstimulation can leave organisms vulnerable to genuine pathogens or to the energetic consequences of running their defenses in overdrive.

Oxidative stress, the second pillar of the study, concerns the balance between reactive oxygen species that damage cells and the antioxidants that neutralize them. The researcher measured two complementary biomarkers in gill and digestive gland tissues. Malondialdehyde, or MDA, is a breakdown product of lipid peroxidation, meaning it rises when reactive oxygen species attack the fatty membranes of cells; it serves as a chemical fingerprint of oxidative damage. Reduced glutathione, or GSH, is a small but powerful antioxidant molecule that cells deploy to mop up reactive species before they do harm. Changes in these two markers, interpreted together, reveal whether an animal’s redox balance is sliding toward damage, compensating through defense, or both.

The patterns that emerged were anything but uniform, and that complexity is one of the study’s most important contributions. In the gills, MDA tended to rise during the early phase of exposure, consistent with the respiratory tissue taking the first oxidative hit from a drug dissolved in the surrounding water, but it generally declined with longer exposure. In the digestive gland, MDA increased at the highest doses during the early period, pointing to damage in the organ responsible for processing ingested contaminants. Glutathione told a mirrored story: levels dropped during the short-term exposures, as if antioxidant reserves were being consumed faster than they could be replenished, but rebounded after 45 days, especially in the digestive gland, where the rebound was most pronounced. Taken at face value, declining damage and rising antioxidant capacity in the long term might look like adaptation, as though the mussels had gradually learned to cope with the pharmaceutical in their water.

The study’s integrative analysis, however, argues forcefully against that comforting interpretation. By combining the MDA and GSH data using the Integrated Biomarker Response version 2, or IBRv2, an index that distills multiple biomarker deviations into a single measure of total stress load, the researcher quantified the overall physiological burden in each treatment group. The picture that emerged was one of escalating stress with dose and time. In the highest-dose group, the IBRv2 value reached 4.19 after 21 days and climbed to 4.80 after 45 days, the largest stress loads recorded in the experiment. Even as individual markers appeared to normalize or improve, the integrated index showed that the animals’ overall stress burden persisted and grew. This is precisely why single-biomarker studies can mislead: an organism can appear to recover on one chemical indicator while its cellular machinery remains broadly perturbed.

The author is explicit in the paper that the decreases in MDA and increases in GSH observed after prolonged exposure should be interpreted cautiously as possible compensatory redox responses rather than definitive evidence of adaptation. In other words, the mussels may have shifted into a defensive mode, investing heavily in antioxidants and suppressing visible lipid damage, without actually escaping the physiological cost of living in carbamazepine-contaminated water. A persistent elevated stress load, invisible to any single marker, is exactly the kind of subtle chronic effect that ecotoxicologists worry most about, because it can erode fitness, reproduction, and disease resistance over generational timescales in ways that are difficult to detect until populations begin to decline.

The findings carry significant weight for environmental risk assessment. Carbamazepine is one of a growing class of pharmaceuticals, alongside compounds like ibuprofen, diclofenac, and various psychiatric medications, that slip through treatment plants designed for organic waste and bacteria rather than synthetic drugs. Reviews of wastewater treatment technologies have repeatedly identified carbamazepine as a particularly recalcitrant case study, and environmental surveys have documented its presence in water and bivalves across marine and freshwater systems on multiple continents. If a drug that persists at low levels can push the immune and redox systems of a keystone filter feeder into a chronically stressed state over just six weeks, the cumulative implications for mussel populations, and for the water-quality services those populations provide, are substantial. Freshwater unionid mussels are already among the most imperiled animal groups worldwide, threatened by habitat loss, invasive species, and pollution.

The study also strengthens the scientific case for biomarker-based monitoring in freshwater ecosystems. Total haemocyte counts, MDA, GSH, and integrated indices like IBRv2 are relatively inexpensive to measure, and together they provide a sensitive early-warning system that detects sublethal harm long before mortality or population crashes become visible. As pharmaceutical consumption rises globally and wastewater infrastructure lags behind in many regions, sentinel species like Unio delicatus may become indispensable sentinels of an increasingly medicated water cycle. What this research makes clear is that the drugs designed to steady human nervous systems can unsettle the biology of the animals sharing our rivers in ways that persist, compound, and hide beneath a deceptively calm surface.

Subject of Research: Effects of chronic carbamazepine exposure on immune and oxidative stress biomarkers in the freshwater mussel Unio delicatus

Article Title: Oxidative stress and immune signatures of carbamazepine in freshwater mussels

Article References: Oxidative stress and immune signatures of carbamazepine in freshwater mussels. (n.d.). https://doi.org/10.1007/s10646-026-03158-w

Image Credits: AI Generated

DOI: 10.1007/s10646-026-03158-w

Keywords: carbamazepine, freshwater mussels, Unio delicatus, oxidative stress, total haemocyte counts, malondialdehyde, glutathione, IBRv2, pharmaceutical pollution, ecotoxicology, water quality, sentinel species