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Review Article
2026
:38;
14212025
doi:
10.25259/JKSUS_1421_2025

Eco-engineered microbes: Advancing green wastewater management

International Research Centre of Nanotechnology for Himalayan Sustainability (IRCNHS), Shoolini University, Solan 173229, India
Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
Institute for Interdisciplinary and Innovation Research, Xi’an University of Architecture and Technology, Xi’an 710055, P.R. China
Department of Mechanical Engineering, UPES Dehradun 248007, India
School of Bioengineering and Food Technology, Shoolini University, Solan 173229, India
Centre of Advanced Innovation Technologies, VSB-Technical University of Ostrava, Ostrava-Poruba 70800, Czech Republic

* Corresponding author: E-mail address: mnaushad@ksu.edu.sa (Mu. Naushad)

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Abstract

The rapidly increasing population, coupled with industrialization and urbanization, has been the major factor in escalating water contamination worldwide, thus making sustainable wastewater treatment a top priority. This review communicates the intricate relationships of microorganisms, bacteria, algae, fungi, protozoa, and genetically modified strains with bioremediation tactics that detoxify a wide range of pollutants, such as heavy metals, pharmaceuticals, dyes, pesticides, and hydrocarbons. The microbial processes, such as biosorption, enzymatic degradation, bioaccumulation, and biofilm formation, are compatible with the environment and are often preferred to those of the conventional treatment systems, which are generally energy-intensive and chemically reliant. Furthermore, advanced methods such as microbial fuel cells (MFCs), clustered regularly interspaced short palindromic repeats (CRISPR) based genetic modifications, and microbial nanomaterials are capable of upgrading the wastewater remediation in terms of both sustainability and efficiency. Biological systems such as activated sludge, anaerobic digestion, constructed wetlands, and sequencing batch reactors (SBR) are examples of the potential for integrated pollutant removal and resource recovery. The article also surveyed the importance of microbial consortia and engineered strains in the breakdown of complex contaminants and the production of value-added products like bioenergy and bioplastics. By applying circular economy principles, microbial methods not only cleanse wastewater but also contribute significantly to environmental recovery and public health protection. If innovation is sustained and integration is interdisciplinary, microbial systems will be the ones to bring the revolution in wastewater treatment, making it a sustainable, resource-generating process.

GRAPHICAL ABSTRACT

Keywords

Bioremediation
Genetically engineered microorganisms
Microbial consortia
Microbial nanotechnology
Wastewater treatment

1. Introduction

Population growth worldwide, along with industrialization and urbanization, has caused an increase in various types of pollution, with water pollution being the most significant one. The human population reached 8 billion in 2022 and is expected to reach 9.7 billion by 2050 (Cai et al., 2013). Such a rapid increase in human activities puts much pressure on freshwater resources, which is why wastewater generation is on the rise, and the environment’s natural purification capacity is being exceeded (Janjhi et al., 2023; Tyagi et al., 2023). Water is indispensable for domestic, industrial, and agricultural use; however, its quality and availability are deteriorating at a high rate because of the release of untreated wastes and inefficient management practices.

Wastewater is mainly divided into three categories: domestic, industrial, and agro-industrial, each of which has different physical, chemical, and microbiological characteristics. Domestic wastewater is relatively low in organics and nutrients, whereas industrial effluents can be extremely different, for instance, a waste stream from a brewery rich in carbon or a discharge from a mining operation containing heavy metals. The agro-industrial wastewater, especially that coming from the livestock sector, is the primary contributor of nitrogen, ammonium, and organic matter at high concentrations (Xie et al., 2023). Dumping of untreated wastewater into water bodies causes the proliferation of waterborne diseases in which microbiological contaminants are the main agents, and they usually have a faster spread rate than chemical pollutants (Okoh et al., 2007).

Employing microbes as the medium in the wastewater treatment process marks a paradigm shift from the traditionally physicochemical methods that are mostly energy-consuming, use costly reagents, and generate secondary pollutants. Microbial systems offer a biologically driven alternative that essentially leverages nature’s metabolic pathways to take out pollutants, recycle nutrients, and recover resources. In contrast to chemical treatments that may only convert pollutants to other hazardous forms, microbial processes have the capability to mineralize organic compounds entirely and can even immobilize heavy metals. The main reasons for their perfect sustainable uses are their flexibility to different wastewater sources, their ability to reproduce, and the fact that they can be used under low-energy conditions. On top of that, microbial technologies do not contradict environmental objectives of the future as they help in circular economy models, reduce carbon footprints, and release less pollution into the environment. The article supports the microbial remediation method as a better option to conventional treatment and also acknowledges its potential as a viable, eco-friendly solution for wastewater management in the future (Meena et al., 2022; Singh et al., 2022).

Although microbial communities are a promising and environmentally friendly method for wastewater remediation, they are just one element of a larger technological spectrum. Present drawbacks, for instance, dependence on environmental changes, low pollutant specificity, and difficulties in enlargement, highlight the necessity of integrated engineering solutions. The use of such new technologies as bioelectrochemical systems, membrane bioreactors, and synthetic biology-based microbial consortia is investigated to increase treatment performance, strength, and flexibility. These innovations intend to remove the limitation zones and extend the use of microbial processes to different kinds of wastewater and working conditions. However, comprehensive reviews focusing specifically on these eco-engineered microbial advancements remain limited in the existing literature. In this context, the present review, entitled Eco-Engineered Microbes: Advancing Green Wastewater Management aims to consolidate state-of-the-art knowledge on microbial wastewater treatment strategies, highlight technological improvements designed to address current challenges, and provide insights into future research directions for sustainable and circular wastewater management.

This review has been divided into three main segments to offer a detailed understanding of microbial wastewater treatment. The first part investigates the causes of water contamination and emphasizes pollutant sources from domestic, industrial, and agricultural activities. The second part locates the mechanisms of pollutants degrading by microbes, which include biosorption, enzymatic degradation, bioaccumulation, and biofilm formation. The third part displays real-world applications of microbial systems, classified by the type of organisms: bacterial-mediated strategies, fungi, and yeast-mediated processes, microalgae-based treatments, and combined rotifer-microalgae systems. In each category, specific microbial roles, pollutant targets, and treatment technologies are discussed. The paper ends with an overview of present barriers, potential research areas, and the technological innovations required for the large-scale use of microbial solutions in wastewater management.

2. The root causes of water contamination

Aquatic systems have the potential to exhibit a broad diversity of environmental contaminants that include pesticides and herbicides. In one category, commercial releases are mainly characterized by inorganic pollutants such as sediment from stormwater, overflow that causes acidification, and heavy metals produced as a result of acid mine runoff. Different sources of residential trash are making their way into water bodies. Products like household cleaners, washing agents, and cosmetic items contain a great number of contaminants that can pollute aquatic environments and make them unsafe for human use. Materials and acids from sectors like metal production and papermaking are given off in waterways (Jabeen et al., 2015; Sanda and Ibrahim, 2020). Sources of water are getting more than 70% of industrial effluents that are loaded with many toxins. The foremost agricultural by-products are fertilizers, pesticides, and various agrochemicals. The production of fertilizers has been on the rise every year to facilitate crop yields, thereby leading to an increase in the waste generated. Irrigation is the main reason for the contamination of surface water in China and is also a factor causing nitrogen pollution in groundwater in the United States. Harmful agents can accumulate in organisms, thus potentially reaching levels that are dangerous and may interfere with the food web. Nutrient overload is next in line to be a significant water contamination contributor (Sanda and Ibrahim, 2020).

Fig. 1 shows the main sources that cause water contamination, include industrial discharges, domestic waste, sewage, agricultural runoff, mining, oil spills, and atmospheric deposition. These pollutants are the root causes of surface and groundwater damage that, in turn, threaten the availability of clean water, which, in essence, demonstrates the strong connectivity of human activity with environmental health.

The illustration shows various sources of water pollution.
Fig. 1.
The illustration shows various sources of water pollution.

3. Recent advances in wastewater treatment mechanisms

Different methods are used to remove contaminants from wastewater, among them are mechanical, molecular, and organic strategies. Physical treatment aims at lowering of pollutants without changing their biochemical properties, and it is normally used as a final stage of the chemical or biological processes. Besides that, there are various techniques such as flow equalization, screening, flotation, membranes, and thermal treatment. Chemical operations like chlorination, precipitation, neutralization, disinfection, exchange alter water quality, and adsorption. The treatment program has three stages: primary (filtration and settling of debris), secondary (aerobic and anaerobic microbial degradation), and tertiary (chemical and membrane processes like flocculation, coagulation, and ion exchange). A real-life combination of these methods is the most common practice (Chang et al., 2018).

3.1 Biologically driven wastewater purification

Biological remediation involves the extraction of toxins from wastewater through the use of living organisms or natural processes. Microbes are essential in the treatment and recovery of wastewater, positioning them as an effective, eco-friendly option. Bacteria, fungi, microalgae, yeast, protozoa, and other microbial species rapidly decompose a significant portion of organic matter. Compared with physical and chemical processes, biological methods are generally more cost-effective. Commonly employed techniques include activated sludge, anaerobic degradation, constructed wetlands, bioreactors, biofilters, algal systems, biosorption, enzymatic treatment, genetically engineered microbes, bioaugmentation, and Microbial Fuel Cells (MFCs). This biological approach employs bacteria, fungi, microalgae, yeast, and various other microbial species, as mentioned in Table 1 (Akpor et al., 2014; Samer, 2015). Table 2 provides a few illustrative examples.

Table 1. Microbial communities used in water pollution control (Akpor et al., 2014).
Microorganisms Applications
Bacteria Primarily, aerobic microorganisms are employed to break down organic contaminants in sewage treatment.
Fungi Fungi generate enzymes that can break down substances that bacteria find difficult to decompose. Moreover, these organisms synthesize proteins, organic acids, chitin, amylase, glucosamine, antimicrobial agents, and a variety of diverse metabolites to thrive in challenging environments, boosting their chances of sustenance. They dismantle these substances through processes like adsorption, chemisorption, chelation, and microprecipitation.
Rotifers These tiny waste-dwelling microscopic creatures, typically located in freshwater and damp earth, possess the ability to stabilize organic materials, promote microbial activities, facilitate decomposition, boost oxygen levels, and recirculate mineral nutrients. They elevate the oxygen concentration in activated sludge.
Protozoa Ciliated protozoa, which can thrive on water surfaces and consume decomposing plant matter and microorganisms, significantly aid in the process of purification and nutrient cycling.
Algae Microalgae have the ability to take up nitrogen appearing as nitrate, nitrite, and ammonium. In addition, they effectively eliminate organic substances, xenobiotics, and metals from the wastewater treatment process. However, they may frequently be surpassed by other microorganisms in the quest for vital nutrients.
Table 2. Microorganism-based strategies for various pollutant degradation.
Technique Pollutant Microbes References
Bio barrier system

Atrazine

Petroleum hydrocarbons

Streptococcus equisimilis, Pseudomonas putida, and sulfate-reducing bacteria. (Cardona and Suárez, 2010; Hsia et al., 2021; Lago et al., 2024)
Immobilization technique Aliphatic and aromatic petroleum hydrocarbons, copper Bacillus brevis and Pseudomonas aeruginosa KH6, Desulfovibrio sp., Chlorella vulgaris, Scenedesmus obliquus, Selenastrum capricornutum, and Anabaena spiroides. (El-Borai et al., 2016; Li et al., 2018)
Microbial consortium Petroleum oil and phenol Alcaligene odorans, B. subtilis, Corynebacterium propinquum, and Pseudomonas aeruginosa (Singh et al., 2013)
Bio consortium Metalworking fluids, Toluene, O-xylene Pseudomonas putida, Candida membranifaciens, Penicillium sp. (Hilal et al., 2005; Jecu et al., 2008)
Bacterial consortium Heavy metals, COD, BOD, MLSS (mixed liquor suspended solids), TSS Chlorella sorokiniana, R. basilensis, Bacillus pumilus, Brevibacterium sp., Pseudomonas aeruginosa (Muñoz et al., 2006; Dhall et al., 2012)
Fungal biosorption Au, Pd, Pt,Zn, Cd, Cr Saccharomyces cerevisiae, Aspergillus sp., Candida tropicalis (Zouboulis et al., 2001 Baik et al., 2002; Barros Júnior et al., 2003;; Godlewska-Żyłkiewicz and Kozłowska, 2005; Lin et al., 2005; Yin et al., 2008)
Enzymatic degradation Proteinaceous wastes, endocrine disrupting chemicals (EDCs) P. aeruginosa, Trametes versicolor, Myceliophthora thermophila (Sivaprakasam et al., 2011; Becker et al., 2017)
Activated sludge Dyes, additives, salts, phenols Bjerkandera adusta MUT3060, Pseudomonas putida (Anastasi et al., 2011; Mohamaden et al., 2016)
Sequencing batch reactor Blue Bezaktiv S-GLD 150 dye, Congo red Microbial consortium ‘Bx,’ Brevibacillus parabrevis (Khouni et al., 2012; Talha et al., 2018)
Photolysis Sulfadiazine Chlamydomonas sp (Xie et al., 2020)
Biodegradation Roxithromycin Haematococcus pluvialis, Selenastrum capricornutum, Scenedesmus quadricauda (Kiki et al., 2020)
Bioadsorption Oxytetracycline Phaeodactylum tricornutum (Santaeufemia et al., 2016)
Bioaccumulation Sulfamethazine Chlorella pyrenoidosa (Sun et al., 2017)

In the activated sludge process, bacteria and protozoa grow in aerobic conditions, forming aggregates that create suspended flocs. Aeration keeps the oxygen supply going, whereas the mixed liquor is settled to separate the purified effluent. Sludge is also recycled to the aeration tank; however, the process generates a considerable quantity of excess sludge, which needs to be disposed of (Rajesh Banu and Kaliappan, 2007; Sikosana et al., 2019). Biofilm-based systems are dependent on the microbial communities that stick to the surfaces, the cells being protected by the extracellular matrices, which thus improves the survival and pollutant degradation. Biofilm reactors like rotating biological contactors and membrane bioreactors are efficient in treating industrial effluents and in dye degradation, which is achieved by biosorption and metabolism. (Watnick and Kolter, 2000).

Without oxygen, anaerobic degradation uses microbial consortia to break down organic materials to produce biogas, which is mostly methane and carbon dioxide. This method includes hydrolysis, acidogenesis, acetogenesis, and methanogenesis; therefore, it can be used for the effective treatment of concentrated effluents with the co-benefit of renewable energy generation. Although this process is very sensitive to changes in temperature, pH, and the presence of toxic substances, it is still an economically viable and environmentally-friendly solution for both municipal and industrial sectors (Chen et al., 2008).

Constructed wetlands are designed to be similar to natural ecosystems; therefore, microbial communities can live in them and decompose organic matter, cycle nitrogen through ammonification, nitrification, and denitrification, and take up phosphorus in the form of polyphosphate. The roots of plants intensify microbial processes as they release oxygen and carbon substrates and, therefore, constructed wetlands become highly efficient and sustainable treatment units (Vymazal, 2011).

Besides that, bioreactors and biofilters have microbial biofilms on their surfaces that are capable of pollutant degradation, and, in some cases, this process can be further improved through the use of photosynthetic bacteria, which are able to metabolize a large variety of contaminants while at the same time producing biohydrogen and biopolymers. Such bacteria facilitate nitrogen and sulfide reduction as well as energy saving and, thus, make these systems highly adaptable and environmentally-friendly (Pachaiappan et al., 2022).

The implementation of algal treatment systems is beneficial for both, the environment and the economy as it combines nutrient removal with the generation of biomass. Microalgae uptake nitrogen and phosphorus from the environment, thus alleviating the risk of eutrophication, and at the same time, they serve as renewable feedstock for the production of biofuels, animal feed, and bioplastics. Whether grown in open ponds or closed photobioreactors, microalgae cultivation is an integral part of the water treatment process, since it also provides oxygen to aerobic bacteria and opens the way for energy recovery (Christenson and Sims, 2011).

Biosorption is a technique that uses natural microbial biomass, remains from agriculture, and by-products from industry to capture metals such as copper, zinc, and chromium through ion exchange, precipitation, and complexation. The method depends on factors such as pH, concentration, temperature, and ionic strength, and at the same time, it is a reversible and low-cost alternative to chemical methods. Enzymatic treatment utilizes microbial enzymes, for instance, azo-reductases, laccases, and peroxidases that can break down dyes, mainly those of the azo type that are highly resistant to physical and chemical methods. These enzymes are very efficient since they work under mild conditions and do not generate secondary pollutants, and recent developments in enzyme immobilization and engineered strains contribute to more stability and better catalytic activity (Saratale et al., 2011).

By the use of genetic engineering techniques, microorganisms can help metal bioremediation become more efficient by including the expression of the genes encoding metallothioneins, phytochelatins, efflux pumps, or surface display proteins, which results in increased binding, accumulation, and detoxification of cadmium, lead, mercury, and arsenic. However, the release of such organisms to the environment should be controlled and regulated to avoid possible ecological risks (Bhatt et al., 2023). Lastly, MFCs involve the use of bacteria as biocatalysts that bring about the oxidation of organic matter and the generation of electricity, along with wastewater treatment. The energy yields are very high when substrates such as acetate or palm oil mill effluent are used, thus allowing for the simultaneous removal of contaminants and power generation (Elliott et al., 1954).

In summary, these biological strategies are a testament to the pivotal role that microbes play in the field of sustainable wastewater treatment. Apart from eliminating pollutants, they also make it possible to recover energy, recycle resources, and integrate into circular bioeconomy frameworks.

4. Microbial applications in wastewater remediation

Microbial remediation through the use of a diverse population of microorganisms has become a preferred option compared to traditional wastewater treatment technologies due to its low cost, improved pollutant removal, and biological adaptability (Singh et al., 2017). Various bacteria, fungi, yeast, and microalgae absorb and accumulate pollutants, thereby changing toxic compounds into less toxic ones, through biosorption and bioaccumulation (Elliott et al., 1954; Doble and Kumar, 2005). Biosorption is a process in which pollutants are passively bound to the functional groups of the microbial surfaces, and hence, the process can use both living and dead biomass. This makes it possible to reuse and thus has low operation costs. On the other hand, bioaccumulation is an active process that is performed by living cells, and thus, it is limited in scalability and is more costly (Du et al., 2015).

Application-wise, the level of maturity and effectiveness of microbial methods varies. Bacterial technologies have been extensively implemented in the operation of reactors, while fungal and yeast-based methods have been demonstrated to be effective for the degradation of recalcitrant organics, although the latter are still facing problems of instability. Microalgae and rotifer-algae systems may be able to deliver nutrient recovery as well as ecological integration; however, they also require precise environmental control. Furthermore, sensitivities of microbes to variations in wastewater conditions, low performances in very concentrated industrial effluents, and insufficient integration with the existing infrastructure are yet to be solved despite the progress made. Besides that, microbial communities may not be able to eliminate pollutants without the help of engineered ones. The following line of research should be on the design of robust bioreactors, genetic enhancement of strains, and real-time monitoring. It would also be essential to highlight and push microbiome wastewater treatment green benefits to pave the way for their scalable and sustainable future deployment, e.g., by showing that such an approach is energy-efficient, requires no or minimal chemical inputs, and is potentially carbon-neutral.

4.1 Bacterial-mediated lowering of organic and inorganic environmental pollutants.

The processing of discharges relies on the ability of bacterial organisms to accumulate contaminants (metals). The community of microorganisms and the presence of xenobiotics influence the rate at which biodegradation occurs. Vegetation supplies organic carbon to rhizosphere microbes, facilitating the breakdown of pollutants. The biofilms formed by aquatic plants can degrade organic compounds (Xu et al., 2016). Methanotrophs utilize methane to acquire carbon and energy, while also decomposing a range of detrimental organic substances (Neifar et al., 2016).

The water hyacinth (Eichhornia crassipes) is one of the factors that helps to purify eutrophic waters by changing nitrogen production. Organisms like Tolypothrix ceytonica and Anabaena oryzae have been singled out as highly effective in the treatment of industrial effluent. Aphanocapsa sp. and Plectonema sp. are the species that can degrade crude oil. In the anaerobic digestion of sewage, sulfate-reducing bacteria include the genera Desulfovibrio, Desulfotomaculum, Desulfobacter, and Desulfococcus (Srinivasan et al., 2017; Srinivasan and Sadasivam, 2018; Basutkar et al., 2019; Franca et al., 2020).

Bacteria have been identified as major biosorbents due to factors that include their availability, size, growth in controlled environments, and resistance to environmental changes (Masarbo and Karegoudar, 2022). The event of metal ion biosorption on the cell wall may be either an active one or a passive one. Passive biosorption is possible in both live and dead/inactive bacterial cells. Whereas active biosorption refers to the metal ion uptake in the living bacterial cells. The metal ions binding involves operations like ion exchange, chelation, complexation, and micro precipitation (Srinivasan and Sadasivam 2021)

Even though bacterial systems are the major choice in wastewater treatment, their performance can be very limited under such conditions as exposure to toxic compounds, sudden temperature changes, and nutrient imbalance. These factors not only affect the microbial community structure but also lead to a decrease in treatment efficiency (Sharma et al., 2023).

4.1.1 Bacterial mediated petrochemical degradation

Petroleum hydrocarbons can be categorized into resins, asphaltenes, aromatics, and saturates. Their decomposition by bacteria is not straightforward and depends on the nature and amount of the hydrocarbons. The microbial degradation of hydrocarbons is also dependent on external factors such as temperature and the presence of inorganic nutrients (Nikolopoulou and Kalogerakis, 2009). Different hydrocarbon structures have different degrees of vulnerability to microbial attack, with straight-chain alkanes being the most vulnerable and cyclic ones the least (Sathishkumar et al., 2020; Narayanan et al., 2022). Some polycyclic hydrocarbons with higher molecular weights may not be easily degraded (Dhodapkar and Gandhi, 2019).

Acinetobacter sp. is capable of degrading n-alkanes with the length of the carbon chain varying from C10 to C40 (Chojnacka et al., 2022). Only carbon is used as a nutrient source. Mycobacterium, Pseudomonas, Brevibacterium, Aeromicrobium, Flavobacteria, Bacilli, Nocardia, Dietzia, Burkholderia, Gordonia, Moraxella, Arthrobacter, and several other genera of bacteria can degrade petroleum derivatives (Sharma et al., 2023). Sphingomonas can break down polyaromatic hydrocarbons (Castelo-Grande et al., 2010). Soil bacteria and marine bacteria differ in their efficiency of degradation. These bacteria use particular enzyme systems to break down petroleum hydrocarbons in the presence of oxygen. The process that starts with microbial cells attaching to substrates is then followed by the synthesis of biosurfactants (Nawaz et al., 2011). Different microorganisms produce biosurfactants that are highly active and contain complex molecules. These biosurfactants are extremely important for the solubilization of the contaminants and their eventual elimination. They increase the surface area and the amount of oil available for bacterial consumption, and at the same time lower the surface tension to allow for micelle formation.

4.1.2 Bacterial mediated pesticide degradation

Pesticides are chemicals that are used to get rid of organisms that are harmful to plants and are classified depending on their use and purpose (Muthusaravanan et al., 2018). The different classes of organic pesticides also include organophosphates, organochlorides, carbamate derivatives, acetamides, neonicotinoid compounds, pyrethroid insecticides, triazole fungicides, and triazine herbicides. Compounds like chlordane, lead DDT, toxaphene, arsenate, and heptachlor are among those persistent pollutants (Guo et al., 2010). Several studies have shown that less than 5% of the total applied pesticides are used for pest control, whereas the rest mostly contaminate the nearby soil and water. The leftover pesticides in the environment are a threat to nature and, therefore, have to be removed. It is known that chemical and physical methods for pesticide removal are inefficient, and bacteria may be considered a biological agent to fight against toxic agricultural chemicals (Ahemad and Malik, 2011).

Several studies have reported the role of bacteria in bioremediation of pesticides; the case of elimination of Endosulfan by Bacillus and Staphylococcus is one of such examples (Wu et al., 2011). Malathion removal by Arthrobacter sp. and Pseudomonas putida (Wang and Sample, 2014). Removal of Ridomil and fitoraz by Pseudomonas putida alongside Acinetobacter sp. (Mónica et al., 2016). Breakdown of endosulfan by Achromobacter sp., Staphylococcus aureus, and Rhodococcus sp. (Rajkumar et al., 2010). Degradation of naphthalene by Cyanobacteria (Igiri et al., 2018).

4.1.3 Bacterial mediated dye degradation

Artificial dyes offer numerous benefits compared to organic dyes regarding color range, coloring speed, absorption capability, and solubility in water (Hassaan and El Nemr, 2017), which accounts for the worldwide dye output of 800,000 tons annually. The repercussions of textile wastewater on the comprehensive well-being of aquatic ecosystems are increasingly alarming as the appetite for dyes escalates. Textile effluents encompass both inorganic and organic supplements, chemicals, and colorants ranging from 10 to 200 mg/L (Wuhrmann et al., 1980; Lin et al., 2010). In the fabric manufacturing sector, azo pigments (70%) are frequently utilized due to their economical pricing and user-friendly nature. As not all pigments adhere to textiles during the coloring process, unbound pigments are rinsed away and detected in elevated levels within wastewater (Sarayu and Sandhya, 2010).

The breakdown of dyes with the aid of bacteria is safe for the environment and can remove pigmentation from colored complex dyes. Research has effectively examined Aeromonas hydrophila, Bacillus subtilis, and Bacillus cereus, which exhibit strong prospects towards the bioremediation of azo dyes (Khandare and Govindwar, 2015). These microorganisms employ oxidoreductive enzymes for pigment breakdown. Aerobic microorganisms utilize oxygen-driven azoreductase to sever the azo linkages. (Nachiyar and Rajkumar 2003). Certain bacterial variants break down colorants in the presence of oxygen and employ mono and dioxygenases to oxidize the aromatic structure of organic materials. Anaerobic microorganisms utilize the enzyme azoreductase to break down azo dyes. Typically, conditions lacking oxygen, enhance the process of dye removal. In most cases, the decolorization reaction adheres to first-order kinetics regarding the dye concentration, although zero-order kinetics can occasionally be observed. Additionally, oxidoreductive enzymes play a role in processes such as desulfonation, hydroxylation, and deamination. Pseudomonas aeruginosa is capable of decolorizing a range of azo dyes, including Navitan Fast Blue S5R, even under aerobic conditions. (Perry 1984, Cooney et al., 1985)

4.1.4 Bacterial mediated pharmaceutical and personal care products degradation

In the past few years, a variety of captivating research efforts have explored the potential application of bacterial cultures in the cleanup of certain substances (Bhaskaralingam et al., 2024). The global increase in pharmaceuticals has been continuous, particularly in the wake of the COVID-19 pandemic. Individuals discharge PPCPs into the aquatic environment through the use of medications: household cleaners, sanitizers, shampoos, detergents, etc. PPCPs consist of intricate and enduring entities that re-enter the hydrological cycle, leading to heightened antibacterial resistance, reproductive issues, and tumor development. Without proper control, these pollutants continue to accumulate in water areas, and several of their metabolites revert to their original forms (Hussaini et al., 2013). They transform precise contaminants into intricate and harmful variants that readily disseminate in aquatic environments. The degradation of PPCPs by microorganisms presents a challenge as pharmaceuticals are intentionally formulated to be detrimental to bacteria (da Silva Rodrigues et al., 2020). However, certain indigenous bacterial species can assist in breaking down pharmaceutical pollutants. Microbes convert or decompose the multifaceted structure into a non-toxic or benign variant.

4.1.5 Bacterial mediated heavy metal degradation

Lead, cadmium, chromium, arsenic, and mercury are pervasive ecological contaminants, exhibiting significant lethality and density. Both natural and human-made origins of heavy metal pollution result in harmful consequences for all forms of life (Muneer et al., 2013). The microbial organisms need cations for various cellular functions, yet a rise in concentration can hinder growth by creating internal complexes (Oshima et al., 2008). Bacteria possess the capability to restrain as well as release, modify, and absorb heavy metals. Numerous research articles have been released regarding the function of endophytic bacteria in the accumulation and neutralization of heavy metals (Sinha et al., 2011; Rajesh Priyalaxmi et al., 2014). Research indicates that microorganisms release organic acids to aid in the microbial cleanup. Additionally, these bacteria generate biosurfactants that are exuded by roots and enhance the availability of metals in aquatic settings (Sinha and Biswas, 2014). Research revealed that glutathione played a role in the cellular retention of cadmium ions within the cells of Rhizobium leguminosarum (Boonsong and Chansiri, 2008).

For example, iron-reducing bacteria such as Geobacter sp., and sulfur-reducing bacteria like Desulfovibrio sp., can change heavy metals to less toxic, or sometimes, non-toxic forms. To illustrate, both metal-reducing and sulfate-reducing bacteria can convert chromate in highly toxic Cr(VI) form to a relatively less toxic Cr(III) (Wu et al., 2015). There are a number of ionizable groups on the bacterial cell wall that can facilitate the uptake of metal ions by bacteria (amino, carboxyl, phosphate, and hydroxyl groups). Microbial methylation is essential in metal remediation. As an example, Escherichia sp. Clostridium sp., Bacillus sp., and Pseudomonas sp. are able to biomethylate Hg(II) (Fauziah et al., 2017). Sulfate-reducing bacteria produce large amounts of hydrogen sulfide, which results in the precipitation of metal cations (Sofu et al., 2015). It is the Vibrio harveyi strain that causes divalent lead to be converted into a lead phosphate compound. Different heavy metals react to microorganisms in various ways, contingent upon the environment. Certain bacterial cells generate siderophores, which create metal complexes, reducing their bioavailability and mitigating their lethality.

4.2 Fungi and yeast mediated wastewater treatment

Fungi can assist in the exclusion of contaminants by boosting their bioaccesibility and transforming them into less harmful variants (Pramanik et al., 2018). Fungi are easy to cultivate and generate a considerable quantity of biomass. Numerous fungal varieties have demonstrated the capacity to break down numerous environmental pollutants, encompassing pharmaceutical substances, dyes, aromatic hydrocarbons, and heavy metals (Agrawal and Verma 2020; Lakshmi et al., 2020). Traits of fungi that render them excellent choices for wastewater treatment are their ability to produce a diversity of extracellular enzymes and the network of hyphae that safeguards the internal delicate organelles from the detrimental impacts of pollutants (Espinosa-Ortiz et al., 2016). Fungi are attracted to the root zone by substances released from roots. Numerous elements affect the relationships between plants and fungi in the rhizosphere, such as soil properties, types of plants, water sources, weather conditions, and additional microorganisms (Gayathiri et al., 2022).

The interactions between plants and fungi carry out a wide range of significant roles, such as the release of metal-binding siderophores, denitrification, and the process of detoxifying harmful substances. Fungi convert organic waste into biochemicals and other precious compounds that hold industrial significance, which presents a benefit of utilizing fungal cultures for wastewater management over bacterial cultures (like proteins and organic acids). Additionally, fungal biomass is applicable as livestock feed (Singh et al., 2021). Fungi such as Acremonium, Verticillium terrestre, Stachybotrys, Glomus, Cephalosporium aphidicola, Peziza, Aspergillus parasitica, Candida, Minimedusa, Talaromyces, Hydnobolites, and Pleurotus pulmonarius species can be utilized in the treatment of wastewater. (Assress et al., 2019) In recent years, numerous research investigations have highlighted the significant contribution of ligninolytic fungi in breaking down synthetic dyes. Fascinatingly, fungi produce ligninolytic enzymes capable of decomposing intricate dyes, such as manganese peroxidase, laccase, and lignin peroxidase (Borne et al., 2014).

Various studies have shown that yeast can clean pollutants from the environment. Besides that, yeast may help reduce the chemical oxygen demand (COD) and get rid of mono and polyphenols since it can absorb, allocate, and convert what is dangerous into friendly compounds in industrial settings. The mentioned species Candida krusei, Galactomyces geotrichum, Saccharomyces cerevisiae, and Trichosporon beigelii are the organisms that disintegrate the dyes in the effluents (Dönmez and Aksu 2001). Though fungi and yeast are metabolically versatile, they usually have a problem with slow growth and are less resistant to mixed microbial environments, which in turn limit their scalability and stability over time in complex wastewater matrices (Latif et al., 2023).

4.3 Microalgae mediated wastewater treatment

It involves the use of eukaryotic algae and cyanobacteria to clean sewage naturally. The term ‘phycoremediation’ reflects the use of algal species for bioremediation. The research is implementing the utilization of algae and cyanobacteria instead of bacteria to enhance wastewater treatment. Common microbial species named Chlorella, Picochlorum, Tetraselmis, Scenedesmus, Anabaena, Oscillatoria, Spirulina, Chroococcus, Pseudospongiococcus, Scytonema, and Dolichospermum are the most usual algal and cyanobacterial strains, respectively (Achal et al., 2011; Ashokkumar et al., 2017).

Microalgae have a lot of positive characteristics that make them perfect for wastewater treatment. They can consume carbon, nitrogen, and phosphorus compounds of both inorganic and organic nature from wastewater, thus nutrient removal goes along with their growth (Bhattacharya et al., 2014). Their fast reproduction and low nutrient requirement make them even more effective in these performances. Besides that, microalgal biomass is a versatile material that can be used for adsorption and desorption, a process that allows the complete recycling of the treatment method, thus it is sustainable (Goswami et al., 2021). Moreover, unlike many other biological systems, microalgae’s growth is almost independent of environmental factors, so it is possible to produce year-round (Salama et al., 2017). On top of that, algal biomass has been proven to be more efficient than membrane-based systems in extracting heavy metals from wastewater (Darda et al., 2019). At the same time, microalgae, being a natural source of oxygen, not only promote the activity of heterotrophic bacteria but also accelerate the organic materials’ degradations. They can work in anaerobic as well as aerobic effluent treatment systems, thus being a versatile option for different wastewater management scenarios (Manzoor et al., 2016).

The design of microalgae-driven wastewater treatment systems can be either open or closed, depending on the source of nutrients, investment, and cultivation conditions (Sharma et al., 2023). Algae are the most common photosynthetic organisms in nature and can be found in the water of ponds, lagoons, and long channels. The two types of places are also sites for such plants. Stabilization ponds with a mix of bacteria and microalgae cultures are the main technology used for the treatment of domestic and industrial effluents in temperate as well as tropical regions. Many papers have proved the successful operation of open microalgal culture treatment facilities in the wastewater treatment process (Mehariya et al., 2021).

Microalgae are kept in the dark inside the closed systems of such plants. Photobioreactors could be an example of these plants. Among the positive effects of closed-loop cultivation are water saving, increased biomass, and the complete elimination of contamination in comparison with open systems. Different microalgae species, such as Arthrospira, Chlorella, Haematococcus, Spirulina, and Phaeodactylum, can be cultured in pilot-scale tubular bioreactors (Goher et al., 2016; Khan et al., 2021).

Algal biosorbents have a very high sorption potential. Algae-based biosorption of heavy metal ions from wastewater is an eco-friendly, cost-saving, and effective method (Shi et al., 2007). Various pieces of research have proved that microalgae can remove pollutants from effluents; for instance, C. vulgaris and S. quadricauda can remove nitrate. Chlorella, Scenedesmus, and Cosmarium species are being used for the treatment of wastewater, among which textile effluent is included (Varjani et al., 2020).

Natural colorants are notable contaminants of the aquatic environment. They are there in the different industrial branches such as textiles, plastics, and pharmaceuticals. When these colorants accumulate in water ecosystems, they lead to the enrichment of nutrients and an oxygen deficit. The formation of harmful amines during dye breaking is a serious threat (Tara et al., 2019). Microalgae remove colors from dyes by either adsorption or degradation. They also have the ability to use coloring agents in wastewater along with the essential nutrients. In the bioconversion route, microalgae can take the dyes as a carbon source and convert them into different byproducts.

Moreover, microalgae are a vital part of wastewater treatment through different processes that result in antibiotic lowering. These processes include extracellular biodegradation, where extracellular polymeric substances (EPS) like proteins, lipids, and polysaccharides attach to and break down pollutants; bioadsorption, which depends on the hydrophobicity and functional groups of antibiotics; and bioaccumulation, where antibiotics get absorbed into microalgal cells. Here, intracellular biodegradation occurs via oxidation, reduction, or hydrolysis (Phase I), followed by conjugation with polar molecules (Phase II). These processes not only break down the harmful compounds but also help reduce oxidative stress, thereby enhancing the overall treatment efficiency. So, Fig. 2 represents the antibiotic removal mechanisms by microalgae (Xiong et al., 2021). Microalgal treatment systems have been highly dependent on light intensity and temperature, which restricts their scalability in variable climatic conditions (Kundu et al., 2024).

Illustrates the processes through which microalgae remove antibiotics. Reproduced with permission from Xiong et al., 2021; copyright © 2021 The Author(s). Published by Elsevier Ltd.
Fig. 2.
Illustrates the processes through which microalgae remove antibiotics. Reproduced with permission from Xiong et al., 2021; copyright © 2021 The Author(s). Published by Elsevier Ltd.

4.4 Rotifers and mediated wastewater remediation

In sewage systems, protozoans are associated with the consumption of organic substances and other microorganisms. Among ciliated protozoans are the primary groups most involved in wastewater management because of their ability to live on water surfaces; thus, they eat decomposed plant material and microbes. Protozoa have major ecological roles in the earth’s ecosystems of self-cleaning and material cycling. Their bacterial consumption is generally believed to be the main factor in treatment, thus lowering the organic load in the processed waste (Pauli et al., 2001).

It is mentioned that the waste products generated by protozoa are highly nutritious in different mineral nutrients, for example, nitrogen and phosphorus, which are essential for recycling mineral nutrients in the activated sludge process. The presence of protozoa in the aeration tanks of an activated sludge system is considered one of the most important signs of a properly handled and efficiently working system. The primary difficulty in their application in the treatment of wastewater is their segmentation since most are in contact with the sludge (Motta et al., 2001).

Several groups of protozoa have been linked with the extraction and mineralization of toxins in wastewater treatment systems (Akpor et al., 2008; Papadimitriou et al., 2010). Rotifers are tiny aquatic microscopic units belonging to the phylum Rotifera, often discovered in various freshwater habitats and damp soil. They reside in the delicate layers of water that gather around soil particles and are recognized for thriving primarily in still water settings, like the lake bottoms, and moving streams and rivers (Papadimitriou et al., 2010).

Microbial wastewater treatment systems represent an inherently environmentally friendly approach that is in line with global sustainability objectives. In general, these systems are less energy-intensive as they usually operate under ambient conditions, thus they are more energy-efficient in comparison with thermal or chemical treatments. Several microbial processes are chemical-free or involve minimal chemical additions, thus secondary pollution and sludge production are minimized. In particular, microalgae-based systems not only serve as a carbon sink through photosynthesis but also facilitate nutrient recovery and biomass valorization. Also, the utilization of biosorption through the dead biomass contributes to eco-efficiency by enabling the recycling and, therefore, less biological replenishing. When we integrate microbial technologies with the principles of a circular economy, they turn into enablers of resource recovery, low-carbon operation, and almost no environmental impact. Hence, they can be considered as possible solutions for climate-resilient wastewater management.

Although rotifers offer a synergistic benefit for nutrient cycling and biomass production, their performance is highly sensitive to pollutant load, predator-prey dynamics, and ecological balance, requiring precise operational control (Al-Jabri et al., 2021).

4.5 Barriers to effective microbial wastewater management

Microbial remediation has been recognized as a trendy and green alternative to traditional methods of wastewater treatment, mainly due to its features of requiring minimal energy, being very flexible, and also providing the possibility of resource recovery. However, the limitation of a few issues that have been persistent confines the implementation of this method on a large scale. For instance, microbial communities are very sensitive to changes in their surroundings like pH, temperature, salinity, and nutrients, which could affect their stability and also their performance (Waoo and Mongia, 2025). In addition, many strains do not have the capability to target pollutant-specificity, and the degradation of complex or recalcitrant compounds is just partial most of the time, as mentioned in Table 3. There are challenges in scaling laboratory successes to industrial-scale operations in maintaining microbial viability and activity under variable field conditions, amongst others. Also, the use of genetically modified organisms (GMOs) brings issues that involve regulations and ecology, and these require being studied cautiously (Pant et al., 2010).

Table 3. Comparative Evaluation of Microbial Groups in wastewater treatment.
Microbial group Merits Drawbacks Applications References
Bacteria
  • Rapid growth

  • Metabolic diversity

  • Scalable in bioreactors

  • Sensitive to toxins and environmental shifts

  • Limited for complex pollutants

  • Activated sludge

  • Petroleum and pesticide degradation

(Sharma et al., 2023)

(Doolotkeldieva et al., 2021)

Fungi
  • Enzymatic breakdown of recalcitrant organics

  • Tolerant to low pH and high pollutant loads

  • Slow growth

  • Less robust in mixed microbial systems

  • Dye degradation

  • Biosorption of heavy metals

(Juárez-Hernández et al., 2021)

(Mondal et al., 2024)

Microalgae
  • Efficient nutrient uptake

  • Biomass is usable for biofuels

  • Oxygenation of aerobic systems

  • Light dependent

  • Sensitive to temperature and contamination

  • Nutrient recovery

  • PPCP removal

  • Coupled algal bacterial systems

(Goh et al., 2022)

(Chen et al., 2024)

Microbial consortia
  • Synergistic degradation

  • Broader metabolic capabilities

  • Enhanced resilience

  • Complex optimization

  • Risk of microbial competition

  • Integrated bioreactors

  • Livestock wastewater treatment

  • Bioenergy recovery

(Murshid and Dhakshinamoorthy 2021)

(Sirohi et al., 2022)

Considering these boundaries, the presence of this article becomes imperative to serve as a single point of microbial taxa and technological knowledge, to examine their pros and cons critically, and to show the scientific advancements at the intersection of different areas of knowledge that can go beyond the existing bottlenecks. This paper differs from earlier ones in that it not only focuses on isolated microbial groups or a single treatment technology but rather offers a comprehensive framework that interrelates microbial diversity, engineered solutions, and sustainability principles. Besides, it intends to be a compass for research and practical execution by pinpointing the gaps, suggesting strategies that can be scaled up, and ensuring microbial remediation is in harmony with circular economy models and global environmental objectives (Chatterji et al., 2025)

5. Developmental Directions and Innovations in Microbial Wastewater Systems

A microbial consortium is an environmentally friendly solution that utilizes biotechnology and represent a departure from traditional methods. The use of a single microbial strain for the treatment of wastewater may lead to a concealment of results, which in turn results in a decrease in the efficiency of the process. As a result, many research articles have suggested the application of microbial consortia for the treatment of wastewater (Hosseinzadeh et al., 2020). Such consortia, which consist of diverse environmental microorganisms capable of degrading pollutants in wastewater, are a promising alternative. Moreover, these consortia have several advantages over single-strain usage, such as fast removal of pollutants, facilitation of secondary utilization of treated wastewater, and enhancement of the ecological sustainability (Ji et al., 2020).

One of the pioneering methods for effluent treatment is the creation of consortia. Due to its properties for purifying biomass and its lower energy consumption, the algal-bacterial consortium enjoys certain advantages (Kang et al., 2018). The principal idea within the microbial community is the exploitation of beneficial interactions that help in the detoxification of wastewater. This positive collaboration can be seen most evidently in the interactions in which bacteria contribute to the lowering of biological oxygen demand (BOD), whereas algae take up nitrogen and phosphorus. The association formed among algae and bacteria not only detoxifies the water but also creates a perfect environment for bioremediation (Li et al., 2016). Cyanobacteria perform photosynthesis, where they turn inorganic carbon from wastewater into organic carbon. The CO2, which is released from bacterial oxidation, serves as a carbon source for photosynthetic algae. Organisms like Acinetobacter, which are decomposers, can remove BOD and convert organic carbon sources to CO2, thus encouraging the growth of algae (Lim et al., 2010).

Extensive research on the subject has qualified the microbial consortium as one of the most reliable means for wastewater treatment. Recent experimental studies of the same topic revealed that the use of the Ecobacter bacterial consortium was instrumental in bioaugmentation for the biological removal of nitrogen compounds: microbial reduction reactions converted ammonium, as a result, by the end of the treatment period, a decrease in the ammonium concentration was recorded (Malik and Ahmed, 2012; Liu and Chen, 2016). In their research, Qi et al. capably demonstrated that a well-formed microbial consortium within the phycosphere can be refined and utilized for innovative treatment (Meckenstock et al., 2016). Findings from a study indicated that treating paper pulp wastewater with a microbial consortium of microalgae and bacteria resulted in a high efficiency in the removal of organic compounds and nutrients (Mónica et al., 2016). Rehman et al. explored a microbial consortium comprising Klebsiella sp. LCR187, Acinetobacter sp. BRS156, Bacillus subtilis LOR166, Typha domingensis, Acinetobacter junii TYRH47, and Leptochloa fuscat for treating oil field wastewater (Newman and Reynolds, 2004). Tara et al. indicated an over 90% efficiency in pollutant removal from textile wastewater using a microbial consortium (Poo et al., 2018). Leong et al. noted a 94% efficiency in eliminating pollutants from municipal effluents utilizing a microalgae consortium with bacteria. Microorganisms perform degradation by secreting various enzymes and organic acids (Qiu et al., 2021; Goswami et al., 2022)

Monica et al. employed Effective Microorganisms (EM), which include Saccharomyces, Pseudomonas, Aspergillus, Streptomyces, and Lactobacillus, to facilitate the biodegradation of sewage contaminants in aquatic environments. Within this microbial group, Lactobacillus is responsible for breaking down lignin and cellulose. Pseudomonas contributes by releasing bioactive substances that mitigate sewage effects and detoxify or precipitate metals. Aspergillus swiftly decomposes organic materials, yielding alcohol and esters (Rathoure, 2015).

Molecularly designed microbial systems for future applications are revolutionizing wastewater treatment by offering exact and efficient pollutant removal. When combined with nanotechnology, it goes a long way in enhancing treatment precision, inspection, and recovery of bioenergy as well as other valuable products, thereby presenting wastewater as a resource under the circular economy model.

CRISPR-Cas9 technology is the major factor behind the breakthrough in microbial wastewater management, as it allows for the design of genetically modified microorganisms with high pollutant degradation, stress resistance, and bioremediation abilities. In contrast to traditional microbial treatments that depend on naturally occurring strains, CRISPR facilitates direct metabolic changes for decomposing complex contaminants such as pharmaceuticals, heavy metals, and persistent organics. In addition, it has been utilized with success in model organisms like E. coli and Pseudomonas in algae, and non-model bacteria to promote biomass, pollutant uptake, and heavy metal lowering. In addition, multiplexing features enable the adjustment of numerous genes at once, resulting in microorganisms capable of diverse functions in a complex wastewater environment (Bravo et al., 2022; John and Rajan, 2022)

Biological nanomaterial-based microbes also represent highly effective wastewater purification techniques of the future because of their green production, biological compatibility, and high reactivity. The microbial strains Bacillus subtilis, Acinetobacter sp., Aspergillus niger, and Fusarium oxysporum are known producing agents of the technology of metal and metal oxide (Ag, ZnO, FeO) nanoparticles that serve as both pollutant adsorbents and catalysts (John and Rajan, 2022). Together, these innovations mark a shift from conventional treatment paradigms toward integrated, intelligent, and sustainable microbial systems, positioning wastewater not as waste, but as a resource.

6. Conclusion

The complexity and volume of wastewater that is going to rise in the future call for new treatment systems, which are both innovative and sustainable. The review presents convincing evidence that microbial systems represent a broadly applicable, environmentally friendly alternative to the treatment of different categories of pollutants such as heavy metals, dyes, pharmaceuticals, pesticides, and hydrocarbons. Various microorganisms, such as bacteria, fungi, algae, protozoa, and genetically modified strains, have been demonstrated to have different metabolic and biosorptive pathways that can efficiently degrade pollutants, cycle nutrients, and recover resources. Several microbial technologies, including anaerobic digestion, constructed wetlands, biofilm reactors, and enzymatic degradation, show strong potential for large-scale implementation across domestic, industrial, and agro-industrial wastewater sectors.

Moreover, genetic engineering, when combined with the use of MFCs as a treatment strategy, not only further improves the work but also serves as a source of energy generation and another step towards circular bioeconomy goals. Actually, microbial remediation leads to less environmental toxicity, thus it is good for public health and a prerequisite for water security in the future. By gathering state-of-the-art research and microbial strategies, this review provides a foundation for further advancement in bioremediation technologies. However, a successful transition from laboratory research to field-scale implementation will require sustained interdisciplinary collaboration, supportive regulatory frameworks, and extensive pilot-scale validation. Ultimately, harnessing the potential of microbial systems could transform wastewater treatment into a regenerative process aligned with long-term sustainability and resilience goals. Despite ongoing challenges, such as environmental unpredictability, scalability, and regulatory hurdles, the ongoing advancement of biotechnological tools, including synthetic biology and bioengineering, offers significant promise. To fully harness the potential of microbially driven wastewater solutions, future initiatives should prioritize interdisciplinary innovation, supportive policies, and the creation of scalable, resilient treatment systems that align with global sustainability objectives.

Acknowledgement

The authors extend their appreciation to the Deputyship for Research and Innovation, Ministry of Education in Saudi Arabia for funding this research (IFKSU-HCRA-11-2).

CRediT authorship contribution statement

Aishwarya Bhaskaralingam: Investigation, Writing original draft. Mu. Naushad: Writing – review & editing. Pooja Dhiman: Writing review & editing. Tongtong Wang: Writing review & editing. Siddharth Jain: Writing review & editing. Dinesh Kumar: Writing review & editing. Gaurav Sharma: Conceptualization, Supervision, Writing review & editing.

Declaration of competing interest

Patient’s consent not required as there are no patients in this study.

Data availability

No new data was used for the research described in the article.

Declaration of generative AI and AI-assisted technologies in the writing process

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

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