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The environmental and epidemiological problems caused by antibiotics and antibiotic resistance genes have attracted a lot of attention. The use of electron shuttles based on enhanced extracellular electron transfer for anaerobic biological treatment to remove widespread antibiotics and antibiotic resistance genes efficiently from wastewater or organic solid waste is a promising technology. This paper reviewed the development of electron shuttles, described the mechanism of action of different electron shuttles and the application of enhanced anaerobic biotreatment with electron shuttles for the removal of antibiotics and related genes. Finally, we discussed the current issues and possible future directions of electron shuttle technology.

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Efficient conversion of organic waste into low-carbon biofuels such as methane through anaerobic digestion (AD) is a promising technology to alleviate energy shortages. However, issues such as inefficient methane production and poor system stability remain for AD technology. Biochar-facilitated direct interspecies electron transfer (DIET) has recently been recognized as an important strategy to improve AD performance. Nonetheless, the underlying mechanisms of biochar-facilitated DIET are still largely unknown. For this reason, this review evaluated the role of biochar-facilitated DIET mechanism in enhancing AD performance. First, the evolution of DIET was introduced. Then, applications of biochar-facilitated DIET for alleviating antibiotic inhibition and enhancing methanogenesis were summarized. Next, the electrochemical mechanism of biochar-facilitated DIET including electrical conductivity, redox-active characteristics, and electron transfer system activity was discussed. It can be concluded that biochar increased the abundance of potential DIET microorganisms, facilitated microbial aggregation, and regulated DIET-associated gene expression as a microbial mechanism. Finally, we also discussed the challenges of biochar in practical application. This review elucidated the role of DIET facilitated by biochar in the AD system, which would advance our understanding of the DIET mechanism underpinning the interaction of biochar and anaerobic microorganisms. However, direct evidence for the occurrence of biochar-facilitated DIET still requires further investigation.