The impact of microplastics (MPs) on aquatic life, given their ubiquitous presence in the water compartment, represents a growing concern. Consistently, scientific knowledge is advancing rapidly, although evidence on actual adverse effects is still highly fragmented. This paper summarizes the recent literature on MP impacts on aquatic organisms in an attempt to link routes of uptake, possible alterations of physiological processes, and outcomes at different levels of biological organization. Animal feeding strategies and MP biodistribution is discussed, alongside with relevant effects at molecular, cellular, and systemic level. Pathways from animal exposure to apical physiological responses are examined to define the relevance of MPs for animal health, and to point out open questions and research gaps. Emphasis is given to emerging threats posed by leaching of plastic additives, many of which have endocrine disruption potential. The potential role of MPs as substrates for microorganism growth and vehicle for pathogen spreading is also addressed.

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