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Kucera C, Ramalingam A, Srivastava S, Bhatnagar A, Carll AP. Nicotine Formulation Influences the Autonomic and Arrhythmogenic Effects of Electronic Cigarettes. Nicotine Tob Res 2024; 26:536-544. [PMID: 38011908 PMCID: PMC11033561 DOI: 10.1093/ntr/ntad237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/09/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Evidence is mounting that electronic cigarette (e-cig) use induces cardiac sympathetic dominance and electrical dysfunction conducive to arrhythmias and dependent upon nicotine. A variety of nicotine types and concentrations are available in e-cigs, but their relative cardiovascular effects remain unclear. Here we examine how different nicotine forms (racemic, free base, and salt) and concentrations influence e-cig-evoked cardiac dysfunction and arrhythmogenesis and provide a mechanism for nicotine-salt-induced autonomic imbalance. METHODS ECG-telemetered C57BL/6J mice were exposed to filtered air (FA) or e-cig aerosols from propylene glycol and vegetable glycerin solvents either without nicotine (vehicle) or with increasing nicotine concentrations (1%, 2.5%, and 5%) for three 9-minute puff sessions per concentration. Spontaneous ventricular premature beat (VPB) incidence rates, heart rate, and heart rate variability (HRV) were compared between treatments. Subsequently, to test the role of β1-adrenergic activation in e-cig-induced cardiac effects, mice were pretreated with atenolol and exposed to either FA or 2.5% nicotine salt. RESULTS During puffing and washout phases, ≥2.5% racemic nicotine reduced heart rate and increased HRV relative to FA and vehicle controls, indicating parasympathetic dominance. Relative to both controls, 5% nicotine salt elevated heart rate and decreased HRV during washout, suggesting sympathetic dominance, and also increased VPB frequency. Atenolol abolished e-cig-induced elevations in heart rate and declines in HRV during washout, indicating e-cig-evoked sympathetic dominance is mediated by β1-adrenergic stimulation. CONCLUSIONS Our findings suggest that inhalation of e-cig aerosols from nicotine-salt-containing e-liquids could increase the cardiovascular risks of vaping by inducing sympathetic dominance and cardiac arrhythmias. IMPLICATIONS Exposure to e-cig aerosols containing commercially relevant concentrations of nicotine salts may increase nicotine delivery and impair cardiac function by eliciting β1-adrenoceptor-mediated sympathoexcitation and provoking ventricular arrhythmias. If confirmed in humans, our work suggests that regulatory targeting of nicotine salts through minimum pH standards or limits on acid additives in e-liquids may mitigate the public health risks of vaping.
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Affiliation(s)
- Cory Kucera
- Department of Physiology, University of Louisville School of Medicine (ULSOM), Louisville, KY, USA
- Christina Lee Brown Envirome Institute, ULSOM, Louisville, KY, USA
- American Heart Association Tobacco Regulation and Addiction Center 2.0 (A-TRAC 2.0), ULSOM, Louisville, KY, USA
- Center for Cardiometabolic Science, ULSOM, Louisville, KY, USA
| | - Anand Ramalingam
- Christina Lee Brown Envirome Institute, ULSOM, Louisville, KY, USA
- American Heart Association Tobacco Regulation and Addiction Center 2.0 (A-TRAC 2.0), ULSOM, Louisville, KY, USA
- Center for Cardiometabolic Science, ULSOM, Louisville, KY, USA
| | - Shweta Srivastava
- Christina Lee Brown Envirome Institute, ULSOM, Louisville, KY, USA
- American Heart Association Tobacco Regulation and Addiction Center 2.0 (A-TRAC 2.0), ULSOM, Louisville, KY, USA
- Center for Cardiometabolic Science, ULSOM, Louisville, KY, USA
| | - Aruni Bhatnagar
- Christina Lee Brown Envirome Institute, ULSOM, Louisville, KY, USA
- American Heart Association Tobacco Regulation and Addiction Center 2.0 (A-TRAC 2.0), ULSOM, Louisville, KY, USA
- Center for Cardiometabolic Science, ULSOM, Louisville, KY, USA
- Division of Environmental Medicine, ULSOM, Louisville, KY, USA
- Center for Integrative Environmental Health Sciences, ULSOM, Louisville, KY, USA
| | - Alex P Carll
- Department of Physiology, University of Louisville School of Medicine (ULSOM), Louisville, KY, USA
- Christina Lee Brown Envirome Institute, ULSOM, Louisville, KY, USA
- American Heart Association Tobacco Regulation and Addiction Center 2.0 (A-TRAC 2.0), ULSOM, Louisville, KY, USA
- Center for Cardiometabolic Science, ULSOM, Louisville, KY, USA
- Division of Environmental Medicine, ULSOM, Louisville, KY, USA
- Center for Integrative Environmental Health Sciences, ULSOM, Louisville, KY, USA
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Han S, Liu C, Chen H, Fu Y, Zhang Y, Miao R, Ren P, Yu P, Shi Z, Tian Y, Wang H, Liu T, Hou H, Hu Q. Pharmacokinetics of freebase nicotine and nicotine salts following subcutaneous administration in male rats. Drug Test Anal 2023; 15:1099-1106. [PMID: 36059224 DOI: 10.1002/dta.3363] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/12/2022] [Accepted: 08/28/2022] [Indexed: 11/08/2022]
Abstract
Nicotine lactate, nicotine tartrate, nicotine benzoate, and freebase nicotine (FBN) are four forms of nicotine salt systems that are present in tobacco products. However, few in vivo studies have compared their pharmacological (pK) efficacies, which are important for understanding their roles in the addiction and abuse of tobacco and nicotine products. In this work, the pK of the above nicotine salt systems was studied by subcutaneously injecting their aqueous solutions in rats and obtaining blood samples from the jugular vein. Nicotine levels in the blood were analyzed by LC-MS/MS. The results demonstrated that rapid nicotine absorption occurred in all nicotine systems. Of them, NB had the smallest Tmax , while FBN had the largest Tmax . The nicotine metabolic rate and clearance decreased for FBN, indicating that nicotine retention in the body was higher than for the other three salt-based systems. Compared with nicotine salts, FBN could reach and maintain a higher concentration in the animal model. Additionally, as the benzoic acid ratios increased, the Cmax of the nicotine benzoate (NB) in the plasma decreased. This indicates that the lower the pH, the lower the Cmax . When different concentrations of NB were used, the higher the NB concentration, the greater the Cmax and AUC(0-t) . These results demonstrate that nicotine adsorption by NB in the animal model depended on both pH and concentration. This baseline information could be used to explain different clinical pharmacological observations in humans, though this study only considered the effects of nicotine on pharmacokinetics in vivo.
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Affiliation(s)
- Shulei Han
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
| | - Chuan Liu
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
| | - Huan Chen
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
| | - Ya'ning Fu
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
| | - Yuan Zhang
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
| | - Ruijuan Miao
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
| | - Peipei Ren
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
| | - Pengpeng Yu
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
| | - Zhihao Shi
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
| | - Yushan Tian
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
| | - Hongjuan Wang
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
| | - Tong Liu
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
| | - Hongwei Hou
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
| | - Qingyuan Hu
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
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Nighbor T, Meredith S, Salazar E, Cartagena C, Koszowski B, Pickworth WB, Hull LC. A Comparison of Use Topography and Nicotine Pharmacokinetics Among Loose and Portioned Smokeless Tobacco Users. Nicotine Tob Res 2023; 25:624-630. [PMID: 35965261 DOI: 10.1093/ntr/ntac195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 06/27/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Moist snuff smokeless tobacco (ST) products are available in the United States in both "loose" and "portioned" (ie, pouched) formats, but no published study to date has clinically evaluated the associations between ST format, use behavior, and nicotine exposure. AIMS AND METHODS Participants used their usual brand of ST (loose ST [n = 30] or portioned ST [n = 20]) during an experimental visit wherein use behavior and plasma nicotine pharmacokinetic parameters were measured following single use (first hour of the session) and ad libitum use (remaining 7 h of the session). Participants' ST products were chemically characterized prior to use for pH and nicotine content. RESULTS The average amount per use (2.99 vs. 1.52 g; p = .005) and total amount used (11.45 vs. 5.4 g; p = .002) were significantly higher among the loose ST group. Maximum plasma nicotine concentration (Cmax; 33.4 vs. 19.1 ng/ml) and area under the nicotine concentration versus time curve (AUC) were significantly higher for the loose ST group for the first hour (1474.8 vs. 807.2 min* ng/ml; p = .003) and throughout the 8-hour session (15827.9 vs. 8155.3 min* ng/ml; p < .001). Significant associations were observed between free nicotine content and first use Cmax (rs = .488, loose ST group) and AUC0-1 h (rs = 0.448, loose ST group; rs = .441, portioned ST group). CONCLUSIONS The loose ST group used more product and had a greater average deposition time per use than the portioned ST group. Nicotine exposure was more strongly associated with free nicotine content than total nicotine content. IMPLICATIONS To our knowledge, the current investigation was the first study to date to clinically evaluate the associations between usual-brand smokeless format, use behavior, and nicotine exposure. We observed meaningful differences in use behavior and subsequent nicotine exposure between loose and portioned ST users. Further, we observed that nicotine exposure was more strongly associated with free nicotine content than total nicotine content.
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Affiliation(s)
| | | | | | | | | | | | - Lynn C Hull
- FDA Center for Tobacco Products, Calverton, MD, USA
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Ratsch A, Bogossian F, Burmeister EA, Ryu B, Steadman KJ. Higher blood nicotine concentrations following smokeless tobacco (pituri) and cigarette use linked to adverse pregnancy outcomes for Central Australian Aboriginal pregnancies. BMC Public Health 2022; 22:2157. [PMID: 36419022 PMCID: PMC9685874 DOI: 10.1186/s12889-022-14609-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In central Australia, Aboriginal women use wild tobacco plants, Nicotiana spp. (locally known as pituri) as a chewed smokeless tobacco, with this use continuing throughout pregnancy and lactation. Our aim was to describe the biological concentrations of nicotine and metabolites in samples from mothers and neonates and examine the relationships between maternal self-reported tobacco use and maternal and neonatal outcomes. METHODS Central Australian Aboriginal mothers (and their neonates) who planned to birth at the Alice Springs Hospital (Northern Territory, Australia) provided biological samples: maternal blood, arterial and venous cord blood, amniotic fluid, maternal and neonatal urine, and breast milk. These were analysed for concentrations of nicotine and five metabolites. RESULTS A sample of 73 women were enrolled who self-reported: no-tobacco use (n = 31), tobacco chewing (n = 19), or smoking (n = 23). Not all biological samples were obtained from all mothers and neonates. In those where samples were available, higher total concentrations of nicotine and metabolites were found in the maternal plasma, urine, breast milk, cord bloods and Day 1 neonatal urine of chewers compared with smokers and no-tobacco users. Tobacco-exposed mothers (chewers and smokers) with elevated blood glucose had higher nicotine and metabolite concentrations than tobacco-exposed mothers without elevated glucose, and this was associated with increased neonatal birthweight. Neonates exposed to higher maternal nicotine levels were more likely to be admitted to Special Care Nursery. By Day 3, urinary concentrations in tobacco-exposed neonates had reduced from Day 1, although these remained higher than concentrations from neonates in the no-tobacco group. CONCLUSIONS This research provides the first evidence that maternal pituri chewing results in high nicotine concentrations in a wide range of maternal and neonatal biological samples and that exposure may be associated with adverse maternal and neonatal outcomes. Screening for the use of all tobacco and nicotine products during pregnancy rather than focusing solely on smoking would provide a more comprehensive assessment and contribute to a more accurate determination of tobacco and nicotine exposure. This knowledge will better inform maternal and foetal care, direct attention to targeted cessation strategies and ultimately improve long-term clinical outcomes, not only in this vulnerable population, but also for the wider population. NOTE TO READERS In this research, the central Australian Aboriginal women chose the term 'Aboriginal' to refer to themselves, and 'Indigenous' to refer to the broader group of Australian First Peoples. That choice has been maintained in the reporting of the research findings.
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Affiliation(s)
- Angela Ratsch
- Research Services, Wide Bay Hospital and Health Services, Nissen Street, Hervey Bay, QLD 4655 Australia
| | - Fiona Bogossian
- University of the Sunshine Coast, Maroochydore, QLD 4558 Australia
| | - Elizabeth A. Burmeister
- Research Services, Wide Bay Hospital and Health Services, Nissen Street, Hervey Bay, QLD 4655 Australia
| | - BoMi Ryu
- Department of Marine Life Science, Jeju National University, Jeju, 63243 Republic of Korea
| | - Kathryn J. Steadman
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102 Australia
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Hoag SW, Mishina EV, Viray L, Wang F, Hollenbeck G, Koszowski B, Pickworth WB. Formulation of Smokeless Tobacco Products with a Wide Range of pH to Study Nicotine Pharmacokinetics and Pharmacodynamics. Pharm Dev Technol 2022; 27:646-653. [PMID: 35850567 DOI: 10.1080/10837450.2022.2102650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The rate of nicotine absorption from tobacco products is a determinant of addiction potential and other detrimental health effects. Oral nicotine bioavailability from moist snuff smokeless tobacco (ST) is influenced by nicotine content, pH, flavors, and tobacco cut. For use in a clinical study testing the effect of pH on nicotine pharmacokinetics, four investigational ST products that differed only in pH were produced. A commercial ST product (Copenhagen Long Cut Original, pH 7.7) was modified with citric acid monohydrate (23 mg/g tobacco) or sodium carbonate (4.6 and 11 mg/g) to create products with pH 5.0, 8.2, and 8.6, respectively. All products - including the original product with pH 7.7 - were individually packaged (approximately 2g) in aluminum foil pouches and stored frozen (-20 °C); pH, nicotine, tobacco-specific nitrosamines, moisture content, and mold and yeast counts were tested for up to 19 months to verify stability. Remarkable stability was demonstrated in this packaging/storage combination. For example, pH from all products were within 0.1 pH units and never exceeded 0.2 units. Nicotine concentration averaged 9.07 mg/g at baseline, maximal deviations from baseline in the four products averaged 0.30 mg/g. Similarly, TSNA, moisture content, yeast, and mold did not materially change. This study illustrates a method of investigational tobacco products formulation by manipulating a single design feature (or component) with the purpose of independently and systematically assessing its influence on nicotine bioavailability in a clinical study.
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Affiliation(s)
| | - Elena V Mishina
- US Food and Drug Administration, Center for Tobacco Products
| | | | - Fang Wang
- University of Maryland School of Pharmacy
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Benowitz NL. The Central Role of pH in the Clinical Pharmacology of Nicotine: Implications for Abuse Liability, Cigarette Harm Reduction and FDA Regulation. Clin Pharmacol Ther 2022; 111:1004-1006. [PMID: 35220591 PMCID: PMC9035094 DOI: 10.1002/cpt.2555] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/07/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Neal L Benowitz
- Research Program in Clinical Pharmacology, Division of Cardiology, Department of Medicine, and Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
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