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Stratford K, Kang JC, Healy SM, Tu Z, Valerio LG. Investigative analysis of blood-brain barrier penetrating potential of electronic nicotine delivery systems (e-cigarettes) chemicals using predictive computational models. Expert Opin Drug Metab Toxicol 2024; 20:647-663. [PMID: 38881199 DOI: 10.1080/17425255.2024.2366385] [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: 12/12/2023] [Accepted: 06/06/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Seizures are known potential side effects of nicotine toxicity and have been reported in electronic nicotine delivery systems (ENDS, e-cigarettes) users, with the majority involving youth or young adults. AREAS COVERED Using chemoinformatic computational models, chemicals (including flavors) documented to be present in ENDS were compared to known neuroactive compounds to predict the blood-brain barrier (BBB) penetration potential, central nervous system (CNS) activity, and their structural similarities. The literature search used PubMed/Google Scholar, through September 2023, to identify individual chemicals in ENDS and neuroactive compounds.The results show that ENDS chemicals in this study contain >60% structural similarity to neuroactive compounds based on chemical fingerprint similarity analyses. The majority of ENDS chemicals we studied were predicted to cross the BBB, with approximately 60% confidence, and were also predicted to have CNS activity; those not predicted to passively diffuse through the BBB may be actively transported through the BBB to elicit CNS impacts, although it is currently unknown. EXPERT OPINION In lieu of in vitro and in vivo testing, this study screens ENDS chemicals for potential CNS activity and predicts BBB penetration potential using computer-based models, allowing for prioritization for further study and potential early identification of CNS toxicity.
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Affiliation(s)
- Kimberly Stratford
- United States Food and Drug Administration, Center for Tobacco Products, Office of Science, Division of Nonclinical Science, Silver Spring, MD, USA
| | - Jueichuan Connie Kang
- United States Food and Drug Administration, Center for Tobacco Products, Office of Science, Division of Nonclinical Science, Silver Spring, MD, USA
- United States Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Sheila M Healy
- United States Food and Drug Administration, Center for Tobacco Products, Office of Science, Division of Nonclinical Science, Silver Spring, MD, USA
- United States Environmental Protection Agency, Washington, DC, USA
| | - Zheng Tu
- United States Food and Drug Administration, Center for Tobacco Products, Office of Science, Division of Nonclinical Science, Silver Spring, MD, USA
| | - Luis G Valerio
- United States Food and Drug Administration, Center for Tobacco Products, Office of Science, Division of Nonclinical Science, Silver Spring, MD, USA
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Franchitto N, Bloch J, Solal C, Pélissier F. Self-poisoning by E-cigarette and E-liquids: National Reports to French Poison Control Centers from July 2019 to December 2020: VIGIlance and VAPE: The VIGIVAPE Study. Nicotine Tob Res 2024; 26:281-288. [PMID: 37422917 DOI: 10.1093/ntr/ntad116] [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: 10/03/2022] [Revised: 06/25/2023] [Accepted: 07/08/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Exposure to e-cigarette liquids, whether intentional or accidental, might lead to adverse events. This study aimed to describe the prevalence and characteristics of exposures to e-liquids reported to French Poison Control Centers. METHODS All e-liquids exposure cases reported to French Poison Control Centers from July 1, 2019, to December 31, 2020, were reviewed. Information was collected about the patient's characteristics, exposure circumstances, management and outcome. RESULTS About 919 cases of exposure to e-liquids were reported. Ages ranged from one month to 89 years, with a mean age of 16.6 ± 18.6 years and a median age of 4 years. The highest number of exposures-50.7%-concerned infants (0-4 years), 3.1% children (5-11 years), 5.9% adolescents (12-17 years), and 40.1% of cases concerned adults. The majority of cases were accidental (95.0%). Intentional exposures (4.9%) were mainly observed in patients older than 12 years of age (P < 0.001). The route of exposure was ingestion in 73.7% of the cases. A total of 455 exposures showed no symptoms or signs related to poisoning. High nicotine concentration in e-liquids was associated with an increase in hospital management (Odds-ratio from 1.77 to 2.60). CONCLUSION Involuntary exposures to e-liquids occurred more often in children under the age of five, mainly by ingestion. Unlike intentional ingestions, unintentional ingestions rarely resulted in severe adverse events. These findings highlight the importance of ongoing surveillance to prevent such exposures and associated injuries, emphasizing the need for effective regulation of these products.
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Affiliation(s)
- Nicolas Franchitto
- Service d'Addictologie Universitaire, Centre Hospitalier de Toulouse-Purpan, Toulouse, France
- CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
| | | | | | - Fanny Pélissier
- Centre Antipoison et Toxicovigilance Occitanie, Centre Hospitalier et Universitaire de Toulouse-Purpan, Toulouse, France
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Sansone L, Milani F, Fabrizi R, Belli M, Cristina M, Zagà V, de Iure A, Cicconi L, Bonassi S, Russo P. Nicotine: From Discovery to Biological Effects. Int J Mol Sci 2023; 24:14570. [PMID: 37834017 PMCID: PMC10572882 DOI: 10.3390/ijms241914570] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
Nicotine, the primary psychoactive agent in tobacco leaves, has led to the widespread use of tobacco, with over one billion smokers globally. This article provides a historical overview of tobacco and discusses tobacco dependence, as well as the biological effects induced by nicotine on mammalian cells. Nicotine induces various biological effects, such as neoangiogenesis, cell division, and proliferation, and it affects neural and non-neural cells through specific pathways downstream of nicotinic receptors (nAChRs). Specific effects mediated by α7 nAChRs are highlighted. Nicotine is highly addictive and hazardous. Public health initiatives should prioritize combating smoking and its associated risks. Understanding nicotine's complex biological effects is essential for comprehensive research and informed health policies. While potential links between nicotine and COVID-19 severity warrant further investigation, smoking remains a significant cause of morbidity and mortality globally. Effective public health strategies are vital to promote healthier lifestyles.
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Affiliation(s)
- Luigi Sansone
- Department of Human Sciences and Quality, Life Promotion San Raffaele University, Via di Val Cannuta 247, 00166 Rome, Italy; (L.S.); (M.B.); (M.C.); (A.d.I.); (S.B.)
- MEBIC Consortium, San Raffaele University, 00166 Rome, Italy
| | - Francesca Milani
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Via di Val Cannuta 247, 00166 Rome, Italy; (F.M.); (R.F.); (L.C.)
| | - Riccardo Fabrizi
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Via di Val Cannuta 247, 00166 Rome, Italy; (F.M.); (R.F.); (L.C.)
| | - Manuel Belli
- Department of Human Sciences and Quality, Life Promotion San Raffaele University, Via di Val Cannuta 247, 00166 Rome, Italy; (L.S.); (M.B.); (M.C.); (A.d.I.); (S.B.)
- MEBIC Consortium, San Raffaele University, 00166 Rome, Italy
| | - Mario Cristina
- Department of Human Sciences and Quality, Life Promotion San Raffaele University, Via di Val Cannuta 247, 00166 Rome, Italy; (L.S.); (M.B.); (M.C.); (A.d.I.); (S.B.)
- Department of Molecular Medicine, University La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Vincenzo Zagà
- Italian Society of Tabaccology (SITAB), 00136 Bologna, Italy;
| | - Antonio de Iure
- Department of Human Sciences and Quality, Life Promotion San Raffaele University, Via di Val Cannuta 247, 00166 Rome, Italy; (L.S.); (M.B.); (M.C.); (A.d.I.); (S.B.)
- Experimental Neurophysiology IRCCS San Raffaele Roma, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Luca Cicconi
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Via di Val Cannuta 247, 00166 Rome, Italy; (F.M.); (R.F.); (L.C.)
| | - Stefano Bonassi
- Department of Human Sciences and Quality, Life Promotion San Raffaele University, Via di Val Cannuta 247, 00166 Rome, Italy; (L.S.); (M.B.); (M.C.); (A.d.I.); (S.B.)
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Via di Val Cannuta 247, 00166 Rome, Italy; (F.M.); (R.F.); (L.C.)
| | - Patrizia Russo
- Department of Human Sciences and Quality, Life Promotion San Raffaele University, Via di Val Cannuta 247, 00166 Rome, Italy; (L.S.); (M.B.); (M.C.); (A.d.I.); (S.B.)
- MEBIC Consortium, San Raffaele University, 00166 Rome, Italy
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Buyel JF. Product safety aspects of plant molecular farming. Front Bioeng Biotechnol 2023; 11:1238917. [PMID: 37614627 PMCID: PMC10442644 DOI: 10.3389/fbioe.2023.1238917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023] Open
Abstract
Plant molecular farming (PMF) has been promoted since the 1990s as a rapid, cost-effective and (most of all) safe alternative to the cultivation of bacteria or animal cells for the production of biopharmaceutical proteins. Numerous plant species have been investigated for the production of a broad range of protein-based drug candidates. The inherent safety of these products is frequently highlighted as an advantage of PMF because plant viruses do not replicate in humans and vice versa. However, a more nuanced analysis of this principle is required when considering other pathogens because toxic compounds pose a risk even in the absence of replication. Similarly, it is necessary to assess the risks associated with the host system (e.g., the presence of toxic secondary metabolites) and the production approach (e.g., transient expression based on bacterial infiltration substantially increases the endotoxin load). This review considers the most relevant host systems in terms of their toxicity profile, including the presence of secondary metabolites, and the risks arising from the persistence of these substances after downstream processing and product purification. Similarly, we discuss a range of plant pathogens and disease vectors that can influence product safety, for example, due to the release of toxins. The ability of downstream unit operations to remove contaminants and process-related toxic impurities such as endotoxins is also addressed. This overview of plant-based production, focusing on product safety aspects, provides recommendations that will allow stakeholders to choose the most appropriate strategies for process development.
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Affiliation(s)
- J. F. Buyel
- Department of Biotechnology (DBT), Institute of Bioprocess Science and Engineering (IBSE), University of Natural Resources and Life Sciences (BOKU), Vienna, Austria
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Becam J, Martin E, Pouradier G, Doudka N, Solas C, Guilhaumou R, Fabresse N. Transdermal Nicotine Poisoning: A Rare Case Report of Occupational Exposure. TOXICS 2023; 11:toxics11050464. [PMID: 37235278 DOI: 10.3390/toxics11050464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
We report a case of accidental nicotine intoxication following transdermal exposure in a 22-year-old man with no medical history, who worked in a company manufacturing e-liquids for electronic cigarettes. He accidentally spilled 300 mL of pure nicotine solution (>99%) on his right leg without wearing protective clothing or a mask. Less than a minute later, he experienced dizziness, nausea, and headaches, followed by painful burning sensations in the affected area. He immediately removed his pants and washed his leg thoroughly with water. He presented to the emergency department two hours later, where he exhibited a respiratory rate of 25 cpm, a heart rate of 70 bpm, headaches, abdominal pain, pallor, and vomiting. He recovered without specific treatment five hours post-intoxication. Plasma levels of nicotine, cotinine, and hydroxycotinine were measured five hours after exposure using liquid chromatography-mass spectrometry. The concentrations found were 447 ng/mL for nicotine, 1254 ng/mL for cotinine, and 197 ng/mL for hydroxycotinine. Nicotine is an alkaloid that can be highly toxic, with doses of 30-60 mg being potentially fatal. Transdermal intoxication is rare, with very few cases reported in the literature. This case highlights the risk of acute intoxication through cutaneous exposure to nicotine-containing liquid products and the need for protective clothing when handling such products in a professional context.
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Affiliation(s)
- Jenny Becam
- Laboratory of Pharmacokinetics and Toxicology, La Timone University Hospital, 264 Rue Saint Pierre, CEDEX 5, 13385 Marseille, France
| | - Edouard Martin
- Intensive Care Unit, Laveran Military Teaching Hospital, 34 Boulevard Laveran, 13384 Marseille, France
| | - Gildas Pouradier
- Intensive Care Unit, Laveran Military Teaching Hospital, 34 Boulevard Laveran, 13384 Marseille, France
| | - Natalia Doudka
- Department of Clinical Pharmacology and Pharmacovigilance, La Timone University Hospital, 264 Rue Saint Pierre, CEDEX 5, 13385 Marseille, France
| | - Caroline Solas
- Laboratory of Pharmacokinetics and Toxicology, La Timone University Hospital, 264 Rue Saint Pierre, CEDEX 5, 13385 Marseille, France
| | - Romain Guilhaumou
- Department of Clinical Pharmacology and Pharmacovigilance, La Timone University Hospital, 264 Rue Saint Pierre, CEDEX 5, 13385 Marseille, France
- Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM UMR 1106, 13385 Marseille, France
| | - Nicolas Fabresse
- Laboratory of Pharmacokinetics and Toxicology, La Timone University Hospital, 264 Rue Saint Pierre, CEDEX 5, 13385 Marseille, France
- Economic and Social Sciences of Health and Medical Information Processing, Aix Marseille University, INSERM UMR 1252, IRD, SESSTIM, 13385 Marseille, France
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Tweet MS, Wilson M, Rosario JM, Duong M. Acute Pediatric Liquid Nicotine Ingestions. Pediatr Ann 2023; 52:e187-e191. [PMID: 37159065 DOI: 10.3928/19382359-20230307-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Electronic cigarette and vaping device use in the household represents a possible source of unintentional nicotine exposure to pediatric patients. Although most ingestions of nicotine may be mild, there is a potential for significant toxicity. Nicotine toxicity can present similarly to many other types of ingestions, which makes the history an important piece of the encounter. Treatment of nicotine toxicity is primarily supportive care directed at the presenting signs and symptoms. There is no antidotal therapy for nicotine toxicity. This review covers information that can assist clinicians who might treat a pediatric patient presenting with significant nicotine toxicity after the accidental ingestion of liquid nicotine products. [Pediatr Ann. 2023;52(5):e187-e191.].
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Aspera-Werz RH, Mück J, Linnemann C, Herbst M, Ihle C, Histing T, Nussler AK, Ehnert S. Nicotine and Cotinine Induce Neutrophil Extracellular Trap Formation-Potential Risk for Impaired Wound Healing in Smokers. Antioxidants (Basel) 2022; 11:antiox11122424. [PMID: 36552632 PMCID: PMC9774423 DOI: 10.3390/antiox11122424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Smoking undoubtedly affects human health. Investigating 2318 representative patients at a level 1 trauma center identified delayed wound healing, tissue infections, and/or sepsis as main complications in smokers following trauma and orthopedic surgery. Therefore, smoking cessation is strongly advised to improve the clinical outcome in these patients, although smoking cessation often fails despite nicotine replacement therapy raising the need for specific interventions that may reduce the complication rate. However, the underlying mechanisms are still unknown. In diabetics, delayed wound healing and infections/sepsis are associated with increased neutrophilic PADI4 expression and formation of neutrophil extracellular traps (NETs). The aim was to investigate if similar mechanisms hold for smokers. Indeed, our results show higher PADI4 expression in active and heavy smokers than non-smokers, which is associated with an increased complication rate. However, in vitro stimulation of neutrophils with cigarette smoke extract (CSE) only moderately induced NET formation despite accumulation of reactive oxygen species (ROS). Physiological levels of nicotine and its main metabolite cotinine more effectively induced NET formation, although they did not actively induce the formation of ROS, but interfered with the activity of enzymes involved in anti-oxidative defense and NET formation. In summary, we propose increased formation of NETs as possible triggers for delayed wound healing, tissue infections, and/or sepsis in smokers after a major trauma and orthopedic surgery. Smoking cessation might reduce this effect. However, our data show that smoking cessation supported by nicotine replacement therapy should be carefully considered as nicotine and its metabolite cotinine effectively induced NET formation in vitro, even without active formation of ROS.
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Lee JE, Jang TC, Seo YW. Unintentional fatal toxicity due to nicotine chewing gum: A case report. Medicine (Baltimore) 2022; 101:e31225. [PMID: 36316878 PMCID: PMC9622611 DOI: 10.1097/md.0000000000031225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RATIONALE Since tobacco contains numerous harmful substances, besides nicotine, which is addictive, smoking cessation products and tobacco alternatives, such as electronic (e-) cigarettes, nicotine chewing gums, and patches, are being widely used. Nicotine gums are consumed orally. The nicotine from the gum is absorbed at a slower rate than that from e-cigarettes, and the former remains in the bloodstream for a longer period. In addition, the maximum number of daily doses is high, and it can be purchased without a doctor's prescription in many countries. PATIENT CONCERNS A 29-year-old male patient consumed 5 2-mg nicotine gums at a time, twice a day, for 4 days (total amount: 70 mg). However, he visited the emergency unit with the chief complaint of involuntary limb movements after consuming an additional 15 gums 3 hour before the visit. At admission, his consciousness was clear, although 2 hour later, he experienced sudden loss of consciousness with worsening hypoxia and respiratory acidosis. DIAGNOSIS The patient's vital signs were stable at the time of admission, and blood test results showed no specific findings other than a white blood cell count of 14,800/µL, lactate level of 6.4 mmol/L, and prolactin level of 119.02 ng/mL. In addition, chest radiography and head computed tomography scans showed no acute phase abnormalities. Two hours later, he experienced loss of consciousness and respiratory failure, and the results of blood tests performed at this time showed that his blood cotinine level was 3491 ng/mL. INTERVENTIONS Supportive treatment, including endotracheal intubation followed by mechanical ventilation, was provided. OUTCOME The patient's vital signs stabilized 3 days after treatment, and his consciousness and respiratory status had improved; therefore, mechanical ventilation was stopped. His condition was stable for the next 2 days, and he was discharged on the fifth day. LESSONS Acute respiratory exacerbation due to nicotine poisoning (from levels exceeding the lethal dose of 30-60 mg) was observed, although the gums were consumed over several days. Patients with nicotine poisoning may show acute respiratory failure and should be monitored carefully. Further studies are required to determine the toxic effects of nicotine replacement therapies.
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Affiliation(s)
- Jung Eun Lee
- Department of Emergency Medicine, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Tae Chang Jang
- Department of Emergency Medicine, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Young Woo Seo
- Department of Emergency Medicine, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
- * Correspondence: Young Woo Seo, Department of Emergency Medicine, School of Medicine, Catholic University, 33, Duryugonwon-ro 17-gil, Nam-gu, Daegu 42472, Republic of Korea (e-mail: )
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Perucic AM, Sandoval RC, Malik S, Morales-Zamora G. Taxation of novel and emerging nicotine and tobacco products (HTPs, ENDS, and ENNDS) globally and in Latin America. Rev Panam Salud Publica 2022; 46:e175. [PMID: 36267147 PMCID: PMC9559335 DOI: 10.26633/rpsp.2022.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
This article provides a snapshot of the market structure and regulatory approaches around novel and emerging tobacco and nicotine products, both globally and in Latin America, with a focus on excise taxation. Using data from leading market research companies, the WHO Report on the Global Tobacco Epidemic 2021, and country laws and decrees, the article analyses the evolution and market structure of heated tobacco products (HTPs), electronic nicotine delivery systems (ENDS), and electronic non-nicotine delivery systems (ENNDS). This is followed by a summary review of regulatory approaches adopted by countries toward these products, with a particular focus on excise tax policies currently implemented. Based on the well-established knowledge about tobacco taxation best practices and on WHO’s recent recommendations on the taxation of novel and emerging tobacco and nicotine products, the authors then discuss possible elements of a good tax policy approach for countries to consider.
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Affiliation(s)
| | | | - Sehr Malik
- Pan American Health Organization, Washington, D.C., United States of America
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Sellner J, Hauer L, Rinaldi F, Covi M, Brigo F, Pikija S, Nardone R. Embolic Stroke Following Ingestion of Liquid Nicotine Refill Solution. Neurohospitalist 2022; 12:693-696. [PMID: 36147756 PMCID: PMC9485683 DOI: 10.1177/19418744221115523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
The use of e-cigarettes is gaining popularity despite knowing about cardiovascular health risks. Cases of intentional or accidental intoxication following ingestion of the refill solution are also a growing concern. Most of these cases were fatal and related to cardiac arrest and hypoxic brain injury. We report the case of a 54-year-old woman who developed bilateral acute ischemic stroke in the anterior and posterior cerebral circulation following intentional oral intake of e-liquid nicotine refill solution. The diagnostic work-up concluded an etiology of embolic stroke of undetermined source, most likely of cardiac origin. We assume that sympathetic overactivation lead to temporary cardiac arrhythmia and subsequent thrombi formation. Moreover, we discuss several additional pathogenic aspects of oral intake of e-liquid refill solution for the development of central nervous system pathology. This case expands the clinical spectrum of health hazards associated with the introduction of e-cigarettes and raises awareness of the need for preventive measures.
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Affiliation(s)
- Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Larissa Hauer
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Fabrizio Rinaldi
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Markus Covi
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Slaven Pikija
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Raffaele Nardone
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
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Sebokolodi TI, Sipuka DS, Muzenda C, Nkwachukwu OV, Nkosi D, Arotiba OA. Electrochemical detection of nicotine at a carbon Nanofiber-Poly(amidoamine) dendrimer modified glassy carbon electrode. CHEMOSPHERE 2022; 303:134961. [PMID: 35577133 DOI: 10.1016/j.chemosphere.2022.134961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/25/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
Development of electrochemical sensors for important drugs such nicotine (an addictive drug) is important for the society. This study reports the electrochemical detection of nicotine at a carbon nanofiber/poly (amidoamine) dendrimer modified glassy carbon electrode. The carbon nanofiber (CNF) modified GCE was prepared by drop-coating followed by the electrodeposition of generation 4 poly (amidoamine) succinamic acid dendrimer (PAMAM) to form the sensor - CNF-PAMAM GCE. Characterization of prepared materials and modified electrodes was carried out using Fourier transmission infrared spectroscopy, field emission scanning electron microscopy, transmission electron microscopy, Raman spectroscopy, cyclic voltammetry, electrochemical impedance spectroscopy (EIS) and differential pulse voltammetry (DPV). The CNF-PAMAM composite was confirmed by microscopy. A marked reduction in charge transfer resistance and increase in current of the CNF-PAMAM GCE in comparison to the bare electrode showed a synergic improvement electrochemical response because of the CNF-PAMAM nanocomposite. The CNF-PAMAM demonstrated an enhanced performance in the oxidation of nicotine in comparison to the bare GCE by shifting the anodic potential Epa of nicotine from 0.9 V to 0.8 V. The electrochemical sensor achieved a detection limit (LOD) of 0.02637 μM in the concentration range of 0.4815-15.41 μM of nicotine in 0.1 M PBS at pH 7.5. The sensor ability to determine nicotine in real samples was assessed in cigarettes obtaining recovery percentages of 88.00 and 97.42%. The sensor demonstrated selectivity toward nicotine in the presence of interferences. Finally, the method was validated by ultraviolet-visible spectroscopy analysis.
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Affiliation(s)
- Tsholofelo I Sebokolodi
- Department of Chemical Sciences, University of Johannesburg, Doornfontein, 2028, South Africa
| | - Dimpo S Sipuka
- Department of Chemical Sciences, University of Johannesburg, Doornfontein, 2028, South Africa
| | - Charles Muzenda
- Department of Chemical Sciences, University of Johannesburg, Doornfontein, 2028, South Africa
| | - Oluchi V Nkwachukwu
- Department of Chemical Sciences, University of Johannesburg, Doornfontein, 2028, South Africa
| | - Duduzile Nkosi
- Department of Chemical Sciences, University of Johannesburg, Doornfontein, 2028, South Africa
| | - Omotayo A Arotiba
- Department of Chemical Sciences, University of Johannesburg, Doornfontein, 2028, South Africa; Centre for Nanomaterials Science Research, University of Johannesburg, South Africa.
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Delijewski M, Radad K, Krewenka C, Kranner B, Moldzio R. The Reassessed Impact of Nicotine against Neurotoxicity in Mesencephalic Dopaminergic Cell Cultures and Neuroblastoma N18TG2 Cells. PLANTA MEDICA 2022; 88:548-558. [PMID: 34229355 DOI: 10.1055/a-1527-1390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Neuroprotective effects of nicotine are still under debate, so further studies on its effectiveness against Parkinson's disease are required. In our present study, we used primary dopaminergic cell cultures and N18TG2 neuroblastoma cells to investigate the effect of nicotine and its neuroprotective potential against rotenone toxicity. Nicotine protected dopaminergic (tyrosine hydroxylase immunoreactive) neurons against rotenone. This effect was not nAChR receptor-dependent. Moreover, the alkaloid at a concentration of 5 µM caused an increase in neurite length, and at a concentration of 500 µM, it caused an increase in neurite count in dopaminergic cells exposed to rotenone. Nicotine alone was not toxic in either cell culture model, while the highest tested concentration of nicotine (500 µM) caused growth inhibition of N18TG2 neuroblastoma cells. Nicotine alone increased the level of glutathione in both cell cultures and also in rotenone-treated neuroblastoma cells. The obtained results may be helpful to explain the potential neuroprotective action of nicotine on neural cell cultures.
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Affiliation(s)
- Marcin Delijewski
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Khaled Radad
- Department of Pathology, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - Christopher Krewenka
- Institute of Medical Biochemistry, Department of Biomedical Sciences, University of Veterinary Medicine, Vienna, Austria
| | - Barbara Kranner
- Institute of Medical Biochemistry, Department of Biomedical Sciences, University of Veterinary Medicine, Vienna, Austria
| | - Rudolf Moldzio
- Institute of Medical Biochemistry, Department of Biomedical Sciences, University of Veterinary Medicine, Vienna, Austria
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Nicotine Affects Multiple Biological Processes in EpiDermTM Organotypic Tissues and Keratinocyte Monolayers. ATMOSPHERE 2022. [DOI: 10.3390/atmos13050810] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Dermal exposure to nicotine is common due to the widespread use of tobacco products. Here, we assessed the effects of nicotine at concentrations found in thirdhand smoke (THS) contaminated environments and electronic cigarette (EC) spills or leaks on a 3D human skin model (EpiDermTM) and on submerged keratinocyte cultures. Air liquid interface treatment of EpiDermTM with 10 or 400 μg/mL of nicotine for 24 h followed by proteomics analysis showed altered pathways related to inflammation, protein synthesis, cell–cell adhesion, apoptosis, and mitochondrial function. Submerged cultured keratinocytes were used to validate the proteomics data and further characterize the response of skin cells to nicotine. Mitochondrial phenotype changed from networked to punctate in keratinocytes treated with 10 or 400 μg/mL of nicotine for 48 h and 24 h, respectively. After 72 h, all concentrations of nicotine caused a significant decrease in the networked phenotype. In Western blots, keratinocytes exposed to 400 μg/mL of nicotine had a significant decrease in mitofusin 2, while mitofusin 1 decreased after 72 h. The shift from networked to punctate mitochondria correlated with a decrease in mitofusin 1/2, a protein needed to establish and maintain the networked phenotype. Mitochondrial changes were reversible after a 24 h recovery period. Peroxisomes exposed to 400 μg/mL of nicotine for 24 h became enlarged and were fewer in number. Nicotine concentrations in THS and EC spills altered the proteome profile in EpiDermTM and damaged organelles including mitochondria and peroxisomes, which are involved in ROS homeostasis. These changes may exacerbate skin infections, inhibit wound healing, and cause oxidative damage to cells in the skin.
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14
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15
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Henstra C, Dekkers BGJ, Olgers TJ, Ter Maaten JC, Touw DJ. Managing intoxications with nicotine-containing e-liquids. Expert Opin Drug Metab Toxicol 2022; 18:115-121. [PMID: 35345955 DOI: 10.1080/17425255.2022.2058930] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Nicotine is an addictive and poisonous agent. The recent development of e-cigarettes has caused a new demand for highly concentrated nicotine-containing solutions. These concentrated nicotine solutions have also increased the risk of nicotine overdoses. AREAS COVERED Essential factors for nicotine exposure are the concentration of the nicotine-containing e-liquid solution and its pharmacokinetics. Liquid nicotine refills contain nicotine in varying concentrations, which vary widely between and within products. The pharmacokinetics of nicotine are dependent on the route of administration, renal/hepatic clearance and urinary pH. The dose is another essential determinant of nicotine exposure. There is a considerable discrepancy between the generally accepted lethal dose and symptoms reported in case studies. Ingested doses correlate poorly to clinical symptoms. Symptoms of liquid nicotine toxicity vary from mild to severe between patients and are the result of overstimulation of nicotinic acetylcholine receptors, which may lead to fatal respiratory failure and cardiovascular collapse. EXPERT OPINION The literature on nicotine-containing e-liquid intoxications originating from vaping device refills are mainly case reports. Based on these case reports, we propose a treatment plan which is primarily symptomatic. Research should focus on providing insight on its toxicity, based on oral and transdermal pharmacokinetics and on toxicodynamics.
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Affiliation(s)
- Charlotte Henstra
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pharmaceutical Analysis, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - Bart G J Dekkers
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tycho J Olgers
- Department of Internal Medicine, Emergency Department, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan C Ter Maaten
- Department of Internal Medicine, Emergency Department, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pharmaceutical Analysis, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
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16
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Application of HPLC-QQQ-MS/MS and New RP-HPLC-DAD System Utilizing the Chaotropic Effect for Determination of Nicotine and Its Major Metabolites Cotinine, and trans-3'-Hydroxycotinine in Human Plasma Samples. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27030682. [PMID: 35163947 PMCID: PMC8839739 DOI: 10.3390/molecules27030682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 01/14/2023]
Abstract
The routine techniques currently applied for the determination of nicotine and its major metabolites, cotinine, and trans-3′-hydroxycotinine, in biological fluids, include spectrophotometric, immunoassays, and chromatographic techniques. The aim of this study was to develop, and compare two new chromatographic methods high-performance liquid chromatography coupled to triple quadrupole mass spectrometry (HPLC-QQQ-MS/MS), and RP-HPLC enriched with chaotropic additives, which would allow reliable confirmation of tobacco smoke exposure in toxicological and epidemiological studies. The concentrations of analytes were determined in human plasma as the sample matrix. The methods were compared in terms of the linearity, accuracy, repeatability, detection and quantification limits (LOD and LOQ), and recovery. The obtained validation parameters met the ICH requirements for both proposed procedures. However, the limits of detection (LOD) were much better for HPLC-QQQ-MS/MS (0.07 ng mL−1 for trans-3′-hydroxcotinine; 0.02 ng mL−1 for cotinine; 0.04 ng mL−1 for nicotine) in comparison to the RP-HPLC-DAD enriched with chaotropic additives (1.47 ng mL−1 for trans-3′-hydroxcotinine; 1.59 ng mL−1 for cotinine; 1.50 ng mL−1 for nicotine). The extraction efficiency (%) was concentration-dependent and ranged between 96.66% and 99.39% for RP-HPLC-DAD and 76.8% to 96.4% for HPLC-QQQ-MS/MS. The usefulness of the elaborated analytical methods was checked on the example of the analysis of a blood sample taken from a tobacco smoker. The nicotine, cotinine, and trans-3′-hydroxycotinine contents in the smoker’s plasma quantified by the RP-HPLC-DAD method differed from the values measured by the HPLC-QQQ-MS/MS. However, the relative errors of measurements were smaller than 10% (6.80%, 6.72%, 2.04% respectively).
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17
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Cool T, Baena ARY, Forsberg EC. Clearing the Haze: How Does Nicotine Affect Hematopoiesis before and after Birth? Cancers (Basel) 2021; 14:184. [PMID: 35008347 PMCID: PMC8750289 DOI: 10.3390/cancers14010184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022] Open
Abstract
Hematopoiesis is a tightly regulated process orchestrated by cell-intrinsic and cell-extrinsic cues. Over the past several decades, much effort has been focused on understanding how these cues regulate hematopoietic stem cell (HSC) function. Many endogenous key regulators of hematopoiesis have been identified and extensively characterized. Less is known about the mechanisms of long-term effects of environmental toxic compounds on hematopoietic stem and progenitor cells (HSPCs) and their mature immune cell progeny. Research over the past several decades has demonstrated that tobacco products are extremely toxic and pose huge risks to human health by causing diseases like cancer, respiratory illnesses, strokes, and more. Recently, electronic cigarettes have been promoted as a safer alternative to traditional tobacco products and have become increasingly popular among younger generations. Nicotine, the highly toxic compound found in many traditional tobacco products, is also found in most electronic cigarettes, calling into question their purported "safety". Although it is known that nicotine is toxic, the pathophysiology of disease in exposed people remains under investigation. One plausible contributor to altered disease susceptibility is altered hematopoiesis and associated immune dysfunction. In this review, we focus on research that has addressed how HSCs and mature blood cells respond to nicotine, as well as identify remaining questions.
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Affiliation(s)
- Taylor Cool
- Program in Molecular, Cell, and Developmental Biology, Institute for the Biology of Stem Cells, University of California Santa Cruz, Santa Cruz, CA 95064, USA; (T.C.); (A.R.y.B.)
| | - Alessandra Rodriguez y Baena
- Program in Molecular, Cell, and Developmental Biology, Institute for the Biology of Stem Cells, University of California Santa Cruz, Santa Cruz, CA 95064, USA; (T.C.); (A.R.y.B.)
| | - E. Camilla Forsberg
- Institute for the Biology of Stem Cells, Department of Biomolecular Engineering, University of California Santa Cruz, Santa Cruz, CA 95064, USA
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18
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Morgan J, Jones A, Kelso C. Nicotine in electronic cigarette fluid: importation pathways to unequal harm. Intern Med J 2021; 51:1156-1159. [PMID: 34278688 DOI: 10.1111/imj.15412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/25/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022]
Abstract
The Australian Government recently walked away from changes to the importation of nicotine-containing electronic cigarette fluids, originally due to come into force on 1 January 2021. Additionally, the Therapeutic Goods Administration is in the process of rescheduling nicotine for use in e-fluids. We are concerned that the 270 000 daily vapers in Australia will purchase high concentrations of nicotine (≥100 mg/mL) for mixing with nicotine-free locally purchased e-fluids, which is a pathway of increased relative harm. We would like to see regulation of these products to limit the maximum concentration of nicotine, ensure appropriate child-resistant containers and compulsory labelling for all nicotine-containing e-fluid bottles.
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Affiliation(s)
- Jody Morgan
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Alison Jones
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Celine Kelso
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.,Molecular Horizons Institute, University of Wollongong, Wollongong, New South Wales, Australia
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19
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Prisco L, Sarwal A, Ganau M, Rubulotta F. Toxicology of Psychoactive Substances. Crit Care Clin 2021; 37:517-541. [PMID: 34053704 DOI: 10.1016/j.ccc.2021.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A trend in the increasing use of prescription psychoactive drugs (PADs), including antidepressants, antipsychotics, and mood stabilizers, has been reported in the United States and globally. In addition, there has been an increase in the production and usage of illicit PADs and emergence of new psychoactive substances (NPSs) all over the world. PADs pose unique challenges for critical care providers who may encounter toxicology issues due to drug interactions, side effects, or drug overdoses. This article provides a summary of the toxicologic features of commonly used and abused PADs: antidepressants, antipsychotics, mood stabilizers, hallucinogens, NPSs, caffeine, nicotine, and cannabis.
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Affiliation(s)
- Lara Prisco
- Neurosciences Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Level 1 West Wing, Headley Way, Oxford OX3 9DU, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Level 6 West Wing, Headley Way, Oxford OX3 9DU, UK.
| | - Aarti Sarwal
- Neurocritical Care Unit, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Mario Ganau
- Neurosciences Department, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Level 2 West Wing, Headley Way, Oxford OX3 9DU, UK
| | - Francesca Rubulotta
- Critical Care Program Department of Anesthesia, McGill University, 845 Sherbrooke St W, Montreal, Quebec H3A 0G4, Canada; Department of Anesthesiology and Intensive Care Medicine, Health Centre, Intensive Care Unit, Imperial College NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
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20
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Marques P, Piqueras L, Sanz MJ. An updated overview of e-cigarette impact on human health. Respir Res 2021; 22:151. [PMID: 34006276 PMCID: PMC8129966 DOI: 10.1186/s12931-021-01737-5] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/03/2021] [Indexed: 12/18/2022] Open
Abstract
The electronic cigarette (e-cigarette), for many considered as a safe alternative to conventional cigarettes, has revolutionised the tobacco industry in the last decades. In e-cigarettes, tobacco combustion is replaced by e-liquid heating, leading some manufacturers to propose that e-cigarettes have less harmful respiratory effects than tobacco consumption. Other innovative features such as the adjustment of nicotine content and the choice of pleasant flavours have won over many users. Nevertheless, the safety of e-cigarette consumption and its potential as a smoking cessation method remain controversial due to limited evidence. Moreover, it has been reported that the heating process itself can lead to the formation of new decomposition compounds of questionable toxicity. Numerous in vivo and in vitro studies have been performed to better understand the impact of these new inhalable compounds on human health. Results of toxicological analyses suggest that e-cigarettes can be safer than conventional cigarettes, although harmful effects from short-term e-cigarette use have been described. Worryingly, the potential long-term effects of e-cigarette consumption have been scarcely investigated. In this review, we take stock of the main findings in this field and their consequences for human health including coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Patrice Marques
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Avda. Blasco Ibañez 15, 46010, Valencia, Spain.,Institute of Health Research INCLIVA, University Clinic Hospital of Valencia, Valencia, Spain
| | - Laura Piqueras
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Avda. Blasco Ibañez 15, 46010, Valencia, Spain.,Institute of Health Research INCLIVA, University Clinic Hospital of Valencia, Valencia, Spain.,CIBERDEM-Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, ISCIII, Av. Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Maria-Jesus Sanz
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Avda. Blasco Ibañez 15, 46010, Valencia, Spain. .,Institute of Health Research INCLIVA, University Clinic Hospital of Valencia, Valencia, Spain. .,CIBERDEM-Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, ISCIII, Av. Monforte de Lemos 3-5, 28029, Madrid, Spain.
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21
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Smith V, Ullah F, Wall G. Survival after intentional ingestion of highly concentrated, bulk nicotine solution. Clin Toxicol (Phila) 2021; 59:1281. [PMID: 33988055 DOI: 10.1080/15563650.2021.1921789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Victoria Smith
- Department of Pharmacy, UnityPoint Health, Des Moines, IA, USA
| | - Fauzia Ullah
- Department of Medicine, UnityPoint Health, Des Moines, IA, USA
| | - Geoffrey Wall
- Department of Pharmacy, UnityPoint Health, 2507 University Avenue, Des Moines, IA, USA
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22
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Amr AEGE, Kamel AH, Almehizia AA, Sayed AYA, Elsayed EA, Abd-Rabboh HSM. Paper-Based Potentiometric Sensors for Nicotine Determination in Smokers' Sweat. ACS OMEGA 2021; 6:11340-11347. [PMID: 34056289 PMCID: PMC8153920 DOI: 10.1021/acsomega.1c00301] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/09/2021] [Indexed: 06/01/2023]
Abstract
Herein, we describe for the first time, the design and fabrication of a novel nicotine paper-based sensor, in which a miniaturized paper reference electrode is integrated for potentiometric measurements. The paper-based sensors were designed using printed wax barriers to define the electrochemical cell and the sample zones. The electrodes were based on the use of the ion association complexes of the nicotinium cation (Nic) with either tetraphenylborate (TPB) or 5-nitrobarbiturate (NB) counter anions as sensing materials for nicotine recognition. A poly (3,4 ethylenedioxythiophene)/poly-(styrene sulfonate) (PEDOT/PSS) conducting polymer was used as an ion-to-electron transducer. The performance characteristics of the proposed sensors were evaluated and it revealed a rapid and stable response with a Nernstian slope of 55.2 ± 0.3 and 51.2 ± 0.6 mV/decade over the linear range of 1.0 × 10-5 to 1.0 × 10-2 M and detection limits of 6.0 and 8.0 μM for [Nic/TPB] and [Nic/NB], respectively. The sensors revealed a constant response over the pH range 3.5-6.5. The designed sensors provided a portable, inexpensive, and disposable way of measuring trace levels of nicotine coming from different cigarettes and in the collected human sweat of heavy smokers. All results were compared favorably with those obtained by the standard gas chromatographic method.
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Affiliation(s)
- Abd El-Galil E. Amr
- Pharmaceutical
Chemistry Department, Drug Exploration and Development Chair (DEDC),
College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
- Applied
Organic Chemistry Department, National Research
Center, Dokki, Giza 12622, Egypt
| | - Ayman H. Kamel
- Department
of Chemistry, Faculty of Science, Ain Shams
University, Cairo 11566, Egypt
| | - Abdulrahman A. Almehizia
- Pharmaceutical
Chemistry Department, Drug Exploration and Development Chair (DEDC),
College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ahmed Y. A. Sayed
- Pharmaceutical
Chemistry Department, Drug Exploration and Development Chair (DEDC),
College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Elsayed A. Elsayed
- Zoology
Department, Faculty of Science, King Saud
University, Riyadh 11451, Saudi Arabia
- Chemistry
of Natural and Microbial Products Department, National Research Centre, Dokki, Cairo 12622, Egypt
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23
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24
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Alberti S, Sotiropoulou M, Fernández E, Solomou N, Ferretti M, Psillakis E. UV-254 degradation of nicotine in natural waters and leachates produced from cigarette butts and heat-not-burn tobacco products. ENVIRONMENTAL RESEARCH 2021; 194:110695. [PMID: 33400945 DOI: 10.1016/j.envres.2020.110695] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/20/2020] [Accepted: 12/27/2020] [Indexed: 06/12/2023]
Abstract
Nicotine is an important emerging contaminant widely detected in water resources. The main nicotine sources are human excretions from users and leaching from discarded tobacco product waste, which represents the most commonly littered item in urban areas and coasts. In this study, the UV254 photolytical fate of nicotine in natural water and leachates produced from conventional cigarettes (CCs) and the new generation heat-not-burn (HnBs) tobacco products is examined for the first time. The effect of UV254 irradiation on nicotine depletion in ultrapure water was initially studied. The reaction was pseudo first-order with respect to nicotine concentration at low concentrations and shifted to lower order at higher concentrations, an effect associated to absorption saturation. Although nicotine removal was fast, only 9.5% of the total organic carbon was removed after irradiation due to the formation of by-products. The chemical structures of six photo-products were derived by means of liquid and gas chromatography coupled to mass spectrometry. The photodegradation kinetics was found to depend on pH and faster kinetics were recorded when the monoprotonated form of nicotine was dominant (pH = 5-8). The presence of humic acids was found to slightly delay kinetics as they competed with nicotine for lamp irradiance, whereas the presence of salt had no effect on the direct photolysis of nicotine. Direct photolysis studies were also performed using natural waters. Compared to ultra-pure water, photodegradation was found to proceed slightly slower in river water, in similar kinetics in seawater, and relatively faster in rain water. The later was assumed to be due to the lower pH compared to the rest of the natural water tested. Leachates from used HnBs and smoked CCs were also submitted to UV254 irradiation and direct photolysis was found to proceed fast despite the high complexity of these matrices. Nonetheless, the total organic carbon in the system remained the same after irradiation due to the abundance of organics and photo-products formed. We take advantage of the present investigations and report the leaching behavior of nicotine from HnBs and CCs. Among others, we found that in HnBs ~70% of the total and bioavailable nicotine content remains in the tobacco sticks after operation and this percentage drops to 15% in CCs due to the reduction in mass after smoking. This finding demonstrated the importance of properly disposing tobacco product waste to prevent nicotine leaching in water bodies.
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Affiliation(s)
- Stefano Alberti
- Laboratory of Aquatic Chemistry, School of Environmental Engineering, Technical University of Crete, 73100, Chania, Crete, Greece; Dipartimento di Chimica e Chimica Industriale, Università Degli Studi di Genova, Via Dodecaneso 31, 16146, Genova, Italy
| | - Maria Sotiropoulou
- Laboratory of Aquatic Chemistry, School of Environmental Engineering, Technical University of Crete, 73100, Chania, Crete, Greece
| | - Elena Fernández
- Laboratory of Aquatic Chemistry, School of Environmental Engineering, Technical University of Crete, 73100, Chania, Crete, Greece
| | - Nicoleta Solomou
- Laboratory of Aquatic Chemistry, School of Environmental Engineering, Technical University of Crete, 73100, Chania, Crete, Greece
| | - Maurizio Ferretti
- Dipartimento di Chimica e Chimica Industriale, Università Degli Studi di Genova, Via Dodecaneso 31, 16146, Genova, Italy
| | - Elefteria Psillakis
- Laboratory of Aquatic Chemistry, School of Environmental Engineering, Technical University of Crete, 73100, Chania, Crete, Greece.
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25
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Scarpino M, Rosso T, Lanzo G, Lolli F, Bonizzoli M, Lazzeri C, Mannaioni G, Baronti R, Fattapposta F, Grippo A. Severe neurological nicotine intoxication by e-cigarette liquids: Systematic literature review. Acta Neurol Scand 2021; 143:121-130. [PMID: 32866996 DOI: 10.1111/ane.13338] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/27/2020] [Accepted: 08/19/2020] [Indexed: 12/20/2022]
Abstract
Electronic cigarettes are a popular, easily purchased, alternative source of nicotine that is considered safer than conventional tobacco. However, Intentional or accidental exposure to e-liquid substances, mainly nicotine, can lead to serious, potentially fatal toxicity. Emergency and critical care physicians should keep in mind acute intoxication of this poison with a biphasic toxic syndrome. We highlight its potentially fatal outcome and suggest monitoring the adverse effects of nicotine according to a multimodal protocol integrating somatosensory evoked potentials, electroencephalography and neuroimaging data with anamnestic report and toxicological and laboratory data.
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Affiliation(s)
- Maenia Scarpino
- Neurophysiopathology Unit Neuromuscolar Department AOU Careggi Florence Italy
- IRCCS Don Carlo Gnocchi Florence Italy
| | - Tiziana Rosso
- UOC Neurologia Distretto di Asolo Azienda ULSS 2 Marca Trevigiana Treviso Italia
| | - Giovanni Lanzo
- Neurophysiopathology Unit Neuromuscolar Department AOU Careggi Florence Italy
| | - Francesco Lolli
- Biomedical Science Department Mario Serio University of Florence Florence Italy
| | - Manuela Bonizzoli
- Traumatic Intensive Care Unit Neuromuscolar Department AOU Careggi Florence Italy
| | - Chiara Lazzeri
- Traumatic Intensive Care Unit Neuromuscolar Department AOU Careggi Florence Italy
| | - Guido Mannaioni
- Section of Pharmacology and Toxicology Department of Neuroscience, Psychology, Drug Research and Child Health (NEURORFARBA) University Florence Florence Italy
| | - Roberto Baronti
- Laboratory of Clinical Toxicology and Antidoping Azienda USL Toscana Centro Florence Italy
| | | | - Antonello Grippo
- Neurophysiopathology Unit Neuromuscolar Department AOU Careggi Florence Italy
- IRCCS Don Carlo Gnocchi Florence Italy
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26
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Iida A, Fujiwara Y, Nojima T, Naito H, Nakao A, Mikane T. Cardiac arrest due to liquid nicotine intoxication: a case report. Acute Med Surg 2021; 8:e720. [PMID: 34992786 PMCID: PMC8713731 DOI: 10.1002/ams2.720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/21/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background With the introduction of electronic cigarettes, reports of nicotine intoxication due to ingestion of large amounts of liquid nicotine have increased. This report presents a rare case of cardiac arrest due to nicotine intoxication that was successfully treated with appropriate respiratory and circulatory support. Case Presentation A 55‐year‐old man ingested 600 mg of liquid nicotine and developed sinus bradycardia followed by asystole. Appropriate and prompt resuscitation led to the return of spontaneous circulation. He was admitted to the intensive care unit and discharged 24 days later without any medical sequelae of nicotine intoxication. Conclusion Ingestion of a large amount of liquid nicotine, as in this case, can result in lethal bradycardia followed by cardiac arrest. Prompt basic life support by paramedic produced good neurological outcomes. Emergency physicians should be aware of the symptoms and appropriate treatment of severe nicotine intoxication.
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Affiliation(s)
- Atsuyoshi Iida
- Department of Emergency Medicine Okayama Red Cross Hospital Okayama Japan
| | - Yuki Fujiwara
- Department of Emergency Medicine Okayama Red Cross Hospital Okayama Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Takeshi Mikane
- Department of Emergency Medicine Okayama Red Cross Hospital Okayama Japan
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27
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Xu X, Chen Z, Li Q, Meng D, Jiang H, Zhou Y, Feng S, Yang Y. Copper and nitrogen-doped carbon dots as an anti-interference fluorescent probe combined with magnetic material purification for nicotine detection. Microchem J 2021. [DOI: 10.1016/j.microc.2020.105708] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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28
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Habibagahi A, Siddique S, Harris SA, Alderman N, Aranda-Rodriguez R, Farhat I, Chevrier J, Kubwabo C. Challenges associated with quantification of selected urinary biomarkers of exposure to tobacco products. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1162:122490. [PMID: 33360416 DOI: 10.1016/j.jchromb.2020.122490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Abstract
Tobacco use, of which cigarette smoking is the most common, is a global health concern and is directly linked to over 7 million premature deaths annually. Measurement of the levels of tobacco-related biomarkers in biological matrices reflects human exposure to the chemicals in tobacco products. Nicotine, nicotine metabolites, anatabine, and anabasine are specific to tobacco and nicotine containing products. However, as nicotine and its metabolites are ubiquitous in the environment, background contamination during sample preparation can occur, making the quantification of target analytes challenging. The main purpose of the present study was to examine quality control measures needed in the determination of urinary nicotine, nicotine metabolites, anatabine, and anabasine. Urine samples (n = 75) and NIST standard reference materials SRM 3671 and SRM 3672 were analysed. A one-step extraction procedure using cold acetone was used in this study, which involved no additional clean up. The blank matrices investigated included synthetic urine prepared with HPLC-grade water, synthetic urine prepared with Milli-Q water, and bovine urine. By adopting strategies for minimizing the background levels, very low detection limits for all the target analytes ranging from 0.025 ng/mL for 3-hydroxycotinine to 0.634 ng/mL for nicotine, were achieved. Recoveries ranged between 67% and 118% with RSD values below 20%. Intra-day and inter-day precisions were in the range of 1.1-11.7% and 4.8-25.2%, respectively. The levels of all target analytes were higher in daily smokers than in non-smokers, with the largest difference observed for 3-hydroxycotinine. No difference was observed in the levels of target analytes between individuals who were former smokers, who never smoked or who were exposed to environmental tobacco smoke (ETS), except for total nicotine equivalents (TNE), which was significantly higher in non-smokers exposed to environmental tobacco smoke compared with study participants who never smoked. The results obtained from SRM 3671 and SRM 3672 could inform a potential certification of additional biomarkers of exposure to tobacco products in those standard reference materials.
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Affiliation(s)
- Arezoo Habibagahi
- Exposure and Biomonitoring Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada
| | - Shabana Siddique
- Exposure and Biomonitoring Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada
| | - Shelley A Harris
- Department of Epidemiology & Department of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nicholas Alderman
- Exposure and Biomonitoring Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada; Present address: Analysis and Air Quality Division, Environment and Climate Change Canada, Ottawa, ON, Canada
| | - Rocio Aranda-Rodriguez
- Exposure and Biomonitoring Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada
| | - Imen Farhat
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Jonathan Chevrier
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Cariton Kubwabo
- Exposure and Biomonitoring Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada.
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Alshareef HZ, Omaye ST. Toxicology of Commonly Found Ingredients in E-Cigarettes: A Brief Review. Health (London) 2021. [DOI: 10.4236/health.2021.1311100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lupacchini L, Maggi F, Tomino C, De Dominicis C, Mollinari C, Fini M, Bonassi S, Merlo D, Russo P. Nicotine Changes Airway Epithelial Phenotype and May Increase the SARS-COV-2 Infection Severity. Molecules 2020; 26:E101. [PMID: 33379366 PMCID: PMC7794754 DOI: 10.3390/molecules26010101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/17/2020] [Accepted: 12/24/2020] [Indexed: 02/07/2023] Open
Abstract
(1) Background: Nicotine is implicated in the SARS-COV-2 infection through activation of the α7-nAChR and over-expression of ACE2. Our objective was to clarify the role of nicotine in SARS-CoV-2 infection exploring its molecular and cellular activity. (2) Methods: HBEpC or si-mRNA-α7-HBEpC were treated for 1 h, 48 h or continuously with 10-7 M nicotine, a concentration mimicking human exposure to a cigarette. Cell viability and proliferation were evaluated by trypan blue dye exclusion and cell counting, migration by cell migration assay, senescence by SA-β-Gal activity, and anchorage-independent growth by cloning in soft agar. Expression of Ki67, p53/phospho-p53, VEGF, EGFR/pEGFR, phospho-p38, intracellular Ca2+, ATP and EMT were evaluated by ELISA and/or Western blotting. (3) Results: nicotine induced through α7-nAChR (i) increase in cell viability, (ii) cell proliferation, (iii) Ki67 over-expression, (iv) phospho-p38 up-regulation, (v) EGFR/pEGFR over-expression, (vi) increase in basal Ca2+ concentration, (vii) reduction of ATP production, (viii) decreased level of p53/phospho-p53, (ix) delayed senescence, (x) VEGF increase, (xi) EMT and consequent (xii) enhanced migration, and (xiii) ability to grow independently of the substrate. (4) Conclusions: Based on our results and on evidence showing that nicotine potentiates viral infection, it is likely that nicotine is involved in SARS-CoV-2 infection and severity.
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Affiliation(s)
- Leonardo Lupacchini
- Molecular and Cellular Neurobiology, IRCSS San Raffaele Pisana, Via di Val Cannuta 247, I-00166 Rome, Italy; (L.L.); (C.D.D.)
| | - Fabrizio Maggi
- Department of Medicine and Surgery, University of Insubria, viale Luigi Borri 57, I-21100 Varese, Italy;
| | - Carlo Tomino
- Scientific Direction, IRCSS San Raffaele Pisana, Via di Val Cannuta 247, I-00166 Rome, Italy;
| | - Chiara De Dominicis
- Molecular and Cellular Neurobiology, IRCSS San Raffaele Pisana, Via di Val Cannuta 247, I-00166 Rome, Italy; (L.L.); (C.D.D.)
| | - Cristiana Mollinari
- Institute of Translational Pharmacology, National Research Council, Via Fosso del Cavaliere 100, 00133 Rome, Italy;
- Department of Neuroscience, Istituto Superiore di Sanità, Viale Regina Elena 299, I-00161 Rome, Italy;
| | - Massimo Fini
- Scientific Direction, IRCSS San Raffaele Pisana, Via di Val Cannuta 247, I-00166 Rome, Italy;
| | - Stefano Bonassi
- Clinical and Molecular Epidemiology, IRCSS San Raffaele Pisana, Via di Val Cannuta 247, I-00166 Rome, Italy;
- Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Via di Val Cannuta 247, I-00166 Rome, Italy
| | - Daniela Merlo
- Department of Neuroscience, Istituto Superiore di Sanità, Viale Regina Elena 299, I-00161 Rome, Italy;
| | - Patrizia Russo
- Clinical and Molecular Epidemiology, IRCSS San Raffaele Pisana, Via di Val Cannuta 247, I-00166 Rome, Italy;
- Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Via di Val Cannuta 247, I-00166 Rome, Italy
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Nicotine pharmacokinetics of electronic cigarettes: A pooled data analysis from the literature. Toxicol Rep 2020; 8:84-95. [PMID: 33437651 PMCID: PMC7786013 DOI: 10.1016/j.toxrep.2020.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
Evaluating the pharmacokinetics of nicotine absorption from electronic cigarettes. Nicotine absorption into the blood is influenced by several factors. These include e-liquid composition, user behavior and device characteristics. Any regulation of nicotine levels in e-liquids should reflect this heterogeneity.
Several regulatory initiatives around the world restrict the amount of nicotine permitted in electronic cigarette liquids in an attempt to reproduce the nicotine delivery of combusted tobacco products, such as cigarettes, and or reduce the risk of consumers absorbing too much nicotine into their body at one time. Such an approach, however, assumes that (i) there is a strong correlation between the levels of nicotine in electronic cigarette liquids and nicotine intake into the body and (ii) that this correlation holds true across the various different types of electronic cigarette devices currently available on the market. In order to test these hypotheses, this study examines the available scientific literature on nicotine intake from electronic cigarettes, as measured by levels in the blood. Analysis of the published data reveals that nicotine absorption into the body is influenced by a combination of many factors, including electronic cigarette liquid composition, user behavior and device characteristics. Notably, it was observed that open-tank (refillable) electronic cigarettes, which often enable users to vary device power, can deliver high nicotine levels to consumers, sometimes at greater doses than a conventional tobacco cigarette, even at the lower nicotine liquid concentrations typically available. For electronic cigarettes to be viable alternative choices to smoking, they should provide consumers with an equally satisfying experience, including in terms of nicotine absorption into the body. Therefore, any regulation seeking to restrict the amount of nicotine in electronic cigarette liquids should take all the factors influencing nicotine intake into account.
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32
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Mehmeti E, Kilic T, Laur C, Carrara S. Electrochemical determination of nicotine in smokers’ sweat. Microchem J 2020. [DOI: 10.1016/j.microc.2020.105155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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33
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Implementation of Recycling Cigarette Butts in Lightweight Bricks and a Proposal for Ending the Littering of Cigarette Butts in Our Cities. MATERIALS 2020; 13:ma13184023. [PMID: 32927905 PMCID: PMC7559538 DOI: 10.3390/ma13184023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/16/2022]
Abstract
Our cities, parks, beaches, and oceans have been contaminated for many years with millions of tonnes of unsightly and toxic cigarette butts (CBs). This study presents and discusses some of the results of an ongoing study on recycling in fired-clay bricks. Energy savings: the energy value of CBs with remnant tobacco was found to be 16.5 MJ/kg. If just 2.5% of all bricks produced annually worldwide included 1% CB content, all of the CBs currently produced could be recycled in bricks, and it is estimated that global firing energy consumption could be reduced by approximately 20 billion MJ (megajoules). This approximately equates to the power used by one million homes in Victoria, Australia, every year. Bacteriological study: CBs were investigated for the presence of ten common bacteria in two pilot studies. Staphylococcus spp. and Pseudomonas aeruginosa were detected in fresh used CB samples, and Listeria spp. were detected in old used CB samples. All of the CB samples except the dried sample had significant counts of Bacillus spp. Some species of the detected bacteria in this study are pathogenic. Further confirmation and comprehensive microbiological study are needed in this area. The contact of naphthalene balls with CBs had a significant disinfecting effect on Bacillus spp. The implementation procedure for recycling CBs in bricks, odour from Volatile Organic Compound (VOC) emissions in CBs, sterilization methods, CB collection systems, and safety instructions were investigated, and they are discussed. Proposal: when considering the combined risks from many highly toxic chemicals and possible pathogens in cigarette butts, it is proposed that littering of this waste anywhere in cities and the environment be strictly prohibited and that offenders be heavily fined.
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Scarpino M, Bonizzoli M, Lanzi C, Lanzo G, Lazzeri C, Cianchi G, Gambassi F, Lolli F, Grippo A. Brain death following ingestion of E-cigarette liquid nicotine refill solution. Brain Behav 2020; 10:e01744. [PMID: 32722878 PMCID: PMC7507521 DOI: 10.1002/brb3.1744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/13/2020] [Accepted: 06/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The use of electronic cigarettes (e-cigarettes) is very common worldwide. To date, an increase of nicotine intoxication following an accidental or intentional ingestion/injection of refill solution (e-liquid) has been detected. CASE A 23-year-old man presented with sudden loss of consciousness, bradycardia, and respiratory muscle paralysis after intentional ingestion of e-liquid. Early clinical data, brain computed tomography, and neurophysiological tests (electroencephalogram [EEG] and somatosensory evoked potentials [SEPs]) did not show features with a poor neurological prognostic meaning of an hypoxic encephalopathy. After 4 days, the patient showed bilateral loss of the pupillary reflex, and severe and cytotoxic edema was detected on brain magnetic resonance imaging. SEPs showed a bilateral loss of cortical responses and EEG a suppressed pattern. Nine days after the onset of coma, the patient evolved toward brain death (BD). DISCUSSION Because nicotine intoxication might cause respiratory muscle paralysis, without cardiac arrest (CA), it would be important to understand the mechanisms underlying brain damage and to take into account that the current neurological prognostic evidence for hypoxic-ischemic encephalopathy, based on data from patients who all experienced CA may not be reliable. Reporting cases of nicotine intoxication through e-liquid is relevant in order to improve regulatory parameters for e-liquid sale.
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Affiliation(s)
- Maenia Scarpino
- Neurophysiopathology Unit, Neuromuscular Department, AOU Careggi, Florence, Italy.,IRCCS Don Carlo Gnocchi, Florence, Italy
| | - Manuela Bonizzoli
- Traumatic Intensive Care Unit, Neuromuscolar Department, AOU Careggi, Florence, Italy
| | - Cecilia Lanzi
- Clinical Toxicology, Emergency Department, AOU Careggi, Florence, Italy
| | - Giovanni Lanzo
- Neurophysiopathology Unit, Neuromuscular Department, AOU Careggi, Florence, Italy
| | - Chiara Lazzeri
- Traumatic Intensive Care Unit, Neuromuscolar Department, AOU Careggi, Florence, Italy
| | - Giovanni Cianchi
- Traumatic Intensive Care Unit, Neuromuscolar Department, AOU Careggi, Florence, Italy
| | | | - Francesco Lolli
- Biomedical Science Department Mario Serio, University of Florence, Florence, Italy
| | - Antonello Grippo
- Neurophysiopathology Unit, Neuromuscular Department, AOU Careggi, Florence, Italy.,IRCCS Don Carlo Gnocchi, Florence, Italy
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Richmond SA, Pike I, Maguire JL, Macpherson A. E-cigarettes: A new hazard for children and adolescents. Paediatr Child Health 2020; 25:317-321. [PMID: 32765168 DOI: 10.1093/pch/pxaa078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/29/2020] [Indexed: 11/12/2022] Open
Abstract
Objectives Electronic cigarettes and fluid (e-cigarettes, e-fluid) are hazardous materials that when inhaled or ingested may pose significant health risks to children and adolescents. The objective of this work was to explore the spectrum of injury related to e-cigarette exposure among Canadian children and adolescents. Methods A one-time survey was sent to all paediatricians in Canada. Information was collected on children and adolescents who presented with e-cigarette exposure (inhalation and ingestion cases) in the previous 12 months. Questions included the number of injuries and symptoms, in addition to age, sex, treatment setting, intentional e-cigarette use, and how the products were accessed. Results A total of 520 surveys were completed and returned, identifying 35 cases. Symptoms related to inhalation were present in 30 cases and in 5 ingestion cases (5 unintentional, 0 intentional). For inhalation cases, most were male, ages 15 to 19 years, who sought treatment for nausea/vomiting, cough, throat irritation, or acute nicotine toxicity in an outpatient clinic/office. Most inhalation cases reported e-cigarette use 2 to 3 days/week, and e-cigarettes purchases from a mall kiosk/store. For ingestion cases, most were male, ages 1 to 4 years presenting to an emergency department with nausea/vomiting, cough, or respiratory irritation. Younger cases accessed e-fluid at home, older cases purchased in a mall kiosk/store. E-fluid flavours reported consumed were fruit, candy, and tobacco. Conclusions E-cigarettes, recently introduced into the North American market are hazardous to children and adolescents. Given the low response rate to the survey, further investigation into the true burden of injury, as well as the risks that e-cigarettes pose, together with ways to reduce exposure, is needed.
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Affiliation(s)
| | - Ian Pike
- Faculty of Health, York University, Toronto, Ontario
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36
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Lemay F, Baker P, McRobbie H. Electronic cigarettes: A narrative review of the implications for the pediatric anesthesiologist. Paediatr Anaesth 2020; 30:653-659. [PMID: 32304606 DOI: 10.1111/pan.13885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 12/20/2022]
Abstract
The use of electronic cigarettes (EC) is increasing and the number of EC publications is rapidly growing. While some health organizations focus on the harmful effects of using EC (vaping), others promote the benefits of ECs as a less harmful alternative to smoking tobacco. There is concern that vaping might have adverse respiratory consequences for pediatric patients facing anesthesia and intensive care. This narrative review summarizes current knowledge and recommendations regarding the risks of EC relevant to the anesthesiologist and the use of ECs as a step-down option from tobacco. We provide guidance on the management of vaping patients in the perioperative period.
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Affiliation(s)
- Francois Lemay
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Paul Baker
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Hayden McRobbie
- National Drug and Alcohol Centre, The University of New South Wales, Sydney, New South Wales, Australia
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37
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Kang D, Hong G, An S, Jang I, Yun WS, Shim JH, Jin S. Bioprinting of Multiscaled Hepatic Lobules within a Highly Vascularized Construct. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2020; 16:e1905505. [PMID: 32078240 DOI: 10.1002/smll.201905505] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/25/2020] [Indexed: 06/10/2023]
Abstract
Highly vascularized complex liver tissue is generally divided into lobes, lobules, hepatocytes, and sinusoids, which can be viewed under different types of lens from the micro- to macro-scale. To engineer multiscaled heterogeneous tissues, a sophisticated and rapid tissue engineering approach is required, such as advanced 3D bioprinting. In this study, a preset extrusion bioprinting technique, which can create heterogeneous, multicellular, and multimaterial structures simultaneously, is utilized for creating a hepatic lobule (≈1 mm) array. The fabricated hepatic lobules include hepatic cells, endothelial cells, and a lumen. The endothelial cells surround the hepatic cells, the exterior of the lobules, the lumen, and finally, become interconnected with each other. Compared to hepatic cell/endothelial cell mixtures, the fabricated hepatic lobule shows higher albumin secretion, urea production, and albumin, MRP2, and CD31 protein levels, as well as, cytochrome P450 enzyme activity. It is found that each cell type with spatial cell patterning in bioink accelerates cellular organization, which could preserve structural integrity and improve cellular functions. In conclusion, preset extruded hepatic lobules within a highly vascularized construct are successfully constructed, enabling both micro- and macro-scale tissue fabrication, which can support the creation of large 3D tissue constructs for multiscale tissue engineering.
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Affiliation(s)
- Donggu Kang
- Research Institute, T&R Biofab. Co. Ltd., 242 Pangyo-ro, Seongnam-si, 13487, Republic of Korea
| | - Gyusik Hong
- Department of Mechanical Engineering, Korea Polytechnic University, 237 Sangidaehak-ro, Siheung-si, 15073, Republic of Korea
| | - Seongmin An
- Department of Mechanical Engineering, Korea Polytechnic University, 237 Sangidaehak-ro, Siheung-si, 15073, Republic of Korea
| | - Ilho Jang
- Research Institute, T&R Biofab. Co. Ltd., 242 Pangyo-ro, Seongnam-si, 13487, Republic of Korea
| | - Won-Soo Yun
- Department of Mechanical Engineering, Korea Polytechnic University, 237 Sangidaehak-ro, Siheung-si, 15073, Republic of Korea
| | - Jin-Hyung Shim
- Department of Mechanical Engineering, Korea Polytechnic University, 237 Sangidaehak-ro, Siheung-si, 15073, Republic of Korea
| | - Songwan Jin
- Department of Mechanical Engineering, Korea Polytechnic University, 237 Sangidaehak-ro, Siheung-si, 15073, Republic of Korea
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Tzortzi A, Kapetanstrataki M, Evangelopoulou V, Behrakis P. A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2248. [PMID: 32230711 PMCID: PMC7177608 DOI: 10.3390/ijerph17072248] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022]
Abstract
Following the recent electronic cigarette (e-cigarette) illness outbreak, the current review aimed to collect all related clinical cases for study and analysis and provide a critical synopsis of the proposed injury mechanism. Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines, e-cigarette-related clinical cases were identified via Google Scholar and PubMed databases. Additionally, references of published case reports and previous review papers were manually searched, revealing 159 publications presenting e-cigarette-related case reports and 19 reports by the Centers for Disease Control and Prevention. 238 individual cases were identified; 53% traumatic injuries due to e-cigarette explosion or self-combustion, 24% respiratory cases, and 12% poisonings. Additional cases pertained to oral, cardiovascular, immunologic, hematologic, allergic reactions, infant complications, and altered medication levels. Case reports were mainly published between 2016-2019 (78%). The oldest case, a lipoid pneumonia, was published in 2012. The current review showed that e-cigarette-related health effects extend beyond the acute lung injury syndrome, including traumatic, thermal injuries and acute intoxications. Physicians should be aware of the distinct clinical presentations and be trained to respond and treat effectively. Regulators and public health authorities should address the regulatory gap regarding electronic nicotine delivery systems (ENDS) and novel tobacco products.
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Affiliation(s)
- Anna Tzortzi
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
- Institute of Public Health, The American College of Greece, 17B Ipitou Street, 10557 Athens, Greece
| | - Melpo Kapetanstrataki
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
| | - Vaso Evangelopoulou
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
| | - Panagiotis Behrakis
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
- Institute of Public Health, The American College of Greece, 17B Ipitou Street, 10557 Athens, Greece
- Pulmonary Department, Athens Medical Center, Distomou 5-7, Marousi, 15125 Athens, Greece
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Obertova N, Navratil T, Zak I, Zakharov S. Acute exposures to e-cigarettes and heat-not-burn products reported to the Czech Toxicological Information Centre over a 7-year period (2012-2018). Basic Clin Pharmacol Toxicol 2020; 127:39-46. [PMID: 32012431 DOI: 10.1111/bcpt.13393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/13/2020] [Accepted: 01/19/2020] [Indexed: 11/29/2022]
Abstract
E-cigarettes and heat-not-burn cigarettes (HNBC) present new health risks due to their rising popularity, high content of nicotine and serious adverse effects. The objective of the study was to analyse the cases of acute exposure to e-cigarettes, e-liquids and HNBC products containing nicotine that led to toxicological consultations at our poisons control centre during a 7-year period (2012-2018) and identify the categories of special concern that require further investigation and intervention. The demographic, toxicological and clinical data were analysed by descriptive statistics. Poisoning severity score (PSS) was estimated. From 119 229 consultations, 148 cases concerned acute exposure to e-cigarettes. Children and adolescents were exposed in 91 (61%) cases, including exposure of neonates and infants in 54 (36%) cases. The main route of exposure was ingestion in 129 (87%), inhalation in nine (6%), ocular in six (4%) and intravenous administration in three (2%) cases. The source of exposure was the cartridge with e-liquid (107; 72%), refillable tank in 29 (20%) and HNBC refill in nine (6%) cases. The reason for exposure was accidental in 110 (74%), incorrect application of the device in 10 (7%), abuse in six (4%), suicide attempt in six (4%) and other/unknown in 16 (11%) cases. The dose estimation was severe/lethal in 6 (4%), toxic in 53 (36%), low-to-moderate in 35 (24%) and unknown in 54 (36%) cases. Vomiting was observed in 38 (26%) patients; 72% of patients were hospitalised. In symptomatic cases, 41 patient had PSS 1, 12 patients had PSS 2, and one patient had PSS 3. Activated charcoal was applied in 57 (39%) patients, and symptomatic treatment was recommended in 75 (51%) patients. Cases of unintentional exposure of children demonstrate the need for preventive risk reduction measures.
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Affiliation(s)
- Nikola Obertova
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic.,Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Navratil
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic.,Department of Electrochemistry at the Nanoscale, J. Heyrovsky Institute of Physical Chemistry of the Czech Academy of Sciences, Prague, Czech Republic
| | - Ivan Zak
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic.,Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sergey Zakharov
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic.,Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Ershad M, Beld J, Mostafa A, Dela Cruz M, Vearrier D, Greenberg MI. Nicotine Content from Cigarettes Submerged in Soda. J Med Toxicol 2020; 16:452-457. [PMID: 32180139 DOI: 10.1007/s13181-020-00766-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Cigarettes and other tobacco products may be extinguished by submersion in liquids in beverage cans or bottles. Cases of nicotine poisoning in children have been reported following ingestion of such liquids. The aim of this study is to analyze the variability of nicotine concentrations with respect to number of cigarettes immersed and the duration of immersion in a soda can METHODS: One unsmoked cigarette was immersed in a cola containing soda can. Three separate samples of the mixture were obtained at different intervals of time post immersion up to 1 week. At the same time, a set of four cola cans were immersed with an increasing number of unsmoked cigarettes and samples obtained. All the samples were then analyzed for nicotine concentrations using liquid chromatography-mass spectrometry. RESULTS The mean concentration of nicotine measured over the course of 6 hours from one full cigarette in 55 ml of a cola beverage was 0.48 mg/ml. Nicotine concentrations steadily increased in the first 6 hours following submersion, after which, the levels plateaued (r = 0.530, n = 18, p = 0.024). There was a strong positive correlation between nicotine concentrations and the number of cigarettes (r = 0.967, n = 12, p = 3e-7). CONCLUSIONS The mean concentration of nicotine measured over the course of 6 hours from one immersed cigarette can be potentially toxic especially to children. Nicotine concentrations are positively correlated with the number of cigarettes and time of immersion.
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Affiliation(s)
- Muhammed Ershad
- Medical Toxicology, Drexel University College of Medicine, Philadelphia, PA, USA.
| | - Joris Beld
- Department of Microbiology & Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Ahmed Mostafa
- Medical Toxicology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Maricel Dela Cruz
- Medical Toxicology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - David Vearrier
- Emergency Medicine, Medical Toxicology, University of Mississipi Medical Center, Jackson, Mississipi, USA
| | - Michael I Greenberg
- Emergency Medicine, Division of Medical Toxicology, Drexel University College of Medicine, Philadelphia, PA, USA
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41
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Lee J, You Y, Park JS, Min JH, Yoo I, Jeong W, Cho Y, Ryu S, Kim S, Cho SU, Oh SK, Lee J, Ahn HJ, Jung SM. Liver Donation After Brain Death Following Intentional Ingestion of 99% E-Cigarette Liquid Nicotine 10 mL. EXP CLIN TRANSPLANT 2020; 18:120-122. [DOI: 10.6002/ect.2017.0275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Compared with children exposed to traditional cigarettes, those exposed to nicotine in e-cigarettes are 5.2 times more likely to be admitted to a healthcare facility and have 2.6 times the risk of a severe outcome. This article discusses nicotine toxicity in children accidentally exposed to e-cigarettes containing nicotine and reviews appropriate nursing interventions.
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Affiliation(s)
- M Thomas Quail
- M. Thomas Quail is a former specialist in poison information and managing director at the Massachusetts/Rhode Island Poison Control Center. He is currently the clinical coordinator for the Massachusetts Department of Public Health, Bureau of Environmental Health, in Boston, Mass. This article is Mr. Quail's own work and does not represent the opinions of the Massachusetts Department of Public Health or the Commonwealth of Massachusetts
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Price LR, Martinez J. Biological effects of nicotine exposure: A narrative review of the scientific literature. F1000Res 2019; 8:1586. [PMID: 32595938 PMCID: PMC7308884 DOI: 10.12688/f1000research.20062.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 09/07/2023] Open
Abstract
The emergence of new tobacco heating products and electronic nicotine delivery systems (ENDS) is changing the way humans are exposed to nicotine. The purpose of this narrative review is to provide a broad overview of published scientific literature with respect to the effects of nicotine on three key health-related areas: 1) cardiovascular risk, 2) carcinogenesis and 3) reproductive outcomes. These areas are known to be particularly vulnerable to the effects of cigarette smoke, and in addition, nicotine has been hypothesized to play a role in disease pathogenesis. Acute toxicity will also be discussed. The literature to February 2019 suggests that there is no increased cardiovascular risk of nicotine exposure in consumers who have no underlying cardiovascular pathology. There is scientific consensus that nicotine is not a direct or complete carcinogen, however, it remains to be established whether it plays some role in human cancer propagation and metastasis. These cancer progression pathways have been proposed in models in vitro and in transgenic rodent lines in vivo but have not been demonstrated in cases of human cancer. Further studies are needed to determine whether nicotine is linked to decreased fertility in humans. The results from animal studies indicate that nicotine has the potential to act across many mechanisms during fetal development. More studies are needed to address questions regarding nicotine exposure in humans, and this may lead to additional guidance concerning new ENDS entering the market.
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Affiliation(s)
- Leonie R. Price
- Scientific and Regulatory Affairs, Japan Tobacco International, Genève, Genève, 1202, Switzerland
| | - Javier Martinez
- Scientific and Regulatory Affairs, Japan Tobacco International, Genève, Genève, 1202, Switzerland
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45
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Price LR, Martinez J. Cardiovascular, carcinogenic and reproductive effects of nicotine exposure: A narrative review of the scientific literature. F1000Res 2019; 8:1586. [PMID: 32595938 PMCID: PMC7308884 DOI: 10.12688/f1000research.20062.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2019] [Indexed: 12/14/2022] Open
Abstract
The emergence of new tobacco heating products and electronic nicotine delivery systems (ENDS) is changing the way humans are exposed to nicotine. The purpose of this narrative review is to provide a broad overview of published scientific literature with respect to the effects of nicotine on three key health-related areas: 1) cardiovascular risk, 2) carcinogenesis and 3) reproductive outcomes. These areas are known to be particularly vulnerable to the effects of cigarette smoke, and in addition, nicotine has been hypothesized to play a role in disease pathogenesis. Acute toxicity will also be discussed. The literature to February 2019 suggests that there is no increased cardiovascular risk of nicotine exposure in consumers who have no underlying cardiovascular pathology. There is scientific consensus that nicotine is not a direct or complete carcinogen, however, it remains to be established whether it plays some role in human cancer propagation and metastasis. These cancer progression pathways have been proposed in models in vitro and in transgenic rodent lines in vivo but have not been demonstrated in cases of human cancer. Further studies are needed to determine whether nicotine is linked to decreased fertility in humans. The results from animal studies indicate that nicotine has the potential to act across many mechanisms during fetal development. More studies are needed to address questions regarding nicotine exposure in humans, and this may lead to additional guidance concerning new ENDS entering the market.
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Affiliation(s)
- Leonie R. Price
- Scientific and Regulatory Affairs, Japan Tobacco International, Genève, Genève, 1202, Switzerland
| | - Javier Martinez
- Scientific and Regulatory Affairs, Japan Tobacco International, Genève, Genève, 1202, Switzerland
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Mendelsohn CP, Wodak AD. Unintended consequences of a cautious approach to e‐cigarette laws. Med J Aust 2019; 211:190-190.e1. [DOI: 10.5694/mja2.50263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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47
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Neilsen BK, Aloi J, Sharma A. Acute Carbon Monoxide Poisoning Secondary to Cigarette Smoking in a 40-Year-Old Man: A Case Report. Am J Addict 2019; 28:413-415. [PMID: 31348564 DOI: 10.1111/ajad.12939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/16/2019] [Accepted: 06/26/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Carbon monoxide is one of the most common causes of fatal intoxications in the United States, and multiple previous studies have demonstrated that cigarette smokers have higher levels of carbon monoxide in their blood. However, the potential negative effects due to acute carbon monoxide poisoning from excessive cigarette smoking have not been well established. METHODS This is a single patient case report. RESULTS In this case report, a 40-year-old male with a past medical history of depression, anxiety, panic attacks, and substance use disorder developed symptomatic, acute carbon monoxide poisoning secondary to heavy cigarette smoking in a confined space. In this patient, the cessation of clonazepam therapy coincided with increasing anxiety and panic disorder with agoraphobia triggering an escalation in his cigarette smoking. The patient smoked three packs of cigarettes in 3 hours and developed worsening of his symptoms. He required inpatient treatment with benzodiazepines and hyperbaric oxygen. DISCUSSION AND CONCLUSIONS Therefore, it is important to recognize cigarette smoke as a significant source of carbon monoxide exposure. SCIENTIFIC SIGNIFICANCE While the negative effects of cigarette smoking are often perceived as being chronic and only coming to fruition after numerous years of exposure, it is important for both physicians and patients to recognize the possibility for potentially life-threatening acute toxicity secondary to carbon monoxide exposure. (Am J Addict 2019;28:413-415).
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Affiliation(s)
- Beth K Neilsen
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska
| | - Joseph Aloi
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ashish Sharma
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska
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Maessen GC, Wijnhoven AM, Neijzen RL, Paulus MC, van Heel DAM, Bomers BHA, Boersma LE, Konya B, van der Heyden MAG. Nicotine intoxication by e-cigarette liquids: a study of case reports and pathophysiology. Clin Toxicol (Phila) 2019; 58:1-8. [PMID: 31286797 DOI: 10.1080/15563650.2019.1636994] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Electronic cigarettes (e-cigarettes), the smokeless alternative to conventional tobacco cigarettes, have become increasingly popular. E-cigarettes vaporise e-liquid, a solution of highly concentrated nicotine, propylene glycol (PG) and vegetable glycerine (VG). With the popularity of e-cigarettes, e-liquid refills have become easily accessible and several cases of intoxication due to the ingestion of e-liquid have been reported. We provide an overview of these cases, their pathophysiology and patients' characteristics.Methods: We carried out a retrospective evaluation of the scientific literature reporting on cases of liquid nicotine intoxication, using the following inclusion criteria: (1) the article is or contains a case report, (2) describes an intoxication with e-liquid, (3) the substance contains nicotine, and (4) intake is oral, intravenous or subcutaneous.Results: We found 26 case reports describing a total of 31 patients who suffered from e-liquid intoxication. All intoxications up to the age of six were reported as unintentional, whereas nearly all cases from ages 13 to 53 were due to suicide attempts. The three most prevalent symptoms of e-liquid intoxication were tachycardia, altered mental status and vomiting. Eleven cases resulted in the death of the patient. In the survivors, the highest plasma concentration of nicotine was 800 µg L-1, while the lowest concentration in the non-survivors was 1600 µg L-1.Conclusions: There is a mismatch between the generally accepted lethal oral nicotine dose of 60 mg, resulting in approximately 180 µg L-1 plasma concentration, and the 4.4- to 8.9-fold higher lethal plasma concentrations we found in cases of e-liquid intoxication. In these severe intoxications, plasma cotinine concentration does not act as a more reliable indicator of nicotine intoxication than nicotine itself. The ages of the patients display a bimodal distribution. In patients above the age of 10, intoxication results mainly from suicide attempts rather than accidental ingestion. The role of PG and VG in e-liquid intoxications is remarkably unclear. However, the similarity across nicotine and PG toxicity symptoms leads us to believe a cumulative effect cannot be excluded.
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Affiliation(s)
- Gerdinique C Maessen
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anjali M Wijnhoven
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rosalie L Neijzen
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michelle C Paulus
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dayna A M van Heel
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart H A Bomers
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lucie E Boersma
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Burak Konya
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel A G van der Heyden
- Department of Medical Physiology, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
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Choi A, Le M, Rahim T, Rose C, Kosatsky T. Electronic cigarette exposures reported to the British Columbia Drug and Poison Information Centre: an observational case series. CMAJ Open 2019; 7:E462-E471. [PMID: 31320329 PMCID: PMC6639097 DOI: 10.9778/cmajo.20180203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDSs), including electronic cigarettes (e-cigarettes), are rapidly gaining popularity. The aim of this study was to use poison centre data to describe epidemiological trends in ENDS-related exposures. METHODS We conducted an observational case series study using records containing both coded fields and free-text narratives from the British Columbia Drug and Poison Information Centre for all calls involving exposure to ENDS received from 2012 to 2017. We described trends in exposures and exposed people, as well as clinical effects. RESULTS A total of 243 calls were recorded for 186 unique exposures to ENDS devices, e-juice, e-cigarette cartridges and other associated paraphernalia over the study period. Calls related to ENDS exposures increased nearly sixfold between 2013 and 2014 and did not decline subsequently. Exposures were most frequently documented in children aged 4 years or less (81 [43.5%]), with 58 (31.0%) in 1- and 2-year-olds. Seventy-two exposures (89%) in children aged 4 years or less were due to accidental ingestion, whereas adults aged 25 years or more called the poison centre following ENDS malfunctions (7 [23%], spills (4 [13%]) and exposure to e-juice mistaken for other substances (4 [13%]). Of the 186 exposed people, 87 (46.8%) reported symptoms. INTERPRETATION British Columbia experienced a sixfold increase in ENDS-related calls to the provincial poison centre between 2012 and 2017, driven by ingestions in young children. Regulatory approaches aimed at minimizing children's access to ENDS, clear labelling of nicotine concentration, and packaging that reduces the likelihood of spills, product confusion and malfunction should be considered.
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Affiliation(s)
- Alex Choi
- School of Population and Public Health (Choi, Le, Rose), Faculty of Medicine, University of British Columbia; BC Centre for Disease Control (Rahim, Rose, Kosatsky), Vancouver, BC
| | - Megan Le
- School of Population and Public Health (Choi, Le, Rose), Faculty of Medicine, University of British Columbia; BC Centre for Disease Control (Rahim, Rose, Kosatsky), Vancouver, BC
| | - Tissa Rahim
- School of Population and Public Health (Choi, Le, Rose), Faculty of Medicine, University of British Columbia; BC Centre for Disease Control (Rahim, Rose, Kosatsky), Vancouver, BC
| | - Caren Rose
- School of Population and Public Health (Choi, Le, Rose), Faculty of Medicine, University of British Columbia; BC Centre for Disease Control (Rahim, Rose, Kosatsky), Vancouver, BC
| | - Tom Kosatsky
- School of Population and Public Health (Choi, Le, Rose), Faculty of Medicine, University of British Columbia; BC Centre for Disease Control (Rahim, Rose, Kosatsky), Vancouver, BC
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Larcombe AN. Early-life exposure to electronic cigarettes: cause for concern. THE LANCET RESPIRATORY MEDICINE 2019; 7:985-992. [PMID: 31160239 DOI: 10.1016/s2213-2600(19)30189-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 01/29/2023]
Abstract
Electronic nicotine delivery systems, or ENDS, are devices that heat and aerosolise a solution of propylene glycol, glycerine, nicotine, and flavourings. They have only achieved widespread use in the past 5 years or so, and therefore evidence around their potential to effect health is scarce. Importantly, they are often viewed as safer than tobacco cigarettes, meaning that at-risk populations, including pregnant women, might be more inclined to use them. No human studies, however, have assessed the potential for maternal ENDS use to effect the health of a developing baby. Experimental research suggests that nicotine alone is likely to adversely affect the fetus. Further, there is a misconception that ENDS do not produce second-hand aerosols. This misconception might put infants and young children at risk because their parents are more likely to use ENDS around them than they are to use tobacco cigarettes. Emerging evidence also proposes that nicotine and other substances produced by ENDS can deposit onto surfaces, and subsequently be exposed to infants and children; a process known as third-hand exposure. Finally, ENDS are often refillable, and instances of accidental poisonings of children who drink nicotine-containing refills have occurred. Thus, there are a multitude of ways that, with respect to early-life exposures and health, ENDS are a cause for concern.
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Affiliation(s)
- Alexander N Larcombe
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia; School of Public Health, Curtin University, Bentley, WA, Australia.
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