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Ghazi S, Song MA, El-Hellani A. A scoping review of the toxicity and health impact of IQOS. Tob Induc Dis 2024; 22:TID-22-97. [PMID: 38832049 PMCID: PMC11145630 DOI: 10.18332/tid/188867] [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: 08/29/2023] [Revised: 05/14/2024] [Accepted: 05/18/2024] [Indexed: 06/05/2024] Open
Abstract
This work aims to summarize the current evidence on the toxicity and health impact of IQOS, taking into consideration the data source. On 1 June 2022, we searched PubMed, Web of Science, and Scopus databases using the terms: 'heated tobacco product', 'heat-not-burn', 'IQOS', and 'tobacco heating system'. The search was time-restricted to update a previous search conducted on 8 November 2021, on IQOS data from 2010-2021. The data source [independent, Philip Morris International (PMI), or other manufacturers] was retrieved from relevant sections of each publication. Publications were categorized into two general categories: 1) Toxicity assessments included in vitro, in vivo, and systems toxicology studies; and 2) The impact on human health included clinical studies assessing biomarkers of exposure and biomarkers of health effects. Generally, independent studies used classical in vitro and in vivo approaches, but PMI studies combined these with modeling of gene expression (i.e. systems toxicology). Toxicity assessment and health impact studies covered pulmonary, cardiovascular, and other systemic toxicity. PMI studies overall showed reduced toxicity and health risks of IQOS compared to cigarettes, but independent data did not always conform with this conclusion. This review highlights some discrepancies in IQOS risk assessment regarding methods, depth, and breadth of data collection, as well as conclusions based on the data source.
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Affiliation(s)
- Sarah Ghazi
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus OH, United States
| | - Min-Ae Song
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus OH, United States
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus OH, United States
| | - Ahmad El-Hellani
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus OH, United States
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus OH, United States
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Liu Y, Cao J, Zhang J, Chen G, Luo C, Huang L. Research progress and prospect on the safety of heated tobacco products. Toxicology 2024; 505:153823. [PMID: 38705559 DOI: 10.1016/j.tox.2024.153823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/16/2024] [Accepted: 04/28/2024] [Indexed: 05/07/2024]
Abstract
In recent years, Heated tobacco products (HTP) have gradually entered the market and become more and more popular with consumers because of their low risk (compared with traditional cigarette). With the increasing popularity and proportion of HTP in the international market, people pay more and more attention to the safety evaluation of HTP, but there is still a lack of systematic review of HTP safety research. In this review, the harmful components of HTP, multi-organ functional programming effects (including respiratory system, cardiovascular system, etc.), and mechanism of the effect generation (including oxidative stress, inflammatory response, etc.) were systematically reviewed, the safety effects of HTP and traditional cigarettes were compared in detail, and the shortcomings and future research directions in the field of HTP safety were discussed. In summary, this review conforms to the general trend of contemporary "tobacco and health", helps people to understand and evaluate HTP more systematically, and provides a strong theoretical support and literature basis for the tobacco industry to carry out HTP risk assessment and exposure improvement.
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Affiliation(s)
- Yi Liu
- China Tobacco Hubei Industrial Co., Ltd, Wuhan 430040, China
| | - JiXue Cao
- China Tobacco Hubei Industrial Co., Ltd, Wuhan 430040, China
| | - Jing Zhang
- China Tobacco Hubei Industrial Co., Ltd, Wuhan 430040, China
| | - Guang Chen
- China Tobacco Hubei Industrial Co., Ltd, Wuhan 430040, China
| | - ChengHao Luo
- China Tobacco Hubei Industrial Co., Ltd, Wuhan 430040, China.
| | - Long Huang
- China Tobacco Hubei Industrial Co., Ltd, Wuhan 430040, China.
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Picchio V, Ferrero G, Cozzolino C, Pardini B, Floris E, Tarallo S, Dhori X, Nocella C, Loffredo L, Biondi-Zoccai G, Carnevale R, Frati G, Chimenti I, Pagano F. Effect of traditional or heat-not-burn cigarette smoking on circulating miRNAs in healthy subjects. Eur J Clin Invest 2024; 54:e14140. [PMID: 38050790 DOI: 10.1111/eci.14140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/07/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Traditional combustion cigarette (TCC) smoking is an established risk factor for several types of cancer and cardiovascular diseases. Circulating microRNAs (miRNAs) represent key molecules mediating pathogenetic mechanisms, and potential biomarkers for personalized risk assessment. TCC smoking globally changes the profile of circulating miRNAs. The use of heat-not-burn cigarettes (HNBCs) as alternative smoking devices is rising exponentially worldwide, and the circulating miRNA profile of chronic HNBC smokers is unknown. We aimed at defining the circulating miRNA profile of chronic exclusive HNBC smokers, and identifying potentially pathogenetic signatures. METHODS Serum samples were obtained from 60 healthy young subjects, stratified in chronic HNBC smokers, TCC smokers and nonsmokers (20 subjects each). Three pooled samples per group were used for small RNA sequencing, and the fourth subgroup constituted the validation set. RESULTS Differential expression analysis revealed 108 differentially expressed miRNAs; 72 exclusively in TCC, 10 exclusively in HNBC and 26 in both smoker groups. KEGG pathway analysis on target genes of the commonly modulated miRNAs returned cancer and cardiovascular disease associated pathways. Stringent abundance and fold-change criteria nailed down our functional bioinformatic analyses to a network where miR-25-3p and miR-221-3p are main hubs. CONCLUSION Our results define for the first time the miRNA profile in the serum of exclusive chronic HNBC smokers and suggest a significant impact of HNBCs on circulating miRNAs.
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Affiliation(s)
- Vittorio Picchio
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Giulio Ferrero
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Claudia Cozzolino
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Barbara Pardini
- Italian Institute for Genomic Medicine (IIGM), Candiolo, Italy
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Erica Floris
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Sonia Tarallo
- Italian Institute for Genomic Medicine (IIGM), Candiolo, Italy
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Xhulio Dhori
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Cristina Nocella
- Department of Clinical, Internal, Anaesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Loffredo
- Department of Clinical, Internal, Anaesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Roberto Carnevale
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Department of Angio Cardio Neurology, Neuromed, Pozzilli, Italy
| | - Giacomo Frati
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Department of Angio Cardio Neurology, Neuromed, Pozzilli, Italy
| | - Isotta Chimenti
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Francesca Pagano
- Institute of Biochemistry and Cell Biology, Italian National Council of Research, Monterotondo, Rome, Italy
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Kopa-Stojak PN, Pawliczak R. Comparison of effects of tobacco cigarettes, electronic nicotine delivery systems and tobacco heating products on miRNA-mediated gene expression. A systematic review. Toxicol Mech Methods 2023; 33:18-37. [PMID: 35722939 DOI: 10.1080/15376516.2022.2089610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/16/2022] [Accepted: 06/09/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This work attempts to summarize current knowledge on the effects of cigarettes, electronic nicotine delivery systems and tobacco heating products on miRNA-mediated gene expression regulation and on their possible impact on smoking-related respiratory disease development. MATERIALS AND METHODS Literature search by terms combination: 'smoking', 'cigarette' 'THP', 'tobacco heating product', 'ENDS', 'electronic nicotine delivery system', 'e-cigarette', electronic cigarette' and 'miRNA-mediated gene expression' has been performed from October 2021 to February 2022. In this systematic review all relevant literature, including clinical trials, cellular and animal-based studies were included. RESULTS Cigarette smoke (CS) significantly altered transcriptome, including miRNAs expression profile. MiRNA-mediated gene expression is mentioned as one of the mechanisms associated with smoking-related respiratory disease development. Differential expression of miRNAs was reduced in aerosol from e-cigarettes (EC) and tobacco heating products (THP) when compared to CS. However, there was a significant alteration of some miRNAs expression when compared to air-controls in both EC and THP. DISCUSSION CS negatively affects transcriptome and miRNA-mediated gene expression regulation because of a huge number of hazardous substances which predispose to smoking-related diseases. Despite the reduced effect of ENDS and THP on miRNAs profile compared to CS, differences in expression of miRNAs when compared to air-control were observed, which may be harmful to never-smokers who may perceive such alternative smoking products as non-hazardous. To clearly indicate the role of ENDS and THP in the alteration of miRNA-mediated gene expression and the development of smoking-related respiratory diseases associated with this mechanism, more long-term studies should be performed in the future.
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Affiliation(s)
- Paulina Natalia Kopa-Stojak
- Department of Immunopathology, Division of Biomedical Science, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
| | - Rafał Pawliczak
- Department of Immunopathology, Division of Biomedical Science, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
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Uguna CN, Snape CE. Should IQOS Emissions Be Considered as Smoke and Harmful to Health? A Review of the Chemical Evidence. ACS OMEGA 2022; 7:22111-22124. [PMID: 35811880 PMCID: PMC9260752 DOI: 10.1021/acsomega.2c01527] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
The chemical evidence that IQOS emissions fit the definition of both an aerosol and smoke, and that IQOS and potentially other heated tobacco products (HTPs) pose some harmful health threats from the range of compounds released even at somewhat lower concentrations is reviewed. Further, we address the yields of harmful and potentially harmful compounds (HPHCs), including polycyclic aromatic hydrocarbons (PAHs), and the constituents of IQOS emission that are diagnostic of pyrolysis to provide information on the temperatures reached in IQOS tobacco sticks. The HPHCs present in IQOS emissions are the same as in conventional cigarette smoke (CCs), analogous to emissions from earlier generation of HTPs classed as smoke. However, Philip Morris International (PMI) studies have to some degree underestimated IQOS aerosol HPHC yields, which are a factor of between 3.2 and 3.6 higher when expressed on a tobacco rather than an IQOS stick basis compared to the reference 3R4F cigarette. Further, IQOS emissions contain carbon particles, which fit definition of both aerosol and smoke. Continual reheating of deposited tar in the IQOS device will occur with real-life use, likely leading to generation of even higher concentrations of HPHCs and particulate matter. Despite IQOS not exceeding 350 °C, local hot spots could exist, causing formation of species (phenol/cresols, PAHs). It is recommended that the impact of repeated use to determine the levels of black carbon (insoluble organic matter) in the particulate matter, and the extent to which compounds in IQOS emissions are formed by pyrolysis need to be assessed rigorously. To address whether uneven temperature profiles in heat sticks can lead to potential hot spots that could, for example, lead to PAH formation, it is recommended that pyrolysis studies on tobacco and other constituents of HTPs are required in conjunction with more effort on heating tobacco blends under controlled temperature/time conditions.
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Amorós-Pérez A, Cano-Casanova L, Román-Martínez MDC, Lillo-Ródenas MÁ. Comparison of particulate matter emission and soluble matter collected from combustion cigarettes and heated tobacco products using a setup designed to simulate puffing regimes. CHEMICAL ENGINEERING JOURNAL ADVANCES 2021. [DOI: 10.1016/j.ceja.2021.100144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Dusautoir R, Zarcone G, Verriele M, Garçon G, Fronval I, Beauval N, Allorge D, Riffault V, Locoge N, Lo-Guidice JM, Anthérieu S. Comparison of the chemical composition of aerosols from heated tobacco products, electronic cigarettes and tobacco cigarettes and their toxic impacts on the human bronchial epithelial BEAS-2B cells. JOURNAL OF HAZARDOUS MATERIALS 2021; 401:123417. [PMID: 32763707 DOI: 10.1016/j.jhazmat.2020.123417] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
The electronic cigarettes (e-cigs) and more recently the heated tobacco products (HTP) provide alternatives for smokers as they are generally perceived to be less harmful than conventional cigarettes. However, it is crucial to compare the health risks of these different emergent devices, in order to determine which product should be preferred to substitute cigarette. The present study aimed to compare the composition of emissions from HTP, e-cigs and conventional cigarettes, regarding selected harmful or potentially harmful compounds, and their toxic impacts on the human bronchial epithelial BEAS-2B cells. The HTP emitted less polycyclic aromatic hydrocarbons and carbonyls than the conventional cigarette. However, amounts of these compounds in HTP aerosols were still higher than in e-cig vapours. Concordantly, HTP aerosol showed reduced cytotoxicity compared to cigarette smoke but higher than e-cig vapours. HTP and e-cig had the potential to increase oxidative stress and inflammatory response, in a manner similar to that of cigarette smoke, but after more intensive exposures. In addition, increasing e-cig power impacted levels of certain toxic compounds and related oxidative stress. This study provides important data necessary for risk assessment by demonstrating that HTP might be less harmful than tobacco cigarette but considerably more harmful than e-cig.
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Affiliation(s)
- Romain Dusautoir
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | - Gianni Zarcone
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | - Marie Verriele
- IMT Lille Douai, Univ. Lille, SAGE, F-59000, Lille, France.
| | - Guillaume Garçon
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | | | - Nicolas Beauval
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | - Delphine Allorge
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | | | - Nadine Locoge
- IMT Lille Douai, Univ. Lille, SAGE, F-59000, Lille, France.
| | - Jean-Marc Lo-Guidice
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | - Sébastien Anthérieu
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
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Schlage WK, Titz B, Iskandar A, Poussin C, Van der Toorn M, Wong ET, Pratte P, Maeder S, Schaller JP, Pospisil P, Boue S, Vuillaume G, Leroy P, Martin F, Ivanov NV, Peitsch MC, Hoeng J. Comparing the preclinical risk profile of inhalable candidate and potential candidate modified risk tobacco products: A bridging use case. Toxicol Rep 2020; 7:1187-1206. [PMID: 32995294 PMCID: PMC7502378 DOI: 10.1016/j.toxrep.2020.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/24/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022] Open
Abstract
Heated tobacco products tested for reduced exposure and reduced risk properties. Bridging opportunities for nonclinical results from two heated tobacco products. Similarly reduced impact on apical and molecular endpoints relative to cigarettes. Evidence evaluated along a “causal chain of events leading to disease” (CELSD). Representative assays along CELSD could support nonclinical substantial equivalence.
Cigarette smoking causes major preventable diseases, morbidity, and mortality worldwide. Smoking cessation and prevention of smoking initiation are the preferred means for reducing these risks. Less harmful tobacco products, termed modified-risk tobacco products (MRTP), are being developed as a potential alternative for current adult smokers who would otherwise continue smoking. According to a regulatory framework issued by the US Food and Drug Administration, a manufacturer must provide comprehensive scientific evidence that the product significantly reduces harm and the risk of tobacco-related diseases, in order to obtain marketing authorization for a new MRTP. For new tobacco products similar to an already approved predicate product, the FDA has foreseen a simplified procedure for assessing “substantial equivalence”. In this article, we present a use case that bridges the nonclinical evidence from previous studies demonstrating the relatively reduced harm potential of two heat-not-burn products based on different tobacco heating principles. The nonclinical evidence was collected along a “causal chain of events leading to disease” (CELSD) to systematically follow the consequences of reduced exposure to toxicants (relative to cigarette smoke) through increasing levels of biological complexity up to disease manifestation in animal models of human disease. This approach leverages the principles of systems biology and toxicology as a basis for further extrapolation to human studies. The experimental results demonstrate a similarly reduced impact of both products on apical and molecular endpoints, no novel effects not seen with cigarette smoke exposure, and an effect of switching from cigarettes to either MRTP that is comparable to that of complete smoking cessation. Ideally, a subset of representative assays from the presented sequence along the CELSD could be sufficient for predicting similarity or substantial equivalence in the nonclinical impact of novel products; this would require further validation, for which the present use case could serve as a starting point.
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Key Words
- BIF, biological impact factor
- CELSD, causal chain of events leading to disease
- CHTP, carbon heated tobacco product
- CS, cigarette smoke
- CVD, cardiovascular disease
- GVP, gas/vapor phase
- HPHC, harmful and potentially harmful constituents
- MRTP, modified risk tobacco product
- Modified risk tobacco product (MRTP)
- NPA, network perturbation amplitude
- PMI, Philip Morris International
- RBIF, relative BIF
- Substantial equivalence
- Systems toxicology
- THS, Tobacco Heating System
- TPM, total particulate matter
- Tobacco harm reduction
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Affiliation(s)
| | - Bjoern Titz
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Anita Iskandar
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Carine Poussin
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Marco Van der Toorn
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Ee Tsin Wong
- PMI R&D, Philip Morris International Research Laboratories Pte. Ltd., Science Park II, Singapore
| | - Pascal Pratte
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Serge Maeder
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Jean-Pierre Schaller
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Pavel Pospisil
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Stephanie Boue
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Grégory Vuillaume
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Patrice Leroy
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Florian Martin
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Nikolai V Ivanov
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Manuel C Peitsch
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Julia Hoeng
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
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Haziza C, de La Bourdonnaye G, Donelli A, Skiada D, Poux V, Weitkunat R, Baker G, Picavet P, Lüdicke F. Favorable Changes in Biomarkers of Potential Harm to Reduce the Adverse Health Effects of Smoking in Smokers Switching to the Menthol Tobacco Heating System 2.2 for 3 Months (Part 2). Nicotine Tob Res 2020; 22:549-559. [PMID: 31125079 PMCID: PMC7164580 DOI: 10.1093/ntr/ntz084] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 05/23/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Tobacco Heating System (THS) 2.2, a candidate modified-risk tobacco product, aims at offering an alternative to cigarettes for smokers while substantially reducing the exposure to harmful and potentially harmful constituents found in cigarette smoke. METHODS One hundred and sixty healthy adult US smokers participated in this randomized, three-arm parallel group, controlled clinical study. Subjects were randomized in a 2:1:1 ratio to menthol Tobacco Heating System 2.2 (mTHS), menthol cigarette, or smoking abstinence for 5 days in confinement and 86 subsequent ambulatory days. Endpoints included biomarkers of exposure to harmful and potentially harmful constituents (reported in our co-publication, Part 1) and biomarkers of potential harm (BOPH). RESULTS Compliance (protocol and allocated product exposure) was 51% and 18% in the mTHS and smoking abstinence arms, respectively, on day 90. Nonetheless, favorable changes in BOPHs of lipid metabolism (total cholesterol and high- and low-density cholesterol), endothelial dysfunction (soluble intercellular adhesion molecule-1), oxidative stress (8-epi-prostaglandin F2α), and cardiovascular risk factors (eg, high-sensitivity C-reactive protein) were observed in the mTHS group. Favorable effects in other BOPHs, including ones related to platelet activation (11-dehydrothromboxane B2) and metabolic syndrome (glucose), were more pronounced in normal weight subjects. CONCLUSIONS The results suggest that the reduced exposure demonstrated when switching to mTHS is associated with overall improvements in BOPHs, which are indicative of pathomechanistic pathways underlying the development of smoking-related diseases, with some stronger effects in normal weight subjects. IMPLICATIONS Switching to mTHS was associated with favorable changes for some BOPHs indicative of biological pathway alterations (eg, oxidative stress and endothelial dysfunction). The results suggest that switching to mTHS has the potential to reduce the adverse health effects of smoking and ultimately the risk of smoking-related diseases. Switching to mTHS for 90 days led to reductions in a number of biomarkers of exposure in smokers, relative to those who continued smoking cigarettes, which were close to those observed when stopping smoking (reported in our co-publication, Part 1). Initial findings suggest reduced levels of 8-epi-prostaglandin F2α and intercellular adhesion molecule 1, when switching to mTHS for 90 days. These changes are comparable to what is observed upon smoking cessation. In normal weight subjects, additional favorable changes were seen in 11-dehydrothromboxane B2, fibrinogen, homocysteine, hs-CRP, percentage of predicted forced expiratory volume in 1 second, systolic blood pressure, diastolic blood pressure, glucose, high-density lipoprotein, apolipoprotein A1, and triglycerides. TRIAL REGISTRATION NCT01989156.
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Affiliation(s)
- Christelle Haziza
- PMI Research and Development, Philip Morris Products S.A., Neuchâtel, Switzerland
| | | | - Andrea Donelli
- PMI Research and Development, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Dimitra Skiada
- PMI Research and Development, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Valerie Poux
- PMI Research and Development, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Rolf Weitkunat
- PMI Research and Development, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Gizelle Baker
- PMI Research and Development, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Patrick Picavet
- PMI Research and Development, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Frank Lüdicke
- PMI Research and Development, Philip Morris Products S.A., Neuchâtel, Switzerland
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Papaefstathiou E, Stylianou M, Andreou C, Agapiou A. Breath analysis of smokers, non-smokers, and e-cigarette users. J Chromatogr B Analyt Technol Biomed Life Sci 2020; 1160:122349. [PMID: 32920481 DOI: 10.1016/j.jchromb.2020.122349] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/17/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022]
Abstract
Solid phase micro extraction-Gas Chromatography/Mass Spectrometry (SPME-GC/MS) analysis was performed in exhaled breath samples of 48 healthy volunteers: 20 non-smokers, 10 smokers and 18 e-cigarette (EC, vape) users. Each volunteer provided 1 L of exhaled breath in a pre-cleaned Tedlar bag, in which an SPME fiber was exposed to absorb the emitted breath volatile organic compounds (VOCs). The acquired data were processed using multivariate data analysis (MDA) methods in order to identify the characteristic chemicals of the three groups. The results revealed that the breath of non-smokers demonstrated inverse correlation with a variety of molecules related to the breath from smokers including furan, toluene, 2-butanone and other organic substances. Vapers were distinguished from smokers by the chemical speciation of the e-liquids, such as that of esters (e.g. ethyl acetate), terpenes (e.g. α-pinene, β-pinene, d-limonene, p-cymene, etc.) and oxygenated compounds (e.g. 3-hexen-1-ol, benzaldehyde, hexanal, decanal, etc). Two classification models were developed (a) using principal component analysis (PCA) with hierarchical cluster analysis (HCA) and (b) using partial least squares-discriminant analysis (PLS-DA). Both models were validated using 8 new samples (4 vapers and 4 smokers), collected in addition to the 48 samples of the calibration set. The combination of GC/MS breath analysis and MDA contributed successfully in classifying the volunteers into their respective groups and highlighted the relevant characteristic VOCs. The respective dynamic combination (SPME-GC/MS and MDA) provides a means for long term non-invasive monitoring of the population's health status for early detection purposes.
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Affiliation(s)
- E Papaefstathiou
- Department of Chemistry, University of Cyprus, P.O.Box 20537, 1678 Nicosia, Cyprus
| | - M Stylianou
- Department of Chemistry, University of Cyprus, P.O.Box 20537, 1678 Nicosia, Cyprus
| | - C Andreou
- Department of Electrical and Computer Engineering, University of Cyprus, 1678 Nicosia, Cyprus
| | - A Agapiou
- Department of Chemistry, University of Cyprus, P.O.Box 20537, 1678 Nicosia, Cyprus.
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Aspera-Werz RH, Ehnert S, Müller M, Zhu S, Chen T, Weng W, Jacoby J, Nussler AK. Assessment of tobacco heating system 2.4 on osteogenic differentiation of mesenchymal stem cells and primary human osteoblasts compared to conventional cigarettes. World J Stem Cells 2020; 12:841-856. [PMID: 32952862 PMCID: PMC7477651 DOI: 10.4252/wjsc.v12.i8.841] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/17/2020] [Accepted: 08/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cigarette smoking (CS) is the most common method of consuming tobacco. Deleterious effects on bone integrity, increased incidence of fractures, and delayed fracture healing are all associated with CS. Over 150 of the 6500 molecular species contained in cigarette smoke and identified as toxic compounds are inhaled by CS and, via the bloodstream, reach the skeletal system. New technologies designed to develop a reduced-risk alternative for smokers are based on electronic nicotine delivery systems, such as e-cigarettes and tobacco heating systems (THS). THS are designed to heat tobacco instead of burning it, thereby reducing the levels of harmful toxic compounds released.
AIM To examine the effects of THS on osteoprogenitor cell viability and function compared to conventional CS.
METHODS Human immortalized mesenchymal stem cells (n = 3) and primary human pre-osteoblasts isolated from cancellous bone samples from BG Unfall Klinik Tübingen (n = 5) were osteogenically differentiated in vitro with aqueous extracts generated from either the THS 2.4 “IQOS” or conventional “Marlboro” cigarettes for up to 21 d. Cell viability was analyzed using resazurin conversion assay (mitochondrial activity) and calcein-AM staining (esterase activity). Osteogenic differentiation and bone cell function were evaluated using alkaline phosphatase (AP) activity, while matrix formation was analyzed through alizarin red staining. Primary cilia structure was examined by acetylated α-tubulin immunofluorescent staining. Free radical production was evaluated with 2’,7’-dichlorofluorescein-diacetate assay.
RESULTS Our data clearly show that THS is significantly less toxic to bone cells than CS when analyzed by mitochondrial and esterase activity (P < 0.001). No significant differences in cytotoxicity between the diverse flavors of THS were observed. Harmful effects from THS on bone cell function were observed only at very high, non-physiological concentrations. In contrast, extracts from conventional cigarettes significantly reduced the AP activity (by two-fold) and matrix mineralization (four-fold) at low concentrations. Additionally, morphologic analysis of primary cilia revealed no significant changes in the length of the organelle involved in osteogenesis of osteoprogenitor cells, nor in the number of ciliated cells following THS treatment. Assessment of free radical production demonstrated that THS induced significantly less oxidative stress than conventional CS in osteoprogenitor cells.
CONCLUSION THS was significantly less harmful to osteoprogenitor cells during osteogenesis than conventional CS. Additional studies are required to confirm whether THS is a better alternative for smokers to improve delays in bone healing following fracture.
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Affiliation(s)
- Romina H Aspera-Werz
- Department of Traumatology, BG Trauma Clinic, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen, Tübingen 72076, Germany
| | - Sabrina Ehnert
- Department of Traumatology, BG Trauma Clinic, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen, Tübingen 71076, Germany
| | - Monja Müller
- Department of Traumatology, BG Trauma Clinic, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen, Tübingen 71076, Germany
| | - Sheng Zhu
- Department of Traumatology, BG Trauma Clinic, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen, Tübingen 71076, Germany
| | - Tao Chen
- Department of Traumatology, BG Trauma Clinic, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen, Tübingen 71076, Germany
| | - Weidong Weng
- Department of Traumatology, BG Trauma Clinic, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen, Tübingen 71076, Germany
| | - Johann Jacoby
- Institute for Clinical Epidemiology and Applied Biometry, Eberhard Karls Universität Tübingen, Tübingen 71076, Germany
| | - Andreas K Nussler
- Department of Traumatology, BG Trauma Clinic, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen, Tübingen 71076, Germany
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12
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Cao Z, Guo Y, Ao Y, Zhou S. Dysregulated microRNAs in laryngeal cancer: a comprehensive meta-analysis using a robust rank aggregation approach. Future Oncol 2020; 16:2723-2734. [PMID: 32812475 DOI: 10.2217/fon-2020-0394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We need a reasonable method of compiling data from different studies regarding the expression of microRNA (miRNA) in laryngeal squamous cell carcinoma (LSCC). The robust rank aggregation method was used to integrate the rank lists of miRNAs from 11 studies. The enrichment analysis was performed on target genes of meta-signature miRNAs. The Cancer Genome Atlas database was used to confirm the results of meta-analysis. Three meta-signature miRNAs (miR-21-5p, miR-196a-5p and miR-145-5p) were obtained. All three miRNAs could be prognostic for LSCC. The enrichment analysis showed that these miRNAs were associated significantly with multiple cancer-related signaling pathways. The robust rank aggregation approach is an effective way to identify important miRNAs from different studies. All identified miRNAs could be candidates for LSCC diagnostic and prognostic biomarkers.
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Affiliation(s)
- Zaizai Cao
- Zhejiang University, Zhejiang Province, 310003, PR China.,Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, 310003, PR China
| | - Yu Guo
- Zhejiang University, Zhejiang Province, 310003, PR China.,Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, 310003, PR China
| | - Yinjie Ao
- Zhejiang University, Zhejiang Province, 310003, PR China.,Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, 310003, PR China
| | - Shuihong Zhou
- Zhejiang University, Zhejiang Province, 310003, PR China.,Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, 310003, PR China
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13
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Li X, Luo Y, Jiang X, Zhang H, Zhu F, Hu S, Hou H, Hu Q, Pang Y. Chemical Analysis and Simulated Pyrolysis of Tobacco Heating System 2.2 Compared to Conventional Cigarettes. Nicotine Tob Res 2020; 21:111-118. [PMID: 29319815 DOI: 10.1093/ntr/nty005] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 01/06/2018] [Indexed: 01/13/2023]
Abstract
Introduction Tobacco Heating System 2.2 (THS 2.2, marketed as iQOS) is a heat-not-burn (HNB) tobacco product that has been successfully introduced to global markets. Despite its expanding market, few independent and systematic researches into THS 2.2 have been carried out to date. Methods We tested a comprehensive list of total particulate matter (TPM), water, tar, nicotine, propylene glycol, glycerin, carbon monoxide, volatile organic compounds, aromatic amines, hydrogen cyanide, ammonia, N-nitrosamines, phenol, and polycyclic aromatic hydrocarbon under both ISO and HCI regimes. We also simulated pyrolysis of THS 2.2 heating sticks and made comparisons with conventional cigarette tobacco fillers using comprehensive gas chromatography-mass spectrometry (GC × GC-MS) to determine whether the specially designed ingredients help reduce harmful constituents. Results Other than some carbonyls, ammonia, and N-nitrosoanabasine (NAB), the delivered releases from THS 2.2 were at least 80% lower than those from 3R4F. Tar and nicotine remained almost the same as 3R4F. Interestingly, the normalized yield of THS 2.2 to 3R4F under the HCI regime was lower than that under the ISO regime. Conclusions THS 2.2 delivered fewer harmful constituents than the conventional cigarette 3R4F. Simulated pyrolysis results showed that the lower temperature instead of specially designed ingredients contributed to the distinct shift. In particular, if smoking machines are involved to evaluate the HNB products, smoking regimes of heat-not-burn tobacco products should be carefully chosen. Implications To our knowledge, few independent studies of HNB products have been published. In this paper, a comprehensive list of chemical releases was tested systematically and compared to those from 3R4F. Although THS 2.2 generates lower levels of harmful constituents, the nicotine and tar levels were almost identical to 3R4F.The results should be discussed carefully in the future when assessing the dual-use with other conventional cigarettes, nicotine dependence of HNB products, etc. This study also suggests that regulatory agencies should pay attention to the smoking regimes that are adopted to evaluate HNB tobacco products.
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Affiliation(s)
- Xiangyu Li
- Department of Environmental Science and Technology, School of Environment, Tsinghua University, Beijing, China
| | - Yanbo Luo
- Department of Analytical Chemistry, College of Chemistry and Molecular Sciences, Wuhan University, Wuhan, Hubei, China
| | - Xingyi Jiang
- Department of Biotechnology, School of International Education, Henan University of Technology, Zhengzhou, Henan, China
| | - Hongfei Zhang
- Department of Tobacco Chemistry, School Of Food Science and Engineering, Zhengzhou University of Light Industry, Zhengzhou, Henan, China
| | - Fengpeng Zhu
- Department of Tobacco Chemistry, School Of Food Science and Engineering, Zhengzhou University of Light Industry, Zhengzhou, Henan, China
| | - Shaodong Hu
- Department of polymer science and engineer, Sichuan University, Chengdu, Sichuan, China
| | - Hongwei Hou
- Department of Inorganic Chemistry, Chemistry, University of Science and Technology of China, Hefei, Anhui, China
| | - Qingyuan Hu
- Department of Optics, Anhui Institute of Optics and Fine Mechanics, The Chinese Academy of Sciences, Hefei, Anhui, China
| | - Yongqiang Pang
- Department of Analytical Chemistry, Chemistry, University of Science and Technology of China, Hefei, Anhui, China
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14
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Newland N, Lowe FJ, Camacho OM, McEwan M, Gale N, Ebajemito J, Hardie G, Murphy J, Proctor C. Evaluating the effects of switching from cigarette smoking to using a heated tobacco product on health effect indicators in healthy subjects: study protocol for a randomized controlled trial. Intern Emerg Med 2019; 14:885-898. [PMID: 31049783 PMCID: PMC6722146 DOI: 10.1007/s11739-019-02090-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/16/2019] [Indexed: 12/18/2022]
Abstract
Tobacco heating products (THPs) are a potentially safer alternative to combustible cigarette smoking. Through continued use, THPs may reduce smoking-related disease risk, whilst maintaining the sensorial experience and nicotine delivery sought by smokers. While literature evidence of the biological effects of THP aerosol exposure is increasing, there remains a knowledge gap with respect to substantiation of THP reduced risk potential in longer term real-life use. This randomized, multi-centre, controlled clinical study will test the hypotheses that following a switch from combustible cigarettes to a THP for 1 year, participants will experience a sustained reduction in exposure to tobacco-related toxicants that will lead to favourable changes in health effect indicators associated with smoking-related disease development. Changes in such indicators will be contextualized against smoking cessation and never-smoker cohorts. Up to 280 participants who do not intend to quit smoking will be randomized to continued combustible smoking (arm A, up to n = 80) or a commercially available THP (arm B n = 200). Furthermore, up to 190 participants with a high intent to quit smoking will undergo smoking cessation (arm D), and 40 never smokers will serve as a control group (arm E). Recruitment numbers were determined to be sufficient to achieve n = 50 in arms A, B and D, at study end. Enrolment started in March 2018 and the trial is scheduled to be completed in March 2020. Data from this study will be a valuable addition to the growing body of evidence in the field of understanding the individual and public health impact of THPs.Clinical Trial Registration: https://www.isrctn.com/ISRCTN81075760.
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Affiliation(s)
- Nik Newland
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
| | - Frazer John Lowe
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK.
| | - Oscar Martin Camacho
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
| | - Mike McEwan
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
| | - Nathan Gale
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
| | - James Ebajemito
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
| | - George Hardie
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
| | - James Murphy
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
| | - Christopher Proctor
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
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15
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Sponsiello-Wang Z, Langer P, Prieto L, Dobrynina M, Skiada D, Camille N, Weitkunat R, Lüdicke F. Household Surveys in the General Population and Web-Based Surveys in IQOS Users Registered at the Philip Morris International IQOS User Database: Protocols on the Use of Tobacco- and Nicotine-Containing Products in Germany, Italy, and the United Kingdom (Greater London), 2018-2020. JMIR Res Protoc 2019; 8:e12061. [PMID: 31094340 PMCID: PMC6532333 DOI: 10.2196/12061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 12/26/2022] Open
Abstract
Background Philip Morris International (PMI) has developed a novel heat-not-burn tobacco product, Tobacco Heating System (THS), which is marketed under the brand name of IQOS with HEETS (IQOS). The aerosol generated by THS has substantially fewer toxicants than combustible cigarette smoke, although the extent of the reduction of harmful and potentially harmful constituents reported varies between studies. To evaluate the potential harm reduction associated with IQOS use, the assessment of the uptake and continued use of IQOS in the context of all other tobacco- and nicotine-containing products is crucial. In March 2018, PMI launched cross-sectional surveys in Germany, Italy, and the United Kingdom (Greater London) to estimate the prevalence and use patterns of IQOS and other tobacco- and nicotine-containing products use in these 3 markets following the commercialization of IQOS. This study describes the protocol of the surveys. Objective The objectives of these surveys are to estimate the prevalence of tobacco- and nicotine-containing products use; describe past and current patterns of use; and explore their associations with self-reported health, motivation to use, risk perceptions, and perceived aesthetic changes. Methods The overall design of the surveys is similar in all 3 countries. Repeated cross-sectional surveys are being conducted annually over 3 consecutive years (2018 to 2020) and in 2 samples: a representative sample of the general population and a sample of IQOS users. A total of 6085 adults per year will be selected from the general population for each survey through multistage stratified sampling, and participants will respond to face-to-face computer-assisted personal interviews. In addition, 1404, 1384, and 1246 IQOS users per year in Germany, Italy, and Greater London, respectively, will be randomly selected from the PMI IQOS user database and will be invited to complete the Web-based survey using computer-assisted self-interviews. The Smoking Questionnaire is used to assess the tobacco use patterns of the participants. Results The recruitment of the general population sample began in March 2018 and that of the IQOS user sample began in April 2018. The data collection is ongoing, and the results of the first year data analysis are expected to be available by June 2019. Conclusions As the design of the 3 surveys is similar, the results will allow for cross-countries comparison of the prevalence of IQOS and other tobacco- and nicotine-containing products use as well as patterns of use and associated factors. International Registered Report Identifier (IRRID) DERR1-10.2196/12061
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Affiliation(s)
| | - Peter Langer
- Philip Morris Products SA, Neuchatel, Switzerland
| | - Luis Prieto
- Philip Morris Products SA, Neuchatel, Switzerland
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Roulet S, Chrea C, Kanitscheider C, Kallischnigg G, Magnani P, Weitkunat R. Potential predictors of adoption of the Tobacco Heating System by U.S. adult smokers: An actual use study. F1000Res 2019; 8:214. [PMID: 31559015 PMCID: PMC6743249 DOI: 10.12688/f1000research.17606.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background: This was a pre-market, observational, actual use study with the Tobacco Heating System (THS), a candidate modified risk tobacco product. The main goal of the study was to describe THS adoption within current adult daily smokers by replicating the usage of THS in real-world conditions with participants being able to consume cigarettes, THS, and any other nicotine-containing products (e.g., e-cigarettes, cigars, etc.) ad libitum. Methods: This study assessed self-reported stick-by-stick consumption of THS compared with the use of commercial cigarettes over six weeks. The aim of the analysis was to identify potential predictors for adoption of THS using stepwise logistic regression analysis. Results: By the end of the observational period (in Week 6), 14.6% of participants (n=965) had adopted THS meaning that THS formed 70% or more of their total tobacco consumption. The main predictors of adoption were the liking of the smell, taste, aftertaste, and ease of use of THS. The proportion of adoption was higher in participants aged 44 years and older and in Hispanic or Latino adult smokers. Additionally, adoption of THS was more likely in participants who had never attempted to quit smoking and in participants who smoked up to 10 cigarettes per day. Finally, the adoption of THS was higher in participants who consumed both regular and menthol THS compared with those who consumed only one THS variant. Conclusions: The findings suggest that the introduction of THS in the U.S. has the potential to result in adoption by current adult smokers who would otherwise continue to smoke cigarettes, and that the adoption of THS is unlikely to result in an increase of tobacco consumption. Post-marketing studies will provide further insights on THS adoption and THS use patterns to allow assessment of the impact of the THS at the individual and the overall population level.
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Affiliation(s)
- Steve Roulet
- Science and Innovation, Philip Morris International Management S.A., Lausanne, 1007, Switzerland
| | - Christelle Chrea
- Science and Innovation, Philip Morris Products S.A., Neuchatel, 2000, Switzerland
| | | | - Gerd Kallischnigg
- ARGUS Statistics and Information Systems in Environment and Public Health GmbH, Berlin, Germany
| | - Pierpaolo Magnani
- Science and Innovation, Philip Morris International Management S.A., Lausanne, 1007, Switzerland
| | - Rolf Weitkunat
- Science and Innovation, Philip Morris Products S.A., Neuchatel, 2000, Switzerland
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17
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Roulet S, Chrea C, Kanitscheider C, Kallischnigg G, Magnani P, Weitkunat R. Potential predictors of adoption of the Tobacco Heating System by U.S. adult smokers: An actual use study. F1000Res 2019; 8:214. [PMID: 31559015 PMCID: PMC6743249 DOI: 10.12688/f1000research.17606.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2019] [Indexed: 12/17/2023] Open
Abstract
Background: This was a pre-market actual use study with the Tobacco Heating System (THS), a candidate modified risk tobacco product, conducted with adult smokers in eight cities in the United States. The main goal of the study was to describe THS adoption in a real-world setting. The aim of this analysis was to identify potential predictors for adoption of THS using stepwise logistic regression method. Methods: This actual use study was an observational study assessing self-reported stick-by-stick consumption of the THS product compared with the use of commercial cigarettes over six weeks. The study aimed at replicating the usage of THS in real-world conditions with participants being able to consume cigarettes, THS, and any other nicotine-containing products (e.g., e-cigarettes, cigars, etc.) ad libitum. Results: 14.6% of participants adopted THS, which comprised 70% or more of their total tobacco consumption by the end of the observational period (in Week 6). The main predictors of adoption were the liking of the smell, taste, aftertaste, and ease of use of THS. The proportion of adoption was higher in participants aged 44 years and older and in Hispanic or Latino adult smokers. Additionally, adoption of THS was more likely in participants who had never attempted to quit smoking and in participants who smoked up to 10 cigarettes per day. Finally, the adoption of THS was higher in participants who consumed both regular and menthol THS compared with those who consumed only one THS variant. Conclusions: The main predictors of THS adoption were positive sensory assessment and the ease of use. Socio-demographic characteristics and smoking habits appeared much less important. Post-marketing studies will provide further insights on the impact of the THS at the individual and the overall population level.
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Affiliation(s)
- Steve Roulet
- Science and Innovation, Philip Morris International Management S.A., Lausanne, 1007, Switzerland
| | - Christelle Chrea
- Science and Innovation, Philip Morris Products S.A., Neuchatel, 2000, Switzerland
| | | | - Gerd Kallischnigg
- ARGUS Statistics and Information Systems in Environment and Public Health GmbH, Berlin, Germany
| | - Pierpaolo Magnani
- Science and Innovation, Philip Morris International Management S.A., Lausanne, 1007, Switzerland
| | - Rolf Weitkunat
- Science and Innovation, Philip Morris Products S.A., Neuchatel, 2000, Switzerland
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18
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Dautzenberg B, Dautzenberg MD. [Systematic analysis of the scientific literature on heated tobacco]. Rev Mal Respir 2019; 36:82-103. [PMID: 30429092 DOI: 10.1016/j.rmr.2018.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The tobacco industry (TI) reports that heated tobacco reduces risk of tobacco use and will replace cigarettes. An analysis of the scientific literature was conducted in order to enlighten professionals and decision-makers. METHOD After a Medline query in February 2018, a systematic analysis was conducted. RESULTS Of the 100 papers published in 2008-2018, 75 have authors affiliated or linked to TI. Emissions contain gases, droplets and solid particles, so are smokes. The main products are: THS2.2 (Iqos®) which heats mini-cigarettes at 340°C, the THP1.0 (Glo®) which heats at 240°C sticks delivering about half as much nicotine, Ploom® which uses reconstituted tobacco microcapsules heated at 180°C. Under the experimental conditions, there is a reduction of toxic emissions and biological effects, but the expected risk reduction is not demonstrated. Symptoms related to passive smoking are described. The 4 epidemiological articles report that heated tobacco is used in 10 to 45% of cases by non-smokers and demonstrate the effectiveness of TI promotion campaigns. Thus, the THS2.2 is more a gateway to smoking (20%) than an exit door (11%); moreover, it is not expected risk reduction among the 69% who are mixed users. CONCLUSIONS While reducing emissions is documented, reducing the risk to the smoker who switches to heated-tobacco remains to be demonstrated. On the other hand, the worsening of the global tobacco risk related to the promotion of the products by the TI is anticipated, justifying that the authorities take the appropriate measures to control the promotion of heated tobacco.
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Affiliation(s)
- B Dautzenberg
- Service de pharmacologie, Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Consultation de médecine, hôpital Marmottan, 75017 Paris, France; Consultation de tabacologie, institut Arthur-Vernes, 75006 Paris, France; Paris sans tabac, 14, avenue Bosquet, 75007 Paris, France.
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Nabavizadeh P, Liu J, Havel CM, Ibrahim S, Derakhshandeh R, Jacob Iii P, Springer ML. Vascular endothelial function is impaired by aerosol from a single IQOS HeatStick to the same extent as by cigarette smoke. Tob Control 2018; 27:s13-s19. [PMID: 30206183 PMCID: PMC6202192 DOI: 10.1136/tobaccocontrol-2018-054325] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Heated tobacco products (also called 'heat-not-burn' products) heat tobacco at temperatures below that of combustion, causing nicotine and other compounds to aerosolise. One such product, IQOS from Philip Morris International, is being marketed internationally with claims of harm reduction. We sought to determine whether exposure to IQOS aerosol impairs arterial flow-mediated dilation (FMD), a measure of vascular endothelial function that is impaired by tobacco smoke. METHODS We exposed anaesthetised rats (n=8/group) via nose cone to IQOS aerosol from single HeatSticks, mainstream smoke from single Marlboro Red cigarettes or clean air for a series of consecutive 30 s cycles over 1.5-5 min. Each cycle consisted of 15 or 5 s of exposure followed by removal from the nose cone. We measured pre-exposure and postexposure FMD, and postexposure serum nicotine and cotinine. RESULTS FMD was impaired comparably by ten 15 s exposures and ten 5 s exposures to IQOS aerosol and to cigarette smoke, but not by clean air. Serum nicotine levels were similar to plasma levels after humans have smoked one cigarette, confirming that exposure conditions had real-world relevance. Postexposure nicotine levels were ~4.5-fold higher in rats exposed to IQOS than to cigarettes, despite nicotine being measured in the IQOS aerosol at ~63% the amount measured in smoke. When IQOS exposure was briefer, leading to comparable serum nicotine levels to the cigarette group, FMD was still comparably impaired. CONCLUSIONS Acute exposures to IQOS aerosol impairs FMD in rats. IQOS use does not necessarily avoid the adverse cardiovascular effects of smoking cigarettes.
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Affiliation(s)
- Pooneh Nabavizadeh
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Jiangtao Liu
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Christopher M Havel
- Division of Clinical Pharmacology and Experimental Therapeutics, University of California, San Francisco, San Francisco, California, USA
| | - Sharina Ibrahim
- Division of Cardiology, University of California, San Francisco, San Francisco, California, USA
| | - Ronak Derakhshandeh
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Peyton Jacob Iii
- Division of Clinical Pharmacology and Experimental Therapeutics, University of California, San Francisco, San Francisco, California, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California, USA
| | - Matthew L Springer
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
- Division of Cardiology, University of California, San Francisco, San Francisco, California, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California, USA
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20
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Kaur G, Muthumalage T, Rahman I. Mechanisms of toxicity and biomarkers of flavoring and flavor enhancing chemicals in emerging tobacco and non-tobacco products. Toxicol Lett 2018; 288:143-155. [PMID: 29481849 PMCID: PMC6549714 DOI: 10.1016/j.toxlet.2018.02.025] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/19/2018] [Accepted: 02/21/2018] [Indexed: 01/11/2023]
Abstract
Tobacco products containing flavorings, such as electronic nicotine delivery devices (ENDS) or e-cigarettes, cigars/cigarillos, waterpipes, and heat-not-burn devices (iQOS) are continuously evolving. In addition to increasing the exposure of teenagers and adults to nicotine containing flavoring products and flavoring enhancers, chances of nicotine addiction through chronic use and abuse also increase. These flavorings are believed to be safe for ingestion, but little information is available about their effects on the lungs. In this review, we have discussed the in vitro and in vivo data on toxicity of flavoring chemicals in lung cells. We have further discussed the common flavoring agents, such as diacetyl and menthol, currently available detection methods, and the toxicological mechanisms associated with oxidative stress, inflammation, mucociliary clearance, and DNA damage in cells, mice, and humans. Finally, we present potential biomarkers that could be utilized for future risk assessment. This review provides crucial parameters important for evaluation of risk associated with flavoring agents and flavoring enhancers used in tobacco products and ENDS. Future studies can be designed to address the potential toxicity of inhaled flavorings and their biomarkers in users as well as in chronic exposure studies.
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Affiliation(s)
- Gurjot Kaur
- Human and Environmental Toxicology, Department of Biology, University of Konstanz, Konstanz, Germany
| | - Thivanka Muthumalage
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
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Abstract
OBJECTIVE To evaluate performance of the I quit original smoking (iQOS) heat-not-burn system as a function of cleaning and puffing topography, investigate the validity of manufacturer's claims that this device does not burn tobacco and determine if the polymer-film filter is potentially harmful. METHODS iQOS performance was evaluated using five running conditions incorporating two different cleaning protocols. Heatsticks were visually and stereomicroscopically inspected preuse and postuse to determine the extent of tobacco plug charring (from pyrolysis) and polymer-film filter melting, and to elucidate the effects of cleaning on charring. Gas chromatography-mass spectrometry headspace analysis was conducted on unused polymer-film filters to determine if potentially toxic chemicals are emitted from the filter during heating. RESULTS For all testing protocols, pressure drop decreased as puff number increased. Changes in testing protocols did not affect aerosol density. Charring due to pyrolysis (a form of organic matter thermochemical decomposition) was observed in the tobacco plug after use. When the manufacturer's cleaning instructions were followed, both charring of the tobacco plug and melting of the polymer-film filter increased. Headspace analysis of the polymer-film filter revealed the release of formaldehyde cyanohydrin at 90°C, which is well below the maximum temperature reached during normal usage. DISCUSSION Device usage limitations may contribute to decreases in interpuff intervals, potentially increasing user's intake of nicotine and other harmful chemicals. This study found that the tobacco plug does char and that charring increases when the device is not cleaned between heatsticks. Release of formaldehyde cyanohydrin is a concern as it is highly toxic at very low concentrations.
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Affiliation(s)
| | | | - Prue Talbot
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, California, USA
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Ichitsubo H, Kotaki M. Indoor air quality (IAQ) evaluation of a Novel Tobacco Vapor (NTV) product. Regul Toxicol Pharmacol 2018; 92:278-294. [PMID: 29277437 DOI: 10.1016/j.yrtph.2017.12.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/03/2017] [Accepted: 12/21/2017] [Indexed: 11/27/2022]
Abstract
The impact of using a Novel Tobacco Vapor (NTV) product on indoor air quality (IAQ) was simulated using an environmentally-controlled chamber. Three environmental simulations were examined; two non-smoking areas (conference room and dining room) and one ventilated smoking area (smoking lounge). IAQ was evaluated by (i) measuring constituents in the mainstream NTV product emissions, (ii) and by determining classical environmental tobacco smoke (ETS) and representative air quality markers. Analysis of the mainstream emissions revealed that vapor from the NTV product is chemically simpler than cigarette smoke. ETS markers (RSP, UVPM, FPM, solanesol, nicotine, 3-ethenylpyridine), volatile organic compound (toluene), carbon monoxide, propylene glycol, glycerol, and triacetin were below the limit of detection or the limit of quantification in both the non-smoking and smoking environments after using the NTV product. The concentrations of ammonia, carbonyls (formaldehyde, acetaldehyde, and acetone), and total volatile organic compounds were the same levels found in the chamber without NTV use. There was no significant increase in the levels of formaldehyde, acetone or ammonia in exhaled breath following NTV use. In summary, under the simulations tested, the NTV product had no measurable effect on the IAQ, in either non-smoking or smoking areas.
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Affiliation(s)
- Hirokazu Ichitsubo
- Tobacco Science Research Center, Japan Tobacco Inc., 6-2 Umegaoka, Aoba-ku, Yokohama, Kanagawa 227-8512, Japan.
| | - Misato Kotaki
- Corporate, Scientific and Regulatory Affairs Div., Tobacco Business Headquarters, Japan Tobacco Inc., JT Bldg. 2-2-1 Toranomon, Minato-ku, Tokyo, 105-8422, Japan
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23
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Sewer A, Kogel U, Talikka M, Wong ET, Martin F, Xiang Y, Guedj E, Ivanov NV, Hoeng J, Peitsch MC. Evaluation of the Tobacco Heating System 2.2 (THS2.2). Part 5: microRNA expression from a 90-day rat inhalation study indicates that exposure to THS2.2 aerosol causes reduced effects on lung tissue compared with cigarette smoke. Regul Toxicol Pharmacol 2016; 81 Suppl 2:S82-S92. [PMID: 27866933 DOI: 10.1016/j.yrtph.2016.11.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/07/2016] [Accepted: 11/16/2016] [Indexed: 12/25/2022]
Abstract
Modified-risk tobacco products (MRTP) are designed to reduce the individual risk of tobacco-related disease as well as population harm compared to smoking cigarettes. Experimental proof of their benefit needs to be provided at multiple levels in research fields. Here, we examined microRNA (miRNA) levels in the lungs of rats exposed to a candidate modified-risk tobacco product, the Tobacco Heating System 2.2 (THS2.2) in a 90-day OECD TG-413 inhalation study. Our aim was to assess the miRNA response to THS2.2 aerosol compared with the response to combustible cigarettes (CC) smoke from the reference cigarette 3R4F. CC smoke exposure, but not THS2.2 aerosol exposure, caused global miRNA downregulation, which may be explained by the interference of CC smoke constituents with the miRNA processing machinery. Upregulation of specific miRNA species, such as miR-146a/b and miR-182, indicated that they are causal elements in the inflammatory response in CC-exposed lungs, but they were reduced after THS2.2 aerosol exposure. Transforming transcriptomic data into protein activity based on corresponding downstream gene expression, we identified potential mechanisms for miR-146a/b and miR-182 that were activated by CC smoke but not by THS2.2 aerosol and possibly involved in the regulation of those miRNAs. The inclusion of miRNA profiling in systems toxicology approaches increases the mechanistic understanding of the complex exposure responses.
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Affiliation(s)
- Alain Sewer
- Philip Morris International R&D, Part of Philip Morris International Group of Companies, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland.
| | - Ulrike Kogel
- Philip Morris International R&D, Part of Philip Morris International Group of Companies, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Marja Talikka
- Philip Morris International R&D, Part of Philip Morris International Group of Companies, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Ee Tsin Wong
- Philip Morris International Research Laboratories Pte Ltd, Part of Philip Morris International Group of Companies, 50 Science Park Road, The Kendall #02-07, Science Park II, 117406, Singapore
| | - Florian Martin
- Philip Morris International R&D, Part of Philip Morris International Group of Companies, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Yang Xiang
- Philip Morris International R&D, Part of Philip Morris International Group of Companies, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Emmanuel Guedj
- Philip Morris International R&D, Part of Philip Morris International Group of Companies, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Nikolai V Ivanov
- Philip Morris International R&D, Part of Philip Morris International Group of Companies, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Julia Hoeng
- Philip Morris International R&D, Part of Philip Morris International Group of Companies, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Manuel C Peitsch
- Philip Morris International R&D, Part of Philip Morris International Group of Companies, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
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Oviedo A, Lebrun S, Kogel U, Ho J, Tan WT, Titz B, Leroy P, Vuillaume G, Bera M, Martin F, Rodrigo G, Esposito M, Dempsey R, Ivanov NV, Hoeng J, Peitsch MC, Vanscheeuwijck P. Evaluation of the Tobacco Heating System 2.2. Part 6: 90-day OECD 413 rat inhalation study with systems toxicology endpoints demonstrates reduced exposure effects of a mentholated version compared with mentholated and non-mentholated cigarette smoke. Regul Toxicol Pharmacol 2016; 81 Suppl 2:S93-S122. [DOI: 10.1016/j.yrtph.2016.11.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/28/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
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25
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Evaluation of the Tobacco Heating System 2.2. Part 1: Description of the system and the scientific assessment program. Regul Toxicol Pharmacol 2016; 81 Suppl 2:S17-S26. [DOI: 10.1016/j.yrtph.2016.07.006] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/08/2016] [Indexed: 11/19/2022]
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26
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Haziza C, de La Bourdonnaye G, Skiada D, Ancerewicz J, Baker G, Picavet P, Lüdicke F. Evaluation of the Tobacco Heating System 2.2. Part 8: 5-Day randomized reduced exposure clinical study in Poland. Regul Toxicol Pharmacol 2016; 81 Suppl 2:S139-S150. [DOI: 10.1016/j.yrtph.2016.11.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 01/26/2023]
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27
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Wong ET, Kogel U, Veljkovic E, Martin F, Xiang Y, Boue S, Vuillaume G, Leroy P, Guedj E, Rodrigo G, Ivanov NV, Hoeng J, Peitsch MC, Vanscheeuwijck P. Evaluation of the Tobacco Heating System 2.2. Part 4: 90-day OECD 413 rat inhalation study with systems toxicology endpoints demonstrates reduced exposure effects compared with cigarette smoke. Regul Toxicol Pharmacol 2016; 81 Suppl 2:S59-S81. [DOI: 10.1016/j.yrtph.2016.10.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/04/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
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28
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Schaller JP, Pijnenburg JP, Ajithkumar A, Tricker AR. Evaluation of the Tobacco Heating System 2.2. Part 3: Influence of the tobacco blend on the formation of harmful and potentially harmful constituents of the Tobacco Heating System 2.2 aerosol. Regul Toxicol Pharmacol 2016; 81 Suppl 2:S48-S58. [DOI: 10.1016/j.yrtph.2016.10.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
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29
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Schaller JP, Keller D, Poget L, Pratte P, Kaelin E, McHugh D, Cudazzo G, Smart D, Tricker AR, Gautier L, Yerly M, Reis Pires R, Le Bouhellec S, Ghosh D, Hofer I, Garcia E, Vanscheeuwijck P, Maeder S. Evaluation of the Tobacco Heating System 2.2. Part 2: Chemical composition, genotoxicity, cytotoxicity, and physical properties of the aerosol. Regul Toxicol Pharmacol 2016; 81 Suppl 2:S27-S47. [DOI: 10.1016/j.yrtph.2016.10.001] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 12/27/2022]
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30
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Evaluation of the Tobacco Heating System 2.2. Part 7: Systems toxicological assessment of a mentholated version revealed reduced cellular and molecular exposure effects compared with mentholated and non-mentholated cigarette smoke. Regul Toxicol Pharmacol 2016; 81 Suppl 2:S123-S138. [DOI: 10.1016/j.yrtph.2016.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 12/29/2022]
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31
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Martin F, Talikka M, Ivanov NV, Haziza C, Hoeng J, Peitsch MC. Evaluation of the tobacco heating system 2.2. Part 9: Application of systems pharmacology to identify exposure response markers in peripheral blood of smokers switching to THS2.2. Regul Toxicol Pharmacol 2016; 81 Suppl 2:S151-S157. [DOI: 10.1016/j.yrtph.2016.11.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 01/08/2023]
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