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Reilly S, Cheng T, Feng C, Walters MJ. Harmful and Potentially Harmful Constituents in E-Liquids and Aerosols from Electronic Nicotine Delivery Systems (ENDS). Chem Res Toxicol 2024; 37:1155-1170. [PMID: 38924487 PMCID: PMC11256903 DOI: 10.1021/acs.chemrestox.4c00093] [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: 03/07/2024] [Revised: 05/30/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
In 2012, the U.S. Food & Drug Administration (FDA) published an established list of 93 harmful and potentially harmful constituents (HPHCs) targeting four tobacco product types (cigarettes, cigarette tobacco, roll-your-own tobacco, smokeless tobacco). In 2016, the FDA finalized the deeming rule to regulate electronic nicotine delivery systems (ENDS). However, knowledge gaps exist regarding whether certain HPHCs are present in ENDS e-liquids and aerosols. We identified and addressed these gaps by conducting literature searches and then experimentally quantifying HPHCs in the e-liquid and aerosol of 37 ENDS brands based on gaps in the literature. The literature searches identified 66 e-liquid HPHCs and 68 aerosol HPHCs that have limited to no information regarding the quantifiability of these constituents. A contracted ISO 17025 accredited laboratory performed the HPHC quantifications. The availability of validated analytical methods in the contracted laboratory determined the HPHCs included in the study scope (63/66 for e-liquids, 64/68 for aerosols). Combining the results from the quantifications and literature searches, 36 (39%) and 34 (37%) HPHCs were found quantifiable (≥limit of quantification [LOQ]) in ENDS e-liquids and aerosols, respectively, with 25 HPHCs being quantifiable in both matrices. Quantifiability results imply potential HPHC transfers between matrices, leaching from components, or formations from aerosol generation. The study results can inform the scientific basis for manufacturers and regulators regarding regulatory requirements for HPHC reporting. The HPHC quantities can also inform evaluations of the public health impact of ENDS and public communications regarding ENDS health risks.
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Affiliation(s)
- Samantha
M. Reilly
- Office of Science, Center
for Tobacco Products, U.S. Food and Drug
Administration, Silver
Spring, Maryland 20993-0002, United States
| | - Tianrong Cheng
- Office of Science, Center
for Tobacco Products, U.S. Food and Drug
Administration, Silver
Spring, Maryland 20993-0002, United States
| | - Charles Feng
- Office of Science, Center
for Tobacco Products, U.S. Food and Drug
Administration, Silver
Spring, Maryland 20993-0002, United States
| | - Matthew J. Walters
- Office of Science, Center
for Tobacco Products, U.S. Food and Drug
Administration, Silver
Spring, Maryland 20993-0002, United States
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2
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Ardati O, Adeniji A, El Hage R, Salman R, El-Kaassamani M, Yassine A, Talih S, Hourani M, Karaoghlanian N, Breland A, Eissenberg T, Saliba N, Shihadeh A, El-Hellani A. Impact of smoking intensity and device cleaning on IQOS emissions: comparison with an array of cigarettes. Tob Control 2024; 33:449-456. [PMID: 36609493 PMCID: PMC10323035 DOI: 10.1136/tc-2022-057802] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/26/2022] [Indexed: 01/09/2023]
Abstract
SIGNIFICANCE IQOS is a heated tobacco product that has been widely advertised by Philip Morris International (PMI) as a reduced-exposure product compared with cigarettes. Reduced exposure results from reduced emission of toxicants which could be influenced by product constituents and user behaviour. This study aims to assess the influence of user behaviour, including device cleaning and puffing parameters, on toxicant emissions from IQOS. METHODS IQOS aerosols were generated by a smoking machine using the combination of two cleaning protocols (after 1 stick vs 20 sticks) and five puffing regimes (including standard cigarette puffing regimes and IQOS-tailored regimes). The generated aerosols were analysed by targeted methods for phenol and carbonyl quantification, and by chemical screening for the identification of unknown compounds. RESULTS Puffing parameters significantly affected phenol and carbonyl emissions while device cleaning had no effect. Harsher puffing conditions like more, longer, and larger puffs yielded higher levels for most toxicant emissions. Comparing the obtained data with data reported by PMI on 50 cigarette brands smoked under different puffing regimes showed various trends for phenol and carbonyl emissions, with IQOS emissions sometimes higher than cigarettes. Also, the chemical screening resulted in the tentative identification of ~100 compounds in the IQOS aerosols (most of limited toxicity data). CONCLUSION This study showed that puffing parameters, but not device cleaning, have significant effects on carbonyl, phenol and other emissions. Data analysis highlighted the importance of comparing IQOS emissions with an array of commercial cigarettes tested under different puffing regimes before accepting reduced exposure claims.
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Affiliation(s)
- Ola Ardati
- Department of Chemistry, American University of Beirut Faculty of Arts and Sciences, Beirut, Lebanon
| | - Ayomipo Adeniji
- Division of Environmental Health Sciences, The Ohio State University College of Public Health, Columbus, Ohio, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Rachel El Hage
- Department of Chemistry, American University of Beirut Faculty of Arts and Sciences, Beirut, Lebanon
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rola Salman
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Malak El-Kaassamani
- Department of Physical and Environmental Sciences, University of Toronto Faculty of Arts & Science, Toronto, Ontario, Canada
| | - Amira Yassine
- Department of Environmental Health and Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland, USA
| | - Soha Talih
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Mario Hourani
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Nareg Karaoghlanian
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Alison Breland
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Najat Saliba
- Department of Chemistry, American University of Beirut Faculty of Arts and Sciences, Beirut, Lebanon
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Alan Shihadeh
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Ahmad El-Hellani
- Division of Environmental Health Sciences, The Ohio State University College of Public Health, Columbus, Ohio, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
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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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Allbright K, Villandre J, Crotty Alexander LE, Zhang M, Benam KH, Evankovich J, Königshoff M, Chandra D. The paradox of the safer cigarette: understanding the pulmonary effects of electronic cigarettes. Eur Respir J 2024; 63:2301494. [PMID: 38609098 DOI: 10.1183/13993003.01494-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 03/16/2024] [Indexed: 04/14/2024]
Abstract
Electronic cigarette (e-cigarette) use continues to rise globally. E-cigarettes have been presented as safer alternatives to combustion cigarettes that can mitigate the harm associated with tobacco products; however, the degree to which e-cigarette use itself can lead to morbidity and mortality is not fully defined. Herein we describe how e-cigarettes function; discuss the current knowledge of the effects of e-cigarette aerosol on lung cell cytotoxicity, inflammation, antipathogen immune response, mucociliary clearance, oxidative stress, DNA damage, carcinogenesis, matrix remodelling and airway hyperresponsiveness; and summarise the impact on lung diseases, including COPD, respiratory infection, lung cancer and asthma. We highlight how the inclusion of nicotine or flavouring compounds in e-liquids can impact lung toxicity. Finally, we consider the paradox of the safer cigarette: the toxicities of e-cigarettes that can mitigate their potential to serve as a harm reduction tool in the fight against traditional cigarettes, and we summarise the research needed in this underinvestigated area.
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Affiliation(s)
- Kassandra Allbright
- Department of Medicine and the Electronic Cigarette Research Initiative, University of Pittsburgh, Pittsburgh, PA, USA
| | - John Villandre
- Department of Medicine and the Electronic Cigarette Research Initiative, University of Pittsburgh, Pittsburgh, PA, USA
| | - Laura E Crotty Alexander
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Michael Zhang
- Department of Medicine and the Electronic Cigarette Research Initiative, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kambez H Benam
- Department of Medicine and the Electronic Cigarette Research Initiative, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - John Evankovich
- Department of Medicine and the Electronic Cigarette Research Initiative, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melanie Königshoff
- Department of Medicine and the Electronic Cigarette Research Initiative, University of Pittsburgh, Pittsburgh, PA, USA
| | - Divay Chandra
- Department of Medicine and the Electronic Cigarette Research Initiative, University of Pittsburgh, Pittsburgh, PA, USA
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Kassem NOF, Strongin RM, Stroup AM, Brinkman MC, El-Hellani A, Erythropel HC, Etemadi A, Exil V, Goniewicz ML, Kassem NO, Klupinski TP, Liles S, Muthumalage T, Noël A, Peyton DH, Wang Q, Rahman I, Valerio LG. A review of the toxicity of ingredients in e-cigarettes, including those ingredients having the FDA's "Generally Recognized as Safe (GRAS)" regulatory status for use in food. Nicotine Tob Res 2024:ntae123. [PMID: 38783714 DOI: 10.1093/ntr/ntae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Some firms and marketers of electronic cigarettes (e-cigarettes; a type of electronic nicotine delivery system (ENDS)) and refill liquids (e-liquids) have made claims about the safety of ingredients used in their products based on the term "GRAS or Generally Recognized As Safe" (GRAS). However, GRAS is a provision within the definition of a food additive under section 201(s) (21 U.S.C. 321(s)) of the U.S. Federal Food Drug and Cosmetic Act (FD&C Act). Food additives and GRAS substances are by the FD&C Act definition intended for use in food, thus safety is based on oral consumption; the term GRAS cannot serve as an indicator of the toxicity of e-cigarette ingredients when aerosolized and inhaled (i.e., vaped). There is no legal or scientific support for labeling e-cigarette product ingredients as "GRAS". This review discusses our concerns with the GRAS provision being applied to e-cigarette products and provides examples of chemical compounds that have been used as food ingredients but have been shown to lead to adverse health effects when inhaled. The review provides scientific insight into the toxicological evaluation of e-liquid ingredients and their aerosols to help determine the potential respiratory risks associated with their use in e-cigarettes. IMPLICATIONS The rise in prevalence of e-cigarette use and emerging evidence of adverse effects, particularly on lung health, warrant assessing all aspects of e-cigarette toxicity. One development is manufacturers' stated or implied claims of the safety of using e-cigarette products containing ingredients determined to be "Generally Recognized As Safe" (GRAS) for use in food. Such claims, typically placed on e-cigarette product labels and used in marketing, are unfounded, as pointed out by the United States Food and Drug Administration (FDA)1 and the Flavor and Extract Manufacturers Association (FEMA)2. Assessment of inhalation health risks of all ingredients used in e-liquids, including those claimed to be GRAS, is warranted.
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Affiliation(s)
- Nada O F Kassem
- Health Promotion and Behavioral Science, San Diego State University, San Diego, CA 92182, U.S
- Hookah Tobacco Research Center, San Diego State University Research Foundation, San Diego, CA 92123, U.S
| | - Robert M Strongin
- Department of Chemistry, Portland State University, Portland, OR 97207-0751, U.S
| | - Andrea M Stroup
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD 20850, U.S
| | - Marielle C Brinkman
- College of Public Health, The Ohio State University, Columbus, OH 43210, U.S
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, U.S
| | - Ahmad El-Hellani
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH 43210, U.S
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, U.S
| | - Hanno C Erythropel
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT 06511, U.S
- Yale Center for the Study of Tobacco Products (YCSTP), Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, U.S
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892, U.S
| | - Vernat Exil
- School of Medicine, St. Louis University, St. Louis, MO 63104, U.S
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14226, U.S
| | - Noura O Kassem
- Hookah Tobacco Research Center, San Diego State University Research Foundation, San Diego, CA 92123, U.S
| | | | - Sandy Liles
- Hookah Tobacco Research Center, San Diego State University Research Foundation, San Diego, CA 92123, U.S
| | | | - Alexandra Noël
- Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, U.S
| | - David H Peyton
- Department of Chemistry, Portland State University, Portland, OR 97207-0751, U.S
| | - Qixin Wang
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY 14642, U.S
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY 14642, U.S
| | - Luis G Valerio
- Division of Nonclinical Science (DNCS), Office of Science/Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, U.S
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6
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Deng H, Tang S, Yang F, Chen D, Bian Z, Wang Y, Tang G, Lee HK. Recent advances in the analysis of electronic cigarette liquids and aerosols: Sample preparation and chromatographic characterization. J Chromatogr A 2023; 1712:464495. [PMID: 37952386 DOI: 10.1016/j.chroma.2023.464495] [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: 09/20/2023] [Revised: 10/21/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
Electronic cigarette (e-cigarette) usage has risen dramatically worldwide in recent years. It has been publicized as a safer alternative to the conventional combustible cigarette. This, however, has not yet been supported by robust toxicological research evidence. Analysis of the chemical compositions of e-liquids and generated aerosols is an important step in evaluating the toxicity effects of e-cigarettes. Currently, a broad spectrum of analytical methods have been employed for qualitative and quantitative analysis of chemical compositions of e-cigarette liquids and aerosols. The aim of this article is to review the advances in the chromatographic characterization of chemical composition of the latter in the recent five years. In addition, sample preparation methods for e-liquids and aerosols are surveyed and discussed. A study of the relevant literature indicates that, expectedly, gas chromatography and liquid chromatography with a variety of detection systems, particularly mass spectrometry, have been the main analytical techniques used in this field. Sample preparation procedures primarily include headspace sampling, dilute-and-shoot approach, liquid-liquid extraction and sorbent-based extraction for e-liquids and for aerosols (the latter usually with laboratory-built collection devices). Some challenges of current e-cigarette analytical research, and an overview on prospective work are also presented.
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Affiliation(s)
- Huimin Deng
- China National Tobacco Quality Supervision and Test Center, High and New Technology Industries Development Zone, No.6 Cuizhu Street, Zhengzhou 450001, China
| | - Sheng Tang
- School of Environmental and Chemical Engineering, Jiangsu University of Science and Technology, Zhenjiang, Jiangsu Province 212003, China
| | - Fei Yang
- China National Tobacco Quality Supervision and Test Center, High and New Technology Industries Development Zone, No.6 Cuizhu Street, Zhengzhou 450001, China
| | - Dan Chen
- Yunnan Institute of Tobacco Quality Inspection & Supervision, Kunming 650106, China; School of Materials Science and Engineering, Peking University, Beijing 100871, China
| | - Zhaoyang Bian
- China National Tobacco Quality Supervision and Test Center, High and New Technology Industries Development Zone, No.6 Cuizhu Street, Zhengzhou 450001, China
| | - Ying Wang
- China National Tobacco Quality Supervision and Test Center, High and New Technology Industries Development Zone, No.6 Cuizhu Street, Zhengzhou 450001, China
| | - Gangling Tang
- China National Tobacco Quality Supervision and Test Center, High and New Technology Industries Development Zone, No.6 Cuizhu Street, Zhengzhou 450001, China.
| | - Hian Kee Lee
- School of Environmental and Chemical Engineering, Jiangsu University of Science and Technology, Zhenjiang, Jiangsu Province 212003, China; Department of Chemistry, National University of Singapore, 3 Science Drive 3, Singapore 117543, Singapore.
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Adeniji A, El-Hage R, Brinkman MC, El-Hellani A. Nontargeted Analysis in Tobacco Research: Challenges and Opportunities. Chem Res Toxicol 2023; 36:1656-1665. [PMID: 37903095 DOI: 10.1021/acs.chemrestox.3c00150] [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] [Indexed: 11/01/2023]
Abstract
Tobacco products are evolving at a pace that has outstripped tobacco control, leading to a high prevalence of tobacco use in the population. Researchers have been tirelessly developing suitable techniques to assess these products' emissions, toxicity, and public health impact. The nonclinical testing of tobacco products to assess the chemical profile of emissions is needed for evidence-based regulations. This testing has largely relied on targeted analytical methods that focus on constituent lists that may fall short in determining the toxicity of newly designed tobacco products. Nontargeted analysis (NTA), or the process of identifying and quantifying compounds within a complex matrix without prior knowledge of its chemical composition, is a promising technique for tobacco regulation, but it is not without challenges. The lack of standardized methods for sample generation, sample preparation, chromatographic separation, compound identification, and data analysis and reporting must be addressed so that the quality and reproducibility of the data generated by NTA can be benchmarked. This review discusses the challenges and highlights the opportunities of NTA in studying tobacco product constituents and emissions.
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Affiliation(s)
- Ayomipo Adeniji
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, Ohio 43210, United States
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43214, United States
| | - Rachel El-Hage
- Department of Chemistry, Faculty of Arts and Sciences, American University of Beirut, Beirut 1107 2020, Lebanon
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
| | - Marielle C Brinkman
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio 43210, United States
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43214, United States
| | - Ahmad El-Hellani
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, Ohio 43210, United States
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43214, United States
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Sala M, Gotti C. Electronic nicotine delivery systems (ENDS): A convenient means of smoking? Pharmacol Res 2023; 195:106885. [PMID: 37634554 DOI: 10.1016/j.phrs.2023.106885] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023]
Abstract
Electronic nicotine delivery systems (ENDS), which are becoming increasingly popular in many parts of the world, have recently become more sophisticated in terms of their more active content and better controlled vaporisation. This review begins by describing how cigarette smoking led to the development of ENDS as a means of combatting nicotine addiction. ENDS are usually categorised as belonging to one of only three main generations, but a fourth has been added in order to differentiate the latest, most powerful, most advanced and innovative that have improved heating efficiency. Descriptions of the principal substances contained in ENDS are followed by considerations concerning the risk of toxicity due to the presence of albeit low concentrations of such a variety of compounds inhaled over a long time, and the increasingly widespread use of ENDS as a means of smoking illicit drugs. We also review the most widely used pharmacotherapeutic approaches to smoking cessation, and recent epidemiological data showing that ENDS can help some people to stop smoking. However, in order to ensure their appropriate regulation, there is a need for higher-quality evidence concerning the health effects and safety of ENDS, and their effectiveness in discouraging tobacco smoking.
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Affiliation(s)
- Mariaelvina Sala
- Institute of Neuroscience, CNR-Milan Unit, c/o Bldg. U28, University of Milano-Bicocca, Via Follereau 3, 20854 Vedano al Lambro, MB, Italy; NeuroMi Milan Center for Neuroscience University of Milano Bicocca,Italy.
| | - Cecilia Gotti
- Institute of Neuroscience, CNR-Milan Unit, c/o Bldg. U28, University of Milano-Bicocca, Via Follereau 3, 20854 Vedano al Lambro, MB, Italy; NeuroMi Milan Center for Neuroscience University of Milano Bicocca,Italy
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9
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Soto B, Costanzo L, Puskoor A, Akkari N, Geraghty P. The implications of Vitamin E acetate in E-cigarette, or vaping, product use-associated lung injury. Ann Thorac Med 2023; 18:1-9. [PMID: 36968330 PMCID: PMC10034821 DOI: 10.4103/atm.atm_144_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 11/05/2022] [Indexed: 01/26/2023] Open
Abstract
In the summer of 2019, a cluster of cases were observed with users of battery-operated or superheating devices presenting with multiple symptoms, such as dyspnea, cough, fever, constitutional symptoms, gastrointestinal upset, and hemoptysis, that is now termed e-cigarette, or vaping, product use-associated lung injury (EVALI). The Centers for Disease Control and Prevention reported 2807 cases within the USA leading to at least 68 deaths as of February 18, 2020. The heterogeneous presentations of EVALI make diagnosis and treatment difficult; however, treatment focused on identifying and removal of the noxious substance and providing supportive care. Vitamin E acetate (VEA) is a likely cause of this lung injury, and others have reported other components to play a possible role, such as nicotine and vegetable glycerin/propylene glycol. EVALI is usually observed in adolescents, with a history of vaping product usage within 90 days typically containing tetrahydrocannabinol, and presenting on chest radiograph with pulmonary infiltrates or computed tomography scan with ground-glass opacities. Diagnosis requires a high degree of suspicion to diagnose and exclusion of other possible causes of lung disease. Here, we review the current literature to detail the major factors contributing to EVALI and primarily discuss the potential role of VEA in EVALI. We will also briefly discuss other constituents other than just VEA, as a small number of EVALI cases are reported without the detection of VEA, but with the same clinical diagnosis.
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Affiliation(s)
- Brian Soto
- Department of Medicine, State University of New York Downstate Health Sciences University, NY, USA
| | - Louis Costanzo
- Department of Medicine, State University of New York Downstate Health Sciences University, NY, USA
| | - Anoop Puskoor
- Department of Medicine, State University of New York Downstate Health Sciences University, NY, USA
| | - Nada Akkari
- Department of Medicine, State University of New York Downstate Health Sciences University, NY, USA
| | - Patrick Geraghty
- Department of Medicine, State University of New York Downstate Health Sciences University, NY, USA
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Non-Targeted Chemical Characterization of JUUL-Menthol-Flavored Aerosols Using Liquid and Gas Chromatography. SEPARATIONS 2022. [DOI: 10.3390/separations9110367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aerosol constituents generated from JUUL Menthol pods with 3.0% and 5.0% nicotine by weight (Me3 and Me5) are characterized by a non-targeted approach, which was developed to detect aerosol constituents that are not known to be present beforehand or that may be measured with targeted methods. Three replicates from three production batches (n = 9) were aerosolized using two puffing regimens (intense and non-intense). Each of the 18 samples were analyzed by gas chromatography electron ionization mass spectrometry and by liquid chromatography electrospray ionization high-resolving power mass spectrometry. All chemical constituents determined to differ from control were identified and semi-quantified. To have a complete understanding of the aerosol constituents and chemistry, each chemical constituent was categorized into one of five groups: (1) flavorants, (2) harmful and potentially harmful constituents, (3) leachables, (4) reaction products, and (5) chemical constituents that were unable to be identified or rationalized (e.g., chemical constituents that could not be categorized in groups (1–4). Under intense puffing, 74 chemical constituents were identified in Me3 aerosols and 68 under non-intense puffing, with 53 chemical constituents common between both regimens. Eighty-three chemical constituents were identified in Me5 aerosol using an intense puffing regimen and seventy-five with a non-intense puffing regimen, with sixty-two chemical constituents in common. Excluding primary constituents, reaction products accounted for the greatest number of chemical constituents (approximately 60% in all cases, ranging from about 0.05% to 0.1% by mass), and flavorants—excluding menthol—comprised the second largest number of chemical constituents (approximately 25%, ranging consistently around 0.01% by mass). The chemical constituents detected in JUUL aerosols were then compared to known constituents from cigarette smoke to determine the relative chemical complexities and commonalities/differences between the two. This revealed (1) a substantial decrease in the chemical complexity of JUUL aerosols vs. cigarette smoke and (2) that there are between 55 (Me3) and 61 (Me5) unique chemical constituents in JUUL aerosols not reported in cigarette smoke. Understanding the chemical complexity of JUUL aerosols is important because the health effects of combustible cigarette smoke are related to the combined effect of these chemical constituents through multiple mechanisms, not just the effects of any single smoke constituent.
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El-Hellani A, Soule EK, Daoud M, Salman R, El Hage R, Ardati O, El-Kaassamani M, Yassine A, Karaoghlanian N, Talih S, Saliba N, Shihadeh A. Assessing toxicant emissions from e-liquids with DIY additives used in response to a potential flavour ban in e-cigarettes. Tob Control 2022; 31:s245-s248. [PMID: 36328456 PMCID: PMC9664124 DOI: 10.1136/tc-2022-057505] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/15/2022] [Indexed: 11/22/2022]
Abstract
SIGNIFICANCE Electronic cigarettes (e-cigarettes) aerosolise liquids that contain nicotine, propylene glycol, glycerol and appealing flavours. In the USA, regulations have limited the availability of flavoured e-cigarettes in pod-based systems, and further tightening is expected. In response, some e-cigarette users may attempt to make their e-liquids (do-it-yourself, DIY). This study examined toxicant emissions from several aerosolised DIY e-liquids. METHODS DIY additives were identified by reviewing users' responses to a hypothetical flavour ban, e-cigarette internet forums and DIY mixing internet websites. They include essential oils, cannabidiol, sucralose and ethyl maltol. E-liquids with varying concentrations and combinations of additives and tobacco and menthol flavours were prepared and were used to assess reactive oxygen species (ROS), carbonyl and phenol emissions in machine-generated aerosols. RESULTS Data showed that adding DIY additives to unflavoured, menthol-flavoured or tobacco-flavoured e-liquids increases toxicant emissions to levels comparable with those from commercial flavoured e-liquids. Varying additive concentrations in e-liquids did not have a consistently significant effect on the tested emissions, yet increasing power yielded significantly higher ROS, carbonyl and phenol emissions for the same additive concentration. Adding nicotine to DIY e-liquids with sucralose yielded increase in some emissions and decrease in others, with freebase nicotine-containing e-liquid giving higher ROS emissions than that with nicotine salt. CONCLUSION This study showed that DIY additives can impact aerosol toxicant emissions from e-cigarettes and should be considered by policymakers when restricting commercially available flavoured e-liquids.
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Affiliation(s)
- Ahmad El-Hellani
- Division of Environmental Health Sciences, The Ohio State University College of Public Health, Columbus, Ohio, USA
- Virginia Commonwealth University Center for the Study of Tobacco Products, Richmond, Virginia, USA
| | - Eric K Soule
- Virginia Commonwealth University Center for the Study of Tobacco Products, Richmond, Virginia, USA
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina, USA
| | - Mohammad Daoud
- Department of Chemistry, American University of Beirut Faculty of Arts and Sciences, Beirut, Lebanon
| | - Rola Salman
- Virginia Commonwealth University Center for the Study of Tobacco Products, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Rachel El Hage
- Virginia Commonwealth University Center for the Study of Tobacco Products, Richmond, Virginia, USA
- Department of Chemistry, American University of Beirut Faculty of Arts and Sciences, Beirut, Lebanon
| | - Ola Ardati
- Department of Chemistry, American University of Beirut Faculty of Arts and Sciences, Beirut, Lebanon
| | - Malak El-Kaassamani
- Department of Chemistry, American University of Beirut Faculty of Arts and Sciences, Beirut, Lebanon
| | - Amira Yassine
- Department of Chemistry, American University of Beirut Faculty of Arts and Sciences, Beirut, Lebanon
| | - Nareg Karaoghlanian
- Virginia Commonwealth University Center for the Study of Tobacco Products, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Soha Talih
- Virginia Commonwealth University Center for the Study of Tobacco Products, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Najat Saliba
- Virginia Commonwealth University Center for the Study of Tobacco Products, Richmond, Virginia, USA
- Department of Chemistry, American University of Beirut Faculty of Arts and Sciences, Beirut, Lebanon
| | - Alan Shihadeh
- Virginia Commonwealth University Center for the Study of Tobacco Products, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
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12
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Chemical characterisation of the vapour emitted by an e-cigarette using a ceramic wick-based technology. Sci Rep 2022; 12:16497. [PMID: 36192548 PMCID: PMC9529894 DOI: 10.1038/s41598-022-19761-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
Fourth-generation ‘pod’ e-cigarette devices have been driven by technological advances in electronic atomization of the e-liquid. Use of microporous ceramic as a wicking material improves heating efficiency, but how it affects the chemical emissions of these devices is unclear. We assessed the emissions of a pod e-cigarette with innovative ceramic wick-based technology and two flavoured e-liquids containing nicotine lactate and nicotine benzoate (57 and 18 mg mL−1 nicotine, respectively). Among the studied harmful and potentially harmful constituents (HPHCs) listed by the US FDA and/or WHO TobReg, only 5 (acetone, acetaldehyde, formaldehyde, naphthalene and nornicotine) were quantified at levels of 0.14 to 100 ng puff−1. In the combustible cigarette (Kentucky reference 1R6F), levels were from 0.131 to 168 µg puff−1. Nicotine levels ranged 0.10–0.32 mg puff−1 across the 3 study products. From the 19 proposed HPHCs specifically of concern in e-cigarettes, only 3 (glycerol, isoamyl acetate and propylene glycol) were quantified. The low/undetectable levels of HPHCs reflect not only the optimal operating conditions of the e-cigarette, including an efficient supply of e-liquid by the ceramic wick without overheating, but also the potential of the e-cigarettes to be used as an alternative to combustible cigarettes.
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Wu J, Gao Y, Li D, Gao N. Emission and Gas/Particle Partitioning Characteristics of Nicotine in Aerosols for Electronic Cigarettes. Chem Res Toxicol 2022; 35:890-897. [PMID: 35512282 DOI: 10.1021/acs.chemrestox.2c00076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nicotine is a dependence-producing component in electronic cigarettes. The nicotine release characteristics of electronic cigarettes are closely connected with human exposure and respiratory health. In this paper, a theoretical model was established to study the effects of the compositions of e-liquids and the heating powers of device on the emission and gas/particle partitioning characteristics of nicotine in aerosols at equilibrium. The simulation results of nicotine emissions were compared with the experimental data. The errors between them were within a reasonable range. At a larger heating power level, a higher nicotine yield and a larger vaporization amount of e-liquids could be observed. Under the same heating power condition, a higher vegetable glycerin content in e-liquids could result in a lower nicotine emission. When the heating powers supplied by the device increased, a larger mass fraction of particle-phase nicotine in aerosols at equilibrium would appear. As more propylene glycol was added into e-liquids, a lower mass fraction of gas-phase nicotine would exist in aerosols at equilibrium. The results may provide more information for the industry to set technical standards for electronic cigarettes and for the government department to make regulatory policies.
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Affiliation(s)
- Jinlu Wu
- School of Mechanical Engineering, Tongji University, Shanghai 201804, China
| | - Yihan Gao
- Shanghai New Tobacco Product Research Institute, Shanghai 201315, China
| | - Dian Li
- China Tobacco Guangxi Industrial Co., Ltd., Nanning 530001, China
| | - Naiping Gao
- School of Mechanical Engineering, Tongji University, Shanghai 201804, China
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14
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Non-Targeted Chemical Characterization of JUUL Virginia Tobacco Flavored Aerosols Using Liquid and Gas Chromatography. SEPARATIONS 2021. [DOI: 10.3390/separations8090130] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The chemical constituents of JUUL Virginia Tobacco pods with 3.0% and 5.0% nicotine by weight (VT3 and VT5) were characterized by non-targeted analyses, an approach to detect chemicals that are not otherwise measured with dedicated methods or that are not known beforehand. Aerosols were generated using intense and non-intense puffing regimens and analyzed by gas chromatography electron ionization mass spectrometry and liquid chromatography electrospray ionization high resolving power mass spectrometry. All compounds above 0.7 µg/g for GC–MS analysis or above 0.5 µg/g for LC–HRMS analysis and differing from blank measurements were identified and semi-quantified. All identifications were evaluated and categorized into five groups: flavorants, harmful and potentially harmful constituents, extractables and/or leachables, reaction products, and compounds that could not be identified/rationalized. For VT3, 79 compounds were identified using an intense puffing regimen and 69 using a non-intense puffing regimen. There were 60 compounds common between both regimens. For VT5, 85 compounds were identified with an intense puffing regimen and 73 with a non-intense puffing regimen; 67 compounds were in common. For all nicotine concentrations, formulations and puffing regimens, reaction products accounted for the greatest number of compounds (ranging from 70% to 75%; 0.08% to 0.1% by mass), and flavorants comprised the second largest number of compounds (ranging from for 15% to 16%; 0.1 to 0.2% by mass). A global comparison of the compounds detected in JUUL aerosol to those catalogued in cigarette smoke indicated an approximate 50-fold decrease in chemical complexity. Both VT3 and VT5 aerosols contained 59 unique compounds not identified in cigarette smoke.
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15
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Alzoubi KH, Batran RM, Al-Sawalha NA, Khabour OF, Karaoghlanian N, Shihadeh A, Eissenberg T. The effect of electronic cigarettes exposure on learning and memory functions: behavioral and molecular analysis. Inhal Toxicol 2021; 33:234-243. [PMID: 34311661 DOI: 10.1080/08958378.2021.1954732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: Electronic cigarettes (ECIGs) are battery-powered devices that emit vaporized solutions for the user to inhale. ECIGs are marketed as a less harmful alternative to combustible cigarettes. The current study examined the effects of ECIG aerosol exposure on learning and memory, expression of brain derived neurotrophic factor (BDNF), and the activity of antioxidant enzymes in the hippocampus.Methods: Male Wistar rats were exposed to ECIG aerosol, by a whole-body exposure system, 1 h/day for 1 week, 4 weeks, and 12 weeks. Spatial learning and memory were tested using the Radial Arm Water Maze (RAWM). Hippocampal BDNF protein level, and oxidative stress biomarkers (GPx, SOD, GSH, GSSG, GSH/GSSG ratio) were also assessed.Results: ECIG aerosol exposure for 4 and 12 weeks impaired both short- and long- term memory and induced reductions in the hippocampus BDNF, SOD and GPx activities, and GSH/GSSG ratio (p < 0.05). No changes in any examined biomarkers were observed after 1-week exposure to ECIG aerosol (p > 0.05).Conclusions: ECIG aerosol exposure impaired functional memory and elicited changes in brain chemistry that are consistent with reduced function and oxidative stress.
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Affiliation(s)
- Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Rahaf M Batran
- Department of Legal Medicine, Toxicology and Forensic Sciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nour A Al-Sawalha
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar F Khabour
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Nareg Karaoghlanian
- Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Alan Shihadeh
- Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Thomas Eissenberg
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
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16
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El-Hellani A, El-Hage R, Salman R, Talih S, Zeaiter J, Eissenberg T, Shihadeh A, Saliba NA. Electronic Cigarettes Are Chemical Reactors: Implication to Toxicity. Chem Res Toxicol 2020; 33:2489-2490. [PMID: 33021780 DOI: 10.1021/acs.chemrestox.0c00412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ahmad El-Hellani
- Department of Chemistry, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
| | - Rachel El-Hage
- Department of Chemistry, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
| | - Rola Salman
- Department of Mechanical Engineering, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
| | - Soha Talih
- Department of Mechanical Engineering, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
| | - Joseph Zeaiter
- Department of Chemical Engineering, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
| | - Thomas Eissenberg
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia 23284, United States.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
| | - Alan Shihadeh
- Department of Mechanical Engineering, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
| | - Najat Aoun Saliba
- Department of Chemistry, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
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