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Ma T, Lee A, Eng B, Patel V, Michel SLJ, Kane MA, Dalby R, Schneider A. Aerosolized e-liquid base constituents induce cytotoxicity and genotoxicity in oral keratinocytes. Oral Dis 2024. [PMID: 39121459 DOI: 10.1111/odi.15104] [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: 02/01/2024] [Revised: 06/14/2024] [Accepted: 07/30/2024] [Indexed: 08/11/2024]
Abstract
OBJECTIVE Electronic cigarette (e-cigarette) use among adults in the United States continues to rise. Particularly concerning is the impact of e-cigarette aerosol inhalation on the oral mucosa. Aerosols are derived from a heated e-liquid base of propylene glycol/glycerin (PG/G) often mixed with nicotine and chemical flavors. Of note, harmful and potentially harmful constituents (HPHCs), including metals and volatile organic compounds, have been detected in e-cigarette aerosols. It remains unknown, however, whether aerosols exclusively derived from e-liquid PG/G are detrimental to oral keratinocytes. The present study analyzed toxicological outcomes in normal oral keratinocytes exposed to model nicotine-free, unflavored PG/G e-liquid aerosols. MATERIALS AND METHODS Cell viability/cytotoxicity, genotoxicity, and immunoblotting assays were conducted in NOKSI, a gingiva-derived oral keratinocyte cell line, following exposure to model e-liquid aerosols or non-aerosolized controls. The HPHC acrolein, reported to form DNA adducts in the buccal mucosa from e-cigarette users, was also used in similar assays. RESULTS PG/G e-liquid aerosol extracts significantly enhanced cytotoxic and DNA damaging responses in NOKSI cells when compared to non-aerosolized e-liquid treatment. Acrolein treatment led to similar results. CONCLUSIONS The aerosolization process of PG/G e-liquid is a critical determinant of marked cytotoxic and genotoxic stimuli in oral keratinocytes.
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Affiliation(s)
- Tao Ma
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Angela Lee
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Bryan Eng
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Vyomesh Patel
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Sarah L J Michel
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Maureen A Kane
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Richard Dalby
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Abraham Schneider
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA
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2
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Bittoni MA, Carbone DP, Harris RE. Vaping, Smoking and Lung Cancer Risk. JOURNAL OF ONCOLOGY RESEARCH AND THERAPY 2024; 9:10229. [PMID: 39210964 PMCID: PMC11361252 DOI: 10.29011/2574-710x.10229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Nicotine exposure through the use of electronic delivery systems (vaping) has been found to elevate the risk of certain conditions of the lungs, e.g., vaping associated lung injury, EVALI). However, the potential impact of vaping on lung cancer risk remains unexplored. We, therefore, examined the association of vaping and cigarette smoking with lung cancer risk in a case control study conducted in central Ohio. The study design compared 4,975 individuals with recently diagnosed pathologically confirmed carcinoma of the lung to 27,294 controls without cancer that were group matched at a 5:1 ratio to the cases by age, gender, race and location of residence. Odds ratios (OR) adjusted for gender, age and race revealed a fourfold higher risk of lung cancer among individuals who vaped in combination with chronic smoking (OR=58.9, 95% CI=47.3-70.5) versus individuals who only smoked cigarettes (OR=13.9, 95% CI=12.7-15.3, P<0.001). Further adjustment for prevalent comorbidities, chronic obstructive pulmonary disease and coronary artery disease, reduced the magnitude of the OR, but the risk for vaping and smoking (OR=38.7, 95% CI =31.5-47.6) remained fourfold higher than for smoking alone (OR=9.6, 95% CI=8.7-10.6, P<0.001). This finding was consistent for men and women, with adjustment for pack-years of smoking, and for the main histological cell types of lung cancer. Our results suggest that the addition of vaping to smoking accelerates the risk of developing lung cancer.
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Affiliation(s)
- MA Bittoni
- Colleges of Medicine & Public Health, and the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - DP Carbone
- Colleges of Medicine & Public Health, and the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - RE Harris
- Colleges of Medicine & Public Health, and the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
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Sánchez-Romero LM, Liber AC, Li Y, Yuan Z, Tam J, Travis N, Jeon J, Issabakhsh M, Meza R, Levy DT. The smoking and vaping model, A user-friendly model for examining the country-specific impact of nicotine VAPING product use: application to Germany. BMC Public Health 2023; 23:2299. [PMID: 37990171 PMCID: PMC10662637 DOI: 10.1186/s12889-023-17152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/04/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Simulation models play an increasingly important role in tobacco control. Models examining the impact of nicotine vaping products (NVPs) and smoking tend to be highly specialized and inaccessible. We present the Smoking and Vaping Model (SAVM),a user-friendly cohort-based simulation model, adaptable to any country, that projects the public health impact of smokers switching to NVPs. METHODS SAVM compares two scenarios. The No-NVP scenario projects smoking rates in the absence of NVPs using population projections, deaths rates, life expectancy, and smoking prevalence. The NVP scenario models vaping prevalence and its impact on smoking once NVPs became popular. NVP use impact is estimated as the difference in smoking- and vaping-attributable deaths (SVADs) and life-years lost (LYLs) between the No-NVP and NVP scenarios. We illustrate SAVM's adaptation to the German adult ages 18+ population, the Germany-SAVM by adjusting the model using population, mortality, smoking and NVP use data. RESULTS Assuming that the excess NVP mortality risk is 5% that of smoking, Germany-SAVM projected 4.7 million LYLs and almost 300,000 SVADs averted associated with NVP use from 2012 to 2060. Increasing the excess NVP mortality risk to 40% with other rates constant resulted in averted 2.8 million LYLs and 200,000 SVADs during the same period. CONCLUSIONS SAVM enables non-modelers, policymakers, and other stakeholders to analyze the potential population health effects of NVP use and public health interventions.
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Affiliation(s)
- Luz María Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA.
| | - Alex C Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
| | - Jamie Tam
- School of Public Health, Yale University, New Haven, CT, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
- Integrative Oncology, BC Cancer Research Institute, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Columbia, Canada
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
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4
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Turner MC, Cogliano V, Guyton K, Madia F, Straif K, Ward EM, Schubauer-Berigan MK. Research Recommendations for Selected IARC-Classified Agents: Impact and Lessons Learned. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:105001. [PMID: 37902675 PMCID: PMC10615125 DOI: 10.1289/ehp12547] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND The International Agency for Research on Cancer (IARC) Monographs program assembles expert working groups who publish a critical review and evaluation of data on agents of interest. These comprehensive reviews provide a unique opportunity to identify research needs to address classification uncertainties. A multidisciplinary expert review and workshop held in 2009 identified research gaps and needs for 20 priority occupational chemicals, metals, dusts, and physical agents, with the goal of stimulating advances in epidemiological studies of cancer and carcinogen mechanisms. Overarching issues were also described. OBJECTIVES In this commentary we review the current status of the evidence for the 20 priority agents identified in 2009. We examine whether identified Research Recommendations for each agent were addressed and their potential impact on resolving classification uncertainties. METHODS We reviewed the IARC classifications of each of the 20 priority agents and identified major new epidemiological and human mechanistic studies published since the last evaluation. Information sources were either the published Monograph for agents that have been reevaluated or, for agents not yet reevaluated, Advisory Group reports and literature searches. Findings are described in view of recent methodological developments in Monographs evidence evaluation processes. DISCUSSION The majority of the 20 priority agents were reevaluated by IARC since 2009. The overall carcinogen classifications of 9 agents advanced, and new cancer sites with either "sufficient" or "limited" evidence of carcinogenicity were also identified for 9 agents. Examination of published findings revealed whether evidence gaps and Research Recommendations have been addressed and highlighted remaining uncertainties. During the past decade, new research addressed a range of the 2009 recommendations and supported updated classifications for priority agents. This supports future efforts to systematically apply findings of Monograph reviews to identify research gaps and priorities relevant to evaluation criteria established in the updated IARC Monograph Preamble. https://doi.org/10.1289/EHP12547.
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Affiliation(s)
- Michelle C. Turner
- Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Vincent Cogliano
- California Environmental Protection Agency Office of Environmental Health Hazard Assessment, Oakland, California, USA
| | - Kathryn Guyton
- National Academies of Sciences, Engineering, and Medicine, Washington, District of Columbia, USA
| | - Federica Madia
- International Agency for Research on Cancer, Lyon, France
| | - Kurt Straif
- Barcelona Institute for Global Health, Barcelona, Spain
- Boston College, Massachusetts, USA
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Bandara NA, Zhou XR, Alhamam A, Black PC, St-Laurent MP. The genitourinary impacts of electronic cigarette use: a systematic review of the literature. World J Urol 2023; 41:2637-2646. [PMID: 37524850 DOI: 10.1007/s00345-023-04546-1] [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: 05/14/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE Electronic cigarette (e-cig) use is prevalent. The health implications of e-cig use on the genitourinary (GU) system are uncertain. This systematic review aims to evaluate how e-cig use impacts the GU system. METHODS A systematic search was conducted in PubMed, Embase and Ovid alongside citation searching. Review articles, non-English papers, animal model/cell line studies or articles only on combustible cigarettes were excluded. Quality assessment was undertaken using the Joanna Briggs Institute checklists. The primary endpoint was the impact of e-cig use on bladder cancer incidence. Secondary outcomes included urinary carcinogens, chronic kidney disease (CKD), reproductive disorders, and other GU diseases. RESULTS The search yielded 244 articles, 28 were ultimately included. One study assessed risk of bladder cancer and found the use of e-cig was associated with an increased odds ratio of 1.577 for its diagnosis. Twenty-one articles measured potential urinary carcinogens-including crotonaldehyde and benzene-associated with bladder cancer. Two articles evaluated the association of e-cig use with CKD and reported mixed outcomes. Three articles reported on reproductive disorders, specifically, stuttering priapism and changes to sperm quantity and quality. One study reported on other GU diseases, specifically burns to the GU system. After quality assessment, all articles were deemed to be of acceptable quality for inclusion. CONCLUSIONS E-cig use was associated with an increased risk of bladder cancer, increased exposure to carcinogenic compounds, mixed evidence on CKD, increased risk of reproductive disorders and burns to the GU system. Further studies are needed to understand long-term GU effects.
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Affiliation(s)
- Nilanga Aki Bandara
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Xuan Randy Zhou
- Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Abdullah Alhamam
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Level 6, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Peter C Black
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Level 6, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- Vancouver Prostate Centre, Vancouver, Canada
| | - Marie-Pier St-Laurent
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Level 6, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
- Vancouver Prostate Centre, Vancouver, Canada.
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6
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Guo J, Hecht SS. DNA damage in human oral cells induced by use of e-cigarettes. Drug Test Anal 2023; 15:1189-1197. [PMID: 36169810 PMCID: PMC10043052 DOI: 10.1002/dta.3375] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/09/2022]
Abstract
The use of electronic cigarettes (e-cigarettes) has increased rapidly in the United States, especially among high school students. e-Cigarettes contain some recognized carcinogens and may induce DNA damage in oral cells. The aim of this review is to summarize studies reporting DNA adducts or other types of DNA damage in oral cells in vitro or in vivo upon exposure to e-cigarette vapor and to evaluate the possible connections between e-cigarette exposure and oral cancer. Three databases including PubMed, Scopus, and EMBASE and gray literature were searched for articles published up to April 24, 2022. After screening 321 articles, we extracted 27 for further investigation. Based on the inclusion criteria, 22 articles were eligible for this review. The in vitro studies demonstrate that e-cigarette liquid or vapor can induce DNA damage, oxidative stress, DNA double-stranded breaks, apoptosis, cytotoxicity, and genotoxicity in different types of oral cells. The clinical studies showed that e-cigarette users have significantly higher levels of N'-nitrosonornicotine, acrolein DNA adducts, metanuclear anomalies, gene regulation, and lactate dehydrogenase enzyme expression and significantly lower levels of apurinic/apyrimidinic sites than non-users. Comparison of micronuclei levels between e-cigarette users and non-users gave inconsistent results. e-Cigarettes are implicated in DNA damage to oral cells, but publications to date present limited evidence. Future studies with larger sample sizes are required to investigate the long-term consequences of e-cigarette use.
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Affiliation(s)
- Jiehong Guo
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
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7
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Scherer G, Pluym N, Scherer M. Comparison of urinary mercapturic acid excretions in users of various tobacco/nicotine products. Drug Test Anal 2023; 15:1107-1126. [PMID: 36164275 DOI: 10.1002/dta.3372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022]
Abstract
Urinary mercapturic acids (MAs) are detoxification products for electrophiles occurring in the human body. They are suitable biomarkers of exposure to directly acting electrophilic chemicals or to chemicals which generate the electrophile during its metabolism. We determined the urinary excretion of 19 MAs in habitual users of combustible cigarettes (CCs), electronic cigarettes (ECs), heated tobacco products (HTPs), oral tobacco (OT), and nicotine replacement therapy (NRT) products, and nonusers (NUs) of any tobacco/nicotine products. The 19 MAs are assumed to be physiologically formed primarily from 15 toxicants with three of them belonging to IARC Group 1 (human carcinogen), seven to Group 2A (probable human carcinogen), four to Group 2B (possible human carcinogen), and one to Group 3 (not classifiable as carcinogen). Smoking (CC) was found to be associated with significantly elevated exposure to ethylene oxide (or ethylene), 1,3-butadiene, benzene, dimethylformamide, acrolein, acrylamide, styrene, propylene oxide, acrylonitrile, crotonaldehyde, and isoprene compared with the other user groups and NU. Users of HTPs revealed slight elevation in the MAs related to acrolein, acrylamide, and crotonaldehyde compared with the other non-CC groups. Vaping (EC) was not found to be associated with any of the MAs studied. In conclusion, the determination of urinary MAs is a useful tool for assessing the exposure to toxicants (mainly potential carcinogens) in users of various tobacco/nicotine products. Our data also give cause to clarify the role of vaping (EC) in urinary excretion of DHPMA (precursor: glycidol).
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Affiliation(s)
- Gerhard Scherer
- ABF, Analytisch-Biologisches Forschungslabor GmbH, Planegg, Germany
| | - Nikola Pluym
- ABF, Analytisch-Biologisches Forschungslabor GmbH, Planegg, Germany
| | - Max Scherer
- ABF, Analytisch-Biologisches Forschungslabor GmbH, Planegg, Germany
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8
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Kanobe MN, Nelson PR, Brown BG, Chen P, Makena P, Caraway JW, Prasad GL, Round EK. Changes in Biomarkers of Exposure and Potential Harm in Smokers Switched to Vuse Vibe or Vuse Ciro Electronic Nicotine Delivery Systems. TOXICS 2023; 11:564. [PMID: 37505530 PMCID: PMC10384956 DOI: 10.3390/toxics11070564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/05/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023]
Abstract
Electronic nicotine delivery systems (ENDS) have the potential to provide nicotine to tobacco consumers while reducing exposure to combustion-related toxicants. Here, we report changes in biomarkers of exposure (BoE) and biomarkers of potential harm (BoPH) in smokers who completely switched to Vuse Vibe and Vuse Ciro ENDS products, or to smoking abstinence in a randomized, controlled clinical study. Thirteen BoE (12 urinary and one blood) that indicate exposure to harmful and potentially harmful toxicants (HPHCs) were evaluated at baseline on day 5. Urinary BoPH linked to oxidative stress, platelet activation, and inflammation were also assessed at baseline, and on day 5 and day 7. Nicotine exposure was lower in Vuse Vibe and Vuse Ciro groups compared to baseline values. Urinary non-nicotine BoE decreased significantly (52.3-96.7%) in the Vuse ENDS groups, and the reductions were similar in magnitude to those observed in the abstinence group. Blood carboxyhemoglobin decreased 52.8-55.0% in all study groups. Decreases (10-50%) in BoPH were observed in all study groups. Thus, smokers who switch exclusively to Vuse Vibe or Vuse Ciro products or completely abstain from smoking are exposed to substantially lower levels of HPHCs, and experience improvements in BoPH of oxidative stress and inflammation pathways.
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Affiliation(s)
- Milly N Kanobe
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - Paul R Nelson
- Former Employees of RAI Services Company, 105 Bowes Road, Winston Salem, NC 27106, USA
| | - Buddy G Brown
- Former Employees of RAI Services Company, 5714 Wonderous Lane, Durham, NC 27712, USA
| | - Peter Chen
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - Patrudu Makena
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - John W Caraway
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - Gaddamanugu L Prasad
- Former Employees of RAI Services Company, 490 Friendship Place Ct, Lewisville, NC 27023, USA
- Prasad Scientific Consulting LLC, 490 Friendship Place Ct, Lewisville, NC 27023, USA
| | - Elaine K Round
- BAT (Investments) Limited, Globe House, 1 Water Street, London WC2R 3LA, UK
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9
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Keyser BM, Hong KS, DeLuca P, Jin T, Jones BA, Nelson P, Schmidt E, Round EK. Part two: an unblinded, parallel, randomized study to assess nicotine pharmacokinetics of four Vuse Solo ENDS flavors in smokers. Sci Rep 2023; 13:8894. [PMID: 37264061 DOI: 10.1038/s41598-023-35439-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/18/2023] [Indexed: 06/03/2023] Open
Abstract
We report the findings from a randomized, parallel study designed to evaluate nicotine pharmacokinetics (PK) following 10 min of ad libitum use of electronic nicotine delivery system (ENDS) in four flavor variants. Subjects were randomized an investigational product (IP) and blood samples were collected for PK assessments during a test session. Primary endpoints were baseline-adjusted values of maximum plasma nicotine concentration (Cmax) and area under the nicotine concentration-vs-time curve up to 60 min (AUCnic0-60). Baseline-adjusted mean Cmax ranged from 6.53 to 8.21 ng/mL, and mean AUCnic0-60 ranged from 206.87 to 263.52 ng min/mL for all ENDS IPs. Results of geometric mean Cmax and AUCnic0-60 values were within 95% confidence intervals (CI) among the ENDS IP flavor variants tested.
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Affiliation(s)
- Brian M Keyser
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC, 27101, USA
| | - Kyung Soo Hong
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC, 27101, USA
| | - Patricia DeLuca
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC, 27101, USA.
| | - Tao Jin
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC, 27101, USA
| | - Bobbette A Jones
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC, 27101, USA
| | - Paul Nelson
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC, 27101, USA
| | - Eckhardt Schmidt
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC, 27101, USA
| | - Elaine K Round
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC, 27101, USA
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10
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Keller-Hamilton B, Hayley Curran, Stevens EM, Zettler PJ, Mays D, Ferketich A. Effects of "Tobacco Free" Language in Warning Labels on Perceptions of Electronic Cigarettes and Nicotine Pouches among Young Adult Men: A Randomized Trial. Subst Use Misuse 2023; 58:1302-1306. [PMID: 37227265 PMCID: PMC10401609 DOI: 10.1080/10826084.2023.2215308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Background: Manufacturers of Puff Bar electronic cigarettes (e-cigarettes) and Fre nicotine pouches claim that their products contain synthetic nicotine. The packages for Puff Bar and Fre have modified versions of the warning labels required by the Food and Drug Administration (FDA) for tobacco products, which specify that Puff Bar and Fre products contain "tobacco free" or "non-tobacco" nicotine, respectively. We evaluated whether exposure to these "tobacco free" warning labels was associated with differing perceptions about the products. Method: N = 239 young adult men who were enrolled in a cohort study completed a short online experiment. Participants were randomly assigned to view either packages of Puff Bar and Fre nicotine pouches with the standard FDA warning or packages with the standard FDA warning + the tobacco free descriptor. We compared harm and addictiveness perceptions and products' perceived substitutability for cigarettes and smokeless tobacco (SLT) by exposure to a "tobacco free" warning. Results: Viewing a Puff Bar package with a "tobacco free" warning label was associated with increased perceived substitutability of the product for cigarettes and smokeless tobacco (p's<.05). Viewing a Fre package with a "non-tobacco" warning label was associated with thinking the product was less harmful than SLT (p<.01). Conclusions: "Tobacco free" descriptors in warning labels for e-cigarettes and nicotine pouches affect young adults' perceptions of the products. To date, it is unclear whether the FDA will continue to permit "tobacco free" descriptors in warning labels. As e-cigarettes and nicotine pouches are increasingly marketed with "tobacco free" language, urgent action is needed.
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Affiliation(s)
- Brittney Keller-Hamilton
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Hayley Curran
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Elise M. Stevens
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA USA
| | | | - Darren Mays
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Amy Ferketich
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
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11
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Hsiao YC, Matulewicz RS, Sherman SE, Jaspers I, Weitzman ML, Gordon T, Liu CW, Yang Y, Lu K, Bjurlin MA. Untargeted Metabolomics to Characterize the Urinary Chemical Landscape of E-Cigarette Users. Chem Res Toxicol 2023; 36:630-642. [PMID: 36912507 PMCID: PMC10371198 DOI: 10.1021/acs.chemrestox.2c00346] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
The health and safety of using e-cigarette products (vaping) have been challenging to assess and further regulate due to their complexity. Inhaled e-cigarette aerosols contain chemicals with under-recognized toxicological profiles, which could influence endogenous processes once inhaled. We urgently need more understanding on the metabolic effects of e-cigarette exposure and how they compare to combustible cigarettes. To date, the metabolic landscape of inhaled e-cigarette aerosols, including chemicals originated from vaping and perturbed endogenous metabolites in vapers, is poorly characterized. To better understand the metabolic landscape and potential health consequences of vaping, we applied liquid chromatography-mass spectrometry (LC-MS) based nontargeted metabolomics to analyze compounds in the urine of vapers, cigarette smokers, and nonusers. Urine from vapers (n = 34), smokers (n = 38), and nonusers (n = 45) was collected for verified LC-HRMS nontargeted chemical analysis. The altered features (839, 396, and 426 when compared smoker and control, vaper and control, and smoker and vaper, respectively) among exposure groups were deciphered for their structural identities, chemical similarities, and biochemical relationships. Chemicals originating from e-cigarettes and altered endogenous metabolites were characterized. There were similar levels of nicotine biomarkers of exposure among vapers and smokers. Vapers had higher urinary levels of diethyl phthalate and flavoring agents (e.g., delta-decalactone). The metabolic profiles featured clusters of acylcarnitines and fatty acid derivatives. More consistent trends of elevated acylcarnitines and acylglycines in vapers were observed, which may suggest higher lipid peroxidation. Our approach in monitoring shifts of the urinary chemical landscape captured distinctive alterations resulting from vaping. Our results suggest similar nicotine metabolites in vapers and cigarette smokers. Acylcarnitines are biomarkers of inflammatory status and fatty acid oxidation, which were dysregulated in vapers. With higher lipid peroxidation, radical-forming flavoring, and higher level of specific nitrosamine, we observed a trend of elevated cancer-related biomarkers in vapers as well. Together, these data present a comprehensive profiling of urinary biochemicals that were dysregulated due to vaping.
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Affiliation(s)
- Yun-Chung Hsiao
- Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, NC 27599
| | - Richard S. Matulewicz
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Scott E. Sherman
- Section on Tobacco, Alcohol and Drug Use, Department of Population Health, NYU School of Medicine, New York, NY 07920
| | - Ilona Jaspers
- Curriculum in Toxicology & Environmental Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599
- Center for Environmental Medicine, Asthma and Lung Biology, School of Medicine, University of North Carolina, Chapel Hill, NC 27599
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Michael L. Weitzman
- Department of Pediatrics, New York University School of Medicine, New York, NY 10016
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016
| | - Chih-Wei Liu
- Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, NC 27599
| | - Yifei Yang
- Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, NC 27599
| | - Kun Lu
- Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, NC 27599
| | - Marc A. Bjurlin
- Department of Urology, University of North Carolina, Chapel Hill, NC 27599
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599
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12
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Vevang KR, Zhang L, Grill AE, Hatsukami DK, Meier E, Nomura SO, Robien K, Peterson LA. Furan Metabolites Are Elevated in Users of Various Tobacco Products and Cannabis. Chem Res Toxicol 2023; 36:157-161. [PMID: 36716352 PMCID: PMC10035786 DOI: 10.1021/acs.chemrestox.2c00412] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Humans are exposed to furan, a toxicant and possible human carcinogen, through multiple sources including diet and tobacco smoke. The urinary metabolites of furan are derived from the reaction of its toxic metabolite with protein nucleophiles and are biomarkers of exposure and potential harm. An established isotopic dilution liquid-chromatography mass spectrometry method was used to measure these biomarkers in urine from users of e-cigarettes, cannabis, and/or combustible tobacco with/without reduced nicotine levels. Amounts of furan mercapturic acid metabolites were higher in these individuals relative to nonsmokers, indicating that they may be at risk for potential furan-derived toxicities.
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Affiliation(s)
- Karin R. Vevang
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Lin Zhang
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Alex E. Grill
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Dorothy K. Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota 55455, USA
- Department of Psychiatry, University of Minnesota, Minneapolis, MN,55455, USA
| | - Ellen Meier
- Department of Psychology, University of Wisconsin-Stevens Point, Stevens Point, WI, USA
| | - Sarah Oppeneer Nomura
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kim Robien
- Department of Exercise and Nutrition Sciences, George Washington University, Washington, DC 20052, USA
| | - Lisa A. Peterson
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota 55455, USA
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota 55455, USA
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13
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Molony RD, Wu CH, Lee YF. E-liquid exposure induces bladder cancer cells to release extracellular vesicles that promote non-malignant urothelial cell transformation. Sci Rep 2023; 13:142. [PMID: 36599909 PMCID: PMC9813241 DOI: 10.1038/s41598-022-27165-z] [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: 10/06/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
The vaping of electronic cigarettes (E-cigarettes) has recently emerged as a popular alternative to traditional cigarette smoking, but its association with bladder cancer (BC) risk remains to be established. BC patients exhibit high rates of recurrent disease, possibly as a consequence of the field cancerization effect. We have shown that BC-derived extracellular vesicles (BCEVs) can permanently alter recipient urothelial cells in predisposed fields such that they become fully transformed malignant cells. To model the role that BCEVs may play in this potentially oncogenic setting, we treated TCCSUP BC cells with cigarette smoke extract, unflavored E-liquid, or menthol flavored E-liquid. Those treated BCEVs were then tested for their tumorigenic potential. We found that these smoking- and E-cigarette-related BCEVs were able to promote oxidative stress, inflammatory signaling, and DNA damage in recipient SV-HUC urothelial cells. Strikingly, menthol E-liquid-induced BCEVs significantly increased rates of malignant urothelial cell transformation. While further in vivo validation of the simultaneous effects of E-liquid and E-liquid-induced BCEVs on field cancerization is needed, these data highlight the possibility that E-cigarettes may compound user risk in a manner that can contribute to higher rates of BC incidence or recurrence.
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Affiliation(s)
- Ryan D. Molony
- grid.16416.340000 0004 1936 9174Department of Urology, School of Medicine and Dentistry, University of Rochester Medical Center, University of Rochester, 601 Elmwood Ave, Box 656, Rochester, NY 14642 USA
| | - Chia-Hao Wu
- grid.16416.340000 0004 1936 9174Department of Urology, School of Medicine and Dentistry, University of Rochester Medical Center, University of Rochester, 601 Elmwood Ave, Box 656, Rochester, NY 14642 USA
| | - Yi-Fen Lee
- grid.16416.340000 0004 1936 9174Department of Urology, School of Medicine and Dentistry, University of Rochester Medical Center, University of Rochester, 601 Elmwood Ave, Box 656, Rochester, NY 14642 USA ,grid.16416.340000 0004 1936 9174Wilmot Cancer Center, University of Rochester, Rochester, USA ,grid.16416.340000 0004 1936 9174Department of Pathology, University of Rochester, Rochester, USA
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14
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Soo J, Easwaran M, Erickson‐DiRenzo E. Impact of Electronic Cigarettes on the Upper Aerodigestive Tract: A Comprehensive Review for Otolaryngology Providers. OTO Open 2023; 7:e25. [PMID: 36998560 PMCID: PMC10046796 DOI: 10.1002/oto2.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/18/2022] [Accepted: 12/02/2022] [Indexed: 02/19/2023] Open
Abstract
Objective The use and effects of electronic (e)-cigarettes (e-cigs) are particularly relevant for otolaryngology providers as tobacco plays a major role in benign and malignant diseases of the upper aerodigestive tract. This review aims to (1) summarize the recent policies regarding e-cigs and important patterns of use and (2) serve as a comprehensive resource for clinical providers on the known biologic and clinical effects of e-cigs on the upper aerodigestive tract. Data Sources PubMed/MEDLINE. Review Methods We conducted a narrative review on (1) general information on e-cig use and informative findings in the lower respiratory system and a comprehensive review on (2) the effects of e-cigs on cell and animal models and the clinical implications of these products on human health as is relevant to otolaryngology. Conclusions Although e-cigs are likely less harmful than conventional cigarettes, preliminary research on e-cigs suggest several deleterious effects including in the upper aerodigestive tract. Due to this, there has been increased interest in restricting e-cig usage, particularly among the adolescent population, and caution in recommending e-cigs to current smokers. Implications for Practice Chronic e-cig use is likely to have clinical implications. It is critical for otolaryngology providers to be aware of the rapidly changing regulations and use patterns regarding e-cigs and how e-cigs influence human health, particularly with regards to the upper aerodigestive tract, to accurately council patients regarding potential risks and benefits of use.
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Affiliation(s)
- Joanne Soo
- Department of Otolaryngology–Head & Neck Surgery Stanford University School of Medicine Stanford California USA
| | - Meena Easwaran
- Department of Otolaryngology–Head & Neck Surgery Stanford University School of Medicine Stanford California USA
| | - Elizabeth Erickson‐DiRenzo
- Department of Otolaryngology–Head & Neck Surgery Stanford University School of Medicine Stanford California USA
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15
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Part three: a randomized study to assess biomarker changes in cigarette smokers switched to Vuse Solo or Abstinence. Sci Rep 2022; 12:20658. [PMID: 36450821 PMCID: PMC9712618 DOI: 10.1038/s41598-022-25054-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
Biomarkers of exposure (BoE) can help evaluate exposure to combustion-related, tobacco-specific toxicants after smokers switch from cigarettes to potentially less-harmful products like electronic nicotine delivery systems (ENDS). This paper reports data for one (Vuse Solo Original) of three products evaluated in a randomized, controlled, confinement study of BoE in smokers switched to ENDS. Subjects smoked their usual brand cigarette ad libitum for two days, then were randomized to one of three ENDS for a 7-day ad libitum use period, or to smoking abstinence. Thirteen BoE were assessed at baseline and Day 5, and percent change in mean values for each BoE was calculated. Biomarkers of potential harm (BoPH) linked to oxidative stress, platelet activation, and inflammation were also assessed. Levels decreased among subjects randomized to Vuse Solo versus Abstinence, respectively, for the following BoE: 42-96% versus 52-97% (non-nicotine constituents); 51% versus 55% (blood carboxyhemoglobin); and 29% versus 96% (nicotine exposure). Significant decreases were observed in three BoPH: leukotriene E4, 11-dehydro-thromboxane B2, and 2,3-dinor thromboxane B2 on Day 7 in the Vuse Solo and Abstinence groups. These findings show that ENDS use results in substantially reduced exposure to toxicants compared to smoking, which may lead to reduced biological effects.
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16
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Pipe AL, Mir H. E-Cigarettes Reexamined: Product Toxicity. Can J Cardiol 2022; 38:1395-1405. [PMID: 36089290 DOI: 10.1016/j.cjca.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 12/24/2022] Open
Abstract
The introduction of e-cigarettes, or electronic nicotine delivery systems (ENDS), has been accompanied by controversy regarding their safety and effectiveness as a cessation aid and by an explosion in their use by youth. Their use does not involve the combustion of tobacco and the creation of harmful combustion products; they have been seen as a "harm reduction" tool that may be of assistance in promoting smoking cessation. Recognition that ENDS can deliver an array of chemicals and materials with known adverse consequences has spurred more careful examination of these products. Nicotine, nitrosamines, carbonyl compounds, heavy metals, free radicals, reactive oxygen species, particulate matter, and "emerging chemicals of concern" are among the constituents of the heated chemical aerosol that is inhaled when ENDS are used. They raise concerns for cardiovascular and respiratory health that merit the attention of clinicians and regulatory agencies. Frequently cited concerns include evidence of disordered respiratory function, altered hemodynamics, endothelial dysfunction, vascular reactivity, and enhanced thrombogenesis. The absence of evidence of the consequences of their long-term use is of additional concern. Their effectiveness as cessation aids and beneficial impact on health outcomes continue to be examined. It is important to ensure that their production and availability are thoughtfully regulated to optimise their safety and permit their use as harm reduction devices and potentially as smoking-cessation aids. It is equally vital to effectively prevent them from becoming ubiquitous consumer products with the potential to rapidly induce nicotine addiction among large numbers of youth. Clinicians should understand the nature of these products and the implications of their use.
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Affiliation(s)
- Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Hassan Mir
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Chen M, Carmella SG, Lindgren BR, Luo X, Ikuemonisan J, Niesen B, Thomson NM, Murphy SE, Hatsukami DK, Hecht SS. Increased Levels of the Acrolein Metabolite 3-Hydroxypropyl Mercapturic Acid in the Urine of e-Cigarette Users. Chem Res Toxicol 2022; 36:583-588. [PMID: 35858275 PMCID: PMC9852357 DOI: 10.1021/acs.chemrestox.2c00145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Carcinogen and toxicant uptake by e-cigarette users have not been fully evaluated. In the study reported here, we recruited 30 e-cigarette users, 63 nonsmokers, and 33 cigarette smokers who gave monthly urine samples over a period of 4-6 months. Their product use status was confirmed by measurements of exhaled CO, urinary total nicotine equivalents, cyanoethyl mercapturic acid (CEMA), and total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol. Urinary biomarkers of exposure to the carcinogens acrolein (3-hydroxypropyl mercapturic acid, 3-HPMA), benzene (S-phenyl mercapturic acid, SPMA), acrylonitrile (CEMA), and a combination of crotonaldehyde, methyl vinyl ketone, and methacrolein (3-hydroxy-1-methylpropyl mercapturic acid, HMPMA) were quantified at each visit. Data from subject visits with CEMA > 27 pmol/mL were excluded from the statistical analysis of the results because of possible unreported exposures to volatile combustion products such as secondhand cigarette smoke or marijuana smoke exposure; this left 22 e-cigarette users with 4 or more monthly visits and all 63 nonsmokers. Geometric mean levels of 3-HPMA (1249 versus 679.3 pmol/mL urine) were significantly higher (P = 0.003) in e-cigarette users than in nonsmokers, whereas levels of SPMA, CEMA, and HMPMA did not differ between these two groups. All analytes were significantly higher in cigarette smokers than in either e-cigarette users or nonsmokers. The results of this unique multimonth longitudinal study demonstrate consistent significantly higher uptake of the carcinogen acrolein in e-cigarette users versus nonsmokers, presenting a warning signal regarding e-cigarette use.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Stephen S. Hecht
- To whom correspondence should be addressed: Masonic Cancer Center, University of Minnesota, 2231 6th Street SE - 2-148 CCRB, Minneapolis, MN 55455, USA. phone: (612) 624-7604; fax: (612) 624-3869;
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18
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Tattan-Birch H, Kock L, Brown J, Beard E, Bauld L, West R, Shahab L. E-cigarettes to Augment Stop Smoking In-person Support and Treatment With Varenicline (E-ASSIST): A Pragmatic Randomized Controlled Trial. Nicotine Tob Res 2022; 25:395-403. [PMID: 35738868 PMCID: PMC9384384 DOI: 10.1093/ntr/ntac149] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/09/2022] [Accepted: 06/22/2022] [Indexed: 12/01/2022]
Abstract
AIM To examine whether, in adults receiving behavioral support, offering e-cigarettes together with varenicline helps more people stop smoking cigarettes than varenicline alone. METHODS A two-group, parallel arm, pragmatic randomized controlled trial was conducted in six English stop smoking services from 2019-2020. Adults enrolled onto a 12-week programme of in-person one-to-one behavioral smoking cessation support (N = 92) were randomized to receive either (1) a nicotine e-cigarette starter kit alongside varenicline or (2) varenicline alone. The primary outcome was biochemically verified abstinence from cigarette smoking between weeks 9-to-12 post quit date, with those lost to follow-up considered not abstinent. The trial was stopped early due to COVID-19 restrictions and a varenicline recall (92/1266 participants used). RESULTS Nine-to-12-week smoking abstinence rates were 47.9% (23/48) in the e-cigarette-varenicline group compared with 31.8% (14/44) in the varenicline-only group, a 51% increase in abstinence among those offered e-cigarettes; however, the confidence interval (CI) was wide, including the possibility of no difference (risk ratio [RR] = 1.51, 95% CI = 0.91-2.64). The e-cigarette-varenicline group had 43% lower hazards of relapse from continuous abstinence than the varenicline-only group (hazards ratio [HR] = 0.57, 95% CI = 0.34-0.96). Attendance for 12 weeks was higher in the e-cigarette-varenicline than varenicline-only group (54.2% vs. 36.4%; RR = 1.49, 95% CI = 0.95-2.47), but similar proportions of participants in both groups used varenicline daily for ≥8 weeks after quitting (22.9% versus 22.7%; RR = 1.01, 95% CI = 0.47-2.20). Estimates were too imprecise to determine how adverse events differed by group. CONCLUSION Tentative evidence suggests that offering e-cigarettes alongside varenicline to people receiving behavioral support may be more effective for smoking cessation than varenicline alone. IMPLICATIONS Offering e-cigarettes to people quitting smoking with varenicline may help them remain abstinent from cigarettes, but the evidence is tentative because our sample size was smaller than planned-caused by Coronavirus Disease 2019 (COVID-19) restrictions and a manufacturing recall. This meant our effect estimates were imprecise, and additional evidence is needed to confirm that providing e-cigarettes and varenicline together helps more people remain abstinent than varenicline alone.
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Affiliation(s)
| | | | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK,SPECTRUM Consortium, UK
| | - Emma Beard
- Department of Behavioural Science and Health, University College London, London, UK,SPECTRUM Consortium, UK
| | - Linda Bauld
- SPECTRUM Consortium, UK,Usher Institute, College of Medicine, University of Edinburgh, Edinburgh, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK,SPECTRUM Consortium, UK
| | - Lion Shahab
- Corresponding Author: Lion Shahab, PhD, Department of Behavioural Science and Health, University College London, 1–19 Torrington Place, London, WC1E 6BT, UK; Telephone: 44-207679-1895; Fax: 44-2078132848; E-mail:
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19
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Edmiston JS, Webb KM, Wang J, Oliveri D, Liang Q, Sarkar M. Biomarkers of Exposure and Biomarkers of Potential Harm in Adult Smokers Who Switch to e-Vapor Products Relative to Cigarette Smoking in a 24-week, Randomized, Clinical Trial. Nicotine Tob Res 2022; 24:1047-1054. [PMID: 35134961 PMCID: PMC9199942 DOI: 10.1093/ntr/ntac029] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/14/2021] [Accepted: 01/02/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Long-term health effects of e-vapor products (EVPs) are not well-established. We compared biomarkers of exposure (BoE) to select harmful and potentially harmful constituents and biomarkers of potential harm (BoPH) in adult smokers who switched to EVPs versus continued smoking for 24 weeks. METHODS Adult smokers (n = 450, >10 cigarettes per day for ≥10 years) were randomly assigned to continue smoking (control) or switch to one of two cartridge-based EVPs (test 1: classic; test 2: menthol, 4% nicotine). BoE and BoPH were measured at baseline and 12 weeks. The results presented here are from a subset of 150 control and EVP subjects (switchers with exhaled carbon monoxide <8 ppm and <10% baseline cigarettes per day) followed for 24 total weeks. RESULTS Total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and carboxyhemoglobin were significantly reduced (p < .0001) in tests 1 and 2 at 24 weeks. Urinary nicotine equivalents were not statistically significantly different between the control and EVP groups. At week 24, statistically significant reductions (p < .05) were observed for white blood cell counts, 11-dehydrothromboxane β2, and sICAM in both test groups, and there were several significant changes in measures of pulmonary function. High-density lipoprotein cholesterol and 8-epi-prostaglandin-F2α were directionally favorable in both EVP groups versus control. CONCLUSIONS We demonstrate that significant reductions of selected harmful and potentially harmful constituents in EVP aerosol results in significant reductions in BoEs and favorable changes in BoPHs after switching to EVPs for 24 weeks. These changes approached those reported for smoking cessation, suggesting that switching to exclusive use of the EVPs may be less harmful than continuing smoking. IMPLICATIONS Cigarette smoking causes serious diseases. Switching from cigarettes to a noncombustible product is a potential harm reduction pathway for adult smokers unable or unwilling to quit. Long-term health effects of e-vapor products (EVPs) compared with continued smoking have not been extensively studied. We present biomarker of exposure evidence on select harmful and potentially harmful constituents and biomarkers of potential harm related to inflammation and oxidative stress in adult smokers switching to two EVPs. This study demonstrates significant reductions in biomarkers of exposure (except for nicotine) accompanied with favorable changes in various biomarkers of potential harm, including pulmonary function. The totality of evidence suggests that exclusive EVP use may present lower health risks compared with smoking cigarettes.
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Affiliation(s)
- Jeffery S Edmiston
- Altria Client Services LLC, Center for Research and Technology, Richmond, VA, USA
| | - Katy M Webb
- Altria Client Services LLC, Center for Research and Technology, Richmond, VA, USA
| | - Jingzhu Wang
- Altria Client Services LLC, Center for Research and Technology, Richmond, VA, USA
| | - Douglas Oliveri
- Employees of Altria Client Services LLC at the time of the study
| | - Qiwei Liang
- Employees of Altria Client Services LLC at the time of the study
| | - Mohamadi Sarkar
- Altria Client Services LLC, Center for Research and Technology, Richmond, VA, USA
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20
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Feng J, Sosnoff CS, Bernert JT, Blount BC, Li Y, Del Valle-Pinero AY, Kimmel HL, van Bemmel DM, Rutt SM, Crespo-Barreto J, Borek N, Edwards KC, Alexander R, Arnstein S, Lawrence C, Hyland A, Goniewicz ML, Rehmani I, Pine B, Pagnotti V, Wade E, Sandlin J, Luo Z, Piyankarage S, Hatsukami DK, Hecht SS, Conway KP, Wang L. Urinary Nicotine Metabolites and Self-Reported Tobacco Use Among Adults in the Population Assessment of Tobacco and Health (PATH) Study, 2013-2014. Nicotine Tob Res 2022; 24:768-777. [PMID: 35348786 PMCID: PMC9116621 DOI: 10.1093/ntr/ntab206] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/06/2021] [Indexed: 12/17/2023]
Abstract
INTRODUCTION The Population Assessment of Tobacco and Health (PATH) Study is a longitudinal cohort study on tobacco use behavior, attitudes and beliefs, and tobacco-related health outcomes, including biomarkers of tobacco exposure in the U.S. population. In this report we provide a summary of urinary nicotine metabolite measurements among adult users and non-users of tobacco from Wave 1 (2013-2014) of the PATH Study. METHODS Total nicotine and its metabolites including cotinine, trans-3'-hydroxycotinine (HCTT), and other minor metabolites were measured in more than 11 500 adult participants by liquid chromatography tandem mass spectrometry methods. Weighted geometric means (GM) and least square means from statistical modeling were calculated for non-users and users of various tobacco products. RESULTS Among daily users, the highest GM concentrations of nicotine, cotinine and HCTT were found in exclusive smokeless tobacco users, and the lowest in exclusive e-cigarette users. Exclusive combustible product users had intermediate concentrations, similar to those found in users of multiple products (polyusers). Concentrations increased with age within the categories of tobacco users, and differences associated with gender, race/ethnicity and educational attainment were also noted among user categories. Recent (past 12 months) former users had GM cotinine concentrations that were more than threefold greater than never users. CONCLUSIONS These urinary nicotine metabolite data provide quantification of nicotine exposure representative of the entire US adult population during 2013-2014 and may serve as a reference for similar analyses in future measurements within this study. IMPLICATIONS Nicotine and its metabolites in urine provide perhaps the most fundamental biomarkers of recent nicotine exposure. This report, based on Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study, provides the first nationally representative data describing urinary nicotine biomarker concentrations in both non-users, and users of a variety of tobacco products including combustible, e-cigarette and smokeless products. These data provide a urinary biomarker concentration snapshot in time for the entire US population during 2013-2014, and will provide a basis for comparison with future results from continuing, periodic evaluations in the PATH Study.
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Affiliation(s)
- June Feng
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Connie S Sosnoff
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John T Bernert
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin C Blount
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yao Li
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Arseima Y Del Valle-Pinero
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Heather L Kimmel
- Division of Epidemiology, Services and Prevention Research, National Institute of Drug Abuse, Bethesda, MD, USA
| | - Dana M van Bemmel
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Sharyn M Rutt
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Juan Crespo-Barreto
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | | | - Ricky Alexander
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen Arnstein
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Maciej L Goniewicz
- Roswell Park Comprehensive Cancer Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Imran Rehmani
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brittany Pine
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Vincent Pagnotti
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Erin Wade
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James Sandlin
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zuzheng Luo
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sujeewa Piyankarage
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Kevin P Conway
- Division of Epidemiology, Services and Prevention Research, National Institute of Drug Abuse, Bethesda, MD, USA
| | - Lanqing Wang
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Lorkiewicz P, Keith R, Lynch J, Jin L, Theis W, Krivokhizhina T, Riggs D, Bhatnagar A, Srivastava S, Conklin DJ. Electronic Cigarette Solvents, JUUL E-Liquids, and Biomarkers of Exposure: In Vivo Evidence for Acrolein and Glycidol in E-Cig-Derived Aerosols. Chem Res Toxicol 2022; 35:283-292. [PMID: 35044764 PMCID: PMC8864610 DOI: 10.1021/acs.chemrestox.1c00328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Despite the increasing popularity of e-cigarettes, their long-term health effects remain unknown. In animal models, exposure to e-cigarette has been reported to result in pulmonary and cardiovascular injury, and in humans, the acute use of e-cigarettes increases heart rate and blood pressure and induces endothelial dysfunction. In both animal models and humans, cardiovascular dysfunction associated with e-cigarettes has been linked to reactive aldehydes such as formaldehyde and acrolein generated in e-cigarette aerosols. These aldehydes are known products of heating and degradation of vegetable glycerin (VG) present in e-liquids. Here, we report that in mice, acute exposure to a mixture of propylene glycol:vegetable glycerin (PG:VG) or to e-cigarette-derived aerosols significantly increased the urinary excretion of acrolein and glycidol metabolites─3-hydroxypropylmercapturic acid (3HPMA) and 2,3-dihydroxypropylmercapturic acid (23HPMA)─as measured by UPLC-MS/MS. In humans, the use of e-cigarettes led to an increase in the urinary levels of 23HPMA but not 3HPMA. Acute exposure of mice to aerosols derived from PG:13C3-VG significantly increased the 13C3 enrichment of both urinary metabolites 13C3-3HPMA and 13C3-23HPMA. Our stable isotope tracing experiments provide further evidence that thermal decomposition of vegetable glycerin in the e-cigarette solvent leads to generation of acrolein and glycidol. This suggests that the adverse health effects of e-cigarettes may be attributable in part to these reactive compounds formed through the process of aerosolizing nicotine. Our findings also support the notion that 23HPMA, but not 3HPMA, may be a relatively specific biomarker of e-cigarette use.
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Affiliation(s)
- Pawel Lorkiewicz
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States,Department
of Chemistry, University of Louisville, Louisville, Kentucky 40202, United States
| | - Rachel Keith
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States,Division
of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky 40202, United States
| | - Jordan Lynch
- Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States
| | - Lexiao Jin
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States
| | - Whitney Theis
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States
| | - Tatiana Krivokhizhina
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States
| | - Daniel Riggs
- Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States,Division
of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky 40202, United States
| | - Aruni Bhatnagar
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States,Division
of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky 40202, United States
| | - Sanjay Srivastava
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States,Division
of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky 40202, United States
| | - Daniel J. Conklin
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States,Division
of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky 40202, United States,. Tel.: 502-852-5836
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22
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Anic GM, Rostron BL, Hammad HT, van Bemmel DM, Del Valle-Pinero AY, Christensen CH, Erives G, Faulcon LM, Blount BC, Wang Y, Wang L, Bhandari D, Calafat AM, Kimmel HL, Everard CD, Compton WM, Edwards KC, Goniewicz ML, Wei B, Hyland A, Hatsukami DK, Hecht SS, Niaura RS, Borek N, Ambrose BK, Chang CM. Changes in Biomarkers of Tobacco Exposure among Cigarette Smokers Transitioning to ENDS Use: The Population Assessment of Tobacco and Health Study, 2013-2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1462. [PMID: 35162490 PMCID: PMC8835100 DOI: 10.3390/ijerph19031462] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 02/01/2023]
Abstract
Limited data are available for how biomarkers of tobacco exposure (BOE) change when cigarette smokers transition to using electronic nicotine delivery systems (ENDS). Using biomarker data from Waves 1 (2013-2014) and 2 (2014-2015) of the PATH Study, we examined how mean BOE concentrations, including metabolites of nicotine, tobacco-specific nitrosamines (TSNA), polycyclic aromatic hydrocarbons (PAH), and volatile organic compounds (VOC) and metals, changed when 2475 adult smokers transitioned to using ENDS or quit tobacco products. Exclusive smokers who transitioned to dual use had a significant decrease in NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol), but not nicotine metabolites, most PAHs, metals, or VOCs. Exclusive smokers who became dual users had significant reductions in total nicotine equivalents, NNAL, and 2CyEMA (acrylonitrile metabolite), but only in those who reduced cigarettes per day (CPD) by >=50%. Smokers who transitioned to exclusive ENDS use had significant reductions in most TSNAs, PAHs, and VOCs; however, nicotine metabolites did not decrease in dual users who became exclusive ENDS users. Smokers who quit tobacco use had significant decreases in nicotine metabolites, all TSNAs, most PAHs, and most VOCs. Cigarette smokers who became dual users did not experience significant reductions in most BOEs. Reductions were impacted by changes in CPD. However, transitioning from smoking to no tobacco or exclusive ENDS use was associated with reduced exposure to most BOEs measured. Future analyses could incorporate additional waves of PATH data and examine changes in biomarker exposure by ENDS device type and CPD.
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Affiliation(s)
- Gabriella M. Anic
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Brian L. Rostron
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Hoda T. Hammad
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Dana M. van Bemmel
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Arseima Y. Del Valle-Pinero
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Carol H. Christensen
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Gladys Erives
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Lisa M. Faulcon
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Benjamin C. Blount
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (B.C.B.); (Y.W.); (L.W.); (D.B.); (A.M.C.)
| | - Yuesong Wang
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (B.C.B.); (Y.W.); (L.W.); (D.B.); (A.M.C.)
| | - Lanqing Wang
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (B.C.B.); (Y.W.); (L.W.); (D.B.); (A.M.C.)
| | - Deepak Bhandari
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (B.C.B.); (Y.W.); (L.W.); (D.B.); (A.M.C.)
| | - Antonia M. Calafat
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (B.C.B.); (Y.W.); (L.W.); (D.B.); (A.M.C.)
| | - Heather L. Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA; (H.L.K.); (C.D.E.); (W.M.C.)
| | - Colm D. Everard
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA; (H.L.K.); (C.D.E.); (W.M.C.)
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA; (H.L.K.); (C.D.E.); (W.M.C.)
| | | | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.L.G.); (B.W.); (A.H.)
| | - Binnian Wei
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.L.G.); (B.W.); (A.H.)
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.L.G.); (B.W.); (A.H.)
| | - Dorothy K. Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA; (D.K.H.); (S.S.H.)
| | - Stephen S. Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA; (D.K.H.); (S.S.H.)
| | - Raymond S. Niaura
- College of Global Public Health, New York University, New York, NY 10003, USA;
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Bridget K. Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Cindy M. Chang
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
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23
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Tang MS, Lee HW, Weng MW, Wang HT, Hu Y, Chen LC, Park SH, Chan HW, Xu J, Wu XR, Wang H, Yang R, Galdane K, Jackson K, Chu A, Halzack E. DNA damage, DNA repair and carcinogenicity: Tobacco smoke versus electronic cigarette aerosol. MUTATION RESEARCH. REVIEWS IN MUTATION RESEARCH 2022; 789:108409. [PMID: 35690412 PMCID: PMC9208310 DOI: 10.1016/j.mrrev.2021.108409] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 01/03/2023]
Abstract
The allure of tobacco smoking is linked to the instant gratification provided by inhaled nicotine. Unfortunately, tobacco curing and burning generates many mutagens including more than 70 carcinogens. There are two types of mutagens and carcinogens in tobacco smoke (TS): direct DNA damaging carcinogens and procarcinogens, which require metabolic activation to become DNA damaging. Recent studies provide three new insights on TS-induced DNA damage. First, two major types of TS DNA damage are induced by direct carcinogen aldehydes, cyclic-1,N2-hydroxy-deoxyguanosine (γ-OH-PdG) and α-methyl-1, N2-γ-OH-PdG, rather than by the procarcinogens, polycyclic aromatic hydrocarbons and aromatic amines. Second, TS reduces DNA repair proteins and activity levels. TS aldehydes also prevent procarcinogen activation. Based on these findings, we propose that aldehydes are major sources of TS induce DNA damage and a driving force for carcinogenesis. E-cigarettes (E-cigs) are designed to deliver nicotine in an aerosol state, without burning tobacco. E-cigarette aerosols (ECAs) contain nicotine, propylene glycol and vegetable glycerin. ECAs induce O6-methyl-deoxyguanosines (O6-medG) and cyclic γ-hydroxy-1,N2--propano-dG (γ-OH-PdG) in mouse lung, heart and bladder tissues and causes a reduction of DNA repair proteins and activity in lungs. Nicotine and nicotine-derived nitrosamine ketone (NNK) induce the same types of DNA adducts and cause DNA repair inhibition in human cells. After long-term exposure, ECAs induce lung adenocarcinoma and bladder urothelial hyperplasia in mice. We propose that E-cig nicotine can be nitrosated in mouse and human cells becoming nitrosamines, thereby causing two carcinogenic effects, induction of DNA damage and inhibition of DNA repair, and that ECA is carcinogenic in mice. Thus, this article reviews the newest literature on DNA adducts and DNA repair inhibition induced by nicotine and ECAs in mice and cultured human cells, and provides insights into ECA carcinogenicity in mice.
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Affiliation(s)
- Moon-Shong Tang
- Department of Environmental Medicine, Pathology and Medicine, United States.
| | - Hyun-Wook Lee
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Mao-Wen Weng
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Hsiang-Tsui Wang
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Yu Hu
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Lung-Chi Chen
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Sung-Hyun Park
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Huei-Wei Chan
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Jiheng Xu
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Xue-Ru Wu
- Departmemt of Urology, New York University School of Medicine, New York, NY10016, United States
| | - He Wang
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson MedicalSchool, Rutgers University, Piscataway, NJ 08854, United States
| | - Rui Yang
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Karen Galdane
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Kathryn Jackson
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Annie Chu
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Elizabeth Halzack
- Department of Environmental Medicine, Pathology and Medicine, United States
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24
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Roh EJ, Chen-Sankey JC, Wang MQ. Electronic nicotine delivery system (ENDS) use patterns and its associations with cigarette smoking and nicotine addiction among Asian Americans: Findings from the national adult tobacco survey (NATS) 2013-2014. J Ethn Subst Abuse 2022; 21:253-271. [PMID: 32459579 PMCID: PMC7704701 DOI: 10.1080/15332640.2020.1747039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study examined the ENDS use and their associations with conventional cigarette smoking and nicotine addiction among Asian Americans (AAs). The study sample was restricted to Non-Hispanic AAs (n = 1,956) using the National Adult Tobacco Survey (NATS) 2013-2014. Chi-square tests and logistic regressions were employed. AAs who ever used ENDS reported they were more likely to smoke conventional cigarettes, smoke ≤100 cigarettes in a lifetime, and felt more difficulty concentrating without using tobacco than those who never used END. Study findings indicate that ENDS use may be associated with conventional cigarette smoking and may lead to nicotine addiction among AAs.
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Affiliation(s)
- Esther J Roh
- University of Maryland, College Park, Maryland, USA
| | - Julia C Chen-Sankey
- National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Min Q Wang
- University of Maryland, College Park, Maryland, USA
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25
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Guo J, Ikuemonisan J, Hatsukami DK, Hecht SS. Liquid Chromatography-Nanoelectrospray Ionization-High-Resolution Tandem Mass Spectrometry Analysis of Apurinic/Apyrimidinic Sites in Oral Cell DNA of Cigarette Smokers, e-Cigarette Users, and Nonsmokers. Chem Res Toxicol 2021; 34:2540-2548. [PMID: 34846846 DOI: 10.1021/acs.chemrestox.1c00308] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cigarette smoking is an established risk factor for oral cancer. The health effects of e-cigarettes are still under investigation but may disturb oral cavity homeostasis and cause lung and cardiovascular diseases. Carcinogens and toxicants in tobacco products and e-cigarettes may damage DNA, resulting in the formation of apurinic/apyrimidinic (AP) sites and initiation of the carcinogenic process. In this study, we optimized a liquid chromatography-nanoelectrospray ionization-high-resolution tandem mass spectrometry method to analyze AP sites in buccal cell DNA of 35 nonsmokers, 30 smokers, and 30 e-cigarette users. AP sites in e-cigarette users (median 3.3 per 107 nts) were significantly lower than in smokers (median 5.7 per 107 nts) and nonsmokers (median 6.0 per 107 nts). AP sites in smokers were not significantly different from nonsmokers (p > 0.05). The e-cigarette vaporizing solvents propylene glycol and glycerin were tested and did not protect against AP site formation in in vitro control and carcinogen exposed rat liver homogenates. However, propylene glycol may inhibit bacteria in oral cells, resulting in reduced inflammation and related effects, and reduced AP site levels in e-cigarette user DNA. This is the first study to examine AP site formation in e-cigarette users and to evaluate AP sites in human oral cell DNA.
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Affiliation(s)
- Jiehong Guo
- Masonic Cancer Center, University of Minnesota, 2231 6th Street SE, 2-210 CCRB, Minneapolis, Minnesota 55455, United States
| | - Joshua Ikuemonisan
- Masonic Cancer Center, University of Minnesota, 2231 6th Street SE, 2-210 CCRB, Minneapolis, Minnesota 55455, United States
| | - Dorothy K Hatsukami
- Masonic Cancer Center, University of Minnesota, 2231 6th Street SE, 2-210 CCRB, Minneapolis, Minnesota 55455, United States
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, 2231 6th Street SE, 2-210 CCRB, Minneapolis, Minnesota 55455, United States
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26
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Snoderly HT, Nurkiewicz TR, Bowdridge EC, Bennewitz MF. E-Cigarette Use: Device Market, Study Design, and Emerging Evidence of Biological Consequences. Int J Mol Sci 2021; 22:12452. [PMID: 34830344 PMCID: PMC8619996 DOI: 10.3390/ijms222212452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/12/2022] Open
Abstract
Electronic cigarettes are frequently viewed as a safer alternative to conventional cigarettes; however, evidence to support this perspective has not materialized. Indeed, the current literature reports that electronic cigarette use is associated with both acute lung injury and subclinical dysfunction to the lung and vasculature that may result in pathology following chronic use. E-cigarettes can alter vascular dynamics, polarize innate immune populations towards a proinflammatory state, compromise barrier function in the pulmonary endothelium and epithelium, and promote pre-oncogenic phenomena. This review will summarize the variety of e-cigarette products available to users, discuss current challenges in e-cigarette study design, outline the range of pathologies occurring in cases of e-cigarette associated acute lung injury, highlight disease supporting tissue- and cellular-level changes resulting from e-cigarette exposure, and briefly examine how these changes may promote tumorigenesis. Continued research of the mechanisms by which e-cigarettes induce pathology benefit users and clinicians by resulting in increased regulation of vaping devices, informing treatments for emerging diseases e-cigarettes produce, and increasing public awareness to reduce e-cigarette use and the onset of preventable disease.
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Affiliation(s)
- Hunter T. Snoderly
- Department of Chemical and Biomedical Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV 26506, USA;
- Center for Inhalation Toxicology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.R.N.); (E.C.B.)
| | - Timothy R. Nurkiewicz
- Center for Inhalation Toxicology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.R.N.); (E.C.B.)
- Department of Physiology and Pharmacology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Elizabeth C. Bowdridge
- Center for Inhalation Toxicology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.R.N.); (E.C.B.)
- Department of Physiology and Pharmacology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Margaret F. Bennewitz
- Department of Chemical and Biomedical Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV 26506, USA;
- Center for Inhalation Toxicology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.R.N.); (E.C.B.)
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27
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Choi S, Lee K, Park SM. Combined Associations of Changes in Noncombustible Nicotine or Tobacco Product and Combustible Cigarette Use Habits With Subsequent Short-Term Cardiovascular Disease Risk Among South Korean Men: A Nationwide Cohort Study. Circulation 2021; 144:1528-1538. [PMID: 34601948 DOI: 10.1161/circulationaha.121.054967] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The associations of changes in noncombustible nicotine or tobacco product (NNTP) and combustible cigarette (CC) use habits with subsequent cardiovascular disease (CVD) risk are still unclear. METHODS The study population consisted of 5 159 538 adult men who underwent health screening examinations during both the first (2014-2015) and second (2018) health screening periods from the Korean National Health Insurance Service database. All participants were divided into continual CC-only smokers, CC and NNTP users, recent (<5 years) CC quitters without NNTP use, recent CC quitters with NNTP use, long-term (≥5 years) CC quitters without NNTP use, long-term CC quitters with NNTP use, and never smokers. Propensity score matching analysis was conducted to further compare CVD risk among CC quitters according to NNTP use. Starting from the second health screening date, participants were followed up until the date of CVD event, death, or December 31, 2019, whichever came earliest. Multivariable Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% CIs for CVD risk according to changes in NNTP and CC smoking habits. RESULTS Compared with continual CC-only smokers, CC and NNTP users (aHR, 0.83 [95% CI, 0.79-0.88]) and initial CC smokers who quit CCs and switched to NNTP use only (recent CC quitters with NNTP use, aHR, 0.81 [95% CI, 0.78-0.84]) had lower risk for CVD. After propensity score matching, recent CC quitters with NNTP use (aHR, 1.31 [95% CI, 1.01-1.70]) had higher risk for CVD than recent CC quitters without NNTP use. Similarly, compared with long-term CC quitters without NNTP use, long-term CC quitters with NNTP use (aHR, 1.70 [95% CI, 1.07-2.72]) had higher CVD risk. CONCLUSIONS Switching to NNTP use among initial CC smokers was associated with lower CVD risk than continued CC smoking. On CC cessation, NNTP use was associated with higher CVD risk than CC quitting without NNTPs. Compared with CC smokers who quit without NNTP use, CC quitters who use NNTPs may be at higher future CVD risk.
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Affiliation(s)
- Seulggie Choi
- Department of Biomedical Sciences (S.C., S.M.P.), Seoul National University College of Medicine, South Korea
| | - Kiheon Lee
- Department of Family Medicine (K.L., S.M.P.), Seoul National University College of Medicine, South Korea
- Department of Family Medicine, Seoul National University Bundang Hospital, South Korea (K.L.)
| | - Sang Min Park
- Department of Biomedical Sciences (S.C., S.M.P.), Seoul National University College of Medicine, South Korea
- Department of Family Medicine (K.L., S.M.P.), Seoul National University College of Medicine, South Korea
- Department of Family Medicine, Seoul National University Hospital, South Korea (S.M.P.)
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Wilson N, Summers JA, Ait Ouakrim D, Hoek J, Edwards R, Blakely T. Improving on estimates of the potential relative harm to health from using modern ENDS (vaping) compared to tobacco smoking. BMC Public Health 2021; 21:2038. [PMID: 34749706 PMCID: PMC8577029 DOI: 10.1186/s12889-021-12103-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 10/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although the harm to health from electronic nicotine delivery systems (ENDS) compared to smoked tobacco remains highly uncertain, society and governments still need to know the likely range of the relative harm to inform regulatory policies for ENDS and smoking. METHODS We identified biomarkers with specificity of association with different disease groupings e.g., volatile organic compound (VOCs) for chronic obstructive pulmonary disease; and tobacco-specific N´-nitrosamines (TSNAs) and polycyclic aromatic hydrocarbons (PAHs) for all cancers. We conducted a review of recent studies (post January 2017) that compared these biomarkers between people exclusively using ENDS and those exclusively smoking tobacco. The percentage differences in these biomarkers, weighted by study size and adjusted for acrolein from other sources, were used as a proxy for the assumed percentage difference in disease harm between ENDS and smoking. These relative differences were applied to previously modelled estimates of smoking-related health loss (in health-adjusted life-years; HALYs). RESULTS The respective relative biomarker levels (ENDS vs smoking) were: 28% for respiratory diseases (five results, three studies); 42% for cancers (five results, four studies); and 35% for cardiovascular (seven results, four studies). When integrated with the HALY impacts by disease, the overall harm to health from ENDS was estimated to be 33% that of smoking. CONCLUSIONS This analysis, suggests that the use of modern ENDS devices (vaping) could be a third as harmful to health as smoking in a high-income country setting. But this estimate is based on a limited number of biomarker studies and is best be considered a likely upper level of ENDS risk given potential biases in our method (i.e., the biomarkers used being correlated with more unaccounted for toxicants in smoking compared to with using ENDS).
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Affiliation(s)
- Nick Wilson
- University of Otago, Wellington, New Zealand.
| | | | - Driss Ait Ouakrim
- Population Interventions, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Janet Hoek
- University of Otago, Wellington, New Zealand
| | | | - Tony Blakely
- Population Interventions, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Mara A, Langasco I, Deidda S, Caredda M, Meloni P, Deroma M, Pilo MI, Spano N, Sanna G. ICP-MS Determination of 23 Elements of Potential Health Concern in Liquids of e-Cigarettes. Method Development, Validation, and Application to 37 Real Samples. Molecules 2021; 26:6680. [PMID: 34771088 PMCID: PMC8588553 DOI: 10.3390/molecules26216680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022] Open
Abstract
The lack of interest in the determination of toxic elements in liquids for electronic cigarettes (e-liquids) has so far been reflected in the scarce number of accurate and validated analytical methods devoted to this aim. Since the strong matrix effects observed for e-liquids constitute an exciting analytical challenge, the main goal of this study was to develop and validate an ICP-MS method aimed to quantify 23 elements in 37 e-liquids of different flavors. Great attention has been paid to the critical phases of sample pre-treatment, as well as to the optimization of the ICP-MS conditions for each element and of the quantification. All samples exhibited a very low amount of the elements under investigation. Indeed, the sum of their average concentration was of ca. 0.6 mg kg-1. Toxic elements were always below a few tens of a μg per kg-1 and, very often, their amount was below the relevant quantification limits. Tobacco and tonic flavors showed the highest and the lowest concentration of elements, respectively. The most abundant elements came frequently from propylene glycol and vegetal glycerin, as confirmed by PCA. A proper choice of these substances could further decrease the elemental concentration in e-liquids, which are probably barely involved as potential sources of toxic elements inhaled by vapers.
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Affiliation(s)
- Andrea Mara
- Dipartimento di Chimica e Farmacia, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy; (A.M.); (I.L.); (S.D.); (P.M.); (M.I.P.); (N.S.)
| | - Ilaria Langasco
- Dipartimento di Chimica e Farmacia, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy; (A.M.); (I.L.); (S.D.); (P.M.); (M.I.P.); (N.S.)
| | - Sara Deidda
- Dipartimento di Chimica e Farmacia, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy; (A.M.); (I.L.); (S.D.); (P.M.); (M.I.P.); (N.S.)
| | - Marco Caredda
- AGRIS Sardegna, Loc. Bonassai, S.S. 291 Km 18.6, 07100 Sassari, Italy;
| | - Paola Meloni
- Dipartimento di Chimica e Farmacia, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy; (A.M.); (I.L.); (S.D.); (P.M.); (M.I.P.); (N.S.)
| | - Mario Deroma
- Dipartimento di Agraria, Università degli Studi di Sassari, Viale Italia 39/a, 07100 Sassari, Italy;
| | - Maria I. Pilo
- Dipartimento di Chimica e Farmacia, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy; (A.M.); (I.L.); (S.D.); (P.M.); (M.I.P.); (N.S.)
| | - Nadia Spano
- Dipartimento di Chimica e Farmacia, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy; (A.M.); (I.L.); (S.D.); (P.M.); (M.I.P.); (N.S.)
| | - Gavino Sanna
- Dipartimento di Chimica e Farmacia, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy; (A.M.); (I.L.); (S.D.); (P.M.); (M.I.P.); (N.S.)
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Hiler M, Weidner AS, Hull LC, Kurti AN, Mishina EV. Systemic biomarkers of exposure associated with ENDS use: a scoping review. Tob Control 2021:tobaccocontrol-2021-056896. [PMID: 34732539 DOI: 10.1136/tobaccocontrol-2021-056896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/13/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This scoping review provides an overview of the existing literature on biomarkers of exposure from electronic nicotine delivery systems (ENDS) use and identifies gaps in existing knowledge. DATA SOURCES We searched two international databases (PubMed and Web of Science) to identify relevant studies published from August 2013 to February 2021. DATA SELECTION Studies were included if they assessed and compared biomarkers of exposure between exclusive ENDS users, non-users, exclusive cigarette smokers, dual users of ENDS and cigarettes or cigarette smokers who switch to ENDS. DATA EXTRACTION AND SYNTHESIS Of the 5074 studies identified, 188 studies met criteria and were selected for full-text screening. Of these, 27 studies were selected for inclusion and data extraction. CONCLUSIONS Consistent, although limited, evidence shows that exclusive ENDS users have elevated levels of biomarkers of certain volatile organic compounds (VOCs; eg, acrylamide and acrylonitrile), metals (eg, cadmium and selenium) and propylene glycol compared with non-users; however, evidence for biomarkers of other toxicants (eg, acrolein, benzene and chromium) is mixed. Biomarkers of most VOCs are lower in ENDS users compared with cigarette smokers, and cigarette smokers who switch to ENDS consistently show reductions in VOC biomarkers. Evidence comparing metal exposures from exclusive ENDS use, cigarette smoking and dual use is mixed and depends on the metal. ENDS and e-liquid characteristics as well as use patterns may be associated with elevated exposure to VOCs and metals. Additional rigorous, controlled studies can assess biomarker exposures from ENDS use and inform the overall risk-benefit of ENDS use for different user populations.
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Affiliation(s)
- Marzena Hiler
- Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Anna-Sophie Weidner
- Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Lynn C Hull
- Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Allison N Kurti
- Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Elena V Mishina
- Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
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Pamungkasningsih SW, Taufik FF, Samoedro E, Andarini S, Susanto AD. Urinary Cotinine and Nicotine Dependence Levels in Regular Male Electronic Cigarette Users. Eurasian J Med 2021; 53:168-173. [PMID: 35110091 PMCID: PMC9879225 DOI: 10.5152/eurasianjmed.2021.20009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Found in plasma, urine, and saliva, cotinine can be used as a biomarker for nicotine in electronic cigarette (e-cig) users. Nicotine is addictive and causes dependence. Thus, it becomes a problem in smoking cessation programs. This study aimed to determine the relationship between urinary cotinine (UCot) and nicotine dependence levels in regular male e-cig users. MATERIALS AND METHODS This cross-sectional study consecutively included regular male e-cig users and nonsmokers. All subjects were interviewed and had their UCot levels measured using an enzyme-linked immunosorbent assay method. The regular e-cig users completed the Penn State Nicotine Dependence Index questionnaire. RESULTS This study recruited 71 males aged 18-45 years divided into e-cig users and non-smokers group. The predominating characteristics in e-cig users are as follows: 23 males (67.6%) aged <30 years, the highest education of senior high school 25 (73.5%) and 25 (73.5%) subjects had occupation. The UCot levels among the e-cig users in the non-dependency group were lower than that of the medium-high dependency group (P = .008). The median value for UCot level in the regular e-cig users was higher than that of the non-smoker group (276.11 [58.01-284.15] ng/mL vs 5.21 [4.65-23.72] ng/mL, P < .001). Factors influencing the UCot levels of the e-cig users were age (P = .041), nicotine level of the e-cig liquid (P = .013), and the flavor of the e-cig liquid (eg, menthol or non-menthol; P = .040). CONCLUSION UCot and nicotine dependence levels in the regular male e-cig users were significantly related. Nicotine dependence was found in 76.5% of the regular male e-cig users. The UCot levels in the e-cig users were significantly higher than in the non-smokers.
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Affiliation(s)
- Sri Wening Pamungkasningsih
- Department of Pulmonolgy and Respiratory Medicine, Universitas Indonesia School of Medicine, Jakarta, Indonesia; Persahabatan Central General Hospital, Jakarta, Indonesia,Dr. H.A. Rotinsulu Lung Hospital, Bandung, Indonesia,Correspondence to: Sri Wening Pamungkasningsih
| | - Feni Fitriani Taufik
- Department of Pulmonolgy and Respiratory Medicine, Universitas Indonesia School of Medicine, Jakarta, Indonesia; Persahabatan Central General Hospital, Jakarta, Indonesia
| | - Erlang Samoedro
- Department of Pulmonolgy and Respiratory Medicine, Universitas Indonesia School of Medicine, Jakarta, Indonesia; Persahabatan Central General Hospital, Jakarta, Indonesia
| | - Sita Andarini
- Department of Pulmonolgy and Respiratory Medicine, Universitas Indonesia School of Medicine, Jakarta, Indonesia; Persahabatan Central General Hospital, Jakarta, Indonesia
| | - Agus Dwi Susanto
- Department of Pulmonolgy and Respiratory Medicine, Universitas Indonesia School of Medicine, Jakarta, Indonesia; Persahabatan Central General Hospital, Jakarta, Indonesia
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Bjurlin MA, Matulewicz RS, Roberts TR, Dearing BA, Schatz D, Sherman S, Gordon T, Shahawy OE. Carcinogen Biomarkers in the Urine of Electronic Cigarette Users and Implications for the Development of Bladder Cancer: A Systematic Review. Eur Urol Oncol 2021; 4:766-783. [PMID: 32192941 DOI: 10.1016/j.euo.2020.02.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/19/2020] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Use of electronic cigarettes (e-cigarettes) has rapidly increased despite unclear longitudinal health effects. Once thought to be a safer alternative to tobacco smoke, it is possible that e-cigarettes expose the user to similar carcinogenic byproducts during the vaping process. These toxicants are metabolized and excreted in the urine, and may have oncogenic implications for bladder urothelium. OBJECTIVE To characterize and summarize known urinary carcinogenic biomarkers in e-cigarette users as they relate to the risk of developing bladder cancer. EVIDENCE ACQUISITION A systematic literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and included PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL). Relevant articles published in peer-reviewed journals, through January 2019, that reported on urinary biomarkers in e-cigarettes users were included. Parent compounds and urinary biomarkers were classified according to the International Agency for Research on Cancer Monographs on the Evaluation of Carcinogenic Risks to Humans and cross referenced using the Collaborative on Health and the Environment, Toxicant and Disease Database to determine a link to bladder cancer, grouped by strength of evidence. EVIDENCE SYNTHESIS Our initial search identified 1385 articles, 22 of which met final inclusion criteria and were included for analysis. In summation, these studies described 40 different parent compounds and four metals found in the urine of e-cigarette users. Since each parent compound can be metabolized several different ways, 63 unique toxicant or carcinogenic metabolite biomarkers were identified. Compared with nonuser controls, e-cigarette users had higher concentrations of urinary biomarkers of several carcinogenic compounds linked to bladder cancer. The majority of studies were limited by heterogeneous reporting and a dearth of control individuals who had never smoked. CONCLUSIONS Biomarkers of carcinogens, several with a strong link to bladder cancer, are present in the urine of e-cigarette users. Long-term implications of urothelial exposure to these toxicants are unknown but concerning, given the similarities to tobacco smoke and its established relationship with bladder cancer. Further study on the urological safety of e-cigarettes is necessary. PATIENT SUMMARY Our review shows that several carcinogens that have a known link to bladder cancer are present in the urine of electronic cigarette (e-cigarette) users. Further study on the urological safety of e-cigarettes is necessary.
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Affiliation(s)
- Marc A Bjurlin
- Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | | | | | - Bianca A Dearing
- Section on Tobacco, Alcohol and Drug Use, Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Daniel Schatz
- Section on Tobacco, Alcohol and Drug Use, Department of Population Health, NYU School of Medicine, New York, NY, USA; Office of Behavioral Health, Health + Hospitals, New York, NY, USA
| | - Scott Sherman
- Section on Tobacco, Alcohol and Drug Use, Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Terry Gordon
- Department of Environmental Medicine, New York University, New York, NY, USA
| | - Omar El Shahawy
- Section on Tobacco, Alcohol and Drug Use, Department of Population Health, NYU School of Medicine, New York, NY, USA
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Kimber C, Cox S, Frings D, Albery IP, Dawkins L. Development and testing of relative risk-based health messages for electronic cigarette products. Harm Reduct J 2021; 18:96. [PMID: 34496865 PMCID: PMC8424813 DOI: 10.1186/s12954-021-00540-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 08/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health messages on e-cigarette packs emphasise nicotine addiction or harms using similar wording to warnings on cigarette packs. These may not be appropriate for e-cigarettes which constitute a reduced risk alternative for smokers. This research aimed to (1) develop and test a selection of relative risk messages for e-cigarette products; (2) compare these to the two current EU Tobacco Products Directive (TPD) nicotine addiction messages; and (3) explore differences between smokers, non-smokers and dual users. METHOD Twenty-six messages focusing on either harm-reduction or cessation were developed and rated by multidisciplinary experts for accuracy, persuasiveness and clarity. The eight highest ranking messages were compared alongside the TPD messages in a sample of 983 European residents (316 smokers, 327 non-smokers, 340 dual users) on understandability, believability and convincingness. RESULTS On all three constructs combined, the two TPD messages rated the highest, closely followed by four relative risk messages "Completely switching to e-cigarettes lowers your risk of smoking related diseases", "Use of this product is much less harmful than smoking", "Completely switching to e-cigarettes is a healthier alternative to smoking", and "This product presents substantially lower risks to health than cigarettes" which did not differ statistically from the TPD messages. Non-smokers rated TPD1 significantly higher overall than dual users. Dual users rated "This product is a safer alternative to smoking" significantly higher than non-smokers. Messages did not differ on understandability. CONCLUSIONS These alternative messages provide a useful resource for future research and for policy makers considering updating e-cigarette product labelling.
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Affiliation(s)
- Catherine Kimber
- Centre for Addictive Behaviour Research, Division of Psychology, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA UK
| | - Sharon Cox
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Daniel Frings
- Centre for Addictive Behaviour Research, Division of Psychology, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA UK
| | - Ian P. Albery
- Centre for Addictive Behaviour Research, Division of Psychology, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA UK
| | - Lynne Dawkins
- Centre for Addictive Behaviour Research, Division of Psychology, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA UK
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Nyakutsikwa B, Britton J, Bogdanovica I, Boobis A, Langley T. Characterising vaping products in the United Kingdom: an analysis of Tobacco Products Directive notification data. Addiction 2021; 116:2521-2528. [PMID: 33651418 DOI: 10.1111/add.15463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/21/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022]
Abstract
AIMS To analyse content and emission data submitted by manufacturers for nicotine-containing vaping products in the United Kingdom (UK) in accordance with the European Union Tobacco Products Directive. DESIGN Analysis of ingredient and emission data reported for all e-liquid-containing e-cigarettes, cartridges or refill containers notified to the Medicines and Healthcare Regulatory Agency (MHRA) from November 2016 to October 2017. SETTING United Kingdom CASES: A total of 40 785 e-liquid containing products. MEASUREMENTS The average number of ingredients per product, nicotine concentrations, frequency of occurrence ingredients and frequency and levels of chemical emissions. FINDINGS Reports were not standardised in relation to units of measurement or constituent nomenclature. Products listed an average of 17 ingredients and 3.3% were reported not to contain nicotine. A total of 59% of products contained <12 mg nicotine per mL, and <1% were reported to have nicotine concentrations above the legal limit of 20 mg/mL. Over 1500 ingredients were reported, and other than nicotine the most commonly reported non-flavour ingredients were propylene glycol (97% of products) and glycerol (71%). The most common flavour ingredients were ethyl butyrate (42%), vanillin (35%) and ethyl maltol (33%). The most frequently reported chemical emissions were nicotine (65%), formaldehyde (48%) and acetaldehyde (40%). The reporting of the concentration of emissions was not standardised; emissions were reported in a format allowing analysis of median estimated concentration for between 13% and 100% of products for each reported emission. Most of the frequently reported emissions, other than nicotine, were present in median estimated concentrations below 1 μg/L of inspired air, and with the exception of nicotine, acrolein and diacetyl, at median levels below European Chemicals Agency Long Term Exposure and United States (US) Department of Labor Occupational Safety and Health Administration (OSHA) limits, where these were available. CONCLUSIONS An analysis of reports to the United Kingdom's Medicines and Healthcare products Regulatory Agency by manufacturers of vaping products shows that (i) these products have a large range of ingredients and emissions, (ii) the reporting system is unstandardized in terms of reporting requirements, and (iii) for quantified emissions, median levels are for the most part below published safe limits for ambient air.
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Affiliation(s)
- Blessing Nyakutsikwa
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, UK
| | - John Britton
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, UK.,SPECTRUM Consortium, UK
| | - Ilze Bogdanovica
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, UK.,SPECTRUM Consortium, UK
| | - Alan Boobis
- Faculty of Medicine, Imperial College London, London, UK
| | - Tessa Langley
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, UK.,SPECTRUM Consortium, UK
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Leavens ELS, Carpenter MJ, Smith TT, Nollen NL. Exploratory evaluation of online brief education for JUUL pod-mod use and prevention. Addict Behav 2021; 119:106942. [PMID: 33866224 DOI: 10.1016/j.addbeh.2021.106942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Initiation of e-cigarette use by young adults is a significant public health issue within the debate on vaping. The current study is an exploratory evaluation of brief educational information among young adults and investigated outcomes as a function of JUUL use and smoking status. METHODS Participants (N = 947) were young adults (<30 years old) recruited from Amazon's Mechanical Turk based on smoking and JUUL use status. Participants completed baseline assessments, viewed a brief JUUL educational handout, and completed post-assessments. RESULTS There was a significant Time X Group interaction for JUUL-related knowledge (p < .001), with never JUUL/never smokers showing the greatest increase in knowledge. Brief education increased JUUL-related knowledge and risk perceptions and had a modest impact on commitment to quitting and readiness to quit JUUL (all p ≤ 0.001; ds = 0.06-0.74; time × group p > .05 for all contrasts except JUUL-related knowledge). Participants showed modest decreases in interest in future JUUL use, interest in purchasing, and interest in future regular use (all p ≤ 0.001; ds = 0.07-0.08; time × group p > .05 for all contrasts). In terms of smoking outcomes, participants reported reduced perceived harm to others (p < .001; d = 0.09) and decreased intentions to smoke regularly (p = .001; d = 0.07). CONCLUSIONS Brief education was effective in increasing knowledge and risk perceptions while showing a modest effect on intentions for future use. The information was most effective in increasing knowledge among non-users, suggesting that brief education may be useful for preventing initiation. Analysis of group differences suggest current JUUL use status is more important in informing JUUL-related attitudes than smoking status.
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Affiliation(s)
- Eleanor L S Leavens
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, United States; University of Kansas School of Medicine, Department of Population Health, United States.
| | - Matthew J Carpenter
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, United States
| | - Tracy T Smith
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, United States
| | - Nicole L Nollen
- University of Kansas School of Medicine, Department of Population Health, United States
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Hawkey AB, Hoeng J, Peitsch MC, Levin ED, Koshibu K. Subchronic effects of plant alkaloids on anxiety-like behavior in zebrafish. Pharmacol Biochem Behav 2021; 207:173223. [PMID: 34197843 DOI: 10.1016/j.pbb.2021.173223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/18/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022]
Abstract
Zebrafish provide a valuable emerging complementary model for neurobehavioral research. They offer a powerful way to screen for the potential therapeutic effects of neuroactive drugs. A variety of behavioral tests for zebrafish have been developed and validated for assessing neurobehavioral function. The novel tank diving test is a straightforward, reproducible way of measuring anxiety-like behavior in zebrafish. When introduced into a novel tank, zebrafish normally dive to the bottom of the tank and then gradually explore the higher levels of the water column as time progresses. Buspirone is an effective anxiolytic drug in humans, which has been found, with acute administration, to reduce this anxiety-like response in zebrafish. The current study used the zebrafish model to evaluate the potential anxiolytic effects of alkaloids, commonly found in Solanaceae plants, with known neuropharmacology relevant to mood regulation. In line with previous findings, acute treatment with anxiolytic positive controls buspirone and the plant alkaloid nicotine reduced the anxiety-like diving response in the zebrafish novel tank diving test. Further, both buspirone and nicotine continued to produce anxiolytic-like effects in zebrafish after 5 days of exposure. In the same treatment paradigm, the effects of five other alkaloids-cotinine, anatabine, anabasine, harmane, and norharmane-were investigated. Cotinine, the major metabolite of nicotine, also caused anxiolytic-like effects, albeit at a dose higher than the effective dose of nicotine. Nicotine's anxiolytic-like effect was not shared by the other nicotinic alkaloids, anabasine and anatabine, or by the naturally present monoamine oxidase inhibitors harmane and norharmane. We conclude that nicotine uniquely induces anxiolytic-like effects after acute and subchronic treatment in zebrafish. The zebrafish model with the novel tank diving test could be a useful complement to rodent models for screening candidate compounds for anxiolytic effects in nonclinical studies.
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Affiliation(s)
- Andrew B Hawkey
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Julia Hoeng
- 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
| | - Edward D Levin
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Kyoko Koshibu
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
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37
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Cohen G, Goldenson NI, Bailey PC, Chan S, Shiffman S. Changes in Biomarkers of Cigarette Smoke Exposure After 6 Days of Switching Exclusively or Partially to Use of the JUUL System with Two Nicotine Concentrations: A Randomized Controlled Confinement Study in Adult Smokers. Nicotine Tob Res 2021; 23:2153-2161. [PMID: 34161586 PMCID: PMC8570669 DOI: 10.1093/ntr/ntab134] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 06/21/2021] [Indexed: 02/07/2023]
Abstract
Introduction Evidence suggests that cigarette smokers who switch to electronic nicotine delivery systems (ENDS) reduce their exposure to harmful toxicants and carcinogens. It is unclear if dual-use is associated with decreases in exposure to toxicants. Methods This parallel-group confinement study assessed changes in biomarkers of exposure (BOEs) over six days among healthy adult smokers who were randomized into 1 of 11 study groups: eight JUUL-brand System (JUUL) groups (4 JUUL flavors [Virginia Tobacco, Menthol, Mint, Mango] × 2 nicotine concentrations [5.0% or 3.0% by weight]); Dual-Use group used preferred JUUL flavor (5.0% nicotine) and ≤50% usual brand (UB) cigarettes/day; UB Cigarette group and one group abstained from all tobacco/nicotine product use (Abstinence group). Urine and blood analysis assessed changes in primary BOE endpoints (NNAL, 3-HPMA, MHBMA, S-PMA COHb) and secondary BOE endpoints (NNN, HMPMA, CEMA, 1-OHP, O-toluidine, 2-NA, 4-ABP) among 279 adult smokers. Results In JUUL groups, median percent reductions in primary BOEs (Day 6–Baseline) were 90%–≥100% of Abstinence; there were no significant differences between JUUL groups and Abstinence. All reductions in JUUL groups were substantially and statistically significantly greater than reductions in the UB Cigarette group (ps < 0.025). Median reductions in primary BOEs in the Dual-Use group were 43%–55% of Abstinence. Similar results were observed for secondary BOEs. Conclusion This study suggests that the use of JUUL as a complete or partial substitute (i.e., dual-use with ≥50% reduction in cigarette consumption) for combustible cigarettes can substantially reduce exposure to multiple toxins associated with cigarette smoking. Implications This study adds to the growing body of evidence supporting the utility of ENDS products as potentially reduced-harm alternatives to cigarettes for adult smokers. Adult smokers who switched completely from cigarette smoking to use of the JUUL System (“JUUL”) in two nicotine concentrations (5.0% and 3.0%) and four flavors significantly reduced their exposure to multiple classes of cigarette-related toxicants. Additionally, smokers who used JUUL and continued smoking but reduced their daily cigarette consumption by ≥50% (dual users) also significantly reduced their toxicant exposure compared to cigarette smoking.
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Affiliation(s)
- Gal Cohen
- Juul Labs, Inc., Washington, DC, USA
- Corresponding Author: Gal Cohen, PhD, Juul Labs, Inc., 1000 F Street NW, Suite 800, Washington, D.C, 20004, USA. E-mail:
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Levy DT, Tam J, Sanchez-Romero LM, Li Y, Yuan Z, Jeon J, Meza R. Public health implications of vaping in the USA: the smoking and vaping simulation model. Popul Health Metr 2021; 19:19. [PMID: 33865410 PMCID: PMC8052705 DOI: 10.1186/s12963-021-00250-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/31/2021] [Indexed: 12/05/2022] Open
Abstract
Background Nicotine vaping products (NVPs) are increasingly popular worldwide. They may provide public health benefits if used as a substitute for smoking, but may create public health harms if used as a gateway to smoking or to discourage smoking cessation. This paper presents the Smoking and Vaping Model (SAVM), a user-friendly model which estimates the public health implications of NVPs in the USA. Methods SAVM adopts a cohort approach. We derive public health implications by comparing smoking- and NVP-attributable deaths and life-years lost under a No-NVP and an NVP Scenario. The No-NVP Scenario projects current, former, and never smoking rates via smoking initiation and cessation rates, with their respective mortality rates. The NVP Scenario allows for smoking- and NVP-specific mortality rates, switching from cigarette to NVP use, separate NVP and smoking initiation rates, and separate NVP and smoking cessation rates. After validating the model against recent US survey data, we present the base model with extensive sensitivity analyses. Results The SAVM projects that under current patterns of US NVP use and substitution, NVP use will translate into 1.8 million premature smoking- and vaping-attributable deaths avoided and 38.9 million life-years gained between 2013 and 2060. When the NVP relative risk is set to 5%, the results are sensitive to the level of switching and smoking cessation rates and to a lesser extent smoking initiation rates. When the NVP relative risk is raised to 40%, the public health gains in terms of averted deaths and LYL are reduced by 42% in the base case, and the results become much more sensitive to variations in the base case parameters. Discussion Policymakers, researchers, and other public health stakeholders can apply the SAVM to estimate the potential public health impact of NVPs in their country or region using their own data sources. In developing new simulation models involving NVPs, it will be important to conduct extensive sensitivity analysis and continually update and validate with new data. Conclusion The SAVM indicates the potential benefits of NVP use. However, given the uncertainty surrounding model parameters, extensive sensitivity analysis becomes particularly important. Supplementary Information The online version contains supplementary material available at 10.1186/s12963-021-00250-7.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St, NW, Suite 4100, Washington, DC, 20007, USA.
| | - Jamie Tam
- School of Public Health, Yale University, New Haven, CT, USA
| | - Luz María Sanchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St, NW, Suite 4100, Washington, DC, 20007, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St, NW, Suite 4100, Washington, DC, 20007, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St, NW, Suite 4100, Washington, DC, 20007, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
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Sun YW, Chen KM, Atkins H, Aliaga C, Gordon T, Guttenplan JB, El-Bayoumy K. Effects of E-Cigarette Aerosols with Varying Levels of Nicotine on Biomarkers of Oxidative Stress and Inflammation in Mice. Chem Res Toxicol 2021; 34:1161-1168. [PMID: 33761748 DOI: 10.1021/acs.chemrestox.1c00033] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To provide insights into the cause of e-cigarette (e-cig) associated lung injury, we examined the effects of propylene glycol (PG) and glycerol (G), two common solvent carriers used to deliver nicotine/flavor, on markers of oxidative stress and inflammation in female B6C3F1 mice which had been used successfully in tobacco smoke (TS)-induced lung carcinogenesis. Mice exposed to air and TS were used as negative and positive controls, respectively. Using LC-MS/MS, we showed that PG/G alone, in the absence of nicotine, significantly increased the levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG or its tautomer 8-oxodG), a biomarker of DNA oxidative damage, in lung and plasma of mice; moreover, addition of nicotine (12 and 24 mg/mL) in e-cig liquid appears to suppress the levels of 8-oxodG. Exposure to e-cig aerosols or TS induced nonsignificant increases of plasma C-reactive protein (CRP), a biomarker of inflammation; nonetheless, the levels of fibronectin (FN), a biomarker of tissue injury, were significantly increased by e-cig aerosols or TS. Although preliminary, our data showed that exposure to e-cig aerosols induced a higher score of lung injury than did control air or TS exposure. Our results indicate that the B6C3F1 mouse model may be suitable for an in-depth examination of the impact of e-cig on lung injury associated with oxidative stress and inflammation and this study adds to the growing evidence that the use of e-cig can lead to lung damage.
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Affiliation(s)
| | | | | | | | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, New York, New York 10010, United States
| | - Joseph B Guttenplan
- Department of Basic Science, New York University College of Dentistry, New York, New York 10010, United States
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O’Leary R, Polosa R, Li Volti G. Critical appraisal of the European Union Scientific Committee on Health, Environmental and Emerging Risks (SCHEER) Preliminary Opinion on electronic cigarettes. Harm Reduct J 2021; 18:31. [PMID: 33691708 PMCID: PMC7945356 DOI: 10.1186/s12954-021-00476-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In preparation for the 2021 revision of the European Union Tobacco Products Directive, the Scientific Committee on Health, Environmental and Emerging Risks (SCHEER) has posted its Preliminary Opinion on Electronic Cigarettes. They concluded that e-cigarettes only achieve a sub-optimal level of protection of human health. In this paper, we provide evidence that the Opinion's conclusions are not adequately backed up by scientific evidence and did not discuss the potential health benefits of using alternative combustion-free nicotine-containing products as substitute for tobacco cigarettes. METHODS Searches for articles were conducted in PubMed and by citation chasing in Google Scholar. Articles were also retrieved with a review of references in major publications. Primary data from World Health Organization surveys, the conclusions of reviews, and peer-reviewed non-industry studies were cited to address errors and omissions identified in the Opinion. RESULTS The Opinion omitted reporting on the individual and population health benefits of the substitution of e-cigarettes (ENDS) for cigarette smoking. Alternative hypotheses to the gateway theory were not evaluated. Its assessment of cardiovascular risk is contradicted by numerous reviews. It cites ever-use data that do not represent current patterns of use. It did not report non-nicotine use. It presented erroneous statements on trends in ENDS prevalence. It over-emphasized the role of flavours in youth ENDS initiation. It did not discuss cessation in sufficient length. CONCLUSIONS For the delivery of a robust and comprehensive final report, the members of the Working Group of the Scientific Committee on Health, Environmental and Emerging Risks will need to consider (1) the potential health benefits of ENDS substitution for cigarette smoking, (2) alternative hypotheses and contradictory studies on the gateway effect, (3) its assessment of cardiovascular risk, (4) the measurements of frequency of use, (5) non-nicotine use, (6) the role of flavours, and (7) a fulsome discussion of cessation.
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Affiliation(s)
- Renée O’Leary
- Center of Excellence for the Acceleration of Harm Reduction, Via S. Sofia, 89, 95123 Catania, Italy
| | - Riccardo Polosa
- Center of Excellence for the Acceleration of Harm Reduction, Via S. Sofia, 89, 95123 Catania, Italy
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Xia B, Blount BC, Guillot T, Brosius C, Li Y, Van Bemmel DM, Kimmel HL, Chang CM, Borek N, Edwards KC, Lawrence C, Hyland A, Goniewicz ML, Pine BN, Xia Y, Bernert JT, De Castro BR, Lee J, Brown JL, Arnstein S, Choi D, Wade EL, Hatsukami D, Ervies G, Cobos A, Nicodemus K, Freeman D, Hecht SS, Conway K, Wang L. Tobacco-Specific Nitrosamines (NNAL, NNN, NAT, and NAB) Exposures in the US Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013-2014). Nicotine Tob Res 2021; 23:573-583. [PMID: 32716026 PMCID: PMC7885786 DOI: 10.1093/ntr/ntaa110] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/19/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The tobacco-specific nitrosamines (TSNAs) are an important group of carcinogens found in tobacco and tobacco smoke. To describe and characterize the levels of TSNAs in the Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013-2014), we present four biomarkers of TSNA exposure: N'-nitrosonornicotine, N'-nitrosoanabasine, N'-nitrosoanatabine, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) which is the primary urinary metabolite of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone. METHODS We measured total TSNAs in 11 522 adults who provided urine using automated solid-phase extraction coupled to isotope dilution liquid chromatography-tandem mass spectrometry. After exclusions in this current analysis, we selected 11 004 NNAL results, 10 753 N'-nitrosonornicotine results, 10 919 N'-nitrosoanatabine results, and 10 996 N'-nitrosoanabasine results for data analysis. Geometric means and correlations were calculated using SAS and SUDAAN. RESULTS TSNA concentrations were associated with choice of tobacco product and frequency of use. Among established, every day, exclusive tobacco product users, the geometric mean urinary NNAL concentration was highest for smokeless tobacco users (993.3; 95% confidence interval [CI: 839.2, 1147.3] ng/g creatinine), followed by all types of combustible tobacco product users (285.4; 95% CI: [267.9, 303.0] ng/g creatinine), poly tobacco users (278.6; 95% CI: [254.9, 302.2] ng/g creatinine), and e-cigarette product users (6.3; 95% CI: [4.7, 7.9] ng/g creatinine). TSNA concentrations were higher in every day users than in intermittent users for all the tobacco product groups. Among single product users, exposure to TSNAs differed by sex, age, race/ethnicity, and education. Urinary TSNAs and nicotine metabolite biomarkers were also highly correlated. CONCLUSIONS We have provided PATH Study estimates of TSNA exposure among US adult users of a variety of tobacco products. These data can inform future tobacco product and human exposure evaluations and related regulatory activities.
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Affiliation(s)
- Baoyun Xia
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Benjamin C Blount
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tonya Guillot
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christina Brosius
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yao Li
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dana M Van Bemmel
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD
| | - Heather L Kimmel
- Division of Epidemiology, Services and Prevention Research, National Institute of Drug Abuse, Bethesda, MD
| | - Cindy M Chang
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD
| | | | | | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Roswell Park Cancer Institute, Buffalo, NY
| | - Maciej L Goniewicz
- Roswell Park Comprehensive Cancer Center, Roswell Park Cancer Institute, Buffalo, NY
| | - Brittany N Pine
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yang Xia
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - John T Bernert
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - B Rey De Castro
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - John Lee
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Justin L Brown
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Stephen Arnstein
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Diane Choi
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Erin L Wade
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Gladys Ervies
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD
| | - Angel Cobos
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Keegan Nicodemus
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dana Freeman
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Kevin Conway
- Division of Epidemiology, Services and Prevention Research, National Institute of Drug Abuse, Bethesda, MD
| | - Lanqing Wang
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
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Harlow AF, Hatch EE, Wesselink AK, Rothman KJ, Wise LA. Electronic Cigarettes and Fecundability: Results From a Prospective Preconception Cohort Study. Am J Epidemiol 2021; 190:353-361. [PMID: 32378702 DOI: 10.1093/aje/kwaa067] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 01/07/2023] Open
Abstract
Although electronic cigarette (e-cigarette) aerosol contains similar toxicants to combustible cigarettes, few studies have examined their influence on fecundability. We assessed the association between e-cigarette use and fecundability, overall and according to combustible cigarette smoking history, in a cohort of 4,586 North American women (aged 21-45 years) enrolled during 2017-2020 in Pregnancy Study Online, a Web-based prospective preconception study. Women reported current and former e-cigarette use on baseline and follow-up questionnaires, and they completed bimonthly follow-up questionnaires until self-reported pregnancy or censoring. Fecundability ratios and 95% confidence intervals were calculated using proportional probabilities models, controlling for potential confounders. Overall, 17% of women had ever used e-cigarettes and 4% were current users. Compared with never use of e-cigarettes, current e-cigarette use was associated with slightly lower fecundability (fecundability ratio = 0.84, 95% confidence interval (CI): 0.67, 1.06). Compared with current nonusers of e-cigarettes and combustible cigarettes, fecundability ratios were 0.83 (95% CI: 0.54, 1.29) for current dual users of e-cigarettes and combustible cigarettes, 0.91 (95% CI: 0.70, 1.18) for current e-cigarette users who were nonsmokers of combustible cigarettes, and 1.01 (95% CI: 0.85, 1.20) for nonusers of e-cigarettes who were current smokers of combustible cigarettes. Current e-cigarette use was associated with slightly reduced fecundability, but estimates of its independent and joint associations with combustible cigarette smoking were inconsistent and imprecise.
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Chavez J, Smit T, Olofsson H, Mayorga NA, Garey L, Zvolensky MJ. Substance Use among Exclusive Electronic Cigarette Users and Dual Combustible Cigarette Users: Extending Work to Adult Users. Subst Use Misuse 2021; 56:888-896. [PMID: 33726615 PMCID: PMC10032028 DOI: 10.1080/10826084.2021.1899234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) have become increasingly popular in recent years. Existing evidence indicates e-cigarettes used in isolation are less harmful than combustible cigarettes, yet emerging work has demonstrated that adults use e-cigarettes largely in combination with combustible cigarettes (i.e. dual use). Despite this data, little is understood about how exclusive and dual e-cigarette users may differ across behavioral outcomes, such as substance use dependence and behaviors among adults. OBJECTIVES Thus, the current project examined differences in e-cigarette dependence, problematic alcohol use, cannabis use, and nonmedical prescription opioid use (e.g. methadone and oxycodone) across both exclusive and dual e-cigarette adult users. RESULTS Participants included 531 (53.6% female; Mage = 35.29 years, SD = 10.44) adults with past-month e-cigarette use. Dual users reported greater e-cigarette dependence, alcohol use, current cannabis use, and endorsement of nonprescription opioid use. Conclusions/Importance: Importantly, this work suggests that adults who use both combustible and e-cigarettes may constitute a group more vulnerable to experiencing problematic substance use and more severe e-cigarette dependence than exclusive e-cigarette users.
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Affiliation(s)
- JeanFelix Chavez
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Hannah Olofsson
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
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Lavrynenko O, Titz B, Dijon S, Santos DD, Nury C, Schneider T, Guedj E, Szostak J, Kondylis A, Phillips B, Ekroos K, Martin F, Peitsch MC, Hoeng J, Ivanov NV. Ceramide ratios are affected by cigarette smoke but not heat-not-burn or e-vapor aerosols across four independent mouse studies. Life Sci 2020; 263:118753. [PMID: 33189821 DOI: 10.1016/j.lfs.2020.118753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022]
Abstract
AIMS Smoking is an important risk factor for the development of chronic obstructive pulmonary disease and cardiovascular diseases. This study aimed to further elucidate the role of ceramides, as a key lipid class dysregulated in disease states. MAIN METHODS In this article we developed and validated LC-MS/MS method for ceramides (Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/24:0) and Cer(d18:1/24:1(15Z)) for the absolute quantification. We deployed it together with proteomics and transcriptomic analysis to assess the effects of cigarette smoke (CS) from the reference cigarette as well as aerosols from heat-not-burn (HnB) tobacco and e-vapor products in apolipoprotein E-deficient (ApoE-/-) mice over several time points. KEY FINDINGS In the lungs, CS exposure substantially elevated the ratios of Cer(d18:1/24:0) and Cer(d18:1/24:1) to Cer(d18:1/18:0) in two independent ApoE-/- mouse inhalation studies. Data from previous studies, in both ApoE-/- and wild-type mice, further confirmed the reproducibility of this finding. Elevation of these ceramide ratios was also observed in plasma/serum, the liver, and-for the Cer(d18:1/24:1(15Z)) to Cer(d18:1/18:0) ratio-the abdominal aorta. Also, the levels of acid ceramidase (Asah1) and glucocerebrosidase (Gba)-lysosomal enzymes involved in the hydrolysis of glucosylceramides-were consistently elevated in the lungs after CS exposure. In contrast, exposure to HnB tobacco product and e-vapor aerosols did not induce significant changes in the ceramide profiles or associated enzymes. SIGNIFICANCE Our work in mice contributes to the accumulating evidence on the importance of ceramide ratios as biologically relevant markers for respiratory disorders, adding to their already demonstrated role in cardiovascular disease risk assessment in humans.
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Affiliation(s)
- Oksana Lavrynenko
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland.
| | - Bjoern Titz
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Sophie Dijon
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Daniel Dos Santos
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Catherine Nury
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Thomas Schneider
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Emmanuel Guedj
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Justyna Szostak
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Athanasios Kondylis
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Blaine Phillips
- Philip Morris International Research Laboratories Pte. Ltd., Science Park II, 117406, Singapore
| | - Kim Ekroos
- Lipidomics Consulting Ltd., Irisviksvägen 31D, 02230 Esbo, Finland
| | - Florian Martin
- 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
| | - Nikolai V Ivanov
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
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Abstract
PURPOSE OF REVIEW The aim of this article is to provide an overview of recent findings regarding the risk factors for bladder cancer. RECENT FINDINGS Most of the available data derive from retrospective analysis. Smoking represents the most common and important risk factor. Occupational, dietary, and environmental exogenic carcinogen exposure, as well as several lifestyle factors, can increase the risk of developing bladder cancer. SUMMARY Bladder cancer is a common malignancy worldwide. Cigarette smoking, exposure to aromatic amines and arsenic are known risk factors for bladder cancer. Evidence on other modifiable risk factors such as carcinogen exposure derived from the diet or environment as well as occupational hazards is still weak. Medical conditions leading to chronic inflammation, altering insulin resistance, negatively modulating the immune system and/or genetic alterations may have a role in bladder cancer carcinogenesis. Further studies are, however, necessary to identify possible exogenic risk factors, as well as their interactions, that partake in the carcinogenesis of bladder cancer.
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Benowitz NL, Bernert JT, Foulds J, Hecht SS, Jacob P, Jarvis MJ, Joseph A, Oncken C, Piper ME. Biochemical Verification of Tobacco Use and Abstinence: 2019 Update. Nicotine Tob Res 2020; 22:1086-1097. [PMID: 31570931 DOI: 10.1093/ntr/ntz132] [Citation(s) in RCA: 321] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/31/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The changing prevalence and patterns of tobacco use, the advent of novel nicotine delivery devices, and the development of new biomarkers prompted an update of the 2002 Society for Research on Nicotine and Tobacco (SRNT) report on whether and how to apply biomarker verification for tobacco use and abstinence. METHODS The SRNT Treatment Research Network convened a group of investigators with expertise in tobacco biomarkers to update the recommendations of the 2002 SNRT Biochemical Verification Report. RESULTS Biochemical verification of tobacco use and abstinence increases scientific rigor and is recommended in clinical trials of smoking cessation, when feasible. Sources, appropriate biospecimens, cutpoints, time of detection windows and analytic methods for carbon monoxide, cotinine (including over the counter tests), total nicotine equivalents, minor tobacco alkaloids, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol are reviewed, as well as biochemical approaches to distinguishing cigarette smoking from use of electronic nicotine delivery devices (ENDS). CONCLUSIONS Recommendations are provided for whether and how to use biochemical verification of tobacco use and abstinence. Guidelines are provided on which biomarkers to use, which biospecimens to use, optimal cutpoints, time windows to detection, and methodology for biochemical verifications. Use of combinations of biomarkers is recommended for assessment of ENDS use. IMPLICATIONS Biochemical verification increases scientific rigor, but there are drawbacks that need to be assessed to determine whether the benefits of biochemical verification outweigh the costs, including the cost of the assays, the feasibility of sample collection, the ability to draw clear conclusions based on the duration of abstinence, and the variability of the assay within the study population. This paper provides updated recommendations from the 2002 SRNT report on whether and how to use biochemical markers in determining tobacco use and abstinence.
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Affiliation(s)
- Neal L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Departments of Medicine and Biopharmaceutical Sciences; Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - John T Bernert
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jonathan Foulds
- Departments of Public Health Sciences and Psychiatry, Penn State College of Medicine, Hershey, PA
| | - Stephen S Hecht
- Departments of Laboratory Medicine and Pathology, Pharmacology, and Medicinal Chemistry, University of Minnesota, Masonic Cancer Center, Minneapolis, MN
| | - Peyton Jacob
- Departments of Medicine and Psychiatry, University of California San Francisco, San Francisco, CA
| | - Martin J Jarvis
- Department of Behavioural Science and Health, University College London, London, UK
| | - Anne Joseph
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Cheryl Oncken
- Department of Medicine, University of Connecticut, Farmington, CT
| | - Megan E Piper
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
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Oliveri D, Liang Q, Sarkar M. Real-World Evidence of Differences in Biomarkers of Exposure to Select Harmful and Potentially Harmful Constituents and Biomarkers of Potential Harm Between Adult E-Vapor Users and Adult Cigarette Smokers. Nicotine Tob Res 2020; 22:1114-1122. [PMID: 31563966 PMCID: PMC7291803 DOI: 10.1093/ntr/ntz185] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/26/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Real-world evidence regarding likely long-term health effects of e-vapor products (EVP) under actual use conditions relative to cigarette smoking is not well studied. METHODS In this cross-sectional, observational study, biomarkers of exposure (BOE) to select harmful and potentially harmful constituents and biomarkers of potential harm (BOPH) relevant to smoking-related diseases were measured in exclusive adult EVP users (AEVP, n = 144) and exclusive adult cigarette smokers (AS, n = 73). AEVP used their own brand of EVP for 6+ months following 10+ years of cigarette smoking and AS smoked own brand of cigarettes for 10+ years. Subject recruitment and informed consent were obtained online and urine/blood samples were collected at local clinical laboratories, representing a new paradigm for collecting real-world evidence. RESULTS The levels of total NNAL (NNK metabolite), 3-hydroxypropyl mercapturic acid (acrolein metabolite), and carboxyhemoglobin (carbon monoxide measure) were 46% to 86% lower in AEVP compared with AS (p ≤ .0001) as was nicotine equivalents (nicotine and its five metabolites; 36%, p < .01). The levels of some BOPH were significantly lower in AEVP compared with AS for 11-dehydrothromboxane-B2 (29%, p = .04; platelet activation), 8-epi-prostaglandin F2α (23%, p = .02; oxidative stress) and soluble intercellular adhesion molecule-1 (16%, p = .02; endothelial function). CONCLUSIONS This study demonstrates the feasibility of a new approach for collecting real-world evidence. Substantially lower levels of BOEs (NNK, nicotine, acrolein, carbon monoxide) and favorable differences in BOPHs (platelet activation, oxidative stress, endothelial function) suggest EVP users may have lower health risks than cigarette smokers. IMPLICATIONS Cigarette smoking causes serious diseases. Switching from a combustible tobacco product to a noncombustible product is a potential harm reduction pathway for adult smokers unable or unwilling to quit. Real-world evidence regarding the relative risk of EVP use compared with cigarettes is not well established. This study provides data specific to BOE to tobacco smoke constituents and biomarkers of potential harm collected under actual use conditions in a real-world setting. The totality of evidence suggests that exclusive EVP use may present lower health risk compared with smoking cigarettes.
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Smith DM, Shahab L, Blount BC, Gawron M, Kosminder L, Sobczak A, Xia B, Sosnoff CS, Goniewicz ML. Differences in Exposure to Nicotine, Tobacco-Specific Nitrosamines, and Volatile Organic Compounds among Electronic Cigarette Users, Tobacco Smokers, and Dual Users from Three Countries. TOXICS 2020; 8:E88. [PMID: 33066428 PMCID: PMC7712026 DOI: 10.3390/toxics8040088] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 12/27/2022]
Abstract
Country-level differences in nicotine vaping products used and biomarkers of exposure among long-term e-cigarette users and dual users remain understudied. This cross-sectional study was conducted in 2014 in the United States (n = 166), United Kingdom (n = 129), and Poland (n = 161). We compared patterns of tobacco product use and nicotine and toxicant exposure among cigarette-only smokers (n = 127); e-cigarette-only users (n = 124); dual users of tobacco cigarettes and e-cigarettes (n = 95); and non-users (control group, n = 110) across three countries using mixed-effects linear regression. Compared with cigarette smokers, e-cigarette-only users had lower levels of toxicant biomarkers, but higher levels of nicotine biomarkers. Dual users had higher levels of toxicant biomarkers than e-cigarette-only users but similar levels to cigarette-only smokers. E-cigarette users in Poland, who overwhelmingly used refillable tank devices, exhibited greater levels of nicotine, and toxicant biomarkers relative to e-cigarette users in US/UK. Despite smoking fewer cigarettes, dual users from Poland exhibited similar levels of nicotine biomarkers compared with UK dual users, but higher than US dual users. Country-level differences in e-cigarette devices used and smoking behaviors (e.g., intensity) may contribute to differences in biomarker levels among users of the same products residing in different countries.
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Affiliation(s)
- Danielle M. Smith
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA;
| | - Lion Shahab
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK;
| | - Benjamin C. Blount
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (B.C.B.); (B.X.); (C.S.S.)
| | - Michal Gawron
- Department of General and Inorganic Chemistry, Katowice Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Jagiellonska 4, 41-200 Sosnowiec, Poland; (M.G.); (L.K.); (A.S.)
| | - Leon Kosminder
- Department of General and Inorganic Chemistry, Katowice Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Jagiellonska 4, 41-200 Sosnowiec, Poland; (M.G.); (L.K.); (A.S.)
| | - Andrzej Sobczak
- Department of General and Inorganic Chemistry, Katowice Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Jagiellonska 4, 41-200 Sosnowiec, Poland; (M.G.); (L.K.); (A.S.)
| | - Baoyun Xia
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (B.C.B.); (B.X.); (C.S.S.)
| | - Connie S. Sosnoff
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (B.C.B.); (B.X.); (C.S.S.)
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA;
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49
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Sewer A, Zanetti F, Iskandar AR, Guedj E, Dulize R, Peric D, Bornand D, Mathis C, Martin F, Ivanov NV, Peitsch MC, Hoeng J. A meta-analysis of microRNAs expressed in human aerodigestive epithelial cultures and their role as potential biomarkers of exposure response to nicotine-containing products. Toxicol Rep 2020; 7:1282-1295. [PMID: 33014713 PMCID: PMC7522043 DOI: 10.1016/j.toxrep.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 11/03/2022] Open
Abstract
The expression of some microRNAs (miRNA) is modulated in response to cigarette smoke (CS), which is a leading cause of major preventable diseases. However, whether miRNA expression is also modulated by the aerosol/extract from potentially reduced-risk products is not well studied. The present work is a meta-analysis of 12 in vitro studies in human organotypic epithelial cultures of the aerodigestive tract (buccal, gingival, bronchial, nasal, and small airway epithelia). These studies compared the effects of exposure to aerosols from electronic vapor (e-vapor) products and heated tobacco products, and to extracts from Swedish snus products (in the present work, will be referred to as reduced-risk products [RRPs]) on miRNA expression with the effects of exposure to CS or its total particulate matter fraction. This meta-analysis evaluated 12 datasets of a total of 736 detected miRNAs and 2775 exposed culture inserts. The t-distributed stochastic neighbor embedding method was used to find similarities across the diversity of miRNA responses characterized by tissue type, exposure type, and product concentration. The CS-induced changes in miRNA expression in gingival cultures were close to those in buccal cultures; similarly, the alterations in miRNA expression in small airway, bronchial, and nasal tissues resembled each other. A supervised clustering was performed to identify miRNAs exhibiting particular response patterns. The analysis identified a set of miRNAs whose expression was altered in specific tissues upon exposure to CS (e.g., miR-125b-5p, miR-132-3p, miR-99a-5p, and 146a-5p). Finally, we investigated the impact of RRPs on miRNA expression in relation to that of CS by calculating the response ratio r between the RRP- and CS-induced alterations at an individual miRNA level, showing reduced alterations in miRNA expression following RRP exposure relative to CS exposure (94 % relative reduction). No specific miRNA response pattern indicating exposure to aerosols from heated tobacco products and e-vapor products, or extracts from Swedish snus was identifiable.
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Key Words
- 2D, two-dimensional
- AKT, protein kinase B
- ALI, air-liquid interface
- CHTP 1.2, Carbon Heated Tobacco Product 1.2
- COPD, chronic obstructive pulmonary disease
- CRP, CORESTA Reference Product
- CS, cigarette smoke and its TPM fraction
- FDA, Food & Drug Administration
- FDR, false discovery rate
- GCW, General Classic White
- HCI, Health Canada intense
- HTP, heated tobacco product
- Heated tobacco product
- IL-1β, interleukin 1β
- MMP-1, matrix metalloproteinase 1
- N/A, not applicable
- Organotypic aerodigestive culture
- RRP, reduced-risk product
- Systems toxicology
- THS 2.2, Tobacco Heating System 2.2
- TPM, total particulate matter
- Tobacco Heating System 2.2
- e-vapor
- e-vapor, electronic vapor
- mRNA, messenger RNA
- mTOR, mammalian target of rapamycin
- miRNA
- miRNA, microRNA
- t-SNE, t-distributed stochastic neighbor embedding
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Affiliation(s)
- Alain Sewer
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Filippo Zanetti
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Anita R Iskandar
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Emmanuel Guedj
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Remi Dulize
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Dariusz Peric
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - David Bornand
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Carole Mathis
- 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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50
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Azagba S, Qeadan F, Shan L, Latham K, Wolfson M. E-Cigarette Use and Transition in Adult Smoking Frequency: A Longitudinal Study. Am J Prev Med 2020; 59:367-376. [PMID: 32684358 DOI: 10.1016/j.amepre.2020.02.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The relationship between e-cigarette use and cigarette smoking is the subject of ongoing debate. There is limited research on e-cigarette use and changes in the frequency of cigarette smoking. This study examines whether the frequency of e-cigarette use is associated with changes in cigarette smoking behavior among U.S. adults. METHODS The study used data (n=20,558) from Waves 1 (2013-2014) and 2 (2014-2015) of the Population Assessment of Tobacco and Health, analyzed in 2019. Multivariable multinomial logistic regression assessed the association between e-cigarette use at Wave 1 and change in cigarette smoking frequency between Waves 1 and 2. RESULTS Every day cigarette smokers who used e-cigarettes some days (OR=1.95, 95% CI=1.27, 2.98) and every day (OR=3.37, 95% CI=1.78, 6.36) in Wave 1 had significantly higher odds of switching to some days cigarette smoking in Wave 2. Every day smokers who used e-cigarettes every day in Wave 1 had higher odds of becoming former cigarette smokers in Wave 2. Likewise, e-cigarette use at baseline among former cigarette smokers was associated with higher odds of switching to some days cigarette smoking (experimental e-cigarette use: OR=5.43, 95% CI=2.13, 10.72; some days e-cigarette use: OR=4.78, 95% CI=2.13, 10.72). In addition, experimental smokers who were also some days e-cigarettes users in Wave 1 had significantly lower odds of switching to experimental former smokers. CONCLUSIONS Although e-cigarette use may reduce cigarette smoking frequency among continuing smokers, findings suggest that e-cigarette use may be associated with cigarette smoking relapse among former smokers.
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Affiliation(s)
- Sunday Azagba
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Fares Qeadan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Lingpeng Shan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Keely Latham
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Mark Wolfson
- Department of Social Medicine, Population and Public Health, University of California, Riverside School of Medicine, Riverside, California
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