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Cordery S, Thompson K, Stevenson M, Simms L, Chapman F, Grandolfo E, Malt L, Weaver S, Fearon IM, Nahde T. The Product Science of Electrically Heated Tobacco Products: An Updated Narrative Review of the Scientific Literature. Cureus 2024; 16:e61223. [PMID: 38939262 PMCID: PMC11209752 DOI: 10.7759/cureus.61223] [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] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
Heated tobacco products represent a novel category of tobacco products in which a tobacco consumable is heated to a temperature that releases nicotine from the tobacco leaf but not to a temperature sufficient to cause combustion. Heated tobacco products may therefore have the potential to be a less harmful alternative for adult smokers who would otherwise continue to smoke cigarettes, as their use should result in exposure to substantially fewer and lower levels of toxicants. This update represents a two-year extension to our previous narrative review, which covered peer-reviewed journal articles published up to August 31, 2021. The scientific evidence published between 2021 and 2023 continues to indicate that aerosols produced from heated tobacco products contain fewer and substantially lower levels of harmful and potentially harmful constituents and that these observed reductions consistently translate to reduced biological effects in both in vitro and in vivo toxicological studies. Biomarker and clinical data from studies in which product use is controlled within a clinical setting continue to suggest changes in levels of biomarkers of exposure, biomarkers of potential harm, and clinical endpoints indicating the potential for reduced harm with switching to exclusive use of heated tobacco products in adult smokers. Overall, the available peer-reviewed scientific evidence continues to indicate that heated tobacco products offer promise as a potentially less harmful alternative to cigarettes, and as such, the conclusions of our original narrative review remain valid.
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Affiliation(s)
- Sarah Cordery
- Group Science and Regulatory Affairs, Imperial Brands Plc., Bristol, GBR
| | - Keith Thompson
- Independent Scientific Consultant, Elucid8 Holdings Ltd., Coleraine, GBR
| | - Matthew Stevenson
- Group Science and Regulatory Affairs, Imperial Brands Plc., Bristol, GBR
| | - Liam Simms
- Group Science and Regulatory Affairs, Imperial Brands Plc., Bristol, GBR
| | - Fiona Chapman
- Group Science and Regulatory Affairs, Imperial Brands Plc., Bristol, GBR
| | - Erika Grandolfo
- Group Science and Regulatory Affairs, Imperial Brands Plc., Bristol, GBR
| | - Layla Malt
- Group Science and Regulatory Affairs, Imperial Brands Plc., Bristol, GBR
| | - Sarah Weaver
- Group Science and Regulatory Affairs, Imperial Brands Plc., Bristol, GBR
| | - Ian M Fearon
- Scientific Research, whatIF? Consulting Ltd., Harwell, GBR
| | - Thomas Nahde
- Group Science and Regulatory Affairs, Imperial Brands Reemtsma, Hamburg, DEU
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2
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Chandy M, Hill T, Jimenez-Tellez N, Wu JC, Sarles SE, Hensel E, Wang Q, Rahman I, Conklin DJ. Addressing Cardiovascular Toxicity Risk of Electronic Nicotine Delivery Systems in the Twenty-First Century: "What Are the Tools Needed for the Job?" and "Do We Have Them?". Cardiovasc Toxicol 2024; 24:435-471. [PMID: 38555547 DOI: 10.1007/s12012-024-09850-9] [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] [Received: 12/07/2023] [Accepted: 03/19/2024] [Indexed: 04/02/2024]
Abstract
Cigarette smoking is positively and robustly associated with cardiovascular disease (CVD), including hypertension, atherosclerosis, cardiac arrhythmias, stroke, thromboembolism, myocardial infarctions, and heart failure. However, after more than a decade of ENDS presence in the U.S. marketplace, uncertainty persists regarding the long-term health consequences of ENDS use for CVD. New approach methods (NAMs) in the field of toxicology are being developed to enhance rapid prediction of human health hazards. Recent technical advances can now consider impact of biological factors such as sex and race/ethnicity, permitting application of NAMs findings to health equity and environmental justice issues. This has been the case for hazard assessments of drugs and environmental chemicals in areas such as cardiovascular, respiratory, and developmental toxicity. Despite these advances, a shortage of widely accepted methodologies to predict the impact of ENDS use on human health slows the application of regulatory oversight and the protection of public health. Minimizing the time between the emergence of risk (e.g., ENDS use) and the administration of well-founded regulatory policy requires thoughtful consideration of the currently available sources of data, their applicability to the prediction of health outcomes, and whether these available data streams are enough to support an actionable decision. This challenge forms the basis of this white paper on how best to reveal potential toxicities of ENDS use in the human cardiovascular system-a primary target of conventional tobacco smoking. We identify current approaches used to evaluate the impacts of tobacco on cardiovascular health, in particular emerging techniques that replace, reduce, and refine slower and more costly animal models with NAMs platforms that can be applied to tobacco regulatory science. The limitations of these emerging platforms are addressed, and systems biology approaches to close the knowledge gap between traditional models and NAMs are proposed. It is hoped that these suggestions and their adoption within the greater scientific community will result in fresh data streams that will support and enhance the scientific evaluation and subsequent decision-making of tobacco regulatory agencies worldwide.
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Affiliation(s)
- Mark Chandy
- Robarts Research Institute, Western University, London, N6A 5K8, Canada
| | - Thomas Hill
- Division of Nonclinical Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, 20993, USA
| | - Nerea Jimenez-Tellez
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - S Emma Sarles
- Biomedical and Chemical Engineering PhD Program, Rochester Institute of Technology, Rochester, NY, 14623, USA
| | - Edward Hensel
- Department of Mechanical Engineering, Rochester Institute of Technology, Rochester, NY, 14623, USA
| | - Qixin Wang
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Daniel J Conklin
- Division of Environmental Medicine, Department of Medicine, Center for Cardiometabolic Science, Christina Lee Brown Envirome Institute, University of Louisville, 580 S. Preston St., Delia Baxter, Rm. 404E, Louisville, KY, 40202, USA.
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3
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Fernandez MIC, Co MF, Rafael JBM, Mag‐usara RC, Ediza V, Gavino RL, Feliciano JC, Santos NJ, Yano MA, Huibonhoa JA, Tiongco RH, Fernandez L. Acute myocardial infarction with e-cigarette or vaping-use associated lung injury in a young Filipino vape user. Respirol Case Rep 2024; 12:e01353. [PMID: 38633225 PMCID: PMC11023740 DOI: 10.1002/rcr2.1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/07/2024] [Indexed: 04/19/2024] Open
Abstract
Electronic cigarettes (or e-cigarettes) and vape products have multisystemic adverse effects despite being advertised as a safer smoking alternative and cessation device. We present a 22-year-old Filipino male with sudden chest pain. He had no known comorbidities but had a two-year history of daily vape use. Work-up revealed elevated cardiac markers, anteroseptal ST-elevation myocardial infarction, hypokinesia of the anterior wall and interventricular septum, and an ejection fraction of 30%. Chest radiography showed consolidation pneumonia but culture studies and Biofire Pneumonia Panel were negative for microbial detection. Coronary angiography revealed chronic total obstruction of the mid-left anterior descending (LAD) and right coronary arteries (RCA). Percutaneous coronary angioplasty of the LAD was done. The patient eventually required mechanical ventilation for progressive respiratory distress but expired after three hospital days despite medical management. This case highlights a possible association between vape use and the development of both acute lung injury and myocardial infarction.
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Affiliation(s)
| | | | | | | | - Vanessa Ediza
- Department of MedicinePhilippine General HospitalManila CityPhilippines
| | | | | | | | - Mark Andrian Yano
- Department of MedicinePhilippine General HospitalManila CityPhilippines
| | | | | | - Lenora Fernandez
- Department of MedicinePhilippine General HospitalManila CityPhilippines
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4
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Cheung CP, Baker RE, Coates AM, Burr JF. Cannabis containing THC impairs 20-min cycling time trial performance irrespective of the method of inhalation. J Appl Physiol (1985) 2024; 136:583-591. [PMID: 38299223 DOI: 10.1152/japplphysiol.00757.2023] [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: 10/24/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/02/2024] Open
Abstract
Herein, we examine the human exercise response following cannabis inhalation, taking into consideration varied cannabinoid concentrations and different inhalation methods. A semirandomized crossover study design was used, with measures of perceived exertion and physiological responses to submaximal and maximal exercise. Participants (n = 14, 9 males 5 females) completed exercise after 1) smoking Δ-9-tetrahydrocannabinol (THC)-predominant cannabis (S-THC), 2) inhaling aerosol (vaporizing) from THC-predominant cannabis (V-THC), 3) inhaling aerosol from cannabidiol (CBD)-predominant cannabis (V-CBD), or 4) under control conditions. All exercise was performed on a cycle ergometer, with submaximal testing performed at 100 W followed by an evaluation of maximal exercise performance using an all-out 20-min time trial. Metabolism was characterized via the analysis of expired gases while subjective ratings of perceived exertion (RPE) were reported. During submaximal cycling, heart rate was higher during S-THC and V-THC compared with both control and V-CBD (all P < 0.02). During maximal exercise, V̇e was lower in V-THC compared with control, S-THC, and V-CBD (all P < 0.03), as was S-THC compared with control (P < 0.05). Both V̇o2 and RPE were similar between conditions during maximal exercise (both P > 0.1). Mean power output during the 20-min time trial was significantly lower in the S-THC and V-THC conditions compared with both control and V-CBD (all P < 0.04). Cannabis containing THC alters the physiological response to maximal and submaximal exercise, largely independent of the inhalation method. THC-containing cannabis negatively impacts vigorous exercise performance during a sustained 20-min effort, likely due to physiological and psychotropic effects. Inhalation of cannabis devoid of THC and primarily containing CBD has little physiological effect on the exercise response or performance.NEW & NOTEWORTHY Inhalation of cannabis containing THC alters physiological responses to both submaximal and maximal exercise and reduces mean power output during a 20-min time trial, regardless of whether it is inhaled as smoke or aerosol. In contrast, cannabis devoid of THC and predominantly containing CBD has no effect on physiological responses to exercise or performance.
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Affiliation(s)
- Christian P Cheung
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Ryleigh E Baker
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Alexandra M Coates
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jamie F Burr
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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5
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Liu J, Nabavizadeh P, Rao P, Derakhshandeh R, Han DD, Guo R, Murphy MB, Cheng J, Schick SF, Springer ML. Impairment of Endothelial Function by Aerosol From Marijuana Leaf Vaporizers. J Am Heart Assoc 2023; 12:e032969. [PMID: 38014661 PMCID: PMC10727338 DOI: 10.1161/jaha.123.032969] [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] [Received: 10/20/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Marijuana leaf vaporizers, which heat plant material and sublimate Δ-9-tetrahydrocannabinol without combustion, are popular alternatives to smoking cannabis that are generally perceived to be less harmful. We have shown that smoke from tobacco and marijuana, as well as aerosol from e-cigarettes and heated tobacco products, impair vascular endothelial function in rats measured as arterial flow-mediated dilation (FMD). METHODS AND RESULTS We exposed 8 rats per group to aerosol generated by 2 vaporizer systems (Volcano and handheld Yocan) using marijuana with varying Δ-9-tetrahydrocannabinol levels, in a single pulsatile exposure session of 2 s/min over 5 minutes, and measured changes in FMD. To model secondhand exposure, we exposed rats for 1 minute to diluted aerosol approximating release of uninhaled Volcano aerosol into typical residential rooms. Exposure to aerosol from marijuana with and without cannabinoids impaired FMD by ≈50%. FMD was similarly impaired by aerosols from Yocan (237 °C), and from Volcano at both its standard temperature (185 °C) and the minimum sublimation temperature of Δ-9-tetrahydrocannabinol (157 °C), although the low-temperature aerosol condition did not effectively deliver Δ-9-tetrahydrocannabinol to the circulation. Modeled secondhand exposure based on diluted Volcano aerosol also impaired FMD. FMD was not affected in rats exposed to clean air or water vapor passed through the Volcano system. CONCLUSIONS Acute direct exposure and modeled secondhand exposure to marijuana leaf vaporizer aerosol, regardless of cannabinoid concentration or aerosol generation temperature, impair endothelial function in rats comparably to marijuana smoke. Our findings indicate that use of leaf vaporizers is unlikely to reduce the vascular risk burden of smoking marijuana.
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Affiliation(s)
- Jiangtao Liu
- Cardiovascular Research Institute, University of California, San FranciscoSan FranciscoCAUSA
- Division of CardiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Pooneh Nabavizadeh
- Cardiovascular Research Institute, University of California, San FranciscoSan FranciscoCAUSA
- Present address:
Division of CardiologyUniversity of CincinnatiCincinnatiOHUSA
| | - Poonam Rao
- Division of CardiologyUniversity of California, San FranciscoSan FranciscoCAUSA
- Center for Tobacco Control Research and EducationUniversity of California, San FranciscoSan FranciscoCAUSA
- Present address:
Christus Good Shepherd/Texas A&M University Internal Medicine Residency ProgramLongviewTXUSA
| | - Ronak Derakhshandeh
- Division of CardiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Daniel D. Han
- Division of CardiologyUniversity of California, San FranciscoSan FranciscoCAUSA
- Present address:
School of Medicine and DentistryUniversity of RochesterRochesterNYUSA
| | - Raymond Guo
- Division of CardiologyUniversity of California, San FranciscoSan FranciscoCAUSA
- Present address:
Stanford UniversityStanfordCAUSA
| | - Morgan B. Murphy
- Division of Occupational and Environmental MedicineUniversity of California, San FranciscoSan FranciscoCAUSA
- Present address:
Sutter Health California Pacific Medical CenterStanfordCAUSA
| | - Jing Cheng
- Division of Oral Epidemiology and Dental Public HealthUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Suzaynn F. Schick
- Center for Tobacco Control Research and EducationUniversity of California, San FranciscoSan FranciscoCAUSA
- Division of Occupational and Environmental MedicineUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Matthew L. Springer
- Cardiovascular Research Institute, University of California, San FranciscoSan FranciscoCAUSA
- Division of CardiologyUniversity of California, San FranciscoSan FranciscoCAUSA
- Center for Tobacco Control Research and EducationUniversity of California, San FranciscoSan FranciscoCAUSA
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6
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Han DD, Rao P, Qiu H, Navabzadeh M, Wang X, Goyal N, Mohammadi L, Huang A, Perez BG, Schick SF, Springer ML. Impairment of Endothelial Function by Cigarette Smoke and e-Cigarette Aerosol Requires RAGE. Arterioscler Thromb Vasc Biol 2023; 43:2369-2371. [PMID: 37795616 PMCID: PMC10841038 DOI: 10.1161/atvbaha.123.319514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Affiliation(s)
- Daniel D. Han
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Present address: School of Medicine & Dentistry, University of Rochester, Rochester, NY
| | - Poonam Rao
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA
- Present address: CHRISTUS Good Shepherd/Texas A&M University Internal Medicine Residency Program, Longview, TX
| | - Huiliang Qiu
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Present address: Department of Cardiovascular Diseases, Physiology and Biomedical Engineering, Mayo Clinic Arizona, Scottsdale, AZ
| | - Mina Navabzadeh
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Xiaoyin Wang
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Natasha Goyal
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Leila Mohammadi
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Abel Huang
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Bryanna G. Perez
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Suzaynn F. Schick
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Matthew L. Springer
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA
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7
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Wölkart G, Kollau A, Russwurm M, Koesling D, Schrammel A, Mayer B. Varied effects of tobacco smoke and e-cigarette vapor suggest that nicotine does not affect endothelium-dependent relaxation and nitric oxide signaling. Sci Rep 2023; 13:15833. [PMID: 37739972 PMCID: PMC10517138 DOI: 10.1038/s41598-023-42750-6] [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: 06/27/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023] Open
Abstract
Chronic smoking causes dysfunction of vascular endothelial cells, evident as a reduction of flow-mediated dilation in smokers, but the role of nicotine is still controversial. Given the increasing use of e-cigarettes and other nicotine products, it appears essential to clarify this issue. We studied extracts from cigarette smoke (CSE) and vapor from e-cigarettes (EVE) and heated tobacco (HTE) for their effects on vascular relaxation, endothelial nitric oxide signaling, and the activity of soluble guanylyl cyclase. The average nicotine concentrations of CSE, EVE, and HTE were 164, 800, and 85 µM, respectively. At a dilution of 1:3, CSE almost entirely inhibited the relaxation of rat aortas and porcine coronary arteries to acetylcholine and bradykinin, respectively, while undiluted EVE, with a 15-fold higher nicotine concentration, had no significant effect. With about 50% inhibition at 1:2 dilution, the effect of HTE was between CSE and EVE. Neither extract affected endothelium-independent relaxation to an NO donor. At the dilutions tested, CSE was not toxic to cultured endothelial cells but, in contrast to EVE, impaired NO signaling and inhibited NO stimulation of soluble guanylyl cyclase. Our results demonstrate that nicotine does not mediate the impaired endothelium-dependent vascular relaxation caused by smoking.
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Affiliation(s)
- Gerald Wölkart
- Department of Pharmacology and Toxicology, Institute of Pharmaceutical Sciences, Universität Graz, Humboldtstraße 46, 8010, Graz, Austria
| | - Alexander Kollau
- Department of Pharmacology and Toxicology, Institute of Pharmaceutical Sciences, Universität Graz, Humboldtstraße 46, 8010, Graz, Austria
| | - Michael Russwurm
- Department of Pharmacology and Toxicology, Ruhr-Universität Bochum, MA N1-39, 44780, Bochum, Germany
| | - Doris Koesling
- Department of Pharmacology and Toxicology, Ruhr-Universität Bochum, MA N1-39, 44780, Bochum, Germany
| | - Astrid Schrammel
- Department of Pharmacology and Toxicology, Institute of Pharmaceutical Sciences, Universität Graz, Humboldtstraße 46, 8010, Graz, Austria
| | - Bernd Mayer
- Department of Pharmacology and Toxicology, Institute of Pharmaceutical Sciences, Universität Graz, Humboldtstraße 46, 8010, Graz, Austria.
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8
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Klein J, Diaba-Nuhoho P, Giebe S, Brunssen C, Morawietz H. Regulation of endothelial function by cigarette smoke and next-generation tobacco and nicotine products. Pflugers Arch 2023:10.1007/s00424-023-02824-w. [PMID: 37285061 DOI: 10.1007/s00424-023-02824-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/08/2023]
Abstract
Cigarette smoking is the most important avoidable cardiovascular risk factor. It causes endothelial dysfunction and atherosclerosis and increases the risk of its severe clinical complications like coronary artery disease, myocardial infarction, stroke, and peripheral artery disease. Several next-generation tobacco and nicotine products have been developed to decrease some of the deleterious effects of regular tobacco smoking. This review article summarizes recent findings about the impact of cigarette smoking and next-generation tobacco and nicotine products on endothelial dysfunction. Both cigarette smoking and next-generation tobacco products lead to impaired endothelial function. Molecular mechanisms of endothelial dysfunction like oxidative stress, reduced nitric oxide availability, inflammation, increased monocyte adhesion, and cytotoxic effects of cigarette smoke and next-generation tobacco and nicotine products are highlighted. The potential impact of short- and long-term exposure to next-generation tobacco and nicotine products on the development of endothelial dysfunction and its clinical implications for cardiovascular diseases are discussed.
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Affiliation(s)
- Justus Klein
- Department of Medicine III, Division of Vascular Endothelium and Microcirculation, Faculty of Medicine, University Hospital Carl Gustav Carus Dresden, TUD Dresden University of Technology, Fetscherstr. 74, D-01307, Dresden, Germany
| | - Patrick Diaba-Nuhoho
- Department of Medicine III, Division of Vascular Endothelium and Microcirculation, Faculty of Medicine, University Hospital Carl Gustav Carus Dresden, TUD Dresden University of Technology, Fetscherstr. 74, D-01307, Dresden, Germany
- Department of Paediatric and Adolescent Medicine, Paediatric Haematology and Oncology, University Hospital Münster, Albert-Schweitzer-Str. 33, D-48149, Münster, Germany
| | - Sindy Giebe
- Department of Medicine III, Division of Vascular Endothelium and Microcirculation, Faculty of Medicine, University Hospital Carl Gustav Carus Dresden, TUD Dresden University of Technology, Fetscherstr. 74, D-01307, Dresden, Germany
| | - Coy Brunssen
- Department of Medicine III, Division of Vascular Endothelium and Microcirculation, Faculty of Medicine, University Hospital Carl Gustav Carus Dresden, TUD Dresden University of Technology, Fetscherstr. 74, D-01307, Dresden, Germany
| | - Henning Morawietz
- Department of Medicine III, Division of Vascular Endothelium and Microcirculation, Faculty of Medicine, University Hospital Carl Gustav Carus Dresden, TUD Dresden University of Technology, Fetscherstr. 74, D-01307, Dresden, Germany.
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9
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Mears MJ, Hookfin HL, Bandaru P, Vidal P, Stanford KI, Wold LE. Electronic Nicotine Delivery Systems and Cardiovascular/Cardiometabolic Health. Circ Res 2023; 132:1168-1180. [PMID: 37104558 PMCID: PMC10154046 DOI: 10.1161/circresaha.123.321565] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The use of electronic nicotine delivery systems, specifically electronic cigarettes (e-cig), has risen dramatically within the last few years; the demographic purchasing these devices is now predominantly adolescents that are not trying to quit the use of traditional combustible cigarettes, but rather are new users. The composition and appearance of these devices has changed since their first entry into the market in the late 2000s, but they remain composed of a battery and aerosol delivery system that is used to deliver breakdown products of propylene glycol/vegetable glycerin, flavorings, and potentially nicotine or other additives. Manufacturers have also adjusted the type of nicotine that is used within the liquid to make the inhalation more palatable for younger users, further affecting the number of youth who use these devices. Although the full spectrum of cardiovascular and cardiometabolic consequences of e-cig use is not fully appreciated, data is beginning to show that e-cigs can cause both short- and long-term issues on cardiac function, vascular integrity and cardiometabolic issues. This review will provide an overview of the cardiovascular, cardiometabolic, and vascular implications of the use of e-cigs, and the potential short- and long-term health effects. A robust understanding of these effects is important in order to inform policy makers on the dangers of e-cigs use.
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Affiliation(s)
- Matthew J. Mears
- Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, College of Medicine and Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Harrison L. Hookfin
- Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, College of Medicine and Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Priya Bandaru
- Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, College of Medicine and Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Pablo Vidal
- Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, College of Medicine and Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Kristin I. Stanford
- Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, College of Medicine and Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Loren E. Wold
- Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, College of Medicine and Wexner Medical Center, The Ohio State University, Columbus, OH
- Division of Cardiac Surgery, Department of Surgery, College of Medicine, The Ohio State University, Columbus, OH
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10
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Aboaziza E, Feaster K, Hare L, Chantler PD, Olfert IM. Maternal electronic cigarette use during pregnancy affects long-term arterial function in offspring. J Appl Physiol (1985) 2023; 134:59-71. [PMID: 36417201 PMCID: PMC9762967 DOI: 10.1152/japplphysiol.00582.2022] [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: 10/03/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 11/24/2022] Open
Abstract
Vaping, or electronic cigarette (ecig) use, is prevalent among pregnant women, although little is known about the effects of perinatal ecig use on cardiovascular health of the progeny (even when using nicotine-free e-liquid). Maternal toxicant inhalation may adversely affect vital conduit vessel development. We tested the hypothesis that perinatal exposure to maternal vaping would lead to a dose-dependent dysfunction that would persist into later life of offspring. Pregnant Sprague-Dawley rats were exposed to either nicotine-free (ecig0) or nicotine-containing ecig aerosol (18 mg/mL, ecig18) starting on gestational day 2 and continued until pups were weaned (postnatal day 21). Pups were never directly exposed. Conduit artery function (stiffness and reactivity) and structure were assessed in 3- and 7-mo-old offspring. At 3 mo, pulse wave velocity (PWV) in the ecig0 and ecig18 offspring was significantly higher than controls in both the 20 puffs/day (6.6 ± 2.1 and 4.8 ± 1.3 vs. 3.2 ± 0.7 m/s, respectively, P < 0.05, means ± SD) and in 60 puffs/day exposure cohort (7.5 ± 2.8 and 7.5 ± 2.5 vs. 3.2 ± 0.5 m/s, respectively, P < 0.01). Wire myography revealed (range of 23%-31%) impaired aortic relaxation in all ecig exposure groups (with or without nicotine). Incubation of vessels with TEMPOL or Febuxostat reversed the aortic dysfunction, implicating the involvement of reactive oxygen species. Nearly identical changes and pattern was seen in vascular outcomes of 7-mo-old offspring. The take-home message from this preclinical study is that maternal vaping during pregnancy, with or without nicotine, leads to maladaptations in vascular (aortic) development that persist into adult life of offspring.NEW & NOTEWORTHY We observe a significant alteration in arterial structure and function in adolescent and adult offspring due to developmental exposure to toxicants resulting from perinatal maternal vaping. Taken together with previous work that described lasting dysfunction in cerebral microvasculature in offspring, these data underscore the adverse consequences of maternal exposure to electronic cigarette aerosol in conduit and resistance vessels alike, irrespective of nicotine content.
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Affiliation(s)
- Eiman Aboaziza
- West Virginia Clinical and Translational Science Institute, West Virginia University School of Medicine, Morgantown, West Virginia
- WVU Center of Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Kimberly Feaster
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Lance Hare
- WVU Center of Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Paul D Chantler
- West Virginia Clinical and Translational Science Institute, West Virginia University School of Medicine, Morgantown, West Virginia
- WVU Center of Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, West Virginia
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - I Mark Olfert
- West Virginia Clinical and Translational Science Institute, West Virginia University School of Medicine, Morgantown, West Virginia
- WVU Center of Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, West Virginia
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia
- Department of Physiology and Pharmacology, West Virginia University School of Medicine, Morgantown, West Virginia
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11
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Conklin DJ. How Irritating! Electronic Cigarettes Not "95% Safer" Than Combustible Cigarettes: Recent Mechanistic Insights Into Endothelial Dysfunction. Arterioscler Thromb Vasc Biol 2022; 42:1351-1354. [PMID: 36288291 PMCID: PMC10038145 DOI: 10.1161/atvbaha.122.318468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Daniel J. Conklin
- American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville
- Christina Lee Brown Envirome Institute, University of Louisville
- Superfund Research Center, University of Louisville
- Center of Cardiovascular Metabolism Science, University of Louisville
- Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, KY 40202, USA
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