Oral epithelium response of electronic cigarette users to electronic cigarette

Reeve, Gwendolyn S; Rostami, Mahboubeh; Reich, R.; Behrman, David; Leopold, Philip L.; Crystal, Ronald G.; Strulovici-Barel, Yael

doi:10.1111/jop.13380

Cited by 3 publications

(5 citation statements)

References 30 publications

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“…After the removal of duplicates, 822 unique abstracts were screened, resulting in the inclusion of 53 studies (Figure 1, Table 1). 12‐64 Out of the 53 included articles, 34 (64%) analyzed the effects of e‐cigarette use on human subjects or cell lines, 16 (30%) utilized an animal model to investigate the in vivo effects of e‐cigarette aerosol exposure, and 3 (6%) studied both human and animal models. Human studies included: (1) in vitro assessments of e‐cigarette aerosol, condensate, or e‐liquid exposure on primary cultured cells or immortalized cell lines derived from upper airway tissue, or (2) clinical studies using samples obtained from current or former e‐cigarette users.…”

Section: Resultsmentioning

confidence: 99%

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The Toxicological Effects of e‐Cigarette Use in the Upper Airway: A Scoping Review

Worden,

Hicks,

Hackman

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveWhile evidence continues to emerge on the negative health effects of electronic cigarettes (e‐cigarettes) on the lungs, little is known regarding their deleterious effects on the upper airway. The purpose of this review is to summarize the toxicological effects of e‐cigarettes, and their components, on the upper airway.Data SourcesPubMed, SCOPUS, EMBASE databases.Review MethodsSystematic searches were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines from 2003 to 2023. Studies were included if they investigated the toxicological effects of e‐cigarette exposure on human or animal upper airway tissue. Two authors independently screened, reviewed, and appraised all included articles.ResultsA total of 822 unique articles were identified, of which 53 met inclusion criteria and spanned subsites including the oral cavity (22/53 studies), nasal cavity/nasopharynx (13/53), multiple sites (10/53), larynx (5/53), trachea (2/53), and oropharynx (1/53). The most commonly observed consequences of e‐cigarette use on the upper airway included: proinflammatory (15/53 studies), histological (13/53), cytotoxicity (11/53), genotoxicity (11/53), and procarcinogenic (6/53). E‐cigarette humectants independently induced toxicity at multiple upper airway subsites, however, effects were generally amplified when flavoring(s) and/or nicotine were added. Across almost all studies, exposure to cigarette smoke exhibited increased toxicity in the upper airway compared with exposure to e‐cigarette vapor.ConclusionCurrent data suggest that while e‐cigarettes are generally less harmful than traditional cigarettes, they possess a distinct toxicological profile that is enhanced upon the addition of flavoring(s) and/or nicotine. Future investigations into underexamined subsites, such as the oropharynx and hypopharynx, are needed to comprehensively understand the effects of e‐cigarettes on the upper airway.

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Section: Resultsmentioning

confidence: 99%

“…Reeve et al 29 There were no statistically significant histological or transcriptomic changes in the oral epithelium of e-cigarette users vs nonsmokers.…”

Section: Proinflammatory Procarcinogenicmentioning

confidence: 94%

The Toxicological Effects of e‐Cigarette Use in the Upper Airway: A Scoping Review

Worden,

Hicks,

Hackman

et al. 2024

Otolaryngol.--head neck surg.

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“…Most studies rely on self-reports assessed with questionnaires (Table S1). In 11 studies (40)(41)(42)(43)(44)(45)(46)(47)(48)(49), cotinine or other nicotine metabolites have been determined in body uids (blood, saliva, urine), which allows the distinction between users of any tobacco/nicotine product (including NGPs) and NU as well as the extend of product use. However, it does not distinguish between NGP and CC use.…”

Section: General Study Characteristicsmentioning

confidence: 99%

“…In 4 investigations (54)(55)(56)(57), NGP (mostly EC) use of at least 1 year was required for study participation. In another 5 studies (42,45,(58)(59)(60), mean NGP use durations between 2 and 3 year were reported. The longest average NGP use duration in the selected studies amounted to 6.4 (61), 9.2 (62), 12.2 (63) and 12.5 years (64).…”

Section: General Study Characteristicsmentioning

confidence: 99%

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Oral health risks in users of new generation nicotine/tobacco products (NGPs): Systematic review and qualitative meta-analyses

Scherer,

Pluym,

Scherer

2024

Preprint

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Background Use of traditional tobacco products, including combustible cigarettes (CCs) and smokeless oral products, is an established risk factor for various oral diseases. A potential oral health risk of using new generation tobacco/nicotine products (NGPs) such as electronic cigarettes (ECs), heated tobacco products (HTPs) and oral nicotine pouches (ONPs) is not yet well established. Methods In this systematic review, we evaluated published human studies on detrimental oral health effects in NGP users compared to CC smokers and non-users (NU). We identified 52 studies, of which almost all investigations were on EC users. The studies were extremely heterogeneous in terms of design, subjects, endpoints and quality. Reported outcomes, based on both single and grouped endpoints were qualitatively evaluated by comparing NGP users with NU and CC users. Significant increases (indicating a worsening in oral health), significant decreases (indicating an improvement) and no significant difference between groups were assigned scores of + 1, -1 and 0, respectively. Results With this approach, comparisons of EC versus NU yielded mean scores of 0.29 (pre-cancerous lesions, N = 14 observations), 0.27 (inflammatory processes, N = 83), 0.43 (oral clinical parameters, N = 93) and 0.70 (shifts in the oral microbiome, N = 10). The corresponding values for the EC versus CC comparisons amounted to: -0.33 (N = 15), -0.14 (N = 76), -0.27 (N = 78) and 0.57 (N = 7). Most of the evaluated studies have severe limitations in terms of group sizes, duration of NGP use and validity of self-reported exclusive NGP use. In particular, any dual use (EC + CC) was mostly not adequately taken into account. Conclusions The evaluated studies suggest that use of ECs is associated with some improvement of oral health effects compared to cigarette smoking (CC), but oral health is still found to be worse compared to NU. These results have to be interpreted with caution due to a number of limitations and uncertainties in the underlying studies.

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Literature Review on Nicotine’s Role in Human Health

Scherer,

Pluym,

Scherer

2024

Contributions to Tobacco &Amp; Nicotine Research

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Summary Background Next generation of nicotine/tobacco products (NGPs) include electronic cigarettes (ECs), heated tobacco products (HTPs), oral nicotine pouches (NPs) and smokeless tobacco (SLT) products (in particular snus). These products commonly contain nicotine and are intended to replace combustible cigarettes (CCs) and thus can be regarded as tobacco harm reduction products. To fulfill this role, it is essential that nicotine, which has well established addictive properties, is not causally related to health risks upon chronic use. Objectives The purpose of this review is to evaluate the scientific literature to answer the question, whether nicotine is involved in the development of any diseases or disorders associated with the acute, short, mid- and long-term use of NGPs. Appropriate results from studies with nicotine replacement therapy (NRT) products (gum, patches, inhalers, lozenges) are included as reference basis for inferring the health effects of NGPs. Furthermore, suggestions for filling identified gaps and for avoiding or minimizing limitations and weaknesses in study design are provided. Methods Literature databases such as MEDLINE, Google Scholar and an in-house ABF library (containing about 180,000 articles) were searched for relevant articles. Furthermore, pertinent monographs (such as the US Surgeon General Reports) and recent reviews were screened for further publications. Inclusion criteria were: all human studies investigating the association between use (preferably chronic use) of the nicotine/tobacco products mentioned above and health effects, including diseases, disorders, changes in biomarkers of biological effect (BOBEs). In vivo (animal) and in vitro studies were also considered, provided effects of NGPs in the presence and absence of nicotine or in relation to the nicotine exposure dose were reported. Also, reference lists of recent suitable articles were screened. In total, about 500 articles were retrieved by this approach. The role of nicotine was evaluated by considering the article authors’ statements and their cited references as well as by own judgement of reported results. Human studies are presented in a standardized table format. Results In total, 183 human studies were evaluated, with cardiovascular diseases (CVD) ranking highest (N = 75 studies), followed by respiratory diseases (43), oral health disorders (23), cancer (10), metabolic syndrome (7), reproduction disorders (5) and several other diseases (< 5). The majority of studies do not provide evidence for a participation of nicotine in the pathogenesis. Some (weak) evidence was found that nicotine might be involved in some CVD-related effects and metabolic syndrome. This would be also supported by results from animal and in vitro studies. Discussion Human studies showed some severe limitations and weaknesses with respect to the study design and time of availability of NGPs on the market. A severe flaw is the insufficient consideration of dual use (NGP + CC), particularly in studies on chronic use, which could have led to erroneously increased risks for NGPs with direct consequences also for the role of nicotine. Additionally, prior effects from using CC have an impact. Both circumstances could have led to inaccurate conclusions in terms of elevated risk levels, which require changes in method designs. Suggestions for methodological improvements are provided for future studies. Conclusions A final evaluation of the role of nicotine in disease development in NGP users is currently not possible because use durations are too short. Chronic studies often suffer from insufficient separation between NGP only and dual use together with CCs, which may falsely increase the observed health risk. There is some limited evidence that nicotine may be involved in CVD-related effects, which, however, has to be verified in well controlled long-term studies. The potential involvement of nicotine in other patho-mechanisms also requires further research.

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Oral epithelium response of electronic cigarette users to electronic cigarette

Cited by 3 publications

References 30 publications

The Toxicological Effects of e‐Cigarette Use in the Upper Airway: A Scoping Review

The Toxicological Effects of e‐Cigarette Use in the Upper Airway: A Scoping Review

Oral health risks in users of new generation nicotine/tobacco products (NGPs): Systematic review and qualitative meta-analyses

Literature Review on Nicotine’s Role in Human Health

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