Published OnlineFirst November 10, 2015; DOI: 10.1158/1940-6207.CAPR-15-0356
Cancer Prevention Research
Letter to the Editor
Acrolein Levels in e-Cigarettes—Letter
The recent article by McRobbie and colleagues (1) is the first prospective study addressing toxicologic exposure directly in e-cigarettes (EC) users. This study adds key information about harm potential of e-vapor products and gets away from the controversial toxicologic findings that have been generated in recent laboratories studies because of experimental protocols that do not mimic realistic condition of use (2). Given that the debate over the potential benefits and harms of ECs remains unproductive (3), it is imperative to shift toxicologic evaluation directly into the human body. The study not only shows that urinary and exhaled breath toxicants generated by combustion (i.e., acrolein and carbon monoxide) are of several order of magnitude lower after switching to regular EC use, but that an important decrease is also observed in dual users (i.e., consumers who combine ECs and conventional cigarettes use) that have substantially reduced their daily cigarette smoking. Smokers should be informed that substitution of cigarettes with ECs exposes them to only a fraction of toxicants compared with tobacco cigarettes and that switching to less harmful form of nicotine delivery may have long-term beneficial health effects (4). Nonetheless, the data presented by McRobbie and colleagues are not conclusive due to the small sample size and the restricted toxicologic evaluation (limited to only two toxicants). Moreover, doi: 10.1158/1940-6207.CAPR-15-0356 Ó2015 American Association for Cancer Research.
changes in biomarkers of exposure (BoE) may not be uniform. For example, although a significant decrease in acrolein has been reported after use of reduced risk tobacco products, substantial increases were seen in BoE levels for fluorene and naphthalene in the same study population (5). Most importantly, it must be emphasized that significant reductions in BoEs do not automatically imply risk reduction or harm reversal. Despite decreased overall BoE, switching to the reduced risk tobacco products failed to demonstrate consistent reductions in biomarkers of biologic exposure (BoBE). This general lack of response in BoBE levels to a reduction in toxicant exposure has been highlighted in a similar study by Sarkar and colleagues (6) who reported no significant changes in selected cardiovascular disease–related BoBE following a forced switch from a conventional cigarette to a cigarette containing activated carbon in the filter. Future studies on ECs will have to expand the panel of BoE and to integrate data from biomarkers of biologic/physiologic effects.
Riccardo Polosa Massimo Caruso Pasquale Caponnetto Received October 3, 2015; accepted October 19, 2015; published OnlineFirst November 10, 2015.
References 1. McRobbie H, Phillips A, Goniewicz ML, Myers Smith K, Knight-West O, Przulj D, et al. Effects of switching to electronic cigarettes with and without concurrent smoking on exposure to nicotine, carbon monoxide, and acrolein. Cancer Prev Res 2015;8:873–8. 2. Farsalinos KE, Polosa R. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review. Ther Adv Drug Saf 2014;5:67–86. 3. McNeill A, Etter JF, Farsalinos K, Hajek P, le Houezec J, McRobbie H. A critique of a World Health Organization-commissioned report and associated paper on electronic cigarettes. Addiction 2014;109: 2128–34.
4. Polosa R. Electronic cigarette use and harm reversal: emerging evidence in the lung. BMC Med 2015;13:54. 5. Shepperd CJ, Newland N, Eldridge A, Haswell L, Lowe F, Papadopoulou E, et al. Changes in levels of biomarkers of exposure and biological effect in a controlled study of smokers switched from conventional cigarettes to reduced-toxicant-prototype cigarettes. Regul Toxicol Pharmacol 2015; 72:273–91. 6. Sarkar M, Kapur S, Frost-Pineda K, Feng S, Wang J, Liang Q, et al. Evaluation of biomarkers of exposure to selected cigarette smoke constituents in adult smokers switched to carbon-filtered cigarettes in short-term and long-term clinical studies. Nicotine Tob Res 2008;10:1761–72.
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Published OnlineFirst November 10, 2015; DOI: 10.1158/1940-6207.CAPR-15-0356
Acrolein Levels in e-Cigarettes−−Letter Cancer Prev Res 2016;9:115. Published OnlineFirst November 10, 2015.
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Downloaded from cancerpreventionresearch.aacrjournals.org on January 26, 2016. © 2016 American Association for Cancer Research.
Cancer Prevention Research
Letter to the Editor
Acrolein Levels in e-Cigarettes—Letter
The recent article by McRobbie and colleagues (1) is the first prospective study addressing toxicologic exposure directly in e-cigarettes (EC) users. This study adds key information about harm potential of e-vapor products and gets away from the controversial toxicologic findings that have been generated in recent laboratories studies because of experimental protocols that do not mimic realistic condition of use (2). Given that the debate over the potential benefits and harms of ECs remains unproductive (3), it is imperative to shift toxicologic evaluation directly into the human body. The study not only shows that urinary and exhaled breath toxicants generated by combustion (i.e., acrolein and carbon monoxide) are of several order of magnitude lower after switching to regular EC use, but that an important decrease is also observed in dual users (i.e., consumers who combine ECs and conventional cigarettes use) that have substantially reduced their daily cigarette smoking. Smokers should be informed that substitution of cigarettes with ECs exposes them to only a fraction of toxicants compared with tobacco cigarettes and that switching to less harmful form of nicotine delivery may have long-term beneficial health effects (4). Nonetheless, the data presented by McRobbie and colleagues are not conclusive due to the small sample size and the restricted toxicologic evaluation (limited to only two toxicants). Moreover, doi: 10.1158/1940-6207.CAPR-15-0356 Ó2015 American Association for Cancer Research.
changes in biomarkers of exposure (BoE) may not be uniform. For example, although a significant decrease in acrolein has been reported after use of reduced risk tobacco products, substantial increases were seen in BoE levels for fluorene and naphthalene in the same study population (5). Most importantly, it must be emphasized that significant reductions in BoEs do not automatically imply risk reduction or harm reversal. Despite decreased overall BoE, switching to the reduced risk tobacco products failed to demonstrate consistent reductions in biomarkers of biologic exposure (BoBE). This general lack of response in BoBE levels to a reduction in toxicant exposure has been highlighted in a similar study by Sarkar and colleagues (6) who reported no significant changes in selected cardiovascular disease–related BoBE following a forced switch from a conventional cigarette to a cigarette containing activated carbon in the filter. Future studies on ECs will have to expand the panel of BoE and to integrate data from biomarkers of biologic/physiologic effects.
Riccardo Polosa Massimo Caruso Pasquale Caponnetto Received October 3, 2015; accepted October 19, 2015; published OnlineFirst November 10, 2015.
References 1. McRobbie H, Phillips A, Goniewicz ML, Myers Smith K, Knight-West O, Przulj D, et al. Effects of switching to electronic cigarettes with and without concurrent smoking on exposure to nicotine, carbon monoxide, and acrolein. Cancer Prev Res 2015;8:873–8. 2. Farsalinos KE, Polosa R. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review. Ther Adv Drug Saf 2014;5:67–86. 3. McNeill A, Etter JF, Farsalinos K, Hajek P, le Houezec J, McRobbie H. A critique of a World Health Organization-commissioned report and associated paper on electronic cigarettes. Addiction 2014;109: 2128–34.
4. Polosa R. Electronic cigarette use and harm reversal: emerging evidence in the lung. BMC Med 2015;13:54. 5. Shepperd CJ, Newland N, Eldridge A, Haswell L, Lowe F, Papadopoulou E, et al. Changes in levels of biomarkers of exposure and biological effect in a controlled study of smokers switched from conventional cigarettes to reduced-toxicant-prototype cigarettes. Regul Toxicol Pharmacol 2015; 72:273–91. 6. Sarkar M, Kapur S, Frost-Pineda K, Feng S, Wang J, Liang Q, et al. Evaluation of biomarkers of exposure to selected cigarette smoke constituents in adult smokers switched to carbon-filtered cigarettes in short-term and long-term clinical studies. Nicotine Tob Res 2008;10:1761–72.
www.aacrjournals.org
Downloaded from cancerpreventionresearch.aacrjournals.org on January 26, 2016. © 2016 American Association for Cancer Research.
115
Published OnlineFirst November 10, 2015; DOI: 10.1158/1940-6207.CAPR-15-0356
Acrolein Levels in e-Cigarettes−−Letter Cancer Prev Res 2016;9:115. Published OnlineFirst November 10, 2015.
Updated version
Cited articles
E-mail alerts Reprints and Subscriptions Permissions
Access the most recent version of this article at: doi:10.1158/1940-6207.CAPR-15-0356
This article cites 6 articles, 3 of which you can access for free at: http://cancerpreventionresearch.aacrjournals.org/content/9/1/115.full.html#ref-list-1
Sign up to receive free email-alerts related to this article or journal. To order reprints of this article or to subscribe to the journal, contact the AACR Publications Department at [email protected]. To request permission to re-use all or part of this article, contact the AACR Publications Department at [email protected].
Downloaded from cancerpreventionresearch.aacrjournals.org on January 26, 2016. © 2016 American Association for Cancer Research.
