1
|
Wang X, Su S. The hidden impact: the rate of nicotine metabolism and kidney health. Front Endocrinol (Lausanne) 2024; 15:1424068. [PMID: 39355620 PMCID: PMC11442274 DOI: 10.3389/fendo.2024.1424068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 08/27/2024] [Indexed: 10/03/2024] Open
Abstract
Objectives The effects of nicotine metabolism on the kidneys of healthy individuals have not been determined. The nicotine metabolite ratio (NMR) indicates the rate of nicotine metabolism and is linked to smoking behaviors and responses to tobacco treatments. We conducted this study in order to investigated the relationship between nicotine metabolite ratio (NMR) and kidney function. Methods An analysis of cross-sectional data of adults was conducted using a population survey dataset (National Health and Nutrition Examination Survey Data 2013/2018 of the United States). A weighted multivariate regression analysis was conducted to estimate the correlation between NMR and kidney function. Furthermore, we apply fitting smooth curves to make the relationship between NMR and estimated glomerular filtration rate (eGFR) more visualized. Results The research included a total of 16153 participants. Weighted multivariate regression analyses adjusted for possible variables showed a negative relationship between NMR and estimated glomerular filtration rate (eGFR).The β (95%CI) of the regression equation between NMR and eGFR was -2.24 (-2.92, -1.55), the trend testing showed consistent results. NMR is positively correlated with urinary albumin creatinine ratio (uACR), but it is not statistically significant. A stratified analysis found a negative correlation between NMR and eGFR in all age, gender and diabetes subgroups, the results were not statistically significant among Mexican Americans and other races. Notably, each unit rise in NMR corresponded to a 4.54 ml/min·1.73m² lower eGFR in diabetic participants and a 6.04 ml/min·1.73m² lower eGFR in those aged 60 and above. Conclusions Our study shows that nicotine metabolite ratio is negatively associated with kidney function among most adults. It will be necessary to conduct more well-designed prospective clinical trials in order to determine the exact causal interactions between NMR and kidney function. Specific mechanisms also need to be further explored in basic experiments.
Collapse
Affiliation(s)
| | - Shanshan Su
- Department of Nephrology, Affiliated Hospital of Shandong University of Traditional
Chinese Medicine, Jinan, China
| |
Collapse
|
2
|
Qin R, Liu Z, Cheng AQ, Zhou XM, Su Z, Cui ZY, Li JX, Wei XW, Zhao L, Chung KF, Xiao D, Wang C. Efficacy of varenicline or bupropion and its association with nicotine metabolite ratio among smokers with COPD. Respirology 2024; 29:479-488. [PMID: 38494828 DOI: 10.1111/resp.14702] [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: 09/26/2023] [Accepted: 02/14/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND OBJECTIVE Nicotine metabolic ratio (NMR) has been associated with nicotine metabolism and smoking characteristics. However, there are few studies on the potential association between NMR and smoking cessation efficacy in smokers with chronic obstructive pulmonary disease (COPD) in China or elsewhere. METHODS This study was a stratified block randomized controlled trial for smoking cessation in Chinese smokers with COPD. NMR was used as a stratification factor; slow metabolizers were defined as those with NMR <0.31, and normal metabolizers as those with NMR ≥0.31. Participants were randomly assigned to the varenicline or bupropion group. Follow-up visits were conducted at 1, 2, 4, 6, 9, 12 and 24 weeks. RESULTS Two hundred twenty-four participants were recruited and analysed from February 2019 to June 2022. In normal metabolizers, the 9-12 weeks continuous abstinence rate of varenicline (43.1%) was higher than in bupropion (23.5%) (OR = 2.47, 95% CI 1.05-5.78, p = 0.038). There was no significant difference in abstinence rates between treatment groups in slow metabolizers (54.1% vs. 45.9%, OR = 1.39, 95% CI 0.68-2.83, p = 0.366). For slow metabolizers, the total score of side effects in the varenicline group was significantly higher than the bupropion group (p = 0.048), while there was no significant difference in side effects between groups for normal metabolizers (p = 0.360). CONCLUSION Varenicline showed better efficacy than bupropion in normal metabolizers, and bupropion showed equivalent efficacy in slow metabolizers with less side effects. According to our study, NMR provides a better justification for both scientific research and tailoring optimal pharmacotherapy for smoking cessation among smokers in COPD.
Collapse
Affiliation(s)
- Rui Qin
- China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
| | - Zhao Liu
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
| | - An-Qi Cheng
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
| | - Xin-Mei Zhou
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
| | - Zheng Su
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
| | - Zi-Yang Cui
- Department of Geriatric Medicine, Beijing Shijitan Hospital, Beijing, China
| | - Jin-Xuan Li
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Capital Medical University, Beijing, China
| | - Xiao-Wen Wei
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Capital Medical University, Beijing, China
| | - Liang Zhao
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Dan Xiao
- China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
| | - Chen Wang
- China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
| |
Collapse
|
3
|
Cooper RK, Mahoney MC, Tiffany ST, Colder CR, Tyndale RF, Hawk LW. Relationships Between the Nicotine Metabolite Ratio and Laboratory Assessments of Smoking Reinforcement and Craving Among Adults in a Smoking Cessation Trial. Nicotine Tob Res 2024; 26:604-611. [PMID: 37996099 PMCID: PMC11033563 DOI: 10.1093/ntr/ntad232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/10/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION People who metabolize nicotine more quickly are generally less successful at quitting smoking. However, the mechanisms that link individual differences in the nicotine metabolite ratio (NMR), a phenotypic biomarker of the rate of nicotine clearance, to smoking outcomes are unclear. We tested the hypotheses that higher NMR is associated with greater smoking reinforcement, general craving, and cue-induced cigarette craving in a treatment-seeking sample. METHODS Participants were 252 adults who smoke cigarettes enrolled in a randomized controlled smoking cessation trial (NCT03262662) conducted in Buffalo, New York, USA. Participants completed the Choice Behavior Under Cued Conditions (CBUCC) paradigm, a laboratory choice procedure, ~1 week before the first cessation treatment visit, at which time a saliva sample was collected for NMR assessment. On each CBUCC trial, participants reported cigarette craving during cue presentation (cigarette, water) and spent $0.01-$0.25 for a chance (5%-95%) to sample the cue (one puff, sip), providing measures of smoking reinforcement (spending for cigarettes vs. water), general cigarette craving (averaged across cigarette and water cues), and cue-specific craving (cigarette craving during cigarette vs. water cues). RESULTS As observed in prior work, the NMR was significantly higher among White and female participants. As expected, both spending and cigarette craving were significantly greater on cigarette compared to water trials. However, contrary to our hypotheses, higher NMR was not associated with greater smoking reinforcement, general craving, or cue-specific craving. CONCLUSIONS The present data do not support that smoking reinforcement or craving is related to nicotine metabolism among individuals seeking to quit smoking. IMPLICATIONS Though greater smoking reinforcement, general craving, and cue-specific craving are hypothesized to be linked to faster nicotine metabolism, there was no evidence of such relationships in the present sample of adults seeking to quit smoking. Further research, including replication and consideration of alternate hypotheses, is warranted to elucidate the mechanisms by which the NMR is related to smoking cessation.
Collapse
Affiliation(s)
- Robert K Cooper
- Department of Psychology, University at Buffalo, Buffalo, NY, USA
| | | | | | - Craig R Colder
- Department of Psychology, University at Buffalo, Buffalo, NY, USA
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, Buffalo, NY, USA
| |
Collapse
|
4
|
Lee SS, Senft Everson N, Sanderson M, Selove R, Blot WJ, King S, Gilliam K, Kundu S, Steinwandel M, Sternlieb SJ, Cai Q, Warren Andersen S, Friedman DL, Connors Kelly E, Fadden MK, Freiberg MS, Wells QS, Canedo J, Tyndale RF, Young RP, Hopkins RJ, Tindle HA. Feasibility of precision smoking treatment in a low-income community setting: results of a pilot randomized controlled trial in The Southern Community Cohort Study. Addict Sci Clin Pract 2024; 19:16. [PMID: 38491559 PMCID: PMC10941447 DOI: 10.1186/s13722-024-00441-1] [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: 10/21/2023] [Accepted: 01/29/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The feasibility of precision smoking treatment in socioeconomically disadvantaged communities has not been studied. METHODS Participants in the Southern Community Cohort Study who smoked daily were invited to join a pilot randomized controlled trial of three smoking cessation interventions: guideline-based care (GBC), GBC plus nicotine metabolism-informed care (MIC), and GBC plus counseling guided by a polygenic risk score (PRS) for lung cancer. Feasibility was assessed by rates of study enrollment, engagement, and retention, targeting > 70% for each. Using logistic regression, we also assessed whether feasibility varied by age, sex, race, income, education, and attitudes toward precision smoking treatment. RESULTS Of 92 eligible individuals (79.3% Black; 68.2% with household income < $15,000), 67 (72.8%; 95% CI 63.0-80.9%) enrolled and were randomized. Of these, 58 (86.6%; 95% CI 76.4-92.8%) engaged with the intervention, and of these engaged participants, 43 (74.1%; 95% CI 61.6-83.7%) were retained at 6-month follow-up. Conditional on enrollment, older age was associated with lower engagement (OR 0.83, 95% CI 0.73-0.95, p = 0.008). Conditional on engagement, retention was significantly lower in the PRS arm than in the GBC arm (OR 0.18, 95% CI 0.03-1.00, p = 0.050). No other selection effects were observed. CONCLUSIONS Genetically informed precision smoking cessation interventions are feasible in socioeconomically disadvantaged communities, exhibiting high enrollment, engagement, and retention irrespective of race, sex, income, education, or attitudes toward precision smoking treatment. Future smoking cessation interventions in this population should take steps to engage older people and to sustain participation in interventions that include genetic risk counseling. TRIAL REGISTRATION ClinicalTrials.gov No. NCT03521141, Registered 27 April 2018, https://www. CLINICALTRIALS gov/study/NCT03521141.
Collapse
Affiliation(s)
- Scott S Lee
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA.
| | - Nicole Senft Everson
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | | | | | - William J Blot
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Stephen King
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Karen Gilliam
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Suman Kundu
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Mark Steinwandel
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Sarah J Sternlieb
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Qiuyin Cai
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Shaneda Warren Andersen
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
- University of Wisconsin-Madison, University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Debra L Friedman
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Erin Connors Kelly
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | | | - Matthew S Freiberg
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Quinn S Wells
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | | | - Rachel F Tyndale
- Centre for Addiction and Mental Health, and Departments of Pharmacology & Toxicology, and Psychiatry, Campbell Family Mental Health Research Institute, University of Toronto, Toronto, ON, Canada
| | | | | | - Hilary A Tindle
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| |
Collapse
|
5
|
Khouja JN, Sanderson E, Wootton RE, Taylor AE, Church BA, Richmond RC, Munafò MR. Estimating the health impact of nicotine exposure by dissecting the effects of nicotine versus non-nicotine constituents of tobacco smoke: A multivariable Mendelian randomisation study. PLoS Genet 2024; 20:e1011157. [PMID: 38335242 PMCID: PMC10883537 DOI: 10.1371/journal.pgen.1011157] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/22/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
The detrimental health effects of smoking are well-known, but the impact of regular nicotine use without exposure to the other constituents of tobacco is less clear. Given the increasing daily use of alternative nicotine delivery systems, such as e-cigarettes, it is increasingly important to understand and separate the effects of nicotine use from the impact of tobacco smoke exposure. Using a multivariable Mendelian randomisation framework, we explored the direct effects of nicotine compared with the non-nicotine constituents of tobacco smoke on health outcomes (lung cancer, chronic obstructive pulmonary disease [COPD], forced expiratory volume in one second [FEV-1], forced vital capacity [FVC], coronary heart disease [CHD], and heart rate [HR]). We used Genome-Wide Association Study (GWAS) summary statistics from Buchwald and colleagues, the GWAS and Sequencing Consortium of Alcohol and Nicotine, the International Lung Cancer Consortium, and UK Biobank. Increased nicotine metabolism increased the risk of COPD, lung cancer, and lung function in the univariable analysis. However, when accounting for smoking heaviness in the multivariable analysis, we found that increased nicotine metabolite ratio (indicative of decreased nicotine exposure per cigarette smoked) decreases heart rate (b = -0.30, 95% CI -0.50 to -0.10) and lung function (b = -33.33, 95% CI -41.76 to -24.90). There was no clear evidence of an effect on the remaining outcomes. The results suggest that these smoking-related outcomes are not due to nicotine exposure but are caused by the other components of tobacco smoke; however, there are multiple potential sources of bias, and the results should be triangulated using evidence from a range of methodologies.
Collapse
Affiliation(s)
- Jasmine N. Khouja
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Eleanor Sanderson
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Robyn E. Wootton
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- Nic Waals Institute, Lovisenberg diakonale sykehus, Oslo, Norway
| | - Amy E. Taylor
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Billy A. Church
- School of Psychology and Vision Sciences, University of Leicester, United Kingdom
| | - Rebecca C. Richmond
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Marcus R. Munafò
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- NIHR Bristol Biomedical Research Centre, Bristol, United Kingdom
| |
Collapse
|
6
|
Lee SS, Chang Y, Rigotti NA, Singer DE, Levy DE, Tyndale RF, Davis EM, Freiberg MS, King S, Wells QS, Tindle HA. Can Treatment Support Mitigate Nicotine Metabolism-Based Disparities in Smoking Abstinence? Secondary Analysis of the Helping HAND 4 Trial. Nicotine Tob Res 2023; 25:1575-1584. [PMID: 37209421 PMCID: PMC10439488 DOI: 10.1093/ntr/ntad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/23/2023] [Accepted: 05/17/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION The nicotine metabolite ratio (NMR), a biomarker of CYP2A6-mediated nicotine metabolism, predicts the efficacy of nicotine replacement therapy (NRT), with fast metabolizers benefiting less than slow metabolizers. Whether treatment support to optimize NRT use (henceforth "treatment support") modifies this pharmacogenetic relationship is unknown. METHODS Hospitalized adult daily smokers were assigned to one of two post-discharge smoking cessation interventions offering NRT and counseling: (1) Transitional Tobacco Care Management, which delivered enhanced treatment support via free combination NRT at discharge and automated counseling, and (2) a quitline-based approach representing usual care (UC). The primary outcome was biochemically verified 7-day point prevalence abstinence 6 months after discharge. Secondary outcomes were the use of NRT and counseling during the 3-month intervention period. Logistic regression models tested for interactions between NMR and intervention, controlling for sex, race, alcohol use, and BMI. RESULTS Participants (N = 321) were classified as slow (n = 80) or fast (n = 241) metabolizers relative to the first quartile of NMR (0.012-0.219 vs. 0.221-3.455, respectively). Under UC, fast (vs. slow) metabolizers had lower odds of abstinence at 6 months (aOR 0.35, 95% CI 0.13-0.95) and similar odds of NRT and counseling use. Compared to UC, enhanced treatment support increased abstinence (aOR 2.13, 95% CI 0.98-4.64) and use of combination NRT (aOR 4.62, 95% CI 2.57-8.31) in fast metabolizers, while reducing abstinence in slow metabolizers (aOR 0.21, 95% CI 0.05-0.87; NMR-by-intervention interaction p = .004). CONCLUSIONS Treatment support increased abstinence and optimal use of NRT among fast nicotine metabolizers, thereby mitigating the gap in abstinence between fast and slow metabolizers. IMPLICATIONS In this secondary analysis of two smoking cessation interventions for recently hospitalized smokers, fast nicotine metabolizers quit at lower rates than slow metabolizers, but providing fast metabolizers with enhanced treatment support doubled the odds of quitting in this group and mitigated the disparity in abstinence between fast and slow metabolizers. If validated, these findings could lead to personalized approaches to smoking cessation treatment that improve outcomes by targeting treatment support to those who need it most.
Collapse
Affiliation(s)
- Scott S Lee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuchiao Chang
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nancy A Rigotti
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniel E Singer
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Douglas E Levy
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rachel F Tyndale
- Departments of Psychiatry, and Pharmacology and Toxicology, University of Toronto and Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Esa M Davis
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen King
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quinn S Wells
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
7
|
Schwartz EKC, Palmisano AN, Gueorguieva R, DeVito EE, Sofuoglu M. Examining racial differences in smoking outcomes among smokers enrolled in an intravenous nicotine infusion study. Addict Behav 2023; 140:107615. [PMID: 36640662 PMCID: PMC9911383 DOI: 10.1016/j.addbeh.2023.107615] [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: 10/31/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Large racial disparities exist in the prevention and treatment of smoking-related diseases, and minoritized populations carry a heavier burden of smoking-related morbidity and mortality. To date, most studies investigating smoking-related illnesses have been conducted in samples in which the majority, or totality, self-identified as White or Caucasian. While Black individuals who smoke tend to have a lower rate of nicotine clearance, in part due to the use of mentholated cigarettes, less is known about how slower clearance affects their acute subjective and physiologic responses in response to either overnight abstinence or subsequent nicotine administration. This study aimed to investigate differences between the experiences of Black and White individuals who smoke across these outcomes after a period of short-term abstinence and after IV nicotine infusion. METHODS The study included 206 smokers (N = 103 Black, N = 103 White, by self-report). The study investigated self-report, physiological, and biochemical smoking-related outcomes following confirmed overnight abstinence followed by IV nicotine infusion. The outcome measures were separately analyzed with repeated-measures mixed-models. RESULTS Black individuals had lower rates of nicotine clearance and were more likely to smoke mentholated cigarettes than White individuals. Despite these differences, no differences in withdrawal, cravings, or physiological outcomes were observed between the two groups. There were some trends toward differences in subjective experiences, in that an interaction with trend level significance between race and dose was observed for negative subjective drug effects, with White smokers trending towards endorsing higher levels of negative affect after abstinence and nicotine infusion. We also observed that Black individuals trended towards experiencing more negative drug effects in response to initial nicotine delivery than to saline, whereas White individuals had no differences in negative drug effects across saline or nicotine doses. CONCLUSIONS Despite slower nicotine clearance, Black participants exhibited withdrawal and urges to smoke as severe as White participants, and did not have blunted physiological responses to overnight abstinence or administration of nicotine, which were contrary to our hypotheses. Our findings suggest minimal differences across races in the acute pharmacologic effects of nicotine. We observed trend-level differences in subjective and affective responses to nicotine. Greater insight into these differences may lead to improved prevention and treatment strategies for smoking-related illnesses for Black individuals who smoke.
Collapse
Affiliation(s)
- Elizabeth K C Schwartz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Alexandra N Palmisano
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ralitza Gueorguieva
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Yale School of Public Health, Department of Biostatistics, New Haven, CT, USA
| | - Elise E DeVito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| |
Collapse
|
8
|
Nasrin S, Coates S, Bardhi K, Watson C, Muscat JE, Lazarus P. Inhibition of Nicotine Metabolism by Cannabidiol (CBD) and 7-Hydroxycannabidiol (7-OH-CBD). Chem Res Toxicol 2023; 36:177-187. [PMID: 36626330 PMCID: PMC9945182 DOI: 10.1021/acs.chemrestox.2c00259] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Indexed: 01/11/2023]
Abstract
Cannabis-based products have experienced notable increases in co-usage alongside tobacco products. Several cannabinoids exhibit inhibition of a number of cytochrome P450 (CYP) and UDP glucuronosyltransferase (UGT) enzymes, but few studies have examined their inhibition of enzymes involved in nicotine metabolism. The goal of the present study was to examine potential drug-drug interactions occurring in the nicotine metabolism pathway perpetrated by cannabidiol (CBD) and its active metabolite, 7-hydroxy-CBD (7-OH-CBD). The inhibitory effects of CBD and 7-OH-CBD were tested in microsomes from HEK293 cells overexpressing individual metabolizing enzymes and from human liver tissue. Assays with overexpressing microsomes demonstrated that CBD and 7-OH-CBD inhibited CYP-mediated nicotine metabolism. Binding-corrected IC50,u values for CBD inhibition of nicotine metabolism to cotinine and nornicotine, and cotinine metabolism to trans-3'-hydroxycotinine (3HC), were 0.27 ± 0.060, 0.23 ± 0.14, and 0.21 ± 0.14 μM, respectively, for CYP2A6; and 0.26 ± 0.17 and 0.029 ± 0.0050 μM for cotinine and nornicotine formation, respectively, for CYP2B6. 7-OH-CBD IC50,u values were 0.45 ± 0.18, 0.16 ± 0.08, and 0.78 ± 0.23 μM for cotinine, nornicotine, and 3HC formation, respectively, for CYP2A6, and 1.2 ± 0.44 and 0.11 ± 0.030 μM for cotinine and nornicotine formation, respectively, for CYP2B6. Similar IC50,u values were observed in HLM. Inhibition (IC50,u = 0.37 ± 0.06 μM) of 3HC to 3HC-glucuronide formation by UGT1A9 was demonstrated by CBD. Significant inhibition of nicotine metabolism pathways by CBD and 7-OH-CBD suggests that cannabinoids may inhibit nicotine metabolism, potentially impacting tobacco addiction and cessation.
Collapse
Affiliation(s)
- Shamema Nasrin
- Department
of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical
Sciences, Washington State University, Spokane, Washington99223, United States
| | - Shelby Coates
- Department
of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical
Sciences, Washington State University, Spokane, Washington99223, United States
| | - Keti Bardhi
- Department
of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical
Sciences, Washington State University, Spokane, Washington99223, United States
| | - Christy Watson
- Department
of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical
Sciences, Washington State University, Spokane, Washington99223, United States
| | - Joshua E. Muscat
- Penn
State Cancer Institute, Department of Public Health Sciences, Penn State University College of Medicine, Hershey, Pennsylvania17033, United States
| | - Philip Lazarus
- Department
of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical
Sciences, Washington State University, Spokane, Washington99223, United States
| |
Collapse
|
9
|
Siegel SD, Tindle HA, Bergen AW, Tyndale RF, Schnoll R. The Use of Biomarkers to Guide Precision Treatment for Tobacco Use. ADDICTION NEUROSCIENCE 2023; 6. [PMID: 37089247 PMCID: PMC10121195 DOI: 10.1016/j.addicn.2023.100076] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
This review summarizes the evidence to date on the development of biomarkers for personalizing the pharmacological treatment of combustible tobacco use. First, the latest evidence on FDA-approved medications is considered, demonstrating that, while these medications offer real benefits, they do not contribute to smoking cessation in approximately two-thirds of cases. Second, the case for using biomarkers to guide tobacco treatment is made based on the potential to increase medication effectiveness and uptake and reduce side effects. Next, the FDA framework of biomarker development is presented along with the state of science on biomarkers for tobacco treatment, including a review of the nicotine metabolite ratio, electroencephalographic event-related potentials, and other biomarkers utilized for risk feedback. We conclude with a discussion of the challenges and opportunities for the translation of biomarkers to guide tobacco treatment and propose priorities for future research.
Collapse
|
10
|
Pérez-Martín H, Lidón-Moyano C, González-Marrón A, Fu M, Pérez-Ortuño R, Ballbè M, Martín-Sánchez JC, Pascual JA, Fernández E, Martínez-Sánchez JM. Variation in Nicotine Metabolization According to Biological Factors and Type of Nicotine Consumer. Healthcare (Basel) 2023; 11:healthcare11020179. [PMID: 36673548 PMCID: PMC9859072 DOI: 10.3390/healthcare11020179] [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: 11/29/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/10/2023] Open
Abstract
This study aims to describe the nicotine metabolite ratio among tobacco smokers and electronic cigarette (e-cigarette) users and nonusers. We analyzed pooled data from a longitudinal and a cross-sectional study of the adult population from the city of Barcelona. The final sample included information on 166 smokers, 164 e-cigarettes users with nicotine, 41 e-cigarette users without nicotine, 95 dual users (users of both products), and 508 nonusers. We used log-linear models to control for the potential confounding effect of the daily number of cigarettes smoked. Salivary nicotine metabolic rate assessment included the rate of nicotine metabolism (cotinine/nicotine) and the nicotine metabolite ratio (trans-3′-hydroxycotinine/cotinine). Exclusive users of e-cigarette without nicotine have the lowest rate of nicotine metabolism (Geometric mean: 0.08, p-values < 0.001) while cigarette smokers have the highest (Geometric mean: 2.08, p-values < 0.001). Nonusers have lower nicotine metabolic rate than cigarette smokers (Geometric means: 0.23 vs. 0.18, p-value < 0.05). Younger individuals (18−44 years) have a higher rate of nicotine metabolism than older individuals (45−64 years and 65−89) (Geometric means: 0.53 vs. 0.42 and 0.31, respectively, p-values < 0.01) and individuals with lower body mass index (21−25 kg/m2) have a higher rate of nicotine metabolism than the rest (26−30 kg/m2 and 31−60 kg/m2) (Geometric means: 0.52 vs. 0.35 and 0.36, respectively-values < 0.01). Nicotine metabolic rates are useful biomarkers when reporting smoking status and biological differences between individuals.
Collapse
Affiliation(s)
- Hipólito Pérez-Martín
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Carrer de Josep Trueta s/n, 08195 Barcelona, Spain
| | - Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Carrer de Josep Trueta s/n, 08195 Barcelona, Spain
- Correspondence: (C.L.-M.); (A.G.-M.)
| | - Adrián González-Marrón
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Carrer de Josep Trueta s/n, 08195 Barcelona, Spain
- Correspondence: (C.L.-M.); (A.G.-M.)
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d’Oncologia, 08908 Barcelona, Spain
- Tobacco Control Research Group, Epidemiology and Public Health Program, Institut d’Investigació Biomèdica de Bellvitge—IDIBELL, 08908 Barcelona, Spain
- School of Medicine and Health Sciences, Universitat de Barcelona, 08007 Barcelona, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, 28220 Madrid, Spain
| | - Raúl Pérez-Ortuño
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, 08003 Barcelona, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d’Oncologia, 08908 Barcelona, Spain
- Tobacco Control Research Group, Epidemiology and Public Health Program, Institut d’Investigació Biomèdica de Bellvitge—IDIBELL, 08908 Barcelona, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, 28220 Madrid, Spain
- Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Juan Carlos Martín-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Carrer de Josep Trueta s/n, 08195 Barcelona, Spain
| | - José A. Pascual
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona Biomedical Research Park (PRBB), 08003 Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d’Oncologia, 08908 Barcelona, Spain
- Tobacco Control Research Group, Epidemiology and Public Health Program, Institut d’Investigació Biomèdica de Bellvitge—IDIBELL, 08908 Barcelona, Spain
- School of Medicine and Health Sciences, Universitat de Barcelona, 08007 Barcelona, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, 28220 Madrid, Spain
| | - Jose M. Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Carrer de Josep Trueta s/n, 08195 Barcelona, Spain
| |
Collapse
|
11
|
Changes in the salivary cotinine cut-offs to discriminate smokers and non-smokers before and after Spanish smoke-free legislation. Cancer Epidemiol 2022; 80:102226. [PMID: 35878525 DOI: 10.1016/j.canep.2022.102226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/24/2022] [Accepted: 07/15/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION High levels of cotinine in non-smokers indicate passive exposure to tobacco smoke. This study aims to evaluate variations in salivary cotinine cut-offs to discriminate smokers and non-smokers before and after the implementation of smoke-free legislation (Law 28/2005 and Law 42/2010) in a sample of the adult population of Barcelona, Spain. METHODS This longitudinal study analyzes salivary cotinine samples and self-reported information from a representative sample (n = 676) of the adult population from Barcelona before and after the approval of smoke-free legislation. We calculated the receiver operating characteristic (ROC) curves, to obtain optimal cotinine cut-off points to discriminate between smokers and non-smokers overall, by sex and age, and their corresponding sensitivity, specificity, and area under the curve. We used linear mixed-effects models, with individuals as random effects, to model the percentage change of cotinine concentration before and after the implementation of both laws. RESULTS The mean salivary cotinine concentration was significantly lower post-2010 law (-85.8%, p < 0.001). The ROC curves determined that the optimal cotinine cut-off points for discriminating non-smokers and smokers were 10.8 ng/mL (pre-2005 law) and 5.6 ng/mL (post-2010 law), with a post-2010 law sensitivity of 92.6%, specificity of 98.4%, and an area under the curve of 97.0%. The post-2010 law cotinine cut-off points were 5.6 ng/mL for males and 1.9 ng/mL for females. CONCLUSION The implementation of Spanish smoke-free legislation was effective in reducing secondhand smoke exposure and, therefore, also in reducing the cut-off point for salivary cotinine concentration. This value should be used to better assess tobacco smoke exposure in this population.
Collapse
|
12
|
Carroll DM, Murphy S, Meier E, Rhodes K, Dorr C, Braaten G, Jacobson PA, Frizzell L, Tyndale RF, Hatsukami D, Hernandez C. Exploring Potential for a Personalized Medicine Approach to Smoking Cessation With an American Indian Tribe. Nicotine Tob Res 2022; 25:120-126. [PMID: 35661899 PMCID: PMC9717394 DOI: 10.1093/ntr/ntac141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/28/2022] [Accepted: 06/03/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION A potential precision medicine approach to smoking cessation is tailoring pharmacotherapy to a biomarker known as the nicotine metabolite ratio (NMR). Little is known about the potential impact and acceptability of this approach for American Indian (AI) persons. AIMS AND METHODS Tribal-academic collaboration was formed and during 2019-2020 AI adults who smoke(N = 54) were recruited to (1) examine correlations between NMR, dependence, and smoking exposure; (2) assess the extent to which pharmacotherapy preference aligned with NMR-informed recommendations; (3) explore acceptability of NMR-informed pharmacotherapy selection. Participants provided samples for assessment of salivary NMR and urinary total nicotine equivalents (TNE) and completed a questionnaire that assessed cigarettes per day (CPD), Fagerstrom Test for Cigarette Dependence (FTCD), pharmacotherapy preference, and perceptions of NMR-informed pharmacotherapy selection. RESULTS Significant positive correlations were observed between NMR and FTCD (r = 0.29;p = .0383) and its abbreviated version Heaviness of Smoking Index (HIS) (r = 0.28;p =.0426). Post-hoc analyses suggest that relationships between dependence and NMR were driven by time to first cigarette. Nonsignificant, but directionally consistent, relationships were observed between NMR and CPD (r = 0.21; p =0.1436) and TNE (r = 0.24;p = .2906). Most participants preferred nicotine replacement therapy (71%) over varenicline (29%) and preference for pharmacotherapy matched NMR-based recommendations in 54% of participants. NMR-informed pharmacotherapy selection was supported by 62% of participants. CONCLUSION In a sample of AI adults who smoke, NMR was related to cigarette dependence and about one-half of participants' pharmacotherapy preference matched their NMR-informed recommendation. There was lower acceptability of NMR-informed approach in this sample of AI adults than prior studies among white or black/African American people who smoke. IMPLICATIONS Relationships between NMR, dependence, and self-preference for pharmacotherapy suggest that NMR-informed pharmacotherapy selection may have potential for enhancing smoking quitting success in this Tribe. Lower acceptability of NMR-informed pharmacotherapy in this Tribe suggests that this approach may not be equitably utilized. Future work could include identifying community-driven solutions to mitigate precision medicine concerns.
Collapse
Affiliation(s)
- Dana Mowls Carroll
- Corresponding Author: Dana Mowls Carroll, PhD, MPH, 420 Delaware St SE Minneapolis, MN 55455, USA; Telephone: (612)-624-0132; E-mail:
| | - Sharon Murphy
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - Ellen Meier
- Department of Psychology, University of Wisconsin Stevens Point, Stevens Point, WI, USA
| | - Kristine Rhodes
- American Indian Cancer Foundation and Asemaake, LLC, Minneapolis, MN, USA
| | - Casey Dorr
- Department of Nephrology, Hennepin Healthcare Research Institute; Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Greg Braaten
- Minnesota Cancer Clinical Trials Network, Minneapolis, MN, USA
| | - Pamala A Jacobson
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Linda Frizzell
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rachel F Tyndale
- Department of Pharmacology & Toxicology, and Psychiatry, University of Toronto and Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Dorothy Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Carol Hernandez
- Minnesota Cancer Clinical Trials Network, Minneapolis, MN, USA
| |
Collapse
|
13
|
Vogel EA, Benowitz NL, Skan J, Schnellbaecher M, Prochaska JJ. Correlates of the nicotine metabolite ratio in Alaska Native people who smoke cigarettes. Exp Clin Psychopharmacol 2022; 30:359-364. [PMID: 33856821 PMCID: PMC8517031 DOI: 10.1037/pha0000461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research on nicotine metabolism has primarily focused on white adults. This study examined associations between nicotine metabolism, tobacco use, and demographic characteristics among Alaska Native adults who smoke cigarettes. Participants (N = 244) were Alaska Native adults who smoked and who provided a plasma sample at baseline (70.1%) or follow-up (29.9%) of a randomized controlled trial of a cardiovascular risk behavior intervention. At baseline, participants self-reported age, sex, Alaska Native heritage, cigarettes per day, time to first cigarette upon wakening, menthol use, perceived difficulty staying quit, tobacco withdrawal symptoms, and past-month tobacco product use, binge drinking, and cannabis use. At 3-, 6-, 12-, and 18-month follow-ups, participants self-reported 7-day point prevalence abstinence from smoking. Height and weight were measured to calculate body mass index (BMI). Participants' nicotine metabolite ratio (NMR), calculated as the ratio of plasma cotinine and trans-3' hydroxycotinine, was log-transformed. The sample (52.0% male, age M = 47.0 years [SD = 13.8], 60.3% of Inupiaq heritage) averaged 12.5 cigarettes per day (SD = 10.5); 64.0% smoked within 30 min of wakening. NMR was not significantly associated with age, sex, Alaska Native heritage, BMI, cigarettes per day, time to first cigarette upon wakening, menthol use, perceived difficulty staying quit, past-month dual tobacco product use, withdrawal symptoms, past-month binge drinking, past-month cannabis use, or abstinence from smoking (all p-values > .050). Characteristics that relate to NMR in Alaska Native adults may differ from those typically identified among white adults. Specifically, results may suggest that Alaska Native adults with slower nicotine metabolism do not titrate their nicotine intake when smoking. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
- Erin A. Vogel
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | - Neal L. Benowitz
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Jordan Skan
- Alaska Native Tribal Health Consortium, Cardiology Department, Anchorage, AK
| | | | - Judith J. Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| |
Collapse
|
14
|
Leone FT, Evers-Casey S. Tobacco Use Disorder. Med Clin North Am 2022; 106:99-112. [PMID: 34823737 PMCID: PMC8630801 DOI: 10.1016/j.mcna.2021.08.011] [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
Tobacco use disorder is highly prevalent; more than a billion individuals use tobacco worldwide. Popular views on the addictive potential of tobacco often underestimate the complex neural adaptations that underpin continued use. Although sometimes trivialized as a minor substance, effects of nicotine on behavior lead to profound morbidity over a lifetime of exposure. Innovations in processing have led to potent forms of tobacco and delivery devices. Proactive treatment strategies focus on pharmacotherapeutic interventions. Innovations on the horizon hold promise to help clinicians address this problem in a phenotypically tailored manner. Efforts are needed to prevent tobacco use for future generations.
Collapse
Affiliation(s)
- Frank T Leone
- Comprehensive Smoking Treatment Program, Penn Lung Center, Suite 251 Wright-Saunders Building, 51 North 39th Street, Philadelphia, PA, USA; Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
| | - Sarah Evers-Casey
- Comprehensive Smoking Treatment Program, Penn Lung Center, Suite 251 Wright-Saunders Building, 51 North 39th Street, Philadelphia, PA, USA
| |
Collapse
|
15
|
Bergen AW, McMahan CS, McGee S, Ervin CM, Tindle HA, Le Marchand L, Murphy SE, Stram DO, Patel YM, Park SL, Baurley JW. Multiethnic Prediction of Nicotine Biomarkers and Association With Nicotine Dependence. Nicotine Tob Res 2021; 23:2162-2169. [PMID: 34313775 PMCID: PMC8757310 DOI: 10.1093/ntr/ntab124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/11/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The nicotine metabolite ratio and nicotine equivalents are measures of metabolism rate and intake. Genome-wide prediction of these nicotine biomarkers in multiethnic samples will enable tobacco-related biomarker, behavioral, and exposure research in studies without measured biomarkers. AIMS AND METHODS We screened genetic variants genome-wide using marginal scans and applied statistical learning algorithms on top-ranked genetic variants, age, ethnicity and sex, and, in additional modeling, cigarettes per day (CPD), (in additional modeling) to build prediction models for the urinary nicotine metabolite ratio (uNMR) and creatinine-standardized total nicotine equivalents (TNE) in 2239 current cigarette smokers in five ethnic groups. We predicted these nicotine biomarkers using model ensembles and evaluated external validity using dependence measures in 1864 treatment-seeking smokers in two ethnic groups. RESULTS The genomic regions with the most selected and included variants for measured biomarkers were chr19q13.2 (uNMR, without and with CPD) and chr15q25.1 and chr10q25.3 (TNE, without and with CPD). We observed ensemble correlations between measured and predicted biomarker values for the uNMR and TNE without (with CPD) of 0.67 (0.68) and 0.65 (0.72) in the training sample. We observed inconsistency in penalized regression models of TNE (with CPD) with fewer variants at chr15q25.1 selected and included. In treatment-seeking smokers, predicted uNMR (without CPD) was significantly associated with CPD and predicted TNE (without CPD) with CPD, time-to-first-cigarette, and Fagerström total score. CONCLUSIONS Nicotine metabolites, genome-wide data, and statistical learning approaches developed novel robust predictive models for urinary nicotine biomarkers in multiple ethnic groups. Predicted biomarker associations helped define genetically influenced components of nicotine dependence. IMPLICATIONS We demonstrate development of robust models and multiethnic prediction of the uNMR and TNE using statistical and machine learning approaches. Variants included in trained models for nicotine biomarkers include top-ranked variants in multiethnic genome-wide studies of smoking behavior, nicotine metabolites, and related disease. Association of the two predicted nicotine biomarkers with Fagerström Test for Nicotine Dependence items supports models of nicotine biomarkers as predictors of physical dependence and nicotine exposure. Predicted nicotine biomarkers may facilitate tobacco-related disease and treatment research in samples with genomic data and limited nicotine metabolite or tobacco exposure data.
Collapse
Affiliation(s)
- Andrew W Bergen
- Oregon Research Institute, Eugene, OR, USA
- BioRealm, LLC, Walnut, CA, USA
| | - Christopher S McMahan
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC, USA
| | | | | | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
| | - Loïc Le Marchand
- Cancer Epidemiology and University of Hawaii Cancer Center, University of Hawai’i, Honolulu, HI, USA
| | - Sharon E Murphy
- Biochemistry, Molecular Biology, and Biophysics and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Daniel O Stram
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yesha M Patel
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sungshim L Park
- Cancer Epidemiology and University of Hawaii Cancer Center, University of Hawai’i, Honolulu, HI, USA
| | | |
Collapse
|
16
|
Perez-Paramo YX, Lazarus P. Pharmacogenetics factors influencing smoking cessation success; the importance of nicotine metabolism. Expert Opin Drug Metab Toxicol 2021; 17:333-349. [PMID: 33322962 PMCID: PMC8049967 DOI: 10.1080/17425255.2021.1863948] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/10/2020] [Indexed: 01/12/2023]
Abstract
Introduction: Smoking remains a worldwide epidemic, and despite an increase in public acceptance of the harms of tobacco use, it remains the leading cause of preventable death. It is estimated that up to 70% of all smokers express a desire to quit, but only 3-5% of them are successful.Areas covered: The goal of this review was to evaluate the current status of smoking cessation treatments and the feasibility of implementing personalized-medicine approaches to these pharmacotherapies. We evaluated the genetics associated with higher levels of nicotine addiction and follow with an analysis of the genetic variants that affect the nicotine metabolic ratio (NMR) and the FDA approved treatments for smoking cessation. We also highlighted the gaps in the process of translating current laboratory understanding into clinical practice, and the benefits of personalized treatment approaches for a successful smoking cessation strategy.Expert opinion: Evidence supports the use of tailored therapies to ensure that the most efficient treatments are utilized in an individual's smoking cessation efforts. An understanding of the genetic effects on the efficacy of individualized smoking cessation pharmacotherapies is key to smoking cessation, ideally utilizing a polygenetic risk score that considers all genetic variation.
Collapse
Affiliation(s)
- Yadira X. Perez-Paramo
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Philip Lazarus
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| |
Collapse
|
17
|
Verplaetse TL, Peltier MR, Roberts W, Moore KE, Pittman BP, McKee SA. Associations Between Nicotine Metabolite Ratio and Gender With Transitions in Cigarette Smoking Status and E-Cigarette Use: Findings Across Waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) Study. Nicotine Tob Res 2020; 22:1316-1321. [PMID: 32152625 DOI: 10.1093/ntr/ntaa022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/20/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Nicotine metabolite ratio (NMR), the ratio of trans 3'-hydroxycotinine to cotinine, is a biomarker of nicotine metabolism. Discrepant findings among clinical trials and population-based studies warrant replication on whether higher NMR, or faster nicotine metabolism, is associated with quitting cigarette smoking. Associations of NMR and e-cigarette use are largely unknown, as well as the relationship between NMR and gender on quitting cigarette smoking or e-cigarette use. METHODS The Population Assessment of Tobacco and Health (PATH) Study is a nationally representative, longitudinal cohort study assessing tobacco use in the US population. In the current study, the PATH (waves 1 and 2; adult interviews) was used to evaluate longitudinal predictions in relationships among NMR and gender and their association with transitions (quit vs. current stable) in cigarette smoking status and e-cigarette use status across waves 1 and 2 of the PATH study. RESULTS NMR and gender were not significantly associated with quit behavior for combustible cigarettes. Regarding e-cigarettes, a significant two-way interaction demonstrated that women with higher NMR were less likely to quit e-cigarette use compared to women with lower NMR (odds ratio [OR] = 0.10, 95% confidence interval [CI] = 0.02-0.57; p = .01). CONCLUSIONS Findings identify that women with faster nicotine metabolism were 10 times less likely to quit e-cigarettes compared to women with slower nicotine metabolism across waves 1 and 2 of the PATH study. Results suggest that NMR may be used as a biomarker for transitions in e-cigarette quit behavior for women. IMPLICATIONS Findings identify that women with faster nicotine metabolism were 10 times less likely to quit e-cigarettes compared to women with slower nicotine metabolism. Results suggest that NMR may be used as a biomarker for transitions in e-cigarette quit behavior for women. Establishing parameters for NMR collection and for the use of NMR as a biomarker for cigarette smoking behavior and e-cigarette use is an important next step, and may have implications for early intervention and treatment for cessation.
Collapse
Affiliation(s)
| | | | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Kelly E Moore
- Department of Psychology, East Tennessee State University, Johnson City, TN
| | - Brian P Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| |
Collapse
|
18
|
Roberts W, Marotta PL, Verplaetse TL, Peltier MR, Burke C, Ramchandani VA, McKee SA. A prospective study of the association between rate of nicotine metabolism and alcohol use in tobacco users in the United States. Drug Alcohol Depend 2020; 216:108210. [PMID: 32805549 PMCID: PMC7609495 DOI: 10.1016/j.drugalcdep.2020.108210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/13/2020] [Accepted: 07/23/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Rate of nicotine metabolism has been identified as a biochemical risk factor for nicotine use and dependence; however, its role in alcohol consumption and related outcomes is not well understood. The current research examined nicotine metabolism rate as a risk factor for alcohol use among current tobacco users. We also examined sex differences in these associations. METHOD Data were taken from Waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) study, a national longitudinal study of tobacco use and associated health outcomes. The nicotine metabolite ratio (NMR) was calculated as the ratio of trans-3' hydroxycotinine to cotinine in urine samples provided at wave 1. Alcohol use outcomes included past 30-day NIAAA-defined hazardous drinking status, total drinks, and alcohol-related consequences. All analyses controlled for alcohol use at Wave 1. RESULTS NMR at Wave 1 predicted increased odds of meeting hazardous drinking criteria, adjusted odds ratio (aOR) = 1.14, 95 % CI = 1.06; 1.23, p = 0.001, greater total alcohol consumption amount, adjusted rate ratio (aRR) = 1.21, 95 % CI = 1.12; 1.30, p < 0.001, and more alcohol consequences, aRR = 1.07, 95 % CI = 1.01; 1.13, p = 0.018, at wave 2. No significant sex differences were identified. NMR remained a significant predictor of alcohol use in models controlling for severity of nicotine exposure in cigarette smokers. CONCLUSIONS NMR may be a shared risk factor for harmful nicotine and alcohol use that contributes to their co-occurrence.
Collapse
Affiliation(s)
- Walter Roberts
- Department of Psychiatry, Yale School of Medicine, United States.
| | | | | | - MacKenzie R Peltier
- Department of Psychiatry, Yale School of Medicine, United States; Veterans Affairs Connecticut Healthcare System, United States
| | - Catherine Burke
- Department of Psychiatry, Yale School of Medicine, United States
| | - Vijay A Ramchandani
- Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, United States
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, United States
| |
Collapse
|
19
|
Yang J, Hashemi S, Han W, Lee C, Kang Y, Lim Y. Korean male active smokers: quantifying their smoking habits and the transformation factor among biomarkers in urine and blood. Biomarkers 2020; 25:659-669. [PMID: 32912026 DOI: 10.1080/1354750x.2020.1797879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the correlations within the levels of biomarkers in different biological matrices, along with smoking topography variables, among active male smokers in Korea. Accordingly, we defined a transformation factor to convert level of tobacco smoke exposure and impact biomarkers from different biometrics. METHODS We examined smoking topography of recruited volunteers using a self-reporting survey. The level of tobacco smoke exposure and impact biomarkers in subjects' urine and blood were analysed. Results were used to assess the correlations between the topography survey items with biomarkers in biological matrices. The relationship between the biomarkers in urine and blood was analysed. Accordingly, we defined a transformation factor as the ratio of different biomarkers in urine and blood matrices. RESULTS Significant correlations among smoking topography variables and biomarkers were found. Besides, a strong significant association was found among urine and blood cotinine (ρ = 0.817) and NMR (ρ = 0.905). Urine vs blood cotinine and NMR transformation factors were calculated to be 6.17 L-Blood/g-Creatinine and 10.2, respectively. CONCLUSIONS The validated transformation factor connects epidemiological cohort studies with tobacco smoking exposure risk assessment. Hence, this study might be beneficial for further habit-based smoking risk assessments to obtain successful regional cession policies.
Collapse
Affiliation(s)
- Jiyeon Yang
- Institute for Environmental Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Shervin Hashemi
- Institute for Environmental Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wonseok Han
- Institute for Environmental Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chaelin Lee
- Institute for Environmental Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Younseok Kang
- Environment Testing Division, Eurofins Korea Analytic Service Co., Ltd, Anyang, Republic of Korea
| | - Youngwook Lim
- Institute for Environmental Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
20
|
Scoville EA, Tindle HA, Wells QS, Peyton SC, Gurwara S, Pointer SO, Horst SN, Schwartz DA, Adams DW, Freiberg MS, Gatskie V, King S, Abney LR, Beaulieu DB. Precision nicotine metabolism-informed care for smoking cessation in Crohn's disease: A pilot study. PLoS One 2020; 15:e0230656. [PMID: 32214373 PMCID: PMC7098646 DOI: 10.1371/journal.pone.0230656] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/04/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Smoking is a strong risk factor for disease severity in Crohn's disease (CD) and cessation improves outcomes. The nicotine metabolite ratio (NMR) predicts cessation success with pharmacotherapy: varenicline doubles cessation over nicotine replacement therapy (NRT) for "normal", but not "slow" metabolizers. Varenicline side effects are heightened in slow metabolizers. Methods using NMR to optimize cessation pharmacotherapy have not been evaluated in CD. AIMS We aim to determine the prevalence of smoking in a CD population and then assess these smokers' attitudes toward a personalized metabolism-informed care (MIC) approach to cessation. METHODS In this observational study, we surveyed 1098 patients visiting an inflammatory bowel disease center about their smoking history. We then evaluated a subgroup of individuals with CD (n = 32) who participated in a randomized controlled trial of smoking cessation using MIC versus usual care. For MIC, medication selection was informed by the NMR (normal ≥0.31 vs. slow <0.31). The primary outcomes were intervention satisfaction and match rates between NMR and medication choice. RESULTS The baseline prevalence of smoking in our CD population was 13%. Intervention participants reported high rates of satisfaction (85%) and chose a medication that matched their NMR result more often in the MIC group (100% vs. 64%, p = 0.01). Six of 16 (37.5%) patients prescribed varenicline discontinued due to side effects. CONCLUSION MIC produced high rates of satisfaction and matching between NMR and medication in CD patients, supporting patient acceptance and feasibility of precision smoking cessation in this population. To reduce smoking in CD, therapies such as MIC are needed to maximize efficacy and minimize side effects.
Collapse
Affiliation(s)
- Elizabeth A. Scoville
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
| | - Hilary A. Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, United States of America
| | - Quinn S. Wells
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Shannon C. Peyton
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Shelly Gurwara
- Division of Gastroenterology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Stephanie O. Pointer
- Division of Gastroenterology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Sara N. Horst
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - David A. Schwartz
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Dawn W. Adams
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Matthew S. Freiberg
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, United States of America
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Vanessa Gatskie
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Stephen King
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Lesa R. Abney
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Dawn B. Beaulieu
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| |
Collapse
|
21
|
Siegel SD, Lerman C, Flitter A, Schnoll RA. The Use of the Nicotine Metabolite Ratio as a Biomarker to Personalize Smoking Cessation Treatment: Current Evidence and Future Directions. Cancer Prev Res (Phila) 2020; 13:261-272. [PMID: 32132120 PMCID: PMC7080293 DOI: 10.1158/1940-6207.capr-19-0259] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/20/2019] [Accepted: 07/01/2019] [Indexed: 12/15/2022]
Abstract
The nicotine metabolite ratio (NMR), a genetically informed biomarker of rate of nicotine metabolism, has been validated as a tool to select the optimal treatment for individual smokers, thereby improving treatment outcomes. This review summarizes the evidence supporting the development of the NMR as a biomarker of individual differences in nicotine metabolism, the relationship between the NMR and smoking behavior, the clinical utility of using the NMR to personalize treatments for smoking cessation, and the potential mechanisms that underlie the relationship between NMR and smoking cessation. We conclude with a call for additional research necessary to determine the ultimate benefits of using the NMR to personalize treatments for smoking cessation. These future directions include measurement and other methodologic considerations, disseminating this approach to at-risk subpopulations, expanding the NMR to evaluate its efficacy in predicting treatment responses to e-cigarettes and other noncigarette forms of nicotine, and implementation science including cost-effectiveness analyses.See all articles in this Special Collection Honoring Paul F. Engstrom, MD, Champion of Cancer Prevention.
Collapse
Affiliation(s)
- Scott D Siegel
- Value Institute and Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, Delaware.
| | - Caryn Lerman
- Department of Psychiatry and Norris Cancer Center, University of Southern California, Los Angeles, California
| | - Alex Flitter
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
22
|
Carroll DM, Murphy SE, Benowitz NL, Strasser AA, Kotlyar M, Hecht SS, Carmella SG, McClernon FJ, Pacek LR, Dermody SS, Vandrey RG, Donny EC, Hatsukami DK. Relationships between the Nicotine Metabolite Ratio and a Panel of Exposure and Effect Biomarkers: Findings from Two Studies of U.S. Commercial Cigarette Smokers. Cancer Epidemiol Biomarkers Prev 2020; 29:871-879. [PMID: 32051195 DOI: 10.1158/1055-9965.epi-19-0644] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/23/2019] [Accepted: 01/24/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We examined the nicotine metabolite ratio's (NMR) relationship with smoking intensity, nicotine dependence, and a broad array of biomarkers of exposure and biological effect in commercial cigarette smokers. METHODS Secondary analysis was conducted on two cross-sectional samples of adult, daily smokers from Wave 1 (2013-2014) of the Population Assessment of Tobacco Use and Health (PATH) Study and baseline data from a 2014-2017 randomized clinical trial. Data were restricted to participants of non-Hispanic, white race. The lowest quartile of NMR (<0.26) in the nationally representative PATH Study was used to distinguish slow from normal/fast nicotine metabolizers. NMR was modeled continuously in secondary analysis. RESULTS Compared with slow metabolizers, normal/fast metabolizers had greater cigarettes per day and higher levels of total nicotine equivalents, tobacco-specific nitrosamines, volatile organic componds, and polycyclic aromatic hydrocarbons. A novel finding was higher levels of inflammatory biomarkers among normal/fast metabolizers versus slow metabolizers. With NMR modeled as a continuous measure, the associations between NMR and biomarkers of inflammation were not significant. CONCLUSIONS The results are suggestive that normal/fast nicotine metabolizers may be at increased risk for tobacco-related disease due to being heavier smokers, having higher exposure to numerous toxicants and carcinogens, and having higher levels of inflammation when compared with slow metabolizers. IMPACT This is the first documentation that NMR is not only associated with smoking exposure but also biomarkers of biological effects that are integral in the development of tobacco-related disease. Results provide support for NMR as a biomarker for understanding a smoker's exposure and potential risk for tobacco-related disease.
Collapse
Affiliation(s)
- Dana M Carroll
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota. .,Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Sharon E Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Neal L Benowitz
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Kotlyar
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Steve G Carmella
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Francis J McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sarah S Dermody
- School of Psychological Science, Oregon State University, Corvallis, Oregon
| | - Ryan G Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | |
Collapse
|
23
|
Hubacek JA, Kurcova I, Maresova V, Pankova A, Stepankova L, Zvolska K, Lanska V, Kralikova E. SNPs within CHRNA5-A3-B4 and CYP2A6/B6, nicotine metabolite concentrations and nicotine dependence treatment success in smokers. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 165:84-89. [PMID: 31796940 DOI: 10.5507/bp.2019.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/14/2019] [Indexed: 11/23/2022] Open
Abstract
AIM Plasma values of nicotine and its metabolites are highly variable, and this variability has a strong genetic influence. In our study, we analysed the impact of common polymorphisms associated with smoking on the plasma values of nicotine, nicotine metabolites and their ratios and investigated the potential effect of these polymorphisms and nicotine metabolite ratios on the successful treatment of tobacco dependence. METHODS Five variants (rs16969968, rs6474412, rs578776, rs4105144 and rs3733829) were genotyped in a group of highly dependent adult smokers (n=103). All smokers underwent intensive treatment for tobacco dependence; 33 smokers were still abstinent at the 12-month follow-up. RESULTS The rs4105144 (CYP2A6, P<0.005) and rs3733829 (EGLN2, P<0.05) variants were significantly associated with plasma concentrations of 3OH-cotinine and with 3OH-cotinine: cotinine ratios. Similarly, the unweighted gene score was a significant (P<0.05) predictor of both cotinine:nicotine and 3OH-cotinine:cotinine ratios. No associations between the analysed polymorphisms or nicotine metabolite ratios and nicotine abstinence rate were observed. CONCLUSION Although CYP2A6 and EGLN2 polymorphisms were associated with nicotine metabolism ratios, neither these polymorphisms nor the ratios were associated with abstinence rates.
Collapse
Affiliation(s)
- Jaroslav A Hubacek
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ivana Kurcova
- Department of Toxicology and Forensic Medicine, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Vera Maresova
- Department of Toxicology and Forensic Medicine, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Alexandra Pankova
- Centre for Tobacco-Dependent, 3rd Department of Medicine - Department of Endocrinology and Metabolism, 1st Faculty of Medicine, Charles University and the General University Hospital in Prague, Czech Republic.,Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University and the General University Hospital in Prague, Czech Republic
| | - Lenka Stepankova
- Centre for Tobacco-Dependent, 3rd Department of Medicine - Department of Endocrinology and Metabolism, 1st Faculty of Medicine, Charles University and the General University Hospital in Prague, Czech Republic
| | - Kamila Zvolska
- Centre for Tobacco-Dependent, 3rd Department of Medicine - Department of Endocrinology and Metabolism, 1st Faculty of Medicine, Charles University and the General University Hospital in Prague, Czech Republic
| | - Vera Lanska
- Statistical Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Eva Kralikova
- Centre for Tobacco-Dependent, 3rd Department of Medicine - Department of Endocrinology and Metabolism, 1st Faculty of Medicine, Charles University and the General University Hospital in Prague, Czech Republic.,Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University and the General University Hospital in Prague, Czech Republic
| |
Collapse
|
24
|
Jain RB. Nicotine metabolite ratios in serum and urine among US adults: variations across smoking status, gender and race/ethnicity. Biomarkers 2019; 25:27-33. [PMID: 31686544 DOI: 10.1080/1354750x.2019.1688866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: The objective of this study was to evaluate factors affecting variabilities in the observed levels of nicotine metabolite ratios in serum (NMRS, N = 10,234) and urine (NMRU, N = 2286) for US adults aged ≥20 years.Materials and methods: Data from NHANES were used to fit regression models for log10 transformed values of NMRS and NMRU stratified by gender and smoking status.Results: Females had higher NMRS than males among both smokers and non-smokers. Females had lower NMRU than males among both smokers and non-smokers. Smokers had lower levels of both NMRS and NMRU among both males and females. The order in which NMRS by race/ethnicity was observed was non-Hispanic whites > Hispanics and others > non-Hispanic blacks. The order in which NMRU by race/ethnicity was observed was non-Hispanic blacks > non-Hispanic whites > Hispanics and others. Most of the pairwise differences between non-Hispanic blacks and whites were statistically significant (p ≤ 0.02). Exposure to environmental tobacco smoke (ETS) at home was associated with higher NMRU among male smokers (2.13 vs. 1.41, p = 0.01).Conclusions: Data on nicotine metabolite ratios can be used to study differences in how nicotine is metabolized by males and females and by smokers and non-smokers.
Collapse
|
25
|
Wells QS, Freiberg MS, Greevy RA, Tyndale RF, Kundu S, Duncan MS, King S, Abney L, Scoville E, Beaulieu DB, Gatskie V, Tindle HA. Nicotine Metabolism-informed Care for Smoking Cessation: A Pilot Precision RCT. Nicotine Tob Res 2019; 20:1489-1496. [PMID: 29059367 DOI: 10.1093/ntr/ntx235] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/13/2017] [Indexed: 11/14/2022]
Abstract
Introduction Varenicline doubles cessation over nicotine replacement therapy (NRT) patch for "normal," but not "slow," nicotine metabolizers, as assessed by the nicotine metabolite ratio (NMR). Metabolism-informed care (MIC) could improve outcomes by matching normal metabolizers with non-nicotine medication (e.g., varenicline) and slow metabolizers with NRT patch. Methods We conducted a feasibility randomized controlled trial of MIC versus guideline based care (GBC) among 81 outpatient adult daily smokers with medical comorbidity. Participants reported perceptions of MIC, underwent blood draw for NMR, and received expert cessation counseling. For MIC participants, medication selection was informed by NMR result (normal (≥0.31) vs. slow (< 0.31)). The primary outcome was MIC feasibility, reflected by attitudes toward MIC and by match rates between NMR and medication. Secondary endpoints (cessation confidence, medication use, smoking status) were assessed over 6 months to inform future studies. Results Participants were median age 53 years, 46% female, 28% black, and ~90% endorsed MIC. Despite high varenicline prescription rates (~60%) in both arms, NMR-medication matching was higher in MIC (84%) versus GBC (58%) participants (p=0.02); unadjusted odds ratio (OR) 3.67, 95% confidence interval [1.33, 11.00; p-value=0.02]. Secondary endpoints were similar at 1, 3, and 6 months. Conclusions MIC, an NMR-based precision approach to smoking cessation, was acceptable to 90% of smokers and improved NMR-medication match rates more than 3-fold compared to GBC, even with generally high use of varenicline. These data support the feasibility of MIC, which could maximize efficacy of smoking cessation medication while minimizing side effects and cost. Implications Among treatment-seeking daily smokers with medical comorbidity, most viewed metabolism-informed care (MIC), guided by the nicotine metabolism ratio (NMR), favorably, and were willing to accept MIC-guided medication. Compared to GBC participants (58%), more MIC participants (84%) were prescribed NMR-matched medication (i.e., normal metabolizers received varenicline; slow metabolizers received NRT patch). MIC increased the odds of optimized matching between NMR and medication more than 3-fold over GBC. Because the number needed to treat (NNT) to help one normal metabolizer quit smoking is only 4.9 for varenicline versus 26 for patch, broad implementation of MIC will improve drug efficacy in normal metabolizers as well as minimize side effects in slow metabolizers.
Collapse
Affiliation(s)
- Quinn S Wells
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Departments of Psychiatry, Pharmacology and Toxicology, University of Toronto, Ontario, Canada
| | - Suman Kundu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Meredith S Duncan
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Stephen King
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Lesa Abney
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Elizabeth Scoville
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Dawn B Beaulieu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Vanessa Gatskie
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
26
|
Schnoll RA, Thompson M, Serrano K, Leone F, Metzger D, Frank I, Gross R, Mounzer K, Tyndale RF, Weisbrot J, Meline M, Collman RG, Ashare RL. Brief Report: Rate of Nicotine Metabolism and Tobacco Use Among Persons With HIV: Implications for Treatment and Research. J Acquir Immune Defic Syndr 2019; 80:e36-e40. [PMID: 30399039 PMCID: PMC6331237 DOI: 10.1097/qai.0000000000001895] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The nicotine metabolite ratio (NMR) is a biomarker that represents individual variation in the speed that nicotine is metabolized. The rate of nicotine metabolism alters smoking behavior (eg, amount) and has been validated for personalizing tobacco dependence medication selection to increase treatment efficacy and reduce treatment side effects in the general population of smokers. Although smoking rates are extremely high among those with HIV, the NMR has not been evaluated in this underserved population. METHODS We used baseline data from a smoking cessation clinical trial for smokers with HIV (N = 131) to examine associations between NMR and demographic, smoking, disease-related, and psychological characteristics. Pearson r and analysis of variance were used to identify univariate correlates of NMR, which were then entered into a multiple linear regression model. RESULTS In univariate analyses, a higher NMR (faster nicotine metabolism) was associated with being white, and more cigarettes per day, nicotine dependence, exhaled carbon monoxide, and symptoms of depression and anxiety, and using efavirenz. In a multiple regression model, a higher NMR was associated with more cigarettes per day, higher anxiety symptoms, and efavirenz use. CONCLUSIONS As in other populations, faster nicotine metabolism was associated with the use of more cigarettes and higher anxiety symptoms. Notably, efavirenz use was associated with faster metabolism, which might make it harder to quit smoking for people with HIV treated with that medication. These findings could help guide further study and the clinical use of the NMR to personalize nicotine dependence treatment in this underserved population.
Collapse
Affiliation(s)
- Robert A. Schnoll
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA; ; ; ; ; ; ;
| | - Morgan Thompson
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA; ; ; ; ; ; ;
| | - Katrina Serrano
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA; ; ; ; ; ; ;
| | - Frank Leone
- Pulmonary, Allergy, & Critical Care Division, University of Pennsylvania Presbyterian Medical Center, 51 N. 39th Street, Philadelphia, PA 19104, USA;
| | - David Metzger
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA; ; ; ; ; ; ;
| | - Ian Frank
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, 3610 Hamilton Walk, Philadelphia, PA 19104, USA;
| | - Robert Gross
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, 3610 Hamilton Walk, Philadelphia, PA 19104, USA;
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Karam Mounzer
- Philadelphia Fight, 1233 Locust Street, 3rd Floor, Philadelphia, PA 19107, USA;
| | - Rachel F. Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health and Department of Pharmacology and Toxicology, and Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto; 1 King’s College Circle, Toronto, Canada M5S 1A8;
| | - Jessica Weisbrot
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA; ; ; ; ; ; ;
| | - Miles Meline
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA; ; ; ; ; ; ;
| | - Ronald G. Collman
- Pulmonary, Allergy & Critical Care, University of Pennsylvania School of Medicine 522 Johnson Pavilion, 36th & Hamilton Walk, Philadelphia, PA 19104;
| | - Rebecca L. Ashare
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA; ; ; ; ; ; ;
| |
Collapse
|
27
|
Shahab L, Bauld L, McNeill A, Tyndale RF. Does the nicotine metabolite ratio moderate smoking cessation treatment outcomes in real-world settings? A prospective study. Addiction 2019; 114:304-314. [PMID: 30276911 PMCID: PMC6492100 DOI: 10.1111/add.14450] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/18/2018] [Accepted: 09/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS In smoking treatment trials comparing varenicline with transdermal nicotine replacement therapy (NRT), stratified by nicotine metabolite (3-hydroxycotinine/cotinine) ratio (NMR), the relative benefit of varenicline is greater among normal rather than slow metabolizers. This study tested if the relative effectiveness of varenicline and NRT is associated with NMR status in a natural treatment setting. A secondary aim was to test if this relationship is moderated by behavioural support. DESIGN Prospective observational multi-centre study with 4-week and 52-week follow-up. SETTING Nine English Stop Smoking Services (SSS). PARTICIPANTS Data came from 1556 smokers (aged ≥ 16 years) attending SSS between March 2012 and March 2013. INTERVENTIONS Participants received pharmacotherapy together with behavioural support. MEASUREMENTS The primary outcome was carbon monoxide-verified continuous abstinence at both follow-up times. Main explanatory variables were (1) NMR status [slow (NMR < 0.31, n = 451) versus normal (NMR ≥ 0.31, n = 1105) metabolizers]; (2) pharmacotherapy (varenicline versus NRT) and (3) behavioural support (individual versus group-based treatment). Analyses adjusted for baseline socio-demographic, SSS, mental/physical health and smoking characteristics. FINDINGS Of participants, 44.2% [95% confidence interval (CI) = 41.7-46.6%] and 8.0% (95% CI = 6.8-9.5%) were continuously abstinent at 4 and 52 weeks. Varenicline was more effective than NRT at 4 weeks (P < 0.001) but only marginally so at 52 weeks (P = 0.061). There was no or inclusive evidence that NMR status moderated relative efficacy of varenicline and NRT at 4- [P = 0.60, Bayes factor (BF) = 0.25] or 52-week follow-ups (P = 0.74, BF = 0.73). However, this relationship was moderated by behavioural support (p = 0.012): the relative benefit of varenicline over NRT at 52-week follow-up was greater in slow, not normal, metabolizers receiving group rather than individual support (P = 0.012). CONCLUSIONS In a real-world setting, the nicotine metabolite ratio status of treatment-seeking smokers does not appear to contribute substantially to the differential effectiveness of varenicline and nicotine replacement therapy in Stop Smoking Services, when both pharmacotherapy and behavioural support are self-selected.
Collapse
Affiliation(s)
- Lion Shahab
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
- UK Centre for Tobacco and Alcohol StudiesNottinghamUK
| | - Linda Bauld
- UK Centre for Tobacco and Alcohol StudiesNottinghamUK
- Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol StudiesNottinghamUK
- Addictions DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Rachel F. Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH) and Departments of Psychiatry and Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
| |
Collapse
|
28
|
Nicotine metabolite ratio predicts smoking topography: The Pennsylvania Adult Smoking Study. Drug Alcohol Depend 2018; 190:89-93. [PMID: 29990649 PMCID: PMC6348467 DOI: 10.1016/j.drugalcdep.2018.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND The nicotine metabolite ratio (NMR) as measured by the ratio of 3'hydroxycotinine to cotinine has been examined in relation to tobacco use patterns including cigarettes per day and quit success to determine its role in nicotine dependence. We examined the NMR in relation to smoking topography and tested the hypothesis that normal metabolizers have a greater total daily puff volume than slow metabolizers. METHODS The Pennsylvania Adult Smoking Study (PASS) is a longitudinal study of 352 adults who smoked, on average, 17 cigarettes per day. Subjects used a portable smoking topography device over a two-day period at home and at work. We measured the ratio of 3'hydroxycotinine to cotinine in the saliva of the subjects. RESULTS In multiple linear regression analyses, a higher rate of nicotine metabolism was significantly associated with increased daily puffs and total daily puff volume. In a mediation analysis, a significant, indirect effect of race on the relationship between NMR and puff volume was observed, with 22% of the effect mediated by white race. A higher NMR was also associated with female gender, white race, cigarettes per day and nicotine dependence measures. CONCLUSION The NMR was associated with tobacco use patterns including smoking topography. Faster nicotine metabolism was associated with greater total daily puffs and puff volume.
Collapse
|
29
|
Clyde M, Pipe A, Els C, Reid R, Fu A, Clark A, Tulloch H. Nicotine metabolite ratio and smoking outcomes using nicotine replacement therapy and varenicline among smokers with and without psychiatric illness. J Psychopharmacol 2018; 32:979-985. [PMID: 29788791 DOI: 10.1177/0269881118773532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION It has been suggested that the effectiveness of nicotine replacement smoking cessation pharmacotherapy may be enhanced by assessing rates of nicotine metabolism using the nicotine metabolite ratio - which reflects differences in the activity of the CYP2A6 hepatic enzyme - and titrating doses appropriately. To date, supporting evidence is equivocal, with little information regarding the assessment and effectiveness of the nicotine metabolite ratio among smokers with psychiatric conditions. METHODS The nicotine metabolite ratio of 499 smokers from the FLEX trial was determined using urine samples obtained at baseline. They were randomized to receive either: standard transdermal nicotine (nicotine replacement therapy); extended nicotine replacement therapy + adjunct nicotine agent; or varenicline. Primary cessation outcomes were seven-day point prevalence at 5, 10, 22, and 52 weeks post-target quit date, comparing across treatment and psychiatric status. Our principal analysis employed logistic regression (outcome: abstinence), using slow metabolizers as the reference category. RESULTS No differences were observed by nicotine metabolite ratio classification (slow, moderate, fast) with respect to any demographic or smoking-related variables. Nicotine metabolite ratio class did not predict smoking cessation in either the overall sample, or by treatment condition at any time-point (week 52 moderate metabolizers: odds ratio 1.34, 95% confidence interval (0.68-2.63), p=0.394; fast metabolizers: odds ratio 1.04 (0.56-1.91), p=0. 906). CONCLUSION Our results did not find any associations between nicotine metabolite ratio and cessation outcomes among smokers using nicotine replacement therapy or varenicline with and without lifetime psychiatric conditions.
Collapse
Affiliation(s)
- Matthew Clyde
- 1 University of Ottawa Heart Institute, ON, Canada.,2 Department of Psychology, University of Ottawa, ON, Canada
| | - Andrew Pipe
- 1 University of Ottawa Heart Institute, ON, Canada.,3 Faculty of Medicine, University of Ottawa, ON, Canada
| | - Charl Els
- 4 Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Robert Reid
- 1 University of Ottawa Heart Institute, ON, Canada.,3 Faculty of Medicine, University of Ottawa, ON, Canada
| | - Angel Fu
- 3 Faculty of Medicine, University of Ottawa, ON, Canada
| | - Alexa Clark
- 3 Faculty of Medicine, University of Ottawa, ON, Canada
| | - Heather Tulloch
- 1 University of Ottawa Heart Institute, ON, Canada.,3 Faculty of Medicine, University of Ottawa, ON, Canada
| |
Collapse
|
30
|
Smith TT, Rupprecht LE, Denlinger-Apte RL, Weeks JJ, Panas RS, Donny EC, Sved AF. Animal Research on Nicotine Reduction: Current Evidence and Research Gaps. Nicotine Tob Res 2018; 19:1005-1015. [PMID: 28379511 DOI: 10.1093/ntr/ntx077] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 03/31/2017] [Indexed: 01/21/2023]
Abstract
A mandated reduction in the nicotine content of cigarettes may improve public health by reducing the prevalence of smoking. Animal self-administration research is an important complement to clinical research on nicotine reduction. It can fill research gaps that may be difficult to address with clinical research, guide clinical researchers about variables that are likely to be important in their own research, and provide policy makers with converging evidence between clinical and preclinical studies about the potential impact of a nicotine reduction policy. Convergence between clinical and preclinical research is important, given the ease with which clinical trial participants can access nonstudy tobacco products in the current marketplace. Herein, we review contributions of preclinical animal research, with a focus on rodent self-administration, to the science of nicotine reduction. Throughout this review, we highlight areas where clinical and preclinical research converge and areas where the two differ. Preclinical research has provided data on many important topics such as the threshold for nicotine reinforcement, the likelihood of compensation, moderators of the impact of nicotine reduction, the impact of environmental stimuli on nicotine reduction, the impact of nonnicotine cigarette smoke constituents on nicotine reduction, and the impact of nicotine reduction on vulnerable populations. Special attention is paid to current research gaps including the dramatic rise in alternative tobacco products, including electronic nicotine delivery systems (ie, e-cigarettes). The evidence reviewed here will be critical for policy makers as well as clinical researchers interested in nicotine reduction. IMPLICATIONS This review will provide policy makers and clinical researchers interested in nicotine reduction with an overview of the preclinical animal research conducted on nicotine reduction and the regulatory implications of that research. The review also highlights the utility of preclinical research for research questions related to nicotine reduction.
Collapse
Affiliation(s)
- Tracy T Smith
- University of Pittsburgh Cancer Institute, Pittsburgh, PA.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Laura E Rupprecht
- Center for Neuroscience at the University of Pittsburgh, Pittsburgh, PA
| | - Rachel L Denlinger-Apte
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
| | - Jillian J Weeks
- Center for Neuroscience at the University of Pittsburgh, Pittsburgh, PA
| | - Rachel S Panas
- Center for Neuroscience at the University of Pittsburgh, Pittsburgh, PA
| | - Eric C Donny
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Alan F Sved
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA.,Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
31
|
Kranzler HR, Smith RV, Schnoll R, Moustafa A, Greenstreet-Akman E. Precision medicine and pharmacogenetics: what does oncology have that addiction medicine does not? Addiction 2017; 112:2086-2094. [PMID: 28431457 PMCID: PMC5650957 DOI: 10.1111/add.13818] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/08/2017] [Accepted: 03/08/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Precision, personalized or stratified medicine, which promises to deliver the right treatment to the right patient, is a topic of international interest in both the lay press and the scientific literature. A key aspect of precision medicine is the identification of biomarkers that predict the response to medications (i.e. pharmacogenetics). We examined why, despite the great strides that have been made in biomarker identification in many areas of medicine, only in oncology has there been substantial progress in their clinical implementation. We also considered why progress in this effort has lagged in addiction medicine. METHODS We compared the development of pharmacogenetic biomarkers in oncology, cardiovascular medicine (where developments are also promising) and addictive disorders. RESULTS The first major reason for the success of oncologic pharmacogenetics is ready access to tumor tissue, which allows in-vitro testing and insights into cancer biology. The second major reason is funding, with cancer research receiving, by far, the largest allocation by the National Institutes of Health (NIH) during the past two decades. The second largest allocation of research funding has gone to cardiovascular disease research. Addictions research received a much smaller NIH funding allocation, despite the major impact that tobacco use, alcohol consumption and illicit drug use have on the public health and healthcare costs. CONCLUSIONS Greater support for research on the personalized treatment of addictive disorders can be expected to yield disproportionately large benefits to the public health and substantial reductions in healthcare costs.
Collapse
Affiliation(s)
- Henry R. Kranzler
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
- Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, PA 19104
| | - Rachel V. Smith
- Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, PA 19104
| | - Robert Schnoll
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Afaf Moustafa
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Emma Greenstreet-Akman
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| |
Collapse
|
32
|
Fix BV, O’Connor RJ, Benowitz N, Heckman BW, Cummings KM, Fong GT, Thrasher JF. Nicotine Metabolite Ratio (NMR) Prospectively Predicts Smoking Relapse: Longitudinal Findings From ITC Surveys in Five Countries. Nicotine Tob Res 2017; 19:1040-1047. [PMID: 28387850 PMCID: PMC5896535 DOI: 10.1093/ntr/ntx083] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 04/05/2017] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The ratio of trans 3'-hydroxycotinine (3HC) to cotinine (nicotine metabolite ratio [NMR]) is a biomarker of the rate of nicotine metabolism, with higher NMR indicating faster metabolism. Higher NMR has been found to be associated with higher daily cigarette consumption and less success stopping smoking in cessation trials. This study examines differences in NMR among population-based samples of smokers in the five countries and explores the relationship between NMR and smoking abstinence. METHODS Participants (N = 874) provided saliva samples during International Tobacco Control (ITC) surveys in the United States, United Kingdom, Mauritius, Mexico, and Thailand conducted in 2010/2011 with follow-up surveys in 2012/2013. When all samples were received, they were sent to a common laboratory for analysis using liquid chromatography and tandem mass spectroscopy. RESULTS There was significant variation in NMR across countries (F = 15.49, p < .001). Those who reported smoking at follow-up had a mean NMR of 0.32, compared to a mean NMR of 0.42 in participants who reported that they had stopped (F = 8.93; p = .003). Higher mean NMR values were also associated with longer quit duration (p = .007). There was no substantial difference in NMR between current smokers who made a failed quit attempt and those who made no attempt-both had significantly lower NMR compared to those who quit and remained abstinent. Smokers with a higher NMR were more likely to report that they stopped smoking compared to those with a lower NMR (odds ratio = 2.67; 95% confidence interval: 1.25 to 5.68). CONCLUSIONS These results suggest faster nicotine metabolizers may be less likely to relapse following a quit attempt. This finding differs from results of clinical trials testing stop smoking medications, where slower metabolizers have been found to be more likely to maintain abstinence from smoking. IMPLICATIONS Results of this study suggest faster nicotine metabolizers may be less likely to relapse following a quit attempt. This finding differs from results of clinical trials testing stop smoking medications, where slower metabolizers have been found to be more likely to maintain abstinence from smoking.
Collapse
Affiliation(s)
- Brian V Fix
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | - Richard J O’Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | | | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia SC; Department of Tobacco Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| |
Collapse
|
33
|
Allenby CE, Boylan KA, Lerman C, Falcone M. Precision Medicine for Tobacco Dependence: Development and Validation of the Nicotine Metabolite Ratio. J Neuroimmune Pharmacol 2016; 11:471-83. [PMID: 26872457 PMCID: PMC5479354 DOI: 10.1007/s11481-016-9656-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
Quitting smoking significantly reduces the risk of tobacco-related morbidity and mortality, yet there is a high rate of relapse amongst smokers who try to quit. Phenotypic biomarkers have the potential to improve smoking cessation outcomes by identifying the best available treatment for an individual smoker. In this review, we introduce the nicotine metabolite ratio (NMR) as a reliable and stable phenotypic measure of nicotine metabolism that can guide smoking cessation treatment among smokers who wish to quit. We address how the NMR accounts for sources of variation in nicotine metabolism including genotype and other biological and environmental factors such as estrogen levels, alcohol use, body mass index, or menthol exposure. Then, we highlight clinical trials that validate the NMR as a biomarker to predict therapeutic response to different pharmacotherapies for smoking cessation. Current evidence supports the use of nicotine replacement therapy for slow metabolizers, and non-nicotine treatments such as varenicline for normal metabolizers. Finally, we discuss future research directions to elucidate mechanisms underlying NMR associations with treatment response, and facilitate the implementation of the NMR as biomarker in clinical practice to guide smoking cessation.
Collapse
Affiliation(s)
- Cheyenne E Allenby
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, 19104, USA
| | - Kelly A Boylan
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, 19104, USA
| | - Caryn Lerman
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, 19104, USA
| | - Mary Falcone
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, 19104, USA.
| |
Collapse
|
34
|
Van Overmeire IP, De Smedt T, Dendale P, Nackaerts K, Vanacker H, Vanoeteren JF, Van Laethem DM, Van Loco J, De Cremer KA. Nicotine Dependence and Urinary Nicotine, Cotinine and Hydroxycotinine Levels in Daily Smokers. Nicotine Tob Res 2016; 18:1813-9. [DOI: 10.1093/ntr/ntw099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 04/03/2016] [Indexed: 12/25/2022]
|
35
|
Abstract
Introduction: Common short screening measures of dependence that use number of cigarettes per day may not be appropriate for use in populations of occasional smokers.Aims: In this study, we investigate whether perceived addiction (PA) predicts quit attempts and successful cessation among occasional smokers.Methods: Current occasional smokers (18+) in the Ontario Tobacco Survey (OTS) longitudinal cohort study followed up every six months for up to three years. Respondents rated their self-perceived level of addiction (very vs. somewhat or not very addicted). Generalised Estimating Equation models and proportional hazard models were used to test the predictive ability of PA.Results/Findings: Occasional smokers with very high PA had a higher likelihood of reporting a quit attempt (RR: 2.49; 95% CI: 1.88, 3.30) after adjusting for demographics. Given an incident quit attempt, occasional smokers who reported being very addicted were 2.93 times more likely to relapse (95%: 2.01, 4.28). The effect of PA was independent of other predictors of smoking behaviour.Conclusions: For some, occasional smokers, smoking cessation is a difficult process that may require significant support. Asking occasional smokers about PA is an effective way to predict likely success in quitting smokers that may be easily assessed in population based, as well as in community and clinical, settings.
Collapse
|
36
|
Kaufmann A, Hitsman B, Goelz PM, Veluz-Wilkins A, Blazekovic S, Powers L, Leone FT, Gariti P, Tyndale RF, Schnoll RA. Rate of nicotine metabolism and smoking cessation outcomes in a community-based sample of treatment-seeking smokers. Addict Behav 2015; 51:93-9. [PMID: 26240944 DOI: 10.1016/j.addbeh.2015.07.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/16/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In samples from controlled randomized clinical trials, a smoker's rate of nicotine metabolism, measured by the 3-hydroxycotinine to cotinine ratio (NMR), predicts response to transdermal nicotine. Replication of this relationship in community-based samples of treatment-seeking smokers may help guide the implementation of the NMR for personalized treatment for nicotine dependence. METHODS Data from a community-based sample of treatment seeking smokers (N=499) who received 8weeks of transdermal nicotine and 4 behavioral counseling sessions were used to evaluate associations between the NMR and smoking cessation. Secondary outcomes included withdrawal and craving, depression and anxiety, side effects, and treatment adherence. RESULTS The NMR was a significant predictor of abstinence (OR=.56, 95% CI: 0.33-0.95, p=.03), with faster metabolizers showing lower quit rates than slower metabolizers (24% vs. 33%). Faster nicotine metabolizers exhibited significantly higher levels of anxiety symptoms over time during treatment, vs. slower metabolizers (NMR x Time interaction: F[3,357]=3.29, p=.02). NMR was not associated with changes in withdrawal, craving, depression, side effects, and treatment adherence (p's>.05). CONCLUSIONS In a community-based sample of treatment-seeking smokers, faster nicotine metabolizers were significantly less likely to quit smoking and showed higher rates of anxiety symptoms during a smoking cessation treatment program, vs. slower nicotine metabolizers. These results provide further evidence that transdermal nicotine is less effective for faster nicotine metabolizers and suggest the need to address cessation-induced anxiety symptoms among these smokers to increase the chances for successful smoking cessation.
Collapse
|
37
|
Bowker K, Lewis S, Coleman T, Cooper S. Changes in the rate of nicotine metabolism across pregnancy: a longitudinal study. Addiction 2015; 110:1827-32. [PMID: 26119134 PMCID: PMC5014174 DOI: 10.1111/add.13029] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 03/30/2015] [Accepted: 06/22/2015] [Indexed: 12/18/2022]
Abstract
AIMS Increased nicotine metabolism during pregnancy could explain why nicotine replacement therapy (NRT) appears to be less effective on smoking cessation in pregnancy than in non-pregnant smokers, but little is known about nicotine metabolism across pregnancy. This study was conducted to determine when changes in nicotine metabolism occur during pregnancy and to describe the magnitude of these changes. DESIGN Longitudinal cohort study of pregnant smokers' nicotine metabolite ratio (NMR). SETTING AND PARTICIPANTS 101 pregnant smokers recruited from hospital antenatal clinics in Nottingham, UK were asked to provide saliva samples at 8-14 weeks (n = 98), 18-22 weeks (n = 65), 32-36 weeks gestation (n = 47), 4 weeks postpartum (n = 44) and 12 weeks postpartum (n = 47). MEASUREMENTS Nicotine metabolite ratio (NMR) was measured using the ratio of cotinine to its primary metabolite trans-3'-hydroxycotinine. Multi-level modelling was used to detect any overall difference in NMR between time points. The 12 week postpartum NMR was compared with the NMRs collected antenatally and 4 weeks postpartum. FINDINGS NMR changed over time (p = 0.0006). Compared with NMR at 12 weeks postpartum, NMR was significantly higher at 18-22 weeks (26% higher, 95% CI 12% to 38%) and 32-36 weeks (23% higher, 95% CI 9% to 35%). There was no significant difference between the 8-14 weeks gestation or 4 weeks postpartum NMR and 12 weeks postpartum. CONCLUSIONS Nicotine metabolism appears to be faster during pregnancy; this faster metabolism is apparent from 18 to 22 weeks of pregnancy and appears to fall by 4 weeks after childbirth.
Collapse
Affiliation(s)
- Katharine Bowker
- UK Centre for Tobacco and Alcohol Studies and NIHR School for Primary Care Research, Division of Primary CareUniversity of Nottingham Medical SchoolNottinghamUK
| | - Sarah Lewis
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public HealthUniversity of NottinghamNottinghamUK
| | - Tim Coleman
- UK Centre for Tobacco and Alcohol Studies and NIHR School for Primary Care Research, Division of Primary CareUniversity of Nottingham Medical SchoolNottinghamUK
| | - Sue Cooper
- UK Centre for Tobacco and Alcohol Studies and NIHR School for Primary Care Research, Division of Primary CareUniversity of Nottingham Medical SchoolNottinghamUK
| |
Collapse
|
38
|
De Kesel PMM, Lambert WE, Stove CP. Alternative Sampling Strategies for Cytochrome P450 Phenotyping. Clin Pharmacokinet 2015; 55:169-84. [DOI: 10.1007/s40262-015-0306-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
39
|
Vaz LR, Coleman T, Cooper S, Aveyard P, Leonardi-Bee J. The Nicotine Metabolite Ratio in Pregnancy Measured by trans-3'-Hydroxycotinine to Cotinine Ratio: Characteristics and Relationship With Smoking Cessation. Nicotine Tob Res 2015; 17:1318-23. [PMID: 25589677 DOI: 10.1093/ntr/ntu342] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 12/24/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Nicotine replacement therapy (NRT) helps nonpregnant smokers quit, but there is no evidence that standard dose NRT is effective in pregnancy. As nicotine metabolism increases in pregnancy, this could reduce NRT efficacy. Using the ratio of trans-3'-hydroxycotinine to cotinine, the nicotine metabolite ratio (NMR), we investigated relationships between the rate of nicotine metabolism, maternal characteristics and smoking cessation in pregnant women recruited to a randomized controlled trial of NRT. METHODS Data from 1,050 pregnant smokers in the Smoking, Nicotine and Pregnancy trial who were of 12-24 weeks gestation had exhaled carbon monoxide readings of ≥8 ppm at recruitment and who were randomized to NRT or placebo patches were used. Linear and logistic regression investigated associations between maternal characteristics and NMR and also between NMR and subsequent validated cessation from smoking. RESULTS Six hundred and sixty-two women (63%) provided blood samples for NMR estimation. Higher NMR was associated with increased cigarette consumption prior to pregnancy. At 1 month (odds ratio [OR] = 0.87; 95% CI = 0.76-0.99; p = .043) and delivery (OR = 0.79; 95% CI = 0.66-0.95; p = .010), there was a significant negative association between a 0.1 unit increase in NMR and odds of achieving cessation after adjusting for possible confounders. There was no evidence for an interaction between a 0.1 unit increase in NMR and treatment assignment on the odds of cessation at 1 month post-quit date (p = .556). CONCLUSION Pregnant women who metabolize nicotine more rapidly are less likely to achieve cessation when they try to quit smoking. There is no evidence that NRT is more effective in women who metabolize nicotine more slowly.
Collapse
Affiliation(s)
- Luis R Vaz
- U.K. Centre for Tobacco and Alcohol Studies and NIHR School for Primary Care Research Division of Primary Care, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK;
| | - Tim Coleman
- U.K. Centre for Tobacco and Alcohol Studies and NIHR School for Primary Care Research Division of Primary Care, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| | - Sue Cooper
- U.K. Centre for Tobacco and Alcohol Studies and NIHR School for Primary Care Research Division of Primary Care, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| | - Paul Aveyard
- U.K. Centre for Tobacco and Alcohol Studies, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jo Leonardi-Bee
- U.K. Centre for Tobacco and Alcohol Studies Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | | |
Collapse
|
40
|
Schnoll RA, George TP, Hawk L, Cinciripini P, Wileyto P, Tyndale RF. The relationship between the nicotine metabolite ratio and three self-report measures of nicotine dependence across sex and race. Psychopharmacology (Berl) 2014; 231:2515-23. [PMID: 24402139 PMCID: PMC4040302 DOI: 10.1007/s00213-013-3421-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
RATIONALE Variability in the rate of nicotine metabolism, measured by the nicotine metabolite ratio (NMR), is associated with smoking behavior. However, data linking the NMR with nicotine dependence measured by the Fagerström test for nicotine dependence (FTND) are mixed. Few past studies have examined alternative measures of nicotine dependence and how this relationship may vary by sex and race. OBJECTIVE Using data from smokers undergoing eligibility evaluation for a smoking cessation clinical trial (n = 833), this study examined variability in the relationship between NMR and nicotine dependence across sex and race and using three measures of nicotine dependence: FTND, time-to-first-cigarette (TTFC), and the heaviness of smoking index (HSI). RESULTS Controlling for sex and race, nicotine metabolism was associated with nicotine dependence only when using the HSI (p < 0.05). Male normal metabolizers of nicotine were more likely to have high nicotine dependence based on the FTND and HSI (p < 0.05), but NMR was not related to measures of nicotine dependence in women. For African Americans, the NMR was associated with nicotine dependence only for the TTFC (p < 0.05), but NMR was not associated with nicotine dependence among Caucasians. Post hoc analyses indicated that the NMR was associated with cigarettes per day, overall, and among men and Caucasians (p < 0.05). CONCLUSIONS While there was some variation in the relationship between nicotine metabolism and nicotine dependence across measures and sex and race, the results indicate that this relationship may be more attributable to the association between NMR and cigarettes per day.
Collapse
Affiliation(s)
- Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, 3535 Market Street, 4th Floor, Philadelphia, PA, 19104, USA,
| | | | | | | | | | | |
Collapse
|
41
|
Simple, fast and sensitive LC–MS/MS analysis for the simultaneous quantification of nicotine and 10 of its major metabolites. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 951-952:7-15. [DOI: 10.1016/j.jchromb.2014.01.025] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/03/2014] [Accepted: 01/10/2014] [Indexed: 11/19/2022]
|
42
|
Bot M, Vink J, Milaneschi Y, Smit JH, Kluft C, Neuteboom J, Penninx B. Plasma cotinine levels in cigarette smokers: impact of mental health and other correlates. Eur Addict Res 2014; 20:183-91. [PMID: 24481322 DOI: 10.1159/000356809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/17/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS We examined in cigarette smokers whether cotinine was associated with depressive and/or anxiety disorders. METHODS Data were derived from 1,026 smoking adults with and without depressive and/or anxiety disorders participating in the Netherlands Study of Depression and Anxiety (NESDA). Depressive and anxiety disorders were ascertained with the DSM-IV Composite International Diagnostic Interview. Cigarette consumption was inquired about during an interview. Cotinine was assessed in plasma. RESULTS Currently depressed and/or anxious smokers (n=692) reported smoking a higher number of cigarettes per day (CPD) than smokers with a remitted disorder (n=190) and smokers with no lifetime disorder (n=144). After controlling for CPD and other covariates, depressed and/or anxious smokers had lower cotinine levels compared to smokers with no lifetime disorder (B=-56.0, p=0.001). In the full regression model, CPD was positively associated with cotinine levels, whereas current depression and/or anxiety and high body mass index were inversely associated with cotinine. CONCLUSION After considering CPD, the presence of current depressive and/or anxiety disorders was associated with lower cotinine levels, which may point to a different smoking topography or a faster cotinine metabolism in individuals with affective disorders. The latter could help to explain the higher number of cigarettes smoked and poorer cessation rates among depressed or anxious patients.
Collapse
Affiliation(s)
- Mariska Bot
- Department of Psychiatry, EMGO Institute of Health and Care Research, Neuroscience Campus Amsterdam, VU University Medical Center, and GGZinGeest, Amsterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
43
|
Hendricks PS, Delucchi KL, Benowitz NL, Hall SM. Clinical significance of early smoking withdrawal effects and their relationships with nicotine metabolism: preliminary results from a pilot study. Nicotine Tob Res 2013; 16:615-20. [PMID: 24353342 DOI: 10.1093/ntr/ntt204] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Although the early time course of smoking withdrawal effects has been characterized, the clinical significance of early withdrawal symptoms and their predictors are unknown. This study evaluated the relationships of early smoking withdrawal effects with quit attempt outcomes and the rate of nicotine metabolism. METHODS Eleven treatment-seeking smokers abstained from smoking for 4 hr in the laboratory before a quit attempt. Withdrawal measures included heart rate, sustained attention, and self-report. Following baseline assessment, withdrawal measures were administered every 30 min. At the conclusion of the 4-hr early withdrawal session, participants received a brief smoking cessation intervention and then returned 1 week and 12 weeks later for outcome assessments that included biochemically confirmed smoking abstinence, cigarettes smoked in the past 24hr, and self-reported withdrawal symptoms. The rate of nicotine metabolism was estimated at intake with the nicotine metabolite ratio (trans-3'-hydroxycotinine/cotinine) measured in saliva. RESULTS Greater self-reported negative affect and concentration difficulty during early withdrawal, most notably anxiety, were related with poorer quit attempt outcomes. There was some indication that although a faster increase in craving and greater hunger during early withdrawal were associated with more favorable outcomes, a greater decrease in heart rate during this time was associated with poorer outcomes. Faster nicotine metabolism was related to a faster increase in anxiety but a slower increase in craving during early withdrawal. CONCLUSIONS These findings lend support to the clinical significance of early smoking withdrawal effects. The rate of nicotine metabolism may be a useful predictor of early withdrawal symptoms.
Collapse
Affiliation(s)
- Peter S Hendricks
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | |
Collapse
|
44
|
Huang R, Han S, Li XS. Detection of tobacco-related biomarkers in urine samples by surface-enhanced Raman spectroscopy coupled with thin-layer chromatography. Anal Bioanal Chem 2013; 405:6815-22. [PMID: 23807309 DOI: 10.1007/s00216-013-7107-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 04/25/2013] [Accepted: 05/31/2013] [Indexed: 10/26/2022]
Abstract
The nicotine metabolites, cotinine and trans-3'-hydroxycotinine (3HC) are considered as superior biomarkers for identifying tobacco exposure. More importantly, the ratio of 3HC to cotinine is a good indicator to phenotype individuals for cytochrome P450 2A6 activity and to individualize pharmacotherapy for tobacco addiction. In this paper, a simple, robust and novel method based on surface-enhanced Raman spectroscopy coupled with thin-layer chromatography (TLC) was developed to directly quantify the biomarkers in human urine samples. This is the first time surface-enhanced Raman spectroscopy (SERS) was used to detect cotinine and 3HC in urine samples. The linear dynamic range for the detection of cotinine is from 40 nM to 8 μM while that of 3HC is from 1 μM to 15 μM. The detection limits are 10 nM and 0.2 μM for cotinine and 3HC, respectively. The proposed method was further validated by quantifying the concentration of both cotinine and 3HC in smokers' urine samples. This TLC-SERS method allows the direct detection of cotinine in the urine samples of both active and passive smokers and the detection of 3HC in smokers.
Collapse
Affiliation(s)
- Rongfu Huang
- Department of Chemistry, University of South Florida, 4202 E. Fowler Ave CHE205, Tampa, FL 33620, USA
| | | | | |
Collapse
|
45
|
St Helen G, Jacob P, Benowitz NL. Stability of the nicotine metabolite ratio in smokers of progressively reduced nicotine content cigarettes. Nicotine Tob Res 2013; 15:1939-42. [PMID: 23674838 DOI: 10.1093/ntr/ntt065] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The nicotine metabolite ratio (NMR), the ratio of trans-3'-hydroxycotinine (3-HC) to cotinine, has been used as a biomarker of the rate of CYP2A6-mediated nicotine metabolism. While stable in smokers who maintain constant smoking consumption, since smoking has been shown to inhibit nicotine metabolism and this inhibition could be mediated by the nicotine in the smoke, NMR could change during nicotine reduction. The objective of this study was to determine the reproducibility (or stability) of plasma NMR in smokers of progressively reduced nicotine content (RNC) cigarettes. METHODS We analyzed data from subjects in a clinical trial of smoking progressively RNC cigarettes. Plasma NMR in 30 smokers whose plasma cotinine levels had decreased by at least 50% from the use of the first test cigarette (12mg nicotine content) to the final test cigarette (1mg nicotine content) was measured on 4 occasions over a period of 24 weeks. RESULTS Plasma cotinine and 3-HC decreased by an average of 85% and 84%, respectively, following the use of the first type of RNC cigarette to the last type. Plasma NMR had an average absolute change of 28.5% over the same period. Using repeated measures analysis, changes in plasma NMR over time were not significant with or without controlling for the effects of age, body mass index, gender, and race (p = .24 and p = .23, respectively). The reliability coefficient for repeated measurements of plasma NMR was .72. The average within-subject coefficient of variation for plasma NMR was 21.6% (SD = 12.0%). CONCLUSION The plasma NMR is relatively stable over time as nicotine levels decline in smokers of progressively RNC cigarettes.
Collapse
Affiliation(s)
- Gideon St Helen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | | | | |
Collapse
|
46
|
De Cremer K, Van Overmeire I, Van Loco J. On-line solid-phase extraction with ultra performance liquid chromatography and tandem mass spectrometry for the detection of nicotine, cotinine and trans-3′-hydroxycotinine in urine to strengthen human biomonitoring and smoking cessation studies. J Pharm Biomed Anal 2013; 76:126-33. [DOI: 10.1016/j.jpba.2012.12.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 10/31/2012] [Accepted: 12/13/2012] [Indexed: 11/26/2022]
|
47
|
St Helen G, Novalen M, Heitjan DF, Dempsey D, Jacob P, Aziziyeh A, Wing VC, George TP, Tyndale RF, Benowitz NL. Reproducibility of the nicotine metabolite ratio in cigarette smokers. Cancer Epidemiol Biomarkers Prev 2012; 21:1105-14. [PMID: 22552800 DOI: 10.1158/1055-9965.epi-12-0236] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The nicotine metabolite ratio (NMR or 3-hydroxycotinine/cotinine) has been used to phenotype CYP2A6-mediated nicotine metabolism. Our objectives were to analyze (i) the stability of NMR in plasma, saliva, and blood in various storage conditions, (ii) the relationship between NMRs derived from blood, plasma, saliva, and urine, and (iii) the reproducibility of plasma NMR in ad libitum cigarette smokers. METHODS We analyzed data from four clinical studies. In studies 1 and 2, we assessed NMR stability in saliva and plasma samples at room temperature (~22°C) over 14 days and in blood at 4°C for up to 72 hours. In studies 2 and 3, we used Bland-Altman analysis to assess agreement between blood, plasma, saliva, and urine NMRs. In study 4, plasma NMR was measured on six occasions over 44 weeks in 43 ad libitum smokers. RESULTS Reliability coefficients for stability tests of NMR in plasma and saliva at room temperature were 0.97 and 0.98, respectively, and 0.92 for blood at 4°C. Blood NMR agreed consistently with saliva and plasma NMRs but showed more variability in relation to urine NMR. The reliability coefficient for repeated plasma NMR measurements in smokers was 0.85. CONCLUSION The NMR is stable in blood, plasma, and saliva at the conditions tested. Blood, plasma, and saliva NMRs are similar whereas urine NMR is a good proxy for these NMR measures. Plasma NMR was reproducible over time in smokers. IMPACT One measurement may reliably estimate a smoker's NMR for use as an estimate of the rate of nicotine metabolism.
Collapse
Affiliation(s)
- Gideon St Helen
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA 94143, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Rapid nicotine clearance is associated with greater reward and heart rate increases from intravenous nicotine. Neuropsychopharmacology 2012; 37:1509-16. [PMID: 22334123 PMCID: PMC3327855 DOI: 10.1038/npp.2011.336] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The ratio of nicotine metabolites (trans-3'-hydroxycotinine (3HC) to cotinine) correlates with nicotine clearance. In previous studies, high nicotine metabolite ratio (NMR) predicted poor outcomes for smoking cessation treatment with nicotine patch. The underlying mechanisms that associate NMR with treatment outcomes have not been fully elucidated. A total of 100 smokers were divided into quartiles based on their baseline plasma NMR. Following overnight abstinence, smokers received saline followed by escalating intravenous doses of nicotine (0.5 and 1.0 mg/70 kg) given 30 min apart. The effects of nicotine on subjective, plasma cortisol, heart rate, and systolic and diastolic blood pressure measures were obtained. Smokers in the first NMR quartile (slower metabolizers) had lower Fagerstrom Test for Nicotine Dependence (FTND) scores, suggesting lower levels of dependence. In contrast, smokers in the fourth NMR quartile (faster metabolizers) reported greater craving for cigarettes following overnight abstinence from smoking and reported greater ratings of nicotine-induced good drug effects, drug liking, and wanting more drug. Higher NMR was also associated with greater heart rate increases in response to nicotine. These results suggest that enhanced nicotine reward and cigarette craving may contribute to the poor treatment response in smokers with high NMR. These findings warrant further investigation, especially in treatment-seeking smokers undergoing cessation treatment.
Collapse
|