Influence of Smoking Puff Parameters and Tobacco Varieties on Free Radicals Yields in Cigarette Mainstream Smoke

Smoking is a significant contributor to intraoperative blood loss in metastatic spinal tumor surgery: a propensity score analysis

BACKGROUND

Metastatic spinal tumors pose a significant challenge regarding intraoperative blood loss. Identifying risk factors for intraoperative blood loss is crucial for appropriate surgical planning and early intervention. However, current studies have not comprehensively evaluated risk factors for predicting intraoperative blood loss. This study aims to determine whether smoking significantly contributes to intraoperative blood loss among metastatic spinal tumors and to investigate other potential risk factors.

METHODS

This study analyzed 252 patients with metastatic spinal disease who underwent posterior decompressive surgery, and the primary outcome measured was intraoperative blood loss, with massive intraoperative blood loss defined as exceeding 2500 mL. Propensity score matching analysis was employed to analyze the influence of smoking on intraoperative blood loss. In addition, subgroup analysis was performed based on smoking status before and after propensity score analysis. Multivariate analysis was used to analyze the relationship between smoking and intraoperative blood loss. To assess the predictive value of smoking status for intraoperative massive blood loss, we conducted an analysis using the Area Under the Receiver Operating Characteristic Curve (AUROC), and the corresponding Area Under the Curve (AUC) values were subsequently calculated.

RESULTS

Before conducting the propensity score analysis, the study found that smoking patients had a significantly higher volume of intraoperative blood loss (1938.30 mL vs. 1722.32 mL, P = 0.014) and a greater incidence of massive intraoperative blood loss (36.4% vs. 20.1%, P = 0.008) compared to non-smokers. After adjusting for propensity scores, the results showed that smokers still had a higher volume of intraoperative blood loss (1938.30 mL vs. 1703.41 mL, P = 0.019) and a higher proportion of massive intraoperative blood loss (39.7% vs. 14.9%, P = 0.002) than non-smokers. Multiple linear regression analysis confirmed that smoking status was significantly associated with intraoperative blood loss before (Estimate = 1.410, P = 0.001) and after (Estimate = 1.443, P = 0.010) propensity score matching analysis. Additionally, the logistic regression demonstrated that smokers were 2.268 times (95% CI: 1.272-4.044) more likely to experience intraoperative massive blood loss compared to nonsmokers before propensity score analysis (P = 0.005). After propensity score analysis, the fold increase in risk further rose to 3.764 (95% CI: 1.643-8.621), indicating an even stronger association between smoking and intraoperative blood loss (P = 0.002). Furthermore, the AUC value increased from 0.596 (95% CI: 0.527-0.666) for smoking status before propensity score matching analysis to 0.660 (95% CI: 0.567-0.753) after propensity score matching analysis.

CONCLUSIONS

Smoking is a significant risk factor for increased intraoperative blood loss and should be taken into consideration when planning surgical interventions for patients with metastatic spinal tumors.

Free Radicals in Little Cigar Mainstream Smoke and the Potential Influence of Flavoring Chemicals on Free Radical Production

Implementation of the Tobacco Control Act in 2009 banned characterizing flavors in cigarettes (except menthol and tobacco), but substitution has occurred by the continued availability of alternative flavored products (i.e., flavored little cigars). Little is known about how flavorants in noncigarette tobacco products impact human health. Thus, we investigated the impact of flavorants on free radical production in the mainstream smoke of little cigars. Gas- and particulate-phase free radical yields in mainstream smoke generated from 12 commercial little cigar brands and research little cigars and cigarettes were measured via electron paramagnetic resonance spectroscopy using the International Organization of Standardization (ISO) smoking protocol. Flavorants were extracted from unsmoked little cigars and analyzed by gas chromatography-mass spectroscopy. Gas- and particulate-phase radical yields from little cigars ranged from 13.5 to 97.6 and 0.453-1.175 nmol/unit, respectively. Comparatively, research cigarettes yielded an average of 4.9 nmol gas-phase radicals/unit and 0.292 nmol particulate-phase radicals/unit. From the products, 66 flavorants were identified, with each brand containing 4-24 individual flavorants. The free radical content was strongly correlated with the number of flavorants present in each cigar (r = 0.74, p = 0.01), indicating that highly flavored little cigars may produce higher levels of toxic free radicals. The presence of the flavorant ethyl methylphenylglycidate (strawberry) was associated with >2-fold higher levels of GP radicals (p = 0.001). Our results show that free radical delivery from little cigars is greater than that from research cigarettes and provide empirical evidence for the harmfulness of flavored tobacco products. Additionally, it demonstrates that flavorants present in combustible tobacco products can influence the levels of free radicals produced. Therefore, future tobacco product standards should consider little cigars.

Evaluation of Oxidative Stress and Antioxidant Biomarkers in Chronic Cigarette Smokers: A Pilot Study

Introduction The present study was undertaken to assess the status of oxidative stress in chronic cigarette smokers. Materials and methods Thirty adult male chronic cigarette smokers and an equal number of age and sex-matched normal subjects from the Deoghar district of Jharkhand state, India, were included in the study. The status of lipid peroxidation was determined using malondialdehyde (MDA), and the activities of enzymic antioxidants, such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), were determined using standard protocols. Results Results showed that the serum MDA levels were significantly increased, and the enzymic antioxidants were markedly decreased in chronic cigarette smokers compared to the normal subjects. Conclusion Our study demonstrated that oxidative stress is more pronounced in cigarette smokers compared to non-smokers. The number of cigarettes smoked plays a crucial role in increasing the reactive oxygen species and decreasing the cellular antioxidants.

Evidence of the protective effect of anti-pollution products against oxidative stress in skin ex vivo using EPR spectroscopy and autofluorescence measurements

The concentration of air pollution is gradually increasing every year so that daily skin exposure is unavoidable. Dietary supplements and topical formulations currently represent the protective strategies to guard against the effects of air pollution on the body and the skin. Unfortunately, there are not yet enough methods available to measure the effectiveness of anti-pollution products on skin. Here, we present two ex vivo methods for measuring the protective effect against air pollution of different cream formulations on the skin: Electron paramagnetic resonance (EPR) spectroscopy and autofluorescence excited by 785 nm using a confocal Raman microspectrometer (CRM). Smoke from one cigarette was used as a model pollutant. EPR spectroscopy enables the direct measurement of free radicals in excised porcine skin after smoke exposure. The autofluorescence in the skin was measured ex vivo, which is an indicator of oxidative stress. Two antioxidants and a chelating agent in a base formulation and a commercial product containing an antioxidant mixture were investigated. The ex vivo studies show that the antioxidant epigallocatechin-3-gallate (EGCG) in the base cream formulation provided the best protection against oxidative stress from smoke exposure for both methods.

Influence of Tobacco Variety and Curing on Free Radical Production in Cigarette Smoke

INTRODUCTION

Cigarette smoke contains highly reactive free radicals thought to play an important role in tobacco smoke-induced harm. Previously, large variations in free radical and toxicant output have been observed in commercial cigarettes. These variations are likely because of cigarette design features (paper, filter, and additives), tobacco variety (burley, bright, oriental, etc.), and tobacco curing methods (air, sun, flue, and fire). Previous reports show that tobacco varieties and curing methods influence the production of tobacco smoke constituents like the tobacco-specific carcinogen nicotine-derived nitrosamine ketone (NNK).

AIMS AND METHODS

We evaluated free radical, nicotine, and NNK production in cigarette smoke from cigarettes produced with 15 different types of tobacco. Gas-phase free radicals were captured by spin trapping with N-tert-butyl-α-phenylnitrone and particulate-phase radicals were captured on a Cambridge Filter pad (CFP). Both types of radicals were analyzed using electron paramagnetic resonance spectroscopy. Nicotine and NNK were extracted from the CFP and analyzed by gas chromatography flame ionization detection and liquid chromatography-mass spectrometry, respectively.

RESULTS

Gas-phase radicals varied nearly 8-fold among tobacco types with Saint James Perique tobacco producing the highest levels (42 ± 7 nmol/g) and Canadian Virginia tobacco-producing the lowest levels (5 ± 2 nmol/g). Nicotine and NNK levels in smoke varied 14-fold and 192-fold, respectively, by type. Gas-phase free radicals were highly correlated with NNK levels (r = 0.92, p < .0001) and appeared to be most impacted by tobacco curing method.

CONCLUSIONS

Altogether, these data suggest that tobacco types used in cigarette production may serve as a target for regulation to reduce harm from cigarette smoking.

IMPLICATIONS

Variations in cigarette free radical and NNK levels vary based on the tobacco variety and curing method. Reducing the ratio of high-producing free radical and NNK tobacco types offer a potential tool for regulators and producers looking to reduce toxicant output from cigarettes.

Tobacco Nitrate and Free Radical Levels in the Mainstream Smoke of US Cigarette Brands

Tobacco nitrate levels have been known to impact the levels of toxicants such as polyaromatic hydrocarbons and tobacco-specific nitrosamines (TSNAs) produced during smoking. Recent work in our group showed that the intrinsic nitrate levels in individual tobacco varieties also have a large influence on the formation of gas-phase (GP) free radicals in the mainstream smoke of cigarettes produced with a single tobacco variety. As tobacco nitrate content is a potential target for future regulatory policies, we investigated whether the levels of GP free radicals in the smoke from commercially available cigarettes is also dependent on the nitrate content in the corresponding tobacco blends. GP and particulate-phase (PP) free radical yields in mainstream smoke produced from 25 popular US cigarette brands were measured by electron paramagnetic resonance (EPR) spectroscopy. For each brand, we also measured levels of the TSNAs NNN (N'-nitrosonornicotine) and NNK (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone) via HPLC-MS and the nicotine content via GC-FID. Our results show that the intrinsic nitrate levels varied >15-fold and GP radicals varied 4-fold among the 25 brands tested. The GP radicals were correlated with intrinsic nitrate levels (r = 0.87, p < 0.001). NNK and NNN levels varied >8-fold and 12-fold, respectively. We found that NNK was moderately correlated to nitrate content (r = 0.42, p = 0.03) while the NNN was strongly correlated to the nitrate content (r = 0.65, p < 0.001). Nicotine levels varied the least (<3-fold) but showed a moderate negative correlation to nitrate content (r = -0.47, p = 0.02). No statistically significant correlation was observed between nicotine and TSNA levels in mainstream smoke. Overall, this demonstrates that the nitrate content of tobacco blends used in US cigarette brands impacts toxicant output in the mainstream smoke, although other proprietary variables (total ventilation, additives, filter type, etc.) may also modulate these results.

Establishment of a method to expose and measure pollution in excised porcine skin with electron paramagnetic resonance spectroscopy

Health problems associated with the amount of air pollutants are increasing worldwide. Pollution damages not only the lungs; it also has an impact on skin health and is co-responsible for the development of skin diseases. Anti-pollution products are on the rise in the cosmetic market but so far, there is no established method to directly assess the impact of pollution on the skin and to test the efficacy of anti-pollution products. To address this problem, two different chambers were developed for the reproducible exposure to realistic air pollutant concentrations. One chamber for the exclusive use of excised skin and hair samples, the second chamber for ex vivo and in vivo measurements. Measurements of nicotine next to the investigated skin area allow conclusions to be drawn on the particle concentration to which the skin is exposed. Electron paramagnetic resonance spectroscopy, which enables the detection of free radicals in different systems, was applied to assess the hazard potential of pollution in the skin. A direct proof of the formation of free radicals in the skin by the model pollutant cigarette smoke could be demonstrated. An additional application of UV irradiation even increased the formation of free radicals in the skin seven-fold (sum parameter). Depending on the question of interest, the use of different spin probes allows various assessments of the radical formation in skin: the amount of radicals but also the antioxidant status of the microenvironment can be estimated. Using two exposure chambers, the direct formation of oxidative stress by cigarette smoke on ex vivo skin, with and without additional UV exposure, could be reproducibly examined. This measurement method is promising for the assessment of anti-pollution products and could allow a direct causal connection between pollutant, effect on the skin and the protective function of skin care products.

Effects of tobacco nitrate content on free radical levels in mainstream smoke

Tobacco smoke free radicals play an important role in the development of smoking related adverse health effects. We previously reported that gas phase (GP) radicals vary greatly by cigarette brand and tobacco variety and are highly correlated with levels of NNK in smoke. Since NNK production in tobacco is dependent on nitrate, we proposed that GP radical production may also be associated with tobacco nitrate content. To test this, we examined the relationship between intrinsic nitrate levels in 15 individual tobacco types and the levels of free radicals delivered in mainstream smoke from cigarettes produced from these tobaccos. Intrinsic nitrate levels varied >250-fold among the tobacco types, ranging from <0.1 mg/g tobacco in the Bright Leaf types to 24.1 ± 0.4 mg/g in Light Fire Cured Virginia tobacco. Among the tobacco types tested, GP radicals were highly correlated with nitrate levels (r = 0.96, p < 0.0001). To investigate nitrate-specific changes to free radical production during smoking, different concentrations of exogenous sodium nitrate were added to unsmoked shredded leaves of 4 different tobacco types (Bright Leaf Sweet Virginia, American Virginia, Semi-Oriental 456, and reconstituted). Nitrate addition resulted in dose-dependent increases in GP radicals in the corresponding smoke, supporting our hypothesis that intrinsic nitrate levels are responsible for GP radical production in cigarette smoke. We also observed increases in NNK levels as a function of added nitrate that varied significantly among the 4 tobacco types tested, implying that other tobacco-type related factors may be impacting nicotine nitrosation during pyrolysis. Altogether, these findings have identified tobacco nitrate as a key factor in the production of GP radicals, but to a lesser extent with PP radicals, as well as NNK during combustion and highlight its potential implication as a target for regulation.

Antioxidant Systems, lncRNAs, and Tunneling Nanotubes in Cell Death Rescue from Cigarette Smoke Exposure

Cigarette smoke is a rich source of carcinogens and reactive oxygen species (ROS) that can damage macromolecules including DNA. Repair systems can restore DNA integrity. Depending on the duration or intensity of stress signals, cells may utilize various survival and adaptive mechanisms. ROS levels are kept in check through redundant detoxification processes controlled largely by antioxidant systems. This review covers and expands on the mechanisms available to cigarette smoke-exposed cancer cells for restoring the redox balance. These include multiple layers of transcriptional control, each of which is posited to be activated upon reaching a particular stress threshold, among them the NRF2 pathway, the AP-1 and NF-kB pathways, and, finally, TP53, which triggers apoptosis if extreme toxicity is reached. The review also discusses long noncoding RNAs, which have been implicated recently in regulating oxidative stress-with roles in ROS detoxification, the inflammatory response, oxidative stress-induced apoptosis, and mitochondrial oxidative phosphorylation. Lastly, the emerging roles of tunneling nanotubes in providing additional mechanisms for metabolic rescue and the regulation of redox imbalance are considered, further highlighting the expanded redox reset arsenal available to cells.

Content of toxic components of cigarette, cigarette smoke vs cigarette butts: A comprehensive systematic review

The commercially sold cigarettes contain more than 7000 chemicals, and their combustion produces potential toxicants in mainstream smoke (MS), sidestream smoke (SS), secondhand smoke (SHS), thirdhand smoke (THS), and discarded cigarette butts (CBs). We conducted a systematic review of published literature to compare the toxicants produced in each of these phases of tobacco combustion (MS, SS, and CBs). The initial search included 12,301 articles, but after screening and final restrictions considering the aims of this review, 159 published studies were selected for inclusion. Additionally, SHS and THS are briefly discussed here. Overall, polycyclic aromatic hydrocarbons (PAHs) and other aromatic hydrocarbons have been represented in more studies than other compounds. However, metals and nitrosamines were detected in higher concentrations than other components in SS. The concentrations of most PAHs and other aromatic hydrocarbons in MS and SS are higher compared to concentrations found in CBs. Also, the concentrations of all the studied carbonyl compounds, aldehydes and ketones in SS and MS were higher than in CBs. The mean levels of alcohols and phenols in SS were higher than those reported for both MS and CBs. Tobacco toxicants are inhaled by smokers and transmitted to the environment through SS, SHS, THS, and discarded CBs. However, further studies are necessary to assess adverse effects of toxicants found in CBs and THS not only on human health, but also on the environment and ecosystems. The results of this review provide updated information on the chemical contents of MS, SS, SHS, THS, and CBs. It adds to the growing understanding that smoking creates major health problems for smokers and passive smokers, but also that it generates environmental hazards with consequences to the ecosystems and human health through discarded CBs, SHS, and THS exposure.

Short-term whole body cigarette smoke exposure induces regional differences in cellular response in the mouse larynx

The larynx is an essential organ in the respiratory tract and necessary for airway protection, respiration, and phonation. Cigarette smoking is a significant risk factor associated with benign and malignant laryngeal diseases. Despite this association, the underlying mechanisms by which cigarette smoke (CS) drives disease development are not well elucidated. In the current study, we developed a short-term murine whole body inhalation model to evaluate the first CS-induced cellular responses in the glottic [i.e. vocal fold (VF)] and subglottic regions of the larynx. Specifically, we investigated epithelial cell proliferation, cell death, surface topography, and mucus production, at various time points (1 day, 5 days, 10 days) after ∼ 2 h exposure to 3R4F cigarettes (Delivered dose: 5.6968 mg/kg per cigarette) and following cessation for 5 days after a 5 day CS exposure (CSE). CSE elevated levels of BrdU labeled proliferative cells and p63 labeled epithelial basal cells on day 1 in the VF. CSE increased proliferative cells in the subglottis at days 5, 10 and following cessation in the subglottis. Cleaved caspase-3 apoptotic activity was absent in VF at all time points and increased at day 1 in the subglottis. Evaluation of the VF surface by scanning electron microscopy (SEM) revealed significant epithelial microprojection damage at day 10 and early signs of necrosis at days 5 and 10 post-CSE. SEM visualizations additionally indicated the presence of deformed cilia at days 5 and 10 after CSE and post-cessation in the respiratory epithelium lined subglottis. In terms of mucin content, the impact of short-term CSE was observed only at day 10, with decreasing acidic mucin levels and increasing neutral mucin levels. Overall, these findings reveal regional differences in murine laryngeal cellular responses following short-term CSE and provide insight into potential mechanisms underlying CS-induced laryngeal disease development.

Relationships among smoking, oxidative stress, inflammation, macromolecular damage, and cancer

Smoking is a major risk factor for a variety of diseases, including cancer and immune-mediated inflammatory diseases. Tobacco smoke contains a mixture of chemicals, including a host of reactive oxygen- and nitrogen species (ROS and RNS), among others, that can damage cellular and sub-cellular targets, such as lipids, proteins, and nucleic acids. A growing body of evidence supports a key role for smoking-induced ROS and the resulting oxidative stress in inflammation and carcinogenesis. This comprehensive and up-to-date review covers four interrelated topics, including 'smoking', 'oxidative stress', 'inflammation', and 'cancer'. The review discusses each of the four topics, while exploring the intersections among the topics by highlighting the macromolecular damage attributable to ROS. Specifically, oxidative damage to macromolecular targets, such as lipid peroxidation, post-translational modification of proteins, and DNA adduction, as well as enzymatic and non-enzymatic antioxidant defense mechanisms, and the multi-faceted repair pathways of oxidized lesions are described. Also discussed are the biological consequences of oxidative damage to macromolecules if they evade the defense mechanisms and/or are not repaired properly or in time. Emphasis is placed on the genetic- and epigenetic alterations that may lead to transcriptional deregulation of functionally-important genes and disruption of regulatory elements. Smoking-associated oxidative stress also activates the inflammatory response pathway, which triggers a cascade of events of which ROS production is an initial yet indispensable step. The release of ROS at the site of damage and inflammation helps combat foreign pathogens and restores the injured tissue, while simultaneously increasing the burden of oxidative stress. This creates a vicious cycle in which smoking-related oxidative stress causes inflammation, which in turn, results in further generation of ROS, and potentially increased oxidative damage to macromolecular targets that may lead to cancer initiation and/or progression.

Free Radical and Nicotine Yields in Mainstream Smoke of Chinese Marketed Cigarettes: Variation with Smoking Regimens and Cigarette Brands

Free radicals and nicotine are components of cigarette smoke that are thought to contribute to the development of smoking-induced diseases. China has the largest number of smokers in the world, yet little is known about the yields of tobacco smoke constituents in different Chinese brands of cigarettes. In this study, gas-phase and particulate-phase free radicals as well as nicotine yields were quantified in mainstream cigarette smoke from five popular Chinese brands and two research cigarettes (3R4F and 1R6F). Mainstream smoke was generated under International Organization of Standardization (ISO) and Canadian Intense (CI) smoking regimens using a linear smoking machine. Levels of free radicals and nicotine were measured by electron paramagnetic resonance spectroscopy (EPR) and gas chromatography with flame-ionization detection, respectively. Under the ISO puffing regimen, Chinese brand cigarettes produced an average of 3.0 ± 1.2 nmol/cig gas-phase radicals, 118 ± 44.7 pmol/cig particulate-phase radicals, and 0.6 ± 0.2 mg/cig nicotine. Under the CI puffing regimen, Chinese brand cigarettes produced an average of 5.6 ± 1.2 nmol/cig gas-phase radicals, 282 ± 92.1 pmol/cig particulate-phase radicals, and 2.1 ± 0.4 mg/cig nicotine. Overall, both gas- and particulate-phase free radicals were substantially lower compared to the research cigarettes under both regimens, whereas no significant differences were observed for nicotine levels. When Chinese brands were compared, the highest free radical and nicotine yields were found in "LL" and "BS" brands, while lowest levels were found in "YY". These results suggested that the lower radical delivery by Chinese cigarettes compared to United States reference cigarettes may be associated with reductions in oxidant-related harm.

Free Radical Production and Characterization of Heat-Not-Burn Cigarettes in Comparison to Conventional and Electronic Cigarettes

With conventional cigarettes, the burning cone reaches temperatures of >900 °C, resulting in the production of numerous toxicants and significant levels of highly reactive free radicals. In attempts to eliminate combustion while still delivering nicotine and flavorings, a newer alternative tobacco product has emerged known as "heat-not-burn" (HnB). These products heat tobacco to temperatures of 250-350 °C depending on the device allowing for the volatilization of nicotine and flavorants while potentially limiting the production of combustion-related toxicants. To better understand how the designs of these new products compare to conventional cigarettes and different styles of electronic cigarettes (e-cigs), we measured and partially characterized their production of free radicals. Smoke or aerosols were trapped by a spin trap phenyl-N-tert-butylnitrone (PBN) and analyzed for free radicals using electron paramagnetic resonance (EPR). Free radical polarity was assessed by passing the aerosol or smoke through either a polar or nonpolar trap prior to being spin trapped with PBN. Particulate-phase radicals were detected only for conventional cigarettes. Gas-phase free radicals were detected in smoke/aerosol from all products with levels for HnB (IQOS, Glo) (12 pmol/puff) being similar to e-cigs (Juul, SREC, box mod e-cig) and hybrid devices (Ploom) (5-40 pmol/puff) but 50-fold lower than conventional cigarettes (1R6F). Gas phase radicals differed in polarity with HnB products and conventional cigarettes producing more polar radicals compared to those produced from e-cigs. Free radical production should be considered in evaluating the toxicological profile of nicotine delivery products and identification of the radicals is of paramount importance.

Comparative assessment of individual RONS in serum of smokers compared with non-smokers and their correlation with the lipid profile and antioxidant status

Objective

Cigarette smoking generates free radicals, such as reactive oxygen and nitrogen species (RONS) that contribute to many diseases. The aim of this study was to compare the levels of individual RONS in serum from smokers and non-smokers, and to examine their impact on lipid profiles and the endogenous antioxidant status, which is represented by vitamins C and E.

Methods

Ninety-four healthy Egyptian volunteers (48 smokers and 46 non-smokers) were enrolled. Blood samples were collected and analysed for common haematological tests, lipid profiles, and serum antioxidants. Six reactive oxygen species and three reactive nitrogen species were measured.

Results

A significant increase in radical levels was observed, as well as significant increases in haemoglobin (Hb), haematocrit, platelet count, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol in smokers compared with non-smokers. In contrast, high-density lipoprotein cholesterol was significantly reduced in smokers compared with non-smokers. A moderate negative correlation was found between serum levels of vitamins C and E and O₂^–•, HO^•, H₂O₂, NO^•, and ONO^•, reflecting a negative impact of elevated RONS levels on the endogenous antioxidant status.

Conclusion

These results may increase our understanding of the pathological role of smoking in several diseases.