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Comparative assessment of HPHC yields in the Tobacco Heating System THS2.2 and commercial cigarettes


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There has been a sustained effort in recent years to develop products with the potential to present less risk compared with continued smoking as an alternative for adult smokers who would otherwise continue to smoke cigarettes. During the non-clinical assessment phase of such products, the chemical composition and toxicity of their aerosols are frequently compared to the chemical composition and toxicity of the smoke from a standard research cigarette - the 3R4F reference cigarette. In the present study, it is demonstrated that results of these analytical comparisons are similar when considering commercially available cigarette products worldwide. A market mean reduction of about 90% is observed on average across a broad range of harmful and potentially harmful constituents (HPHC) measured in the aerosol of a candidate modified risk tobacco product, the Tobacco Heating System 2.2 (THS2.2), compared against the levels of HPHC of cigarettes representative of selected markets; this mean reduction is well in line with the reduction observed against 3R4F smoke constituents in previous studies.
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Comparative assessment of HPHC yields in the Tobacco Heating
System THS2.2 and commercial cigarettes
G. Jaccard
,D.Tan Djoko, O. Moennikes, C. Jeannet, A. Kondylis, M. Belushkin
Philip Morris International R&D, Philip Morris Products SA, Rue des Usines 56, CH-2000 Neuch^
atel, Switzerland
article info
Article history:
Received 2 June 2017
Received in revised form
7 August 2017
Accepted 12 August 2017
Available online 14 August 2017
Harmful and potentially harmful
Modied risk tobacco products
Tobacco Heating System
THS 2.2
There has been a sustained effort in recent years to develop products with the potential to present less
risk compared with continued smoking as an alternative for adult smokers who would otherwise
continue to smoke cigarettes. During the non-clinical assessment phase of such products, the chemical
composition and toxicity of their aerosols are frequently compared to the chemical composition and
toxicity of the smoke from a standard research cigarette ethe 3R4F reference cigarette. In the present
study, it is demonstrated that results of these analytical comparisons are similar when considering
commercially available cigarette products worldwide. A market mean reduction of about 90% is observed
on average across a broad range of harmful and potentially harmful constituents (HPHC) measured in the
aerosol of a candidate modied risk tobacco product, the Tobacco Heating System 2.2 (THS2.2), compared
against the levels of HPHC of cigarettes representative of selected markets; this mean reduction is well in
line with the reduction observed against 3R4F smoke constituents in previous studies.
©2017 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND
license (
1. Introduction
In recent years, much research and development has focused on
products that provide an acceptable alternative to continued
smoking of cigarettes while having the potential to present a
reduced risk compared with continued cigarette smoking. Exam-
ples of such products are electronic cigarettes and a novel class of
heated tobacco products eproducts which heat tobacco to tem-
peratures well below that required for combustion, thereby sub-
stantially reducing the formation of harmful and potentially
harmful constituents (HPHC) compared to the mainstream smoke
of cigarettes.
One such product ethe Tobacco Heating System 2.2 (THS2.2)
was described recently (Smith et al., 2016). It has been extensively
characterized in non-clinical and clinical studies, and has been
demonstrated to provide lower HPHC yields and a lower in vitro
toxicity of the aerosol in comparison to the smoke of a 3R4F
reference cigarette (Schaller et al., 2016). In addition a substantial
reduction in exposure to HPHC excluding nicotine for adult
smokers switching to THS2.2 as compared to continued smoking of
commercially available cigarettes was reported recently (Haziza
et al., 2016a; Ludicke et al., 2017a).
It is important to consider that such products offer an alterna-
tive to continued cigarette smoking, and as such they should be
evaluated in a comparative manner against cigarettes, i.e. there
must be a starting level against which a reduction is to be achieved.
For most assays in the non-clinical assessment steps, there is a need
to select one specic cigarette comparator and we selected the
3R4F reference cigarette (Smith et al., 2016).
This cigarette is frequently used in non-clinical studies as a
comparator, it is a standard cigarette designed and manufactured
for research purposes. It is distributed by the Center for Tobacco
Reference Products of the University of Kentucky (Anonymous,
2013). Due to the single point in time manufacturing of the 3R4F
cigarettes from a single set of tobacco lots, as well as controlled
storage conditions, it has been shown to elicit long-term variations
in HPHC yields signicantly lower than those observed in com-
mercial cigarette products (Eldridge et al., 2015; Belushkin et al.,
2015). Due to the standardized design and consistency of main-
stream smoke deliveries, the choice of the 3R4F reference cigarette
as a ubiquitous comparator is reasonable.
A range of different HPHC yields is typically observed in com-
mercial products (Bodnar et al., 2012; Piad
e et al., 2013;Eldridge
et al., 2017). It is due to differences in terms of cigarette designs,
which can impact the mainstream smoke yields (Siu et al., 2013;
e et al., 2013; Hearn et al., 2010).
*Corresponding author.
E-mail address: (G. Jaccard).
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Regulatory Toxicology and Pharmacology 90 (2017) 1e8
This is also reported to be the case in biological assays, although
the discriminatory power of chemical analysis of HPHC in cigarette
smoke is higher (Oldham et al., 2012), it has been shown that the
in vitro toxicological activity of cigarette smoke is also inuenced by
cigarette design parameters. The impact of the tobacco type and
blend is well established (Bombick et al., 1998; Roemer et al., 2012;
Schramke et al., 2006; Yauk et al., 2012) and for example cigarette
diameter, lter ventilation or presence of activated charcoal in the
lter have been shown to also have an impact (McAdam et al., 2016;
Rickert et al., 2007).
This raises the question, however, of how representative the
results of aerosol composition and toxicity comparisons against the
3R4F reference cigarette are when considering commercially
available cigarette products.
To address the question above, we assessed the aerosol
composition of THS2.2 compared against the mainstream smoke
composition of 3R4F and commercial cigarettes from selected
countries, on the basis of common lists of HPHC, using the Health
Canada intense smoking regime (Health Canada, 1999) to generate
the aerosol/smoke.
The comparative assessment of composition that was per-
formed is based on the Health Canada list of HPHC (Health Canada,
2000) and subsets of this list: The WHO Study Group on Tobacco
Product Regulation list (TobReg) (World Health Organization,
2015), the U.S. Food and Drug Administration abbreviated list
(FDA, 2012), the Health Canada list of HPHC, HPHC which are
classied as International Agency for Research on Cancer (IARC)
group 1 carcinogenic compounds and the list of rst priority toxi-
cants proposed by TobReg (Burns et al., 2008). Those lists include
44, 39, 19, 12 and 9 HPHC respectively. The Health Canada intense
machine smoking regime (Health Canada, 2000) was selected
based on the recommendation of TobReg to assess cigarette smoke
yields under such conditions (Burns et al., 2008), and because it
provides a more meaningful basis for the comparison of emissions
between the two different product categories. Countries were
selected to be representative of major tobacco blends and cigarette
designs, with Australia (an essentially Virginia/ue-cured blended
products market), Germany, selected European Union countries
grouped together (essentially American blended products, con-
taining a mix of ue-cured and air-cured tobaccos markets), South
Korea (a market with a high proportion of low tarcigarettes),
Japan, and Russia (two diversied markets in terms of cigarette
designs, ie use of lters containing activated charcoal, reduced
diameter cigarettes).
Although the comparative assessment was calculated on a per
article basis and on nicotine-adjusted basis to cope with the
different reporting requirements (e.g. Canada, USA, Brazil versus
TobReg), it is more appropriate to use the data on a per article basis
for the comparison of THS2.2 and commercial cigarettes smoke
constituentsreduction: According to the results obtained in a 3-
month switching clinical study (Ludicke et al., 2017b), the sub-
jects switching to THS2.2 arm and in the continued smoking of
commercial cigarettes arm had no signicant difference in their
mean consumption of articles (of THS2.2 and commercial cigarettes
2. Methods
2.1. Commercial cigarettes samples
Samples of commercial cigarette products were purchased be-
tween 2008 and 2016 in so-called Market Map studies at the point
of sale. Products were selected to be representative of the market in
terms of different manufacturers, blend types, ISO tarlevel and
cigarette designs (cigarette diameter, lter type). The number of
samples is provided in Table 1.
2.2. HPHC analysis
The analyses of the constituents of mainstream smoke in com-
mercial cigarettes, 3R4F reference cigarettes and in the aerosol of
THS2.2 were conducted by Labstat International (Kitchener, Ont.,
Canada), an independent ISO 17025 accredited tobacco testing
laboratory, under contract to Philip Morris International. For com-
mercial cigarettes, the list of constituents mandated for regulatory
reporting by Health Canada (Health Canada list) was assessed. For
THS2.2, the PMI-58 list of HPHC and analytes (Schaller et al., 2016)
was assessed; this list includes the Health Canada list of constitu-
ents. The comparison of emissions of THS2.2 and commercial cig-
arettes is therefore based on the Health Canada list (Health Canada,
2000)ecurrently the most extensive active regulatory reporting
list for cigarette smoke constituents worldwide.
The generation and collection of THS2.2 aerosol necessitates
adequate adaptations to smoking machines: For aerosol collection,
only linear smoking machines could be used in order to accom-
modate the THS2.2 stick holders. The puff number on smoking
machines was set to 12 puffs which corresponds to the 6 min
duration of the heat stick holder battery while applying a Heath
Canada Intense smoking regime, instead of using butt length
detection. The linear smoking machine was equipped with an
activation bar which activated the heat sticks holder by pressing all
activation buttons simultaneously at the start of the process. An
interval of 30 s was taken between the device activation and the
rst puff.
The quantication of constituents in the aerosol also requires
specic considerations, since the composition of the THS2.2 aerosol
is distinctly different to the composition of cigarette smoke. With
respect to ISO parameters, due to the high water content of the
THS2.2 aerosol, accurate water measurements cannot be obtained
with the ISO standard methods due to its evaporation and
condensation (Ghosh and Jeannet, 2014). As such, water is not
considered further. Nicotine-free dry particulate matter (NFDPM),
is not considered in the comparisons, because this quantity
(International Organization for Standardization, 2000), was devel-
oped specically in the context of cigarette smoke analyses and is
not meaningful for product categories that do not involve com-
bustion of tobacco and smoke generation. Indeed, the THS2.2
aerosol has a very high water content which requires special
methodologies deviating from the ISO standard methods for its
quantication, and the overall composition of the aerosol is
distinctively different from cigarette smoke (Schaller et al., 2016). It
is mainly composed of water and glycerin, the latter acting as an
aerosol former. Thus even if the appropriate analytical methodol-
ogy for the quantication of water in the THS2.2 aerosol were
Table 1
Sampling information.
Sampling year Market Number of products
2008 South Korea 13
2010 South Korea 23
2012 South Korea 17
2015 South Korea 35
2008e2016 Germany 59
2008e2015 Russia 204
2008e2016 Japan 169
2010e2016 Australia 44
2015e2016 EU 111
Note: EU (European Union) in the table is limited to the following EU countries:
Germany, Denmark, France, Italy, Netherlands, Poland, Portugal, Romania, Slovenia
and Sweden.
G. Jaccard et al. / Regulatory Toxicology and Pharmacology 90 (2017) 1e82
applied, the resulting value would largely reect the glycerin con-
tent of the aerosol, and could not be interpreted in the same
manner as NFDPM for cigarettes. Therefore, NFDPM is not consid-
ered further.
For commercial cigarettes, all analyses were performed ac-
cording to the ofcial Health Canada methods (Health Canada,
2000), with the exception of the analysis of tobacco-specic ni-
trosamines, which was performed as of 2010 by a liquid
chromatography-tandem mass spectrometry method, according to
the Labstat International internal method TMS-135. Analyses were
performed in triplicate, except for mainstream cigarette smoke
yields of tar, nicotine and carbon monoxide (CO) for which 8
replicates were performed.
For THS2.2 and 3R4F cigarettes, all analyses performed were
based on ofcial Health Canada methods (Health Canada, 2000),
with the exception of two methods: analysis of tobacco-specic
nitrosamines, which was performed by a liquid chromatography-
tandem mass spectrometry method according to the Labstat In-
ternational internal method TMS-135, and the analysis of polycyclic
aromatic hydrocarbons (e.g. benzo[a]pyrene), which was per-
formed by a gas chromatography-mass spectrometry method ac-
cording to the Labstat International internal method TMS-120. The
ofcial Health Canada methods were slightly modied to either
enhance detection limits or extend the number of compounds
determined by the method. For THS2.2, analyses were performed in
triplicate, on each of three samples, and the aggregated results are
reported. For 3R4F, average results across more than a year of
analysis are reported. All modied methods have been validated
and are part of Labstat ISO 17025 scope of accreditation.
2.3. Data treatment
The comparison of chemical composition focuses on the HPHC
which are part of the Health Canada list mandated for regulatory
reporting in Canada or subsets of this list. Aerosol constituents of
THS2.2 have been assessed against the yield of each smoke con-
stituent of commercial cigarette products sampled in each specic
market for a given year. Within each market, the rst step consisted
of calculating an average yield reduction between THS2.2 and each
cigarette product, as the average in the reductions among the in-
dividual HPHC levels in the aerosol of THS2.2 compared to their
levels in cigarette smoke. In a second step, we calculated the
aggregate mean, median value, and selected additional percentiles
(2.5th, 25th, 75th, and 97.5th) of the distribution of the products
average yield reduction values. The summary statistics of average
yield reduction of THS2.2 aerosol constituents are reported for
completeness on a per article and on a nicotine-adjusted basis,
however as previously stated the most relevant comparison is the
one on per article basis.
Additionally, the assessment of the average yield percentage
difference among the Health Canada list of HPHC in THS2.2 was
calculated against the weighted (according to the number of
products) yearly median yields of smoke constituents in commer-
cial cigarettes by country, using all data obtained from 2008 to
2.3.1. Treatment of limit of detection/quantication values
For several HPHC, the reported yields for some or all replicates
were below the limit of detection (<LOD) or limit of quantication
(<LOQ) of the laboratory analytical methods. Some HPHC are below
LOQ only for THS2.2, such as cadmium, lead, hydrogen cyanide,
resorcinol (see also Table 2 for a complete list), some HPHC are
below LOQ for both commercial cigarettes and THS2.2, such as
nickel, chromium, selenium, while some HPHC are very close to
LOQ for THS2.2 only (for example the aromatic amines) or in both
commercial cigarettes and THS2.2 and may be quantiable or not
(for example mercury). This may be due to the analytical variability,
which is higher when the levels are close to LOQ, or to tobacco lot
variability, and may result in large differences in terms of per-
centage reduction for such constituents. In addition, especially
considering the large time period from 2008 to 2016 throughout
which data were obtained, the LOD and LOQ values differ between
different years for some constituents, both for commercial ciga-
rettes as well as for the 3R4F reference cigarette. In all cases in
which a given HPHC yield was reported <LOD or <LOQ for either or
both cigarette product, reference cigarette, or THS2.2, an estimate
of the median value across the replicates is reported for the indi-
vidual HPHC, however the HPHC was omitted from percentage
difference or further quantitative computations. This approach re-
sults in a conservative estimation of the average percentage
reduction of HPHC in THS2.2 towards commercial cigarettes.
3. Results
3.1. Comparisons to the 3R4F reference cigarette
The results for the Kentucky reference cigarette 3R4F and
THS2.2 for the individual HPHC are provided in Table 2. Except for
nicotine, there is a reduction of more than 90% for most HPHC of the
Health Canada list, covering a broad range of chemical classes, with
an average reduction of about 92% on a per article basis.
3.2. Comparisons to commercial products
The comparison of HPHC in the THS2.2 aerosol and the main-
stream smoke of commercial cigarettes was performed on one
hand for South Korea with datasets obtained for cigarettes bought
in 2008 and in 2015 to assess the potential stability of average
reduction results over time, and on the other hand for a number of
countries (list of countries and number of products provided in
Table 1) for cigarettes bought from 2008 to 2016.
3.2.1. Korean market analysis
The comparison of the THS2.2 aerosol HPHC content with
commercial Korean cigarette products sampled and analyzed in
2008 and 2015 is summarized and reported in Table 3. HPHC are
grouped in ve major HPHC lists, and the resulting reductions are
calculated and reported for each HPHC list in a separate column in
Table 3. HPHC reductions are based either on per article basis
comparisons or on nicotine-adjusted yield comparisons. The esti-
mated reductions are statistically analyzed using the average as
well as ve percentile values covering the whole range of the
observed reductions.
The reductions observed in the levels of THS2.2 aerosol HPHC
compared with the HPHC in the mainstream smoke of commercial
cigarettes bought in 2008 and 2015 are very similar, considering
both results obtained on a per article basis or with nicotine-
adjusted results, whatever list of HPHC is taken into account. Us-
ing the Health Canada list of HPHC as an example, the mean
reduction observed in Korea, on per article basis is 90 and 89%
against the cigarettes bought in 2015 and in 2008, while the mean
reduction observed, on nicotine-adjusted yields is 88% and 86% for
the cigarettes bought in 2008 and 2015, respectively. Those results
are well in line with the average percentage reductions calculated
against the weighted median yields obtained by combining the
results for commercial cigarettes in South Korea and bought in
2008, 2010, 2012 and 2014 (average reduction of 90 and 86% on a
per article basis or on nicotine-adjusted basis respectively, using
the Health Canada list, see Table 4).
The range of reduction expressed by the 2.5th and 97.5th
G. Jaccard et al. / Regulatory Toxicology and Pharmacology 90 (2017) 1e83
percentiles is between 88% and 92% for the per article basis results
and between 81% and 92% for the nicotine-adjusted results (using
the Health Canada list). The range of reduction between the HPHC
in the THS2.2 aerosol and the HPHC in the mainstream smoke of
cigarettes is also illustrated in Figs. 1 and 2.
3.2.2. Worldwide markets analysis
The results on the reduction of the levels of THS2.2 aerosol
HPHC as compared to HPHC in the mainstream smoke of com-
mercial cigarettes worldwide are reported in Table 5. Results are
based on both aerosol/smoke yields measured on a per article basis,
as well as yields based on nicotine-adjusted yields. The results
Table 2
HPHC yields of THS2.2 expressed as a percentage of the HPHC yields of the 3R4F. Comparison of percentage reduction perarticle according to the Health Canada list, under HCI
smoking regime.
3R4F Reference
3R4F Reference
THS2.2% Reduction vs. 3R4F, Stick
Nicotine (mg/article) 1.86 0.175 1.14 0.0332 -
Mercury (ng/article) 4.77 0.669 2.04 0.104 57.1%
Ammonia (
g/article) 29.3 2.88 10.5 1.63 64.3%
Butyraldehyde (
g/article) 83.5 5.55 20.3 0.586 75.6%
Pyridine (
g/article) 29.7 6.01 6.14 0.423 79.3%
Catechol (
g/article) 89.8 7.14 14.4 0.68 84.0%
Acetaldehyde (
g/article) 1641 258 217 7.85 86.8%
Propionaldehyde (
g/article) 123 7.75 13.6 0.662 89.0%
Formaldehyde (
g/article) 85.2 16.7 7.98 0.504 90.6%
Hydroquinone (
g/article) 89.1 6.65 7.2 0.391 91.9%
Phenol (
g/article) 14 1.86 1.12 0.0849 92.0%
Styrene (
g/article) 15.4 3.23 1.05 0.145 93.1%
N-nitrosoanabasine (NAB) (ng/article) 30.2 2.61 1.92 0.182 93.6%
Benzo[a]pyrene (ng/article) 15 1.3 0.939 0.0796 93.7%
Acrolein (
g/article) 156 25.4 9.63 0.703 93.8%
N-nitrosoanatabine (NAT) (ng/article) 270 22.9 14 1.13 94.8%
Acetone (
g/article) 690 37.5 35.5 1.84 94.9%
Methyl-ethyl-ketone (MEK) (
g/article) 185 12.3 7.59 0.456 95.9%
N-Nitrosonornicotine (NNN) (ng/article) 283 27.8 10.2 0.486 96.4%
Nitric oxide (NO) (
g/article) 504 29 13.8 0.967 97.3%
4-(Methyl-nitrosamino)-1-(3-pyridyl)-1-butanone (NNK) (ng/
264 26.4 6.75 0.493 97.4%
Nitrogen oxides (NOx) (
g/article) 560 30.6 14.1 0.943 97.5%
Carbon monoxide (CO) (mg/article) 30.2 2.76 0.436 0.0811 98.6%
Toluene (
g/article) 137 16.9 1.82 0.163 98.7%
o-Cresol (
g/article) 4.15 0.494 0.0393 0.00649 99.1%
Benzene (
g/article) 81.1 8.78 0.544 0.0312 99.3%
Acrylonitrile (
g/article) 24.5 3.52 0.158 0.0122 99.4%
1,3-Butadiene (
g/article) 98.5 9.8 0.342 0.0347 99.7%
4-Aminobiphenyl (ng/article) 2.83 0.434 0.00958 0.0014 99.7%
3-Aminobiphenyl (ng/article) 4.18 0.773 0.0112 0.0031 99.7%
Isoprene (
g/article) 894 76.7 2.15 0.202 99.8%
1-Aminonaphthalene (ng/article) 21.6 2.28 0.0407 0.0103 99.8%
2-Aminonaphthalene (ng/article) 16.2 2.54 0.0277 0.00909 99.8%
Crotonaldehyde (
g/article) 50.5 9.42 <3.29 *
Lead (ng/article) 32.1 4 <1.62 * >95
Quinoline (
g/article) 0.431 0.0416 <0.011 * >97.4
Hydrogen cyanide (
g/article) 365 31.2 <4.37 * >98.8
mþp-Cresol (
g/article) 12.1 0.897 <0.0646 * >99.5
Cadmium (ng/article) 92.9 10.4 <0.28 * >99.7
Arsenic (ng/article) 7.9
*<1.2 * NA
Resorcinol (
g/article) 1.79
*<0.055 * NA
Chromium (ng/article) <LOQ
Nickel (ng/article) <LOQ
Selenium (ng/article) 1.95
* 1.57 0.123 NA
Average reduction /Health Canada List 92.27%
Notes: LOQ eLimit of Quantication. The calculations can be reported on yields per unit mass nicotine, by dividing each HPHC yield by the average nicotine concentration. The
data show that THS2.2 reduced HPHC levels on average, by more than 90% considering their concentrations on a per article basis, and by about 87% considering their con-
centrations on nicotine basis relative to the reference cigarette.
LOQ eLimit of Quantication.
The reported Health Canada list of constituents does not include pH, tar, and Total Particulate Matter (TPM).
Standard deviation.
THS2.2 is designed to deliver similar levels of nicotine as cigarettes.
A*in place of the standard deviation indicates that constituent levels for some or all replicates were below the limit of quantication of the analytical method. In these
cases, the median is shown instead of the mean.
10% of values below the limit of quantication. Median value reported in place of the mean.
Not applicable ecould not be quantied in this study.
Few values below the limit of quantication. Median value reported in place of the mean.
80% values below the limit of quantication.
Not detected (below the limit of detection of the method).
90% values below the limit of quantication.
20% of values below the limit of quantication. Median value reported in place of the mean.
G. Jaccard et al. / Regulatory Toxicology and Pharmacology 90 (2017) 1e84
provided in Table 4 are calculated from the weighted median yields
obtained per country using all data from 2008 to 2016.
The results provided in Table 5 are statistically assessed using
the average yield reduction of THS2.2 aerosol HPHC across all
Table 3
Observed percentage reduction of HPHC in THS2.2 compared with commercial cigarettes in South Korean market sampled and analyzed in 2008 and in 2015. Reported
percentage reductions are based on aerosol/smoke yields measured on both per article (top) and a nicotine-adjusted (bottom) basis.
2008 2015
Per Article basis Per Article basis
Health Canada WHO 39 WHO-9 FDA 18 IARC Health Canada WHO 39 WHO-9 FDA 18 IARC
97.5th Percentile 92% 92% 94% 94% 97% 92% 92% 94% 95% 97%
75th Percentile 91% 91% 93% 94% 96% 91% 90% 93% 94% 95%
Median 89% 89% 93% 93% 96% 90% 90% 92% 93% 95%
Mean 90% 89% 92% 93% 96% 90% 89% 92% 93% 95%
25th Percentile 89% 88% 92% 92% 95% 88% 88% 91% 92% 94%
2.5th Percentile 88% 87% 90% 91% 94% 88% 87% 90% 91% 93%
Nicotine basis Nicotine basis
Health Canada WHO 39 WHO-9 FDA 18 IARC Health Canada WHO 39 WHO-9 FDA 18 IARC
97.5th Percentile 92% 92% 95% 95% 97% 89% 89% 93% 93% 96%
75th Percentile 91% 91% 93% 93% 96% 87% 86% 90% 91% 93%
Median 88% 88% 92% 92% 95% 86% 85% 89% 90% 93%
Mean 88% 88% 91% 92% 95% 86% 85% 89% 90% 93%
25th Percentile 88% 87% 90% 92% 95% 85% 84% 88% 90% 92%
2.5th Percentile 83% 82% 86% 88% 92% 81% 80% 85% 87% 88%
Lists of HPHC according to Health Canada (Health Canada, 2000), WHO TobReg nine rst priority toxicants (Burns et al., 2008), WHO TobReg non-exhaustive priority list
(World Health Organization, 2015), FDA abbreviated list (FDA, 2012) and IARC group 1 carcinogens.
Table 4
Observed percentage reduction of HPHC in THS2.2 compared with commercial cigarettes sampled and analyzed between 2008 and 2015, using Health
Canada list of HPHC. Reported percentage reductions are based on aerosol/smokeyields measured on both per article (left) and a nicotine-adjusted (right)
basis and on weighted median smoke constituentsyields in commercial cigarettes.
Country Average % reduction on per article basis Average % reduction on nicotine basis
South Korea 90 86
Japan 91 87
Russia 91 88
Germany 92 86
Australia 90 83
Fig. 1. Box plots summarizing the distribution property of THS2.2 average HPHC yield reductions on a per article basis, against the average yields of individual commercial cigarette
products sampled in 2008 from South Korean Market.
G. Jaccard et al. / Regulatory Toxicology and Pharmacology 90 (2017) 1e85
cigarette products. Five critical percentiles covering the whole
range of the observed reductions are also provided.
The mean reduction observed for the THS2.2 aerosol HPHC to-
wards commercial cigarettes bought in 2015 and 2016, using the
Health Canada list is very similar in all countries with values be-
tween 90% and 92% on a per article basis or between 82% and 87%
with nicotine adjusted values.
Fig. 2. Box plots summarizing the distribution property of THS2.2 average HPHC yield reductions on a per article basis, against the average yields of individual commercial cigarette
products sampled in 2015 from South Korean Market.
Table 5
Observed percentage reduction of HPHC in THS2.2 compared with commercial cigarettes in major markets worldwide in 2015e2016. Reported percentage distribution
reduction statistics are based on aerosol/smoke yields measured on a per article basis (left) and on nicotine-adjusted smoke yields (right).
Per article basis Nicotine basis
Health Canada WHO 39 WHO-9 FDA 18 IARC Health Canada WHO 39 WHO-9 FDA 18 IARC
Australia 97.5th Percentile 93% 93% 94% 95% 96% 86% 86% 90% 91% 94%
75th Percentile 91% 91% 93% 93% 95% 85% 84% 88% 88% 92%
Median 91% 90% 92% 93% 94% 82% 81% 84% 86% 87%
Mean 91% 90% 92% 93% 93% 82% 81% 84% 86% 87%
25th Percentile 90% 89% 90% 91% 92% 80% 79% 81% 83% 84%
2.5th Percentile 89% 88% 89% 91% 90% 78% 76% 78% 81% 80%
Japan 97.5th Percentile 93% 93% 95% 95% 97% 89% 89% 93% 93% 96%
75th Percentile 92% 91% 94% 95% 96% 87% 86% 91% 91% 94%
Median 91% 91% 93% 93% 95% 85% 85% 90% 90% 93%
Mean 90% 90% 93% 93% 95% 85% 84% 88% 89% 91%
25th Percentile 89% 89% 92% 92% 94% 84% 83% 88% 89% 91%
2.5th Percentile 86% 86% 89% 90% 90% 76% 75% 74% 80% 78%
Russia 97.5th Percentile 92% 91% 94% 95% 97% 91% 91% 95% 94% 97%
75th Percentile 91% 91% 94% 94% 96% 87% 87% 91% 92% 94%
Median 91% 90% 94% 94% 96% 87% 86% 90% 91% 94%
Mean 91% 90% 93% 94% 96% 87% 87% 91% 91% 94%
25th Percentile 91% 90% 93% 93% 95% 86% 86% 90% 91% 94%
2.5th Percentile 90% 90% 92% 93% 95% 85% 85% 89% 90% 93%
EU 97.5th Percentile 93% 93% 95% 96% 97% 90% 90% 93% 93% 95%
75th Percentile 92% 92% 94% 95% 96% 87% 87% 91% 91% 94%
Median 92% 91% 94% 94% 96% 86% 85% 90% 91% 93%
Mean 92% 91% 94% 94% 96% 86% 86% 89% 90% 93%
25th Percentile 91% 90% 93% 94% 95% 85% 84% 88% 90% 92%
2.5th Percentile 89% 89% 91% 92% 94% 82% 82% 85% 88% 89%
G. Jaccard et al. / Regulatory Toxicology and Pharmacology 90 (2017) 1e86
4. Discussion
The assessment program for THS2.2 was recently described
(Smith et al., 2016) and followed by a series of publications
providing the results of the non-clinical and parts of the clinical
assessment of THS2.2. Investigations on differences in aerosol
composition compared to the smoke composition of cigarettes,
and differences in biological effects in in vitro assays conducted in
the non-clinical part of the THS2.2 assessment used the University
of Kentucky 3R4F cigarette as a reference cigarette (Schaller et al.,
2016). There are several arguments in favor for that selection: The
availability of the reference cigarette from an independent source;
its widespread use for tobacco research purposes, internally and
externally, which provides a solid data base of results for HPHC
analysis and effects in biological assays supported by a homoge-
neity of the reference cigarettes usually exceeding that of com-
mercial products. There are however also limitations, inter alia the
fact that the 3R4F has been designed as reference for an American
blend type cigarette. Consequently, it remained to be demon-
strated that the commercially available THS2.2 achieves a com-
parable overall reduction in yields of selected HPHC whether
compared with the 3R4F or commercial cigarettes from various
In this work, in comparison with 3R4F cigarettes mainstream
smoke HPHC, the average reduction over all analyzed HPHC in
THS2.2 covering a wide range of chemical classes is found to be 92%
on a per article basis and 87% on a nicotine-adjusted basis. The
results are consistent with what was reported previously for
THS2.2 and 3R4F (Schaller et al., 2016) and with recently published
data related to 3R4F mainstream smoke yields (Margham et al.,
2016; Pazo et al., 2016; Eldridge et al., 2015; Roemer et al., 2012).
In comparison with the HPHC in the mainstream smoke of
commercial cigarettes in specic markets, the mean reduction
observed for the THS2.2 aerosol HPHC is very similar in all markets
and very close to the reduction for 3R4F (e.g., 90%e92% reduction
for the per article basis results using the Health Canada list in in-
dividual markets and 83% and 88% reduction for the nicotine-
adjusted results, using the weighted median values for commer-
cial cigarettes as a comparison). These results conrm that the use
of 3R4F reference cigarette as a comparator provides a value for the
average reduction in aerosol/smoke yields which is representative
of commercial cigarettes available in various markets in studies
with potentially modied risk tobacco products, such as THS2.2.
The generally lower reduction observed for the nicotine-
adjusted results against the results obtained on a per article basis
is mainly due to the average higher machine smoking yields of
nicotine from cigarettes. The range of reduction observed varies
between around 75% and 97% for individual products for nicotine-
adjusted results and between 86% and 97% on a per article basis.
The observed range among different commercial cigarettes in a
given country is due to differences in terms of cigarette designs,
which can impact the mainstream smoke yields of commercial
cigarettes. Typically, the inuence of the cigarette diameter (Siu
et al., 2013; McAdam et al., 2016), the blend types (Piad
e et al.,
2013) or the lter types (Hearn et al., 2010; Piad
e et al., 2015;
Shin et al., 2009) have been pointed out.
If we take the same comparative approach for the HPHC yields
between different commercial cigarette products, we obtain for
example a mean decrease in terms of HPHC of 12% on a per article
basis (or 10% on nicotine-adjusted results) between the cigarettes
from Australia (a typical Virginia blended market) and the ciga-
rettes from selected EU countries (American blended cigarette
markets) in this study, using the 2015-2016 median values of each
HPHC in both markets. This difference is driven mainly by the TSNA,
ammonia and aromatic amines levels which are lower in Virginia
blends than in American blends (Piad
e et al., 2013). Considering
further differences in biological activity of smoke from cigarettes
with different tobacco blends (Belushkin et al., 2014), it is well
known, for example, that Total Particulate Matter (TPM) from Vir-
ginia tobacco is consistently less mutagenic than Burley tobacco in
the Ames bacterial mutagenicity assay (Roemer et al., 2004). On the
contrary, in the mammalian cell based Mouse Lymphoma geno-
toxicity assay, TPM from Virginia tobacco cigarettes is more
mutagenic than that from experimental all Burley tobacco ciga-
rettes (Schramke et al., 2006). Those differences do not, however,
appear to reect any difference in terms of cancer and COPD
occurrence in markets consisting essentially of Virginia blended
cigarettes (such as Australia or UK) or essentially American blended
cigarettes (such as Germany) as shown in a review of epidemio-
logical data (Lee et al., 2009). This is also true for the charcoal
containing lter cigarettes which have lower amounts of mostly
volatile and semi-volatile compounds but not particulate phase
compounds in cigarette mainstream smoke, when compared with
cellulose acetate containing lter cigarettes (Shin et al., 2009;
Hearn et al., 2010). In a clinical study with carbon-ltered ciga-
rettes with a high loading of charcoal and test cigarettes with
regular acetate tow lters, there were no signicant difference in
the measures of biological effect which were performed (Sarkar
et al., 2008), even though there was a signicant decrease of the
HPHC present in the gas phase. A review of published data,
including non-clinical, clinical and epidemiological studies,
concluded that current charcoal lter techniques alone may not be
sufcient to reduce smoking-related disease (Coggins and
Gaworski, 2008).
In addition, it was recently reported that therewas no consistent
change of biomarkers of effect in smokers of cigarettes which were
specically designed for reduced toxicant emissions and delivered
around 50% less on average for a wide range of HPHC than reference
cigarettes (Dittrich et al., 2014; Proctor et al., 2014).
In the case of THS2.2, due to absence of combustion, a signicant
decrease in formation of about 90% is observed on average across a
broad range of chemical compounds when compared against 3R4F
reference cigarettes and commercial cigarettes available in a
number of countries. The reduced formation for this technology is
also consistent with results on toxicity reductions. In comparison
with 3R4F a signicant reduction of the cytotoxicity determined by
the neutral red uptake assay and the mutagenic potency in the
mouse lymphoma assay has been observed, while THS2.2 aerosol
was not mutagenic in the Ames assay (Schaller et al., 2016).
Furthermore, a signicant reduced exposure to HPHC (close to the
levels observed for smoking abstinent subjects) has been observed
for subjects switching to this product in comparison with
continuing to smoke commercially available cigarettes in clinical
trials (Haziza et al., 2016a, 2016b; Ludicke et al., 2017a).
In summary, our results conrm that the average reduction in
aerosol yields shown for the THS2.2 in comparison to the 3R4F
reference cigarette are equally valid when considering commer-
cially available cigarette products from diverse markets worldwide.
This leads to the twofold conclusion, rstly that about 90% average
HPHC emission reductions of the THS2.2 in comparison to the 3R4F
are sufciently representative of commercial market means and
secondly, that the 3R4F is a reasonable comparator for the assess-
ment of aerosols of potentially modied risk tobacco products such
as the THS2.2 in the non-clinical phase of evaluation.
Appendix A. Supplementary data
Supplementary data related to this article can be found at http://
G. Jaccard et al. / Regulatory Toxicology and Pharmacology 90 (2017) 1e87
Transparency document
Transparency document related to this article can be found
online at
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... a Individual product codes were Pulze HTS used with (A) iD Intense American Blend sticks, (B) iD Regular American Blend sticks and (C) iD Regular Menthol sticks, and (D) subjects' usual brand cigarettes. Race White 6 (100%) 6 (100%) 6 (100%) 6 (100%) 24 (100%) Ethnicity Not Hispanic or Latino 6 (100%) 6 (100%) 6 (100%) 6 (100%) 24 Regarding intent to use the product again, 13%, 17%, and 13% of subjects expressed positive likelihood (assessed as a rating on the VAS between the mid-point and 'definitely would') of using the Pulze HTS with the iD Intense American Blend stick, the iD Regular American Blend stick, and the iD Regular Menthol stick again, respectively, compared with 48% of subjects who expressed positive likelihood of using their usual brand cigarettes again. Overall, mean raw VAS scores for intent to use the product again ranged from 25.0 to 26.0 (0 = definitely would not and 100 = definitely would) for the Pulze HTS variants, with a higher score of 51.3 for subjects' usual brand cigarettes. ...
Full-text available
Nicotine delivery and subjective effects are determinants of the ability of potentially less harmful tobacco products such as heated tobacco products (HTPs) to support adult smokers in switching away from cigarettes, and therefore to support tobacco harm reduction. This open-label, randomised, crossover, clinical study in 24 healthy adult smokers study assessed nicotine pharmacokinetics and subjective effects of the Pulze Heated Tobacco System (HTS; Pulze HTP device and three iD stick variants—Intense American Blend, Regular American Blend and Regular Menthol) compared with subjects’ usual brand cigarettes (UBC). Cmax and AUCt were highest for UBC and significantly lower for each Pulze HTS variant. Cmax and AUCt were significantly higher for Intense American Blend compared with Regular American Blend, while AUCt was significantly higher for Intense American Blend compared with Regular Menthol. Median Tmax was lowest (i.e., nicotine delivery was fastest) for subjects’ usual brand cigarettes and similar across the iD stick variants, although no between-product differences were statistically significant. All study products reduced urges to smoke; this effect was greatest for cigarettes although this was not statistically significant. Product evaluation scores for each Pulze HTS variant in the domains of ‘satisfaction’, ‘psychological reward’ and ‘relief’ were similar, and lower than those for UBC. These data demonstrate that the Pulze HTS effectively delivers nicotine and generates positive subjective effects, including satisfaction and reduced urge to smoke. This supports the conclusion that the Pulze HTS may be an acceptable alternative to cigarettes for adult smokers while having a lower abuse liability than cigarettes.
... Although adult smokers smoke for nicotine amongst other reasons, tobacco combustion generates more than 7,000 chemicals (US Department of Health and Human Services, 2014), to which the consumer is exposed. A number of studies have demonstrated, however, that aerosols generated from HTPs are less complex and contain fewer and substantially lower levels of toxicants compared to combustible cigarette smoke, attributed to the heating, as opposed to burning of tobacco (Jaccard et al., 2017;Forster et al., 2018;Malt et al., 2022). A recent study by Chapman et al. (2023) characterised the aerosols generated by two p-HTPs, one of which was used in this study (p-HTP Regular) and reported substantial reductions in the levels and numbers of toxicants present in the aerosol compared to 1R6F smoke. ...
Full-text available
Tobacco harm reduction (THR) involves providing adult smokers with potentially reduced harm modes of nicotine delivery as alternatives to smoking combustible cigarettes. Heated tobacco products (HTPs) form a category with THR potential due to their ability to deliver nicotine and flavours through heating, not burning, tobacco. By eliminating burning, heated tobacco does not produce smoke but an aerosol which contains fewer and lower levels of harmful chemicals compared to cigarette smoke. In this study we assessed the in vitro toxicological profiles of two prototype HTPs’ aerosols compared to the 1R6F reference cigarette using the 3D human (bronchial) MucilAir™ model. To increase consumer relevance, whole aerosol/smoke exposures were delivered repeatedly across a 28 day period (16, 32, or 48 puffs per exposure). Cytotoxicity (LDH secretion), histology (Alcian Blue/H&E; Muc5AC; FoxJ1 staining), cilia active area and beat frequency and inflammatory marker (IL-6; IL-8; MMP-1; MMP-3; MMP-9; TNFα) levels were assessed. Diluted 1R6F smoke consistently induced greater and earlier effects compared to the prototype HTP aerosols across the endpoints, and in a puff dependent manner. Although some significant changes across the endpoints were induced by exposure to the HTPs, these were substantially less pronounced and less frequently observed, with apparent adaptive responses occurring over the experimental period. Furthermore, these differences between the two product categories were observed at a greater dilution (and generally lower nicotine delivery range) for 1R6F (1R6F smoke diluted 1/14, HTP aerosols diluted 1/2, with air). Overall, the findings demonstrate the THR potential of the prototype HTPs through demonstrated substantial reductions in toxicological outcomes in in vitro 3D human lung models.
... Previous laboratory studies from independent and manufacturerfunded studies also showed lower level of CO in mainstream HTP aerosol than in CC smoke. [27][28][29][30] However, our result on saliva cotinine level differed from laboratory results which showed nicotine in mainstream HTPs was about 57%-83% of that in CCs. 31 It should be noted that laboratory studies rely on machine-generated emissions, and cannot accurately replicate human exposure. 32 All but five trials on HTPs in humans were manufacturer funded. ...
Background Independent studies on exhaled carbon monoxide (CO) and saliva cotinine levels in regular heated tobacco product (HTP) users, and how they compare with conventional cigarette (CC) smokers, are lacking. Methods A total of 3294 current users of CCs, HTPs or electronic cigarettes (ECs) from a household survey and a smoking hotspot survey were classified into seven groups: exclusive users of CCs, HTPs, ECs; dual users of CCs and HTPs, CCs and ECs, HTPs and ECs; and triple users. We measured exhaled CO level using the piCo Smokerlyzer (n=780) and saliva cotinine using NicAlert cotinine test strips (n=620). Among the seven groups, the differences in (1) CO and cotinine levels were examined using Kruskal-Wallis test, and (2) the average daily tobacco consumption in the past 30 days was examined using multivariable linear regression. Results Both exclusive and dual users of CCs had a higher CO level than exclusive HTP or EC users (p<0.05). Exhaled CO levels were similar between HTP and EC users, as were saliva cotinine levels among the seven groups. Compared with exclusive CC users, those who also used HTPs or ECs smoked fewer CCs (CCs+HTPs: adjusted coefficient −2.79, 95% CI −3.90 to –1.69; CCs+ECs: −1.34, 95% CI −2.34 to –0.34), but consumed more tobacco sticks equivalent in total (2.79 (95% CI 1.61 to 3.96); 1.95 (95% CI 0.79 to 3.12)). Conclusions HTP or EC use showed lower exhaled CO but similar saliva cotinine levels compared with CC use. Dual users of CCs and HTPs/ECs smoked fewer CCs than exclusive CC users, but consumed more tobacco in total.
... Of the 18 studies on aerosol chemistry, 7 measured a range of analytes represented as established HPHC lists, although the actual list used varied [24,34,52,56,57,62,76]. The other eleven looked at a subset of analytes, such as nicotine, aldehydes, polyaromatic hydrocarbons [1,15,22,39,42,44,[53][54][55], nicotine, carbon monoxide, and tobacco-specific nitrosamines [3] with one paper looking at nicotine delivery [21]. ...
Full-text available
Heated tobacco products (HTP) have become increasingly common in many countries worldwide. The principle of heating tobacco, without combustion, to produce a nicotine-containing aerosol with remarkably reduced levels of other known toxins, compared to combusted tobacco cigarettes, is now well established. As these products are intended as alternatives to traditional combusted products, during the early stages of their development, it is important for manufacturers to ensure that the design of the product does not lead to any unintentionally increased or new risk for the consumer, compared to the traditional products that consumers seek to replace. There is limited guidance from tobacco product regulations concerning the requirements for performing such preliminary toxicological assessments. Here, we review the published literature on studies performed on HTPs in the pursuit of such data, outline a proposed approach that is consistent with regulatory requirements, and provide a logical approach to the preliminary toxicological assessment of HTPs.
This was a randomized, controlled, open-label, confinement study to assess change in exposure to selected cigarette smoke constituents in healthy adult cigarette smokers who switched to using a novel heated tobacco product (direct heating tobacco system, platform 3, generation 3, version a [DT3.0a]). Sixty nonmenthol cigarette smokers were randomized into 1 of the 4 study groups in which subjects switched to a nonmenthol type of tobacco stick used with DT3.0a, switched to a nonmenthol tobacco stick used with an in-market heated tobacco product device (THS), continued to smoke nonmenthol cigarettes, or stopped smoking. Furthermore, 30 menthol cigarette smokers were randomized into 1 of the 2 study groups in which subjects switched to a menthol tobacco stick used with DT3.0a (mDT3.0a) or continued to smoke menthol cigarettes. Fifteen biomarkers of exposure to selected harmful and potentially harmful constituents (HPHCs) were measured during the 5-day exposure period, followed by assessment of nicotine pharmacokinetics with the assigned product. Results indicated that switching to DT3.0a, THS, and mDT3.0a showed significant exposure reductions in most of the selected HPHCs as compared to continuing smoking cigarettes, with reductions being similar in magnitude to reductions observed with smoking cessation. For DT3.0a and mDT3.0a, nicotine pharmacokinetic parameters were not remarkably different from those obtained for cigarettes and the THS except that a longer time to maximum concentration was obtained following use of the mDT3.0a. In conclusion, switching from smoking cigarettes to DT3.0a or THS use reduced exposure to most of the selected HPHCs, and no remarkable differences were observed for the measurements obtained from different flavors of DT3.0a stick.
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Aim : The objective of this study is to evaluate the correlation between tobacco consumption and levels of exhaled carbon monoxide. Material and Methods : To conduct the literature review, multiple databases and sources were utilized. The search was conducted using MeSH Terms related to tobacco and exhaled carbon monoxide. Initially, 421 titles were identified from these sources, and after screening, 118 records were examined, resulting in 25 research-related articles. The review adhered to the PRISMA guidelines for systematic reviews to ensure a standardized and rigorous approach to the evaluation of the selected studies. Results: Six randomized controlled trials were incorporated in the analysis, aiming to compare the association between tobacco consumption and exhaled carbon monoxide levels. The findings from all six trials consistently demonstrated a significant correlation between these two variables. Conclusion: To sum up, the analysis of research publications focusing on tobacco consumption and exhaled carbon monoxide (CO) levels yields valuable insights regarding the correlation between smoking behavior, CO levels, and the associated health implications. This body of literature enhances our understanding of the relationship between smoke & implications on well being, shedding light on the potential risks and consequences of tobacco use. Clinical Significance: Gaining a deeper understanding of these relationships can play a significant role in developing impactful strategies for smoking cessation. Furthermore, it can help raise awareness about the detrimental effects of tobacco smoke and emphasize the importance of reducing tobacco consumption. By leveraging this knowledge, we can work towards implementing effective interventions and public health campaigns aimed at promoting smoking cessation and improving overall population health. KEYWORDS : Smoking cessation, tobacco, carbon monoxide
This paper provides an overview of the legislative and technical regulation of the production, promotion, circulation and consumption of nicotine-containing products (electronic nicotine delivery systems, vapes, electronic cigarettes, non-tobacco smoking mixtures), the relevance in studying the issue is caused by the observed increase in the distribution and consumption of these products among the population of the Russian Federation. The spread among children and young people is of particular concern. The potential danger and toxic risk is caused by exposure to nicotine, as well as glycols, glycerols, aldehydes (including formaldehyde), volatile organic substances, polycyclic aromatic hydrocarbons, dicarbonyls, hydroxycarbonyls (acetol), metals, silicate particles and other elements found in aerosol by inhalation. A comparative analysis of international experience and practice of establishing and applying safety requirements for nicotine-containing products, as well as an analysis of regulatory legal and regulatory and technical acts of the member states of the Eurasian Economic Union in the field of regulation of nicotine-containing products is given. As a result of the work, it was concluded that the development, approval and implementation of legislative technical regulation within the framework of the Eurasian Economic Union – the technical regulation of the EAEU "Technical regulation for nicotine-containing products", interstate standards containing rules and methods of research (testing) and measurements, including the rules for sampling nicotine-containing products as a separate category of products that may carry a potential risk to the health of consumers.
The epidermal growth factor receptor (EGFR) signaling pathway has essential roles in maintaining homeostasis of various tissues by regulating cell proliferation and differentiation. Deregulation of the EGFR signaling pathway is associated with various chronic diseases including chronic obstructive pulmonary disease. Cigarette smoke (CS) is known to activate EGFR, which is linked to chronic obstructive pulmonary disease. The biological sequence from CS exposure to EGFR activation is initiated by oxidative stress caused by intracellular reactive oxygen species (ROS) and the depletion of glutathione, which led to EGFR ligand secretion and EGFR activation. We hypothesized that reducing exposure to CS constituents contributes to preventing CS-inducible EGFR activation. Therefore, we examined the aerosol from heated tobacco products (HTPs) because the aerosol contains fewer chemical constituents at lower levels than CS. We exposed primary human bronchial epithelial cells from four donors to the extracts of CS from a 1R6F reference cigarette or HTP aerosol from three in-market products, including our DT3.0a. The biological sequence from ROS to EGFR activation were assessed. CS induced all the tested endpoints although inter-donor differences were observed, whereas HTPs elicited most of the biological events at higher concentrations; however, EGFR phosphorylation was not observed even at five-fold higher concentration than CS. Overall our results indicate that HTPs are less effective than CS to elicit ROS-induced EGFR activation. The reduced-risk potential of HTPs on EGFR-related diseases should be investigated further. In addition, testing with multiple donors is warranted when considering the individual differences in responses of primary cells to stimuli.
An estimated 65 million people worldwide have moderate or severe chronic obstructive pulmonary disease (COPD), an umbrella term used to describe a group of progressive lung diseases that obstruct airflow such as emphysema and chronic bronchitis. Smoking contributes to an estimated 90% of COPD cases, as the harmful chemicals produced during tobacco combustion damage the lungs and airways. Although smoking cessation is the only intervention shown to improve COPD prognosis in smokers, many patients who try to quit continue to smoke. The continued use of conventional cigarettes exacerbates COPD symptoms, and globally more than 3 million people die from the disease every year. The last two decades have seen the introduction of combustion-free nicotine delivery alternatives that produce significantly lower levels of the harmful components in cigarette smoke, and researchers have begun to assess the impact of switching from cigarettes to these products. Several studies have examined how patients with COPD use e-cigarettes as assistance for quitting, but few have examined how heated tobacco products (HTP) may reduce risk. This narrative review summarises results from pre-clinical, clinical, and real-world evidence studies showing possible harm reduction benefits for patients with COPD who switch to HTPs rather than continuing to smoke cigarettes. Epidemiological studies, real-world data analyses, and randomised clinical trials must be conducted to determine whether switching from cigarettes to HTPs can improve health outcomes in patients with COPD who would otherwise continue to smoke combustible cigarettes.
Smoking remains one of the leading contributory causes for disability and deaths. A tough challenge to healthcare professionals is handling recalcitrant smokers, who slide back to cigarette smoking despite all efforts and interventions to make them quit. The current pandemic has magnified the smoking problem, considering the already increased health risk of active smokers, which is aggravated should they develop coronavirus disease 2019 (COVID-19). Smokers with chronic obstructive pulmonary disease (COPD), a complication many recalcitrant smokers are likely to have already, are at an increased risk leading to much poorer clinical outcomes. The conventional smoking-cessation interventions like nicotine replacement therapy, drugs, behavioral counselling, hypnotherapy, or even acupuncture have proven unsuccessful in weaning the far bigger majority of smokers who wish to quit, but could not help but slide back to cigarette smoking after a short period of complete abstinence. This predicament with recalcitrant smokers has prompted doctors, dentists and other healthcare professionals to reconsider and explore alternatives that could at least mitigate the health risks of recalcitrant smokers. The use of electronic nicotine delivery systems (ENDS)—including heated tobacco products (HTPs) as a smoking-cessation tool in recalcitrant smokers who really could not attain total and sustained smoking cessation despite the use of conventional smoking cessation measures—can increase the chances of success in weaning. Though not considered completely safe, the use of ENDS and HTPs has been shown to reduce the amount of toxic substances a smoker gets up to 95% less, compared to traditional tobacco smoking. Even the youth that are current cigarette smokers, consider it beneficial, and the feared potential ‘gateway effect’ is not borne out in real-world data. Though ENDS, including HTPs, may be considered a pragmatic middle ground for recalcitrant smokers, the long-term nicotine addiction could still pose a problem, for which legislative and regulatory control measures are imperative. This is to prevent the youth and other adult nonsmokers from trying them and being subsequently hooked to it.
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Introduction: The menthol Tobacco Heating System 2.2 (mTHS) is a newly developed candidate modified-risk tobacco product intended to reduce exposure to the harmful and potentially harmful constituents (HPHCs) of conventional cigarette (CC) smoke. This study examined the impact of switching to mTHS on biomarkers of exposure to HPHCs relative to menthol CCs (mCCs) and smoking abstinence (SA). Methods: In this three-arm, parallel-group study, 160 Japanese adult smokers (23-65 years; smoking ≥10 mCCs per day) were randomized to mTHS (n = 78), mCC (n = 42), or SA (n = 40) for 5 days in confinement and 85 days in ambulatory settings. Endpoints included biomarkers of exposure to HPHCs, human puffing topography, safety, and subjective effects of smoking measures. Results: After 5 days of product use, the concentrations of carboxyhemoglobin, 3-hydroxypropylmercapturic acid, monohydroxybutenyl mercapturic acid, and S-phenylmercapturic acid were 55%, 49%, 87%, and 89% lower (p < .001), respectively, in the mTHS group than in the mCC group. Other biomarkers of exposure (measured as secondary endpoints) were 50%-94% lower in the mTHS group than in the mCC group on day 5. These reductions in the mTHS group were maintained at day 90, similar to the SA group. Switching to mTHS was associated with changes in human puffing topography (shorter puff intervals and more frequent puffs). The urge-to-smoke and smoking satisfaction levels on day 90 were similar in the mTHS and the mCC groups. Conclusion: Switching from mCCs to mTHS significantly reduced exposure to HPHCs relative to continuing smoking mCCs with concentrations similar to those observed following SA in Japanese adult smokers. Implications: This randomized study compared the impact of switching to a modified-risk tobacco product candidate mTHS on biomarkers of exposure to HPHCs of cigarette smoke relative to continuing smoking cigarettes or abstaining from smoking in sequential confinement and ambulatory settings. The study showed that switching to mTHS was associated with significant biomarker reductions within 5 days in confinement, these reductions being maintained throughout the ambulatory setting up to day 90. The results provide evidence that switching to mTHS reduces real-life exposure to HPHCs in adult smokers.
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The Tobacco Heating System (THS) 2.2, a candidate Modified Risk Tobacco Product (MRTP), is designed to heat tobacco without burning it. Tobacco is heated in order to reduce the formation of harmful and potentially harmful constituents (HPHC), and reduce the consequent exposure, compared with combustible cigarettes (CC). In this 5-day exposure, controlled, parallel-group, open-label clinical study, 160 smoking, healthy subjects were randomized to three groups and asked to: (1) switch from CCs to THS 2.2 (THS group; 80 participants); (2) continue to use their own non-menthol CC brand (CC group; 41 participants); or (3) to refrain from smoking (SA group; 39 participants). Biomarkers of exposure, except those associated with nicotine exposure, were significantly reduced in the THS group compared with the CC group, and approached the levels observed in the SA group. Increased product consumption and total puff volume were reported in the THS group. However, exposure to nicotine was similar to CC at the end of the confinement period. Reduction in urge-to-smoke was comparable between the THS and CC groups and THS 2.2 product was well tolerated.
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Smoking conventional cigarettes (CCs) exposes smokers to harmful and potentially harmful constituents (HPHCs). The Tobacco Heating System 2.2 (THS 2.2), a candidate modified risk tobacco product, was developed to reduce or eliminate the formation of HPHCs, while preserving as much as possible the taste, sensory experience, nicotine delivery profile and ritual characteristics of CC. This randomized, controlled, open-label study in confinement for 5 day exposure aimed to demonstrate the reduction in exposure to selected HPHCs, to assess nicotine uptake and subjective effects, in participants switching to THS 2.2 (n = 80) compared to participants continuing smoking CCs (n = 40) and abstaining from smoking (n = 40). The subjects were randomized according to sex and daily CC consumption. The levels of biomarkers of exposure to HPHCs were significantly reduced in participants switching to THS 2.2, compared to CC use. More importantly, the magnitude of exposure reduction observed was close to that which was seen in participants who abstained from smoking for 5 days, while nicotine uptake was maintained. Reduction in urge-to-smoke was comparable between THS and CC groups, however THS 2.2 was slightly less satisfactory than CCs. The new, alternative tobacco product THS 2.2 was well tolerated.
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The chemical composition, in vitro genotoxicity, and cytotoxicity of the mainstream aerosol from the Tobacco Heating System 2.2 (THS2.2) were compared with those of the mainstream smoke from the 3R4F reference cigarette. In contrast to the 3R4F, the tobacco plug in the THS2.2 is not burnt. The low operating temperature of THS2.2 caused distinct shifts in the aerosol composition compared with 3R4F. This resulted in a reduction of more than 90% for the majority of the analyzed harmful and potentially harmful constituents (HPHCs), while the mass median aerodynamic diameter of the aerosol remained similar. A reduction of about 90% was also observed when comparing the cytotoxicity determined by the neutral red uptake assay and the mutagenic potency in the mouse lymphoma assay. The THS2.2 aerosol was not mutagenic in the Ames assay. The chemical composition of the THS2.2 aerosol was also evaluated under extreme climatic and puffing conditions. When generating the THS2.2 aerosol under “desert” or “tropical” conditions, the generation of HPHCs was not significantly modified. When using puffing regimens that were more intense than the standard Health Canada Intense (HCI) machinesmoking conditions, the HPHC yields remained lower than when smoking the 3R4F reference cigarette with the HCI regimen.
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Cigarettes with reduced circumference are increasingly popular in some countries, hence it is important to understand the effects of circumference reduction on their burning behaviour, smoke chemistry and bioactivity. Reducing circumference reduces tobacco mass burn rate, puff count and static burn time, and increases draw resistance and rod length burned during puff and smoulder periods. Smoulder temperature increases with decreasing circumference, but with no discernible effect on cigarette ignition propensity during a standard test. At constant packing density, mainstream (MS) and sidestream (SS) tar and nicotine yields decrease approximately linearly with decreasing circumference, as do the majority of smoke toxicants. However, volatile aldehydes, particularly formaldehyde, show a distinctly non-linear relationship with circumference and increases in the ratios of aldehydes to tar and nicotine have been observed as the circumference decreases. Mutagenic, cytotoxic and tumorigenic specific activities of smoke condensates (i.e. per unit weight of condensate) decrease as circumference decreases. Recent studies suggest that there is no statistical difference in mouth-level exposure to tar and nicotine among smokers of cigarettes with different circumferences. Commercially available slim cigarettes usually have changes in other cigarette design features compared with cigarettes with standard circumference, so it is difficult to isolate the effect of circumference on the properties of commercial products. However, available data shows that changes in cigarette circumference offer no discernible change to the harm associated with smoking.
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This publication introduces a series of eight other publications describing the non-clinical assessment and initial clinical study of a candidate modified risk tobacco product (MRTP) – the Tobacco Heating System 2.2 (THS2.2). This paper presents background information on tobacco harm reduction, to complement the approaches of increasing smoking cessation and reducing smoking initiation to reduce the morbidity and mortality caused by cigarette smoking. THS2.2 heats tobacco without combustion, and the subsequent formation of harmful and potentially harmful constituents (HPHC) is greatly reduced compared with cigarette smoke. Assessment of the THS2.2 aerosol in vitro and in vivo reveals reduced toxicity and no new hazards. Additional mechanistic endpoints, measured as part of in vivo studies, confirmed reduced impact on smoking-related disease networks. The clinical study confirmed the reduced exposure to HPHCs in smokers switching to THS2.2, and the associated transcriptomic study confirmed the utility of a gene expression signature, consisting of only 11 genes tested in the blood transcriptome of subjects enrolled in the clinical study, as a complementary measure of exposure response. The potential of THS2.2 as an MRTP is demonstrated by the assessment and additional publications cited in this series.
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Introduction: Heating rather than burning tobacco reduces levels of harmful and potentially harmful constituents, and consumer products using this approach aim to reduce exposure to tobacco toxicants. The Tobacco Heating System (THS) version 2.1 has been enhanced from earlier prototypes with an improved heat control and sensorial experience and thereby user acceptance. Exposure measurements are required to determine whether it may be possible to reduce the individual health risk compared to smoking combustible cigarettes (CCs). Methods: This controlled clinical study randomly assigned 40 smokers to either a group continuing to use of their own CC brand (n = 20) or a group switching to THS 2.1 (n = 20) for 5 days. Biomarkers of exposure were measured at baseline and on day 1 through day 5. Product consumption, Human Puffing Topography, the occurrence of adverse events, and an assessment of subjective effects, such as smoking satisfaction and enjoyment of respiratory tract sensations, were also determined. Results: The group of smokers who switched to THS 2.1 adapted their puffing behavior initially through longer puff duration and more puffs. During the duration of the study, total puff volume returned to baseline levels and the mean daily product consumption increased but with similar nicotine exposure compared to baseline CC use. Biomarkers of exposure to tobacco smoke toxicants which inform product risk assessment were significantly reduced with THS use compared to the CC group. THS 2.1 users experienced less reinforcing effects with THS 2.1 than with their own cigarette brand. Conclusions: THS 2.1 is a promising alternative to smoking CCs. Notwithstanding possible use adaption through consumption or puffing behavior, the exposure to harmful smoke constituents was markedly reduced with the new heated tobacco platform. Implications: Exposure markers to harmful and potentially harmful smoke constituents were lowered with the THS 2.1. Heating tobacco instead of burning can offer a potentially lower risk of delivering nicotine compared to CCs.
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Introduction: A significant portion of the increased risk of cancer and respiratory disease from exposure to cigarette smoke is attributed to volatile organic compounds (VOCs). In this study, 21 VOCs were quantified in mainstream cigarette smoke from 50 U.S. domestic brand varieties that included high market share brands and two Kentucky research cigarettes (3R4F and 1R5F). Methods: Mainstream smoke was generated under ISO 3308 and Canadian Intense (CI) smoking protocols with linear smoking machines with a gas sampling bag collection followed by SPME/GC/MS analysis. Results: For both protocols, mainstream smoke VOC amounts among the different brand varieties were strongly correlated between the majority of the analytes. Overall, Pearson correlation (r) ranged from 0.68 to 0.99 for ISO and 0.36 to 0.95 for CI. However, monoaromatic compounds were found to increase disproportionately compared to unsaturated, nitro, and carbonyl compounds under the CI smoking protocol where filter ventilation is blocked. Conclusions: Overall, machine generated "vapor phase" amounts (µg/cigarette) are primarily attributed to smoking protocol (e.g., blocking of vent holes, puff volume, and puff duration) and filter ventilation. A possible cause for the disproportionate increase in monoaromatic compounds could be increased pyrolysis under low oxygen conditions associated with the CI protocol.
The WHO Tobacco Product Regulation Study Group (TobReg) has proposed three regulatory models for cigarettes, each creating mandatory limits for emissions of nine smoke toxicants. One approach proposes country-specific limits, using median or 1.25× median toxicant/nicotine emission ratios. A second model provides fixed toxicant-ratio limits. The third model limits were three times the lowest toxicant emission on a market. Currently, the practical implications of these models are largely unknown. An impact assessment was conducted using cigarette data from 79 countries to identify four diverse test markets. We sampled all products from each market but limited product availability led to incomplete (80-97%) sourcing. Analysis showed that the country-specific model led to diverse (up to threefold) toxicant limits across the four markets. 70%-80% of products were non-compliant, rising to 100% in some countries with the second and the third models. With each regulatory model the main drivers of non-compliance were the tobacco-specific nitrosamines, the simultaneous application of limits for nine poorly correlated smoke toxicants, and analytical variability. Use of nicotine ratios led to compliance of some high toxicant emission products due to high nicotine emissions. Our findings suggest that these proposals would have greater impact on global markets than TobReg's stated aims.
There is interest in the relative toxicities of emissions from electronic cigarettes and tobacco cigarettes. Lists of cigarette smoke priority toxicants have been developed to focus regulatory initiatives. However, a comprehensive assessment of e-cigarette chemical emissions including all tobacco smoke Harmful and Potentially Harmful Constituents, and additional toxic species reportedly present in e-cigarette emissions, is lacking. We examined 150 chemical emissions from an e-cigarette (Vype ePen), a reference tobacco cigarette (Ky3R4F), and laboratory air/method blanks. All measurements were conducted by a contract research laboratory using ISO 17025 accredited methods. The data show that it is essential to conduct laboratory air/method measurements when measuring e-cigarette emissions, owing to the combination of low emissions and the associated impact of laboratory background that can lead to false-positive results and overestimates. Of the 150 measurands examined in the e-cigarette aerosol, 104 were not detected and 21 were present due to laboratory background. Of the 25 detected aerosol constituents, 9 were present at levels too low to be quantified and 16 were generated in whole or in part by the e-cigarette. These comprised major e-liquid constituents (nicotine, propylene glycol, and glycerol), recognized impurities in Pharmacopoeia-quality nicotine, and eight thermal decomposition products of propylene glycol or glycerol. By contrast, approximately 100 measurands were detected in mainstream cigarette smoke. Depending on the regulatory list considered and the puffing regime used, the emissions of toxicants identified for regulation were from 82 to >99% lower on a per-puff basis from the e-cigarette compared with those from Ky3R4F. Thus, the aerosol from the e-cigarette is compositionally less complex than cigarette smoke and contains significantly lower levels of toxicants. These data demonstrate that e-cigarettes can be developed that offer the potential for substantially reduced exposure to cigarette toxicants. Further studies are required to establish whether the potential lower consumer exposure to these toxicants will result in tangible public health benefits.