Clinical: Individual Risk
Our clinical exposure studies have shown that adult smokers who switch completely to our Smokeless Products reduce their exposure to a number of harmful chemicals as compared to continued smoking.*† Using the same methods, our clinical risk studies focus on biomarkers that reflect unfavourable changes within the body known to occur with smoking.
Referred to as ‘Biomarkers of Potential Harm’ (BoPH) or ‘Biomarkers of Biological Effect’ (BoBE), we monitor those that are known to occur with smoking. These BoPH are markers of physiological processes in the body such as inflammation and oxidative stress. These processes can be indicators of potential disease pathways: chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), and lung cancer.
As these physiological changes take time to occur, our clinical risk studies focus on product use for at least six months. This gives a reasonable time for changes to occur. However, it should be noted that by their very nature these effects can be caused by other lifestyle choices and not just smoking (e.g. obesity also affects cardiovascular disease risk).
In our clinical risk studies, we monitor seven BoPH and one physiological measure associated with disease endpoints:
Unfavourable Changes and Disease
Oxidative Stress
Oxidative stress is a significant factor in the development of CVD, COPD and cancer[97],[98],[99].
Oxidants produced as a result of cigarette smoking can cause damage to DNA and affect arteries and lung tissue. We measure 8-epi-prostaglandin F2α Type III (8-epi-PGF2а Type III) as a biomarker for oxidative stress. Levels have been shown to be higher in smokers compared to never-smokers.
Inflammation
We monitor white blood cell count (WBC) as a biomarker for inflammation. White blood cells are part of the immune system and increased levels occur with bacterial and viral infections. Levels also increase with various cancers, inflammatory disorders (e.g. arthritis) and COPD, as well as playing a prominent role in CVD[100],[101],[102]. Levels have also been shown to be higher in smokers compared to never-smokers.
CVD
We measure several biomarkers for CVD:
- Carbon monoxide
Carbon monoxide attaches to red blood cells and therefore prevents the attachment of oxygen which places stress on the heart to deliver oxygen to the body. Smoking leads to higher carbon monoxide levels in the blood compared to never-smokers. It is measured in exhaled breath (COex) or Carboxyhemoglobin in the blood (COHb)[103],[104]. - Soluble intercellular adhesion molecule (sICAM)
sICAM is part of the blood vessel inflammatory system. It contributes to CVD with levels in blood greater for smokers compared to never-smokers[102]. - High-density lipoprotein (HDL) cholesterol
HDL cholesterol or ‘good cholesterol’ plays a protective role in CVD; levels tend to be lower in smokers compared to never-smokers[102]. - Thromboxane (11-dTx-B2)
Thromboxane is a molecule produced in the blood to help it clot, generally after an injury. Levels measured in urine are greater for smokers compared to never-smokers[102].
Lung Cancer
Tobacco-specific nitrosamine 4-(methylnitrosamino)-1(3-pyridyl)-1-butanone (NNK) has been shown to be associated with lung cancer development in smokers. Measured as total NNAL in the urine, levels in smokers are greater compared to never-smokers[105].
Potential Detrimental Health Outcomes
Inclusive of measuring BoPH/BoBE, we assess potential detrimental health outcomes through physiological measures for all our participants such as blood pressure monitoring. We have also used spirometry, a simple test to help diagnose and monitor certain lung conditions[36],[106].
“BOPH could serve as more intermediate endpoints for assessing potential health risk of new and novel tobacco products in the absence of long-term epidemiological evidence.”
Scientists from the Office of Science
Center for Tobacco Products, Food and Drug Administration[107]
Footnotes
* Based on the weight of evidence and assuming a complete switch from cigarette smoking. These products are not risk free and are addictive.
† Products sold in the U.S., including Vuse, Velo, Grizzly, Kodiak, and Camel Snus, are subject to FDA regulation and no reduced-risk claims will be made as to these products without agency clearance.
References
A full list of references for this page can be found in the section 11. References.
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