Comparative Study on the Chronic Vascular Responses Induced by Regular Versus Occasional Waterpipe Smoke Inhalation in Mice.

BACKGROUND/AIMS: Waterpipe smoke (WPS) is the second most prevalent form of smoking in the world. There are ample evidences about the vascular alterations caused by regular WPS (Reg-WPS). Nonetheless, comparison of the chronic vascular response induced by regular versus occasional WPS (Occ-WPS) exposure is very scarce. METHODS: We investigated, in BALB/c mice, the effects of Occ-WPS (30 minutes/day, 1 day/week) versus Reg-WPS (30 minutes/day, 5 days/week) for 6 months on thrombogenicity and platelet aggregation in vivo and in vitro. Moreover, various markers of endothelial integrity, inflammation and oxidative stress were assessed by enzyme-linked immunosorbent assay and colorimetric assay. Control mice were exposed to air. RESULTS: Our results showed that either Occ-WPS or Reg-WPS exposure shortened the thrombotic time in pial microvessels in vivo. Moreover, in pial venules, this effect was more marked in Reg-WPS group (-47%) compared with Occ-WPS (-34%). Similarly, exposure to either Occ-WPS or Reg-WPS reduced the prothrombin time and activated partial thromboplastin time. Platelet count was increased only in Reg-WPS exposure. Exposure to either Occ-WPS or Reg-WPS induced platelet aggregation in vitro. In addition, there was a statistically significant difference between Occ-WPS and Reg-WPS groups in platelet count and aggregation. Plasma concentration of tissue factor (+98%), P-selectin (+14%) and E-selectin (+16%) were significantly increased in Occ-WPS group compared with air exposed group. Likewise, compared with air group Reg-WPS caused an increase in concentration of tissue factor (+193%), P-selectin (+21%) and E-selectin (+42%). Nevertheless, only Reg-WPS induced a decrease (-38%) in the plasma concentration of tissue plasminogen activator. Notably, our results showed a statistically significant difference between Occ-WPS and Reg-WPS groups in the concentration of tissue factor. Erythrocyte numbers, hemoglobin concentration, hematocrit and lactate dehydrogenase activity were augmented only in Reg-WPS group compared with either control or Occ-WPS groups. Likewise, only Reg-WPS induced an increase in proinflammatory cytokines, tumor necrosis factor-α and interleukin-1ß compared with either control or Occ-WPS groups. However, markers of oxidative stress including 8-isoprostane and total antioxidants were enhanced in both Occ-WPS and Reg-WPS compared with control group. CONCLUSION: Our data confirm the vascular toxicity of the chronic Reg-WPS exposure and shows that even occasional chronic exposure to WPS caused thrombosis, platelet aggregation, endothelial alterations and oxidative stress. The latter findings are an additional cause of concern about the long-term toxicity of occasional waterpipe smoking.

Concurrent Alcohol Use and Waterpipe Tobacco Smoking: Smoking Topography, Toxicant Exposure, and Abuse Liability.

INTRODUCTION: Relative to non-waterpipe (WP) smokers, WP smokers are more than twice as likely to use alcohol and frequently consume alcohol before or during smoking sessions. Co-use of alcohol and WP may result in greater toxicant exposure compared to WP smoking alone. To date, no study systematically has investigated the impact of acute alcohol intoxication on WP smoking topography, exposure to tobacco-related toxicants, or abuse liability. METHODS: Dyads of current WP smokers and drinkers (N = 42; age = 21-32 years) completed two in-laboratory ad libitum smoking sessions (≤2 hours) following 12-hour nicotine abstinence in a double-blind, randomized crossover design in which they consumed a placebo versus active drink (sustained breath alcohol concentration = .08). Exhaled carbon monoxide (eCO) and plasma nicotine concentration were assessed. Questionnaires assessed smoking experience and smoking urge. Smoking topography was measured continuously throughout each smoking session. RESULTS: The alcohol session was associated with increased inhaled volume, flow rate, and WP session duration compared to placebo. Compared to placebo, participants reported a more positive overall smoking experience following the alcohol session and greater smoking urges pre- and post-smoking session. Although both sessions resulted in significant increases in eCO and plasma nicotine, no significant differences emerged in eCO or nicotine exposure between the active and placebo sessions. CONCLUSIONS: Co-use of alcohol and WP may contribute to the maintenance of WP smoking through enhanced smoking experiences, increased urge to smoke, and significant exposure to addictive nicotine. Regulations may be necessary to limit the sale of alcohol in WP smoking lounges and reduce exposure to secondhand smoke. IMPLICATIONS: The findings suggest co-use of alcohol and WP tobacco likely maintain WP use and dependence by enhancing the smoking experience and increasing urges to smoke. These findings have implications for regulations aimed at limiting co-use of alcohol and WP tobacco in WP lounges and limiting exposure to secondhand smoke. CLINICAL TRIALS REGISTRATION: NCT03096860.

Plasma surfactant Protein-D levels in healthy subjects and COPD patients.

OBJECTIVE: To compare plasma surfactant protein-D levels in healthy smokers and Chronic obstructive pulmonary disease patients. METHODS: The comparative study was conducted at the University of Health Sciences, Lahore, Pakistan, from January to December 2015, and comprised chronic obstructive pulmonary disease patients and healthy smokers of either gender aged 40-80 years. Plasma surfactant protein-D levels of male and female subjects were estimated and compared with lung function and tobacco exposure. Blood samples were collected after complete history, physical examination and spirometry. Plasma levels were measured using enzyme-linked immunosorbent assay. Plasma cotinine levels were also measured for the determination of tobacco as well as biomass exposure along with pack years. SPSS 20 was used for data analysis.. RESULTS: Of the 84 subjects, there were 42(50%) patients and as many controls. Both groups had 21(50%) males and as many females. There was no significant difference in the plasma surfactant protein-D levels of males and females in the patient group compared to their counterparts in the control group (p>0.05). Females developed the disease at a younger age compared to males (p=0.04). There was no significant difference in terms of pack-years and cotinine levels between the groups (p>0.05) and lung function showed greater deterioration in the females compared to males with similar tobacco exposure (p<0.05).. CONCLUSIONS: The gender did not affect plasma surfactant protein-D levels.

Genotoxic impact of long-term cigarette and waterpipe smoking on DNA damage and oxidative stress in healthy subjects.

Although a plethora of studies have examined tobacco smoke-cancer disease association, the involvement of cellular genetic toxicity remains unclear. Therefore, the present study provides molecular evidence for a pathway involved in the DNA damage induced by long-term cigarette and waterpipe smoke in human subjects. The study population consisted of 45 subjects who were divided into three groups; healthy nonsmokers group, cigarette smokers group, and waterpipe smokers group. A questionnaire and consent form was distributed and signed by all participants. Total RNA was extracted from the blood using PAXgene Blood RNA Kit and mRNA expression levels of target genes were quantified by RT-PCR. Our results showed that 80% of the participants smoke 20-39 cigarettes/day, whereas 12% smoke more than 40 cigarettes/day. With regard to waterpipe smoke, the majority (46%) smoke more than 5 times/week. Both cigarette and waterpipe smokers showed increased the plasma levels 8-hydroxy-2'-deoxyguanosine (8-OHdG), of DNA damage marker. In addition, the mRNA expression levels of DNA repair genes (OGG1 and XRCC1) were significantly inhibited in both cigarette and waterpipe smokers groups by 30% and 60%, respectively. This was associated with a marked decrease (50%) in the expression of detoxifying genes (NQO1 and GSTA1) with an increase in CYP1A1 mRNA expression, a cancer-activating gene. Both cigarette and waterpipe smokers increased in the plasma concentrations of several toxic heavy metals such as Cd (130%), Pb (47%), and Ni (30%). In conclusion: the present findings clearly explore the genotoxic effect of cigarette and waterpipe smoking on human DNA.

Flavored Versus Nonflavored Waterpipe Tobacco: A Comparison of Toxicant Exposure, Puff Topography, Subjective Experiences, and Harm Perceptions.

INTRODUCTION: Flavored waterpipe (WP) tobacco is the main type of tobacco used by young WP smokers, and a major factor attracting youth to smoke. However, evidence regarding the effect of limiting flavor on WP smokers' experience continues to be lacking. This study aims at evaluating the effect of flavor restriction on WP smokers' toxicant exposure, smoking topography, subjective experiences and harm perception. METHODS: Thirty-two WP smokers completed two, 45-minute ad libitum smoking sessions (preferred flavor vs non-flavored tobacco) in a crossover design pilot study. Plasma nicotine concentration and exhaled carbon monoxide (eCO) were measured before and after each smoking session. Puff topography was recorded throughout the smoking session. Participants completed survey questionnaires assessing subjective smoking experiences and harm perception. RESULTS: Significant differences were observed in plasma nicotine concentration between the two WP tobacco conditions, with a higher increase in plasma nicotine concentration following the flavored tobacco session. There were no significant differences between the two WP tobacco conditions for eCO and smoking topography measures. Compared with the non-flavored WP tobacco, we documented enhanced subjective smoking measures of satisfaction, calmness, taste, puff liking and enjoyment following the preferred flavored WP tobacco session. Cigarette harm perception was significantly higher among participants after smoking their preferred flavor compared with non-flavored WP tobacco. CONCLUSIONS: Limiting tobacco flavor has a substantial effect on WP smokers' nicotine exposure, subjective experience and harm perception. Therefore, eliminating or restricting WP flavors could be an essential element of comprehensive tobacco control policies to reduce the appeal of WP tobacco products for youth. IMPLICATIONS: This study highlights the important role of flavor in shaping WP smokers' experiences and exposures and the potential impact that regulating flavored WP tobacco may have on curbing WP use among youth in the US. Such regulations may reduce the appeal and the interest in WP smoking initiation and continued use.

Systemic Inflammatory Markers Among Waterpipe Smokers, Cigarette Smokers, and Nonsmokers.

OBJECTIVE: To determine the levels of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) among exclusive groups of waterpipe (WP) smokers, cigarette smokers, and nonsmokers. METHODS: This cross-sectional study was conducted among adults, apparently healthy individuals, aged between 18 and 40 years of either gender. NLR and PLR as measures of systemic inflammation were studied in association with individuals' sociodemographic, health, and tobacco use related characteristics. The results of linear and logistic regression models were reported as crude and adjusted beta coefficients and odds ratios with 95% confidence intervals (CIs). RESULTS: Out of 190 participants, 34.2% (n = 65) exclusively smoked WP, 32.6% (n = 62) smoked cigarettes, and 33.2% (n = 63) were nonsmokers. The mean NLR and PLR were significantly higher among WP smokers when compared with nonsmokers; however, the comparison between WP smokers and cigarette smokers for both NLR and PLR was not statistically significant. The odds of raised NLR was 4.40 times higher (AOR = 4.40, 95% CI = 1.97, 9.85), and the odds of raised PLR was 3.48 times higher (AOR = 3.48, 95% CI = 1.60, 7.57) for WP smokers compared to nonsmokers. CONCLUSIONS: WP smoking has a significant association with systemic inflammation as measured by NLR and PLR. The study and existing evidence implicate an urging need to regulate WP industry and its policies.

Plasma and saliva levels of three metals in waterpipe smokers: a case control study.

In this case-control study, the influence of waterpipe tobacco smoking on the plasma and saliva levels of cadmium, lead and zinc was examined in participants who were waterpipe tobacco smokers (WS) or never-smokers (NS). The concentration of metals was higher in WS relative to NS. The mean (SEM) cadmium concentration in plasma was 3.3 (0.18) µg/dL in WS versus 0.82 (0.09) µg/L in NS (p < .001) and in saliva was 5.1 (0.36) µg/L in WS versus 0.64 (0.2) µg/L in NS (p < .001). The mean (SEM) lead concentration in plasma was 5.2 (0.25) µg/dL in WS versus 3.4 (0.41) µg/dL in NS (p < .01) and in saliva was 4.8 (0.58) µg/L in WS versus 2.8 (0.27) µg/L in NS (p < .05). Similarly, a significant difference in zinc concentration was observed, with a mean of 2.0 (0.17) µg/mL in WS plasma versus 1.49 (0.16) µg/mL in NS (p < .05) and a mean 0.94 (0.07) µg/mL in WS saliva versus 0.45 (0.06) µg/mL in NS (p < .01). In conclusion, waterpipe tobacco smoking is associated with elevated levels of metals in body fluids. These results provide another demonstration of how waterpipe tobacco smoking exposes smokers to harmful toxicants.

Deteriorations of pulmonary function, elevated carbon monoxide levels and increased oxidative stress amongst water-pipe smokers.

OBJECTIVES: A water pipe (hookah) is a tobacco smoking tool which is thought to be more harmless than a cigarette, and there are no adequate studies about its hazards to health. Water-pipe smoking is threatening health of the youth in the world today. The objective of this study has been to investigate the carbon monoxide (CO) levels in breath, examine the changes in pulmonary function tests (PFT) and to assess the change of the oxidative stress parameters in blood after smoking a water pipe. MATERIAL AND METHODS: This study is a cross-sectional analytical study that has included 50 volunteers who smoke a water pipe and the control group of 50 volunteers who smoke neither a cigarette nor a water pipe. Carbon monoxide levels were measured in the breath and pulmonary function tests (PFTs) were performed before and after smoking a water pipe. Blood samples were taken from either the volunteer control group or water-pipe smokers group after smoking a water pipe for the purpose of evaluation of the parameters of oxidative stress. RESULTS: Carbon monoxide values were measured to be 8.08±7.4 ppm and 28.08±16.5 ppm before and after smoking a water pipe, respectively. This increment was found statistically significant. There were also significant reductions in PFTs after smoking a water pipe. Total oxidative status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) were found prominently higher after smoking a water pipe for the group of water-pipe smokers than for the control group. CONCLUSIONS: This study has shown that water-pipe smoking leads to deterioration in pulmonary function and increases oxidative stress. To the best of our knowledge this study is the only one that has shown the effect of water-pipe smoking on oxidative stress. More studies must be planned to show the side effects of water-pipe habit and protective policies should be planned especially for young people in Europe. Int J Occup Med Environ Health 2017;30(5):731-742.