18 Responses

  1. Byron P. Lee
    Byron P. Lee at | | Reply

    Cigarettes are unsafe for everyone. With thousands of chemicals, high addiction rates, greatly increased risk of lung cancer in smokers, cigarettes are, without a doubt, dangerous. So, we need to have a discussion around the potential replacement: e-cigarettes. The blog post cites a study from last year that suggests e-cigarettes may also be unsafe because the vaporized flavored liquids results in repression of immune related genes in the epithelial cells lining the nasal mucosa, which is inferred as immune suppression.

    A more recent study cited in the blog post, suggest that the innate immune response activates neutrophils and altered mucin secretion. In e-cigarette smokers, they found that there was a significant increase in neutrophil biomarkers (neutrophil granulocyte- and neutrophil-extracellular-trap (NET)-related proteins) that show uncontrolled neutrophil activity. This can lead to chronic obstructive pulmonary disease (COPD) and cystic fibrosis.

    E-cigarettes may result in some of the same negative results of smoking regular cigarettes. Biomarkers for oxidative stress were higher. Also, the innate immune response was activated. Both can result in lung disease. In both types of smokers, mucin 5AC was overproduced and could result in chronic bronchitis, bronchiectasis, asthma, and wheeze.

    So, what is the major toxin that is consistent with e-cigarettes and cigarettes? Nicotine may play an important role in the immune suppression discussed in this blog post. In a study by Hosseinzadeh, et al., they found that nicotine induces NETs, which may also cause smoking-related lung diseases. They reported “that nicotine induces neutrophils to release nicotine induced NETs in a dose-dependent manner”. (Hosseinzadeh 2016)

    These findings call into question if e-cigarettes are “safer” than cigarettes. There are more toxins in traditional cigarettes, but if the primary toxin is still present, then it doesn’t matter which you smoke. Long-term nicotine use may be the underlying cause of lung disease in smokers.

    Hosseinzadeh 2016

    1. Orezime Uyeh
      Orezime Uyeh at | | Reply

      In response to Byron’s comment, e-cigarettes will indeed be just as dangerous as regular cigarettes, when it can impair the innate immune cell function in the respiratory system and thus contribute to respiratory diseases. I am also familiar with the effects of smoking on the respiratory tract, especially in the alveoli. In addition to nicotine being in the bloodstream, smoking does lead to the production free radicals which could result in an increase in presence of neutrophil elastase, and this elastase will cause tissue damage and more macrophage breakdown in the alveoli. Impaired alveoli can lead to emphysema- a key feature in chronic obstructive pulmonary disease (COPD). Besides the presence of nicotine, as you mentioned, there is a risk to using e-cigarettes in the form of flavored liquids (e-liquids). These liquids may not always contain nicotine, but in addition to that toxin, there are different concentrations of cinnamaldehyde which, according to one study, can be responsible for inducing the suppression of macrophage phagocytosis (Clapp et al. 2017). Reading this article and this comment only confirmed to me that it is too soon say that e-cigarettes would be a better alternative to the traditional cigarettes. The introduction to new toxins with the primary toxins (e.g. nicotine) can only exacerbate (and potentially delay) the immune function and response to these toxins.

    2. Raeesa
      Raeesa at | | Reply

      Byron, I think this is an interesting response.
      To further this line of thought, I am prompted to ask if second hand smoke from e-cigarettes is just as dangerous as second hand smoke from normal cigarettes, and the effect nicotine may have on passive smokers. In a study done testing the makeup of second hand smoke from cigarettes versus e-cigarettes, researchers found that second hand smoke from e-cigarettes contained nicotine but not carbon monoxide, volatile organic compounds or any other combustible toxins (1). However, another study has shown that mice macrophages exposed to nicotine exhibit symptoms of a suppressed immune system. Correspondingly, macrophages that were exposed to nicotine exhibited a decrease in their ability to adhere to tissue receptors during diapedesis, as a result macrophage migration to infection sites was inhibited (2). E-cigarettes are still a novel invention, as a result long term health effects are still unknown. Currently, e-cigarettes are common in public buildings and not restricted in the same way that traditional cigarette use is. Further research is needed to fully understand the effects on the immune system but these preliminary results suggest that passive inhalation of e-cigarettes may be hazardous.

      1) Secondhand Exposure to Vapors from Electronic Cigarettes (https://www.ncbi.nlm.nih.gov/pubmed/24336346)
      2) Alteration of immune functions and Th1/Th2 cytokine balance in nicotine-induced murine macrophages: immunomodulatory role of Eugenol and N-acetycysteine (https://www.ncbi.nlm.nih.gov/pubmed/21237301)

    3. Byron P. Lee
      Byron P. Lee at | | Reply

      I got way ahead of myself! Here is the DOI link for my reference.

      DOI: 10.1189/jlb.3AB0815-379RR

    4. Nate
      Nate at | | Reply

      These are very interesting findings that increased neutrophil activity can cause other pulmonary disorders and disease. However, I am confused about the statement regarding E-Cigs and their causation of Cystic Fibrosis (CF) in smokers. CF is an autosomal recessive genetic disorder that is caused by a mutation in the cystic fibrosis transmembrane regulator (CFTR) gene (1). This mutation causes inhibition of the glycoprotein’s ability to secrete chloride ions out of the cell (1) .Are the symptoms being presented caused by ta mutation of the gene or are they just similar to those found in cystic fibrosis?

      1. Reference: http://thorax.bmj.com/content/53/5/389

      1. Kingsley Nwaobasi
        Kingsley Nwaobasi at | | Reply

        I was initially confused as you were. However, to clarify the connection between E-cigarettes and Cystic Fibrosis (CF), I looked up a study which revealed that emerging data strongly suggested that cigarette smoke and its components can lead to acquired Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) dysfunction (1). In supporting your reference, this study pointed out that the absence of CFTR is the cause of CF. however, findings in vitro, in animal models, as well as in smokers also exhibit acquired CFTR dysfunction. Furthermore, this abnormality is not only seen in the airways but in extrapulmonary organs, hence, the suggestion that CFTR may contribute to smoking-related lung disease. I hope that after reading the study I cited, your confusion will be resolved.


    5. Casey Seldon
      Casey Seldon at | | Reply

      I completely agree, Bryon. Cigarettes in any form are harmful. I cannot even begin to count the countless patient’s I’ve encountered in the ED who state that they have quit smoking and only “vape” as if it is any different. I also cannot count the times where I’ve asked patient’s if they know what they are smoking and most reply “flavored water with nicotine”. Obviously, this is not the case. Nicotine in general is a major contributor to immune suppression as mentioned in the blog post, but evidence from an article review in 2009 demonstrated that nicotine can be used as an anti-inflammatory agent that prevents production of nitric oxide. Contrary to the evidence in that review claiming that nicotine is neuroprotective, it is also known that nicotine can be harmful under some circumstances. I think the best advice for someone considering smoking in general is to JUST SAY NO!

  2. Rouzbeh Teimouri
    Rouzbeh Teimouri at | | Reply

    The adverse effects of e-cigarettes are still being investigated; and, as the article mentions, are relatively unknown as compared with the research done on conventional cigarettes. However, there are additional factors that must alarm any person who is seriously considering switching over from conventional cigarettes.
    Among these alarming new discoveries is the low level of attention paid to what goes into the e-liquid that is used for e-cigarettes. Its consistency has been called into question by the CDC and warnings has been issued. [1] Additionally, companies producing these products may not be as thorough in their screening for contaminants, or toxic chemicals that occasionally find their way into the e-liquids.[2]
    Overall, the industry is extremely new and unknown, and with such delicate epithelial tissues as those lining the lungs, it is careless to commit to any of the electronic smoking products present on the market at this time.
    [1] https://www.webmd.com/smoking-cessation/news/20131112/e-cigarettes-cdc#1
    [2] https://www.karger.com/Article/FullText/353253

  3. Rouzbeh Teimouri
    Rouzbeh Teimouri at | | Reply

    The antagonistic effects of e-cigarettes are still being investigated; and, as the article mentions, are relatively unknown as compared with the research done on orthodox cigarettes. However, there are additional factors that must alarm an individual contemplating the idea of switching from conventional cigarettes.
    Among the alarming new discoveries is the low level of care given what goes into the e-liquid that is produced for use in e-cigarettes; the consistency of e-liquids has been called into question by the CDC and warnings has been issued. [1] Moreover, companies producing these products may not be thorough in their screening of contaminants or toxic compounds that often find their way into the liquids during production.[2]
    The e-cigarette industry is new and unknown, and with delicate epithelial tissues as those lining the lungs and the respiratory tracts, it is dangerous to commit to any of the electronic smoking products present on the market.
    [1] https://www.webmd.com/smoking-cessation/news/20131112/e-cigarettes-cdc#1
    [2] https://www.karger.com/Article/FullText/353253

  4. A. Ferrell
    A. Ferrell at | | Reply

    E-cigarette vapors (ECV) are as harmful as cigarette smoke (CS). ECV cause chronic respiratory illnesses like those that are caused by CS. Unfortunately, inhaling these fumes cause harm in non-smokers too based on studies of CS and ECV. These studies indicated that ECV suppresses the immune system as well as activate the innate immune response which contradicts the benefit of ECV being a better alternative than CS (1,2). A person immune system that is suppressed changes the natural environment of the host more specifically the lungs and prevents epithelial cells in the lungs from activating the innate immune cells – macrophages(M), neutrophils(N), and natural killer (NK) cells that are responsible for eradicating microbial infection (1). As a result, opportunistic microbes are readily available to attack when the immune system is impaired. Conversely, ECV activates the innate cells which can be harmful because continuous activation of M, N, and NK cells disrupt the protective mucosal layer of epithelial cells which leads to inflammation, the breakdown of tissue, and leaves the environment susceptible to opportunistic infections (2). Whether an individual is a cigarette or an e-cigarette smoker both leads to opportunistic infections, second-hand smoke victims, as well as health-associated diseases with no recovery stage because of continuous immune cell – activation and immunosuppression. Therefore, individuals that are exposed to harmful vapors may have to eliminate smoking because neither have beneficial incentives for their health. Future studies should focus on whether individuals can curb the habit of cigarettes or e-cigarettes through exercise, meditation, and healthy dieting that leads to the recovery of the innate immune system.



    2. https://doi.org/10.1164/rccm.201708-1590OC

  5. Anthony Kram
    Anthony Kram at | | Reply

    I found this article very interesting because for many years, the safety, or lack there of, associated with cigarette has been called into question countless times. As a result, advancement have been made in a direct effort to minimize the harms that smokers endure, while still creating an avenue that offers them a comforting sensation of smoking. However, it seems as though the advancements to offer a simulation while removing the harm has been unsuccessful overall.

    Based upon the blog post, evidence has been uncovered giving insight to the harms associated with electronic smoking, and even more frightening, inclusive of the over popularized but very similar act of vaporizing. In the blog post, it informs us of a very serious and quite harmful impact that the practice has upon the lungs, which is something that many users may not be aware of, or fully understand. Due to the use of the electronic cigarettes, there seems to be an overproduction of neutrophils that are produced, along with an altered mucin secretion, which in essence means that the electronic smoker users are still at risk for long-term effects as they would be with traditional cigarettes, if not higher risks.

    Basically, after further experimentation was completed, researchers found that neutrophils, neutrophil granulocyte- and neutrophil-extracellular-trap (NET), were at increased levels within the airways of users. With this happening, one’s innate immune response becomes compromised, as well as the body’s natural defense against pathogens, while also leaving the body prone to increased chances of chronic obstructive pulmonary disease, and cystic fibrosis. With this being said, in seeking to better understand these impacts, I located an article (1) which did further research and concluded that e-cigarette use is believed to alter the innate defense of proteins in the airway secretions, as noted by the blog, and it induces unique changes relative to cigarette smoking. Ultimately, the findings challenge the idea that electronic smoking is safer on the body.

    With this in mind, I begin to question if the use of hookah which can also be inhaled from a larger device aside from e-hookahs and vape pens are also as harmful to the body as are the electronic versions? Also, I find it interesting that the CDC has not provided more extensive testing on the products before allowing them on the market, or doing more promotion against the e-devices as was done with traditional cigarettes as I believe they must have known that smoking of any form is harmful, and cannot be made safer.

    Citation: https://www-ncbi-nlm-nih-gov.ezproxy.gsu.edu/pubmed/29053025

    1. Philip S.
      Philip S. at | | Reply

      In light of the dangers that you mentioned, I came across an article that elaborated further on the dangers of e-cigarettes. According to the authors, the components of e-cigarette vaporizing liquid often times have the potential to generate toxins when heated at higher than advised temperatures (1). Examples of these toxins include benzaldehyde, formaldehyde, acrolein, and acetaldehyde (1). To further examine the effects of e-cigarettes, the researchers performed a series of experiments that examined changes in the nasal mucosa of patients smoking regular cigarettes, vs. e-cigarettes. What they found was that immune-related gene expression was suppressed for both types of smokers (1). They indicated that the most impacted pathway was with the cytokine-cytokine receptor. Also suppressed was a variety of other immune-related genes impacting cytokines, chemokines, associated receptors. Examples of this would be the suppression of CCL26/eotaxin-3 and CSF-1 chemokines (1). Although traditionally thought of as a safe alternative, smoking e-cigarettes still pose a significant threat to one’s immune system.


    2. Kelly Freeman
      Kelly Freeman at | | Reply

      Smoking is something that could affect someone even if they are not smoking because it is something that is in the air and our exposure is not always in our control. The article discussed the fact that neutrophils, neutrophil granulocytes, and NET were increased in the airways of users. I wonder if this is true for those who do not use but could just happen to be exposed to smoke from a family member or spouse or friends that smoke around them on occasions. The fact that the immune system’s response is compromised because due to the exposure and the increase in the neutrophils, neutrophil granulocytes and NET.

      The article that I read by Ambrose and Barua showed potential pathways for both mainstream smoking and sidestream smoking. The article discussed the inflammation in cigarette smoking which showed an increase of more than 25% in peripheral blood leukocytes. It is associated with multiple inflammatory markers like C-reactive protein, and interleukin-6. There is also an elevation in the in proinflammatory cytokines. These were just dealing with inflammation but there was also mention of platelet dysfunction, alteration in antithrombotic and prothrombotic processes, and of course vascular function (1).

      The effects of smoking whether mainstream or sidestream, and even hookah versus e-cigarettes is so detrimental to the health and immune system of individuals.


  6. Panda Southtown
    Panda Southtown at | | Reply

    It’s unfortunate, but unsurprising news that e-cigarettes may be just as bad as smoking traditional cigarettes. I’m sure we all have an older family member or two that we wish would just quit such a pointless habit.

    To expand on the knowledge point out here, Clapp and others have produced data from their recent study supporting that e-cigarette liquids, cinnamaldehyde in particular, impede the function of innate immune cells in the lungs and respiratory tract. In terms of direct air exposure and our physiological need for oxygen, the lungs are uniquely vulnerable to contaminants and possible pathogens. Liquids without nicotine were studied in different dilutions, focusing how they affected alveolar macrophages, neutrophils, and Natural Killer T-cells. Three of the liquids containing cinnamaldehyde (found via mass spectrometry) seemed to induce the general suppression of normal immune behavior in all of the observed Effector cells. After isolating cinnamaldehyde and giving a dose to these cell types at different dilutions of this single component, was found to impede the same immune functions.


    1. Raven Gougis
      Raven Gougis at | | Reply

      Panda Southtown,
      Although, there have been studies that discuss the dangers of vaping and e-cigarettes. I believe that there are some benefits of e-cigarettes as opposed to regular cigarettes. E-cigarettes are made for users to inhale nicotine without most of the harmful effects of smoking (1). Previous smokers who switched to using e-cigarettes have lower levels of toxins than those who continue to smoke regular cigarettes (1). However, I feel that air pollutants are more of a danger than e-cigarettes or even regular cigarettes for that matter, due to its widespread environmental effects. In an article published by The Journal of Research in Medical Science , air pollutants were considered one of the major environmental risk factor for some respiratory diseases such as asthma and lung cancer.
      These pollutants also harp on the nervous system causing neurological complications and psychiatric disorders, especially in infants (2). These pollutants even cause organ damage when inhaled or through skin absorption. I feel that air pollutants are another topic that people need to be educated on.

      1. https://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2017-02-07-long-term-vaping-far-safer-than-smoking-says-landmark-study/
      2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122104/

  7. Owlette
    Owlette at | | Reply

    Anthony, I agree. Hookah and e-cigarettes (aka vapes) have been termed “Safer” by advertising firms, leading adolescents and young adults to increase their use over cigarettes. In the article below, Khabour et al found that exposure to waterpipe tobacco (aka hookah) induced increases in inflammatory cytokines similar to responses when participants were exposed to the traditional tobacco cigarette. The study showed elevated TNF-alpha and IL-6, as well as oxidative stress markers. Thus, hookah is not safer than cigarettes.

    Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752682/

  8. Sarah Leeann Smart
    Sarah Leeann Smart at | | Reply

    Studies support the indication that e-cigarettes induce neutrophil activity that is commonly related to chronic lung diseases, such as COPD. It has been demonstrated that exposing neutrophils collected from healthy teen nonsmokers to e-cigarette vapor lead to increased levels of CXCL8, a neutrophil attractant, as well as other markers for inflammatory response. Upon exposure, neutrophils increased secretions of matrix metalloproteinase (MMP9) and neutrophil elastase (NE), which cause tissue remodeling and destruction. Expression levels of CD11b and CD66b were noted as well, their functions relating to neutrophil migration and and activation. It is notable that e-cigarretes containing no nicotine also initiated a similar inflammatory response, indicating that the complex makeup of chemicals within the solution contain irritants and possible carcinogens. It is also notable that acrolein, the combusted form of glycerol, also caused similar responses, such as the release of MMP9. The finding of this study support the author’s claim that e-cigarettes are not to be judged as safer than cigarettes, and the complex array of chemicals in e-cigarette solution such as (but not limited to) nicotine and glycerol are major contributors to the neutrophil response.

  9. Sarah Leeann Smart
    Sarah Leeann Smart at | | Reply

    Yikes, I did the same thing and forgot my link! Here it is.

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