The Effects of a Standardized Research E-Cigarette On The Human Lung: A Clinical Trial With Bronchoscopic Biomarkers

摘要 电子烟（e-cigs）的使用正在迅速增加。然而，人们对潜在的肺部毒性知之甚少。 与吸烟相关的吸入电子烟气溶胶。 FDA 已认为对电子烟和需求的监管机构 数据来确定如何监管其设计和成分。电子烟气溶胶成分似乎是合理的 （载体、风味剂和副产品）会引起肺部炎症反应，但没有直接的作用 这方面的证据，以及影响的程度（如果有的话）。虽然可能有许多正在进行的 实验室体外和体内研究评估电子烟暴露和毒性，这些研究利用间接方法 评估肺毒性。还有正在进行的人体研究，重点关注电子烟的使用对吸烟的影响—— 暴露的相关生物标志物，但这些通常评估肺外的生物液体（例如血液和尿液）。它是 尚不清楚这些研究与肺毒性（例如靶器官）有何关系，因此存在一个关键问题 研究差距。为了评估电子烟使用对人体肺部的毒性，我们建议对 128 名吸烟者进行临床试验 通过系列支气管镜检查评估肺部的炎症反应。为此，我们将利用非凡的 通过采用新的 NIDIA 标准化研究电子烟 (SREC) 来研究电子烟毒性的机会。科目 将被随机分配到继续吸烟（对照），这是两种电子烟使用条件之一（完整 用尼古丁 SREC 替代或双重使用并计划减少吸烟），或完全替代 尼古丁替代疗法（NRT）。每组将有 32 名受试者，试验将持续 5 周（1 周运行- 期间，随后是 4 周的实验条件）。主要结果将是肺生物标志物（细胞 计数、细胞因子、呼出一氧化氮、RNA 和 microRNA 基因表达以及非靶向代谢组学）。 将采用多种生化措施来评估依从性。尿液和鼻腔生物储存库 将为未来的研究创建样本，以将非侵入性生物标志物与肺部生物标志物进行比较。的 该试验的基础设施已经根据 FDA 和 IRB 批准的方案建立。这项研究是 意义重大，因为它将重点关注肺部炎症、电子烟使用对肺部的合理影响以及影响 改用电子烟或双重用途，而不是完全戒烟 NRT。一旦需要此类数据 可能协助 FDA 对电子烟进行监管，包括尼古丁含量。该研究具有创新性，利用 使用系列支气管镜检查的临床试验设计，将炎症生物标志物与代谢组学和 基因表达数据，并通过多种方式使用综合、互补和综合的方法 “组学测定（基因表达 - mRNA 和 miRNA、代谢组学、细胞浸润和细胞因子水平）。这个 研究具有相当大的公共健康影响，因为它将提供目标人类的实验证据 器官效应。

Abstract The use of electronic cigarettes (e-cigs) is increasing rapidly. Yet, little is known about the potential lung toxicity for inhaling e-cig aerosols relative to smoking. The FDA has deemed regulatory authority over e-cigs and needs data to determine how to regulate their designs and constituents. It is plausible that e-cig aerosol constituents (carriers, flavor, and byproducts of these) induce an inflammatory response in the lung, but there is no direct evidence for this, and what the magnitude of the effect is, if any. While there may be numerous ongoing laboratory in vitro and in vivo studies to assess e-cig exposure and toxicity, these utilize indirect methods for assessing lung toxicity. There also are ongoing human studies that focus on the effect of e-cig use on smoking- related biomarkers of exposure, but these usually assess biofluids outside the lung (e.g., blood and urine). It is unknown how any of these studies may relate to lung toxicity, e.g., the target organ, and thus there is a critical research gap. To assess human lung toxicity from e-cig use, we propose to conduct a clinical trial of 128 smokers to assess inflammatory responses in the lung via serial bronchoscopy. To do this, we will exploit an extraordinary opportunity for study e-cig toxicity by employing the new NIDIA standardized research e-cig (SREC). Subjects will be randomized to continued cigarette smoking (control), one of two e-cig use conditions (complete substitution with the nicotine SREC or dual use with planned smoking reduction), or complete substitution with nicotine replacement therapy (NRT). Each group will be 32 subjects and the trial will be 5 weeks (a 1 week run- in period, followed by 4 weeks of the experimental condition). Primary outcomes will be lung biomarkers (cell counts, cytokines, exhaled nitric oxide, RNA and microRNA gene expression, and untargeted metabolomics). Several biochemical measures to assess compliance will be employed. A biorepository of urine and nasal samples will be created for future studies to compare non-invasive biomarkers with lung biomarkers. The infrastructure for this trial is already established under an FDA- and IRB approved protocol. This study is significant because it will focus on lung inflammation, a plausible effect on the lungs of e-cig use, and the impact for switching to e-cigs or dual use, versus complete cessation with NRT. Such data are needed as soon as possible to assist the FDA in the regulation of e-cigs, including nicotine content. The study is innovative by using a clinical trial design using serial bronchoscopy, incorporating inflammation biomarkers with metabolomic and gene expression data, and uses an integrative, complementary and comprehensive approach through multiple ‘omics assays (gene expression – mRNA and miRNA, metabolomics, cell infiltrates and cytokine levels). This study has considerable public health impact because it will provide experimental evidence in humans of target organ effects.