Background: Heated tobacco products (HTPs) are gaining popularity as a potentially less harmful alternative to conventional cigarettes. HTPs produce aerosols by heating —not burning— tobacco, resulting in fewer harmful constituents than conventional cigarettes (CS), but their effects on human lung cells are not fully investigated. This study aimed to evaluate the cytotoxic effects of HTP and CS extracts on human lung epithelial cells (A549) using the MTT assay.

Material and Methods: A549 cells were exposed to CS or IQOS (an HTP product) extracts at dilutions of 20%, 10%, 5%, and 2.5%, derived from 100% solutions containing approximately 42 μg/mL nicotine. Cell viability/ proliferation was assessed after 24 and 48 hours of exposure using the MTT assay. Absorbance values were normalized to untreated controls to determine percent viability.

Results: At 24 hours, treatment with 20% IQOS extract resulted in an increase in cell proliferation (113.7%), whereas the same concentration of CS extract maintained at baseline levels (100%), indicating no proliferative stimulation. In contrast, lower concentrations of both IQOS and CS extracts significantly enhanced cell proliferation (>120%), indicating a stimulatory effect on cell metabolism.

At 48 hours, a time-dependent cytotoxic shift was observed. Both extracts at 20% caused marked reductions in viability (73.8% and 62.7%, respectively), with IQOS demonstrating slightly lower cytotoxicity. At lower concentrations (2.5%), cell viability remained near 76%, although the proliferative effect reported at 24 hours was no longer evident. These findings indicate a dose- and time-dependent biological response with lower concentrations promote proliferation during short-term exposure, while prolonged exposure leads to reduced viability, particularly at higher doses.

Conclusions: IQOS induced lower cytotoxicity than cigarette smoke in A549 cells, particularly after 48 hours at high concentrations. However, both products affected cell viability in a time- and dose-dependent manner. While IQOS appears less harmful, it still exerts biological effects.

AUTHORS: Myrto Aikaterini Daponte¹, Kyriaki Kyriakidou¹, Konstantinos Mesiakaris², Konstantinos Farsalinos², Konstantinos Poulas², Xanthippi Dereka¹

AFFILIATIONS: ¹Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece

²Department of Pharmacy, University of Patras, Patras, Greece

Background: Periodontal ligament-derived mesenchymal stem cells (PDL-MSCs) play a vital role in the repair and maintenance of periodontal tissues. However, their regenerative potential can be compromised by external factors such as exposure to cigarette smoke (CS) and aerosols from electronic nicotine delivery systems (ENDS). While ENDS are often marketed as a safer alternative to traditional tobacco products, the scientific evidence supporting their safety remains limited and inconclusive.

Material and Methods: Following the generation of cigarette smoke and ENDS aerosol, PDL-MSCs were exposed under controlled conditions. Cell viability and proliferation were assessed post-exposure. Additionally, the immunomodulatory function of PDL-MSCs was analyzed through co-culture with T lymphocytes. Cytokine profiling and flow cytometric analysis were conducted to evaluate changes in immune response and T cell phenotype.

Results: Exposure to cigarette smoke resulted in significantly reduced viability and proliferation of PDL-MSCs compared to ENDS aerosol. Moreover, cigarette smoke triggered a heightened pro-inflammatory immune response, potentially contributing to further tissue degradation. In contrast, ENDS exposure appeared to elicit an immunosuppressive effect, which may help mitigate ongoing cellular damage.

Conclusions: Both cigarette smoke and ENDS aerosol were found to negatively affect the regenerative functions of PDL-MSCs. Although the impact of ENDS was less severe, the findings highlight the need for comprehensive research to determine the long-term safety of ENDS and their influence on the regenerative potential of PDL-MSCs, especially in the context of chronic exposure and oral health preservation.

AUTHORS: Vladislav Volarevic, Ana Volarevic, Nikolina Kastratovic

AFFILIATION: Faculty of Medical Sciences University of Kragujevac, Kragujevac, Serbia

Background: Cytisinicline is a partial agonist of nicotinic acetylcholine receptors (nAChRs), used for smoking cessation.

The purpose of this study was to evaluate the impact of cytisinicline on arterial stiffness, endothelial function, and cardiac performance.

Material and Methods: Sixty healthy smokers were enrolled in our smoking cessation clinic. Thirty initiated cytisinicline treatment, while thirty smokers unwilling to quit served as controls. Groups were matched for age, sex, and pack-years. Assessments were performed at baseline and 1-month follow-up, including: a) Smoking status: self-reported smoking burden and exhaled carbon monoxide (eCO), b) Arterial stiffness: carotid-femoral pulse wave velocity (PWV), central aortic and pulse pressure, c) Endothelial function: perfused boundary region (PBR) of the sublingual microvessels with diameter range 20-25 μm and brachial artery flow-mediated dilation (FMD), d) Cardiac Performance: by Doppler Echocardiography the E-wave, early diastolic velocity (E’), E/E’ ratio, global longitudinal strain (GLS), and e) the PWV/GLS ratio, to assess Ventriculoarterial Interaction.

Results: Participants were 49 ± 8 years old, 57% male, with 28 ± 8 pack-years. Baseline measurements did not differ between groups. At 1-month, 29/30 cytisinicline users had quit smoking, confirmed by significantly reduced eCO levels (p<0.001). Compared to baseline, the cytisinicline group showed significant improvements in PWV, pulse pressure, central systolic BP, FMD, GLS, PWV/GLS ratio, E/E′, and PBR20-25 (all p<0.05). No changes were observed in the control group, except for an increase in PBR20-25 (p=0.045). Conclusions: The use of cytisinicline for one month in smokers resulted in amelioration of arterial stiffness, endothelial function, cardiac performance in conjunction with safe and effective smoking cessation.

AUTHORS: Ignatios Ikonomidis, John Thymis, Gavriela Kostelli, Konstantinos Katogiannis, Eleni Gatourtzidou, Kallirhoe Kourea

AFFILIATION: 2nd Cardiology Department National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece

Background: Smoking is a modifiable risk factor in patients with ST-Elevation Myocardial Infarction (STEMI). Smoking cessation after STEMI reduces cardiovascular risk and mortality by one-third within two years.

The purpose of this study was to assess whether STEMI smokers who quit after their index event differ in arterial stiffness and endothelial glycocalyx integrity compared to those who continue smoking.

Material and Methods: We enrolled 60 STEMI smokers from the Cardiology Department of Attikon University Hospital. Propensity score matching was applied for age, sex, and cardiovascular risk factors (diabetes, hypertension, smoking burden, hyperlipidemia). After discharge, 30 patients quit smoking while 30 continued. Assessments were performed at recruitment and at 4-month follow-up. We measured:

(a) Perfused boundary region (PBR) of sublingual microvessels (4–25 μm diameter) as a marker of endothelial glycocalyx thickness, and

(b) Carotid-femoral pulse wave velocity (PWV) and central systolic blood pressure (cSBP) as markers of arterial stiffness.

Results: Participants were 59 ± 8 years old, 70% male. Baseline values for PWV, cSBP, and PBR were similar between groups (p>0.05). At 4 months, quitters showed significant reductions in PBR across all vessel diameters (4–25 μm) and in PWV (all p<0.05). No significant changes were observed in continued smokers. While cSBP remained stable in quitters, it worsened in continued smokers (p=0.039). In quitters, the reduction in PBR 4–25 correlated with a decrease in PWV (r=0.39, p=0.042). Conclusions: Smoking cessation after STEMI improves arterial stiffness and endothelial glycocalyx integrity within four months, supporting early and aggressive tobacco intervention in post-MI care.

AUTHORS: Ignatios Ikonomidis, John Thymis, Eleni Gatourtzidou, Gavriella Kostelli, Konstantinos Katogiannis, Kallirhoe Kourea

AFFILIATION: 2nd Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece

Background: The topics “Interventions for smoking cessation” as well as “embracing harm reduction through alternative nicotine products” were presented to family doctors and nurses across various districts in 2024, as part of ongoing professional development initiatives.

Material and Methods: Several activities have been organized, both online and in person, focusing on reducing the risk from smoking. These activities were conducted during 2024 for health personnel in the districts of Korçe, Durrës, Lushnje, Berat and Vlora. The level of knowledge obtained was evaluated through the forms filled in by the participants. Pre-Test and Post-Test were two important mechanisms through which personnel were evaluated for the knowledge they had before and after training.

Results: A total of 288 doctors and nurses participated in the training activities focused on addressing smoking as a public health issue. Among the participants, 68% were women and 32% were men. The training attracted significant engagement from both rural (44%) and urban (56%) areas. Evaluation results indicated that 70% of participants reported an improvement in their knowledge and expressed confidence in their ability to provide counseling and support to individuals seeking to quit smoking (p<0.01). The proportion of health professionals who answered knowledge-based questions correctly ranged from 32% to 56%. Conclusions: It is imperative to strengthen the knowledge and understanding of healthcare professionals regarding harm reduction strategies, as these play a critical role in decreasing smoking prevalence within the populations they serve. Harm reduction not only supports individuals who have successfully quit smoking but also provides viable alternatives for those who are unwilling or unable to quit, through the use of less harmful nicotine delivery products. Smoking cessation and harm reduction should be regarded as mutually reinforcing components of a comprehensive tobacco control strategy.

AUTHORS: Adrian Hoxha^1,2, Roland Shuperka³, Alba Agaraj^4,2, Bukurie Hyseni²

AFFILIATIONS: ¹University of Medicine Tirana, Albania

²National Association of Public Health, Albania

³NGO “For Albania without smoking”

⁴QSUNT

Smoking is a problem in the population and especially in cardiology patients. Currently 4.8 million people die from smoking-related diseases every year. Quitting smoking is one of the most effective preventable risk factors. Nicotine, although addictive and not without risk, is not the primary cause of smoking-related diseases.

Smoking contributes to the development of ischemic heart disease, atherosclerosis and other cardiovascular diseases. Passive smoking has negative impact on health, contributing to inflammation of the upper respiratory tract and other respiratory problems.

Currently, there are over 1600 independent studies in Pubmed.

Munzel et al. compared a population of smokers undergoing PCI using a large, representative population database. The primary objective was to understand how different smoking behaviors after PCI-stopping smoking, continuing to smoke commercial cigarettes, or switching to e-cigarettes entirely or as a dual user affect the risk of MACE in a high-risk population. The authors found that successful smoking cessation after PCI, as expected, was associated with a significantly lower risk of MACE (defined as the sum of all-cause death, spontaneous myocardial infarction, or repeat revascularization) compared with continuing to smoke commercial cigarettes. They concluded that continued smoking leads to negative short- and long-term effects, and that switching to e-cigarettes or dual use shows positive short-term effects but uncertain long-term outcomes. Quitting smoking completely has positive short- and long-term health outcomes.

Vaping is generally considered less harmful than smoking (including according to the ESC conclusions in London 2024), but it is not completely risk-free. Switching smokers from traditional cigarettes to nicotine alternatives could therefore represent a breakthrough way to significantly reduce health risks.

The best option for health is to completely quit nicotine in any form.

AUTHORS: Julianna Gabzdilová¹, Viola Vargová²

AFFILIATIONS: ¹Department of Hematology and Oncohematology, UPJŠ LF and UNLP Košice, Košice, Slovakia

²1st Department of Internal Medicine, UPJŠ LF and UNLP Košice, Košice, Slovakia