Oral nicotine pouches (ONPs) may offer lower risks compared with combustible tobacco products. ONPs are placed between the lip and gum for 5-30 min to allow nicotine absorption via the oral mucosa. There is limited information on ONP use in a real-world setting or product use trajectories over time, due to the novel nature of these products and their low usage prevalence since market introduction.

An online survey was implemented in four countries (Sweden, Denmark, Switzerland and the UK) with strong focus on ONP usage behaviour patterns, mouth hold times, as well as past and concurrent tobacco and nicotine product (TNP) consumption. Changes in TNP use since starting ONP use and comparative risk perception were also collected. A 6 month follow up survey is planned to observe product use trajectories. 2,133 participants completed the questionnaire on the following key parameters: ONP frequency and pattern of use, flavour and nicotine strength preferences and comparative risk perceptions among various TNPs.

The majority of participants reported using ONP daily and started use, on average, 3 years prior to the study and in Sweden, up to 5 years prior. Average daily consumption for daily users was five pouches per day in the UK, seven in Switzerland, eight in Denmark, and 10 in Sweden. Non-daily users averaged roughly one pouch per day in the UK, one to two pouches in Switzerland and Denmark, and two to three pouches in Sweden. Mouth hold time was mostly between five and less than 30 minutes except in Sweden, where it was up to one hour. The most common product nicotine levels were between 6 to 15 mg, and use of products with levels higher than 20 mg was rare. Additionally, flavour preferences, main reasons for use and risk perceptions of ONPs and other TNPs were measured.

AUTHORS: Mandara Shetty¹, Krishna Prasad¹, Daniel Jelstrup², Bo Elvers², David Azzopardi¹, Tasheen Jilani¹, Claudia Kanitscheider³

AFFILIATIONS: ¹British American Tobacco (BAT), UK || ²Kantar Denmark || ³Cerner Enviza

Background: Several studies have provided evidence that electronic cigarettes (e-cigarettes) serve as a general substitute for cigarettes. This substitution influences the overall public health consequences of regulation and taxation because policies for smoke-free tobacco and nicotine products (e.g., e-cigarettes, heated tobacco, nicotine pouches, and snus) should be assessed in the context of their impact on the demand for more harmful smoked tobacco products, primarily cigarettes.

Material and Methods: The present work focused on smoke-free products other than e-cigarettes. The national sales volume estimates were obtained from Philip Morris International’s investor communication disclosures and other publicly available sources. We calculated Pearson correlation coefficients (r) to examine the relationships between sales of smoked tobacco products (primarily cigarettes) and sales of heated tobacco product consumables in nine countries (the Czech Republic, Greece, Hungary, Italy, Japan, Korea, Lithuania, Portugal, Slovakia) where heated tobacco products reached a 15% share of the total tobacco market in 2022. The same approach was used to examine snus sales in Norway and Sweden. The r values reflect the strength and direction of the correlation between the two product categories’ sales volumes.

Results: The strongest negative correlation between cigarettes and smoke-free tobacco product sales was found in Japan (r = -0.987, p-value <0.001), indicating that cigarette sales decrease as smoke-free product sales increase. The results for the other countries also showed strong negative correlations.

Using real-life examples, we also examined limitations and confounders that can impact observed correlations, including seasonality, cross-border sales, and illicit trade.

Conclusions: Despite limitations, the results indicate that heated tobacco products and snus are competing against cigarettes. Future research needs to account for the confounding and other factors and to be triangulated with population data that can provide information on the prevalence of use of different product categories and product use trajectories.

AUTHORS: Pierre Belamri, Ondrej Koumal

AFFILIATION: Philip Morris International

Background: Smoking is a major modifiable risk factor for cardiovascular disease. Quitting smoking is the most cost-effective strategy to prevent CVD. One effective approach of tobacco control is the participation of healthcare workers in the prevention efforts against tobacco use. This study aimed to determine healthcare workers’ knowledge, attitude, and practice the participation of tobacco cessation.

Material and Methods: A cross-sectional survey study was conducted among healthcare workers working in Russia using a self-administered online questionnaire in 2022. Participants were healthcare workers aged 18 years and above (n=965) from 8 regions of Russia.

Results: There were 57 specialties, of which 28.6% (n=276) and 20.9% (n=202) were internists and cardiologists, respectively. 79% of healthcare workers (n=765) ask about smoking history, regardless of whether there is a smoking-related illness. Eighty-nine percent of physicians (n=857) believe that smoking cessation advice given by a healthcare professional improves a patient’s chances of quitting smoking. Only 28% (n=272) of doctors were aware the principle of the difference between electronic cigarettes and traditional cigarettes. 75% (n=728) of respondents agreed with the statement “The greatest harm caused by tobacco smoking is due to its combustion products”. However, only 28% (n=272) physicians had the knowledge of difference of using non-combustible tobacco product and traditional cigarettes.

Conclusions: Much of the medical community is unaware of how e-cigarettes and tobacco heating systems work and how they differ from traditional cigarettes. The medical community needs to be educated about the concept of harm reduction and the difference between smokeless products and cigarettes. It is expedient to introduce sections on THR in physician education programs or clinical guidelines. This strategy would help adult smokers who are not motivated to quit to get qualified advice from a physician not only from a complete quit, but also from a harm reduction perspective.

AUTHORS: Artur Tuktarov, Aleksandr Filippov, Andrey Obrezan

AFFILIATION: Saint Petersburg State University, Saint Petersburg, Russian Federation

Background: Monitoring trends in the use of combustible and non-combustible nicotine products is crucial to implement tobacco/nicotine control policies and assess their effectiveness. We aimed to estimate the trends in tobacco/nicotine use and evaluate the perceptions concerning non-combustible alternatives in the adult Greek population over the period 2022-2023.

Material and Methods: Two cross-sectional surveys were conducted throughout Greece (June 2022, N=2,004 and May 2023, N=1,999). Random digit dialling and proportional quota sampling was used to recruit participants. The estimates were adjusted for the age-sex-NUTS I distribution of the population. Smokers, users of electronic cigarettes (ECs) and users of heated tobacco products (HTPs) were defined as those who had smoked at least 100 cigarettes, used ECs at least 100 times and used at least 100 sticks in their lifetime, respectively. Current use was defined as use in the past 30 days. Comparisons by period were performed using the Chi-squared test.

Results: Compared to 2022, in 2023 the prevalence of current use of any tobacco/nicotine product remained relatively stable (34.4% vs. 32.7%, respectively), with a decrease in boxed/hand-rolled cigarettes (29.5% vs. 24.8%, p=0.003), stable levels of ECs (3.8% vs. 4.6%, p=0.268) and an increase in HTPs (4.3% vs. 6.4%, p=0.008). The prevalence of exclusive use was 24.7% vs. 19.5% for boxed/hand-rolled cigarettes (p<0.001), 1.8% vs. 2.2% for ECs (p=0.434) and 2.4% vs. 4.3% (p=0.002) for HTPs in 2022 and 2023, respectively. Out of those aware of non-combustible alternatives in the two surveys, 3 and 4 out of ten believed that the use of ECs and HTPs, respectively, is less harmful than cigarettes.

Conclusions: There were decreasing trends in the prevalence of current cigarette smoking and increases in the current use of HTPs over 2022-2023. The proportion of current and exclusive users of alternative products is small yet growing.

AUTHORS: Vasiliki Engeli, Angelos Hatzakis, Vana Sypsa

AFFILIATION: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece

Background: Monitoring the patterns of combustible tobacco products and non-combustible alternatives among young individuals is an important indicator to measure the success of the Global Strategy for tobacco control. We aim to provide estimates of the prevalence and initiation patterns of combustible tobacco products and non-combustible alternatives [electronic cigarettes (ECs) and heated tobacco products (HTPs)] among young adults in Greece in 2023.

Material and Methods: We collected data for adults 18-24 years old from two cross-sectional telephone surveys conducted throughout Greece in May-June 2023 (N_overall=612). Random digit dialing and proportional quota sampling were used to recruit participants. The estimates were adjusted for the age-sex-NUTS I distribution of the young adult population. Smokers, users of ECs and users of HTPs were defined as those who had smoked at least 100 cigarettes, used ECs at least 100 times and used at least 100 sticks in their lifetime, respectively. Current use was defined as use in the past 30 days.

Results: The prevalence of current use of any product was 40% (boxed/hand-rolled cigarettes: 27.3%, ECs: 9.9%, HTPs: 13.4%). Among current users of boxed/hand-rolled cigarettes, ECs and HTPs, 63.3%, 42.0% and 54.3% were exclusive users, respectively. In the total sample of young adults, boxed/hand-rolled cigarettes were the first product tried by 55.9% at a median age of 16 years, ECs by 8.8% (median age: 17 years) and HTPs by 1.4% (median age: 18 years) (among ever users: 81.1% boxed/hand-rolled cigarettes, 12.7% ECs, 2% HTPs).

Conclusions: In 2023, four out of ten young adults report current use of any product and one fourth report non-combustible alternatives. Non-combustible alternatives were reported as the first product tried by a small proportion of ever users.

AUTHORS: Vasiliki Engeli, Angelos Hatzakis, Vana Sypsa

AFFILIATION: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece

Background: The primary objective was to assess the levels of biomarkers of exposure in smokers transitioning from conventional cigarettes (CC) to tobacco heating system (THS) in comparison to continuing smoking CC and smoking abstinence.

Material and Methods: Sixty volunteers (adult smokers, m-48, f-12; age 21 to 69) were randomized to 3 groups (THS; conventional cigarettes, CC; smoking abstinence, SA). The duration of the study was 5 days. Levels of nicotine, nicotine glucuronides and their derivatives, and mercapturic acids were detected in 24-hour urine; levels of nicotine derivatives and carboxyhemoglobin were measured in blood.

Results: No adverse events were registered during the study. On Day 5 blood carboxyhemoglobin levels in CC group were significantly higher than in THS (р=0.037) and SA (р=0.003) groups whereas no significant difference was observed between THS and SA groups (р=0.531). On Day 0 volunteers of all 3 groups (CC, THS, SA) were comparable in terms of nicotine metabolites concentration in daily urine. Levels of nicotine and metabolites (cotinine, nornicotine, trans-3-hydroxycotinine), nicotine glucuronides and cotinine, nitrosonornicotine, 4-methylnitrosamino-1-3-pyridyl-1-butanol, and anabasine in urine didn’t differ statistically in CC group on Day 0 and Day 5. Switching from CC to THS leads to significant decrease in several metabolites while still sustaining consistent nicotine level by Day 5: 1) Concentration of urine mercapturic acids in THS and SA groups significantly decreased by Day 5 (р<0.001 for 2-cyanoethylmercapturic acid, S-(3-hydroxypropyl) mercapturic acid, 3-hydroxy-1-methylpropyl-mercapturic acid (НМРМА), S-phenylmercapturic acid; р=0.001 for monohydroxybutenyl-mercapturic acid. 2) No difference was found in mercapturic acids levels between THS and SA groups on Day 5 (р>0.05), with the exception for HMPMA (р=0.045). 3) Levels of all measured mercapturic acids in THS group were significantly lower on Day 5 comparing with CC group (р<0.001).

Conclusions: Our results of the 5-day study demonstrate the significant decrease of bioexposure markers concentrations almost to the level of smoking abstinence when switching from CC to THS.

AUTHORS: Sayar R. Abdulkhakov, Rashat I. Faizullin, Tatyana V. Grigoryeva, Leonid V. Lopukhov, Andrey P. Kiassov

AFFILIATION: Kazan Federal University, Kazan, Russian Federation

Background: Electronic cigarette (EC) aerosol emissions generally contain fewer and lower concentrations of harmful and potentially harmful constituents, compared with cigarette smoke. Further studies are needed to establish whether decreased emissions translate to reduced health risks for EC users.

Material and Methods: In a cross-sectional study, biomarkers of exposure (BoE) to certain tobacco smoke toxicants and biomarkers of potential harm (BoPH), associated with biological processes linked to the potential development of smoking-related diseases and oxidative stress, were assessed in solus Vuse ECs users and current, former, and never smokers. In total, 213 participants were enrolled, and smoking status was confirmed by urinary cotinine, exhaled carbon monoxide, and N-(2-cyanoethyl)valine levels (EC users and former smokers only). During confinement participants used their usual product (EC or cigarette) as normal and BoE and BoPHs were assessed via blood, 24-h urine, and physiological assessment.

Results: Significantly lower levels of all urinary BoE; MHBMA, HMPMA, 3-HPMA, NNN, 3-OH-B[a]P, S-PMA, NNAL (all p<0.0001), and TNeq (p=0.0074) were observed in EC users when compared with smokers. Moreover, significantly lower levels were observed in EC users for 3 of the 7 BoPH measured, carboxyhaemoglobin (p<0.0001), soluble intercellular adhesion molecule-1 (p=0.0028), and 11-dehydrothromboxane B2 (p=0.0012), when compared with smokers.

Conclusions: As compared with smokers, solus Vuse EC users have significantly lower exposure to tobacco toxicants for the BoE, and 3 BoPH measured. These results add to the weight of evidence supporting EC as part of a tobacco harm reduction strategy.

AUTHORS: Linsey E. Haswell, Nathan Gale, Elaine Brown, David Azzopardi, Michael McEwan, Filimon Meichanetzidis, Senthil Vel

AFFILIATION: R&D Centre, B.A.T. (Investments) Limited, Southampton, UK

International Standard Registered Clinical Trial number: ISRCTN58921739

Background: Oral nicotine pouches (NPs) are smokeless, tobacco-free products that have a potential role in tobacco harm reduction strategies.

Material and Methods: This was a cross-sectional study where biomarkers of exposure (BoE) to tobacco/tobacco smoke toxicants and several recognised biomarkers of potential harm (BoPH) linked to smoking-related diseases were compared among exclusive adult users of Velo NPs and current/former/never smokers in Sweden/Denmark. In clinic over 24 hours, participants used their usual product (Velo NP or cigarette) as normal, and BoE/BoPH were assessed via blood/24-h urine/exhaled breath/physiological assessments.

Results: Among the primary endpoints, total NNAL (16.9±29.47 vs 187.4±228.93 pg/24 h), white blood cell count (5.59±1.223 vs 6.90±1.758 × 10⁹/L), and COHb (4.36±0.525 vs 8.03±2.173% saturation) were significantly lower among Velo users than among smokers (91%, 19% and 46% lower, respectively, all P<0.0001), while fractional exhaled NO, previously shown to be lower in smokers, was significantly higher (23.18±17.909 vs 11.20±6.980 ppb) among Velo users (107% higher, P<0.0001). Furthermore, sICAM-1 tended to be lower (185.9±42.88 vs 204.5±64.85 ng/mL) among Velo users than smokers (9% lower). Several secondary endpoints, including six BoEs (3-HPMA (246.7±91.07 vs 1165.7±718.35 μg/24 h), 3-OH-B[a]P (82.4±217.58 vs 258.3±190.20 pg/24 h), HMPMA (135.1±77.85 vs 368.8±183.15 μg/24 h), MHBMA (0.22±0.166 vs 3.39±2.943 μg/24 h), S-PMA (0.10±0.059 vs 3.53±2.736 µg/24 h) and total NNN (7.5±24.84 vs 9.7±5.93 ng/24 h)), were significantly lower among Velo users (78.8%, 68.1%, 63.4%, 93.5%, 97.2% and 22.7% lower, respectively, P<0.0001–0.0011), while total nicotine equivalents was significantly higher among Velo users (22.6±12.69 vs 12.1±7.92 mg/24 h, P<0.0001), although Velo user levels are comparable to those previously reported among oral tobacco users, and Velo user and smoker mean levels were similar in Denmark.

Conclusions: With exclusive use of Velo NPs participants have significantly less exposure to tobacco toxicants and more favourable BoPH associated with initiating biological processes of smoking-related diseases compared to users of combustible cigarettes.

AUTHORS: Michael McEwan, David Azzopardi, Linsey E. Haswell, Justin Frosina, Nathan Gale, Filimon Meichanetzidis, Senthil Vel

AFFILIATION: R&D Centre, B.A.T. (Investments) Limited, Southampton, UK

International Standard Registered Clinical Trial number:ISRCTN16988167

Background: Multiple lines of evidence support the role of genetic constitution in the initiation, persistence, intensity and success in cessation of tobacco smoking. Switching to less harmful tools for nicotine delivery may serve as a balanced strategy to reduce the health risks for severe tobacco addicts.

Material and Methods: The study included 1230 subjects (570 current smokers; 246 former smokers; 267 non-smokers, who tried cigarettes at least ones but did not become a smoker; and 147 never-smokers, who did not even attempt to taste tobacco products). The group of former smokers included 54 subjects, whose cessation interval was lower than 6 months; these cases were excluded when comparing former smokers against current smokers. Twenty gene polymorphisms, which belong to the dopamine pathway and demonstrated evidence for functional role in in vitro or in vivo studies, have been selected for investigation and analyzed in the above groups.

Results: Three groups of comparisons were performed. First, we compared never-smokers, i.e. people who never even attempted to smoke, against the rest of the study. This comparison aimed to reveal whether variations in dopamine pathway genes are involved in the interest to smoking. Secondly, we compared non-smokers versus habitual (former and current) smokers. This comparison addressed the question whether some of the studied genes influence the transition from occasional to habitual smoking. Thirdly, we analyzed genotypes of former smokers with cessation period exceeding 6 months in comparison with current smokers. If p value is 0.05, 3 out of total 60 comparisons will pass this threshold solely due to a chance. In fact, there were 13 comparisons with p<0.05, which indicates that at least some of the observed associations are indeed relevant to smoking behavior. There were statistically significant differences between never- versus ever-smokers (p=0.021) and between non-smokers versus habitual former or current smokers (p=0.029). In contrast, the difference between former and current smokers did not reach statistical significance. Two gene polymorphisms showed consistent associations across all three comparisons, i.e., DAT1 40-bp repeat and MAOA 30-nucleotide repeat.

Conclusions: This study confirms that genetic constitution influences the interest to smoking initiation as well as the transition from occasional to habitual smoking. Subjects with unfavorable genotypes may constitute an especial group of people requiring personalized strategies for smoking harm reduction. The analysis of dopamine pathway polymorphisms deserves to be extended to subjects with modern smoking attitudes, e.g., to the current and former users of electronic nicotine delivery systems.

AUTHORS: Evgeny N. Imyanitov^1,2, Natalia V. Mitiushkina^1,2, Olga A. Sukhovskaya^3,4

AFFILIATIONS: ¹N.N. Petrov Institute of Oncology, Saint Petersburg, Russian Federation || ²St. Petersburg Pediatric Medical University, Saint Petersburg, Russian Federation || ³Institute of Pulmonology, Saint Petersburg, Russian Federation || ⁴Institute of Phthisiopulmonology, Saint Petersburg, Russian Federation

Acknowledgments: This work has been supported by the Russian Science Foundation (grant 23-45-10038).

Background: Cigarette smoke contains nicotine (a natural component of tobacco) and a variety of harmful chemicals. It is these toxins, not nicotine, that are the leading cause of smoking-related diseases. The risk reduction is due to the use of products that will become an alternative to traditional cigarettes. These products contain nicotine, have a rich taste and give the aroma familiar to smokers, but do not produce smoke. The purpose of this study was to analyze biomarkers of exposure when using cigarettes and electronic tobacco heating systems.

Material and Methods: Analysis of literature data (Japanese study) on biomarkers of clinical risk of cardiovascular disease in cigarette smoking and use of electronic tobacco heating systems.

Results: Exposure biomarkers indicate exposure to a potentially hazardous substance. The biomarker may be a substance included in cigarette smoke or a metabolite measured in a biological fluid or tissue. From biomarkers of exposure, the amount of substance absorbed by the body can be determined.

Сarboxyhaemoglobin - indicates exposure to carbon monoxide (СО).

Total NNAL - tobacco nitrosamines have carcinogenic properties, makes a significant contribution to the etiology of lung and pancreatic cancers.

MHBMA (monohydroxybutenyl mercapturic acid) – 1,3-butadiene biomarker, carcinogen, causes central nervous system damage and impaired embryonic development.

3-HPMA (3-hydroxypropylmercapturic acid) – an acrolein biomarker, an irritating effect on the eyes, skin, and airways. Carcinogen, can cause asthma, cystitis.

S-PMA (S-phenylmercapturic acid) – a biomarker of benzene, toxic effect - causes acute and chronic poisoning. It has irritating, immunotoxic allergic effects, mutagenic activity. Carcinogen can cause leukemia.

Conclusions: The 5-day and 90-day clinical studies measured biomarkers in blood and urine signaling exposure to selected harmful and potentially harmful substances. Levels of 15 biomarkers of exposure in the group switching completely to using electronic tobacco heating systems were comparable to those who quit smoking during the study. In both cases, levels remained significantly lower than those of subjects who continued smoking during the study. A complete switch to electronic tobacco heating systems is less harmful than continuing to smoke cigarettes.

AUTHORS: Anna Chernova, Svetlana Nikulina

AFFILIATION: Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation

Background: There is no harmless form or dose of tobacco. The smoke of one cigarette contains, according to various sources, from 4,000 to more than 7,000 chemicals, including 69 proven carcinogens and 250 components with cytotoxic effects. Tobacco contains nicotine, which is a highly addictive psychoactive substance. The purpose of the study was to analyze literature data on clinical risk markers (based on a randomized US trial) when using cigarettes and electronic tobacco heating systems.

Material and Methods: Literature data: Effects of Switching to a Heat-Not-Burn Tobacco Product on Biologically Relevant Biomarkers to Assess a Candidate Modified Risk Tobacco Product: A Randomized Trial.

Results: Clinical risk markers represent a measurable change in biochemical, physiological (organs, tissues, cells) or behavioral function of the body, indicating a deterioration in health or the presence of disease. Participants were randomized to a group continuing smoking (n=496) or a group switching to using electronic tobacco heating systems (n=488) for 6 months.

• Total NNAL - genotoxicity, tumor development.
• 8-epi PGF 2a - oxidative stress, cardiovascular system disease, COPD, cancer.
• WBC - inflammation, cardiovascular system disease, COPD, cancer.
• FEV1% - respiratory impairment, COPD.
• COHb - acute exposure, cardiovascular system.
• sICAM-1 - endothelial dysfunction, cardiovascular system.
• 11-DTX-B - thrombus formation, cardiovascular system.
• HDL-C - lipid metabolism, cardiovascular system.

The main outcome was a favorable change at 6 months with statistically significant improvements in 5 out of 8 biomarkers of exposure (HDL-C, WBC, FEV1% pre, COHb, total NNAL), in the group switching to electronic tobacco heating systems compared to those continuing to smoke cigarettes.

Conclusions: When using electronic tobacco heating systems, the tobacco is heated, not burned. As a result, the formation of harmful and potentially harmful substances is significantly reduced. Scientific studies have shown that the complete transition from cigarette smoking to the use of electronic tobacco heating systems significantly reduces the impact of harmful and potentially harmful substances on the human body.

AUTHORS: Anna Chernova, Svetlana Nikulina

AFFILIATION: Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation

Human body odour comprises volatile compounds emanating from the skin surface, which are known as human skin gases. The body odour is usually recognised as a matter of comfort or discomfort for the surrounding people, whilst human skin gases have been attracting considerable attentions as a non-invasive biomarker for individual health status. Our previous study showed cigarette smoking significantly altered the skin gas composition by releasing inhaled volatile chemicals through the skin surface. To date, however, effects of heated tobacco products use have not been reported on the skin gas composition. Ammonia is a typical skin gas with pungent odour. The skin ammonia is a possible biomarker reflecting autonomic nervous system because the dermal emission tends to increase due to physical and/or psychological stress. Heated tobacco product is a delivery system of nicotine which can relax muscles and decrease psychological stress of users. This study aimed to investigate the effect of heated tobacco products use on the cutaneous ammonia emission. The skin ammonia was collected by a passive flux sampler at the forearm of current users (#1 and #2) for 1 hour before and after the use of iQOS ILUMA. After sampling, the emission flux of ammonia was determined by ion chromatography. As for #1, the emission flux before use resulted in 307 ng cm^-2 h^-1 (n=2) which can contribute to his/her body odour. However, the level remarkably decreased to 212 ng cm^-2 h^-1 immediately after use and to 74 ng cm^-2 h^-1 after 1 hour of the use. Similar tendency was also found for #2. Even though ammonia is present in aerosols, the results suggested no additive effect of inhaled ammonia on the emission level. Rather, the use of the device has reduced the stress of users and improved the body odour caused by ammonia.

AUTHORS: Yoshika Sekine, Masaki Kawaguchi

AFFILIATION: School of Science, Tokai University, Japan