Abstract B46: Evaluation of biomarkers of exposure to selected smoke constituents in adult cigarette smokers using unidentified Marlboro Snus.
Authors: Sarkar Mohamadi , Koval Tamara , Wang Jingzhu , Serafin Richard , Schulz Diane , Yan Jin , Roethig Hans-Juergen 
Published: May 2012

Abstract
B46

Introduction
It has been recently suggested in literature that adult smokers may be considering smokeless tobacco products (STP) as an alternative to smoking. While there are several STP available commercially, there is significant interest in tobacco pouch products (referred to as Snus), similar to those available in Sweden. There are few studies that have systematically investigated the changes in exposure when adult smokers use such products. Therefore, this study was conducted with the objective to evaluate the change in exposure in adult smokers who use unidentified Marlboro Snus (MS). Methods: A randomized, controlled, open-label study was conducted in which 120 adult smokers were randomized into one of the groups; CS - subjects (n=30) continue smoking their own brand, DU - subjects (n=60) reduced their normal daily cigarette consumption by ≥ 50% and were allowed to use MS (~0.3 g tobacco in a pouch, ~4 mg nicotine in tobacco) in test market in June 2007, ExclSn- subjects (n=15) stopped smoking their cigarettes but were allowed to use MS, StopTob- Subjects (n=15) were not allowed to use any tobacco products for the entire duration of the eight day study. Biomarkers of exposure measured at Baseline (Days -2 and -1) and Days 7 and 8 were 24 hr urinary excretion of the N-nitrosamines (total NNAL and total NNN), nicotine (estimated as nicotine equivalents - NE), o-toluidine (OT), 2-aminonaphthalene (2-AN), 4-aminobiphenyl (4-ABP), S-phenyl mercapturic acid (S-PMA), 3-hydroxy benzo[a]pyrene (3-OH BaP) and urine mutagenicity; plasma nicotine, cotinine, trans-3’hydroxycotinine, and blood carboxyhemoglobin (COHb) were also measured at various time points.

Results
Statistically significant (p &lt; 0.05) reductions in post-baseline 24-hr urinary levels of NNAL, NNN, NE, OT, 2-AN, 4-ABP, S-PMA, 3-OH BaP, urine mutagenicity and COHb were observed in adult smokers in the DU group compared to CS. After correcting for the residual effect, using the biomarker levels in the StopTob Group, a proportionate ~50% reduction in most of the biomarkers (except for urinary NE ~36%, OT ~24%, and COHb ~ 29%) were observed. The overall average MS consumption in the DU group was 2.6 pouches/day with a residence time of 54.3 minutes. Adult smokers in the ExclSn group manifested an even larger reduction in all the urinary and blood biomarkers of exposure when compared to those in the DU group. These reductions in the ExclSn Group were similar (p&gt;0.05) to that observed for the StopTob Group for all the biomarkers of exposure except urinary NNN (-81%), NNAL (-62%), and nicotine equivalents(-71%). MS consumption was 4 pouches/day and the average residence time was 49.4 minutes in the ExclSn group.

Conclusion
It can be concluded from this study that there is minimal contribution to exposure from MS in the dual usage group when adult smokers reduce the number of cigarettes by &gt; 50% and chose to use MS under the consumption patterns observed in this study. The adult smokers sustained a substantial reduction in exposure when exclusively using MS.
Citation Information: Cancer Prev Res 2008;1(7 Suppl):B46.