Use of the Acrylonitrile Haemoglobin Adduct N‑(2‑cyanoethyl)valine as a Biomarker Of Compliance in Smokers Switching to Tobacco Heating Products

Abstract

Objective: To investigate the use of blood levels of N-(2 cyanoethyl)valine (CEVal), a haemoglobin adduct of acrylonitrile, to assess lack of compliance with smoking cessation. Methods: We report CEVal concentrations and percentiles over time for 2 cessation groups, compliance was established using NNAL concentrations. CEVal half-life was estimated. Optimal thresholds were calculated based on receiver operating characteristics analysis. Results: At 180 days, among 67 participants in the continued smoking group and 159 assigned to smoking cessation or sole THP use. CEVal half-life was estimated to be approximately 30 days and the optimal thresholds were for NNAL at 40 pg/mL and CEVal at 35 pmol/g globin (81% sensitivity and specificity). Conclusions: A new generation of biomarkers of compliance is required, specific to the new generation of nicotine products. Methodological validation and standardisation could allow robust assessment of effects across clinical and observational studies while promoting comparability between studies. CEVal could play an important role as biomarker of compliance for smoking cessation and switching studies.

Oral health risks in users of new generation nicotine/tobacco products (NGPs): Systematic review and qualitative meta-analyses

“…In only a few studies, at least the short-term compliance of exclusive EC use was veri ed by suitable biomarkers such as COex or COHb, CEMA, NNAL (46-48, 50, 53) (23). In none of the studies, a long-term biomarker for CC use applied, such as for example the hemoglobin adduct CEVal (2-cyanoethyl valine) (119). Among adult (18 + years) EC users ) in the US in 2021 (about 11.6 million persons), almost 30% were dual users (120).…”

Examining the evidence for the health impact of combustion-free products: progress and prospects for tobacco harm reversal and reduction

“…This study also included testing a biomarker called Acrylonitrile Haemoglobin Adduct N [2-cyanoethyl]valine (CEVal). CEVaL is an important compliance check, which identifies if participants in the switching and cessation arm of the study had recently smoked cigarettes [ 11 ]. Compliance to exclusive HTPs use and complete adherence to smoking cessation protocols is paramount in a study substantiating harm reduction when switching away from combustible cigarettes or when stopping smoking.…”