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Short-Term Cardiovascular Effects of E-Cigarettes: Influence of E-Liquid pH (TCORS-2)

Primary Purpose

Cardiovascular Risk Factor, Nicotine Dependence

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Electronic Cigarette
Sponsored by
University of California, San Francisco
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Cardiovascular Risk Factor focused on measuring E-Cigarettes, Vaping, E-Cig Mods

Eligibility Criteria

21 Years - 70 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Heart rate < 105 beats per minute (BPM)*
  • Systolic Blood pressure <160 and > 90*
  • Diastolic Blood Pressure <100 and > 50*
  • Body Mass Index (BMI) < 38.0 (at investigator's discretion for higher BMI if no other concurrent health issues)

    *considered out of range if both machine and manual readings are above/below these thresholds

  • Use e-cigarettes on at least 15 days in the past 30 for at least 3 months
  • Smoke 10 or fewer cigarettes/tobacco products per day in the last 30 days
  • Willing to use mod e-cigarette
  • Willing to abstain from tobacco product use for night before study
  • Age: > 21 years old and < 70 years old
  • Using e-liquid > 0mg/ml nicotine
  • Saliva cotinine of ≥ 30 ng/ml or NicAlert=6 (in cases where lab turn around time will delay study procedure)

Exclusion Criteria:

  • Seizures
  • Cancer
  • Hepatitis B or C or Liver Disease
  • Oral Thrush
  • Heart disease
  • Glaucoma
  • Kidney disease or urinary retention
  • Diabetes
  • High Blood Pressure (taking sympatholytic medications such as alpha and beta blockers)
  • History of stroke
  • An ulcer in the past year
  • Thyroid disease (okay if controlled with medication)
  • Active use of an inhaler for asthma or Chronic Obstructive Pulmonary Disease (COPD)
  • Psychiatric conditions
  • Current or past schizophrenia, and/or current or past bipolar disorder
  • Major depression, current or within the past year
  • Major personality disorder
  • Participants with current or past minor or moderate depression and/or anxiety disorders will be reviewed by the study physician and considered for inclusion.
  • History of psychiatric hospitalizations are not exclusionary, but study participation will be determined as per study physician's approval
  • Recent onset or change in cough, fever and/or abdominal symptoms (vomiting or pain) in the past two weeks. (If yes, participant can re-screen when symptoms resolve).
  • Drug/Alcohol Dependence
  • Alcohol or illicit drug dependence within the past 12 months with the exception of those who have recently completed an alcohol/drug treatment program
  • Positive toxicology test at the screening visit (THC & prescribed medications okay)
  • Opioid replacement therapy (including methadone, buprenorphine, or other)
  • Positive urine cannabis is not exclusionary but participant must report use of cannabis and agree to abstain from cannabis use for the duration of the study
  • Psychiatric medications
  • Current regular use of any psychiatric medications with the exception of Selective Serotonin Reuptake Inhibitor (SSRI) and serotonin-norepinephrine reuptake Inhibitor (SNRIs) and current evaluation by the study physician that the participant is otherwise healthy, stable, and able to participate.
  • Medications
  • Use of medications that are inducers of nicotine metabolizing enzyme CYP2A4 (Example: rifampicin, carbamazepine, phenobarbital, and other anticonvulsant drugs).
  • Concurrent use of nicotine-containing medications
  • Any stimulant medications (example: Adderall) generally given for Attention deficit hyperactivity disorder (ADHD) treatment
  • Use of sympatholytic medications that affect cardiovascular conditions including hypertension, (Example: beta and alpha-blockers)
  • Other/Misc. Chronic Health Conditions
  • Fainting (within the last 30 days)
  • Other "life threatening illnesses" as per study physician's discretion
  • Pregnancy
  • Pregnancy (self-reported and urine pregnancy test)
  • Breastfeeding (determined by self-report)
  • Concurrent participation in another clinical trial
  • Inability to communicate in English
  • Planning to quit vaping within the next 60 days
  • Uncomfortable with getting blood drawn

Sites / Locations

  • Zuckerberg San Francisco General HospitalRecruiting
  • University of California, San FranciscoRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Other

Other

Other

Arm Label

E-liquid pH 5, 7, or 9

1 of the other 2 remaining e-liquid pH

Remaining e-liquid pH

Arm Description

Using an electronic cigarette, the patient will participate in a standardized vaping session using 1 of 3 assigned e-liquid pH.

Using an electronic cigarette, the patient will participate in a standardized vaping session using 1 of the other 2 assigned e-liquid pH.

Using an electronic cigarette, the patient will participate in a standardized vaping session using the remaining assigned e-liquid pH.

Outcomes

Primary Outcome Measures

Nicotine Exposure: Blood Nicotine
Concentration of plasma nicotine (ng/ml) will be used to assess differences across the three e-liquid pH levels.
Nicotine Exposure: Saliva pH
Participant saliva pH will be measured before and during outpatient stay.
Subjective Effects: Withdrawal
We will compile a score for the subjective effect of withdrawal using the sum of points scored on the Minnesota Nicotine Withdrawal Scale (MNWS), where a higher score (score range from 0 points to 60 points) indicates a higher intensity of the indicated subjective effect.
Subjective Effects: Craving
We will compile a score for the subjective effect of craving using the sum of points scored in the two subscales (intention and desire to engage in smoking behavior that is anticipated as pleasant, and anticipation of relief from negative affect through smoking) of the Questionnaire of Smoking Urges (QSU-Brief), where a higher score (score range from 10 points to 70 points) indicates a higher intensity of the indicated subjective effect.
Subjective Effects: Reward
We will compile a score for the subjective effect of reward using the sum of points scored in the five subscales (Smoking Satisfaction - score range from 1 point to 7 points; Psychological Reward - score range from 5 points to 35 points; Aversion - score range from 2 points to 14 points; Enjoyment of Respiratory Tract Sensations - score range from 2 points to 14 points; and Craving Reduction - score range from 1 point to 7 points) of the modified Cigarette Evaluation Scale (mCES), where a higher score indicates a higher intensity of the indicated subjective effect.
Cardiovascular Effects: Heart Rate
Participant heart rate will be measured in beats per minute throughout the outpatient stay.
Cardiovascular Effects: Skin Blood Flow
Participant skin blood flow will be measured by product of average blood cell velocity and concentration in mL/min during outpatient stay.

Secondary Outcome Measures

Vaping Topography: Puff Number
Vaping topography measures will be obtained from frame by frame analysis of high definition videos during the ad libitum sessions and measured as puffs per minute.
Vaping Topography: Puff Duration
Vaping topography measures will be obtained from frame by frame analysis of high definition videos during the ad libitum sessions and measured as seconds per puff.
Vaping Topography: Inter-Puff Interval
Vaping topography measures will be obtained from frame by frame analysis of high definition videos during the ad libitum sessions and measured as seconds/minutes between puffs.

Full Information

First Posted
June 24, 2020
Last Updated
October 11, 2023
Sponsor
University of California, San Francisco
Collaborators
National Institutes of Health (NIH), Food and Drug Administration (FDA), National Cancer Institute (NCI), National Heart, Lung, and Blood Institute (NHLBI)
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1. Study Identification

Unique Protocol Identification Number
NCT04449510
Brief Title
Short-Term Cardiovascular Effects of E-Cigarettes: Influence of E-Liquid pH
Acronym
TCORS-2
Official Title
Short-Term Cardiovascular Effects of E-Cigarettes: Influence of E-Liquid pH
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Recruiting
Study Start Date
January 4, 2021 (Actual)
Primary Completion Date
August 31, 2024 (Anticipated)
Study Completion Date
August 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of California, San Francisco
Collaborators
National Institutes of Health (NIH), Food and Drug Administration (FDA), National Cancer Institute (NCI), National Heart, Lung, and Blood Institute (NHLBI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will examine the short-term cardiovascular (CV) effects of e-liquid pH in a randomized, crossover clinical and behavioral pharmacology study of experienced adult e-cigarette users (N=21). The specific aim of the study is to assess the impact of changes in e-liquid pH on nicotine pharmacokinetics, cardiovascular, and subjective effects of e-cigarettes.
Detailed Description
This is a single-site, randomized, crossover study of experienced adult e-cigarette users to assess nicotine exposure, toxicant exposure, and the short-term CV effects of e-liquid pH. Three e-liquid pH conditions will be assessed on all participants: 5, 7, and 9. Hypothesis 2a: The rate of systemic nicotine absorption is inversely related to e-liquid pH and results in lower peak blood nicotine levels at higher pH. Hypothesis 2b: Heart rate acceleration will decrease and subjective measures of sensation in the throat, reward, and satisfaction will increase with increasing e-liquid pH.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cardiovascular Risk Factor, Nicotine Dependence
Keywords
E-Cigarettes, Vaping, E-Cig Mods

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
21 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
E-liquid pH 5, 7, or 9
Arm Type
Other
Arm Description
Using an electronic cigarette, the patient will participate in a standardized vaping session using 1 of 3 assigned e-liquid pH.
Arm Title
1 of the other 2 remaining e-liquid pH
Arm Type
Other
Arm Description
Using an electronic cigarette, the patient will participate in a standardized vaping session using 1 of the other 2 assigned e-liquid pH.
Arm Title
Remaining e-liquid pH
Arm Type
Other
Arm Description
Using an electronic cigarette, the patient will participate in a standardized vaping session using the remaining assigned e-liquid pH.
Intervention Type
Other
Intervention Name(s)
Electronic Cigarette
Intervention Description
E-cigarette Device: The delivery device will be a variable wattage all-in-one device with operating wattage of 7.0 - 75.0 W. The device will be set at 10 watts for the study visits.
Primary Outcome Measure Information:
Title
Nicotine Exposure: Blood Nicotine
Description
Concentration of plasma nicotine (ng/ml) will be used to assess differences across the three e-liquid pH levels.
Time Frame
Day 1 of each Arm
Title
Nicotine Exposure: Saliva pH
Description
Participant saliva pH will be measured before and during outpatient stay.
Time Frame
Day 1 of each Arm
Title
Subjective Effects: Withdrawal
Description
We will compile a score for the subjective effect of withdrawal using the sum of points scored on the Minnesota Nicotine Withdrawal Scale (MNWS), where a higher score (score range from 0 points to 60 points) indicates a higher intensity of the indicated subjective effect.
Time Frame
Day 1 of each Arm
Title
Subjective Effects: Craving
Description
We will compile a score for the subjective effect of craving using the sum of points scored in the two subscales (intention and desire to engage in smoking behavior that is anticipated as pleasant, and anticipation of relief from negative affect through smoking) of the Questionnaire of Smoking Urges (QSU-Brief), where a higher score (score range from 10 points to 70 points) indicates a higher intensity of the indicated subjective effect.
Time Frame
Day 1 of each Arm
Title
Subjective Effects: Reward
Description
We will compile a score for the subjective effect of reward using the sum of points scored in the five subscales (Smoking Satisfaction - score range from 1 point to 7 points; Psychological Reward - score range from 5 points to 35 points; Aversion - score range from 2 points to 14 points; Enjoyment of Respiratory Tract Sensations - score range from 2 points to 14 points; and Craving Reduction - score range from 1 point to 7 points) of the modified Cigarette Evaluation Scale (mCES), where a higher score indicates a higher intensity of the indicated subjective effect.
Time Frame
Day 1 of each Arm
Title
Cardiovascular Effects: Heart Rate
Description
Participant heart rate will be measured in beats per minute throughout the outpatient stay.
Time Frame
Day 1 of each Arm
Title
Cardiovascular Effects: Skin Blood Flow
Description
Participant skin blood flow will be measured by product of average blood cell velocity and concentration in mL/min during outpatient stay.
Time Frame
Day 1 of each Arm
Secondary Outcome Measure Information:
Title
Vaping Topography: Puff Number
Description
Vaping topography measures will be obtained from frame by frame analysis of high definition videos during the ad libitum sessions and measured as puffs per minute.
Time Frame
Day 1 of each Arm
Title
Vaping Topography: Puff Duration
Description
Vaping topography measures will be obtained from frame by frame analysis of high definition videos during the ad libitum sessions and measured as seconds per puff.
Time Frame
Day 1 of each Arm
Title
Vaping Topography: Inter-Puff Interval
Description
Vaping topography measures will be obtained from frame by frame analysis of high definition videos during the ad libitum sessions and measured as seconds/minutes between puffs.
Time Frame
Day 1 of each Arm

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Heart rate < 105 beats per minute (BPM)* Systolic Blood pressure <160 and > 90* Diastolic Blood Pressure <100 and > 50* Body Mass Index (BMI) < 38.0 (at investigator's discretion for higher BMI if no other concurrent health issues) *considered out of range if both machine and manual readings are above/below these thresholds Use e-cigarettes on at least 15 days in the past 30 for at least 3 months Smoke 10 or fewer cigarettes/tobacco products per day in the last 30 days Willing to use mod e-cigarette Willing to abstain from tobacco product use for night before study Age: > 21 years old and < 70 years old Using e-liquid > 0mg/ml nicotine Saliva cotinine of ≥ 30 ng/ml or NicAlert=6 (in cases where lab turn around time will delay study procedure) Exclusion Criteria: Seizures Cancer Hepatitis B or C or Liver Disease Oral Thrush Heart disease Glaucoma Kidney disease or urinary retention Diabetes High Blood Pressure (taking sympatholytic medications such as alpha and beta blockers) History of stroke An ulcer in the past year Thyroid disease (okay if controlled with medication) Active use of an inhaler for asthma or Chronic Obstructive Pulmonary Disease (COPD) Psychiatric conditions Current or past schizophrenia, and/or current or past bipolar disorder Major depression, current or within the past year Major personality disorder Participants with current or past minor or moderate depression and/or anxiety disorders will be reviewed by the study physician and considered for inclusion. History of psychiatric hospitalizations are not exclusionary, but study participation will be determined as per study physician's approval Recent onset or change in cough, fever and/or abdominal symptoms (vomiting or pain) in the past two weeks. (If yes, participant can re-screen when symptoms resolve). Drug/Alcohol Dependence Alcohol or illicit drug dependence within the past 12 months with the exception of those who have recently completed an alcohol/drug treatment program Positive toxicology test at the screening visit (THC & prescribed medications okay) Opioid replacement therapy (including methadone, buprenorphine, or other) Positive urine cannabis is not exclusionary but participant must report use of cannabis and agree to abstain from cannabis use for the duration of the study Psychiatric medications Current regular use of any psychiatric medications with the exception of Selective Serotonin Reuptake Inhibitor (SSRI) and serotonin-norepinephrine reuptake Inhibitor (SNRIs) and current evaluation by the study physician that the participant is otherwise healthy, stable, and able to participate. Medications Use of medications that are inducers of nicotine metabolizing enzyme CYP2A4 (Example: rifampicin, carbamazepine, phenobarbital, and other anticonvulsant drugs). Concurrent use of nicotine-containing medications Any stimulant medications (example: Adderall) generally given for Attention deficit hyperactivity disorder (ADHD) treatment Use of sympatholytic medications that affect cardiovascular conditions including hypertension, (Example: beta and alpha-blockers) Other/Misc. Chronic Health Conditions Fainting (within the last 30 days) Other "life threatening illnesses" as per study physician's discretion Pregnancy Pregnancy (self-reported and urine pregnancy test) Breastfeeding (determined by self-report) Concurrent participation in another clinical trial Inability to communicate in English Planning to quit vaping within the next 60 days Uncomfortable with getting blood drawn
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Lisa Lawrence
Phone
(415) 608-4864
Email
Lisa.Lawrence@ucsf.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gideon St. Helen, PhD
Organizational Affiliation
University of California, San Francisco
Official's Role
Principal Investigator
Facility Information:
Facility Name
Zuckerberg San Francisco General Hospital
City
San Francisco
State/Province
California
ZIP/Postal Code
94110
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lisa Lawrence
Email
Lisa.Lawrence@ucsf.edu
First Name & Middle Initial & Last Name & Degree
Gideon St. Helen, PhD
Facility Name
University of California, San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94143
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lisa Lawrence
Email
Lisa.Lawrence@ucsf.edu
First Name & Middle Initial & Last Name & Degree
Gideon St. Helen, PhD

12. IPD Sharing Statement

Plan to Share IPD
No

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Short-Term Cardiovascular Effects of E-Cigarettes: Influence of E-Liquid pH

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