Background: Heat-not-burn (HNB) tobacco products are not burnt but instead are inserted into a tobacco-heating system, which heats the tobacco at temperatures below that required to initiate combustion. This mechanism potentially results in significantly reduced concentrations of heat-generated toxicants in the inhalable aerosol.Method: The margin of exposure (MOE) approach was applied for quantitative risk assessment. The MOE is defined as the ratio between the toxicological threshold and the estimated human intake of the same compound. The higher the MOE, the lower the risk of a compound.Findings: The MOEs were increased by factors of 3 to 415 for the most toxic compounds in tobacco smoke, comparing use of HNB with smoking conventional tobacco products. The combined MOE for all compounds was increased 23-fold, excluding nicotine, or 10-fold including nicotine. Thus, the overall risk for cumulative toxic effects was markedly lower for HNB products.Conclusions: HNB tobacco reduced the risk of exposure to 9 out of the 20 most toxic compounds in tobacco beyond an MOE threshold of 10,000. While our results show that use of HNB products leads to a considerable risk reduction compared to conventional tobacco, the products cannot be considered completely “risk-free” due to risk of exposure to the remaining toxicants with MOE below the threshold.

中文翻译：

---

加热不燃烧烟草制品：变相的恶魔还是显着降低风险？

背景：加热不燃烧 (HNB) 烟草产品不会燃烧，而是插入烟草加热系统，该系统将烟草加热到低于开始燃烧所需的温度。这种机制可能会导致可吸入气溶胶中热产生毒物的浓度显着降低。方法：将暴露边际 (MOE) 方法应用于定量风险评估。MOE 定义为毒理学阈值与估计的相同化合物的人体摄入量之间的比率。MOE 越高，化合物的风险越低。研究结果：与使用 HNB 和吸食传统烟草产品相比，烟草烟雾中毒性最大的化合物的 MOE 增加了 3 倍至 415 倍。所有化合物的综合 MOE 增加了 23 倍，不包括尼古丁，或 10 倍，包括尼古丁。因此，加热不燃烧产品的累积毒性作用的总体风险显着降低。结论：加热不燃烧烟草降低了接触烟草中 20 种毒性最大的化合物中的 9 种超过 MOE 阈值 10,000 的风险。虽然我们的结果表明，与传统烟草相比，使用加热不燃烧产品可以显着降低风险，但由于暴露于 MOE 低于阈值的剩余有毒物质的风险，这些产品不能被认为是完全“无风险”的。