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| ID | Type | Description | Link |
|---|---|---|---|
| 1R01DA052565-01A1 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| American University of Beirut Medical Center | OTHER |
| National Institute on Drug Abuse (NIDA) | NIH |
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The investigators will examine the relationship between nicotine flux, nicotine form, and the rate and dose of nicotine delivery. Participants will puff on electronic nicotine delivery system (ENDS) devices under conditions that differ by flux and form, while arterial blood is sampled in high time resolution. The outcome will indicate the degree to which nicotine flux and form determine the speed and dose of ENDS nicotine delivery, and thus, abuse liability.
The purpose of this study is to examine the influence of nicotine flux, and nicotine form, on the rate and dose of nicotine delivery obtained from arterial blood measurements. This study involves a 4 x 2 crossover experimental design of four nicotine fluxes: 9, 18, 27, 35 μg/sec, and two nicotine forms (i.e., free-base and protonated). These nicotine fluxes are within the range reported for ENDS (3.1-111µg/sec). The investigators will isolate the effect of form on the pharmacokinetics of nicotine delivery by controlling for puffing behavior. The investigators will hold puff topography constant by controlling puff duration, inter-puff interval, and number of puffs using the LabVape PTL and confirm the data using eTop.
The flux/form conditions will be tested by participants in two lab visits separated by three weeks to minimize carryover effects. All sessions will be double-blinded. In the first visit, participants will use the ENDS device with one nicotine form and four fluxes in random order. Participants will be instructed to attend the lab for a second visit, to test the four fluxes but with the other nicotine form. The second visit will allow us to isolate the effect of nicotine form on nicotine delivery. The order of nicotine form in the two visits will be counter-balanced across participants. Outcome measures include arterial blood nicotine delivery, and puff topography.
Participants will be instructed to use the Subox mini C ENDS device connected to the LabVape PTL (which limits puff duration to 3 seconds) in four bouts separated by a 60min resting period. The e-liquids vaped are as follows: Propylene glycol(PG)/Glycerol (VG), 30/70 ratio by volume. Nicotine at different concentrations: (2, 4, 7 and 10mg/mL) Benzoic acid: approximately 1:1 molar ratio with nicotine. All these ingredients will be used to prepare the needed e-liquids to conduct the study.
All bouts will be directed; each bout will consist of 3 puffs in which puff duration is fixed to 3sec, as in 50, and inter-puff interval fixed to 30sec (CORESTA recommended method Nº 81).123 The puff duration and inter-puff interval will be fixed using the LabVape PTL. A puff topography device (eTop) will record the puffing topography to identify any deviation between directed and actual puffs drawn and to measure the puffing flow rate. Participants will be trained to follow the puffing cues prior to sampling using an unpowered ENDS device. For arterial blood sampling, a radial arterial line will be placed on the non-dominant side to provide access to blood samples during vaping sessions. Each blood sample (0.5cc) will be drawn manually by a trained nurse at every time point and stored in the freezer at -25°C. Blood nicotine samples will be assayed using LCMS/ MS with deuterated internal standards, as in 114. Blood will be sampled 30sec prior to the initial puff, 5, 15, and 25sec after each puff, and 60sec after the last puff of a bout. The obtained data will be used to calculate pharmacokinetic parameters of nicotine delivery under each condition (Cmax, Tmax, dCi/dt, and AUC). AUC from 0 to 160min for the four 3-puff directed bouts will be estimated using a non-compartmental model and trapezoidal rule. All measures will be corrected for baseline values by subtracting the blood nicotine concentrations by the initial value (at the start of each bout).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Nicotine vaping group visit 1 | Experimental | Subjects will receive the either free-base or protonated form of four nicotine fluxes: 9, 18, 27, 35 μg/sec at their first of two visits. In the first visit, participants will use the ENDS device with one nicotine form and four fluxes in random order. Participants will be instructed to attend the lab for a second visit, to test the four fluxes but with the other nicotine form. |
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| Nicotine vaping group visit 2 | Experimental | The same subjects from visit 1 will receive the either free-base or protonated form of four nicotine fluxes: 9, 18, 27, 35 μg/sec at their second study visit, using the opposite nicotine form that was used during the first visit. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Nicotine vaping visit 1 (free-base nicotine) | Other | Participants will receive the free-base form of four nicotine fluxes: 9, 18, 27, 35 μg/sec at one of their two visits. Participants will use the ENDS device with free-base nicotine and four fluxes in random order. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Maximum Arterial Blood Nicotine Delivery (Cmax) | For arterial blood sampling, a radial arterial line will be placed on the non-dominant side to provide access to blood samples during vaping sessions. Blood will be sampled 30sec prior to the initial puff, 5, 15, and 25sec after each puff, and 60sec after the last puff of a bout (3 puffs per bout; 4 bouts per visit day; two visit days, separated by three weeks). The obtained data will be used to calculate pharmacokinetic parameters of nicotine delivery under each condition. | Day 1 and Week 3 |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Area Under the Curve for Nicotine (AUC) | AUC from 0 to 160min for the four 3-puff directed bouts will be estimated using a non-compartmental model and trapezoidal rule. The four 3-puff directed bouts occur on both visit day 1 and 2, separated by 3 weeks. All measures will be corrected for baseline values by subtracting the blood nicotine concentrations by the initial value (at the start of each bout). |
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Inclusion Criteria:
Exclusion Criteria:
Any significant current medical condition such as neurological, cardiovascular, endocrine, renal, or hepatic pathology that would increase risk or would interfere with/mimic tobacco abstinence
Untreated, unresolved active pulmonary or cardiovascular conditions (i.e. chest pain, dyspnea, acute infection, recurring bronchitis, and reactive airway disorder)
Breast-feeding or Pregnant (by urinalysis at screening).
Vaping less than 3 months and less than 3 times per week
Taking anticoagulants and blood thinners
Known hypersensitivity to propylene glycol
History of environmental - bronchospastic allergies, multiple chemical sensitivities, or other airway sensitivities that require the use of an epi pen or that in the investigator's view would make it risky for participation.
Has current symptoms as identified by the Health Assessment Checklist including cough, shortness of breath, chest pain, nausea, vomiting, stomach pain, diarrhea, fever, chills, or weight loss
Participants intending to quit tobacco/nicotine use in the next 30 days will be excluded and referred to cessation treatment.
Abnormal Allen Test (impaired collateral circulation)
Positive pregnancy test at any study visit
Infection of skin or soft tissue at insertion site (erythema, swelling, ulceration)
Peripheral vascular disease
Coronary artery disease/advance atherosclerosis
Raynaud's phenomenon
Coagulopathy (hereditary bleeding disorders, advanced liver disease)
Thromboangiitis obliterans
COPD/emphysema/chronic bronchitis
Allergy to lidocaine or anesthetics
Inability to tolerate blood draws for any reason
Additional Screening Procedures: Significant changes and/or abnormalities in these assessments during the study period may warrant exclusion at the discretion of the PI.
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| Name | Affiliation | Role |
|---|---|---|
| Stephen R Baldassarri, M.D. | Yale University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Human Research Unit (HRU) | New Haven | Connecticut | 06510 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37733666 | Derived | El-Hellani A, Hanna E, Sharma M, Blohowiak R, Joseph P, Eid T, Nadim H, El-Hage R, Salman R, Karaoghlanian N, Adeniji A, Salam S, Talih F, Elbejjani M, Breland A, Eissenberg T, Shihadeh A, Baldassarri SR, Talih S. Nicotine flux as a powerful tool for regulating nicotine delivery from e-cigarettes: Protocol of two complimentary randomized crossover clinical trials. PLoS One. 2023 Sep 21;18(9):e0291786. doi: 10.1371/journal.pone.0291786. eCollection 2023. |
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36 participants were enrolled and signed consent but 10 of those participants never started therefore 26 participants started.
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| ID | Title | Description |
|---|---|---|
| FG000 | Free-base nicotine first, then protonated nicotine | Subjects will receive the free-base form of four nicotine fluxes: 9, 18, 27, 35 μg/sec at their first of two visits. In the first visit, participants will use the ENDS device with one nicotine form and four fluxes in random order. Participants will be instructed to attend the lab for a second visit, to test the four fluxes but with the other nicotine form. The same subjects from visit 1 will receive the protonated form of four nicotine fluxes: 9, 18, 27, 35 μg/sec at their second study visit. |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| First Intervention (1 day) |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 17, 2024 |
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The investigators will measure arterial nicotine concentrations over discrete time-periods in a within-subject study with 15 anticipated participants who will undergo 2 ENDS use sessions that differ by nicotine form (protonated, freebase). In each session, participants will draw three 3-sec puffs with four randomly ordered nicotine fluxes (9, 18, 27, 35 μg/sec).
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The flux/form conditions will be tested by participants in two lab visits separated by three weeks to minimize carryover effects. All sessions will be double-blinded. In the first visit, participants will use the ENDS device with one nicotine form and four fluxes in random order.
| Nicotine vaping visit 1 (protonated nicotine) | Other | Participants will receive the protonated form of four nicotine fluxes: 9, 18, 27, 35 μg/sec at the other study visit. Participants will use the ENDS device with protonated nicotine and four fluxes in random order. |
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| Nicotine vaping visit 2 (free-base nicotine) | Other | Participants who received protonated nicotine during visit 1 will now receive free-base nicotine fluxes for visit 2: 9, 18, 27, 35 μg/sec. |
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| Nicotine vaping visit 2 (protonated nicotine) | Other | Participants who received free-base nicotine during visit 1 will now receive protonated nicotine fluxes for visit 2: 9, 18, 27, 35 μg/sec. |
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| Day 1 and Week 3 |
| Change in Liquid Consumed | Determined by ENDS gravimetric weight change. Pre- and Post- vaping on both visit day 1 and 2, separated by 3 weeks. | Day 1 and Week 3 |
| Mean Change in Puff Topography | Average puff duration in seconds for 3 puffs on both visit day 1 and 2, separated by 3 weeks. Data presented here is the average duration per condition. | Day 1 and Week 3 |
| Change in Rate of Nicotine Rise After the Initial Puff (dCi/dt) | Blood will be sampled 30sec prior to the initial puff, 5, 15, and 25sec after each puff, and 60sec after the last puff of a bout. Measurements occur 4 times per visit day, on both visit day 1 and 2, separated by 3 weeks). The obtained data will be used to calculate pharmacokinetic parameters of nicotine delivery under each condition (dCi/dt). | Day 1 and Week 3 |
| Change in Time to Maximum Arterial Blood Level Nicotine Concentration (Tmax) | Blood will be sampled 30sec prior to the initial puff, 5, 15, and 25sec after each puff, and 60sec after the last puff of a bout. Measurements occur 4 times per visit day, on both visit day 1 and 2, separated by 3 weeks). The obtained data will be used to calculate pharmacokinetic parameters of nicotine delivery under each condition (Tmax). | Day 1 and Week 3 |
| FG001 | Protonated nicotine first, then free-base nicotine | Subjects will receive the protonated form of four nicotine fluxes: 9, 18, 27, 35 μg/sec at their first of two visits. In the first visit, participants will use the ENDS device with one nicotine form and four fluxes in random order. Participants will be instructed to attend the lab for a second visit, to test the four fluxes but with the other nicotine form. The same subjects from visit 1 will receive the free-base form of four nicotine fluxes: 9, 18, 27, 35 μg/sec at their second study visit. |
| 9 μg/s |
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| 18 μg/s |
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| 27 μg/s |
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| 35 μg/s |
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| COMPLETED |
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| NOT COMPLETED |
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| Washout (3 weeks) |
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| Second Intervention (1 day) |
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| ID | Title | Description |
|---|---|---|
| BG000 | Nicotine Vaping Group | Subjects will receive the either free-base or protonated form of four nicotine fluxes: 9, 18, 27, 35 μg/sec at their first of two visits. In the first visit, participants will use the ENDS device with one nicotine form and four fluxes in random order. Participants will be instructed to attend the lab for a second visit, to test the four fluxes but with the other nicotine form. The same subjects from visit 1 will receive the either free-base or protonated form of four nicotine fluxes: 9, 18, 27, 35 μg/sec at their second study visit, using the opposite nicotine form that was used during the first visit. |
| Units | Counts |
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| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Change in Maximum Arterial Blood Nicotine Delivery (Cmax) | For arterial blood sampling, a radial arterial line will be placed on the non-dominant side to provide access to blood samples during vaping sessions. Blood will be sampled 30sec prior to the initial puff, 5, 15, and 25sec after each puff, and 60sec after the last puff of a bout (3 puffs per bout; 4 bouts per visit day; two visit days, separated by three weeks). The obtained data will be used to calculate pharmacokinetic parameters of nicotine delivery under each condition. | Blood sample from 2 participants was unusable. | Posted | Mean | Standard Deviation | ng/ml | Day 1 and Week 3 |
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| Secondary | Change in Area Under the Curve for Nicotine (AUC) | AUC from 0 to 160min for the four 3-puff directed bouts will be estimated using a non-compartmental model and trapezoidal rule. The four 3-puff directed bouts occur on both visit day 1 and 2, separated by 3 weeks. All measures will be corrected for baseline values by subtracting the blood nicotine concentrations by the initial value (at the start of each bout). | Posted | Mean | Standard Deviation | (ng/ml)*s | Day 1 and Week 3 |
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| Secondary | Change in Liquid Consumed | Determined by ENDS gravimetric weight change. Pre- and Post- vaping on both visit day 1 and 2, separated by 3 weeks. | Data presented here is for all participants that completed the assessment. | Posted | Mean | Standard Deviation | grams | Day 1 and Week 3 |
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| Secondary | Mean Change in Puff Topography | Average puff duration in seconds for 3 puffs on both visit day 1 and 2, separated by 3 weeks. Data presented here is the average duration per condition. | Posted | Mean | Standard Deviation | seconds | Day 1 and Week 3 |
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| Secondary | Change in Rate of Nicotine Rise After the Initial Puff (dCi/dt) | Blood will be sampled 30sec prior to the initial puff, 5, 15, and 25sec after each puff, and 60sec after the last puff of a bout. Measurements occur 4 times per visit day, on both visit day 1 and 2, separated by 3 weeks). The obtained data will be used to calculate pharmacokinetic parameters of nicotine delivery under each condition (dCi/dt). | Posted | Mean | Standard Deviation | ng/(ml*s) | Day 1 and Week 3 |
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| Secondary | Change in Time to Maximum Arterial Blood Level Nicotine Concentration (Tmax) | Blood will be sampled 30sec prior to the initial puff, 5, 15, and 25sec after each puff, and 60sec after the last puff of a bout. Measurements occur 4 times per visit day, on both visit day 1 and 2, separated by 3 weeks). The obtained data will be used to calculate pharmacokinetic parameters of nicotine delivery under each condition (Tmax). | Posted | Mean | Standard Deviation | seconds | Day 1 and Week 3 |
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3 weeks
The one serious adverse event occurred while the participant was between study visits and not treatment related. Each nicotine flux was given sequentially at each visit therefore adverse events can only be reported for the assigned interventions: Free-base vs Protonated nicotine.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Free-base nicotine | Subject received free-base nicotine | 0 | 26 | 0 | 26 | 0 | 26 |
| EG001 | Protonated nicotine | Subject received protonated nicotine | 0 | 26 | 0 | 26 | 0 | 26 |
| EG002 | Arterial-line related | Adverse event occurred due to arterial-line placement prior to intervention and unrelated to the interventions | 0 | 26 | 0 | 26 | 8 | 26 |
| EG003 | Between visits | Adverse event occurred between visits and unrelated to the interventions | 0 | 26 | 1 | 26 | 0 | 26 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Self harm episode | Injury, poisoning and procedural complications | Systematic Assessment |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Vomiting | Gastrointestinal disorders | Systematic Assessment |
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| Wrist discomfort | Musculoskeletal and connective tissue disorders | Systematic Assessment |
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| Pre-syncope | Cardiac disorders | Systematic Assessment |
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| Arterial vasospasm | Cardiac disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Stephen R Baldassarri, M.D. | Yale University | 203-785-3627 | stephen.baldassarri@yale.edu |
| Jun 21, 2025 |
| Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | Apr 17, 2024 | Jun 21, 2025 | ICF_001.pdf |
| ID | Term |
|---|---|
| D000072137 | Vaping |
| ID | Term |
|---|---|
| D012907 | Smoking |
| D001519 | Behavior |
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| Unknown or Not Reported |
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| Native Hawaiian or Other Pacific Islander |
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| Black or African American |
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| White |
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| More than one race |
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| Unknown or Not Reported |
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| 27 μg/s |
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| 35 μg/s |
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| Participants |
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| Participants |
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