Urinary cyanoethyl mercapturic acid, a biomarker of the smoke toxicant acrylonitrile, clearly distinguishes smokers from non-smokers.

Cyanoethyl mercapturic acid (CEMA) is a urinary metabolite of acrylonitrile, a toxicant found in substantial quantities in cigarette smoke, but not in non-combusted products such as e-cigarettes or smokeless tobacco and rarely in the diet or in the general human environment. Thus, we hypothesized that CEMA is an excellent biomarker of combusted tobacco product use.We tested this hypothesis by analyzing CEMA in the urine of 1259 cigarette smokers (urinary cotinine ≥ 25 ng/ml) and 1191 non-smokers. The analyses of CEMA and cotinine were performed by validated liquid chromatography-tandem mass spectrometry methods.

Logistic regression was fit for log-transformed CEMA to construct the ROC curve.We found that a CEMA cut point of 27 pmol/ml urine differentiated cigarette smokers from non-smokers with sensitivity and specificity >99%. Use of different cotinine cut points to define smokers (10-30 ng/ml) had little effect on the results.CEMA is a highly reliable urinary biomarker to identify users of combusted tobacco products such as cigarettes as opposed to users of non-combusted products, medicinal nicotine, or non-users of tobacco products.

CEMA can be used to distinguish users of combusted tobacco products from non-combusted products such as e-cigarettes, smokeless tobacco, and medicinal nicotine. Levels of CEMA in the urine of people who use these non-combusted products are extremely low, in contrast to cotinine.

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