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<p>Heated tobacco products (HTPs) are promoted as reduced-risk alternatives to conventional cigarettes due to their heating-based aerosol generation, yet inconsistencies in animal study outcomes–such as divergent findings in respiratory versus cardiovascular toxicity–and variability in experimental designs (e.g., exposure modes and dose markers) complicate regulatory assessments. This systematic review addressed this gap by conducting a SYRCLE-compliant evaluation of 48 animal studies identified through a comprehensive search of PubMed, Medline, Scopus, Web of Science, and Google Scholar through July 2024. Results indicated that 28 studies supported reduced toxicological effects of HTPs compared to cigarettes (e.g., mitigated lung histopathology and inflammation), while 20 studies highlighted persistent safety concerns, including adverse effects relative to the air control (e.g., alveolar apoptosis and testicular damage). Although switching to HTPs reduced cigarette-related toxicity, inherent risks and methodological limitations preclude definitive safety claims. Consequently, high-quality, independent studies expanding to multi-organ endpoints and diverse models are urgently needed to inform evidence-based regulation.</p>

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Critical appraisal of animal studies assessing risk of heated tobacco products: a systematic review

  • 期刊论文

  • 发表日期：

    2026年3月16日

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  • Xingyu Liu,
  • Rana Tayyarah,
  • Shaofeng Liu

摘要

Heated tobacco products (HTPs) are promoted as reduced-risk alternatives to conventional cigarettes due to their heating-based aerosol generation, yet inconsistencies in animal study outcomes–such as divergent findings in respiratory versus cardiovascular toxicity–and variability in experimental designs (e.g., exposure modes and dose markers) complicate regulatory assessments. This systematic review addressed this gap by conducting a SYRCLE-compliant evaluation of 48 animal studies identified through a comprehensive search of PubMed, Medline, Scopus, Web of Science, and Google Scholar through July 2024. Results indicated that 28 studies supported reduced toxicological effects of HTPs compared to cigarettes (e.g., mitigated lung histopathology and inflammation), while 20 studies highlighted persistent safety concerns, including adverse effects relative to the air control (e.g., alveolar apoptosis and testicular damage). Although switching to HTPs reduced cigarette-related toxicity, inherent risks and methodological limitations preclude definitive safety claims. Consequently, high-quality, independent studies expanding to multi-organ endpoints and diverse models are urgently needed to inform evidence-based regulation.