Effects of tobacco smoke on immunity, inflammation and autoimmunity

https://doi.org/10.1016/j.jaut.2009.12.003Get rights and content

Abstract

Smoking is a central factor in many pathological conditions. Its role in neoplasm, lung and cardiovascular diseases has been well established for years.

However it is less acknowledged the cigarette smoking affects both the innate and adoptive immune arms. Cigarette smoke was shown to augment the production of numerous pro-inflammatory cytokines such as TNF-α, IL-1, IL-6, IL-8 GM-CSF and to decrease the levels of anti-inflammatory cytokines such as IL-10. Tobacco smoke via multiple mechanisms leads to elevated IgE concentrations and to the subsequent development of atopic diseases and asthma. Cigarette smoke has also been shown activate in many ways macrophage and dendritic cell activity.

While it is better evident how cigarette smoke evokes airway diseases more mechanisms are being revealed linking this social hazard to autoimmune disorders, for instance via the production of antibodies recognizing citrullinated proteins in rheumatoid arthritis or by the elevation of anti-dsDNA titers in systemic lupus erythematosus.

The current review underlines the importance of smoking prevention and eradication not only in respiratory disorders but also in autoimmune conditions as well.

Section snippets

Cigarette smoke composition

The burning of tobacco at the tip of the cigarette heats the air drawn through it. The heated air then passes through unburned tobacco causing nicotine and other components to evaporate. As the air later cools, some of these components condense into smoke particles. The smoker inhales the nicotine-enriched aerosol, with particle size in the micron range, permitting efficient alveolar deposition and rapid absorption in the systemic blood. Burning cigarettes produce as much as 6000 different

The effects of smoking on the immune system

Cigarette smoking affects both cell-mediated and humoral immune responses (Table 1). Studies show that maternal smoking alters both the adaptive and innate immune arms of newborns [3]. Smoking is associated with both release and inhibition of pro-inflammatory and anti-inflammatory mediators. A large network of pulmonary and systemic cytokines is involved in chronic inflammation of smokers. Cigarette smoke induces the release of TNF-α, TNF-α receptors, interleukin (IL)-1, IL-6, IL-8 and

Smoking, chronic obstructive pulmonary disease, allergies and asthma

Complex gene–environmental interactions play a key role in the development of asthma and rhinitis. Some recognized factors are early-life sensitization to aeroallergens, presence of atopic dermatitis or allergic rhinitis, early lower respiratory tract infections with respiratory syncytial virus and potentially infections with other viruses as well. Maternal smoking during pregnancy and children's exposure to environmental tobacco smoke are among the nonallergic factors associated with an

The autoimmune hazards of smoking

The etiopathogenesis of autoimmune disorders are multifactorial in nature. Environmental factors such as exposure to infectious agents, vaccines, medications, stress, and smoking are thought to predispose certain individuals to the development of autoimmune diseases [42].

Existing studies present conflicting evidence regarding the role of cigarette smoking in the development and severity of autoimmune diseases. Studies discussing this association vary widely in their designs, population sizes,

Smoking and RA

RA is a common rheumatologic condition affecting approximately 1% of the adult population in the United States [47]. Several reports support the view that RA is probably a clinical syndrome consisting of at least two distinct diseases defined by the presence or absence of autoantibodies recognizing citrullinated proteins (ACPA). As mentioned earlier, RA is one of the classical disorders that result from the interaction between environmental and predisposing genetic factors. Associations have

Smoking and SLE

Cigarette smoking has been proposed to be a trigger for both development and severity of SLE and many studies have examined that correlation with mixed results [65]. In a prospective study of 64,000 African-American women, the RR for SLE incidence in current and past smokers was 1.6, with an increased risk in women who started smoking before the age of 19 [66]. Costenbader et al. [67] performed a meta-analysis of seven case-control studies and two large cohort studies and concluded that smoking

Smoking and autoimmune thyroid diseases

Smoking is a risk factor for the development of Graves' hyperthyroidism (GH) and even more so for Graves' ophthalmopathy [75]. A meta-analysis showed an odds ratio for GH of 3.30 (95% CI 2.09 to 5.22), based on data from eight studies among current smokers compared with persons who had never smoked [76]. The meta-analysis also showed that the odds ratio for Graves' ophthalmopathy among persons who had ever smoked was 4.40 (95% CI, 2.88 to 6.73). Among current smokers, the HR for GH increases

Smoking and inflammatory bowel disease

The link between smoking and inflammatory bowel disease (IBD) was first made in 1982 when Harries et al. [82] noticed that a low proportion of ulcerative colitis (UC) patients were smokers. The RR of developing Crohn's disease (CD) was reported to be 4.8 in those who smoked before disease onset, and 3.5 for those with a current smoking habit [83].

A meta-analysis conducted over twenty years ago found a pooled OR of 0.41 (95% CI 0.34–0.48) for current smokers to develop UC in compared with

Smoking and vasculitis syndromes

Cigarette smoke exposure relates to pathological processes in blood vessel walls. Except for the atherosclerotic process associated with cigarette smoke, there are a few specific vasculitis syndromes related to smoking. Thromboangiitis obliterans (Buerger's disease) is a vasculitis in young, mostly male smokers that affects the small and medium-sized arteries and veins of the limbs. Discontinuation of smoking is the only proven definitive therapy. Various investigations have been carried out to

Smoking and other autoimmune diseases

Smoking has been demonstrated to accelerate the progression of primary biliary cirrhosis (PBC) and to be a risk factor for the development of the disease, with past smoking associated with an OR of 1.6 [95]. These results have not been replicated due to the relative rareness of PBC; the precise mechanism is not yet apparent.

Systemic sclerosis (SS) is a disorder characterized mainly by skin thickening, vasculitis, and immune dysfunction. No studies have associated smoking with increased

Conclusion

Smoking has multiple deleterious effects on the immune system causing relative immune deficiency, higher rates of infection and hazardous effects on various phases of many autoimmune diseases. Smoking plays a direct pathogenic role in the disease development of many conditions. Given the high costs of modern therapies, smoking prevention and cessation seem to be more essential than ever.

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