Dear Editor,

We thank Drs. Chaouachi and Sajid for their interest and careful reading of our letter to the editor. In their letter, Chaouachi and Sajid express their concern regarding our hypothesis on the role of water pipe smoking (WPS) in human carcinogenesis. We proposed to conduct an international epidemiological study, in collaboration with several International Cancer Centers, regarding the risk factor of WPS in human pancreatic cancer as well as other cancers. Moreover, we proposed thorough molecular and cellular biological studies to determine the specific role of WPS in the development of human pancreatic cancer. Well, Drs. Chaouachi and Sajid believe that there are numerous published investigations about WPS and human cancer. This is not exact as we found only 15 papers regarding this subject; in the majority of them, the authors mentioned that WPS could play a role in some human cancers without thorough investigation especially on a molecular and cellular level. Concerning the comparison between WPS and tobacco smoking, we clearly mentioned that WPS is probably more toxic than cigarette based on the longer duration of a WPS session, which is related to human behavior; for that reason, it is believed that WPS is more dangerous on human health than cigarette.1 Consequently, we think that WPS plays an important role in the development of several human cancers that can be compared to tobacco smoking as reported in several studies.2, 3 On the other hand, regarding the levels of some toxic and carcinogenic substances in cigarette and WPS reported in a conference which Dr. Chaouachi has attended; we did not have the chance to read their data since we did not attend this conference; however, we will examine their findings once they are published.

The authors also mentioned some controversy between one of our references, Maziak et al.,4 and other studies published several years earlier regarding the role of WPS and human cancer. First, we encourage Dr. Chaouachi to address these controversies separately and directly to the respective journal; however, the fact that WPS is the subject of such controversy implies the need for more intensive investigation to clarify the sources of the controversy and the real dangers of WPS on human health. Second, we want to mention that presently we are investigating the effect of WPS on human normal bronchial epithelial (HNBE) cells using cDNA microarray; we recently conducted a similar study on the effect of single wall carbon-nanotubes in HNBE cells5; moreover, we are comparing the effect of WPS and tobacco smoking on these cells. Our preliminary data show that WPS and tobacco smoking has comparable toxic effect on these cells; moreover, we will compare the effect of these smokes on human normal pancreatic (HNP) cells using cDNA microarray to identify the target genes in both cases; this kind of study is amongst what we proposed in our letter to the editor; meanwhile, we believe that WPS smoking affects many important tumor suppressor genes and oncogens, which can enhance human cancer progression as it has already been demonstrated by tobacco smoking.2, 3 Finally, the vast knowledge of Dr. Chaouachi in regards to what is already published about WPS is commendable; however, we recommend that he would use this extensive knowledge to find a better methodology to perform original scientific research regarding the effect of WPS on human health since the majority of his published work are comments on other published papers.

Yours sincerely,


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  • 1
    Shihadeh A, Saleh R. Polycyclic aromatic hydrocarbons, carbon monoxide, ‘tar’, and nicotine in the mainstream smoke aerosol of the narghile water pipe. Food Chem Toxicol 2005; 43: 655661.
  • 2
    Dasari V, Gallup M, Lemjabbar H, Maltseva I, McNamara N. Epithelial-mesenchymal transition in lung cancer: is tobacco the “smoking gun”? Am J Respir Cell Mol Biol 2006; 35: 39.
  • 3
    Smith CJ, Perfetti TA, King JA. Perspectives on pulmonary inflammation and lung cancer risk in cigarette smokers. Inhal Toxicol 2006; 18: 66777.
  • 4
    Maziak W, Ward KD, Afifi Soweid RA, Eissenberg T. Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic. Tob Control 2004; 13: 32733.
  • 5
    Alazzam A, Mfoumou E, Yasmeen A, Darnel A, Kassab A, Stiharu I, Sivakumar N, Bhat R, Al Moustafa A-E. Identification of deregulated genes by single wall carbon-nanotubes in human normal bronchial epithelial cells. Nanomed J. (Published online: Jan. 6, 2010).

Ala-Eddin Al Moustafa, Fouad M. Fouad, Samer Rastam.