https://doi.org/10.4081/monaldi.2026.3946
Associations of light smoking with serum carcinoembryonic antigen and relative leukocyte telomere length in men with asthma
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Published: 23 September 2026
Smoking and asthma are associated with oxidative stress and chronic inflammation, which may contribute to accelerated cellular aging. Relative leukocyte telomere length (RTL) and serum carcinoembryonic antigen (CEA) are accessible biomarkers linked to these pathways, but their associations with light smoking (1-4 cigarettes/day) in men with asthma remain unclear. This cross-sectional study included 156 men: 73 with asthma and 83 healthy controls, classified as asthmatic light smokers, asthmatic nonsmokers, healthy light smokers, or healthy nonsmokers. Primary analyses used outcome-specific datasets after within-group Tukey 1.5×IQR exclusion, yielding 150 observations for CEA and 148 for RTL; complete-data and age-restricted analyses were sensitivity analyses. CEA differed across groups and was higher in asthmatic light smokers than in healthy nonsmokers (Dunn-Bonferroni p=0.006). In the age-adjusted full-cohort model, light smoking among participants with asthma was associated with higher CEA [adjusted ratio 1.18, 95% confidence interval (CI) 1.01-1.38; p=0.034]. This association became statistically inconclusive after broader adjustment. RTL also differed across groups and was shorter in asthmatic light smokers than in asthmatic nonsmokers (Dunnett T3 p=0.001). In the primary median-regression model, light smoking among participants with asthma was associated with lower RTL (adjusted conditional-median ratio 0.38, 95% bootstrap CI 0.22-0.67; p=0.001), but this association was not consistently retained in severity-adjusted, complete-data, and age-restricted analyses. Asthma-status×smoking-status interactions were nonsignificant for both biomarkers. Light smoking was associated with higher CEA and lower RTL in the primary models, but both findings were sensitive to analytical specification. These exploratory cross-sectional associations do not establish causality and require longitudinal confirmation.
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Vijverberg SJH, Hilvering B, Raaijmakers JAM, et al. Clinical utility of asthma biomarkers: From bench to bedside. Biologics 2013;7:199-210. DOI: https://doi.org/10.2147/BTT.S29976
Belsky DW, Shalev I, Sears MR, et al. Is chronic asthma associated with shorter leukocyte telomere length at midlife? Am J Respir Crit Care Med 2014;190:384-91. DOI: https://doi.org/10.1164/rccm.201402-0370OC
Savin IA, Zenkova MA, Sen’kova AV. Bronchial asthma, airway remodeling and lung fibrosis as successive steps of one process. Int J Mol Sci 2023;24. DOI: https://doi.org/10.3390/ijms242216042
Li Z, Hong L, Li Y, et al. Allergic hyper-carcinoembryonic antigen syndrome: A syndrome summarized by case series. SAGE Open Med Case Rep 2024;12. DOI: https://doi.org/10.1177/2050313X241261152
Di Vincenzo S , Ferrante G, Ferraro M, et al. Oxidative stress, environmental pollution, and lifestyle as determinants of asthma in children. Biology 2023;12:133. DOI: https://doi.org/10.3390/biology12010133
Ahmed W, Lingner J. Impact of oxidative stress on telomere biology. Differentiation 2018;99:21-7. DOI: https://doi.org/10.1016/j.diff.2017.12.002
Han F, Riaz F, Pu J, et al. Connecting the dots: telomere shortening and rheumatic diseases. Biomolecules 2024;14:1261. DOI: https://doi.org/10.3390/biom14101261
Wan R, Srikaram P, Guntupalli V, et al. Cellular senescence in asthma: from pathogenesis to therapeutic challenges. EBioMedicine 2023;94:104717. DOI: https://doi.org/10.1016/j.ebiom.2023.104717
Beauchemin N, Arabzadeh A. Carcinoembryonic antigen-related cell adhesion molecules (CEACAMs) in cancer progression and metastasis. Cancer Metastasis Rev 2013;32:643-71. DOI: https://doi.org/10.1007/s10555-013-9444-6
No YJ, Park KS, Chung HS, et al. Factors associated with serum levels of carcinoembryonic antigen in healthy non-smokers. Korean J Fam Med 2013;34:413-9. DOI: https://doi.org/10.4082/kjfm.2013.34.6.413
Arnson Y, Shoenfeld Y, Amital H. Effects of tobacco smoke on immunity, inflammation and autoimmunity. J Autoimmun 2010;34:J258-65. DOI: https://doi.org/10.1016/j.jaut.2009.12.003
Caliri AW, Tommasi S, Besaratinia A. Relationships among smoking, oxidative stress, inflammation, macromolecular damage, and cancer. Mutat Res Rev Mutat Res 2021;787:108365. DOI: https://doi.org/10.1016/j.mrrev.2021.108365
Stapleton M, Howard-Thompson A, George C, et al. Smoking and asthma. J Am Board Fam Med 2011;24:313-22. DOI: https://doi.org/10.3122/jabfm.2011.03.100180
National Asthma Education and Prevention Program. Expert panel report III: guidelines for the diagnosis and management of asthma. J Allergy Clin Immunol 2007;120:S94-138. DOI: https://doi.org/10.1016/j.jaci.2007.09.029
Farhang S, Faramarzi E, Sani NA, et al. Cohort profile: the AZAR cohort, a health-oriented research model in areas of major environmental change in Central Asia. Int J Epidemiol 2019;48:382-382h. DOI: https://doi.org/10.1093/ije/dyy215
Herischi A, Ghobeh M, Soleymani J. Comparative study on the effects of several erythrocyte lysing buffers on the extraction of genomic DNA from frozen blood samples in evaluation of telomere length by qPCR method. Stud Med Sci 2024;35:274-86. DOI: https://doi.org/10.61186/umj.35.4.274
Sobhanparast S, Soleymani J, Aftabi Y, Chaparzadeh N. Optimizing DNA extraction from frozen blood samples for studying telomere length. South Med J 2024;27:37-52. DOI: https://doi.org/10.61186/ismj.27.1.37
Joglekar MV, Satoor SN, Wong WKM, et al. An optimised step-by-step protocol for measuring relative telomere length. Methods Protoc 2020;3:27. DOI: https://doi.org/10.3390/mps3020027
Cawthon RM. Telomere measurement by quantitative PCR. Nucleic Acids Res 2002;30:e47. DOI: https://doi.org/10.1093/nar/30.10.e47
Dahlgren PN, Bishop K, Dey S, et al. Development of a new monochrome multiplex qPCR method for relative telomere length measurement in cancer. Neoplasia 2018;20:425-31. DOI: https://doi.org/10.1016/j.neo.2018.02.007
Nettle D, Seeker L, Nussey D, et al. Consequences of measurement error in qPCR telomere data: a simulation study. PLoS One 2019;14:e0216118. DOI: https://doi.org/10.1371/journal.pone.0216118
Jesenak M, Zelieskova M, Babusikova E. Oxidative stress and bronchial asthma in children—causes or consequences? Front Pediatr 2017;5:162. DOI: https://doi.org/10.3389/fped.2017.00162
Strzelak A, Ratajczak A, Adamiec A, Feleszko W. Tobacco smoke induces and alters immune responses in the lung triggering inflammation, allergy, asthma and other lung diseases: a mechanistic review. Int J Environ Res Public Health 2018;15:1033. DOI: https://doi.org/10.3390/ijerph15051033
Aftabi Y, Gilani N, Ansarin A, et al. Female-biased association of NOS2-c.1823C>T (rs2297518) with co-susceptibility to metabolic syndrome and asthma. Can J Physiol Pharmacol 2023;101:200-13. DOI: https://doi.org/10.1139/cjpp-2022-0334
Aftabi Y, Amiri-Sadeghan A, Gilani N, et al. Male-biased association of endothelial nitric oxide synthase Asp298Glu substitution (NOS3-c.894G/T) with asthma risk and severity. J Asthma 2023;60:1895-906. DOI: https://doi.org/10.1080/02770903.2023.2196689
DeMeo DL. Sex, gender, and COPD. Annu Rev Physiol 2025;87:471-90. DOI: https://doi.org/10.1146/annurev-physiol-042022-014322
Babizhayev MA, Savel’yeva EL, Moskvina SN, Yegorov YE. Telomere length is a biomarker of cumulative oxidative stress, biologic age, and an independent predictor of survival and therapeutic treatment requirement associated with smoking behavior. Am J Ther 2011;18:e209-26. DOI: https://doi.org/10.1097/MJT.0b013e3181cf8ebb
Barnes RP, Fouquerel E, Opresko PL. The impact of oxidative DNA damage and stress on telomere homeostasis. Mech Ageing Dev 2019;177:37-45. DOI: https://doi.org/10.1016/j.mad.2018.03.013
Sanders JL, Newman AB. Telomere length in epidemiology: a biomarker of aging, age-related disease, both, or neither? Epidemiol Rev 2013;35:112-31. DOI: https://doi.org/10.1093/epirev/mxs008
Cho YS, Moon HB. The role of oxidative stress in the pathogenesis of asthma. Allergy Asthma Immunol Res 2010;2:183-7. DOI: https://doi.org/10.4168/aair.2010.2.3.183
Herischi A, Sobhanparast S, Seyyedi M, et al. Shorter leukocyte telomere length in Iranian men with asthma: a case–control study. Human Gene 2026;14:201549. DOI: https://doi.org/10.1016/j.humgen.2026.201549
Wadsworth SJ, Sin DD, Dorscheid DR. Clinical update on the use of biomarkers of airway inflammation in the management of asthma. J Asthma Allergy 2011;4:77-86. DOI: https://doi.org/10.2147/JAA.S15081
Alexander JC, Silverman NA, Chretien PB. Effect of age and cigarette smoking on carcinoembryonic antigen levels. JAMA 1976;235:1975-9. DOI: https://doi.org/10.1001/jama.1976.03260440027017
Foronjy R, D’Armiento J. The effect of cigarette smoke-derived oxidants on the inflammatory response of the lung. Clin Appl Immunol Rev 2006;6:53-72. DOI: https://doi.org/10.1016/j.cair.2006.04.002
Cha SR, Jang J, Park SM, et al. Cigarette smoke-induced respiratory response: insights into cellular processes and biomarkers. Antioxidants 2023;12:1210. DOI: https://doi.org/10.3390/antiox12061210
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CRediT authorship contribution
Nader Chaparzadeh, Jafar Soleymani, Younes Aftabi: design and supervision. Maryam Seyyedi: blood sample collection from the examined individuals, including those recruited by Khalil Ansarin. Sajedeh Sobhanparast, Alireza Herischi, Amir Amiri-Sadeghan, Maryam Shirforoush-Sattari: experiments. Sajedeh Sobhanparast, Alireza Herischi, Amir Amiri- Sadeghan: data analysis. Sajedeh Sobhanparastand, Younes Aftabi: initial draft preparation. Jafar Soleymaniwas, Nader Chaparzadeh, Amir Amiri-Sadeghan: review of the manuscript. All authors have read and approved the final version of the manuscript.
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