Biochemistry of nicotine metabolism and its relevance to lung cancer

Research output: Contribution to journalReview articlepeer-review


Nicotine is the key addictive constituent of tobacco. It is not a carcinogen, but it drives smoking and the continued exposure to the many carcinogens present in tobacco. The investigation into nicotine biotransformation has been ongoing for more than 60 years. The dominant pathway of nicotine metabolism in humans is the formation of cotinine, which occurs in two steps. The first step is cytochrome P450 (P450, CYP) 2A6-catalyzed 5'-oxidation to an iminium ion, and the second step is oxidation of the iminium ion to cotinine. The half-life of nicotine is longer in individuals with low P450 2A6 activity, and smokers with low activity often decrease either the intensity of their smoking or the number of cigarettes they use compared with those with "normal" activity. The effect of P450 2A6 activity on smoking may influence one's tobacco-related disease risk. This review provides an overview of nicotine metabolism and a summary of the use of nicotine metabolite biomarkers to define smoking dose. Some more recent findings, for example, the identification of uridine 5'-diphosphoglucuronosyltransferase 2B10 as the catalyst of nicotine N-glucuronidation, are discussed. We also describe epidemiology studies that establish the contribution of nicotine metabolism and CYP2A6 genotype to lung cancer risk, particularly with respect to specific racial/ethnic groups, such as those with Japanese, African, or European ancestry. We conclude that a model of nicotine metabolism and smoking dose could be combined with other lung cancer risk variables to more accurately identify former smokers at the highest risk of lung cancer and to intervene accordingly.

Original languageEnglish (US)
Article number100722
JournalJournal of Biological Chemistry
StatePublished - May 2 2021

Bibliographical note

Funding Information:
Acknowledgments—This study was supported by grant P01 CA-138338 from the National Cancer Institute, National Institutes of Health. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2021 THE AUTHOR.


  • Biomarkers, Tumor/metabolism
  • Cytochrome P-450 CYP2A6/metabolism
  • Half-Life
  • Humans
  • Lung Neoplasms/enzymology
  • Nicotine/metabolism
  • Smoking/metabolism

PubMed: MeSH publication types

  • Review
  • Journal Article
  • Research Support, N.I.H., Extramural


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