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as tightly as a tobacco cigarette, and the smokable substance is about half that in a tobacco cigarette. In addition, tobacco smokers generally smoke considerably more cigarettes per day than do marijuana smokers.

Cellular Damage
Lymphocytes: T and B Cells.

Human studies of the effect of marijuana smoking on immune cell function are not all consistent with cannabinoid cell culture and animal studies. For example, antibody production was decreased in a group of hospitalized patients who smoked marijuana for four days (12 cigarettes/day), but the decrease was seen in only one subtype of humoral antibody (IgG), whereas two other subtypes (IgA and IgM) remained normal and one (IgE) was increased.108 In addition, T cell proliferation was normal in the blood of a group of marijuana smokers, although closer evaluation showed an increase in one subset of T cells161 and a decrease in a different subset (CD8).157 It appears that marijuana use is associated with intermittent disturbances in T and B cell function, but the magnitude is small and other measures are often normal.87

Macrophages.

Alveolar macrophages are the principal immune-effector cells in the lung and are primarily responsible for protecting the lung against infectious microorganisms, inhaled foreign substances, and tumor cells. They are increased during tissue inflammation. In a large sample of volunteers, habitual marijuana smokers had twice as many alveolar macrophages as nonsmokers, and smokers of both marijuana and tobacco had twice as many again.11 Marijuana smoking also reduced the ability of alveolar macrophages to kill fungi, such as Candida albicans;* pathogenic bacteria, such as Staphylococcus aureus; and tumor target cells. The reduction in ability to destroy fungal organisms was similar to that seen in tobacco smokers. The inability to kill pathogenic bacteria was not seen in tobacco smokers.10 Furthermore, marijuana smoking depressed production of proinflammatory cytokines, such as TNF-I and IL-6, but not of immunosuppressive cytokines.10 Cytokines are important regulators of macrophage function, so this marijuana-related decrease in inflammatory cytokine production might be a mechanism whereby marijuana smokers are less able to destroy fungal and bacterial organisms, as well as tumor cells.

The inability of alveolar macrophages from habitual marijuana smokers without apparent disease to destroy fungi, bacteria, and tumor cells

*Candida albicans is a yeast infection that is particularly prevalent among people whose immune systems are suppressed, such as in AIDS patients.



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