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(2007) find that counterfeit cigarettes can have as much as seven times the lead of legitimate brands, and close to three times as much thallium.[13] Other sources report finding insect eggs, dead flies, mold, and human feces in counterfeit cigarettes.[14] As was the case during the prohibition of alcohol in the United States during the 1920s, increased enforcement has not yielded beneficial results for decreasing the prevalence of bootlegging because the profit margins are so large and the distribution networks are growing more sophisticated

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Future research should further dissect key nodes in the metabolism-oxidative stress network (e.g., the SOD2/mPTP/HIF-1 axis) and screen personalized therapeutic markers via multi-omics technologies to accelerate the translation of mechanistic research to clinical applications