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"The industry said they weren't going to market to kids but that has never stopped them before so we were monitoring because we never know what to expect from them," said study author John Pierce, a professor of family and preventive medicine and the director of the Cancer Prevention and Control Program at the Moores Cancer Center at the University of California, San Diego

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Similarly, the SUMO-E3 ligase plays a role in directing nuclear export of SMAD proteins, exacerbating pulmonary fibrosis by enhancing TGF- activity

Thats why the FDAs pre-marketing authorization only allows nicotine pouches to be marketed as a modified risk tobacco product. The manufacturers know that the tobacco-derived nicotine in their products is not pure enough to qualify for medicinal status