Immunological Changes Related to Smoking in Buerger’s Disease (Thromboangiitis Obliterans): A Systematic Review

Thromboangiitis obliterans (TAO), or Buerger’s disease (BD), is a progressive inflammatory condition that affects small and medium arteries, primarily in the limbs, and is strongly associated with tobacco use. In this systematic review, PubMed, Web of Science, Scopus, and Google Scholar databases (۲۰۱۷–۲۰۲۵) were searched using keywords such as "Buerger’s disease", "Thromboangiitis Obliterans", "tobacco", and "inflammatory cytokines". Studies underwent a four-stage screening process using PRISMA and PICO criteria. After duplicate removal, eligible articles were included for analysis. The review investigated tobacco-related immune dysregulation and its role in TAO pathogenesis, as well as smoking-related immune parameters in BD and their therapeutic potential. The obtained studies, encompassing ۹۷۱ TAO patients, demonstrated that tobacco use alters immune cytokines and mediators. Immunosuppressant treatment in human studies reduced inflammatory markers, such as tumor necrosis factor-alpha, while also improving symptoms. Interventions also modulated interleukin (IL)-۶, IL-۱, Toll-like receptors, and T helper cells in human and animal models. The findings confirmed that inflammatory cytokines significantly contribute to tissue necrosis and serve as prognostic biomarkers. The results further support classifying BD as a smoking-induced autoimmune condition. It is recommended that future studies integrate pro-inflammatory cytokines into treatment strategies and prioritize them as therapeutic targets.