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1 Introduction Electronic Nicotine Delivery Systems (ENDS) are devices designed to heat a liquid solution, commonly known as e-liquid ( Immune checkpoints are a group of molecules with co-stimulatory or co-inhibitory functions that bind their respective ligands to activate or suppress intracellular signaling pathways in T cells ( Several studies have reviewed the effects of cigarette smoke and its components on immune checkpoints, including biological implications and therapeutic relevance ( A literature search was conducted between September and October of 2025, with no time restrictions