Description:The use of alternative tobacco products is rampant among the youth in the Middle East and currently spreading worldwide. It is speculated that public policies that have proven effective in limiting cigarette usage and facilitating cessation of its use resulted in the widespread use of alternative tobacco products (ATPs) as major forms of tobacco delivery systems. Previous studies have reported the acute effects of smoking medwak on altering the systolic blood pressure, cardiovascular and respiratory systems. Smoking medwakh results in the release of a mixture of toxic chemicals including nicotine, carbon monoxide, and oxidizing gases 8-10. Inhalation of these toxic gases results in triggering of oxidative stress pathways that leads to endothelial dysfunction, inflammation, and platelet activation 11,12. Therefore, in this study, we aim to discover the biochemical and physiological changes induced by medwak smoking and explore the metabolomics profile of medwak smokers with a focus on the markers of oxidative stress and inflammation in comparison to nonsmokers.