Vaping-associated Acute Lung Injury: A Case Series

Triantafyllou, G.; Tiberio, Perry J.; Zou, Richard H; Lamberty, Phillip E.; Lynch, Michael J.; Kreit, John W.; Gladwin, Mark T.; Morris, Alison; Chiarchiaro, Jared

doi:10.1164/rccm.201909-1809le

Cited by 98 publications

(84 citation statements)

References 7 publications

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“…Recent histopathological reports showed the presence of burnt/ blackened lungs, suggesting that aromatic/volatile hydrocarbons, including terpenes (diluent) and oils, are involved in EVALI (Butt et al, 2019;Triantafyllou et al, 2019). There are five components that affect the toxicity of these agents: cutting agents or oils, temperature, flavoring (e.g.…”

Section: Discussion On Toxicity and Biomarkers Of Evalimentioning

confidence: 99%

“…In patients with EVALI, there was a higher concentration of serum C-reactive protein (Kalininskiy et al, 2019). Some studies have reported increased inflammatory cell influx in the lung of patients with EVALI (Butt et al, 2019;Layden et al, 2019;Navon et al, 2019;Triantafyllou et al, 2019). In another study, the nasal scrapes from the E-Cig users showed significantly altered expression of early growth response (EGR1), ZBTB16, PIGR, PTGS2, and FKBP5 compared to the occasional E-Cig users with reduced CSF-1, CCL26, and eotaxin-3 levels that are essential for the mucosal host-defense (Martin et al, 2016).…”

Section: Disussion On Cellular and Molecular Mechanisms Of Evalimentioning

confidence: 99%

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Pulmonary Toxicity and the Pathophysiology of Electronic Cigarette, or Vaping Product, Use Associated Lung Injury

et al. 2020

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New emerging tobacco products, especially electronic cigarettes (E-Cig) or electronic nicotine delivery systems (ENDS), have gained a huge popularity, particularly in younger populations. The lack of sufficient evidence-based health effect studies has promoted widespread use/abuse with the assumption that E-Cig or ENDS and/or vaping products are safer and less toxic than conventional tobacco smoking. However, the recent escalation in acute lung injuries and their associated fatalities among ENDS or vaping product users has now brought attention to this silent epidemic via investigation into the constituents of ENDS/vaping products and their toxic effects on pulmonary health. Accordingly, CDC has declared an "outbreak" of the e-cigarette or vaping product use associated lung injury (EVALI). EVALI is characterized by sterile exogenous pneumonitis like reaction with substantial involvement of innate immune mechanisms. Vitamin-E acetate (VEA) is found in counterfeit cartridges and bronchoalveolar lavage fluid of EVALI patients. Other reports implicated the presence of aromatic/volatile hydrocarbons and oils consisting of medium-chain triglycerides (MCT oil), including terpenes and mineral oil in tetrahydrocannabinol (THC) containing counterfeit vaping products. These compounds are involved in oxidative stress and inflammatory responses in the lung. Here, we provide the perspectives on the recent case reports on EVALI, etiology, and discuss pulmonary toxicity as well as the mechanisms underlying EVALI susceptibility and lung pathophysiology.

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Section: Discussion On Toxicity and Biomarkers Of Evalimentioning

confidence: 99%

Section: Disussion On Cellular and Molecular Mechanisms Of Evalimentioning

confidence: 99%

Pulmonary Toxicity and the Pathophysiology of Electronic Cigarette, or Vaping Product, Use Associated Lung Injury

et al. 2020

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“…Radiological and histological analyses of lungs with darkened patches and ground-glass opacities suggest that volatile hydrocarbons such as terpenes and oils in e-cigs are possibly involved in the pathogenesis of EVALI [25,26]. Various hydrocarbons and reactive aldehydes are formed upon heating and thermal decomposition of e-liquids around 500 °F.…”

Section: Resultsmentioning

confidence: 99%

Pulmonary toxicity and inflammatory response of e-cigarettes containing medium-chain triglyceride oil and vitamin E acetate: Implications in the pathogenesis of EVALI but independent of SARS-COV-2 COVID-19 related proteins

Muthumalage

Lucas

Wang

et al. 2020

Preprint

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Recently, there has been an outbreak associated with the use of e-cigarette or vaping products, associated lung injury (EVALI). The primary components of vaping products, vitamin E acetate (VEA) and medium-chain triglycerides (MCT) may be responsible for acute lung toxicity. Currently, little information is available on the physiological and biological effects of exposure to these products. We hypothesized that these e-cig cartridges and their constituents (VEA and MCT) induce pulmonary toxicity, mediated by oxidative damage and inflammatory responses, leading to acute lung injury. We studied the potential mechanisms of cartridge aerosol induced inflammatory response by evaluating the generation of reactive oxygen species by MCT, VEA, and cartridges, and their effects on the inflammatory state of pulmonary epithelium and immune cells both in vitro and in vivo. Cells exposed to these aerosols generated reactive oxygen species, caused cytotoxicity, induced epithelial barrier dysfunction, and elicited an inflammatory response. Using a murine model, the parameters of acute toxicity to aerosol inhalation were assessed. Infiltration of neutrophils and lymphocytes was accompanied by significant increases in IL-6, eotaxin, and G-CSF in the bronchoalveolar lavage fluid (BALF). In mouse plasma, eicosanoid inflammatory mediators, leukotrienes, were significantly increased. Plasma from e-cig users also showed increased levels of hydroxyeicosatetraenoic acid (HETEs) and various eicosanoids. Exposure to e-cig cartridge aerosols showed the most significant effects and toxicity compared to MCT and VEA. In addition, we determined at SARS-COV-2 related proteins and found no impact associated with aerosol exposures from these tested cartridges. Overall, this study demonstrates acute exposure to specific e-cig cartridges induces in vitro cytotoxicity, barrier dysfunction, and inflammation and in vivo mouse exposure induces acute inflammation with elevated pro-inflammatory markers in the pathogenesis of EVALI.

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“…Interactions between these hydrocarbons, particulates and other organic oils, such as mineral oil, MCT oil, and coconut oil, may promote or delay the absorption and metabolism of these compounds (Gerarde 1959). However, given the nature of the disease manifestation of the reported cases of EVALI with neutrophil and eosinophil infiltration in the BALF, and their successful treatment with steroids, most of the cases may have been chemical-induced pneumonitis (Henry et al 2019; Triantafyllou et al 2019).…”

Section: Discussionmentioning

confidence: 99%

Chemical constituents involved in e-cigarette, or vaping product use-associated lung injury (EVALI)

Muthumalage

Friedman

McGraw

et al. 2020

Preprint

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AbstractBackgroundThe Centers for Disease Control (CDC) declared e-cigarette (e-cig), or vaping product use-associated lung injury (EVALI) a national outbreak due to the high incidence of emergency department admissions and deaths. Investigators have identified vitamin E acetate (VEA) as the plausible cause for EVALI, based on compounds found in bronchoalveolar lavage fluid.ObjectivesWe defined the chemical constituents present in e-cig cartridges associated with EVALI and compared constituents to medical-grade and cannabidiol (CBD) containing cartridges.MethodsWe measured chemicals and elemental metals in e-liquid and vapor phases of e-cig counterfeit cartridges by Gas Chromatography (GC) and Mass Spectrometry (MS), EPA method TO-15 by GCMS, and ICP-MS analysis.ResultsWe have identified chemical constituents in e-cig vaping tetrahydrocannabinol (THC)-containing counterfeit cartridges compared to medical-grade and cannabidiol (CBD) containing cartridges. Apart from VEA and THC, other potential toxicants correlated with EVALI included solvent-derived hydrocarbons, silicon conjugated compounds, various terpenes, pesticides/plasticizers/polycaprolactones, and metals. These chemicals are known to cause symptoms, such as cough, shortness of breath or chest pain, nausea, vomiting or diarrhea, fatigue, fever, or weight loss, all symptoms presenting in patients with EVALI.ConclusionThis study provides insights into understanding the chemical-induced disease mechanism of acute lung injury.

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Vaping-associated Acute Lung Injury: A Case Series

Cited by 98 publications

References 7 publications

Pulmonary Toxicity and the Pathophysiology of Electronic Cigarette, or Vaping Product, Use Associated Lung Injury

Pulmonary Toxicity and the Pathophysiology of Electronic Cigarette, or Vaping Product, Use Associated Lung Injury

Pulmonary toxicity and inflammatory response of e-cigarettes containing medium-chain triglyceride oil and vitamin E acetate: Implications in the pathogenesis of EVALI but independent of SARS-COV-2 COVID-19 related proteins

Chemical constituents involved in e-cigarette, or vaping product use-associated lung injury (EVALI)

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