E-cigarettes – BioQuakes

This article explores the new phenomenon of deaths that have arisen in relatively healthy people linked to vaping or e-cigarette use. Despite the title referring to the victims as “healthy”, there is an inherent contradiction as the people being studied in fact are using vaping as part of the daily lifestyle. As such, they are exposing themselves to harmful contaminates and toxins including both viscous oils and chemical contaminants present in the vaping liquids that are potentially toxic to the lungs. The vaping outbreak has led to almost 1,300 lung injuries and 26 deaths as of October 2019.

While the cause of the vaping related illnesses remains a mystery to investigators, numerous potential causes have been proposed. Two of the major culprits, according to Dr. Michael Siegel a professor at BU School of Public Health, are thought to be either the oils or chemicals found in vaping products. Regardless of which is the cause, both place an excessive burden on the lungs, resulting in difficulty pulping oxygen to the body tissues. As a result of the reduced oxygen, a variety of symptoms have emerged in the victims, and overall these symptoms have been coined EVALI: E-cigarette or vaping product use associated lung injury.

There are various risks associated with exposure to both the oils and the chemicals present in most vaping products. The oils, such as vitamin E Acetate are often added as thickening agents to black market vaping products which are inherently dangerous as they are not regulated by the FDA. Furthermore, the oils are thought to coat the lungs and as Dr. Siegel points out, our lungs are not designed to handle oil exposure, as the oil coats the air sacs that are needed for gas exchange and thus limit the body’s ability to acquire oxygen. The patients may experience respiratory failure, and as a result require mechanical ventilation in order to be able to breathe sufficiently. Conversely, it is also thought that chemical contaminants may be the primary problem. Dr. Siegel draws attention to the risks associated with them including “damage to the lungs, which triggers a severe inflammatory response“.

Building on the knowledge that vaping is causing a mysterious outbreak of illnesses and deaths, researchers have taken interest in studying the problem more in depth. Samples were taken from 17 patients throughout the US who suffered from EVALI, and researchers concluded that the lung samples did not indicate that the oils were in fact the primary cause of the disease and symptoms. Instead, the samples showed evidence of injury similar to chemical pneumonitis, which results from inhalation of chemical fumes, and the authors cited in the publication in the New England Journal of Medicine that these chemicals are most likely the cause. This information can be very promising for future research, as with this knowledge the actual cause of EVALI can be better pinpointed.

The damage found in vaping patients included very severe symptoms, with some patients even experiencing their lung cells falling off from extreme damage. The severity of this damage also led to acute respiratory distress syndrome, which allows materials such as dead cells and blood clotting proteins to enter the lung’s air sacs. The presence of these materials are quite dangerous as they prevent efficient oxygen exchange from occurring. Shockingly, this disease has an extremely high mortality rate and no known cure. This leaves people with the prospect that they may not recover, and as of right now all that can be done is temporary treatment or more importantly prevention in those portions of the population who are not vaping. Scientists and doctors do not yet know if EVALI and associated acute respiratory distress syndrome is reversible or permanent. Thus, education is key to warn people of these risks so that they can make educated choices when being exposed to the possibility of partaking in vaping.

New York State just placed the first temporary ban on the distribution of flavored e-cigarettes. Although this motion was repealed last week due to the “state’s executive overreach” (Tony Abound of Vapor Technology Association), the ban will be rediscussed on October 18th. Actions to reduce use of e-cigarettes are gaining momentum. This is in part due to a recent article discussing a study involving mice, which linked e-cigarette smoke to lung adenocarcinoma and bladder urothelial hyperplasia.

(Teenage Girl With Vaping Device)

Just published two days ago, Moon-shong Tang, PhD of NYU School of Medicine, studied the affect of e-cigarette smoke on forty mice. Over a 54 week period of exposure, the results were both shocking and devastating. Twenty-three of the forty mice (57.5%) developed bladder urothelial hyperplasia (lack of cytologic atypia in thickened urothelium), changes in gene multiplication, and cancerous abnormal tissue growth. In addition, nine of the mice (22.5%) developed lung adenocarcinomas, a divison of lung cancer. Although the study was restricted due to the small trial size and the full-body smoke exposure opposed to inhalation, it is still prevalent to consider this trail in the dangers of e-cigarettes.

Once nicotine enters a cell, nitrosation (addition of a nitrosonium ion) converts nicotine to nitrosamines, a proven carcinogen. Although a 2017 study revealed nitrosamines in e-cigarette smokers was 95% less than in tobacco smokers, a new study proves mammalian cells already contain nitrosonium which react with inhaled nicotine to produce nitrosamines. Nitrosamine is unable to leave the cell, and therefore is undetectable by blood tests.

E-cigarettes have infiltrated todays society, specifically affecting teenagers and young adults. With appealing flavors and attractive packaging, e-cigarettes has swayed away from helping recovering smokers, to targeting young individuals, who generally have never smoked a cigarette before. I was not surprised to hear this trial’s results, as teenagers across the country have been experiencing hospitalization due to collapsed lungs and other illnesses related to e-cigarettes. I urge everyone to consider the consequences of e-cigarettes before using one.

For more details involving the trail, click here.

BioQuakes

AP Biology class blog for discussing current research in Biology

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