| Title: | E-cigarette vaping associated acute lung injury (EVALI): state of science and future research needs |
| Author(s): | Marrocco A; Singh D; Christiani DC; Demokritou P; |
| Address: | "Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA. Environmental Occupational Health Sciences Institute, School of Public Health, Rutgers University, New Brunswick, NJ, USA" |
| DOI: | 10.1080/10408444.2022.2082918 |
| ISSN/ISBN: | 1547-6898 (Electronic) 1040-8444 (Print) 1040-8444 (Linking) |
| Abstract: | "'E-Cigarette (e-cig) Vaping-Associated Acute Lung Injury' (EVALI) has been linked to vitamin-E-acetate (VEA) and Delta-9-tetrahydrocannabinol (THC), due to their presence in patients' e-cigs and biological samples. Lacking standardized methodologies for patients' data collection and comprehensive physicochemical/toxicological studies using real-world-vapor exposures, very little data are available, thus the underlying pathophysiological mechanism of EVALI is still unknown. This review aims to provide a comprehensive and critical appraisal of existing literature on clinical/epidemiological features and physicochemical-toxicological characterization of vaping emissions associated with EVALI. The literature review of 161 medical case reports revealed that the predominant demographic pattern was healthy white male, adolescent, or young adult, vaping illicit/informal THC-containing e-cigs. The main histopathologic pattern consisted of diffuse alveolar damage with bilateral ground-glass-opacities at chest radiograph/CT, and increased number of macrophages or neutrophils and foamy-macrophages in the bronchoalveolar lavage. The chemical analysis of THC/VEA e-cig vapors showed a chemical difference between THC/VEA and the single THC or VEA. The chemical characterization of vapors from counterfeit THC-based e-cigs or in-house-prepared e-liquids using either cannabidiol (CBD), VEA, or medium-chain triglycerides (MCT), identified many toxicants, such as carbonyls, volatile organic compounds, terpenes, silicon compounds, hydrocarbons, heavy metals, pesticides and various industrial/manufacturing/automotive-related chemicals. There is very scarce published toxicological data on emissions from THC/VEA e-liquids. However, CBD, MCT, and VEA emissions exert varying degrees of cytotoxicity, inflammation, and lung damage, depending on puffing topography and cell line. Major knowledge gaps were identified, including the need for more systematic-standardized epidemiological surveys, comprehensive physicochemical characterization of real-world e-cig emissions, and mechanistic studies linking emission properties to specific toxicological outcomes" |
| Keywords: | *Acute Lung Injury/epidemiology Adolescent Dronabinol/chemistry *Electronic Nicotine Delivery Systems Humans Male *Vaping/adverse effects Vitamin E Young Adult Evali acute lung injury acute respiratory distress syndrome (ARDS) counterfeit cartridges e-cig; |
| Notes: | "MedlineMarrocco, Antonella Singh, Dilpreet Christiani, David C Demokritou, Philip eng T32 HL007118/HL/NHLBI NIH HHS/ U24 ES026946/ES/NIEHS NIH HHS/ Research Support, N.I.H., Extramural Review England 2022/07/14 Crit Rev Toxicol. 2022 Mar; 52(3):188-220. doi: 10.1080/10408444.2022.2082918. Epub 2022 Jul 13" |
