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Kishinchand R, Boyce M, Vyas H, Sewell L, Mohi A, Brengartner L, Miller R, Gorr MW, Wold LE, Cray J. In Utero Exposure to Maternal Electronic Nicotine Delivery System use Demonstrate Alterations to Craniofacial Development. Cleft Palate Craniofac J 2023:10556656231163400. [PMID: 36916055 DOI: 10.1177/10556656231163400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE Develop a model for the study of Electronic Nicotine Device (ENDS) exposure on craniofacial development. DESIGN Experimental preclinical design followed as pregnant murine dams were randomized and exposed to filtered air exposure, carrier exposure consisting of 50% volume of propylene glycol and vegetable glycine (ENDS Carrier) respectively, or carrier exposure with 20 mg/ml of nicotine added to the liquid vaporizer (ENDS carrier with nicotine). SETTING Preclinical murine model exposure using the SciReq exposure system. PARTICIPANTS C57BL6 adult 8 week old female pregnant mice and exposed in utero litters. INTERVENTIONS Exposure to control filtered air, ENDS carrier or ENDS carrier with nicotine added throughout gestation at 1 puff/minute, 4 h/day, five days a week. MAIN OUTCOME MEASURES Cephalometric measures of post-natal day 15 pups born as exposed litters. RESULTS Data suggests alterations to several facial morphology parameters in the developing offspring, suggesting electronic nicotine device systems may alter facial growth if used during pregnancy. CONCLUSIONS Future research should concentrate on varied formulations and exposure regimens of ENDS to determine timing windows of exposures and ENDS formulations that may be harmful to craniofacial development.
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Affiliation(s)
- Rajiv Kishinchand
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Mark Boyce
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Heema Vyas
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Leslie Sewell
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Amr Mohi
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Lexie Brengartner
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Roy Miller
- School of Nursing, 2647The Ohio State University, Columbus, OH 43210, USA
| | - Matthew W Gorr
- School of Nursing, 2647The Ohio State University, Columbus, OH 43210, USA.,Department of Physiology and Cell Biology, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Loren E Wold
- School of Nursing, 2647The Ohio State University, Columbus, OH 43210, USA.,Department of Physiology and Cell Biology, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - James Cray
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA.,Division of Biosciences, College of Dentistry, 2647The Ohio State University, Columbus, OH 43210, USA
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Rebuli ME, Rose JJ, Noël A, Croft DP, Benowitz NL, Cohen AH, Goniewicz ML, Larsen BT, Leigh N, McGraw MD, Melzer AC, Penn AL, Rahman I, Upson D, Crotty Alexander LE, Ewart G, Jaspers I, Jordt SE, Kligerman S, Loughlin CE, McConnell R, Neptune ER, Nguyen TB, Pinkerton KE, Witek TJ. The E-cigarette or Vaping Product Use-Associated Lung Injury Epidemic: Pathogenesis, Management, and Future Directions: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2023; 20:1-17. [PMID: 36584985 PMCID: PMC9819258 DOI: 10.1513/annalsats.202209-796st] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
E-cigarette or vaping product use-associated lung injury (EVALI) is a severe pulmonary illness associated with the use of e-cigarettes or vaping products that was officially identified and named in 2019. This American Thoracic Society workshop was convened in 2021 to identify and prioritize research and regulatory needs to adequately respond to the EVALI outbreak and to prevent similar instances of disease associated with e-cigarette or vaping product use. An interdisciplinary group of 26 experts in adult and pediatric clinical care, public health, regulatory oversight, and toxicology were convened for the workshop. Four major topics were examined: 1) the public health and regulatory response to EVALI; 2) EVALI clinical care; 3) mechanisms contributing to EVALI; and 4) needed actions to address the health effects of EVALI. Oral presentations and group discussion were the primary modes used to identify top priorities for addressing EVALI. Initiatives including a national EVALI case registry and biorepository, integrated electronic medical record coding system, U.S. Food and Drug Administration regulation and enforcement of nicotine e-cigarette standards, regulatory authority over nontobacco-derived e-cigarettes, training in evaluating exogenous exposures, prospective clinical studies, standardized clinical follow-up assessments, ability to more readily study effects of cannabinoid e-cigarettes, and research to identify biomarkers of exposure and disease were identified as critical needs. These initiatives will require substantial federal investment as well as changes to regulatory policy. Overall, the workshop identified the need to address the root causes of EVALI to prevent future outbreaks. An integrated approach from multiple perspectives is required, including public health; clinical, basic, and translational research; regulators; and users of e-cigarettes. Improving the public health response to reduce the risk of another substantial disease-inducing event depends on coordinated actions to better understand the inhalational toxicity of these products, informing the public of the risks, and developing and enforcing regulatory standards for all e-cigarettes.
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Wiens T, Taylor J, Cole C, Saravia S, Peterson J, Lunda M, Margetta J, D’Heilly P, Holzbauer S, Lynfield R. Lessons Learned From the E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) Outbreak Response, Minnesota, 2019-2020. Public Health Rep 2022; 137:1053-1060. [PMID: 34694926 PMCID: PMC9574319 DOI: 10.1177/00333549211051394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Electronic cigarette (e-cigarette), or vaping, product use-associated lung injury (EVALI) is a novel noncommunicable disease with an unknown cause. The objective of this analysis was to describe the Minnesota Department of Health's (MDH's) outbreak response to EVALI, including challenges, successes, and lessons learned. METHODS MDH began investigating EVALI cases in August 2019 and quickly coordinated an agencywide response. This response included activating the incident command system; organizing multidisciplinary teams to perform the epidemiologic investigation; laboratory testing of e-cigarette, or vaping, products (EVPs) and clinical specimens; and collaborating with partners to gather information and develop recommendations. RESULTS MDH faced numerous investigational challenges during the outbreak response of EVALI, including the need to gather information on unregulated and illicit substances and their use and collecting information from minors and critically ill people. MDH laboratorians faced methodologic challenges in characterizing EVPs. Despite these challenges, MDH epidemiologists successfully collaborated with the MDH public health laboratory, law enforcement, partners with clinical and toxicology expertise, and local and national public health partners. PRACTICE IMPLICATIONS Lessons learned included ensuring the state public health agency has legal authority to conduct noncommunicable disease outbreak investigations and the necessity of cultivating and using internal and external partnerships, specifically with laboratories that can analyze clinical specimens and unknown substances. The lessons learned may be useful to public health agencies responding to similar public health emergencies. To improve preparedness for the next outbreak of EVALI or other noncommunicable diseases, we recommend building and maintaining partnerships with internal and external partners.
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Affiliation(s)
- Terra Wiens
- Minnesota Department of Health, St. Paul, MN, USA
- Now with Washington State Department of Health, Seattle, WA, USA
| | - Joanne Taylor
- Minnesota Department of Health, St. Paul, MN, USA
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cory Cole
- Minnesota Department of Health, St. Paul, MN, USA
- Council of State and Territorial Epidemiologists, Atlanta, GA, USA
| | | | | | - Mark Lunda
- Minnesota Department of Health, St. Paul, MN, USA
| | | | | | - Stacy Holzbauer
- Minnesota Department of Health, St. Paul, MN, USA
- Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Marrocco A, Singh D, Christiani DC, Demokritou P. E-cigarette vaping associated acute lung injury (EVALI): state of science and future research needs. Crit Rev Toxicol 2022; 52:188-220. [PMID: 35822508 PMCID: PMC9716650 DOI: 10.1080/10408444.2022.2082918] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Abstract
"E-Cigarette (e-cig) Vaping-Associated Acute Lung Injury" (EVALI) has been linked to vitamin-E-acetate (VEA) and Δ-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.
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Affiliation(s)
- Antonella Marrocco
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - Dilpreet Singh
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - David C. Christiani
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - Philip Demokritou
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
- Environmental Occupational Health Sciences Institute, School of Public Health, Rutgers University, 170 Piscataway, NJ 08854, USA
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Cohn AM, Blount BC, Hashibe M. Nonmedical Cannabis Use: Patterns and Correlates of Use, Exposure, and Harm, and Cancer Risk. J Natl Cancer Inst Monogr 2021; 2021:53-67. [PMID: 34850898 DOI: 10.1093/jncimonographs/lgab006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 11/12/2022] Open
Abstract
Cannabis has certain health benefits, but some people may experience harms from use. Co-use of tobacco and cannabis is common. Smoke from cannabis contains many of the same carcinogens and toxicants as the smoke from tobacco, raising concerns that cannabis smoking may be a risk factor for cancer. With growing access to and acceptance of medical and nonmedical cannabis, there is an urgent need to understand the risks and benefits of the current modes of cannabis use and how cannabis may be associated with cancer risk. This monograph summarizes a session from a National Cancer Institute Symposium on nonmedical cannabis use and cancer risk. We had 3 objectives: describe the relation between nonmedical cannabis use and cancer risk, delineate patterns and correlates of cannabis co-use with tobacco, and document potentially harmful inhalational exposure resulting from smoked and vaped cannabis. Methodological limitations in the literature and future research recommendations are provided.
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Affiliation(s)
- Amy M Cohn
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Stephenson Center, Oklahoma City, OK, USA.,Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Benjamin C Blount
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT, USA
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Morel Espinosa M, Blount BC, Valentin-Blasini L. Liquid chromatography-tandem mass spectrometry method for measuring vitamin E acetate in bronchoalveolar lavage fluid. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1171:122607. [PMID: 33740693 DOI: 10.1016/j.jchromb.2021.122607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 11/15/2022]
Abstract
We investigated the suitability of isotope-dilution liquid chromatography coupled with tandem mass spectrometry for identifying vitamin E acetate (VEA) in bronchoalveolar lavage (BAL) fluid. This new method demonstrates high accuracy, selectivity, and sensitivity, with mean recoveries higher than 90%, coefficients of variation ranging from 1.5% to 4.5%, and a limit of detection of 1.10 ng/mL. Calibration curves were linear (R2 > 0.99). The linear range and detection limit of the method were adequate for identifying VEA in 48 of 51 BAL fluid samples collected from people with lung injury resulting from e-cigarettes, or vaping, product use. We conclude that this method is an effective tool for studying VEA accumulation in lungs caused by using e-cigarettes, or vaping, products that contain VEA.
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Affiliation(s)
- Maria Morel Espinosa
- Division of Laboratory Sciences, National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | - Benjamin C Blount
- Division of Laboratory Sciences, National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | - Liza Valentin-Blasini
- Division of Laboratory Sciences, National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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