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Danielsson T, Bennet H, McColgan B, Wang J. Effect of nicotine mouth spray on urges to vape: A randomized, placebo-controlled, pharmacodynamic clinical trial in exclusive e-cigarette users. Addiction 2024. [PMID: 39315821 DOI: 10.1111/add.16669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 08/14/2024] [Indexed: 09/25/2024]
Abstract
AIMS To determine whether nicotine mouth spray provides rapid and prolonged relief of urges to vape and measure the steady-state plasma nicotine levels during vaping and ad libitum mouth spray usage in e-cigarette users. DESIGN Randomized, parallel group, double-blind trial. SETTING Single site at Hammersmith Medicines Research Ltd (HMR), London, UK. PARTICIPANTS 216 (25.9% females, average age 27.6 ± 7.63 [standard deviation, SD]) exclusive vapers who used their e-cigarette within 30 minutes of waking up and had vaped about 2 years on average. INTERVENTIONS Two sprays of 1 mg nicotine mouth spray (Nicorette QuickMist Freshmint, n = 109), or placebo (identical in appearance and presentation, n = 107). MEASUREMENTS Urge to vape was rated on a 100 mm visual analogue scale before and repeatedly for 2 hours after administration. The primary outcome measured average change from baseline in urges to vape ratings during the first hour. FINDINGS Nicotine mouth spray achieved statistically significantly greater reductions in urges to vape than placebo from the first assessment point at 30 seconds to 1 hour, when the estimated mean treatment difference was 11.90 mm (95% confidence interval [CI] = 6.86-16.95, P < 0.001). The integrated urge to vape over 11 hours ad libitum usage showed a statistically significant benefit compared with placebo (2.00 [0.88 SD] vs 2.51 [0.84 SD], P < 0.001). Mean steady-state plasma nicotine concentrations were lower after nicotine mouth spray usage compared with vaping (6.22 [4.70 SD] ng/ml vs 9.91 [7.59 SD] ng/ml, respectively). Adverse events were more commonly reported in the nicotine mouth spray group and were mostly mild. CONCLUSIONS Among regular e-cigarette users, nicotine mouth spray provided statistically significant and fast relief of urges to vape one hour after dosing. Nicotine mouth spray showed statistically significant reductions in urges to vape as soon as 30 seconds and up to 2 hours after dosing compared with placebo, and nicotine mouth spray was well-tolerated and safe.
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Affiliation(s)
| | - Hedvig Bennet
- Global Clinical Operations, Kenvue Inc, Helsingborg, Sweden
| | - Bryan McColgan
- Global Clinical Sciences, Kenvue Inc, Helsingborg, Sweden
| | - Jianfeng Wang
- Global Biostatistics, Kenvue Inc, Helsingborg, Sweden
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2
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Toxicity studies of acetoin and 2,3-pentanedione administered by inhalation to Wistar Han [Crl:WI(Han)] rats and B6C3F1/N mice. TOXICITY REPORT SERIES 2023:NTP-TOX-98. [PMID: 36999846 PMCID: PMC10201376 DOI: 10.22427/ntp-tox-98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Acetoin and 2,3-pentanedione are highly volatile components of artificial butter flavoring (ABF). Concerns over the inhalation toxicity of these compounds originate from the association between occupational exposures to ABF and adverse fibrotic lung effects, specifically obliterative bronchiolitis (OB) in the distal airways. 2,3-Pentanedione has been used as a replacement for 2,3-butanedione (diacetyl) in some ABF due to concerns about the respiratory toxicity of 2,3-butanedione. However, 2,3-pentanedione is structurally similar to 2,3-butanedione and has been shown to exhibit potency similar to 2,3-butanedione regarding airway toxicity following acute inhalation (whole-body) exposure. This report describes a series of studies to evaluate the 2-week inhalation toxicity of acetoin and the 3-month inhalation toxicity of acetoin and 2,3-pentanedione. (Abstract Abridged).
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Effah F, Taiwo B, Baines D, Bailey A, Marczylo T. Pulmonary effects of e-liquid flavors: a systematic review. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2022; 25:343-371. [PMID: 36154615 PMCID: PMC9590402 DOI: 10.1080/10937404.2022.2124563] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Electronic cigarettes (ECs) are purported to be tobacco harm-reduction products whose degree of harm has been highly debated. EC use is considered less hazardous than smoking but is not expected to be harmless. Following the banning of e-liquid flavors in countries such as the US, Finland, Ukraine, and Hungary, there are growing concerns regarding the safety profile of e-liquid flavors used in ECs. While these are employed extensively in the food industry and are generally regarded as safe (GRAS) when ingested, GRAS status after inhalation is unclear. The aim of this review was to assess evidence from 38 reports on the adverse effects of flavored e-liquids on the respiratory system in both in vitro and in vivo studies published between 2006 and 2021. Data collected demonstrated greater detrimental effects in vitro with cinnamon (9 articles), strawberry (5 articles), and menthol (10 articles), flavors than other flavors. The most reported effects among these investigations were perturbations of pro-inflammatory biomarkers and enhanced cytotoxicity. There is sufficient evidence to support the toxicological impacts of diacetyl- and cinnamaldehyde-containing e-liquids following human inhalation; however, safety profiles on other flavors are elusive. The latter may result from inconsistencies between experimental approaches and uncertainties due to the contributions from other e-liquid constituents. Further, the relevance of the concentration ranges to human exposure levels is uncertain. Evidence indicates that an adequately controlled and consistent, systematic toxicological investigation of a broad spectrum of e-liquid flavors may be required at biologically relevant concentrations to better inform public health authorities on the risk assessment following exposure to EC flavor ingredients.
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Affiliation(s)
- Felix Effah
- Pharmacology Section, St George’s University of London, London, UK
- Radiation, Chemical and Environmental Hazards, UK Health Security Agency, Didcot, UK
| | - Benjamin Taiwo
- Physiology Section, St George’s University of London, London, UK
| | - Deborah Baines
- Infection and Immunity Institute, St George’s University of London, London, UK
| | - Alexis Bailey
- Pharmacology Section, St George’s University of London, London, UK
| | - Tim Marczylo
- Radiation, Chemical and Environmental Hazards, UK Health Security Agency, Didcot, UK
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4
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Card JW, Scaife KM, Haighton LA. Review of evidence relating to occupational exposure limits for alpha-diketones and acetoin, and considerations for deriving an occupational exposure limit for 2,3-pentanedione. Crit Rev Toxicol 2022; 52:715-730. [PMID: 36803409 DOI: 10.1080/10408444.2023.2168175] [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: 02/23/2023]
Abstract
Alpha-diketones, notably diacetyl, have been used as flavoring agents. When airborne in occupational settings, exposures to diacetyl have been associated with serious respiratory disease. Other α-diketones, such as 2,3-pentanedione, and analogues such as acetoin (a reduced form of diacetyl), require evaluation, particularly, in light of recently available toxicological studies. The current work reviewed mechanistic, metabolic, and toxicology data available for α-diketones. Data were most available for diacetyl and 2,3-pentanedione, and a comparative assessment of their pulmonary effects was performed, and an occupational exposure limit (OEL) was proposed for 2,3-pentanedione. Previous OELs were reviewed and an updated literature search was performed. Respiratory system histopathology data from 3-month toxicology studies were evaluated with benchmark dose (BMD) modelling of sensitive endpoints. This demonstrated comparable responses at concentrations up to 100 ppm, with no consistent overall pattern of greater sensitivity to either diacetyl or 2,3-pentanedione. In contrast, based on draft raw data, no adverse respiratory effects were observed in comparable 3-month toxicology studies that evaluated exposure to acetoin at up to 800 ppm (highest tested concentration), indicating that acetoin does not present the same inhalation hazard as diacetyl or 2,3-pentanedione. To derive an OEL for 2,3-pentanedione, BMD modelling was conducted for the most sensitive endpoint from 90-day inhalation toxicity studies, namely, hyperplasia of nasal respiratory epithelium. On the basis of this modelling, an 8-hour time-weighted average OEL of 0.07 ppm is proposed to be protective against respiratory effects that may be associated with chronic workplace exposure to 2,3-pentanedione.
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Affiliation(s)
- Jeffrey W Card
- Intertek Health Sciences Inc., Mississauga, Ontario, Canada
| | - Kevin M Scaife
- Intertek Health Sciences Inc., Mississauga, Ontario, Canada
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5
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Virji MA, Fechter-Leggett ED, Groth CP, Liang X, Blackley BH, Stanton ML, LeBouf RF, Harvey RR, Bailey RL, Cummings KJ, Cox-Ganser JM. Decrements in lung function and respiratory abnormalities associated with exposure to diacetyl and 2,3-pentanedione in coffee production workers. Front Public Health 2022; 10:966374. [PMID: 36033819 PMCID: PMC9412051 DOI: 10.3389/fpubh.2022.966374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/18/2022] [Indexed: 01/24/2023] Open
Abstract
Coffee production workers are exposed to complex mixtures of gases, dust, and vapors, including the known respiratory toxins, diacetyl, and 2,3-pentanedione, which occur naturally during coffee roasting and are also present in flavorings used to flavor coffee. This study evaluated the associations of these two α-diketones with lung function measures in coffee production workers. Workers completed questionnaires, and their lung function was assessed by spirometry and impulse oscillometry (IOS). Personal exposures to diacetyl, 2,3-pentanedione, and their sum (SumDA+PD) were assigned to participants, and metrics of the highest 95th percentile (P95), cumulative, and average exposure were calculated. Linear and logistic regression models for continuous and binary/polytomous outcomes, respectively, were used to explore exposure-response relationships adjusting for age, body mass index, tenure, height, sex, smoking status, race, or allergic status. Decrements in percent predicted forced expiratory volume in 1 second (ppFEV1) and forced vital capacity (ppFVC) were associated with the highest-P95 exposures to 2,3-pentanedione and SumDA+PD. Among flavoring workers, larger decrements in ppFEV1 and ppFVC were associated with highest-P95 exposures to diacetyl, 2,3-pentanedione, and SumDA+PD. Abnormal FEV1, FVC, and restrictive spirometric patterns were associated with the highest-P95, cumulative, and average exposures for all α-diketone metrics; some of these associations were also present among flavoring and non-flavoring workers. The combined category of small and peripheral airways plus small and large airways abnormalities on IOS had elevated odds for highest-P95 exposure to α-diketones. These results may be affected by the small sample size, few cases of abnormal spirometry, and the healthy worker effect. Associations between lung function abnormalities and exposure to α-diketones suggest it may be prudent to consider exposure controls in both flavoring and non-flavoring settings.
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Affiliation(s)
- Mohammed Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States,*Correspondence: Mohammed Abbas Virji
| | - Ethan D. Fechter-Leggett
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States
| | - Caroline P. Groth
- Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, Morgantown, WV, United States
| | - Xiaoming Liang
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States
| | - Brie H. Blackley
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States
| | - Marcia L. Stanton
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States
| | - Ryan F. LeBouf
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States
| | - R. Reid Harvey
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States
| | - Rachel L. Bailey
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States
| | - Kristin J. Cummings
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States
| | - Jean M. Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States
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6
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Havermans A, Mallock N, Zervas E, Caillé-Garnier S, Mansuy T, Michel C, Pennings JLA, Schulz T, Schwarze PE, Solimini R, Tassin JP, Vardavas CI, Merino M, Pauwels CGGM, van Nierop LE, Lambré C, Bolling AK. Review of industry reports on EU priority tobacco additives part A: Main outcomes and conclusions. Tob Prev Cessat 2022; 8:27. [PMID: 35860504 PMCID: PMC9255285 DOI: 10.18332/tpc/151529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023]
Abstract
The European Union Tobacco Products Directive (EU TPD) mandates enhanced reporting obligations for tobacco manufacturers regarding 15 priority additives. Within the Joint Action on Tobacco Control (JATC), a review panel of independent experts was appointed for the scientific evaluation of the additive reports submitted by a consortium of 12 tobacco manufacturers. As required by the TPD, the reports were evaluated based on their comprehensiveness, methodology and conclusions. In addition, we evaluated the chemical, toxicological, addictive, inhalation facilitating and flavoring properties of the priority additives based on the submitted reports, supplemented by the panel's expert knowledge and some independent literature. The industry concluded that none of the additives is associated with concern. Due to significant methodological limitations, we question the scientific validity of these conclusions and conclude that they are not warranted. Our review demonstrates that many issues regarding toxicity, addictiveness and attractiveness of the additives have not been sufficiently addressed, and therefore concerns remain. For example, menthol facilitates inhalation by activation of the cooling receptor TRPM8. The addition of sorbitol and guar gum leads to a significant increase of aldehydes that may contribute to toxicity and addictiveness. Titanium dioxide particles (aerodynamic diameter <10 µm) are legally classified as carcinogenic when inhaled. For diacetyl no report was provided. Overall, the industry reports were not comprehensive, and the information presented provides an insufficient basis for the regulation of most additives. We, therefore, advise MS to consider alternative approaches such as the precautionary principle.
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Affiliation(s)
- Anne Havermans
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Nadja Mallock
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - Efthimios Zervas
- Hellenic Thoracic Society, Athens, Greece
- School of Applied Arts and Sustainable Design, Hellenic Open University, Athens, Greece
| | | | - Thibault Mansuy
- French Agency for Food, Environmental and Occupational Health and Safety, Paris, France
| | - Cécile Michel
- French Agency for Food, Environmental and Occupational Health and Safety, Paris, France
| | - Jeroen L. A. Pennings
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Thomas Schulz
- German Federal Institute for Risk Assessment, Berlin, Germany
| | | | | | | | | | - Miguel Merino
- Andalusia Agency For Agriculture and Fisheries Development, Seville, Spain
| | - Charlotte G. G. M. Pauwels
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Lotte E. van Nierop
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Claude Lambré
- National Institute of Health and Medical Research, Paris, France
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7
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Blackley BH, Groth CP, Cox-Ganser JM, Fortner AR, LeBouf RF, Liang X, Virji MA. Determinants of Task-Based Exposures to Alpha-Diketones in Coffee Roasting and Packaging Facilities Using a Bayesian Model Averaging Approach. Front Public Health 2022; 10:878907. [PMID: 35757620 PMCID: PMC9218577 DOI: 10.3389/fpubh.2022.878907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Coffee production workers can be exposed to inhalational hazards including alpha-diketones such as diacetyl and 2,3-pentanedione. Exposure to diacetyl is associated with the development of occupational lung disease, including obliterative bronchiolitis, a rare and irreversible lung disease. We aimed to identify determinants contributing to task-based exposures to diacetyl and 2,3-pentanedione at 17 U.S. coffee production facilities. We collected 606 personal short-term task-based samples including roasting (n = 189), grinding (n = 74), packaging (n = 203), quality control (QC, n = 44), flavoring (n = 15), and miscellaneous production/café tasks (n = 81), and analyzed for diacetyl and 2,3-pentanedione in accordance with the modified OSHA Method 1013/1016. We also collected instantaneous activity-based (n = 296) and source (n = 312) samples using evacuated canisters. Information on sample-level and process-level determinants relating to production scale, sources of alpha-diketones, and engineering controls was collected. Bayesian mixed-effect regression models accounting for censored data were fit for overall data (all tasks) and specific tasks. Notable determinants identified in univariate analyses were used to fit all plausible models in multiple regression analysis which were summarized using a Bayesian model averaging method. Grinding, flavoring, packaging, and production tasks with ground coffee were associated with the highest short-term and instantaneous-activity exposures for both analytes. Highest instantaneous-sources of diacetyl and 2,3-pentanedione included ground coffee, flavored coffee, liquid flavorings, and off-gassing coffee bins or packages. Determinants contributing to higher exposures to both analytes in all task models included sum of all open storage sources and average percent of coffee production as ground coffee. Additionally, flavoring ground coffee and flavoring during survey contributed to notably higher exposures for both analytes in most, but not all task groups. Alternatively, general exhaust ventilation contributed to lower exposures in all but two models. Additionally, among facilities that flavored, local exhaust ventilation during flavoring processes contributed to lower 2,3-pentanedione exposures during grinding and packaging tasks. Coffee production facilities can consider implementing additional exposure controls for processes, sources, and task-based determinants associated with higher exposures to diacetyl and 2,3-pentanedione, such as isolating, enclosing, and directly exhausting grinders, flavoring mixers, and open storage of off-gassing whole bean and ground coffee, to reduce exposures and minimize risks for lung disease among workers.
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Affiliation(s)
- Brie Hawley Blackley
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Caroline P Groth
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States.,Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, United States
| | - Jean M Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Alyson R Fortner
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Ryan F LeBouf
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Xiaoming Liang
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Mohammed Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
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Takigawa Y, Sato K, Inoue A, Nagae M, Inoue T, Onishi K, Mitsumune S, Watanabe H, Kudo K, Sato A, Fujiwara K, Shibayama T. Acute eosinophilic pneumonia caused by nicotine‐free vaping in an adolescent patient: A case report. Respirol Case Rep 2022; 10:e0961. [PMID: 35592268 PMCID: PMC9105137 DOI: 10.1002/rcr2.961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
An 18‐year‐old man was admitted to our hospital with pneumonia 4 days after he initiated vaping. The patient did not show improvement after ceftriaxone and azithromycin treatment. The cell count of the bronchoalveolar lavage fluid (BALF) revealed 64% eosinophils and 18% lymphocytes. Based on the BALF findings, the patient met the current diagnostic criteria and was diagnosed with vaping‐induced acute eosinophilic pneumonia (AEP). AEP caused by nicotine‐free vaping is rare in Japan. Thus, in cases of AEP, the patient's history of cigarette smoking as well as vaping should be considered.
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Affiliation(s)
- Yuki Takigawa
- Department of Respiratory Medicine National Hospital Organization Okayama Medical Center Okayama Japan
| | - Ken Sato
- Department of Respiratory Medicine National Hospital Organization Okayama Medical Center Okayama Japan
| | - Ayumi Inoue
- Department of Respiratory Medicine National Hospital Organization Okayama Medical Center Okayama Japan
| | - Momoka Nagae
- Department of Respiratory Medicine National Hospital Organization Okayama Medical Center Okayama Japan
| | - Tomoyoshi Inoue
- Department of Respiratory Medicine National Hospital Organization Okayama Medical Center Okayama Japan
| | - Kiriko Onishi
- Department of Respiratory Medicine National Hospital Organization Okayama Medical Center Okayama Japan
| | - Sho Mitsumune
- Department of Respiratory Medicine National Hospital Organization Okayama Medical Center Okayama Japan
| | - Hiromi Watanabe
- Department of Respiratory Medicine National Hospital Organization Okayama Medical Center Okayama Japan
| | - Kenichiro Kudo
- Department of Respiratory Medicine National Hospital Organization Okayama Medical Center Okayama Japan
| | - Akiko Sato
- Department of Respiratory Medicine National Hospital Organization Okayama Medical Center Okayama Japan
| | - Keiichi Fujiwara
- Department of Respiratory Medicine National Hospital Organization Okayama Medical Center Okayama Japan
| | - Takuo Shibayama
- Department of Respiratory Medicine National Hospital Organization Okayama Medical Center Okayama Japan
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How E-cigarettes and vaping can affect asthma in children and adolescents. Curr Opin Allergy Clin Immunol 2022; 22:86-94. [PMID: 35197429 DOI: 10.1097/aci.0000000000000807] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Electronic nicotine delivery systems such as e-cigarettes are commonly felt to be harmless devices when compared to traditional cigarettes. However, an increasing number of studies support the biological plausibility for the potential detrimental effects of vaping on the respiratory mucosa. To date, few human studies have been carried out on adult vapers showing a reduction in lung function testing, especially in those with asthma, whereas the effects of vaping on children and adolescents have not been elucidated so far. RECENT FINDINGS Several cross-sectional, national, population-based studies on large groups of adolescents have been carried out showing an association between vape exposure and self-reported asthma diagnosis and/or respiratory symptoms in this age group. The effects of second and third-hand exposure together with those of active and passive exposure in pregnancy, are almost completely unknown. SUMMARY This review outlines recent data on the potential effects of vaping on asthma, focusing on vape composition, reported effects on the respiratory mucosa, available data in adolescents, and reasons behind the current vaping epidemic. The evidence so far available both in animals and humans suggests that vaping is not harmless, and its exposure should be limited in children and adolescents, especially when affected by asthma.
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Optimal Design Approach Applied to Headspace GC for the Monitoring of Diacetyl Concentration, Spectrophotometric Assessment of Phenolic Compounds and Antioxidant Potential in Different Fermentation Processes of Barley. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app12010037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study aimed to validate a control method on the gas chromatography system (GC) based on the experimental design strategy, to examine the changes and correlation between the fermentation process and the quality of alcoholic and non-alcoholic beer product, especially the formation of diacetyl. On the other hand, spectrophotometric methods were applied to the determination of polyphenols content and the potential antioxidant activity of beer during different fermentation processes. with this aim, three modes of barley fermentation were used, specifically classical fermentation, stopped fermentation and thermal process. The results showed that the different fermentation modes had a major impact on diacetyl production. The highest concentration was obtained using stopped fermentation 0.36 mg/L, the lowest concentration value 0.07 mg/L was detected using the thermal process. Monitoring the increase of oxygen concentration between fermentation, filtration, and filling of the final product (32, 107, 130 ppm, respectively) has a significant impact on the concentration of diacetyl. The obtained results of spectrophotometric analysis showed that the total antioxidant activity changed during beer fermentation process and demonstrate that the extend of the antioxidant activity was very much dependent on the total polyphenolic content with a higher value in Hopped wort (13.41%, 65 mg GAE 100 mL−1, 28 mg CE 100 mL−1) for antioxidant potential, total phenolic content, and total flavonoids content, respectively, whereas the lowest values was detected in Non-alcoholic beer using thermal process (7.24%, 35 mg GAE 100 mL−1, 10 mg CE 100 mL−1) for antioxidant potential, total phenolic contents, and total flavonoids contents, respectively. Based on the results achieved, we reveal the impact of the fermentation process on the nutritional value of the final product.
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11
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Ghio AJ, Soukup JM, Dailey LA, Roggli VL, Crumbliss AL, Palmer SM. Diacetyl exposure disrupts iron homeostasis in animals and cells. Inhal Toxicol 2021; 33:268-274. [PMID: 34752160 DOI: 10.1080/08958378.2021.1989092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Several mechanisms have been proposed for the biological effect of diacetyl. We tested the postulate that animal and cell exposures to diacetyl are associated with a disruption in iron homeostasis. MATERIALS AND METHODS Male, Sprague-Dawley rats were intratracheally-instilled with either distilled water or diacetyl. Seven days after treatment, animals were euthanized and the lungs removed, fixed, and embedded. Sections were cut and stained for iron, collagen, and ferritin. Human epithelial (BEAS-2B) and monocytic (THP-1) cells were exposed in vitro to ferric ammonium citrate (FAC), diacetyl, and both FAC and diacetyl. Cell non-heme iron concentrations and ferritin levels were quantified using inductively coupled plasma optical emission spectroscopy and an immunoassay respectively. RESULTS After exposure of animals to diacetyl, there were airway polypoid lesions which stained positively for both iron and the intracellular storage protein ferritin. Trichrome stain showed a deposition of collagen immediately adjacent to accumulated metal following diacetyl exposure. In in vitro cell exposures, FAC increased non-heme iron concentration but co-incubations of FAC and diacetyl elevated levels to significantly greater values. Levels of ferritin were increased with exposures of BEAS-2B and THP-1 cells to FAC but were similarly greater after co-exposure with FAC and diacetyl. CONCLUSIONS Results of animal and cell studies support a disruption of iron homeostasis by diacetyl. It is proposed that, following internalization, diacetyl complexes intracellular sources of iron. The cell recognizes a loss of its requisite iron to diacetyl and imports greater concentrations of the metal.
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Affiliation(s)
- Andrew J Ghio
- US Environmental Protection Agency, Chapel Hill, NC, USA
| | | | - Lisa A Dailey
- US Environmental Protection Agency, Chapel Hill, NC, USA
| | - Victor L Roggli
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | | | - Scott M Palmer
- Deparment of Medicine, Duke University Medical Center, Durham, NC, USA
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12
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Fransen LFH, Leonard MO. Small Airway Susceptibility to Chemical and Particle Injury. Respiration 2021; 101:321-333. [PMID: 34649249 DOI: 10.1159/000519344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/11/2021] [Indexed: 11/19/2022] Open
Abstract
Small airways (SA) in humans are commonly defined as those conducting airways <2 mm in diameter. They are susceptible to particle- and chemical-induced injury and play a major role in the development of airway disease such as COPD and asthma. Susceptibility to injury can be attributed in part to structural features including airflow dynamics and tissue architecture, but recent evidence may indicate a more prominent role for cellular composition in directing toxicological responses. Animal studies support the hypothesis that inherent cellular differences across the tracheobronchial tree, including metabolic CYP450 expression in the distal conducting airways, can influence SA susceptibility to injury. Currently, there is insufficient information in humans to make similar conclusions, prompting further necessary work in this area. An understanding of why the SA are more susceptible to certain chemical and particle exposures than other airway regions is fundamental to our ability to identify hazardous materials, their properties, and accompanying exposure scenarios that compromise lung function. It is also important for the ability to develop appropriate models for toxicity testing. Moreover, it is central to our understanding of SA disease aetiology and how interventional strategies for treatment may be developed. In this review, we will document the structural and cellular airway regional differences that are likely to influence airway susceptibility to injury, including the role of secretory club cells. We will also describe recent advances in single-cell sequencing of human airways, which have provided unprecedented details of cell phenotype, likely to impact airway chemical and particle injury.
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Affiliation(s)
| | - Martin Oliver Leonard
- Toxicology Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, United Kingdom
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13
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Banks DE, Morris MJ. Inhalational Constrictive Bronchiolitis: The Evolution of our Understanding of this Disease. Lung 2021; 199:327-334. [PMID: 34415399 DOI: 10.1007/s00408-021-00466-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
The case definition of inhalational constrictive bronchiolitis (CB) has changed over the generations. We identify changes in the description of this illness over time associated with different exposures and present the natural history of CB in a case attributed to military burn pit exposure. The initial descriptions of this disease began with nitric acid spills and silage exposures. In these events, there was an acute exposure, typically a short-term resolution of the adverse respiratory events, and then a progression, leading to disability or a respiratory death. The life-saving role of corticosteroid therapy in this situation was recognized. War gas exposures of World War I and then Saddam Hussein's use of sulfur mustard gas in the Iran-Iraq War followed. More recently the findings associated with diacetyl exposure in commercial popcorn workers remained consistent with previously described presentations, but then the clinical presentation in troops returning from deployment to Southwest Asia was very different, yet with the same histologic findings. We recognize unreconciled disparities in the clinical, physiologic, and imaging presentation in those with inhalational bronchiolitis and acknowledge this as perhaps one of the difficult diagnoses in respiratory medicine.
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Affiliation(s)
- Daniel E Banks
- Orlando Veterans Administration Medical Center, Room 4H811, 13800 Veterans Way, Orlando, FL, 32827, USA.
| | - Michael J Morris
- Pulmonary and Critical Care Service, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX, USA
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14
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Spirometric Abnormalities and Lung Function Decline in Current and Former Microwave Popcorn and Current Flavoring Manufacturing Workers. J Occup Environ Med 2021; 62:412-419. [PMID: 32510907 DOI: 10.1097/jom.0000000000001860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare spirometry results in microwave popcorn and flavoring manufacturing workers. METHODS We used NIOSH data on current and former microwave popcorn workers (MPWs) and surveillance data on flavoring manufacturing workers (FMWs). RESULTS Former MPW had higher prevalence of mixed and high severity abnormalities, some had excessive lung function drops. Current MPW had lowest occurrence of excessive lung function drops. FMW with excessive drops and spirometric abnormalities at last test had developed a restrictive pattern. Spirometric abnormalities and excessive drops were associated with work-related factors. CONCLUSION There was evidence of a healthy worker survivor effect in MPW. Importantly, removal from exposure did not always stabilize lung function decline indicating a need for continued monitoring. The development of a restrictive pattern should raise the level of suspicion for possible work-related disease in flavoring-exposed workers.
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15
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Sharma H, Verma S. “Vaping”- a Trojan Horse Against Fight Toward Tobacco Use and Cancer: A Systematic Review of the Existing Evidence. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_11_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractThe purpose of this systematic review is to understand many aspects of vaping, like what is vaping, why it is more enticing to adolescents and young adults, what makes it more harmful than regular smoked tobacco products, subsequent health consequences, and what measures are currently being taken against this activity. A literature search was conducted in online database PubMed using search string “(((((Lung injury*[Title/Abstract]) AND Vaping[Title/Abstract]) OR electronic nicotine delivery device[Title/Abstract]) OR electronic cigarette*[Title/Abstract]) AND e-cigarettes liquid) AND electronic cigars and search filter used were “published in the last 5 years” and “Human Studies.” Similar search terms were used to search EMBASE, Web of Science, Google Scholar, and the CENTRAL database of the Cochrane Library with the help of Boolean terms. Thirty-six articles were included for a final systematic review. Many of the known brands use additives such as flavoring and thickening agents that, when used even for the short term, can cause toxicity to human lung tissues. This toxicity depends not only on the extent of the habit, but also on the variable susceptibility to lung damage, dual use with cigarettes, variability in the product design of different brands, and the liquid content used in them. Vaping may be linked with significant health issues, including respiratory diseases such as asthma, very severe forms of bronchitis such as popcorn lung, or E-cigarette, or vaping, product use-associated lung injury, and cardiovascular illnesses such as atherosclerotic plaque and myocardial ischemia. From the current systematic review, we would like to emphasize that no long-term toxicological and health studies have been carried out in humans using these vaping products and their constituents to date. Although cessation should be strongly encouraged in smokers for better quality of life, it is uncertain whether it is a universally safer option to replace cigarettes with these vaping devices.
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Affiliation(s)
- Hunny Sharma
- Department of Public Health Dentistry, Triveni Institute of Dental Sciences, Hospital and Research Centre, Bilaspur, Chhattisgarh, India
| | - Swati Verma
- Department of Public Health Dentistry, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
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16
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Harvey RR, Blackley BH, Korbach EJ, Rawal AX, Roggli VL, Bailey RL, Cox-Ganser JM, Cummings KJ. Case Report: Flavoring-Related Lung Disease in a Coffee Roasting and Packaging Facility Worker With Unique Lung Histopathology Compared With Previously Described Cases of Obliterative Bronchiolitis. Front Public Health 2021; 9:657987. [PMID: 34095061 PMCID: PMC8173047 DOI: 10.3389/fpubh.2021.657987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Occupational exposure to diacetyl, a butter flavor chemical, can result in obliterative bronchiolitis. Obliterative bronchiolitis is characterized by exertional dyspnea, fixed airflow obstruction, and histopathologic constrictive bronchiolitis, with bronchiolar wall fibrosis leading to luminal narrowing and obliteration. We describe a case of advanced lung disease with histopathology distinct from obliterative bronchiolitis in a 37-year-old male coffee worker following prolonged exposure to high levels of diacetyl and the related compound 2,3-pentanedione, who had no other medical, avocational, or occupational history that could account for his illness. He began working at a coffee facility in the flavoring room and grinding area in 2009. Four years later he moved to the packaging area but continued to flavor and grind coffee at least 1 full day per week. He reported chest tightness and mucous membrane irritation when working in the flavoring room and grinding area in 2010. Beginning in 2014, he developed dyspnea, intermittent cough, and a reduced sense of smell without a work-related pattern. In 2016, spirometry revealed a moderate mixed pattern that did not improve with bronchodilator. Thoracoscopic lung biopsy results demonstrated focal mild cellular bronchiolitis and pleuritis, and focal peribronchiolar giant cells/granulomas, but no evidence of constrictive bronchiolitis. Full-shift personal air-samples collected in the flavoring and grinding areas during 2016 measured diacetyl concentrations up to 84-fold higher than the recommended exposure limit. Medical evaluations indicate this worker developed work-related, airway-centric lung disease, most likely attributable to inhalational exposure to flavorings, with biopsy findings not usual for obliterative bronchiolitis. Clinicians should be aware that lung pathology could vary considerably in workers with suspected flavoring-related lung disease.
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Affiliation(s)
- R Reid Harvey
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Brie H Blackley
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | | | | | - Victor L Roggli
- Department of Pathology, Duke University, Durham, NC, United States
| | - Rachel L Bailey
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Jean M Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Kristin J Cummings
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
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17
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St Helen G. A ban targeting only open-system e-cigarettes is unlikely to prevent a future EVALI-like outbreak among e-cigarette users. Addiction 2021; 116:995-997. [PMID: 32812673 DOI: 10.1111/add.15205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/16/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Gideon St Helen
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, University of California, San Francisco
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18
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Abstract
Bronchiolar abnormalities are common and can occur in conditions that affect either the large airways or the more distal parenchyma. In this review, we focus on the diagnosis and management of primary bronchiolar disorders, or conditions in which bronchiolitis is the predominant pathologic process, including constrictive bronchiolitis, follicular bronchiolitis, acute bronchiolitis, respiratory bronchiolitis, and diffuse panbronchiolitis. Due to the nature of abnormalities in the small airway, clinical and physiological changes in bronchiolitis can be subtle, making diagnosis challenging. Primary bronchiolar disorders frequently present with progressive dyspnea and cough that can be out of proportion to imaging and physiologic studies. Pulmonary function tests may be normal, impaired in an obstructive, restrictive, or mixed pattern, or have an isolated decrease in diffusion capacity. High-resolution computed tomography scan is an important diagnostic tool that may demonstrate one or more of the following three patterns: 1) solid centrilobular nodules, often with linear branching opacities (i.e., "tree-in-bud" pattern); 2) ill-defined ground glass centrilobular nodules; and 3) mosaic attenuation on inspiratory images that is accentuated on expiratory images, consistent with geographic air trapping. Bronchiolitis is often missed on standard transbronchial lung biopsies, as the areas of small airway involvement can be patchy. Fortunately, many patients can be diagnosed with a combination of clinical suspicion, inspiratory and expiratory high-resolution computed tomography scans, and pulmonary function testing. Joint consultation of clinicians with both radiologists and pathologists (in cases where histopathology is pursued) is critical to appropriately assess the clinical-radiographic-pathologic context in each individual patient.
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19
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Walkoff L, Hobbs S. Chest Imaging in the Diagnosis of Occupational Lung Diseases. Clin Chest Med 2021; 41:581-603. [PMID: 33153681 DOI: 10.1016/j.ccm.2020.08.007] [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: 10/23/2022]
Abstract
Imaging plays a crucial role in the diagnosis and monitoring of occupational lung diseases (OLDs); however, the sensitivity and specificity of detection and diagnosis vary greatly depending on the imaging modality used. There is substantial overlap in appearance with non-occupation-related entities. OLDs should be considered in the differential even in the absence of a provided exposure history. Because many findings are not specific, a multidisciplinary approach is important in arriving at the diagnosis and will continue to be important as workplace-related pulmonary diseases evolve with changing industrial practices and workplace regulations.
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Affiliation(s)
- Lara Walkoff
- Divisions of Thoracic and Cardiovascular Radiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
| | - Stephen Hobbs
- Radiology Informatics and Integrated Clinical Operations, Division of Cardiovascular and Thoracic Radiology, UK HealthCare Imaging Informatics, University of Kentucky, 800 Rose Street, HX 302, Lexington, KY 40536, USA
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20
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Abstract
PURPOSE OF REVIEW Electronic cigarettes have quickly risen to be the leading alternative nicotine source to tobacco. E-cigarette use is hard to research and regulate because of the novelty and rapid evolution of the devices and E-liquids. Epidemiological data on long-term usage is currently lacking, but in smaller cohort studies we are starting to understand the usage patterns and demographics of users, which differ depending on where the study takes place and the regulatory environment. The present review describes the current knowledge of the effects of E-cigarettes on the pulmonary system and knowledge of their usage patterns worldwide. RECENT FINDINGS E-cigarette use is continuing to rise in young adults in United States and Canada, but not in United Kingdom. These suggest that regulation is influencing uptake in young adults. If E-cigarettes are to be considered as a harm minimisation smoking cessation product, use in young never smokers must be factored into the risk assessment. A recent surge in cases of lung injury associated with vaping in America has resulted in the definition of vaping associated pulmonary injury, although the exact cause remains unknown. SUMMARY It is our opinion that E-cigarettes can no longer be defined as harmless. Further studies are needed to determine the risks for all populations as it is evident that a large proportion of E-cigarette users are never-smokers, meaning they cannot only be considered from a harm reduction perspective.
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21
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Azimi P, Keshavarz Z, Lahaie Luna M, Cedeno Laurent JG, Vallarino J, Christiani DC, Allen JG. An Unrecognized Hazard in E-Cigarette Vapor: Preliminary Quantification of Methylglyoxal Formation from Propylene Glycol in E-Cigarettes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E385. [PMID: 33419122 PMCID: PMC7825490 DOI: 10.3390/ijerph18020385] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 02/01/2023]
Abstract
Up to 95% of the liquid volume in an e-cigarette consists of propylene glycol. Previous research has shown that propylene glycol can generate diacetyl and formaldehyde when heated. New research shows that propylene glycol can also generate methylglyoxal, an alpha di-carbonyl compound recently shown to cause epithelial necrosis at even lower concentrations than diacetyl, the flavoring chemical associated with bronchiolitis obliterans ("Popcorn Lung"). We analyzed chemical emissions from 13 JUUL pod flavors. Diacetyl and methylglyoxal was detected in 100% of samples with median concentration (range) of 20 µg/m3 (less than limit of quantification: 54 µg/m3) and 4219 µg/m3 (677-15,342 µg/m3), respectively. We also detected acetaldehyde (median concentration: 341 µg/m3) and propionaldehyde (median concentration: 87 µg/m3) in all samples. The recent evidence that methylglyoxal is more cytotoxic to airway epithelial cells than diacetyl makes this an urgent public health concern. Current smokers considering e-cigarettes as a smoking cessation tool, and never users, who may be under the impression that e-cigarettes are harmless, need information on emissions and potential risks to make informed decisions.
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Affiliation(s)
- Parham Azimi
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA; (P.A.); (Z.K.); (M.L.L.); (J.G.C.L.); (J.V.); (D.C.C.)
| | - Zahra Keshavarz
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA; (P.A.); (Z.K.); (M.L.L.); (J.G.C.L.); (J.V.); (D.C.C.)
| | - Marianne Lahaie Luna
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA; (P.A.); (Z.K.); (M.L.L.); (J.G.C.L.); (J.V.); (D.C.C.)
- Occupational & Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Jose Guillermo Cedeno Laurent
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA; (P.A.); (Z.K.); (M.L.L.); (J.G.C.L.); (J.V.); (D.C.C.)
| | - Jose Vallarino
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA; (P.A.); (Z.K.); (M.L.L.); (J.G.C.L.); (J.V.); (D.C.C.)
| | - David C. Christiani
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA; (P.A.); (Z.K.); (M.L.L.); (J.G.C.L.); (J.V.); (D.C.C.)
| | - Joseph G. Allen
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA; (P.A.); (Z.K.); (M.L.L.); (J.G.C.L.); (J.V.); (D.C.C.)
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22
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Homma S, Ebina M, Kuwano K, Goto H, Sakai F, Sakamoto S, Johkoh T, Sugino K, Tachibana T, Terasaki Y, Nishioka Y, Hagiwara K, Hashimoto N, Hasegawa Y, Hebisawa A. Intractable diffuse pulmonary diseases: Manual for diagnosis and treatment. Respir Investig 2021; 59:8-33. [PMID: 32622842 DOI: 10.1016/j.resinv.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
This manual has been compiled by a joint production committee with the Diffuse Lung Disease Assembly of the Japanese Respiratory Society (JRS) to provide a practical manual for the epidemiology, diagnosis, and treatment of intractable diffuse pulmonary diseases. The contents are based upon the results of research into these diseases by the Diffuse Pulmonary Diseases Study Group (principal researcher: Sakae Homma) supported by the FY2014-FY2016 Health and Labor Sciences Research Grant on Intractable Diseases. This manual focuses on: 1) pulmonary alveolar microlithiasis, 2) bronchiolitis obliterans, and 3) Hermansky-Pudlak Syndrome with interstitial pneumonia. As these are rare/intractable diffuse lung diseases (2 and 3 were first recognized as specified intractable diseases in 2015), there have not been sufficient epidemiological studies made, and there has been little progress in formulating diagnostic criteria and severity scales; however, the results of Japan's first surveys and research into such details are presented herein. In addition, the manual provides treatment guidance and actual cases for each disease, aiming to assist in the establishment of future modalities. The manual was produced with the goal of enabling clinicians specialized in respiratory apparatus to handle these diseases in clinical settings and of further advancing future research and treatment.
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Affiliation(s)
- Sakae Homma
- Department of Advanced and Integrated Interstitial Lung Diseases Research, School of Medicine, Toho University, Tokyo, Japan.
| | - Masahito Ebina
- Department of Respiratory Medicine in the 1st Internal Medicine, Tohoku Medical and Pharmaceutical University School of Medicine, Sendai, Japan.
| | - Kazuyoshi Kuwano
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
| | - Hisatsugu Goto
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Saitama, Japan.
| | - Susumu Sakamoto
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan.
| | - Takeshi Johkoh
- Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Hyogo, Japan.
| | - Keishi Sugino
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan.
| | - Teruo Tachibana
- Department of Internal Medicine, Aizenbashi Hospital, Osaka, Japan.
| | - Yasahiro Terasaki
- Department of Pathology (Analytic Human Pathology), Nippon Medical School, Tokyo, Japan.
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Jichi Medical University, Saitama, Japan.
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan.
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan.
| | - Akira Hebisawa
- National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
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23
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Abstract
Occupational bronchiolitis is characterized by inflammation of the small airways, and represents a heterogeneous set of lung conditions that can occur following a range of inhalation exposures related to work. The most common clinical presentation includes insidious onset of exertional dyspnea and cough. Multiple reports in recent years have drawn attention to previously unrecognized risk factors for occupational bronchiolitis following exposures in several settings. Both current and past occupational exposures, including prior military deployment-related exposures, should be considered in patients undergoing evaluation for unexplained dyspnea. Diagnostic testing for potential bronchiolitis should include a thorough assessment of the small airways.
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24
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Di Cicco M, Sepich M, Ragazzo V, Peroni DG, Comberiati P. Potential effects of E-cigarettes and vaping on pediatric asthma. Minerva Pediatr 2020; 72:372-382. [PMID: 32686924 DOI: 10.23736/s0026-4946.20.05973-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Asthma is the most common chronic disease in childhood and exposure to tobacco smoke has been long recognized as a risk factor for its onset as well as for exacerbations and poor disease control. Since the early 2000s, electronic cigarettes have been marketed worldwide as a non-harmful electronic alternative to combustible cigarettes and as a device likely to help stop smoking, and their use is continuously rising, particularly among adolescents. However, several studies have shown that vape contains many different well-known toxicants, causing significant cytotoxic and pro-inflammatory effects on the airways in-vitro and in animal models. In humans, a variety of harmful lung effects related to vaping, ranging from bronchoconstriction to severe respiratory distress has been already reported. To investigate the potential effects of vaping in pediatric asthma, we searched relevant published studies in the MEDLINE/PubMed database by combining the adequate Medical Subject Headings terms and key words. At the end of our study selection process, five cross-sectional studies focusing on electronic cigarettes use in adolescents and self-reported asthma and/or other respiratory symptoms, one study focusing on the effects of electronic cigarettes second-hand exposure and one case report were retrieved. These preliminary data support a likely detrimental effect of vaping in asthmatic adolescents. Currently available evidence supports that electronic cigarettes are a potential threat to respiratory health, particularly in adolescents with asthma. High-quality studies on larger population assessing the long-term effects of vape exposure, are urgently needed.
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Affiliation(s)
- Maria Di Cicco
- Unit of Pediatrics, Pisa University Hospital, Pisa, Italy - .,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy -
| | - Margherita Sepich
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Vincenzo Ragazzo
- Division of Pediatrics and Neonatology, Department of Women's and Children's Health, Versilia Hospital, Camaiore, Lucca, Italy
| | - Diego G Peroni
- Unit of Pediatrics, Pisa University Hospital, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Pasquale Comberiati
- Unit of Pediatrics, Pisa University Hospital, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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25
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Winters BR, Kochar TK, Clapp PW, Jaspers I, Madden MC. Impact of E-Cigarette Liquid Flavoring Agents on Activity of Microsomal Recombinant CYP2A6, the Primary Nicotine-Metabolizing Enzyme. Chem Res Toxicol 2020; 33:1689-1697. [PMID: 32496054 DOI: 10.1021/acs.chemrestox.9b00514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Nicotine is the primary psychoactive chemical in both traditional and electronic cigarettes (e-cigarettes). Nicotine levels in both traditional cigarettes and e-cigarettes are an important concern for public health. Nicotine exposure due to e-cigarette use is of importance primarily due to the addictive potential of nicotine, but there is also concern for nicotine poisoning in e-cigarette users. Nicotine concentrations in e-liquids vary widely. Additionally, there is significant genetic variability in the rate of metabolism of nicotine due to polymorphisms of CYP2A6, the enzyme responsible for the metabolism of approximately 80% of nicotine. Recent studies have shown CYP2A6 activity is also reduced by aromatic aldehydes such as those added to e-liquids as flavoring agents, which may increase nicotine serum concentrations. However, the impacts of flavored e-liquids on CYP2A6 activity are unknown. In this study, we investigated the impact of three flavored e-liquids on microsomal recombinant CYP2A6. Microsomal recombinant CYP2A6 was challenged at e-liquid concentrations ranging up to 0.125% (v/v) and monitored for metabolic activity using a probe molecule approach. Two e-liquids exhibited dose-dependent inhibition of CYP2A6 activity. Mass spectrometry was conducted to identify flavoring agents in flavored e-liquids that inhibited CYP2A6. Microsomal recombinant CYP2A6 was subsequently exposed to flavoring agents at concentrations ranging from 0.03 μM to 500 μM. Cinnamaldehyde and benzaldehyde were found to be the most potent inhibitors of microsomal CYP2A6 of the flavoring agents tested, with identified IC50 values of 1.1 μM and 3.0 μM, respectively. These data indicate certain aromatic aldehyde flavoring agents are potent inhibitors of CYP2A6, which may reduce nicotine metabolism in vivo. These findings indicate an urgent need to evaluate the effects of flavoring agents in e-cigarette liquids on the pharmacokinetics of nicotine in vivo.
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Affiliation(s)
- Brett R Winters
- Curriculum in Toxicology and Environmental Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, United States.,GSI Environmental Inc., Oakland, California 94612, United States
| | - Tavleen K Kochar
- Department of Chemistry, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, United States
| | - Phillip W Clapp
- Center for Environmental Medicine, Asthma, and Lung Biology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, United States
| | - Ilona Jaspers
- Curriculum in Toxicology and Environmental Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, United States.,Center for Environmental Medicine, Asthma, and Lung Biology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, United States
| | - Michael C Madden
- Public Health and Integrative Toxicology Division, Office of Research and Development, United States Environmental Protection Agency, Chapel Hill, North Carolina 27514, United States
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26
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Cox CW, Chung JH, Ackman JB, Berry MF, Carter BW, de Groot PM, Hobbs SB, Johnson GB, Maldonado F, McComb BL, Tong BC, Walker CM, Kanne JP. ACR Appropriateness Criteria® Occupational Lung Diseases. J Am Coll Radiol 2020; 17:S188-S197. [PMID: 32370962 DOI: 10.1016/j.jacr.2020.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 11/28/2022]
Abstract
Ordering the appropriate diagnostic imaging for occupational lung disease requires a firm understanding of the relationship between occupational exposure and expected lower respiratory track manifestation. Where particular inorganic dust exposures typically lead to nodular and interstitial lung disease, other occupational exposures may lead to isolated small airway obstruction. Certain workplace exposures, like asbestos, increase the risk of malignancy, but also produce pulmonary findings that mimic malignancy. This publication aims to delineate the common and special considerations associated with occupational lung disease to assist the ordering physician in selecting the most appropriate imaging study, while still stressing the importance of a multidisciplinary approach. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | | | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Pengelly I, O'Shea H, Smith G, Coggins MA. Measurement of Diacetyl and 2,3-Pentanedione in the Coffee Industry Using Thermal Desorption Tubes and Gas Chromatography-Mass Spectrometry. Ann Work Expo Health 2020; 63:415-425. [PMID: 30893419 DOI: 10.1093/annweh/wxz015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/10/2018] [Accepted: 02/11/2019] [Indexed: 11/13/2022] Open
Abstract
Diacetyl is a potentially harmful chemical that is used as an artificial flavouring in the food industry and may also be generated during processing of some natural products including coffee. In Europe, an 8-h time weighted average occupational exposure limit (TWA-OEL) of 20 ppb has been adopted for diacetyl, together with a short-term exposure limit (STEL) of 100 ppb. A new measurement method involving sampling on thermal desorption tubes and analysis by gas chromatography-mass spectrometry has been used to investigate potential exposure to diacetyl, and the related compound 2,3-pentanedione, at eight companies involved in the coffee industry including large- and small-scale manufacturers and coffee shops. A total of 124 static and personal samples were collected. In the majority of personal samples airborne concentrations of diacetyl were <5 ppb, with those at coffee shops generally <1 ppb. However, diacetyl concentrations in ~40% of the long-term personal samples, mainly originating from one site, were found to be in excess of the newly adopted European TWA-OEL of 20 ppb. Diacetyl concentrations up to 400 ppb were detected on the static samples, with the highest values occurring during grinding of roasted coffee beans. 2,3-Pentanedione was also detected in most of the samples at airborne concentrations around half of those for diacetyl. A significant number of other volatile organic compounds (VOCs) were also detected at sub-ppm concentrations, including acetoin, aliphatic carboxylic acids, aldehydes, ketones and esters, methylfuran, furfural and furfuryl-based alcohols and ketones, and nitrogen containing compounds, such as pyridines and pyrazines. In laboratory tests, diacetyl emissions generated during heating of whole beans were found to be significantly lower than those from heating the same beans after grinding. Diacetyl emissions from both ground and whole beans were also found to be significantly dependent on temperature.
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Affiliation(s)
- Ian Pengelly
- Health and Safety Executive, Harpur Hill, Buxton, UK
| | - Hannah O'Shea
- Centre for Climate and Air Pollution Studies, School of Physics and the Ryan Institute, National University of Ireland, Galway, University Road, Galway, Ireland
| | - Gordon Smith
- Health and Safety Executive, Benton Park View, Newcastle-upon-Tyne, UK
| | - Marie A Coggins
- Centre for Climate and Air Pollution Studies, School of Physics and the Ryan Institute, National University of Ireland, Galway, University Road, Galway, Ireland
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Tzortzi A, Kapetanstrataki M, Evangelopoulou V, Behrakis P. A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2248. [PMID: 32230711 PMCID: PMC7177608 DOI: 10.3390/ijerph17072248] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022]
Abstract
Following the recent electronic cigarette (e-cigarette) illness outbreak, the current review aimed to collect all related clinical cases for study and analysis and provide a critical synopsis of the proposed injury mechanism. Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines, e-cigarette-related clinical cases were identified via Google Scholar and PubMed databases. Additionally, references of published case reports and previous review papers were manually searched, revealing 159 publications presenting e-cigarette-related case reports and 19 reports by the Centers for Disease Control and Prevention. 238 individual cases were identified; 53% traumatic injuries due to e-cigarette explosion or self-combustion, 24% respiratory cases, and 12% poisonings. Additional cases pertained to oral, cardiovascular, immunologic, hematologic, allergic reactions, infant complications, and altered medication levels. Case reports were mainly published between 2016-2019 (78%). The oldest case, a lipoid pneumonia, was published in 2012. The current review showed that e-cigarette-related health effects extend beyond the acute lung injury syndrome, including traumatic, thermal injuries and acute intoxications. Physicians should be aware of the distinct clinical presentations and be trained to respond and treat effectively. Regulators and public health authorities should address the regulatory gap regarding electronic nicotine delivery systems (ENDS) and novel tobacco products.
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Affiliation(s)
- Anna Tzortzi
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
- Institute of Public Health, The American College of Greece, 17B Ipitou Street, 10557 Athens, Greece
| | - Melpo Kapetanstrataki
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
| | - Vaso Evangelopoulou
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
| | - Panagiotis Behrakis
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
- Institute of Public Health, The American College of Greece, 17B Ipitou Street, 10557 Athens, Greece
- Pulmonary Department, Athens Medical Center, Distomou 5-7, Marousi, 15125 Athens, Greece
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Sobczak A, Kośmider L, Koszowski B, Goniewicz MŁ. E-cigarettes and their impact on health: from pharmacology to clinical implications. Pol Arch Intern Med 2020; 130:668-675. [PMID: 32155137 DOI: 10.20452/pamw.15229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Worldwide, cigarette smoking is the major cause of premature mortality and diseases that can be prevented. Given that people continue smoking despite associated health risks, delivering nicotine without combustion should be considered a valuable and much less harmful way to reduce the public health burden caused by smoking. E‑cigarettes could play such a role if they were proven to be less harmful than combustible cigarettes. Although the number of clinical trials and human studies assessing the safety of e‑cigarettes is limited, numerous in vitro and in vivo studies reported on the potential harmful effects of the aerosol generated from e‑cigarettes. This article reviews the results of major clinical trials and laboratory studies with regard to cancer as well as cardiovascular and respiratory risk associated with the use of e‑cigarettes. Additionally, it also discusses the potential application of e‑cigarettes as smoking cessation tools. Most studies have indicated so far that e‑cigarettes are less harmful, but this applies only to smokers who completely switched to e‑cigarettes. In the opinion of the authors, good-quality research is crucial to establish the tolerance, safety, efficacy, and harm reduction potential of new technologies. Considering a significant role that physicians and other health providers play in helping smokers, there is an urgent need for evidence‑based guidelines and recommendations for clinical practitioners on potential benefits and risks of e‑cigarette use.
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Affiliation(s)
- Andrzej Sobczak
- Department of General and Analytical Chemistry, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland.
| | - Leon Kośmider
- Department of General and Analytical Chemistry, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | | | - Maciej Ł Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
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Vaping Is Not Safe: A Case of Acute Eosinophilic Pneumonia following Cannabis Vapor Inhalation. Case Rep Pulmonol 2020; 2020:9496564. [PMID: 32047695 PMCID: PMC7007742 DOI: 10.1155/2020/9496564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/29/2019] [Indexed: 12/04/2022] Open
Abstract
There is a well-established association between inhalational exposures and acute eosinophilic pneumonia (AEP). The most reported exposure is cigarette smoking. Here, we present a case of progressive shortness of breath and nonproductive cough in a college student with no significant medical history, approximately 10 days after inhaling cannabis aerosols on two separate occasions. He was started on empiric antibiotics and bronchodilators without improvement. He was diagnosed with AEP based on peripheral eosinophilia and high-resolution CT image results. He made rapid recovery on intravenous glucocorticoids. Vaping has gained popularity among young adults mainly due to the perception that it is a safe alternative to smoking. This case shows that there may be a false sense of security with vaping. Vaping poses a yet-to-be quantified public health threat, which requires further studies.
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32
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Vas CA, Porter A, McAdam K. Acetoin is a precursor to diacetyl in e-cigarette liquids. Food Chem Toxicol 2019; 133:110727. [DOI: 10.1016/j.fct.2019.110727] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/27/2019] [Accepted: 07/26/2019] [Indexed: 12/21/2022]
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33
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Hubbs AF, Kreiss K, Cummings KJ, Fluharty KL, O'Connell R, Cole A, Dodd TM, Clingerman SM, Flesher JR, Lee R, Pagel S, Battelli LA, Cumpston A, Jackson M, Kashon M, Orandle MS, Fedan JS, Sriram K. Flavorings-Related Lung Disease: A Brief Review and New Mechanistic Data. Toxicol Pathol 2019; 47:1012-1026. [PMID: 31645208 DOI: 10.1177/0192623319879906] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Flavorings-related lung disease is a potentially disabling and sometimes fatal lung disease of workers making or using flavorings. First identified almost 20 years ago in microwave popcorn workers exposed to butter-flavoring vapors, flavorings-related lung disease remains a concern today. In some cases, workers develop bronchiolitis obliterans, a severe form of fixed airways disease. Affected workers have been reported in microwave popcorn, flavorings, and coffee production workplaces. Volatile α-dicarbonyl compounds, particularly diacetyl (2,3-butanedione) and 2,3-pentanedione, are implicated in the etiology. Published studies on diacetyl and 2,3-pentanedione document their ability to cause airway epithelial necrosis, damage biological molecules, and perturb protein homeostasis. With chronic exposure in rats, they produce airway fibrosis resembling bronchiolitis obliterans. To add to this knowledge, we recently evaluated airway toxicity of the 3-carbon α-dicarbonyl compound, methylglyoxal. Methylglyoxal inhalation causes epithelial necrosis at even lower concentrations than diacetyl. In addition, we investigated airway toxicity of mixtures of diacetyl, acetoin, and acetic acid, common volatiles in butter flavoring. At ratios comparable to workplace scenarios, the mixtures or diacetyl alone, but not acetic acid or acetoin, cause airway epithelial necrosis. These new findings add to existing data to implicate α-dicarbonyl compounds in airway injury and flavorings-related lung disease.
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Affiliation(s)
- Ann F Hubbs
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Kathleen Kreiss
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Kristin J Cummings
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Kara L Fluharty
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Ryan O'Connell
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA.,West Virginia University, Morgantown, WV, USA. Cummings is now with California Department of Public Health, Richmond, CA, USA. O'Connell is now with Department of Biochemistry, West Virginia, University, Morgantown, WV, USA. Flesher is now with Department of Biology, West Virginia University, Morgantown, WV, USA. Cole is now with Department of Pediatrics-Hematology/Oncology, University of Colorado School of Medicine, Aurora, CO, USA. Kreiss (retired) is in Sitka, AK, USA
| | - Allison Cole
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA.,Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Tiana M Dodd
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Sidney M Clingerman
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA.,West Virginia University, Morgantown, WV, USA. Cummings is now with California Department of Public Health, Richmond, CA, USA. O'Connell is now with Department of Biochemistry, West Virginia, University, Morgantown, WV, USA. Flesher is now with Department of Biology, West Virginia University, Morgantown, WV, USA. Cole is now with Department of Pediatrics-Hematology/Oncology, University of Colorado School of Medicine, Aurora, CO, USA. Kreiss (retired) is in Sitka, AK, USA
| | - Jordan R Flesher
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA.,West Virginia University, Morgantown, WV, USA. Cummings is now with California Department of Public Health, Richmond, CA, USA. O'Connell is now with Department of Biochemistry, West Virginia, University, Morgantown, WV, USA. Flesher is now with Department of Biology, West Virginia University, Morgantown, WV, USA. Cole is now with Department of Pediatrics-Hematology/Oncology, University of Colorado School of Medicine, Aurora, CO, USA. Kreiss (retired) is in Sitka, AK, USA
| | - Rebecca Lee
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA.,West Virginia University, Morgantown, WV, USA. Cummings is now with California Department of Public Health, Richmond, CA, USA. O'Connell is now with Department of Biochemistry, West Virginia, University, Morgantown, WV, USA. Flesher is now with Department of Biology, West Virginia University, Morgantown, WV, USA. Cole is now with Department of Pediatrics-Hematology/Oncology, University of Colorado School of Medicine, Aurora, CO, USA. Kreiss (retired) is in Sitka, AK, USA
| | - Samantha Pagel
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA.,West Virginia University, Morgantown, WV, USA. Cummings is now with California Department of Public Health, Richmond, CA, USA. O'Connell is now with Department of Biochemistry, West Virginia, University, Morgantown, WV, USA. Flesher is now with Department of Biology, West Virginia University, Morgantown, WV, USA. Cole is now with Department of Pediatrics-Hematology/Oncology, University of Colorado School of Medicine, Aurora, CO, USA. Kreiss (retired) is in Sitka, AK, USA
| | - Lori A Battelli
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Amy Cumpston
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Mark Jackson
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Michael Kashon
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Marlene S Orandle
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Jeffrey S Fedan
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Krishnan Sriram
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
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34
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Thimraj TA, Sompa SI, Ganguly K, Ernstgård L, Johanson G, Palmberg L, Upadhyay S. Evaluation of diacetyl mediated pulmonary effects in physiologically relevant air-liquid interface models of human primary bronchial epithelial cells. Toxicol In Vitro 2019; 61:104617. [PMID: 31381966 DOI: 10.1016/j.tiv.2019.104617] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/03/2019] [Accepted: 08/01/2019] [Indexed: 12/17/2022]
Abstract
Diacetyl is an artificial flavouring agent, known to cause bronchiolitis obliterans. Diacetyl-induced pulmonary effects were assessed in human primary bronchial epithelial cells (PBEC) cultured at air-liquid interface (ALI). The PBEC-ALI models were exposed to clean air (sham) and diacetyl vapour (1, 3, 10 and 30 ppm) for 30 min. At 6 and 24 h post-exposure, cell medium was sampled for assessment of cytotoxicity measurement, and CXCL8, MMP9 secretion by ELISA. Pro-inflammatory, oxidative stress, tissue injury/repair, anti-protease and beta-defensin markers were assessed using qRT-PCR. Additionally, epidermal growth factor receptor ligands (amphiregulin) and anti-protease (SLPI) were analysed at 6 h, 8 h and 24 h post exposure to 1 and 10 ppm diacetyl. No significant cytotoxicity was observed at any exposure level. MMP9 was significantly increased in both apical and basal media at 24 h. Both SLPI and amphiregulin secretion were significantly increased following exposure to 10 ppm diacetyl. Exposure of PBEC-ALI model to diacetyl vapour resulted in significantly altered transcript expression of pro-inflammatory, oxidative stress, anti-protease, tissue injury/repair markers. Changes in transcript expression of significantly altered markers were more prominent 24 h post-exposure compared to 6 h. This study warrants further mechanistic investigations to elucidate the pulmonary effects of inhaled diacetyl vapour using physiologically relevant in vitro models.
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Affiliation(s)
- Tania A Thimraj
- Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Shanzina I Sompa
- Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Koustav Ganguly
- Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Lena Ernstgård
- Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Gunnar Johanson
- Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Lena Palmberg
- Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Swapna Upadhyay
- Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Polosa R, O'Leary R, Tashkin D, Emma R, Caruso M. The effect of e-cigarette aerosol emissions on respiratory health: a narrative review. Expert Rev Respir Med 2019; 13:899-915. [PMID: 31375047 DOI: 10.1080/17476348.2019.1649146] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Due to the uptake in the use of e-cigarettes (ECs), evidence on their health effects is needed to inform health care and policy. Some regulators and health professionals have raised concerns that the respirable aerosols generated by ECs contain several constituents of potential toxicological and biological relevance to respiratory health. Areas covered: We critically assess published research on the respiratory system investigating the effects of ECs in preclinical models, clinical studies of people who switched to ECs from tobacco cigarettes, and population surveys. We assess the studies for the quality of their methodology and accuracy of their interpretation. To adequately assess the impact of EC use on human health, addressing common mistakes and developing robust and realistic methodological recommendations is an urgent priority. The findings of this review indicate that ECs under normal conditions of use demonstrate far fewer respiratory risks than combustible tobacco cigarettes. EC users and smokers considering ECs have the right to be informed about the relative risks of EC use, and to be made aware that findings of studies published by the media are not always reliable. Expert opinion: Growing evidence supports the relative safety of EC emission aerosols for the respiratory tract compared to tobacco smoke.
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Affiliation(s)
- Riccardo Polosa
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "Policlinico-V. Emanuele", Università of Catania , Catania , Italy.,Center of Excellence for the acceleration of HArm Reduction (CoEHAR), University of Catania , Catania , Italy
| | - Renée O'Leary
- Canadian Institute for Substance Use Research , Victoria , Canada
| | - Donald Tashkin
- David Geffen School of Medicine at the University of California, Los Angeles (UCLA) , Los Angeles , CA , USA
| | - Rosalia Emma
- Dipartimento di Medicina Clinica e Sperimentale (MEDCLIN), University of Catania , Catania , Italy.,Dipartimento di Scienze biomediche e biotecnologiche (BIOMETEC), University of Catania , Catania , Italy
| | - Massimo Caruso
- Dipartimento di Medicina Clinica e Sperimentale (MEDCLIN), University of Catania , Catania , Italy.,Dipartimento di Scienze biomediche e biotecnologiche (BIOMETEC), University of Catania , Catania , Italy
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36
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Lee JYJ, Miller JA, Basu S, Kee TZV, Loo LH. Building predictive in vitro pulmonary toxicity assays using high-throughput imaging and artificial intelligence. Arch Toxicol 2018; 92:2055-2075. [PMID: 29705884 PMCID: PMC6002469 DOI: 10.1007/s00204-018-2213-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/25/2018] [Indexed: 01/22/2023]
Abstract
Human lungs are susceptible to the toxicity induced by soluble xenobiotics. However, the direct cellular effects of many pulmonotoxic chemicals are not always clear, and thus, a general in vitro assay for testing pulmonotoxicity applicable to a wide variety of chemicals is not currently available. Here, we report a study that uses high-throughput imaging and artificial intelligence to build an in vitro pulmonotoxicity assay by automatically comparing and selecting human lung-cell lines and their associated quantitative phenotypic features most predictive of in vivo pulmonotoxicity. This approach is called “High-throughput In vitro Phenotypic Profiling for Toxicity Prediction” (HIPPTox). We found that the resulting assay based on two phenotypic features of a human bronchial epithelial cell line, BEAS-2B, can accurately classify 33 reference chemicals with human pulmonotoxicity information (88.8% balance accuracy, 84.6% sensitivity, and 93.0% specificity). In comparison, the predictivity of a standard cell-viability assay on the same set of chemicals is much lower (77.1% balanced accuracy, 84.6% sensitivity, and 69.5% specificity). We also used the assay to evaluate 17 additional test chemicals with unknown/unclear human pulmonotoxicity, and experimentally confirmed that many of the pulmonotoxic reference and predicted-positive test chemicals induce DNA strand breaks and/or activation of the DNA-damage response (DDR) pathway. Therefore, HIPPTox helps us to uncover these common modes-of-action of pulmonotoxic chemicals. HIPPTox may also be applied to other cell types or models, and accelerate the development of predictive in vitro assays for other cell-type- or organ-specific toxicities.
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Affiliation(s)
- Jia-Ying Joey Lee
- Bioinformatics Institute, Agency for Science, Technology, and Research, 30 Biopolis Street, #07-01 Matrix, Singapore, 138671, Singapore
| | - James Alastair Miller
- Bioinformatics Institute, Agency for Science, Technology, and Research, 30 Biopolis Street, #07-01 Matrix, Singapore, 138671, Singapore
| | - Sreetama Basu
- Bioinformatics Institute, Agency for Science, Technology, and Research, 30 Biopolis Street, #07-01 Matrix, Singapore, 138671, Singapore
| | - Ting-Zhen Vanessa Kee
- Bioinformatics Institute, Agency for Science, Technology, and Research, 30 Biopolis Street, #07-01 Matrix, Singapore, 138671, Singapore
| | - Lit-Hsin Loo
- Bioinformatics Institute, Agency for Science, Technology, and Research, 30 Biopolis Street, #07-01 Matrix, Singapore, 138671, Singapore.
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38
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Sassano MF, Davis ES, Keating JE, Zorn BT, Kochar TK, Wolfgang MC, Glish GL, Tarran R. Evaluation of e-liquid toxicity using an open-source high-throughput screening assay. PLoS Biol 2018; 16:e2003904. [PMID: 29584716 PMCID: PMC5870948 DOI: 10.1371/journal.pbio.2003904] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 02/21/2018] [Indexed: 01/08/2023] Open
Abstract
The e-liquids used in electronic cigarettes (E-cigs) consist of propylene glycol (PG), vegetable glycerin (VG), nicotine, and chemical additives for flavoring. There are currently over 7,700 e-liquid flavors available, and while some have been tested for toxicity in the laboratory, most have not. Here, we developed a 3-phase, 384-well, plate-based, high-throughput screening (HTS) assay to rapidly triage and validate the toxicity of multiple e-liquids. Our data demonstrated that the PG/VG vehicle adversely affected cell viability and that a large number of e-liquids were more toxic than PG/VG. We also performed gas chromatography-mass spectrometry (GC-MS) analysis on all tested e-liquids. Subsequent nonmetric multidimensional scaling (NMDS) analysis revealed that e-liquids are an extremely heterogeneous group. Furthermore, these data indicated that (i) the more chemicals contained in an e-liquid, the more toxic it was likely to be and (ii) the presence of vanillin was associated with higher toxicity values. Further analysis of common constituents by electron ionization revealed that the concentration of cinnamaldehyde and vanillin, but not triacetin, correlated with toxicity. We have also developed a publicly available searchable website (www.eliquidinfo.org). Given the large numbers of available e-liquids, this website will serve as a resource to facilitate dissemination of this information. Our data suggest that an HTS approach to evaluate the toxicity of multiple e-liquids is feasible. Such an approach may serve as a roadmap to enable bodies such as the Food and Drug Administration (FDA) to better regulate e-liquid composition.
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Affiliation(s)
- M. Flori Sassano
- Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eric S. Davis
- Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - James E. Keating
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bryan T. Zorn
- Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tavleen K. Kochar
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew C. Wolfgang
- Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gary L. Glish
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert Tarran
- Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Cell Biology & Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- * E-mail:
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De Matteis S, Heederik D, Burdorf A, Colosio C, Cullinan P, Henneberger PK, Olsson A, Raynal A, Rooijackers J, Santonen T, Sastre J, Schlünssen V, van Tongeren M, Sigsgaard T. Current and new challenges in occupational lung diseases. Eur Respir Rev 2017; 26:170080. [PMID: 29141963 PMCID: PMC6033059 DOI: 10.1183/16000617.0080-2017] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/02/2017] [Indexed: 01/13/2023] Open
Abstract
Occupational lung diseases are an important public health issue and are avoidable through preventive interventions in the workplace. Up-to-date knowledge about changes in exposure to occupational hazards as a result of technological and industrial developments is essential to the design and implementation of efficient and effective workplace preventive measures. New occupational agents with unknown respiratory health effects are constantly introduced to the market and require periodic health surveillance among exposed workers to detect early signs of adverse respiratory effects. In addition, the ageing workforce, many of whom have pre-existing respiratory conditions, poses new challenges in terms of the diagnosis and management of occupational lung diseases. Primary preventive interventions aimed to reduce exposure levels in the workplace remain pivotal for elimination of the occupational lung disease burden. To achieve this goal there is still a clear need for setting standard occupational exposure limits based on transparent evidence-based methodology, in particular for carcinogens and sensitising agents that expose large working populations to risk. The present overview, focused on the occupational lung disease burden in Europe, proposes directions for all parties involved in the prevention of occupational lung disease, from researchers and occupational and respiratory health professionals to workers and employers.
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Affiliation(s)
- Sara De Matteis
- Respiratory Epidemiology, Occupational Medicine and Public Health, Imperial College London, London, UK
| | - Dick Heederik
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Alex Burdorf
- Dept of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Claudio Colosio
- Dept of Health Sciences of the University of Milan and International Centre for Rural Health of the S. Paolo Hospital, Milan, Italy
| | - Paul Cullinan
- Respiratory Epidemiology, Occupational Medicine and Public Health, Imperial College London, London, UK
| | - Paul K Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Ann Olsson
- International Agency for Research on Cancer, Lyon, France
| | - Anne Raynal
- Occupational Medicine Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jos Rooijackers
- Netherlands Expertise Center for Occupational Respiratory Disorders, Utrecht, The Netherlands
| | - Tiina Santonen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Joaquin Sastre
- Allergy Service, Fundacion Jimenez Diaz, Faculty of Medicine Universidad Autonoma de Madrid, CIBER of Respiratory Diseases, Ministry of Economy, Madrid, Spain
| | - Vivi Schlünssen
- Dept of Public Health, Section of Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
- National Research Center for the Working Environment, Copenhagen, Denmark
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health; Centre for Epidemiology; Division of Population Health, Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Torben Sigsgaard
- Dept of Public Health, Section of Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
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Health impact of E-cigarettes: a prospective 3.5-year study of regular daily users who have never smoked. Sci Rep 2017; 7:13825. [PMID: 29150612 PMCID: PMC5693960 DOI: 10.1038/s41598-017-14043-2] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/03/2017] [Indexed: 01/12/2023] Open
Abstract
Although electronic cigarettes (ECs) are a much less harmful alternative to tobacco cigarettes, there is concern as to whether long-term ECs use may cause risks to human health. We report health outcomes (blood pressure, heart rate, body weight, lung function, respiratory symptoms, exhaled breath nitric oxide [eNO], exhaled carbon monoxide [eCO], and high-resolution computed tomography [HRCT] of the lungs) from a prospective 3.5-year observational study of a cohort of nine daily EC users (mean age 29.7 (±6.1) years) who have never smoked and a reference group of twelve never smokers. No significant changes could be detected over the observation period from baseline in the EC users or between EC users and control subjects in any of the health outcomes investigated. Moreover, no pathological findings could be identified on HRCT of the lungs and no respiratory symptoms were consistently reported in the EC user group. Although it cannot be excluded that some harm may occur at later stages, this study did not demonstrate any health concerns associated with long-term use of EC in relatively young users who did not also smoke tobacco.
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Abstract
PURPOSE OF REVIEW Vaping is gaining popularity in the USA, particularly among teens and young adults. While e-cigs are commonly represented as safer alternatives to tobacco cigarettes, little is known regarding the health effects of their short- or long-term use, especially in individuals with pre-existing respiratory diseases such as asthma. Flavored e-cig liquids (e-liquids) and e-cig aerosols contain airway irritants and toxicants that have been implicated in the pathogenesis and worsening of lung diseases. In this review, we will summarize existing data on potential health effects of components present in e-cig aerosols, such as propylene glycol, vegetable glycerin, nicotine, and flavorings, and discuss their relevance in the context of asthma. RECENT FINDINGS Recent survey data indicate that adolescents with asthma had a higher prevalence of current e-cig use (12.4%) compared to their non-asthmatics peers (10.2%) and conveyed positive beliefs about tobacco products, especially e-cigs. Similarly, a study conducted among high school students from Ontario, Canada, indicated a greater likelihood of e-cig use in asthmatics as compared to their non-asthmatic peers. Availability of different flavorings is often cited as the main reason among youth/adolescents for trying e-cigs or switching from cigarettes to e-cigs. Occupational inhalation of some common food-safe flavoring agents is reported to cause occupational asthma and worsen asthmatic symptoms. Moreover, workplace inhalation exposures to the flavoring agent diacetyl have caused irreversible obstructive airway disease in healthy workers. Additionally, recent studies report that thermal decomposition of propylene glycol (PG) and vegetable glycerin (VG), the base constituents of e-liquids, produces reactive carbonyls, including acrolein, formaldehyde, and acetaldehyde, which have known respiratory toxicities. Furthermore, recent nicotine studies in rodents reveal that prenatal nicotine exposures lead to epigenetic reprogramming in the offspring, abnormal lung development, and multigenerational transmission of asthmatic-like symptoms. Comparisons of the toxicity and health effects of e-cigs and conventional cigarettes often focus on toxicants known to be present in cigarette smoke (CS) (i.e., formaldehyde, nitrosamines, etc.), as well as smoking-associated clinical endpoints, such as cancer, bronchitis, and chronic obstructive pulmonary disease (COPD). However, this approach disregards potential toxicity of components unique to flavored e-cigs, such as PG, VG, and the many different flavoring chemicals, which likely induce respiratory effects not usually observed in cigarette smokers.
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Affiliation(s)
- Phillip W Clapp
- Curriculum in Toxicology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Center for Environmental Medicine, Asthma, and Lung Biology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Ilona Jaspers
- Curriculum in Toxicology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
- Center for Environmental Medicine, Asthma, and Lung Biology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA.
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St Helen G, Dempsey DA, Havel CM, Jacob P, Benowitz NL. Impact of e-liquid flavors on nicotine intake and pharmacology of e-cigarettes. Drug Alcohol Depend 2017; 178:391-398. [PMID: 28704768 PMCID: PMC5565733 DOI: 10.1016/j.drugalcdep.2017.05.042] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To describe the effect of e-liquid flavors on nicotine intake and pharmacology of e-cigarettes. METHODS 11 males and 3 females participated in a 3-day inpatient crossover study with strawberry, tobacco, and their usual flavor e-liquid. Nicotine levels were nominally 18mg/mL in the strawberry (pH 8.29) and tobacco (pH 9.10) e-liquids and ranged between 3-18mg/mL in the usual brands (mean pH 6.80). Each day consisted of a 15-puff session followed by 4h of abstinence, then 90min of ad libitum use. Subjects used a KangerTech mini ProTank 3. RESULTS After 15 puffs, the amount of nicotine inhaled and systemically retained were not significantly different between the strawberry and tobacco e-liquids but plasma AUC(0→180) was significantly higher with the strawberry e-liquid. While not significantly different, Cmax was 22% higher and various early time point AUCs to measure rate of rise of nicotine in blood ranged between 17 and 23% higher with the strawberry e-liquid compared to the tobacco e-liquid. During ad libitum use, systemic exposure to nicotine (AUC(0→90)) was the same for the tobacco and usual brand e-liquids but were both significantly lower than after using the strawberry e-liquid. The usual flavors were more liked and satisfying than the strawberry and tobacco e-liquids. CONCLUSION Flavors influence nicotine exposure through flavor liking, may affect rate of nicotine absorption possibly through pH effects, and contribute to heart rate acceleration and subjective effects of e-cigarettes. E-cigarette users titrate their nicotine exposure but the extent of titration may vary across flavors.
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Affiliation(s)
- Gideon St Helen
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA, USA; Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA; Tobacco Center of Regulatory Science (TCORS), University of California, San Francisco, CA, USA.
| | - Delia A Dempsey
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA, USA
| | - Christopher M Havel
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA, USA
| | - Peyton Jacob
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA, USA; Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA; Tobacco Center of Regulatory Science (TCORS), University of California, San Francisco, CA, USA
| | - Neal L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA, USA; Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA; Tobacco Center of Regulatory Science (TCORS), University of California, San Francisco, CA, USA; Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
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Brass DM, Palmer SM. Models of toxicity of diacetyl and alternative diones. Toxicology 2017; 388:15-20. [PMID: 28232124 PMCID: PMC5540796 DOI: 10.1016/j.tox.2017.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/23/2017] [Accepted: 02/17/2017] [Indexed: 11/28/2022]
Abstract
Diacetyl (DA; 2,3-butanedione), with the chemical formula (CH3CO)2 is a volatile organic compound with a deep yellow color and a strong buttery flavor and aroma. These properties have made DA a particularly useful and common food flavoring ingredient. However, because of this increased occupational use, workers can be exposed to high vapor concentrations in the workplace. Despite being listed by the USFDA to be 'generally regarded as safe' (GRAS), multiple lines of evidence suggest that exposure to high concentrations of DA vapor causes long-term impairments in lung function with lung function testing indicating evidence of either restrictive or obstructive airway narrowing in affected individuals. A growing number of pre-clinical studies have now addressed the short and long-term toxicity associated with DA exposure providing further insight into the toxicity of DA and related diones. This review summarizes these observations.
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Affiliation(s)
- David M Brass
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Scott M Palmer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
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Brass DM, Gwinn WM, Valente AM, Kelly FL, Brinkley CD, Nagler AE, Moseley MA, Morgan DL, Palmer SM, Foster MW. The Diacetyl-Exposed Human Airway Epithelial Secretome: New Insights into Flavoring-Induced Airways Disease. Am J Respir Cell Mol Biol 2017; 56:784-795. [PMID: 28248570 DOI: 10.1165/rcmb.2016-0372oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Bronchiolitis obliterans (BO) is an increasingly important lung disease characterized by fibroproliferative airway lesions and decrements in lung function. Occupational exposure to the artificial food flavoring ingredient diacetyl, commonly used to impart a buttery flavor to microwave popcorn, has been associated with BO development. In the occupational setting, diacetyl vapor is first encountered by the airway epithelium. To better understand the effects of diacetyl vapor on the airway epithelium, we used an unbiased proteomic approach to characterize both the apical and basolateral secretomes of air-liquid interface cultures of primary human airway epithelial cells from four unique donors after exposure to an occupationally relevant concentration (∼1,100 ppm) of diacetyl vapor or phosphate-buffered saline as a control on alternating days. Basolateral and apical supernatants collected 48 h after the third exposure were analyzed using one-dimensional liquid chromatography tandem mass spectrometry. Paired t tests adjusted for multiple comparisons were used to assess differential expression between diacetyl and phosphate-buffered saline exposure. Of the significantly differentially expressed proteins identified, 61 were unique to the apical secretome, 81 were unique to the basolateral secretome, and 11 were present in both. Pathway enrichment analysis using publicly available databases revealed that proteins associated with matrix remodeling, including degradation, assembly, and new matrix organization, were overrepresented in the data sets. Similarly, protein modifiers of epidermal growth factor receptor signaling were significantly altered. The ordered changes in protein expression suggest that the airway epithelial response to diacetyl may contribute to BO pathogenesis.
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Affiliation(s)
- David M Brass
- 1 Division of Pulmonary, Allergy, and Critical Care Medicine
| | - William M Gwinn
- 2 National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | | | | | | | - Andrew E Nagler
- 1 Division of Pulmonary, Allergy, and Critical Care Medicine
| | - M Arthur Moseley
- 4 Proteomics and Metabolomics Shared Resource, Duke University Medical Center, Durham, North Carolina; and
| | - Daniel L Morgan
- 2 National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Scott M Palmer
- 1 Division of Pulmonary, Allergy, and Critical Care Medicine
| | - Matthew W Foster
- 1 Division of Pulmonary, Allergy, and Critical Care Medicine.,4 Proteomics and Metabolomics Shared Resource, Duke University Medical Center, Durham, North Carolina; and
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Rose CS. Early detection, clinical diagnosis, and management of lung disease from exposure to diacetyl. Toxicology 2017; 388:9-14. [PMID: 28344095 DOI: 10.1016/j.tox.2017.03.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 11/28/2022]
Abstract
Inhalation of diacetyl-containing products is associated with risk for occupational bronchiolitis obliterans (BO) and fixed airways obstruction, particularly in workers exposed to heated liquids and powdered formulations. This review describes the occupational settings in which diacetyl-related lung disease has been reported and the clinical presentation of disease, along with an approach to diagnosis and management. The importance of early disease recognition, appropriate removal from exposure, and medical monitoring to optimize prognosis is reviewed. The roles of public health follow-up and medical surveillance for primary and secondary prevention are discussed.
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Affiliation(s)
- Cecile S Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health and Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver, CO, USA.
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Hubbs AF, Fluharty KL, Edwards RJ, Barnabei JL, Grantham JT, Palmer SM, Kelly F, Sargent LM, Reynolds SH, Mercer RR, Goravanahally MP, Kashon ML, Honaker JC, Jackson MC, Cumpston AM, Goldsmith WT, McKinney W, Fedan JS, Battelli LA, Munro T, Bucklew-Moyers W, McKinstry K, Schwegler-Berry D, Friend S, Knepp AK, Smith SL, Sriram K. Accumulation of Ubiquitin and Sequestosome-1 Implicate Protein Damage in Diacetyl-Induced Cytotoxicity. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 186:2887-2908. [PMID: 27643531 PMCID: PMC5222965 DOI: 10.1016/j.ajpath.2016.07.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/09/2016] [Accepted: 07/21/2016] [Indexed: 01/12/2023]
Abstract
Inhaled diacetyl vapors are associated with flavorings-related lung disease, a potentially fatal airway disease. The reactive α-dicarbonyl group in diacetyl causes protein damage in vitro. Dicarbonyl/l-xylulose reductase (DCXR) metabolizes diacetyl into acetoin, which lacks this α-dicarbonyl group. To investigate the hypothesis that flavorings-related lung disease is caused by in vivo protein damage, we correlated diacetyl-induced airway damage in mice with immunofluorescence for markers of protein turnover and autophagy. Western immunoblots identified shifts in ubiquitin pools. Diacetyl inhalation caused dose-dependent increases in bronchial epithelial cells with puncta of both total ubiquitin and K63-ubiquitin, central mediators of protein turnover. This response was greater in Dcxr-knockout mice than in wild-type controls inhaling 200 ppm diacetyl, further implicating the α-dicarbonyl group in protein damage. Western immunoblots demonstrated decreased free ubiquitin in airway-enriched fractions. Transmission electron microscopy and colocalization of ubiquitin-positive puncta with lysosomal-associated membrane proteins 1 and 2 and with the multifunctional scaffolding protein sequestosome-1 (SQSTM1/p62) confirmed autophagy. Surprisingly, immunoreactive SQSTM1 also accumulated in the olfactory bulb of the brain. Olfactory bulb SQSTM1 often congregated in activated microglial cells that also contained olfactory marker protein, indicating neuronophagia within the olfactory bulb. This suggests the possibility that SQSTM1 or damaged proteins may be transported from the nose to the brain. Together, these findings strongly implicate widespread protein damage in the etiology of flavorings-related lung disease.
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Affiliation(s)
- Ann F Hubbs
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia.
| | - Kara L Fluharty
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Rebekah J Edwards
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; Department of Forensic and Investigative Science, West Virginia University, Morgantown, West Virginia
| | - Jamie L Barnabei
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - John T Grantham
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Scott M Palmer
- Duke University School of Medicine, Durham, North Carolina
| | - Francine Kelly
- Duke University School of Medicine, Durham, North Carolina
| | - Linda M Sargent
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Steven H Reynolds
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Robert R Mercer
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Madhusudan P Goravanahally
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; Centers for Neuroscience, West Virginia University, Morgantown, West Virginia
| | - Michael L Kashon
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - John C Honaker
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Mark C Jackson
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Amy M Cumpston
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - William T Goldsmith
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Walter McKinney
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Jeffrey S Fedan
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Lori A Battelli
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Tiffany Munro
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Winnie Bucklew-Moyers
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Kimberly McKinstry
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Diane Schwegler-Berry
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Sherri Friend
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Alycia K Knepp
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; Department of Forensic and Investigative Science, West Virginia University, Morgantown, West Virginia
| | - Samantha L Smith
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; Department of Forensic and Investigative Science, West Virginia University, Morgantown, West Virginia
| | - Krishnan Sriram
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
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Azithromycin for the Treatment of Obliterative Bronchiolitis after Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis. Biol Blood Marrow Transplant 2016; 22:2264-2269. [PMID: 27575542 DOI: 10.1016/j.bbmt.2016.08.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/24/2016] [Indexed: 12/18/2022]
Abstract
Obliterative bronchiolitis (OB) is a major cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). Our objective was to perform a systematic review and meta-analysis of the impact of azithromycin on change in forced expiratory volume in 1 second (FEV1). We searched MEDLINE, EMBASE, Web of Science, Cochrane CENTRAL and Scopus databases and included studies that compared azithromycin with placebo or no intervention in the treatment of OB or bronchiolitis obliterans syndrome (BOS) in patients who had undergone allogeneic HSCT. Ninety-one unique publications were identified, and 4 studies met inclusion criteria, with a total of 90 patients. Changes in FEV1 were measured between 12 and 24 weeks after initiation of treatment. The meta-analysis demonstrated a mean increase in FEV1 of 30 mL (95% confidence interval, -260 to +330 mL; P = .82) after initiation of azithromycin. One patient death was reported but not attributed to azithromycin therapy. In conclusion, current evidence can neither support nor refute the use of azithromycin in the treatment of patients who develop OB/BOS after HSCT. Further studies are needed to determine whether azithromycin is beneficial for the treatment of OB/BOS in this setting.
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Morgan DL, Jokinen MP, Johnson CL, Price HC, Gwinn WM, Bousquet RW, Flake GP. Chemical Reactivity and Respiratory Toxicity of the α-Diketone Flavoring Agents: 2,3-Butanedione, 2,3-Pentanedione, and 2,3-Hexanedione. Toxicol Pathol 2016; 44:763-83. [PMID: 27025954 PMCID: PMC5286456 DOI: 10.1177/0192623316638962] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Occupational exposure to 2,3-butanedione (BD) vapors has been associated with severe respiratory disease leading to the use of potentially toxic substitutes. We compared the reactivity and respiratory toxicity of BD with that of two structurally related substitutes, 2,3-pentanedione (PD) and 2,3-hexanedione (HD). Chemical reactivity of the diketones with an arginine substrate decreased with increasing chain length (BD > PD > HD). Animals were evaluated the morning after a 2-week exposure to 0, 100, 150, or 200 ppm BD, PD, or HD (postexposure) or 2 weeks later (recovery). Bronchial fibrosis was observed in 5/5 BD and 5/5 PD rats at 200 ppm and in 4/6 BD and 6/6 PD rats at 150 ppm in the postexposure groups. Following recovery, bronchial fibrosis was observed in all surviving rats exposed to 200 ppm BD (5/5) or PD (3/3) and in 2/10 BD and 7/9 PD rats exposed to 150 ppm. Bronchial fibrosis was observed only in 2/12 HD-exposed rats in the 200 ppm postexposure group. Patchy interstitial fibrosis affected lungs of recovery groups exposed to 200 ppm PD (3/3) or BD (1/5) and to 150 ppm PD (4/9) or BD (7/10) and correlated with pulmonary function deficits. BD and PD were more reactive and produced more bronchial fibrosis than HD.
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Affiliation(s)
- Daniel L Morgan
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | | | | | - Herman C Price
- Alion Science and Technology, Research Triangle Park, North Carolina, USA
| | - William M Gwinn
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Ronald W Bousquet
- Alion Science and Technology, Research Triangle Park, North Carolina, USA
| | - Gordon P Flake
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
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Reid D, McDonald B, Khalid T, Vo T, Schenck L, Surette M, Beck P, Reimer R, Probert C, Rioux K, Eksteen B. Unique microbial-derived volatile organic compounds in portal venous circulation in murine non-alcoholic fatty liver disease. Biochim Biophys Acta Mol Basis Dis 2016; 1862:1337-44. [DOI: 10.1016/j.bbadis.2016.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/15/2016] [Accepted: 04/03/2016] [Indexed: 12/23/2022]
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