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Wang D, Li X, Li W, Duong T, Wang H, Kleschevnikova N, Patel HH, Breen E, Powell S, Wang S, Head BP. Nicotine inhalant via E-cigarette facilitates sensorimotor function recovery by upregulating neuronal BDNF-TrkB signalling in traumatic brain injury. Br J Pharmacol 2024; 181:3082-3097. [PMID: 38698493 DOI: 10.1111/bph.16395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND AND PURPOSE Traumatic brain injury (TBI) causes lifelong physical and psychological dysfunction in affected individuals. The current study investigated the effects of chronic nicotine exposure via E-cigarettes (E-cig) (vaping) on TBI-associated behavioural and biochemical changes. EXPERIMENTAL APPROACH Adult C57/BL6J male mice were subjected to controlled cortical impact (CCI) followed by daily exposure to E-cig vapour for 6 weeks. Sensorimotor functions, locomotion, and sociability were subsequently evaluated by nesting, open field, and social approach tests, respectively. Immunoblots were conducted to examine the expression of mature brain-derived neurotrophic factor (mBDNF) and associated downstream proteins (p-Erk, p-Akt). Histological analyses were performed to evaluate neuronal survival and neuroinflammation. KEY RESULTS Post-injury chronic nicotine exposure significantly improved nesting performance in CCI mice. Histological analysis revealed increased survival of cortical neurons in the perilesion cortex with chronic nicotine exposure. Immunoblots revealed that chronic nicotine exposure significantly up-regulated mBDNF, p-Erk and p-Akt expression in the perilesion cortex of CCI mice. Immunofluorescence microscopy indicated that elevated mBDNF and p-Akt expression were mainly localized within cortical neurons. Immunolabelling of Iba1 demonstrated that chronic nicotine exposure attenuated microglia-mediated neuroinflammation. CONCLUSIONS AND IMPLICATIONS Post-injury chronic nicotine exposure via vaping facilitates recovery of sensorimotor function by upregulating neuroprotective mBDNF/TrkB/Akt/Erk signalling. These findings suggest potential neuroprotective properties of nicotine despite its highly addictive nature. Thus, understanding the multifaceted effects of chronic nicotine exposure on TBI-associated symptoms is crucial for paving the way for informed and properly managed therapeutic interventions.
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Affiliation(s)
- Dongsheng Wang
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, California, USA
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Xiaojing Li
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, California, USA
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Wenxi Li
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, California, USA
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Tiffany Duong
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, California, USA
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Hongxia Wang
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, California, USA
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Natalia Kleschevnikova
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, California, USA
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Hemal H Patel
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, California, USA
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Ellen Breen
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - Susan Powell
- Research Service and Desert Pacific Mental Illness Research, Education & Clinical Center, Veterans Affairs San Diego Health System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Shanshan Wang
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, California, USA
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Brian P Head
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, California, USA
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
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2
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Harris T. Physical and Chemical Characterization of Aerosols Produced from Experimentally Designed Nicotine Salt-Based E-Liquids. Chem Res Toxicol 2024. [PMID: 39078024 DOI: 10.1021/acs.chemrestox.4c00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Nicotine salt-based e-liquids deliver nicotine more rapidly and efficiently to electronic nicotine delivery system (ENDS) users than freebase nicotine formulations. Nicotine salt-based products represent a substantial majority of the United States ENDS market. Despite the popularity of nicotine salt formulations, the chemical and physical characteristics of aerosols produced by nicotine salt e-liquids are still not well understood. To address this, this study reports the harmful and potentially harmful constituents (HPHCs) and particle sizes of aerosols produced by laboratory-made freebase nicotine and nicotine salt e-liquids. The nicotine salt e-liquids were formulated with benzoic acid, citric acid, lactic acid, malic acid, or oxalic acid. The nicotine salt aerosols had different HPHC profiles than the freebase nicotine aerosols, indicating that the carboxylic acids were not innocent bystanders. The polycarboxylic acid e-liquids containing citric acid, malic acid, or oxalic acid produced higher acrolein yields than the monocarboxylic acid e-liquids containing benzoic acid or lactic acid. Across most PG:VG ratios, nicotine benzoate or nicotine lactate aerosols contained the highest nicotine quantities (in %) and the highest nicotine yields (per milligram of aerosol). Additionally, the nicotine benzoate and nicotine lactate e-liquids produced the highest carboxylic acid yields under all tested conditions. The lower acid yields of the citric, malic, and oxalic acid formulations are potentially due to a combination of factors such as lower transfer efficiencies, lower thermostabilities, and greater susceptibility to side reactions because of their additional carboxyl groups serving as new sites for reactivity. For all nicotine formulations, the particle size characteristics were primarily controlled by the e-liquid solvent ratios, and there were no clear trends between nicotine salt and freebase nicotine aerosols that indicated nicotine protonation affected particle size. The carboxylic acids impacted aerosol output, nicotine delivery, and HPHC yields in distinct ways such that interchanging them in ENDS can potentially cause downstream effects.
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Affiliation(s)
- Trevor Harris
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland 20993, United States
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3
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Zora-Guzman E, Guzman-Sepulveda JR. Optical characterization of native aerosols from e-cigarettes in localized volumes. BIOMEDICAL OPTICS EXPRESS 2024; 15:1697-1708. [PMID: 38495726 PMCID: PMC10942682 DOI: 10.1364/boe.507316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/17/2024] [Accepted: 02/06/2024] [Indexed: 03/19/2024]
Abstract
Measuring the size distribution of aerosols typically requires processing a sample, specifically to adjust the particle concentration to an adequate level. Unfortunately, this manipulation can significantly alter the native composition of some aerosols, which can lead to unreliable or even unusable measurements. We demonstrate that coherence-gated dynamic light scattering is suitable to measure the size distribution of native aerosols without the need for sample processing. Another novel aspect of the present work is the first demonstration of these type of localized light-scattering-based measurements in aerial media. Measuring the size distribution reliably in optically dense aerosols is possible thanks to the interferometric amplification of single scattering in an optically isolated, picolitre-sized coherence volume. We carried out proof-of-concept experiments in aerosols from electronic cigarettes, which poses a challenge mainly due to their high concentration, volatility, and hygroscopicity. We generated aerosols using two common moisturizers, propylene glycol and glycerol, and measured their particle size distribution as a function of the burning power. The aerosols generated in the presence of glycerol are more polydisperse and have larger particles with increasing burning power. This unique characterization of native aerosols can provide valuable information for dosimetry and hosting sites in the respiratory system.
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Affiliation(s)
- Erick Zora-Guzman
- Centro de Investigación y de Estudios Avanzados del IPN, Unidad Monterrey, Vía del Conocimiento 201, Parque de Investigación e Innovacion Tecnológica, km 9.5 de la Autopista Nueva al Aeropuerto, Apodaca, Nuevo Leon 66600, Mexico
| | - Jose R. Guzman-Sepulveda
- Centro de Investigación y de Estudios Avanzados del IPN, Unidad Monterrey, Vía del Conocimiento 201, Parque de Investigación e Innovacion Tecnológica, km 9.5 de la Autopista Nueva al Aeropuerto, Apodaca, Nuevo Leon 66600, Mexico
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4
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Jaafar A, Albarazanchi A, Kadhim MJ, Darvin ME, Váczi T, Tuchin VV, Veres M. Impact of e-cigarette liquid on porcine lung tissue-Ex vivo confocal Raman micro-spectroscopy study. JOURNAL OF BIOPHOTONICS 2023:e202300336. [PMID: 37851480 DOI: 10.1002/jbio.202300336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 10/19/2023]
Abstract
Ex vivo porcine lung immersed in e-liquid was investigated in-depth using confocal Raman micro-spectroscopy to assess the e-liquid influence on the lung. It was found that lung-related Raman band intensities at 1002, 1548, 1618 and 1655 cm-1 increased after first and second treatments except the surface, which was attributed to the well-known optical clearing (OC) effect due to alveoli filling with e-liquid resulting in light scattering reduction. The autofluorescence enhancement was explained by oxidative stress induced in lung during exposure to e-liquid. Moreover, e-liquid induced collagen dehydration was revealed by the I937 /I926 Raman band intensity ratio change. The effect was enhanced after the second treatment of the same lung tissue that indicates the possibility of multi-step OC treatment. We hypothesize that the nicotine-flavour-free e-liquids containing glycerol and propylene glycol could potentially be used in clinical protocols as OC agent for enhanced in-depth Raman-guided bronchoscopy.
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Affiliation(s)
- Ali Jaafar
- Institute for Solid State Physics and Optics, Wigner Research Center for Physics, Budapest, Hungary
- Institute of Physics, University of Szeged, Szeged, Hungary
- Ministry of Higher Education and Scientific Research, Baghdad, Iraq
| | - Abbas Albarazanchi
- Department of Physics, College of Science, Mustansiriyah University, Baghdad, Iraq
| | | | | | - Tamás Váczi
- Institute for Solid State Physics and Optics, Wigner Research Center for Physics, Budapest, Hungary
| | - Valery V Tuchin
- Institute of Physics and Science Medical Center, Saratov State University, Saratov, Russia
- Laboratory of Laser Diagnostics of Technical and Living Systems, Institute of Precision Mechanics and Control, FRC "Saratov Scientific Centre of the Russian Academy of Sciences", Saratov, Russia
| | - Miklós Veres
- Institute for Solid State Physics and Optics, Wigner Research Center for Physics, Budapest, Hungary
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5
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Kolaczyk K, Jiang H. Photometric Monitoring of Electronic Cigarette Puff Topography. SENSORS (BASEL, SWITZERLAND) 2023; 23:8220. [PMID: 37837050 PMCID: PMC10575377 DOI: 10.3390/s23198220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023]
Abstract
To study and monitor the adverse health consequences of using electronic cigarettes, a user's puff topography, which are quantification parameters of the user's vaping habits, plays a central role. In this work, we introduce a topography sensor to measure the mass of total particulate matter generated in every puff and to estimate the nicotine yield. The sensor is compact and low-cost, and is integrated into the electronic cigarette device to promptly and conveniently monitor the user's daily puff topography. The topography sensor is comprised of a photometric sensor and a pressure sensor. The photometric sensor measures the mass concentration of the aerosol, based on scattering of near-infrared light from airborne particles, while the pressure sensor measures the flow rate. The topography sensor was tested under various conditions including a wide range of atomizer power, puff duration, and inhalation pressure. The sensor's accuracy was validated by comparing the sensor's readings with reference measurements, and the results matched closely with the trends reported by existing studies on electronic cigarettes. An example application for tracking a user's puff topography was also demonstrated. Our topography sensor holds great promise in mitigating the health risks of vaping, and in promoting quality control of electronic cigarette products.
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6
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Vedøy TF, Lund KE. How do Smokers in a Snus-Prevalent Society Consider E-cigarettes, Snus, and Nicotine Replacement Therapy Products as Relevant Replacements for Cigarettes in the Event They Should Stop Smoking? Nicotine Tob Res 2023; 25:1753-1761. [PMID: 37410922 PMCID: PMC10475606 DOI: 10.1093/ntr/ntad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/24/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Around 50 percent of the tobacco in Norway is consumed in the form of snus, a smokeless oral tobacco. We examined Norwegian smokers' openness, and thereby the potential reach, to use e-cigarettes, nicotine replacement therapy products (NRT), and snus in the event of quitting smoking, in a society where snus use is common. METHODS Using data from an online survey of 4073 smokers from 2019 to 2021, we calculated predicted probabilities of smokers' being open, undecided, and not open to use e-cigarettes, snus, and NRT in the event they should quit smoking. RESULTS Among daily smokers, the probability of being open to use e-cigarettes in the event of quitting smoking was .32. The corresponding probabilities for using snus and NRT were .22 and .19. Snus was the product with the highest probability of not being open (.60). NRT had the highest probability of being undecided (.39). Among smokers who had never used e-cigarettes or snus, the probabilities of being open were .13 for e-cigarettes, .02 for snus and .11 for NRT. CONCLUSIONS In a snus-friendly norm climate where smokers have traditionally used snus as an alternative to cigarettes, the probability of using e-cigarettes in the event of smoking cessation was higher compared to both snus and NRT. However, among smokers who had never used e-cigarettes or snus, the likelihood of being open to use of NRT was similar to e-cigarettes, and higher than snus, which suggests that NRT may still play a role in smoking cessation. IMPLICATIONS In a snus-prevalent country in the endgame phase of the cigarette epidemic, where robust infrastructure for tobacco control in combination with the availability of snus has reduced smoking to a minimum, the remaining smokers seem to prefer e-cigarettes to snus if they should quit smoking. This indicates that availability of several nicotine alternatives might increase the likelihood of a future product replacement within the small group of remaining smokers.
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Affiliation(s)
- Tord Finne Vedøy
- Department Alcohol, Tobacco, and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Karl Erik Lund
- Department Alcohol, Tobacco, and Drugs, Norwegian Institute of Public Health, Oslo, Norway
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7
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Lee J, Su WC, Han I. Understanding the influence of atomizing power on electronic cigarette aerosol size and inhalation dose estimation. AEROSOL SCIENCE AND TECHNOLOGY : THE JOURNAL OF THE AMERICAN ASSOCIATION FOR AEROSOL RESEARCH 2023; 57:633-644. [PMID: 37997608 PMCID: PMC10665025 DOI: 10.1080/02786826.2023.2202753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/24/2023] [Indexed: 11/25/2023]
Abstract
Although many studies have estimated the inhalation dose of aerosols emitted from electronic cigarettes (e-cigs), the association between the atomizing power and inhalation dose of e-cig aerosols has not been fully examined. The aim of this study was to determine the mass and inhalation doses of e-cig aerosols and their association with the atomizing power of vaping devices. Size-segregated aerosol masses were collected using an 11-stage cascade impactor and the deposition dose in the human respiratory tract was estimated using the size-segregated aerosol mass. The results showed that an increase in atomizing power was positively associated with the amount of aerosol mass generated (p-value < 0.001). The mass median aerodynamic diameter and mass mean diameter of aerosol were 0.91 μm and 0.84 μm, respectively. The average deposition fractions of aerosols in the head airway, tracheobronchial region, and alveolar region were 67.2, 6.2, and 26.6%, respectively. In conclusion, vaping with a higher atomizing power increases the e-cig aerosol inhalation dose in the airway.
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Affiliation(s)
- Jinho Lee
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Texas USA
| | - Wei-Chung Su
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Texas USA
- Southwest Center for Occupational and Environmental Health (SWCOEH), School of Public Health, University of Texas Health Science Center at Houston, Texas, USA
| | - Inkyu Han
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Pennsylvania, USA
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8
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Ranpara A, Stefaniak AB, Fernandez E, Bowers LN, Arnold ED, LeBouf RF. Influence of puff topographies on e-liquid heating temperature, emission characteristics and modeled lung deposition of Puff Bar ™. AEROSOL SCIENCE AND TECHNOLOGY : THE JOURNAL OF THE AMERICAN ASSOCIATION FOR AEROSOL RESEARCH 2023; 57:450-466. [PMID: 37969359 PMCID: PMC10641718 DOI: 10.1080/02786826.2023.2190786] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/27/2023] [Indexed: 11/17/2023]
Abstract
Puff Bar™, one of the latest designs of e-cigarettes, heats a mixture of liquid using a battery-powered coil at certain temperatures to emit aerosol. This study presents a mass-based characterization of emissions from seven flavors of Puff Bar™ devices by aerosolizing with three puff topographies [(puff volume: 55 < 65 < 75-mL) within 4-seconds at 30-seconds interval]. We evaluated the effects of puff topographies on heating temperatures; characterized particles using a cascade impactor; and measured volatile carbonyl compounds (VCCs). Modeled dosimetry and calculated mass median aerodynamic diameters (MMADs) were used to estimate regional, total respiratory deposition of the inhaled aerosol and exhaled fractions that could pose secondhand exposure risk. Temperatures of Puff Bar™ e-liquids increased with increasing puff volumes: 55mL (116.6 °C), 65 mL (128.3 °C), and 75mL (168.9 °C). Flavor types significantly influenced MMADs, total mass of particles, and VCCs (μg/puff: 2.15-2.30) in Puff Bar™ emissions (p < 0.05). Increasing puff volume (mL:55 < 65 < 75) significantly increased total mass (mg/puff: 4.6 < 5.6 < 6.2) of particles without substantially changing MMADs (~1μm:1.02~0.99~0.98). Aerosol emissions were estimated to deposit in the pulmonary region of e-cigarette user (41-44%), which could have toxicological importance. More than 2/3 (67-77%) of inhaled particles were estimated to be exhaled by users, which could affect bystanders. The VCCs measured contained carcinogens-formaldehyde (29.6%) and acetaldehyde (16.4%)-as well as respiratory irritants: acetone (23.9%), isovaleraldehyde (14.5%), and acrolein (4.9%). As Puff Bar™ emissions contain respirable particles and harmful chemicals, efforts should be made to minimize exposures, especially in indoor settings where people (including vulnerable populations) spend most of their life-time.
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Affiliation(s)
- Anand Ranpara
- Department of Physiology and Pharmacology, School of Medicine, West Virginia University, Health Science Center, Morgantown, West Virginia, USA
| | - Aleksandr B. Stefaniak
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Elizabeth Fernandez
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Lauren N. Bowers
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Elizabeth D. Arnold
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Ryan F. LeBouf
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
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9
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Canchola A, Langmo S, Meletz R, Lum M, Lin YH. External Factors Modulating Vaping-Induced Thermal Degradation of Vitamin E Acetate. Chem Res Toxicol 2023; 36:83-93. [PMID: 36534744 PMCID: PMC9846828 DOI: 10.1021/acs.chemrestox.2c00298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Indexed: 12/23/2022]
Abstract
Despite previous studies indicating the thermal stability of vitamin E acetate (VEA) at low temperatures, VEA has been shown to readily decompose into various degradation products such as alkenes, long-chain alcohols, and carbonyls such as duroquinone (DQ) at vaping temperatures of <200 °C. While most models simulate the thermal decomposition of e-liquids under pyrolysis conditions, numerous factors, including vaping behavior, device construction, and the surrounding environment, may impact the thermal degradation process. In this study, we investigated the role of the presence of molecular oxygen (O2) and transition metals in promoting thermal oxidation of e-liquids, resulting in greater degradation than predicted by pure pyrolysis. Thermal degradation of VEA was performed in inert (N2) and oxidizing atmospheres (clean air) in the absence and presence of Ni-Cr and Cu-Ni alloy nanopowders, metals commonly found in the heating coil and body of e-cigarettes. VEA degradation was analyzed using thermogravimetric analysis (TGA) and gas chromatography/mass spectrometry (GC/MS). While the presence of O2 was found to significantly enhance the degradation of VEA at both high (356 °C) and low (176 °C) temperatures, the addition of Cu-Ni to oxidizing atmospheres was found to greatly enhance VEA degradation, resulting in the formation of numerous degradation products previously identified in VEA vaping emissions. O2 and Cu-Ni nanopowder together were also found to significantly increase the production of OH radicals, which has implications for e-liquid degradation pathways as well as the potential risk of oxidative damage to biological systems in real-world vaping scenarios. Ultimately, the results presented in this study highlight the importance of oxidation pathways in VEA thermal degradation and may aid in the prediction of thermal degradation products from e-liquids.
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Affiliation(s)
- Alexa Canchola
- Environmental
Toxicology Graduate Program, University
of California, Riverside, California 92521, United States
| | - Siri Langmo
- Department
of Evolution, Ecology, and Organismal Biology, University of California, Riverside, California 92521, United States
| | - Ruth Meletz
- Department
of Environmental Sciences, University of
California, Riverside, California 92521, United States
| | - Michael Lum
- Department
of Environmental Sciences, University of
California, Riverside, California 92521, United States
| | - Ying-Hsuan Lin
- Environmental
Toxicology Graduate Program, University
of California, Riverside, California 92521, United States
- Department
of Environmental Sciences, University of
California, Riverside, California 92521, United States
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10
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Dibaji SAR, Oktem B, Williamson L, DuMond J, Cecil T, Kim JP, Wickramasekara S, Myers M, Guha S. Characterization of aerosols generated by high-power electronic nicotine delivery systems (ENDS): Influence of atomizer, temperature and PG:VG ratios. PLoS One 2022; 17:e0279309. [PMID: 36538548 PMCID: PMC9767331 DOI: 10.1371/journal.pone.0279309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
The aerosol characteristics of electronic nicotine delivery systems (ENDS) are important parameters in predicting health outcomes since parameters such as aerosol particle size correlate strongly to aerosol delivery and deposition efficiency. However, many studies to date do not account for aerosol aging, which may affect the measurement of ultra-fine particles that typically coagulate or agglomerate during puff development. To reduce aerosol aging, we herein present a unique instrumentation method that combines a) positive pressure ENDS activation and sample collection, b) minimization of both sample tubing length and dilution factors, and c) a high-resolution, electrical low-pressure impactor. This novel approach was applied to systematically investigate the effects of coil design, coil temperature, and propylene glycol to vegetable glycerol ratios on aerosol characteristics including aerosol mass generation, aerosol count generation, and the mass and count size distributions for a high-powered ENDS. Aerosol count measurements revealed high concentrations of ultra-fine particles compared to fine and coarse particles at 200°C, while aerosol mass measurements showed an increase in the overall aerosol mass of fine and coarse particles with increases in temperature and decreases in propylene glycol content. These results provide a better understanding on how various ENDS design parameters affect aerosol characteristics and highlight the need for further research to identify the design parameters that most impact ultra-fine particle generation.
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Affiliation(s)
| | - Berk Oktem
- Office of Science and Engineering Laboratories, Silver Spring, MD, United States of America
| | - Lee Williamson
- Center for Tobacco Products, Office of Science, Silver Spring, MD, United States of America
| | - Jenna DuMond
- Center for Tobacco Products, Office of Science, Silver Spring, MD, United States of America
| | - Todd Cecil
- Center for Tobacco Products, Office of Science, Silver Spring, MD, United States of America
| | - Jimin P. Kim
- Center for Tobacco Products, Office of Science, Silver Spring, MD, United States of America
| | | | - Matthew Myers
- Office of Science and Engineering Laboratories, Silver Spring, MD, United States of America
| | - Suvajyoti Guha
- Office of Science and Engineering Laboratories, Silver Spring, MD, United States of America
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11
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Hinds DM, Nick HJ, Vallin TM, Bloomquist LA, Christeson S, Bratcher PE, Cooper EH, Brinton JT, Bosco-Lauth A, White CW. Acute vaping in a golden Syrian hamster causes inflammatory response transcriptomic changes. Am J Physiol Lung Cell Mol Physiol 2022; 323:L525-L535. [PMID: 36041220 PMCID: PMC9602905 DOI: 10.1152/ajplung.00162.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
E-cigarette vaping is a major aspect of nicotine consumption, especially for children and young adults. Although it is branded as a safer alternative to cigarette smoking, murine and rat models of subacute and chronic e-cigarette vaping exposure have shown many proinflammatory changes in the respiratory tract. An acute vaping exposure paradigm has not been demonstrated in the golden Syrian hamster, and the hamster is a readily available small animal model that has the unique benefit of becoming infected with and transmitting respiratory viruses, including SARS-CoV-2, without genetic alteration of the animal or virus. Using a 2-day, whole body vaping exposure protocol in male golden Syrian hamsters, we evaluated serum cotinine, bronchoalveolar lavage cells, lung, and nasal histopathology, and gene expression in the nasopharynx and lung through reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Depending on the presence of nonnormality or outliers, statistical analysis was performed by ANOVA or Kruskal-Wallis tests. For tests that were statistically significant (P < 0.05), post hoc Tukey-Kramer and Dunn's tests, respectively, were performed to make pairwise comparisons between groups. In nasal tissue, RT-qPCR analysis revealed nicotine-dependent increases in gene expression associated with type 1 inflammation (CCL-5 and CXCL-10), fibrosis [transforming growth factor-β (TGF-β)], nicotine-independent increase oxidative stress response (SOD-2), and a nicotine-independent decrease in vasculogenesis/angiogenesis (VEGF-A). In the lung, nicotine-dependent increases in the expression of genes involved in the renin-angiotensin pathway [angiotensin-converting enzyme (ACE), ACE2], coagulation (tissue factor, Serpine-1), extracellular matrix remodeling (MMP-2, MMP-9), type 1 inflammation (IL-1β, TNF-α, and CXCL-10), fibrosis (TGF-β and Serpine-1), oxidative stress response (SOD-2), neutrophil extracellular traps release (ELANE), and vasculogenesis and angiogenesis (VEGF-A) were identified. To our knowledge, this is the first demonstration that the Syrian hamster is a viable model of e-cigarette vaping. In addition, this is the first report that e-cigarette vaping with nicotine can increase tissue factor gene expression in the lung. Our results show that even an acute exposure to e-cigarette vaping causes significant upregulation of mRNAs in the respiratory tract from pathways involving the renin-angiotensin system, coagulation, extracellular matrix remodeling, type 1 inflammation, fibrosis, oxidative stress response, neutrophil extracellular trap release (NETosis), vasculogenesis, and angiogenesis.
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Affiliation(s)
- Daniel M. Hinds
- 1Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | - Heidi J. Nick
- 2Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado,3Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Tessa M. Vallin
- 2Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Leslie A. Bloomquist
- 2Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sarah Christeson
- 2Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Preston E. Bratcher
- 2Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado,3Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Emily H. Cooper
- 2Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - John T. Brinton
- 2Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado,4Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Angela Bosco-Lauth
- 5Biomedical Sciences Department, Colorado State University, Fort Collins, Colorado
| | - Carl W. White
- 2Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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12
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Sussman RA, Golberstein E, Polosa R. Analytic modeling and risk assessment of aerial transmission of SARS-CoV-2 virus through vaping expirations in shared micro-environments. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:83020-83044. [PMID: 35754079 PMCID: PMC9244239 DOI: 10.1007/s11356-022-20499-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
It is well known that airborne transmission of COVID-19 in indoor spaces occurs through various respiratory activities: breathing, vocalizing, coughing, and sneezing. However, there is a complete lack of knowledge of its possible transmission through exhalations of e-cigarette aerosol (ECA), which is also a respiratory activity. E-cigarettes have become widely popular among smokers seeking a much safer way of nicotine consumption than smoking. Due to restrictive lockdown measures taken during the COVID-19 pandemic, many smokers and vapers (e-cigarette users) were confined to shared indoor spaces, making it necessary to assess the risk of SARS-CoV-2 virus aerial transmission through their exhalations. We summarize inferred knowledge of respiratory particles emission and transport through ECA, as well as a theoretical framework for explaining the visibility of exhaled ECA, which has safety implications and is absent in other respiratory activities (apart from smoking). We also summarize and briefly discuss the effects of new SARS-CoV-2 variants, vaccination rates, and environmental factors that may influence the spread of COVID-19. To estimate the risk of SARS-CoV-2 virus aerial transmission associated with vaping exhalations, we adapt a theoretical risk model that has been used to analyze the risks associated with other respiratory activities in shared indoor spaces. We consider home and restaurant scenarios, with natural and mechanical ventilation, with occupants wearing and not wearing face masks. We consider as "control case" or baseline risk scenario an indoor space (home and restaurant) where respiratory droplets and droplet nuclei are uniformly distributed and aerial contagion risk might originate exclusively from occupants exclusively rest breathing, assuming this to be the only (unavoidable) respiratory activity they all carry on. If an infected occupant uses an e-cigarette in a home or restaurant scenarios, bystanders not wearing face masks exposed to the resulting ECA expirations face a [Formula: see text] increase of risk of contagion with respect the control case. This relative added risk with respect to the control case becomes [Formula: see text] for high-intensity vaping, [Formula: see text], and over [Formula: see text] for speaking for various periods or coughing (all without vaping). Infectious emissions are significantly modified by mechanical ventilation, face mask usage, vaccination, and environmental factors, but given the lack of empiric evidence, we assume as a working hypothesis that all basic parameters of respiratory activities are equally (or roughly equally) affected by these factors. Hence, the relative risk percentages with respect to the control state should remain roughly the same under a wide range of varying conditions. By avoiding direct exposure to the visible exhaled vaping jet, wearers of commonly used face masks are well protected from respiratory droplets and droplet nuclei directly emitted by mask-less vapers. Compared to the control case of an already existing (unavoidable) risk from continuous breathing, vaping emissions in shared indoor spaces pose just a negligible additional risk of COVID-19 contagion. We consider that it is not necessary to take additional preventive measures beyond those already prescribed (1.5 m separation and wearing face masks) in order to protect bystanders from this contagion.
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Affiliation(s)
- Roberto A Sussman
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, 04510, Mexico City, Mexico
| | - Eliana Golberstein
- Myriad Pharmaceuticals Limited, Unit 3, 36 Greenpark Rd, Penrose, 1061, Auckland, New Zealand
| | - Riccardo Polosa
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy.
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13
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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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14
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Abstract
Widespread uptake of vaping has signaled a sea change in the future of nicotine consumption. Vaping has grown in popularity over the past decade, in part propelled by innovations in vape pen design and nicotine flavoring. Teens and young adults have seen the biggest uptake in use of vape pens, which have superseded conventional cigarettes as the preferred modality of nicotine consumption. Relatively little is known, however, about the potential effects of chronic vaping on the respiratory system. Further, the role of vaping as a tool of smoking cessation and tobacco harm reduction remains controversial. The 2019 E-cigarette or Vaping Use-Associated Lung Injury (EVALI) outbreak highlighted the potential harms of vaping, and the consequences of long term use remain unknown. Here, we review the growing body of literature investigating the impacts of vaping on respiratory health. We review the clinical manifestations of vaping related lung injury, including the EVALI outbreak, as well as the effects of chronic vaping on respiratory health and covid-19 outcomes. We conclude that vaping is not without risk, and that further investigation is required to establish clear public policy guidance and regulation.
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Affiliation(s)
- Andrea Jonas
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Stanford University, Stanford, CA, USA
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15
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Canchola A, Meletz R, Khandakar RA, Woods M, Lin YH. Temperature dependence of emission product distribution from vaping of vitamin E acetate. PLoS One 2022; 17:e0265365. [PMID: 35324938 PMCID: PMC8947410 DOI: 10.1371/journal.pone.0265365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/26/2022] [Indexed: 01/01/2023] Open
Abstract
Nearly two years after vitamin E acetate (VEA) was identified as the potential cause of the 2019–2020 outbreak of e-cigarette, or vaping product-associated lung injuries (EVALI), the toxicity mechanisms of VEA vaping are still yet to be fully understood. Studies since the outbreak have found that e-liquids such as VEA undergo thermal degradation during the vaping process to produce various degradation products, which may pose a greater risk of toxicity than exposure to unvaped VEA. Additionally, a wide range of customizable parameters–including the model of e-cigarette used, puffing topography, or the applied power/temperature used to generate aerosols–have been found to influence the physical properties and chemical compositions of vaping emissions. However, the impact of heating coil temperature on the chemical composition of VEA vaping emissions has not been fully assessed. In this study, we investigated the emission product distribution of VEA vaping emissions produced at temperatures ranging from 176 to 356°C, corresponding to a variable voltage vape pen set at 3.3 to 4.8V. VEA degradation was found to be greatly enhanced with increasing temperature, resulting in a shift towards the production of lower molecular weight compounds, such as the redox active duroquinone (DQ) and short-chain alkenes. Low temperature vaping of VEA resulted in the production of long-chain molecules, such as phytol, exposure to which has been suggested to induce lung damage in previous studies. Furthermore, differential product distribution was observed in VEA degradation products generated from vaping and from pyrolysis using a tube furnace in the absence of the heating coil at equivalent temperatures, suggesting the presence of external factors such as metals or oxidation that may enhance VEA degradation during vaping. Overall, our findings indicate that vaping behavior may significantly impact the risk of exposure to toxic vaping products and potential for vaping-related health concerns.
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Affiliation(s)
- Alexa Canchola
- Environmental Toxicology Graduate Program, University of California, Riverside, CA, United States of America
| | - Ruth Meletz
- Department of Environmental Sciences, University of California, Riverside, CA, United States of America
| | - Riste Ara Khandakar
- Department of Environmental Sciences, University of California, Riverside, CA, United States of America
| | - Megan Woods
- Department of Chemistry, University of California, Riverside, CA, United States of America
| | - Ying-Hsuan Lin
- Environmental Toxicology Graduate Program, University of California, Riverside, CA, United States of America
- Department of Environmental Sciences, University of California, Riverside, CA, United States of America
- * E-mail:
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16
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Marrocco A, Singh D, Christiani DC, Demokritou P. E-Cigarette (E-Cig) Liquid Composition and Operational Voltage Define the In Vitro Toxicity of Δ8Tetrahydrocannabinol/Vitamin E Acetate (Δ8THC/VEA) E-Cig Aerosols. Toxicol Sci 2022; 187:279-297. [PMID: 35478015 PMCID: PMC9154258 DOI: 10.1093/toxsci/kfac047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The 2019 United States outbreak of E-cigarette (e-cig), or Vaping, Associated Acute Lung Injury (EVALI) has been linked to presence of vitamin E acetate (VEA) in Δ8tetrahydrocannabinol (Δ8THC)-containing e-liquids, as supported by VEA detection in patient biological samples. However, the pathogenesis of EVALI and the complex physicochemical properties of e-cig emissions remain unclear, raising concerns on health risks of vaping. This study investigates the effect of Δ8THC/VEA e-liquids and e-cig operational voltage on in vitro toxicity of e-cig aerosols. A novel E-cigExposure Generation System platform was used to generate and characterize e-cig aerosols from a panel of Δ8THC/VEA or nicotine-based e-liquids at 3.7 or 5 V. Human lung Calu-3 cells and THP-1 monocytes were exposed to cell culture media conditioned with collected e-cig aerosol condensate at doses of 85 and 257 puffs/m2 lung surface for 24 h, whereafter specific toxicological endpoints were assessed (including cytotoxicity, metabolic activity, reactive oxygen species generation, apoptosis, and inflammatory cytokines). Higher concentrations of gaseous volatile organic compounds were emitted from Δ8THC/VEA compared with nicotine-based e-liquids, especially at 5 V. Emitted PM2.5 concentrations in aerosol were higher for Δ8THC/VEA at 5 V and averagely for nicotine-based e-liquids at 3.7 V. Overall, aerosols from nicotine-based e-liquids showed higher bioactivity than Δ8THC/VEA aerosols in THP-1 cells, with no apparent differences in Calu-3 cells. Importantly, presence of VEA in Δ8THC and menthol flavoring in nicotine-based e-liquids increased cytotoxicity of aerosols across both cell lines, especially at 5 V. This study systematically investigates the physicochemical and toxicological properties of a model of Δ8THC/VEA and nicotine e-cigarette condensate exposure demonstrating that pyrolysis of these mixtures can generate hazardous toxicants whose synergistic actions potentially drive acute lung injury upon inhalation.
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Affiliation(s)
- Antonella Marrocco
- To whom correspondence should be addressed at Department of Environmental Health, Center for Nanotechnology and Nanotoxicology, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 1, Room 1310, Boston, MA 02115, USA. E-mail:
| | - Dilpreet Singh
- Department of Environmental Health, Center for Nanotechnology and Nanotoxicology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA
| | - David C Christiani
- Department of Environmental Health, Center for Nanotechnology and Nanotoxicology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA
| | - Philip Demokritou
- Department of Environmental Health, Center for Nanotechnology and Nanotoxicology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA,Department of Environmental and Population Health Bio-Sciences, Environmental Occupational Health Sciences Institute, School of Public Health, Rutgers University, Piscataway, New Jersey 08854, USA
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17
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Kapiamba KF, Hao W, Adom S, Liu W, Huang YW, Wang Y. Examining Metal Contents in Primary and Secondhand Aerosols Released by Electronic Cigarettes. Chem Res Toxicol 2022; 35:954-962. [PMID: 35385266 DOI: 10.1021/acs.chemrestox.1c00411] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The usage of electronic cigarettes (ECs) has surged since their invention two decades ago. However, to date, the health effects of EC aerosol exposure are still not well understood because of insufficient data on the chemical composition of EC aerosols and the corresponding evidence of health risks upon exposure. Herein, we quantified the metals in primary and secondhand aerosols generated by three brands of ECs. By combining aerosol filter sampling and inductively coupled plasma mass spectrometry (ICP-MS), we assessed the mass of metals as a function of EC flavoring, nicotine concentration, device power, puff duration, and aging of the devices. The masses of Cr, Cu, Mn, Ni, Cu, and Zn were consistently high across all brands in the primary and secondhand aerosols, some of which were above the regulated maximum daily intake amount, especially for Cr and Ni with mass (nanograms per 10 puffs) emitted at 117 ± 54 and 50 ± 24 (JUUL), 125 ± 77 and 219 ± 203 (VOOPOO), and 33 ± 10 and 27 ± 2 (Vapor4Life). Our analysis indicates that the metals are predominantly released from the EC liquid, potentially through mechanisms such as bubble bursting or the vaporization of metal-organic compounds. High metal contents were also observed in simulated secondhand aerosols, generally 80-90% of those in primary aerosols. Our findings provide a more detailed understanding of the metal emission characteristics of EC for assessing its health effects and policymaking.
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Affiliation(s)
- Kashala Fabrice Kapiamba
- Department of Civil, Architectural and Environmental Engineering, Missouri University of Science and Technology, Rolla, Missouri 65409, United States
| | - Weixing Hao
- Department of Civil, Architectural and Environmental Engineering, Missouri University of Science and Technology, Rolla, Missouri 65409, United States
| | - Stephen Adom
- Department of Chemistry and Center for Research in Energy and Environment, Missouri University of Science and Technology, Rolla, Missouri 65409, United States
| | - Wenyan Liu
- Department of Chemistry and Center for Research in Energy and Environment, Missouri University of Science and Technology, Rolla, Missouri 65409, United States
| | - Yue-Wern Huang
- Department of Biological Sciences, Missouri University of Science and Technology, Rolla, Missouri 65409, United States
| | - Yang Wang
- Department of Civil, Architectural and Environmental Engineering, Missouri University of Science and Technology, Rolla, Missouri 65409, United States
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18
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Stefaniak AB, Ranpara AC, Virji MA, LeBouf RF. Influence of E-Liquid Humectants, Nicotine, and Flavorings on Aerosol Particle Size Distribution and Implications for Modeling Respiratory Deposition. Front Public Health 2022; 10:782068. [PMID: 35372219 PMCID: PMC8968757 DOI: 10.3389/fpubh.2022.782068] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/15/2022] [Indexed: 01/10/2023] Open
Abstract
Electronic cigarette, or vaping, products are used to heat an e-liquid to form an aerosol (liquid droplets suspended in gas) that the user inhales; a portion of this aerosol deposits in their respiratory tract and the remainder is exhaled, thereby potentially creating opportunity for secondhand exposure to bystanders (e.g., in homes, automobiles, and workplaces). Particle size, a critical factor in respiratory deposition (and therefore potential for secondhand exposure), could be influenced by e-liquid composition. Hence, the purposes of this study were to (1) test the influence of laboratory-prepared e-liquid composition [ratio of propylene glycol (PG) to vegetable glycerin (VG) humectants, nicotine, and flavorings] on particle size distribution and (2) model respiratory dosimetry. All e-liquids were aerosolized using a second-generation reference e-cigarette. We measured particle size distribution based on mass using a low-flow cascade impactor (LFCI) and size distribution based on number using real-time mobility sizers. Mass median aerodynamic diameters (MMADs) of aerosol from e-liquids that contained only humectants were significantly larger compared with e-liquids that contained flavorings or nicotine (p = 0.005). Humectant ratio significantly influenced MMADs; all aerosols from e-liquids prepared with 70:30 PG:VG were significantly larger compared with e-liquids prepared with 30:70 PG:VG (p = 0.017). In contrast to the LFCI approach, the high dilution and sampling flow rate of a fast mobility particle sizer strongly influenced particle size measurements (i.e., all calculated MMAD values were < 75 nm). Dosimetry modeling using LFCI data indicated that a portion of inhaled particles will deposit throughout the respiratory tract, though statistical differences in aerosol MMADs among e-liquid formulations did not translate into large differences in deposition estimates. A portion of inhaled aerosol will be exhaled and could be a source for secondhand exposure. Use of laboratory-prepared e-liquids and a reference e-cigarette to standardize aerosol generation and a LFCI to measure particle size distribution without dilution represents an improved method to characterize physical properties of volatile aerosol particles and permitted determination of MMAD values more representative of e-cigarette aerosol in situ, which in turn, can help to improve dose modeling for users and bystanders.
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19
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Das D, Alam El Din SM, Pulczinski J, Mihalic JN, Chen R, Bressler J, Rule AM, Ramachandran G. Assessing variability of aerosols generated from e-Cigarettes. Inhal Toxicol 2022; 34:90-98. [PMID: 35275758 DOI: 10.1080/08958378.2022.2044414] [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: 11/05/2022]
Abstract
While some in vitro and in vivo experiments have studied the toxic effects of e-cigarette (e-cig) components, the typical aerosol properties released from e-cigarettes have not been well characterized. In the present study, we characterized the variability in mass concentration and particle size distribution associated with the aerosol generation of different devices and e-liquid compositions in an experimental setup. The findings of this study indicate a large inter-day variability in the experiments, likely due to poor quality control in some e-cig devices, pointing to the need for a better understanding of all the factors affecting exposures in in vitro and in vivo experiments, and the development of standardized protocols for generation and measurement of e-cig aerosols.
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Affiliation(s)
- Darpan Das
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sarah-Marie Alam El Din
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jairus Pulczinski
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jana N Mihalic
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rui Chen
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph Bressler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ana M Rule
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gurumurthy Ramachandran
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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20
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Effect of Heating on Physicochemical Property of Aerosols during Vaping. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031892. [PMID: 35162914 PMCID: PMC8835267 DOI: 10.3390/ijerph19031892] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022]
Abstract
Many electronic cigarette manufacturers have offered different types of “high-end mods” that allow for controlled heating of the e-liquid. However, the controlled heating condition can drastically alter the inhaled aerosols’ physical properties and chemical substances, causing potential health risks. To investigate the contribution of heating on aerosol properties, we used four common power settings in the mods to conduct a physicochemical analysis. Our data showed that the aerosol mass and nicotine content in the aerosols increased at high power. Additionally, high power led to aerosolization of a viscous component in the e-liquid, increasing the viscosity of aerosol. However, the pH of the aerosol was constant regardless of the applied power. In addition, high-power operation made nicotine prone to oxidation, resulting in the color of the aerosol turning yellow. Lastly, we demonstrated that e-cigarette aerosol could contain various metals, including aluminum, arsenic, cadmium, chromium, copper, iron, magnesium, nickel, lead, and zinc. Even though these metal contents proportionally increased with the power setting, they remained far below the recommended exposure limits. Our finding demonstrates that the heating conditions of the e-cigarette change the physicochemical properties of the aerosols and their metal contents, thereby possibly affecting users’ oral and respiratory systems.
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21
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Oar MA, Savage CH, Rufer ES, Rucker RP, Guzman JA. Thermography of cannabis extract vaporization cartridge heating coils in temperature- and voltage-controlled systems during a simulated human puff. PLoS One 2022; 17:e0262265. [PMID: 35081135 PMCID: PMC8791474 DOI: 10.1371/journal.pone.0262265] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 12/19/2021] [Indexed: 01/13/2023] Open
Abstract
Vaporized cannabis is believed to be safer than smoking, but when heated to excessive temperatures nearing combustion (>900 °C) harmful byproducts may form. While some cannabis extract vaporizers operate well below these high temperatures, heating coil temperatures obtained during actual use are frequently not reported and many operate at high temperatures. We report on two major objectives: 1) development of an infrared thermography method to measure heating coil temperatures in cannabis extract vaporizers during a simulated puff and 2) a comparison of temperature- to voltage- controlled cannabis extract vaporization systems during a puff. Infrared thermography was used to measure heating coil temperatures in one temperature-controlled and two voltage-controlled systems. The cartridges were modified for direct line-of-sight on the heating coils, the wick and coils were saturated with cannabis extract, and fixtures were developed to force two liters per minute air flow past the coils for the full duration of the puff allowed by the device. The voltage-controlled systems produced higher temperatures with greater variability than the temperature-controlled system. At the highest temperature setting (420 °C) the temperature-controlled system reached an average heating coil temperature of 420 ± 9.5 °C whereas the 4.0V setting on the variable voltage system reached an average temperature of 543 ± 95.9 °C and the single voltage (3.2V) system an average of 450 ± 60.8 °C. The average temperature at the lowest setting (270 °C) on the temperature-controlled system was 246 ± 5.1 °C and the variable voltage system (2.4V) was 443 ± 56.1 °C. Voltage alone was a poor indicator of coil temperature and only the temperature-controlled system consistently maintained temperatures less than 400 °C for the full puff duration. These lower temperatures could reduce the likelihood of harmful thermal degradation products and thus may reduce potential health risk to consumers when vaporizing cannabis extracts.
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Affiliation(s)
- Michael A. Oar
- Product Integrity, PAX Labs, Inc., San Francisco, California, United States of America
- * E-mail:
| | - Cynthia H. Savage
- Product Integrity, PAX Labs, Inc., San Francisco, California, United States of America
| | - Echoleah S. Rufer
- Biocompatibility and Toxicology, PAX Labs, Inc., San Francisco, California, United States of America
| | - Richard P. Rucker
- Product Integrity, PAX Labs, Inc., San Francisco, California, United States of America
| | - Jesse A. Guzman
- Product Integrity, PAX Labs, Inc., San Francisco, California, United States of America
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22
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Palazzolo DL, Caudill J, Baron J, Cooper K. Fabrication and Validation of an Economical, Programmable, Dual-Channel, Electronic Cigarette Aerosol Generator. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413190. [PMID: 34948804 PMCID: PMC8703563 DOI: 10.3390/ijerph182413190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
Vaping (inhalation of electronic cigarette-generated aerosol) is a public health concern. Due to recent spikes in adolescent use of electronic cigarettes (ECIGs) and vaping-induced illnesses, demand for scientific inquiry into the physiological effects of electronic cigarette (ECIG) aerosol has increased. For such studies, standardized and consistent aerosol production is required. Many labs generate aerosol by manually activating peristaltic pumps and ECIG devices simultaneously in a predefined manner. The tedium involved with this process (large puff number over time) and risk of error in keeping with puff topography (puff number, duration, interval) are less than optimal. Furthermore, excess puffing on an ECIG device results in battery depletion, reducing aerosol production, and ultimately, its chemical and physical nature. While commercial vaping machines are available, the cost of these machines is prohibitive to many labs. For these reasons, an economical and programmable ECIG aerosol generator, capable of generating aerosol from two atomizers simultaneously, was fabricated, and subsequently validated. Validation determinants include measurements of atomizer temperatures (inside and outside), electrical parameters (current, resistance and power) of the circuitry, aerosol particle distribution (particle counts and mass concentrations) and aerosol delivery (indexed by nicotine recovery), all during stressed conditions of four puffs/minute for 75 min (i.e., 300 puffs). Validation results indicate that the ECIG aerosol generator is better suited for experiments involving ≤100 puffs. Over 100 puffs, the amount of variation in the parameters measured tends to increase. Variations between channels are generally higher than variations within a channel. Despite significant variations in temperatures, electrical parameters, and aerosol particle distributions, both within and between channels, aerosol delivery remains remarkably stable for up to 300 puffs, yielding over 25% nicotine recovery for both channels. In conclusion, this programmable, dual-channel ECIG aerosol generator is not only affordable, but also allows the user to control puff topography and eliminate battery drain of ECIG devices. Consequently, this aerosol generator is valid, reliable, economical, capable of using a variety of E-liquids and amenable for use in a vast number of studies investigating the effects of ECIG-generated aerosol while utilizing a multitude of puffing regimens in a standardized manner.
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Affiliation(s)
- Dominic L. Palazzolo
- Department of Physiology, DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN 37752, USA; (J.C.); (J.B.)
- Correspondence:
| | - Jordan Caudill
- Department of Physiology, DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN 37752, USA; (J.C.); (J.B.)
| | - James Baron
- Department of Physiology, DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN 37752, USA; (J.C.); (J.B.)
| | - Kevin Cooper
- Department of Chemistry and Physics, School of Mathematics & Sciences, Lincoln Memorial University, Harrogate, TN 37752, USA;
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23
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Ranpara A, Stefaniak AB, Fernandez E, LeBouf RF. Effect of Puffing Behavior on Particle Size Distributions and Respiratory Depositions From Pod-Style Electronic Cigarette, or Vaping, Products. Front Public Health 2021; 9:750402. [PMID: 34926374 PMCID: PMC8671759 DOI: 10.3389/fpubh.2021.750402] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
The current fourth generation ("pod-style") electronic cigarette, or vaping, products (EVPs) heat a liquid ("e-liquid") contained in a reservoir ("pod") using a battery-powered coil to deliver aerosol into the lungs. A portion of inhaled EVP aerosol is estimated as exhaled, which can present a potential secondhand exposure risk to bystanders. The effects of modifiable factors using either a prefilled disposable or refillable pod-style EVPs on aerosol particle size distribution (PSD) and its respiratory deposition are poorly understood. In this study, the influence of up to six puff profiles (55-, 65-, and 75-ml puff volumes per 6.5 and 7.5 W EVP power settings) on PSD was evaluated using a popular pod-style EVP (JUUL® brand) and a cascade impactor. JUUL® brand EVPs were used to aerosolize the manufacturers' e-liquids in their disposable pods and laboratory prepared "reference e-liquid" (without flavorings or nicotine) in refillable pods. The modeled dosimetry and calculated aerosol mass median aerodynamic diameters (MMADs) were used to estimate regional respiratory deposition. From these results, exhaled fraction of EVP aerosols was calculated as a surrogate of the secondhand exposure potential. Overall, MMADs did not differ among puff profiles, except for 55- and 75-ml volumes at 7.5 W (p < 0.05). For the reference e-liquid, MMADs ranged from 1.02 to 1.23 μm and dosimetry calculations predicted that particles would deposit in the head region (36-41%), in the trachea-bronchial (TB) region (19-21%), and in the pulmonary region (40-43%). For commercial JUUL® e-liquids, MMADs ranged from 0.92 to 1.67 μm and modeling predicted that more particles would deposit in the head region (35-52%) and in the pulmonary region (30-42%). Overall, 30-40% of the particles aerosolized by a pod-style EVP were estimated to deposit in the pulmonary region and 50-70% of the inhaled EVP aerosols could be exhaled; the latter could present an inhalational hazard to bystanders in indoor occupational settings. More research is needed to understand the influence of other modifiable factors on PSD and exposure potential.
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Affiliation(s)
| | | | | | - Ryan F. LeBouf
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
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24
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Ranpara A, Stefaniak AB, Williams K, Fernandez E, LeBouf RF. Modeled Respiratory Tract Deposition of Aerosolized Oil Diluents Used in Δ 9-THC-Based Electronic Cigarette Liquid Products. Front Public Health 2021; 9:744166. [PMID: 34805068 PMCID: PMC8599147 DOI: 10.3389/fpubh.2021.744166] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/27/2021] [Indexed: 12/26/2022] Open
Abstract
Electronic cigarette, or vaping, products (EVP) heat liquids ("e-liquids") that contain substances (licit or illicit) and deliver aerosolized particles into the lungs. Commercially available oils such as Vitamin-E-acetate (VEA), Vitamin E oil, coconut, and medium chain triglycerides (MCT) were often the constituents of e-liquids associated with an e-cigarette, or vaping, product use-associated lung injury (EVALI). The objective of this study was to evaluate the mass-based physical characteristics of the aerosolized e-liquids prepared using these oil diluents. These characteristics were particle size distributions for modeling regional respiratory deposition and puff-based total aerosol mass for estimating the number of particles delivered to the respiratory tract. Four types of e-liquids were prepared by adding terpenes to oil diluents individually: VEA, Vitamin E oil, coconut oil, and MCT. A smoking machine was used to aerosolize each e-liquid at a predetermined puff topography (volume of 55 ml for 3 s with 30-s intervals between puffs). A cascade impactor was used to collect the size-segregated aerosol for calculating the mass median aerodynamic diameter (MMAD) and geometric standard deviation (GSD). The respiratory deposition of EVP aerosols on inhalation was estimated using the Multiple-Path Particle Dosimetry model. From these results, the exhaled fraction of EVP aerosols was calculated as a surrogate of secondhand exposure potential. The MMAD of VEA (0.61 μm) was statistically different compared to MCT (0.38 μm) and coconut oil (0.47 μm) but not to Vitamin E oil (0.58 μm); p < 0.05. Wider aerosol size distribution was observed for VEA (GSD 2.35) and MCT (GSD 2.08) compared with coconut oil (GSD 1.53) and Vitamin E oil (GSD 1.55). Irrespective of the statistical differences between MMADs, dosimetry modeling resulted in the similar regional and lobular deposition of particles for all e-liquids in the respiratory tract. The highest (~0.08 or more) fractional deposition was predicted in the pulmonary region, which is consistent as the site of injury among EVALI cases. Secondhand exposure calculations indicated that a substantial amount of EVP aerosols could be exhaled, which has potential implications for bystanders. The number of EVALI cases has declined with the removal of VEA; however, further research is required to investigate the commonly available commercial ingredients used in e-liquid preparations.
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Affiliation(s)
- Anand Ranpara
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Aleksandr B Stefaniak
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Kenneth Williams
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Elizabeth Fernandez
- 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
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25
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Snoderly HT, Nurkiewicz TR, Bowdridge EC, Bennewitz MF. E-Cigarette Use: Device Market, Study Design, and Emerging Evidence of Biological Consequences. Int J Mol Sci 2021; 22:12452. [PMID: 34830344 PMCID: PMC8619996 DOI: 10.3390/ijms222212452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/12/2022] Open
Abstract
Electronic cigarettes are frequently viewed as a safer alternative to conventional cigarettes; however, evidence to support this perspective has not materialized. Indeed, the current literature reports that electronic cigarette use is associated with both acute lung injury and subclinical dysfunction to the lung and vasculature that may result in pathology following chronic use. E-cigarettes can alter vascular dynamics, polarize innate immune populations towards a proinflammatory state, compromise barrier function in the pulmonary endothelium and epithelium, and promote pre-oncogenic phenomena. This review will summarize the variety of e-cigarette products available to users, discuss current challenges in e-cigarette study design, outline the range of pathologies occurring in cases of e-cigarette associated acute lung injury, highlight disease supporting tissue- and cellular-level changes resulting from e-cigarette exposure, and briefly examine how these changes may promote tumorigenesis. Continued research of the mechanisms by which e-cigarettes induce pathology benefit users and clinicians by resulting in increased regulation of vaping devices, informing treatments for emerging diseases e-cigarettes produce, and increasing public awareness to reduce e-cigarette use and the onset of preventable disease.
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Affiliation(s)
- Hunter T. Snoderly
- Department of Chemical and Biomedical Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV 26506, USA;
- Center for Inhalation Toxicology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.R.N.); (E.C.B.)
| | - Timothy R. Nurkiewicz
- Center for Inhalation Toxicology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.R.N.); (E.C.B.)
- Department of Physiology and Pharmacology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Elizabeth C. Bowdridge
- Center for Inhalation Toxicology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.R.N.); (E.C.B.)
- Department of Physiology and Pharmacology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Margaret F. Bennewitz
- Department of Chemical and Biomedical Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV 26506, USA;
- Center for Inhalation Toxicology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.R.N.); (E.C.B.)
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26
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McDaniel C, Mallampati SR, Wise A. Metals in Cannabis Vaporizer Aerosols: Sources, Possible Mechanisms, and Exposure Profiles. Chem Res Toxicol 2021; 34:2331-2342. [PMID: 34705462 DOI: 10.1021/acs.chemrestox.1c00230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In recent years, cannabis vaporizer cartridges have increased in popularity and availability, and there are concerns regarding exposure to heavy-metal compounds from their use. The physical components of the cartridge devices themselves have been implicated as a potential source of metal exposure, but it is not known if these metals migrate into the inhalable vapor. This study analyzes the components of vaporizer cartridges for 10 different metals and also collects aerosol mixtures from 13 randomly purchased commercially available cannabis cartridges from Washington State to compare their elemental profiles. Results indicate that chromium, copper, nickel, as well as smaller amounts of lead, manganese, and tin migrate into the cannabis oil and inhaled vapor phase, resulting in a possible acute intake of an amount of inhaled metals above the regulatory standard of multiple governmental bodies. Noncartridge heating methods of cannabis flower and concentrate were compared, and results indicate that the heating device itself is a source of metal contamination. As safety and compliance testing regulations evolve, it will be important to include more than the standard As, Cd, Hg, and Pb to the list of regulated metals.
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Affiliation(s)
- Charles McDaniel
- Medicine Creek Analytics, 3700 Pacific Highway East, Fife, Washington 98424, United States
| | | | - Amber Wise
- Medicine Creek Analytics, 3700 Pacific Highway East, Fife, Washington 98424, United States
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27
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Zakiyah N, Purwadi FV, Insani WN, Abdulah R, Puspitasari IM, Barliana MI, Lesmana R, Amaliya A, Suwantika AA. Effectiveness and Safety Profile of Alternative Tobacco and Nicotine Products for Smoking Reduction and Cessation: A Systematic Review. J Multidiscip Healthc 2021; 14:1955-1975. [PMID: 34326646 PMCID: PMC8315778 DOI: 10.2147/jmdh.s319727] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/02/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Alternative tobacco and nicotine products such as electronic cigarettes (EC), smokeless tobacco, and nicotine replacement therapy (NRT) are currently being assessed as options in tobacco harm reduction due to their potential role in smoking reduction and smoking cessation. OBJECTIVE To provide the current evidence on the effectiveness and safety of various alternative tobacco and nicotine products for smoking reduction and cessation. METHODS A systematic review using databases from MEDLINE (PubMed), EMBASE, and The Cochrane Library was conducted up to December 2020 to identify eligible experimental and observational studies assessing the use of alternative tobacco and nicotine products on smoking reduction and smoking cessation and the safety of these products. The Cochrane Risk of Bias 2 (RoB 2) and ROBINS-I tools were used to assess the risk of bias of the included studies. Results were described through a narrative synthesis of the evidence. RESULTS From 1955 retrieved references, 44 studies (31 randomized controlled trials/RCTs and 13 prospective cohort studies) met the inclusion criteria and were included in the review. Twenty-nine studies were assessing EC, one study evaluated heat-not-burn (HNB) product, five studies were focused on snus, and nine studies assessed NRT in the form of nicotine patch, gum, etc. The overall results suggested that alternative tobacco and nicotine products in the form of EC, snus, and NRT can moderately reduce daily cigarette consumption and has potential to assist smoking cessation attempts, with fewer adverse events. CONCLUSION The findings suggested that alternative tobacco and nicotine products have a potential role in assisting smoking reduction and cessation, highlighting their role in the tobacco harm reduction approach. Further studies should focus on investigating long-term outcomes, safety, and effectiveness of alternative tobacco and nicotine products to better inform smoking reduction/cessation policy. PROSPERO REGISTRATION NUMBER CRD42020205830.
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Affiliation(s)
- Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Febby V Purwadi
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Widya N Insani
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Irma M Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Melisa I Barliana
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Department of Biological Pharmacy, Biotechnology Pharmacy Laboratory, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Ronny Lesmana
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Division of Physiology, Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Division of Biological Activity, Central Laboratory, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Amaliya Amaliya
- Department of Periodontics, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Auliya A Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center for Health Technology Assessment, Universitas Padjadjaran, Bandung, West Java, Indonesia
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28
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Modeling Aerial Transmission of Pathogens (Including the SARS-CoV-2 Virus) through Aerosol Emissions from E-Cigarettes. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11146355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We examine the plausibility of aerial transmission of pathogens (including the SARS-CoV-2 virus) through respiratory droplets that might be carried by exhaled e-cigarette aerosol (ECA). Given the lack of empiric evidence on this phenomenon, we consider available evidence on cigarette smoking and respiratory droplet emission from mouth breathing through a mouthpiece as convenient proxies to infer the capacity of vaping to transport pathogens in respiratory droplets. Since both exhaled droplets and ECA droplets are within the Stokes regime, the ECA flow acts effectively as a visual tracer of the expiratory flow. To infer quantitatively the direct exposure distance, we consider a model that approximates exhaled ECA flow as an axially symmetric intermittent steady starting jet evolving into an unstable puff, an evolution that we corroborate by comparison with photographs and videos of actual vapers. On the grounds of all this theoretical modeling, we estimate for low-intensity vaping (practiced by 80–90% of vapers) the emission of 6–210 (median 39.9, median deviation 67.3) respiratory submicron droplets per puff and a horizontal distance spread of 1–2 m, with intense vaping possibly emitting up to 1000 droplets per puff in the submicron range with a distance spread over 2 m. The optical visibility of the ECA flow has important safety implications, as bystanders become instinctively aware of the scope and distance of possible direct contagion through the vaping jet.
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29
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Li Y, Burns AE, Tran LN, Abellar KA, Poindexter M, Li X, Madl AK, Pinkerton KE, Nguyen TB. Impact of e-Liquid Composition, Coil Temperature, and Puff Topography on the Aerosol Chemistry of Electronic Cigarettes. Chem Res Toxicol 2021; 34:1640-1654. [PMID: 33949191 DOI: 10.1021/acs.chemrestox.1c00070] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
E-cigarette aerosol is a complex mixture of gases and particles with a composition that is dependent on the e-liquid formulation, puffing regimen, and device operational parameters. This work investigated mainstream aerosols from a third generation device, as a function of coil temperature (315-510 °F, or 157-266 °C), puff duration (2-4 s), and the ratio of propylene glycol (PG) to vegetable glycerin (VG) in e-liquid (100:0-0:100). Targeted and untargeted analyses using liquid chromatography high-resolution mass spectrometry, gas chromatography, in situ chemical ionization mass spectrometry, and gravimetry were used for chemical characterizations. PG and VG were found to be the major constituents (>99%) in both phases of the aerosol. Most e-cigarette components were observed to be volatile or semivolatile under the conditions tested. PG was found almost entirely in the gas phase, while VG had a sizable particle component. Nicotine was only observed in the particle phase. The production of aerosol mass and carbonyl degradation products dramatically increased with higher coil temperature and puff duration, but decreased with increasing VG fraction in the e-liquid. An exception is acrolein, which increased with increasing VG. The formation of carbonyls was dominated by the heat-induced dehydration mechanism in the temperature range studied, yet radical reactions also played an important role. The findings from this study identified open questions regarding both pathways. The vaping process consumed PG significantly faster than VG under all tested conditions, suggesting that e-liquids become more enriched in VG and the exposure to acrolein significantly increases as vaping continues. It can be estimated that a 30:70 initial ratio of PG:VG in the e-liquid becomes almost entirely VG when 60-70% of e-liquid remains during the vaping process at 375 °F (191 °C). This work underscores the need for further research on the puffing lifecycle of e-cigarettes.
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Affiliation(s)
- Yichen Li
- Department of Environmental Toxicology, University of California at Davis, Davis, California 95616, United States
| | - Amanda E Burns
- Department of Environmental Toxicology, University of California at Davis, Davis, California 95616, United States
| | - Lillian N Tran
- Department of Environmental Toxicology, University of California at Davis, Davis, California 95616, United States
| | - Karizza A Abellar
- Department of Chemistry, University of California at Davis, Davis, California 95616, United States
| | - Morgan Poindexter
- Center for Health and the Environment, University of California at Davis, Davis, California 95616, United States
| | - Xiaohan Li
- Center for Health and the Environment, University of California at Davis, Davis, California 95616, United States
| | - Amy K Madl
- Center for Health and the Environment, University of California at Davis, Davis, California 95616, United States
| | - Kent E Pinkerton
- Center for Health and the Environment, University of California at Davis, Davis, California 95616, United States
| | - Tran B Nguyen
- Department of Environmental Toxicology, University of California at Davis, Davis, California 95616, United States
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30
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Hayeck N, Zoghzoghi C, Karam E, Salman R, Karaoghlanian N, Shihadeh A, Eissenberg T, Zein El Dine S, Saliba NA. Carrier Solvents of Electronic Nicotine Delivery Systems Alter Pulmonary Surfactant. Chem Res Toxicol 2021; 34:1572-1577. [PMID: 33945261 PMCID: PMC8220501 DOI: 10.1021/acs.chemrestox.0c00528] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
![]()
In late 2019, hundreds
of users of electronic products that aerosolize
a liquid for inhalation were hospitalized with a variety of respiratory
and gastrointestinal symptoms. While some investigations have attributed
the disease to the presence of vitamin E acetate in liquids that also
contained tetrahydrocannabinol, some evidence suggests that chronic
inhalation of two common solvents used in electronic nicotine delivery
systems (ENDS), propylene glycol (PG) and vegetable glycerin (VG),
can interfere with the lipid components of pulmonary surfactant and
cause or exacerbate pulmonary injury. The interaction between PG,
VG, and lung surfactant is not yet understood. This study presents
an examination of the molecular interactions of PG and VG with lung
surfactant mimicked by 1,2-dipalmitoyl-sn-glycero-3-phosphocholine
(DPPC). The interaction of DPPC and PG-VG is studied by attenuated
total reflectance fourier transform infrared spectroscopy. The results
showed that PG and VG altered the molecular alignment of the DPPC
surfactant. The orientation of the surfactant at the surface of the
lung affects the surface tension at the air–water interface,
thereby influencing breathing. These findings suggest that chronic
aerosolization of the primary solvents in ENDS might alter the function
of pulmonary surfactant.
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Affiliation(s)
- Nathalie Hayeck
- Chemistry Department, Faculty of Arts and Sciences, American University of Beirut, Beirut 1107-2020, Lebanon.,Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia 23284, United States
| | - Carl Zoghzoghi
- Chemistry Department, Faculty of Arts and Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Ebrahim Karam
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia 23284, United States.,Mechanical Engineering Department, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, 1107-2020 Beirut, Lebanon
| | - Rola Salman
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia 23284, United States.,Mechanical Engineering Department, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, 1107-2020 Beirut, Lebanon
| | - Nareg Karaoghlanian
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia 23284, United States.,Mechanical Engineering Department, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, 1107-2020 Beirut, Lebanon
| | - Alan Shihadeh
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia 23284, United States.,Mechanical Engineering Department, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, 1107-2020 Beirut, Lebanon
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia 23284, United States.,Department of Psychology, Virginia Commonwealth University, Richmond, Virginia 23284, United States
| | - Salah Zein El Dine
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, 1107-2020 Beirut, Lebanon
| | - Najat A Saliba
- Chemistry Department, Faculty of Arts and Sciences, American University of Beirut, Beirut 1107-2020, Lebanon.,Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia 23284, United States
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31
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Gholap VV, Pearcy AC, Halquist MS. Potential factors affecting free base nicotine yield in electronic cigarette aerosols. Expert Opin Drug Deliv 2021; 18:979-989. [PMID: 33576695 DOI: 10.1080/17425247.2021.1890714] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND The free base and protonated nicotine forms in e-cigarette aerosol have shown different absorption profiles in users. Therefore, it is also important to identify the factors which can affect the ratio of these nicotine forms in the aerosol. Such factors may include nicotine concentrations, flavors, PG:VG ratios, types of nicotine chemical compounds and e-cigarette battery power outputs. The current study attempts to identify such factors using a controlled experiment. RESEARCH DESIGNS AND METHODS The aerosol was generated using validated aerosol generating model. Various factors were tested for their effect on nicotine forms. Additionally, a degradation study of one of the nicotine compounds, nicotine salicylate, was also carried out using mass spectrometry. RESULTS The free base nicotine in the aerosol was found to be affected by flavors, battery power output, nicotine compound type and PG:VG ratios. Based on the preliminary mass spectrometry data, degradation of nicotine salicylate was found to be one of the significant factors affecting free base nicotine in aerosol. CONCLUSIONS Potential factors affecting free base nicotine in e-cigarette aerosol have been identified in this study. These findings would help in understanding the nicotine delivery better and assist for better regulations.
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Affiliation(s)
- Vinit V Gholap
- Department of Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, Richmond, USA
| | - Adam C Pearcy
- Department of Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, Richmond, USA
| | - Matthew S Halquist
- Department of Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, Richmond, USA
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32
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Hilpert M, Ilievski V, Hsu SY, Rule AM, Olmedo P, Drazer G. E-cigarette aerosol collection using converging and straight tubing Sections: Physical mechanisms. J Colloid Interface Sci 2021; 584:804-815. [PMID: 33268068 PMCID: PMC7736306 DOI: 10.1016/j.jcis.2020.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 12/30/2022]
Abstract
HYPOTHESIS Identification and quantification of harmful chemicals in e-cigarette aerosol requires collecting the aerosolized e-liquid for chemical analysis. In 2016, Olmedo at al. empirically developed a simple method for aerosol collection by directing the aerosol through a sequence of alternating straight and converging tubing sections, which drain the recovered e-liquid into a collection vial. The tubing system geometry and flow conditions promote inertial impaction of aerosolized e-liquid on tube walls, where it deposits and flows into the collection vial. EXPERIMENTS We use high-speed optical imaging to visualize aerosol transport in proxies of the collection system. We also determined collection efficiencies of various configurations of the collection system. FINDINGS A turbulent jet emerges from converging conical sections and impinges onto the wall of downstream tubing sections, resulting in inertial impaction and deposition of the aerosol. For inertial impaction to occur the tip radius of the converging section must be small enough for a jet to be formed and the sequence of tubing sections must be curved in a polygon-like manner such that the jet emerging from a converging section impinges on the downstream tube wall. The collection efficiency is significantly smaller without such curvature.
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Affiliation(s)
- Markus Hilpert
- Department of Environmental Health Sciences, Columbia University, United States.
| | - Vesna Ilievski
- Department of Environmental Health Sciences, Columbia University, United States
| | - Shao-Yiu Hsu
- Department of Bioenvironmental Systems Engineering, National Taiwan University, Taiwan
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins University, United States
| | - Pablo Olmedo
- Department of Legal Medicine and Toxicology, University of Granada, Spain
| | - German Drazer
- Department of Mechanical and Aerospace Engineering, Rutgers, The State University of New Jersey, United States
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33
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Vaping-Related Acute Parenchymal Lung Injury: A Systematic Review. Chest 2020; 158:1555-1565. [PMID: 32442559 DOI: 10.1016/j.chest.2020.03.085] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 12/12/2022] Open
Abstract
The outbreak of vaping-related acute lung injury in the United States, named EVALI (e-cigarette or vaping product use associated acute lung injury), has reignited concerns about the health effects of vaping. Initial case reports of vaping-related lung injury date back to 2012, but the ongoing outbreak of EVALI began in the summer of 2019 and has been implicated in 2,807 cases and 68 deaths as of this writing. Review of the scientific literature revealed 216 patient cases that spanned 41 reports of parenchymal lung injury attributed to vaping. In this review, we detail the clinical, radiographic, and pathologic patterns of lung injury that are attributable to vaping and provide an overview of the scientific literature to date on the effects of vaping on respiratory health. Tetrahydrocannabinol was the most commonly vaped substance, and vitamin E acetate was found in BAL specimens from many affected individuals. However, no specific component or contaminant has been identified conclusively to date as the cause for the injury. Patients present with cough, dyspnea, constitutional symptoms, and GI symptoms. Radiologic and histopathologic findings demonstrate a spectrum of nonspecific acute injury patterns. A high index of suspicion combined with a good history are the keys to an accurate diagnosis. Treatment is supportive; the mortality rate is low, and most patients recover. Corticosteroids have been used with apparent success in patients with severe disease, but more rigorous studies are needed to clarify their role in the treatment of vaping-related lung injury.
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The health effects of ultrafine particles. Exp Mol Med 2020; 52:311-317. [PMID: 32203102 PMCID: PMC7156741 DOI: 10.1038/s12276-020-0403-3] [Citation(s) in RCA: 273] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 01/17/2020] [Indexed: 01/08/2023] Open
Abstract
Ultrafine particles (PM0.1), which are present in the air in large numbers, pose a health risk. They generally enter the body through the lungs but translocate to essentially all organs. Compared to fine particles (PM2.5), they cause more pulmonary inflammation and are retained longer in the lung. Their toxicity is increased with smaller size, larger surface area, adsorbed surface material, and the physical characteristics of the particles. Exposure to PM0.1 induces cough and worsens asthma. Metal fume fever is a systemic disease of lung inflammation most likely caused by PM0.1. The disease is manifested by systemic symptoms hours after exposure to metal fumes, usually through welding. PM0.1 cause systemic inflammation, endothelial dysfunction, and coagulation changes that predispose individuals to ischemic cardiovascular disease and hypertension. PM0.1 are also linked to diabetes and cancer. PM0.1 can travel up the olfactory nerves to the brain and cause cerebral and autonomic dysfunction. Moreover, in utero exposure increases the risk of low birthweight. Although exposure is commonly attributed to traffic exhaust, monitored students in Ghana showed the highest exposures in a home near a trash burning site, in a bedroom with burning coils employed to abate mosquitos, in a home of an adult smoker, and in home kitchens during domestic cooking. The high point-source production and rapid redistribution make incidental exposure common, confound general population studies and are compounded by the lack of global standards and national reporting. The potential for PM0.1 to cause harm to health is great, but their precise role in many illnesses is still unknown and calls for more research. Tiny particles found in air pollution enter the body usually through the lungs and disperse to other organs, causing more inflammation and cellular toxicity than larger particles. Dean Schraufnagel from the University of Illinois at Chicago, USA, reviews the way by which nano-sized air pollutants threaten human health. He describes how ultrafine particles measuring less than 100 nanometres in diameter elicit greater inflammatory responses and stay in the lungs longer than larger particles. Repeated contact with extremely small particulate matter can trigger heart disease, diabetes, cancer, neurological disorders and respiratory ailments, especially among children and people with long-term occupational exposure. Much remains to be learned about the disease-causing properties of these nanoparticles and their long-term effects. Further developments in understanding remain handicapped by the lack of international standards and reporting measures.
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Son Y, Mainelis G, Delnevo C, Wackowski OA, Schwander S, Meng Q. Investigating E-Cigarette Particle Emissions and Human Airway Depositions under Various E-Cigarette-Use Conditions. Chem Res Toxicol 2020; 33:343-352. [PMID: 31804072 PMCID: PMC7301609 DOI: 10.1021/acs.chemrestox.9b00243] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
E-cigarette use is dramatically increasing, particularly with adolescents. While the chemical composition of e-liquids and e-vapor is well characterized, the particle size distribution and the human airways deposition patterns of e-cigarette particles are understudied and poorly understood despite their likely contribution to adverse health effects from e-cigarette usage. In this study, we examined the impacts of e-cigarette device power, e-liquid composition, and vaping topography on e-cigarette particle sizes and their deposition in human airways. In addition, we observed that particle measurement conditions (dilution ratio, temperature, and humidity) significantly affect measured e-cigarette particle sizes. E-cigarette power output significantly increased particle count median diameters (CMD) from 174 ± 13 (particles generated under 6.4 W) to 236 ± 14 nm (particles generated under 31.1 W). E-cigarette particles generated from propylene glycol-based e-liquids (CMD = 145 ± 8 nm and mass median diameter [MMD] = 3.06 ± 0.17 μm) were smaller than those generated from vegetable glycerin-based e-liquids (CMD = 182 ± 9 nm and MMD = 3.37 ± 0.21 μm). Puff volume also impacted vapor particle size: CMD and MMD were 154 ± 11 nm and 3.50 ± 0.27 μm, 163 ± 6 nm and 3.35 ± 0.24 μm, and 146 ± 12 nm and 2.95 ± 0.14 μm, respectively, for 35, 90, and 170 mL puffs. Estimated e-cigarette particle mass deposition fractions in tracheobronchial and bronchoalveolar regions were 0.504-0.541 and 0.073-0.306, respectively. Interestingly, e-cigarette particles are smaller than the particles generated from cigarette smoking but have similar human airway deposition patterns.
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Affiliation(s)
- Yeongkwon Son
- Department of Environmental and Occupational Health, School of Public Health, Rutgers University, Piscataway, New Jersey 08854, United States
- Division of Atmospheric Sciences, Desert Research Institute, Reno, Nevada 89512, United States
| | - Gediminas Mainelis
- Department of Environmental Sciences, Rutgers University, New Brunswick, New Jersey 08901, United States
| | - Cristine Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, New Jersey 08854, United States
- Cancer Prevention & Control Program, Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey 08901, United States
| | - Olivia A. Wackowski
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, New Jersey 08854, United States
- Cancer Prevention & Control Program, Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey 08901, United States
| | - Stephan Schwander
- Department of Environmental and Occupational Health, School of Public Health, Rutgers University, Piscataway, New Jersey 08854, United States
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, New Jersey 08854, United States
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey 08854, United States
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, Newark, New Jersey 07102, United States
| | - Qingyu Meng
- Department of Environmental and Occupational Health, School of Public Health, Rutgers University, Piscataway, New Jersey 08854, United States
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, New Jersey 08854, United States
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey 08854, United States
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Abstract
In the United States, an epidemic of unusual and severe lung disease associated with the use of e-cigarettes, or vaping, began in spring 2019. By fall 2019, the US Centers for Disease Control and Prevention had received reports of e-cigarette or vaping product use-associated lung injury (EVALI) cases from all state health departments in the continental US, Hawaii, and the US Virgin Islands. According to the cases, a number of young people had developed severe lung disease characterized by marked shortness of breath and cough. Constitutional and gastrointestinal symptoms are common. Clinical laboratory test results in EVALI are often consistent with nonspecific findings of pulmonary/systemic inflammation. Many reported cases of EVALI have required critical care interventions including noninvasive positive airway pressure, cardiotonic pressors, and intubation/mechanical ventilation. The need for extracorporeal membrane oxygenation support has been reported in some cases. The lung disease is diffuse and has multiple pathologies. Patients are often treated with intravenous or oral corticosteroids with clinical improvement, although the natural history of the disease remains unknown. In rare cases, the outcome is fatal. This article reviews the epidemiology, clinical presentation, radiographic appearance, diagnostic approach, and treatment regimens for patients with vaping-induced lung disease as noted in multiple patients and the current literature. [Pediatr Ann. 2020;49(2):e93-e98.].
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Parraga G, Morissette MC. E-cigarettes: What evidence links vaping to acute lung injury and respiratory failure? CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2019. [DOI: 10.1080/24745332.2019.1684857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Grace Parraga
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Canada
| | - Mathieu C. Morissette
- Respiratory Research Axis, Quebec Heart and Lung Institute - Université Laval, Quebec City, Quebec, Canada
- Department de Medicine, Université Laval, Quebec City, Quebec, Canada
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Balkissoon R. Journal Club-Electronic Cigarettes and Vaping as a Harm Reduction Alternative: Really? CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2019; 6:281-291. [PMID: 31342733 DOI: 10.15326/jcopdf.6.3.2019.0143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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