EVALI Vaping Liquids Part 2: Mass Spectrometric Identification of Diluents and Additives

Rapid Screening of Vaping Liquids by DART-MS

BACKGROUND

E-cigarette, or vaping, product use-associated lung injury was reported in over 2800 cases from August 2019 to February 2020. Samples of vaping products were submitted for laboratory analysis in conjunction with investigation of the outbreak. A rapid screening method that was selective and sensitive for multiple analytes was required to aid in the investigation.

OBJECTIVE

To develop a multi-analyte method capable of screening vaping liquid samples that consumed small amounts of sample, required minimal sample preparation and analysis time, employed automated data processing, and provided the necessary sensitivity and selectivity.

METHODS

Vaping liquids were dissolved in acetonitrile and sampled with DIP-it® tips. The tips were analyzed by direct analysis in real-time mass spectrometry (DART-MS) and the resulting data processed with TraceFinder™ software. Laboratory-fortified samples consisting of various analytes and matrixes were evaluated prior to the analysis of submitted samples.

RESULTS

The method was successful at detecting all target analytes in all matrixes evaluated, although the method detection limits varied by analyte/matrix combination: from 0.1% nicotine in poly(propylene glycol) average Mn 1000 (the lowest level evaluated) to 5.0% poly(ethylene glycol) average Mn 400 in cannabis concentrate. Results for the analysis of submitted samples by this method compared favorably to GC-MS and FTIR results.

CONCLUSION

The DART-MS method met the objective of speed, sensitivity, and selectivity (although certain cannabinoid isomers could not be distinguished). The method may be easily adapted or expanded for additional analytes.

HIGHLIGHTS

This is a simple DART-MS method for screening vaping liquids for substances of concern in less than 2 min per sample.

Vaping Aerosols from Vitamin E Acetate and Tetrahydrocannabinol Oil: Chemistry and Composition

The popularity of vaping cannabis products has increased sharply in recent years. In 2019, a sudden onset of electronic cigarette/vaping-associated lung injury (EVALI) was reported, leading to thousands of cases of lung illness and dozens of deaths due to the vaping of tetrahydrocannabinol (THC)-containing e-liquids that were obtained on the black market. A potential cause of EVALI has been hypothesized due to the illicit use of vitamin E acetate (VEA) in cannabis vape cartridges. However, the chemistry that modifies VEA and THC oil, to potentially produce toxic byproducts, is not well understood under different scenarios of use. In this work, we quantified carbonyls, organic acids, cannabinoids, and terpenes in the vaping aerosol of pure VEA, purified THC oil, and an equal volume mixture of VEA and THC oil at various coil temperatures (100-300 °C). It was found under the conditions of our study that degradation of VEA and cannabinoids, including Δ⁹-THC and cannabigerol (CBG), occurred via radical oxidation and direct thermal decomposition pathways. Evidence of terpene degradation was also observed. The bond cleavage of aliphatic side chains in both VEA and cannabinoids formed a variety of smaller carbonyls. Oxidation at the ring positions of cannabinoids formed various functionalized products. We show that THC oil has a stronger tendency to aerosolize and degrade compared to VEA at a given temperature. The addition of VEA to the e-liquid nonlinearly suppressed the formation of vape aerosol compared to THC oil. At the same time, toxic carbonyls including formaldehyde, 4-methylpentanal, glyoxal, or diacetyl and its isomers were highly enhanced in VEA e-liquid when normalized to particle mass.

E-cigarette vaping associated acute lung injury (EVALI): state of science and future research needs

"E-Cigarette (e-cig) Vaping-Associated Acute Lung Injury" (EVALI) has been linked to vitamin-E-acetate (VEA) and Δ-9-tetrahydrocannabinol (THC), due to their presence in patients' e-cigs and biological samples. Lacking standardized methodologies for patients' data collection and comprehensive physicochemical/toxicological studies using real-world-vapor exposures, very little data are available, thus the underlying pathophysiological mechanism of EVALI is still unknown. This review aims to provide a comprehensive and critical appraisal of existing literature on clinical/epidemiological features and physicochemical-toxicological characterization of vaping emissions associated with EVALI. The literature review of 161 medical case reports revealed that the predominant demographic pattern was healthy white male, adolescent, or young adult, vaping illicit/informal THC-containing e-cigs. The main histopathologic pattern consisted of diffuse alveolar damage with bilateral ground-glass-opacities at chest radiograph/CT, and increased number of macrophages or neutrophils and foamy-macrophages in the bronchoalveolar lavage. The chemical analysis of THC/VEA e-cig vapors showed a chemical difference between THC/VEA and the single THC or VEA. The chemical characterization of vapors from counterfeit THC-based e-cigs or in-house-prepared e-liquids using either cannabidiol (CBD), VEA, or medium-chain triglycerides (MCT), identified many toxicants, such as carbonyls, volatile organic compounds, terpenes, silicon compounds, hydrocarbons, heavy metals, pesticides and various industrial/manufacturing/automotive-related chemicals. There is very scarce published toxicological data on emissions from THC/VEA e-liquids. However, CBD, MCT, and VEA emissions exert varying degrees of cytotoxicity, inflammation, and lung damage, depending on puffing topography and cell line. Major knowledge gaps were identified, including the need for more systematic-standardized epidemiological surveys, comprehensive physicochemical characterization of real-world e-cig emissions, and mechanistic studies linking emission properties to specific toxicological outcomes.