New research reported in the New England Journal of Medicine by the Centers for Disease Control and Prevention (CDC) in collaboration with The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC — James) strengthens prior findings on the link between vitamin E acetate and EVALI (E-cigarette or vaping product use-associated lung injury).
In this new study, the CDC analyzed bronchoalveolar lavage (BAL) fluid from 51 EVALI patients from 16 states and compared it to BAL fluid from 99 healthy individuals. Vitamin E acetate, also found in product samples tested by the Food and Drug Administration (FDA) and state laboratories, was identified in BAL fluid from 48 of 51 EVALI patients but was not found in any BAL fluid from healthy people. No other toxicants were found in BAL fluid from either group, except coconut oil and limonene (one EVALI patient each).
For this study, BAL samples were collected by the CDC from public health laboratories and health departments across the United States. These samples were received from hospital clinical teams that had collected the samples to guide clinical management decisions.
A team of scientists led by Peter Shields, MD, deputy director of the OSUCCC and thoracic oncologist at The James, provided BAL fluid samples from 99 healthy comparison subjects collected between 2015 and 2019 as part of a tobacco product study unrelated to the ongoing CDC investigation of EVALI.
“These findings support the conclusion that vitamin E acetate is a potential causative agent of EVALI, and that is an important discovery as decisions are made about how to best regulate the rapidly evolving e-cig industry,” says Shields, who leads numerous e-cigarette research studies at the OSUCCC — James, including a bronchoscopy study to look at how e-cigarettes impact the lung microenvironment.
In October 2019, Shields and colleagues reported the first evidence that even short-term vaping causes concerning inflammation in the lungs in the medical journal Cancer Prevention Research. Additional data was reported in the medical journal Cancer Epidemiology on Dec. 17, 2019, online ahead of print which finds that the smoking related damage in e-cig users is much less than smokers, and more similar to never-smokers.