Chand Hitendra S, Muthumalage Thivanka, Maziak Wasim, Rahman Irfan
Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States.
Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States.
Front Pharmacol. 2020 Jan 14;10:1619. doi: 10.3389/fphar.2019.01619. eCollection 2019.
New emerging tobacco products, especially electronic cigarettes (E-Cig) or electronic nicotine delivery systems (ENDS), have gained a huge popularity, particularly in younger populations. The lack of sufficient evidence-based health effect studies has promoted widespread use/abuse with the assumption that E-Cig or ENDS and/or vaping products are safer and less toxic than conventional tobacco smoking. However, the recent escalation in acute lung injuries and their associated fatalities among ENDS or vaping product users has now brought attention to this silent epidemic investigation into the constituents of ENDS/vaping products and their toxic effects on pulmonary health. Accordingly, CDC has declared an "outbreak" of the e-cigarette or vaping product use associated lung injury (EVALI). EVALI is characterized by sterile exogenous pneumonitis like reaction with substantial involvement of innate immune mechanisms. Vitamin-E acetate (VEA) is found in counterfeit cartridges and bronchoalveolar lavage fluid of EVALI patients. Other reports implicated the presence of aromatic/volatile hydrocarbons and oils consisting of medium-chain triglycerides (MCT oil), including terpenes and mineral oil in tetrahydrocannabinol (THC) containing counterfeit vaping products. These compounds are involved in oxidative stress and inflammatory responses in the lung. Here, we provide the perspectives on the recent case reports on EVALI, etiology, and discuss pulmonary toxicity as well as the mechanisms underlying EVALI susceptibility and lung pathophysiology.
新出现的烟草产品，尤其是电子烟（E-Cig）或电子尼古丁传送系统（ENDS），已大受欢迎，在年轻人群体中尤为如此。由于缺乏足够的循证健康影响研究，人们在认为电子烟或ENDS及/或雾化产品比传统吸烟更安全、毒性更小的假设下广泛使用/滥用这些产品。然而，最近电子烟或雾化产品使用者中急性肺损伤及其相关死亡人数的增加，现已引起人们对这一无声流行病的关注，促使对电子烟/雾化产品的成分及其对肺部健康的毒性作用展开调查。因此，美国疾病控制与预防中心（CDC）宣布了与电子烟或雾化产品使用相关的肺损伤（EVALI）“疫情”。EVALI的特征是无菌性外源性肺炎样反应，伴有先天性免疫机制的大量参与。在EVALI患者的假冒烟弹和支气管肺泡灌洗液中发现了维生素E醋酸酯（VEA）。其他报告指出，含有四氢大麻酚（THC）的假冒雾化产品中存在由中链甘油三酯（MCT油）组成的芳香/挥发性碳氢化合物和油，包括萜烯和矿物油。这些化合物参与肺部的氧化应激和炎症反应。在此，我们提供关于EVALI近期病例报告、病因的观点，并讨论肺部毒性以及EVALI易感性和肺部病理生理学的潜在机制。
