Liu Zhuoying, Zhang Yixuan, Youn Ji Youn, Zhang Yabing, Makino Ayako, Yuan Jason X-J, Cai Hua
Department of Anesthesiology, Department of Medicine/Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA.
Department of Medicine, University of California San Diego, San Diego, CA 92093, USA.
Antioxidants (Basel). 2022 May 5;11(5):904. doi: 10.3390/antiox11050904.
The prevalent use of electronic cigarettes (e-cigarettes) has increased exponentially in recent years, especially in youth who are attracted to flavored e-cigarettes. Indeed, e-cigarette or vaping product use-associated lung injury (EVALI) cases started to emerge in the United States in August 2019, resulting in 2807 hospitalized cases and 68 deaths as of 18 February 2020. In the present study, we investigated, for the first time, whether flavored and nicotine containing e-cigarettes induce endothelial dysfunction to result in impaired angiogenesis and wound healing particularly under diabetic condition. Nicotine containing e-cigarettes with various contents of nicotine (0, 1.2%, 2.4%), and flavored e-cigarettes of classic tobacco, mint, menthol, and vanilla or fruit from BLU (nicotine 2.4%) or JUUL (nicotine 3%), were used to treat endothelial cells in vitro and streptozotocin-induced diabetic mice in vivo. Endothelial cell superoxide production, determined by dihydroethidium (DHE) fluorescent imaging and electron spin resonance (ESR), was markedly increased by exposure to e-cigarette extract (e-CSE) in a nicotine-content dependent manner, while nitric oxide (NO) bioavailability detected by DAF-FM fluorescent imaging was substantially decreased. All of the different flavored e-cigarettes examined also showed significant effects in increasing superoxide production while diminishing NO bioavailability. Endothelial cell apoptosis evaluated by caspase 3 activity was markedly increased by exposure to e-CSE prepared from flavored and nicotine containing e-cigarettes. Endothelial monolayer wound assays revealed that nicotine-containing and flavored e-cigarettes induced impaired angiogenic wound repair of endothelial cell monolayers. Furthermore, vascular endothelial growth factor (VEGF) stimulated wound healing in diabetic mice was impaired by exposure to e-CSEs prepared from nicotine-containing and flavored e-cigarettes. Taken together, our data demonstrate for the first time that flavored and nicotine-containing e-cigarettes induce endothelial dysfunction through excessive ROS production, resulting in decreased NO bioavailability, increased endothelial cell apoptosis, and impairment in angiogenesis and wound healing, especially under diabetic condition. These responses of endothelial dysfunction likely underlie harmful effects of e-cigarettes in endothelial-rich organs, such as heart and lungs. These data also indicate that rigorous regulation on e-cigarette use should be enforced in diabetic and/or surgical patients to avoid severe consequences from impaired angiogenesis/wound healing.
近年来,电子烟的广泛使用呈指数级增长,尤其是在被调味电子烟吸引的年轻人中。事实上,2019年8月美国开始出现与电子烟或雾化产品使用相关的肺损伤(EVALI)病例,截至2020年2月18日,已有2807例住院病例和68例死亡。在本研究中,我们首次调查了含调味剂和尼古丁的电子烟是否会诱发内皮功能障碍,从而导致血管生成受损和伤口愈合不良,尤其是在糖尿病状态下。使用含有不同尼古丁含量(0、1.2%、2.4%)的含尼古丁电子烟,以及来自BLU(尼古丁含量2.4%)或JUUL(尼古丁含量3%)的经典烟草味、薄荷味、薄荷醇味、香草味或水果味的调味电子烟,在体外处理内皮细胞,并在体内处理链脲佐菌素诱导的糖尿病小鼠。通过二氢乙锭(DHE)荧光成像和电子自旋共振(ESR)测定,暴露于电子烟提取物(e-CSE)后,内皮细胞超氧化物生成以尼古丁含量依赖的方式显著增加,而通过DAF-FM荧光成像检测到的一氧化氮(NO)生物利用度则大幅下降。所有检测的不同调味电子烟在增加超氧化物生成同时降低NO生物利用度方面也显示出显著效果。通过半胱天冬酶3活性评估的内皮细胞凋亡在暴露于由含调味剂和尼古丁的电子烟制备的e-CSE后显著增加。内皮单层伤口试验表明,含尼古丁和调味剂的电子烟会导致内皮细胞单层血管生成性伤口修复受损。此外,暴露于由含尼古丁和调味剂的电子烟制备的e-CSE后,血管内皮生长因子(VEGF)刺激的糖尿病小鼠伤口愈合受到损害。综上所述,我们的数据首次证明,含调味剂和尼古丁的电子烟通过过量产生活性氧诱发内皮功能障碍,导致NO生物利用度降低、内皮细胞凋亡增加以及血管生成和伤口愈合受损,尤其是在糖尿病状态下。内皮功能障碍的这些反应可能是电子烟对富含内皮的器官(如心脏和肺)产生有害影响的基础。这些数据还表明,应严格监管糖尿病和/或外科手术患者使用电子烟,以避免血管生成/伤口愈合受损带来的严重后果。