Imaging Findings of Vaping-Associated Lung Injury

Henry, Travis S.; Kligerman, Seth; Raptis, Constantine A.; Mann, Howard; Sechrist, Jacob W.; Kanne, Jeffrey P.

doi:10.2214/ajr.19.22251

Cited by 84 publications

(88 citation statements)

References 28 publications

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“…Inhaled metals/metalloids are rapidly absorbed through the respiratory tract (Nordberg et al 2007;Henry et al 2019), and those that were detected in the studies in this review have been associated with serious adverse health effects. For instance, the lung is the most sensitive target of Ni toxicity, and lung inflammatory changes have been observed at the lowest adverse effect levels (ATSDR 2005a).…”

Section: Discussionmentioning

confidence: 92%

Metal/Metalloid Levels in Electronic Cigarette Liquids, Aerosols, and Human Biosamples: A Systematic Review

Zhao

Aravindakshan

Hilpert

et al. 2020

Environ Health Perspect

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BACKGROUND: Electronic cigarettes (e-cigarettes) have become popular, in part because they are perceived as a safer alternative to tobacco cigarettes. An increasing number of studies, however, have found toxic metals/metalloids in e-cigarette emissions. OBJECTIVE: We summarized the evidence on metal/metalloid levels in e-cigarette liquid (e-liquid), aerosols, and biosamples of e-cigarette users across e-cigarette device systems to evaluate metal/metalloid exposure levels for e-cigarette users and the potential implications on health outcomes. METHODS: We searched PubMed/TOXLINE, Embase ® , and Web of Science for studies on metals/metalloids in e-liquid, e-cigarette aerosols, and biosamples of e-cigarette users. For metal/metalloid levels in e-liquid and aerosol samples, we collected the mean and standard deviation (SD) if these values were reported, derived mean and SD by using automated software to infer them if data were reported in a figure, or calculated the overall mean (mean ± SD) if data were reported only for separate groups. Metal/metalloid levels in e-liquids and aerosols were converted and reported in micrograms per kilogram and nanograms per puff, respectively, for easy comparison. RESULTS: We identified 24 studies on metals/metalloids in e-liquid, e-cigarette aerosols, and human biosamples of e-cigarette users. Metal/metalloid levels, including aluminum, antimony, arsenic, cadmium, cobalt, chromium, copper, iron, lead, manganese, nickel, selenium, tin, and zinc, were present in e-cigarette samples in the studies reviewed. Twelve studies reported metal/metalloid levels in e-liquids (bottles, cartridges, open wick, and tank), 12 studies reported metal/metalloid levels in e-cigarette aerosols (from cig-a-like and tank devices), and 4 studies reported metal/metalloid levels in human biosamples (urine, saliva, serum, and blood) of e-cigarette users. Metal/metalloid levels showed substantial heterogeneity depending on sample type, source of e-liquid, and device type. Metal/metalloid levels in e-liquid from cartridges or tank/open wicks were higher than those from bottles, possibly due to coil contact. Most metal/metalloid levels found in biosamples of e-cigarette users were similar or higher than levels found in biosamples of conventional cigarette users, and even higher than those found in biosamples of cigar users. CONCLUSION: E-cigarettes are a potential source of exposure to metals/metalloids. Differences in collection methods and puffing regimes likely contribute to the variability in metal/metalloid levels across studies, making comparison across studies difficult. Standardized protocols for the quantification of metal/metalloid levels from e-cigarette samples are needed. https://doi.

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Section: Discussionmentioning

confidence: 92%

Metal/Metalloid Levels in Electronic Cigarette Liquids, Aerosols, and Human Biosamples: A Systematic Review

Zhao

Aravindakshan

Hilpert

et al. 2020

Environ Health Perspect

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“…Adulterated CBD oils could pose a serious public health threat due to their altered biological activities. Recent cases of acute and severe respiratory distress related to vaping of CBD products together with THC and nicotine products [46][47][48][49][50][51] further highlight the need to understand the toxicity profiles of adulterated CBD oils. For medicinal applications, it is advisable to use pure and unadulterated CBD oils that have been tested for both chemical composition and biological activities.…”

Section: Discussionmentioning

confidence: 99%

Potency Assessment of CBD Oils by Their Effects on Cell Signaling Pathways

Urasaki

Beaumont²,

Workman³

et al. 2020

Nutrients

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This study used nanofluidic protein posttranslational modification (PTM) profiling to measure the effects of six cannabidiol (CBD) oils and isolated CBD on the signaling pathways of a cultured SH-SY5Y neuronal cell line. Chemical composition analysis revealed that all CBD oils met the label claims and legal regulatory limit regarding the CBD and tetrahydrocannabinol (THC) contents, respectively. Isolated CBD was cytotoxic, with an effective concentration (EC50) of 40 µM. In contrast, the CBD oils had no effect on cell viability at CBD concentrations exceeding 1.2 mM. Interestingly, only an unadulterated CBD oil had strong and statistically significant suppressive effects on the pI3K/Akt/mTOR signaling pathway with an EC50 value of 143 µM and a slow-acting timescale requiring hours. Systematic profiling of twenty-six proteins, which served as biomarkers for nine signaling pathways, revealed that the unadulterated CBD oil downregulated seven signaling pathways but had no measurable effect on the other two signaling pathways. The remaining CBD oils, which were adulterated, and isolated CBD had weak, variable, or undetectable effects on neuronal signaling pathways. Our data clearly showed that adulteration diminished the biological activities of CBD oils. In addition, nanofluidic protein PTM profiling provided a robust means for potency assessment of CBD oils.

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“…Recent reports suggest that vaping causes radiological abnormalities,21 and these appearances have been described as being similar to covid-19.…”

Section: What Are the Differential Diagnoses?mentioning

confidence: 92%

The role of chest radiography in confirming covid-19 pneumonia

Cleverley

Piper

Jones

2020

BMJ

194

142

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Contributorship and guarantor: MJ conceptualised this article, undertook the literature search and is guarantor. JC used her knowledge of chest radiology to inform the content of the article and sourced the images. JP used his knowledge of assessment and management of covid-19 patients to inform the article. MJ, JC, and JP drafted and checked the final article. Patient consent:We considered seeking individual consent to use radiological images. However, as patients with covid-19 are ill and an infectious risk, obtaining consent was not possible. We approached the hospital ethics committee chair, Trust R&D, and Data Protection lead for permission to use anonymised radiological images without specific consent. They agreed this was acceptable.

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Imaging Findings of Vaping-Associated Lung Injury

Cited by 84 publications

References 28 publications

Metal/Metalloid Levels in Electronic Cigarette Liquids, Aerosols, and Human Biosamples: A Systematic Review

Metal/Metalloid Levels in Electronic Cigarette Liquids, Aerosols, and Human Biosamples: A Systematic Review

Potency Assessment of CBD Oils by Their Effects on Cell Signaling Pathways

The role of chest radiography in confirming covid-19 pneumonia

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