Recent updates on biomarkers of exposure and systemic toxicity in e-cigarette users and EVALI

Abstract

Electronic nicotine delivery systems (ENDS), or e-cigarettes, are emerging tobacco products that produce aerosols by heating e-liquids, which most often consist of propylene glycol and vegetable glycerin along with various flavoring compounds, bypassing the combustion that occurs in the use of traditional tobacco cigarettes. These products have seen a drastic increase in popularity in recent years both as smoking cessation devices as well as among younger generations, due in large part to the widespread perception among consumers that e-cigs are significantly less harmful for health than traditional tobacco cigarettes. Due to the novelty of ENDS as well as their rapidly increasing use, research into biomarkers of e-cig exposure and toxicity have lagged behind their popularity, leaving important questions about their potential toxicity unanswered. Research into potential biomarkers of acute, chronic e-cig use and E-cigarette- or Vaping-Associated Lung Injury is necessary for informing both clinical and regulatory decision-making. We aim to provide an updated review of recent research into potential circulating, genomic, transcriptomic and epigenetic biomarkers of exposure to and toxicity of e-cigs. We additionally highlight research areas that warrant additional study to gain better understanding of health risks associated with ENDS use, as well as to provide validation of existing data and methods for measuring and analyzing e-cig-associated biomarkers in human and animal biofluids, tissues and cells. This review also highlights ongoing efforts within the WNY Center for Research on Flavored Tobacco for research into novel biomarkers in extracellular vesicles that may be associated with short- and long-term ENDS use.

The E-cigarette or Vaping Product Use–Associated Lung Injury Epidemic: Pathogenesis, Management, and Future Directions: An Official American Thoracic Society Workshop Report

“…In addition to active ingredients, chemical degradation products that form during heating and aerosolization may be important sources of exposure biomarkers ( 148 ). Major aerosol products in nicotine e-cigarettes may include formaldehyde, acrolein, acetaldehyde, and glycolaldehyde-releasing agents ( 149 ); for cannabinoid e-cigarettes, isoprene, methacrolein, methyl vinyl ketone, isoprene epoxide, butadiene, etc.…”

Perspectives on Epigenetics Alterations Associated with Smoking and Vaping

“…Meanwhile, whether the differences in the epigenetic changes between vapers and cigarette smokers could result in toxicities unique to vaping such as the EVALI (e-cigarette, or vaping, product use-associated lung injury) cases in vapers awaits further investigation. 78 However, the role of those identified epigenetic biomarkers in the etiology of vaping-associated diseases remains unanswered. All of current studies are cross-sectional.…”

Impact of the Main Cardiovascular Risk Factors on Plasma Extracellular Vesicles and Their Influence on the Heart’s Vulnerability to Ischemia-Reperfusion Injury

“…Studies show that also vaping is harmful to the endothelium, and it can cause a change in the concentration and content of EVs [ 318 , 319 ]. More studies are needed to assess the impact of substances released by electronic devices on IRI.…”