Safety study RE: Vaper Lung levels of Neutrophil Elastase and Matrix Metalloprotease

[wolcen]

I haven't been able to find discussion of this one here. Sounds relatively damning to me, unfortunately. It is a pretty small study however (and I've only read the abstract so far). Came here to see the latest discussions, since I've been hearing a fair bit more negative news lately.

TL/DR is approximately "Your lung's immune system response includes the creation of neutrophil elastase and matrix metalloproteases (which have knock on effects/are "causative" of emphysema/copd). this happens both with smoking, and vaping, but not in non-smoker/vaper lungs" Testing included bronchoscopies (camera down to lungs), and testing of bronchoalveolar lavage (which is sort of like "lung wash water" - squirt the lungs with liquid and collect that.

Anyway, here's the link:
Title: Chronic E-Cigarette Use Increases Neutrophil Elastase and Matrix Metalloprotease Levels in the Lung
Location: https://www.atsjournals.org/doi/abs/10.1164/rccm.201903-0615OC?journalCode=ajrccm

 

[wolcen]

Just realized I'm probably NOT going to read it, either. Paywalled for $30. Doh.

 

[wolcen]

Better formatting of the abstract via pubmed. Chronic E-Cigarette Use Increases Neutrophil Elastase and Matrix Metalloprotease Levels in the Lung. - PubMed - NCBI

Good link to have anyway - more familiar site to most people.

 

[wolcen]

OK - last thing: post from the originating source.
University of North Carolina at Chapel Hill School of Medicine
Scientists Show How Vaping Induces Reactions in Lungs that Can Lead to Disease — News Room - UNC Health Care

 

[Baditude]

 

[englishmick]

Er, it said chronic vaping. Phew. Glad I'm not a chronic vaper.

Seriously though. Maybe there's something there, maybe not. Guess we'll have to wait and see. There have been too many studies like this that went nowhere for me to believe it just because someone says so.

Their decision to include this para in the abstract didn't increase my confidence in their credibility.

"Moreover, a study from Tarran’s lab last year found evidence of toxic compounds in commonly used vaping liquids, and the CDC currently is investigating about 100 recent cases in the U.S. of sudden, serious lung disease in otherwise healthy young vapers."

They aren't claiming to have found disease, just cell characteristics that are associated with disease. Presumably their sample of chronic vapers have a history of smoking. Maybe they accounted for that in the study, but I didn't see the study.

I have COPD. Since I started vaping and quit the cigs I haven't used an inhaler in 5 years. I can spend a whole day mowing and weeding which I couldn't do before. Hard to believe they really discovered that vaping causes COPD when my own has apparently disappeared for that long.

 

[Baditude]

Seriously though. Maybe there's something there, maybe not. Guess we'll have to wait and see. There have been too many studies like this that went nowhere for me to believe it just because someone says so.

Their decision to include this para in the abstract didn't increase my confidence in their credibility.

"Moreover, a study from Tarran’s lab last year found evidence of toxic compounds in commonly used vaping liquids, and the CDC currently is investigating about 100 recent cases in the U.S. of sudden, serious lung disease in otherwise healthy young vapers."

They aren't claiming to have found disease, just cell characteristics that are associated with disease.

I tried to read the links. I'm reasonably educated (physician's assistant and registered nurse) in the medical field, and this study went WAY over my head. I did see a lot of "suggests" and not a lot of "confirms", though. Not very convincing for a serious scientific study in my book.

The reference to the CDC investigating 100 recent cases in the US of sudden, serious lung disease in otherwise healthy young vapers will probably boil down to these young individuals vaping black market non-nicotine substances with the sole intent to get "high".

21 Cases of Lung Disease Linked to Vaping T.H.C. Bought on Street

"...a spokesman for the Department of Public Health wrote that the agency is "working with local public health departments, other state departments and the Centers for Disease Control and Prevention to gather more information on patients, and on products and substances used."

The Department is urging people to avoid vaping T.H.C. products sold by unlicensed vendors."​

In a nutshell, although still under investigation, it appears the person who died had purchased a vial of a black market substance to get high and vaped it.

Dank Vapes Is the "Biggest Conspiracy" in Pot That Can Put You in a Coma | Inverse

This one is really scary. ​

Shady Companies and Black Market Substances, Not JUUL, Are Causing Hospitalizations

"It should be noted that issues with black market vape products have already sent teens to the hospital. I suppose T.H.C. products aren’t as sexy as JUUL. In January, three teens in two Indiana schools were hospitalized after smoking “T.H.C. vape pens that were laced with an unknown substance, possibly a narcotic.” Also in January, six high school students in New Mexico were hospitalized “after vaping T.H.C. wax.” In fact, the U.S. Army issued a warning in 2018 on the dangers of vaping synthetic T.H.C. This came after more than 90 military personnel had been hospitalized and two died after vaping illicit substances.

This is deeply problematic. Unlike e-cigarette products sold in convenience and mom-and-pop vape shops, these products are totally unregulated and commonly sold on the black market. Moreover, this influx of illegal and unregulated vaping products is being lumped into the same category as legal vaping products, which are regulated as tobacco harm reduction products."​

Why blame the crack (unknown vape liquid) when you can blame the pipe (e-cigarettes)?

 

[United States]

I saw "smoking causes it" and "vaping might". Duh.
Inhaling nicotine laiden steam is certainly not as healthy as fresh air. Duh.
So neither one is as good as never have inhaled foreign substances. Duh.

But vaping is better than smoking for a lot of reasons and many former smokers are living proof. Should healthy people just pick up a habit of nicotine laiden vaper or cigarettes? No. Duh.

 

[Eskie]

Well, without paying $30, which maybe I could set up a GoFundMe to get, that abstract essentially states (after you get through all the bronchoscopy lavage results) that nicotine alone causes elevated elastase and MMP release from neutrophils in vitro. They state elevated elastase and MMPs are responsible for causing emphysema (sorta true, as they do contribute but are not the only damaging enzymes released to damage tissue.. They are therefore concluding nicotine itself is responsible for causing emphysema and bronchiectasis is a pretty dramatic claim.

This would be the very first study to suggest nicotine itself is the cause of emphysema. As bronchiectasis occurs in many settings, including non-smokers suffering from chronic infections, rheumatic diseases such as Rheumatoid Arthritis (and other inflammatory disorders), aspiration of irritants into the lungs, Cystic Fibrosis, and some rare inheritable diseases, so that's a bit of a stress at best. For emphysema this would be big news as it's never been attributed solely to the nicotine itself in smoking, as there's plenty of other stuff to cause it. So let's stick with emphysema.

First, the big question for any of these studies. How many of those e cigarette users were cigarette smokers prior, and how long had they been vaping?

The findings that nicotine causes elastase and other protease release from neutrophils is already known. We know that from the studies showing oxidative stress from nicotine exposure with cells lining the blood vessels. This has raised the question of nicotine itself as a causative agent for things like heart attacks (see Glantz's articles for some of that) which to date is speculation.

Without the full text to figure out what these guys actually did no real conclusion can be drawn. But it would be a first to specifically claim nicotine in and of itself is a cause of emphysema and would require some very solid evidence before being accepted as a basis for the cause of emphysema in smokers, let alone vapers. Other animal models failed to show what this study found in humans, so holding it to a high standard is appropriate, and without the full text that's tough to do.

 

[United States]

I'll add to the above; (great post by the way)
What kind of wick was being used? Coil material? What temperature was the vape? What was said vape juice composed of? How much nicotine? DTL? MTL?

 

[Eskie]

I'll add to the above; (great post by the way)
What kind of wick was being used? Coil material? What temperature was the vape? What was said vape juice composed of? How much nicotine? DTL? MTL?

All lacking, but I expect they just did a "do you vape" crowd. They certainly didn't test subgroups, as their goal was to look at vaping in general, and they only had 41 subjects in total. It would take a bunch of additional subgroups to tease that out, and finding vapers willing to have a bronchoscope passed down their nose into their lungs to have saline sprayed in and then sucked out can be a tough recruiting issue even with some financial incentive (maybe I'd do it for 2 VA Spades, but not much less).

They did say that the concentrations of nicotine measured in the bronchoscopy aspirate they pulled out corresponded to the concentration of nicotine they used in their in vitro cell model, so in a sense it doesn't matter how you vaped, just that that's how much nicotine you took in ,mtl, dl, high nic, low nic, which is pretty fair in teasing that out of the equation. Besides, they're not looking to implicate anything else in the vape juice, just the nicotine, so you could have cooked it and released a bunch of formaldehyde and other VOCs, but in this setup they weren't allowing or testing for that as it was examining purported lung damage from nicotine, not the effects and levels of carcinogens being inhaled.

 

[wolcen]

Your feedback helped me a bunch @Eskie thanks! That's great @englishmick !