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Many high school students and apparently healthy young adults are getting very sick. Since June, 28 cases of mysterious respiratory disease have been reported in Utah. Wisconsin has found 32 to date. Nationally, more than 200 cases of patients with severe respiratory problems have been discovered in 25 states. A 30-year-old woman in Illinois died last month and Tuesday, another death was reported in Oregon.
Patients whose symptoms include breathing difficulties, chest pain, shortness of breath, and sometimes vomiting and diarrhea, have no known viral or bacterial infections. They can not seem to breathe normally. Until now, the only known link between these previously healthy patients is that they have all recently evaporated.
Centers for Disease Control and Prevention, local health agencies and the Food and Drug Administration are looking for answers. With about 20% of students who are out of breath, the question of what the practice does to the human body has taken a great urgency.
A study published today in the Journal of Clinical Investigation can add a piece to the puzzle. Baylor researchers have shown that, even though mice exposed to electronic cigarette vapor did not develop the same diseases as cigarette-smoking mice, they developed another set of disturbing problems.
The study found that inhaling only electronic cigarette vapor, without any nicotine, fundamentally alters the important cells that defend the mouse's lungs against infections. Farrah Kheradmand, a Baylorian pulmonologist who led the study, says these changes mean that the lungs' defenses against bacteria and viruses are "compromised", leaving the mice with a dysfunctional lung immune system.
Immune problems have been associated with anecdotal vaping for years. But Ilona Jaspers, a professor at the University of North Carolina, Chapel Hill, who did not participate in the Baylor study, explains that these findings are essentially the first time researchers are examining how the Electronic cigarettes impair lung function.
The lungs regulate gas exchanges. The oxygen enters, the carbon dioxide goes out. But hardly anyone breathes a perfect and intact air. Pollution, bacteria and viruses can all be trapped. The lungs – and eventually the rest of the body – are protected from these contaminants by a thin layer of lipids that covers the lungs and very large cells called macrophages.
The lipid layer collects these invaders and toxins, binds them and prevents them from reaching the air sacs. Macrophages, in turn, have two important jobs. First, they engulf all the invaders that they meet. They also recycle the lipid lining of the lungs, helping to renew this layer several times a day. As this mouse study shows, the solvents in vape cartridges seem to disrupt this crucial dynamic by damaging lipids and sabotaging macrophage cleansing work. Kheradmand does not know exactly what is happening in lipids – they need more research to understand what's changing – but no matter what happens, the system is shaken.
Not only do macrophages become less efficient lipid recyclers, they are also diverted from their other job of filtering out toxins and invaders. "Your immune system is out of balance," says Jaspers, whose work has shown that vaping causes similar immune problems in the cells of the nose. "Because your system is not prepared, you get sick."
Some of the mysterious cases the CDC is studying have been diagnosed as lipoid pneumonia, a disease with symptoms similar to pneumonia, but not caused by bacteria. Instead, lipoid pneumonia is an immune response in which fats accumulate in the lungs. In his laboratory, Kheradmand has seen his mice develop such a state without ever inhaling nicotine. "Chronic exposure to solvents was enough," she says.
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