Toxic Ketene Gas Forms on Vaping Vitamin E Acetate Prompting Interest in Its Possible Role in the EVALI Outbreak
Open accessAbstract
Recent efforts by the Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration (FDA), and state authorities have led to the determination that vitamin E acetate (VEA) is strongly associated with e-cigarette or vaping product use-associated lung injury (EVALI) (1). VEA has been found in nearly all patient lung fluid samples analyzed and not observed in lung fluid from healthy cohorts. Despite strong evidence linking VEA to EVALI, its putative role as a causative agent has yet to be determined. To address the key issue of whether VEA is a just marker or a significant mediator of EVALI, Wu and O’Shea (2) report in PNAS that VEA reacts when aerosolized with an e-cigarette to produce the highly toxic gas ketene. Confirmation that VEA-derived ketene is a causative agent of EVALI must await rigorous clinical investigation. However, Wu and O’Shea (2) have in the meantime uncovered a compelling lead.
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VEA and vaping oils disrupt lung surfactants.
“while a 2020 MDPI review and a report of Centers for Disease Control and Prevention (CDC) describe how VEA and vaping oils disrupt lung surfactants [18,21,22].”
From Mobilizing for Health: A Case Study of Kazakhstan’s Vaping Ban Advocacy Campaign (2025) · cites this paper as [21]
Strongin’s discussion (pp. 7553–7554) addresses VEA’s association with EVALI and the possibility that vaping VEA produces toxic ketene. A search for lung surfactant disruption found no passage in our copy addressing whether VEA or vaping oils disrupt surfactants. (LLM, conf=0.76)
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Mobilizing for Health: A Case Study of Kazakhstan’s Vaping Ban Advocacy Campaign
Sadykova, J., Ayaganova, A., & Yergaliyev, K. A. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22071102 · Cited by 1 · see citing works
- Authors
- Strongin, R. M.
- Affiliations
- Portland State University (US)
- Corresponding author
- Strongin, Robert M.
- ORCID
- Strongin, Robert M.
- Venue
- Proceedings of the National Academy of Sciences
- Publisher
- National Academy of Sciences
- Published
- 2020-03-31
- Volume
- 117
- Issue
- 14
- Pages
- 7553-7554
- ISSN
- 0027-8424 (ISSN-L)
- 1091-6490
- PMC
- PMC7149441
- OpenAlex
- W3014868001
- Cited by
- 14
- References
- 0
- Citations by year
- 2025: 3 · 2024: 2 · 2022: 4 · 2021: 5
- FWCI
- 1.35
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Proceedings of the National Academy of Sciences (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- PDXScholar (Portland State University) (submittedVersion, cc-by)
- Funders
- HHS | National Institutes of Health (R01 ES025257)
- HHS | U.S. Food and Drug Administration (R01 ES025257)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Biochemistry › Antioxidant Activity and Oxidative Stress
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Keywords
- alpha-tocopherol acetate, ketenes, EVALI, vaping
- MeSH terms
- Vaping, Pyrolysis, Acetates, Disease Outbreaks, Ethylenes, Ketones, Vitamin E, Lung Injury
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