Cited by 78Smoking Behavior and CessationPoisoning and overdose treatmentsForensic Toxicology and Drug Analysis

The DOI matches its Crossref record; 271 of the 271 references it cites were found in a registry or an index.

E-cigarette vaping associated acute lung injury (EVALI): state of science and future research needs

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Abstract

"E-Cigarette (e-cig) Vaping-Associated Acute Lung Injury" (EVALI) has been linked to vitamin-E-acetate (VEA) and Δ-9-tetrahydrocannabinol (THC), due to their presence in patients' e-cigs and biological samples. Lacking standardized methodologies for patients' data collection and comprehensive physicochemical/toxicological studies using real-world-vapor exposures, very little data are available, thus the underlying pathophysiological mechanism of EVALI is still unknown. This review aims to provide a comprehensive and critical appraisal of existing literature on clinical/epidemiological features and physicochemical-toxicological characterization of vaping emissions associated with EVALI. The literature review of 161 medical case reports revealed that the predominant demographic pattern was healthy white male, adolescent, or young adult, vaping illicit/informal THC-containing e-cigs. The main histopathologic pattern consisted of diffuse alveolar damage with bilateral ground-glass-opacities at chest radiograph/CT, and increased number of macrophages or neutrophils and foamy-macrophages in the bronchoalveolar lavage. The chemical analysis of THC/VEA e-cig vapors showed a chemical difference between THC/VEA and the single THC or VEA. The chemical characterization of vapors from counterfeit THC-based e-cigs or in-house-prepared e-liquids using either cannabidiol (CBD), VEA, or medium-chain triglycerides (MCT), identified many toxicants, such as carbonyls, volatile organic compounds, terpenes, silicon compounds, hydrocarbons, heavy metals, pesticides and various industrial/manufacturing/automotive-related chemicals. There is very scarce published toxicological data on emissions from THC/VEA e-liquids. However, CBD, MCT, and VEA emissions exert varying degrees of cytotoxicity, inflammation, and lung damage, depending on puffing topography and cell line. Major knowledge gaps were identified, including the need for more systematic-standardized epidemiological surveys, comprehensive physicochemical characterization of real-world e-cig emissions, and mechanistic studies linking emission properties to specific toxicological outcomes.

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Crossref · 10.1080/10408444.2022.2082918

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Research works printed but not linked: 4

  1. CDC. 2016. E-cigarette use among youth and young adults: a report of the Surgeon General. Atlanta (GA): GA US Department of Health and Human Services.
  2. Committee on Acute Exposure Guideline Level, Committee on Toxicology, Board on Environmental Studies and Toxicology, Division on Earth and Life Studies, National Research Council. 2014. 6, Ketene. Acute exposure guideline levels for selected airborne chemicals. Vol. 16. Washington (DC): National Academies Press (US).
  3. FDA. 2012. Harmful and potentially harmful constituents in tobacco products and tobacco smoke: established list. Washington (DC): Office of the Federal Register.
  4. Research GV. 2021. E-cigarette and vape market growth & trends. Available from: https://www.grandviewresearch.com/press-release/global-e-cigarette-vaping-market#.

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Metadata

Authors
Marrocco, A., Singh, D., Christiani, D. C., & Demokritou, P.
Affiliations
  • Harvard University (US)
  • Rutgers, The State University of New Jersey (US)
Corresponding author
Demokritou, Philip
Venue
Critical Reviews in Toxicology
Published
2022-03-16
Volume
52
Issue
3
Pages
188-220
ISSN
  • 0045-6446 (ISSN-L)
  • 1040-8444
  • 1547-6898
OpenAlex
W4285085267
Cited by
78
References
271
Citations by year
2026: 17 · 2025: 19 · 2024: 28 · 2023: 14
FWCI
2.10
Type
journal article
Language
en
Open access
Locations
  • Critical Reviews in Toxicology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
NIH
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
Keywords
alpha-tocopherol acetate, tetrahydrocannabinol, diffuse alveolar damage, ground-glass opacities, bronchoalveolar lavage, cannabidiol, medium-chain triglycerides, cytotoxicity, lung inflammation, terpenes, heavy metals, volatile organic compounds, pathophysiology
MeSH terms
Vaping, Adolescent, Humans, Male, Dronabinol, Vitamin E, Acute Lung Injury, Young Adult, Electronic Nicotine Delivery Systems

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