Over the past few weeks, the tone of the discussion over the health issues raised by vaping has evolved from quiet concern to full-blown nationwide panic. With hundreds of cases of mysterious, vaping-related lung ailments reported in more than 33 states, and more than six vaping-related deaths reported in the United States, the potential health issues that may arise from vaping are now impossible to ignore, to the degree that even President Trump has declared it a health crisis. Yet we don’t actually have the answer to one extremely important question: What is actually causing these health issues linked to vaping? While some theories have been put forth, including that vitamin E in bootleg THC cartridges may be playing a role, a new study in the New England Journal of Medicine sheds further light on some potential answers.
According to the study, which examined six vaping-related cases at University Hospital in Salt Lake City, the illnesses caused by vaping may be linked to a certain type of white blood cells called macrophages, which help protect your immune system by essentially trapping potentially dangerous viruses and bacteria and digesting them. In people with healthy immune systems, macrophages are able to distinguish between “good” and “bad” cells; in people with inflammatory bowel diseases like Crohn’s, it is believed that the macrophages in the intestinal system are unable to make this distinction, and end up attacking the wrong types of cells.
This is ultimately what University of Utah researchers believe is happening with these vaping cases, except with macrophages in the lungs. When researchers examined samples from the patients’ lungs, they found in the patients’ cells the presence of lipid-laden macrophages, or macrophages that contain fat particles. Lipid-laden macrophages are extremely unusual and have a distinctive appearance, Scott Aberegg, lead author and U of U Health critical care pulmonologist, said in a press release.
Notably, the presence of lipid-laden macrophages in a person’s lungs is also used to diagnose lipoid pneumonia, a rare type of lung condition caused by inhaling these fat particles. Lipoid pneumonia is marked by such symptoms as shortness of breath, coughing, and chest pain, all of which have been reported by those presenting at hospitals with vaping-related lung ailments. In an email to Rolling Stone, Aberegg says that lipoid pneumonia usually results from accidentally inhaling liquid into the lungs, usually by taking oil-based laxatives. Usually, he says, it presents on X-rays as a “puddle” of liquid with inflammation around it. “If the vaping associated lung injury we’re seeing is a new form of lipoid pneumonia (and it’s looking more and more like it may be) then it’s different because the inflammation we’re seeing in the lungs is not limited to a specific area,” but spread throughout the lungs during an extended period of time, he says.
Such a diagnosis, Aberegg says, “would be consistent with the dominant theory” shared by numerous health professionals that the lung ailments are linked to the inhalation of vitamin E acetate, a substance most often found in skin creams that is now being used by black-market dealers as a THC vape oil cutting agent. And on Monday, Gov. Andrew Cuomo announced in a press conference that most of the vape cartridges tested by the Department of Health tested positive for vitamin E acetate, and that three companies manufacturing diluents containing the substance had been subpoenaed in its investigation.
That said, the FDA and CDC have cautioned that it is too early in the investigation to draw any conclusions about one sole cause, and that not all of the samples tested contained vitamin E acetate. Aberegg similarly urged caution, saying that his team did not test the samples for the presence of vitamin E. Additionally, while Aberegg says the majority of the patients studied did admit to using THC vapes, others said they hadn’t, which significantly detracts from the theory that these cases are confined solely to black-market THC cartridges. While his study is consistent with the vitamin E theory, “it does not prove it,” he says.
So while this study is far from a silver bullet in terms of identifying the culprit, it does confirm that it’s best to heed the FDA and CDC warnings for now and just lay off the cartridges for the time being.