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Experts finally have a strong contender for the cause of the vaping outbreak that has led to over 2,000 cases of lung illnesses and 39 deaths across the country, according to new findings. The potential culprit? A substance called vitamin E acetate.
In an analysis conducted by the Environmental Health Laboratory of the Center for Disease Control and Prevention (CDC), vitamin E acetate was found in all the samples of lung fluid taken from 29 patients across 10 states hospitalized with EVALI, the new name given to the lung illnesses caused by vaping. (EVALI stands for e-cigarette, or vaping, product use-associated lung injury.)
Vitamin E acetate is an oil derived from vitamin E that's added to vaping products containing THC (the active ingredient in marijuana) as a cutting agent. Previously, the U.S. Food and Drug Administration (FDA) and investigations by New York state had suggested this oil might be a cause for concern after it was found in a number of products taken from patients with EVALI.
But this is the first time the oil has been detected directly in the lungs of patients in what's called bronchoalveolar lavage (BAL) samples, which are extracted from the lining of the lung using a tube pushed in through the nose. "These findings provide direct evidence of vitamin E acetate at the primary site of injury" in the lungs, Dr. Anne Schuchat, the principal deputy director of the CDC, said during a news conference today (Nov. 8).
Vitamin E acetate is a "very strong culprit of concern," Schuchat said. The CDC's analysis of these samples didn't reveal any other potential contaminant or ingredient that could be linked to the illnesses, but these findings don't rule out other compounds or ingredients that may be causing the illnesses, she said.
This oil is sometimes added to THC-containing products in high concentrations for "illicit" or "profit" purposes, such as to dilute the material, make it look nice or make it so that manufacturers of illegal products won't have to use as much THC or active ingredients, Schuchat added.
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That being said, there is still a small group of EVALI patients who report having used only nicotine-containing e-cigarettes or vaping products rather than THC-containing products. Vitamin E acetate "could potentially be used in a variety of substances," Schuchat said. But "in those that were tested so far, it's primarily been [in] THC-containing e-liquids."
THC or hints of it were detected in 82% of the BAC samples. Finding THC in 82% of samples is "very noteworthy," but on the flip side, not finding it in 18% of samples is "very explainable," said Dr. Jim Pirkle of the CDC's Environmental Health Laboratory during the news conference. "THC is not something we would expect to be hanging around in the lung fluids," whereas vitamin E acetate is "enormously sticky… like honey," he added. So when it goes into the lung "it does hang around."
Vitamin E acetate can be found in skin products or in foods and doesn't cause harm when swallowed or applied as such, Schuchat said. But studies have not been conducted to see what happens when the oil is inhaled. "When vitamin E acetate is inhaled, it may interfere with normal lung function," she said.
It's not clear how vitamin E acetate might actually harm the lungs. But it's likely that the oil coats the lungs and makes it so they can't exchange oxygen. As the lungs attempt to get rid of the oil, they become inflamed, which hampers the breathing process even more, according to a previous Live Science report.
However, one previous study found no evidence of the lungs being coated by oil in tissue samples taken from 17 EVALI patients across the U.S. Rather, the authors concluded in their study, published in The New England Journal of Medicine, that the injuries are similar to "chemical pneumonitis," or inflammation in the lungs caused by breathing in chemical fumes.
Schuchat notes that more studies are needed to determine if other compounds or vaping ingredients, in addition to vitamin E acetate, could be contributing to the lung injuries. "There may be more than one cause of the outbreak," she said.
The CDC's study was published today in the Morbidity and Mortality Weekly Report (MMWR). Another MMWR report published today, found through a survey conducted in Illinois, that patients who had EVALI were about nine times more likely to have gotten their products from informal sources such as a friend, a family member or the black market.
The findings reinforce the agency's recommendation that people should not use vaping products containing THC, particularly those obtained from informal sources. "Until the relationship of vitamin E acetate and lung health is better characterized, it is important that vitamin E acetate not be added to e-cigarette, or vaping, products," the authors concluded.
Yasemin is a staff writer at Live Science, covering health, neuroscience and biology. Her work has appeared in Scientific American, Science and the San Jose Mercury News. She has a bachelor's degree in biomedical engineering from the University of Connecticut and a graduate certificate in science communication from the University of California, Santa Cruz.
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