The CDC Links Vitamin E Acetate to Vaping-Related Illnesses

During the 4th of July week, the Children’s Hospital of Wisconsin admitted two teenage boys for difficulty breathing, fevers and a host of other symptoms. Their airways were irritated to the point of bleeding in some cases, but did not have any signs of common lung infections, like pneumonia. This reminded pulmonologist Dr. Lynn D’Andrea of another teenage boy who had been admitted in mid-June with similar symptoms. It was apparent to doctors in the pediatric unit that this was not anything they had seen before or a documented contagious infection. Looking into links between the boys, the only thing they all had in common was that they had vaped before.

Dr. D’Andrea and her colleagues became the first to report a deadly disease that would drive regulatory agencies, governing bodies and the Centers for Disease Control (CDC) to take action. E-cigarette, or vaping, product use associated illness (EVALI), can cause a variety of symptoms, including cough, shortness of breath, chest pain, nausea, vomiting, fever, chills and weight loss;
these symptoms can develop in as little as a few days or over several weeks. The illness has affected 2506 people, as of the Dec. 17, 2019 CDC report, including fifty-four associated deaths. While the disease appears to have peaked in September and declined in prevalence ever since, the CDC and healthcare providers remain vigilant.

On December 20, 2019, the CDC released a study that found a link between vitamin E acetate and EVALI. According to a study of bronchoalveolar lavage fluid (lung fluid) from 51 EVALI patients and 99 healthy people, vitamin E acetate was found in almost all of the EVALI fluid samples, but not in any of the healthy samples. Vitamin E acetate is found in THC-containing e-cigarettes because vitamin E acetate can be used as a cutting agent. This practice became common in the illicit market in 2019, aligning with the onset of EVALI cases.

Despite this breakthrough in the EVALI investigation, the CDC warns that there may be multiple causes of EVALI and other potential causes are still being investigated. The CDC cautions that any person using e-cigarettes should monitor for EVALI symptoms and see a healthcare professional immediately if any symptoms develop.

Fighting Kidney Cancer at the Source

William G. Kaelin, Jr., MD, Sidney Farber Professor of Medicine at Harvard Medical School and the Dana Farber Cancer Institute, started work 15 years ago with an interesting bit of information about kidney cancer: patients with a mutation in the VHL gene (von Hippel Lindau syndrome) were much more likely to develop kidney cancer. Kaelin set out to figure out why and possibly
find a treatment for several cancers, including clear-cell renal carcinoma, a deadly form of kidney cancer.

Through his research, Kaelin found that the VHL gene regulates cell response to oxygen levels as well as another molecular factor, HIF, which is responsible for triggering the production of red blood cells and blood vessels based on oxygen supply. Cancer cells with mutated VHL genes can take advantage of this system to trick the body into building blood vessels straight to cancerous tumors, thus feeding their own growth with the body’s blood supply. This mutation in the VHL gene allows the tumor to hijack the HIFs and stimulate the production of the protein VEGF, which enables extra blood vessels to enhance blood supply directly to the tumor.

This discovery led to the production of VEGF inhibitors, which showed success in improving the chances for patients with renal cell carcinoma, a fatal kidney cancer with a median survival of one year. In 2019, Kaelin on two other renown scientists were awarded the Nobel Prize in Physiology or Medicine “for their discoveries of how cells sense and adapt to oxygen availability.”

The link between oxygen and cancer cells continues to be an area of interest for the medical field. Normal cells use HIFs to regulate oxygen supply based on external oxygen availability, but cancer cells use HIFs to increase blood supply and grow tumors. On the other hand, cancer cells without enough oxygen (hypoxic cells) can spread beyond their origin and resist cancer treatments. While it is clear that the use of oxygen (or lack thereof) by cancer cells is tied to cancer growth and treatment, the full story is the subject of ongoing research.