CLEVELAND, Ohio –A Cleveland Clinic study of lung tissue is among the first in the scientific community to confirm by biopsy that people who have become sick after vaping are suffering from acute lung injury – and it’s not caused by an infection.
The research also calls into question – but doesn’t completely disprove — a popular theory in the medical community: that vitamin E oil, which manufacturers of illicit THC products have mixed into vape juices, are the culprit of the illnesses.
For weeks, physicians have diagnosed – first based on patient symptoms and later by X-ray and CT scan – that people are becoming sick after using e-cigarettes. But there hadn’t been completed biopsies of patients’ lungs.
Dr. Sanjay Mukhopadhyay, a Cleveland Clinic pathologist who specializes in the lungs, and other staff pathologists are among the first to complete biopsies and publish their research in the American Journal of Clinical Pathology.
The Cleveland Clinic team conducted biopsies of lungs of eight men, age 19 to 61, who suffered from respiratory problems following e-cigarette use. Mukhopadhyay said the lung tissue came from Cleveland Clinic patients, as well as from patients from Vanderbilt University and other collaborating hospitals.
All patients had vaped THC, which is the active ingredient in marijuana. Some said they also vaped nicotine. Mukhopadhyay’s research didn’t make any conclusions about whether nicotine e-cigarettes were contributing to the illnesses. He was more interested in looking at injury to the lungs after all vaping-related illnesses.
The team conducted tests to determine if there were infections in the lungs. The tests were negative in all cases, he said.
Mukhopadhyay said they looked for what they call “exogenous lipoid pneumonia,” or fats in the lungs.
The condition isn’t rare. It can occur when people take mineral oil to relieve constipation and the oil is breathed into the lungs, instead of getting to the stomach, he said.
Researchers have discovered that Vitamin E oil had been inserted into vape cartridges. Vitamin E oil has similar viscosity as THC, and appears to be used as a cutting agent. Many researchers have posited that fats in the lungs are making people sick.
But Mukhopadhyay said there was no lipoid pneumonia.
That doesn’t rule out vitamin E being the cause of the illnesses, but more research needs to be done before public health officials can call it the culprit, Mukhopadhyay said.
“We were very excited to see lung biopsies in these patients and say, ‘Hey, we’ve been able to confirm that what the clinicians are thinking is correct,’” he said. “But, in fact, it doesn’t turn out like that. We were surprised none of our cases had this.”
Mukhopadhyay said his research came out shortly after the New England Journal of Medicine published lung biopsy research from the Mayo Clinic, which also showed none of the patients had exogenous lipoid pneumonia.
“Two different groups came to basically the same conclusion that this is not lipoid pneumonia,” he said.
So if the Cleveland Clinic researchers were able to eliminate infections and lipoid pneumonia, what did they find?
“We call it acute lung injury patterns,” he said. “What that means is when the lung gets injured by anything toxic to it – it could be a bug, it could be a chemical, it could be a toxic drug. The lung has a few common ways to react to it.”
He found the lungs healed in certain predictable ways, too.
“It’s proof the lung is being damaged,” he said. “There’s no question about it.”
On Thursday afternoon, the Ohio Department of Health released the latest data about lung injuries. Thirty-nine cases have been confirmed to be related to vaping. Patients were ages 15 to 65. The median age was 21.
There have been 35 hospitalizations and no deaths in Ohio.
Cuyahoga County has had the most cases — seven. Franklin County has had six. Summit County has had four.
Public health officials are investigating whether 30 additional cases are tied to vaping.