University of North Carolina School of Medicine: Study shows that e-cigarettes containing nicotine salts may cause more damage to immune cells than other e-cigarettes

A new UNC School of Medicine study finds that users of e-cigarette cartridges containing nicotine salts and disposable e-cigarettes display unique markers of immune suppression not seen in users of other types of e-cigarettes. The study suggests that the long-term health effects of this altered immune system response are unknown.

The new study, funded by the National Institutes of Health, aimed to explore the health effects of different kinds of e-cigarette devices. In particular, the study focused on what are known as "fourth-generation" e-cigarette devices. These are modern devices that use nicotine salts, like cartridge-based e-cigarettes and Juul products, unlike "third-generation" devices, like box mod e-cigarettes and Vape Pens.

The researchers collected sputum samples from four different groups: non-smokers, tobacco smokers, third-generation e-cigarette users, and fourth-generation e-cigarette users. They measured a number of different inflammatory biomarkers in the sputum samples.

The main finding of the study was that the sputum of fourth-generation e-cigarette users had unusually high numbers of bronchial epithelial cells. These cells are not usually found in sputum samples and are often a sign of airway damage.

Another important finding was that the fourth-generation e-cigarette users had lower levels of a wide range of immune cells, including CRP, IFN-g, MCP-1, uteroglobin, MMP-2, and VEGF. The levels of these immune biomarkers were significantly lower than those of the third-generation e-cigarette users. The researchers pointed out that this may mean that the immune system of the fourth-generation e-cigarette users is abnormally suppressed.

"A key finding of this study is that when a mixture of immune markers were examined across the board rather than one by one, fourth-generation e-cigarette users had the most pronounced changes of all groups, suggesting a shift in immune balance," said Elise Hickman, lead author of the study.

It’s important to note that the study can’t directly link these immune differences to specific health outcomes. The researchers made clear that the findings don’t link fourth-generation e-cigarette use to diseases like cancer or emphysema.

Instead, the researchers say the findings suggest that these specific types of e-cigarette devices may lead to new effects on the immune system that are not seen with other types of e-cigarette devices, and the long-term health effects are unknown.

“It’s impossible to know whether vaping reduces cancer risk or many other long-term conditions,” explains Ilona Jaspers, another researcher working on the project. “It took 60 years of research to show that smoking causes cancer. Despite this, studies from our lab and many others are showing many of the same acute biological effects in the respiratory tract that we document in smokers. And we’ve seen some changes in cellular and immune defenses in smokers that, frankly, we’ve never seen before, and that’s very worrying.”

While this is the first study to zoom in on differences in immune biomarkers between different types of e-cigarette users, other recent studies have pointed to some of the possible dangers of cartridge-based vaping devices. Earlier this year, an animal study from the University of California San Diego School of Medicine found that nicotine-salt e-cigarettes produced inflammatory markers in various organs.

Jaspers said it will be important for e-cigarette researchers to consider the effects of different devices in future studies. Exactly what the long-term health effects of smoking are is still unclear, but it is becoming increasingly clear that not all e-cigarette devices affect the body in the same way.

The new study was published in the American Journal of Respiratory and Critical Care Medicine.

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