Respiratory Effects, Metal and Aldehyde exposure from e-cigarette use in young adults (REMA)

PROJECT SUMMARY
My long-term goal is to become an independent investigator focusing on how pollutant exposures may adversely
affect respiratory health and identify measures to effectively mitigate such exposures. My primary project
objective is to investigate the exposure and toxicity of chemical constituents of concern (CCOC), namely metal
and aldehydes, as well as the pulmonary health effects, including inflammation, of using new and emerging
electronic cigarette (e-cig) devices among young adults. E-cig devices work by heating a mixture of chemicals
to generate an aerosol that is inhaled by the user. Use of e-cigs has increased and, among adults, remains the
highest among those aged 18 to 24 years. More recent e-cig devices such as disposable PODs have grown in
popularity, yet it is currently unknown whether these new devices’ design characteristics in conjunction with user
vaping regimen impact CCOC exposure and influence respiratory health. Thus, my specific aims are to 1)
evaluate the relationship between e-cig use and CCOC exposure and effect, 2) assess the association of e-cig
use with respiratory outcomes and inflammatory markers, and 3) assess CCOC exposure as a mixture and
potential mediator in e-cig related respiratory health outcomes. In this cross-sectional study, to achieve Aim 1
(K99 phase), 150 participants (75 e-cig users, 75 non-users) will be recruited to assess biomarkers of exposure
(aldehydes, metals) and effect (metallothionein) from e-cig use. This will leverage the ongoing EMIT study which
looks at metal exposure and collects e-cig user regimen via questionnaire, aerosol samples, biospecimens
(blood, urine), and spirometry measures. After receiving training in chemical analysis, respiratory clinical
outcomes, and inflammatory markers, including gene expression changes, a new cohort of 150 participants (75
e-cig users, 75 non-users) will be recruited for Aim 2 (R00 phase). This phase will not only collect the same data
as in Aim 1 but also biomarkers of effect and inflammation (blood, urine, FeNO) and gene expression profiles (in
nasal epithelial cells). Whether e-cig users have increased respiratory symptoms, inflammation and altered gene
expression profiles compared to non-users will be evaluated. Combining Aims 1 and 2 cohorts (n= 300), Aim 3
will employ the use of Bayesian and causal mediation methods to assess if CCOC exposure is positively
associated with and explains, at least in part, the respiratory effects from e-cig use. With the proliferation of
newer e-cig devices, there is an urgent need to characterize exposure and respiratory health effects resulting
from their use. This study has the potential to generate critical data to inform FDA regulation to limit adverse
exposures and health outcomes and curb the increasing prevalence of use among young adults. Through this
research, my didactic coursework, and the guidance of my mentoring team consisting of a pulmonologist,
exposure scientist, immunologist, analytical chemist, and environmental epidemiologist, I will acquire critical
skills needed to be a successful independent researcher in environmental health and tobacco control.

Grant Number: 5R00ES034507-04
NIH Institute/Center: NIH
Principal Investigator: Angela Aherrera