Role of diabetes in lung injury from acute exposure to electronic cigarette, heated tobacco product, and combustible cigarette aerosols in an animal model.

Background
Patients with diabetes are more vulnerable to the detrimental respiratory effects of combustible
cigarette smoke (CS) when compared to the general population. Electronic cigarettes
(ECIG) and heated tobacco products (HTP) are marketed as less harmful alternatives to
CS. In this study, we compared the effects of acute ECIG, HTP and CS exposure on the
lungs of type II diabetes versus non-diabetic mice in an animal model.
Methods
Type II Diabetic (Diab) and Non-Diabetic (Non-Diab) mice were divided into Control, ECIG,
HTP and CS groups. Animals were exposed for 6 hrs./day to either air, ECIG, HTP or CS for
seven days. Lung injury was determined by a) histopathology, b) wet to dry ratio, c) albumin
concentration in bronchoalveolar lavage fluid, d) expression of TNF-α, IL-6, and IL-1 β, e)
reactive oxygen species production (ROS), and f) assessment of cellular apoptosis.
Results
Lung histology revealed increased edema and inflammatory cells in diabetic mice exposed
to ECIG, HTP and CS. The expression of Inflammatory mediators was, in general, more significant
in the Diabetic groups as well. TNF-α expression, for example, was upregulated in
Diab + ECIG but not in Non-Diab + ECIG. ROS was significantly increased in Diab + CS,
less in Non-Diab + CS and weakly noted in ECIG + Diab. Significant albumin leak was
observed in Diab and Non-Diab HTP-exposed animals. CS exposure worsened lung injury
in Diab when compared to Non-Diab mice.

Daou MaZ, Shihadeh a, hashem Y, et al. Role of diabetes in lung injury from acute exposure to electronic cigarette, heated tobacco product, and combustible cigarette aerosols in an animal model. PloS one. 2021;16(8):1. doi:10.1371/journal.pone.0255876