Promotion of a Protease-antiprotease Imbalance in the airways through Chronic Vaping.

Introduction:
This text provides an analysis of the impact of electronic cigarettes (e-cigarettes) on the protease-antiprotease balance in the airways of vapers. The study compares e-cigarette users, tobacco smokers, and never-smokers. The researchers measured protease levels and relevant inhibitors in bronchoalveolar lavage (BaL) samples and immune cells stimulated with e-liquid components. The study also measured serum nicotine, cotinine, and hydroxycotinine to confirm tobacco/vape use.

Key points:

* The study found that neutrophil elastase (NE) and matrix metalloproteases (MMP-2/9) were significantly elevated in both smokers and vapers compared to nonsmokers.
* Relevant protease inhibitors, such as alpha-1 antitrypsin, secretory leukocyte proteinase inhibitor, tissue inhibitor of metalloproteinases-1 and -2, were not significantly increased in smokers or vapers.
* The study identified three novel genetic associations in ILa patients, including rs6886640 at 5q12 near IPO11, rs73199442 at 3q13 near the long noncoding RNa FCF1P3, and rs7744971 near hTR1E in subpleural ILas.
* Only the MUC5B variant reached genome-wide significance in both ILa and IPF, while other IPF risk loci had lower odds ratios in ILa.
* The findings suggest that not all individuals with ILa share the same genetic risk for IPF, and that some may have a predisposition to other non-IPF ILDs.
* The study highlights the need for further research to determine the full significance of inhaling the complex mixtures of components in e-cigarette products on the protease-antiprotease balance, the proteome, lung tissue injury, and chronic airways disease progression.

Main message:
The study suggests that chronic e-cigarette use disrupts the protease-antiprotease balance in the airways, similar to tobacco smoking. additionally, the study identified novel genetic associations in ILa patients, indicating that not all individuals with ILa share the same genetic risk for IPF. These findings have important implications for the regulation of e-cigarettes and the development of genetic risk profiles for ILDs.

Martin SL, Reihill Ja. Promotion of a Protease-antiprotease Imbalance in the airways through Chronic Vaping. american journal of respiratory and critical care medicine. 2019;200(11):1337-1339. doi:10.1164/rccm.201908-1605ED