Summary
Introduction:
This text discusses a study that aimed to identify a non-invasive biomarker for the diagnosis of EV aLI (E-cigarette or Vaping Product Use-associated Lung Injury) by analyzing the lipid profiles of non-smoking controls, e-cig users without EV aLI, and e-cig users hospitalized with EV aLI. The study identified reduced plasma phosphatidylethanolamines (PEs) as a potential biomarker for diagnosing EV aLI.
Key Points:
* The study enrolled three groups of subjects: non-smoking controls, e-cig users without EV aLI, and e-cig users hospitalized with EV aLI.
* Untargeted lipidomics were performed on human plasma via lipid extraction and subsequent LC-MS/MS identification.
* Phosphatidylethanolamines (PEs) were significantly reduced in all EV aLI subjects compared to control groups of non-users and e-cig users.
* PE’s play an essential role in surfactant homeostasis and reduced PE concentrations in the lung would predispose EV aLI subjects to alveolar collapse from increased surface tension of surfactant.
* The study identified reduced PE’s in a younger cohort of subjects with aLI and identified reduced plasma PE’s levels prior to the development of severe respiratory failure.
* The study was not powered to provide accurate measurements of sensitivity and specificity for PE’s as biomarkers of diagnosing EV aLI, but solely used for identification of biologically relevant plasma biomarkers using untargeted lipidomics.
* all EV aLI subjects were enrolled after CDC stopped reporting, emphasizing the continued importance and need for non-invasive biomarkers for this new disease that remains a diagnosis of exclusion and significantly different from other forms of acute lung injury.
Main Message:
The study identified reduced plasma phosphatidylethanolamines (PEs) as a potential non-invasive biomarker for diagnosing EV aLI, which is a significant finding considering the limitations of using BaLF VEa levels as a diagnostic biomarker. The study also highlights the importance of understanding the role of PEs in surfactant homeostasis and how reduced PE concentrations in the lung could predispose EV aLI subjects to alveolar collapse. Further studies are needed to validate PE’s as a biomarker for diagnosing EV aLI and differentiating PE plasma levels in EV aLI from other forms of aLI/aRDS. The study also emphasizes the need for non-invasive biomarkers for this new disease that remains a diagnosis of exclusion and significantly different from other forms of acute lung injury.
Citation
McGraw MD, Croft DP, Nacca NE, Rahman I. Reduced plasma phosphatidylethanolamines in e-cigarette, or vaping, product use-associated lung injury (EVaLI). Pediatric pulmonology. 2022;57(5):1350-1354. doi:10.1002/ppul.25874
