Nov. 26 (UPI) -- The cutting agent vitamin E acetate was found in Illegal THC cartridges obtained from victims of Minnesota's outbreak of vaping-related illness, the U.S. Centers for Disease Control and Prevention said Tuesday.
The Minnesota Department of Health found that vitamin E acetate was present in vaping products turned in by patients who had been hospitalized in 2019 with e-cigarette, or vaping, product use-associated lung injury, or EVALI, they said in CDC's Morbidity and Mortality Weekly Report.
Researchers analyzed 46 THC-containing vaping cartridges from 12 EVALI patients and found 24 vape cartridges contained vitamin E acetate.
Minnesota researchers also tested vaping products seized in raids by law enforcement from before and after the outbreak. They found vitamin E acetate in all of the tested vaping products seized in 2019. The agency compared vape cartridges seized by police in 2018 raids and found no vitamin E acetate, they said.
"[T]he number of products tested was small, and further research is needed to establish a causal link between exposure to inhaled vitamin E acetate and EVALI," the report said.
The Minnesota state health department has reported 96 cases of EVALI so far. Three patients have died.
Among 58 Minnesota patients interviewed, 53, or 91 percent, reported buying illicit THC-containing vapes from informal sources such as friends, family members, or in-person or online drug dealers. Recreational marijuana is illegal in Minnesota.
The CDC recently reported the presence of vitamin E acetate in all of 24 samples of lung tissue obtained from patients with EVALI in 10 states. The agency identified the cutting agent as a "culprit of concern" in the vaping illness crisis.
Vitamin E acetate, a product approved for consumption and for use in cosmetics, was introduced this spring into the illicit THC market as a way to stretch profits by cutting cannabis oil.
When inhaled as a vapor, it produces a gummy, oxygen-sequestering coating on the lungs, scientists have found.
However, CDC scientists and others have not necessarily linked EVALI to vitamin E acetate. Federal health officials have said that there may be more than one substance, or combination of substances, that has led to the lung illness that has killed 47 people and sent more than 2,000 to the hospital in 49 states.
The CDC and U.S. Food and Drug Administration have advised people to stay away from vaping THC products obtained through illegal sources or online. They also advised people to refrain from vaping e-cigarettes until the exact cause of the outbreak is identified.
Meanwhile, the U.S. National Institutes of Health has issued a call for research into the vaping crisis.
The NIH is looking for research that might include animal or human experiments or "any potential constituent that might be related to the disease," said Lisa Postow of the National Heart, Lung and Blood Institute.
Those include research into whether EVALI is influenced by vape behaviors (such as dripping and dabbing); whether patients can have long term effects of EVALI that could make them more susceptible to common diseases like influenza; how devices are used and what effects other cutting agents and additives might have on the lungs, among others.
"We want to give the academic and external research community a chance to address these questions that have come up quite suddenly over the last few months," Postow said. The agency's Notice of Special Interest allows researchers to change their NIH grant funding to specialize in EVALI research.
"I'm expecting to get a range of requests," Postow said.
As a lung specialist, Postow said EVALI is still a puzzle.
Some research, like that done by the Mayo Clinic, has shown no presence of vitamin E acetate, but instead found EVALI patients with a chemical burn in the lungs. Other research shows vaping-related lung damage due to "popcorn lung," a condition caused by inhaled chemical additives.
"I think there's a lot of uncertainty, a lot of variability in the presentation of this disease, and we're waiting for more data to come out," Postow said. "The CDC is doing a great job and they've been working 24/7 and made an amazing amount of progress."