Nicotine promotes e-cigarette vapour-induced lung inflammation and structural alterations

Background Electronic cigarette (e-cigarette) vapour is gaining popularity as an alternative to tobacco smoking and can induce acute lung injury. However, the specific role of nicotine in e-cigarette vapour and its long-term effects on the airways, lung parenchyma and vasculature remain unclear.Results In vitro exposure to nicotine-containing e-cigarette vapour extract (ECVE) or to nicotine-free e-cigarette vapour extract (NF ECVE) induced changes in gene expression of epithelial cells and pulmonary arterial smooth muscle cells (PASMCs), but ECVE in particular caused functional alterations (e.g. a decrease in human and mouse PASMC proliferation by 29.3 & PLUSMN;5.3% and 44.3 & PLUSMN;8.4%, respectively). Additionally, acute inhalation of nicotine-containing e-cigarette vapour (ECV) but not nicotine-free e-cigarette vapour (NF ECV) increased pulmonary endothelial permeability in isolated lungs. Long-term in vivo exposure of mice to ECV for 8 months significantly increased the number of inflammatory cells, in particular lymphocytes, compared to control and NF ECV in the bronchoalveolar fluid (BALF) (ECV: 853.4 & PLUSMN;150.8 cells & BULL;mL-1; control: 37.0 & PLUSMN;21.1 cells & BULL;mL-1; NF ECV: 198.6 & PLUSMN;94.9 cells & BULL;mL-1) and in lung tissue (ECV: 25.7 & PLUSMN;3.3 cells & BULL;mm-3; control: 4.8 & PLUSMN;1.1 cells & BULL;mm-3; NF ECV: 14.1 & PLUSMN;2.2 cells & BULL;mm-3). BALF cytokines were predominantly increased by ECV. Moreover, ECV caused significant changes in lung structure and function (e.g. increase in airspace by 17.5 & PLUSMN;1.4% compared to control), similar to mild tobacco smoke-induced alterations, which also could be detected in the NF ECV group, albeit to a lesser degree. In contrast, the pulmonary vasculature was not significantly affected by ECV or NF ECV.Conclusions NF ECV components induce cell type-specific effects and mild pulmonary alterations, while inclusion of nicotine induces significant endothelial damage, inflammation and parenchymal alterations.

Automated summary

The long-term effects of nicotine in e-cigarette vapour on the airways, lung parenchyma, and vasculature are unclear. In vitro and in vivo experiments showed that nicotine induced changes in gene expression and functional alterations in epithelial cells and smooth muscle cells. Nicotine also increased pulmonary endothelial permeability and caused inflammation and parenchymal alterations. Therefore, the inclusion of nicotine in e-cigarettes can lead to significant damage to the lungs.