Mayo Clinic researchers studying the pathology of severe lung distress in patients who vape have found that “toxic chemical fumes” and “poisonous gases” are making patients sick, not vitamin E and other oils as previously reported.

In a study published Oct. 2 in the New England Journal of Medicine, a group of physicians from four Mayo Clinic hospitals analyzed the lung biopsies from 17 patients. The patients are among more than 1,000 sickened nationwide in an outbreak associated with vaping that has claimed at least 23 lives. Two of the biopsies are from deceased patients.

The researchers found no evidence of tissue injury caused by the accumulation of lipids — fatty substances such as mineral oils — among the 17 specimens. Previously, health officials have said it appeared that many of the sickened patients suffered from an accumulation of lipids in the lungs from vape products containing oil.

“While we can’t discount the potential role of lipids, we have not seen anything to suggest this is a problem caused by lipid accumulation in the lungs. Instead, it seems to be some kind of direct chemical injury, similar to what one might see with exposures to toxic chemical fumes, poisonous gases and toxic agents,” said Dr. Brandon Larsen, a surgical pathologist at Mayo Clinic Arizona, and a national expert in lung pathology.

The study’s authors said that their research on the lung injuries linked to vaping is still in its early stages and that the findings should be interpreted cautiously. Their conclusions, however, underscore the enigmatic character of the outbreak and investigators’ inability so far to find a common denominator linking all the sudden lung illnesses.

According to the Centers for Disease Control and Prevention (CDC), more than 60% of the affected patients have reported using vapes containing THC, the psychoactive compound in marijuana. But many patients have reported using a combination of THC and nicotine while others said they only use vapes containing nicotine.

Of the 17 patients in the Mayo Clinic study, less than three-fourths of them said they had vaped marijuana or cannabis oils, yet all of them suffered acute lung injury, including pneumonitis, an infection and inflammation of the lungs.

On Oct. 3, the CDC said that it has received reports of 1,080 cases of lung injury and disease linked to various vape products. The agency has confirmed 18 deaths in 48 states and the U.S. Virgin Islands. By Oct. 9, the reported number of deaths had increased to 23, including the youngest victim, a 17-year-old male in the Bronx, New York.

“This is a public health crisis, and a lot of people are working frantically around the clock to find out what the culprit or culprits could be — and what chemicals may be responsible,” Dr. Larsen said. “Based on what we have seen in our study, we suspect that most cases involve chemical contaminants, toxic byproducts or other noxious agents within vape liquids.”

Beasley Allen lawyers Joseph VanZandt and Sydney Everett, together with Mass Torts Section Head Andy Birchfield, are currently representing several individuals who are suing JUUL for the negative impact its products have had on their lives. On Oct. 7 they also filed lawsuits on behalf of school districts in three states, which seek to protect students and recover resources spent fighting the vaping epidemic.

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