Electronic cigarettes operate based on what seems to be a simple assumption: Tobacco products can cause serious health problems, so removing the tobacco and leaving the nicotine must be safer.
However, according to an ongoing study between researchers at Boston University and University of California-Los Angeles, the answer may not be this simple and straightforward. In fact, their research indicates that electronic cigarettes, often referred to as e-cigs, may still be unsafe.
“It’s incredibly successful marketing on the tobacco companies’ side, where by now, millions of Americans are using this product,” said Dr. Avrum Spira, a professor at Boston University School of Medicine and the principle investigator of BU’s contributions to the study. “They seem safer, but that’s where our research comes in.”
This research reveals a potentially darker side of a product that has been growing quickly in popularity. From 2008 to 2012, the net e-cigarette sales in the United States skyrocketed from approximately $20 million to $500 million, according to data from statisticbrain.com. Since then, they have surpassed $1 billion, according to an August story from Business Insider.
At the annual American Association for Cancer Research convention on April 6, the joint BU-UCLA team presented findings that reveal similar effects of both traditional smoking and electronic vapor intake.
The research has been a two-fold process. The team at UCLA first kicked off the investigation by collecting epithelial cells, the cells that line and protect organs, from non-smoking patients.
“We collected them during a procedure called bronchoscopy, where we insert a fibro-optic scope into the airway and brushed the cells that line that airway,” Spira, who is also a pulmonary and critical care physician at Boston Medical Center, said.
The cells were then mutated in order to simulate the more cancer-prone nature of a smoker’s epithelium.
“What that means is basically these were modified human lung cells,” said Teresa Wang, a fourth-year Ph.D. candidate and researcher in the Spira-Lenburg Lab at BUSM.
The cells were separated into cultures and exposed to either traditional cigarette (t-cig) smoke or e-cig vapor. The vapor and smoke administrations were given in four-hour durations over 10 days.
The UCLA researchers then observed the cultures for their ability to form something called the “anchorage-independence growth,” the behavior of cancer cells to spread abnormally. Both e-cig and t-cig exposures produced similar levels of this growth.
“The cells that were exposed to high concentrations of the electronic cigarette had a change in their behavior in that they were able to grow very quickly, almost looking cancer-like,” Spira said. “They had a very similar growth rate to when you take these very same cells and expose them to tobacco smoke. This was a very concerning observation.”
The team then extracted the RNA from both the smoke-exposed and vapor-exposed cells and sent it over to BU for gene profiling through microarray technology. This experiment once again produced similar results for both types: Data suggested that both e-cig and t-cig-treated RNA experienced similar gene expression at a certain level of nicotine intake, Wang said.
“In other words, electronic cigarettes induce activities in a number of genes that are similar to what regular tobacco smoke induces,” Spira said.
These similarities in gene expression behavior and cell population growth both add to the skepticism over e-cigs as a “safer” alternative to smoking and serve as incentives for continued investigation over the method, Spira said, though he was quick to caution that further examination is needed.
The joint team plans on pushing the study toward a more realistic scope by retrieving epithelial cells from already-smoking patients who switch over to e-cigs. The team is currently recruiting people in the Boston and Los Angeles areas for this next stage of research.
Michael Siegel, a professor of community health sciences at BU School of Public Health, said e-cigarettes also satisfy desires other than that for nicotine.
“A lot of the people who are addicted to smoking are not just addicted to the nicotine,” Siegel said. “They’re addicted to all the aspects of smoking behavior — everything from the hand motions, to the throat sensations to the tactile feeling of the cigarette, to the social behaviors. In that sense, it’s kind of a holistic approach.”
Spira said he believes continuation of the study is a necessary precursor to future e-cig usage and advancement.
“The major take-home message, I think, is that it’s very early days in terms of our understanding of the health impact of these newer types of tobacco products, specifically electronic cigarettes,” he said. “A lot more studies like these are needed before we can feel that these products are, in fact, safe.”