The role of vitamin E acetate (VEA) and its derivatives in the vaping associated lung injury: systematic review of evidence

Abstract

Small scale observational evidence suggested that Vitamin E (VE) might play beneficial role in human and animal respiratory conditions of various origin by stabilizing surfactant functions. The intra-aleveolar VE level is directly proportionate to the lung’s response to inflammation. Electronic cigarette or vaping associated lung injury was a dominantly respiratory syndrome in the United States with seemingly strong association between potential Vitamin E acetate inhalation exposure and the onset of symptoms. This systematic review intended to assess if there was previous evidence of any potential respiratory/gastrointestinal toxicity associated with Vitamin E acetate or any of its derivatives. A systematic review was constructed and prospectively registered at PROSPERO to search important clinical databases between 2000 and 2020 for full text human articles investigating the effect of VEA or any of its derivatives administered via any route (oral/parenteral/aerosolised) in adults with any respiratory conditions. Out of 363 records investigating the effect of VEA and/or its derivatives/isomers in (any) lung injury (inflammatory, oxidative, infective, asthma/COPD) seven articles qualified. The papers reported various surrogate outcomes (APACHEII score, spirometry, etc) with equivocal results. There was one case report of harmful exposure to both Vitamin E (intramuscular) and Vitamin E acetate (topical). The present review found evidence of neither harm nor any significant clinical improvement associated with the administration of VEA or any derivatives via any route in adult inflammatory lung conditions however, the articles were of low-level evidence. Further studies are needed to correct flaws in research to explore the role of Vitamin E in pulmonology.

Keywords:

• e-cigarette or vaping associated lung injury (EVALI)
• Vitamin E acetate
• respiratory distress syndrome
• ARDS
• Vitamin E
• acute lung injury

Acknowledgements

The authors acknowledge the advice of the editor gratefully and also the comments of the reviewer who was selected by the editor. They helped them to improve the quality of final version of the manuscript.

Declaration of interest

The authors take complete accountability for the content of this paper. Affiliations for the authors have been inserted in the cover page. All authors have contributed to the preparation of this article. This paper had no financial support to be prepared, designed, provided and reviewed. The authors declare no conflict of interest in this study.

Authors’ contributions

GX generated the idea and design of study. PS and GX searched the literatures in databases, wrote some part of manuscript. VAGy participated in statistical analyses and edited result part. CAJ, and VAGy reviewed the manuscript. GX and PS wrote the discussion section, and with CAJ and VAGy, supervised all parts of revision part of manuscript. GX acted as the corresponding author.