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Impact of JUUL Use on Lung Physiologic and Immune Health and Systemic Inflammation

Institution: Veterans Medical Research Foundation
Investigator(s): Laura Crotty Alexander,
Award Cycle: 2019 (Cycle 30) Grant #: T30IP0965 Award: $567,587
Subject Area: Pulmonary Disease
Award Type: High Impact Pilot Award

Initial Award Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Cigarette smoking is responsible for the vast majority of these deaths, however electronic (e)-cigarettes have been found to have some of the same effects and may cause lung disease as well. E-cigarettes are already widely used across California by men, women, and children, with between 25-50% of high-schoolers having tried them. JUUL is the newest type of e-cigarette, originating out of San Francisco, and has rapidly dominated the market. It is estimated that 50-60% of all inhalant users are JUULing. Use has gone viral in California youth in particular, most likely due to the attractive, sleek design and appealing flavors (Mango, Mint, Creme Brulee, etc). The JUUL device has a different form of nicotine, due to a molecular alteration done by the chemists at JUUL to create nicotine salts. This allows higher amounts of nicotine to be packed into each device, equivalent to nicotine in an entire pack of cigarettes. Compared to inhalation of vapor from conventional e-cigarettes (even Mods), JUUL aerosol produces a much more powerful hit, with users describing it as equivalent to chugging a beer. In our own human subjects studies, we have found the JUULs to be highly addictive. Because use of the device leads to rapid absorption of nicotine and intense CNS effects (based on symptoms and effects described by users) there are use patterns specific to this device. Thus, established in vivo mouse and in vitro cell models must be redesigned and adapted to be relevant to JUUL use. In the studies proposed, we will use our new JUUL mouse exposure model and our human cohort of young adult inhalant users which we recruited over the past two years. By conducting the research outlined in this proposal, we hope to define what effects JUUL has on lung function. We will also define what effects JUUL has on lung and systemic inflammation. Finally, we will determine whether JUUL use predisposes to bacterial infections and decreases the ability of the body to fight infections. This research is necessary to guide the public about risks of JUUL use and inform policy makers in California and nationwide.