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Lectures on vaping and cell death attract alumni

Yale Medicine Magazine, 2019 - Spring


Alumni at Yale School of Medicine’s annual reunion on June 1 listened as experts share their latest findings on two cutting-edge subjects, the exploding youth e-cigarette epidemic and potentially game-changing research into cell death.

On e-cigarettes, the numbers outlined by Suchitra Krishnan-Sarin, PhD, professor of psychiatry, were stark and sobering. A 2018 survey revealed that 20% of teenagers had regularly used the nicotine delivery systems in the prior month and 27% reported having tried the devices at least once, said Krishnan-Sarin, an expert in tobacco and nicotine addiction. That figure is expected to go even higher in this year’s survey, she said.

The survey results highlight the exponential growth in the use of e-cigarettes— originally created as smoking cessation devices—among young people, a problem doctors attending Alumni Reunion Weekend were eager to discuss, Krishnan-Sarin said.

“They seemed very concerned,” Krishnan-Sarin said. “They were all talking about incidents where they had seen people vaping, kids vaping, and what to do about it.”

Krishnan-Sarin advised adding a question during routine physical exams about e-cigarette use and educating patients about the many and serious health dangers associated with nicotine. While anti-smoking campaigns have been successful at reducing teen smoking rates, they appear to have left a false impression among the young that nicotine itself is not bad for them, she said.

Also, Krishnan-Sarin advised physicians to be on the lookout for and report to the Food and Drug Administration any instances of nicotine poisoning associated with e-cigarette use, another growing concern. How much nicotine teens are ingesting through the devices is unclear, Krishnan-Sarin said. “A single ‘pod’—the container inserted into e-cigarettes like the JUUL—has more nicotine than a pack of cigarettes, and anecdotal evidence suggests many teens report using a pod a day,” she said. Heightening the worry is research suggesting nicotine can damage the developing teenagers’ brains, she said.

Why the habit has caught fire among youth is something that Krishnan-Sarin, co-lead investigator at the Yale Tobacco Center of Regulatory Science, is researching. While controlling the marketing of these products to youth is important, the practice appears to have spread primarily through kids interacting with each other on social media. One research focus is the use of flavor, she said. E-cigarettes come in more than 15,000 flavors that users can customize to their individual tastes, and there is little known about the short- and long-term effects of exposure to these flavor chemicals. Yet another worry is the growing use of the devices to vape marijuana, she said.

Adding to the challenge is that researchers don’t know how effective e-cigarettes are in performing their original mission, helping people quit smoking, Krishnan-Sarin said. She said that while it is quite possible that some patients might benefit from the use of these devices for smoking cessation, there was little information on dosage, duration of treatment, and other relevant issues. She advised doctors to have patients try other methods, like approved medications and nicotine replacement therapy, first.

In discussing the problem with children, Krishnan-Sarin emphasized to the doctors the importance of learning the lingo associated with vaping.

“The kids don’t call it an ‘e-cigarette’ or ‘electronic nicotine delivery device,’” she said. “They use words like ‘vaping’ or ‘juuling.’ You have to use the terms they understand.”

The presentation to alumni by Carla Rothlin, PhD, covered a very different subject. An associate professor of immunobiology and pharmacology, Rothlin used quotes from such famous writers as Nobel Prize-winning novelist Jose Saramago and Simone de Beauvoir to explain her research into cell death.

Her key insight: identification of codes for cell regeneration not only inside dying cells, but also free-floating outside of them. The context in which the cell dies—whether through injury, infection, or natural process—appears to play in a role in determining the code, she said.

“In death, there’s a code for life,” said Rothlin, who runs a lab at Yale together with Sourav Ghosh, PhD, associate professor of pharmacology, that is researching the subject. “There’s continuity. When cells die, they encode for what will come next.”

That insight could eventually lead to improved treatments for degenerative and inflammatory diseases, she said. The next step is to crack the codes and understand their expression patterns. Armed with that understanding, researchers would then aim to manipulate the process with the goal of treating patients with Alzheimer’s and other diseases, she said.

But don’t expect any such treatments any time soon. The regenerative codes are very complex and will take years to figure out. Any clinical applications are likely many years away, Rothlin said.

“We’re still in the early basic science stage,” she said. “It’s too soon to say when the research might yield clinical therapies.”

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