By Lena H. Sun

The Washington Post

WASHINGTON — Federal health officials have identified vitamin E acetate in the lung fluids of 29 people sickened in the outbreak of dangerous vaping-related lung injuries. The discovery is a “breakthrough” that points to the oil as a likely culprit in the outbreak that has sickened more than 2,000 people and killed at least 39, a top official said Friday.

“These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs,” said Anne Schuchat, principal deputy director at the Centers for Disease Control and Prevention. The latest information points to growing evidence of vitamin E acetate as “a very strong culprit of concern,” she said.

The findings announced Friday do not rule out other possible compounds or ingredients that may be causing the lung injuries. But Schuchat described the lab results as a “breakthrough” in the investigation. CDC tested for a wide range of substances that might be found in patients’ lung fluids, including plant oils and petroleum distillates, such as mineral oil.

But what they did not find was just as important. “No other potential toxins were detected,” Schuchat said.

CDC officials found vitamin E acetate, an oil derived from the vitamin, in all 29 samples of lung fluid collected from patients who had fallen ill or died from lung injuries. THC, the psychoactive ingredient in marijuana, was also found in 23 patients, including three who said they had not used THC products. Nicotine was detected in 16 of 26 patients. Most patients who have fallen ill in the outbreak have vaped THC, officials have said.

Vitamin E acetate, an oil derived from the vitamin, has been identified in previous testing by the Food and Drug Administration and state laboratories in vape products that contain THC. New York State’s Wadsworth Center lab was the first to discover it about two months ago in samples from sick patients. Of 595 vaping product samples linked to patients that have been tested by FDA, 70% contained THC. Half of those THC-containing products also had vitamin E acetate, with concentrations as high as 88%, the FDA said Friday.

Many of the THC-containing products were obtained on the illicit market, officials have said. Vitamin E acetate has been used in recent months as a cutting agent or additive on the cannabis black market to stretch the amount of THC in vape cartridges, officials and industry experts have said. Vitamin E acetate is a popular additive because it is colorless and odorless, has similar viscosity to THC oil and is much cheaper.

The findings are significant because for the first time, scientists have been able to connect results from product testing with clinical specimens from patients, she said. The 29 patients are from 10 states, representing a diverse geographical area, making the findings “much more robust” than if all the patients were from a single location. Two of the patients died.

“They help us better understand the potential compounds” that may contribute to the injuries, Schuchat said.

Vitamin E acetate is found in many foods and in cosmetics, especially skin care products. It’s not known to cause harm when swallowed or applied to the skin, Schuchat said. But when it is heated and inhaled, it may interfere with normal lung function.