A newly published article in The New England Journal Of Medicine is offering the most detailed clinical insight to date into the rapidly growing vaping crisis spreading across the United States. As some scientists report the illness to possibly be a new, vaping-induced form of lipoid pneumonia, other experts suspect a chemical called vitamin E acetate is a potential primary culprit.

During a press conference on Friday, CDC officials revealed there are now over 450 cases of lung illness suspected to be associated with e-cigarette use, spanning 33 states. Three deaths are reported to be connected to the mystery illness, with a fourth currently under investigation.

Examining 53 case studies spanning two states, a new article outlines the most detailed clinical insight into the mystery illness published to date. Evaluating medical records, chest imaging, laboratory results, and exposure information, the research revealed 83 percent of patients were men with an average age of 19.

No single vaping device or e-liquid product was found to unify all of the cases studied. However, 84 percent of patients reported using some kind of THC product, and the symptomatic progression of the disease was relatively similar across all cases. Despite the illness showing symptoms of an infectious pneumonia-like condition, no infectious agent has been found. Daniel Fox, a pulmonary specialist from WakeMed working on the research, suggests the illness may be a novel form of lipoid pneumonia.

“All of our patients underwent evaluation, and after the clinical evaluation we found a certain type of pneumonia that was noninfectious,” says Fox. “It’s called lipoid pneumonia. Basically, it can occur when either oils or lipid-containing substances enter the lungs.”

A team of scientists from the University of Utah also recently published the findings of their recent investigations, suggesting the illness may be a new form of lipoid pneumonia. This research looked at six cases in Utah and found all patients displayed a unique kind of immune cell collecting in their lungs. Through a diagnostic procedure called bronchoalveolar lavage, the study identified lipid-laden macrophages in the lungs of all six patients.

“These cells are very distinctive, and we don't often see them. That made everybody start to think carefully about why they were there. Are they scavenging debris in the lungs that was introduced through vaping?” says Scott Aberegg, senior author on the new study.

These lipid-laden macrophages have now been identified in 10 of 10 Utah patients, but the researchers note the form of lipoid pneumonia presenting in the patients is not how the disease usually presents itself. This vaping-induced condition does not look like classic lipoid pneumonia as traditionally seen on a chest X-ray, leading Albregg and his Utah team to hypothesize it could be a new form of the illness.

"We need to determine if these cells are specific for the illness or whether they are also seen in vaping patients who are not ill and don't have symptoms,” says Aberegg. “If they are only seen in patients who get sick, we can begin to make some connections between what we're seeing in the lipid laden macrophages and whatever components of the vaping oils may be causing this syndrome."

Homing in on what exactly could be triggering this illness, New York State Department of Health officials say their lab results point to a compound called vitamin E acetate. Results from suspect vape liquids sampled in that state reveal high levels of that compound could be identified in a number of products being tested.

Dana Meaney-Delman, an incident manager from the CDC, affirms the illness is most likely caused by acute exposure to a chemical in illicit vaping liquids. Meaney-Delman does point out that no single compound, even vitamin E acetate, has so far been found to link all the suspected cases.

“We are aware that some laboratories have identified Vitamin E acetate in product samples, and we have connected those laboratories with the FDA Forensic laboratories to compare results,” says Meaney-Delman. “At this time, no one device, product, or substance has been linked to all cases. Continued investigation is needed to better understand if a true relationship exists between any specific product or substance and the illnesses observed in patients.”

