The health effects from e-cigarettes may be written in smokers' genes before people need to see doctors for various conditions. That's because e-cigarettes cause so-called epigenetic changes -- alterations that affect the function of a gene without changing the sequence -- that researchers can monitor.
"We think we have some pretty unique biomarkers which indicate vaping," said He "Peter" Wang, Clinical Professor and Vice Chair of Anatomic Pathology at Stony Brook University.
Wang, who joined Stony Brook in April, is juggling several jobs at the university. He spends most of his time as a practicing pathologist, where he specializes in evaluating lung, head and neck cancer.
Wang is also the vice chairman of anatomical pathology, which means he also has administrative and leadership responsibilities in a department run by chairman Kenneth Shroyer.
"Dr. Wang has proven to be highly effect as a leader in our division of Anatomic Pathology, advancing our expertise in pulmonary and head and neck pathology, serving as a role model and enhancing the quality of our training programs," said Shroyer, adding that he is a "great asset to my ongoing recruitment efforts."
Wang previously served for five years as Director of Anatomic Pathology and Cytopathology at Yale New Haven Health Systems on the St. Raphael Campus.
"Stony Brook has a strong environmental health [group] that clearly correlates with my research field," he said. The Stony Brook team has a strong focus on environmental heavy metal damage, which appealed to him.
Concern for youth
The clinical work Wang does in evaluating various types of cancer in the lungs, head and neck are highly affected by smoking and vaping. With the introduction of e-cigarettes, doctors haven't yet documented the longer term health effects, which is what concerns Wang in the shorter and longer term.
Estimates of the percentage of high school students who vape are around 10 percent, according to the Centers for Disease Control and Prevention. Young smokers come from a wide range of backgrounds, as Hispanic, Caucasian and Black American high school students are almost equally affected, Wang said.
"That's why it makes me so concerned about the trend in high school students" who are vaping, he said.
Indeed, in his research, Wang is hoping to search for epigenetic and genetic changes and is looking to develop specific treatments.
In addition to their potential role in cancer, e-cigarettes can also contribute to the development of other types of diseases, such as vascular damage that can lead to heart problems.
"Our group is among the first to publish that vaping is really accelerating atherosclerosis," said Wang.
In atherosclerosis, fatty plaque builds up in arteries and can lead to heart attacks. E-cigarettes can also accelerate the development of aneurisms, in which a blood vessel becomes bulged or dilated.
Wang searches for methylation of DNA, which is a particular signature in which an enzyme replaces a hydrogen in the base cytosine with a methyl, or CH3 group. He screened the entire genome for sciences of such changes. That methyl group doesn't alter the underlying genetic code, but it can change the way the gene is expressed.
Through genetic studies, Wang has been able to correlate epigenetic changes with smoking e-cigarettes.
In addition to nicotine, e-cigarettes contain a number of other elements, such as flavoring, including metals, that can damage health. Smoking regular cigarettes also causes similar epigenetic changes, although they also have differences. The different chemical components in e-liquid, including the recent synthetic nicotine, have different biological effects.
Growing his Stony Brook lab
Wang's lab is sponsored by a Stony Brook fund, the National Institutes of Health and the Food and Drug Administration. He has an R01 grant and an R03 grant, both of which are in their first year of funding.
In addition to studying the effects of smoking, Wang is looking for ways to help people stop once they've started, including creating a potential cessation medicine.
He's working on a product that blocks the connection between nicotine and its receptor, which would cut back on the cellular impact of the chemical.
"I expect that Dr. Wang's research might identify individuals that are most vulnerable to e-cigarettes-associated impact on their health," Shroyer added. "Since the pathways that are impacted by e-cigarettes may be different from those that mediate injury following cigarette smoking, it is possible that Dr. Wang's work could guide the development of more effective treatment options."
When he was at Yale, Wang was a part of a team that reached out to people who were vaping to evaluate the potential damage. He would like to duplicate that effort on Long Island.
When people stop vaping, he speculates that the epigenetic methylated biomarker will decline over time. While such biomarker studies with regular cigarettes suggest that could take about 15 to 20 years, he doesn't know how long the reversal could take with e-cigarettes.
The research he's done suggests that the epigenetic signal is dose related, meaning that the more e-cigarettes someone smokes, the larger the potentially negative effect on their DNA.
Written in his genes
Originally from Shenyang in northeastern China, Wang grew up as a part of a family that had deep roots in science and medicine.
His mother taught high school and his father was a physician. When he was in primary school, he did his homework outside his father's lab.
"I was exposed to medicine very early on," Wang said.
Outside of work, Wang enjoys hiking and visiting museums. As for his short time at Stony Brook, Wang appreciates the atmosphere and the opportunity to work with other members of the staff.
"Collaboration is critical for my research," he explained, adding that he "really enjoys his current progress."