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In 2024, an estimated 3.87 million middle and high school students in the US used ENDS ( 3 Immune checkpoints Numerous immune checkpoint molecules have been identified ( 3.1 TIGIT T-cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) plays a central role in autoimmunity and immune regulation, functioning primarily to limit T cell-mediated inflammation rather than to drive acute T cell priming ( 3.2 CTLA-4 Cytotoxic T-cell-associated protein 4 (CTLA-4) is a T-cell-associated receptor that acts as a critical immune checkpoint

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