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. 2022 Sep 25;25(7):343–371. doi: 10.1080/10937404.2022.2124563

Table 4.

In vitro studies where toxicological effects of flavored e-liquids were investigated in pulmonary carcinoma cells alone or together with primary pulmonary cells.

Cell type Flavors or flavoring chemicals investigated Exposure (Time & flavor dose) E-liquid Nicotine Dose Nicotine Control Main findings Reference
Human bronchial epithelial cells (H292)
  • Strawberry

  • Tobacco

  • Pina colada

  • Menthol

  • Coffee

3 s puff duration, every 30s, with a 55 mL puff volume. A period of 30 min was used as this was the minimum exposure at ALI. 0, 6, 12, 18, or 24 mg/mL of nicotine Nicotine alone control present.
  • Strawberry flavor was most cytotoxic following neutral red assay.

  • Exposure to each aerosol decreased metabolic activity and cell viability.

  • Coffee increased the release of IL-6, CXCL1, and CXCL2.

  • Strawberry increased the release of IL-1ß IL-10, CYCL1, CXCL2, and CXCL10.

  • No significant differences were observed between the different concentrations of nicotine and air control for both metabolic activity and viability.

  • Unflavored e-liquids significantly decreased in IL-1β, CXCL1, and CXCL2 in response to 18 mg/mL nicotine aerosol versus air controls.

  • Unflavored e-liquids significantly increased IL-6 in response to 24 mg/mL nicotine aerosol versus air control.

  • Metabolic activity was significantly decreased in cells exposed to PG/VG and VG-only, but not PG-only aerosols compared to air controls.

(Leigh et al. 2016)
Primary bronchial epithelial cells and human distal lung epithelial cells (NCI-H441)
  • Mix-1: raspberry, orange, lemon, and lime

  • Mix-2: ripe strawberry, sweet apples, and tart kiwi

40 ml/puff, 3s puff duration, 30s puff interval, 10 puffs/ session at ALI 0, 3 mg/ml No nicotine alone control present Exposure to mix-1 (nicotine-free) significantly increased transcript expression of pro-inflammatory cytokines CXCL8, IL6, NFKB1, TNF (not specified whether α or β
  • ) by more than three-fold and IL-1ß by 44-fold.

  • Mix-2 (nicotine-free) PI3 transcript was reduced two-fold.

  • The presence of nicotine in mix-1 significantly reduced the release of inflammatory markers of IL-1ß, 1 L-10, IL-13, and IL-6.


The presence of nicotine in mix-2 increased the transcript of TNF (not specified whether α or β)
(Ganguly et al. 2020)
H292 cells
  • Cinnamon

  • Butter

  • 2-h/day for 1 or 3 consecutive days aerosol exposure. Using sub-ohm EC

  • mg/mL

No nicotine control
  • 1 Day of exposure is cytotoxic, alters gene expression, and increases reactive oxygen species (cinnamon> butter).

  • After 3 days of exposure, cinnamon flavor is more cytotoxic following LDH assay and causes oxidative damage to a greater extent


than butter-flavored e‑cig aerosol.
  • Cinnamon-flavored aerosol induced pro-oxidant effects, e.g., increased 8-hydroxy-2-deoxyguanosine levels.

  • It is unclear whether the effects observed are due to nicotine plus as there are no nicotine controls.

(Noël et al. 2020b)
A549 (3D) co-culture of alveolar
and H441 cells
  • Menthol

  • Cinnamon

  • Tobacco

24-h exposure to condensed aerosol (puff regime was set to 55 mL puff volume, 3 s draw, 60s 200 puff) 0 mg/ mL & 18 mg/ mL No Nicotine control present
  • Cell viability significantly decreased in mono- and 3D culture by mint and cinnamon.

  • Significant IL-8 release only in monoculture after Cinnamon exposure.

  • No increase in MCP-1 release

  • E-liquids containing nicotine did not alter cytotoxicity or pro-inflammatory effects relative to nicotine-free.

(Bengalli et al. 2017)
CALU-3 airway epithelial cells
  • Banana Pudding (Southern Style)

  • Kola

  • Hot Cinnamon Candies

  • Menthol Tobacco

  • Solid Menthol

  • Captain black cigar

  • Peanut butter cookies

  • Popcorn

  • Black Licorice

  • Vanilla Tobacco

24-h direct e-liquid exposure (0%, 0.1%, 0.3%, 1%, 3.0%, 6.0%, 10% (v/v)) 0 mg/mL and 12 mg/mL of nicotine Nicotine alone control present
  • Hot cinnamon candies and menthol tobacco show cytotoxicity (cell and mitochondria viability) in the absence of nicotine.

  • Nicotine control decreases cell proliferation and viability dose-dependently and is cytotoxic compared to the PG/VG controls.

  • Nicotine (12 mg/mL) containing captain black cigar e-liquid showed more cytotoxicity (MTT assay) compared to captain black cigar alone.

  • Nicotine-free e-liquids inhibit cell proliferation and viability in a dose-dependent manner.

  • Nicotine-free kola, hot cinnamon candies, and menthol tobacco significantly decrease viability (calcein assay) than vehicle control.

(Rowell et al. 2017)
Human adenocarcinoma alveolar basal epithelial cells (A549 cells)
  • Balsamic flavor (with and without nicotine)

50 min aerosol exposure followed by analysis at 2-h, 6-h, 24-h. Nicotine concentration not specified No nicotine alone control present
  • Nicotine-free balsamic aerosol caused a significant, progressive, time-dependent loss of viability and increased cytotoxicity following LDH assay.

  • Nicotine-contained e-liquids compared to flavor alone caused a significant loss in viability and enhanced LDH release. Quantitative and qualitative responses are superimposable to that of cigarette smoke exposure.

  • Humectants alone did not cause cytotoxicity even 24 hours after treatment.

(Cervellati et al., 2014)
Human airway epithelial cells (H292) AND human lung fibroblast cells (HFL-1)
  • Tobacco

  • Cinnamon roll

  • Grape

30 s interval with a 4 s pulse for different time durations 5, 10, and 15 minutes 0, 6, 16, 18 and 24 mg No nicotine alone control present
  • Nicotine-free tobacco and cinnamon roll-flavored e-liquid increased the secretion of inflammatory cytokines IL-6 and IL-8 in H292 and HFL-1.

  • Nicotine-contained tobacco flavored e-liquid had a significant increase in IL-8 secretion in a dose-dependent manner in HFL-1 but not on other markers.

(Lerner et al., 2015)
Human adenocarcinoma alveolar basal epithelial cells (A549)
  • Tobacco

  • Menthol

Six puffs were dissolved per 1 mL of A549 culture medium, referred to as 6 total-puff- equivalents (TPE) of aerosol, and grown in control or treatment medium for 3–8 days. 48 mg/ml
(No nicotine free e-liquids present)
No nicotine control
  • Both EC liquids and aerosols induced epithelial-to-mesenchymal transition (EMT)

  • Both tobacco and Menthol flavors alter cell-to-cell junctions induced an EMT, internalization of E-cadherin, increased motility, and upregulation of EMT markers.

  • The EMT was concurrent with the plasma membrane to nuclear translocation of active β-catenin.

  • Due to the lack of nicotine controls, it is unclear whether the effects observed are a result of an interaction between flavor and nicotine or as a flavor effect.

  • No cytotoxicity was measured.

(Zahedi et al. 2018)
Primary human epithelial cells (HBEC), cancerous human bronchial epithelial cells CALU-3
  • Banana Pudding (BP)

5–25 puffs 0 and 12 mg/ml nicotine No nicotine alone control, but 0 mg/mL BP
  • BP acutely elevates cytosolic Ca2+ in both pulmonary cell types in no nicotine samples.

  • No adverse effects induced by PG:VG in HBEC and CALU-3.

  • Nicotine increased ER Ca2+ in CALU-3. Effect of nicotine on HBEC was not characterized.

(Rowell et al., 2020)