Table 1.

Health impacts of vaping.

	Clinical studies	Animal studies	Cell line studies
Cancer	N/A	•Tumorigenic transformation in mouse bladder and lung tissues[85] •Increased levels of CYP family genes, activators of PAHs and DNA damage in a rat lung cancer model[25]	•High rates of apoptosis and necrosis in HNSCC cells[82] •Increased expression of double strand DNA break marker γ-H2AX in HNSCC cells[82] •Decreased DNA repair proteins in bronchial epithelial cells[85] •Increase of EMT markers in lung cancer epithelial cells[26] •Increased CSC properties of lung cancer epithelial cells[26]
Pulmonary	•Lipoid pneumonias, acute eosinophilic pneumonias, pneumonias with pleural effusion, acute pneumonitis, respiratory bronchiolitis, interstitial lung disease, bronchiolitis obliterans organizing pneumonia and diffuse alveolar hemorrhages[45] •Bilateral pulmonary opacity[22], [23] •Hypoxic respiratory failure[57] •Presence of lipid-laden AM in BAL fluids[55], [57] •Increase in serum levels of CC16 and airway vasoconstriction[65] •Increase of mucin MUC5AC concentrations and NET formation[78]	•Alteration of lipid profiles in both alveolar type II cells and alveolar macrophages from mice[53] •Increase in IL-1α, IL-13, IL-6 and CCL2 levels in BAL fluids from mice[69] •Reduction in neutrophil recruitment and antimicrobial efficiency in a Pseudomonas mouse model[73]	•Increased ROS in AEC[69] •Increased secretion of pro-inflammatory cytokines, IL6 and IL-8 in AEC[69] •Decreased NET formation and ROS in neutrophils[73] •Suppression of general innate immune responses[76] •Decrease or increase in NET formation depending on e-liquid flavoring[76]
Neurological & Neurovascular	•Seizures, syncope, or tremors[28], [93], [94], [95] •Headaches, malaise, nausea, tiredness, dizziness, fatigue, lightheadedness, dehydration, stroke[29]	•Increased nicotine serum levels by JUUL devices in a rat model[7] •Mice offspring born to e-smoking mothers: short term memory deficits, reduced anxiety, hyperactivity and altered DNA methylation[98] •Increase onset of stroke and cerebrovascular toxicity in mice[27]	•Increased OS in brain vascular endothelium[27] •Decrease in BBB integrity[27]
Cardiovascular	•High blood pressure and elevated heart rate[106], [107], [108] •Arterial stiffness[30] •Increase in serum levels of inflammatory cytokines[31]	•High angiogenesis activity in mice[112] •Increased vascular OS and apoptosis in a cardiovascular mouse model[114]	•Endothelial dysfunction in iPSC-ECs: lower cell viability, increase in ROS, OS, apoptosis and LDL uptake[31] •Increase ROS in HUVEC[67], [110] •Activation of inflammatory complement cascade in platelet cells[109], [111]
Oral & Dental	•Black and hairy tongue[32], [124], [125], [126], [127] •Oral mucosal lesions[32], [124], [125], [126], [127] •Dryness of the throat, cough, and soreness[32], [33], [41] •Para-tracheal edema, uvulitis, tonsilloliths, tonsillitis, and laryngitis[29], [33], [130] •Increase probability of periodontal and gingival disease[34], [134]	N/A	N/A

Summary of relevant clinical, animal and cell studies on the adverse health effects of vaping which include cancer, pulmonary injury, neurological symptoms, cardiovascular disease and oro-dental symptoms. N/A, not applicable.