Effects of E-cigarette E-liquid components on bronchial epithelial cells: Demonstration of dysfunctional efferocytosis

Respirology. 2020 Jun;25(6):620-628. doi: 10.1111/resp.13696. Epub 2019 Sep 22.


Background and objective: E-cigarettes are often marketed and thought of as emitting harmless vapour; however, verification of their safety for non-smokers is scarce. We have previously shown that E-cigarettes cause decreased phagocytosis of bacteria by macrophages via reductions in surface bacterial recognition receptors. This study assessed the effect of E-cigarette constituents, 3 E-liquid apple flavours, nicotine, vegetable glycerine and propylene glycol, on bronchial epithelial cell viability, apoptosis and cytokine secretion and macrophage phagocytosis of apoptotic airway cells and phagocytic recognition molecules.

Methods: Cell necrosis and apoptosis were measured by Sytox Green stain and Annexin V. Efferocytosis was measured by internalization of pHrodo Green labelled apoptotic airway cells by macrophages. Expression of macrophage cell surface apoptotic cell receptors was measured by flow cytometry. Cytokine release by E-cigarette-exposed airway cells was measured by cytokine bead array.

Results: E-cigarette vapour increased primary bronchial epithelial necrosis and apoptosis. E-cigarette vapour reduced efferocytosis (lowest flavour 12.1%) versus control (20.2%, P = 0.032). The efferocytosis receptor CD44 was reduced by one flavour (MFI 1863 vs 2332 control, P = 0.016) and all components reduced expression of CD36, including the glycol bases (MFI 1067-12 274 vs 1415 control). Reduced secretion of TNF-α, IL-6, IP-10, MIP-1α and MIP-1β was observed for all flavour variants.

Conclusion: E-cigarettes can cause bronchial epithelial apoptosis and macrophage efferocytosis dysfunction via reduced expression of apoptotic cell recognition receptors. These data further show that E-cigarettes should not be considered harmless to non-smokers and their effects may go far beyond cytotoxicity to cells.

Keywords: E-cigarettes; airways; apoptosis; cytokines; efferocytosis; macrophages.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptor Proteins, Signal Transducing / metabolism
  • Apoptosis / drug effects
  • Bronchi / physiopathology
  • CD36 Antigens / biosynthesis
  • Cell Line
  • Cell Survival / drug effects
  • Chemokine CXCL10 / metabolism
  • Electronic Nicotine Delivery Systems*
  • Epithelial Cells / drug effects*
  • Epithelial Cells / metabolism
  • Glycerol / toxicity*
  • Humans
  • Hyaluronan Receptors / biosynthesis
  • Interleukin-6 / metabolism
  • Macrophages / immunology
  • Necrosis / chemically induced
  • Nicotine / toxicity*
  • Phagocytosis / drug effects
  • Propylene Glycol / toxicity*
  • Receptors, Cell Surface / drug effects
  • Respiratory Mucosa / drug effects
  • Respiratory Mucosa / physiopathology*
  • Tobacco Products
  • Tumor Necrosis Factor-alpha / metabolism


  • Adaptor Proteins, Signal Transducing
  • CD36 Antigens
  • CD36 protein, human
  • CD44 protein, human
  • CXCL10 protein, human
  • Chemokine CXCL10
  • Hyaluronan Receptors
  • IL6 protein, human
  • Interleukin-6
  • MAPKAP1 protein, human
  • Receptors, Cell Surface
  • TNF protein, human
  • Tumor Necrosis Factor-alpha
  • Propylene Glycol
  • Nicotine
  • Glycerol