Abstract
BACKGROUND: Electronic nicotine delivery systems (ENDS) heat "e-liquids" to generate "e-vapor", an inhalable aerosol. E-liquids contain nicotine and flavors in a solvent of 70% vegetable glycerin, 30% propylene glycol (70VG/30PG). Flavored ENDS are very popular among teens vapers, however, the possible cardiac electrophysiological harm of inhalation exposure to flavored ENDS are not fully understood. PURPOSE: To test if inhalation exposure to e-liquids or their constituents compromises mitochondrial integrity, increases oxidative stress, and leads to cardiac electrophysiological toxicity. METHODS: Gas chromatography mass spectrometry (GC/MS), and flow cytometry, in-vivo programmed electrical stimulation (PES), and transmission electron microscopy (TEM) were used in atrial like HL-1 myocytes and in mice overexpressing the antioxidant mitochondrial catalase (MCAT) which underwent inhalation exposure to e-vapor. RESULTS: We compared the toxicity of e-vapor exposure to 30 differently flavored e-liquids (70VG/30PG, with 6 mg/ml nicotine) in HL-1 cells using annexinV flow cytometry. Most e-liquids were toxic. We then quantified the concentrations of major flavoring carbonyls (cinnamaldehyde, vanillin, ethyl-vanillin, maltol, and ethyl-maltol) in the 30 e-liquids using GC/MS. Toxicity of the e-liquids in HL-1 cells correlated with their flavoring carbonyls concentration. We assessed oxidative stress (OS) via CellROX flow cytometry in HL-1 cells exposed to vanilla flavored e-vapor. OS increased in exposed cells but this was blunted by N-acetylcycteine pretreatment. In-vivo inhalation exposure to e-vapor of vanilla flavored e-liquid with 6 mg/ml nicotine increased inducible ventricular tachycardia duration in WT but not in MCAT mice versus control. In TEM, mitochondrial perimeter was unaffected, but cristae thickness decreased in exposed WT, but not in exposed MCAT hearts versus controls. We then investigated whether adverse cardiac effects of vaping are due only to nicotine. Mice were exposed to the e-vapor of 70VG/30PG base alone or base plus vanillin WITHOUT nicotine. In telemetric ECG analysis of heart rate variability, exposure to base plus vanillin decreased parasympathetic indices more than exposure to base alone. In PES, the effective refractory periods of base alone and base plus vanillin groups tended to be shortened vs air controls. While exposure to base alone and to base plus vanillin significantly increased inducible ventricular tachycardia duration compared to air controls, the increase in the base plus vanillin group was more significant compared to that of base alone. CONCLUSIONS: Inhalation exposure to flavored ENDS or to their NON-NICOTINE constituents negatively affects ventricular electrophysiology, possibly via adverse mitochondrial remodeling, and increased oxidative stress.