The absolute safety of electronic cigarettes has not yet been scientifically demonstrated: it is presumable that these products present less toxic effects compared to cigars, cigarettes, and the like, but further research may help understand the long-term health effects. A recent study conducted in 2021 by the University of Southern California (Tommasi, S., Pabustan, N., Li, M. et al. 2021, A novel role for vaping in mitochondrial gene dysregulation and inflammation fundamental to disease development. Scientific Reports 11 , 22773) showed that the gene expression of people who use electronic cigarettes (e-cig) and those who smoke conventional cigarettes is very similar and not comparable to those who have never smoked. In particular, analyzing the transcriptome (i.e. the set of messenger RNAs) it was observed that those who used electronic cigarettes showed a significant alteration in the expression of genes that: Regulate the activity of the mitochondria: they are the energy centers of the cell and play a fundamental role in immunity and inflammation . When mitochondria become dysfunctional, they release key molecules, such as reactive oxygen species, which can act as signals to the immune system, triggering an immune response that leads to inflammation, which is not only important for maintaining health, but it also plays a critical role in the development of various diseases, such as cardiovascular, respiratory, and metabolic diseases. Involved in immunity and inflammatory responses, including those coding for interleukins and interferons, which play a crucial role in inflammation and numerous diseases involving defenses, including cancer. That means the vape, also used by young people because it is perceived as a safe alternative to tobacco cigarettes, it is linked to adverse biological changes that can cause disease. Possible harm from nicotine Generally, e-cigarettes appear to deliver less nicotine to the lungs than tobacco smoke. In tobacco products, nicotine is the main addictive chemical and in excessive quantities it can be toxic (if > 0.5-1.0 mg per kg of person’s weight). The concentration of nicotine contained in the cartridges of the electronic cigarette can therefore represent a risk of poisoning; for example, if a 30 kg child swallows the contents of a 24 mg nicotine cartridge, he could suffer acute poisoning. Nicotine that is inhaled, ingested or placed in direct contact with the skin can be particularly dangerous for the health and safety of certain categories of people, such as children, young people, pregnant women or those who breastfeeding people, people with heart disease, and the elderly. Electronic cigarettes, their nicotine cartridges and refill accessories must be kept out of the reach of children, to avoid the risk of suffocation or poisoning from improper use in childhood. Electronic Cigarette: is it safe to use? Since e-cigarettes do not generate smoke from burning tobacco, their use is commonly believed to be safer by consumers. However, the chemicals used in e-cigarettes have not been fully researched and regulated. Experimentation with some of these products suggests the presence of toxic chemicals. A preliminary analysis by the FDA’s Division of Pharmaceutical Analysis analyzed the ingredients in a small sample of cartridges from two leading e-cigarette brands. In one sample, FDA tests found diethylene glycol, a toxic chemical for humans, usually used as an additive for antifreeze liquids. In several other samples, FDA analyzes have found carcinogens, including tobacco-specific nitrosamines (TSNAs) and formaldehyde. Finally, the analyzes have found nicotine in some cartridges declared free from the substance. In Italy, consignments of e-cigarette refills containing benzene have been intercepted. Acrolein, toluene, heavy metals (such as nickel, copper, zinc, tin, and lead), and acetaldehyde are other known substances of concern. Some scientific studies have also shown that aromas inhaled at high concentrations exert irritating and inflammatory effects on the mucous membrane of the respiratory tract. In the future, it is presumable that – thanks to regulation and strict surveillance of production processes, together with the use of chemicals and materials that are safer for consumer health – electronic cigarettes become an increasingly safe alternative to tobacco smoke. In the meantime, it is a good general rule: be wary of cheaper products and avoid purchasing electronic cigarettes and/or refills through risky channels (marketplaces, suspicious websites, etc.).

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