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Other evidence of the possible irritant and inflammatory effect on cells comes from an in vitro study in which the exposure of tracheobronchial cells to electronic cigarette nicotine-free vapours was related to a concomitant increase in interleukin-6 and interleukin-8 cytokine production with a dose-dependent response and direct evidence of endothelial dysfunction.84 The association with inflammation and endothelial dysfunction is most likely mediated via nitric oxide pathways