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Then we investigated whether either prolonged (until 25 weeks) or short term (24 h) CSE exposure induces alterations in mtDNA gene expression, and whether the changes were accompanied by alteration in mtDNA methylation

doi: 10.1136/bmj.l5275 Summary Keywords E-cigarettes, health effects, tobacco harm reduction, chronic effects of vaping, systematic review Citation Izquierdo-Condoy JS, Naranjo-Lara P, Morales-Lapo E, Hidalgo MR, Tello-De-la-Torre A, Vsconez-Gonzles E, Salazar-Santoliva C, Loaiza-Guevara V, Rincn Hernndez W, Becerra DA, Gonzlez MBD, Lpez-Corts A and Ortiz-Prado E (2024) Direct health implications of e-cigarette use: a systematic scoping review with evidence assessment

Using both together can amplify their effects

So we know for certain that there is a damage that is called genotoxic damage