A mechanism of the cytotoxicity of plasma-activated medium (PAM) is revealed by examining the intracellular effects of reactive oxygen nitrogen species (RONS) and lipid oxidation. PAM is cell culture medium activated by irradiation using non-equilibrium atmospheric-pressure plasma using pure Ar gas in ambient air. Extracellular RONS in PAM induced the apoptotic death of HeLa cells. Temporal changes in intracellular RONS, such as ONOO − , NO, and O À 2 , were analyzed. Intracellular RONS generation in HeLa cells following incubation in PAM triggered activation of the caspase cascade pathway and lipid peroxidation of intracellular membranes to induce apoptosis. K E Y W O R D S non-equilibrium atmospheric-pressure plasma, plasma medicine plasma-activated medium (PAM), reactive oxygen and nitrogen species (RONS)