Hyperbaric oxygen therapy ameliorates osteonecrosis in patients by modulating inflammation and oxidative stress

Gerardo Bosco, Giuliano Vezzani, Simona Mrakic Sposta, Alex Rizzato, Garrett Enten, Abdullah Abou-Samra, Sandro Malacrida, Silvia Quartesan, Alessandra Vezzoli, Enrico Camporesi, Gerardo Bosco, Giuliano Vezzani, Simona Mrakic Sposta, Alex Rizzato, Garrett Enten, Abdullah Abou-Samra, Sandro Malacrida, Silvia Quartesan, Alessandra Vezzoli, Enrico Camporesi

Abstract

Early stages of avascular necrosis of the femoral head (AVNFH) can be conservatively treated with hyperbaric oxygen therapy (HBOT). This study investigated how HBOT modulates inflammatory markers and reactive oxygen species (ROS) in patients with AVNFH. Twenty-three male patients were treated with two cycles of HBOT, 30 sessions each with a 30 days break between cycles. Each session consisted of 90 minutes of 100% inspired oxygen at 2.5 absolute atmospheres of pressure. Plasma levels of tumor necrosis factor alfa (TNF-α), interleukin 6 (IL-6), interleukin 1 beta (IL-1β) and ROS production were measured before treatment (T0), after 15 and 30 HBOT sessions (T1 and T2), after the 30-day break (T3), and after 60 sessions (T4). Results showed a significant reduction in TNF-α and IL-6 plasma levels over time. This decrease in inflammatory markers mirrored observed reductions in bone marrow edema and reductions in patient self-reported pain.

Keywords: IL-1β; IL–6; Reactive oxygen species; TNF-α; femoral head necrosis.

Figures

Figure 1.
Figure 1.
Experimental design of working protocol with timeline of blood samples collection.
Figure 2.
Figure 2.
Effects of HBOT on plasma levels (pg·mL−1) of: (A) TNF-α, 9B) IL-6 and 9C) IL-1β in ANFH patients are shown. T0 before the beginning of the first HBOT cycle of treatments (filled bars), T1: after 15 HBOT, T2: after 30 HBOT, T3: beginning of the second HBOT cycle after a 30 days break, T4: end of the second HBOT cycle (empty bars). Data are presented as mean ± SD. Significance of differences: P < .05 (*), P < .01 (#), P < .001 (§), P < .0001 (¶).
Figure 3.
Figure 3.
Effect of HBOT on plasma level of ROS production (μmol·min−1) in ANFH patients is shown. T0 before the beginning of the first HBOT cycle of treatments (filled bar), T1: after 15 HBOT, T2: after 30 HBOT, T3: beginning of the second HBOT cycle after a 30 days break, T4: end of the second HBOT cycle (empty bars). Data are presented as mean ± SD. Significance of differences: P < .05 (*), P < .01 (#), P < .0001 (¶).

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Source: PubMed

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