1270 Autohemotherapy With Ozone As A Possible Effective Treatment For Fibromyalgia File
1270 Autohemotherapy With Ozone As A Possible Effective Treatment For Fibromyalgia File
1270 Autohemotherapy With Ozone As A Possible Effective Treatment For Fibromyalgia File
pression, and dream disorder16, 17. Moreover, it has MAterIAls And Methods
been proved that vitamin C and D improve clinical
symptoms in FM patients18,19. Thus, glutathione and PAtIents
N-acetylcysteine, both featuring antioxidant proper- The study was performed with the informed consent
ties, have been used in these patients in addition to of all participants and the approval of the local Ethical
moderate exercise20. Committee. We studied 20 FM patients, all women,
However, few treatments have been proved to be with a mean age of 47.5 (±11.0) years, mean disease
successful and approved by FDA (Food and Drugs Ad- duration of 13.6 years (±9.2), mean tender points of
ministration) or EMA (European Medicines Agency) 14.9 (±3.1) and FIQ (Fibromyalgia Impact Question-
for FM, such as duloxetine and pregabalin21. Besides naire) of 59 (range 0-80). Patients were recruited from
these, exercise is still the main therapeutic strategy the Unidad de Fibromialgia de la Policlínica Aljarafe
against this illness. (Seville, Spain), where they were diagnosed by a spe-
On the other hand, ozone (O3) therapy, a proce- cialist according to the ACR criteria (2010 revision1, 2).
dure that helps the body activate its own immune sys- FM patients were then treated only with O3 therapy in
tem and free radical scavengers, is thought to act by the Anti-aging Unit of Clínica Infanta Luisa (Seville) and
exerting a mild, transient, and controlled oxidative nutritional counseling. Blood samples were collected
stress when it reacts with lipids, promoting an up-reg- before and after treatment for serotonin and oxidative
ulation of the antioxidant system and a modulation stress parameter determinations, and for standard bio-
of the immune system22,23. This moderate oxidative chemical analyses.
stress produced by O3 induces the activation of the The inclusion criteria for this study were the fol-
transcription factor Nrf2 (nuclear factor-erythroid lowing: patients diagnosed of FM in the last 2–3 years,
2-related factor 2), activating in turn the transcription based on the current ACR diagnostic criteria1,2, who
of antioxidant response elements (ARE). This activa- did not consume any drug or vitamin/nutritional sup-
tion results in an increase of several antioxidant en- plement during a 15-day period before the collection
zymes, including, but not limited to, SOD, GPx, glu- of the blood samples. Exclusion was subject to any of
tathione S-transferase (GST), CAT, heme oxygenase-1 following circumstances: (i) acute infectious diseases
(HO-1), NADPH-quinone-oxidoreductase (NQO-1), in the previous 3 weeks, (ii) past or present neurolo-
and heat shock proteins (HSP). These enzymes act, gical, psychiatric, metabolic, autoimmune, allergy-re-
directly or indirectly, as free radical scavengers, and lated, dermal or chronic inflammatory disease, (iii) un-
have been proved to be important in the successful desired habits (e.g., smoking, alcohol, etc.), (iv)
treatment of many diseases23. medical conditions that required glucocorticoid treat-
This procedure has been applied by Hidalgo-Tal- ment, use of analgesics, antidepressant drugs, (v) past
lón et al.24 and Tirelli et al.25, who observed beneficial or current substance abuse or dependence, and (vi)
effects of O3 treatment in FM patients by rectal insuf- pregnancy or current breast-feeding.
flations, including better FIQ, and a statistically sig-
nificant improvement of pain and fatigue. In this AutoheMotherAPy wIth o3
sense, as far as we are concerned, only two papers This treatment is based on treating 150 ml of the pa-
have been published related to the use of O 3 by tient’s blood with 150 ml of O3 followed by reinfusion
hemotherapy in FM, one of which featuring only 5 in the donor, in a fast procedure. The O3 generator
patients24. Tirelli et al. also treated patients with O3 by used was Hyper Medozon Confort, Herrmann. Each
autohemotransfusion, but despite the good results, patient received 10 sessions of autohemotherapy with
the authors did not distinguish which of the two O3 twice a week. Concentration for the first three ses-
methods used (rectal insufflation and hemotherapy)25 sions was 30 µg/ml, 40 µg/ml for the fourth, 50 µg/ml
was in fact behind the success. Therefore, more in- for the fifth, and 60 µg/ml for the last five. Time of O3
vestigation is needed to study to what extent O3 is infusion in each session was 7-10 min. The protocol
useful for improving symptoms in FM patients. The used was a modified version of ACEOOT-TRA-012B.
purpose of the present work is to investigate the pro-
tective effect of autohemotherapy on the health of 20 serotonIn deterMInAtIon
patients suffering from FM by analyzing oxidative Blood samples were extracted from patients by venous
stress parameters. puncture one week before O3 hemotherapy and one
week after treatment. The sera collected from FM pa- tive statistics and tests were performed at a significance
tients were centrifuged at 3,000 r.p.m. for 15 minutes level of 0.05, and the power of the statistical test was
at room temperature. The super-natants were collect- 90% (P = 0.9), using the STATA software (version 12,
ed, and the samples were quickly frozen to -80ºC un- 2011, StataCorp).
til analysis. Serotonin from those samples was mea- This study conforms to STROBE statement
sured by immunoassay using a commercial kit (Labor (Strengthening the Reporting of Observational Studies
Diagnostica Nord; Nordhorn, Germany). in Epidemiology) 28.
In relation to oxidative stress, after 8 weeks of treat- CoQ10) are beneficial as a therapy for mitochondrial ill-
ment with O3, an important decrease of malondialde- nesses5. Interestingly, one of the most accepted treat-
hyde and protein carbonyl was observed, as well as a ments for FM patients is moderate physical exercise15.
moderated reduction of ROS, which indicate a global This is based on the fact that aerobic exercise increas-
decrease of the oxidative stress with respect to the lev- es mitochondrial biogenesis and mitochondrial size,
el that had been observed in these patients before treat- and for this reason it is proposed as alternative thera-
ment (Table I). peutic strategy in diseases with mitochondrial dys-
No side effects were detected in patients after O3 function30. In this work, we have described the antiox-
therapy treatment. idant effects of O3 hemotherapy, with a reduction in
ROS generation, and a subsequent decrease in oxida-
tive damage in lipids and proteins, improving redox
dIscussIon homeostasis. These results may contribute to the im-
provement in the symptoms of FM described in the pa-
One of the main problems of FM is the lack of useful tients under study.
treatments, so specialists are forced to offer drugs as However, serotonin is an important modulator of
symptomatic treatment, leading sometimes to the pain perception, sleep and mood. In a previous paper,
aggravation of illness provoked by side effects. Many of our group has correlated the decrease of pain thresh-
these drugs induce mitochondrial damage and produce old and the presence of general pain, common in FM
oxidative stress11, and are not appropriate for patients patients, with a decrease in serotonin values in serum.
with signs of mitochondrial dysfunction or elevated ox- This suggests that the measurement of serotonin level
idative stress. FM patients are especially sensitive to ox- is a useful indicator to evaluate the severity of FM
idative damage since they usually show high levels of symptoms31. In the present work, a moderate increase
oxidative stress and mitochondrial damage7, 10. Among in serotonin levels have been detected in patients treat-
these drugs, tricyclic anti-depressant stands out, like ed with O3, which may have also contributed to im-
amitriptyline, a common drug for analgesic treatment prove symptoms of this disease, expressed by a signif-
in FM patients. We have previously described that icant decrease in tender points and FIQ score. This
amitriptyline induces mitochondrial dysfunction, re- could be explained in part due to balanced diet tips
duction of CoQ10 level, and high oxidative stress; co- given to patients before the treatment with O3. It has
treatment with antioxidants restored mitochondrial been reported that diet guidelines containing trypto-
damage provoked by this anti-depressant29. phan and antioxidant components may have a special
In relation to this issue, it has been demonstrated relevance by affecting inflammatory signaling cascades,
that antioxidant treatments (e.g. vitamin E, SOD and including tryptophan breakdown, and could increase
tAble I. clInIcAl And bIocheMIcAl dAtA In fM PAtIents Pre And Post treAtMent wIth ozone therAPy
BMI: body mass index; FIQ: fibromyalgia impact questionnaire; MDA: malondialdehyde; ROS: reactive oxygen species. a.u: Arbitrary units. All values
are mean (±SD). Serotonin reference in female: 70-270 ng/ml±0,1. MDA reference for lipid peroxidation: 6±1. Protein carbonyl reference: 18.3 ±2.2.
ROS levels reference: 5.8 au± 0.4).
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