Abstract
To date, the application of oxygen-ozone (O2O3) therapy has significantly increased in the common clinical practice in several pathological conditions. However, beyond the favorable clinical effects, the biochemical effects of O2O3 are still far from being understood. This comprehensive review aimed at investigating the state of the art about the effects of O2O3 therapy on pro-inflammatory cytokines serum levels as a modulator of oxidative stress in patients with musculoskeletal and temporomandibular disorders (TMD). The efficacy of O2O3 therapy could be related to the moderate oxidative stress modulation produced by the interaction of ozone with biological components. More in detail, O2O3 therapy is widely used as an adjuvant therapeutic option in several pathological conditions characterized by chronic inflammatory processes and immune overactivation. In this context, most musculoskeletal and temporomandibular disorders (TMD) share these two pathophysiological processes. Despite the paucity of in vivo studies, this comprehensive review suggests that O2O3 therapy might reduce serum levels of interleukin 6 in patients with TMD, low back pain, knee osteoarthritis and rheumatic diseases with a concrete and measurable interaction with the inflammatory pathway. However, to date, further studies are needed to clarify the effects of this promising therapy on inflammatory mediators and their clinical implications.
Highlights
Ozone gas (O3 ) was discovered in 1840, and its expansion into the medical field has given rise to compelling research in the recent decades to validate its clinical value [1].Despite some controversies, several papers [2–11] have proposed relevant medical features, including bactericidal and virucidal effects, inflammatory modulation and circulatory stimulation, with considerable applications in several medical fields such as wound healing, ischemic disorders, infections, and chronic inflammatory conditions such as musculoskeletal disorders.The function of O3 shares similarities with that of a prodrug, as it is modified upon reacting with molecules to develop more active substrates, prompting an endogenous cascade of reactions [12]
lipid ozonation products (LOP) (lipoperoxides-LOO, alkoxy radicals-LO, lipohydroperoxides-LOOH, iso-prostane and alkenes (4-hydroxy-2,3-transnonenal-HNE and malonyldialdehyde-MDA)) are signal molecules of acute oxidative stress and they cause an upregulation of antioxidant enzymes, such as superoxide dismutase (SOD), GSH-peroxidase (GSH-Px), GSH-reductase (GSHRd) and catalase (CAT), which play a key role in antioxidant defense
Results of this study showed that bone morphogenetic protein (BMP) type 2 and 4, epidermal growth factor (EGF), eotaxin, granulocytecolony stimulating factor (G-CSF), IL-1β, IL-7, IL-8, IL-10, macrophage inflammatory protein (MIP) 1β, tumor necrosis factor-α (TNF-α) and TNF-β had significantly higher concentrations in patients with disc displacement without reduction
Summary
Ozone gas (O3 ) was discovered in 1840, and its expansion into the medical field has given rise to compelling research in the recent decades to validate its clinical value [1]. O2 O3 therapy has assumed the role of an adjuvant therapeutic approach in various pathological disorders characterized by chronic inflammatory processes and immune hyper activation, and most musculoskeletal disorders share these two pathophysiological scenarios [40]. In this context, several authors presented a practical function of O2 O3 in the management of low back pain (LBP) with promising perspectives, as a minimally invasive approach, for the conservative therapies of disc herniation or protrusion and in case of failed back surgery syndrome [41–47]. In the present comprehensive review, we aimed to investigate the state of the art about the effects of O2 O3 therapy on pro-inflammatory cytokines serum levels as a modulator of oxidative stress in patients with TMD and musculoskeletal disorders
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