Hyperbaric oxygen therapy leads to neuroplasticity formation and repairs injured tissue at an accelerated rate
May 16, 2020
HBOT can induce neuroplasticity and significant brain function improvement in mild TBI patients with prolonged Post-Concussion-Syndrome at late chronic stage, years after brain injury (1).
Changes in SPECT images after treatment indicate that HBOT led to reactivation of neuronal activity in stunned areas that seemed normal under CT and MRI imaging. While SPECT imaging has a limited spatial resolution (compared, for example, to fMRI), the changes in activity were sufficiently robust to be clearly detected by the SPECT images (1).
There is a need for potent interventions, such sa elevated tissue oxygen, capable of repairing microenvironment alterations after mTBI (e.g impairments in vascular changes, in cerebral blood flow and in perfusion), leading to reduced oxygen availability followed by reduced metabolism, which in turn leads to reduced neuronal activity, loss of synapses and tampered neuronal connectivity (2).
The observed reactivation of neuronal activity in the stuned areas found here, along with similar results in post-stroke patients (3), imply that increasing the plasma oxygen concentration with hyperbaric oxygenation is a potent means of delivering to the brain sufficient oxygen for tissue repair. More specifically, HBOT induces regernation of axonal white matter (4-7), has positive effect upon the myelinization and maturation of injured neural fibers (8), and can stimulate axonal growth and increase the ability of neurons to function and communicate with each other (9). In addition, HBOT was found to have a role in initiation and/or facilitation of angiogenesis and cell proliferation processes needed for axonal regeneration (10).
At the cellular level, HBOT can improve cellular metabolism, reduce apoptosis, alleviate oxidative stress and increase levels of neurotrophins and nitric oxide through enhancement of mitochondrial function (in both neurons and glial cells). Moreover, the effects of HBOT on neurons can be mediated indirectly by glial cells, including astrocytes (11). HBOT may promote the neurogenesis of endogenous neural stem cells (12). With regard to secondary injury mechanisms in mTBI, HBOT can initiate vacular repair mechanism and improve cerebral vascular flow (13,14,15,16), promote blood brain barrier integrity and reduce inflammatory reactions (17) as well as brain edema (18,19,20,21,22,23).
(1) Hyperbaric Oxygen Therapy Can Improve Post Concussion Syndrome Years after Mild Traumatic Brain Injury - Randomized Prospective Trial. Rahav Boussi-Gross. November 2013, Volume 9, Issue 11
(2) Kan EM, Ling EA, Lu J (2012) Microenvironment changes in mild traumatic brain injury. Brain research bulletin 87: 359–372. [PubMed] [Google Scholar]
(3) Efrati S, Fishlev G, Bechor Y, Volkov O, Bergan J, et al. (2013) Hyperbaric oxygen induces late neuroplasticity in post stroke patients - randomized, prospective trial. PloS one 8: e53716.[PMC free article] [PubMed] [Google Scholar]
(4) Chang CC, Lee YC, Chang WN, Chen SS, Lui CC, et al. (2009) Damage of white matter tract correlated with neuropsychological deficits in carbon monoxide intoxication after hyperbaric oxygen therapy. Journal of neurotrauma 26: 1263–1270. [PubMed] [Google Scholar]
(5) Lo C, Shifteh K, Gold T, Bello JA, Lipton ML (2009) Diffusion tensor imaging abnormalities in patients with mild traumatic brain injury and neurocognitive impairment. Journal of computer assisted tomography 33: 293–297. [PubMed] [Google Scholar]
(6) Lo CP, Chen SY, Chou MC, Wang CY, Lee KW, et al. (2007) Diffusion-tensor MR imaging for evaluation of the efficacy of hyperbaric oxygen therapy in patients with delayed neuropsychiatric syndrome caused by carbon monoxide inhalation. European journal of neurology: the official journal of the European Federation of Neurological Societies 14: 777–782. [PubMed] [Google Scholar]
(7) Chen Z, Ni P, Xiao H, Chen J, Qian G, et al. (2008) Changes in brain function and anatomical structure following treatment of hyperbaric oxygen for visual pathway abnormalities in 16 cases. Neural Regeneration Research 3: 117–123. [Google Scholar]
(8) Vilela DS, Lazarini PR, Da Silva CF (2008) Effects of hyperbaric oxygen therapy on facial nerve regeneration. Acta oto-laryngologica 128: 1048–1052. [PubMed] [Google Scholar]
(9) Neubauer RA, Walker M (2000) Hyperbaric Oxygen Therapy. Garden City Park, NY: Avery Publishing Group.
(10) Kuffler DP (2011) The role of hyperbaric oxygen therapy in enhancing the rate of wound healing with a focus on axon regeneration. Puerto Rico health sciences journal 30: 35–42. [PubMed][Google Scholar]
(11) Gunther A, Kuppers-Tiedt L, Schneider PM, Kunert I, Berrouschot J, et al. (2005) Reduced infarct volume and differential effects on glial cell activation after hyperbaric oxygen treatment in rat permanent focal cerebral ischaemia. Eur J Neurosci 21: 3189–3194. [PubMed] [Google Scholar]
(12) Yang YJ, Wang XL, Yu XH, Wang X, Xie M, et al. (2008) Hyperbaric oxygen induces endogenous neural stem cells to proliferate and differentiate in hypoxic-ischemic brain damage in neonatal rats. Undersea Hyperb Med 35: 113–129. [PubMed] [Google Scholar]
(13) Neubauer RA, James P (1998) Cerebral oxygenation and the recoverable brain. Neurological research 20 Suppl 1S33–36. [PubMed] [Google Scholar]
(14) Golden ZL, Neubauer R, Golden CJ, Greene L, Marsh J, et al. (2002) Improvement in cerebral metabolism in chronic brain injury after hyperbaric oxygen therapy. The International journal of neuroscience 112: 119–131. [PubMed] [Google Scholar]
(15) Rockswold SB, Rockswold GL, Defillo A (2007) Hyperbaric oxygen in traumatic brain injury. Neurological research 29: 162–172. [PubMed] [Google Scholar]
(16) Zhou Z, Daugherty WP, Sun D, Levasseur JE, Altememi N, et al. (2007) Protection of mitochondrial function and improvement in cognitive recovery in rats treated with hyperbaric oxygen following lateral fluid-percussion injury. Journal of neurosurgery 106: 687–694. [PubMed][Google Scholar]
(17) Vlodavsky E, Palzur E, Soustiel JF (2006) Hyperbaric oxygen therapy reduces neuroinflammation and expression of matrix metalloproteinase-9 in the rat model of traumatic brain injury. Neuropathology and applied neurobiology 32: 40–50. [PubMed] [Google Scholar]
(18) 20. Neubauer RA, James P (1998) Cerebral oxygenation and the recoverable brain. Neurol Res 20 Suppl 1S33–36. [PubMed] [Google Scholar]
(19) 21. Golden ZL, Neubauer R, Golden CJ, Greene L, Marsh J, et al. (2002) Improvement in cerebral metabolism in chronic brain injury after hyperbaric oxygen therapy. Int J Neurosci 112: 119–131. [PubMed] [Google Scholar]
(20) 22. Zhang JH, Lo T, Mychaskiw G, Colohan A (2005) Mechanisms of hyperbaric oxygen and neuroprotection in stroke. Pathophysiology 12: 63–77. [PubMed] [Google Scholar]
(21) Palzur E, Vlodavsky E, Mulla H, Arieli R, Feinsod M, et al. (2004) Hyperbaric oxygen therapy for reduction of secondary brain damage in head injury: an animal model of brain contusion. Journal of neurotrauma 21: 41–48. [PubMed] [Google Scholar]
(22) Harch PG, Andrews SR, Fogarty EF, Amen D, Pezzullo JC, et al. (2012) A phase I study of lowpressure hyperbaric oxygen therapy for blast-induced post-concussion syndrome and post-traumatic stress disorder. Journal of neurotrauma 29: 168–185. [PubMed] [Google Scholar]
(23) Calvert JW, Cahill J, Zhang JH (2007) Hyperbaric oxygen and cerebral physiology. Neurological research 29: 132–141. [PubMed] [Google Scholar]