Researchers at two medical schools in the United States are reporting what they say is the first PET scan-documented case of improvement in brain metabolism in Alzheimer’s disease in a patient treated with hyperbaric oxygen therapy (HBOT). Though they say their results suggest the possibility of a long-term Alzheimer’s treatment, some experts say they still need to see more studies.
“We demonstrated the largest improvement in brain metabolism of any therapy for Alzheimer’s disease,” said Dr. Paul Harch, clinical professor and director of Hyperbaric Medicine at Louisiana State University (LSU) Health New Orleans School of Medicine. “HBOT in this patient may be the first treatment not only to halt, but temporarily reverse disease progression in Alzheimer’s disease.”
The study was conducted by Harch and Dr. Edward Fogarty, chairman of Radiology at the University of North Dakota (UND) School of Medicine and published in the current issue of the peer-reviewed journal Medical Gas Research, in January.
Harch and Fogarty reported the case of a 58-year-old female who had experienced five years of cognitive decline, which began accelerating rapidly. Single photon emission computed tomography (SPECT) suggested Alzheimer’s, and positron emission tomography (PET) brain imaging confirmed the diagnosis and revealed deficits of the disease, they reported.
The patient received 40 HBOT treatments for five days a week over a period of 66 days, with each treatment consisting of 1.15 atmosphere absolute/50 minutes total treatment time. “After 21 treatments, the patient reported increased energy and level of activity, better mood and ability to perform daily living activities as well as work crossword puzzles,” the authors wrote. “After 40 treatments, she reported increased memory and concentration, sleep, conversation, appetite, ability to use the computer, more good days (5/7) than bad days, resolved anxiety and decreased disorientation and frustration. Tremor, deep knee bend, tandem gain, and motor speed were also improved.” Follow-up PET scans a month after hyperbaric treatment showed improvement in brain metabolism.
Glycogen metabolism has important implications for the functioning of the brain, especially the cooperation between astrocytes and neurons, and helps ensure preservation of neuronal function.
A 2015 study published in the International Journal of Molecular Sciences showed that “Interactions between astrocytes and neurons have the purpose of not only meeting the energy needs of these cells, but are also important in the control of many important brain functions such as homeostasis of the body or memory consolidation.” The study authors wrote that metabolic disorders in the interactions between neurons and astrocytes “can cause neurodegenerative disorders and a number of other pathologies. New therapeutic options in order to preserve or strengthen the neuroprotective function of astrocytes may set new directions for research.”
According to LSU Health, the new report also contains video imaging, including unique rotating PET 3D Surface Reconstructions, “which allow the lay person to easily see the improvements in brain function.”
“PET imaging is used around the world as a biomarker in oncology and cardiology to assay responses to therapy,” Fogarty said. “We now have an irrefutable biomarker system that this intervention has promise where no other real hope for recovery of dementia has ever existed before.”
While the physicians report that two months post-HBOT, the patient did feel a recurrence in her symptoms, subsequent treatment produced the original result and stabilized her symptoms. “She was retreated over the next 20 months with 56 HBOTs (total 96) at the same dose, supplemental oxygen and medications with stability of her symptoms and Folstein Mini-Mental Status exam,” LSU reported.
Currently the sixth leading cause of death in the United States, Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks. According to the National Institute on Aging (NIA), symptoms of Alzheimer’s disease first appear in people in their mid-60s. And while estimates vary, experts suggest that more than 5.5 million Americans may have Alzheimer’s and recent estimates, says the NIA, indicate that the disorder may rank as the third leading cause of death for older people in America, just behind heart disease and cancer.
The authors note that “four pathological processes have been identified and primary treatment is with acetylcholinesterase inhibitors or the N-methyl-D-aspartate receptor antagonist memantine, which have been shown to have a positive impact on Alzheimer’s disease progression with no significant disease-modifying effects.”
Researchers said HBOT is an “epigenetic modulation of gene expression and suppression to treat wounds and disease pathophysiology, particularly inflammation.” By definition, modulation of epigenetic mechanisms enables the alteration of cellular phenotype (the set of observable characteristics of an individual resulting from the interaction of its genotype with the environment) without altering the genotype (part of the genetic makeup of a cell, and therefore of an individual, which determines one of its characteristics).
“Thus, epigenetic processes can be viewed as one possible mediator between genes and the environment,” writes Sharon A. Ross from the Nutritional Science Research Group, Division of Cancer Prevention, the National Cancer Institute (NCI), in a study published in The American Journal of Clinical Nutrition.
“HBOT targets all four of the pathological processes of AD by affecting the microcirculation; mitochondrial dysfunction and biogenesis; reducing amyloid burden and tau phosphorylation; controlling oxidative stress; and reducing inflammation,” Harch and Fogarty wrote in their study.
According to the Health Science Journal, HBOT is achieved when the patient is breathing 100% oxygen intermittently in a closed chamber (hyperbaric chamber) at a pressure higher than the pressure of the sea level.
During the 17th century in England, the Journal states, metallic vessels strong enough to hold air under pressure along with pumps capable of compressing air were used to treat of patients with a variety of medical problems. Then in the 19th century, in various European countries hyberbaric chambers were created for exposing patients to ambient air under modest pressure. These chambers eventually became health spa accoutrements and were used empirically to treat a variety of maladies. Two German inventors first used pressurized pure oxygen to treat decompression sickness in 1917. Hyperbaric therapy has been approved by the Food and Drug Administration for over 50 years as a treatment for non-healing wounds, carbon monoxide poisoning, burns and decompression sickness.
The Mayo Clinic lists hyperbaric oxygen therapy as a well-established treatment for some conditions, though holds its ground that more research is needed before declaring HBOT a long-term treatment for Alzheimer’s and a host of other diseases.
And according to a spokesperson for Mayo, the clinic won’t be changing its position that “the evidence is insufficient to support claims that hyperbaric oxygen therapy can effectively treat” Alzheimer’s disease, any time soon.
“A short answer is that this single case report is not deemed sufficient grounds to recommend a therapy by our experts, who would require results from a larger series of studies, that included randomization to an appropriate control condition (ie sham HBO) in people who were carefully charterized as actually having Alzheimer’s disesase,” wrote Duska Anastasijevic, a Public Affairs officer at Mayo Clinic in Rochester, Minnesota in a statement.
One of the largest not‐for‐profit, academic health systems in the U.S. and ranked the #1 hospital and #1 in more specialties than any other hospital in the nation by U.S. News and World Report, Mayo Clinic operates in five states and cares for more than one million people a year, from all 50 states and nearly 140 countries.
“In a hyperbaric oxygen therapy chamber, the air pressure is increased to three times higher than normal air pressure. Under these conditions, your lungs can gather more oxygen than would be possible breathing pure oxygen at normal air pressure,” Mayo Clinic states on a hyperbaric oxygen therapy information page on its website. “Your blood carries this oxygen throughout your body. This helps fight bacteria and stimulate the release of substances called growth factors and stem cells, which promote healing. Your body’s tissues need an adequate supply of oxygen to function. When tissue is injured, it requires even more oxygen to survive. Hyperbaric oxygen therapy increases the amount of oxygen your blood can carry. An increase in blood oxygen temporarily restores normal levels of blood gases and tissue function to promote healing and fight infection.”
Mayo lists several medical conditions that can be treated using hyperbaric oxygen therapy:
- Anemia, severe
- Brain abscess
- Bubbles of air in your blood vessels (arterial gas embolism)
- Decompression sickness
- Carbon monoxide poisoning
- Crushing injury
- Deafness, sudden
- Infection of skin or bone that causes tissue death
- Nonhealing wounds, such as a diabetic foot ulcer
- Radiation injury
- Skin graft or skin flap at risk of tissue death
- Vision loss, sudden and painless
The following are the conditions Mayo lists as still not having enough evidence to support their treatment with hyperbaric oxygen therapy:
- Alzheimer’s disease
- Bell’s palsy
- Brain injury
- Cerebral palsy
- Chronic fatigue syndrome
- Gastrointestinal ulcers
- Heart disease
- Multiple sclerosis
- Parkinson’s disease
- Spinal cord injury
- Sports injury
Still Harch appears unfazed. “Our results suggest the possibility of treating Alzheimer’s disease long-term with HBOT and pharmacotherapy,” he concluded.