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Hyperbaric Oxygen in Mild TBI Conflicting Civilian and Department of Defense Studies Explained.

HBOT in Chronic TBI Oxygen Pressure and Gene Therapy

Hyperbaric oxygen in chronic traumatic brain injury: oxygen, pressure, and gene therapy

Paul G. Harch

Author Affiliations

Section of Emergency Medicine, Department of Medicine, Louisiana State University School of Medicine, 1542 Tulane Avenue, Rm. 452, New Orleans 70112, LA, USA

Medical Gas Research 2015, 5:9  doi:10.1186/s13618-015-0030-6

The electronic version of this article is the complete one and can be found online at: http://www.hbot.com/article/hbot-chronic-tbi-oxygen-pressure-and-gene-therapy#overlay-context=user



30 May 2015


4 July 2015


14 July 2015

© 2015 Harch.


Hyperbaric oxygen therapy is a treatment for wounds in any location and of any duration that has been misunderstood for 353 years. Since 2008 it has been applied to the persistent post-concussion syndrome of mild traumatic brain injury by civilian and later military researchers with apparent conflicting results. The civilian studies are positive and the military-funded studies are a mixture of misinterpreted positive data, indeterminate data, and negative data. This has confused the medical, academic, and lay communities. The source of the confusion is a fundamental misunderstanding of the definition, principles, and mechanisms of action of hyperbaric oxygen therapy. This article argues that the traditional definition of hyperbaric oxygen therapy is arbitrary. The article establishes a scientific definition of hyperbaric oxygen therapy as a wound-healing therapy of combined increased atmospheric pressure and pressure of oxygen over ambient atmospheric pressure and pressure of oxygen whose main mechanisms of action are gene-mediated. Hyperbaric oxygen therapy exerts its wound-healing effects by expression and suppression of thousands of genes. The dominant gene actions are upregulation of trophic and anti-inflammatory genes and down-regulation of pro-inflammatory and apoptotic genes. The combination of genes affected depends on the different combinations of total pressure and pressure of oxygen. Understanding that hyperbaric oxygen therapy is a pressure and oxygen dose-dependent gene therapy allows for reconciliation of the conflicting TBI study results as outcomes of different doses of pressure and oxygen.


Hyperbaric; Oxygen; Traumatic; Brain; Injury; Concussion; Pressure; Gene; Therapy; Veteran



Confusion over the conflicting conclusions of recent civilian and United States Department of Defense (DoD) trials of hyperbaric oxygen therapy (HBOT) in the treatment of mild traumatic brain injury (mTBI) persistent post-concussion syndrome (PPCS) [1]–[6] have focused attention on critical flaws [7], [8] in the historical definition of HBOT [9] that beg the question “What is hyperbaric oxygen therapy?” The answer to this question has led to a re-appraisal of HBOT as a dual-component [7], [8] gene therapy [7] that is poised to not only change, but also expand the field of hyperbaric therapy.

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