Ozone therapy as a novel complementary therapeutic approach in refractory idiopathic granulomatous mastitis

Background: Autoimmunity may play a major role in the pathogenesis of idiopathic granulomatous mastitis (IGM). The therapeutic potential of ozone therapy has recently been shown in rheumatological diseases, and this study aimed to assess the clinical efficacy of ozone therapy (OT) in refractory IGM. Methods: Patients with biopsy-verified IGM and incomplete response after steroid therapy (n = 47) between 2018 and 2021 were enrolled. Of these, 23 cases in cohort A had standard treatment with further steroid therapy (ST), and 24 were treated with systemic OT via autohemotherapy (AHT) in addition to steroid therapy (cohort B). Results: The median age was 33 years (range, 24–45). Patients in cohort B had a higher complete response rate after completion of a four-month ozone therapy than those in the ST-group (OT-group, 37.5% vs. ST-group, 0%; p = 0.002). At a median follow-up of 12 months (range, 12–35), the patients treated with OT had a lower one-year recurrence in the affected breast than cases in cohort A treated with ST (OT-group, 21% vs. ST-group, 70%; p = 0.001). No significant side effects were observed in patients in cohort B related to AHT. Furthermore, OT significantly decreased the total steroid treatment duration (median week of steroid use; 26 weeks in cohort A vs. 12 weeks in cohort B; p = 0.001). Conclusion: Systemic OT increases the complete response rate and decreases the duration of steroid treatment in patients with refractory IGM. Therefore, ozone therapy is an effective, well-tolerated, and safe novel complementary therapeutic modality.Istanbul Breast Societ

Ozone therapy restores immune dysfunction in refractory idiopathic granulomatous mastitis as a novel potential therapeutic approach

Immunological dysfunction has been suggested to play a major role in the pathogenesis of idiopathic granulomatous mastitis (IGM). We recently showed that ozone therapy was effective in patients with steroid-resistant IGM. This study assessed alterations in intracellular cytokine expression patterns in different T-lymphocyte subsets after ozone therapy in refractory IGM. Peripheral blood T lymphocyte subsets (CD8(+), CD4(+), CD4(+)CD25(+) CD127(-)) were analyzed via flow-cytometry for intracellular cytokine expressions IFN-gamma, TNF-alpha, IL-10, and TGF-beta before and after completion of 4-month systemic ozone therapy. Ozone therapy significantly increased the CD4(+)IFN-gamma(+) (p = 0.032), CD4(+)TNF-alpha(+) (p = 0.028), and the CD8(+) TNF-alpha(+) (p =0.012) T cells. In contrast, significant decreases in CD4(+) IL-10(+) (p = 0.047) and CD8(+)IL-10(+) T cells (p = 0.022) and CD4(+)CD25(+) CD127(-//low) Treg cells secreting TGF-beta (p = 0.005) were found after ozone therapy. When patients were analyzed according to the response to ozone therapy, patients with a complete remission were more likely to have increased CD3(-)CD16(+)CD56(+) natural killer cells (p = 0.0027) and decreased CD19(+)B lymphocytes (p = 0.046) following ozone therapy. Our results suggest that ozone therapy stimulated a T-helper-1 response associated with IFN-gamma production and downregulation of TGF-beta expression in CD4(+)CD25(+)CD127(-) Treg cells. These alterations in the immune system following ozone therapy can improve wound healing and restore immune dysfunction in patients with refractory IGM.Istanbul Breast Societ

Efficacy of ozone therapy as a novel potential therapeutic approach in severe granulomatous mastitis

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