The low-dose ozone acts as mild oxidative stress and induces both inflammatory and anti-inflammatory responses which are mainly regulated by two nuclear transcriptional factors, NFκB and Nrf2. NFκB is involved in the expressions of cyclooxygenase-2 and various inflammatory cytokines whereas Nrf2 is involved in the up-regulations of numerous antioxidant enzymes and cytoprotective proteins. In major autohemotherapy, the most used application form in ozone therapy, ozone in contact with blood instantaneously reacts with unsaturated fatty acids generating H2O2 and 4-hydroxynonenal which are responsible for activations of NFκB and Nrf2, respectively. Thus, upon infusing the ozonized blood into the donor patient, it induces antioxidant enzymes and cytoprotective proteins by activating Nrf2 in cells all over the body.
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