UHM 2018, Vol. 45, No.

1 – HBO2 INFLUENCE ON OXIDATIVE STRESS IN PROFESSIONAL DIVERS

Research Article
Influence of exposure in hyperbaric chambers on selected parameters
of oxidative stress in professional divers
Mariusz Kozakiewicz 1, Kornelia Kędziora-Kornatowska 2, Dorota Kaczerska 3,
Piotr Siermontowski 4, Romuald Olszański 5, Karolina Krefft 6
1 Department of Food Chemistry, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Poland
Department and Clinic of Geriatrics, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz,
2

Poland
3 University of Bydgoszcz in Bydgoszcz, Poland
4 Department of Underwater Works Technology, Polish Naval Academy in Gdynia, Poland
5 Maritime and Hyperbaric Medicine Department in Gdynia, Military Institute of Medicine in Warsaw, Poland
6 Department of Physics and Biophysics, Medical University of Gdansk in Gdansk, Poland

CORRESPONDING AUTHOR: Mariusz Kozakiewicz – markoz@cm.umk.pl

_____________________________________________________________________________________________________________________________________________________________________

ABSTRACT

Purpose: This study evaluated the influence of hyperbaric
exposure chambers on selected parameters of oxidative stress
in divers’ blood.
Methods: 25 healthy men (non-smoking experienced divers)
ages 18-40 took part in the experiment. Subjects were exposed
to hyperbaric conditions similar to those at 30 meters of depth
while diving. A control group consisted of 20 healthy men who
have never dived or been exposed to hyperbaric conditions.
Blood was drawn from the cubital vein after overnight fasting.
Superoxide dismutase (SOD-1) activity and malondialdehyde
(MDA) concentration were marked in red blood cells (RBCs),
carbonyl group concentration marked in serum proteins,
and nitrate/nitrite concentrations were estimated in plasma.
Results: Statistically significant differences were found
between the divers and the control group in MDA concentration
in erythrocytes and carbonyl group concentration in serum
_____________________________________________________________________________________________________________________________________________________________________
proteins. Nitrite/nitrate concentrations in plasma plus
SOD-1 activity in RBCs decreased significantly in the diver
group compared with the control group. After hyperbaric
exposure MDA concentration in erythrocytes increased
considerably in the test group and a significant increase
in SOD-1 activity was observed. A significant increase of
nitrite/nitrate concentration was noted in plasma as well as
an increase in the carbonyl group in serum proteins.
Conclusion: Considerably weak enzymatic antioxidative
defense was observed in the RBCs of individuals exposed to
hyperbaric pressures versus those in normobary. This issue
indicates that a diver’s system has a larger susceptibility for
negative effects from oxidative stress. The results also
indicate that hyperbaric conditions can intensify reactions
via free radicals.

INTRODUCTION It is known that as a result of oxygen metabolism,

Several publications have shown that hyperbaric oxygen
(HBO2) therapy can be applied in treatment of many
diseases. This method is used in treating decompression
sickness and carbon monoxide intoxication [1-3]. It has
become more popular in gas gangrene treatment [4],
as well as in treatment of difficult-to-heal wounds that
result from burns or surgical procedures [5]. Studies
have been conducted on application of hyperbaric
therapy as supportive treatment after radiotherapy or
chemotherapy [6-9].
even in physiological conditions, reactive oxygen
species (ROS) are formed that are dangerous to several
cell structures. According to some authors, a healthy
person’s 3% to 10% molecular oxygen is converted to
its reactive forms [10-12]. HBO2 exposure can induce
enhanced ROS generation, which can cause damage of
protein structures [13], lipids [14,22] and nucleic
acids [15].
Investigators have suggested that oxygen toxicity
appears to result from oxidative stress [16,17], but

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KEYWORDS: oxidative stress; hyperbaric; malondialdehyde; carbonyl groups; superoxide dismutase; nitrate/nitrite

Copyright © 2018 Undersea & Hyperbaric Medical Society, Inc. 49

 UHM 2018, Vol. 45, No. 1 – HBo2 INFlUENCE oN oXIDATIVE STRESS IN PRoFESSIoNAl DIVERS
FIGURe 1. Decompression table profile
only a few studies have investigated the effect of
hyperbaric conditions on oxidative stress. Most of
these studies demonstrated the effect of HBO2 on
animals. In experiments with mammals, exposure to
HBO2 had a marked effect on antioxidant status
[18,19]. In another work where rats were exposed
to hyperbaric conditions an increase of antioxidant
enzyme was observed after exposure [20].
Until now there have been few studies concerning
the effect of hyperbarism on oxidative stress in humans
[21,22]. The scientific works that are available cover
the research conducted in the natural environment
on volunteers descending to different depths in areas
of natural or artificial waters [22-25].
The purpose of this study was to eliminate influence
of factors such as water environment and temperature,
presenting only the influence of pressure on selected
parameters of oxidative stress in a diver’s blood and
to evaluate the influence of exposure in hyperbaric
chambers on pro-oxidative and antioxidative processes.
We chose the most often investigated antioxidative
enzymes and markers of oxidative stress. The first of
these is intercellular superoxide dismutase (SOD-1,
E.C.1.15.1.1), which holds the first line of defense
against damage caused by the superoxide anion radical.
Next is MDA, which is the most often observed lipid
peroxidation marker. Carbonyl groups were estimated
as a marker of protein damage and level of nitrate/ni-
trite as a determinant of nitrogen oxide generation.
The aim was to examine what effect hyperbaric treat-
ment has on oxidative stress in erythrocytes.
50 Kozakiewicz M, Kędziora-Kornatowska K, Kaczerska D, et al.
METHODS / BASIC PROCEDURES
A permit from the Bioethics Commission of the
Collegium Medicum in Bydgoszcz of Nicolaus
Copernicus University in Toruń (KB/402/2004) was
obtained to carry out this study (KB/402/2004).
Twenty-five (25) healthy non-smoking men, ages 18 to
40 (average age 27 years), took part in this experiment.
Volunteers who agreed to take part in the research were
divers with different diving experiences (seven years of
diving on average). All volunteers were free from any
high-pressure exposure for at least 72 hours before
hyperbaric studies began. Chamber study conditions
imitated those at 30 meters’ depth (4 atmospheres)
while diving. Hyperbaric exposure was organized in
cooperation with the Institute of Maritime and
Tropical Medicine of the Military Institute of the
Health Services in Gdynia.
Exposure was conducted by a qualified medical and
technical employee at the Institute of Diving
Equipment and Underwater Technology of the Polish
Naval Academy in Gdynia. The control group included
17 healthy men, 21-48 years of age (average age:
36 years old ) who have never dived nor have ever been
exposed to hyperbaric conditions.
Exposure, together with decompression, lasted a total
of 65 minutes; plateau occurred at approximately
30 minutes. A profile of exposure is presented in
Figure 1. Exposure proceeded as follows: Pressure in
chamber increased to 30 meters of seawater (msw) five
minutes from the start; volunteers remained in these
 UHM 2018, Vol. 45, No. 1 – HBO2 INFLUENCE ON OXIDATIVE STRESS IN PROFESSIONAL DIVERS

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Table 1. Oxidative stress parameters before and after hyperbaric exposure

parameter control group diver group n=25 diver group n=25
n=17 before exposure after exposure
_____________________________________________________________________________________________________________________________
†
MDA (μmol/gHb) 0.23±0.03 0.22±0.04 0.28±0.04
_____________________________________________________________________________________________________________________________
†
carbonyl group (nmol/mg protein) 0.081±0.02* 0.109±0.04 0.151±0.04
_____________________________________________________________________________________________________________________________
†
nitrate/nitrite (μmol/l) 2.71±0.5* 1.30±0.5 1.96±0.6
_____________________________________________________________________________________________________________________________
†
SOD-1 (U/gHb) 3301.80±308* 2716.06±305 3165.71±359
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* P<0.05 control group vs. diver group before exposure; † P<0.05 diver group before vs. diver group after exposure

conditions for 25 minutes; then decompression took
place (Figure 1) in accordance with decompression
tables of the Polish Navy.
The volunteers remained under a pressure of 9 msw
for six minutes (step I of decompression); then pressure
was reduced to 6 msw for eight minutes (step II of
decompression). Afterward, volunteers remained under
a pressure of 3 msw for 14 minutes (step III of
decompression). Finally, the pressure in the chamber
was equalized to normobary.
Before and after exposure the divers’ blood samples
(4mL) were put into two test tubes. One with heparin
as an anticoagulant to get (2mL) plasma and (2 mL)
erythrocytes, and the second (2mL) one with silica as
a clotting activator to get serum. Isolation of erythro-
cytes consisted of rotation in a physiological salt solu-
tion at 5000x g. After every rotation the top layer
was removed and the rest of the sediment was mixed
with a new portion of physiological salt. Hemolysate
was prepared after the last rotation by mixing the
sediment with deionized water in a ratio of 1:1.
Intercellular SOD-1 activity was determined in hemo-
lysate by the Misra and Fridovich method [26], based
on generation of superoxide anions from molecular
oxygen in the presence of EDTA, adrenaline and man-
ganese chloride. SOD-1 activity was given in U/gHb.
Concentration of malondialdehyde (MDA), which is a
marker of lipid peroxidation processes, was determined
by the Placer, et al. [27] method. In this method the
reaction of thiobarbituric acid and MDA was used,
which resulted in a colored adduct. Adduct con-
centration was assayed colorimetrically at 532 nm
and given in µmol/gHb.
Carbonyl group concentration in serum proteins
was determined according to the Levine, et al. method
[28]. Nitric oxide concentration was analyzed by an in-
direct method used by Marletta [29]: i.e., determination
of nitrate/nitrite concentrations in plasma. This method
was based on a reaction of nitrate and nitrite anions
with N-(1-naphtyl)ethylenediamine in the presence
of sulfanilic acid (the Griess reaction) that as a result
created a colored complex; its absorbance at 545 nm
is directly proportional to nitrate and nitrite con-
centrations in the analyzed sample. Nitrate/nitrite
concentrations were given in µmol/L. Protein concen-
tration was assayed by the Gornall, et al. method [30]
based on the biuret reaction.
All results were expressed as mean ± SD (standard
deviation). A one-way analysis of the variance followed
by the Tukey post hoc test was performed to determine
the statistical significance of differences. P<0.05 was
considered statistically significant.
RESULTS
Results are given in Table 1. Statistically significant
differences in MDA concentration in the red blood
cells (RBCs) of the diver group and the control group
were not found under normal conditions. Hyperbaric
exposure of the studied diver group resulted in a
statistically significant increase of MDA concentration
in erythrocytes (0.28±0.04 μmol/gHb P<0.0001).
Carbonyl group concentration in proteins presented
significant statistical differences in the diver group
compared to the control group (resp. 0.109±0.04;
0.081±0.02 nmol/mg of protein, P<0.02). Hyperbaric
exposure caused a significant increase of carbonyl
group concentration in the diver group (0.151
± 0.04 nmol/mg of protein P<0.05).
Nitric oxide concentration in plasma (measured in-
directly by nitrate/nitrite concentration) was statis-

Kozakiewicz M, Kędziora-Kornatowska K, Kaczerska D, et al. 51

 UHM 2018, Vol. 45, No. 1 – HBO2 INFLUENCE ON OXIDATIVE STRESS IN PROFESSIONAL DIVERS
tically significantly lower in the diver group than that
in the control group (respectively 1.30±0.5 μmol/L;
2.71±0.5 μmol/L, P<0.00001). After exposure to hyper-
baric conditions a statistically significant increase
in nitrate/nitrite concentration was observed in the
diver group (1.96±0.6 μmol/L, P<0.01).
SOD-1 activity in the divers’ erythrocytes was sta-
tistically significantly lower in comparison with the
control group (resp. 2716.06 ± 305 U/g Hb; 3301.8 ±
308 U/g Hb, P<0.0001). A significant increase in the
activity of this enzyme was observed (3165 ± 359 U/g Hb,
P<0.001) after hyperbaric exposure.
DISCUSSION
Cellular response to oxidative stress in hyperbaric
conditions was analyzed in animals [22,31], and only
a few studies show effects of hyperbaric conditions
on humans [24,32,33].
Several works have appeared such as that of Dennog,
et al. [34] and Lemaitre, et al. [35] which show a lack
of change or an increase of some parameters such as
heat shock protein 70 in the antioxidative system as a
result of hyperbaric action. However, apart from Ben-
edetti, et al. [32] and Fabrice, et al. [36], studies show
statistically significant changes in activity of antioxidant
enzymes such as superoxide dismutase, glutathione
peroxidase, catalase and concentration of oxidative
stress markers such as malondialdehyde, thiobarbituric
acid reactive substances, and reduced glutathione after
hyperbaric exposure.
During hyperbaric exposure an enhanced generation
of ROS can take place that can cause toxic effects. As a
result, the probability of cellular and tissue damage is
higher. Hyperbaric exposure can also increase a lipid
peroxidation process that was confirmed by an ob-
served increase in MDA concentration in this study.
MDA is one of the markers of enhanced pro-oxidative
processes in which lipids react with oxidative com-
pounds – e.g., free radicals. Lipid structures attacked
by free radicals become radicals as well, and can start
a chain reaction that results in cell membrane destruc-
tion [37,38,8]. Proteins at the proline-, histidine- and
arginine-rich end [13], which are often accompanied by
transition metal ions [39,2], are particularly exposed
to OH• (hydroxyl radical) activity. The carbonyl group
concentration increase observed in this study also
confirms hyperbaric influence on oxidative damage of
52 Kozakiewicz M, Kędziora-Kornatowska K, Kaczerska D, et al.
protein structures. Carbonyl groups are better oxidative
stress markers than lipid peroxidation products because
they remain in blood circulation for a longer period
of time and their concentration in serum is stable for
at least four hours [13,20].
The observed increase of SOD-1 activity in the diver
group can also mean enhanced oxidative stress under
exposure to increased atmospheric pressure. It can be
a compensation effect connected with enhanced ROS
generation in that group.
When analyzing selected parameters of the control
and diver groups we observed a reduction in activity
of SOD-1. Nitrate/nitrite levels in the diver group, even
after hyperbaric exposure, did not exceed the values
observed in the control group, although a significant
increase in comparison with the initial level was ob-
served. This can be caused by nitric oxide antioxidative
properties. As a free radical this compound can react
with other free radicals, take part in lipid peroxidation
processes and terminate this reaction [40-42]. Sureda,
et al. suggest that scuba diving can induce an anti-
oxidant response both in plasma and erythrocytes
without the appearance of cellular damage and an
increase in NO production in the endothelium [25].
However, other authors suggest that lower nitrate/
nitrite levels that we observed in the studied groups
can be a result of the reaction between nitric oxide
and superoxide anion radicals, when peroxynitrite is
also formed [41-43]. This is supported by the fact that
the reaction of superoxide anion radicals and nitric
oxide is three times faster than the dismutation reac-
tion catalyzed by SOD. Peroxynitrite formed in this
reaction is a compound that can diffuse throughout
the whole organism and has strong oxidative proper-
ties [44]. It is very reactive to thiol groups of proteins
[13] and unsaturated, long-chain fatty acids of lipids,
and can initiate lipid peroxidation.
The observed activity of SOD-1, which is one of the
main antioxidative cell enzymes [45-48], also proves
antioxidative barrier dysfunction in the divers’ blood.
Before exposure, activity of this enzyme was signifi-
cantly lower in the diver group than in the control
group. We can suppose that the observed differences
in the organism antioxidative state between the
control group and the diver group resulted from
physiological adaptation of the organism to environ-
mental conditions. However, permanent dysfunction
 UHM 2018, Vol. 45, No. 1 – HBO2 INFLUENCE ON OXIDATIVE STRESS IN PROFESSIONAL DIVERS
of the organism’s antioxidative barrier, caused by the
high atmospheric pressure acting on cell structures
responsible for the organism’s antioxidative defense,
cannot be excluded. To learn in detail about hyperbaric
influence on the free radical processes in organism,
further studies involving a larger volunteer group
are necessary.
It seems reasonable to investigate whether the
changes observed in the determined parameters are
the result of a permanent disorder of antioxidant bar-
rier of the organism due to the effect of the hyper-
baric environment or rather if it is an effect of the
organism’s adaptation to the hyperbaric conditions.
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