Tag: Medicine

A new treatment developed at Tel Aviv University may significantly enhance the efficacy of chemotherapy in breast cancer patients, reducing the risk for lung metastasis following chemo from 52% to only 6%. Conducted in a lab model, the study identified the mechanism that generates a cancer-promoting inflammatory environment in response to chemotherapy. Moreover, the researchers found that by adding an anti-inflammatory agent to the chemotherapy, metastasis can be prevented.

The study was led by Prof. Neta Erez of the Department of Pathology at TAU’s Sackler Faculty of Medicine, and researchers from her group: Lea Monteran, Dr. Nour Ershaid, Yael Zait, and Ye’ela Scharff, in collaboration with Prof. Iris Barshack of the Sheba Medical Center and Dr. Amir Sonnenblick of the Tel Aviv Sourasky (Ichilov) Medical Center. The paper was published in Nature Communications. The study was funded by ERC, the Israel Cancer Association, and the Emerson Cancer Research Fund.

The Dark Side of Chemo

“In many cases of breast cancer, surgical removal of the primary tumor is followed by a chemotherapy regimen intended to kill any remaining malignant cells – either left behind by the surgeon or already colonizing in other organs,” explains Prof. Erez. “However, while effectively killing cancer cells, chemotherapy also has some undesirable and even harmful side effects, including damage to healthy tissues. The most dangerous of these, is probably internal inflammations that might paradoxically help remaining cancer cells to form metastases in distant organs. The goal of our study was to discover how this happens and try to find an effective solution.”

To this end, the researchers created an animal model for breast cancer metastasis. The animals received the same treatment as human patients: surgical removal of the primary tumor, then chemotherapy, followed by monitoring to detect metastatic relapse as early as possible. The disturbing results: metastatic tumors were detected in the lungs of a large percentage of the treated animals – similar to the percentage found in the control group.

“In humans, this interval between chemotherapy and detection of metastatic tumors is an inaccessible ‘black box.’ Working with an animal model, we could check what happens inside this ‘box’.” Prof. Neta Erez

 

What’s Going on Inside the “Black Box”?

To decipher these adverse effects, the researchers examined the animals’ lungs at an intermediate stage – when tiny micro-metastases may have already developed, but even advanced imaging technologies like CT cannot detect them.

“In humans, this interval between chemotherapy and detection of metastatic tumors is an inaccessible ‘black box’,” says Prof. Erez. “Working with an animal model we could check what happens inside this ‘box’.”

“We discovered a previously unknown mechanism: the chemotherapy generates an inflammatory response in connective tissue cells called ‘fibroblasts’, causing them to summon immune cells from the bone marrow. This, in turn, creates an inflammatory environment that supports the micro-metastases, helping them grow into full-fledged metastatic tumors. In this way, the chemotherapy, administered as a means for combating cancer, achieves the opposite result.”

The researchers also identified the mechanism through which fibroblasts recruit immune cells, and ‘train’ them to support the cancer. “We found that in response to chemotherapy, the fibroblasts secrete ‘complement proteins’ – proteins that mediate cell recruitment and intensify inflammation, often by summoning white blood cells to damaged or infected areas, a process called chemotaxis,” notes Prof. Erez. “When the immune cells reach the lungs, they create an inflammatory environment that supports cancer cells and helps them grow.”

 

“We identified an inflammatory mechanism through which chemotherapy inadvertently supports the growth of metastatic tumors, and also discovered an effective solution: combining chemotherapy with an inflammation inhibitor.” Prof. Neta Erez

Potential to Save Many Lives

To combat this newly discovered process, the researchers combined the chemotherapy administered to the animals with a drug that blocks the activity of complement proteins.

The results were very encouraging: following the combined treatment, the percentage of lab models developing no metastases rose from 32% to 67%; and the percentage of those with extensive cancer colonization in their lungs decreased from 52% with regular chemotherapy to 6% when the inflammation inhibitor was added.

“We discovered the mechanism behind a severe problem in the treatment of breast cancer: many patients develop metastatic tumors following removal of the primary tumor plus chemotherapy,” says Prof. Erez, and concludes: “We identified an inflammatory mechanism through which chemotherapy inadvertently supports the growth of metastatic tumors, and also discovered an effective solution: combining chemotherapy with an inflammation inhibitor. We hope that our findings will enable more effective treatment for breast cancer, and perhaps other types of cancer as well – to prevent metastatic relapse and save numerous lives worldwide.”  

Featured image: Members of the TAU research team (left to right): Dr. Nour Ershaid, Prof. Neta Erez and Lea Monteran

A first-of-its-kind study conducted by Tel Aviv University has found that the national resilience of the citizens of Ukraine, who are currently fighting for their independence, is comparatively very high (4.35) on a scale of 1 to 6. It is, in fact, significantly higher than the national resilience that characterized Israeli citizens (3.89) at the height of “Operation Guardian of the Walls” in May 2021.

The researchers explain this difference by saying that whereas Ukrainian citizens now find themselves fighting for their homeland and are ready to do anything to win the war, the rounds of fighting in Gaza have become a kind of recurrent nuisance for the citizens of Israel, accompanied by a moderate level of national resilience.

The study was led by Prof. Bruria Adini and Prof. Shaul Kimhi of the ResWell Research Center at Tel Aviv University’s Sackler Faculty of Medicine.

Ukrainian Citizens Still Have Hope

According to the researchers, the current study constitutes the first attempt by academic researchers to assess Ukrainian citizens’ positive and negative coping indices during wartime. The study indicates that in such conditions of conflict, a population may experience high levels of stress and, simultaneously, high levels of societal resilience and hope for the future.

In the current situation in Ukraine, the population has also demonstrated a great deal of support for their government.

The study surveyed 1000 Ukrainian citizens, as well as a sample of about 650 Israeli citizens using data collected during Operation Guardian of the Walls. The study’s findings suggest that the danger, in the eyes of Ukrainian citizens, is perceived as much more tangible (3.7 on a scale of 1 to 5) than Israelis’ perception of danger in the rounds of fighting against Hamas in Gaza (2.45). The perception of threat amongst Ukrainians is also more significant (3.29) than among the citizens of Israel (2.79).

The researchers note that the younger population, those between the ages of 26 to 30, present higher levels of stress and post-traumatic stress symptoms compared to other age groups. Women report higher levels of all negative coping mechanisms in comparison to men.

Interestingly, despite the significant dangers and threats they face, Ukrainian citizens have not lost hope, with their ‘hope index’ being higher (an average of 3.95) than that of Israelis (an average of 3.5).

“Israelis, unlike the Ukrainian People, do not feel that their country is under a direct existential threat and have, to a certain degree, adapted to an ‘emergency routine’ due to the recurrent conflicts.” Prof. Adini and Prof. Kimhi

Israelis Adapted to ‘Emergency Routine’

Prof. Adini and Prof. Kimhi explain that “the perception of a threat as existential to the survival and sovereignty of the state and society is likely, under certain conditions, to enhance the population’s societal resilience and sense of hope. This is the case even when the population feels anxious and threatened by the situation. “

“Moreover, it appears that the war launched by Russia against Ukraine has actually contributed to the process of Ukrainian identity-building, which also leads to increased levels of resilience, as well as an extremely high sense of hope.”

“Israelis, unlike the Ukrainian People, do not feel that their country is under a direct existential threat and have, to a certain degree, adapted to an ‘emergency routine’ due to the recurrent conflicts. In light of this, they present lower levels of resilience relative to Ukrainians, but at the same time higher levels of well-being and morale.”

Many young women with increased risk of breast cancer (carriers of BRCA1/BRCA2 genes) suffer from a state of uncertainty regarding their future, mainly due to the realization that they are highly likely to contract breast cancer and/or ovarian cancer. There is currently no effective treatment for preventing the illness and the only active procedure available is a risk-reducing mastectomy [surgery to remove a breast] and/or oophorectomy [a surgical procedure to remove one or both ovaries] around the age of 40 (it was this procedure that Angelina Jolie underwent in 2013).

Due to fear and uncertainty, these women often suffer psychological and physical symptoms that significantly disrupt their normal lives. In a new study conducted at Tel Aviv University, researchers sought to examine whether workshops and tools for promoting personal health, relief of stress and tension, and strengthening of mental soundness can improve the emotional well-being and quality of sleep of these young women. The researchers determined that use of the Inquiry Based Stress Reduction (IBSR) technique can be very helpful in coping with stressful events, enhance emotional and psychological well-being, improve quality of sleep, and assist in decision making.

Doing “The Work”

The study was led by Dr. Shahar Lev-Ari of the Sackler Faculty of Medicine at Tel Aviv University, in cooperation with Prof. Eitan Friedman of Sheba Medical Center and assistance from other researchers, as part of PhD student Clara Landau’s dissertation. The study was published in the prestigious medical journal JAMA Network Open.

The study included 100 women, all carriers of BRCA1/BRCA2 genes and currently under supervision at the Meirav Breast Center at Sheba Medical Center. As part of the study, the women learned and practiced the IBSR method, a clinical application of “The Work” by Byron Katie, consisting of a mindful self-inquiry for increased mindfulness, work on stress-causing beliefs (the “Inquiry” process) for reduction of stress, and cognitive reframing.

Dr. Shahar Lev-Ari

“To the best of our knowledge, this is the largest ever study in the world in the framework of such an experiment, as far as the number of participants is concerned.” 

Significant Improvements

The results were impressive. After participating in the workshops, as well as self-practice, the women showed great improvement in all aspects of personal growth, positive relations with others, life goals, and self acceptance. A clear improvement was seen in quality of sleep, which returned to normal.

Furthermore, a clear change of attitude was found among the participants with regard to previous doubts over whether to undergo surgical procedures such as mastectomy and oophorectomy. The technique helped the women make rational medical decisions, and some changed their position from ruling out the option of having any procedure done to scheduling a doctor’s appointment to discuss the option.

The researchers believe their findings indicate that study and practice of IBSR techniques might improve the psychological well-being of women with BRCA1/BRCA2 gene mutations, and form the basis (in conjunction with other studies) for recommending to consider providing this technique to women, along with their oncogenetic consultation.

“To the best of our knowledge, this is the largest ever study in the world in the framework of such an experiment, as far as the number of participants is concerned,” says Dr. Shahar Lev-Ari.

“We think that healthcare services in Israel and worldwide should evaluate the impact of coping with the genetic information and surgical procedures offered to asymptomatic women carriers on their emotional well-being and quality of life, and offer them interventions to promote their health on the individual level, such that have been scientifically proven in improving the quality of life and emotional well-being of women with the BRCA1/BRCA2 genes,” he summarizes.

Once melanoma, or skin cancer, spreads to the brain, it becomes extremely aggressive. Individuals with this stage of cancer are given an average 15 months to live, and that is following surgery, radiation, and chemotherapy. Researchers from Tel Aviv University deciphered, for the first time, a mechanism that enables skin cancer to metastasize to the brain and managed to delay the spread of the disease by 60% to 80% (depending on the stage of the intervention) using existing treatments.

The encouraging study was led by Prof. Ronit Satchi-Fainaro and Ph.D. student Sabina Pozzi of the Sackler Faculty of Medicine at Tel Aviv University. The results were published in the scientific journal JCI Insight.

“In an advanced stage, 90% of melanoma patients will develop brain metastases. This is a puzzling statistic. We expect to see metastases in the lungs and liver, but the brain is supposed to be a protected organ.”

How do the Cancer Cells Infiltrate the Brain?

“In an advanced stage, 90% of melanoma [/skin cancer] patients will develop brain metastases,” explains Prof. Satchi-Fainaro. “This is a puzzling statistic. We expect to see metastases in the lungs and liver, but the brain is supposed to be a protected organ. The blood-brain barrier keeps harmful substances from entering the brain, and here it supposedly doesn’t do the job—cancer cells from the skin circulate in the blood and manage to reach the brain. We asked ourselves with ‘whom’ the cancer cells ‘talk’ to in the brain to infiltrate it.”

The researchers found that in melanoma patients with brain metastases, the cancer cells “recruit” cells called ‘astrocytes’, star-shaped cells found in the spinal cord and brain which are responsible for maintaining stable conditions (/homeostasis) in the brain.

“The astrocytes are the first to come to correct the situation in the event of a stroke or trauma, for example,” says Prof. Satchi-Fainaro, “and it is with them that the cancer cells interact, exchanging molecules and corrupting them.”

Protecting the Brain’s Border Guards

“Moreover, the cancer cells recruit the astrocytes so that they do not inhibit the spread of the metastases. As such, they create local inflammation in the melanoma cells-astrocytes interaction areas that increase the permeability through the blood-brain barrier, as well as the division and migration of the cancer cells.”

“The communication between them is reflected in the fact that the astrocytes begin to secrete a protein that promotes inflammation called MCP-1 (also known as CCL2), and in response to this, the cancer cells begin to express its receptors CCR2 and CCR4, which we suspected to be responsible for the destructive communication with the astrocytes.”

“Both the antibody and the small molecule we used (…) have already been tested on humans as part of clinical trials. Therefore, these treatments are considered safe, and we can try to repurpose them for melanoma.”

To test their hypothesis, Prof. Satchi-Fainaro and her team tried to inhibit the expression of the protein and its receptors in genetically engineered lab models and in 3D models of primary melanoma and brain metastases. To this end, the researchers used both an antibody (biological molecule) and a small molecule (synthetic), designed to block the MCP-1 protein. They also employed CRISPR technology, a gene-editing technique, to genetically edit the cancer cells and cut out the two genes that express the two relevant receptors, CCR2 and CCR4. With each of the methods, the researchers were able to delay the spread of metastases.

“These treatments succeeded in delaying the penetration of the cancer cells into the brain and their subsequent spread throughout the brain,” says Prof. Satchi-Fainaro. The team succeeded in achieving a 60% to 80% delay, depending on the stage of the intervention. They achieved the best results with the treatment conducted immediately after surgery to remove the primary melanoma and were able to prevent the metastases from penetrating the brain.

“I believe that the treatment is suitable for the clinic as a preventive measure,” says Satchi-Fainaro. “Both the antibody and the small molecule we used—which are primarily intended to treat sclerosis, diabetes, liver fibrosis, and cardiovascular diseases, as well as serve as a biomarker for other types of cancer—have already been tested on humans as part of clinical trials. Therefore, these treatments are considered safe, and we can try to repurpose them for melanoma.”

The research was conducted in collaboration with additional scientists and physicians from Tel Aviv University, including Prof. Adi Barzel, Dr. Asaf Madi, Prof. Iris Barshack, Prof. Eran Perlson, and Prof. Inna Slutsky. International researchers also participated in the study, including Prof. Eytan Ruppin from the US National Institutes of Health (NIH), Prof. Henry Brem and Thomas Hyde from Johns Hopkins University-, and Prof. Helena Florindo from the University of Lisbon.

The study was funded by the European Research Council (ERC), the Melanoma Research Alliance (MRA), the Kahn Foundation, the Israel Cancer Research Fund (ICRF), and the Israel Science Foundation (ISF).

Featured image: Ph.D. student Sabina Pozzi and Prof. Ronit Satchi-Fainaro

A team of Tel Aviv University researchers has demonstrated that antibodies isolated from the immune system of recovered COVID-19 patients are effective in neutralizing all known strains of the virus, including the Delta and the Omicron variants. The discovery may eliminate the need for repeated booster vaccinations and strengthen the immune system of populations at risk.

The research was led by Dr. Natalia Freund and doctoral students Michael Mor and Ruofan Lee of the Department of Clinical Microbiology and Immunology at the Sackler Faculty of Medicine and of the TAU Center for Combating Pandemics. The study was conducted in collaboration with Dr. Ben Croker of the University of California San Diego. Prof. Ye Xiang of Tsinghua University in Beijing. Prof. Meital Gal-Tanamy and Dr. Moshe Dessau of Bar-Ilan University also took part in the study. The study was published in the Nature journal Communications Biology.

Highly Effective Against Delta and Omicron

The present study is a continuation of a preliminary study conducted in October 2020, at the height of the COVID-19 crisis. At that time, Dr. Freund and her colleagues sequenced all the B immune system cells from the blood of people who had recovered from the original COVID strain in Israel, and isolated nine antibodies that the patients produced. The researchers now found that some of these antibodies are very effective in neutralizing the new coronavirus variants, Delta and Omicron.

“In the previous study, we showed that the various antibodies that are formed in response to infection with the original virus are directed against different sites of the virus,” says Dr. Freund. “The most effective antibodies were those that bound to the virus’s ‘spike’ protein, in the same place where the spike binds the cellular receptor ACE2. Of course, we were not the only ones to isolate these antibodies, and the global health system made extensive use of them until the arrival of the different variants of the coronavirus, which in fact rendered most of those antibodies useless.”

“In the current study, we proved that two other antibodies, TAU-1109 and TAU-2310, which bind the viral spike protein in a different area from the region where most of the antibodies were concentrated until now (and were therefore less effective in neutralizing the original strain) are actually very effective in neutralizing the Delta and Omicron variants. According to our findings, the effectiveness of the first antibody, TAU-1109, in neutralizing the Omicron strain is 92%, and in neutralizing the Delta strain, 90%. The second antibody, TAU-2310, neutralizes the Omicron variant with an efficacy of 84%, and the Delta variant with an efficacy of 97%.”

Can Serve as Effective Substitute for Boosters

According to Dr. Freund, the surprising effectiveness of these antibodies might be related to the evolution of the virus: “The infectivity of the virus increased with each variant because each time, it changed the amino acid sequence of the part of the spike protein that binds to the ACE2 receptor, thereby increasing its infectivity and at the same time evading the natural antibodies that were created following vaccinations.”

“In contrast, the antibodies TAU-1109 and TAU-2310 don’t bind to the ACE2 receptor binding site, but to another region of the spike protein – an area of ​​the viral spike that for some reason does not undergo many mutations – and they are therefore effective in neutralizing more viral variants. These findings emerged as we tested all the known COVID strains to date.”

“In our view, targeted treatment with antibodies and their delivery to the body in high concentrations can serve as an effective substitute for repeated boosters, especially for at-risk populations and those with weakened immune systems.” 

The two antibodies, cloned in Dr. Freund’s laboratory at Tel Aviv University, were sent for tests to check their effectiveness against live viruses in laboratory cultures at the University of California San Diego, and against pseudo viruses in the laboratories of the Faculty of Medicine of Bar-Ilan University in the Galilee; the results were identical and equally encouraging in both tests.

Dr. Freund believes that the antibodies can bring about a real revolution in the fight against COVID-19: “We need to look at the COVID-19 pandemic in the context of previous disease outbreaks that humankind has witnessed. People who were vaccinated against smallpox at birth and who today are 50 years old still have antibodies, so they are probably protected, at least partially, from the monkeypox virus that we have recently been hearing about. Unfortunately, this is not the case with the coronavirus. For reasons we still don’t yet fully understand, the level of antibodies against COVID-19 declines significantly after three months, which is why we see people getting infected again and again, even after being vaccinated three times.”

“In our view, targeted treatment with antibodies and their delivery to the body in high concentrations can serve as an effective substitute for repeated boosters, especially for at-risk populations and those with weakened immune systems. COVID-19 infection can cause serious illness, and we know that providing antibodies in the first days following infection can stop the spread of the virus. It is therefore possible that by using effective antibody treatment, we will not have to provide booster doses to the entire population every time there is a new variant.”

Featured image: Dr. Natalia Freund from the Sackler Faculty of Medicine (Photo: Yoram Reshef)

A new study from Tel Aviv University proposes a new learning method for people with autism that may accelerate the learning process and significantly improve capabilities in terms of visual perception. According to the researchers, improving the perceptual capacity of people with autism is often a challenge, and usually requires long and tedious training alongside additional learning challenges that characterizes autism, such as the ability to generalize learning to new situations.

The study was conducted by doctoral student Shira Klorfeld-Auslender and Prof. Nitzan Censor from the School of Psychological Sciences and the Sagol School of Neuroscience at Tel Aviv University, in collaboration with Prof. Ilan Dinstein and his team from Ben-Gurion University. The study was published in the journal Current Biology.

“A large part of learning does not happen in formal training settings but afterwards, through processes of assimilation and reinforcement of memory that occur in an ‘offline’ state; for example, when our brain is asleep.”

Longer Not Necessarily Better

The new method proposed by the researchers is based on utilizing “memory flashes,” by exposing a person for just a few seconds to a task that has already been learned. While standard teaching practice reinforce length and repetition of new skills, the new method improved both visual perception capabilities and the generalization of learning through helping the subjects excel in the same tasks, under different conditions.

“In my laboratory, we focus on the study of learning in humans, and we know that a large part of learning does not happen in formal training settings but afterwards, through processes of assimilation and reinforcement of memory that occur in an ‘offline’ state; for example, when our brain is asleep,” explains Prof. Censor.

“However, standard teaching methods still advocate an approach where longer practice equals better learning: if you want to play the piano, you should practice playing the piano for many hours every day until the playing becomes second nature to you. We have identified an alternative learning mechanism that uses ‘memory flashes’ – a brief exposure to a task that has already been learned –to assimilate and generalize skill developed.”

Prof. Nitzan Censor

Effective with Added Value

In the study, 30 high-functioning adults with autism were asked to learn a visual task (for example, identifying the direction of lines that appear for a few milliseconds on the screen). However, instead of repeating the task for a long time each day, the examinees in the main experimental group learned the task in depth on the first day, and in the following days they were exposed to the visual stimulus for only a few seconds. At the end of the process, although the study participants studied the task for a minimal amount of time, their performance improved significantly, by about 20–25%, which was a similar result to those subjected to multiple-repetition learning and to the achievements of subjects without autism.

“We have shown that it does not take prolonged practice time to assimilate the task – it is enough to flash it for a few seconds to stimulate the relevant brain network, and the brain will then assimilate the material on its own.”

Moreover, even when presented with the task under new conditions (for example, when the stimulus was learned in a new location), the examinees who learned with the memory flash method performed better than those in the control group – they knew how to generalize the skills learned in the first task. The participants’ success in generalizing the learning to other situations is considered significant, as these are skills that people with autism tend to struggle with.

“We have already proven in previous studies that processes of learning assimilation can be improved through flashes of memory,” says Prof. Censor. “We have shown that it does not take prolonged practice time to assimilate the task – it is enough to flash it for a few seconds to stimulate the relevant brain network, and the brain will then assimilate the material on its own.”

“In this case, we tested people with autism. People with autism often have difficulty learning and generalizing repetitive learning, that is, using tools that have also been learned when executing new tasks. Through short flashes of visual stimulus of a task learned, we were able to produce learning that is identical to repetitive learning in terms of its effectiveness; meaning, we significantly shortened the learning time. The added value is the ability to generalize: the examinees performed a task under new conditions, as if they had fully learned it. “

According to Prof. Censor, the new method may have significant potential implications in a wide range of areas. The new study could pave the way for more meaningful approaches to learning for people with autism, and in a wide variety of tasks. Moreover, the method may contribute to shorten rehabilitation after neurological injuries.

A groundbreaking new study from Tel Aviv University, the first of its kind in the world, found a promising treatment for long-term COVID-19 symptoms, based on advanced hyperbaric (high-pressure oxygen) therapy (HBOT).

Long COVID, which affects up to 30% of patients infected by the COVID-19 virus, is characterized by a range of debilitating cognitive symptoms such as inability to concentrate, brain fog, forgetfulness and difficulty recalling words or thoughts – persisting for more than three months, and sometimes up to two years. To date, no effective therapy has been suggested, leaving many millions of sufferers around the world with no remedy.

The researchers: “Our study is the first randomized controlled trial to demonstrate a real solution for long COVID. Patients exposed to an intensive protocol of Hyperbaric Oxygen Therapy treatments showed significant improvement compared to the control group. For millions suffering from long-term COVID-19 symptoms, the study provides new hope for recovery.”

Long Covid – Detrimental to Quality of Life

The study was conducted by the Sagol Center for Hyperbaric Medicine and Research at Tel Aviv University and the Shamir Medical Center (Assaf Harofeh). It was led by Prof. Shai Efrati, Director of the Sagol Center and a faculty member at TAU’s Sackler School of Medicine and Sagol School of Neuroscience, and by Dr. Shani-Itskovich Zilberman from the Sagol Center for Hyperbaric Medicine and TAU’s Sackler School of Medicine. Other chief contributors were Dr. Merav Catalogna, lead data scientist from the Shamir Medical Center (Assaf Harofeh), and Dr. Amir Hadanny from the Sagol Center and TAU’s Sackler School of Medicine. The paper was published in Scientific Reports.

Prof. Efrati explains: “Today, we understand that in some patients, the COVID-19 virus penetrates the brain through the cribriform plate, the part of the skull located just above our nose, and triggers chronic brain injury – mainly in brain regions in the frontal lobe, responsible for cognitive function, mental status and pain interpretation. Consequently, affected patients experience a long-term cognitive decline, with symptoms such as brain fog, loss of concentration and mental fatigue. In addition, since the frontal lobe is damaged, patients may suffer from mood disturbance, depression, and anxiety.”

According to Efrati, these clinical symptoms, identified in patients all over the world, were corroborated by the World Health Organization in an official definition of so-called ‘long COVID’ issued in October 2021, including cognitive dysfunction as one of the common symptoms. A recent study from the Universities of Cambridge and Exeter reported that 78% of long-term COVID-19 patients experienced difficulties with concentration, 69% reported brain fog, and 68% reported forgetfulness. “Thus, long-term COVID-19 effects can be very detrimental to the sufferer’s quality of life,” continues Efrati, “and no effective treatment has yet been found.”

Prof. Shai Efrati

HBOT – Proven Effective Against other Brain Injuries

“In our study, we harnessed Hyperbaric Oxygen Therapy, already proven effective in the treatment of other forms of brain injury such as stroke, trauma, age-related cognitive decline and treatment-resistant PTSD, to the global effort to find a solution for long COVID-19,” explains Efrati.

The study, designed as a prospective, randomized, double-blind, placebo-controlled clinical trial, included 73 patients with reported post-COVID-19 cognitive symptoms such as inability to concentrate, brain fog, forgetfulness and difficulty recalling words or thoughts, persisting for more than three months following an RT-PCR test confirming COVID-19 infection.

Participants were divided into two groups: 37 patients received HBOT treatment, while 36 patients served as a sham-controlled group, receiving placebo treatment. Both patients and investigators were unaware of their designated treatment protocol. The unique protocol consisted of 40 daily HBOT sessions, five sessions per week within a two-month period, in which patients entered a multi-place HBOT chamber and breathed 100% oxygen by mask at 2 atmospheres absolute (ATA) for 90 minutes with oxygen fluctuations. The control group received placebo treatment, breathing normal air. In addition, all participants underwent a computerized cognitive test, as well as advanced high-resolution brain imaging (profusion MRI and DTI) at two points in time – when entering the trial and after its completion.

Improved cerebral blood flow by HBOT in patient suffering from post-COVID symptoms (photo:  Sagol Center for Hyperbaric Medicine)

Repairing through Regeneration

The results were highly encouraging: patients treated with HBOT showed significant improvement, while in the control group long COVID symptoms remained largely unchanged.

In HBOT-treated patients, the greatest improvements were exhibited in the global cognitive function, attention, and executive functions (the capacity to plan, organize, initiate, self-monitor and control one’s responses to achieve a goal). Other benefits included better information processing speed, improved psychiatric symptoms, more mental energy, better sleep quality, and less body pain.

All clinical findings were correlated with the participants’ brain images, indicating significant change in the parts of the brain related to each function, which had been visibly damaged by the COVID-19 virus.

Dr. Shani-Itskovich Zilberman: “We know that HBOT repairs brain damage through a process of regeneration – generating new neurons and blood vessels. We believe that the beneficial effects of the unique treatment protocol in this study can be attributed to renewed neuroplasticity and increased brain perfusion in regions associated with cognitive and emotional roles.”

Prof. Efrati: “For the first time, our study proposes an effective treatment for the debilitating long COVID syndrome, repairing brain injury with an intensive protocol of HBOT. Moreover, the study reveals the very real biological damage to brain tissues induced by the COVID-19 virus, and how repairing this damage reduces symptoms and can eventually lead to recovery.”

“From a broader perspective, these findings can also suggest that other neurological and psychiatric syndromes might be triggered by biological agents such as viruses, opening new possibilities for future treatments.” 

Note: For patients with long COVID and other neurological disorders, reliable high-quality HBOT is now available at Aviv Clinics in Florida and Dubai, international arms of the Sagol Center at Shamir Medical Center (Assaf Harofeh) in Israel – administering the same strict protocols, with additional cognitive, physical and nutrition support provided to patients.