HBO clearly has a DNA-damaging and possibly mutagenic potential. In vitro studies with mammalian cells suggest that HBO-induced oxidative DNA damage mainly leads to gross genetic alterations and chromosome aberrations. Under therapeutic exposure conditions, DNA damage is detected with the comet assay, but mutations and chromosome aberrations are not observed in peripheral blood cells. Although human blood cells do not seem to run a significant risk for producing (chromosome-) mutations, mutagenic effects in other target cells (e.g. lung cells) cannot be completely excluded. Nevertheless, genotoxicity of hyperbaric oxygen should be taken seriously, and, for this reason, induction of DNA damage by HBO should be avoided.

A very simple and efficient way to avoid HBO-induced DNA damage is to start with a shortened treatment before the standard protocol is applied the following days. Therefore, the hyperbaric community should think about an adaptation of the commonly used treatment protocols.

The supplementation with antioxidants such as vitamin C, E or even N-acetylcysteine seems to be ineffective to prevent hyperbaric oxygen induced genotoxicity, at least in healthy volunteers. Their usefulness in patients with antioxidant depletion, however, is yet unknown. In contrast, the orally effective mixture of a vegetal SOD and wheat gliadin Glisodin® protects against HBO-induced DNA damage and may have a role in the prevention of oxidative DNA damage.

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