capacity of ozone therapy which is able to improve: a) blood circulation and oxygen delivery to ischemic tissues; b) corrects the chronic oxidative stress by upregulating the antioxidant system; c) induces, without side effects, a state of wellness and euphoria and d) may improve insulin secretion or its effectiveness. Diabetic patients, particularly those with foot ulcers, are critical and today they still have a gloomy prognosis. This is because they need a multiform therapy aiming to eliminate infection, the peripheral ischemia and the neuropathy. While we are not yet sure about correcting the dysinsulinemia, we have witnessed dramatic improvements in patients ready for amputation by performing AHT and topical, daily application of ozonated oil. While certainly we are not overlooking the importance of antidiabetic drugs, statins, antihypertensive agents and so forth, we judge it deplorable to disregard the benefit of a combined ozone therapy.

Life-long ozonetherapy is feasible as we have shown in age-related macular degeneration, in chronic limb ischemia and in angina abdominis. After an initial cycle including 24 treatments in three months (twice weekly), the therapeutic effect can be probably maintained with three treatments per month. Upregulation af antioxidant enzymes and 2,3-diphosphoglycerate is likely to occur during the first two months, while rheological improvement (decrease of arterial pressure is the norm) due to NO(cid:0)/Superoxide rebalance may take two-to three months.

Ozonation of patient’s blood must be carefully performed, firstly evaluating the antioxidant capacity in order to employ the optimal ozone concentration. The usual strategy “starts low, go slow” is the most idoneous for inducing ozone tolerance and the rebalance of the redox system. This approach will likely diminish the frequency of allotransfusion, the severity of painful vaso-occlusive crises in SCA and will improve the metabolism and the quality of life. Chelation therapy with desferrioxamine must be continued regularly and, for potentiating the plasma antioxidant capacity, we must prescribe the usual oral daily antioxidant supplementation one week before starting the therapy. Haemoglobinopathies are often complicated by chronic hepatitis C infection and, although the combination of interferon alpha and ribavirin is effective (Li et al., 2002), it may well be strengthened by the ozonated AHT. The treatment proposed by Cuban physicians of ozone insufflation via the rectal route has been evaluated in the rabbit (Bocci et al., 2000) but in comparison to the stoichiometry of AHT, it is too approximate.

However it is even cheaper and amenable to self-administration. If ozonetherapy can be proven to be useful in haemoglobinopathies, a reevaluation of the RI route is warranted also because the patient, once properly instructed, can do it at home. One drawback of ozonetherapy is that lack of electricity and medical oxygen may impede ozone production for SCA therapy in remote parts of Africa. The same problem attains for treating malaria and HIV infections. In order to overcome these difficulties, one promising option is the infusion of the “glucoperoxide-solution” with hydrogen peroxide concentrations in the low-medium range (0.03-0.09%).