A comprehensive analysis to understand the mechanism of action of balneotherapy: why, how, and where they can be used? Evidence from in vitro studies performed on human and animal samples
Key Findings
- Comprehensive review of in-vitro evidence for balneotherapy mechanisms of action
- Details anti-inflammatory, antioxidant, and immunomodulatory pathways
- Links molecular-level evidence to clinical observations
With 64 citations, a highly influential review of balneotherapy mechanisms at the molecular level. Published in the International Journal of Biometeorology, Cheleschi and Gallo systematically reviewed in vitro studies — experiments on human and animal cells and tissues — to explain why balneotherapy produces the clinical outcomes that trials report. This is the bridge paper between “it works” and “here is why it works.”
What Gap It Fills
Most balneotherapy clinical trials measure whether patients improve; they do not measure why. Mechanism reviews like this one assemble the laboratory evidence to answer the second question. The in vitro approach is appropriate here: you cannot easily measure cytokine inhibition or free radical scavenging in a live patient during a peat bath, but you can measure them in cell cultures treated with peat extracts.
Three Mechanism Categories
Anti-inflammatory: Peloid compounds — particularly humic substances — suppress pro-inflammatory cytokine production (TNF-α, IL-1β, IL-6, IL-8) in stimulated cell lines. The suppression operates at multiple points in the inflammatory cascade, explaining why effects are broad rather than pathway-specific.
Antioxidant: Peat compounds scavenge reactive oxygen species (ROS), reducing oxidative stress in cells. This mechanism is relevant both to chronic inflammatory conditions (where ROS accumulate) and to skin aging (where oxidative damage contributes to structural degradation).
Immunomodulatory: Beyond simple suppression, peloid compounds shift immune cell populations and cytokine profiles toward regulatory states — reducing pathological over-activation without eliminating normal immune function. This distinction between anti-inflammatory and immunomodulatory is important for understanding why peat therapy can be used in conditions requiring a rebalanced immune response, not just a suppressed one.
Why It’s Cited So Often
Cheleschi 2020 appeared at a point when the molecular evidence for balneotherapy was fragmentary across dozens of papers in different journals. By aggregating it into a single review with consistent framing, it became the go-to citation for mechanism claims across the subsequent literature.