Extracorporeal blood oxygenation and ozonation: clinical and biological implications of ozone therapy

Some lines of evidence have suggested that the challenge to antioxidants and biomolecules provoked by pro-oxidants such as ozone may be used to generate a controlled stress response of possible therapeutic relevance in some immune dysfunctions and chronic, degenerative conditions. Immune and endothelial cells have been proposed to be elective targets of the positive molecular effects of ozone and its derived species formed during blood ozonation. On the bases of these underlying principles and against often prejudicial scepticism and concerns about its toxicity, ozone has been used in autohemotherapy (AHT) for four decades with encouraging results. However, clinical application and validation of AHT have been so far largely insufficient. Latterly, a new and more effective therapeutic approach to ozone therapy has been established, namely extracorporeal blood oxygenation and ozonation (EBOO). This technique, first tested in vitro and then in vivo in sheep and humans (more than 1200 treatments performed in 82 patients), is performed with a high-efficiency apparatus that makes it possible to treat with a mixture of oxygen-ozone (0.5-1 microg/ml oxygen) in 1 h of extracorporeal circulation up to 4800 ml of heparinized blood without technical or clinical problems, whereas only 250 ml of blood can be treated with ozone by AHT. The EBOO technique can be easily adapted for use in hemodialysis also. The standard therapeutic cycle lasts for 7 weeks in which 14 treatment sessions of 1 h are performed. After a session of EBOO, the interaction of ozone with blood components results in 4-5-fold increased levels of thiobarbituric acid reactants and a proportional decrease in plasma protein thiols without any appreciable erythrocyte haemolysis. On the basis of preliminary in vitro evidence, these simple laboratory parameters may represent a useful complement in the routine monitoring of biological compliance to the treatment. The clinical experience gained so far confirms the great therapeutic potential of EBOO in patients with severe peripheral arterial disease, coronary disease, cholesterol embolism, severe dyslipidemia, Madelung disease, and sudden deafness of vascular origin. Extensive investigation on oxidative stress biomarkers and clinical trials are under way to validate this new technique further.     

Assessing the microbial oxidative stress mechanism of ozone treatment through the responses of Escherichia coli mutants

Aims:  To investigate the effect of the oxidative stress of ozone on the microbial inactivation, cell membrane integrity and permeability and morphology changes of Escherichia coli. Methods and Results:  Escherichia coli BW 25113 and its isogenic mutants in soxR, soxS, oxyR, rpoS and dnaK genes were treated with ozone at a concentration of 6 μg ml^?1 for a period up to 240 s. A significant effect of ozone exposure on microbial inactivation was observed. After ozonation, minor effects on the cell membrane integrity and permeability were observed, while scanning electron microscopy analysis showed slightly altered cell surface structure. Conclusions:  The results of this study suggest that cell lysis was not the major mechanism of microbial inactivation. The deletion of oxidative stress–related genes resulted in increased susceptibility of E. coli cells to ozone treatment, implying that they play an important role for protection against the radicals produced by ozone. However, DnaK that has previously been shown to protect against oxidative stress did not protect against ozone treatment in this study. Furthermore, RpoS was important for the survival against ozone. Significance and Impact of the Study:  This study provides important information about the role of oxidative stress in the responses of E. coli during ozonation.     

A realistic evaluation of the action of ozone on whole human blood

We have clarified the role of the ozone concentration in relation to the resistance of human erythrocytes in whole human blood or in blood diluted either in saline or in distilled water.

Spectrophotometric data related to haemoglobin were evaluated by exposing samples of fresh human blood directly to ozone doses (ratio 1:1 volume), within the therapeutic range (0.21–1.68 mM) and to one toxic dose (3.36 mM). Furthermore, the same determinations have been carried out after previous dilution of the same blood with either pure water or physiological saline (1 ml blood + 29 ml diluent) followed by ozonation with the above reported ozone doses. Addition of either saline or water implies a dilution of plasma antioxidants and also total haemolysis after water dilution. Particularly the latter case represents a most unphysiological situation because the osmotic shock causes the solubilization of the erythrocytic content. While it is possible to demonstrate that after haemolysis there is an ozone-concentration dependent transformation of some oxyhaemoglobin to methaemoglobin, no such process occurs after ozonation of whole blood.

The results of this study fully confirm our previous data that judicious ozone doses neither damage erythrocytes, nor induce oxidation of intracellular haemoglobin. We hope that our conclusions will definitively clarify the absence of toxicity of ozonetherapy.     

Water disinfection using the novel approach of ozone and a liquid whistle reactor

A novel approach of ozone treatment assisted by a liquid whistle reactor (LWR), which generates hydrodynamic cavitation, has been explored for water disinfection using a simulated effluent containing Escherichia coli (E. coli), one of the dominant markers in faecal coliforms. A suspension having an E. coli concentration of approximately 10⁸ to 10⁹ CFU mL⁻¹ was introduced into the LWR to examine the effect of hydrodynamic cavitation alone and in combination with ozone. Operating conditions of inlet pressure and ozone doses as well as time of ozonation for individual operation along with the combined operation have been varied with the aim of maximizing the extent of disinfection and arriving at an optimum strategy for treatment. It has been observed that nearly 75% disinfection can be achieved in about 3 h of treatment time using an optimized combination of hydrodynamic cavitation and ozonation. This combination has been found to be a cost-effective technique for achieving maximum disinfection compared to the individual operation of hydrodynamic cavitation (lower extent of disinfection) and ozonation (higher costs of treatment usually due to higher cost of ozone generation).     

The effects of oxygen–ozone therapy on regulatory T-cell responses in multiple sclerosis patients

Multiple sclerosis (MS) is a common degenerative disorder of the central nervous system. The decreased frequency and dysfunction of Treg cells cause inflammation and disease progression. Ozone autohemotherapy can be used as a potential therapeutic approach to regulate the immune system responses and inflammation in MS. For this purpose, 20 relapsing-remitting multiple sclerosis patients were under treatment with ozone twice weekly for 6 months. The frequency of Treg cell, the expression levels of the Treg cell-related factors (FoxP3, IL-10, TGF-β, miR-17, miR-27, and miR-146A), and the secretion levels of IL-10 and TGF-β were assessed. We found a significant increase in the number of Treg cells, expression levels of FoxP3, miRNAs (miR-17 and miR-27), IL-10, and TGF-β factors in patients after oxygen–ozone (O₂-O₃) therapy compared to before treatment. In contrast, oxygen–ozone therapy notably decreased the expression level of miR-146a in treated patients. Interestingly, the secretion levels of both IL-10 and TGF-β cytokines were considerably increased in both serum and supernatant of cultured peripheral blood mononuclear cells in posttreatment condition compared to pretreatment condition. According to results, oxygen–ozone therapy raised the frequency of Treg cell and its relevant factors in treated MS patients. Oxygen–ozone therapy would contribute to improving the MS patients by elevating the Treg cell responses.     

Combined Biological Treatment/Ozonation of Wastewaters for the Mineralisation of Non‐Biodegradable Naphthalene‐1,5‐Disulphonic Acid

This paper deals with the ozonation and biological treatment for achieving the mineralisation of the non‐biodegradable compound naphthalene‐1,5‐disulphonic acid (NADSA; C₁₀H₈O₆S₂), a basic chemical for dyes and building materials. This combination of ozonation and biological treatment is expected to minimise the ozone consumption compared to ozonation alone. To examine the influence of ozone on the biodegradability of NADSA, a lab‐scale plant was run semi‐continuously and batch tests were conducted for comparison. For total ozonation, 1.8 mol O₃/mol DOC have to be used. For optimum biodegradation, only 0.8 mol O₃/mol DOC are needed. The results show that by using a combination of ozonation and biological treatment the ozone consumption can be reduced by more than 50% compared to ozonation alone. Some of the intermediate products are isolated and suggestions for their chemical structures are made. A proposal for the first steps of ozonation is also presented to illustrate a possible pathway of ozonation. All the major identifiable compounds are non‐biodegradable. From these results, it is quite clear that further intermediate products are formed, which are biodegradable.     

Bioremediation of phenolic compounds having endocrine-disrupting activity using ozone oxidation and activated sludge treatment

The bioremediation of water system contaminated with phenolic compounds having endocrine-disrupting activity,i.e. 2,4-dichlorophenol, 2,4-dichlorophenoxy acetic acid (2,4-D), and 2,4,5-trichlorophenoxy acetic acid (2,4,5-T), was investigated by using ozone oxidation and activated sludge treatment. Ozone oxidation (ozonation time: 30 min) followed by activated sludge treatment (incubation time: 5 days) was an efficient treatment method for the conversion of phenolic compounds in water into carbon dioxide and decreased the value of total organic carbon (TOC) up to about 10% of initial value. Furthermore, 2,4-D was dissolved in water containing salt,i.e. artificial seawater (ASW), and this water was used as model coastal water contaminated with phenolic compounds. The activated sludge treatment (incubation time: 5 days) could consume significantly organic acids produced from 2,4-D in the model costal water by the ozone oxidation (ozonation time: 30 min) and decrease the value of TOC up to about 35% of initial value.     

Estimation of biological kinetic parameters from an analysis of the BOD curve of waste waters–effects of a chemical preoxidation

Urban waste waters were treated with pure ozone or combinations of ozone, hydrogen peroxide and/or UV radiation to study the course of resulting BOD (biological oxygen demand)-time profiles and to propose a kinetic model. BOD-time profiles of chemically treated waste waters show an initial lag period that first order kinetic models cannot describe. A second order kinetic model is then proposed that satisfactorily fits experimental BOD-time profiles, except when hydrogen peroxide has been used. In these cases, BOD-time profiles present the highest lag periods observed. By applying this model, three parameters are determined: the biokinetic constant (k) which is an index of the biological removal rate; the potential amount of biodegradable matter (BOD_T), and the measure of the size of inocula and microbial activities of microoganisms (λ). The model was checked with experimental results of BOD-time profiles corresponding to both untreated and chemically ozonated urban waste waters. Ozonated waste waters showed the highest values of k and BOD_T, which implies an improvement of waste water biodegradability after ozonation. However, values of λ corresponding to ozonated waste waters presented lower values than those of untreated waste waters. This was due to the lag period observed in the BOD-time profile, which was a consequence of a lack of microorganism acclimation to ozonated waste waters. The effect of the ozone does, pH and carbonates during ozonation on COD (chemical oxygen demand) and the above indicated parameters was also studied. There was an optimum ozone dose which was 138 mg/l for this specific system. This led to the highest biodegradable fraction (φ) and the highest biokinetic constant (39% increase in φ and 4.7- fold increase in the value of k, respectively, compared to untreated waste waters.). Another significant fact was that a higher COD reduction was observed in the absence of carbonate during ozonation at basic pH values. In addition, the percentage of variation in the biodegradable fraction (Δφ) of ozonated waste water increased compared to the untreated waste water at acid pH. The results suggest that ozonolysis, the direct molecular ozone way of reaction, due to its selective character, increases the biodegradability of waste water more than other chemically advanced oxidation processes based on hydroxyl radical reactions.     

<Emphasis Type="Italic">Dethiobacter alkaliphilus </Emphasis> gen. nov. sp. nov., and <Emphasis Type="Italic">Desulfurivibrio alkaliphilus</Emphasis> gen. nov. sp. nov.: two novel representatives of reductive sulfur cycle from soda lakes

Anaerobic enrichments with H₂ as electron donor and thiosulfate/polysulfide as electron acceptor at pH 10 and 0.6 M total Na⁺ yielded two non sulfate-reducing representatives of reductive sulfur cycle from soda lake sediments. Strain AHT 1 was isolated with thiosulfate as the electron acceptor from north–eastern Mongolian soda lakes and strain AHT 2—with polysulfide as the electron acceptor from Wadi al Natrun lakes in Egypt. Both isolates represented new phylogenetic lineages: AHT 1—within Clostridiales and AHT 2—within the Deltaproteobacteria. Both bacteria are obligate anaerobes with respiratory metabolism. Both grew chemolithoautotrophically with H₂ as the electron donor and can use thiosulfate, elemental sulfur and polysulfide as the electron acceptors. AHT 2 also used nitrate as acceptor, reducing it to ammonia. During thiosulfate reduction, AHT 1 excreted sulfite. dsrAB gene was not found in either strain. Both strains were moderate salt-tolerant (grow up to 2 M total Na⁺) true alkaliphiles (grow between pH 8.5 and 10.3). On the basis of the phenotypic and phylogenetic data, strains AHT 1 and AHT 2 are proposed as new genera and species Dethiobacter alkaliphilus and Desulfurivibrio alkaliphilus, respectively. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. Nucleotide sequence accession number: The GenBank/EMBL accession number of the 16S rRNA gene sequence of strains AHT 1T and AHT 2T are EF422412 and EF422413.     

Functional group analysis during ozonation of sunflower oil methyl esters by FT-IR and NMR

Ozonation of neat sunflower oil (SFO) methyl esters was monitored by FT-IR and 1H and 13C NMR spectroscopy. During the early stage of ozonation, ozone absorption was essentially quantitative. This was accompanied by the formation of 1,2,4-trioxolane. IR and NMR spectra of ozonated samples showed that scission of ozonide to give aldehyde were minimal. 1H NMR analysis revealed that the amount of ozonide relative to aldehyde was more than 90% regardless of the extent of ozonation. Complete ozonation was attained after supplying around 0.20 g O3/ml methyl ester after which ozone absorption suddenly dropped to around 25%. At the latter part of ozonation, ozonide and aldehyde reacted with excess ozone to give carboxylic acid. Reaction products were identified according to Criegee mechanism.     

Status and needs for online control of tertiary ozone-based water treatment: use of surrogate correlation models for removal of trace organic contaminants

The number of studies dealing with tertiary ozonation to remove trace organic contaminants (TrOCs) in effluents originating from wastewater treatment plants (WWTPs) is increasing due to the need for upgrading the WWTPs overall performance. To follow-up TrOCs removal in real-time during ozone-based treatment, online surrogate measurements are necessary, of which mainly spectroscopic surrogates (i.e. UV–VIS absorbance and fluorescence) are the emerging techniques in literature. This paper summarizes and reflects on the state-of-the-art as retrieved from more than 100 peer-reviewed studies published between January 2007 and December 2020 and dealing with (1) surrogate correlation models for the prediction of TrOCs removal in secondary effluent and (2) control strategies to adjust the ozone dose during (full-scale) operation. Next to the flow and load proportional ozone dosing strategies, controlling the ozone dose solely based on the characteristics of the effluent entering the ozonation unit, also a differential control strategy based on the change in characteristics due to ozonation of the WWTP effluent is highlighted. The latter seems the best option as flow and load proportional ozone dosing do not consider the amount and/or reactivity of the matrix constituents. The presence of organic and inorganic scavengers of ozone and radicals in the effluent matrix has a significant impact on the TrOCs removal efficiency. This effluent quality can differ in time and between WWTPs, hence the surrogate correlation models should be widely applicable. At the end of the review, recommendations are made for future research and implementation of an effective control strategy for (full-scale) applications.

     

The degradation of Karenia brevis toxins utilizing ozonated seawater

Florida red tides impose both an economic and health impact on the state. The purpose of this research was to examine the effectiveness of ozone to reduce the numbers of Florida red tide organism (Karenia brevis Davis) and its associated toxins in an artificial seawater environment. The results obtained in this experiment showed an approximate 1.25 log₁₀ unit reduction in the major toxin groups recovered after 10 min of ozone exposure (approximately 135 mg). In initial trials, K. brevis toxins were extracted and reintroduced into an artificial seawater (ASW) media. Subsequent experiments exposed whole cell K. brevis culture to ozone treatment. Samples from both experiments displayed approximately 1.10 log₁₀ unit reduction in total toxin and an approximate 1.25 log₁₀ unit reduction in three of the six major toxins associated with K. brevis (PxTx-1, -2, -9). The reduction in toxin concentration, as measured by high performance liquid chromatography (HPLC) analysis, displayed a positive correlation with the reduction of toxicity as determined by a fish (Cyprinodon variegatus) bioassay. Despite large total doses of ozone applied, as compared to levels that might be found at a commercial ozonation facility, some toxins were still recoverable by HPLC after ozone treatment.     

Mechanism of Ozone Inactivation of Bacteriophage f2

The inactivation kinetics of bacteriophage f2 were studied by using ozone under controlled laboratory conditions. The phage were rapidly inactivated during the first 5 s of the reaction by 5 and 7 logs at ozone concentrations of 0.09 and 0.8 mg/liter, respectively. During the next 10 min, the phage were further inactivated at a slower rate in both treatments. The [³H]uridine-labeled f2 phage and its ribonucleic acid (RNA) were examined to elucidate the mechanism of ozone inactivation, utilizing adsorption to host bacteria, sucrose density gradient analysis, and electron microscopy. The specific adsorption of the phage was reduced by ozonation in the same pattern as plaque-forming unit reduction. RNA was released from the phage particles during ozonation, although it had reduced infectivity for spheroplasts. Electron microscopic examination showed that the phage coat was broken by ozonation into many protein subunit pieces and that the specific adsorption of the phage to host pili was inversely related to the extent of phage breakage. The RNA enclosed in the phage coat was inactivated less by ozonation than were whole phage, but inactivated more than naked RNA. These findings suggest that ozone breaks the protein capsid into subunits, liberating RNA and disrupting adsorption to the host pili, and that the RNA may be secondarily sheared by a reduction with and/or without the coat protein molecules, which have been modified by ozonation.     

Rapid Removal of Tetrabromobisphenol A by Ozonation in Water: Oxidation Products,Reaction Pathways and Toxicity Assessment

Tetrabromobisphenol A (TBBPA) is one of the most widely used brominated flame retardants and has attracted more and more attention. In this work, the parent TBBPA with an initial concentration of 100 mg/L was completely removed after 6 min of ozonation at pH 8.0, and alkaline conditions favored a more rapid removal than acidic and neutral conditions. The presence of typical anions and humic acid did not significantly affect the degradation of TBBPA. The quenching test using isopropanol indicated that direct ozone oxidation played a dominant role during this process. Seventeen reaction intermediates and products were identified using an electrospray time-of-flight mass spectrometer. Notably, the generation of 2,4,6-tribromophenol was first observed in the degradation process of TBBPA. The evolution of reaction products showed that ozonation is an efficient treatment for removal of both TBBPA and intermediates. Sequential transformation of organic bromine to bromide and bromate was confirmed by ion chromatography analysis. Two primary reaction pathways that involve cleavage of central carbon atom and benzene ring cleavage concomitant with debromination were thus proposed and further justified by calculations of frontier electron densities. Furthermore, the total organic carbon data suggested a low mineralization rate, even after the complete removal of TBBPA. Meanwhile, the acute aqueous toxicity of reaction solutions to Photobacterium Phosphoreum and Daphnia magna was rapidly decreased during ozonation. In addition, no obvious difference in the attenuation of TBBPA was found by ozone oxidation using different water matrices, and the effectiveness in natural waters further demonstrates that ozonation can be adopted as a promising technique to treat TBBPA-contaminated waters.     

Wine vinasses treatments by ozone and an activated sludge system in continuous reactors

In this work wine vinasses have been treated separately by means of a chemical ozonation and a biological aerobic degradation in an activated sludge system, and later by means of a combined process which consisted of an aerobic pretreatment followed by an ozonation treatment, in continuous reactors in all cases. In the ozonation experiments, the hydraulic retention time and the ozone partial pressure were varied leading to substrate removals in the range 4.4-16%, with increases in this removal when both operating variables were increased. A kinetic study, which combines mixed flow reactor model for the liquid phase and plug flow reactor model for the gas phase, allows to determine the rate constant for the ozone reaction and the consumption ratio, which are k_O3 = 3.6 l/(g COD · h) and b = 22.5 g COD degraded/mol O₃ consumed. The aerobic degradation experiments were conducted in the activated sludge system with variations in the retention time and influent organic substrate concentration in the wastewater. A modified Contois model applied to the experimental results leads to the determination of the kinetic parameters of that model: K₁ = 5.43 l/g VSS and q_max = 6.29 g COD/(g VSS · h). Finally, the combined process reveals an improvement in the efficiency of the ozonation stage due to the previous aerobic treatment with increases in the substrate removal reached and in the rate constant obtained, the last one being k_O3 = 5.6 l/(g COD · h).     

Effect of ozone on respiration of adult Sitophilus oryzae (L.), Tribolium castaneum (Herbst) and Rhyzopertha dominica (F.)

The effect of ozone on the respiration of three species of adult stored-product Coleoptera was tested in an air-tight flask. Sitophilus oryzae (L.), Rhyzopertha dominica (F.) and Tribolium castaneum (Herbst) adults were exposed to atmosphere containing 0.1, 0.2 or 0.4 μg/ml initial ozone at 23–25 °C and 50% r.h. Carbon dioxide (CO₂) production reflected the respiration rates of insects and was determined with a gas chromatograph (GC). The experiments showed that the effects of ozone on respiration had two distinct phases. Phase 1 involved a lower respiration rate of the adult stored-product Coleoptera under ozone atmosphere and reflected the need for insects to reduce ozone toxicity. After 1 h, CO₂ production of S. oryzae was 3.19, 2.63, 2.27 and 1.99 μl/mg for the ozone concentration of 0, 0.1, 0.2 and 0.4 μg/ml, respectively. The results also showed that there were decreases in the rate of respiration in R. dominica and T. castaneum with an increase in ozone concentration. During phase 2, respiration of S. oryzae, R. dominica, and T. castaneum adults treated with ozone increased as the ozone degraded to oxygen. After 7 h, the effect of ozone on CO₂ production, relative to the control, changed from a decrease to an increase. The findings in relation to control strategies were discussed.     

Semiautomated enzymic micro methods for blood glucose and lactic acid on a single filtrate

Methods have been modified and adapted to permit enzymic automated micro analysis of glucose on 0.021 ml of blood, and of lactic acid on 0.0115 ml of blood. By means of a single 1:20 Somogyi filtrate with a final volume of 1–1.4 ml prepared from 0.1–0.15 ml blood, both determinations can be accomplished individually on the autoanalyzer.The range of concentrations of each method has been extended so that glucose may be determined between 5 and $\text{200 mg}\text{100 ml}$ (or higher depending on dilution) and lactic acid between 5 and $\text{125 mg}\text{100 ml}$.The methods are sensitive, reproducible, and stable. The recoveries and the comparison studies with manual methods are well within the limits of clinical investigation procdures.     

Properties of sesame oil by detailed 1H and 13C NMR assignments before and after ozonation and their correlation with iodine value,peroxide value,and viscosity measurements

Gaseous ozone chemically reacts with unsaturated triglyceride substrates leading to ozonated derivatives with a wide potential applications, ranging from the petrochemical to the pharmaceutical industry. To date, an ultimate understanding of the ozone reactivity during sesame oil ozonation process as well as detailed ¹H and ¹³C NMR assignments are lacking. A practical advantage of NMR is that a single NMR sample measurement can explain many issues, while similar analysis by traditional methods may require several independent and time-consuming measurements. Moreover, significant relationships among NMR spectra and both conventional chemical analysis and viscosity measurements have been found. Eventually, NMR could play an important role for quality attributes of ozonated oil derivatives.     

Vascular access for extracorporeal therapy in the rabbit

A technique allowing short-term blood access for extracorporeal therapy in rabbits is described. The technique utilizes silicone rubber cannulae and teflon vessel tips to construct an externalized carotid-jugular arteriovenous shunt. The insertion procedure takes 1 h and extracorporeal blood flows in excess of 10 ml/min are obtainable for up to 7 days. Blood flow may still be obtained following shunt clotting by insertion of smaller diameter catheters through the arterial cannula. This technique has been successfully used for extracorporeal therapy in rabbit disease models.     

Ozone‐induced stomatal sluggishness changes stomatal parameters of Jarvis‐type model in white birch and deciduous oak

• Stomatal ozone flux is closely related to ozone injury to plants. Jarvis‐type multiplicative model has been recommended for estimating stomatal ozone flux in forest trees. Ozone can change stomatal conductance by both stomatal closure and less efficient stomatal control (stomatal sluggishness). However, current Jarvis‐type models do not account for these ozone effects on stomatal conductance in forest trees.
• We examined seasonal course of stomatal conductance in two common deciduous tree species native to northern Japan (white birch: Betula platyphylla var. japonica ; deciduous oak: Quercus mongolica var. crispula ) grown under free‐air ozone exposure. We innovatively considered stomatal sluggishness in the Jarvis‐type model using a simple parameter, s , relating to cumulative ozone uptake (defined as POD : phytotoxic ozone dose).
• We found that ozone decreased stomatal conductance of white birch leaves after full expansion (?28%). However, such a reduction of stomatal conductance by ozone fell in late summer (?10%). At the same time, ozone reduced stomatal sensitivity of white birch to VPD and increased stomatal conductance under low light conditions. In contrast, in deciduous oak, ozone did not clearly change the model parameters.
• The consideration of both ozone‐induced stomatal closure and stomatal sluggishness improved the model performance to estimate stomatal conductance and to explain the dose–response relationship on ozone‐induced decline of photosynthesis of white birch. Our results indicate that ozone effects on stomatal conductance (i.e . stomatal closure and stomatal sluggishness) are crucial for modelling studies to determine stomatal response in deciduous trees, especially in species sensitive to ozone.