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Spark Wave® Therapy Improves Cardiac FunctionIschemic heart disease remains the leading cause of mortality (12.7 %) worldwide, causing more than 7 million deaths per year.
Native angiogenesis after infarction most often is not sufficient for appropriate supply of hibernating cardiomyocytes, leading to pathologic left ventricle (LV) remodeling and ischemic cardiomyopathy, a clinical entity characterized by a poor prognosis and severe symptoms in affected patients. Management of this disease often is limited, and curative strategies beside heart transplantation are lacking. Therefore, therapies enhancing vascularization in the infarction zone by induction of capillary sprouting from existing vessels (angiogenesis) and/or by recruitment of bone marrow–derived endothelial cells (BMEC) for de novo vessel formation (vasculogenesis) are of high relevance.

Epicardial shock-wave therapy improves ventricular function in a porcine model of ischaemic heart disease. - Previously we have shown that epicardial shock-wave therapy improves left ventricular ejection fraction (LVEF) in a rat model of myocardial infarction. In the present experiments we aimed to address the safety and efficacy of epicardial shock-wave therapy in a preclinical large animal model and to further evaluate mechanisms of action of this novel therapy. Four weeks after left anterior descending (LAD) artery ligation in pigs, the animals underwent re-thoracotomy with (shock-wave group, n = 6) or without (control group, n = 5) epicardial shock waves (300 impulses at 0.38 mJ/mm2 ) applied to the infarcted anterior wall.

Shock waves activate in vitro cultured progenitors and precursors of cardiac cell lineages from the human heart - Postischemic cardiomyopathy remains one of the disorders in urgent need of effective noninvasive therapy. It is currently accepted that the isolation, expansion and application of resident cardiac stem cells may hold therapeutic promise for the future. Recently, it has been demonstrated that shock waves (SW) could enhance the expression of vascular endothelial growth factor (VEGF) and its receptor, Flt-1.

Shock Wave Therapy Improves Cardiac Function in a Model of Chronic Ischemic Heart Failure: Evidence for a Mechanism Involving VEGF Signaling and the Extracellular Matrix - Mechanical stimulation of acute ischemic myocardium by shock wave therapy (SWT) is known to improve cardiac function by induction of angiogenesis. However, SWT in chronic heart failure is poorly understood. We aimed to study whether mechanical stimulation upon SWT improves heart function in chronic ischemic heart failure by induction of angiogenesis and postnatal vasculogenesis and to dissect underlying mechanisms.

Alteration of inflammatory response by shock wave therapy leads to reduced calcification of decellularized aortic xenografts in mice. -  Tissue-engineered xenografts represent a promising treatment option in heart valve disease. However, inflammatory response leading to graft failure and incomplete in vitro repopulation with recipient cells remain challenging. Shock waves (SWs) were shown to modulate inflammation and to enhance re-epithelialization. We therefore aimed to investigate whether SWs could serve as a feasible adjunct to tissue engineering. 

​Exosomes and Cardiovascular Protection - Most, if not all, cells of the cardiovascular system secrete small, lipid bilayer vesicles called exosomes. Despite technical challenges in their purification and analysis, exosomes from various sources have been shown to be powerfully cardioprotective. Indeed, it is possible that much of the so called "paracrine" benefit in cardiovascular function obtained by stem cell therapy can be replicated by the injection of exosomes produced by stem cells. However, exosomes purified from plasma appear to be just as capable of activating cardioprotective pathways.

Heart Regeneration becomes Reality! - Regeneration of infarcted heart muscle remained a dream of modern medicine despite of comprehensive research on stem cell and gene therapy. Both technologies have not gained broad clinical use due to limited clinical results and significant side-effects including tumor formation.

​Shockwave Therapy Helping Patients With Peripheral Artery Disease - CBS News Stephanie Stahl reports. (Video)

Current research in this field is focused on shockwave therapy and on the role of inflammation and innaty immunity in myocardial infarction. - The main aim of our research in this field is to regenerate infarcted myocardium, respectively the hibernating myocardium. We use LAD ligation models – chronic, acute and ischemia/ reperfusion – in different species. Besides regeneration we work on the induction of angiogenesis as well as vasculogenesis.

Toll-like receptor 3 signalling mediates angiogenic response upon shock wave treatment of ischaemic muscle - Shock wave therapy (SWT) represents a clinically widely used angiogenic and thus regenerative approach for the treatment of ischaemic heart or limb disease. Despite promising results in preclinical and clinical trials, the exact mechanism of action remains unknown. Toll-like receptor 3, which is part of the innate immunity, is activated by binding doublestranded (ds) RNA. It plays a key role in inflammation, a process that is needed also for angiogenesis. We hypothesize that SWT causes cellular cavitation without damaging the target cells, thus liberating cytoplasmic RNA that in turn activates TLR3

Shockwave therapy of the heart​ - Ischemic heart disease represents a collective term for a continuous disease pathophysiology, ranging from acute myocardial infarction to congestive and chronic heart failure. According to the World Health Organization (WHO) and its Global Burden of Disease study 2010 ischemic heart disease represents the most common cause of death and disability-adjusted life years (DALY) worldwide

Low energy shock wave therapy induces angiogenesis in acute hind-limb ischemia via vegf receptor 2 phosphorylation - : Low energy shock waves have been shown to induce angiogenesis, improve left ventricular ejection fraction and decrease angina symptoms in patients suffering from chronic ischemic heart disease. Whether there is as well an effect in acute ischemia was not yet investigated.

Shockwave therapy differentially stimulates endothelial cells: implications on the control of inflammation via toll-like receptor 3 - Inflammatory processes play an important role in post-infarction myocardial remodelling. Adequate repair after loss of a large amount of cardiomyocytes requires a balanced response between inflammatory and regenerative stimuli.

Shock wave treatment induces angiogenesis and mobilizes endogenous cd31/cd34-positive endothelial cells in a hindlimb ischemia model: implications for angiogenesis and vasculogenesis - Shock waves have been shown to induce recruitment of intravenously injected endothelial progenitor cells to ischemic hind limbs in rats. We hypothesized that shock wave treatment as sole therapy would induce angiogenesis in this ischemia model and would lead to mobilization of endogenous endothelial (progenitor) cells.

Optimal timing of extracorporeal shock wave treatment to protect ischemic tissue - Enhancement of flap survival through extracorporeal shock wave treatment (ESWT) is a promising new technique; however, no attempt has been made to define the optimal time point and frequency of ESWT to optimize treatment with ESWT for ischemic indications.

 Low-energy shock wave for enhancing recruitment of endothelial progenitor cells: a new modality to increase efficacy of cell therapy in chronic hind limb ischemia - ​—Stem and progenitor cell therapy is a novel approach to improve neovascularization and function of ischemic tissue. Enhanced tissue expression of chemoattractant factors such as stromal cell–derived factor 1 and vascular endothelial growth factor is crucial for the recruitment of circulating endothelial progenitor cells (EPCs) during acute ischemia. In chronic ischemia, however, expression of these chemoattractants is less pronounced, which results in insufficient EPC recruitment into the target tissue.

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