Biologic Response

Effect of shock waves on macrophages - Extracorporeal Shock Wave Therapy (ESWT) is broadly used as a non-surgical therapy in various diseases for its pro-angiogenic and anti-inflammatory effects. However, the molecular mechanisms translating tissue exposure to shock waves (SW) in a biological response with potential therapeutic activity are largely unknown. As macrophages take part in both the onset and amplification of the inflammatory response, and well in its resolution, we investigated the effect of SW on their biology.

Lohse - Busch ISMST Presentation - High-energy ESW can destroy non myelinated nerves but afterwards there is an even faster regeneration.

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 double stranded (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. 

Shock wave as biological therapeutic tool: from mechanical stimulation to recovery and healing, through mechanotransduction - Extracorporeal Shock Wave Therapy (ESWT) is a form of “mechanotherapy”, that, from its original applications as urological lithotripsy, gained the field of musculo-skeletal diseases as Orthotripsy (mainly tendinopaties and bone regenerative disorders) and Regenerative Medicine as well.

Shockwave treatment enhances cell proliferation and improves wound healing by ATP release coupled extracellular signal-regulated kinase (ERK) activation - Shock wave treatment accelerates impaired wound healing in diverse clinical situations. However, the mechanisms underlying the beneficial effects of shock waves have not yet been fully revealed. Because cell proliferation is a major requirement in the wound healing cascade, we used in vitro studies and an in vivo wound healing model to study whether shock wave treatment influences proliferation by altering major extracellular factors and signaling pathways involved in cell proliferation.We identified extracellular ATP, released in an energy- and pulse number-dependent manner, as a trigger of the biological effects of shock wave treatment.

​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.

Shock wave application to cell cultures - Shock waves nowadays are well known for their regenerative effects. Basic research findings showed that shock waves do cause a biological stimulus to target cells or tissue without any subsequent damage. Therefore, in vitro experiments are of increasing interest. Various methods of applying shock waves onto cell cultures have been described. In general, all existing models focus on how to best apply shock waves onto cells. 

​ShockWave therapy differentially stimulates endothelial cells: implications on the control of inflammation via toll-like receptor 3 - Shock wave therapy (SWT) reportedly improves ventricular function in ischemic heart failure. Angiogenesis and inflammation modulatory effects were described. However, the mechanism remains largely unknown. We hypothesized that SWT modulates inflammation via toll-like receptor 3 (TLR3) through the release of cytosolic RNA. SWT was applied to human umbilical vein endothelial cells (HUVECs) with 250 impulses, 0.08 mJ/mm2 and 3 Hz. Gene expression of TLR3, inflammatory genes and signalling molecules was analysed at different time points by real-time polymerase chain reaction.

​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. Therefore, we investigated the effect of targeted extracorporeal shock wave (SW) application in order to facilitate EPC recruitment into nonischemic and chronic ischemic tissue.

IVSWT Water Bath V2.0 Manual - The number of in-vitro experiments in shock wave science increases continuously. This fact reflects how important basic research findings on the cellular and sub-cellular level are for the future progress of shock wave therapy. In some very emerging fields better mechanistic understandings may be prerequisite for translation into clinical use or will at least support the application of already well established indications.

 Biological mechanism of musculoskeletal shockwaves - ​Shock waves are defined as types of acoustic pressure waves that develop during sudden releases of energy. The best-known natural phenomenon is thunder following lightning. Another example is the “bang” an aircraft produces when it breaks the sound barrier. Both focused shock waves and unfocused sound waves are produced in these examples. Additionally, almost all other forms of energy are released during these natural discharges, including electrical, heat, light, and electromagnetic energy. Since the first medical application of acoustic waves was the disintegration of kidney stones in the early 1980’s, high energy, focused shock waves were the first to be studied and understood.