Epicardial shock-wave therapy improves ventricular function in a porcine model of ischaemic heart disease

Holfeld, Johannes; Zimpfer, Daniel; Albrecht-Schgoer, Karin; Stojadinovic, Alexander; Paulus, Patrick; Dumfarth, Julia; Thomas, Anita; Lobenwein, Daniela; Tepeköylü, Can; Rosenhek, Raphaël; Schaden, Wolfgang; Kirchmair, Rudolf; Aharinejad, Seyedhossein; Grimm, Michael

doi:10.1002/term.1890

Cited by 39 publications

(32 citation statements)

References 25 publications

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“…Vasodilation and angiogenesis of the corpus cavernosum are proposed mechanisms of LI‐SWT on erectile function recovery. Shock waves induce shear stress, which induces various cytokine releases, such as NO and VEGF . Shock wave forms NO non‐enzymatically, and enhances the expression of VEGF and its receptor Flt‐1 .…”

Section: Discussionmentioning

confidence: 99%

“…Shock waves induce shear stress, which induces various cytokine releases, such as NO and VEGF. [13][14][15][16] Shock wave forms NO non-enzymatically, and enhances the expression of VEGF and its receptor Flt-1. 13,15 Wang et al reported that shock wave therapy produced a significantly higher number of neovessels and angiogenesis-related markers including endothelial NO synthase, VEGF and proliferating cell nuclear antigen than the control without shock wave treatment.…”

Section: Discussionmentioning

confidence: 99%

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Impact of aging and comorbidity on the efficacy of low‐intensity shock wave therapy for erectile dysfunction

et al. 2015

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Abbreviations & Acronyms ED = erectile dysfunction EHS = erection hardness score LI-SWT = low-intensity shock wave therapy MPCC = mean penile circumferential change NO = nitric oxide PDE5i = phosphodiesterase type-5 inhibitor SHIM = sexual health inventory for men SRE = sleep-related erection VEGF = vascular endothelial growth factor Objectives: To evaluate the efficacy of low-intensity shock wave therapy and to identify the predictive factors of its efficacy in Japanese patients with erectile dysfunction. Methods: The present study included 57 patients with erectile dysfunction who satisfied all the following conditions: more than 6-months history of erectile dysfunction, sexual health inventory for men score of ≤12 without phosphodiesterase type-5 inhibitor, erection hardness score grade 1 or 2, mean penile circumferential change by erectometer assessing sleep related erection of <25 mm and non-neurological pathology. Patients were treated by a low-energy shock waves generator (ED1000; Medispec, Gaithersburg, MD, USA). A total of 12 shock wave treatments were applied. Sexual health inventory for men score, erection hardness score with or without phosphodiesterase type-5 inhibitor, and mean penile circumferential change were assessed at baseline, 1, 3 and 6 months after the termination of low-intensity shock wave therapy. Results: Of 57 patients who were assigned for the low-intensity shock wave therapy trial, 56 patients were analyzed. Patients had a median age of 64 years. The sexual health inventory for men and erection hardness score (with and without phosphodiesterase type-5 inhibitor) were significantly increased (P < 0.001) at each timepoint. The mean penile circumferential change was also increased from 13.1 to 20.2 mm after low-intensity shock wave therapy (P < 0.001). In the multivariate analysis, age and the number of concomitant comorbidities were statistically significant predictors for the efficacy. Conclusions: Low-intensity shock wave therapy seems to be an effective physical therapy for erectile dysfunction. Age and comorbidities are negative predictive factors of therapeutic response.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of aging and comorbidity on the efficacy of low‐intensity shock wave therapy for erectile dysfunction

et al. 2015

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“…The diameter of the applicator's membrane is 4.5 cm and 300 impulses were delivered to the ischaemic area with an energy flux density of 0.1 mJ/mm 2 at a frequency of 5 Hz. The rationale for the treatment parameters is experience from previous studies (Tepekoylu et al ., ; Holfeld et al ., ,b). No adverse effects have been observed at these energy levels.…”

Section: Methodsmentioning

confidence: 99%

“…First clinical applications resulted in a relief of angina symptoms in patients suffering from coronary heart disease; induction of angiogenesis at the border zone of the infarcted area and subsequent contractile improvement of hibernating myocardium were described. Although numerous effects, including increased vascular endothelial growth factor (VEGF) and nitric oxide (NO) production, enhanced progenitor cell recruitment and induction of endothelial cell proliferation have been described, the underlying mechanisms remain largely unknown (Aicher et al, 2006;Tepekoylu et al, 2013;Holfeld et al, 2014b;Weihs et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Shock wave treatment after hindlimb ischaemia results in increased perfusion and M2 macrophage presence

Tepeköylü

Lobenwein

Urbschat

et al. 2017

J Tissue Eng Regen Med

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Shock wave therapy (SWT) has been shown to induce angiogenesis in ischaemic muscle. However, the mechanism of action remains unknown. Macrophages are crucial for angiogenic responses after ischaemic injury. The M2 macrophage subset enables tissue repair and induces angiogenesis. It was hypothesized that the angiogenic effects of SWT are at least partly caused by enhanced macrophage recruitment. C57BL/6 mice were subjected to hind limb ischaemia with subsequent SWT or sham treatment. Muscles were analysed via immunofluorescence staining, reverse-transcription polymerase chain reaction and western blot. Gene expression and proteins involved in macrophage recruitment were analysed and tissue sections were stained for macrophages, including subsets, capillaries and arterioles. Laser Doppler perfusion imaging was performed to assess functional outcome. Treated muscles showed increased expression of the pivotal macrophage recruiting factor monocyte chemotactic protein 1 (MCP-1). Higher levels of macrophage marker CD14 were found. Increased numbers of macrophages after SWT could be confirmed by immunofluorescence staining. The expression of the M2 polarization promoting chemokine interleukin 13 was significantly elevated in the treatment group. Elevated mRNA expression of the M2 scavenger receptor CD163 was found after SWT. Immunofluorescence staining confirmed increased numbers of M2 macrophages after treatment. It was found that SWT resulted in higher number of capillaries and arterioles. Assessment of functional outcome revealed significantly improved limb perfusion in treated animals. Shock wave therapy causes increased macrophage recruitment and enhanced polarization towards reparative M2 macrophages in ischaemic muscle resulting in angiogenesis and improved limb perfusion and therefore represents a promising new treatment option for the treatment of ischaemic heart disease. Copyright © 2016 John Wiley & Sons, Ltd. Additional supporting information may be found in the online version of this article at the publisher's web site.

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“…It has been previously demonstrated that CSWT improves LV function and inhibits LV remodeling [26] by enhancing angiogenesis [11,[27][28][29], attenuating the inflammatory response [9,30,31] and reducing oxidative stress [9] in the ischemic heart in vivo. However, the role of the CSWT effect on cardiomyocyte apoptosis after AMI remains to be elucidated.…”

Section: Mechanisms Of the Suppression Effects Of Cswt On Cardiomyocymentioning

confidence: 99%

Cardiac Shock Wave Therapy Attenuates Cardiomyocyte Apoptosis after Acute Myocardial Infarction in Rats

Zhang

Shen

Liu

et al. 2018

Cell Physiol Biochem

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Background/Aims: Researches have showed that cardiac shock wave therapy (CSWT) could improve left ventricular function and attenuate LV remodeling of the ischemic heart. Apoptosis plays an important role in myocardial infarction and determines heart function and prognosis. However, it is still not clear whether CSWT is sufficient to attenuate acute myocardial infarction (AMI) induced cardiomyocyte apoptosis in vivo. In this study, we used a rat model to examine whether CSWT could attenuate cardiomyocyte apoptosis after AMI and to explore potential mechanisms. Methods: We generated an AMI rat model to investigate the function and possible regulatory mechanisms of CSWT. All rats were randomly divided into four groups: the sham-operated only group, sham-operated with SW treatment group, AMI only group, and AMI treated with SW treatment group.The rats were treated with a left anterior descending coronary artery ligation for 12h and then treated with or without CSWT (800 shots at 0.1 mJ/ mm²). Cytochrome c release was measured to analyze mitochondrial function and integrity. The apoptotic cell rate was determined by TUNEL assay. Western blot was used to analyze the cell apoptosis-, inflammation-, and survival-related signaling pathways. Results: First, the methodology of CSWT in the rat model of AMI was established. Second, CSWT attenuated the cardiomyocyte apoptosis rate in the infarct border zone. Third, CSWT suppressed the expression of apoptosis and inflammation molecules after AMI. Fourth, CSWT inhibited activation of the JNK pathway, which indicated inhibition of the cell inflammatory pathways and promotion of cardiomyocyte survival after AMI. Conclusion: These results indicate that CSWT exerts a protective effect against AMI-induced cardiomyocyte apoptosis, potentially by attenuating cytochrome c release from the mitochondria and inhibiting of the mitochondrial-dependent intrinsic apoptotic pathway. We also demonstrate that CSWT suppresses the JNK pathway and cardiomyocyte inflammation, which may also decrease cardiomyocyte apoptosis in vivo.

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Epicardial shock-wave therapy improves ventricular function in a porcine model of ischaemic heart disease

Cited by 39 publications

References 25 publications

Impact of aging and comorbidity on the efficacy of low‐intensity shock wave therapy for erectile dysfunction

Impact of aging and comorbidity on the efficacy of low‐intensity shock wave therapy for erectile dysfunction

Shock wave treatment after hindlimb ischaemia results in increased perfusion and M2 macrophage presence

Cardiac Shock Wave Therapy Attenuates Cardiomyocyte Apoptosis after Acute Myocardial Infarction in Rats

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