Extracorporeal shock wave therapy suppresses the early proinflammatory immune response to a severe cutaneous burn injury*

Abstract

Elster EA. Extracorporeal shock wave therapy suppresses the early proinflammatory immune response to a severe cutaneous burn injury. Int Wound J 2009;6:11-21. ABSTRACTFollowing severe burn injury, persistent inflammation perpetuated by surface eschar, bacterial colonisation and neutrophil proteolytic activity can impede normal healing and result in further tissue damage. Extracorporeal shock wave treatment (ESWT) has been shown in the clinical setting to promote the healing of burn and difficultto-heal wounds; however, the mechanism is unclear. We investigated the role of ESWT on the early proinflammatory response using a severe, full-thickness and highly inflammatory cutaneous burn wound in a murine model. Various wound-healing parameters were measured and leukocyte infiltration quantitated. A panel of 188 candidate genes known to be involved in acute inflammation and wound healing was screened. We show that ESWT of burn wounds 1 hour postwounding significantly blunts polymorphonuclear neutrophil and macrophage infiltration into the wound. ESWT treatment potently attenuates both CC-and CXC-chemokine expression, acute proinflammatory cytokine expression and extracellular matrix proteolytic activity at the wound margin. Given these findings and the clinical success of ESWT, we speculate that ESWT may be a potential therapeutic modality to treat severe wounds wherein excessive inflammatory responses involving increased levels of inflammatory cells, proinflammatory cytokines and proteases may become self-resolving allowing wound healing to progresses by way of normal physiological repair processes.

Shock Wave Treatment Enhances Cell Proliferation and Improves Wound Healing by ATP Release-coupled Extracellular Signal-regulated Kinase (ERK) Activation

“…activating immune cells including T cells (3,22,34,56). Our findings with these different cell types suggest that ESWT may aid tissue repair by influencing the inflammatory and regenerative aspects of wound healing.…”

“…of ESWT, namely its ability to induce the healing of chronic ulcers and non-healing wounds (1)(2)(3)(4)(5).…”

“…In addition to the accelerated healing rates in patients treated with ESWT, this therapeutic approach is noninvasive and cost-effective. Despite the growing evidence of the beneficial clinical effects of ESWT in treating musculoskeletal disorders and soft tissue wounds in animal models and clinical studies (3)(4)(5)(6)(7)(8)(9)(10), the underlying mechanisms of how ESWT exerts these beneficial effects have remained unclear.…”

“…The application of extracorporeal shock wave treatment (ESWT) 3 is a novel and effective therapeutic strategy to treat musculoskeletal disorders as well as chronic soft tissue wounds including bedsores, burn wounds, and diabetic and vascular ulcers (1,2). In addition to the accelerated healing rates in patients treated with ESWT, this therapeutic approach is noninvasive and cost-effective.…”

In Vitro Effects of Extracorporeal Shockwave Therapy (ESWT) on Proliferation and Metabolic Activity of Adult Human Keratinocytes

“…Shockwaves are sonic pulses characterized by a high peak pressure (500mbar) short life cycle (10ms), fast pressure rise (<10ns), broad frequency spectrum (Hz) and the generation of stress forces upon interaction with interface [14]. Energy Flux Density (EFD [mJ/ clinics, ESWT was applied in animal models of soft tissue injuries, burns [16][17][18], ischemic isografts [19,20], incisional wounds, and models of compromised wound healing such as diabetic wounds [21]. Investigations of mechanisms of action for the beneficial effects of ESWT led to reports of application of ESWT in vitro [22][23][24][25][26][27].…”