Unfocused Extracorporeal Shock Waves Induce Anabolic Effects in Rat Bone

Jagt, Olav P. van der; Piscaer, T.M.; Schaden, Wolfgang; Li, J; Kops, Nicole; Jahr, Holger; Linden, J.C. van der; Waarsing, J.H.; Verhaar, Jan A N; Jong, Marion de; Weinans, Harrie

doi:10.2106/jbjs.i.01535

Cited by 33 publications

(30 citation statements)

References 36 publications

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“…Extracorporeal shockwave therapy may provide multiple benefits after stifle surgery by increasing comfort and use of the limb while also stimulating bone healing. 16,30,31 Overall, the study results support growing evidence that percutaneous ESWT may benefit TPLO recovery in dogs. Promotion of bone healing is a previously documented effect of ESWT.…”

Section: Discussionsupporting

confidence: 75%

Extracorporeal shock wave therapy improves short‐term limb use after canine tibial plateau leveling osteotomy

et al. 2019

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Objective To determine the influence of postoperative extracorporeal shock wave therapy (ESWT) on hind limb use after tibial plateau leveling osteotomy (TPLO). Study design Randomized, prospective clinical trial. Animals Sixteen client‐owned dogs, 2 to 10 years old weighing 18 to 75 kg. Methods Dogs were randomly assigned to treatment cohorts, TPLO with ESWT (ESWT, n = 9) or TPLO without ESWT (control, n = 7). Treatment consisted of 1000 pulses at 0.15 mJ/mm2 immediately and 2 weeks after surgery. Subjective pain, stifle goniometry, stifle circumference, peak vertical force (PVF) and vertical impulse (VI) were measured before surgery, prior to ESWT, and 2 and 8 weeks after surgery. Measures were compared between treatments at each time point and among time points for each treatment (P < .05). Results The PVF (5.5 ± 1.0 N/kg, mean ± SD) and VI (0.67 ± 0.14 N‐s/kg) of surgically treated limbs in the ESWT cohort were higher 8 weeks after surgery compared with preoperative (3.8 ± 1.1 N/kg, P < .0001 and 0.47 ± 0.21 N‐s/kg, P = .0012, respectively) values. In the control cohort, PVF (2.9 ± 1.3 N/kg, P = .0001) and VI (0.33 ± 0.20 N‐s/kg, P = .0003) 2 weeks after surgery and VI (0.42 ± 0.2 N‐s/kg, P = .0012) 8 weeks after surgery were lower (4.59 ± 2.33 N/kg and 0.592 ± 0.35 N‐s/kg, respectively) than before surgery. Other parameters did not differ between groups. Conclusion Weight bearing increased faster after TPLO in dogs treated with postoperative ESWT. Clinical significance This study provides evidence to consider adjunct ESWT after TPLO.

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Section: Discussionsupporting

confidence: 75%

Extracorporeal shock wave therapy improves short‐term limb use after canine tibial plateau leveling osteotomy

et al. 2019

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“…Despite the widespread use of shockwave therapy for orthopedic procedures, the underlying mechanism of action by which shockwaves improve bone healing has remained unclear [37, 38]. Histological studies provide evidence that shockwave treatment stimulates osteogenesis, but clinical and experimental studies supporting this notion have been lacking [37–39]. In this study, we investigated whether shockwaves elicit hMSC responses that could explain the beneficial clinical findings others and we have made with shockwave therapy of nonunion long bone fractures.…”

Section: Discussionmentioning

confidence: 99%

Shockwaves Induce Osteogenic Differentiation of Human Mesenchymal Stem Cells Through ATP Release and Activation of P2X7 Receptors

et al. 2013

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Shockwave fractures treatment promotes bone healing of nonunion fractures. In this study, we investigated whether this effect could be due to adenosine 5’-triphosphate (ATP) release-induced differentiation of human mesenchymal stem cells (hMSCs) into osteoprogenitor cells. Cultured bone marrow-derived hMSCs were subjected to shockwave treatment and ATP release was assessed. Osteogenic differentiation and mineralization of hMSCs were evaluated by examining alkaline phosphatase activity, osteocalcin production, and calcium nodule formation. Expression of P2X7 receptors and c-fos and c-jun mRNA was determined with real-time reverse transcription polymerase chain reaction and Western blotting. P2X7-siRNA, apyrase, P2 receptor antagonists, and p38 MAPK inhibitors were used to evaluate the roles of ATP release, P2X7 receptors, and p38 MAPK sig naling in shockwave-induced osteogenic hMSCs differentiation. Shockwave treatment released significant amounts (~7 μM) of ATP from hMSCs. Shockwaves and exogenous ATP induced c-fos and c-jun mRNA transcription, p38 MAPK activation, and hMSC differentiation. Removal of ATP with apyrase, targeting of P2X7 receptors with P2X7-siRNA or selective antagonists, or blockade of p38 MAPK with SB203580 prevented osteogenic differentiation of hMSCs. Our findings indicate that shockwaves release cellular ATP that activates P2X7 receptors and downstream signaling events that caused osteogenic differentiation of hMSCs. We conclude that shockwave therapy promotes bone healing through P2X7 receptor signaling, which contributes to hMSC differentiation.

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“…So far, research into the molecular and cellular mechanisms of new bone formation and biocalcification after exposure of bone to ESWs has to the best knowledge only been conducted in vertebrate models (e.g. Bulut et al, 2006; Rompe et al, 2001; van der Jagt et al, 2011). Tischer et al (2002) demonstrated that ESWs can induce new bone formation inside and outside the focus zone.…”

Section: Discussionmentioning

confidence: 99%

Exposure of zebra mussels to extracorporeal shock waves demonstrates formation of new mineralized tissue inside and outside the focus zone

Sternecker¹,

Geist

Beggel

et al. 2018

Preprint

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A substantial body of evidence supports the use of extracorporeal shock wave therapy (ESWT) for fracture nonunions in human medicine. However, the success rate (i.e., radiographic union at six months after ESWT) is only approximately 75%. Detailed knowledge regarding the underlying mechanisms that induce bio-calcification after ESWT is limited. The aim of the present study was to analyze the biological response within mineralized tissue of a new invertebrate model organism, the zebra mussel Dreissena polymorpha, after exposure with extracorporeal shock waves (ESWs). Mussels were exposed to ESWs with positive energy density of 0.4 mJ/mm2 or were sham exposed. Detection of newly calcified tissue was performed by concomitantly exposing the mussels to fluorescent markers. Two weeks later, the fluorescence signal intensity of the valves was measured. Mussels exposed to ESWs showed a statistically significantly higher mean fluorescence signal intensity within the shell zone than mussels that were sham exposed. Additional acoustic measurements revealed that the increased mean fluorescence signal intensity within the shell of those mussels that were exposed to ESWs was independent of the size and position of the focal point of the ESWs. These data demonstrate that induction of bio-calcification after ESWT may not be restricted to the region of direct energy transfer of ESWs into calcified tissue. The results of the present study are of relevance for better understanding of the molecular and cellular mechanisms that induce formation of new mineralized tissue after ESWT. Specifically, bio-calcification following ESWT may extend beyond the direct area of treatment.Summary statementThe use of zebra mussels in research on extracorporeal shock wave (ESW) therapy for fracture nonunions allows new insights into the complex process of induction of biomineralization by ESWs.

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Unfocused Extracorporeal Shock Waves Induce Anabolic Effects in Rat Bone

Cited by 33 publications

References 36 publications

Extracorporeal shock wave therapy improves short‐term limb use after canine tibial plateau leveling osteotomy

Extracorporeal shock wave therapy improves short‐term limb use after canine tibial plateau leveling osteotomy

Shockwaves Induce Osteogenic Differentiation of Human Mesenchymal Stem Cells Through ATP Release and Activation of P2X7 Receptors

Exposure of zebra mussels to extracorporeal shock waves demonstrates formation of new mineralized tissue inside and outside the focus zone

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