Preclinical and Clinical Application of Extracorporeal Shockwave for Ischemic Cardiovascular Disease
Yip, H.-K.; Lee, F.-Y.; Chen, K.-H.; Sung, P.-H.; Sun, C.-K. (Kaohsiung)
Mechanisms Underlying Extracorporeal Shockwave Treatment for Ischemic Cardiovascular Disease
Sun, C.-K.; Yip, H.-K. (Kaohsiung)
Leu, S.; Huang, T.-H.; Chen, Y.-L.; Yip, H.-K. (Kaohsiung)
Section IV: Urinary Diseases and Other Applications
Extracorporeal Shockwave Therapy Assisted Intravesical Drug Delivery
Tyagi, P. (Pittsburgh, PA); Chuang, Y.-C. (Kaohsiung)
Wang, H.-J. (Kaohsiung)
Section V: Future Prospects of Shockwave Medicine
Current Applications and Future Prospects of Extracorporeal Shockwave Therapy
Sansone, V. (Milan); Frairia, R. (Torino); Brañes, M. (Santiago); Romeo, P. (Milan); Catalano, M.G. (Torino); Applefield, R.C. (Milan)
Welcome to volume 6 of Translational Research in Biomedicine, a monograph series dedicated to the dissemination of seminal information in contemporary biomedicine with a translational orientation.
This volume is designed to be a comprehensive reference for shockwave medicine, a relatively new clinical specialty in modern medicine. Originally established as the gold standard for the disintegration of kidney stones, Extracorporeal Shockwave Therapy (ESWT) has progressively evolved to a regenerative treatment modality, and is currently indicated for musculoskeletal disorders and nonskeletal diseases that include ischemic heart disease, diabetic foot ulcers, acute or chronic wounds, and burn lesions. Authored by a panel of international experts and in the spirit of translational medicine, this volume provides a succinct summary of the history and principles of ESWT, the documentations that substantiate the launch of this new clinical specialty, the myriad of physical and cellular or molecular mechanisms that underpin the effects of shockwave, and the future prospects and directions of ESWT.
I wish to express my deep appreciation to Professors Ching-Jen Wang, Wolfgang Schaden, and Jih-Yang Ko, who have taken time from their heavy clinical duties and research endeavors to make this timely volume on “Shockwave Medicine” a reality. I am indebted to the generous patronage of Chang Gung Medical Foundation, Taiwan, which reduces substantially the increasing financial constraints on scientific publication, and allows us to concentrate on publishing timely and crucial themes in translational medicine. I also wish to acknowledge the capable hands of Freddy Brian and Angela Hefti at S. Karger AG during the development and production of this volume. Last but not least, the publication of Translational Research in Biomedicine would not have been possible without the foresight, enthusiasm, and whole-hearted support of my dear friend, Dr. Thomas Karger.
Samuel H.H. Chan, Kaohsiung
Series Editor
Extracorporeal Shockwave Therapy (ESWT) was originally designed for the disintegration of kidney stones and has remained the gold standard for the treatment of urolithiasis because of its clinical success. In orthopedics, an incidental observation of osteoblast responses in bone after ESWT triggered the clinical use of this practice for musculoskeletal disorders. This change resulted in expanding ESWT from a destructive force for stone disintegration into a regenerative treatment modality. Advancements in research and technology further revealed additional mechanisms and pathways of action, and widened the indications of ESWT from musculoskeletal disorders to non-skeletal diseases such as ischemic heart disease, diabetic foot ulcers, acute or chronic wounds, and burn lesions. As such, ESWT has evolved into a multidisciplinary and multifunctional medical subspecialty.
Despite its clinical success, the exact mechanism of ESWT in biological tissue remains unknown. In 1997, Dr. Haupt [1] proposed 4 possible mechanisms for the actions of ESWT on tissue. In its physical phase, ESWT causes a positive pressure to generate absorption, reflection, refraction, and transmission of energy on tissues or cells. Additional studies demonstrated a negative pressure to induce the physical effects such as cavitation and increasing the permeability of cell membrane and ionization of biological tissues. Many signal transductions, including mechanotransduction signal pathway, the extracellular signal-regulated signal kinase, focal adhesion kinase signal pathway, and toll-like receptor 3 signal pathway to regulate gene expression, are activated. In its physical-chemical phase, ESWT stimulates cells to release biomolecules such as ATP to activate signal pathways. ESWT also alters the functions of ion channel in cell membrane and calcium mobilization in cells. In biological tissues, ESWT modulates angiogenesis (vWF, VEGF, eNOS, and PCNA), bone healing (BMP2, osteocalcin, alkaline phosphatase, DKK1 and IGF-1), anti-inflammatory (si-CAM and sVCAM) and wound healing (Wnt3 and B-catenin). Furthermore, ESWT stimulates the shift of the macrophage phenotypes from M1 to M2 and increases T-cell proliferation. ESWT activates the toll-like receptor 3 signal pathway to modulate inflammation by controlling the expression of IL6–10 and improves the treatment in ischemic muscles. The future application of ESWT should be combined with advanced and innovative technology, including stem cell therapy, miRNA analysis, gene sequencing, and genomic medicine. This book follows the evolution of ESWT in medicine from the initial stage of destructive ESWT force for lithotripsy to regenerative effects in biological tissues. Section 1 covers the history of shockwave treatment and basic principles. Section 2 includes the application of ESWT in musculoskeletal disorders including osteonecrosis of the femoral head (hip), tendinopathy, fracture treatment, local and systemic effects of ESWT on bone and ESWT and sports related injuries. Section 3 explains the application of ESWT for cardiovascular diseases including preclinical and clinical application of ESWT for ischemic cardiovascular disease and mechanism underlying ESWT for ischemic cardiovascular disease and effects of ESWT on angiogenesis and anti-inflammation-molecular-cellular signaling pathways. Section 4 elaborated on the application of ESWT in urinary disease and other applications including ESWT-assisted intravesical drug delivery and erectile dysfunction and lower urinary tract inflammatory diseases. Section 5 presents the future prospects of shockwave medicine including current application and future procedures of ESWT.
We are grateful to Karger Publishers and to the Series Editor, Professor Samuel H.H. Chan for the opportunity to publish this volume. This book commemorates the two-year anniversary of the Center for Shockwave Medicine
