Extracorporeal shock waves enhance normal fibroblast proliferation in vitro and activate mRNA expression for TGF-β1 and for collagen types I and III

Abstract

Background and purpose Extracorporeal shock waves (ESWs) are used to good effect in the treatment of soft tissue injuries, but the underlying mechanisms are still unknown. We therefore determined the effects of ESWs on normal fibroblasts in vitro, in order to assess treatment-induced cell response.Methods A normal human fibroblast cell line (NHDF-12519) was treated with ESWs generated by a piezoelectric device (Piezoson 100; Richard Wolfe) using different protocols of impulses (300, 1,000, or 2,000 shots) and energy (0.11 or 0.22 mJ/mm2). Untreated controls and treated cells were cultivated for 12 days following a single shock-wave treatment. Viability, growth rate, and expression of mRNA for TGFβ -1 and collagen types I and III were evaluated at days 3, 6, 9, and 12.Results 1 hour after shock-wave treatment, cell viability showed a decrease related mainly to impulse numbers applied. Fibroblasts treated with energy of 0.22 mJ/mm2 subsequently showed an increase in proliferation from day 6 to day 9 that was higher than in untreated controls, without interference with the normal cell kinetic profile. mRNA expression was also higher in treated fibroblasts than in untreated controls for TGFβ -1 on day 6 and day 9, for collagen type I on day 6, and for collagen type III on day 9.Interpretation These in vitro data confirm that the main factors involved in the repair process of connective tissues are activated by ESWs. The study gives the rationale for, and may provide schedules for, ESW treatment of tendonopathies.

Extracorporeal Shock Wave Treatment Improves Incisional Wound Healing in Diabetic Rats

“…However, the number of fibroblasts that migrated to the wound site increased notably after ESWT. This phenomenon was consistent with previous studies (Berta et al 2009;Kuo et al 2009b). Berta et al (2009) reported that application of ESW enhanced human dermal fibroblasts proliferation in vitro.…”

“…This phenomenon was consistent with previous studies (Berta et al 2009;Kuo et al 2009b). Berta et al (2009) reported that application of ESW enhanced human dermal fibroblasts proliferation in vitro. Results from Kuo's study indicated that an appropriate dosage of ESWT could modulate fibroblasts recruitment, and thus, promote tissue remodeling in an ischemic skin flap rat model (Kuo et al 2009b).…”

“…Increasing the endogenous release of growth factors is one potential mechanism by which ESWT facilitates tissue repair. Up-regulation of TGF-β1 expression following ESWT has been observed in various cell types, such as dermal fibroblasts (Berta et al 2009), tenocytes (Chen et al 2004a), mesenchymal stem cells, chondral cells and osteoblastic cells (Chen et al 2004b). In the proliferative phase, TGF-β1 is mainly released from fibroblasts.…”

“…More recently, studies showed that ESWT could enhance proliferation and collagen synthesis in cultured tenocytes and dermal fibroblasts (Chao et al 2008;Berta et al 2009). Considering that synthesis of collagen is essential to regain wound strength, we hypothesized that lowenergy ESWT would increase collagen content in wound tissue and thus accelerate the healing of incision in surgical patients with diabetes.…”

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 Citation: Ottomann CMD, Antonic V, Münch S, Belfekroun C, [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]. These studies indeed contributed toward improved understanding of biological effects of ESWT.…”