Extracorporeal Shockwave Therapy for Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis

Hitchman, Louise; Totty, Joshua; Raza, Ali; Cai, Paris; Smith, George E.; Carradice, Daniel; Wallace, Tom; Harwood, Amy; Chetter, Ian

doi:10.1016/j.avsg.2018.10.013

Cited by 25 publications

(19 citation statements)

References 22 publications

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“…As shown in Figure 5, the intervening treatments including rESW, Nano-PFC@O 2 , and rESW plus Nano-PFC@O 2 inordinately accelerated the wound healing of DFUs, compared to diseased rats with DFUs that did not receive any treatment, namely, the untreated control (Ctrl). Moreover, the wound healing effect of rESW and PFC was also consistent with previous studies [2,43,[51][52][53][54][55][56][57]. And the rate of wound healing in the rESW+Nano-PFC@O 2 group was significantly higher than that in the Nano-PFC@O 2 group and rESW group ( Figure 5; # P < 0 001 and * P < 0 05).…”

Section: Nano-pfc Plus Resw Treatment Accelerated Diabeticsupporting

confidence: 89%

Improved Healing of Diabetic Foot Ulcer upon Oxygenation Therapeutics through Oxygen-Loading Nanoperfluorocarbon Triggered by Radial Extracorporeal Shock Wave

Wang

Yin

Han

et al. 2019

Oxidative Medicine and Cellular Longevity

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Diabetic foot ulcers (DFUs), the most serious complication of diabetes mellitus, can induce high morbidity, the need to amputate lower extremities, and even death. Although many adjunctive strategies have been applied for the treatment of DFUs, the low treatment efficiency, potential side effects, and high cost are still huge challenges. Recently, nanomaterial-based drug delivery systems (NDDSs) have achieved targeted drug delivery and controlled drug release, offering great promises in various therapeutics for diverse disorders. Additionally, the radial extracorporeal shock wave (rESW) has been shown to function as a robust trigger source for the NDDS to release its contents, as the rESW harbors a potent capability in generating pressure waves and in creating the cavitation effect. Here, we explored the performance of oxygen-loaded nanoperfluorocarbon (Nano-PFC) combined with the rESW as a treatment for DFUs. Prior to in vivo assessment, we first demonstrated the high oxygen affinity in vitro and great biocompatibility of Nano-PFC. Moreover, the rESW-responsive oxygen release behavior from oxygen-saturated Nano-PFC was also successfully verified in vitro and in vivo. Importantly, the wound healing of DFUs was significantly accelerated due to improved blood microcirculation, which was a result of rESW therapy (rESWT), and the targeted release of oxygen into the wound from oxygen-loaded Nano-PFC, which was triggered by the rESW. Collectively, the oxygen-saturated Nano-PFC and rESW provide a completely new approach to treat DFUs, and this study highlights the advantages of combining nanotechnology with rESW in therapeutics.

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Section: Nano-pfc Plus Resw Treatment Accelerated Diabeticsupporting

confidence: 89%

Improved Healing of Diabetic Foot Ulcer upon Oxygenation Therapeutics through Oxygen-Loading Nanoperfluorocarbon Triggered by Radial Extracorporeal Shock Wave

Wang

Yin

Han

et al. 2019

Oxidative Medicine and Cellular Longevity

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“…Hayashi and colleagues 24 found an increase in capillary number using SW to induce wound healing. In the ischemic heart, SW upregulated mRNA expression of VEGF and its receptor 25 and decreased tissue damage, and both experimental and clinical studies have shown improvement in myocardial blood flow and cardiac function after SW therapy 26 , 27 .…”

Section: Discussionmentioning

confidence: 99%

Low-Energy Shockwave Treatment Promotes Endothelial Progenitor Cell Homing to the Stenotic Pig Kidney

et al. 2020

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Endothelial progenitor cells (EPCs) patrols the circulation and contributes to endothelial cell regeneration. Atherosclerotic renal artery stenosis (ARAS) induces microvascular loss in the stenotic kidney (STK). Low-energy shockwave therapy (SW) can induce angiogenesis and restore the STK microcirculation, but the underlying mechanism remains unclear. We tested the hypothesis that SW increases EPC homing to the swine STK, associated with capillary regeneration. Normal pigs and pigs after 3 wk of renal artery stenosis were treated with six sessions of low-energy SW (biweekly for three consecutive weeks) or left untreated. Four weeks after completion of treatment, we assessed EPC (CD34+/KDR+) numbers and levels of the homing-factor stromal cell-derived factor (SDF)-1 in the inferior vena cava and the STK vein and artery, as well as urinary levels of vascular endothelial growth factor (VEGF) and integrin-1β. Subsequently, we assessed STK morphology, capillary count, and expression of the proangiogenic growth factors angiopoietin-1, VEGF, and endothelial nitric oxide synthase ex vivo. A 3-wk low-energy SW regimen improved STK structure, capillary count, and function in ARAS+SW, and EPC numbers and gradients across the STK decreased. Plasma SDF-1 and renal expression of angiogenic factors were increased in ARAS+SW, and urinary levels of VEGF and integrin-1β tended to rise during the SW regimen. In conclusion, SW improves ischemic kidney capillary density, which is associated with, and may be at least in part mediated by, promoting EPCs mobilization and homing to the stenotic kidney.

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“…75 Multiple lines of evidence exist in the literature regarding ESWT's effectiveness in enhancing healing in patients with acute and chronic wounds and diabetic foot ulcers. 76,77 A few studies have evaluated ESWT for treating post-burn, hypertrophic and keloid scars. [78][79][80] In one study, 17 patients with burn scars on their extremities underwent ESWT sessions once a week for six weeks.…”

Section: Extracorporeal Shockwave Therapymentioning

confidence: 99%

Emerging and Novel Therapies for Keloids

Memariani

Moravvej

et al. 2021

Sultan Qaboos Univ Med J

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Keloids are abnormal fibroproliferative scars with aggressive dermal growth expanding beyond the borders of the original injury. Different therapeutic modalities, such as corticosteroids, surgical excision, topical silicone gel sheeting, laser therapy, cryotherapy, photodynamic therapy and radiotherapy, have been used to treat keloids; however, none of these modalities has proven completely effective. Recently, researchers have devised several promising anti-keloid therapies including anti-hypertensive pharmaceuticals, calcineurin inhibitors, electrical stimulation, mesenchymal stem cell therapy, microneedle physical contact and ribonucleic acid-based therapies. The present review summarises emerging and novel treatments for keloids. PubMed® (National Library of Medicine, Bethesda, Maryland, USA), EMBASE (Elsevier, Amsterdam, Netherlands) and Web of Science (Clarivate Analytics, Philadelphia, Pennsylvania, USA) were searched for relevant literature published between January 1987 to June 2020. A total of 118 articles were included in this review. A deeper understanding of the molecular mechanisms underlying keloid scarring pathogenesis would open further avenues for developing innovative treatments. KEYWORDS Keloid; Treatment; Fibroblast; Scar; Dermatology.

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Extracorporeal Shockwave Therapy for Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis

Cited by 25 publications

References 22 publications

Improved Healing of Diabetic Foot Ulcer upon Oxygenation Therapeutics through Oxygen-Loading Nanoperfluorocarbon Triggered by Radial Extracorporeal Shock Wave

Improved Healing of Diabetic Foot Ulcer upon Oxygenation Therapeutics through Oxygen-Loading Nanoperfluorocarbon Triggered by Radial Extracorporeal Shock Wave

Low-Energy Shockwave Treatment Promotes Endothelial Progenitor Cell Homing to the Stenotic Pig Kidney

Emerging and Novel Therapies for Keloids

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