Mechanisms of extracorporeal shock wave therapy in promoting healing of diabetic foot ulcer_West China Medical Journal

Authors：

LIANG Likan ¹ , LIU Xiaogang ² , Huang Jianjun ² , GONG Fei ¹ ,  ZHANG Jingchun ²

1. Graduate School, Shanxi University of Chinese Medicine, Taiyuan, Shanxi 030000, P. R. China;
2. Department of Orthopaedics, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan, Shanxi 030000, P. R. China;

Corresponding author：

ZHANG Jingchun, Email: zhjch1461@163.com

Keywords：

Diabetic foot ulcer; Extracorporeal shock wave therapy; Mechanism

DOI：

10.7507/1002-0179.201912103

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Diabetic foot ulcer is one of the severe chronic complications that lead to disability and death of diabetic patients. In order to solve this problem, adjuvant therapy studies of diabetic foot ulcers have increased in recent years. Extracorporeal shock wave therapy is a novel adjuvant therapy that has been approved by the US Food and Drug Administration for diabetic foot ulcers wounds. In this paper, the mechanisms of extracorporeal shock wave therapy for diabetic foot ulcers are described, including wound angiogenesis, wound tissue blood perfusion, nerve regeneration, granulation tissue proliferation, inflammatory response, anti-infection, migration and differentiation of mesenchymal stem cells and endothelial progenitor cells. This study aims to provide a theoretical basis for the clinical application of extracorporeal shock wave therapy in clinical treatment of diabetic foot ulcers.

Citation： LIANG Likan, LIU Xiaogang, Huang Jianjun, GONG Fei, ZHANG Jingchun. Mechanisms of extracorporeal shock wave therapy in promoting healing of diabetic foot ulcer. West China Medical Journal, 2020, 35(3): 363-366. doi: 10.7507/1002-0179.201912103 Copy

1.	中华预防医学会组织感染与损伤预防与控制专业委员会, 中华医学会肠外肠内营养学分会, 中国中西医结合学会周围血管疾病专业委员会糖尿病足学组. 糖尿病足病医学营养治疗指南. 中国组织工程研究, 2019, 23(35): 5682-5689.
2.	中国医疗保健国际交流促进会糖尿病足病分会, 国际血管联盟中国分部糖尿病足病专家委员会. 中国糖尿病足诊治指南. 中国临床医生杂志, 2020, 48(1): 19-27.
3.	US Food and Drug Administration. FDA permits marketing of device to treat diabetic foot ulcers. (2017-12-28)[2020-01-17]. https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-device-treat-diabetic-foot-ulcers.
4.	中华医学会糖尿病学分会, 中华医学会感染病学分会, 中华医学会组织修复与再生分会. 中国糖尿病足防治指南(2019版)(Ⅰ). 中华糖尿病杂志, 2019, 11(2): 92-108.
5.	宋薇, 解嘉慧, 肖宇. 糖尿病足溃疡的危险因素与治疗研究进展. 山东医药, 2019, 59(4): 88-91.
6.	van Netten JJ, Price PE, Lavery LA, et al. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev, 2016, 32(Suppl 1): 84-98.
7.	中国研究型医院学会冲击波医学专业委员会, 国际冲击波医学学会中国部. 骨肌疾病体外冲击波疗法中国专家共识(第2版). 中国医学前沿杂志(电子版), 2017, 9(2): 25-33.
8.	Haupt G, Chvapil M. Effect of shock waves on the healing of partial-thickness wounds in piglets. J Surg Res, 1990, 49(1): 45-48.
9.	Chamberlain GA, Colborne GR. A review of the cellular and molecular effects of extracorporeal shockwave therapy. Vet Comp Orthop Traumatol, 2016, 29(2): 99-107.
10.	Ha CH1, Kim S, Chung J, et al. Extracorporeal shock wave stimulates expression of the angiogenic genes via mechanosensory complex in endothelial cells: mimetic effect of fluid shear stress in endothelial cells. Int J Cardiol, 2013, 168(4): 4168-4177.
11.	燕晓宇, 杨光, 成亮, 等. 低能量体外震波对糖尿病慢性创面模型血管新生和血管内皮细胞生长因子表达的影响. 中国组织工程研究, 2012, 16(15): 2745-2749.
12.	Birgin E, Gebhardt C, Hetjens S, et al. Extracorporal shock wave therapy enhances receptor for advanced glycated end-product-dependent flap survival and angiogenesis. Ann Plast Surg, 2018, 80(4): 424-431.
13.	Kisch T, Sorg H, Forstmeier V, et al. Remote effects of extracorporeal shock wave therapy on cutaneous microcirculation. J Tissue Viability, 2015, 24(4): 140-145.
14.	Yang JP, Lee YN, Son JW, et al. The impact of extracorporeal shock wave therapy on microcirculation in diabetic feet: a pilot study. Adv Skin Wound Care, 2019, 32(12): 563-567.
15.	Amin N, Doupis J. Diabetic foot disease: from the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities. World J Diabetes, 2016, 7(7): 153-164.
16.	Hausner T, Pajer K, Halat G, et al. Improved rate of peripheral nerve regeneration induced by extracorporeal shock wave treatment in the rat. Exp Neurol, 2012, 236(2): 363-370.
17.	Murata R, Ohtori S, Ochiai N, et al. Extracorporeal shockwaves induce the expression of ATF3 and GAP-43 in rat dorsal root ganglion neurons. Auton Neurosci, 2006, 128(1/2): 96-100.
18.	田晓红, 柏树令, 田伟, 等. 表皮干细胞在糖尿病创面愈合过程中的动态变化. 中国修复重建外科杂志, 2007, 21(7): 693-697.
19.	Aschermann I, Noor S, Venturelli S, et al. Extracorporal shock waves activate migration, proliferation and inflammatory pathways in fibroblasts and keratinocytes, and improve wound healing in an open-label, single-arm study in patients with therapy-refractory chronic leg ulcers. Cell Physiol Biochem, 2017, 41(2): 890-906.
20.	Qi M, Zhou Q, Zeng W, et al. Growth factors in the pathogenesis of diabetic foot ulcers. Front Biosci (Landmark Ed), 2018, 23: 310-317.
21.	燕晓宇, 杨光, 成亮, 等. 体外震波治疗对糖尿病大鼠慢性创面愈合及组织学影响. 中国修复重建外科杂志, 2012, 26(8): 961-967.
22.	Mirza RE, Fang MM, Weinheimer-Haus EM, et al. Sustained inflammasome activity in macrophages impairs wound healing in type 2 diabetic humans and mice. Diabetes, 2014, 63(3): 1103-1114.
23.	Mirza RE, Fang MM, Novak ML, et al. Macrophage PPARγ and impaired wound healing in type 2 diabetes. J Pathol, 2015, 236(4): 433-444.
24.	Davis TA, Stojadinovic A, Anam K, et al. Extracorporeal shock wave therapy suppresses the early proinflammatory immune response to a severe cutaneous burn injury. Int Wound J, 2009, 6(1): 11-21.
25.	Jeppesen SM, Yderstraede KB, Rasmussen BS, et al. Extracorporeal shockwave therapy in the treatment of chronic diabetic foot ulcers: a prospective randomised trial. J Wound Care, 2016, 25(11): 641-649.
26.	von Eiff C, Overbeck J, Haupt G, et al. Bactericidal effect of extracorporeal shock waves on Staphylococcus aureus . J Med Microbiol, 2000, 49(8): 709-712.
27.	Qi X, Zhao Y, Zhang J, et al. Increased effects of extracorporeal shock waves combined with gentamicin against Staphylococcus aureus biofilms in vitro and in vivo. Ultrasound Med Biol, 2016, 42(9): 2245-2252.
28.	Lokhandwalla M, McAteer JA, Williams JC Jr, et al. Mechanical haemolysis in shock wave lithotripsy (SWL): Ⅱ. In vitro cell lysis due to shear. Phys Med Biol, 2001, 46(4): 1245-1264.
29.	Gerdesmeyer L, Maier M, Haake M, et al. Physical-technical principles of extracorporeal shockwave therapy (ESWT). Orthopade, 2002, 31(7): 610-617.
30.	Heyboer M 3rd. Hyperbaric oxygen therapy side effects - where do we stand?. J Am Coll Clin Wound Spec, 2016, 8(1/2/3): 2-3.
31.	Guo J, Dardik A, Fang K, et al. Meta-analysis on the treatment of diabetic foot ulcers with autologous stem cells. Stem Cell Res Ther, 2017, 8(1): 228.
32.	Shu X, Shu S, Tang S, et al. Efficiency of stem cell based therapy in the treatment of diabetic foot ulcer: a meta-analysis. Endocr J, 2018, 65(4): 403-413.
33.	Jin P, Zhang X, Wu Y, et al. Streptozotocin-induced diabetic rat-derived bone marrow mesenchymal stem cells have impaired abilities in proliferation, paracrine, antiapoptosis, and myogenic differentiation. Transplant Proc, 2010, 42(7): 2745-2752.
34.	黄钟炼, 罗绍伟, 林海明, 等. SDF-1/CXCR4介导体外冲击波促进大鼠骨髓间充质干细胞的黏附、迁移作用. 颈腰痛杂志, 2019, 40(6): 721-726.
35.	Aicher A, Heeschen C, Sasaki K, et al. Low-energy shock wave for enhancing recruitment of endothelial progenitor cells: a new modality to increase efficacy of cell therapy in chronic hind limb ischemia. Circulation, 2006, 114(25): 2823-2830.

1. 中华预防医学会组织感染与损伤预防与控制专业委员会, 中华医学会肠外肠内营养学分会, 中国中西医结合学会周围血管疾病专业委员会糖尿病足学组. 糖尿病足病医学营养治疗指南. 中国组织工程研究, 2019, 23(35): 5682-5689.
2. 中国医疗保健国际交流促进会糖尿病足病分会, 国际血管联盟中国分部糖尿病足病专家委员会. 中国糖尿病足诊治指南. 中国临床医生杂志, 2020, 48(1): 19-27.
3. US Food and Drug Administration. FDA permits marketing of device to treat diabetic foot ulcers. (2017-12-28)[2020-01-17]. https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-device-treat-diabetic-foot-ulcers.
4. 中华医学会糖尿病学分会, 中华医学会感染病学分会, 中华医学会组织修复与再生分会. 中国糖尿病足防治指南(2019版)(Ⅰ). 中华糖尿病杂志, 2019, 11(2): 92-108.
5. 宋薇, 解嘉慧, 肖宇. 糖尿病足溃疡的危险因素与治疗研究进展. 山东医药, 2019, 59(4): 88-91.
6. van Netten JJ, Price PE, Lavery LA, et al. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev, 2016, 32(Suppl 1): 84-98.
7. 中国研究型医院学会冲击波医学专业委员会, 国际冲击波医学学会中国部. 骨肌疾病体外冲击波疗法中国专家共识(第2版). 中国医学前沿杂志(电子版), 2017, 9(2): 25-33.
8. Haupt G, Chvapil M. Effect of shock waves on the healing of partial-thickness wounds in piglets. J Surg Res, 1990, 49(1): 45-48.
9. Chamberlain GA, Colborne GR. A review of the cellular and molecular effects of extracorporeal shockwave therapy. Vet Comp Orthop Traumatol, 2016, 29(2): 99-107.
10. Ha CH1, Kim S, Chung J, et al. Extracorporeal shock wave stimulates expression of the angiogenic genes via mechanosensory complex in endothelial cells: mimetic effect of fluid shear stress in endothelial cells. Int J Cardiol, 2013, 168(4): 4168-4177.
11. 燕晓宇, 杨光, 成亮, 等. 低能量体外震波对糖尿病慢性创面模型血管新生和血管内皮细胞生长因子表达的影响. 中国组织工程研究, 2012, 16(15): 2745-2749.
12. Birgin E, Gebhardt C, Hetjens S, et al. Extracorporal shock wave therapy enhances receptor for advanced glycated end-product-dependent flap survival and angiogenesis. Ann Plast Surg, 2018, 80(4): 424-431.
13. Kisch T, Sorg H, Forstmeier V, et al. Remote effects of extracorporeal shock wave therapy on cutaneous microcirculation. J Tissue Viability, 2015, 24(4): 140-145.
14. Yang JP, Lee YN, Son JW, et al. The impact of extracorporeal shock wave therapy on microcirculation in diabetic feet: a pilot study. Adv Skin Wound Care, 2019, 32(12): 563-567.
15. Amin N, Doupis J. Diabetic foot disease: from the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities. World J Diabetes, 2016, 7(7): 153-164.
16. Hausner T, Pajer K, Halat G, et al. Improved rate of peripheral nerve regeneration induced by extracorporeal shock wave treatment in the rat. Exp Neurol, 2012, 236(2): 363-370.
17. Murata R, Ohtori S, Ochiai N, et al. Extracorporeal shockwaves induce the expression of ATF3 and GAP-43 in rat dorsal root ganglion neurons. Auton Neurosci, 2006, 128(1/2): 96-100.
18. 田晓红, 柏树令, 田伟, 等. 表皮干细胞在糖尿病创面愈合过程中的动态变化. 中国修复重建外科杂志, 2007, 21(7): 693-697.
19. Aschermann I, Noor S, Venturelli S, et al. Extracorporal shock waves activate migration, proliferation and inflammatory pathways in fibroblasts and keratinocytes, and improve wound healing in an open-label, single-arm study in patients with therapy-refractory chronic leg ulcers. Cell Physiol Biochem, 2017, 41(2): 890-906.
20. Qi M, Zhou Q, Zeng W, et al. Growth factors in the pathogenesis of diabetic foot ulcers. Front Biosci (Landmark Ed), 2018, 23: 310-317.
21. 燕晓宇, 杨光, 成亮, 等. 体外震波治疗对糖尿病大鼠慢性创面愈合及组织学影响. 中国修复重建外科杂志, 2012, 26(8): 961-967.
22. Mirza RE, Fang MM, Weinheimer-Haus EM, et al. Sustained inflammasome activity in macrophages impairs wound healing in type 2 diabetic humans and mice. Diabetes, 2014, 63(3): 1103-1114.
23. Mirza RE, Fang MM, Novak ML, et al. Macrophage PPARγ and impaired wound healing in type 2 diabetes. J Pathol, 2015, 236(4): 433-444.
24. Davis TA, Stojadinovic A, Anam K, et al. Extracorporeal shock wave therapy suppresses the early proinflammatory immune response to a severe cutaneous burn injury. Int Wound J, 2009, 6(1): 11-21.
25. Jeppesen SM, Yderstraede KB, Rasmussen BS, et al. Extracorporeal shockwave therapy in the treatment of chronic diabetic foot ulcers: a prospective randomised trial. J Wound Care, 2016, 25(11): 641-649.
26. von Eiff C, Overbeck J, Haupt G, et al. Bactericidal effect of extracorporeal shock waves on Staphylococcus aureus . J Med Microbiol, 2000, 49(8): 709-712.
27. Qi X, Zhao Y, Zhang J, et al. Increased effects of extracorporeal shock waves combined with gentamicin against Staphylococcus aureus biofilms in vitro and in vivo. Ultrasound Med Biol, 2016, 42(9): 2245-2252.
28. Lokhandwalla M, McAteer JA, Williams JC Jr, et al. Mechanical haemolysis in shock wave lithotripsy (SWL): Ⅱ. In vitro cell lysis due to shear. Phys Med Biol, 2001, 46(4): 1245-1264.
29. Gerdesmeyer L, Maier M, Haake M, et al. Physical-technical principles of extracorporeal shockwave therapy (ESWT). Orthopade, 2002, 31(7): 610-617.
30. Heyboer M 3rd. Hyperbaric oxygen therapy side effects - where do we stand?. J Am Coll Clin Wound Spec, 2016, 8(1/2/3): 2-3.
31. Guo J, Dardik A, Fang K, et al. Meta-analysis on the treatment of diabetic foot ulcers with autologous stem cells. Stem Cell Res Ther, 2017, 8(1): 228.
32. Shu X, Shu S, Tang S, et al. Efficiency of stem cell based therapy in the treatment of diabetic foot ulcer: a meta-analysis. Endocr J, 2018, 65(4): 403-413.
33. Jin P, Zhang X, Wu Y, et al. Streptozotocin-induced diabetic rat-derived bone marrow mesenchymal stem cells have impaired abilities in proliferation, paracrine, antiapoptosis, and myogenic differentiation. Transplant Proc, 2010, 42(7): 2745-2752.
34. 黄钟炼, 罗绍伟, 林海明, 等. SDF-1/CXCR4介导体外冲击波促进大鼠骨髓间充质干细胞的黏附、迁移作用. 颈腰痛杂志, 2019, 40(6): 721-726.
35. Aicher A, Heeschen C, Sasaki K, et al. Low-energy shock wave for enhancing recruitment of endothelial progenitor cells: a new modality to increase efficacy of cell therapy in chronic hind limb ischemia. Circulation, 2006, 114(25): 2823-2830.

Previous Article
Advances in stem cell transplantation for thromboangiitis obliterans
Next Article
免疫治疗假性进展之大量胸腔积液一例

West China Medical Journal

Mechanisms of extracorporeal shock wave therapy in promoting healing of diabetic foot ulcer

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content