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Liu T. et al., 2019: Cellular signaling pathways modulated by low-intensity extracorporeal shock wave therapy

Liu T, Shindel AW, Lin G, Lue TF.
Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA, 94143, USA.
Department of Urology, Beijing Shijitan Hospital, Capital Medical University, 100038, Beijing, China.

Abstract

Low-intensity extracorporeal shock wave therapy (Li-ESWT) is a form of energy transfer that is of lower intensity (<0.2mJ/mm2) relative to traditional Extracorporeal Shock Wave Lithotripsy (ESWL) used for management of urinary stones. At this intensity and at appropriate dosing energy transfer is thought to induce beneficial effects in human tissues. The proposed therapeutic mechanisms of action for Li-ESWT include neovascularization, tissue regeneration, and reduction of inflammation. These effects are thought to be mediated by enhanced expression of vascular endothelial growth factor, endothelial nitric oxide synthase, and proliferating cell nuclear antigen. Upregulation of chemoattractant factors and recruitment/activation of stem/progenitor cells may also play a role. Li-ESWT has been studied for management of musculoskeletal disease, ischemic cardiovascular disorders, Peyronie's Disease, and more recently erectile dysfunction (ED). The underlying mechanism of Li-ESWT for treatment of ED is incompletely understood. We summarize the current evidence basis by which Li-ESWT is thought to enhance penile hemodynamics with an intention of outlining the fundamental mechanisms by which this therapy may help manage ED.

Int J Impot Res. 2019 Jan 22. doi: 10.1038/s41443-019-0113-3. [Epub ahead of print] Review

 

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Comments 1

Peter Alken on Wednesday, 17 July 2019 08:29

This is an extensive overview on the action of shock waves on soft tissue. Treatment of ED is just one aspect and basic research in this special, easily accessible area my help to understand better shock wave action in the treatment of wound healing, brain stimulation or cardiac diseases. The first sentence of the summary consequently addresses the larger picture: “Li-ESWT is a non-invasive and promising physical method for regenerative medicine.”
“Numerous animal models of erectile dysfunction indicate that Li-ESWT may improve angiogenesis, activation of stem/progenitor cells, and muscle/ nerve regeneration for remodeling penile erectile tissues. A robust and growing body of evidence supports the utility of Li-ESWT in ED.”

The first quarter of 2019 offers at least 7 publication on LI-ESWT (1-7)
The LI-ESWT community seems to stand up like one man to defend this therapy, which tries to restore the aging tissue of the aging male, against criticism and skepticism.

1 Faix A, Chevallier D.
Low-intensity extracorporeal shockwave therapy for erectile dysfunctio: a new option ?
Rev Med Suisse. 2019 Mar 13;15(642):590-595.

2 Liu T, Shindel AW, Lin G, Lue TF.
Cellular signaling pathways modulated by low-intensity extracorporeal shock wave therapy.
Int J Impot Res. 2019 Jan 22. doi: 10.1038/s41443-019-0113-3.

3 Patel P, Fode M, Lue T, Ramasamy R.
Should Low-intensity Extracorporeal Shockwave Therapy Be the First-line Erectile Dysfunction Treatment for Nonresponders to Phosphodiesterase Type 5 Inhibition?
Eur Urol Focus. 2019 Feb 15. pii: S2405-4569(19)30024-0. doi: 10.1016/j.euf.2019.02.004.

4 Patel P, Huang C, Molina M, Ramasamy R.
Clinical trial update on shockwave therapy and future of erectile function restoration.
Int J Impot Res. 2019 Jan 22. doi: 10.1038/s41443-019-0115-1.

5 Sokolakis I, Dimitriadis F, Teo P, Hatzichristodoulou G, Hatzichristou D, Giuliano F.
The Basic Science Behind Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction: A Systematic Scoping Review of Pre-Clinical Studies.
J Sex Med. 2019 Feb;16(2):168-194. doi: 10.1016/j.jsxm.2018.12.016.

6 Sokolakis I, Hatzichristodoulou G.
Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials.
Int J Impot Res. 2019 Jan 21. doi: 10.1038/s41443-019-0117-z.

7 Usta MF, Gabrielson AT, Bivalacqua TJ.
Low-intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction following radical prostatectomy: a critical review. Int J Impot Res. 2019 Feb 1. doi: 10.1038/s41443-019-0121-3.

This is an extensive overview on the action of shock waves on soft tissue. Treatment of ED is just one aspect and basic research in this special, easily accessible area my help to understand better shock wave action in the treatment of wound healing, brain stimulation or cardiac diseases. The first sentence of the summary consequently addresses the larger picture: “Li-ESWT is a non-invasive and promising physical method for regenerative medicine.” “Numerous animal models of erectile dysfunction indicate that Li-ESWT may improve angiogenesis, activation of stem/progenitor cells, and muscle/ nerve regeneration for remodeling penile erectile tissues. A robust and growing body of evidence supports the utility of Li-ESWT in ED.” The first quarter of 2019 offers at least 7 publication on LI-ESWT (1-7) The LI-ESWT community seems to stand up like one man to defend this therapy, which tries to restore the aging tissue of the aging male, against criticism and skepticism. 1 Faix A, Chevallier D. Low-intensity extracorporeal shockwave therapy for erectile dysfunctio: a new option ? Rev Med Suisse. 2019 Mar 13;15(642):590-595. 2 Liu T, Shindel AW, Lin G, Lue TF. Cellular signaling pathways modulated by low-intensity extracorporeal shock wave therapy. Int J Impot Res. 2019 Jan 22. doi: 10.1038/s41443-019-0113-3. 3 Patel P, Fode M, Lue T, Ramasamy R. Should Low-intensity Extracorporeal Shockwave Therapy Be the First-line Erectile Dysfunction Treatment for Nonresponders to Phosphodiesterase Type 5 Inhibition? Eur Urol Focus. 2019 Feb 15. pii: S2405-4569(19)30024-0. doi: 10.1016/j.euf.2019.02.004. 4 Patel P, Huang C, Molina M, Ramasamy R. Clinical trial update on shockwave therapy and future of erectile function restoration. Int J Impot Res. 2019 Jan 22. doi: 10.1038/s41443-019-0115-1. 5 Sokolakis I, Dimitriadis F, Teo P, Hatzichristodoulou G, Hatzichristou D, Giuliano F. The Basic Science Behind Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction: A Systematic Scoping Review of Pre-Clinical Studies. J Sex Med. 2019 Feb;16(2):168-194. doi: 10.1016/j.jsxm.2018.12.016. 6 Sokolakis I, Hatzichristodoulou G. Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials. Int J Impot Res. 2019 Jan 21. doi: 10.1038/s41443-019-0117-z. 7 Usta MF, Gabrielson AT, Bivalacqua TJ. Low-intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction following radical prostatectomy: a critical review. Int J Impot Res. 2019 Feb 1. doi: 10.1038/s41443-019-0121-3.
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