Advances in Clinical and Experimental Medicine
2020, vol. 29, nr 7, July, p. 819–824
Publication type: original article
Extracorporeal shockwave therapy enhances peripheral nerve remyelination and gait function in a crush model
1 Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Daejeon, South Korea
2 Department of Medical Science, Chungnam National University School of Medicine, Daejeon, South Korea
3 Department of Anatomy, Korea University College of Medicine, Seoul, South Korea
4 Department of Neurology, Mayo Clinic, Rochester, USA
5 Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
6 Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
Background. Conservative treatment, such as electrical stimulation and steroid injection, have been employed in an attempt to improve symptoms after peripheral nerve injury, without significant success. Although non-invasive and safe extracorporeal shockwave therapy (ESWT) can be a practical alternative, the therapeutic effects of ESWT on peripheral nerve remyelination has not been established.
Objectives. To investigate the effects of ESWT on peripheral nerve remyelination and gait function for 5 weeks in a sciatic nerve crush model.
Material and Methods. In total, we divided 97 rats into 5 groups: group 1 – a healthy negative control group; group 2 – 3 weeks after sciatic nerve crush and 3 sessions of ESWT; group 3 – 5 weeks after crush injury with 3 sessions of ESWT; group 4 – 3 weeks after crush injury with no ESWT; and group 5 – 5 weeks after crush injury with no ESWT. The focused ESWT was applied to the unilateral sciatic nerve injury site. One session consisted of 1,500 stimuli, and the session were performed at intervals of 1 week.
Results. The degree of myelination and expression of myelin basic protein at the distal part of the injured sciatic nerve tended to increase in the ESWT groups compared with the no-ESWT groups 3 and 5 weeks after crush injury. Regarding the functional gait recovery, the print width and area of the injured leg in the ESWT groups was significantly larger than that in the no-ESWT groups 3 and 5 weeks after crush injury.
Conclusion. The ESWT may enhance peripheral nerve remyelination and gait function in a nerve crush model. Long-term follow-up after ESWT and investigation of molecular mechanisms will be needed to confirm these therapeutic effects.
peripheral nerve injuries, extracorporeal shockwave therapy, myelin basic protein, remyelination, gait
- Morton PD, Johnstone JT, Ramos AY, Liebl DJ, Bunge MB, Bethea JR. Nuclear factor-κB activation in Schwann cells regulates regeneration and remyelination. Glia. 2012;60(4):639–650.
- Glenn TD, Talbot WS. Signals regulating myelination in peripheral nerves and the Schwann cell response to injury. Curr Opin Neurobiol. 2013;23(6):1041–1048.
- Martini R, Fischer S, López-Vales R, David S. Interactions between Schwann cells and macrophages in injury and inherited demyelinating disease. Glia. 2008;56(14):1566–1577.
- Bae H, Kim HJ. Clinical outcomes of extracorporeal shock wave therapy in patients with secondary lymphedema: A pilot study. Ann Rehabil Med. 2013;37(2):229–234.
- Schuh CM, Heher P, Weihs AM, et al. In vitro extracorporeal shock wave treatment enhances stemness and preserves multipotency of rat and human adipose-derived stem cells. Cytotherapy. 2014;16(12):1666–1678.
- 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.
- Wu YH, Liang HW, Chen WS, Lai JS, Luh JJ, Chong FC. Electrophysiological and functional effects of shock waves on the sciatic nerve of rats. Ultrasound Med Biol. 2008;34(10):1688–1696.
- Wang FS, Yang KD, Chen RF, Wang CJ, Sheen-Chen SM. Extracorporeal shock wave promotes growth and differentiation of bone-marrow stromal cells towards osteoprogenitors associated with induction of TGF-beta1. J Bone Joint Surg Br. 2002;84(3):457–461.
- Livak KJ, Schmittgen TD. Analysis of relative gene expression data using real-time quantitative PCR and the 2(-delta delta C(T)) method. Methods. 2001;25(4):402–408.
- Lee EJ, Xu L, Kim GH, et al. Regeneration of peripheral nerves by transplanted sphere of human mesenchymal stem cells derived from embryonic stem cells. Biomaterials. 2012;33(29):7039–7046.
- Zhou S, Shen D, Wang Y, et al. microRNA-222 targeting PTEN promotes neurite outgrowth from adult dorsal root ganglion neurons following sciatic nerve transection. PLoS One. 2012;7(9):e44768.
- Wu D, Murashov AK. Molecular mechanisms of peripheral nerve regeneration: Emerging roles of microRNAs. Front Physiol. 2013;4:55.
- Mensching L, Börger AK, Wang X, Charalambous P, Unsicker K, Haastert-Talini K. Local substitution of GDF-15 improves axonal and sensory recovery after peripheral nerve injury. Cell Tissue Res. 2012;350(2):225–238.
- Pereira JA, Lebrun-Julien F, Suter U. Molecular mechanisms regulating myelination in the peripheral nervous system. Trends Neurosci. 2012;35(2):123–134.
- Hung HA, Sun G, Keles S, Svaren J. Dynamic regulation of Schwann cell enhancers after peripheral nerve injury. J Biol Chem. 2015;290(11):6937–6950.
- Jessen KR, Mirsky R. Negative regulation of myelination: Relevance for development, injury, and demyelinating disease. Glia. 2008;56(14):1552–1565.