It Comes As a Shock: Kidney Repair Using Shockwave Therapy.
It Comes As a Shock: Kidney Repair Using Shockwave Therapy.
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令人震惊的是：使用冲击波疗法进行肾脏修复。
DOI：
10.1161/hypertensionaha.120.14595
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发表时间：
2020-12
期刊：
影响因子：
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通讯作者：
Lerman LO
中科院分区：
文献类型：
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作者：
Klomjit N;Lerman A;Lerman LO
慢性肾脏疾病是全球医疗保健负担，但临床证明的治疗方法有限。低强度冲击波是一种很有前途的技术，它利用了临床上适用的冲击波碎石术中使用的大约10%的能量水平，以改善缺血和再生组织。已证明其通过多种机制，特别是通过促进新血管形成来改善组织（如骨、肌肉、心肌和肾脏）的愈合。低强度冲击波刺激主要位于内皮细胞和近端肾小管细胞的机械感受器，随后上调血管内皮生长因子。这反过来又促进血管生成并改善肾缺氧、炎症和纤维化，并最终保护肾功能。此外，低强度冲击波可以刺激归巢因子的释放，以吸引内皮祖细胞或干细胞进入损伤的肾脏进行组织修复。这些作用在几种肾脏疾病模型中可能是有益的，包括肾动脉狭窄、糖尿病肾病和各种慢性肾脏疾病，尽管迄今为止报道的大多数研究都是在动物模型中进行的。由于其能量强度低，该手术相对耐受和安全，但需要更多的临床研究来确定其超出现有策略的有效性。因此，低强度冲击波治疗作为一种替代治疗方法出现，可能提供一个有前途的非侵入性干预治疗肾脏疾病。
Chronic kidney disease is a global healthcare burden, yet clinically-proven treatments are limited. Low-intensity shockwave, which utilizes approximately 10% of the energy levels used in clinically-indicated shockwave lithotripsy, is a promising technique to ameliorate ischemia and regenerate tissues. It has been demonstrated to improve healing in tissues such as bone, muscle, myocardium, and kidney via several mechanisms, particularly through promoting neovascularization. Low-intensity shockwave stimulates mechanoreceptors located primarily in endothelial and proximal tubular cells, and subsequently upregulates vascular endothelial growth factors. This, in turn, promotes angiogenesis and ameliorates renal hypoxia, inflammation, and fibrosis, and ultimately preserves renal function. Furthermore, low-intensity shockwave can stimulate release of homing factors to attract endothelial progenitor or stem cells into injured kidneys for tissue repair. These effects may be beneficial in several kidney disease models, including renal artery stenosis, diabetic kidney disease, and various chronic kidney diseases, although most studies reported to date have been performed in animal models. Due to its low energy intensity, the procedure is relatively tolerable and safe, yet, more clinical studies are needed to establish its efficacy beyond currently-existing strategies. Therefore, low-intensity shockwave therapy emerges as an alternative therapeutic approach that may offer a promising noninvasive intervention for treating renal diseases.