title: Effects of shock wave therapy in the skin of patients with progressive systemic sclerosis: a pilot study.
abstract: Vasculopathy, immunological abnormalities, and excessive tissue fibrosis are key elements in the pathogenesis of progressive systemic sclerosis (SSc). Extracorporeal shock waves (ESW) have anti-inflammatory and regenerative effects on different tissues. We hypothesized that ESW can reduce endothelial cell damage and skin fibrosis in patients with SSc. We enrolled 30 patients affected by SSc, 29 females and 1 male. Rodnan Skin Score (RSS) and Visuo-Analogical Scale (VAS) for skin wellness were performed before and immediately after ESW therapy (ESWT) and at 7, 30, 60, and 90 days after the treatment. Sonographic examination of the patients' arms was performed before and 7, 30, 60, 90 days after treatment. Blood samples were obtained before and 30 and 60 days after treatment to measure serological levels of von Willebrand factor, vascular endothelial growth factor, intracellular adhesion molecule-1, monocyte chemotactic protein-1. The number of endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) were determined at the same time points. After ESWT we observed a rapid and persistent reduction of RSS and decrease of VAS. There was no difference in skin thickness before and after ESWT; however, we observed a more regular skin structure and an improvement in skin vascularization 90 days after treatment. EPCs and CECs increased 60 and 90 days after treatment, while serological biomarkers showed no variation before and after therapy. In conclusion, ESWT resulted in an improvement of VAS, RSS, and of skin vascular score, and in an increase of CECs and EPCs.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Verona, Verona, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Tinazzi
authors.forename: Ernesto
authors.initials: E
authors.lastname: Amelio
authors.forename: Elettra
authors.initials: E
authors.lastname: Marangoni
authors.forename: Claudio
authors.initials: C
authors.lastname: Guerra
authors.forename: Antonio
authors.initials: A
authors.lastname: Puccetti
authors.forename: Orazio Michele
authors.initials: OM
authors.lastname: Codella
authors.forename: Sara
authors.initials: S
authors.lastname: Simeoni
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Cavalieri
authors.forename: Martina
authors.initials: M
authors.lastname: Montagnana
authors.forename: Roberto
authors.initials: R
authors.lastname: Adani
authors.forename: Roberto
authors.initials: R
authors.lastname: Corrocher
authors.forename: Claudio
authors.initials: C
authors.lastname: Lunardi
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D018932:Chemokine CCL2 / Q000097:blood; D042783:Endothelial Cells / Q000378:metabolism / Q000473:pathology; D005260:Female; D005355:Fibrosis; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D007558:Italy; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood; D010865:Pilot Projects; D045743:Scleroderma, Diffuse / Q000097:blood / Q000473:pathology / Q000628:therapy*; D012867:Skin / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D013234:Stem Cells / Q000378:metabolism / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods*; D018615:Ultrasonography, Doppler, Color; D042461:Vascular Endothelial Growth Factor A / Q000097:blood; D014841:von Willebrand Factor / Q000378:metabolism
chemical_list: D015415:Biomarkers; C111835:CCL2 protein, human; D018932:Chemokine CCL2; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D014841:von Willebrand Factor; D018799:Intercellular Adhesion Molecule-1; D009569:Nitric Oxide