title: Original hypothesis: Extracorporeal shockwaves as a homeostatic autoimmune restorative treatment (HART) for Type 1 diabetes mellitus.
abstract: Mononuclear invasion of Langerhans islet and the ensuing insulitis triggers signal-transduction for the autoimmune mediated pancreatic beta-cell (β-cell) apoptosis that severely disrupts insulin production resulting in hyperglycemia associated with Type-1 diabetes (T1DM). Today extensive global research is being conducted to eliminate the need for insulin, and even prevent or find a cure for T1DM. The multifactorial combination of autoimmune dysfunction, Langerhans islet hypoxia, and bio-chemical disruption are seen to be contributory factors for β-cell destruction and the consequential disruption to insulin production. Regeneration of β-cells back to physiological levels may restore homeostatic insulin levels, reversing T1DM. Evidence suggests that there are still functioning pancreatic β-cells even in long standing T1DM providing the potential for their regeneration. Although the exact mechanism of extracorporeal shockwaves (ESW) is yet to be fully elucidated, it is seen to influence a complex spectrum of bio-chemical, cellular and neuronal functions (i.e. suppression of pro-inflammatory immune response, improved tissue hemodynamics, anti-microbial properties, and the induction of progenitor cell expression including proangiogenic factors and nitric oxide syntheses). The rationale for the use of ESW as a therapeutic modality in this instance is attributed to its restorative properties and safety profile demonstrated in urology, cardiology, chronic wounds, osteogenesis, complex pain syndromes, and tendinopathies. ESW may restore autoimmune homeostasis creating a suitable environment for pancreatic β-cell proliferation which in-turn may significantly increase or normalize endogenous insulin secretion reducing or totally eliminating dependency of exogenous insulin. The devastating complications, morbidity and mortality associated with T1DM warrants the exploration of homeostatic autoimmune restorative treatment (HART) modalities that may partially or fully reverse this disease condition. We present our hypothesis discussing ESW as a potential homeostatic autoimmune restorative treatment (HART) option for T1DM.
authors.affiliation: Kompass Health Associates, Auckland, New Zealand. Electronic address: nopain@xtra.co.nz.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Craig
authors.affiliation: Shock Wave Therapy Research Unit, Rehabilitation Department, Instituto Clinico Humanitas, Milan, Italy. Electronic address: cristina.d'agostino@humanitas.it.
authors.forename: Cristina
authors.initials: C
authors.lastname: d'Agostino
authors.affiliation: Auckland University of Technology, Auckland, New Zealand. Electronic address: daniel.poratt@aut.ac.nz.
authors.forename: Daniel
authors.initials: D
authors.lastname: Poratt
authors.affiliation: Kompass Health Associates, Auckland, New Zealand. Electronic address: injury360@xtra.co.nz.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Walker
mesh_terms: D001327:Autoimmune Diseases / Q000628:therapy*; D049109:Cell Proliferation; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D019220:High-Energy Shock Waves; D006706:Homeostasis; D006801:Humans; D000860:Hypoxia / Q000378:metabolism; D007249:Inflammation / Q000378:metabolism; D050417:Insulin-Secreting Cells / Q000166:cytology / Q000378:metabolism; D007515:Islets of Langerhans / Q000378:metabolism; D016377:Organ Transplantation; D013234:Stem Cells / Q000166:cytology