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Extracorporeal Shockwave Therapy Enhanced Diabetic Wound Healing is Associated with Modulation of wnt/β- Catenin Expression
Kuender Yang (1), Yur-Ren Kuo (2), Chun-Ting Wang (2), Ching-Jen Wang (2)

Institution:
(1) Show Chwan Memorial Hospital, Changhua; (2) Kaohsiung Chang Gung Memorial Hospital, Taiwan

Device and producing company:
none

Introduction:
Our previous studies demonstrated extracorporeal shockwave therapy (ESWT) has a significant positive effect to accelerate chronic wound healing. However, the bio-mechanisms operating during ESWT of wounds remain unclear. Studies have been proved that Wnt/ β-catenin signaling induces epithelial differentiation during cutaneous wound healing. This study investigated the effectiveness of ESWT in the enhancement of diabetic wound healing is related of wnt/β-catenin pathway.

Methods:
In this study, we used a dorsal skin defect (area, 6×5 cm) in a streptozotocin (STZ)-induced diabetes rodent model. Wistar rats were divided into different groups. Group I consisted of non-diabetic control; group II, diabetic control receiving no ESWT; group III, rats received 1 session of ESWT (800 impulses at 0.099mJ/mm2) on day 3; group IV, rats received 2 sessions of ESWT on days 3 and 7: group V, rats received BIO as a GSK-3β inhibitor to mimic the β-catenin effect. The wound healing was assessed clinically. The tissue samples were analyzed with immunohistochemical (IHC) stain and RT-PCR after different time -periods.

Results:
The wound size was significantly reduced in the ESWT-treated rats as compared to the control (P< 0.01). In IHC stain, Wnt3a and Wnt5a expressions were significant increase in 3 days and 10 days post-ESWT in 2 sessions, as compared to that in controls without treatment. The β-catenin expression was significant increase in 3 days and 10 days post two-sessions of ESWT as compared to that in controls.

Discussion:
In this study, the results demonstrated that Wnt/β-catenin pathway is involved in ESWT enhanced wound healing.

Conclusion:
Treatment with multiple sessions of ESWT significantly enhanced diabetic wound healing associated with increased wnt / β-catenin and tissue regeneration.
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