Shockwave Therapy Outperforms HBOT in Treating Diabetic Ulcers
Title of Study: Molecular changes in diabetic foot ulcers
Authors: Ching-Jen Wang a, Jih-Yang Ko a, Yur-Ren Kuo b, Ya-Ju Yang a
This study examined the effectiveness of extracorporeal shockwave therapy (ESWT) compared to hyperbaric oxygen therapy (HBOT) in treating chronic diabetic foot ulcers. The goal was to understand the molecular changes induced by these therapies and identify which method better promotes healing.
The research involved a cohort of 77 patients divided into two groups. Thirty-nine patients with 44 ulcers received ESWT, undergoing six treatments over three weeks. Meanwhile, 38 patients with 40 ulcers underwent 20 daily sessions of HBOT. Ulcers were biopsied before and after these treatments to assess molecular markers associated with healing.
Key molecules involved in wound healing were analyzed, including von Willebrand Factor (vWF), Vascular Endothelial Growth Factor (VEGF), endothelial Nitric Oxide Synthase (eNOS), Proliferating Cell Nuclear Antigen (PCNA), Epidermal Growth Factor (EGF), and markers of cell death (TUNEL assay). These markers help evaluate blood vessel formation, tissue regeneration, and cellular health.
The findings revealed significant improvements in the ESWT group. There was a marked increase in the expressions of vWF, VEGF, eNOS, PCNA, and EGF—all crucial for angiogenesis and tissue regeneration. Moreover, there was a notable decrease in TUNEL expression, indicating reduced cell death. In contrast, the HBOT group did not show statistically significant changes.
The initial comparison between the two groups before treatment showed no significant differences in molecular markers. However, post-treatment, the ESWT group exhibited statistically significantly better outcomes than the HBOT group in all tested parameters.
This study highlights ESWT’s potential to significantly enhance molecular responses associated with healing in diabetic foot ulcers. By promoting increased angiogenesis and reducing cell death, ESWT may offer a more effective treatment approach than HBOT, suggesting a promising avenue for improving healing outcomes in patients with chronic diabetic ulcers.