Influence of extracorporeal shockwaves on macrophage polarization in a 3D collagen matrix

Introduction: The host’s immune response determines the success of guided tissue regeneration. Extracorporeal shockwave therapy (ESWT) has been shown to reduce inflammation and improve wound healing. Nevertheless, its impact on macrophage polarization, as the first line of host defense, has not yet...

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Main Authors: Diana Heimes, Moritz Große-Leege, Nadja Engel, Katharina Peters, Walburgis Brenner, Jürgen Brieger, Nadine Wiesmann-Imilowski, Peer W. Kämmerer
Format: Article
Language:English
Published: Elsevier 2025-12-01
Series:Regenerative Therapy
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Online Access:http://www.sciencedirect.com/science/article/pii/S235232042500135X
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author Diana Heimes
Moritz Große-Leege
Nadja Engel
Katharina Peters
Walburgis Brenner
Jürgen Brieger
Nadine Wiesmann-Imilowski
Peer W. Kämmerer
author_facet Diana Heimes
Moritz Große-Leege
Nadja Engel
Katharina Peters
Walburgis Brenner
Jürgen Brieger
Nadine Wiesmann-Imilowski
Peer W. Kämmerer
author_sort Diana Heimes
collection DOAJ
description Introduction: The host’s immune response determines the success of guided tissue regeneration. Extracorporeal shockwave therapy (ESWT) has been shown to reduce inflammation and improve wound healing. Nevertheless, its impact on macrophage polarization, as the first line of host defense, has not yet been elucidated. Therefore, this study aimed to investigate the effect of ESWT on macrophage polarization in a 3D collagen matrix model. Methods: Macrophages were isolated from human donor blood and differentiated into M1 macrophages. The cells were seeded into a collagen gel, and macrophages treated with ESWT (500 impulses, energy flux density 0.12 mJ/mm2) (+ESWT) were compared to non-treated cells (–ESWT). Furthermore, macrophages treated with 20 ng/μl IL-4 and 50 ng/μl M-CSF for M2-polarization in the gel (1.) or on a 6-well cell culture plate with Upcell™ surface (2.) as well as M1 macrophages cultured on a conventional cell culture dish (3.) served as reference cultures. Flow cytometry assessed polarization into M2 macrophages by measuring the expression of CD209, CD86, CD200R, and CD163. Results: Flow cytometry revealed no significant differences between the ESWT-treated (+ESWT) and untreated (–ESWT) macrophages for any of the markers. However, macrophages cultured in collagen gel (3) exhibited significantly higher CD200R expression rates than the other groups. Conclusions: The lack of significant differences in macrophage polarization following ESWT in this 3D model may be attributed to the absence of cell-cell interactions and other tissue structures that are present in vivo. Since the culturing environment significantly affected the expression of M2-polarization markers, with a significantly higher expression in collagen gel compared to cell culture plates, future studies should incorporate more complex co-culture systems or in vivo models to better simulate the clinical environment. Clinical evidence suggests that ESWT can effectively promote tissue healing and regeneration, indicating that the observed results may reflect limitations in the chosen model or cell type rather than the therapy itself, warranting further investigation.
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spelling doaj-art-e5b5e95a96e04323a657e2e8af63d8952025-08-20T02:07:47ZengElsevierRegenerative Therapy2352-32042025-12-013019520610.1016/j.reth.2025.06.003Influence of extracorporeal shockwaves on macrophage polarization in a 3D collagen matrixDiana Heimes0Moritz Große-Leege1Nadja Engel2Katharina Peters3Walburgis Brenner4Jürgen Brieger5Nadine Wiesmann-Imilowski6Peer W. Kämmerer7Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany; Corresponding author.Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, GermanyDepartment of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Center Rostock, Schillingallee 35, 18057, Rostock, GermanyDepartment of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, GermanyDepartment of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, GermanyDepartment of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany; Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, GermanyDepartment of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany; Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, GermanyDepartment of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, GermanyIntroduction: The host’s immune response determines the success of guided tissue regeneration. Extracorporeal shockwave therapy (ESWT) has been shown to reduce inflammation and improve wound healing. Nevertheless, its impact on macrophage polarization, as the first line of host defense, has not yet been elucidated. Therefore, this study aimed to investigate the effect of ESWT on macrophage polarization in a 3D collagen matrix model. Methods: Macrophages were isolated from human donor blood and differentiated into M1 macrophages. The cells were seeded into a collagen gel, and macrophages treated with ESWT (500 impulses, energy flux density 0.12 mJ/mm2) (+ESWT) were compared to non-treated cells (–ESWT). Furthermore, macrophages treated with 20 ng/μl IL-4 and 50 ng/μl M-CSF for M2-polarization in the gel (1.) or on a 6-well cell culture plate with Upcell™ surface (2.) as well as M1 macrophages cultured on a conventional cell culture dish (3.) served as reference cultures. Flow cytometry assessed polarization into M2 macrophages by measuring the expression of CD209, CD86, CD200R, and CD163. Results: Flow cytometry revealed no significant differences between the ESWT-treated (+ESWT) and untreated (–ESWT) macrophages for any of the markers. However, macrophages cultured in collagen gel (3) exhibited significantly higher CD200R expression rates than the other groups. Conclusions: The lack of significant differences in macrophage polarization following ESWT in this 3D model may be attributed to the absence of cell-cell interactions and other tissue structures that are present in vivo. Since the culturing environment significantly affected the expression of M2-polarization markers, with a significantly higher expression in collagen gel compared to cell culture plates, future studies should incorporate more complex co-culture systems or in vivo models to better simulate the clinical environment. Clinical evidence suggests that ESWT can effectively promote tissue healing and regeneration, indicating that the observed results may reflect limitations in the chosen model or cell type rather than the therapy itself, warranting further investigation.http://www.sciencedirect.com/science/article/pii/S235232042500135XMacrophage polarizationESWTExtracorporeal shockwave therapy3D modelCollagen matrix
spellingShingle Diana Heimes
Moritz Große-Leege
Nadja Engel
Katharina Peters
Walburgis Brenner
Jürgen Brieger
Nadine Wiesmann-Imilowski
Peer W. Kämmerer
Influence of extracorporeal shockwaves on macrophage polarization in a 3D collagen matrix
Regenerative Therapy
Macrophage polarization
ESWT
Extracorporeal shockwave therapy
3D model
Collagen matrix
title Influence of extracorporeal shockwaves on macrophage polarization in a 3D collagen matrix
title_full Influence of extracorporeal shockwaves on macrophage polarization in a 3D collagen matrix
title_fullStr Influence of extracorporeal shockwaves on macrophage polarization in a 3D collagen matrix
title_full_unstemmed Influence of extracorporeal shockwaves on macrophage polarization in a 3D collagen matrix
title_short Influence of extracorporeal shockwaves on macrophage polarization in a 3D collagen matrix
title_sort influence of extracorporeal shockwaves on macrophage polarization in a 3d collagen matrix
topic Macrophage polarization
ESWT
Extracorporeal shockwave therapy
3D model
Collagen matrix
url http://www.sciencedirect.com/science/article/pii/S235232042500135X
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