Analyze Diet
Frontiers in veterinary science2017; 4; 205; doi: 10.3389/fvets.2017.00205

Extracorporeal Shockwave Therapy Increases Growth Factor Release from Equine Platelet-Rich Plasma In Vitro.

Abstract: Extracorporeal shockwave therapy (ESWT) and platelet-rich plasma (PRP) are common treatments for soft tissue injuries in horses. Shockwave triggers cell specific responses to promote healing. Growth factors released from PRP also promote healing. It has been hypothesized that greater growth factor release would amplify the healing process. The combination of ESWT and PRP could promote healing in injured tendons and ligaments in the horse. The objective of this study was to determine if application of shockwaves to PRP samples increases the concentration of transforming growth factor-β1 (TGF-β1) and platelet-derived growth factor ββ (PDGF-ββ) released from the platelets in vitro. Methods: PRP was produced from blood drawn from six horses. The PRP from each horse was exposed to the following treatments: (1) positive control (freeze-thaw cycle), (2) untreated negative control, or shockwaves with either (3) a "standard probe" (ESWT-S) with a 2 cm focal width and medium energy density or (4) a "power probe" (ESWT-P) with a 1 cm focal width and high energy density. After each treatment, the samples were centrifuged, and the supernatant was harvested. The supernatant was then used for growth factor quantification via commercially available ELISA kits for TGF-β1 and PDGF-ββ. Results: Concentrations of TGF-β1 and PDGF-ββ in PRP that underwent a freeze-thaw cycle were significantly increased compared with all other treatments. Both ESWT-S and ESWT-P resulted in significantly increased TGF-β1 concentrations, 46 and 33%, respectively, when compared with the negative control. Both ESWT-S and ESWT-P resulted in significantly increased PDGF-ββ concentrations, 219 and 190%, respectively, when compared with the negative control. Conclusions: These data indicate that the application of ESWT to PRP increases the expression of growth factors in vitro. This suggests that the combination therapy of local PRP injection followed by ESWT may stimulate release of growth factors from platelets after they have been injected into the area of injury. Conclusions: The combination of PRP and ESWT might result in synergism of two modalities previously utilized individually for tendon and ligament injuries in horses.
Publication Date: 2017-12-07 PubMed ID: 29270410PubMed Central: PMC5726030DOI: 10.3389/fvets.2017.00205Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research explores how extracorporeal shockwave therapy (ESWT), combined with platelet-rich plasma (PRP), could improve the healing of soft tissue injuries in horses by increasing the release of growth factors.

Research Objective

  • The aim of this study was to discover if ESWT can increase the release of growth factors from PRP, which could potentially improve the healing process. The specific growth factors examined were transforming growth factor-β (TGF-β) and platelet-derived growth factor ββ (PDGF-ββ).

Methods

  • The researchers created PRP from blood drawn from six horses.
  • Four different treatments were applied to the PRP: a positive control (freeze-thaw cycle), a negative control (no treatment), shockwaves with a “standard probe” (lower energy), and shockwaves with a “power probe” (higher energy).
  • After each treatment, the PRP samples were centrifuged and the liquid part (supernatant) was collected for analysis.
  • The researchers used ELISA kits to quantify the amount of TGF-β and PDGF-ββ in the supernatant.

Results

  • The freeze-thaw cycle (positive control) significantly increased the concentration of both growth factors compared to the other treatments.
  • The ESWT treatments also significantly increased the concentrations of the growth factors compared to the negative control. The standard probe increased TGF-β by 46% and PDGF-ββ by 219%. Similarly, the power probe increased TGF-β by 33% and PDGF-ββ by 190%.

Conclusions

  • The study demonstrated that the application of ESWT to PRP increases the release of growth factors, which underpins its therapeutic potential for healing soft tissue injuries in horses.
  • The researchers suggest that a combination therapy of injecting PRP into the injury site, followed by ESWT, may stimulate the release of growth factors from platelets, thus enhancing healing.
  • The combination of PRP and ESWT, both used individually for such injuries before, might show a synergistic effect in promoting healing in horses’ tendons and ligaments.

Cite This Article

APA
Seabaugh KA, Thoresen M, Giguère S. (2017). Extracorporeal Shockwave Therapy Increases Growth Factor Release from Equine Platelet-Rich Plasma In Vitro. Front Vet Sci, 4, 205. https://doi.org/10.3389/fvets.2017.00205

Publication

ISSN: 2297-1769
NlmUniqueID: 101666658
Country: Switzerland
Language: English
Volume: 4
Pages: 205

Researcher Affiliations

Seabaugh, Kathryn A
  • Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States.
  • Department of Large Animal Medicine, University of Georgia, Athens, GA, United States.
Thoresen, Merrilee
  • Department of Large Animal Medicine, University of Georgia, Athens, GA, United States.
  • Department of Pathobiology & Population Medicine, College of Veterinary Medicine, Mississippi State University, Starkville, MS, United States.
Giguère, Steeve
  • Department of Large Animal Medicine, University of Georgia, Athens, GA, United States.

References

This article includes 42 references
  1. McClure S, Weinberger T. Extracorporeal shock wave therapy: clinical applications and regulation. Clin Tech Equine Pract (2003) 2(4):358–67.
  2. McClure SR, VanSickle D, Evans R, Reinertson EL, Moran L. The effects of extracorporeal shock-wave therapy on the ultrasonographic and histologic appearance of collagenase-induced equine forelimb suspensory ligament desmitis. Ultrasound Med Biol (2004) 30(4):461–7.
  3. Caminoto EH, Alves AL, Amorim RL, Thomassian A, Hussni CA, Nicoletti JL. Ultrastructural and immunocytochemical evaluation of the effects of extracorporeal shock wave treatment in the hind limbs of horses with experimentally induced suspensory ligament desmitis. Am J Vet Res (2005) 66(5):892–6.
    doi: 10.2460/ajvr.2005.66.892pubmed: 15934618google scholar: lookup
  4. Kersh KD, McClure SR, Van Sickle D, Evans RB. The evaluation of extracorporeal shock wave therapy on collagenase induced superficial digital flexor tendonitis. Vet Comp Orthop Traumatol (2006) 19(2):99–105.
    pubmed: 16810352
  5. Bosch G, de Mos M, van Binsbergen R, van Schie HT, van de Lest CH, van Weeren PR. The effect of focused extracorporeal shock wave therapy on collagen matrix and gene expression in normal tendons and ligaments. Equine Vet J (2009) 41(4):335–41.
    doi: 10.2746/042516409X370766pubmed: 19562893google scholar: lookup
  6. Waguespack RW, Burba DJ, Hubert JD, Vidal MA, Lomax LG, Chirgwin SR. Effects of extracorporeal shock wave therapy on desmitis of the accessory ligament of the deep digital flexor tendon in the horse. Vet Surg (2011) 40(4):450–6.
  7. Lischer CJ, Ringer SK, Schnewlin M, Imboden I, Furst A, Stockli M. Treatment of chronic proximal suspensory desmitis in horses using focused electrohydraulic shockwave therapy. Schweiz Arch Tierheilkd (2006) 148(10):561–8.
    doi: 10.1024/0036-7281.148.10.561pubmed: 17076464google scholar: lookup
  8. Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res (2012) 7:11.
    doi: 10.1186/1749-799X-7-11pmc: PMC3342893pubmed: 22433113google scholar: lookup
  9. McClure S, Dorfmüller C. Extracorporeal shock wave therapy: theory and equipment. Clin Tech Equine Pract (2003) 2(4):348–57.
  10. Chamberlain GA, Colborne GR. A review of the cellular and molecular effects of extracorporeal shockwave therapy. Vet Comp Orthop Traumatol (2016) 29(2):99–107.
    doi: 10.3415/VCOT-15-04-0057pubmed: 26846274google scholar: lookup
  11. Arguelles D, Carmona JU, Climent F, Munoz E, Prades M. Autologous platelet concentrates as a treatment for musculoskeletal lesions in five horses. Vet Rec (2008) 162(7):208–11.
    doi: 10.1136/vr.162.7.208pubmed: 18281627google scholar: lookup
  12. Waselau M, Sutter WW, Genovese RL, Bertone AL. Intralesional injection of platelet-rich plasma followed by controlled exercise for treatment of midbody suspensory ligament desmitis in standardbred racehorses. J Am Vet Med Assoc (2008) 232(10):1515–20.
    doi: 10.2460/javma.232.10.1515pubmed: 18479242google scholar: lookup
  13. Bosch G, van Schie HT, de Groot MW, Cadby JA, van de Lest CH, Barneveld A. Effects of platelet-rich plasma on the quality of repair of mechanically induced core lesions in equine superficial digital flexor tendons: a placebo-controlled experimental study. J Orthop Res (2010) 28(2):211–7.
    doi: 10.1002/jor.20980pubmed: 19714688google scholar: lookup
  14. Bosch G, Moleman M, Barneveld A, van Weeren PR, van Schie HT. The effect of platelet-rich plasma on the neovascularization of surgically created equine superficial digital flexor tendon lesions. Scand J Med Sci Sports (2011) 21(4):554–61.
  15. Textor J. Autologous biologic treatment for equine musculoskeletal injuries: platelet-rich plasma and IL-1 receptor antagonist protein. Vet Clin North Am Equine Pract (2011) 27(2):275–98.
    doi: 10.1016/j.cveq.2011.05.001pubmed: 21872759google scholar: lookup
  16. Bazzano M, Piccione G, Giannetto C, Tosto F, Di Pietro S, Giudice E. Platelet rich plasma intralesional injection as bedside therapy for tendinitis in athletic horse. Acta Sci Vet (2013) 41:1–7.
  17. Zuffova K, Krisova S, Zert Z. Platelet rich plasma treatment of superficial digital flexor tendon lesions in racing thoroughbreds. Vet Med (2013) 58(4):230–9.
  18. Estrada RJ, van Weeren PR, van de Lest CH, Boere J, Reyes M, Ionita JC. Comparison of healing in forelimb and hindlimb surgically induced core lesions of the equine superficial digital flexor tendon. Vet Comp Orthop Traumatol (2014) 27(5):358–65.
    doi: 10.3415/VCOT-13-11-0136pubmed: 25078543google scholar: lookup
  19. Romagnoli N, Rinnovati R, Ricciardi G, Lambertini C, Spinella G, Spadari A. Clinical evaluation of intralesional injection of platelet-rich plasma for the treatment of proximal suspensory ligament desmitis in horses. J Equine Vet Sci (2015) 35(2):141–6.
  20. Geburek F, Gaus M, van Schie HT, Rohn K, Stadler PM. Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies – a randomized prospective controlled clinical trial. BMC Vet Res (2016) 12(1):191.
    doi: 10.1186/s12917-016-0826-1pmc: PMC5015224pubmed: 27604193google scholar: lookup
  21. Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg (2004) 62(4):489–96.
    doi: 10.1016/j.joms.2003.12.003pubmed: 15085519google scholar: lookup
  22. Anitua E, Prado R, Orive G. Allogeneic platelet-rich plasma: at the dawn of an off-the-shelf therapy?. Trends Biotechnol (2017) 35(2):91–3.
    doi: 10.1016/j.tibtech.2016.11.001pubmed: 27908451google scholar: lookup
  23. Textor JA, Norris JW, Tablin F. Effects of preparation method, shear force, and exposure to collagen on release of growth factors from equine platelet-rich plasma. Am J Vet Res (2011) 72(2):271–8.
    doi: 10.2460/ajvr.72.2.271pubmed: 21281204google scholar: lookup
  24. Textor JA, Tablin F. Activation of equine platelet-rich plasma: comparison of methods and characterization of equine autologous thrombin. Vet Surg (2012) 41(7):784–94.
  25. Textor JA, Willits NH, Tablin F. Synovial fluid growth factor and cytokine concentrations after intra-articular injection of a platelet-rich product in horses. Vet J (2013) 198(1):217–23.
    doi: 10.1016/j.tvjl.2013.07.020pubmed: 23992870google scholar: lookup
  26. Harrison S, Vavken P, Kevy S, Jacobson M, Zurakowski D, Murray MM. Platelet activation by collagen provides sustained release of anabolic cytokines. Am J Sports Med (2011) 39(4):729–34.
    doi: 10.1177/0363546511401576pmc: PMC3176726pubmed: 21398575google scholar: lookup
  27. Theoret CL, Barber SM, Moyana TN, Gordon JR. Expression of transforming growth factor beta(1), beta(3), and basic fibroblast growth factor in full-thickness skin wounds of equine limbs and thorax. Vet Surg (2001) 30(3):269–77.
    doi: 10.1053/jvet.2001.23341pubmed: 11340559google scholar: lookup
  28. Desjardins I, Theoret C, Joubert P, Wagner B, Lavoie JP. Comparison of TGF-beta 1 concentrations in bronchoalveolar fluid of horses affected with heaves and of normal controls. Vet Immunol Immunopathol (2004) 101(3–4):133–41.
    doi: 10.1016/j.vetimm.2004.03.008pubmed: 15350743google scholar: lookup
  29. Schnabel LV, Mohammed HO, Miller BJ, McDermott WG, Jacobson MS, Santangelo KS. Platelet rich plasma (PRP) enhances anabolic gene expression patterns in flexor digitorum superficialis tendons. J Orthop Res (2007) 25(2):230–40.
    doi: 10.1002/jor.20278pubmed: 17106885google scholar: lookup
  30. Tablin F, Walker NJ, Hogle SE, Pratt SM, Norris JW. Assessment of platelet growth factors in supernatants from rehydrated freeze-dried equine platelets and their effects on fibroblasts in vitro. Am J Vet Res (2008) 69(11):1512–9.
    doi: 10.2460/ajvr.69.11.1512pubmed: 18980435google scholar: lookup
  31. Textor JA, Murphy KC, Leach JK, Tablin F. Ultrastructure and growth factor content of equine platelet-rich fibrin gels. Am J Vet Res (2014) 75(4):392–401.
    doi: 10.2460/ajvr.75.4.392pubmed: 24669926google scholar: lookup
  32. Dietz-Laursonn K, Beckmann R, Ginter S, Radermacher K, de la Fuente M. In-vitro cell treatment with focused shockwaves-influence of the experimental setup on the sound field and biological reaction. J Ther Ultrasound (2016) 4:10.
    doi: 10.1186/s40349-016-0053-zpmc: PMC4812651pubmed: 27030807google scholar: lookup
  33. Zell K, Sperl JI, Vogel MW, Niessner R, Haisch C. Acoustical properties of selected tissue phantom materials for ultrasound imaging. Phys Med Biol (2007) 52(20):N475–84.
    doi: 10.1088/0031-9155/52/20/N02pubmed: 17921571google scholar: lookup
  34. Metcalf KB, Mandelbaum BR, McIlwraith CW. Application of platelet-rich plasma to disorders of the knee joint. Cartilage (2013) 4(4):295–312.
    doi: 10.1177/1947603513487553pmc: PMC4297162pubmed: 26069674google scholar: lookup
  35. Dunkel B, Bolt DM, Smith RK, Cunningham FM. Stimulus-dependent release of tissue-regenerating factors by equine platelets. Equine Vet J (2012) 44(3):346–54.
  36. Ionita CR, Troillet AR, Vahlenkamp TW, Winter K, Brehm W, Ionita JC. Comparison of humoral insulin-like growth factor-1, platelet-derived growth factor-BB, transforming growth factor-beta1, and interleukin-1 receptor antagonist concentrations among equine autologous blood-derived preparations. Am J Vet Res (2016) 77(8):898–905.
    doi: 10.2460/ajvr.77.8.898pubmed: 27463555google scholar: lookup
  37. Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg (2004) 114(6):1502–8.
  38. Lee JW, Kwon OH, Kim TK, Cho YK, Choi KY, Chung HY. Platelet-rich plasma: quantitative assessment of growth factor levels and comparative analysis of activated and inactivated groups. Arch Plast Surg (2013) 40(5):530–5.
    doi: 10.5999/aps.2013.40.5.530pmc: PMC3785585pubmed: 24086805google scholar: lookup
  39. Del Bue M, Ricco S, Conti V, Merli E, Ramoni R, Grolli S. Platelet lysate promotes in vitro proliferation of equine mesenchymal stem cells and tenocytes. Vet Res Commun (2007) 31(Suppl 1):289–92.
    doi: 10.1007/s11259-007-0099-zpubmed: 17682897google scholar: lookup
  40. Schmitz JP, Hollinger JO. The biology of platelet-rich plasma. J Oral Maxillofac Surg (2001) 59(9):1119–21.
    doi: 10.1053/joms.2001.26801pubmed: 11526592google scholar: lookup
  41. Sun D, Junger WG, Yuan C, Zhang W, Bao Y, Qin D. Shockwaves induce osteogenic differentiation of human mesenchymal stem cells through ATP release and activation of P2X7 receptors. Stem Cells (2013) 31(6):1170–80.
    doi: 10.1002/stem.1356pmc: PMC4243484pubmed: 23404811google scholar: lookup
  42. Raabe O, Shell K, Goessl A, Crispens C, Delhasse Y, Eva A. Effect of extracorporeal shock wave on proliferation and differentiation of equine adipose tissue-derived mesenchymal stem cells in vitro. Am J Stem Cells (2013) 2(1):62–73.
    pmc: PMC3636727pubmed: 23671817

Citations

This article has been cited 11 times.
  1. Qiu Z, Wang J, Zhang Y, Liu X, Wei C, Ma T. Extracorporeal shock wave therapy for equine musculoskeletal disorders: from biological mechanisms to clinical applications. Front Vet Sci 2025;12:1719123.
    doi: 10.3389/fvets.2025.1719123pubmed: 41487475google scholar: lookup
  2. Carmona JU, López C, Argüelles D. Addressing Heterogeneity in Equine PRP Therapies: A Scoping Review of Methods, Evidence, and Commercial Validation. Animals (Basel) 2025 Dec 13;15(24).
    doi: 10.3390/ani15243586pubmed: 41463871google scholar: lookup
  3. Janout H, Flatscher J, Winkler SM, Slezak P, Slezak C. Use of Secondary Reflectors for Enhanced ESWT Treatment of the Penis. Biomedicines 2025 Aug 13;13(8).
    doi: 10.3390/biomedicines13081967pubmed: 40868220google scholar: lookup
  4. Daneshwar D, Lee Y, Nordin A. Stem cell assisted low-intensity shockwave for erectile dysfunction treatment: Current perspective. Regen Ther 2024 Jun;26:1150-1158.
    doi: 10.1016/j.reth.2024.11.006pubmed: 39640922google scholar: lookup
  5. Morya VK, Shahid H, Lang J, Kwak MK, Park SH, Noh KC. Advancements in Therapeutic Approaches for Degenerative Tendinopathy: Evaluating Efficacy and Challenges. Int J Mol Sci 2024 Nov 4;25(21).
    doi: 10.3390/ijms252111846pubmed: 39519397google scholar: lookup
  6. Toner S, Crosby C. Pro-stride and extracorporeal shockwave therapy as treatment of lateral collateral desmopathy of the proximal interphalangeal joint in a Dutch Warmblood gelding. Can Vet J 2023 Mar;64(3):268-274.
    pubmed: 36874545
  7. Rola P, Włodarczak A, Barycki M, Doroszko A. Use of the Shock Wave Therapy in Basic Research and Clinical Applications-From Bench to Bedsite. Biomedicines 2022 Feb 28;10(3).
    doi: 10.3390/biomedicines10030568pubmed: 35327369google scholar: lookup
  8. Rola P, Włodarczak A, Kulczycki JJ, Barycki M, Furtan Ł, Pęcherzewski M, Szudrowicz M, Włodarczak S, Doroszko A, Lesiak M. Efficacy and safety of shockwave intravascular lithotripsy (S-IVL) in calcified unprotected left main percutaneous coronary intervention - short-term outcomes. Postepy Kardiol Interwencyjnej 2021 Dec;17(4):344-348.
    doi: 10.5114/aic.2021.112524pubmed: 35126548google scholar: lookup
  9. Fan T, Zhou X, He P, Zhan X, Zheng P, Chen R, Li R, Li R, Wei M, Zhang X, Huang G. Effects of Radial Extracorporeal Shock Wave Therapy on Flexor Spasticity of the Upper Limb in Post-stroke Patients: Study Protocol for a Randomized Controlled Trial. Front Neurol 2021;12:712512.
    doi: 10.3389/fneur.2021.712512pubmed: 34566855google scholar: lookup
  10. Maleas G, Mageed M. Effectiveness of Platelet-Rich Plasma and Bone Marrow Aspirate Concentrate as Treatments for Chronic Hindlimb Proximal Suspensory Desmopathy. Front Vet Sci 2021;8:678453.
    doi: 10.3389/fvets.2021.678453pubmed: 34222402google scholar: lookup
  11. Wei B, Lu J. Characterization of Tendon-Derived Stem Cells and Rescue Tendon Injury. Stem Cell Rev Rep 2021 Oct;17(5):1534-1551.
    doi: 10.1007/s12015-021-10143-9pubmed: 33651334google scholar: lookup