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

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 <i>in vivo</i>. 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 <i>in vivo</i> 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.