Low-intensity extracorporeal shock wave therapy ameliorates fibrosis and renal function in a preclinical model of chronic kidney disease

This study investigates the potential therapeutic effects of low-intensity extracorporeal shock wave therapy (Li- ESWT) in the treatment of chronic kidney disease (CKD) using a preclinical mice model, which was established by high adenine diet. Four experimental groups were formed: normal (NL), NL+Li-ESWT (NL+ESWT), CKD, and CKD+Li-ESWT (CKD+ESWT), and received appropriate interventions over a period of 3 weeks. Immunohistochemistry analysis revealed significant upregulation of HSP70 expression, a marker for cells affected by mechanical stimulus, in the NL+ESWT group, confirming successful delivery of Li-ESWT to kidney tissues. Body weight, kidney weight, blood urea nitrogen (BUN), and creatinine values showed no significant differences between the NL and NL+ESWT groups, indicating that Li-ESWT alone did not affect these parameters. However, in the CKD+ESWT group, although kidney weight did not significantly differ from the CKD group, both body weight and renal function parameters showed marked improvement compared to the CKD group, suggesting a positive impact of Li-ESWT on general condition and renal function in CKD. The following histological examination showed that the CKD+ESWT group exhibited significantly reduced tubulointerstitial injury and fibrosis compared to the CKD group, further supporting the therapeutic potential of Li-ESWT in CKD management. To reveal potential modulation of ESWT on the upstream of fibrosis, fibrosis-related gene expressions, ^i.e., Acta2, Col1a1, Col3a1, and Fn1, were examined. The results demonstrated a significant reduction in the expression of fibrosis-related genes in the CKD+ESWT group compared to the CKD group, highlighting the molecular effects of Li-ESWT in mitigating CKDassociated fibrosis.