Low-intensity extracorporeal shock wave therapy for pediatric respiratory diseases: current evidence and translational barriers.
- 1Department of Pediatrics, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Beijing, China.
- 2Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Abstract
Low-intensity extracorporeal shock wave therapy (Li-ESWT) has demonstrable mechanobiologic activity in nonpulmonary systems, where it has been linked to adenosine triphosphate (ATP) release and downstream signaling, macrophage and fibroblast responses, matrix remodeling, and tissue repair. Whether those effects extend to pediatric respiratory disease is uncertain. Adult clinical studies indicate biologic responsiveness in selected inflammatory or reparative settings, but effect sizes are variable and durability is often undemonstrated. Direct pulmonary evidence comes from bronchial cell cultures, including chronic obstructive pulmonary disease (COPD)-derived fibroblasts, and acute lung injury/acute respiratory distress syndrome models. These show biological responses without establishing a calibrated lung-tissue dose or a pulmonary safety window. The air-filled, acoustically heterogeneous lung presents physical challenges to pressure-wave delivery that nonpulmonary experience cannot resolve: interface reflections, inflation-dependent energy scatter, and uncertain lesion depth collectively mean that energy deposition in lung tissue remains poorly characterized. In children, these physical uncertainties are compounded by ongoing alveolarization, age-dependent chest-wall mechanics, and the absence of pediatric device data. This narrative review integrates cross-organ mechanistic studies, pulmonary cellular and animal data, pediatric respiratory biology, and ethics and device-governance literature to define what lung-directed preclinical work is needed and why pediatric pulmonary trials are not yet justified. Pulmonary dosimetry, injury-threshold characterization, standardized adverse-event monitoring, and adult pulmonary pilot safety data must precede any consideration of pediatric enrollment.
Related
- Effects of metallic components in ambient PM₂.₅ on pediatric respiratory diseases in Shijiazhuang
- Inhaled nucleic acid therapeutics for respiratory diseases: delivery barriers, translational challenges, and emerging solutions.
- Low-intensity extracorporeal shockwave therapy for chronic prostatitis/chronic pelvic pain syndrome: a retrospective single-center observational study in Japan
- Low-energy extracorporeal shock wave therapy for interstitial cystitis/bladder pain syndrome: mechanisms, evidence, and translational perspectives—a narrative review
- "White-Out Lung" Following Veno-Venous Extracorporeal Membrane Oxygenation (ECMO) Initiation for Acute Refractory Respiratory Failure From Obstructive Lung Disease: A Case Series.
BibTeX
@article{su2026lowintensity,
title = {{Low-intensity extracorporeal shock wave therapy for pediatric respiratory diseases: current evidence and translational barriers.}},
author = {Xingyue Su and Die Liu and Jing Liu and Di Lv and Jianning Guo and Qin Hui and Fang Ye and Yuanmei Chen and Chao Wang and Lijuan Tang and Meihong Xia and Qi Zhang},
journal = {Frontiers in pediatrics},
year = {2026},
month = oct,
doi = {10.3389/fped.2026.1876906},
url = {https://europepmc.org/article/MED/43011667},
note = {CC BY},
}
RIS
TY - JOUR
TI - Low-intensity extracorporeal shock wave therapy for pediatric respiratory diseases: current evidence and translational barriers.
AU - Xingyue Su
AU - Die Liu
AU - Jing Liu
AU - Di Lv
AU - Jianning Guo
AU - Qin Hui
AU - Fang Ye
AU - Yuanmei Chen
AU - Chao Wang
AU - Lijuan Tang
AU - Meihong Xia
AU - Qi Zhang
PY - 2026
DA - 2026/10/27
JO - Frontiers in pediatrics
DO - 10.3389/fped.2026.1876906
UR - https://europepmc.org/article/MED/43011667
AB - Low-intensity extracorporeal shock wave therapy (Li-ESWT) has demonstrable mechanobiologic activity in nonpulmonary systems, where it has been linked to adenosine triphosphate (ATP) release and downstream signaling, macrophage and fibroblast responses, matrix remodeling, and tissue repair. Whether those effects extend to pediatric respiratory disease is uncertain. Adult clinical studies indicate biologic responsiveness in selected inflammatory or reparative settings, but effect sizes are variable and durability is often undemonstrated. Direct pulmonary evidence comes from bronchial cell cultures, including chronic obstructive pulmonary disease (COPD)-derived fibroblasts, and acute lung injury/acute respiratory distress syndrome models. These show biological responses without establishing a calibrated lung-tissue dose or a pulmonary safety window. The air-filled, acoustically heterogeneous lung presents physical challenges to pressure-wave delivery that nonpulmonary experience cannot resolve: interface reflections, inflation-dependent energy scatter, and uncertain lesion depth collectively mean that energy deposition in lung tissue remains poorly characterized. In children, these physical uncertainties are compounded by ongoing alveolarization, age-dependent chest-wall mechanics, and the absence of pediatric device data. This narrative review integrates cross-organ mechanistic studies, pulmonary cellular and animal data, pediatric respiratory biology, and ethics and device-governance literature to define what lung-directed preclinical work is needed and why pediatric pulmonary trials are not yet justified. Pulmonary dosimetry, injury-threshold characterization, standardized adverse-event monitoring, and adult pulmonary pilot safety data must precede any consideration of pediatric enrollment.
SN - 2296-2360
ER -