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This difference is primarily attributable to the cyclic respiratory shear forces to which chest wall PEEK implants are subjected. However, the mechanisms by which cyclic respiratory shear force influences soft\u2010tissue integration around the PEEK interface have rarely been reported. Herein, we constructed an in vitro dynamic culture system to simulate the respiration\u2010induced shear force at the PEEK\u2010soft tissue interface. Our results showed that moderate alternating shear force promoted fibroblast proliferation and M2 macrophage polarization. Co\u2010culture experiments revealed that activated L929 fibroblasts induced M2 polarization of macrophages via paracrinally produced transforming growth factor beta 1 (TGF\u2010\u03b21). Inversely, macrophages facilitated L929 fibroblast adhesion and migration by secreting TGF\u2010\u03b21. Molecular tension probe measurements further demonstrated that integrin \u03b21 (ITGB1) was activated at 12 pN. Animal experiments confirmed superior soft\u2010tissue integration around chest wall PEEK implants compared with craniomaxillofacial implants. These findings elucidate the core molecular mechanisms by which dynamic shear force mediates soft tissue integration at the PEEK\u2010tissue interface, thereby providing theoretical support for the clinical application of PEEK implants.<\/jats:p>","DOI":"10.1002\/advs.77118","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T11:48:57Z","timestamp":1786967337000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Alternating Shear Force of Respiration Regulates Cell Interactions of Fibroblasts and Macrophages to Promote Soft Tissue Integration of Chest Wall Polyetheretherketone Implants"],"prefix":"10.1002","author":[{"given":"Rou","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Tangdu Hospital The Fourth Military Medical University  Xi'an China"},{"name":"School of Advanced Materials and Nanotechnology Xidian University Xi'an 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