{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:19:53Z","timestamp":1792790393170,"version":"4.5.0"},"reference-count":57,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2024,10,31]],"date-time":"2024-10-31T00:00:00Z","timestamp":1730332800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Antwerp, Belgium"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Fibrosis is characterized by scarring and hardening of tissues and organs. It can affect every organ system, and so could result in organ failure due to the accumulation of extracellular matrix proteins. Previous studies suggest that mechanical forces (such as shockwave therapy, SWT) initiate a process of mechanotransduction and thus could regulate fibrosis. Nevertheless, it is largely unexamined which pathways are exactly involved in the application of SWT and can regulate fibrosis. The present article seeks to elucidate the underlying effect of SWT on fibrosis. Evidence shows that SWT activates macrophage activity, fibroblast activity, collagen amount and orientation and apoptosis, which ultimately lead to an adaptation of inflammation, proliferation, angiogenesis and apoptosis. The included articles reveal that other proteins and pathways can be activated depending on the energy levels and frequency of SWT. These findings demonstrate that SWT has beneficial effects on fibrosis by influencing the proteins and pathways. Based on these data, which highlights the underlying mechanisms, we can make preliminary conclusions about the treatment modalities of SWT in scar formation, such as the energy levels and frequencies that are necessary to prevent or treat fibrotic tissue.<\/jats:p>","DOI":"10.3390\/ijms252111729","type":"journal-article","created":{"date-parts":[[2024,10,31]],"date-time":"2024-10-31T12:31:32Z","timestamp":1730377892000},"page":"11729","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Systematic Review on Working Mechanisms of Signaling Pathways in Fibrosis During Shockwave Therapy"],"prefix":"10.3390","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0710-1226","authenticated-orcid":false,"given":"Lot","family":"Demuynck","sequence":"first","affiliation":[{"name":"Research Group MOVANT (Movement Antwerp), Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, 2610 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4748-6314","authenticated-orcid":false,"given":"Sarah","family":"Moonen","sequence":"additional","affiliation":[{"name":"Research Group MOVANT (Movement Antwerp), Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, 2610 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filip","family":"Thiessen","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Multidisciplinary Breast Clinic, Antwerp University Hospital, 2610 Antwerp, Belgium"},{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Ziekenhuis Aan de Stroom, 2020 Antwerp, Belgium"},{"name":"Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Care Sciences, University of Antwerp, 2650 Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9357-2099","authenticated-orcid":false,"given":"Ina","family":"Vrints","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Multidisciplinary Breast Clinic, Antwerp University Hospital, 2610 Antwerp, Belgium"},{"name":"Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Care Sciences, University of Antwerp, 2650 Edegem, Belgium"},{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Heilig Hart Ziekenhuis, 2500 Lier, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6840-762X","authenticated-orcid":false,"given":"Peter","family":"Moortgat","sequence":"additional","affiliation":[{"name":"Organisation for Burns, Scar Aftercare and Research: OSCARE, 2170 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6383-2961","authenticated-orcid":false,"given":"Jill","family":"Meirte","sequence":"additional","affiliation":[{"name":"Research Group MOVANT (Movement Antwerp), Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, 2610 Antwerp, Belgium"},{"name":"Organisation for Burns, Scar Aftercare and Research: OSCARE, 2170 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"van Breda","sequence":"additional","affiliation":[{"name":"Research Group MOVANT (Movement Antwerp), Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, 2610 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6967-006X","authenticated-orcid":false,"given":"Ulrike","family":"Van Daele","sequence":"additional","affiliation":[{"name":"Research Group MOVANT (Movement Antwerp), Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, 2610 Antwerp, Belgium"},{"name":"Organisation for Burns, Scar Aftercare and Research: OSCARE, 2170 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,31]]},"reference":[{"key":"ref_1","first-page":"933","article-title":"Lower energy radial shock wave therapy improves characteristics of hypertrophic scar in a rabbit ear model","volume":"15","author":"Zhao","year":"2018","journal-title":"Exp. 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