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Received Nov 1, 2017; Revised Jan 20, 2018; Accepted Feb 1, 2018
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1. Introduction
Rhabdomyolysis is a clinical syndrome characterized by muscle necrosis and loss of muscle function, resulting in the intracellular muscle constituents (e.g., electrolytes, myoglobin, creatine kinase, aldolase, lactate dehydrogenase, alanine aminotransferase, and aspartate aminotransferase) released into the circulation [1, 2]. The causal etiology of acute rhabdomyolysis is multifactorial, including those of acute ischemia-reperfusion (IR) injury, strenuous exercise, anesthesia, drug- or toxin-induced myopathies, muscle compression (e.g., crush syndrome or prolonged immobilization), hyperthermia, metabolic myopathies, electrolyte disorders, or even viral infections [1–8].
Increased circulating levels of myoglobin and creatine phosphokinase (CPK) (i.e., CK-MM form) are common biomarkers found after acute rhabdomyolysis. Additionally, the clinical manifestations and diagnosis of rhabdomyolysis include acute kidney injury and related metabolic complications. Furthermore, an increased intracellular calcium leads to the activation of proteases, increasing contractility of skeletal muscle cell, mitochondrial dysfunction and depletion of adenosine triphosphate (ATP) (i.e., results attributed to the dysfunction of the Na/K-ATPase and Ca2+-ATPase pump), and increase of reactive oxygen species (ROS) production as well as inflammatory reaction, resulting in skeletal muscle cell death [8].
Clinical observational study has shown that acute kidney injury (an estimated incidence from 13% to over 50% depending on both the cause and the clinical and organizational setting where they are diagnosed) [9] which is a serious complication of acute rhabdomyolysis will cause an unacceptably high morbidity and mortality [1] event undergoing the aggressive treatment such as decompression of compartment syndrome, restoration of ischemic etiology, diuretic agents, antioxidant therapy, or renal replacement therapy [10]. Accordingly, developing an alternative option with safety and efficacy is of paramount importance for physicians and patients.
Extracorporeal shock wave (ECSW) therapy is currently applied widely to muscle-skeletal disorders and rehabilitative medicine [11–14]. Additionally, studies have shown that ECSW plays a crucial role in regenerative medicine [15–18]. Moreover, growing data have demonstrated that ECSW has anti-inflammation angiogenesis properties [15, 17–20]. Interestingly, abundant data have shown that mesenchymal stem cells (MSCs), especially those of adipose-derived MSCs (ADMSCs), have strong capacity of anti-inflammation and immunomodulation as well as...