The clinical observation of an immediate vasodilatation and
laboratory findings of an enhancement of angiogenesis around
the ESW-treated area immediately give rise to the hypothesis
that ESWmay modulate the production of NO. In this respect,
we have reported that NO is produced non-enzymatically by
the treatment of a L L-arginine/hydrogen peroxide mixture with
ESW, although this NO production requires higher energy
potencies (0.89 mJ/mm2
) than those employed clinically [12].
More recently, we have demonstrated that ESW, at a clinically
compatible energy density, are able to induce the enhancement
of enzymatic NO production in resting cells [13]. Indeed, we
have showed that ESW quickly enhance eNOS activity and
NO production in human umbilical vein endothelial cells (HU-
VEC).