Figure 8.

Schematic of the proposed mechanism for the shockwave-induced increase in extracellular matrix (ECM) synthesis in chondrocytes. Shockwaves induced reactive oxygen species (ROS) production mainly through xanthine oxidase (XO) in porcine articular chondrocytes. Transient ROS signaling activated the phosphorylation of ERK1/2 and p38, which increased the nuclear translocation of Nrf2 and the downstream gene expressions of Ho-1 and Nqo-1. Activation of Nrf2 function increased ECM production in porcine articular chondrocytes.