Researchers at The University of Alabama in Huntsville (UAH), part of The University of Alabama System, have identified a promising new use for continuous low-intensity ultrasound that could one day help treat joint injuries and reduce the risk of post-traumatic osteoarthritis. Their findings suggest the non-invasive approach may shift the body’s immune response away from long-lasting inflammation and toward tissue repair, offering a potential drug-free strategy for improving healing.
The study, published in the Nature journal Scientific Reports, was led by Dr. Anuradha Subramanian, professor of chemical and materials engineering. It combined biological research conducted by Dr. Shahid Khan during his doctoral studies with computational and statistical analysis developed by Dr. Satyaki Roy, professor of mathematical sciences, along with contributions from graduate student Owen Trippany. The research was funded by the National Institutes of Health through an R01 grant awarded to Subramanian.
How Ultrasound Influences Immune Cells
The team focused on macrophages, specialized immune cells that play a key role in both inflammation and tissue repair, to understand how they respond to continuous low-intensity ultrasound.
“Following injury, the body recruits inflammatory ‘defender’ macrophages (M1) to clear damaged tissue and healer macrophages (M2) to support repair and recovery,” Subramanian explains. “Persistent dominance of defender macrophages can create a prolonged inflammatory environment that contributes to post-traumatic osteoarthritis.”
The researchers wanted to determine whether ultrasound could encourage these immune cells to transition from an inflammatory state to one that promotes healing.
“In an ‘M1’ state, microphages promote inflammation to fight damage or infection, but prolonged M1 activity can also harm healthy tissue,” Subramanian notes. “In contrast, ‘M2-like’ macrophages support tissue repair and recovery. Shifting macrophages toward an M2-like state is important, because it may help reduce chronic inflammation while encouraging healing in damaged joints. Our findings suggest that continuous low-intensity ultrasound may help restore this balance by promoting a more reparative macrophage response.”
Roy says chronic inflammation is a major factor in the development of post-traumatic osteoarthritis.
“Post-traumatic osteoarthritis is driven in part by persistent inflammation that limits tissue repair and accelerates joint degeneration,” Roy adds. “Our team is interested in continuous low-intensity ultrasound because it offers a non-pharmacological, non-invasive approach that may help regulate immune cell behavior and promote a more reparative healing environment in injured joints.”
A More Realistic Model of Joint Injury
To better recreate the conditions inside an injured joint, the researchers relied on fibronectin fragments, molecules generated as damaged tissue breaks down, instead of using only conventional laboratory methods to trigger inflammation. This approach produced a model that more closely reflects the biological environment that develops after a joint injury.
The team also combined transcriptomics, the large-scale study of gene activity, with an advanced computational method known as differential clustering. Rather than analyzing genes one by one, this technique identifies groups of genes whose behavior changes together, providing a broader picture of how immune cells respond to ultrasound treatment.
“This allowed us to study not only which genes changed, but also how groups of genes changed their coordinated behavior in response to ultrasound stimulation,” Roy says.
Early Results Show Reduced Inflammation
The researchers found that continuous low-intensity ultrasound lowered biological markers linked to inflammation while increasing markers associated with a more reparative, M2-like macrophage state.
Although the research is still limited to laboratory experiments, the findings suggest that non-drug, non-invasive technologies could eventually be used to influence immune cell behavior and improve healing after joint injuries. The researchers believe the technique could become part of future treatments designed to slow the progression of osteoarthritis and improve recovery after joint trauma.
“The next steps will involve validating these findings in animal models of early post-traumatic osteoarthritis and studying how ultrasound-based modulation affects long-term tissue repair in joint injury settings,” Subramanian says.