Page 27 - VOL 26 N. 72 - 2015

June 5, 2015 - Auditoire A. Tissot
FREE COMMUNICATIONS 4
IMMUNOLOGICAL EXAMINATIONS OF THE SECONDARY LYMPHEDEMA
Department of Dermatology, Sakai hospital, Kinki University, School of Medicine, Osaka, Japan, *Department of Gynecology&Obstetrics, National Osaka Médical Center South
It has been said a bacterial complication occurs only in the lymphedematous skin because the involved skin has an impaired immunity. To answer the question this examainations are performed.
Methods: Various immunological examinations are preformed in randomely selected ones out of 589 secondary lymphedema patients. PPD skin tests are done after selecring the patients observed before 1997 when 97% of adults were test positive. Both PPD test and PHA are compared with senile volunteers and with the ones with malignant neoplasma in the past history. PPD is also compared with young controls.
Results: Peripheral monocyte count, C3, C4 and CH50 are high in some patients. Results of PPD tests of the lymphedematous skin are not statistically different from those of the uninvolved extremity (p>0.0 5).
They are weaker than in young and senile controls. Rwesults of PHA are similar with weaker reactions in the lymphedema than in the aged and in the patients with maligant neoplasma in the past. Both PHA (p>0.2) and PPD skin test (p>0.3) are not different in two groups, the one with and the other without past history of bacterial complications.
Discussions: lncreaased monocyte count and complements suggest the lymphedematous skin is always invaded by small amount of bacteria with innate immunological reactions. Bacterial complications ocurrs only in the lymphedematous skin not because its immunity is impared but because the edematous skin has a weaker barrier due to a swollen, moist & warm skin caused by adhazed digits receiving desquamating microtrauma easily.
Conclusions: Innate immunoogical reactions are activated in the lymphedema. Although lymphedematous skin is not specially impared in immunology as compared with the uninvolved skin, lymphedema patients have decreased delayed immunity than senile controls.
MORIYA OHKUMA, TAKAYOSHI KANDA*
UNRAVELING THE PATHOBIOLOGY OF LYMPHEDEMA
E. GOUSOPOULOS, K. LEU, S. PROULX, M. UECKER, S. KARAMAN, M. DETMAR
Institute of Pharmaceutical Sciences, ETH Zurich, Vladimir Prelog Weg 1-5/10, CH-8093, Zurich, Switzerland Email: e.gousopoulos@pharma.ethz.ch
Introduction: Lymphedema is a major health problem that occurs in up to 30% of breast cancer patients after surgical lymph node excision. Lymphedema is associated with arm swelling, fibrosis, increased risk of infection and impaired wound healing. At present, there are no curative therapies for secondary, post-surgical lymphedema, and even symptomatic therapies have little beneficial effect. Thus, there is an urgent need to better understand the mechanisms of lymphatic drainage and to develop new therapeutic strategies to promote lymphatic vessel regeneration and function after surgery.
Materials and Methods: A mouse-tail lymphedema model has been used removing a circumferential band of skin 2cm below the tail base and ablating the collecting lymphatic vessels. Fluid stasis induced lymphedema that was established within 2 weeks and maintained for a minimum of 6 weeks. Next-generation-sequencing of lymphedema tissue, (immuno)histological analysis, flow cytometry analysis and in vivo imaging have been used to investigate the pathophysiology of lymphedema development and progression.
Results: Our data obtained depict the complexity of the disease and identified the interplay between inflammation and lymphatic vasculature in the pathogenesis of lymphedema. Prevailing inflammation and thus infiltration of specific types of T cells and leukocytes appear to play a critical role in the establishment of lymphedema. Lymphangiogenesis by remodelling with dilation and proliferation of lymphatic vessels during early lymphedema establishment as well as both systemic and local increase of lymphangiogenic factors indicate an active participation of the lymphatic vessels in the disease progression.
Conclusions: Our data constitute a roadmap of lymphedema development indicating an important yet undefined role of specific immune cell subset infiltrates as well as distinct chemokines and cytokines. Further studies should offer mechanistic insights into their involvement in lymphedema and potential use as targets of therapeutic interventions.
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THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015