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Chronische Lymphödeme (cLÖ)- Entstehung und naturheilkundliche Therapie, unter bes. Berücksichtigung der Regulativen Enzymtherapie/ Enzyme therapy and lymphedema treatment

Ich freue mich sehr diesen wissenschaftlichen Artikel mit euch teilen zu dürfen. Es ist mir eine große Ehre das Dr. Inderst für meinen Blog und alle die Hilfe brauchen dieses zur Verfügung gestellt hat. Herzlichen Dank nochmal an dieser Stelle!

I’m very happy and proud to be able to present a very interesting article about enzymes and how they can help to cope with Lymphedema. I am the best example, I’ve been taking enzymes, vitamins, high dosage D3, selenium and antioxidants for years and due to that and other methods that I am using I am able to lead an almost normal life. I’m very proud that Dr. Inderst has taken the time to write about this especially for my blog and my international readers. If you have any questions let me know and I’ll be happy to help.

 

Chronische Lymphödeme (cLÖ)- Entstehung und

naturheilkundliche Therapie, unter bes. Berücksichtigung der Regulativen Enzymtherapie

 

Dr. med. Rudolf Inderst

MEF (Medizinische Enzymforschungsgesellschaft) eV, Grassau

 

Einleitung


Lymphödeme sind keineswegs seltene Erscheinungen: In Deutschland sind ca. 4,5 Millionen Menschen von dieser Krankheitseinheit  betroffen, weltweit 60 bis 120 Millionen. Angesichts der großen Zahl von Patienten verwundert es, dass z. B. im Gegensatz zu Forschungsansätzen bei  der Rheumatoiden Arthritis (in Deutschland 1,2 Millionen Betroffene) nur wenige fachärztliche Kongresse durchgeführt werden oder/und auch nur wenige aktuelle wissenschaftliche Traktate existieren.  Auch Medizinstudenten erfahren viel über Arterien und Venen, aber viel zu wenig über Lymphgefäße.  Dabei waren die weiße Flüssigkeit führenden Gefäße bereits im Altertum bekannt, ihre entscheidende Bedeutung in der Humoralmedizin durchaus verstanden, aber in der modernen Medizin werden Lymphgefäße eher stiefmütterlich behandelt. So gibt es keine eigene Zusatzbezeichnung in der Weiterbildungsordnung für Ärztinnen und Ärzte und auch Fachkliniken zur spezifischen Behandlung  sind spärlich in Deutschland. Bedauerlicherweise sind diese Kliniken zumeist private Einrichtungen und sind daher aus Kostengründen für die Betroffenen schwer zugängig.

 

Ursachenforschung

Ursachen für das csLÖ sind in Europa chronische Entzündungen, Tumorinfiltration in Lymphgefäße, postoperative Lymphadenektomie und nach Bestrahlung von Tumoren auftretende Veränderungen. Hier ist das Mammakarzinom die häufigste Ursache.

Nicht zu vergessen ist das Postthrombotische Syndrom -nach wiederholten Venenentzündungen oder Thrombosen-, in dessen Gefolge eine chronisch-venöse Insuffizienz mit sekundärem Lymphödem auftritt.

Bei intensivem Studium der weltweiten Literatur finden sich wichtige neue Erkenntnisse hinsichtlich der einzelnen pathologischen Entwicklung des Lymphödems.

Basis der Erkenntnis ist, dass sich ein LÖ aufgrund eines erhöhten Druckes innerhalb der Lymphgefäße entwickelt und dass es – im Gegensatz zu kardialen Ödemen- ein eiweißreiches Ödem ist. Daraus folgen reaktive Schritte des umgebendes Gewebes bzw. der Lymphgefäße. Schon mit bloßem Auge und bes. lichtmikroskopisch ist die zunehmende Sklerosierung/  Fibrosierung des Gewebes besonders in den höheren Stadien (Stadium 2 + 3) zu erkennen. Dadurch wird das subkutane Fettpolster verschmälert und die Verletzbarkeit in diesen Bezirken nimmt zu: Mögliche Eintrittspforten für pathogene Keime. Die seit vielen Jahren bekannten und immer wiederkehrenden Entzündungsreaktionen (Erysipele) sind die typische Folge.

Biochemisch lassen sich im betroffenen Gewebe vermehrt sog. Matrix- Metallo-Proteasen( MMP 1,3,9) nachweisen, die einen erhöhten Abbau von spezifischem Bindegewebsstrukturen einleiten. Die Konzentration der Gegenspieler (TIMPS) ist erniedrigt, wie das schon bei chronisch nicht heilenden Wunden beobachtet wurde. Gleichzeitig wird aus den ins umliegende Gewebe auswandernden Phagozyten und aus dem Gewebe präformiertes TGF beta in unphysilogisch hohen Konzentrationen freigesetzt und damit die Fibrosierung des Gewebes in Gang gesetzt bzw. unterhalten. Einige Forscher zeigten zudem in Tierstudien, dass zusätzlich abnorm hohe Spiegel von IL 6 auftreten und so in Verbindung zu erhöhtem TGF eine typische chronische Entzündung induzieren. Interessanterweise verfügen die in das betroffene Gebiet auswandernden  und hochaktiven Makrophagen/Phagozyten über deutlich erhöhte Konzentrationen von Defensinen, auch Lysozym: Das gleiche gilt für die in diesem Gebiet befindlichen Keratinozyten: Konstitutionell ist bereits Lysozym vorhanden und nach einem Trauma bilden sich alpha- und beta-Defensine. Das bedeutet, dass der Organismus mit Hilfe von Defensinen möglichen Infektionen gegensteuern will!

Stadieneinteilung:

Üblicherweise werden LÖ in 3 unterschiedliche Schwergrade eingeteilt, wobei angenommen wird, dass bis zum Stadium 2 eine (Defekt)-Heilung möglich ist. Das Vor- oder Latenzstadium (Stadium 0) kann lebenslang bestehen oder in das Stadium I übertreten, wenn keine adäquate Behandlung durchgeführt wird. Das noch weiche Ödem (typische Dellenbildung) lässt sich durch gezielte Hochlagerung des Beins gut beeinflussen. Allerdings hat bereits zu diesem Zeitpunkt eine Fibrosierung des Gewebes eingesetzt. Schreitet die Erkrankung fort, lässt sich die Schwellung auch durch Hochlagerung des Beins nicht mehr beseitigen. Aus der teigigen Schwellung entwickelt sich die für das III. Stadium typische harte Schwellung bzw. eine Elephantiasis. Dazu treten irreversible Hauterscheinungen wie Verfärbungen auf. Ob operative Maßnahmen dann noch sinnvoll sind, sollten lymphologisch geschulte Ärzte zusammen mit Chirurgen entscheiden.

Therapiemöglichkeiten:

Die erste naturheilkundliche Maßnahme sollte  sein:

Zufuhr von hochaktiven Proteasen wie Bromelain, Lysozym und Trypsin und parallele Gabe von Antioxidantien (z. B. innovazym, Fa Innova Vital). Damit werden die übermäßig ablaufenden entzündlichen Vorgänge sinnvoll herab geregelt!

Beispielsweise können Selen und sekundäre Pflanzenstoffe zugeführt werden, die dann als intra- und extrazellulär wirksame Antioxidantien zur Verfügung stehen, wie Zink, die Vitamine C und E sowie Lysozym!

Messbar führen solche Veränderungen im Lymphgefäßbereich zu erhöhtem oxidativen Stress und der ungewöhnliche Druck erniedrigt zusätzlich die lokale Sauerstoffversorgung. Selbst In der neueren Heilkunde hatte man daher zu Recht von einer “Versumpfung” des Gewebes gesprochen, in der biologischen Medizin werden  Begriffe wie “Verschlackung und Übersäuerung” verwendet.

Schon seit langen ist bekannt, dass sich bei chronisch verlaufenden Entzündungen die körpereigenen anti-oxidativen Schutzsysteme (Glutathion etc.) zunehmend erschöpfen und damit die Radikalenbildung zunimmt. Folge ist unter anderem auch eine vermehrte Durchlässigkeit von Gefäßen.

In diesem Zusammenhang sollte auf die additive Wirkung von Vitamin D3 (D- Mulsin) hingewiesen werden. Aktuelle immunologische Forschungen zeigen den nachhaltigen Einfluss dieser Substanz nicht nur auf Immunzellen (Phagozyten, B-Zellen, regulatorisch wirksame T-Zellen), sondern auf den die chronische Entzündung fördernden Botenstoff NK kappa B, der aufgrund der vorne angegebenen Ereignisse in der Lage ist, dauerhaft die sog. Entzündungsgene anzuschalten. Aufgrund persönlicher  Erfahrungen sowie Erkenntnissen der Literatur kann eine tägliche Dosis von 2-3.000 IE empfohlen werden.

Die 2. naturheilkundliche Maßnahme muss sein: Entsäuerung , Verminderung der Durchlässigkeit sowie Erhöhung des Lymphflusses:

Es ist histologisch erwiesen, dass sich im betroffenen Gewebe eine chronische Entzündung entwickelt, wobei es also neben erhöhtem Druck zusätzlich zu Permeabilitätsstörungen der Lymphgefäße kommt. Chronische Entzündungen führen zur lokalen Azidose, daher sind auch Basenmittel angezeigt! Permeabilitätsstörungen wirken Bioflavonoide gut entgegen, daher ist innovazym plus (mit Omega 3 Fettsäuren, Dosierung 7 Tabletten/Tag  und Hinweis auf Nüchterneinnahme)  in Kombination mit innova balance besonders wirksam.  Sogar eine gewisse Erhöhung des Lymphflusses lässt sich zudem mit Proteasen erzielen. Die Lymphdrainage  (Achtung Gegenanzeigen bei noch bestehenden Tumoren!) führt zu deutlicher Anregung des Lymphflusses und ist daher in das Gesamttherapiekonzept zu integrieren.

Erfahrungsgemäß liegt bei vielen Betroffenen aufgrund der langandauernden Erkrankung sowie diversen Therapieversuchen mit Antibiotika auch eine Störung der Darmflora vor. Es empfiehlt sich beispielsweise ein 3 Monatskur mit Enterokokken (Symbioflor1) oder Laktobazillen/Bifidobakterien (Symbiovital) ggf. mit Mutaflor (E. coli Stamm).

Die hier angeführten Erkenntnisse und Ergebnisse stützen sich auf die Erfahrungsheilkunde,  sie sind aber aufgrund der Vielzahl von Therapeutika  nicht im Sinne der klassischen Medizin in DB-Plazebo-kontrollierten Studien untersucht worden. Kann es den chronisch leidenden Menschen zugemutet werden auf  “saubere klinische Ergebnisse” zu warten, die sich aufgrund der Komplexität ohnehin nur schwer erbringen lassen?

Allerdings: Die parallele Maßnahme muss sein, den bestehenden Druck dauerhaft zu senken. Das wird durch die komplexe Entstauungstherapie erreicht.

Die in situ verbleibende Flüssigkeitsmenge erzeugt zunehmenden Druck und führt zur Erweiterung der Lymphgefäße. Der normale Aufbau der Lymphgefäße Intima, Media mit Muskelschicht und Adventitia (Aussenschicht) verändert sich.

Nachdem offensichtlich im Gewebe ein Sauerstoffmangelzustand herrscht, kommt für den naturheilkundlichen Therapeuten auch die Verwendung von OZON (ROCKITANSKY-STIEFEL) bzw. die intravenöse Sauerstofftherapie nach  Dr. REGELSBERGER in Betracht.

Die Leitlinie der klassischen Medizin stellt die Pathophysiologie/Entstehung des chronischen LÖ ähnlich dar, misst aber medikamentösen Maßnahmen wenig Bedeutung zu, insb. bleiben die hier vorgetragenen Therapiemaßnahmen unerwähnt. Dadurch ist der Patient u.a. gezwungen, die Kosten für diese wertvollen Maßnahmen selbst zu übernehmen.

Es ist aber nicht auszuschließen, dass die Zukunft hier Veränderungen bringt: Schon jetzt (2011) werden Bromelain bzw. Kombinationen und Antioxidantien in der Zeitschrift für Komplementärmedizin als sinnvoll und nachhaltig dargestellt.

Die Ernährung sollte im Sinne der biologischen Gesamt-Situation umgestellt und auf den (chronisch einwirkenden) Stress muss geachtet werden! Hitzeeinwirkungen (Sauna, Sonnenbaden etc.)auf die Lymphödeme sind strikt zu meiden. Hochdruckmittel, die Diuretika enthalten, sollten solche Patienten nicht einnehmen, da sie auf das eiweißreiche Ödem keinen Einfluss nehmen!

Chirurgische Therapiemöglichkeiten:

Derzeit gibt es zwar einige erfolgsversprechende Therapiemethoden -wie die sie z. B. an der Universität in Freiburg in Zusammenarbeit mit der Foeldi -Klinik  oder plastisch-chirurgischen Abteilungen an anderen Universtäten in Erlangen oder Heidelberg praktiziert werden- aber die möglichen Verfahren haben sich deutschlandweit bisher nicht durchgesetzt. Eine gute Übersicht über die derzeitigen Möglichkeiten finden die Betroffenen in der im Internet befindlichen Seite des “Vereins zur Förderung der Lymphödemtherapie e.V.”)

Prophylaxe derzeit unzureichend

Natürlich wäre es optimal, die Patienten im Vorfeld (vor OP/Behandlung) eingehend auf die mögliche Entstehung eines LÖ zu unterrichten und sofort nach OP auch mit der Behandlung zu beginnen. Die jetzige Situation ist aber dadurch gekennzeichnet, dass die Mehrzahl der Patienten weder nach OP eine Rehabilitation durchläuft noch über die therapeutischen Möglichkeiten unterrichtet wird. Das ist ein Versäumnis, das man nicht den Ärzten, sondern in erster Linie den Krankenkassen anlasten muss.

Literatur (Auswahl)

Földi E et al.: Zur Diagnostik und Therapie  des Lymphödems. Deutsches Ärzteblatt 95, 1998

GfbK INFO: Lymphödeme. 2015

Inderst R. Chronische low-Level Entzündungen. EHK 66, 2017

Korpan M: Behandlung des Lymphödems mit Enzymen. MMW Taschenbuch, Herausg.: Wrba H et al München 1997

Kraft K: Lymphödem. MMW-Fortschr. Med. Nr. 16/2001

Negar Vaezipour:

Inzidenz und Risikofaktoren des sekundären Lymphödems nach Therapie des Mammakarzinoms

DISSERTATION Freiburg 2015

 

Siems W und R Brenke: Chronische Lymphödeme umfassend behandeln. DAZ 38/2004

AWMF Leitlinie : Diagnostik und Therapie der Lymphödeme-2009

 

 

 


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Livestream Symposium: The Genetic Basis of Primary LE in Humans, Current State of the Science am 22. Mai

Quelle: Livestream Symposium: The Genetic Basis of Primary LE in Humans, Current State of the Science

Schauen Sie sich live, organisiert und ermöglicht von LE & RN ein Symposium (in Englisch),  über “Die genetische Basis der primären LE in den Menschen, der aktuelle Stand der Wissenschaft”, mit Dr. Peter Mortimer an . Sie können zuschauen, auf der Website von LE & RN oder auf Youtube. Es folgt live „Fragen und Antworten“. Das Symposium beginnt am Montag, den 22. Mai um 10 Uhr Eastern Daylight Time. (3pm GMT, 9am CDT, 8 Uhr MDT, 7 Uhr PDT).

Professor Peter Mortimer, ausgebildet in der Dermatologie in Sheffield und Oxford, wurde ernannt als Arzt im“ Skin Department ” bei St. George’s und Beratender Hautarzt an die Royal Marsden Hospital seit 1986 und ist Professor für Dermatologische Medizin an der University of London seit 2000. Seine Interesse an Lymphgefäße begann in Oxford, wo er seine These über, die Messung des Lymphflusses geschrieben hat. Die aktuelle Forschung konzentriert sich auf Brustkrebs-bezogene Lymphödeme, die genetische Basis der primären Lymphödem und Lipödeme sowie Melanome die durch Lymphgefäße verbreitet werden. Er hat über 240 Publikationen die auf PubMed veröffentlicht worden. Er ist Chef-Forscher in Forschungsprogrammen mit Zuschüssen von The Wellcome Trust, British Heart Foundation und Cancer Research UK. Seine klinische Praxis beschäftigt sich fast ausschließlich mit chronischen Ödemen, Lymphödeme, lymphatischen Fehlbildungen, lymphgebundenen Erkrankungen und Lipödeme. Er ist ein Gründer von des Lymphoedema Support Network sowie der British Lymphology Society, und ernannt zu den ersten klinischen Training Fellow in der Lymphgefäßmedizin in Großbritannien.

Es lohnt sich sicherlich, auch mit keine 100% English Kenntnisse dieses anzuschauen, entweder live oder zum späteren Zeitpunkt. Nochmal meinen herzlichen und aufrichtigen dank für die fantastische Arbeit und globalen Einsatz von der Lymphatic Education and Research Network.

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Join LE&RN for this livestreamed Symposium, “The Genetic Basis of Primary LE in Humans, Current State of the Science,” with Dr. Peter Mortimer. You can watch it above, here on LE&RN’s website, or on Youtube. It will be followed by a live Q&A. The Symposium will begin on Monday, May 22, at 10am Eastern Daylight Time. (3pm GMT, 9am CDT, 8am MDT, 7am PDT).

Professor Peter Mortimer trained in Dermatology in Sheffield and Oxford. He was appointed ‘Physician to the Skin Department’ at St George’s and consultant skin physician to the Royal Marsden Hospital since 1986 and has been Professor of Dermatological Medicine to the University of London since 2000. Interest in lymphatics began in Oxford where he undertook his thesis on ‘the measurement of skin lymph flow’. Current research is focused on breast cancer related lymphoedema, the genetic basis of primary lymphoedema and lipoedema as well as melanoma spread by lymphatics. He has over 240 publications cited on PubMed. He has been Chief Investigator on research programme grants from The Wellcome Trust, British Heart Foundation and Cancer Research UK. His clinical practice deals almost entirely with chronic oedema, lymphoedema, lymphatic malformations, lymph-related disorders and lipoedema. He is a founder of both the Lymphoedema Support Network and British Lymphology Society and appointed the first Clinical Training Fellow in Lymphovascular Medicine in the UK.


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Collaboration between two Stanford labs has resulted in the discovery of a molecular cause for lymphedema the first possible drug treatment for it

Study finds first possible drug treatment for lymphedema

Collaboration between two Stanford labs has resulted in the discovery of a molecular cause for lymphedema and the first possible drug treatment for it.

Woman standing in front of her garden and home

Tracey Campbell suffers from lymphedema and is participating in a clinical trial of a drug to determine whether it can treat the painful condition.
Mark Williams

Tracey Campbell has lived for seven years with lymphedema, a chronic condition that causes unsightly swelling in her left leg.

The disease, which stems from a damaged lymphatic system, can lead to infections, disfigurement, debilitating pain and disability. There is no cure. The only available treatment is to wear compression garments or use massage to suppress the swelling, which can occur throughout the body in some cases. Campbell — who had two quarts of excess water in her left leg by the time she was diagnosed — has for years worn restrictive garments 24 hours a day and has spent an hour each night massaging the lymph fluid out of her leg.

Lymphedema is uncomfortable, exhausting and dangerous if left uncontrolled. As many as 10 million Americans and hundreds of millions of people worldwide suffer from the condition, many from the after-effects of cancer therapy treatments.

“There’s this extra layer of emotional burden,” said Campbell, who added that she has to be constantly vigilant to protect against infection. “All you want to be is normal.”

Now there’s new hope for a possible pharmaceutical treatment for patients like Campbell. A study led by scientists at the Stanford University School of Medicine has uncovered for the first time the molecular mechanism responsible for triggering lymphedema, as well as a drug with the potential for inhibiting that process.

The study was published May 10 in Science Translational Medicine.

“We figured out that the biology behind what has been historically deemed the irreversible process of lymphedema is, in fact, reversible if you can turn the molecular machinery around,” said Stanley Rockson, MD, professor of cardiovascular medicine and the Allan and Tina Neill Professor of Lymphatic Research and Medicine at Stanford. Rockson shares senior authorship of the study with Mark Nicolls, MD, professor of pulmonary and critical care medicine. Stanford research scientists Wen “Amy” Tian, PhD, and Xinguo Jiang, MD, PhD, share lead authorship of the study and are also affiliated with the Veterans Affairs Palo Alto Health Care System.

‘Fundamental new discovery’

“This is a fundamental new discovery,” said Nicolls, who is also a researcher at the VA Palo Alto.

Stanley Rockson

Stanley Rockson

The researchers found that the buildup of lymph fluid is actually an inflammatory response within the tissue of the skin, not merely a “plumbing” problem within the lymphatic system, as previously thought.

Working in the lab, scientists discovered that a naturally occurring inflammatory substance known as leukotriene B4, or LTB4, is elevated in both animal models of lymphedema and in humans with the disease, and that at elevated levels it causes tissue inflammation and impaired lymphatic function.

Further research in mice showed that by using pharmacological agents to target LTB4, scientists were able to induce lymphatic repair and reversal of the disease processes.

“There is currently no drug treatment for lymphedema,” Tian said. Based on results of the study, the drug bestatin, which is not approved for use in the United States but which has been used for decades in Japan to treat cancer, was found to work well as an LTB4 inhibitor, with no side effects, she said.

Based on the research, bestatin (also known as ubenimex), is being tested in a clinical trial that started in May 2016 — known as ULTRA — as a treatment for secondary lymphedema, which occurs because of damage to the lymphatic system from surgery, radiation therapy, trauma or infection. Primary lymphedema, on the other hand, is hereditary. The results of the research pertain to both types.

Rockson is principal investigator for this multisite phase-2 clinical trial.

“The cool thing about this story — which you almost never see — is that a clinical trial testing the therapy has already started before the basic research was even published,” Nicolls said. “This is the first pharmaceutical company-sponsored trial for a medical treatment of lymphedema, a condition that affects millions.”

Nicolls and Tian are co-founders of Eiccose LLC. Eiccose is now part of Eiger BioPharmaceuticals, which gets the drug from Nippon Kayaku in Japan. Eiger is sponsoring the clinical trial. Nicolls and Rockson are both scientific advisers to the company.

Two labs, two diseases

The study, which got underway about four years ago, began somewhat uniquely as a collaboration between two labs that were studying two completely different diseases. At the time, the Nicolls lab, where Tian works, was studying pulmonary hypertension. The Rockson lab was conducting lymphedema research.

Mark Nicolls

Mark Nicolls

The two teams met through SPARK, a Stanford program designed to help scientists translate biomedical research into treatments for patients.

“I was in a privileged position of seeing two faculty conducting important research and recognizing the possible link in causality,” said Kevin Grimes, MD, associate professor of chemical and systems biology and co-founder of SPARK. “It occurred to me that both diseases affected vascular tissues and had strong inflammatory components.”

“He blind-dated us,” Nicolls said. “When Amy Tian and I looked at the data from Stan’s research, Amy said, ‘It looks like it could be the same molecular process.’”

“It was an arranged marriage between us and Stan which worked out great,” Tian said.

At the time, Rockson had begun to suspect that lymphedema was an inflammatory disease. This led to his team’s discovery that the anti-inflammatory drug ketoprofen successfully helped to relieve lymphedema symptoms, although it wasn’t a perfect drug; side effects were a concern, and it remained unclear how the drug worked at the molecular level.

Meanwhile, the Nicolls lab had discovered that LTB4 was part of the cycle of inflammation and injury that keeps pulmonary hypertension progressing. When researchers blocked LTB4 in rats with the disease, their symptoms lessened and blood vessels became less clogged, lowering blood pressure in the lungs.

“When we became aware of Mark’s work, we began to realize that we were both possibly dealing with the activation of steps downstream of the 5-LO [5-lipoxygenase] pathway,” Rockson said. “This became intriguing and formed the basis of our relationship.”

Joining forces

The two teams joined forces to figure out the mechanism that triggered lymphedema, hopefully revealing a target for drug treatment in humans. After determining that ketoprofen was primarily working on the 5-LO pathway, the researchers began blocking the various endpoint pathways after 5-LO activation in mouse models of lymphedema, Rockson said.

“It turned out that, in fact, we were both dealing with the same branch, which is LTB4,” Rockson said.

When all of the sudden one of your limbs begins to swell, you want to understand what the heck is going on.

“So now it became clear we really were dealing with a very similar biological process in two different diseases,” he said. “Because of Mark’s work in pulmonary hypertension, we knew that we had an ideal form of therapy that we could try in lymphedema as well.”

The Nicolls lab had used the drug bestatin, which blocks the enzyme that generates LTB4, to reverse pulmonary hypertension disease processes. When researchers tested bestatin in the mouse lymphedema model, it worked to reverse symptoms of that disease.

“I’m still in awe,” Rockson said. “There are few situations where you take a problem at the bedside, and go into the lab, and then take discoveries back to the bedside. It’s amazingly gratifying.”

Campbell, who is now participating in the double-blinded, placebo-controlled bestatin trial at Stanford, remains hopeful.

“When all of the sudden one of your limbs begins to swell, you want to understand what the heck is going on,” she said. “It’s a tough condition that few people seem to care about, even though millions and millions suffer with it. We’re hoping for something that gives some relief.”

Other Stanford authors are research associate Jeanna Kim; former medical students Adrian Begaye, MD, and Abdullah Feroze, MD; Roham Zamanian, MD, associate professor of medicine and director of the Adult Pulmonary Hypertension Service; Gundeep Dhillon, MD, associate professor of medicine and medical director of the Stanford Lung Transplant Program; and research assistants Eric Shuffle and Allen Tu. Shuffle and Tu are affiliated with both Stanford and the VA Palo Alto.

Researchers at Georgia Institute of Technology, Virginia Commonwealth University, the University of Michigan Health Systems and the University of Illinois at Chicago are also co-authors.

Eiger BioPharmaceuticals has licensed intellectual property developed by Tian, Rockson, Jiang, Kim and Nicolls involving the targeting of LTB4 for the treatment of lymphedema.

Stanford’s Department of Medicine supported the work.

  • Tracie White

    ByTRACIE WHITE

    Tracie White is a science writer for the medical school’s Office of Communication & Public Affairs. Email her at tracie.white@stanford.edu.

Stanford Medicine integrates research, medical education and health care at its three institutions – Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children’s Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.

 

 

http://med.stanford.edu/news/all-news/2017/05/study-finds-first-possible-drug-treatment-for-lymphedema.html


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Fighting cancer with immunotherapy: Signaling molecule causes regression of blood vessels

Immunotherapy with T-cells offers great hope to people suffering from cancer. Some initial successes have already been made in treating blood cancer, but treating solid tumors remains a major challenge. The signaling molecule interferon gamma, which is produced by T-cells, plays a key role in the therapy. It cuts off the blood supply to tumors, as a new study reveals.

A microscopic image of tumor tissue under the influence of TNF (left) and IFN- ? (right). Red blood cells are pictured in a magenta color. TNF bursts the blood vessels and releases large amounts of blood cells, whereas IFN-? lets vessels retreat.
Credit: Christian Friese / MDC

Immunotherapy with T-cells offers great hope to people suffering from cancer. Some initial successes have already been made in treating blood cancer, but treating solid tumors remains a major challenge. The signaling molecule interferon gamma, which is produced by T-cells, plays a key role in the therapy. It cuts off the blood supply to tumors, as a new study in the journal Nature reveals.

The immune system is the body’s most powerful weapon against diseases. So what if it were possible to use the immune system to fight cancer? For a long time now, researchers have been trying to do just that — for example, by employing a special kind of immune cell called T-cells. They are “special mobile forces” that — after undergoing training — patrol the body, and can seek out and kill cancer cells. This strategy has been successful in initial clinical trials — but mostly just in the treatment of cancers that do not form tumors, such as blood cancer.

Good at fighting blood cancer, but not so effective against solid tumors

Large solid tumors, on the other hand, sometimes pose big problems for T-cells. Though adept at targeting cancer cells swimming in the bloodstream, they have difficulty attacking compact tumors. The tumor weakens the aggressors through the delivery of inhibiting signals.

The scientists working with Dr. Thomas Kammertöns, Prof. Thomas Blankenstein, Prof. Hans Schreiber and Christian Friese are searching for solutions with their research team at Charité — Universitätsmedizin Berlin, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Institute of Health (BIH) and the Einstein Foundation.

In a study published in the journal Nature, they investigated how the signaling molecules of T-cells affect the immediate tumor environment, which includes the connective tissue as well as the blood vessels that supply the tumor.

T-cells produce not only tumor necrosis factor (TNF) but also the molecule interferon gamma (IFN-γ). Until now, however, there has been little understanding about how IFN-γ really works. “We knew that IFN-γ attacks cancer cells via the tumor microenvironment,” says Kammertöns. “We now wanted to find out exactly which cells are targeted by the signaling molecules.”

Blood vessel regression is induced

The researchers generated genetically modified mice and used a clinically relevant cancer model. This included animals in which only blood vessel cells were susceptible to the signaling molecule.

In this mouse model IFN-γ pruned back the blood vessels in the tumors, thus shutting down the supply of oxygen and nutrients and killing the tumors. The researchers were able to observe this process microscopically in living mice in fine detail. They found that the blood vessel cells alone responded to the signaling molecule. When the researchers targeted other types of cells with IFN-γ, the tumors continued their growth.

These findings provided an explanation for the molecule’s powerful properties, which were already well known. “IFN-γ is one of the most important weapons in the T-cells’ arsenal,” says Thomas Kammertöns.

Thomas Blankenstein, lead investigator of the study, says: “The two together — IFN-γ and tumor necrosis factor — are a powerful team. TNF bursts tumor blood vessels, thus opening up the tissue, while IFN-γ cuts off the blood supply and keeps the tumor at bay over the long term.”

Optimizing T-cell therapy

The study offered the researchers clues on how to improve T-cell therapy for solid cancer tumors. Thomas Blankenstein explains: “We want to understand exactly how T-cells target tumors. Destroying a tumor’s infrastructure is probably more effective than killing individual cancer cells.”

“Our findings are significant beyond tumor therapy,” says Thomas Kammertöns. “Interestingly, the mechanism used by IFN-γ to eliminate solid tumors resembles the physiological regression of blood vessels during development. It also disrupts wound healing.”

“IFN-γ might also affect the formation of new blood vessels after strokes or heart attacks. That’s why we want to find out more about the molecular processes behind all of this.”

Story Source:

Materials provided by Max Delbrück Center for Molecular Medicine in the Helmholtz Association. Note: Content may be edited for style and length.

Journal Reference:

  1. Thomas Kammertoens, Christian Friese, Ainhoa Arina, Christian Idel, Dana Briesemeister, Michael Rothe, Andranik Ivanov, Anna Szymborska, Giannino Patone, Severine Kunz, Daniel Sommermeyer, Boris Engels, Matthias Leisegang, Ana Textor, Hans Joerg Fehling, Marcus Fruttiger, Michael Lohoff, Andreas Herrmann, Hua Yu, Ralph Weichselbaum, Wolfgang Uckert, Norbert Hübner, Holger Gerhardt, Dieter Beule, Hans Schreiber, Thomas Blankenstein. Tumour ischaemia by interferon-γ resembles physiological blood vessel regression. Nature, 2017; DOI: 10.1038/nature22311

Max Delbrück Center for Molecular Medicine in the Helmholtz Association. “Fighting cancer with immunotherapy: Signaling molecule causes regression of blood vessels.” ScienceDaily. ScienceDaily, 26 April 2017. <www.sciencedaily.com/releases/2017/04/170426131018.htm>

Quelle: Fighting cancer with immunotherapy: Signaling molecule causes regression of blood vessels


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Lymphedema After Mastectomy Breathing Exercises & Restorative Yoga

It is not unusual for a woman to develop lymphedema after a mastectomy. Lymphedema is a sometimes-painful swelling in the soft tissues.  This can be due to the removal of lymph nodes, scar tissue, strictures, and other factors.

Manual lymph drainage massage is the usual recommended technique to treat this swelling.  It may be surprising to know that another therapy that benefits lymphedema is yoga, especially restorative yoga. When the lymphatic system is at its optimum, it is like a free flowing river, running without obstacles.  However, when the lymph nodes are removed or damaged, that same river meets obstacles and begins to slow down and this creates a pooling of fluids.  This build up in the tissues can cause swelling and inflammation and reduce oxygen in the lymphatic tissues. The white blood cells, or immune soldiers of the body, can be impaired in their function in this situation.  This may increase the risk of infection and create a possible permanent disability.  Edema is often found in the arms and legs, but can be found in other parts of the body.

Knowing how important it is to keep this fluid running like a free flowing river, we need to foster relaxation and gentle movements that encourage its increased flow.  This is especially important after breast surgery or removal of nodes, when it is paramount to undertake new activities to increase impaired lymphatic function.

The need to develop a deeper state of relaxation to counter the mental and physical stress of illness and its treatment is critically important to our health and well-being.

Practicing yoga, especially Restorative Yoga which targets the pectoral area, keeps the fluid moving through the body rather than slowing down and creating a back up.  This benefits the breasts by promoting drainage and healing and creating a sense of safety when expanding the chest.

Practicing Restorative Yoga daily will undo the harmful effects of too much sitting or inactivity.  Starting yoga practice with a knowledgeable Restorative Yoga teacher is as important as wearing a bandage or support garment.

An important thing to understand in your practice of Restorative Yoga is that you must to slow down enough to listen to what your body is telling you.  Any time you overwork your muscles or strain your healing tissues,  you run the risk of fluid build up.

Let this be the yoga practice of self-understanding.

More Great Articles

  1. How Breathing Exercises Can Raise Energy Levels For Breast Cancer Patients
  2. Breathing, Yoga and Cancer
  3. Breast Cancer Breathing Guidelines & Techniques During Exercise
  4. Diaphragmatic Breathing for Cancer Survivors
  5. Learn Natural Breath Breathing Exercise For Breast Cancer Treatment
  6. Yoga Pose for Breast Cancer – Root Lock KRIYA Breathing
  7. 4 Benefits of Breathing Exercises For Breast Cancer Treatment
  8. Why Start A Breathing Practice For Breast Cancer Recovery? Good Health!

Dawn Breast CancerAbout Dawn Bradford Lange:  Co-founder of Breast Cancer Yoga. Dawn is making a difference with Breast Cancer Yoga therapeutic products designed to support you emotionally and physically during breast cancer . We want to give you the attention and personal service you need so please email us at info@breastcanceryoga.com if you have questions.

Lymphedema After Mastectomy Breathing Exercises & Restorative Yoga


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Herantis Pharma’s clinical study with Lymfactin advances to high dose level

Herantis Pharma’s clinical study with Lymfactin advances to high dose level

Herantis Pharma Plc
Company release 6 March 2017 at 10:00 am

Herantis Pharma Plc’s (“Herantis”) clinical study with the company’s innovative gene therapy investigational product Lymfactin® for the treatment of secondary lymphedema has advanced to highest planned dose level owing to good reported safety. A Data Monitoring Committee of independent experts recommended proceeding to high dose treatments after assessing safety data on the previously treated patients. Following the recommendation, the first high dose treatment has already been administered.

 “We are naturally very happy for the safety of Lymfactin® in the first treatments”, comments Pekka Simula, Herantis’ CEO. “This is the first clinical study in the world to apply gene therapy for repairing damages of the lymphatic system. Safety of the patients is our #1 priority so we want to move ahead carefully. We are thrilled to announce this milestone by coincidence on March 6: World Lymphedema Day!”

“Collaboration with the participating university hospitals in this study has been excellent”, adds Katarina Jääskeläinen, Herantis’ Project Manager for the clinical study. “Secondary lymphedema is a disfiguring, disabling disease that severely impacts the quality of life of patients. We hope our Lymfactin® will significantly improve the quality of life of patients in the future.”

The Phase 1 clinical study continues recruiting patients with breast cancer associated lymphedema at three university hospitals in Finland: In Helsinki, Tampere, and Turku. The study intends to recruit at most 18 patients by the end of 2017.

World Lymphedema Day

March 6 was officially recognized World Lymphedema Day since 2015 by e.g. the U.S. Senate. It is celebrated around the world largely thanks to the patient advocacy group Lymphatic Education & Research Network (LE&RN) to increase lymphedema awareness.

About breast-cancer associated lymphedema

Approximately 20% of breast cancer patients who undergo axillary lymph node dissection develop secondary lymphedema, a chronic, progressive, disabling and disfiguring disease that severely affects quality of life. Symptoms include a chronic swelling of an upper limb, thickening and hardening of skin, loss of mobility and flexibility, pain, and susceptibility to secondary infections. Secondary lymphedema is currently treated with compression garments, special massage, and exercises. While these therapies may relief the symptoms in some patients they do not cure lymphedema, which is caused by damage to the lymphatic system. There are currently no approved medicines for the treatment of this condition.

About Lymfactin®

Lymfactin® is a gene therapy expressing the growth factor VEGF-C specific to the development of lymphatic vessels. Based on preclinical studies Lymfactin® triggers the growth of new functional lymphatic vasculature in the damaged area and thus repairs the underlying cause of secondary lymphedema. Lymfactin®, patented by Herantis, is based on the internationally renowned scientific research of academy professor Kari Alitalo and his research group, a national centre of excellence at the University of Helsinki. Herantis also holds patents for a combination therapy, which may expand the use of Lymfactin® in other lymphedemas. See our introductory video on Lymfactin®: http://herantis.com/media/videos/

About Herantis Pharma Plc

Herantis Pharma Plc is an innovative drug development company focused on regenerative medicine and unmet clinical needs. Our first-in-class assets are based on globally leading scientific research in their fields: CDNF for disease modification in neurodegenerative diseases, primarily Parkinson’s and ALS; and Lymfactin® for breast cancer associated lymphedema, with potential also in primary lymphedema. The shares of Herantis are listed on the First North Finland marketplace run by Nasdaq Helsinki Ltd.

Distribution:

Nasdaq Helsinki
Main media
http://www.herantis.com

https://globenewswire.com/news-release/2017/03/06/931689/0/en/Herantis-Pharma-s-clinical-study-with-Lymfactin-advances-to-high-dose-level.html?utm_content=buffer4533b&utm_medium=social&utm_source

 

LE&RN Symposium Real-time Visualization of Lymph Movement

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https://livestream.com/LymphaticRF/Aldrich

Thanks for all the fantastic work you are doing Lymphatic Education & Research Network !


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Primäre Lymphödeme-Hereditary Lymphedema – NORD (National Organization for Rare Disorders)

Quelle: Hereditary Lymphedema – NORD (National Organization for Rare Disorders)

Hereditary Lymphedema

NORD gratefully acknowledges Joseph L. Feldman, MD, Senior Clinician Educator, Pritzker School of Medicine University of Chicago; Director, Lymphedema Treatment Center, NorthShore University Health System, for assistance in the preparation of this report.

Synonyms of Hereditary Lymphedema

  • primary lymphedema

Subdivisions of Hereditary Lymphedema

  • congenital hereditary lymphedema
  • hereditary lymphedema, type I
  • lymphedema-distichiasis
  • lymphedema praecox
  • lymphedema tarda
  • Milroy disease
  • Nonne-Milroy disease

General Discussion

Hereditary lymphedema is a genetic developmental disorder affecting the lymphatic system. It is characterized by swelling (edema) of certain parts of the body. The lymphatic system is a circulatory network of vessels, ducts, and nodes that filter and distribute certain protein-rich fluid (lymph) and blood cells throughout the body. In hereditary lymphedema, lymphatic fluid collects in the subcutaneous tissues under the epidermis due to obstruction, malformation, or underdevelopment (hypoplasia) of various lymphatic vessels. There are three forms of hereditary lymphedema: congenital hereditary lymphedema or Milroy disease; lymphedema praecox or Meige disease; and lymphedema tarda. Symptoms include swelling (lymphedema) and thickening and hardening of the skin in affected areas. In most cases, hereditary lymphedema is inherited as an autosomal dominant trait. Lymphedema may be classified as primary or secondary. Hereditary lymphedema is also known as primary lymphedema. Secondary lymphedema occurs because of damage to the lymphatic system from surgery, radiation therapy, trauma or infection (e.g. filariasis). Lipedema is a symmetrical accumulation of subcutaneous fat, most often in the legs. Lipedema occurs almost exclusively in females. Tenderness and bruising are also common. Typically, the feet are not swollen and thickening of the skin of the toes (Stemmer’s sign).  Lipedema is frequently misdiagnosed as lymphedema.

Signs & Symptoms

The main symptom associated with hereditary lymphedema is swelling (edema) or puffiness in different parts of the body because of the accumulation of protein-rich fluid (lymph) in the soft layers of tissue under the epidermis (lymphedema). Swelling frequently occurs in one or both legs, but may also be present in the trunk, face, genitalia and arms. When lymphedema develops in the legs, swelling is usually most noticeable in the foot and ankle but may also be present in the calf and thigh.. In some cases, swelling may cause tightness, discomfort and unusual tingling sensations (paresthesias) in the affected areas. The affected area heals poorly even after minor trauma (e.g., cut or insect bite). The skin of the affected area may become abnormally dry, thickened or scaly skin (hyperkeratosis) resulting in a “woody” texture.

Hereditary lymphedema type IA (Milroy’s disease) is characterized by swelling (edema) that is present at or shortly after birth (congenital). In rare cases, edema may develop later in life. The legs are most often affected. The extent and location of edema varies greatly from case to case even among individuals in the same family. In some cases the genitals may also be affected. Additional complications sometimes associated with hereditary lymphedema type I include upslanting toenails, small warty growths on the affected areas (papillomatosis), abnormally large or prominent leg veins, and, in males, urethral abnormalities and the development of a fluid-filled sac along the spermatic cord of the scrotum (hydrocele).

Hereditary lymphedema type II (Meige disease, lymphedema praecox) develops around puberty or shortly thereafter in most individuals. This is the most common type of primary lymphedema. In addition to lymphedema of the legs, other areas of the body such as the arms, face and larynx may be affected. Some individuals may develop yellow nails.

Lymphedema tarda is defined as primary lymphedema occurring after the age of 35. The legs are most often affected, but the arms and other areas may be affected as well.

Hereditary lymphedema may progress and, in some cases, may improve over time. Obesity makes management of lymphedema more difficult. Affected individuals with lymphedema are at risk for developing infections including bacterial infection of the skin and underlying tissue (cellulitis) or infection of the lymphatic vessels (lymphangitis). These infections are characterized by areas of warm, painful and reddened skin. Red skin “streaks” may also develop in the infected area. Increased edema is common. A general feeling of ill health (malaise), fever, chills, and/or headaches may also occur. If left untreated, cellulitis can lead to septicemia, skin abscesses, areas of ulceration, and/or tissue damage (necrosis). Cellulitis is more common in males than females. Athlete’s foot (Tinea pedis) can cause cracks in the interdigital skin, bacterial invasion and cellulitis.

In rare cases of persistent lymphedema, additional complications may develop including fluid (e.g., chyle) accumulation body cavities such as the thorax (chylothorax) and abdomen (chylous ascities). Chyle is a fat-laden cloudy fluid that is absorbed during digestion by the lymphatic vessels located around the intestine. Chyle normally flows through lymphatic vessels into the upper chest (thoracic duct) and is then deposited into veins, where it mixes with blood. In some people with hereditary lymphedema, the lymphatic vessels may rupture or become blocked (obstructed), causing chyle to accumulate in the chest cavity (chylothorax). A patient with primary chylous ascites needs to be on a no-fat diet supplemented with medium chair triglycerides and vitamins. Addition of a diuretic such as Spironolactone has been reported to be a valuable adjunct to dietary control.

Affected individuals may also be at a greater risk than the general population for developing a malignancy at the affected site. These malignancies include angiosarcoma. Angiosarcomas are cancerous tumors that develop from blood or lymphatic vessels. They may occur in any area of the body. A specific type of angiosarcoma is known as lymphagiosarcoma, or Stewart-Treves syndrome. This cancerous tumor may rarely develop in longstanding cases of primary or secondary lymphedema. Angiosarcoma occurs in the lymphedematous extremity but can spread to the adjacent trunk and lungs.

Causes

Many researchers believe that hereditary lymphedema may result from changes (mutations) in one of the different disease genes (genetic heterogeneity). Most cases of hereditary lymphedema type IA and type II are inherited as autosomal dominant traits. Genetic diseases are determined by the combination of genes for a particular trait that are on the chromosomes received from the father and the mother. Dominant genetic disorders occur when only a single copy of an abnormal gene is necessary for the appearance of the disease. The abnormal gene can be inherited from either parent, or can be the result of a new mutation (gene change) in the affected individual. The risk of passing the abnormal gene from affected parent to offspring is 50 percent for each pregnancy regardless of the sex of the resulting child.

Investigators have determined that some cases of hereditary lymphedema type IA (Milroy’s disease) occur because of mutation in the FLT4 gene which encodes of the vascular endothelial growth factor receptor 3 (VEGFR-3) gene located on the long arm (q) on chromosome 5 (5q35.3). Chromosomes, which are present in the nucleus of human cells, carry the genetic information for each individual. Human body cells normally have 46 chromosomes. Pairs of human chromosomes are numbered from 1 through 22 and the sex chromosomes are designated X and Y. Males have one X and one Y chromosome and females have two X chromosomes. Each chromosome has a short arm designated “p” and a long arm designated “q”. Chromosomes are further sub-divided into many bands that are numbered. For example, “chromosome 5q35.3” refers to band 35.3 on the long arm of chromosome 5. The numbered bands specify the location of the thousands of genes that are present on each chromosome.

Investigators have determined that some cases of hereditary lymphedema type II (Meige disease) occur because of mutations of the ‘forkhead’ family transcription factor (FOXC2) gene located on the long arm (q) of chromosome 16 (16q24.3).

Affected Populations

Hereditary lymphedema affects females more often than males. The estimated prevalence of these disorders is 1 in 6,000 individuals within the general population. Hereditary lymphedema type II (Meige syndrome) is the most common form accounting for approximately 80 percent of cases. The prevalence of hereditary lymphedema type I (Milroy disease) is unknown. Approximately 200 cases have been reported in the medical literature.

Diagnosis

The diagnosis of hereditary lymphedema may be confirmed by a thorough clinical evaluation and a variety of specialized imaging tests including lymphoscintigraphy, ultrasound, and magnetic resonance imaging (MRI). During lymphoscintigraphy, a radioactively labeled colloid substance is injected intradermally into either the hands or feet. The time required for the tracer to be transported from the point of injection to the regional lymph nodes is recorded. In congenital lymphedema, the tracer may move sluggishly or not move from the site of injection. During an ultrasound, reflected sound waves create an image of the developing fetus. An ultrasound is used to rule out other conditions. A Doppler ultrasound can evaluate venous conditions such as varicose veins and venous blood clots. An MRI uses a magnetic field and radio waves to produce cross-sectional images of particular organs and bodily tissues. An MRI is used to detect findings characteristic of hereditary lymphedema including swelling (edema), a mass surrounded by a sac containing lymph fluid (lymphocele), and the formation of fibrous tissue (fibrosis).

Standard Therapies

Treatment

No gene therapy for hereditary lymphedema is currently available. There is no FDA approved medication to treat lymphedema. Lymphedema risk reduction practices should be followed to reduce complications such as infection and an increase in swelling. Treatment is aimed at reducing swelling and preventing infection. Complete decongestive therapy (CDT) is a form of treatment in which specialized manual techniques (manual lymph drainage) is combined with multilayered compression bandaging, meticulous skin care, exercise, and the use of well-fitted compression garments.. Decongestive and conditioning exercises are important components of CDT. Patients and their parents/caregivers should be counseled on the importance of adhering to lymphedema management recommendations to prevent progression the lymphedema. Antibiotics can be used to treat infections such as cellulitis or as a preventive (prophylactic) measure in individuals with recurrent infections. Athlete’s foot can be treated with antifungal topical medications.

Various surgical techniques have been used to treat individuals with hereditary lymphedema including the surgical joining of small lymphatic vessels to nearby small veins (microsurgical anastomosis) has had some limited success in people with lymphedema. The goal of this surgery is to reduce swelling by creating new pathways for lymphatic fluid flow and “rechanneling” this flow into the venous system. According to the medical literature, these therapies have had only limited effectiveness. Reducing operations are available to remove excess fibrotic tissue in cases of severe lymphedema. Continued use of compression garments is necessary after reducing surgery. Liposuction has not been found to be effective in primary lymphedema.

Individuals with hereditary lymphedema should avoid long periods of immobility with legs in a dependent position. Affected individuals should also take special care to avoid wounds in any affected area because of a reduced resistance to infection. Certain medications such as calcium channel blocking drugs and non-steroidal anti-inflammatory drugs may worsen swelling in the legs and the benefits and risks need to be discussed with the patient’s physician. Excessive salt intake can cause fluid retention.

Genetic counseling will benefit people with hereditary lymphedema and their families. Rehabilitation therapy may be necessary in cases where extreme lymphedema impairs daily activities.

 

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com.

For information about clinical trials conducted in Europe, contact:
https://www.clinicaltrialsregister.eu/

Botanicals such as the Benzopyrones and Saponins (e.g., horse chestnut seed extract) as well as the trace element Selenium have been advocated by some as adjunctive treatments for lymphedema.

Benzopyrones, a group of substances such as coumarin, hydroxethylrutin and flavinoid derivatives, have been used for the treatment of individuals with hereditary lymphedema. These drugs breakdown proteins found in lymph and may stimulation lymph flow thereby reducing lymph accumulation and subsequent swelling. However, the effectiveness of such medications is unproven and under debate. Hepatotoxicity has been reports in up to 6% of the patients taking coumarin. More research is necessary to determine the long-term effectiveness and safety of benzopyrone therapy in individuals with hereditary lymphedema.

Occasionally, drugs that promote fluid mobilization (i.e., diuretics) have been used for people with lymphedema. These medications increase urinary output and may help to reduce swelling in some affected individuals. However, diuretics have not been proven successful in reducing the swelling in primary lymphedema but may be beneficial in patients with mixed origin edema, e.g., phlebolymphedema. The prolonged use of diuretics for the treatment of hereditary lymphedema should be carefully directed by a physician as these medications may have several long-term side effects.

Contact for additional information about hereditary lymphedema:

Joseph L. Feldman, MD
Senior Clinician Educator
Pritzker School of Medicine
University of Chicago
Director, Lymphedema Treatment Center
NorthShore University HealthSystem

 


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Understanding Lymphedema – Lymphedema & Wound Care Session – LE&RN -David Zawieja PhD

Einen super interessanten Beitrag! Herzlichen Dank für die Bereitstellung.


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Retinoic acid may significantly prevent lymphedema development, experimental model suggests

Using newly updated mouse models, researchers demonstrated the impactful preventive properties of 9-cis retinoic acid against lymphedema. Currently, there is no cure for lymphedema, a swelling of the extremities that most commonly occurs after treatment for cancer.

Quelle: Retinoic acid may significantly prevent lymphedema development, experimental model suggests

 

A study conducted at the Keck School of Medicine of the University of Southern California (USC) showed that 9-cis retinoic acid (alitretinoin) could significantly prevent postsurgical lymphedema. Furthermore, the experiments were conducted with updated, easily reproducible mouse models that more accurately simulated lymphedema development in humans. The National Institutes of Health-funded study was published in the Annals of Surgery.

Lymphedema occurs when damaged lymph nodes are unable to drain properly, causing swelling and tissue buildup. Lymphedema affects 140 million individuals globally, including 5 million people in the United States whose lymphedema is related to cancer-related lymphadenectomy. As surgical developments continue to increase cancer survival rates, the prevalence of lymphedema is expected to rise. And with no known cure for post-surgical lymphedema, lymph node dysfunction can negatively impact long-term quality of life.

“Physically, lymphedema is both uncomfortable and inconvenient,” said Alex Wong, MD, assistant professor of surgery at Keck School of Medicine and one of the co-corresponding authors of the study. “Some patients express frustration at things we take for granted, like getting dressed. And for many of them, the swollen and deformed extremity is an unwelcome reminder of the cancer they fought or are still fighting.”

To examine the effect of alitretinoin, the research team induced lymphedema by making a small incision in the hind legs of mice rather than the base of the tail, as previous studies had done. This updated model better simulated lymph node dysfunction in humans in that rodent tails are not subject to the effects of gravity to the same extent as human arms and legs. And more simply, humans do not have a tail.

“Developing a more effective model for lymphedema research is as much of an achievement from our research as illustrating the potential benefits of retinoic acid,” said Young-Kwon Hong, PhD, associate professor of surgery at Keck School of Medicine and co-corresponding author of the study. Hong previously illustrated the potential benefits of alitretinoin on preventing lymphedema in petri-dish models before developing the mouse model.

After the hind paw incisions were repaired, the mice were divided into two groups. One group received daily injections of 9-cis retinoic acid, while the other received a vehicle solution as a control. The mice treated with the retinoic acid experienced less postsurgical edema and significantly less paw lymphedema compared to the control group. Moreover, the mice treated with the retinoic acid had much faster lymphatic drainage and increased lymphatic vessel density.

“Lymphatic drainage and maintenance of the integrity of the lymphatic vessels are two key factors in preventing lymphedema,” Hong said. “9-cis retinoic acid’s ability to accomplish both makes it a promising treatment option.”

Alitretinoin is already approved by the Food and Drug Administration for the treatment of skin lesions in acquired immune deficiency syndrome-related Kaposi’s sarcoma and eczema. If further studies prove fruitful, Wong hopes to establish a clinical trial for alitretinoin as a preventive measure against lymphedema.

“Our immediate next step is to experiment with timing,” Wong said. “Currently, physicians watch and wait for lymphedema, but our study suggests that treatment at the time of surgery may be a more effective course.”

Story Source:

Materials provided by Keck Medicine of USC. Note: Content may be edited for style and length.

Journal Reference:

  1. Athanasios Bramos, David Perrault, Sara Yang, Eunson Jung, Young Kwon Hong, Alex K. Wong. Prevention of Postsurgical Lymphedema by 9-cis Retinoic Acid. Annals of Surgery, 2016; 264 (2): 353 DOI: 10.1097/SLA.0000000000001525