Experimental Lymphedema: Can Cellular Therapies Augment the Therapeutic Potential for Lymphangiogenesis?
- Correspondence to:
Stanley G. Rockson, MD, Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California 94305. E-mail: rockson@stanford.edu
The lymphatic system, the subject of centuries of paradoxical relative neglect, is finally and deservedly coming into focus. This integral component of the mammalian vasculature plays a central role in immunocompetence and fluid homeostasis and, therefore, is often an active participant in the progression of disease.
The biology of regional lymphatic vascular insufficiency is complex. When regional lymphatic flow is insufficient to maintain tissue fluid homeostasis, interstitial fluid accumulates and swelling ensues. Furthermore, in addition to this readily observed role in the maintenance of tissue fluid homeostasis, functioning lymphatics are crucial to the traffic of immunocompetent cells from the tissue periphery to the lymph node, where antigenic processing can occur.
Lymphedema is the all-too-frequent clinical consequence of impaired lymphatic function. The condition does not typically threaten survival, yet the advent of lymphedema can significantly undermine productivity and quality of life for affected individuals. The sequelae of lymphedema include loss of function, restriction of movement, risk of infection, and profound alterations in psychosocial adjustment that include fear, affective disorders, and loss of self-esteem and body image. Lymphedema is a chronic debilitating disease for which there continues to be a great deal of clinical confusion and treatment delay.
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