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Am J Physiol Heart Circ Physiol (January 18, 2008). doi:10.1152/ajpheart.00900.2007
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Submitted on August 2, 2007
Accepted on January 14, 2008

The Resolution of Lymphedema by Interstitial Flow in the Mouse Tail Skin

Joseph Uzarski1, Megan B Drelles1, Sarah E Gibbs1, Emily L Ongstad1, Julie C Goral1, Katherine K McKeown1, Alisha Raehl1, Melissa A. Roberts1, Bronislaw Pytowski2, Martyn R Smith1, and Jeremy Goldman1*

1 Biomedical Engineering, Michigan Technological University, Houghton, Michigan, United States
2 Molecular and Cellular Biology, ImClone Systems, NY, New York, United States

* To whom correspondence should be addressed. E-mail: jgoldman{at}mtu.edu.

Lymphangiogenesis is considered a promising approach for increasing fluid drainage during secondary lymphedema. However, organization of lymphatics into functional capillaries may be dependent upon interstitial flow (IF). The present study was undertaken to determine the importance of lymphangiogenesis for lymphedema resolution. We created a lymphatic obstruction that produces lymphedema in mouse tail skin. The relatively scar-free skin regeneration that occurred across the obstruction allowed the progression of lymphangiogenesis to be observed and compared with the evolution of lymphedema. The role of VEGF-C/VEGFR-3 signaling in lymphedema resolution was investigated by exogenous administration of VEGF-C or neutralizing antibodies against VEGFR-3. VEGF-C protein improved lymphedema at 15 days (reducing dermal thickness from 742±105µm to 559+/-141µm with 95% confidence intervals (CIs), p<0.05) without increasing lymphatic capillary coverage (11.6±6.4% following VEGF-C treatment relative to 9.6±6.2% with 95% CIs, p>0.50). Blocking VEGFR-3 signaling did not inhibit lymphedema resolution at 25 days (dermal thickness of 462±127µm following VEGFR-3 inhibition relative to 502+/-87µm with 95% CIs) or inhibit IF, although VEGFR-3 blocking prevented lymphangiogenesis (reducing lymphatic coverage to 0.2±0.7% relative to 8.7±7.3% with 95% CIs, p<0.005). A second mouse tail lymphedema model was employed to investigate the ability of VEGF-C to increase fluid drainage across a scar. We found that neither neutralization of VEGFR-3 nor administration of VEGF-C affected the course of skin swelling over 25 days. These findings suggest that resolution of lymphedema in the mouse tail skin may be more dependent upon IF and regeneration of the extracellular matrix across the obstruction than lymphatic capillary regeneration.







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