Mechanisms of fibrosis and lymphatic dysfunction in post-surgical lymphedema

术后淋巴水肿纤维化和淋巴功能障碍的机制

• 批准号: 8372995
• 负责人: Babak J Mehrara
• 金额: $ 77.95万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8372995
• 关键词: Adoptive Transfer; American; Anti-Inflammatory Agents; Anti-inflammatory; Antibodies; Axillary Lymph Node Dissection; Axillary lymph node group; Bypass; CD4 Positive T Lymphocytes; Cancer Patient; Chronic; Clinical; Clinical Research; Clinical Trials; Complication; Congenital Abnormality; Data; Development; Disease; Down-Regulation; Etiology; Event; Fibrosis; Functional disorder; IL4 gene; Immunity; Infection; Infiltration; Inflammation; Inflammatory; Injury; Interleukin-13; Knowledge; Laboratories; Lead; Liquid substance; Lymph; Lymphangiogenesis; Lymphatic; Lymphatic Endothelial Cells; Lymphatic Metastasis; Lymphatic System; Lymphedema; Mediating; Medical; Methods; Mission; Modeling; Morbidity - disease rate; Mus; Natural regeneration; Neoplasm Metastasis; Obesity; Obstruction; Operative Surgical Procedures; Organ; Organ failure; Palliative Care; Pathology; Patients; Pharmaceutical Preparations; Play; Positioning Attribute; Prevalence; Prevention; Proteins; Quality of life; Radiation; Recurrence; Recurrent pain; Research; Risk; Role; Sampling; Secondary to; Source; Specimen; Staging; Surgical complication; Swelling; System; T-Lymphocyte; Tail; Testing; Th2 Cells; Time; Tissues; Transgenic Mice; United States National Institutes of Health; Upper Extremity; Vascular Endothelial Growth Factor C; Work; base; cancer therapy; clinical application; clinically relevant; clinically significant; cytokine; design; high risk; improved; innovation; lipid metabolism; macrophage; malignant breast neoplasm; mouse model; multidisciplinary; novel; palliative; prevent; repaired; research study; response; therapy development; tumor

DESCRIPTION (provided by applicant): Lymphedema is the accumulation of protein rich fluid in tissues, and in the US, occurs most commonly as a surgical complication of cancer treatment. Despite the fact that 3-5 million Americans suffer from lymphedema, its etiology is unknown and treatment remains palliative. Based on our laboratory data as well as the clinical presentation of lymphedema we hypothesize that the pathology of lymphedema is secondary to progressive fibrosis and is mediated by chronic T-helper (CD4+) cell inflammation. The objective of this proposal is to determine how lymphatic fluid stasis causes tissue fibrosis and lymphatic dysfunction. Our long-term objective is to develop therapies to treat or prevent lymphedema by disrupting the cycle of stasis, fibrosis, and lymphatic dysfunction. This approach is innovative since previous efforts have attempted to treat lymphedema by augmenting lymphatic repair and regeneration using cytokines. These cytokines, however, can also cause tumor metastasis or recurrence thereby limiting the applicability of this approach in cancer patients. This proposal is relevant since lymphedema is a common and morbid complication of cancer treatment for which there is no proven preventative methods and treatment is palliative. We plan to achieve our objectives using 3 specific aims. Aim 1: Determine the cellular sources of profibrotic cytokines. This aim will test the working hypothesis that CD4+ T-cells are the primary source of profibrotic cytokines using transgenic mice, antibody depletion, and adoptive transfer experiments in a mouse-tail and axillary dissection model. Aim 2: Determine how the expression of profibrotic cytokines is regulated. This aim will test the working hypothesis is that lymphatic stasis causes Th2 cell inflammation and IL4 and IL13 expression and that these cytokines interact to cause fibrosis and lymphatic dysfunction. We will use clinical specimens from patients with lymphedema before and after medical or surgical treatment as well as our mouse tail model. Aim 3: Determine how profibrotic cytokines regulate lymphatic function and fibrosis. This aim will test the working hypothesis that impaired lymphatic function secondary to fibrosis is a consequence of indirect effects of T-cells and Th2 cytokines on the lymphatic system rather than down-regulation of lymphangiogenic cytokine expression. PUBLIC HEALTH RELEVANCE: This application is relevant and in-line with the mission of the NIH since we aim to identify the basic pathophysiology of a common and disabling complication of cancer treatment. This information can be used to design targeted, rational treatments and preventative strategies that are oncologically safe. In addition, our research has broader relevance as it will increase our understanding of the lymphatic system which plays a critical role in fat metabolism, immunity, inflammation, and tumor metastasis.

描述（由申请人提供）：淋巴水肿是富含蛋白质的液体在组织中积聚，在美国，最常见的是作为癌症治疗的手术并发症。尽管有 3-500 万美国人患有淋巴水肿，但其病因尚不清楚，治疗仍然是姑息治疗。根据我们的实验室数据以及淋巴水肿的临床表现，我们假设淋巴水肿的病理继发于进行性纤维化，并由慢性 T 辅助细胞 (CD4+) 细胞炎症介导。该提案的目的是确定淋巴液淤滞如何导致组织纤维化和淋巴功能障碍。我们的长期目标是开发通过破坏瘀滞、纤维化和淋巴功能障碍的循环来治疗或预防淋巴水肿的疗法。这种方法是创新的，因为之前的努力试图通过使用细胞因子增强淋巴修复和再生来治疗淋巴水肿。然而，这些细胞因子也可能导致肿瘤转移或复发，从而限制了这种方法在癌症患者中的适用性。这个提议是 相关的，因为淋巴水肿是癌症治疗的常见病态并发症，没有经过证实的预防方法，并且治疗是姑息性的。我们计划通过 3 个具体目标来实现我们的目标。目标 1：确定促纤维化细胞因子的细胞来源。该目标将使用转基因小鼠、抗体耗竭以及小鼠尾部和腋窝解剖模型中的过继转移实验来检验 CD4+ T 细胞是促纤维化细胞因子的主要来源这一工作假设。目标 2：确定促纤维化细胞因子的表达是如何调节的。这一目标将检验以下假设：淋巴淤滞会导致 Th2 细胞炎症以及 IL4 和 IL13 表达，并且这些细胞因子相互作用会导致纤维化和淋巴功能障碍。我们将使用淋巴水肿患者在药物或手术治疗前后的临床标本以及我们的小鼠尾部模型。目标 3：确定促纤维化细胞因子如何调节淋巴功能和纤维化。这一目标将检验以下假设：继发于纤维化的淋巴功能受损是 T 细胞和 Th2 细胞因子对淋巴系统的间接影响的结果，而不是淋巴管生成细胞因子表达下调的结果。 公共健康相关性：该应用程序相关且符合 NIH 的使命，因为我们的目标是确定癌症治疗的常见致残并发症的基本病理生理学。这些信息可用于设计有针对性的、合理的治疗方法和肿瘤学安全的预防策略。此外，我们的研究具有更广泛的相关性，因为它将增加我们对淋巴系统的了解，淋巴系统在脂肪代谢、免疫、炎症和肿瘤转移中发挥着关键作用。