Lymphedema is a dreaded complication of cancer treatment. However, despite the fact that >5 million Americans are affected by this disorder, the development of effective treatments is limited by the fact that the pathology of lymphedema remains unknown. The purpose of these studies was to determine the role of inflammatory responses in lymphedema pathology. Using mouse models of lymphedema, as well as clinical lymphedema specimens, we show that lymphatic stasis results in a CD4 T-cell inflammation and T-helper 2 (Th2) differentiation. Using mice deficient in T cells or CD4 cells, we show that this inflammatory response is necessary for the pathological changes of lymphedema, including fibrosis, adipose deposition, and lymphatic dysfunction. Further, we show that inhibition of Th2 differentiation using interleukin-4 (IL-4) or IL-13 blockade prevents initiation and progression of lymphedema by decreasing tissue fibrosis and significantly improving lymphatic function, independent of lymphangiogenic growth factors. We show that CD4 inflammation is a critical regulator of tissue fibrosis and lymphatic dysfunction in lymphedema and that inhibition of Th2 differentiation markedly improves lymphatic function independent of lymphangiogenic cytokine expression. Notably, preventing and/or reversing the development of pathological tissue changes that occur in lymphedema may be a viable treatment strategy for this disorder.

译文

:淋巴水肿是一种可怕的癌症治疗并发症。然而,尽管事实上有超过500万美国人受到这种疾病的影响,但淋巴水肿的病理学仍然未知,这限制了有效疗法的发展。这些研究的目的是确定炎症反应在淋巴水肿病理中的作用。使用小鼠模型的淋巴水肿,以及临床淋巴水肿标本,我们显示淋巴淤积导致CD4 T细胞炎症和T辅助2(Th2)分化。使用缺乏T细胞或CD4细胞的小鼠,我们表明这种炎症反应对于淋巴水肿的病理变化(包括纤维化,脂肪沉积和淋巴功能障碍)是必需的。此外,我们显示,使用白介素4(IL-4)或IL-13阻滞抑制Th2分化可通过减少组织纤维化并显着改善淋巴功能来防止淋巴水肿的发生和进展,而与淋巴管生成生长因子无关。我们显示,CD4炎症是淋巴水肿中组织纤维化和淋巴功能障碍的关键调节器,抑制Th2分化显着提高了淋巴功能,而与淋巴管生成细胞因子的表达无关。值得注意的是,预防和/或逆转在淋巴水肿中发生的病理组织改变的发展可能是该疾病的可行治疗策略。

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