Cited by 241Lymphatic System and DiseasesLymphatic Disorders and TreatmentsParasitic Diseases Research and Treatment

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Th2 differentiation is necessary for soft tissue fibrosis and lymphatic dysfunction resulting from lymphedema

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Avraham, Tomer, Zampell, Jamie C., Yan, Alan, Elhadad, Sonia, Weitman, Evan S., Rockson, Stanley G., Bromberg, Jacqueline, Mehrara, Babak J.·2013·The FASEB Journal

DOI 10.1096/fj.12-222695PMC PMC3574290

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Abstract

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.

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Keratinocytes coordinate inflammatory responses and regulate development of secondary lymphedemaPreprint
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Self-citation

Authors: Avraham, T., Zampell, J. C., Yan, A., Elhadad, S., Weitman, E. S., Rockson, S. G., Bromberg, J., & Mehrara, B. J.
Affiliations: Memorial Sloan Kettering Cancer Center (US)
Division of Plastic and Reconstructive Surgery Department of Surgery New York New York USA
Stanford Medicine (US)
ORCID: Avraham, Tomer
Weitman, Evan S.
Rockson, Stanley G.
Bromberg, Jacqueline
Mehrara, Babak J.
Venue: The FASEB Journal
Publisher: Wiley
Published: 2012-11-27
Volume: 27
Issue: 3
Pages: 1114-1126
ISSN: 0892-6638 (ISSN-L)
1530-6860
DOI: 10.1096/fj.12-222695
PMC: PMC3574290
OpenAlex: W2102471792
Cited by: 241
References: 42
Citations by year: 2026: 22 · 2025: 21 · 2024: 19 · 2023: 26 · 2022: 24 · 2021: 24 · 2020: 16 · 2019: 21 · 2018: 12 · 2017: 16 · 2016: 10 · 2015: 12 · 2014: 12 · 2013: 4
FWCI: 4.43
Type: journal article
Language: en
Open access: green
europepmc.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: The FASEB Journal (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: U.S. Department of Defense (BC103691)
National Heart, Lung, and Blood Institute
National Institutes of Health (R01HL111130)
Center for Scientific Review (P30 CA08748)
Topics: Health Sciences › Medicine › Oncology › Lymphatic System and Diseases
Health Sciences › Medicine › Surgery › Lymphatic Disorders and Treatments
Health Sciences › Medicine › Infectious Diseases › Parasitic Diseases Research and Treatment
Keywords: lymphedema, Th2 differentiation, fibrosis, lymphatic dysfunction, lymphatic stasis, IL-4, IL-13, lymphangiogenesis, cancer treatment complications, lymphedema treatment
MeSH terms: Animals, Cell Differentiation, Disease Models, Animal, Fibrosis, Inflammation, Lymphedema, Mice, Nude, Interleukin-4, Mice, Knockout, Th2 Cells, Interleukin-13, Mice

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Th2 differentiation is necessary for soft tissue fibrosis and lymphatic dysfunction resulting from lymphedema

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