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10/01/2021

Brain Development Insights
The origin of two neuron types reveals how some cellular diversity emerges in the brain

By ALLESSANDRA DiCORATO | Broad Communications September 24, 2021 Research
5 min read

colorful digital illustration of brain cells firing on black background
Image: bestdesigns/iStock/Getty Images Plus


Inside our brains lives a myriad of cell types that support complex human thought — from our ability to make memories and decisions to our capacity to smell, taste, move, and communicate. Scientists do not yet fully understand how this critical cellular diversity arises as the brain grows and develops.

Now, researchers at Harvard Medical School and the Broad Institute of MIT and Harvard, working with colleagues at the Flatiron Institute, have shown how two key cell types in the brain’s cortex arise from a single progenitor in mice, as well as genetic and molecular factors that allow the two populations of interneurons to develop different identities.

The work was led by Kathryn Allaway and Gord Fishell of HMS and the Stanley Center for Psychiatric Research at the Broad, Orly Wapinsky, formerly at the Broad, and Mariano Gabitto and Richard Bonneau of the Flatiron Institute.

Get more HMS news here

The findings, published Sept. 22 in Nature, could provide a model for studying the emergence of cellular diversity in the brain. Because many neurodevelopmental and psychiatric disorders affect different cell types, including interneurons, differently, the authors say their work could also help researchers better understand how these disorders come about.

The methods developed by the team could also help scientists study the effect of disease-related genetic mutations on various cell types in the brain.

“Part of the future of neuroscience will be to create tools that we can use to correct the activity of very specific cell types,” said Fishell, professor of neurobiology in the Blavatnik Institute at HMS and an institute member at the Broad.

“An important step towards those tools is what we’ve done in this study: getting more detailed knowledge of the individual cell types,” he said.

Inhibitory interneurons

Interneurons are neurons located exclusively in the central nervous system and are more diverse in shape, connectivity, and function than any other type of cell in the front of the brain.

The two most prominent types of interneurons are parvalbumin (PV)- and somatostatin (SST)-positive cells. In adults, these cells could not be more dissimilar.

While both are inhibitory cells—they stop or slow down neuronal firing—PV and SST cells do this in different ways.

PV cells act as a kind of veto, stopping a signal altogether, whereas SST cells fine-tune neuronal communication, allowing some signals to go through while halting others.

Fishell’s team knew from previous work that despite their differences, PV and SST cells arise from the same cell type.

To determine what factors might influence how and when the cells diverge, the researchers used a combination of RNA sequencing, which provides information about how genes are expressed, and a technique called Assay for Transposase-Accessible Chromatin using sequencing, or ATAC-seq, to analyze the two cell types. ATAC-seq reveals which parts of chromatin—the tightly wound package of DNA and protein in the cell’s nucleus—are accessible to the cell’s protein-making machinery.

“When you bring these two data sets together, it's a really rich data source for building amazing computational models for gene regulation,” said Allaway, co-first author of the study and a graduate student in Fishell’s lab when the research took place.

Using these data, the researchers built maps showing how molecular regulators—such as complexes of DNA, RNA, and proteins—interconnect to control gene expression in mouse PV and SST cells.

In collaboration with Bonneau at the Flatiron Institute, Fishell’s team modeled these gene regulatory networks computationally.

“We have been absolutely privileged to work with computational scientists who can make use of this complicated data,” said Fishell. “And we're very proud and very, very happy to be here in the early stages of watching biology transition from an experimental science to a field where there's true theory behind it.”

Evaluating models

By comparing gene regulatory networks for different time points before and after birth, the team found that the two interneuron types diverged when they stopped migrating during early development and settled in the cortex.

They found that certain proteins called transcription factors, which help regulate gene activity, were shared in both cell types but acted differently to direct development of the two cell types.

This suggests that chromatin architecture plays a major role in maintaining the ultimate fate of the cells by controlling which transcription factors can access DNA to regulate gene expression.

Using their computational models, Fishell’s team was then able to predict the impact of certain genes on cell type development. In particular, they found that the Mef2c gene, which is mutated in a severe form of autism, was involved in sculpting chromatin in both PV and SST cells but was particularly critical for PV cells.

When the team disabled Mef2c in cells in the lab, they confirmed that their model accurately predicted 80 percent of the molecular targets that are regulated by Mef2c in both SST and PV cells.

Fishell says that the accuracy of their model suggests that the team’s approach could be used to predict the impact of genetic mutations on other cell types quickly before running experiments.

With that kind of insight, researchers could ultimately develop tools to target gene expression in specific cell types and restore normal activity in cells that might be malfunctioning in a particular neurodevelopmental or psychiatric disorder.

Next, the researchers will work towards understanding how other proteins besides transcription factors, such as chromatin modifiers, affect gene expression in different cells.

“In 10 years, we're going to be using incredibly powerful computation with incredibly powerful DNA and RNA work to model how genes affect the way our brain functions at a cellular level,” said Fishell. “That is a holy grail. We're not there yet, but this really took a big step in the direction of predicting how gene loss affects brain function.”

This work was supported by the National Institutes of Health, Simons Foundation, and National Science Foundation.

10/01/2021

Breast Cancer Awareness
Month Survival Guide

To be frank, and at the risk of being cliché, Breast Cancer Awareness Month is the best of times and the worst of times. People can feel empowered and supported with an outburst of community engagement such as walks, runs, and even pink ribbons plastered on everything from public transportation to egg cartons at the grocery store! However, there are others who would rather hibernate for the next 31 days and reemerge November 1, once the outpour of pink has dissipated.

At the height of community discourse on diversity and inclusion, how does that translate into the important work taking place within our breast cancer network? Let's be cognizant of the language we use this month; how we can support the multitude of emotions that October may trigger; and to take that extra step in compassion and empathy.

Some people love pink and all that the ribbon represents. For others, it can feel quite marginalizing. Let's not only celebrate those who are SURVIVING, day in and day out, but let us remember all of our friends, and members of our vaunted breast cancer community that we have lost to this hideous disease. If you would like to honor a friend or a loved one who has passed to MBC by sharing their story in remembrance, please consider submitting an article and photos that we can honor and acknowledge at SBC! Please send submissions to Desiree at dleroy@survivingbreastcancer.org.

Below is a survival list for Breast Cancer Awareness Month:

Mindfulness tips
-Sparkly pink survivor sashes can certainly be a badge of honor, but let's remember that not everyone identifies with being a "survivor".
-Let's follow the money when making donations in the name of Breast Cancer Awareness, make sure you know how your money is being spent.
-Let's remember that if we start with finding a cure for metastatic disease, which is a terminal illness and takes lives, everyone else with earlier stage breast cancer will benefit.
-Let's check in on each other.
-Let's share the diversity we enjoy within our breast cancer communities.
-Let's unite. Let's partner. Let's take Awareness and strive for Action and Advocacy.

Advocating for yourself
It is important to advocate for yourself at every step of your diagnosis: whether you want a second opinion of a symptom you think could be breast cancer, or want to get more information about all of the available treatment options. Remember, you are your own best advocate and need to speak up when something doesn’t feel right or you want to make better informed decisions. Your doctors and care team all want what's best for you. At the end of the day, however, it’s your body and you will feel more empowered.

Connect with others in the breast cancer community
Consider participating in a number of events and programs being offered this month through our organization. October for SBC is business as usual with a few additional bells and whistles. Join us for our Thursday Night Thrivers meetups, attend one of our Movement Monday sessions or our upcoming Writing as Healing workshop on October 11. Cozy up with a book and join us for our Breast Cancer Book Club meeting on Sunday where we pick readings that have absolutely nothing to do with cancer! If you are looking for some of those bells and whistles events, head to Chicago where we are hosting two fundraisers: a burlesque show and water color painting workshop! Check out everything that is happening this month here!

Give voice
One of the most powerful ways to navigate BCA Month is to give voice to your experience. This can be done through social media, posting on twitter, or even being a guest on a podcast. You may find that writing about your experience is the perfect outlet for letting the world know what BCA month means to you, whether or not you love this month! We've developed a list of 20 writing prompts and if you are interested, we'd encourage you to share with our community!

Read on for more from survivors and healthcare professionals explaining why self-advocacy is so necessary, their experiences advocating for themselves, and tips on how you can do the same.

10/01/2021

BCA Month Survival Guide

To be frank, and at the risk of being cliché, Breast Cancer Awareness Month is the best of times and the worst of times. People can feel empowered and supported with an outburst of community engagement such as walks, runs, and even pink ribbons plastered on everything from public transportation to egg cartons at the grocery store! However, there are others who would rather hibernate for the next 31 days and reemerge November 1, once the outpour of pink has dissipated.

At the height of community discourse on diversity and inclusion, how does that translate into the important work taking place within our breast cancer network? Let's be cognizant of the language we use this month; how we can support the multitude of emotions that October may trigger; and to take that extra step in compassion and empathy.

Some people love pink and all that the ribbon represents. For others, it can feel quite marginalizing. Let's not only celebrate those who are SURVIVING, day in and day out, but let us remember all of our friends, and members of our vaunted breast cancer community that we have lost to this hideous disease. If you would like to honor a friend or a loved one who has passed to MBC by sharing their story in remembrance, please consider submitting an article and photos that we can honor and acknowledge at SBC! Please send submissions to Desiree at dleroy@survivingbreastcancer.org.

Below is a survival list for Breast Cancer Awareness Month:

Mindfulness tips
-Sparkly pink survivor sashes can certainly be a badge of honor, but let's remember that not everyone identifies with being a "survivor".
-Let's follow the money when making donations in the name of Breast Cancer Awareness, make sure you know how your money is being spent.
-Let's remember that if we start with finding a cure for metastatic disease, which is a terminal illness and takes lives, everyone else with earlier stage breast cancer will benefit.
-Let's check in on each other.
-Let's share the diversity we enjoy within our breast cancer communities.
-Let's unite. Let's partner. Let's take Awareness and strive for Action and Advocacy.

Advocating for yourself
It is important to advocate for yourself at every step of your diagnosis: whether you want a second opinion of a symptom you think could be breast cancer, or want to get more information about all of the available treatment options. Remember, you are your own best advocate and need to speak up when something doesn’t feel right or you want to make better informed decisions. Your doctors and care team all want what's best for you. At the end of the day, however, it’s your body and you will feel more empowered.

Connect with others in the breast cancer community
Consider participating in a number of events and programs being offered this month through our organization. October for SBC is business as usual with a few additional bells and whistles. Join us for our Thursday Night Thrivers meetups, attend one of our Movement Monday sessions or our upcoming Writing as Healing workshop on October 11. Cozy up with a book and join us for our Breast Cancer Book Club meeting on Sunday where we pick readings that have absolutely nothing to do with cancer! If you are looking for some of those bells and whistles events, head to Chicago where we are hosting two fundraisers: a burlesque show and water color painting workshop! Check out everything that is happening this month here!

Give voice
One of the most powerful ways to navigate BCA Month is to give voice to your experience. This can be done through social media, posting on twitter, or even being a guest on a podcast. You may find that writing about your experience is the perfect outlet for letting the world know what BCA month means to you, whether or not you love this month! We've developed a list of 20 writing prompts and if you are interested, we'd encourage you to share with our community!

Read on for more from survivors and healthcare professionals explaining why self-advocacy is so necessary, their experiences advocating for themselves, and tips on how you can do the same.

11/02/2020

Protein Mapping Study Reveals Valuable Clues for COVID-19 Drug Development

Dr. Francis Collins Dr. Francis Collins
6 days ago

COVID-19 Update

Credit: DE Gordon et al., Science, 2020
One way to fight COVID-19 is with drugs that directly target SARS-CoV-2, the novel coronavirus that causes the disease. That’s the strategy employed by remdesivir, the only antiviral drug currently authorized by the U.S. Food and Drug Administration to treat COVID-19. Another promising strategy is drugs that target the proteins within human cells that the virus needs to infect, multiply, and spread.

With the aim of developing such protein-targeted antiviral drugs, a large, international team of researchers, funded in part by the NIH, has precisely and exhaustively mapped all of the interactions that take place between SARS-CoV-2 proteins and the human proteins found within infected host cells. They did the same for the related coronaviruses: SARS-CoV-1, the virus responsible for outbreaks of Severe Acute Respiratory Syndrome (SARS), which ended in 2004; and MERS-CoV, the virus that causes the now-rare Middle East Respiratory Syndrome (MERS).

The goal, as reported in the journal Science, was to use these protein “interactomes” to uncover vulnerabilities shared by all three coronaviruses. The hope is that the newfound knowledge about these shared proteins—and the pathways to which they belong—will inform efforts to develop new kinds of broad-spectrum antiviral therapeutics for use in the current and future coronavirus outbreaks.

Facilitated by the Quantitative Biosciences Institute Research Group, the team, which included David E. Gordon and Nevan Krogan, University of California, San Francisco, and hundreds of other scientists from around the world, successfully mapped nearly 400 protein-protein interactions between SARS-CoV-2 and human proteins.

You can see one of these interactions in the video above. The video starts out with an image of the Orf9b protein of SARS-CoV-2, which normally consists of two linked molecules (blue and orange). But researchers discovered that Orf9b dissociates into a single molecule (orange) when it interacts with the human protein TOM70 (teal). Through detailed structural analysis using cryo-electron microscopy (cryo-EM), the team went on to predict that this interaction may disrupt a key interaction between TOM70 and another human protein called HSP90.

While further study is needed to understand all the details and their implications, it suggests that this interaction may alter important aspects of the human immune response, including blocking interferon signals that are crucial for sounding the alarm to prevent serious illness. While there is no drug immediately available to target Orf9b or TOM70, the findings point to this interaction as a potentially valuable target for treating COVID-19 and other diseases caused by coronaviruses.

This is just one intriguing example out of 389 interactions between SARS-CoV-2 and human proteins uncovered in the new study. The researchers also identified 366 interactions between human and SARS-CoV-1 proteins and 296 for MERS-CoV. They were especially interested in shared interactions that take place between certain human proteins and the corresponding proteins in all three coronaviruses.

To learn more about the significance of these protein-protein interactions, the researchers conducted a series of studies to find out how disrupting each of the human proteins influences SARS-CoV-2’s ability to infect human cells. These studies narrowed the list to 73 human proteins that the virus depends on to replicate.

Among them were the receptor for an inflammatory signaling molecule called IL-17, which has been suggested as an indicator of COVID-19 severity. Two other human proteins—PGES-2 and SIGMAR1—were of particular interest because they are targets of existing drugs, including the anti-inflammatory indomethacin for PGES-2 and antipsychotics like haloperidol for SIGMAR1.

To connect the molecular-level data to existing clinical information for people with COVID-19, the researchers looked to medical billing data for nearly 740,000 Americans treated for COVID-19. They then zeroed in on those individuals who also happened to have been treated with drugs targeting PGES-2 or SIGMAR1. And the results were quite striking.

They found that COVID-19 patients taking indomethacin were less likely than those taking an anti-inflammatory that doesn’t target PGES-2 to require treatment at a hospital. Similarly, COVID-19 patients taking antipsychotic drugs like haloperidol that target SIGMAR1 were half as likely as those taking other types of antipsychotic drugs to require mechanical ventilation.

More research is needed before we can think of testing these or similar drugs against COVID-19 in human clinical trials. Yet these findings provide a remarkable demonstration of how basic molecular and structural biological findings can be combined with clinical data to yield valuable new clues for treating COVID-19 and other viral illnesses, perhaps by repurposing existing drugs. Not only is NIH-supported basic science essential for addressing the challenges of the current pandemic, it is building a strong foundation of fundamental knowledge that will make us better prepared to deal with infectious disease threats in the future.

Reference:

[1] Comparative host-coronavirus protein interaction networks reveal pan-viral disease mechanisms. Gordon DE et al. Science. 2020 Oct 15:eabe9403.

Links:

Coronavirus (COVID-19) (NIH)

Krogan Lab (University of California, San Francisco)

NIH Support: National Institute of Allergy and Infectious Diseases; National Institute of Neurological Disorders and Stroke; National Institute of General Medical Sciences

10/29/2020

How Lymphatic Insufficiencies Result in Edema or Lymphedema
BY JOACHIM ZUTHER, ON OCTOBER 28TH, 2020



The term “swelling” is used to describe an enlargement of a body part and can be used to describe edema, as well as lymphedema. While the initial causes for the formation of the swelling are different, both involve the accumulation of fluid in the soft tissues of the skin due to some form of insufficiency of the lymphatic system. However, edema and lymphedema are clearly not the same and require different treatment approaches.

Function of the Lymphatic System

The lymphatic system is part of the circulatory system and consists of a network of lymphatic vessels that carry a clear fluid called lymph. The lymphatic system has multiple interrelated functions:



Collection and transport of fluids (water) from the tissues of the body back to the venous system (fluid homeostasis),
Absorption and transportation of fatty acids from the digestive system, and
Immune response – lymph nodes and other lymphatic organs filter the lymph to remove microorganisms and other foreign particles.
Components of Lymph Fluid

Once the fluid from the tissues enters the lymphatic system, it is called lymph (from Latin lympha = water). Lymph fluid is clear and transparent, with the exception of the lymph fluid found in lymph vessels draining the intestinal system; fatty acids absorbed by intestinal lymphatics produce a cloudy or milky appearance of the lymph fluid. In addition to the water and fatty acids, lymph fluid contains proteins and cellular components.
The main component of lymph fluid is water, which flows through the lymphatic system and plays an essential role in the body’s fluid management. The fluid, which is filtered out through the walls of the blood capillaries, is located between the cells in all body tissues and enters the lymphatic system via the smallest lymph vessels, the lymph capillaries. This lymphatic fluid is then transported by progressively larger lymph vessels (collectors) to lymph nodes, where substances are removed from the lymph fluid by tissue lymphocytes, and circulating lymphocytes are added to the fluid. Following the passage through lymph nodes, the lymph fluid ultimately enters into the right or the left subclavian vein, where it mixes with the central venous blood. Throughout the course of a day, between 70 to 100 fluid ounces (2-3 liters) of water are returned by the lymphatic system back into the venous circulation.

Transport Capacity of the Lymphatic System

The amount of lymph fluid the body produces varies; increased activity or certain pathologies, like venous insufficiencies, increases the amount of lymph fluid the lymphatic system is responsible to transport. As long as the lymphatic system is healthy and sufficient, it will be able to cope with the increased amount of fluid, due to its transport capacity, which has a built in functional reserve. The transport capacity is the maximum amount of fluid the lymphatic system can handle. In an undisrupted, healthy lymphatic system, the transport capacity exceeds the normal amount of lymph fluid by a factor of almost 10, which allows the lymphatic system to react to an increased volume of water and proteins by increasing its activity and cope with the additional volume.

Insufficiencies of the Lymphatic System

An insufficiency is present if the transport capacity of the lymphatic system is smaller than the volume of lymphatic fluid; there are three forms of insufficiency, which can result in either edema or lymphedema: dynamic, mechanical, or combined insufficiency.

Dynamic Insufficiency: This is the most common insufficiency, also known as high-volume insufficiency. In this case, the volume of water (sometimes of protein and water) exceeds the transport capacity of the healthy lymphatic system, which results in edema. Edema is a swelling caused by the accumulation of abnormally large amounts of fluid in the inter-cellular tissue spaces of the body, which is visible and/or palpable (pitting). It is a symptom rather than a disease or disorder, and may be caused by cardiac insufficiency, immobility, chronic venous insufficiency (stage I and II), pregnancy, and other factors.

Prolonged dynamic insufficiency (e.g., months; the duration varies depending on the condition and severity) can cause secondary damage to the lymphatic system. The constant overload causes the lymph collectors working at their transport capacity over extended periods of time, possibly resulting in damage to the structure of lymph collectors (walls and valves). Secondary damage to the lymph collectors could cause a reduction in their transport capacity, which would exacerbate the situation.

To avoid secondary damage to the lymphatic system and the tissues, it is imperative to reduce the amount of lymphatic fluid as soon as possible. In localized edema, this can be achieved by elevation, exercise, and compression, as long as the overload is not caused by cardiac insufficiency, in which case compression therapy is contraindicated. In some instances, diuretics may be prescribed to reduce the edema.

Mechanical Insufficiency: This form, also known as low-volume insufficiency, is caused by a reduction in the transport capacity of the lymphatic system due to surgery, radiation, trauma, or inflammation involving the lymphatic system. The impairment is so severe that the lymphatic system is unable to perform one of its basic functions, which is the removal of water and protein from the tissues, or to respond to an increase in the lymphatic load of water and protein. This will result in high-protein edema or lymphedema.

Lymphedema, if left untreated, will lead to serious consequences. The stagnation of water, protein, and other waste products in the interstitial tissues may cause tissue damage. The stagnated protein-rich swelling causes increased tissue formation (fibrosis) and leads to a high susceptibility to infections (cellulitis).

To reduce lymphedema and to avoid further damage, it is imperative to treat this condition as soon as possible with complete decongestive therapy (CDT), which is the therapy of choice, and internationally recognized as the gold-standard for the treatment and management of lymphedema. Diuretics are not indicated to treat lymphedema.

Combined Insufficiency: In this case, the transport capacity of the lymphatic system is below its normal level, and in addition, the amount of lymph fluid is elevated. The maximum degree of this insufficiency is reached if the transport capacity is reduced below the level of normal lymphatic fluid (mechanical insufficiency), and simultaneously the volume of lymph fluid is greater than the transport capacity of a healthy lymphatic system (dynamic insufficiency). The combination of these insufficiencies may lead to severe tissue damage (necrosis) and chronic inflammation in the affected areas.
If a mechanical insufficiency is present and the lymphatic load of water, or protein and water increases, combined insufficiency will be the result.

To avoid the additional complication of a combined insufficiency in the presence of dynamic insufficiency, the primary goal is to reduce the lymphatic volume.
In lymphedema (mechanical insufficiency), the clinical goal is to reduce the interstitial swelling as soon as possible and to avoid an additional increase in lymphatic load. It is also important to understand that infection, trauma, and certain forms of exercise result in an increase in lymphatic fluid (as well as protein and cells), which may lead to combined insufficiency with further complications. To avoid this situation it is necessary to provide patients affected by lymphedema with as much information as possible.

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Rehab Science Blog » Lymphedema » Could Lymphedema Cause Arteriosclerosis? COULD LYMPHEDEMA CAUSE ARTERIOSCLEROSIS?By: R...
10/28/2020

Rehab Science Blog » Lymphedema » Could Lymphedema Cause Arteriosclerosis?

COULD LYMPHEDEMA CAUSE ARTERIOSCLEROSIS?
By: Ryan Davey, PhD
April 25, 2017
Editors: Ryan Davey, PhD and Lindsay Davey, MScPT, MSc, CDT

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New research is pointing to a possible link between lymphedema and arteriosclerosis – a potentially lethal vascular condition. Is arteriosclerosis a complication of lymphedema that patients should be worried about?

Arteriosclerosis is a hardening and thickening of the arteries. These vascular changes can eventually restrict blood flow to organs and tissues, resulting in severe complications such as myocardial infarction (heart attack) and stroke. Atherosclerosis is a common type of arteriosclerosis, one that includes fatty plaque accumulation within the arteries (Fig. 1).

lymphedema and atherosclerosis: progression of atherosclerosisFig 1: Progression of atherosclerosis. For the source of this figure and more information on atherosclerosis please see:
here


Contents [hide]
1 Why would there be a link between lymphedema and arteriosclerosis?
1.1 1. Lymphatic vessels are involved in lipoprotein absorption and circulation
1.2 2. Lymphatic vessels are involved in inflammatory processes
2 The plot thickens
3 New data links arteriosclerosis to lymphedema in people
4 And vice versa: high cholesterol may exacerbate lymphedema
5 Take home messages
6 References
WHY WOULD THERE BE A LINK BETWEEN LYMPHEDEMA AND ARTERIOSCLEROSIS?
Lymphedema is a disease of the lymphatic system, whereas arteriosclerosis is a disease of the blood vascular system. How could there be a link between these two very different conditions? Here’s how:

1. LYMPHATIC VESSELS ARE INVOLVED IN LIPOPROTEIN ABSORPTION AND CIRCULATION
Lipids (fats) in the bloodstream are primarily found in complexes called lipoproteins. The accumulation of certain lipoproteins in circulation, such as LDL (low-density lipoprotein), is a key factor involved in the development of atherosclerosis.

Lymphatic vessels play a role in lipoprotein absorption and circulation:

Lymphatic vessels in the intestine absorb lipids from the food we ingest, and transport them into the blood stream.
Lymphatic vessels are actively involved in lipid transport throughout the body. Vascular and lymphatic systems work together to maintain fluid balance and transport lipoproteins. A quick explanation: blood vessels deliver nutrient and oxygen-rich fluid to bathe the cells of the body and wash away waste and other products secreted from cells. This includes lipids (fats) released from adipose tissue (fat stores). But not all this fluid returns to the blood, some is instead collected by the lymphatic system for transport back to the blood at the heart. The fluid collected by the lymphatic system (known as ‘lymph’) is lipoprotein rich.
When normal lymphatic transport is disrupted, as in the case of lymphedema, this leads to a build up of lipoprotein rich fluid in the tissues and swelling. Eventually this lymphedema causes the formation of new adipose tissue in the area – an abnormal physiological event triggered by the altered tissue environment.

Lymphedema that impacts lymphatics connected to the small intestine could also disrupt normal absorption and transport of ingested fats.

The consequences of lymphedema on lipid homeostasis (the balance of lipids in the body) are not well understood, and would be expected to vary with the extent and location of lymphedema. However, a potential link to arteriosclerosis seems feasible.

2. LYMPHATIC VESSELS ARE INVOLVED IN INFLAMMATORY PROCESSES
Lymphatic vessels play a significant role in the immune system, carrying immune cells throughout the body, and filtering fluid through lymph nodes. Lymphatic disruption observed in lymphedema is known to alter inflammatory processes. Inflammatory processes are also believed to play a key role in the development of atherosclerosis.

As discussed above, the impact of lymphedema on lipid processing and inflammation provides a possible connection to arteriosclerosis. This sets the stage for what comes next: experimental and clinical evidence of this proposed connection.

THE PLOT THICKENS
In 2014 two experimental strains of mice were bred together, one with a propensity to develop lymphedema, and the other atherosclerosis (ref 1). The result? The authors of the study concluded that impaired lymphatic function appeared to interfere with proper lipoprotein processing, and caused an increase in blood cholesterol levels and the acceleration of atherosclerosis (fatty plaque build up in the arteries) in the mutant mice.

Additional mouse studies have offered further support for a link between lymphatic function and atherosclerotic processes. But mice, and in particular genetically modified experimental strains of them, are not always a great model for human disease processes.

NEW DATA LINKS ARTERIOSCLEROSIS TO LYMPHEDEMA IN PEOPLE
A recent study for the first time has demonstrated a link between lymphedema and arteriosclerosis in humans (ref 2). The authors of this small but interesting study examined arterial stiffness (a symptom of arteriosclerosis) using an indirect measure called the cardio-ankle vascular index (CAVI) in the legs of 24 females with pelvic cancer-related lower extremity lymphedema. Both lymphedematous and non-lymphedematous legs were examined.

The authors concluded that lymphedema duration and the extent of lymphedema were independent risk factors for arterial stiffening. In other words, the authors suggested that the longer you have lymphedema, or the greater the lymphatic deficiency you have, the more likely you are to exhibit arterial hardening, one of the hallmarks of arteriosclerosis.

However, this study is by no means definitive. Putting aside the obvious issues with this type of strictly observational study (such as the inability to draw conclusions about any cause-effect relationship), if lymphedema does in fact promote arterial hardening as this paper suggests, it remains to be seen if this hardening is clinically significant. In other words, could vascular changes caused by lymphedema actually increase the risk of heart attack or stroke?

There is one more thing to consider here: is this apparent link between lymphedema and arteriosclerotic processes limited to forms of lymphedema that significantly impede the function of deep lymphatic vessels of the lower extremities – such as in the case of pelvic cancer-related lower extremity lymphedema examined in this study? Unlike lymphedema present in other areas of the body, lymphedema in the pelvis could influence the ability of the lymphatic system to process fats from the gastrointestinal tract.

AND VICE VERSA: HIGH CHOLESTEROL MAY EXACERBATE LYMPHEDEMA
Interestingly, this possible connection between lymphedema and arteriosclerosis may be a two-way street.

High levels of cholesterol (hypercholesterolemia) in adult mice (more specifically, an experimental mouse strain with a genetic deficiency in the ability to efficiently process lipoproteins) appears to cause lymphatic leakage, reduced lymphatic function, and tissue swelling (ref 3). In fact, this relationship appears to be ‘dose-dependent’: as levels of cholesterol increased, lymph vessel integrity and function was found to further decrease.

The authors of this study concluded that the degeneration of lymphatic function appeared to be a direct response to hypercholesterolemia. But this conclusion once again needs to be tempered. First, we are talking about an experimental mouse strain. Second, this mutant mouse line also exhibits abnormal inflammatory responses, and could also foreseeably suffer from some unidentified lymphatic malformation during development. The authors can’t really rule out either of these alternative possibilities.

So, we can conclude that if you have lymphedema, hypercholesterolemia MAY exacerbate lymphatic vessel dysfunction and worsen your symptoms.

TAKE HOME MESSAGES
There is certainly sufficient medical evidence to suggest that you should eat well, exercise and otherwise stay as healthy as you can, to avoid arteriosclerosis. You don’t need to believe in a potential link between lymphedema and arteriosclerosis to convince you of this.

Nevertheless, if you do have lymphedema you should consider three important takeaways from this new area of research:

Your lymphedema MAY predispose you to arteriosclerotic changes which MAY further push you down the path towards arteriosclerosis. Therefore, you MAY wish to be more cautious about your blood vessel health compared to the average Joe/Josephine.
Prolonged levels of high circulating cholesterol MAY worsen your lymphedema symptoms, and further progress your condition.
Lymphatic function and cholesterol metabolism MAY operate in a beneficial cycle – improving one may help improve the other, which may in turn help improve the first, and on and on. But unfortunately there is a flip side to this coin: a potentially vicious cycle of ever-worsening lymphatic function and cholesterol metabolism.
REFERENCES
Vuorio T., Nurmi H., Moulton K. Lymphatic vessel insufficiency in hypercholesterolemic mice alters lipoprotein levels and promotes artherogenesis. Arterioscler Thromb Vasc Biol. 2014 Jun;34(6):1162-70.
Yamamoto T., Yamamoto N., Yamash*ta M., et al. Relationship Between Lyphedema and Arteriosclerosis: Higher Cardio-Ankle Vascular Index (CAVI) in Lymphedematous Limbs. Ann Plast Surg. 2016 Mar;76(3):336-9.
Ying Lim H., Rutkoweski J.M., Helft J., et al. Hypercholesterolemic Mice Exhibit Lymphatic Vessel Dysfunction and Degeneration. Am J Pathol. 2009 Sep;175(3):1328-37.

Physical and Lymphedema Therapies

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250 S Harding Boulevard, Ste 2
Roseville, CA
95678

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Thursday 7am - 7pm
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