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Olmeda D, Cerezo-Wallis D, Castellano-Sanz E, García-Silva S, Peinado H, Soengas MS. Physiological models for in vivo imaging and targeting the lymphatic system: Nanoparticles and extracellular vesicles. Adv Drug Deliv Rev 2021; 175:113833. [PMID: 34147531 DOI: 10.1016/j.addr.2021.113833] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/24/2021] [Accepted: 06/11/2021] [Indexed: 02/06/2023]
Abstract
Imaging of the lymphatic vasculature has gained great attention in various fields, not only because lymphatic vessels act as a key draining system in the body, but also for their implication in autoimmune diseases, organ transplant, inflammation and cancer. Thus, neolymphangiogenesis, or the generation of new lymphatics, is typically an early event in the development of multiple tumor types, particularly in aggressive ones such as malignant melanoma. Still, the understanding of how lymphatic endothelial cells get activated at distal (pre)metastatic niches and their impact on therapy is still unclear. Addressing these questions is of particular interest in the case of immune modulators, because endothelial cells may favor or halt inflammatory processes depending on the cellular context. Therefore, there is great interest in visualizing the lymphatic vasculature in vivo. Here, we review imaging tools and mouse models used to analyze the lymphatic vasculature during tumor progression. We also discuss therapeutic approaches based on nanomedicines to target the lymphatic system and the potential use of extracellular vesicles to track and target sentinel lymph nodes. Finally, we summarize main pre-clinical models developed to visualize the lymphatic vasculature in vivo, discussing their applications with a particular focus in metastatic melanoma.
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Affiliation(s)
- David Olmeda
- Melanoma Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - Daniela Cerezo-Wallis
- Melanoma Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Center (CNIO), Madrid, Spain; Area of Cell & Developmental Biology, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, 28029, Spain
| | - Elena Castellano-Sanz
- Microenvironment and Metastasis Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - Susana García-Silva
- Microenvironment and Metastasis Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - Héctor Peinado
- Microenvironment and Metastasis Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Center (CNIO), Madrid, Spain.
| | - María S Soengas
- Melanoma Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Center (CNIO), Madrid, Spain.
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3
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Bordonaro V, Ciancarella P, Ciliberti P, Curione D, Napolitano C, Santangelo TP, Natali GL, Rollo M, Guccione P, Pasquini L, Secinaro A. Dynamic contrast-enhanced magnetic resonance lymphangiography in pediatric patients with central lymphatic system disorders. LA RADIOLOGIA MEDICA 2021; 126:737-743. [PMID: 33394367 DOI: 10.1007/s11547-020-01309-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/15/2020] [Indexed: 11/28/2022]
Abstract
Central conducting lymphatics (CCLs) disorders represent a broad spectrum of clinical entities ranging from self-limiting traumatic leaks treated by conservative strategies, to complex lymphatic circulation abnormalities that are progressive and unresponsive to currently available treatments. Dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) performed by intranodal injection of gadolinium-based contrast material is a recently developed technique which allows a minimally invasive evaluation of the CCL abnormalities providing a dynamic assessment of lymph flow and its pathways. In our institution, DCMRL is performed after bilateral cannulation of inguinal lymph nodes, using a MR protocol which includes volumetric 3D T2-SPACE (sampling perfection with application-optimized contrasts using different flip-angle evolution) and free-breathing respiratory navigated sequence and TWIST (time-resolved angiography with Interleaved stochastic trajectories) MR angiography sequence, during intranodal injection of paramagnetic contrast medium. Although DCMRL applications in clinical practice are still improving, a minimally invasive assessment of lymphatic pathways is particularly important both in pediatric patients with primitive lymphatic system disorders and in children with complex congenital heart disease associated with CCL impairment.
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Affiliation(s)
- Veronica Bordonaro
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Paolo Ciancarella
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Ciliberti
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Davide Curione
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carmela Napolitano
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Gian Luigi Natali
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimo Rollo
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Guccione
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luciano Pasquini
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Aurelio Secinaro
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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4
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Jackson SA, Prise KM. 125 years of BJR and radiological research: reflecting on the anniversary series in celebration of the world's oldest radiology journal. Br J Radiol 2021; 94:bjr20219001. [PMID: 33305997 DOI: 10.1259/bjr.20219001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Simon A Jackson
- Peninsula Radiology Academy, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Kevin M Prise
- Patrick G, Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
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Cholet C, Delalandre C, Monnier-Cholley L, Le Pimpec-Barthes F, El Mouhadi S, Arrivé L. Nontraumatic Chylothorax: Nonenhanced MR Lymphography. Radiographics 2020; 40:1554-1573. [PMID: 33001788 DOI: 10.1148/rg.2020200044] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Chylothorax is a rare cause of pleural effusion, secondary to accumulation of lymph in the pleural space. Diagnosis is based on the triglyceride and cholesterol content of pleural fluid obtained with thoracentesis. Because the lymphatic system plays an essential role in fat absorption and immune response, lymphatic leak associated with chylothorax may cause life-threatening malnutrition and immunodeficiency. Chylothorax is usually described as traumatic or nontraumatic. The main cause of chylothorax is traumatic, typically postsurgical, secondary to iatrogenic direct puncture of the thoracic duct during thoracic surgery. Causes of nontraumatic chylothorax include a wide range of differential diagnoses. Lymphoma and thoracic malignancies are the most common causes and are responsible for chylothorax by extrinsic compression or invasion of the thoracic duct. Other rare causes include primary and secondary diffuse lymphatic diseases, responsible for chylothorax by lymphatic vessel wall dysfunction. Imaging the lymphatic system remains a challenge in the days of modern imaging. Nonenhanced MR lymphography is a noninvasive technique based on heavily T2-weighted sequences, thus enabling visualization of the lymphatic circulation. This technique allows diagnosis and differential diagnosis, evaluation of disease severity, and guidance of therapeutic management in nontraumatic chylothorax. Furthermore, it may offer radiologic classification of primary lymphatic diseases on the basis of morphologic features of lymphatic vessels. The authors describe the anatomy and physiology of the thoracic lymphatic system, present the technique of nonenhanced MR lymphography, and discuss pathophysiologic mechanisms and imaging features in different causes of nontraumatic chylothorax. ©RSNA, 2020.
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Affiliation(s)
- Clément Cholet
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| | - Coline Delalandre
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| | - Laurence Monnier-Cholley
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| | - Françoise Le Pimpec-Barthes
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| | - Sanaâ El Mouhadi
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| | - Lionel Arrivé
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
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Abstract
Patients with lower limb edema are frequently referred to vascular specialists
for evaluation. Multiple etiologies must be considered and often more than one
cause may be present. Notably, the role of lymphatic system regardless of the
underlying pathology has been underestimated. A thorough history and physical
examination and a carefully considered laboratory and imaging evaluation are
critical in differentiating causes. In this opinion article, we propose a
diagnostic algorithm that incorporates a systematic approach to the patient with
leg swelling and provides an efficient pathway for the differential diagnosis
for this problem.
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Affiliation(s)
| | - Pamela S Kim
- Center for Vein Restoration and Center for Vascular Medicine, Framingham, MA, USA
| | - Steven M Dean
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Neil M Khilnani
- Division of Interventional Radiology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA
| | - Nicos Labropoulos
- Division of Vascular Surgery, Stony Brook Medicine, Stony Brook, NY, USA
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