Release of [3H]-noradrenaline from the sympathetic nerves to bovine mesenteric lymphatic vessels and its modification by alpha-agonists and antagonists

Drug-Related Lymphedema: Mysteries, Mechanisms, and Potential Therapies

The lymphatic circulation is an important component of the circulatory system in humans, playing a critical role in the transport of lymph fluid containing proteins, white blood cells, and lipids from the interstitial space to the central venous circulation. The efficient transport of lymph fluid critically relies on the rhythmic contractions of collecting lymph vessels, which function to “pump” fluid in the distal to proximal direction through the lymphatic circulation with backflow prevented by the presence of valves. When rhythmic contractions are disrupted or valves are incompetent, the loss of lymph flow results in fluid accumulation in the interstitial space and the development of lymphedema. There is growing recognition that many pharmacological agents modify the activity of ion channels and other protein structures in lymph muscle cells to disrupt the cyclic contraction and relaxation of lymph vessels, thereby compromising lymph flow and predisposing to the development of lymphedema. The effects of different medications on lymph flow can be understood by appreciating the intricate intracellular calcium signaling that underlies the contraction and relaxation cycle of collecting lymph vessels. For example, voltage-sensitive calcium influx through long-lasting (“L-type”) calcium channels mediates the rise in cytosolic calcium concentration that triggers lymph vessel contraction. Accordingly, calcium channel antagonists that are mainstay cardiovascular medications, attenuate the cyclic influx of calcium through L-type calcium channels in lymph muscle cells, thereby disrupting rhythmic contractions and compromising lymph flow. Many other classes of medications also may contribute to the formation of lymphedema by impairing lymph flow as an off-target effect. The purpose of this review is to evaluate the evidence regarding potential mechanisms of drug-related lymphedema with an emphasis on common medications administered to treat cardiovascular diseases, metabolic disorders, and cancer. Additionally, although current pharmacological approaches used to alleviate lymphedema are largely ineffective, efforts are mounting to arrive at a deeper understanding of mechanisms that regulate lymph flow as a strategy to identify novel anti-lymphedema medications. Accordingly, this review also will provide information on studies that have explored possible anti-lymphedema therapeutics.

Experimental Models Used to Assess Lymphatic Contractile Function

Recent years have seen a renewed interest in studies of the lymphatic system. This review addresses the differences between in vivo and ex vivo methods for visualization and functional studies of lymphatic networks, with an emphasis on studies of collecting lymphatic vessels. We begin with a brief summary of the historical uses of both approaches. For the purpose of detailed comparisons, we subdivide in vivo methods into those visualizing lymphatic networks through the intact skin and those using surgically opened skin. We subdivide ex vivo methods into isobaric studies (using a pressure myograph) or isometric studies (using a wire myograph). For all four categories, we compile a comprehensive list of the advantages, disadvantages, and limitations of each preparation, with the goal of informing the research community as to the appropriate kinds of experiments best suited, and ill suited, for each.

Morphological and Molecular Characterization of Human Dermal Lymphatic Collectors

Millions of patients suffer from lymphedema worldwide. Supporting the contractility of lymphatic collectors is an attractive target for pharmacological therapy of lymphedema. However, lymphatics have mostly been studied in animals, while the cellular and molecular characteristics of human lymphatic collectors are largely unknown. We studied epifascial lymphatic collectors of the thigh, which were isolated for autologous transplantations. Our immunohistological studies identify additional markers for LECs (vimentin, CCBE1). We show and confirm differences between initial and collecting lymphatics concerning the markers ESAM1, D2-40 and LYVE-1. Our transmission electron microscopic studies reveal two types of smooth muscle cells (SMCs) in the media of the collectors with dark and light cytoplasm. We observed vasa vasorum in the media of the largest collectors, as well as interstitial Cajal-like cells, which are highly ramified cells with long processes, caveolae, and lacking a basal lamina. They are in close contact with SMCs, which possess multiple caveolae at the contact sites. Immunohistologically we identified such cells with antibodies against vimentin and PDGFRα, but not CD34 and cKIT. With Next Generation Sequencing we searched for highly expressed genes in the media of lymphatic collectors, and found therapeutic targets, suitable for acceleration of lymphatic contractility, such as neuropeptide Y receptors 1, and 5; tachykinin receptors 1, and 2; purinergic receptors P2RX1, and 6, P2RY12, 13, and 14; 5-hydroxytryptamine receptors HTR2B, and 3C; and adrenoceptors α2A,B,C. Our studies represent the first comprehensive characterization of human epifascial lymphatic collectors, as a prerequisite for diagnosis and therapy.

Analysis of nerve supply pattern in human lymphatic vessels of young and old men

BACKGROUND

The present work deals with innervation patterns along collector lymphatic vessels from cervical, mesenteric, and femoral regions, and lymph capillaries in young and elderly subjects.

METHODS AND RESULTS

Morphological and morphometric analysis of nerve fibers along lymph vessels was performed by immunohistochemistry for PGP 9.5, NPY, TH, ChAT, VIP, SP, and dopamine. Nerves containing NPY and TH were frequent, whereas immunoreactivity for ChAT and VIP were few. SP-positive fibers were widely distributed in the medial and endothelial layers. Dopamine neurotransmitters were observed in a few short nerve fibers. A more diffuse presence of nerve fibers in mesenteric and femoral lymph vessels, compared to cervical ones, was detected. In lymph capillary vessels, a few nerve fibers positive for neuropeptides and neurotransmitters were detected, whereas no dopamine and VIP immunoreactive fibers were detected. A wide reduction of all specific nerve fibers analyzed was detected in lymph vessels from elderly subjects.

CONCLUSIONS

The presence on lymph vessels of sympathetic and parasympathetic nerve systems can be declared. The differences observed in lymphatic vessel innervation patterns may note the involvement in lymph flow regulation, calling attention in aging, when nerve fibers reduction may cause functional default of lymph vessels.

A Model for Lymphatic Regeneration in Tissue Repair of the Intestinal Muscle Coat

The gastrointestinal lymphatic system, which comprises a network of thin-walled vessels, is essential for the regulation of tissue fluid volume, immune function, and transport of fatty nutrients. The identification of specific lymphatic endothelial markers has facilitated analyses of lymphatic organization and lymphangiogenesis during individual development and tissue repair. The intestinal muscle coat producing motor activity develops a dense maze-like lymphatic network by vascular sprouting consisting of thin lymphatic endothelial projections and splitting of the vessels. The lymphatic regeneration in the tissue repair of the intestinal muscle coat is essentially attributable to sprouting from preexisting lymphatics, and it progresses vigorously with vascular maturation. The regrowing lymphatic endothelial cells exhibit structural changes indicating a high migratory potential and a close association with regenerating stromal cells. The upregulation of VEGF-C, a specific lymphangiogenic molecule, in a subpopulation of the stromal cells probably contributes to lymphatic regeneration by activating its receptor, VEGFR-3, on the regrowing lymphatic endothelial cells.

Mediation of excitatory neurotransmission by the release of ATP and noradrenaline in sheep mesenteric lymphatic vessels

1. Spontaneous isometric contractions were measured in rings of sheep mesenteric lymphatics. Field stimulation at short pulse widths increased the frequency of spontaneous contractions and this response was blocked by 3 x 10(-7) M omega-conotoxin and by 10(-6) M guanethidine. 2. Rings that had been incubated with [3H]noradrenaline release 3H in response to field stimulation in a frequency-dependent manner. 3. Exogenous ATP mimicked the response to field stimulation and this was blocked by 10(-4) M suramin but not by prior desensitization with 10(-6) M alpha, beta-methylene ATP. Exogenous noradrenaline was not blocked by 10(-4) M suramin. 4. The excitatory response to field stimulation was not blocked by 10(-4) M suramin but a combination of 10(-4) M suramin and 3 x 10(-6) M phentolamine did block the response. 5. In rings taken from sheep that had been pretreated with reserpine, 10(-4) M suramin alone blocked the response to field stimulation. 6. The results of this study suggest that the excitatory response to stimulation of intramural nerves in sheep mesenteric lymphatics is mediated by the release of both ATP and noradrenaline.

Substance P and gastrin releasing peptide in bovine mesenteric lymphatic vessels: chemical characterization and action

Alcoholic extracts of bovine mesenteric lymphatic vessels were assayed for the presence of SP, GRP, VIP, PHI, GIP and NT using specific radioimmunoassays. SP and GRP immunoreactivities were detected at concentrations of 190 +/- 20 and 1,000 +/- 130 pg.g-1, respectively. No significant levels of immunoreactivity were detected for any of the other peptides. SP and GRP immunoreactivities coeluted with their synthetic counterparts from both Sephadex G-50 and reversed phase HPLC columns. Synthetic SP (10(-9)-10(-7) M) and the naturally occurring analogue of GRP, bombesin (10(-9)-10(-7) M), increased spontaneous contraction rate in isolated vessel segments. This excitatory effect was not blocked by the alpha-adrenoceptor antagonist phentolamine (3 x 10(-6) M).

Beta-adrenoceptor-mediated facilitation of [3H]-noradrenaline release from the intramural nerves of bovine mesenteric lymphatic vessels

1. Isolated segments of bovine mesenteric lymphatic vessels were loaded with [3H]-noradrenaline and its efflux in response to field stimulation at 2 Hz (0.3 ms pulses, 1 min train) examined. 2. Isoprenaline (10(-6) M) increased evoked fractional 3H efflux (3H released as a percentage of total tissue 3H at the onset of stimulation) from its control value of 0.67 +/- 0.09 to 1.2 +/- 0.18% (s.e.mean; n = 5). 3. Propranolol (10(-6) M) alone had no effect on evoked fractional 3H efflux but blocked the increase in transmitter overflow induced by isoprenaline (10(-6) M). 4. In the presence of the alpha-adrenoceptor antagonist phentolamine (10(-6) M) the facilitatory effect of isoprenaline (10(-6) M) on transmitter efflux was enhanced. In 5 experiments isoprenaline increased evoked fractional 3H efflux from its control value of 1.07 +/- 0.17 to 2.5 +/- 0.37% when phentolamine was present. 5. Adrenaline (10(-8) M) increased evoked fractional 3H efflux from its control value of 0.76 +/- 0.09 to 1.13 +/- 0.17% (n = 7). 6. These findings are consistent with the presence of presynaptic beta-adrenoceptors in this preparation. There is no evidence that these receptors play any role in feedback regulation of transmitter release.