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Yin X, Zhang S, Lee JH, Dong H, Mourgkos G, Terwilliger G, Kraus A, Geraldo LH, Poulet M, Fischer S, Zhou T, Mohammed FS, Zhou J, Wang Y, Malloy S, Rohner N, Sharma L, Salinas I, Eichmann A, Thomas JL, Saltzman WM, Huttner A, Zeiss C, Ring A, Iwasaki A, Song E. Compartmentalized ocular lymphatic system mediates eye-brain immunity. Nature 2024; 628:204-211. [PMID: 38418880 PMCID: PMC10990932 DOI: 10.1038/s41586-024-07130-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
The eye, an anatomical extension of the central nervous system (CNS), exhibits many molecular and cellular parallels to the brain. Emerging research demonstrates that changes in the brain are often reflected in the eye, particularly in the retina1. Still, the possibility of an immunological nexus between the posterior eye and the rest of the CNS tissues remains unexplored. Here, studying immune responses to herpes simplex virus in the brain, we observed that intravitreal immunization protects mice against intracranial viral challenge. This protection extended to bacteria and even tumours, allowing therapeutic immune responses against glioblastoma through intravitreal immunization. We further show that the anterior and posterior compartments of the eye have distinct lymphatic drainage systems, with the latter draining to the deep cervical lymph nodes through lymphatic vasculature in the optic nerve sheath. This posterior lymphatic drainage, like that of meningeal lymphatics, could be modulated by the lymphatic stimulator VEGFC. Conversely, we show that inhibition of lymphatic signalling on the optic nerve could overcome a major limitation in gene therapy by diminishing the immune response to adeno-associated virus and ensuring continued efficacy after multiple doses. These results reveal a shared lymphatic circuit able to mount a unified immune response between the posterior eye and the brain, highlighting an understudied immunological feature of the eye and opening up the potential for new therapeutic strategies in ocular and CNS diseases.
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Affiliation(s)
- Xiangyun Yin
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Sophia Zhang
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Ju Hyun Lee
- Department of Biomedical Engineering, Yale School of Engineering and Applied Science, New Haven, CT, USA
| | - Huiping Dong
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - George Mourgkos
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Gordon Terwilliger
- Section of Comparative Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Aurora Kraus
- Center of Evolutionary and Theoretical Immunology, Department of Biology, University of New Mexico, Albuquerque, NM, USA
| | - Luiz Henrique Geraldo
- Department of Internal Medicine, Cardiovascular Research Center, Yale School of Medicine, New Haven, CT, USA
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
| | - Mathilde Poulet
- Department of Internal Medicine, Cardiovascular Research Center, Yale School of Medicine, New Haven, CT, USA
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
| | - Suzanne Fischer
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Ting Zhou
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
- Westlake Laboratory of Life Sciences and Biomedicine, School of Life Sciences, Westlake University, Hangzhou, China
| | - Farrah Shalima Mohammed
- Department of Biomedical Engineering, Yale School of Engineering and Applied Science, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Jiangbing Zhou
- Department of Biomedical Engineering, Yale School of Engineering and Applied Science, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Yongfu Wang
- Stowers Institute for Medical Research, Kansas City, MO, USA
| | - Seth Malloy
- Stowers Institute for Medical Research, Kansas City, MO, USA
| | - Nicolas Rohner
- Stowers Institute for Medical Research, Kansas City, MO, USA
| | - Lokesh Sharma
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Irene Salinas
- Center of Evolutionary and Theoretical Immunology, Department of Biology, University of New Mexico, Albuquerque, NM, USA
| | - Anne Eichmann
- Department of Internal Medicine, Cardiovascular Research Center, Yale School of Medicine, New Haven, CT, USA
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
- Université de Paris, INSERM, PARCC, Paris, France
| | - Jean-Leon Thomas
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Institut du Cerveau, Pitié-Salpêtrière Hospital, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - W Mark Saltzman
- Department of Biomedical Engineering, Yale School of Engineering and Applied Science, New Haven, CT, USA
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
- Department of Chemical & Environmental Engineering, Yale School of Engineering and Applied Science, New Haven, CT, USA
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Anita Huttner
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Caroline Zeiss
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Aaron Ring
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Eric Song
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA.
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA.
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Granoff MD, Pardo J, Shillue K, Fleishman A, Teller P, Lee BT, James T, Singhal D. Variable Anatomy of the Lateral Upper Arm Lymphatic Channel: An Anatomical Risk Factor for Breast Cancer-Related Lymphedema. Plast Reconstr Surg 2023; 152:422-429. [PMID: 36727729 DOI: 10.1097/prs.0000000000010245] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The lateral upper arm channel is an accessory lymphatic pathway that drains the upper extremity by means of the deltopectoral groove and supraclavicular nodes, thereby bypassing the axilla. Its variable connectivity to the forearm has not been studied in vivo. METHODS Indocyanine green (ICG) lymphography was performed preoperatively to map the superficial and functional arm lymphatics in breast cancer patients without clinical or objective evidence of lymphedema. A retrospective review was performed to extract demographic, ICG imaging, and surgical data. RESULTS Sixty patients underwent ICG lymphography before axillary lymph node dissection between June of 2019 and October of 2020. In 59%, the lateral upper arm lymphatic channel was contiguous with the forearm (long bundle). In 38%, the lateral upper arm lymphatic channel was present but not contiguous with the forearm (short bundle). In 3%, the lateral upper arm pathway was entirely absent. Seven patients developed at least one sign of lymphedema during postoperative surveillance, of which 71% demonstrated the short bundle variant. CONCLUSION Although the lateral upper arm pathway is most often present, its connections to the forearm are frequently absent (short bundle), which, in this pilot report, appears to represent a potential risk factor for the development of lymphedema. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, V.
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Affiliation(s)
| | - Jaime Pardo
- From the Division of Plastic and Reconstructive Surgery
| | | | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Paige Teller
- Division of Surgical Oncology, Maine Medical Center
| | - Bernard T Lee
- From the Division of Plastic and Reconstructive Surgery
| | - Ted James
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Dhruv Singhal
- From the Division of Plastic and Reconstructive Surgery
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Wu M, Agarwal S. Discussion: Variable Anatomy of the Lateral Upper Arm Lymphatic Channel: An Anatomical Risk Factor for Breast Cancer-Related Lymphedema. Plast Reconstr Surg 2023; 152:430-431. [PMID: 37498927 DOI: 10.1097/prs.0000000000010419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Mengfan Wu
- From Brigham and Women's Hospital, Harvard Medical School
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Wainwright D, Weinstein B, Le NK, Parikh J, Panetta NJ. Reliable Location of Upper Extremity Lymphatic Channels for Use in Immediate Lymphatic Reconstruction. Ann Plast Surg 2023; 90:S391-S394. [PMID: 37332210 DOI: 10.1097/sap.0000000000003452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND Breast cancer-related lymphedema (BCRL) is a limiting sequelae of breast cancer treatment that may negatively impact 30% to 50% of high-risk breast cancer survivors. Risk factors for development of BCRL include axillary lymph node dissection (ALND), and recently, axillary reverse lymphatic mapping and immediate lymphovenous reconstruction (ILR) at time of ALND have been implemented to prevent BCRL. Reliable anatomy of neighboring venules has been commented on in the literature; however, little information exists about anatomical location of local lymphatic channels amenable for bypass. METHODS After institutional review board approval, patients who underwent ALND with axillary reverse lymphatic mapping and ILR at a tertiary cancer center from November 2021 to August 2022 were applicable for this study. The location and number of lymphatic channels used for ILR were identified and measured intraoperatively with the arm abducted to 90 degrees and soft tissue under no tension. Four measurements were taken to localize each lymphatic and were based on relationship with reliable anatomic landmarks including 4th rib, anterior axillary line, and lower border of the pectoralis major muscle. Demographics, oncologic treatments, intraoperative factors, and outcomes were prospectively maintained. RESULTS Twenty-seven patients met inclusion for this study by August 2022 with a total of 86 lymphatic channels identified. Patients were on average 50 ± 12 years old with a body mass index of 30 ± 6 and had an average of 1 vein and 3 identifiable lymphatic channels amenable to bypass. Seventy percent of lymphatic channels were found in a cluster of 2 or more channels. The average horizontal location was 4.5 ± 1.4 cm lateral to the 4th rib. The average vertical location was 1.3 ± 0.9 cm from the superior border of the 4th rib. CONCLUSIONS These data comment upon intraoperatively identified and consistent location of upper extremity lymphatic channels used for ILR. These lymphatic channels are often found in clusters with 2 or more lymphatic channels at the same location. Such insight may aid in easier intraoperative identification of amenable vessels for the unexperienced surgeon, decrease in intraoperative time, and higher success of ILR.
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Affiliation(s)
- D'Arcy Wainwright
- From the Department of Plastic and Reconstructive Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL
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Yang JCS, Wu SC, Hayashi A, Lin WC, Wang YM, Luo SD, Chiang MH, Hsieh CH. Selection of Optimal Functional Lymphatic Vessel Cutoff Size in Supermicrosurgical Lymphaticovenous Anastomosis in Lower Extremity Lymphedema. Plast Reconstr Surg 2022; 149:237-246. [PMID: 34813508 DOI: 10.1097/prs.0000000000008674] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Functional lymphatic vessels are essential for supermicrosurgical lymphaticovenous anastomosis. Theoretically, the larger the lymphatic vessel, the better the flow. However, large lymphatic vessels are not readily available. Since the introduction of lymphaticovenous anastomosis, no guidelines have been set as to how small a lymphatic vessel is still worthwhile for anastomosis. METHODS In this longitudinal cohort study, unilateral lower limb lymphedema patients who underwent lymphaticovenous anastomosis between March of 2016 and January of 2019 were included. Demographic data and intraoperative findings including the number and size of lymphatic vessels were recorded. The cutoff size was determined by receiver operating characteristic curve analysis, based on the functional properties of lymphatic vessels. Clinical correlation was made with post-lymphaticovenous anastomosis volume measured by magnetic resonance volumetry. RESULTS A total of 141 consecutive patients (124 women and 17 men) with a median age of 60.0 years (range, 56.7 to 61.2 years) were included. The cutoff size for a functional lymphatic vessel was determined to be 0.50 mm (i.e., lymphatic vessel0.5) from a total of 1048 lymphatic vessels. Significant differences were found between the number of lymphatic vessels0.5 anastomosed (zero to one, two to three, and greater than over equal to four lymphatic vessels0.5), the median post-lymphaticovenous anastomosis volume reduction (in milliliters) (p < 0.001), and the median percentage volume reduction (p = 0.012). CONCLUSIONS Lymphatic vessel0.5 can be a valuable reference for lymphaticovenous anastomosis. Post-lymphaticovenous anastomosis outcome can be enhanced with the use of lymphatic vessel0.5 for anastomoses. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
- Johnson Chia-Shen Yang
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and Departments of Anesthesiology, Diagnostic Radiology, Radiation Oncology, and Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University; Lymphedema and Reconstructive Surgery Section, Department of Breast Center, Kameda Medical Center and Kameda Kyobashi Clinic; and Departments of Plastic and Reconstructive Surgery and Anesthesiology, Xiamen Changgung Hospital
| | - Shao-Chun Wu
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and Departments of Anesthesiology, Diagnostic Radiology, Radiation Oncology, and Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University; Lymphedema and Reconstructive Surgery Section, Department of Breast Center, Kameda Medical Center and Kameda Kyobashi Clinic; and Departments of Plastic and Reconstructive Surgery and Anesthesiology, Xiamen Changgung Hospital
| | - Akitatsu Hayashi
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and Departments of Anesthesiology, Diagnostic Radiology, Radiation Oncology, and Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University; Lymphedema and Reconstructive Surgery Section, Department of Breast Center, Kameda Medical Center and Kameda Kyobashi Clinic; and Departments of Plastic and Reconstructive Surgery and Anesthesiology, Xiamen Changgung Hospital
| | - Wei-Che Lin
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and Departments of Anesthesiology, Diagnostic Radiology, Radiation Oncology, and Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University; Lymphedema and Reconstructive Surgery Section, Department of Breast Center, Kameda Medical Center and Kameda Kyobashi Clinic; and Departments of Plastic and Reconstructive Surgery and Anesthesiology, Xiamen Changgung Hospital
| | - Yu-Ming Wang
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and Departments of Anesthesiology, Diagnostic Radiology, Radiation Oncology, and Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University; Lymphedema and Reconstructive Surgery Section, Department of Breast Center, Kameda Medical Center and Kameda Kyobashi Clinic; and Departments of Plastic and Reconstructive Surgery and Anesthesiology, Xiamen Changgung Hospital
| | - Sheng-Dean Luo
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and Departments of Anesthesiology, Diagnostic Radiology, Radiation Oncology, and Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University; Lymphedema and Reconstructive Surgery Section, Department of Breast Center, Kameda Medical Center and Kameda Kyobashi Clinic; and Departments of Plastic and Reconstructive Surgery and Anesthesiology, Xiamen Changgung Hospital
| | - Min-Hsien Chiang
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and Departments of Anesthesiology, Diagnostic Radiology, Radiation Oncology, and Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University; Lymphedema and Reconstructive Surgery Section, Department of Breast Center, Kameda Medical Center and Kameda Kyobashi Clinic; and Departments of Plastic and Reconstructive Surgery and Anesthesiology, Xiamen Changgung Hospital
| | - Ching-Hua Hsieh
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and Departments of Anesthesiology, Diagnostic Radiology, Radiation Oncology, and Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University; Lymphedema and Reconstructive Surgery Section, Department of Breast Center, Kameda Medical Center and Kameda Kyobashi Clinic; and Departments of Plastic and Reconstructive Surgery and Anesthesiology, Xiamen Changgung Hospital
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Oliver G, Kipnis J, Randolph GJ, Harvey NL. The Lymphatic Vasculature in the 21 st Century: Novel Functional Roles in Homeostasis and Disease. Cell 2020; 182:270-296. [PMID: 32707093 PMCID: PMC7392116 DOI: 10.1016/j.cell.2020.06.039] [Citation(s) in RCA: 298] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/17/2020] [Accepted: 06/25/2020] [Indexed: 12/19/2022]
Abstract
Mammals have two specialized vascular circulatory systems: the blood vasculature and the lymphatic vasculature. The lymphatic vasculature is a unidirectional conduit that returns filtered interstitial arterial fluid and tissue metabolites to the blood circulation. It also plays major roles in immune cell trafficking and lipid absorption. As we discuss in this review, the molecular characterization of lymphatic vascular development and our understanding of this vasculature's role in pathophysiological conditions has greatly improved in recent years, changing conventional views about the roles of the lymphatic vasculature in health and disease. Morphological or functional defects in the lymphatic vasculature have now been uncovered in several pathological conditions. We propose that subtle asymptomatic alterations in lymphatic vascular function could underlie the variability seen in the body's response to a wide range of human diseases.
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Affiliation(s)
- Guillermo Oliver
- Center for Vascular and Developmental Biology, Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
| | - Jonathan Kipnis
- Center for Brain Immunology and Glia (BIG), University of Virginia, Charlottesville, VA 22908, USA; Department of Neuroscience, University of Virginia, Charlottesville, VA 22908, USA
| | - Gwendalyn J Randolph
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Natasha L Harvey
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
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Akiyama G, Saraswathy S, Bogarin T, Pan X, Barron E, Wong TT, Kaneko MK, Kato Y, Hong Y, Huang AS. Functional, structural, and molecular identification of lymphatic outflow from subconjunctival blebs. Exp Eye Res 2020; 196:108049. [PMID: 32387381 PMCID: PMC7328765 DOI: 10.1016/j.exer.2020.108049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/05/2020] [Accepted: 04/27/2020] [Indexed: 01/26/2023]
Abstract
The purpose of this study is to evaluate outflow pathways from subconjunctival blebs and to identify their identity. Post-mortem porcine (n = 20), human (n = 1), and bovine (n = 1) eyes were acquired, and tracers (fluorescein, indocyanine green, or fixable/fluorescent dextrans) were injected into the subconjunctival space to create raised blebs where outflow pathways were visualized qualitatively and quantitatively. Rodents with fluorescent reporter transgenes were imaged for structural comparison. Concurrent optical coherence tomography (OCT) was obtained to study the structural nature of these pathways. Using fixable/fluorescent dextrans, tracers were trapped to the bleb outflow pathway lumen walls for histological visualization and molecular identification using immunofluorescence against lymphatic and blood vessel markers. Bleb outflow pathways could be observed using all tracers in all species. Quantitative analysis showed that the nasal quadrant had more bleb-related outflow pathways compared to the temporal quadrant (nasal: 1.9±0.3 pathways vs. temporal: 0.7±0.2 pathways; p = 0.003). However, not all blebs resulted in an outflow pathway (0-pathways = 18.2%; 1-pathway = 36.4%; 2-pathways = 38.6%; and 3-pathways = 6.8%). Outflow signal was validated as true luminal pathways using optical coherence tomography and histology. Bicuspid valves were identified in the direction of flow in porcine eyes. Immunofluorescence of labeled pathways demonstrated a lymphatic (Prox-1 and podoplanin) but not a blood vessel (CD31) identity. Therefore, subconjunctival bleb outflow occurs in discrete luminal pathways. They are lymphatic as assessed by structural identification of valves and molecular identification of lymphatic markers. Better understanding of lymphatic outflow may lead to improved eye care for glaucoma surgery and ocular drug delivery.
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Affiliation(s)
- Goichi Akiyama
- Doheny Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Jikei School of Medicine, Tokyo, Japan
| | - Sindhu Saraswathy
- Doheny Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thania Bogarin
- Doheny Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Xiaojing Pan
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong First Medical University, Qingdao, China
| | - Ernesto Barron
- Doheny Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tina T Wong
- Singapore National Eye Center and Singapore Research Institute, Singapore, Singapore
| | - Mika K Kaneko
- Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yukinari Kato
- Tohoku University Graduate School of Medicine, Miyagi, Japan; New Industry Creation Hatchery Center, Tohoku University, Miyagi, Japan
| | - Young Hong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Norris Comprehensive Cancer Center Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alex S Huang
- Doheny Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Jacob L, Boisserand LSB, Geraldo LHM, de Brito Neto J, Mathivet T, Antila S, Barka B, Xu Y, Thomas JM, Pestel J, Aigrot MS, Song E, Nurmi H, Lee S, Alitalo K, Renier N, Eichmann A, Thomas JL. Anatomy and function of the vertebral column lymphatic network in mice. Nat Commun 2019; 10:4594. [PMID: 31597914 PMCID: PMC6785564 DOI: 10.1038/s41467-019-12568-w] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/11/2019] [Indexed: 12/26/2022] Open
Abstract
Cranial lymphatic vessels (LVs) are involved in the transport of fluids, macromolecules and central nervous system (CNS) immune responses. Little information about spinal LVs is available, because these delicate structures are embedded within vertebral tissues and difficult to visualize using traditional histology. Here we show an extended vertebral column LV network using three-dimensional imaging of decalcified iDISCO+-clarified spine segments. Vertebral LVs connect to peripheral sensory and sympathetic ganglia and form metameric vertebral circuits connecting to lymph nodes and the thoracic duct. They drain the epidural space and the dura mater around the spinal cord and associate with leukocytes. Vertebral LVs remodel extensively after spinal cord injury and VEGF-C-induced vertebral lymphangiogenesis exacerbates the inflammatory responses, T cell infiltration and demyelination following focal spinal cord lesion. Therefore, vertebral LVs add to skull meningeal LVs as gatekeepers of CNS immunity and may be potential targets to improve the maintenance and repair of spinal tissues.
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Affiliation(s)
- Laurent Jacob
- Université Pierre et Marie Curie Paris 06 UMRS1127, Sorbonne Université, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | | | - Luiz Henrique Medeiros Geraldo
- INSERM U970, Paris Cardiovascular Research Center, 56 Rue Leblanc, 75015, Paris, France
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jose de Brito Neto
- Université Pierre et Marie Curie Paris 06 UMRS1127, Sorbonne Université, Institut du Cerveau et de la Moelle Epinière, Paris, France
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thomas Mathivet
- INSERM U970, Paris Cardiovascular Research Center, 56 Rue Leblanc, 75015, Paris, France
| | - Salli Antila
- Wihuri Research Institute and Translational Cancer Medicine Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Besma Barka
- Université Pierre et Marie Curie Paris 06 UMRS1127, Sorbonne Université, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Yunling Xu
- INSERM U970, Paris Cardiovascular Research Center, 56 Rue Leblanc, 75015, Paris, France
| | | | - Juliette Pestel
- Université Pierre et Marie Curie Paris 06 UMRS1127, Sorbonne Université, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Marie-Stéphane Aigrot
- Université Pierre et Marie Curie Paris 06 UMRS1127, Sorbonne Université, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Eric Song
- Department of Immunology, Yale University School of Medicine, New Haven, CT, 06510-3221, USA
| | - Harri Nurmi
- Wihuri Research Institute and Translational Cancer Medicine Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Seyoung Lee
- Department of Neurology, Yale University School of Medicine, New Haven, CT, 06511, USA
| | - Kari Alitalo
- Wihuri Research Institute and Translational Cancer Medicine Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Nicolas Renier
- Université Pierre et Marie Curie Paris 06 UMRS1127, Sorbonne Université, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Anne Eichmann
- INSERM U970, Paris Cardiovascular Research Center, 56 Rue Leblanc, 75015, Paris, France
- Cardiovascular Research Center and the Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT, 06510-3221, USA
| | - Jean-Leon Thomas
- Université Pierre et Marie Curie Paris 06 UMRS1127, Sorbonne Université, Institut du Cerveau et de la Moelle Epinière, Paris, France.
- Department of Neurology, Yale University School of Medicine, New Haven, CT, 06511, USA.
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Abstract
In the last few years, a cluster of anatomical discoveries has been reported which overturned the long existing dogmas about the structure and function of human body. First to come was the discovery that established the existence of a lymphatic system pertaining to the central nervous system (CNS). CNS was believed to be anatomically immune privileged owing to the absence of any lymphatics and presence of the blood-brain barrier around it, but latest research has established beyond any reasonable doubt that true lymphatic channels carry immune cells in meninges thus challenging the existing theory. Studies also supported the presence of a 'Glymphatic system' (created by the perivascular spaces lined with the leptomeninges and a sheath of glial cells) in the CNS draining interstitial metabolic waste from CNS. The second discovery unraveled the previously unknown parts of the human mesentery in adult and established that it is a continuous entity all along the intra-abdominal gut tube against the previous notion that it is fragmented in the adult humans. A very recently reported third discovery demonstrated a previously unknown tissue component-'interstitium'-a networked collagen bound fluid-filled space existent in a number of human organs. All these structures bear considerable applied importance towards the pathogenesis, prognostic and diagnostic investigations and management of human diseases. This article attempts to present a brief review of all three remarkable discoveries and emphasizes their applied importance within the realm of medical sciences.
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Affiliation(s)
- A Kumar
- From the Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - S K Ghosh
- From the Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - M A Faiq
- Neuroimaging and Visual Science Laboratory, Langone Medical Centre, New York University School of Medicine, NY, USA
| | - V R Deshmukh
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Karaikal, India
| | - C Kumari
- Department of Anatomy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - V Pareek
- Computational Neuroscience and Neuroimaging Division, National Brain Research Centre (NBRC), Manesar, India
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Possenti L, Casagrande G, Di Gregorio S, Zunino P, Costantino ML. Numerical simulations of the microvascular fluid balance with a non-linear model of the lymphatic system. Microvasc Res 2018; 122:101-110. [PMID: 30448400 DOI: 10.1016/j.mvr.2018.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 02/03/2023]
Abstract
Fluid homeostasis is required for life. Processes involved in fluid balance are strongly related to exchanges at the microvascular level. Computational models have been presented in the literature to analyze the microvascular-interstitial interactions. As far as we know, none of those models consider a physiological description for the lymphatic drainage-interstitial pressure relation. We develop a computational model that consists of a network of straight cylindrical vessels and an isotropic porous media with a uniformly distributed sink term acting as the lymphatic system. In order to describe the lymphatic flow rate, a non-linear function of the interstitial pressure is defined, based on literature data on the lymphatic system. The proposed model of lymphatic drainage is compared to a linear one, as is typically used in computational models. To evaluate the response of the model, the two are compared with reference to both physiological and pathological conditions. Differences in the local fluid dynamic description have been observed using the non-linear model. In particular, the distribution of interstitial pressure is heterogeneous in all the cases analyzed. The resulting averaged values of the interstitial pressure are also different, and they agree with literature data when using the non-linear model. This work highlights the key role of lymphatic drainage and its modeling when studying the fluid balance in microcirculation for both to physiological and pathological conditions, e.g. uremia.
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Affiliation(s)
- Luca Possenti
- LaBS, Chemistry, Material and Chemical Engineering Department "Giulio Natta", Politecnico di Milano, Italy.
| | - Giustina Casagrande
- LaBS, Chemistry, Material and Chemical Engineering Department "Giulio Natta", Politecnico di Milano, Italy
| | - Simone Di Gregorio
- LaBS, Chemistry, Material and Chemical Engineering Department "Giulio Natta", Politecnico di Milano, Italy; MOX, Department of Mathematics, Politecnico di Milano, Italy
| | - Paolo Zunino
- MOX, Department of Mathematics, Politecnico di Milano, Italy
| | - Maria Laura Costantino
- LaBS, Chemistry, Material and Chemical Engineering Department "Giulio Natta", Politecnico di Milano, Italy
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Abstract
Due to its accessible position and tissue heterogeneity, the eye is ideally suited for studying the lymphatic system. As early as the 19th century, questions about the origin and function of this system were discussed. For example, whether Schlemm's canal, which is of particular importance in the pathogenesis of glaucoma, is a lymphatic vessel, or does this vascular system begin with finger-shaped protuberances? Despite the discovery of lymphatic endothelial molecules and the use of molecular imaging technologies, these questions are still discussed controversially today. Leber demonstrated in 1873 with a solution consisting of two dyes of different particle size that only the smaller particles from the anterior chamber of the eye filled the episcleral and conjunctival veins around the corneal margin. He believed to have proven - to be read in the historical review of our article - that the Canalis Schlemmii in humans is a venous circular vessel and not a lymphatic vessel. In our own investigations, we reduced the rather contradictory and complex question of whether there are lymphatic vessels in the eye to the question of whether there are drainage connections between the different sections of the eye and the lymphatic system or not. With different radioactive tracers and combined with unilateral ligation of cervical lymph vessels, we observed outflow from the subconjunctival and retrobulbar space, from the anterior chamber and the vitreous body. The rate of discharge of the radioactive tracer was determined by the radiopharmaceutical and injection site. In analogy to the lymphatic drainage of the head we found a segmental drainage of lymphatic substances on the eye. Vitreous humour and retrobulbar space were drained by lymphatic vessels, predominantly to the deep cervical lymph nodes, while anterior chamber and subconjunctival space drains predominated over the superficial cervical lymph nodes. Eyeball tattoos - as loved by some fan communities - should therefore cause a coloured staining of the superficial cervical lymph nodes. The boundary of the drained segments would be in the area of the eyeball's equator. According to the textbooks, the lymph is actively removed from finger-shaped initial segments via pre-collectors and collectors with properly functioning intraluminal valves and smooth muscle cells in the vessels' media. In patients with spontaneous conjunctival bleeding, however, we observed phenomena in the conjunctival lymph vessels, which ca not be explained with old familiar ideas. At nozzle-shaped vessel constrictions separation of blood components occurred. The erythrocytes formed partially a so-called fluidic "resting bulk layer". Parallel vessel parts caused a retrograde filling of already emptied segments. These observations led our experimental investigations. In the literature, there are different scanning electron microscopy (SEM) images of lymphatic endothelial surfaces; nevertheless they are unassigned to a particular vessel segment. In the conjunctiva, we studied the question whether there is a dependence between vessel diameter and the surface characteristics of endothelial cells (after unfolding by lymphography). A constantly applied photo-mathematical procedure for all specimens allowed determining the size of the cross sections. The specimens were randomized into seven groups with diameters of 0.1-1.0mm and above and examined by SEM. In the smallest vessels (diameter=0.11mm), the impressions of the occasionally occurring nuclei in the lumen were clearly impressive. With increasing diameter, these impressions were lost and the individual endothelial nuclei could no longer be identified. Rather, one recognized only wall-like structures. In vessels of intermediate diameter (0.3-0.4mm), structures could be seen on the surface similar to reticular fibres. With increasing diameters, their prominent character weakened. In the group with diameters above 0.5mm, wavy surface structures were shown. Finally, in vessels of diameters over 1.0mm, a uniform, flat surface was observed. Regardless of the collection site of the specimens, we found certain surface characteristics related to the vessels' calibre. In further investigations by means of interstitial dye lymphography, we were able to demonstrate in the conjunctiva that under increasing injection pressure, additional vessels stained from finger-shaped processes. At least in the conjunctiva, the existence of so-called "blind-ending initial segments" seems doubtful (despite the fact that initial segments or "initial lymphatics" would begin in periphery, not end). Rather, these are likely to be temporary filling states. SEM investigations were carried out on the internal structure of these dome-shaped vessel parts by means of a specially developed preparation technique. Despite numerous variants in the lymphographic design of the blind bags - in the form of finger, balloon, dome, piston, pyramidal, double-humped and spearhead-like endings - slot-shaped, lip-shaped and saw blade-like structures were repeatedly found, similar to a zipper. These findings suggest preformed connections to the next segment and may control lymphatic flow. To clarify the retrograde fluid movements, we examined the lymph vessels' valves or those structures that were previously interpreted as valves. The different structures found could be subdivided into three groups. The lack of common bicuspid structures provides an explanation for retrograde fluid movement. That nevertheless a directional flow is possible, is explained by the flow model developed by Gerhart Liebau. Conjunctival lymphatics show intraluminal structures by double contrast injection, which we divided into four groups due to anatomical differences: An accurate statement about the occurrence of certain intraluminal vascular structures in certain vascular calibres was possible only conditionally. However, complex and extended structures (group d) were found almost exclusively in larger vessel calibres (diameter>0.9mm). The structures are reminiscent of published findings in the "collector channel orifices of Schlemm's canal". They should play an important role in the regulation of the intraocular pressure, or the balance between production and outflow of the aqueous humour. The influence of such structures on the function of the lymphatic vessels is not yet known. As an approach models could be used, which for instance are applied in the water industry for the drainage, the degradation of introduced substances, or the detention pond. The latter serves for the retention and purification of drainage water (storage, treatment and reuse of drainage water). Dead zones, barriers, short-circuit currents and swirling are further hydraulic terms. Can intraluminal vascular structures, for example, affect the lymphatic flow and thus the mechano-sensitivity of lymphatic endothelial cells? Whatever interpretation model we use, the warning of the Swiss anatomist His from 1862 is still true today that all theories about the formation and movement of lymph should be based on precise anatomical basics. This review article therefore tries to make a contribution therefore. Despite knowing of lymphatic endothelial molecules, despite the discovery of the role of lymphangiogenic growth factors in diseases and the use of molecular imaging technologies, we still know too little about the anatomy and function of the lymphatic system.
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Affiliation(s)
- Johannes Grüntzig
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Heinrich Heine Universität Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
| | - Frank Hollmann
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Heinrich Heine Universität Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
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Abstract
Intraluminal valves of collecting lymphatic vessels ensure unidirectional lymph transport against hydrostatic pressure gradient. Mouse mesentery harbors up to 800 valves and represents a convenient model for lymphatic valve quantification, high resolution imaging of different stages of valve development as well as for analysis of valve function. The protocol describes embryonic and postnatal mesenteric lymphatic vessel preparation for whole-mount immunofluorescent staining and visualization of valve organization, quantification of main morphological parameters such as valve size and leaflet length, and the quantitative assessment of functional properties of adult valves using back-leak and closure tests.
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Affiliation(s)
- Amélie Sabine
- Department of Oncology, Division of Experimental Pathology, CHUV, Ludwig Institute for Cancer Research, University of Lausanne, Epalinges, Switzerland.
| | - Michael J Davis
- Medical Pharmacology & Physiology, University of Missouri, Columbia, MO, USA
| | - Esther Bovay
- Department of Oncology, Division of Experimental Pathology, CHUV, Ludwig Institute for Cancer Research, University of Lausanne, Epalinges, Switzerland
| | - Tatiana V Petrova
- Department of Oncology, Division of Experimental Pathology, CHUV, Ludwig Institute for Cancer Research, University of Lausanne, Epalinges, Switzerland.
- Swiss Institute for Cancer Research, EPFL, Lausanne, Switzerland.
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Absinta M, Ha SK, Nair G, Sati P, Luciano NJ, Palisoc M, Louveau A, Zaghloul KA, Pittaluga S, Kipnis J, Reich DS. Human and nonhuman primate meninges harbor lymphatic vessels that can be visualized noninvasively by MRI. eLife 2017; 6:e29738. [PMID: 28971799 PMCID: PMC5626482 DOI: 10.7554/elife.29738] [Citation(s) in RCA: 348] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/01/2017] [Indexed: 01/20/2023] Open
Abstract
Here, we report the existence of meningeal lymphatic vessels in human and nonhuman primates (common marmoset monkeys) and the feasibility of noninvasively imaging and mapping them in vivo with high-resolution, clinical MRI. On T2-FLAIR and T1-weighted black-blood imaging, lymphatic vessels enhance with gadobutrol, a gadolinium-based contrast agent with high propensity to extravasate across a permeable capillary endothelial barrier, but not with gadofosveset, a blood-pool contrast agent. The topography of these vessels, running alongside dural venous sinuses, recapitulates the meningeal lymphatic system of rodents. In primates, meningeal lymphatics display a typical panel of lymphatic endothelial markers by immunohistochemistry. This discovery holds promise for better understanding the normal physiology of lymphatic drainage from the central nervous system and potential aberrations in neurological diseases.
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Affiliation(s)
- Martina Absinta
- Translational Neuroradiology SectionNational Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaUnited States
| | - Seung-Kwon Ha
- Translational Neuroradiology SectionNational Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaUnited States
| | - Govind Nair
- Translational Neuroradiology SectionNational Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaUnited States
| | - Pascal Sati
- Translational Neuroradiology SectionNational Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaUnited States
| | - Nicholas J Luciano
- Translational Neuroradiology SectionNational Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaUnited States
| | - Maryknoll Palisoc
- Hematopathology Section, Laboratory of PathologyNational Cancer Institute, National Institutes of HealthBethesdaUnited States
| | - Antoine Louveau
- Center for Brain Immunology and Glia, Department of Neuroscience, School of MedicineUniversity of VirginiaCharlottesvilleUnited States
| | - Kareem A Zaghloul
- Surgical Neurology BranchNational Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaUnited States
| | - Stefania Pittaluga
- Hematopathology Section, Laboratory of PathologyNational Cancer Institute, National Institutes of HealthBethesdaUnited States
| | - Jonathan Kipnis
- Center for Brain Immunology and Glia, Department of Neuroscience, School of MedicineUniversity of VirginiaCharlottesvilleUnited States
| | - Daniel S Reich
- Translational Neuroradiology SectionNational Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaUnited States
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Proulx ST, Ma Q, Andina D, Leroux JC, Detmar M. Quantitative measurement of lymphatic function in mice by noninvasive near-infrared imaging of a peripheral vein. JCI Insight 2017; 2:e90861. [PMID: 28097238 DOI: 10.1172/jci.insight.90861] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Optical imaging methods have been developed to measure lymphatic function in skin; however, the lymphatic system of many organs is not accessible to this technology. Since lymphatic transport of macromolecules from any organ proceeds to the blood circulation, we aimed to develop a method that can measure lymphatic function by monitoring the fluorescence in a superficial vein of an interstitially injected tracer. We selected a 40-kDa PEGylated near-infrared dye conjugate, as it showed lymphatic system-specific uptake and extended circulation in blood. Lymphatic transport to blood from subcutaneous tissue required a transit time before signal enhancement was seen in blood followed by a steady rise in signal over time. Increased lymphatic transport was apparent in awake mice compared with those under continuous anesthesia. The methods were validated in K14-VEGFR-3-Fc and K14-VEGF-C transgenic mice with loss and gain of lymphatic function, respectively. Reduced lymphatic transport to blood was also found in aged mice. The technique was also able to measure lymphatic transport from the peritoneal cavity, a location not suitable for optical imaging. The method is a promising, simple approach for assessment of lymphatic function and for monitoring of therapeutic regimens in mouse models of disease and may have potential for clinical translation.
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Amore M, Bernárdez R, Enríquez R, Granja S, Romeo H. Anatomical Variations of the Thoracic Duct: A Preliminary Report in Adult and Fetal Specimens. Lymphology 2016; 49:205-209. [PMID: 29908553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The study aim is to evaluate anatomical variations of the thoracic duct using a specialized sequential injection procedure. The different types, frequencies, and anatomical topography were recorded and evaluated using 12 adult and 16 fetus specimens. By employing a perfusion pump device, cadavers were sequentially perfused with acrylic colored latex first through the internal marginal vein, then the thoracic duct at the interazygous-aortic recess, and finally through the posterior tibial artery. After perfusion, thoracic ducts were identified, partially dissected, and cadavers fixed by soaking in an aqueous solution of 5% formalin (v/v). Finally, further dissection and detailed photography were performed. Plexus shapes at different levels were clearly evident in 80% of the adult specimens. Whereas the presence of the cisterna chyli was detected in 100% of fetuses as an ampule dilatation at the beginning of the thoracic duct, in only one adult specimen was a dilatation found at the lumbar lymphatic trunk level. Functionally it is not known whether these modified anatomical features (plexus shapes) have served to compensate (as a derivative pathway) for lymphatic hypertension in life as a reflection of lymphatic system challenges and subsequent growth in the adult specimens.
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Abstract
Immunohistochemical detection of lymphatic capillaries was performed in the periodontium of maxillary and mandibular cheek teeth from 6 horses (aged 3–23 years). Tissue sections of the periodontium were taken at 4 different horizontal levels along the long axis of the tooth. The specimens were processed for immunoreaction with anti-Proxl, in order to distinguish lymphatic endothelium from blood vascular endothelium. Lymphatic vessels were detected in all periodontal tissues except for the dental cementum. Lymphatic capillaries were most densely distributed in the gingiva compared to other tissues of the periodontium. Lymphatic capillaries were found most consistently in samples taken from the gingival and subgingival regions in all horses examined. Within these levels, the gingiva as well as the spongiosa of the maxillary and mandibular bone had the greatest incidence of lymphatic vessels. Considering the distinct distribution of the lymphatic capillaries in the periodontium of the maxillary and mandibular cheek teeth, two complementary lymphatic drainage pathways are proposed: (1) superficial lymph drainage via the gingiva, emptying into the mandibular lymph nodes; (2) deep lymph drainage via the mandibular and maxillary spongiosa, emptying into the mandibular and retropharyngeal lymph nodes, respectively.
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Affiliation(s)
- Carsten Staszyk
- Institute of Anatomy, University of Veterinary Medicine Hannover, Germany.
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Pessa JE. SMAS Fusion Zones Determine the Subfascial and Subcutaneous Anatomy of the Human Face: Fascial Spaces, Fat Compartments, and Models of Facial Aging. Aesthet Surg J 2016; 36:515-26. [PMID: 26906345 DOI: 10.1093/asj/sjv139] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fusion zones between superficial fascia and deep fascia have been recognized by surgical anatomists since 1938. Anatomical dissection performed by the author suggested that additional superficial fascia fusion zones exist. OBJECTIVES A study was performed to evaluate and define fusion zones between the superficial and the deep fascia. METHODS Dissection of fresh and minimally preserved cadavers was performed using the accepted technique for defining anatomic spaces: dye injection combined with cross-sectional anatomical dissection. RESULTS This study identified bilaminar membranes traveling from deep to superficial fascia at consistent locations in all specimens. These membranes exist as fusion zones between superficial and deep fascia, and are referred to as SMAS fusion zones. CONCLUSIONS Nerves, blood vessels and lymphatics transition between the deep and superficial fascia of the face by traveling along and within these membranes, a construct that provides stability and minimizes shear. Bilaminar subfascial membranes continue into the subcutaneous tissues as unilaminar septa on their way to skin. This three-dimensional lattice of interlocking horizontal, vertical, and oblique membranes defines the anatomic boundaries of the fascial spaces as well as the deep and superficial fat compartments of the face. This information facilitates accurate volume augmentation; helps to avoid facial nerve injury; and provides the conceptual basis for understanding jowls as a manifestation of enlargement of the buccal space that occurs with age.
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Affiliation(s)
- Joel E Pessa
- Dr Pessa is a plastic surgeon currently doing independent research in Abilene, TX
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Ciupilan C, Stan CI. CONSIDERATIONS ON ANATOMY AND PHYSIOLOGY OF LYMPH VESSELS OF UPPER AERO DIGESTIVE ORGANS AND CERVICAL SATELLITE LYMPH NODE GROUP. Rev Med Chir Soc Med Nat Iasi 2016; 120:409-416. [PMID: 27483727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The almost constant local regional development of the cancers of upper aero digestive organs requires the same special attention to cervical lymph node metastases, as well as to the primary neoplastic burning point. The surgical therapy alone or associated has a mutilating, damaging character, resulting in loss of an organ and function, most of the times with social implications, involving physical distortions with aesthetic consequences, which make the reintegration of the individual into society questionable. The problem of cervical lymph node metastases is vast and complex, reason why we approached several anatomical and physiological aspects of lymph vessels of the aero digestive organs. Among the available elements during treatment, the headquarters of the tumour, its histologic degree, and its infiltrative nature, each of them significantly influences the possibility of developing metastases.
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Jang H, Yoon J, Gil H, Jung SJ, Kim MS, Lee JK, Kim YJ, Soh KS. Observation of a Flowing Duct in the Abdominal Wall by Using Nanoparticles. PLoS One 2016; 11:e0150423. [PMID: 26937963 PMCID: PMC4777417 DOI: 10.1371/journal.pone.0150423] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/13/2016] [Indexed: 11/19/2022] Open
Abstract
The primo vascular system (PVS) is being established as a circulatory system that corresponds to acupuncture meridians. There have been two critical questions in making the PVS accepted as a novel liquid flowing system. The first one was directly to show the flow of liquid in PVS and the second one was to explain why it was not observed in the conventional histological study of animal tissues. Flow in the PVS in the abdominal cavity was previously verified by injecting Alcian blue into a primo node. However, the tracing of the dye to other subsystems of the PVS has not been done. In the current work we injected fluorescent nanoparticles (FNPs) into a primo node and traced them along a primo vessel which was inside a fat tissue in the abdominal wall. Linea alba is a white middle line in the abdominal skin of a mammal and a band of fat tissue is located in parallel to the linea alba in the parietal side of the abdominal wall of a rat. In this fat band a primo vessel runs parallel to the prominent blood vessels in the fat band and is located just inside the parietal peritoneum. About the second question on the reason why the PVS was not in conventional histological study the current work provided the answer. Histological analysis with hematoxyline and eosine, Masson’s trichrome, and Toluidine blue could not discriminate the primo vessel even when we knew the location of the PVS by the trace of the FNPs. This clearly explains why the PVS is hard to observe in conventional histology: it is not a matter of resolution but the contrast. The PVS has very similar structure to the connective tissues that surround the PVS. In the current work we propose a method to find the PVS: Observation of mast cell distribution with toluidine blue staining and the PN has a high density of mast cells, while the lymph node has low density.
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Affiliation(s)
- HyunSuk Jang
- Nano Primo Research Center, Advanced Institute of Convergence Technology, Seoul National University, Suwon, 443–270, Korea
- College of Physical Education, University of Suwon, Hwaseong, 445–743, Korea
| | - Joohwan Yoon
- Nano Primo Research Center, Advanced Institute of Convergence Technology, Seoul National University, Suwon, 443–270, Korea
| | - HyunJi Gil
- Nano Primo Research Center, Advanced Institute of Convergence Technology, Seoul National University, Suwon, 443–270, Korea
| | - Sharon Jiyoon Jung
- Nano Primo Research Center, Advanced Institute of Convergence Technology, Seoul National University, Suwon, 443–270, Korea
| | - Min-Suk Kim
- Department of Medical Engineering, Konyang Univiersity, Nonsan-si, 320–711, Korea
- * E-mail: (MSK); (KSS)
| | - Jin-Kyu Lee
- Department of Chemistry, Seoul National University, Seoul, 151–747, Korea
| | - Young-Jae Kim
- Department of Chemistry, Seoul National University, Seoul, 151–747, Korea
| | - Kwang-Sup Soh
- Nano Primo Research Center, Advanced Institute of Convergence Technology, Seoul National University, Suwon, 443–270, Korea
- * E-mail: (MSK); (KSS)
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Han C, Yang B, Zuo WS, Zheng G, Yang L, Zheng MZ. The Feasibility and Oncological Safety of Axillary Reverse Mapping in Patients with Breast Cancer: A Systematic Review and Meta-Analysis of Prospective Studies. PLoS One 2016; 11:e0150285. [PMID: 26919589 PMCID: PMC4769133 DOI: 10.1371/journal.pone.0150285] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 02/11/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The axillary reverse mapping (ARM) technique has recently been developed to prevent lymphedema by preserving the arm lymphatic drainage during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) procedures. The objective of this systematic review and meta-analysis was to evaluate the feasibility and oncological safety of ARM. METHODS We searched Medline, Embase, Web of science, Scopus, and the Cochrane Library for relevant prospective studies. The identification rate of ARM nodes, the crossover rate of SLN-ARM nodes, the proportion of metastatic ARM nodes, and the incidence of complications were pooled into meta-analyses by the random-effects model. RESULTS A total of 24 prospective studies were included into meta-analyses, of which 11 studies reported ARM during SLNB, and 18 studies reported ARM during SLNB. The overall identification rate of ARM nodes was 38.2% (95% CI 32.9%-43.8%) during SLNB and 82.8% (78.0%-86.6%) during ALND, respectively. The crossover rate of SLN-ARM nodes was 19.6% (95% CI 14.4%-26.1%). The metastatic rate of ARM nodes was 16.9% (95% CI 14.2%-20.1%). The pooled incidence of lymphedema was 4.1% (95% CI 2.9-5.9%) for patients undergoing ARM procedure. CONCLUSIONS The ARM procedure was feasible during ALND. Nevertheless, it was restricted by low identification rate of ARM nodes during SLNB. ARM was beneficial for preventing lymphedema. However, this technique should be performed with caution given the possibility of crossover SLN-ARM nodes and metastatic ARM nodes. ARM appeared to be unsuitable for patients with clinically positive breast cancer due to oncological safety concern.
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Affiliation(s)
- Chao Han
- Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
- School of Medicine and life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Ben Yang
- Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Wen-Shu Zuo
- Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
- * E-mail:
| | - Gang Zheng
- Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Li Yang
- Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Mei-Zhu Zheng
- Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
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Brambilla D, Proulx ST, Marschalkova P, Detmar M, Leroux JC. Microneedles for the Noninvasive Structural and Functional Assessment of Dermal Lymphatic Vessels. Small 2016; 12:1053-1061. [PMID: 26727610 DOI: 10.1002/smll.201503093] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/30/2015] [Indexed: 06/05/2023]
Abstract
The medical and scientific communities' interest in the lymphatic system has been growing rapidly in recent years. It has become evident that the lymphatic system is much more than simply a homeostasis controller and that it plays key roles in several pathological conditions. This work describes the identification of the optimal combination of poly(N-vinylpyrrolidone) and a near-infrared dye (indocyanine green) for the manufacturing of soluble microneedles and their application to the imaging of the lymphatic system. Upon application to the skin, the microneedle-bearing indocyanine green is delivered in the dermal layer, where the lymphatic vessels are abundant. The draining lymphatics can then be visualized and the clearance kinetics from the administration site simply determined using a near-infrared camera. This painless functional "tattooing" procedure can be used for quantitative assessment of the dermal lymphatic function in several dermal conditions and treatment-response evaluations. The two components of these microneedles are extensively used in routine medical care, potentially leading to rapid clinical translation. Moreover, this procedure may have a significant impact on preclinical lymphatic studies.
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Affiliation(s)
- Davide Brambilla
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 3, 8093, Zurich, Switzerland
| | - Steven T Proulx
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 3, 8093, Zurich, Switzerland
| | - Patrizia Marschalkova
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 3, 8093, Zurich, Switzerland
| | - Michael Detmar
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 3, 8093, Zurich, Switzerland
| | - Jean-Christophe Leroux
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 3, 8093, Zurich, Switzerland
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Margaris KN, Nepiyushchikh Z, Zawieja DC, Moore J, Black RA. Microparticle image velocimetry approach to flow measurements in isolated contracting lymphatic vessels. J Biomed Opt 2016; 21:25002. [PMID: 26830061 PMCID: PMC8357335 DOI: 10.1117/1.jbo.21.2.025002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 12/24/2015] [Indexed: 05/06/2023]
Abstract
We describe the development of an optical flow visualization method for resolving the flow velocity vector field in lymphatic vessels in vitro. The aim is to develop an experimental protocol for accurately estimating flow parameters, such as flow rate and shear stresses, with high spatial and temporal resolution. Previous studies in situ have relied on lymphocytes as tracers, but their low density resulted in a reduced spatial resolution whereas the assumption that the flow was fully developed in order to determine the flow parameters of interest may not be valid, especially in the vicinity of the valves, where the flow is undoubtedly more complex. To overcome these issues, we have applied the time-resolved microparticle image velocimetry (μ -PIV) technique, a well-established method that can provide increased spatial and temporal resolution that this transient flow demands. To that end, we have developed a custom light source, utilizing high-power light-emitting diodes, and associated control and image processing software. This paper reports the performance of the system and the results of a series of preliminary experiments performed on vessels isolated from rat mesenteries, demonstrating, for the first time, the successful application of the μ -PIV technique in these vessels.
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Affiliation(s)
- Konstantinos N. Margaris
- University of Strathclyde, Department of Biomedical Engineering, 106 Rottenrow, Glasgow G4 0NW, United Kingdom
- Address all correspondence to: Konstantinos N. Margaris, E-mail:
| | - Zhanna Nepiyushchikh
- Georgia Institute of Technology, The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332-0405, United States
| | - David C. Zawieja
- Texas A&M University, Department of Systems Biology and Translational Medicine, Health Science Center, Temple, Texas 77843-111, United States
| | - James Moore
- Imperial College London, Department of Bioengineering, Royal School of Mines, Exhibition Road, London SW7 2AZ, United Kingdom
| | - Richard A. Black
- University of Strathclyde, Department of Biomedical Engineering, 106 Rottenrow, Glasgow G4 0NW, United Kingdom
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23
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Kim J, Kim DH, Jung SJ, Soh KS. Temporal Change of Alcian Blue-Stained Primo Vascular System in Lymph Vessels of Rats. Adv Exp Med Biol 2016; 923:311-317. [PMID: 27526158 DOI: 10.1007/978-3-319-38810-6_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
This study aims to investigate the temporal change of a vascular system now known as the primo vascular system (PVS). We used Alcian blue (AB) dye for imaging the distribution of the PVS in lymphatic vessels. The target lymph vessels were chosen as they are easily accessible from the skin, and long-term observation is possible with intact physiological conditions due to a minimal surgical procedure. AB solution was injected into the inguinal lymph node and the target lymph vessels were located along the superficial epigastric vessels. The imaging system allowed processing for extraction of images showing changes in the AB intensity of the visualized PVS components. This newly developed procedure can be used for further study on various dynamic processes of PVS in lymph vessels.
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Affiliation(s)
- Jungdae Kim
- Nano Primo Research Center, Advanced Institute of Convergence Technology, Seoul National University, Suwon, 443-270, South Korea
| | - Dong-Hyun Kim
- Nano Primo Research Center, Advanced Institute of Convergence Technology, Seoul National University, Suwon, 443-270, South Korea
| | - Sharon Jiyoon Jung
- Nano Primo Research Center, Advanced Institute of Convergence Technology, Seoul National University, Suwon, 443-270, South Korea
- Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Suwon, 443-270, South Korea
| | - Kwang-Sup Soh
- Nano Primo Research Center, Advanced Institute of Convergence Technology, Seoul National University, Suwon, 443-270, South Korea.
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Shao L, Takeda K, Kato S, Mori S, Kodama T. Communication between lymphatic and venous systems in mice. J Immunol Methods 2015; 424:100-5. [PMID: 26009246 DOI: 10.1016/j.jim.2015.05.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 01/27/2023]
Abstract
The lymphatic system in mice consists of lymphatic vessels and 22 types of lymph nodes. Metastatic tumor cells in the lymphatic system spread to distant organs through the venous system. However, the communication routes between the lymphatic and venous systems have not been fully elucidated. Here, we identify the communication routes between the lymphatic and venous systems in the axillary and subiliac regions of MXH10/Mo-lpr/lpr inbred mice, which develop systemic swelling of lymph nodes up to 10mm in diameter, allowing investigation of the topography of the lymph nodes and lymphatic vessels. Using a gross anatomy dissection approach, the efferent lymphatic vessels of the proper axillary lymph node were shown to communicate with the subclavian vein. Furthermore, we found that the thoracoepigastric vein, which connects the subclavian vein and inferior vena cava, runs adjacent to the subiliac and proper axillary lymph nodes, and receives venous blood from these lymph nodes routed through small branches. The direction of blood flow in the thoracoepigastric vein occurred in two directions in the intermediate region between the proper axillary lymph node and subiliac lymph node; one to the subclavian vein, the other to the inferior vena cava. This paper reveals the anatomy of the communication between the lymphatic and venous systems in the axillary and subiliac regions of the mouse, and provides new insights relevant to the investigation of the mechanisms of lymph node metastasis and cancer immunology, and the development of diagnostic and treatment methods for lymph node metastasis, including drug delivery systems.
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Affiliation(s)
- Lenan Shao
- Laboratory of Biomedical Engineering for Cancer, Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan; Department of Oral and Maxillofacial Surgery, Tongji Hospital, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China
| | - Kazu Takeda
- Laboratory of Biomedical Engineering for Cancer, Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan
| | - Shigeki Kato
- Laboratory of Biomedical Engineering for Cancer, Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan
| | - Shiro Mori
- Laboratory of Biomedical Engineering for Cancer, Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan; Department of Oral and Maxillofacial Surgery, Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Tetsuya Kodama
- Laboratory of Biomedical Engineering for Cancer, Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan.
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25
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Martel C, Yao J, Huang CH, Zou J, Randolph GJ, Wang LV. Photoacoustic lymphatic imaging with high spatial-temporal resolution. J Biomed Opt 2014; 19:116009. [PMID: 25408958 PMCID: PMC4407768 DOI: 10.1117/1.jbo.19.11.116009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 10/14/2014] [Indexed: 05/08/2023]
Abstract
Despite its critical function in coordinating the egress of inflammatory and immune cells out of tissues and maintaining fluid balance, the causative role of lymphatic network dysfunction in pathological settings is still understudied. Engineered-animal models and better noninvasive high spatial-temporal resolution imaging techniques in both preclinical and clinical studies will help to improve our understanding of different lymphatic-related pathologic disorders. Our aim was to take advantage of our newly optimized noninvasive wide-field fast-scanning photoacoustic (PA) microcopy system to coordinately image the lymphatic vasculature and its flow dynamics, while maintaining high resolution and detection sensitivity. Here, by combining the optical-resolution PA microscopy with a fast-scanning water-immersible microelectromechanical system scanning mirror, we have imaged the lymph dynamics over a large field-of-view, with high spatial resolution and advanced detection sensitivity. Depending on the application, lymphatic vessels (LV) were spectrally or temporally differentiated from blood vessels. Validation experiments were performed on phantoms and in vivo to identify the LV. Lymphatic flow dynamics in nonpathological and pathological conditions were also visualized. These results indicate that our newly developed PA microscopy is a promising tool for lymphatic-related biological research.
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Affiliation(s)
- Catherine Martel
- Washington University School of Medicine, Department of Pathology and Immunology, 425 S Euclid, St. Louis, Missouri 63110, United States
- Université de Montréal, Faculty of Medicine; Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada
- Address all correspondence to: Catherine Martel, E-mail: ; Gwendalyn J. Randolph, E-mail: ; Lihong V. Wang, E-mail:
| | - Junjie Yao
- Washington University in St. Louis, Department of Biomedical Engineering, 1 Brookings Drive, St. Louis, Missouri 63130, United States
| | - Chih-Hsien Huang
- Texas A&M University, Department of Electrical and Computer Engineering, College Station, Texas 77843-3128, United States
| | - Jun Zou
- Texas A&M University, Department of Electrical and Computer Engineering, College Station, Texas 77843-3128, United States
| | - Gwendalyn J. Randolph
- Washington University School of Medicine, Department of Pathology and Immunology, 425 S Euclid, St. Louis, Missouri 63110, United States
- Address all correspondence to: Catherine Martel, E-mail: ; Gwendalyn J. Randolph, E-mail: ; Lihong V. Wang, E-mail:
| | - Lihong V. Wang
- Washington University in St. Louis, Department of Biomedical Engineering, 1 Brookings Drive, St. Louis, Missouri 63130, United States
- Address all correspondence to: Catherine Martel, E-mail: ; Gwendalyn J. Randolph, E-mail: ; Lihong V. Wang, E-mail:
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Abstract
BACKGROUND Light and electron microscopy have not identified a distinct anatomical structure associated with either skin wrinkles or creases, and a histological difference between wrinkled and adjacent skin has not been identified. OBJECTIVES The authors investigate whether facial wrinkles are related to underlying lymphatic vessels and perilymphatic fat. METHODS Lymphatic vessels with a specialized tube of perilymphatic fat were identified beneath palmar creases. Sections of skin, adipose tissue, and muscle were harvested from each of 13 cadavers. Three sites were investigated: the transverse forehead crease, lateral orbicularis oculi wrinkle (crow's feet), and the nasojugal crease. The tissue was paraffin embedded and processed. Two-step indirect immunohistochemistry was performed, and images were examined using laser confocal microscopy. Measurements were taken with software. RESULTS Every wrinkle examined was found above and within ±1 mm of a major lymphatic vessel and its surrounding tube of adipose tissue. The results satisfied our null hypothesis and were statistically significant. Lymphatic vessels were identified by positive immunofluorescence as well as histological criteria. These findings have been further validated by fluorochrome tracer studies. CONCLUSIONS An anatomical basis for wrinkles was identified among the specimens studied. Lymphatic vessels, along with the surrounding distinct perilymphatic fat, traveled directly beneath wrinkles and creases. Lymphatic dysregulation leads to inflammation, scarring, and fibrosis, but inadvertent injection of these vessels can be avoided with anatomical knowledge.
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Affiliation(s)
- Joel E Pessa
- Dr Pessa is a plastic surgeon in private practice in Abilene, Texas
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27
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Riquet M, Rivera C, Gibault L, Pricopi C, Mordant P, Badia A, Arame A, Le Pimpec Barthes F. [Lymphatic spread of lung cancer: anatomical lymph node chains unchained in zones]. Rev Pneumol Clin 2014; 70:16-25. [PMID: 24566031 DOI: 10.1016/j.pneumo.2013.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/12/2013] [Indexed: 06/03/2023]
Abstract
Lung cancer is characterized by its lymphophilia. Its metastatic spread mainly occurs by tumor cells lymphatic drainage into the blood circulation. Initially, the lymph node TNM classification was based on clinical and therapeutic considerations, particularly concerning N2 involvement. The goals were to avoid futile exploratory thoracotomies without lung resection, to provide more accurate data from mediastinoscopy, and to take into account the radiation therapy fields. Since 1997, the international lymph node classification was more used to analyse the disparities within N1 and N2 groups. However, this attempt did not succeed in clarifying the lymphatic metastazing process, and was not progressing any more. Anatomy not being considered, it did not permit to grasp the anatomical and physiological significances of N2 and N3 involvement. In effect, this classification is now confined in zones and is lacking the anatomical and physiological descriptions that characterise the lymphatic pathways draining the lungs and their tumoral pathology. The stations proposed in numbers in cartographies should have gained in accuracy and in prognostic value if they had been expressed in their anatomical counterparts.
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Affiliation(s)
- M Riquet
- Service de chirurgie thoracique, laboratoire d'anatomie pathologique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20-40, rue Leblanc, 75015 Paris, France.
| | - C Rivera
- Service de chirurgie thoracique, laboratoire d'anatomie pathologique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - L Gibault
- Service de chirurgie thoracique, laboratoire d'anatomie pathologique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, laboratoire d'anatomie pathologique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - P Mordant
- Service de chirurgie thoracique, laboratoire d'anatomie pathologique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - A Badia
- Service de chirurgie thoracique, laboratoire d'anatomie pathologique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - A Arame
- Service de chirurgie thoracique, laboratoire d'anatomie pathologique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique, laboratoire d'anatomie pathologique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20-40, rue Leblanc, 75015 Paris, France
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28
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del Pozo-Jiménez G, Jara Rascón J, Aragón Chamizo J, Blaha I, Hernández Fernández C, Lledó García E. [Anatomy and vascularization on the male urethra and penis]. ARCH ESP UROL 2014; 67:5-11. [PMID: 24531666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this review we present an update on the anatomy and vascularization of the male urethra. The real objective of this review is to make the following chapters more understandable, both to know the physio-pathological mechanisms of urethral pathology and also to help us in their surgical management.
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Affiliation(s)
- G del Pozo-Jiménez
- Unidad de Andrologia y Cirugia Reconstructiva Uretro Genital. Servicio de Urologia.Hospital General Universitario Gregorio Marañon.Instituto de Investigación Sanitaria Gregorio Marañon. Universidad Complutense.Madrid.Spain
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29
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Yousefi S, Qin J, Zhi Z, Wang RK. Label-free optical lymphangiography: development of an automatic segmentation method applied to optical coherence tomography to visualize lymphatic vessels using Hessian filters. J Biomed Opt 2013; 18:86004. [PMID: 23922124 PMCID: PMC3734368 DOI: 10.1117/1.jbo.18.8.086004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Lymphatic vessels are a part of the circulatory system that collect plasma and other substances that have leaked from the capillaries into interstitial fluid (lymph) and transport lymph back to the circulatory system. Since lymph is transparent, lymphatic vessels appear as dark hallow vessel-like regions in optical coherence tomography (OCT) cross sectional images. We propose an automatic method to segment lymphatic vessel lumen from OCT structural cross sections using eigenvalues of Hessian filters. Compared to the existing method based on intensity threshold, Hessian filters are more selective on vessel shape and less sensitive to intensity variations and noise. Using this segmentation technique along with optical micro-angiography allows label-free noninvasive simultaneous visualization of blood and lymphatic vessels in vivo. Lymphatic vessels play an important role in cancer, immune system response, inflammatory disease, wound healing and tissue regeneration. Development of imaging techniques and visualization tools for lymphatic vessels is valuable in understanding the mechanisms and studying therapeutic methods in related disease and tissue response.
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Affiliation(s)
- Siavash Yousefi
- University of Washington, Department of Bioengineering, Seattle, Washington 98195
| | - Jia Qin
- University of Washington, Department of Bioengineering, Seattle, Washington 98195
| | - Zhongwei Zhi
- University of Washington, Department of Bioengineering, Seattle, Washington 98195
| | - Ruikang K. Wang
- University of Washington, Department of Bioengineering, Seattle, Washington 98195
- Address all correspondence to: Ruikang K. Wang, University of Washington, Department of Bioengineering, Seattle, Washington 98195. Tel: 206 6165025; Fax: 206 6853300; E-mail:
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30
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Kretschmer S, Dethlefsen I, Hagner-Benes S, Marsh LM, Garn H, König P. Visualization of intrapulmonary lymph vessels in healthy and inflamed murine lung using CD90/Thy-1 as a marker. PLoS One 2013; 8:e55201. [PMID: 23408960 PMCID: PMC3568125 DOI: 10.1371/journal.pone.0055201] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 12/28/2012] [Indexed: 01/31/2023] Open
Abstract
Background Lymphatic vessels play a pivotal role in fluid drainage and egress of immune cells from the lung. However, examining murine lung lymphatics is hampered by the expression of classical lymph endothelial markers on other cell types, which hinders the unambiguous identification of lymphatics. The expression of CD90/Thy-1 on lymph endothelium was recently described and we therefore examined its suitability to identify murine pulmonary lymph vessels under healthy and inflammatory conditions. Methodology/Principal Findings Immunohistochemistry with a monoclonal antibody against CD90.2/Thy-1.2 on 200 µm thick precision cut lung slices labeled a vascular network that was distinct from blood vessels. Preembedding immunostaining and electron microscopy verified that the anti-CD90.2/Thy-1.2 antibody labeled lymphatic endothelium. Absence of staining in CD90.1/Thy-1.1 expressing FVB mice indicated that CD90/Thy-1 was expressed on lymph endothelium and labeling was not due to antibody cross reactivity. Double-labeling immunohistochemistry for CD90/Thy-1 and α-smooth muscle actin identified two routes for lymph vessel exit from the murine lung. One started in the parenchyma or around veins and left via venous blood vessels. The other began in the space around airways or in the space between airways and pulmonary arteries and left via the main bronchi. As expected from the pulmonary distribution of lymph vessels, intranasal application of house dust mite led to accumulation of T cells around veins and in the connective tissue between airways and pulmonary arteries. Surprisingly, increased numbers of T cells were also detected around intraacinar arteries that lack lymph vessels. This arterial T cell sheath extended to the pulmonary arteries where lymph vessels were located. Conclusions/Significance These results indicate that CD90/Thy-1 is expressed on lymphatic endothelial cells and represents a suitable marker for murine lung lymph vessels. Combining CD90/Thy-1 labeling with precision cut lung slices allows visualizing the anatomy of the lymphatic system in normal and inflamed conditions.
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Affiliation(s)
- Sarah Kretschmer
- Institut für Anatomie, Zentrum für medizinische Struktur- und Zellbiologie, Universität zu Lübeck, Lübeck, Germany
| | - Ina Dethlefsen
- Institut für Anatomie, Zentrum für medizinische Struktur- und Zellbiologie, Universität zu Lübeck, Lübeck, Germany
| | - Stefanie Hagner-Benes
- Institut für Laboratoriumsmedizin und Pathobiochemie, Molekulare Diagnostik, Philipps-Universität, Marburg, Germany
| | - Leigh M. Marsh
- Institut für Laboratoriumsmedizin und Pathobiochemie, Molekulare Diagnostik, Philipps-Universität, Marburg, Germany
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Holger Garn
- Institut für Laboratoriumsmedizin und Pathobiochemie, Molekulare Diagnostik, Philipps-Universität, Marburg, Germany
| | - Peter König
- Institut für Anatomie, Zentrum für medizinische Struktur- und Zellbiologie, Universität zu Lübeck, Lübeck, Germany
- * E-mail:
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31
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Noh YI, Rho M, Yoo YM, Jung SJ, Lee SS. Isolation and Morphological Features of Primo Vessels in Rabbit Lymph Vessels. J Acupunct Meridian Stud 2012; 5:201-5. [PMID: 23040099 DOI: 10.1016/j.jams.2012.07.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 07/05/2012] [Accepted: 07/06/2012] [Indexed: 11/12/2022] Open
Affiliation(s)
- Young-Il Noh
- Department of Oriental Biomedical Engineering, College of Health and Science, Sangji University, Wonju-si, Gangwon-do, Republic of Korea
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32
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Bazigou E, Makinen T. Flow control in our vessels: vascular valves make sure there is no way back. Cell Mol Life Sci 2012; 70:1055-66. [PMID: 22922986 PMCID: PMC3578722 DOI: 10.1007/s00018-012-1110-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 07/24/2012] [Accepted: 07/26/2012] [Indexed: 01/06/2023]
Abstract
The efficient transport of blood and lymph relies on competent intraluminal valves that ensure unidirectional fluid flow through the vessels. In the lymphatic vessels, lack of luminal valves causes reflux of lymph and can lead to lymphedema, while dysfunction of venous valves is associated with venous hypertension, varicose veins, and thrombosis that can lead to edema and ulcerations. Despite their clinical importance, the mechanisms that regulate valve formation are poorly understood and have only recently begun to be characterized. Here, we discuss new findings regarding the development of venous and lymphatic valves that indicate the involvement of common molecular mechanisms in regulating valve formation in different vascular beds.
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Affiliation(s)
- Eleni Bazigou
- Lymphatic Development Laboratory, Cancer Research UK London Research Institute, 44 Lincoln’s Inn Fields, London, WC2A 3LY UK
- Present Address: Cardiovascular Mechanics Lab, Department of Bioengineering, Imperial College London, London, SW7 2AZ UK
| | - Taija Makinen
- Lymphatic Development Laboratory, Cancer Research UK London Research Institute, 44 Lincoln’s Inn Fields, London, WC2A 3LY UK
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33
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Pavlista D, Eliška O. [Lymphatic mapping in axilla as possible prevention of lymphedema in breast cancer patients - first results of the anatomical study]. Ceska Gynekol 2012; 77:251-254. [PMID: 22779729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Lymphatic mapping is a method to find and preserve upper extremity lymphatics during axillary surgery (axilla clearance and sentinel node biopsy) in breast cancer patients. This may reduce the incidence of lymphedema. We examined on anatomical model, if the lymphatic drainage of the upper extremity is fully separable from the lymphatic drainage of the breast. We further endeavored to find an explanation as to why lymphedema occurs in the upper extremity after sentinel node biopsy in breast carcinoma. DESIGN Pilot study. SETTING Oncogynecologic Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague. METHODS Patent blue dye was injected deep and superficially in arm and breast bilaterally in 9 cadavers. After visualization and precise dissection of the lymphatic vessels and nodes, a record of their routes was made. A scheme of arm and breast lymphatics was constructed. RESULTS The lymph from arm is drained by 2-4 main afferent collectors. As opposed to cranial and medial collectors, caudal collectors diverged from the axillary vein and entered the caudal axilla. In one case the caudal collector entered a node, which was considered to be the sentinel node of the breast. The other important finding is the demonstration of lymphatic anastomoses that take place between imaged nodes in the caudal axilla, which is the most frequent localization of the breast sentinel lymph node. CONCLUSION The relationship of lymphatic drainage of the arm and breast are closely related and share connections. These connections represent the main problem, which could explain lymphedema following surgery if damaged. Further studies are necessary to improve understanding of this method and to increase the number of observations.
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Affiliation(s)
- D Pavlista
- Gynekologicko-porodnicka klinika 1. Praha
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34
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Davies-Venn CA, Angermiller B, Wilganowski N, Ghosh P, Harvey BR, Wu G, Kwon S, Aldrich MB, Sevick-Muraca EM. Albumin-binding domain conjugate for near-infrared fluorescence lymphatic imaging. Mol Imaging Biol 2012; 14:301-14. [PMID: 21688052 PMCID: PMC3346932 DOI: 10.1007/s11307-011-0499-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this study was to develop and characterize a novel peptide imaging agent for noninvasive near-infrared fluorescence imaging of protein transport by the lymphatics. An imaging agent consisting of a cyclic albumin-binding domain (cABD) peptide, with sequence, Arg-Leu-Ile-Glu-Asp-Ile-Cys-Leu-Pro-Arg-Trp-Gly-Cys-Leu-Trp-Glu-Asp-Asp-Lys, was conjugated to a near-infrared fluorophore, IRDye800CW, allowing for enhanced vascular uptake, retention, and fluorescence imaging. PROCEDURE Characterization of the cABD-IRDye800 peptide conjugate was performed using fluorescence spectroscopy to assess optical properties and SDS-PAGE and Biacore binding assays to determine binding affinity and specificity. Fluorescence imaging of normal C57BL/6 mice was conducted to monitor lymphatic uptake and retention. RESULTS cABD-IRDye800 exhibited approximately six times greater fluorescent yield and greater stability than indocyanine green, an agent previously used in humans to image lymphatic vasculature. The agent exhibited affinity for albumin with IC(50) and Kd in the nanomolar range and demonstrated superior retention characteristics within mouse lymphatics when compared with IRDye800CW. CONCLUSIONS cABD-IRDye800 has utility for assessing lymphatic function in mouse models of human lymphatic disease and the potential for use in clinical diagnostic imaging of the lymphatic vasculature.
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Affiliation(s)
- Cynthia A. Davies-Venn
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
- Translational Biology and Molecular Medicine Program, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Bonnie Angermiller
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
| | - Nathaniel Wilganowski
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
| | - Pradip Ghosh
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
| | - Barrett R. Harvey
- The Center for Immunology and Autoimmune Diseases, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler St. SRB 330A, Houston, TX 77030 USA
| | - Grace Wu
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
| | - Sunkuk Kwon
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
| | - Melissa B. Aldrich
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
| | - Eva M. Sevick-Muraca
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
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35
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Wu X, Yu Z, Liu N. Comparison of approaches for microscopic imaging of skin lymphatic vessels. Scanning 2012; 34:174-180. [PMID: 21898460 DOI: 10.1002/sca.20285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Accepted: 08/11/2011] [Indexed: 05/31/2023]
Abstract
Assessment of skin lymphatic vessels is of great significance in understanding their roles in many pathological conditions. Our aim was to identify the optimal approach for investigation of cutaneous lymphatic system. We performed comparative studies on skin lymphatic vessels using immunohistochemistry of tissue sections, computer graphic reconstruction method together with immunohistochemically stained serial sections and whole mount fluorescence in human lower limb. Lymphatic vessels were identified with podoplanin antibody. The relative merits and drawbacks of each method in evaluation of structure, spatial organization, and distribution of cutaneous lymphatic vessels were described. Immunohistology of tissue sections enabled the investigation of the structure and distribution of the whole cutaneous lymphatic system in two-dimensional slices, whereas three-dimensional morphology of only the most superficial lymph capillary network immediately under the epidermis could be evaluated with the whole mount technique. Meanwhile, only little segmentation of skin lymphatic vessel from five immunohistochemically stained serial sections was reconstructed and evaluated due to expense and special skills required using computer graphic three-dimensional reconstruction. Furthermore, a great number of artifacts and special skills required in its processes leaded to less accurate structure of skin lymphatic vessels. Our findings demonstrated that the use of either of the proposed techniques alone could not allow a comprehensive analysis of the skin lymphatic system due to their relative drawbacks. Combination of immunohistology of tissue sections and three-dimensional whole-mount preparations appears to be the best candidate for comprehensive evaluation of skin lymphatic system.
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Affiliation(s)
- Xiufeng Wu
- Lymphology Center of Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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36
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Bellini C, Rutigliani M, Boccardo F, Campisi C, Bellini T, Bonioli E, Fulcheri E. Are there lymphatic vessels in the placenta? Lymphology 2012; 45:34-36. [PMID: 22768471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The role of lymphatics in placentation has been scantily studied and the true existence of placental lymphatics is under debate. Numerous blood and lymphatic-lineage molecule markers are now available and they are expressed in human placental tissue. D2-40 expression at the placental stromal level seems to indicate that network-forming, podoplanin-expressing cells may act as a reticular-lymphatic-like conductive network. This exciting area at the intersection of perinatology and lymphology needs further investigation.
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Affiliation(s)
- C Bellini
- Neonatal Intensive Care Unit, University of Genoa, I.R.C.C.S. Gaslini Institute, Genoa, Italy.
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37
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Ando Y, Murai O, Kuwajima Y, Furukawa S, Sasaki D, Okawa Y, Yaegashi T, Miura H, Fujimura A. Lymphatic architecture of the human gingival interdental papilla. Lymphology 2011; 44:146-154. [PMID: 22458116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Many studies have investigated the lymphatic architecture of head and neck using experimental animals, confirming the existence of lymphatic networks beneath the epithelium in gingival tissue. In this study, we investigated the use of these lymphatics as a drug delivery route by studying the architecture of lymphatic vessels in human interdental papilla. Serial cryosections were cut using the film-transfer method. To identify lymphatics, the sections were stained using enzyme histochemical and immunohistochemical techniques and three-dimensional images of lymphatics were reconstructed using 3D visualization software. Capillary lymphatic networks were observed in the lamina propria beneath the epithelium in human interdental papilla, and they joined with lymphatic networks beneath the epithelium in free gingiva. The networks consisted of a single layer of large irregular, hexagonal meshes and precollecting lymphatic vessels heading toward collecting lymphatic vessels that exited on the periosteum of the alveolar crest. These findings suggest that lymphatic flow from the interdental papilla drains into collecting lymphatic vessels running buccolingually on the alveolar crest of the interdental papilla. This may be an important anatomical feature during inflammation throughout the oral cavity in that the drainage function is maintained by part of lymphatic flow that is not impaired during the healing process.
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Affiliation(s)
- Y Ando
- Department of Anatomy, Division of Functional Morphology, Iwate Medical University, Iwate, Japan
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38
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Davis MJ, Rahbar E, Gashev AA, Zawieja DC, Moore JE. Determinants of valve gating in collecting lymphatic vessels from rat mesentery. Am J Physiol Heart Circ Physiol 2011; 301:H48-60. [PMID: 21460194 PMCID: PMC3129915 DOI: 10.1152/ajpheart.00133.2011] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 03/29/2011] [Indexed: 11/22/2022]
Abstract
Secondary lymphatic valves are essential for minimizing backflow of lymph and are presumed to gate passively according to the instantaneous trans-valve pressure gradient. We hypothesized that valve gating is also modulated by vessel distention, which could alter leaflet stiffness and coaptation. To test this hypothesis, we devised protocols to measure the small pressure gradients required to open or close lymphatic valves and determine if the gradients varied as a function of vessel diameter. Lymphatic vessels were isolated from rat mesentery, cannulated, and pressurized using a servo-control system. Detection of valve leaflet position simultaneously with diameter and intraluminal pressure changes in two-valve segments revealed the detailed temporal relationships between these parameters during the lymphatic contraction cycle. The timing of valve movements was similar to that of cardiac valves, but only when lymphatic vessel afterload was elevated. The pressure gradients required to open or close a valve were determined in one-valve segments during slow, ramp-wise pressure elevation, either from the input or output side of the valve. Tests were conducted over a wide range of baseline pressures (and thus diameters) in passive vessels as well as in vessels with two levels of imposed tone. Surprisingly, the pressure gradient required for valve closure varied >20-fold (0.1-2.2 cmH(2)O) as a passive vessel progressively distended. Similarly, the pressure gradient required for valve opening varied sixfold with vessel distention. Finally, our functional evidence supports the concept that lymphatic muscle tone exerts an indirect effect on valve gating.
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Affiliation(s)
- Michael J Davis
- Dept. of Medical Pharmacology & Physiology, Univ. of Missouri School of Medicine, 1 Hospital Dr., Rm. M451, Columbia, MO 65212, USA.
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Morikawa LK, Roach M. Pelvic nodal radiotherapy in patients with unfavorable intermediate and high-risk prostate cancer: evidence, rationale, and future directions. Int J Radiat Oncol Biol Phys 2011; 80:6-16. [PMID: 21481721 DOI: 10.1016/j.ijrobp.2010.11.074] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/21/2010] [Accepted: 11/30/2010] [Indexed: 11/19/2022]
Abstract
Over the past 15 years, there have been three major advances in the use of external beam radiotherapy in the management of men with clinically localized prostate made. They include: (1) image guided (IG) three-dimensional conformal/intensity modulated radiotherapy; (2) radiation dose escalation; and (3) androgen deprivation therapy. To date only the last of these three advances have been shown to improve overall survival. The presence of occult pelvic nodal involvement could explain the failure of increased conformality and dose escalation to prolong survival, because the men who appear to be at the greatest risk of death from clinically localized prostate cancer are those who are likely to have lymph node metastases. This review discusses the evidence for prophylactic pelvic nodal radiotherapy, including the key trials and controversies surrounding this issue.
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Abstract
Sentinel lymph nodes (SLNs) are the first lymph nodes to drain wastes originated from cancerous tissue. There is a need for an in vivo imaging method that can image the intact SLN to further our understanding of its normal as well as abnormal functions. We report the use of ultrahigh sensitive optical microangiography (UHS-OMAG) to image functional microvascular and lymphatic vessel networks that innervate the intact lymph node in mice in vivo. The promising results show a potential role of UHS-OMAG in the future understanding and diagnosis of the SLN involvement in cancer development.
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Affiliation(s)
- Yeongri Jung
- Oregon Health & Science University, Department of Biomedical Engineering 3303 SW Bond Avenue, Portland, Oregon 97239, USA
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Jung Y, Zhi Z, Wang RK. Three-dimensional optical imaging of microvascular networks within intact lymph node in vivo. J Biomed Opt 2010; 15:050501. [PMID: 21054073 PMCID: PMC2966489 DOI: 10.1117/1.3496301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 08/31/2010] [Accepted: 09/02/2010] [Indexed: 05/18/2023]
Abstract
Sentinel lymph nodes (SLNs) are the first lymph nodes to drain wastes originated from cancerous tissue. There is a need for an in vivo imaging method that can image the intact SLN to further our understanding of its normal as well as abnormal functions. We report the use of ultrahigh sensitive optical microangiography (UHS-OMAG) to image functional microvascular and lymphatic vessel networks that innervate the intact lymph node in mice in vivo. The promising results show a potential role of UHS-OMAG in the future understanding and diagnosis of the SLN involvement in cancer development.
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Affiliation(s)
- Yeongri Jung
- Oregon Health & Science University, Department of Biomedical Engineering 3303 SW Bond Avenue, Portland, Oregon 97239, USA
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Abstract
The lymphatics began receiving attention in the scientific community as early as 1622, when Gasparo Aselli noted the appearance of milky-white vessels in the mesentery of a well-fed dog. Since this time, the lymphatic system has been historically regarded as the sewer of the vasculature, passively draining fluid and proteins from the interstitial spaces (along with lipid from the gut) into the blood. Recent reports, however, suggest that the lymphatic role in lipid transport is an active and intricate process, and that when lymphatic function is compromised, there are systemic consequences to lipid metabolism and transport. This review highlights these recent findings, and suggests future directions for understanding the interplay between lymphatic and lipid biology in health and disease.
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Affiliation(s)
- J Brandon Dixon
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA.
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Fowler JC, Solanki CK, Ballinger JR, Ravichandran D, Douglas-Jones A, Lawrence D, Bobrow L, Purushotham AD, Peters AM. Axillary lymph node drainage pathways from intradermal and intraparenchymal breast planes. J Surg Res 2010; 161:69-75. [PMID: 19439325 DOI: 10.1016/j.jss.2009.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 12/11/2008] [Accepted: 01/06/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND To compare functional anatomy of breast peri-areolar and peri-tumoral lymphatic drainage basins. METHODS Fifteen breast cancer patients received simultaneous peri-areolar (intradermal) and peri-tumoral (intraparenchymal) injections of human polyclonal immunoglobulin (HIG) labeled with (99m)Tc and (111)In 2 to 4 h before axillary lymph node clearance surgery. Resected nodes (range 5-20; median 16) were individually counted for (99m)Tc and (111)In in a well-counter and ranked according to activity content (echelon). Activity in distal nodes was negligible so extraction efficiency (E) of HIG in the first echelon node was calculated as counts divided by total counts in the chain. RESULTS Five- to 10-fold more activity was recovered after intradermal injection. The injection planes identified the same first echelon node in 10 patients (group 1) but different in five (group 2). In group 1, intradermal E correlated with intra-parenchymal E (r = 0.82; P < 0.01). E of intradermal first echelon nodes in group 2 was 51 (SD 13)%, similar to intradermal E in group 1 (58 [23]%). E of intraparenchymal first echelon nodes in group 2, however, was 28 (6)%, lower than intraparenchymal E in group 1 (54 [20]%; P < 0.02). CONCLUSIONS Lymph nodes extract approximately 50% of HIG. Extracted HIG does not cascade to distal nodes, validating HIG for sentinel node lymphoscintigraphy. HIG injected intradermally at the areola drains via a single route to the axilla. In two-thirds of patients, peri-tumoral HIG follows a similar route, but in one-third of patients drainage from the parenchymal plane is more complex, with more than one route to the axilla.
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Affiliation(s)
- J Charlotte Fowler
- Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
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44
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Duffy K, Hyde MA, Tanner B, Goldgar D, Bowen AR, Florell SR, Bowen GM. Anatomic variability in superficial blood vessel and lymphatic vessel density. J Cutan Pathol 2010; 37:1108-9. [PMID: 20492081 DOI: 10.1111/j.1600-0560.2010.01561.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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45
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Hikage M, Gonda K, Takeda M, Kamei T, Kobayashi M, Kumasaka M, Watanabe M, Satomi S, Ohuchi N. Nano-imaging of the lymph network structure with quantum dots. Nanotechnology 2010; 21:185103. [PMID: 20388975 DOI: 10.1088/0957-4484/21/18/185103] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Sentinel lymph node diagnosis contributes to operative strategy in cancer surgery. During lymph node metastasis, cancer cells first reach the sentinel lymph node (SLN) via lymph flow. To perform SLN biopsy effectively, it is important that cancer cells are detected with high sensitivity in SLN connected to the tumor site. Here we present a method to visualize a high-risk area in the SLN for lymph node metastasis with a high degree of accuracy. Quantum dots (QDs), bright fluorescent nanoparticles, were endoscopically injected into the gastrointestinal wall of pigs, and their signal was specifically detected in the SLN with a laparoscopic device. Single-particle imaging under a confocal microscope showed that the QDs were distributed heterogeneously in the SLN and that their distribution marked the inflow locus of afferent lymphatic vessels where lymph node metastasis begins. Moreover, we developed a method using cellular marker conjugated QDs that visualizes specific cells in SLNs, suggesting that this method can be applied for the detection of cancer cells in sentinel lymph nodes using tumor-specific-molecular conjugated QDs. These results show that our method might significantly increase the detection rate of cancer metastasis in SLNs.
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Affiliation(s)
- Makoto Hikage
- Department of Nano-Medical Science, Graduate School of Medicine, Tohoku University, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
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46
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Petunov SG, Egorova AA, Orlov RS, Nikitina ER. Effect of histamine on spontaneous contractions of mesenteric lymphatic vessels and lymph nodes of white rats: endothelium-dependent responses. Dokl Biol Sci 2010; 432:176-180. [PMID: 20665147 DOI: 10.1134/s0012496610030038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Indexed: 05/29/2023]
Affiliation(s)
- S G Petunov
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, pr. Morisa Toresa 44, St. Petersburg, 194223, Russia
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Mirilas P, Skandalakis JE. Surgical anatomy of the retroperitoneal spaces, Part III: Retroperitoneal blood vessels and lymphatics. Am Surg 2010; 76:139-144. [PMID: 20336888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In this article, we discuss the surgical anatomy of the blood vessels and the lymphatic vessels and lymph nodes found in the retroperitoneum. Retroperitoneal blood vessels include the aorta and all its branches--parietal and visceral--from the diaphragm to the pelvis, and the inferior vena cava and its tributaries. The retroperitoneal lymphatics form a very rich and extensive chain. As a general rule, lymphatics follow the arteries and named lymph nodes are found at the root of the arteries. Retroperitoneal nodes of the abdomen comprise the inferior diaphragmatic nodes and the lumbar nodes. The latter are classified as left lumbar (aortic), intermediate (interaorticovenous), and right lumbar (caval). These nodes surround the aorta and the inferior vena cava. Around the aorta lie the paraortic nodes, preaortic nodes (include celiac, superior mesenteric, inferior mesenteric nodes collecting lymph from the splanchna supplied by the homonymous arteries), and retroaortic nodes. Similarly, around the vena cava lie the paracaval, precaval, and retrocaval nodes. Pelvic nodes include the common iliac, external and internal iliac, obturator, and sacral nodes.
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Affiliation(s)
- Petros Mirilas
- Centers for Surgical Anatomy and Technique, Emory University School of Medicine, 1462 Clifton Road NE, Suite 303, Atlanta, GA 30322, USA.
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Hugon J, Barthelemy L, Rostain JC, Gardette B. The pathway to drive decompression microbubbles from the tissues to the blood and the lymphatic system as a part of this transfer. Undersea Hyperb Med 2009; 36:223-236. [PMID: 20088241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The formation sites of the microbubbles that are routinely detected in the bloodstream at precordial level by Doppler after a decompression are reviewed and discussed here. First, microbubbles could form on the endothelium lumen wall of the capillaries, at specific nanometric sites, but the release mechanism of such small emerging entities remains puzzling. They could be also formed from pre-existing gas nuclei present in the blood when favorable local hydrodynamic/supersaturation conditions generate microcavitation and tribonucleation phenomena. Finally, tissues could represent large pools for microbubble formation and amplification. Nevertheless, it remains to explain what the potential pathways are to drive them to the blood. Knowing that the permeability of most of the blood capillary network is quite low, an alternative is proposed for such transport. The lymphatic system, which drains the interstitial fluid to guarantee the fluid balance of tissues, could allow the transfer of micrometric elements like stabilized microbubbles formed in tissues on long distances. A final rejection in the bloodstream at the termination of both right lymphatic and thoracic ducts can be expected. The characteristics of this slow transport, activated by the muscular pump, could explain the detection on long periods of massive venous gas emboli.
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Affiliation(s)
- J Hugon
- Université de la Méditerranée, UMR - MD2, P2COE, Institut de Neuroscience J. Roche, Faculté de Médecine Nord, 13916 Marseille Cedex 20 France
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Ortín-Pérez J, Vidal-Sicart S, Duch J, Doménech B, Pons F. [Bilateral drainage in the internal mammary chain in the detection of the sentinel lymph node in a breast tumor]. ACTA ACUST UNITED AC 2009; 28:128-9. [PMID: 19558954 DOI: 10.1016/s0212-6982(09)71356-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- J Ortín-Pérez
- Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, España
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50
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Guseĭnov TS, Guseĭnova ST. [Controversial problems in lymphology]. Morfologiia 2009; 136:77-80. [PMID: 20210103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This work analyzes the controversial problems of lymphology, which require the scientific substantiation. Authors express their opinion on the functional anatomy of the lymphatic system, based on their own research and the literature data. The issues of lymphatic drainage from the spleen, bones, muscles, ligaments and fascia are discussed. The data on the diameter of the lymphatic vessels and its variability are presented. The significant attention is given to the changes of the lymphatic system structures during dehydration and rehydration. The role of lymphatic capillaries in the inflammatory processes is emphasized. The contradictions in the description of lymphatic postcapillaries are noted.
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