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Adipose-Derived Stem Cells and Vascularized Lymph Node Transfers Successfully Treat Mouse Hindlimb Secondary Lymphedema by Early Reconnection of the Lymphatic System and Lymphangiogenesis

Hayashida, Kenji M.D.; Yoshida, Shuhei M.D., Ph.D.; Yoshimoto, Hiroshi M.D., Ph.D.; Fujioka, Masaki M.D., Ph.D.; Saijo, Hiroto M.D.; Migita, Kiyoshi M.D., Ph.D.; Kumaya, Misato; Akita, Sadanori M.D., Ph.D.

Plastic and Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 639–651
doi: 10.1097/PRS.0000000000003110
Experimental: Original Articles

Background: Secondary lymphedema is often observed in postmalignancy treatment of the breast and the gynecologic organs, but effective therapies have not been established in chronic cases even with advanced physiologic operations. Currently, reconstructive surgery with novel approaches has been attempted.

Methods: The hindlimbs of 10-week-old male C57BL/6J mice, after 30-Gy x-irradiation, surgical lymph node dissection, and 5-mm gap creation, were divided into four groups, with vascularized lymph node transfer abdominal flap and 1.0 × 104 adipose-derived stem cells. Lymphatic flow assessment, a water-displacement plethysmometer paw volumetry test, tissue quantification of lymphatic vessels, and functional analysis of lymphatic vessels and nodes were performed.

Results: Photodynamic Eye images, using indocyanine green fluorescence, demonstrated immediate staining in subiliac lymph nodes, and linear pattern imaging of the proximal region was observed with the combined treatment of adipose-derived stem cells and vascularized lymph node transfer. Both percentage improvement and percentage deterioration with the combined treatment of adipose-derived stem cells and vascularized lymph node transfer were significantly better than with other treatments (p < 0.05). The numbers of lymphatic vessels with LYVE-1 immunoreactivity significantly increased in mice treated with adipose-derived stem cells (p < 0.05), and B16 melanoma cells were metastasized in groups treated with vascularized lymph node transfers by day 28.

Conclusions: Adipose-derived stem cells increase the number of lymphatic vessels and vascularized lymph node transfers induce the lymphatic flow drainage to the circulatory system. Combined adipose-derived stem cell and vascularized lymph node transfer treatment in secondary lymphedema may effectively decrease edema volume and restore lymphatic function by lymphangiogenesis and the lymphatic-to-venous circulation route.

Nagasaki and Oita, Japan

From the Departments of Plastic and Reconstructive Surgery and Molecular Immunology, Nagasaki University Graduate School of Biomedical Sciences; the Department of Plastic and Reconstructive Surgery, National Nagasaki Medical Center; and Oita University.

Received for publication March 17, 2016; accepted June 24, 2016.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Sadanori Akita, M.D., Ph.D., Department of Plastic and Reconstructive Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 8528501, Japan,

©2017American Society of Plastic Surgeons