LPT mobilizes leukocytes from GALT, and these leukocytes are transported by the lymphatic circulation. This enhanced release of leukocytes from GALT may provide scientific rationale for the clinical use of LPT to improve immune function.

Background: Lymphatic pump techniques (LPT) are used by osteopathic practitioners for the treatment of edema and infection; however, the mechanisms by which LPT enhances the lymphatic and immune systems are poorly understood. Methods and Results: To measure the effect of LPT on the rat, the cisterna chyli (CC) of 10 rats were cannulated and lymph was collected during 4 min of 1) pre-LPT baseline, 2) 4 min LPT, and 3) 10 min post-LPT recovery. LPT increased significantly (p < 0.05) lymph flow from a baseline of 24 AE 5 ml/min to 89 AE 30 ml/min. The baseline CC lymphocyte flux was 0.65 AE 0.21Â10 6 lymphocytes/min, and LPT increased CC lymphocyte flux to 6.10 AE 0.99Â10 6 lymphocytes/min (p < 0.01). LPT had no preferential effect on any lymphocyte population, since total lymphocytes, CD4+ T cells, CD8+ T cells, and B cell numbers were similarly increased. To determine if LPT mobilized gut-associated lymphocytes into the CC lymph, gut-associated lymphocytes in the CC lymph were identified by staining CC lymphocytes for the gut homing receptor integrin a4b7. LPT significantly increased (p < 0.01) the flux of a4b7 positive CC lymphocytes from a baseline of 0.70 AE 0.03Â10 5 lymphocytes/min to 6.50 AE 0.10Â10 5 lymphocytes/min during LPT. Finally, lymphocyte flux during recovery was similar to baseline, indicating the effects of LPT are transient. Conclusions: Collectively, these results suggest that LPT may enhance immune surveillance by increasing the numbers of lymphocytes released in to lymphatic circulation, especially from the gut associated lymphoid tissue. The rat provides a useful model to further investigate the effect of LPT on the lymphatic and immune systems.

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Lymph stasis can result in edema and accumulation of particulate matter, exudates, toxins, and bacteria. This can lead to inflammation, impaired immune cell trafficking, tissue hypoxia, tissue fibrosis, and a variety of diseases. Previously, we demonstrated that osteopathic lymphatic pump treatment (LPT) significantly increased thoracic and mesenteric duct lymph flow. The purpose of this study was to determine if LPT would mobilize inflammatory mediators into the lymphatic circulation. Under anesthesia, thoracic or mesenteric lymph of dogs was collected at baseline (resting), during 4 min of LPT, and 10 min following LPT and the lymphatic concentrations of cytokines, chemokines, superoxide dismutase (SOD) and nitric oxide (NO) were measured. LPT significantly increased both thoracic and mesenteric lymph cytokine and chemokine concentrations when compared to their relative baseline concentrations. In addition, LPT increased lymphatic concentrations of SOD and NO. Ten minutes following cessation of LPT, both thoracic and mesenteric lymph cytokine, chemokine, NO and SOD concentrations were similar to baseline, suggesting their release is transient. This redistribution of inflammatory mediators during LPT may provide scientific rationale for the clinical use of LPT to enhance immunity and treat infection. Funding: NIH: U19 AT002023 (H. F.D), R01 AT004361 (L.M.H).

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