A double-blind, cross-over trial of O-(β-hydroxyethyl)-rutosides (benzo-pyrones) in the treatment of lymphoedema of the arms and legs

Oral Administration of Purified Micronized Flavonoid Fraction Suppresses Leukocyte Adhesion in Ischemia-Reperfusion Injury: In vivo Observations in the Hamster Skin Fold

“…Activation of comple ment induces GDI 1/CD18 expression, promoting leuko cyte-endothelial cell interaction [32], and consequently depletion of the complement system may reduce activa tion and adhesion [33]. Flavonoids have also been found to inhibit platelet aggregation [34], which supports the hypothesis that inhibition of leukocyte adhesion is me diated through the complement system, since C5a stimu lation activates platelets, enhancing the activation of polymorphonuclear leukocytes in a positive feedback pro cess [35], Therefore, in view of the relation between leukocyte adhesion and increase in microvascular permeability, the finding that oral administration of flavonoids significant ly decreases the number of adherent leukocytes could in part explain their beneficial effects in the treatment of edema found by previous investigators [1,2,4],…”

“…Flavonoids are reported to significantly decrease the elevated vascular permeability caused by the intracutaneous administration of histamine, bradykinin, and fibrin degradation products [ 1], an effect that is corroborated by the finding that these compounds are clinically beneficial in reducing different types of high-protein edemas [2][3][4], One of the causes of edema is a nonfunctional endothe lial wall, leading to an increased microvascular permeabil-ity [5] by which high-molecularweight substances, namely plasma proteins, are not retained within the vessels, thus causing a disruption of the Starling fluid balance which favors the filtration of fluid into the interstitial space [6], To the extent that this phenomenon is also present in inflammation and is one of the consequences of ischemiareperfusion injury [7], it may be hypothesized that flavonoids also have an effect on the cellular mechanisms associ ated with the development of tissue damage in ischemiareperfusion injury.…”

Overview of treatment options and review of the current role and use of compression garments, intermittent pumps, and exercise in the management of lymphedema

“…This class of drug may work by stimulating proteolysis by macrophages as well as increasing the absolute number of macrophages within the edematous extremity. 50 Two randomized, placebo-controlled, cross-over studies found statistically significant benefits in patients with lymphedema who received benzopyrones for several months. 50,51 Unfortunately, there are no data about the long term effects or potential toxicities of these agents.…”

Workgroup III

“…Although bioflavenoids 7 are readily available, long term studies have not yet documented the efficacy of this pharmacologic approach. Prophylactic, long term use of systemic antibiotics is routinely warranted for these patients.…”