Pharmacotherapy Agents in Lymphedema Treatment: A Systematic Review

Forte, Antonio J.; Boczar, Daniel; Huayllani, María T.; Lu, Xiaona

doi:10.7759/cureus.6300

Cited by 10 publications

(10 citation statements)

References 15 publications

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“…Accordingly, anti-inflammatory and immunosuppressive agents have been considered as potential therapies to treat lymphatic vascular insufficiency and lymphedema (Forte et al, 2019). Ketoprofen, a non-steroid anti-inflammatory drug (NSAID) has demonstrated a remarkable ability to promote lymphangiogenesis, improve lymphatic function and reduce lymphedema in animal models and clinical trials (Nakamura et al, 2009;Rockson et al, 2018;Forte et al, 2019). Accordingly, there are additional clinical trials in progress to evaluate the effect of ketoprofen on lymphedema.…”

Section: Anti-inflammatory and Immunosuppressive Agentsmentioning

confidence: 99%

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

Pal

Rahman

et al. 2022

Front. Pharmacol.

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

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Section: Anti-inflammatory and Immunosuppressive Agentsmentioning

confidence: 99%

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

Pal

Rahman

et al. 2022

Front. Pharmacol.

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“…Otro estudio donde se evaluaron 21 pacientes con linfedema primario o secundario que tomaron dosis orales de ketoprofeno 3 veces al día por cuatro meses donde se evidencio una mejora considerable del linfedema, luego se realizó una segunda fase en donde se reclutaron 34 pacientes (16 recibieron ketoprofeno y 18 placebo), al final del estudio se demostró que el ketoptofeno disminuyó el grosor de la piel y la expresión del factor estimulante de colonias de granulocitos(GCSF). Se concluye que la terapia antiinflamatoria dirigida podría mejorar la biología cutánea del linfedema humano (11,18) Si bien las respuestas favorables al ketoprofeno son alentadoras, el uso crónico y generalizado es limitado, al igual que todos los AINE, por una advertencia con respecto a la toxicidad cardiovascular ( 18)…”

Section: Ketoprofenounclassified

“…En otro estudio clínico prospectivo, aleatorizado, controlado con placebo y doble ciego en 20 pacientes con linfedema se administró selenito de sodio antes, intra y posoperatorio para el tratamiento del carcinoma de células escamosas de cabeza y cuello (10 pacientes fueron tratados con selenito de sodio y 10 recibieron placebo). En comparación con el placebo, los pacientes tratados con selenito de sodio tuvieron una reducción de volumen estadísticamente significativa (11) El selenito de sodio se muestra prometedor como agente antiinflamatorio no tóxico rentable además podría reducir la incidencia de infecciones recurrentes por erisipela después del tratamiento del cáncer de mama, pero los resultados deben interpretarse con precaución y no deben generalizarse otras poblaciones (19) Otro estudio en donde se evaluó la medición del selenio en pacientes con linfedema mediante digestión por microondas y espectrometría de absorción atómica sin llama. La concentración media de selenio fue 102,4 ± 19,8 g / l. Se definió un déficit de selenio como valores inferiores a 100 g / l de selenio en sangre total, respecto a ese parámetro, el 44% de los pacientes presentaban un déficit de selenio.…”

Section: Seleniounclassified

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Tema Linfedema: Tratamiento Farmacologico

Villalobos¹,

Miní²

2022

RCMUI

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RESUMEN El Linfedema es una inflamación que ocurre cuando el líquido linfático rico en proteínas se acumula en el tejido intersticial, que se presenta en pacientes con cáncer de útero, ovario, próstata, melanoma, linfomas, pero es más frecuente en el cáncer de mama, luego de la disección los ganglios linfáticos axilares. El manejo es complejo e incluye varias modalidades de tratamiento que pueden usarse solas o en combinación, como es la terapia física compleja (drenaje, masajes y ejercicios), los medicamentos y la intervención quirúrgica. Las benzopironas son los fármacos más utilizados, han tenido éxito como tratamiento cuando se combinan con la terapia física, su eficacia se debe a que aumentan el número de macrófagos, lo que favorece la proteólisis y la reabsorción de proteínas, sin embargo, su uso aún está en controversia.

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“…Surgical interventions may be beneficial in specific cases. Pharmacological therapy comprises agents that modulate tissue inflammation, fibrosis, and lymphangiogenesis [ 92 ]. Utilization of lymphangiogenic growth factors, such as VEGF-C, could be efficient if this growth factor had positive effects not only on the number but also on the function of lymphatic vessels.…”

Section: Lung Changes In Ardsmentioning

confidence: 99%

Acute Respiratory Distress Syndrome: Focus on Viral Origin and Role of Pulmonary Lymphatics

Frőhlich

2021

Biomedicines

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Acute respiratory distress syndrome (ARDS) is a serious affection of the lung caused by a variety of pathologies. Great interest is currently focused on ARDS induced by viruses (pandemic influenza and corona viruses). The review describes pulmonary changes in ARDS and specific effects of the pandemic viruses in ARDS, and summarizes treatment options. Because the known pathogenic mechanisms cannot explain all aspects of the syndrome, the contribution of pulmonary lymphatics to the pathology is discussed. Organization and function of lymphatics in a healthy lung and in resorption of pulmonary edema are described. A future clinical trial may provide more insight into the role of hyaluronan in ARDS but the development of promising pharmacological treatments is unlikely because drugs play no important role in lymphedema therapy.

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Pharmacotherapy Agents in Lymphedema Treatment: A Systematic Review

Cited by 10 publications

References 15 publications

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

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

Tema Linfedema: Tratamiento Farmacologico

Acute Respiratory Distress Syndrome: Focus on Viral Origin and Role of Pulmonary Lymphatics

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