Azhar Syaza Hazwany, Lim Hwee Ying, Tan Bien-Keem, Angeli Veronique
Department of Microbiology and Immunology, Life Science Institute, Yoon Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore.
Front Physiol. 2020 Mar 17;11:137. doi: 10.3389/fphys.2020.00137. eCollection 2020.
Lymphedema is the clinical manifestation of impaired lymphatic transport. It remains an under-recognized and under-documented clinical condition that still lacks a cure. Despite the substantial advances in the understanding of lymphatic vessel biology and function in the past two decades, there are still unsolved questions regarding the pathophysiology of lymphedema, especially in humans. As a consequence of impaired lymphatic drainage, proteins and lipids accumulate in the interstitial space, causing the regional tissue to undergo extensive and progressive architectural changes, including adipose tissue deposition and fibrosis. These changes are also associated with inflammation. However, the temporal sequence of these events, the relationship between these events, and their interplay during the progression are not clearly understood. Here, we review our current knowledge on the pathophysiology of lymphedema derived from human and animal studies. We also discuss the possible cellular and molecular mechanisms involved in adipose tissue and collagen accumulation during lymphedema. We suggest that more studies should be dedicated to enhancing our understanding of the human pathophysiology of lymphedema to pave the way for new diagnostic and therapeutic avenues for this condition.
淋巴水肿是淋巴运输受损的临床表现。它仍然是一种未得到充分认识和记录的临床病症，目前仍无法治愈。尽管在过去二十年中对淋巴管生物学和功能的理解取得了重大进展，但关于淋巴水肿的病理生理学仍存在未解决的问题，尤其是在人类中。由于淋巴引流受损，蛋白质和脂质在间质空间中积聚，导致局部组织发生广泛且渐进的结构变化，包括脂肪组织沉积和纤维化。这些变化也与炎症相关。然而，这些事件的时间顺序、它们之间的关系以及在进展过程中的相互作用尚不清楚。在此，我们回顾了来自人类和动物研究的关于淋巴水肿病理生理学的现有知识。我们还讨论了淋巴水肿期间脂肪组织和胶原蛋白积累可能涉及的细胞和分子机制。我们建议应开展更多研究，以增进我们对人类淋巴水肿病理生理学的理解，为这种病症的新诊断和治疗方法铺平道路。
