EFFECT OF COMPLEX DECONGESTIVE PHYSIOTHERAPY ON GENE EXPRESSION FOR THE INFLAMMATORY RESPONSE IN PERIPHERAL LYMPHEDEMA

Abstract

Complex decongestive physiotherapy (CDP), consisting of manual lymph drainage,compression bandaging, remedial exercises and skin care, mobilizes accumulated edema fluidand increases lymph flow. On the other hand, it also has a beneficial therapeutic effect onfibrosclerosis. Because little is known of its possible mode of action on a molecular level, thispreliminary study evaluated CDP in patients with peripheral leg lymphedema as to the potentialrole of gene expression in the inflammatory response. The quantitative expression of genes forCD14, interferon-( receptor (IFN(R), tumor necrosis factor-" (TNF"), integrin "4$1 (VLA-4),tumor necrosis factor receptor p55 (TNFR1) and CD44 (standard form) was examined in 9patients with primary or secondary leg lymphedema before and after phase 1 of CDP. Overall,there was a decrease of expression of these pro-inflammatory genes after CDP, suggesting thatbiologic mechanisms implicated in the inflammatory cascades in other disorders are alsoinvolved in the fibrosclerotic reactivity in lymphedema. However, whereas each patient acted ashis or her own control before and after CDP, gene expression in normal patients and normallimbs before and after CDP needs to be examined before the full meaning of these observationscan be understood.