TGF‐β1 mediates pathologic changes of secondary lymphedema by promoting fibrosis and inflammation. Issue 6 (2nd June 2022)

• Record Type: Journal Article
• Authors: Baik, Jung Eun; Park, Hyeung Ju; Kataru, Raghu P.; Savetsky, Ira L.; Ly, Catherine L.; Shin, Jinyeon; Encarnacion, Elizabeth M.; Cavali, Michele R.; Klang, Mark G.; Riedel, Elyn; Coriddi, Michelle; Dayan, Joseph H.; Mehrara, Babak J.
• Is Part Of: Clinical and translational medicine. Volume 12:Issue 6(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-06-02
• Subjects: fibrosis -- inflammation -- pirfenidone -- TGF‐β; Clinical medicine -- Periodicals; Medicine, Experimental -- Periodicals; Medical innovations -- Periodicals; Molecular biology -- Periodicals; Pathology, Molecular -- Periodicals; 616.027
• DOI: 10.1002/ctm2.758
• Languages: English
• ISSNs: 2001-1326

Abstract

Abstract: Background: Secondary lymphedema is a common complication of cancer treatment, and previous studies have shown that the expression of transforming growth factor‐beta 1 (TGF‐β1), a pro‐fibrotic and anti‐lymphangiogenic growth factor, is increased in this disease. Inhibition of TGF‐β1 decreases the severity of the disease in mouse models; however, the mechanisms that regulate this improvement remain unknown. Methods: Expression of TGF‐β1 and extracellular matrix molecules (ECM) was assessed in biopsy specimens from patients with unilateral breast cancer‐related lymphedema (BCRL). The effects of TGF‐β1 inhibition using neutralizing antibodies or a topical formulation of pirfenidone (PFD) were analyzed in mouse models of lymphedema. We also assessed the direct effects of TGF‐β1 on lymphatic endothelial cells (LECs) using transgenic mice that expressed a dominant‐negative TGF‐β receptor selectively on LECs (LEC DN‐RII ). Results: The expression of TGF‐β1 and ECM molecules is significantly increased in BCRL skin biopsies. Inhibition of TGF‐β1 in mouse models of lymphedema using neutralizing antibodies or with topical PFD decreased ECM deposition, increased the formation of collateral lymphatics, and inhibited infiltration of T cells. In vitro studies showed that TGF‐β1 in lymphedematous tissues increases fibroblast, lymphatic endothelial cell (LEC), and lymphatic smooth muscle cell stiffness. Knockdown of TGF‐β1 responsiveness in LEC DN‐RII resulted in increased lymphangiogenesis and collateral lymphatic formation; however, ECM deposition and fibrosis persisted, and the severity of lymphedema was indistinguishable from controls. Conclusions: Our results show that TGF‐β1 is an essential regulator of ECM deposition in secondary lymphedema and that inhibition of this response is a promising means of treating lymphedema. Abstract : TGF‐β1 expression, fibroblast proliferation and ECM deposition are increased in lymphedematous skin. Tissue lysate of lymphedematous skin induces fibroblast proliferation, ECM production and increases the stiffness of fibroblasts, LECs and LSMCs. Inhibition of TGF‐β1 decreases ECM deposition, immune cell infiltration and increases collateral lymphatics formation. Topical treatment of pirfenidone is highly effective for lymphedema treatment.