Lymphatic Pump Treatment Research Articles

Efficacy of lymphatic pump treatment in conjunction with methotrexate on rats with adjuvant-induced arthritis

Abstract Rheumatoid Arthritis (RA) is an autoimmune disease targeting synovial joints in which self-reactive T cells release cytokines and B cells produce self-reactive antibodies resulting in an inflammatory response. Lymphatic pump treatment (LPT) promotes lymphatic flow resulting in a flushing out of the immune-complexes and cytokines. A rat mode on RA (AIA) was used to determine whether LPT in conjunction with the anti-rheumatic drug, methotrexate (MTX), enhanced its therapeutic impact on RA. A preventative study was performed in which MTX was given along with LPT (3 times a day for 7 days) . Ankles were assessed daily for signs of inflammation. Flow cytometry was performed on spleen and popliteal lymph nodes (PLN) to determine changes in leukocyte populations. Cytokine levels were determined on ankle lysates. The study showed that MTX treatment delayed the onset of arthritis. MTX reduced the spleen weights (p<0.05). LPT also reduced spleen weights but did not enhance the MTX reduction. LPT reduced PLN weights compared to MTX. MTX resulted in higher numbers of CD4+ T cells and lower numbers of CD8+ T cells and B cells in spleens. PLNs treated with MTX had reduced lymphocyte numbers. MTX treatment reduced CINC-1 and TNFa levels (p<0.05). LPT also reduced CINC-1 levels. In conclusion, MTX treatments delayed arthritis formation in AIA rats while LPT affected both spleen and PLN weights. Thus, the addition of LPT to RA treatment showed potential benefits without negative effects.

Impact of Lymphatic Pump Treatment and Methotrexate on Inflammation, Cytokine Production, and Leukocyte Infiltration in a Rat Model of Rheumatoid Arthritis

Abstract Rheumatoid Arthritis in autoimmune disease afflicting synovial joints leading to chronic joint damage. While the specific mechanisms have not been fully identified, the immune system and inflammatory factors are actively involved. T cells release cytokines and chemokines, such as TNF-alpha, IL-1 and IL-6, CINC-1 and CINC-2, and B cells produce self-reactive antibodies including rheumatoid factor and anti-citrullinated protein antibodies. All these factors result in a pronounced and aggressive inflammatory response within the joints. Lymphatic pump treatment (LPT) promotes lymphatic flow within the body, causing a flushing out of the immune-complexes and pro-inflammatory cells. Using a rat AIA model, the goal was to determine if LPT in conjunction with methotrexate had a greater impact on rheumatoid arthritis symptoms than methotrexate alone. A 21-day AIA rat study was performed using LPT and methotrexate treatments on days 14–21. Ankle circumference and articular index scores were recorded daily as a measurement of inflammation. ELISAs of arthritic ankles homogenates and serum were used to analyze cytokine, chemokine, and autoantibody concentrations. Immune cell infiltration into the ankles was determined using immunohistochemistry. We found that LPT with methotrexate treatment did not significantly alter ankle circumference, articular index scores, immune cell infiltration, cytokine, chemokine, or antibody concentrations compared to methotrexate alone. Overall, methotrexate combined with LPT treatments on days 14–21 did not significantly alter disease progression, however, it is possible that earlier LPT treatment may have a more significant impact on disease progression. College of Graduate Studies Biomedical Sciences program at Midwestern University, Downers Grove, IL.

The effect of induced lymphatic circulation on lymphangiogenesis and inflammatory mediators in rats with adjuvant induced arthritis

Abstract Rheumatoid arthritis (RA) is a chronic inflammatory disease involving dysfunctional lymphatic circulation leading to edema. The adjuvant-induced arthritis (AIA) rat model was used to study the effect of lymphatic pump treatment (LPT) on the expression levels of inflammatory cytokines and lymphangiogenesis within the draining popliteal lymph nodes (PLN). PLN from both control and LPT treatment groups were harvested, and their cDNA were analyzed by qPCR to determine the levels of cytokines, VEGF-C, and VEGFR-3. Additionally, immunohistochemistry was used to visualize the expression of VEGF-C and VEGFR-3 and flow cytometry was used to quantify leukocyte cell types in the PLN. The LPT group showed a decrease in ankle circumference and arthritis grade a few days after the initiation of treatment. Flow cytometry of popliteal lymph nodes showed an increase in CD8, CD4, and CD3 cells in arthritic rats, however cell populations were not significantly different between treatment groups. The qPCR data indicated that the LPT group had a slight reduction in levels of IL-17a, IL-4, IL-6, and IL-1β. IHC showed that the PLN from the LPT group had the highest expression area of VEGF-C and the lowest expression area of VEGFR-3 compared to control. In conclusion, The LPT group showed a reduction in ankle circumference and arthritis score, suggesting that LPT helped alleviate edema and inflammation. When compared to control, the LPT group had lower expression of pro-inflammatory cytokines and elevated levels of VEGF-C, an important lymphatic vessel growth factor, in PLN. Thus, the data suggests that LPT may elevate the swelling and inflammation in rat AIA through the reduction of inflammatory cytokines and the elevation of a lymphatic growth factor.

Induced lymphatic circulation decreases IL-17 expression in the lymph nodes of rats in adjuvant-induced arthritis

Abstract Rheumatoid arthritis (RA) is an autoimmune disorder characterized by chronic inflammation mediated by Th-17 cells. Rat adjuvant-induced arthritis (AIA) is a Th-17-dependent RA model with dysfunctional lymphatic circulation. We hypothesized that induction of lymphatic circulation would attenuate arthritic inflammation. We utilized Lymphatic Pump Treatment (LPT), an osteopathic lymphatic manipulation, to determine if inducing lymphatic flow would alleviate arthritic inflammation. LPT was accomplished on AIA rats by gradually increasing compression on the chest wall for 5 seconds followed by a rapid release. This technique was performed on the rats for 1 minute 3X/day over 7 consecutive days following the onset of measurable inflammation on day 14 post adjuvant injection. Ankle caliper measurements, articular index scoring, popliteal lymph nodes, peripheral blood, and spleens were collected. The LPT-treated rats fell into two groups. LPT responders and non-responders. LPT responders had significantly reduced inflammation (as determined by both in ankle circumference and index scoring). These therapeutically treated animals also had significantly decreased IL-17 expression in their draining popliteal lymph nodes. These results along with our previous findings indicate that LPT can reduce arthritis, alter lymphocyte trafficking and differentiation in secondary lymphoid organs during inflammation. These data suggest that induced lymphatic circulation using osteopathic manipulation may serve as a therapy for chronic inflammation in autoimmune disorders and may also be an enhancement to current treatments.

Effect of Abdominal Lymphatic Pump Treatment on Disease Activity in a Rat Model of Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD), such as ulcerative colitis and Crohn disease, are chronic relapsing inflammatory diseases that affect 1.5 million people in the United States. Lymphatic pump treatment (LPT) techniques were designed to enhance the movement of lymph and can be used to relieve symptoms in patients with IBD and other gastrointestinal disorders. To determine whether LPT would decrease gastrointestinal inflammation and reduce disease severity in rats with acute IBD. On day 0, rats were randomized into control or experimental groups. Control rats received normal drinking water for days 0 to 9. On days 0 to 9, rats in the experimental groups received drinking water containing 3.5% dextran sodium sulfate (DSS). On day 3, experimental rats were randomized into 3 groups. On days 3 to 8, experimental rats received either (1) no treatment or anesthesia (DSS alone); (2) 4 minutes of LPT with anesthesia administration (DSS+LPT); or (3) 4 minutes of sham treatment (ie, light touch) and anesthesia (DSS+sham). On day 9, colons and gastrointestinal lymphoid tissue were collected. Colon weight, histologic changes, disease activity index (DAI) score, and the concentration of leukocytes were measured. At day 9, the mean (SD) DAI score in the DSS+LPT group (1.0 [0.1]) was significantly decreased (P<.01) compared with the DAI score of DSS-alone rats (1.5 [0.1]). While the DAI in DSS+LPT rats was reduced on days 8 to 9, this difference was not statistically different (P>.05) compared with DSS+sham (1.3 [0.1]). No significant differences were found in colon weight, histopathologic findings, or the concentration of gastrointestinal leukocytes between DSS alone, DSS+sham, or DSS+LPT (P>.05). While DSS+LPT reduced IBD compared with DSS+sham, the decrease was not statistically significant. Considering the growing use of adjunctive treatment for the management of IBD, it is important to identify the effect of osteopathic manipulative medicine on IBD progression.

Increased lymphatic circulation decreases CD4 counts in the lymph nodes of rats in adjuvant-induced arthritis

Abstract Rheumatoid arthritis (RA) is a disorder characterized by chronic inflammation. Rat adjuvant-induced arthritis (AIA) is a RA model with dysfunctional lymphatic circulation. We hypothesized that increasing lymphatic circulation would decrease arthritic inflammation. In order to determine if increasing lymphatic flow would decrease arthritic inflammation, we utilized osteopathic lymphatic manipulation (Lymphatic pump treatment (LPT)) during either the onset or during arthritis. LPT was performed by gradually increasing compression on the rat chest wall over 5 seconds followed by rapid release for 5 seconds. This technique was repeated for 1 minute 3X/day for 7 consecutive days either before the onset of inflammation (preventative treatment) or after measurable inflammation (therapeutic treatment). Articular index scoring, ankle caliper measurements, and peripheral blood, spleens, and popliteal lymph nodes were collected. In both the preventative and therapeutic studies, the LPT-treated rats had reduced inflammation. Therapeutically treated animals also had significantly decreased CD4+ lymphocytes in the draining popliteal lymph nodes, with increases in CD4+ cells in the spleen. These results suggest that LPT can reduce arthritis and alter lymphocyte trafficking in secondary lymphoid organs during inflammation. These data suggest that forced lymphatic circulation through osteopathic manipulation may serve to enhance current treatments to decrease inflammatory diseases.

Lymphatic Pump Treatment Mobilizes Bioactive Lymph That Suppresses Macrophage Activity In Vitro

By promoting the recirculation of tissue fluid, the lymphatic system preserves tissue health, aids in the absorption of gastrointestinal lipids, and supports immune surveillance. Failure of the lymphatic system has been implicated in the pathogenesis of several infectious and inflammatory diseases. Thus, interventions that enhance lymphatic circulation, such as osteopathic lymphatic pump treatment (LPT), should aid in the management of these diseases. To determine whether thoracic duct lymph (TDL) mobilized during LPT would alter the function of macrophages in vitro. The thoracic ducts of 6 mongrel dogs were cannulated, and TDL samples were collected before (baseline), during, and 10 minutes after LPT. Thoracic duct lymph flow was measured, and TDL samples were analyzed for protein concentration. To measure the effect of TDL on macrophage activity, RAW 264.7 macrophages were cultured for 1 hour to acclimate. After 1 hour, cell-free TDL collected at baseline, during LPT, and after TDL was added at 5% total volume per well and co-cultured with or without 500 ng per well of lipopolysaccharide (LPS) for 24 hours. As a control for the addition of 5% TDL, macrophages were cultured with phosphate-buffered saline (PBS) at 5% total volume per well and co-cultured with or without 500 ng per well of LPS for 24 hours. After culture, cell-free supernatants were assayed for nitrite (NO2-), tumor necrosis factor α (TNF-α) and interleukin 10 (IL-10). Macrophage viability was measured using flow cytometry. Lymphatic pump treatment significantly increased TDL flow and the flux of protein in TDL (P<.001). After culture, macrophage viability was approximately 90%. During activation with LPS, baseline TDL, TDL during LPT, and TDL after LPT significantly decreased the production of NO2-, TNF-α, and IL-10 by macrophages (P<.05). However, no significant differences were found in viability or the production of NO2-, TNF-α, or IL-10 between macrophages cultured with LPS plus TDL taken before, during, and after LPT (P>.05). The redistribution of protective lymph during LPT may provide scientific rationale for the clinical use of LPT to reduce inflammation and manage edema.

Alleviation of joint inflammation by lymphatic pump treatment of rats with adjuvant-induced arthritis (CAM1P.163)

Abstract Rheumatoid arthritis (RA) is characterized by synovial inflammation, cytokine production and lymph node collapse. Lymphatic pump treatment (LPT) is an osteopathic manipulative treatment used to reduce edema through increasing lymphatic circulation. This study examined the therapeutic potential of LPT on rats with adjuvant-induced arthritis (AIA). We hypothesize that LPT would lessen joint inflammation through increasing lymphatic drainage resulting in the reduction of cytokines in synovial space. AIA was induced in female Lewis rats and randomly placed into a LPT groups or sham groups. Experiments were repeated using different LPT protocols varying the frequency and number of LPT treatments. However in each experiment LPT consisted of rhythmically pressing below the rib cage once a second for 30 seconds, while the sham group was held for 30 seconds. Joint inflammation was determined by measuring ankle circumferences and by articular index scoring. Ankles were collected and homogenized to determine changes in synovial cytokine levels by magnetic immunoassays and ELISA. Clustering LPT treatments three-times a day at the peak of joint inflammation had the greatest impact on arthritis. Animals treated with LPT in this manner exhibited significantly reduced ankle edema and inflammation. Additionally, synovial levels of inflammatory cytokines (GRO, IL17, and IL-6) were reduced with LPT. These results indicate that LPT can reduce joint edema and inflammation in a rat model of RA.

Lymphatic pump treatment as an adjunct to antibiotics for pneumonia in a rat model.

Lymphatic pump treatment (LPT) is a technique used by osteopathic physicians as an adjunct to antibiotics for patients with respiratory tract infections, and previous studies have demonstrated that LPT reduces bacterial load in the lungs of rats with pneumonia. Currently, it is unknown whether LPT affects drug effcacy. To determine whether the combination of antibiotics and LPT would reduce bacterial load in the lungs of rats with acute pneumonia. Rats were infected intranasally with 5×107 colony-forming units (CFU) of Streptococcus pneumoniae. At 24, 48, and 72 hours after infection, the rats received no therapy (control), 4 minutes of sham therapy, or 4 minutes of LPT, followed by subcutaneous injection of 40 mg/kg of levofoxacin or sterile phosphate-buffered saline. At 48, 72, and 96 hours after infection, the spleens and lungs were collected, and S pneumoniae CFU were enumerated. Blood was analyzed for a complete blood cell count and leukocyte differential count. At 48 and 72 hours after infection, no statistically significant differences in pulmonary CFU were found between control, sham therapy, or LPT when phosphate-buffered saline was administered; however, the reduction in CFU was statistically significant in all rats given levofoxacin. The combination of sham therapy and levofoxacin decreased bacterial load at 72 and 96 hours after infection, and LPT and levofoxacin significantly reduced CFU compared with sham therapy and levofoxacin at both time points (P&lt;.05). Colony-forming units were not detected in the spleens at any time. No statistically significant differences in hematologic findings between any treatment groups were found at any time point measured. The results suggest that 3 applications of LPT induces an additional protective mechanism when combined with levofoxacin and support its use as an adjunctive therapy for the management of pneumonia; however, the mechanism responsible for this protection is unclear.

Lymphatic Pump Treatment Repeatedly Enhances the Lymphatic and Immune Systems

Osteopathic practitioners utilize manual therapies called lymphatic pump techniques (LPT) to treat edema and infectious diseases. While previous studies examined the effect of a single LPT treatment on the lymphatic system, the effect of repeated applications of LPT on lymphatic output and immunity has not been investigated. Therefore, the purpose of this study was to measure the effects of repeated LPT on lymphatic flow, lymph leukocyte numbers, and inflammatory mediator concentrations in thoracic duct lymph (TDL). The thoracic ducts of five mongrel dogs were cannulated, and lymph samples were collected during pre-LPT, 4 min of LPT, and 2 hours post-LPT. A second LPT (LPT-2) was applied after a 2 hour rest period. TDL flow was measured, and TDL were analyzed for the concentration of leukocytes and inflammatory mediators. Both LPT treatments significantly increased TDL flow, leukocyte count, total leukocyte flux, and the flux of interleukin-8 (IL-8), keratinocyte-derived chemoattractant (KC), nitrite (NO2(-)), and superoxide dismutase (SOD). The concentration of IL-6 increased in lymph over time in all experimental groups; therefore, it was not LPT dependent. Clinically, it can be inferred that LPT at a rate of 1 pump per sec for a total of 4 min can be applied every 2 h, thus providing scientific rationale for the use of LPT to repeatedly enhance the lymphatic and immune system.

Lymphatic pump treatment enhances the clearance of pneumonia

BackgroundOsteopathic lymphatic pump treatments (LPT) are thought to aid in the removal of metabolic wastes, toxins, exudates, and cellular debris that occur during infection or oedema. In elderly patients with pneumonia LPT decreased hospital stay, length of intravenous antibiotics, and incidence of death when compared to conventional care. In animals, LPT has been reported to enhance the lymphatic and immune systems and facilitate the clearance pneumonia caused by Streptoccocus pneumoniae. The purpose of this study was to determine the number of LPT necessary to enhance the clearance of S. pneumoniae from the lungs and explore the mechanisms associated with this protection. MethodsRats were nasally infected with S. pneumoniae. Twenty-four hours after infection, rats were divided into control sham and LPT groups. For four consecutive days, the control group received no treatment or anaesthesia, the sham group received four min of light touch (under anaesthesia), and the LPT group received four min of LPT (under anaesthesia). On days 1, 3 and 4 post-infection, lungs were removed and measured for S. pneumoniae bacteria and the number of pulmonary leukocytes. Bronchoalveolar lavage fluid (BALF) was collected at day 4 post-infection and analysed for inflammatory mediators, antibacterial factors and alveolar macrophage function. ResultsThree applications of LPT were able to significantly (p < 0.05) reduce the numbers of pulmonary bacteria compared to control and sham. There were no significant differences in lung leukocytes between treatment groups at any time point, suggesting LPT does not enhance the concentration of pulmonary leukocytes. There were also no significant differences in the BALF concentrations of IL-1β, C-reactive protein, TNF-α, and MCP-1 between control, sham or LPT groups at day 4. This was not surprising, since these factors mediate pneumococcal clearance within the first 0–48 h of infection. Of importance, LPT increased the concentration of SP-D, IL-6, IL-17 and IL-12 in the BALF and enhanced the production of NO2- and IL-6 by alveolar macrophages compared to sham and control. ConclusionsWe have shown that three daily LPT enhance the clearance of pneumococcal bacteria, and the concentration of SP-D, IL-6, IL-12 and IL-17 in the BALF. During pneumococcal pneumonia, IL-12 and IL-17 enhance the entry of neutrophils into the lungs, SP-D enhances phagocytosis by neutrophils, and IL-6 delays neutrophil apoptosis and enhances neutrophil cytotoxic function. Alveolar macrophages from LPT treated rats produced more nitric oxide and IL-6 in vitro. Therefore, by enhancing the concentration of immune factors, LPT may preserve neutrophil-mediated clearance of pneumococcus. Collectively, our study supports the clinical use of LPT to treat pneumonia.

Is lymphatic pumping safe for breast cancer patients?: The role of lymphatic flow in tumor formation and metastasis (46.19)

Abstract Lymphedema, a common side effect of breast cancer, can only be treated effectively with techniques such as pneumatic compression, exercise, massage, and osteopathic manipulation. However, the effect of such therapies on tumors and metastases is unknown. We have developed a murine model to test the effect of abdominal lymphatic pump treatment (LPT) on cancer. F344 rats were injected intravenously or subcutaneously with MADB106 mammary carcinoma cells. Rats were then given 4 minutes of LPT under anesthesia, 4 minutes of light touch under anesthesia (sham), or no treatment (control) for 7 days. At day 8, lung tissues were analyzed for metastases, and for leukocyte number/activity. LPT on intravenously-inoculated rats reduced tumor metastases in the lungs by more than 40% compared to sham and control. This corresponded with an increase in IFN-γ, and in CCR9+CD4+, CCR9+CD8+, and CCR9+ NK cells in the lungs, suggesting that these cells were actually gut-derived. Interestingly, in the case of subcutaneous solid tumors, LPT may be detrimental, as tumor size and number of metastases were more than doubled. These data suggest that increasing lymphatic flow may mobilize gut-derived leukocytes, which can traffic to the lungs and confer protection against tumor metastases, possibly through IFN-γ. To our knowledge, this is the first time gut-derived cells have been shown to be protective in the lungs. However, these therapies may cause harm when performed in proximity to solid tumors.

Lymphatic pump treatment enhances the lymphatic and immune systems

The osteopathic medical profession has long advocated the use of osteopathic lymphatic pump treatments (LPT) to improve lymphatic circulation, reduce edema and combat infectious disease. However, until recently, there was no scientific evidence that LPT enhances function of the lymphatic and immune systems. This review discusses the physiological functions of the lymphatic system, the ability of LPT to increase lymph flow under normal and experimental conditions, the clinical benefits of LPT, current research models for the study of LPT and the potential mechanisms by which LPT enhances lymphatic and immune function.

Lymphatic pump treatment enhances pulmonary immunity and protects against solid tumor formation in the rat lung. (161.14)

Abstract Lymphatic pump treatments (LPT) are used by osteopathic physicians to treat edema and infection. In animals, LPT increases lymph flow and leukocyte numbers, which may enhance protection against infection and cancer. To determine if LPT would enhance anti-tumor immunity and reduce tumor formation in the lungs, F344 rats were injected intravenously with MADB106. Rats received no treatment (control), 4 min of light touch under anesthesia (sham), or 4 min of LPT under anesthesia, for 7 days. At day 8, tissues were measured for tumors and leukocyte numbers/activities. Serum was measured for vascular endothelial growth factor C (VEGF-C). LPT reduced solid tumors and increased B cell, CD4+ T cell, CD8+ T cell, NK cell and macrophage numbers in the lungs. In addition, Leukocytes isolated from the lungs of LPT rats secreted more IL-2, IL-10 and IFN-γ but did not enhance tumor lysis in vitro. Previously we demonstrated LPT mobilizes gut-derived lymphocytes into lymphatic circulation; therefore, we stained pulmonary lymphocytes for the gut marker α4β7. LPT increased α4+β7+ leukocytes in the lungs, suggesting LPT mobilizes gut-derived leukocytes into the lungs. Finally, there were no differences in the levels of VEGF-C between treatment groups, suggesting that LPT does not promote lymphangiogenesis in this model. Our data suggests LPT inhibits pulmonary tumor formation by enhancing the numbers of leukocytes with anti-tumor activities that migrate into the lungs.

Lymphatic Pump Treatment Augments Lymphatic Flux of Lymphocytes in Rats

Lymphatic pump techniques (LPT) are used by osteopathic practitioners for the treatment of edema and infection; however, the mechanisms by which LPT enhances the lymphatic and immune systems are poorly understood. To measure the effect of LPT on the rat, the cisterna chyli (CC) of 10 rats were cannulated and lymph was collected during 4 min of 1) pre-LPT baseline, 2) 4 min LPT, and 3) 10 min post-LPT recovery. LPT increased significantly (p < 0.05) lymph flow from a baseline of 24 ± 5 μl/min to 89 ± 30 μl/min. The baseline CC lymphocyte flux was 0.65 ± 0.21 × 10⁶ lymphocytes/min, and LPT increased CC lymphocyte flux to 6.10 ± 0.99 × 10⁶ lymphocytes/min (p < 0.01). LPT had no preferential effect on any lymphocyte population, since total lymphocytes, CD4+ T cells, CD8+ T cells, and B cell numbers were similarly increased. To determine if LPT mobilized gut-associated lymphocytes into the CC lymph, gut-associated lymphocytes in the CC lymph were identified by staining CC lymphocytes for the gut homing receptor integrin α4β7. LPT significantly increased (p < 0.01) the flux of α4β7 positive CC lymphocytes from a baseline of 0.70 ± 0.03 × 10⁵ lymphocytes/min to 6.50 ± 0.10 × 10⁵ lymphocytes/min during LPT. Finally, lymphocyte flux during recovery was similar to baseline, indicating the effects of LPT are transient. Collectively, these results suggest that LPT may enhance immune surveillance by increasing the numbers of lymphocytes released in to lymphatic circulation, especially from the gut associated lymphoid tissue. The rat provides a useful model to further investigate the effect of LPT on the lymphatic and immune systems.

Lymphatic Pump Treatment Increases Thoracic Duct Lymph Flow in Conscious Dogs with Edema Due to Constriction of the Inferior Vena Cava

Osteopathic lymphatic pump treatments (LPT) are used to treat edema, but their direct effects on lymph flow have not been studied. In the current study, we examined the effects of LPT on lymph flow in the thoracic duct of instrumented conscious dogs in the presence of edema produced by constriction of the inferior vena cava (IVC). Six dogs were surgically instrumented with an ultrasonic flow transducer on the thoracic lymph duct and catheters in the descending thoracic aorta and in IVC. After postoperative recovery, lymph flow and hemodynamic variables were measured 1) pre-LPT, 2) during 4 min LPT, 3) post-LPT, in the absence and presence of edema produced by IVC constriction. This constriction increased abdominal girth from 60 +/-2.6 to 75 +/- 2.9 cm. Before IVC constriction, LPT increased lymph flow (P < 0.05) from 1.9 +/- 0.2 ml/min to a maximum of 4.7 +/-1.2 ml/min, whereas after IVC constriction, LPT increased lymph flow (P < 0.05) from 7.9 +/-2.2 to a maximum of 11.7 +/-2.2 ml/min. The incremental lymph flow mobilized by 4 min of LPT (ie, the flow that exceeded 4 min of baseline flow), was 10.6 ml after IVC constriction. This incremental flow was not significantly greater than that measured before IVC constriction. Edema caused by IVC constriction markedly increased lymph flow in the thoracic duct. LPT increased thoracic duct lymph flow before and after IVC constriction. The lymph flow mobilized by 4 min of LPT in presence of edema was not significantly greater than that mobilized prior to edema.

Lymphatic pump treatment reduces pulmonary tumors in the rat

Lymphatic pump treatment reduces pulmonary tumors in the rat

Lymphatic Pump Treatment Mobilizes Leukocytes from the Gut Associated Lymphoid Tissue into Lymph

Lymphatic pump techniques (LPT) are used clinically by osteopathic practitioners for the treatment of edema and infection; however, the mechanisms by which LPT enhances lymphatic circulation and provides protection during infection are not understood. Rhythmic compressions on the abdomen during LPT compress the abdominal area, including the gut-associated lymphoid tissues (GALT), which may facilitate the release of leukocytes from these tissues into the lymphatic circulation. This study is the first to document LPT-induced mobilization of leukocytes from the GALT into the lymphatic circulation. Catheters were inserted into either the thoracic or mesenteric lymph ducts of dogs. To determine if LPT enhanced the release of leukocytes from the mesenteric lymph nodes (MLN) into lymph, the MLN were fluorescently labeled in situ. Lymph was collected during 4 min pre-LPT, 4 min LPT, and 10 min following cessation of LPT. LPT significantly increased lymph flow and leukocytes in both mesenteric and thoracic duct lymph. LPT had no preferential effect on any specific leukocyte population, since neutrophil, monocyte, CD4+ T cell, CD8+ T cell, IgG+B cell, and IgA+B cell numbers were similarly increased. In addition, LPT significantly increased the mobilization of leukocytes from the MLN into lymph. Lymph flow and leukocyte counts fell following LPT treatment, indicating that the effects of LPT are transient. LPT mobilizes leukocytes from GALT, and these leukocytes are transported by the lymphatic circulation. This enhanced release of leukocytes from GALT may provide scientific rationale for the clinical use of LPT to improve immune function.

Lymphatic Pump Manipulation Mobilizes Inflammatory Mediators into Lymphatic Circulation

Lymph stasis can result in edema and accumulation of particulate matter, exudates, toxins, and bacteria. This can lead to inflammation, impaired immune cell trafficking, tissue hypoxia, tissue fibrosis, and a variety of diseases. Previously, we demonstrated that osteopathic lymphatic pump treatment (LPT) significantly increased thoracic and mesenteric duct lymph flow. The purpose of this study was to determine if LPT would mobilize inflammatory mediators into the lymphatic circulation. Under anesthesia, thoracic or mesenteric lymph of dogs was collected at baseline (resting), during 4 min of LPT, and 10 min following LPT and the lymphatic concentrations of cytokines, chemokines, superoxide dismutase (SOD) and nitric oxide (NO) were measured. LPT significantly increased both thoracic and mesenteric lymph cytokine and chemokine concentrations when compared to their relative baseline concentrations. In addition, LPT increased lymphatic concentrations of SOD and NO. Ten minutes following cessation of LPT, both thoracic and mesenteric lymph cytokine, chemokine, NO and SOD concentrations were similar to baseline, suggesting their release is transient. This redistribution of inflammatory mediators during LPT may provide scientific rationale for the clinical use of LPT to enhance immunity and treat infection. Funding: NIH: U19 AT002023 (H. F.D), R01 AT004361 (L.M.H).

Lymphatic Pump Treatment Increases Thoracic Duct Lymph Flow in Conscious Dogs with Edema Due to Constriction of the Inferior Vena Cava

ObjectiveTo examine the effects of osteopathic lymphatic pump treatment (LPT) on lymph flow in the thoracic duct of instrumented conscious dogs in the presence of edema produced by constriction of the inferior vena cava (IVC).MethodsSix dogs were surgically instrumented with an ultrasonic flow transducer on the thoracic lymph duct and catheters in the descending thoracic aorta and in the IVC. After post‐operative recovery, lymph flow and hemodynamic variables were measured 1) pre‐LPT, 2) during 4 min LPT, 3) post‐LPT, in the absence and presence of edema produced by IVC constriction.ResultsIVC constriction increased abdominal girth from 60±2.6 to 75±2.9 cm. Before IVC constriction, LPT increased lymph flow (P&lt;0.05) from 1.9±0.2 ml/min to a maximum of 4.7±1.2 ml/min, whereas after IVC constriction, LPT increased lymph flow (P&lt;0.05) from 7.9±2.2 to a maximum of 11.7±2.2 ml/min. The incremental lymph flow mobilized by 4 min of LPT, i.e., the flow that exceeded 4 min of baseline flow, was 10.6 ml after IVC constriction (not different from before IVC constriction).ConclusionsEdema caused by IVC constriction markedly increased lymph flow in the thoracic duct. LPT increased thoracic duct lymph flow before and after IVC constriction. The lymph flow mobilized by 4 min of LPT in presence of edema was not significantly greater than that mobilized prior to edema. (Support: NIH grant U19 AT002023 and Osteopathic Research Center.)