Lymphatic Pump Treatment Research Articles

Lymphatic pump treatment enhances immunity and reduces pulmonary disease during experimental pneumonia infection

Clinical studies have shown that patients given osteopathic lymphatic pump treatment (LPT) during pneumonia have enhanced clearance of the tracheobronchial tissues, shorter duration of cough, and shorter duration of total and intravenous antibiotic treatment and hospitalization. These studies suggest that LPT may reduce pulmonary infection by enhancing immunity; however, the exact mechanisms responsible for the clinical benefits of LPT have not been identified. The purpose of this study was to determine if LPT would enhance immunity and reduce pulmonary disease during chronic pneumonia. To determine if a single LPT would increase blood leukocytes, samples were collected from the jugular vein at baseline, immediately following LPT (n¼7) or sham (n¼7), and at 10, 20, 30 45, and 60 minutes post LPT or sham and analyzed for leukocyte concentrations. Consistent with reports in humans, LPT released approximately 4,000,000 more leukocytes into blood circulation 45 minutes after treatment compared to sham (p<0.01). Differential analysis revealed these were primarily lymphocytes. In a separate set of experiments, rats were intranasally infected with 5 x 10 5 colony forming units of Mycoplasma pulmonis. Twenty-four hours following infection, rats received either Sham (n¼8) or LPT (n¼9), under anesthesia, daily for days 1-4, and 7-10 post infection. Fourteen days following infection rats were euthanized, lungs were removed and analyzed for gross lesions and bacterial numbers, and blood samples were analyzed for leukocyte concentrations. During M. pulmonis infection, LPT reduced pulmonary bacterial numbers 4-fold, and lung lesions 13% compared to sham (p<0.05). Furthermore, LPT increased blood leukocyte numbers compared to sham (p<0.05). Specifically, LPT released approximately 1, 000,000 more lymphocytes and 80,000 more monocytes into blood circulation compared to sham. Collectively, these data suggest that during pulmonary infection, LPT increases circulating leukocytes that may traffic into the lung and kill bacteria, thereby reducing lung lesions. Ongoing and future studies will examine if LPT enhances leukocyte activation and recruitment into the lung. These data are essential to identifying the mechanisms by which LPT enhances immunity and clearance of pneumonia, and will provide scientific support for the clinical use of LPT. Funding for this project was provided by the American Osteopathic Association (Grant No. 06-11-547).

Lymphatic pump treatment mobilizes leukocytes from the gut associated lymphoid tissue into thoracic duct lymph

s from the 7 International Conference on Advances in Osteopathic Research (ICAOR 7), Bradenton, Florida, USA 5e7 September 2008 Lymphatic pump treatment mobilizes leukocytes from the gut associated lymphoid tissue into thoracic duct lymph Artur Schander , Melissa K. Bearden , Jamie B. Huff , Arthur Williams Jr., Scott T. Stoll , Jerry W. Simecka , Hollis H. King , H. Fred Downey , Lisa M. Hodge a,b a Department of Molecular Biology and Immunology, University of North Texas Health Science Center at Fort Worth, TX b National Osteopathic Research Center, University of North Texas Health Science Center at Fort Worth, TX c Department of Integrative Physiology, University of North Texas Health Science Center at Fort Worth, TX Rhythmic compressions on the abdomen during lymphatic pump treatment (LPT) most likely compress the abdominal area, including the spleen and gastrointestinal mucosa, which may facilitate the release of leukocytes from these tissues into circulation. To determine the acute effects of LPT on canine intestinal lymph leukocytes, a catheter was inserted into the large intestinal lymph duct. In a separate set of experiments, the thoracic lymph duct was cannulated and 25-50% of the mesenteric lymph nodes (MLN) were fluorescently labeled in situwith carboxyfluorescein diacetate succinimidyl ester (CFSE). The abdominal incision was closed, and thoracic duct lymph was collected at baseline, during 4 min of LPT, and during 10 min following LPT. Total leukocytes in both thoracic duct and intestinal duct lymph were enumerated, and the number of neutrophils, macrophages, and lymphocytes was determined by differential cell staining. In addition, the percentage of CFSE labeled leukocytes (reflective of cells from the MLN), B cells, CD4+ T cells, CD8+ T cells, IgA and IgG antibody forming cells were measured by flow cytometry. Within the first 2 min of LPT, leukocytes are mobilized into intestinal and thoracic duct lymph circulation; however, larger increases in thoracic duct leukocytes appear later, in the last 2-4 min of treatment, and stay elevated during recovery while intestinal leukocyte numbers decrease. Flow cytometry and differential cell staining revealed that CD4+ T cells, CD8+ T cells, B cells and IgG antibody forming cells numbers were similarly increased during LPT. Interestingly, the baseline population of IgA forming cells was 6.10 1.80%, which increased to 8.75 2.62 % during LPT, suggesting that LPT acts preferentially on mucosal-derived cells. Furthermore, LPT increased the percentage of CFSE labeled leukocytes in the thoracic duct lymph from 15% to 22.6%, suggesting that the MLN are a tissue source that LPT can release leukocytes from. Collectively, these data suggest that LPT immediately releases leukocytes from the intestine that enter lymph circulation and reach the thoracic duct within 2-4 min. Furthermore, increased numbers of CFSE labeled leukocytes in thoracic duct lymph during LPT suggests that LPT can mobilize T and B cells from theMLN into the thoracic duct lymph. The gut associated lymphoid tissue (GALT) is an inductive tissue of antigen-specific leukocytes which migrate fromGALT into other mucosal associated tissues, such as the lung. Therefore, treatments, such as LPT, that specifically mobilize leukocytes from GALT may increase the numbers of leukocytes that are able to traffic into the lung during pulmonary infection. Funding for this project was provided by the National Institutes of Health (Grant No. U19 AT002023-01A1) and UNTHSC (Grant No. G67717). doi:10.1016/j.ijosm.2008.08.002

How do patients feel post-treatment? pilot study at a UK osteopathic teaching clinic of self-reported adverse events

interventions were applied for longer periods than has been studied previously, so that their ability to produce sustained elevations of lymph flow could be evaluated. Experimental Design and Methods: Experiments were conducted in eight conscious dogs surgically instrumented with aortic and inferior vena cava catheters and an ultrasonic flow transducer implanted on the thoracic lymph duct (J Am Osteopath Assoc 105:447-456, 2005). Abdominal LPT (1-2 compressions per sec) and moderate treadmill exercise (3 mi per hr, 0 % grade) were performed on different days for 8 min before and after ECE with normal saline, iv, 4.4 0.3 % of body weight. Data were collected prior to each intervention and at 1-min intervals during LPT and exercise. Results: Before ECE, LPT and exercise increased mean aortic and mean inferior vena cava pressures (P<0.05). ECE increased pretreatment mean aortic pressure, inferior vena cava pressure, and pretreatment lymph flow in the thoracic duct (P<0.05). After ECE, LPT did not further increase aortic pressure but did increase inferior vena caval pressure. After ECE, exercise increased aortic pressure, but not inferior cava pressure. Before ECE, LPT increased lymph flow from 1.7 0.5 to 5.0 1.1 ml/min at 1 min (P<0.05). Following ECE, LPT increased lymph flow from 4.8 0.6 to 9.9 1.1 ml/min at 1 min (P<0.05). Lymph flow remained significantly above pre-treatment baseline for 4 min both before and after ECE. The net increase in lymph flow produced by 8-min LPT was 15.4 1.1 ml before ECE and 18.3 3.8 ml after ECE. Moderate treadmill exercise increased lymph flow from 1.0 0.3 to 8.9 1.9 ml/min at 1 min before ECE (P<0.05) and from 4.0 0.3 to 15.2 3.0 ml/min at 1 min after ECE (P<0.05). Lymph flow during exercise remained significantly above baseline for 4 min before ECE and for 6 min after ECE. The net increase in lymph flow produced by 8 min of exercise was 24.9 5.5 ml before ECE and 39.6 5.1 ml after ECE (P<0.05 vs LPT). Conclusions: Expansion of the extracellular fluid volume produced large increases in thoracic duct lymph flow, which were further augmented by lymphatic pump treatment and by moderate treadmill exercise. (A report of this investigation has been accepted for publication in Lymphatic Research and Biology. This research was supported by NIH grant U19 AT002023.)

Osteopathic lymphatic pump treatment and exercise increase lymph flow in conscious dogs with normal and expanded extracellular fluid volume

Jamie Huff , Artur Schander , Scott T. Stoll , Jerry W. Simecka , H. Fred Downey , Hollis H. King , Lisa M. Hodge a,b a Department of Molecular Biology and Immunology, University of North Texas Health Science Center at Fort Worth, TX b National Osteopathic Research Center, University of North Texas Health Science Center at Fort Worth, TX c Department of Integrative Physiology, University of North Texas Health Science Center at Fort Worth, TX

Lymph Flow in the Thoracic Duct of Conscious Dogs During Lymphatic Pump Treatment, Exercise, and Expansion of Extracellular Fluid Volume

This investigation examined interactions between expansion of the extracellular fluid volume (ECE), osteopathic lymphatic pump treatment (LPT), and exercise on lymph flow in the thoracic duct of eight instrumented, conscious dogs. After recovery from surgery, LPT was performed for 8 min before and after ECE with normal saline, i.v., 4.4+/-0.3% of body weight. Baseline lymph flow was 1.7+/-0.5 mL/min. LPT rapidly increased lymph flow to 5.0+/-1.1 mL/min at 1 min, and lymph flow remained above baseline for 4 min (p<0.05). LPT produced a net increase in lymph flow of 15.4+/-1.1 mL. Following ECE, baseline lymph flow was 4.8+/-0.6 mL/min (p<0.05). LPT increased lymph flow to 9.9+/-1.1 mL/min at 1 min (p<0.05), and lymph flow remained above baseline for 4 min (p<0.05); all flow values after ECE were greater than corresponding values before ECE. However, the net increase in lymph flow produced by 8 min of LPT (18.3+/-3.8 mL) was not significantly greater than that observed before ECE. Moderate treadmill exercise increased lymph flow for 4 min before ECE and for 6 min after ECE. All lymph flows during exercise were greater after ECE than before ECE. The net increase in lymph flow produced by 8 min of exercise was 24.9+/-5.5 mL before ECE and 39.6+/-5.1 mL after ECE (p<0.05). Expansion of the extracellular fluid volume produced large increases in thoracic duct lymph flow, that were further augmented by lymphatic pump treatment and by moderate treadmill exercise.

Abdominal Lymphatic Pump Treatment Increases Leukocyte Count and Flux in Thoracic Duct Lymph

Previous studies suggest that rhythmic compression of the abdomen (abdominal lymphatic pump techniques, LPT) enhances immunity and resistance to infectious disease, but direct evidence of this has not been documented. In this study, the thoracic duct of eight anesthetized mongrel dogs was catheterized, so the immediate effects of LPT on lymph flow and leukocyte output could be measured. Lymph flow was measured by timed collection or ultrasonic flowmeter, and lymph was collected over ice under 1) resting (baseline) conditions, and 2) during application of LPT. The baseline leukocyte count was 4.8 +/- 1.7 x 10(6) cells/ml of lymph, and LPT significantly increased leukocytes to 11.8 +/- 3.6 x 10(6) cells/ml. Flow cytometry and differential cell staining revealed that numbers of macrophages, neutrophils, total lymphocytes, T cells and B cells were similarly increased during LPT. Furthermore, LPT significantly enhanced lymph flow from 1.13 +/- 0.44 ml/min to 4.14 +/- 1.29 ml/min. Leukocyte flux, computed from the product of lymph flow and cell count, was increased by LPT from 8.2 +/- 4.1 x 10(6) to 60 +/- 25 x 10(6) total cells/min. Similar trends were observed in macrophages, neutrophils, total lymphocytes, T cells and B cells during LPT. LPT significantly increased both thoracic duct lymph flow and leukocyte count, so lymph leukocyte flux was markedly enhanced. Increased mobilization of immune cells is likely and important mechanism responsible for the enhanced immunity and recovery from infection of patients treated with LPT.

Abdominal lymphatic pump treatment increases leukocyte count and flux in thoracic duct lymph (99.13)

Abstract Studies suggest that lymphatic pump techniques (LPT) enhance immunity and resistance to infection, but direct evidence of this has not been documented. In this study, the immediate effects of LPT on thoracic duct lymph flow and leukocyte output was measured. Lymph flow was measured and lymph was collected at baseline and during LPT. The baseline leukocyte count was 4.8 ± 1.7 x 106 cells/ml, and LPT increased leukocytes to 11.8 ± 3.6 x 106cells/ml (P&amp;lt;0.05). While macrophages, neutrophils, total lymphocytes, T cells and B cell numbers were similarly increased during LPT, their relative percentage in lymph was unaltered by LPT; however, IgA antibody forming B cells increased from 5.8% at baseline to 17% during LPT. Furthermore, LPT enhanced lymph flow 4-fold. Leukocyte flux was computed from the product of lymph flow and cell count. LPT enhanced leukocyte flux from 8.2± 4.1 x 106total cells per min to 60 ± 25 x 106cells per min. In summary, LPT significantly increased both thoracic duct lymph flow and leukocyte count, so lymphatic leukocyte flux was markedly enhanced. In addition, our data suggests that LPT can act preferentially on mucosal tissues, revealing a source of these mobilized leukocytes. Enhanced mobilization and lymphatic transport of immune cells during abdominal compression is likely an important mechanism responsible for the increased immune responses of patients treated with LPT.

Comparison of thoracic manipulation with incentive spirometry in preventing postoperative atelectasis

Atelectasis is a preventable complication that often occurs after upper abdominal surgery. In our 1-year randomized, researcher-blinded trial, low-risk cholecystectomy patients were subjected to either the thoracic lymphatic pump (n = 21) or incentive spirometry (n = 21) to prevent atelectasis. The treatment groups were equal with respect to risk factors for atelectasis and deviation of preoperative respiratory parameters (forced vital capacity [FVC] and forced expiratory volume in one second [FEV1]) from the predicted values. Atelectasis occurred in 2 (5%) of 21 patients regardless of whether incentive spirometry or thoracic lymphatic pump treatment was used. Study patients treated with the thoracic lymphatic pump technique had an earlier recovery and quicker return toward preoperative values for FVC and FEV1 than patients treated with incentive spirometry.