Stanley G. Rockson, MD

Journal Articles

The Lymphatics and the Inflammatory Response: Lessons Learned from Human Lymphedema LYMPHATIC RESEARCH AND BIOLOGY Rockson, S. G. 2013; 11 (3): 117-120
Abstract

In lymphedema, there is a profound predisposition to infection with bacterial pathogens. It therefore seems appropriate to reconsider our unique functional definition of the lymphatic structures within a circulatory construct. While the lymphatics unquestionably fulfill a vital circulatory function, it seems more appropriate to view this complex network, comprised both of endothelial-lined vessels and of lymphoid tissue, as the nexus between the circulatory and immune systems. Viewed in this fashion, it becomes evident that the complex biology of regional lymphatic disruption is a manifestation of the interplay between these two vital bodily functions. Experimental lymph stasis in murine model has been utilized to effectively demonstrate the pathological attributes of human lymphedema, namely, inflammation, fat deposition, and fibrosis. Large-scale transcriptional corroborates the role of inflammatory mechanisms. The murine studies have set the stage for subsequent translational investigation of human lymphedema. Many of the gene expression pathways invoked by lymphedema are relevant to the inflammatory response and have provided a pragmatic approach to the successful identification of potentially relevant circulating biomarkers for human lymphedema.

View details for DOI 10.1089/lrb.2013.1132

View details for Web of Science ID 000324477300003

View details for PubMedID 24024576
Lymphatics: Where the Circulation Meets the Immune System LYMPHATIC RESEARCH AND BIOLOGY Rockson, S. G. 2013; 11 (3): 115-115
View details for DOI 10.1089/lrb.2013.1131

View details for Web of Science ID 000324477300001

View details for PubMedID 24024578
Assessing extracellular fluid volume in breast cancer lymphedema. Lymphatic research and biology Rockson, S. G. 2013; 11 (2): 65-?
View details for DOI 10.1089/lrb.2013.1122

View details for PubMedID 23772714
Th2 differentiation is necessary for soft tissue fibrosis and lymphatic dysfunction resulting from lymphedema FASEB JOURNAL Avraham, T., Zampell, J. C., Yan, A., Elhadad, S., Weitman, E. S., Rockson, S. G., Bromberg, J., Mehrara, B. J. 2013; 27 (3): 1114-1126
Abstract

Lymphedema is a dreaded complication of cancer treatment. However, despite the fact that >5 million Americans are affected by this disorder, the development of effective treatments is limited by the fact that the pathology of lymphedema remains unknown. The purpose of these studies was to determine the role of inflammatory responses in lymphedema pathology. Using mouse models of lymphedema, as well as clinical lymphedema specimens, we show that lymphatic stasis results in a CD4 T-cell inflammation and T-helper 2 (Th2) differentiation. Using mice deficient in T cells or CD4 cells, we show that this inflammatory response is necessary for the pathological changes of lymphedema, including fibrosis, adipose deposition, and lymphatic dysfunction. Further, we show that inhibition of Th2 differentiation using interleukin-4 (IL-4) or IL-13 blockade prevents initiation and progression of lymphedema by decreasing tissue fibrosis and significantly improving lymphatic function, independent of lymphangiogenic growth factors. We show that CD4 inflammation is a critical regulator of tissue fibrosis and lymphatic dysfunction in lymphedema and that inhibition of Th2 differentiation markedly improves lymphatic function independent of lymphangiogenic cytokine expression. Notably, preventing and/or reversing the development of pathological tissue changes that occur in lymphedema may be a viable treatment strategy for this disorder.

View details for DOI 10.1096/fj.12-222695

View details for Web of Science ID 000315585200025

View details for PubMedID 23193171
The Aging Lymphatics Become More Mature LYMPHATIC RESEARCH AND BIOLOGY Rockson, S. G. 2013; 11 (1): 1-1
View details for DOI 10.1089/lrb.2013.1111

View details for Web of Science ID 000316735400001

View details for PubMedID 23531178
Prospective Transcriptomic Pathway Analysis of Human Lymphatic Vascular Insufficiency: Identification and Validation of a Circulating Biomarker Panel PLOS ONE Lin, S., Kim, J., Lee, M., Roche, L., Yang, N. L., Tsao, P. S., Rockson, S. G. 2012; 7 (12)
Abstract

In our previous transcriptional profiling of a murine model, we have identified a remarkably small number of specific pathways with altered expression in lymphedema. In this investigation, we utilized microarray-based transcriptomics of human skin for an unbiased a priori prospective candidate identification, with subsequent validation of these candidates through direct serum assay. The resulting multi-analyte biomarker panel sensitively should sensitively discriminate human lymphedema subjects from normal individuals.We enrolled 63 lymphedema subjects and 27 normals in our attempt to discover protein analytes that can distinguish diseased individuals from controls. To minimize technical and biologically irrelevant variation, we first identified potential candidates by performing transcriptional microarray analysis on paired diseased and normal skin specimens sampled from the same individuals. We focused our attention on genes with corresponding protein products that are secreted and took these candidates forward to a protein multiplex assay applied to diseased and normal subjects. We developed a logistic regression-based model on an eventual group of six proteins and validated our system on a separate cohort of study subjects. The area under the receiver operating characteristic curve was calculated to be 0.87 (95% CI : 0.75 to 0.97).We have developed an accurate bioassay utilizing proteins representing four central pathogenetic modalities of the disease: lymphangiogenesis, inflammation, fibrosis, and lipid metabolism, suggesting that these proteins are directly related to the pathogenesis of the tissue pathology in lymphatic vascular insufficiency. Further studies are warranted to determine whether this newly-identified biomarker panel will possess utility as an instrument for in vitro diagnosis of early and latent disease; the ultimate applicability to risk stratification, quantitation of disease burden, and response to therapy can easily be envisioned.

View details for DOI 10.1371/journal.pone.0052021

View details for Web of Science ID 000312483300046

View details for PubMedID 23272198
Experimental lymphedema: can cellular therapies augment the therapeutic potential for lymphangiogenesis? Journal of the American Heart Association Rockson, S. G. 2012; 1 (4)
View details for DOI 10.1161/JAHA.112.003400

View details for PubMedID 23130177
Lack of Significant Interactions Between Clopidogrel and Proton Pump Inhibitor Therapy: Meta-Analysis of Existing Literature DIGESTIVE DISEASES AND SCIENCES Gerson, L. B., McMahon, D., Olkin, I., Stave, C., Rockson, S. G. 2012; 57 (5): 1304-1313
Abstract

Published data regarding the effect of concomitant clopidogrel and proton pump inhibitor (PPI) therapy on cardiovascular outcomes have been conflicting.To perform an updated meta-analysis in order to determine changes in risk differences (RD) between primary and secondary outcome analyses.Primary analysis was based on definite vascular outcomes, including all cause mortality, cardiac death, myocardial infarction, and/or stroke. Secondary analysis also incorporated probable cardiac events, which included re-hospitalization for cardiac symptoms or revascularization procedures. RD were combined using a random-effects model.We reviewed 1,204 publications of which 26 studies (16 published articles, 10 abstracts) met inclusion criteria. The meta-analysis of outcomes from the two randomized controlled trials did not show an increased risk (RD 0.0, 95% CI -0.01, 0.01) for adverse outcomes. The meta-analysis of primary outcomes showed a RD of 0.02 (95% CI 0.01, 0.03) for all studies. The meta-analysis for secondary outcomes yielded a RD of 0.02 (95% CI 0.01-0.04) based on 19 published papers and abstracts. When primary and secondary outcomes were combined, the meta-analysis for published papers yielded an overall RD of 0.05 (95% CI 0.03-0.06).In patients using concomitant clopidogrel and PPI therapy, the risk of adverse cardiac outcomes was 0% based on data from well-controlled randomized trials. Data from retrospective studies and the addition of probable vascular events significantly increased the RD estimates, likely due to lack of adjustment for potential confounders.

View details for DOI 10.1007/s10620-011-2007-1

View details for Web of Science ID 000303385100025

View details for PubMedID 22198703
Update on the biology and treatment of lymphedema. Current treatment options in cardiovascular medicine Rockson, S. G. 2012; 14 (2): 184-192
Abstract

OPINION STATEMENT: The past decade has produced an explosion of insights into lymphatic vascular development and structural biology and, in parallel, into the function of the lymphatics in health and in disease. In lymphedema, there is a spectrum that extends from primary (heritable) to acquired causes of disease. The diagnosis of lymphatic edema implicates a very specific treatment approach that is predicated upon the favorable impact of physiotherapy upon lymph flow and protein clearance from the edematous zones of the body. The recognition of the unique biology that accompanies lymphatic causes of edema has stimulated new research directions that are likely to translate into exciting new pharmacologic and molecular approaches to diagnosis and treatment.

View details for DOI 10.1007/s11936-012-0170-0

View details for PubMedID 22382848
Cancer Is Part of the Lymphatic Continuum LYMPHATIC RESEARCH AND BIOLOGY Rockson, S. G. 2012; 10 (3): 95-95
View details for DOI 10.1089/lrb.2012.1031

View details for Web of Science ID 000309054500001

View details for PubMedID 22984903
The Lymphatic Biology of Aging LYMPHATIC RESEARCH AND BIOLOGY Rockson, S. G. 2012; 10 (2): 45-45
View details for DOI 10.1089/lrb.2012.1021

View details for Web of Science ID 000305865400001

View details for PubMedID 22720660
Reflections on a Decade of Lymphatic Research and Biology LYMPHATIC RESEARCH AND BIOLOGY Rockson, S. G. 2012; 10 (1): 1-1
View details for DOI 10.1089/lrb.2012.1011

View details for Web of Science ID 000302275800001

View details for PubMedID 22439852
Angiogenesis, Lymphangiogenesis, and Inflammation LYMPHATIC RESEARCH AND BIOLOGY Rockson, S. G. 2012; 10 (4): 151-151
View details for DOI 10.1089/lrb.2012.1041

View details for Web of Science ID 000312461100001

View details for PubMedID 23240955
Temporal and spatial patterns of endogenous danger signal expression after wound healing and in response to lymphedema AMERICAN JOURNAL OF PHYSIOLOGY-CELL PHYSIOLOGY Zampell, J. C., Yan, A., Avraham, T., Andrade, V., Malliaris, S., Aschen, S., Rockson, S. G., Mehrara, B. J. 2011; 300 (5): C1107-C1121
Abstract

While acute tissue injury potently induces endogenous danger signal expression, the role of these molecules in chronic wound healing and lymphedema is undefined. The purpose of this study was to determine the spatial and temporal expression patterns of the endogenous danger signals high-mobility group box 1 (HMGB1) and heat shock protein (HSP)70 during wound healing and chronic lymphatic fluid stasis. In a surgical mouse tail model of tissue injury and lymphedema, HMGB1 and HSP70 expression occurred along a spatial gradient relative to the site of injury, with peak expression at the wound and greater than twofold reduced expression within 5 mm (P < 0.05). Expression primarily occurred in cells native to injured tissue. In particular, HMGB1 was highly expressed by lymphatic endothelial cells (>40% positivity; twofold increase in chronic inflammation, P < 0.001). We found similar findings using a peritoneal inflammation model. Interestingly, upregulation of HMGB1 (2.2-fold), HSP70 (1.4-fold), and nuclear factor (NF)-κβ activation persisted at least 6 wk postoperatively only in lymphedematous tissues. Similarly, we found upregulation of endogenous danger signals in soft tissue of the arm after axillary lymphadenectomy in a mouse model and in matched biopsy samples obtained from patients with secondary lymphedema comparing normal to lymphedematous arms (2.4-fold increased HMGB1, 1.9-fold increased HSP70; P < 0.01). Finally, HMGB1 blockade significantly reduced inflammatory lymphangiogenesis within inflamed draining lymph nodes (35% reduction, P < 0.01). In conclusion, HMGB1 and HSP70 are expressed along spatial gradients and upregulated in chronic lymphatic fluid stasis. Furthermore, acute expression of endogenous danger signals may play a role in inflammatory lymphangiogenesis.

View details for DOI 10.1152/ajpcell.00378.2010

View details for Web of Science ID 000289884300017

View details for PubMedID 21248077
Animal Models for the Mechanistic Study of Systemic Lymphangiomatosis LYMPHATIC RESEARCH AND BIOLOGY Rockson, S. G. 2011; 9 (4): 195-199
Abstract

The systematic study of focused animal models has produced an explosion of information regarding the mechanisms governing lymphatic development and the diseases associated with lymphatic dysfunction. Nevertheless, the pathogenesis of systemic lymphangiomatosis has, thus far, eluded mechanistic comprehension. In this review, recent molecular advances in lymphatic vascular development are considered within the context of the animal models that have produced evolving insights. The emerging role of the zebrafish within lymphatic investigation is discussed. Specific models of the human disease pathology are considered in detail. While much has been learned about the molecular framework that surrounds normal lymphatic vascular development, the defect responsible for systemic lymphangiomatosis remains elusive. Development of more robust, recapitulative models will also be invaluable to investigate new and emerging therapeutics for the often devastating disease of systemic lymphangiomatosis.

View details for DOI 10.1089/lrb.2011.0017

View details for Web of Science ID 000299009200005

View details for PubMedID 22196285
Blockade of Transforming Growth Factor-beta 1 Accelerates Lymphatic Regeneration during Wound Repair AMERICAN JOURNAL OF PATHOLOGY Avraham, T., Daluvoy, S., Zampell, J., Yan, A., Haviv, Y. S., Rockson, S. G., Mehrara, B. J. 2010; 177 (6): 3202-3214
Abstract

Lymphedema is a complication of cancer treatment occurring in approximately 50% of patients who undergo lymph node resection. Despite its prevalence, the etiology of this disorder remains unknown. In this study, we determined the effect of soft tissue fibrosis on lymphatic function and the role of transforming growth factor (TGF)-?1 in the regulation of this response. We determined TGF-? expression patterns in matched biopsy specimens collected from lymphedematous and normal limbs of patients with secondary lymphedema. To determine the role of TGF-? in regulating tissue fibrosis, we used a mouse model of lymphedema and inhibited TGF-? function either systemically with a monoclonal antibody or locally by using a soluble, defective TGF-? receptor. Lymphedematous tissue demonstrated a nearly threefold increase in the number of cells that stained for TGF-?1. TGF-? inhibition markedly decreased tissue fibrosis, increased lymphangiogenesis, and improved lymphatic function compared with controls. In addition, inhibition of TGF-? not only decreased TGF-? expression in lymphedematous tissues, but also diminished inflammation, migration of T-helper type 2 (Th2) cells, and expression of profibrotic Th2 cytokines. Similarly, systemic depletion of T-cells markedly decreased TGF-? expression in tail tissues. Inhibition of TGF-? function promoted lymphatic regeneration, decreased tissue fibrosis, decreased chronic inflammation and Th2 cell migration, and improved lymphatic function. The use of these strategies may represent a novel means of preventing lymphedema after lymph node resection.

View details for DOI 10.2353/ajpath.2010.100594

View details for Web of Science ID 000285369800050

View details for PubMedID 21056998
Current concepts and future directions in the diagnosis and management of lymphatic vascular disease VASCULAR MEDICINE Rockson, S. G. 2010; 15 (3): 223-231
Abstract

Despite the central, complex role for the lymphatic system in the maintenance of human health, the biology of this important and complex vasculature has been relatively under-investigated. However, the last decade has witnessed a substantial growth in the elucidation of lymphatic structural biology and the function of this system in health and in disease. These newly gained insights can be used to formulate our evolving concepts about the diagnostic and therapeutic approaches to patients with lymphatic vascular disorders. In lymphedema, there is a spectrum of disease that extends from primary (heritable) to secondary (acquired) causes. Once detected, the presence of lymphatic edema mandates very specific modalities of intervention, predominated by physiotherapeutic techniques. In addition, a physiological basis for adjunctive, intermittent pneumatic compression has been established, and these modalities may be indicated in selected patient populations. The acknowledgement of a unique biology in lymphatic edemas is, increasingly, guiding research efforts within this field. Increasing investigative attention is being directed toward animal models of lymphatic vascular disease. As insight into the complex biology of the lymphatic vasculature continues to expand through focused biomedical investigation, the translation of these mechanistic insights into targeted, rationally conceived therapeutics will become increasingly feasible.

View details for DOI 10.1177/1358863X10364553

View details for Web of Science ID 000277807800008

View details for PubMedID 20483987
Anti-Inflammatory Pharmacotherapy with Ketoprofen Ameliorates Experimental Lymphatic Vascular Insufficiency in Mice PLOS ONE Nakamura, K., Radhakrishnan, K., Wong, Y. M., Rockson, S. G. 2009; 4 (12)
Abstract

Disruption of the lymphatic vasculature causes edema, inflammation, and end-tissue destruction. To assess the therapeutic efficacy of systemic anti-inflammatory therapy in this disease, we examined the impact of a nonsteroidal anti-inflammatory drug (NSAID), ketoprofen, and of a soluble TNF-alpha receptor (sTNF-R1) upon tumor necrosis factor (TNF)-alpha activity in a mouse model of acquired lymphedema.Lymphedema was induced by microsurgical ablation of major lymphatic conduits in the murine tail. Untreated control mice with lymphedema developed significant edema and extensive histopathological inflammation compared to sham surgical controls. Short-term ketoprofen treatment reduced tail edema and normalized the histopathology while paradoxically increasing TNF-alpha gene expression and cytokine levels. Conversely, sTNF-R1 treatment increased tail volume, exacerbated the histopathology, and decreased TNF-alpha gene expression. Expression of vascular endothelial growth factor-C (VEGF-C), which stimulates lymphangiogenesis, closely correlated with TNF-alpha expression.Ketoprofen therapy reduces experimental post-surgical lymphedema, yet direct TNF-alpha inhibition does not. Reducing inflammation while preserving TNF-alpha activity appears to optimize the repair response. It is possible that the observed favorable responses, at least in part, are mediated through enhanced VEGF-C signaling.

View details for DOI 10.1371/journal.pone.0008380

View details for Web of Science ID 000272940100016

View details for PubMedID 20027220
Therapeutic responses to exogenous VEGF-C administration in experimental lymphedema: immunohistochemical and molecular characterization. Lymphatic research and biology Jin, D. P., An, A., Liu, J., Nakamura, K., Rockson, S. G. 2009; 7 (1): 47-57
Abstract

In a widely employed murine tail model of human acquired lymphedema, we have previously observed that, distal to the site of experimental lymphatic ablation, there is immunohistochemical evidence of a profound increase in cutaneous lymphatic vessel number and size that normalizes after VEGF-C administration.In order to investigate the mechanistic basis of the lymphatic microvascular remodeling, we have studied the lymphedematous responses to VEGF-C after co-administration of systemic VEGFR-3 neutralizing antibody. We have also undertaken genome-wide whole-tissue transcriptional profiling of lymphedematous tissues before and after exogenous VEGF-C administration.We provoked postsurgical lymphedema in the mouse tail model and assessed the effects of exogenously administered human recombinant VEGF-C in the presence of a monoclonal anti-VEGFR-3 antibody. Polyclonal IgG was administered to a series of control subjects. Microvascular lymphatic remodeling was assessed through quantitative and qualitative anti-LYVE1 immunohistochemistry. Genome-wide transcriptional profiling was performed in whole skin derived from lymphedema with and without exogenous VEGF-C administration. Normal mice and surgical shams served as controls.In the presence of the monoclonal anti-VEGFR-3 neutralizing antibody, positive lymphatic microvascular remodeling in lymphedematous skin is nearly completely abrogated. Furthermore, the therapeutic impact of added VEGF-C is markedly attenuated, as is the ability of the growth factor to ameliorate tissue edema. Transcriptional profiling of the VEGF-C responses in treated lymphedema reveals a very restricted list of genes whose expression is upregulated in lymphedema and re-normalized following VEGF-C treatment.The postsurgical murine tail model of lymphedema closely simulates attributes of human lymphedema. The current series of investigations underscores the utility of the murine tail model to the preclinical and translational investigation of lymphedema. The derived insights continue to focus favorably upon the central role of the VEGFR-3 receptor and its ligands in the development and therapeutic resolution of lymphedema. Whole tissue transcriptional profiling continues to shed light on disease mechanisms and potential future targets for therapeutic intervention.

View details for DOI 10.1089/lrb.2009.0002

View details for PubMedID 19302023
The unique biology of lymphatic edema. Lymphatic research and biology Rockson, S. G. 2009; 7 (2): 97-100
Abstract

Sadly, the subject of lymphatic vascular insufficiency continues to engender relative neglect by health care professionals, which represents a source of frustration and fear among patients. A re-consideration of the unique, complex biology of lymphatic vascular disorders has the capacity both to reinvigorate interest and facilitate the implementation of the correct, existing treatment interventions for individuals affected by these disease states. While most of this complex lymphatic biology remains somewhat elusive, growing insights into the molecular mechanisms of lymphatic development and repair have been instructive. Present and future considerations in lymphedema diagnosis and management must acknowledge the unique tissue biology of this disorder. Many changes are unique to the lymphatic mechanisms of chronic edema. The profound stimulus to collagen deposition in the integument seems to be unique to chronic lymphatic edema, although this biology remains largely unexplicated. Several lines of evidence also suggest that lymphatic function has a unique and important influence upon adipose biology. Molecular investigation of murine models of human acquired lymphedema are beginning to shed light on these processes. Such focused mechanistic, approaches to the study of lymphedema and other lymphatic diseases are vital, as we attempt to expand our insights into the complex biology of lymphedema and its potential responsiveness to pharmacologic control and molecular intervention, prevention, and reversal.

View details for DOI 10.1089/lrb.2009.7202

View details for PubMedID 19522679
Appropriate Secondary Prevention of Acute Atherothrombotic Events and Strategies to Improve Guideline Adherence POSTGRADUATE MEDICINE Rockson, S. G. 2009; 121 (1): 25-39
Abstract

The use of guideline-recommended secondary prevention measures is essential for reducing the risk of subsequent events and mortality in patients who have survived an acute atherothrombotic event or have peripheral arterial disease. Although initial hospitalization provides an ideal environment to initiate such therapies, implementation of effective longterm prevention strategies is hindered by the absence of a systematic approach. In general, evidence-based clinical practice guidelines recommend antiplatelet therapy as a cornerstone of post-discharge secondary prevention, in addition to preventive measures targeting risk factors such as hypertension, dyslipidemia, cigarette smoking, and physical inactivity. Observational data indicate that, although there has been improvement over time, current utilization of guideline-recommended post-discharge treatment remains suboptimal. Recognizing the importance of a systematic approach to discharge planning, numerous hospital-based initiatives have been established. In conjunction with effective lines of communication between hospital and primary care teams, initiation of the most effective secondary prevention strategy at the time of hospital discharge will help to ensure optimal long-term management of patients after an atherothrombotic event.

View details for Web of Science ID 000262803900003

View details for PubMedID 19179811
The role of the lymphatic circulation in the natural history and expression of cardiovascular disease INTERNATIONAL JOURNAL OF CARDIOLOGY Nakamura, K., Rockson, S. G. 2008; 129 (3): 309-317
Abstract

The lymphatic vasculature is essential to fluid, protein and cellular transport, and to immune responsiveness. The last decade has witnessed a virtual renaissance of investigation into the function of the lymphatic microvasculature, prompting re-consideration of its role in the genesis and progression of cardiovascular pathology. The lymphatic microvasculature of the heart and vascular wall likely participate in atherogenesis, myocardial infarction, congestive heart failure, and cardiac transplantation. Intensive exploration of lymphatic mechanisms of cardiovascular disease is likely to lead to enhanced insights and novel therapeutic approaches.

View details for DOI 10.1016/j.ijcard.2008.02.007

View details for Web of Science ID 000259564000002

View details for PubMedID 18559287
Diagnosis and management of lymphatic vascular disease JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Rockson, S. G. 2008; 52 (10): 799-806
Abstract

The lymphatic vasculature is comprised of a network of vessels that is essential both to fluid homeostasis and to the mediation of regional immune responses. In health, the lymphatic vasculature possesses the requisite transport capacity to accommodate the fluid load placed upon it. The most readily recognizable attribute of lymphatic vascular incompetence is the presence of the characteristic swelling of tissues, called lymphedema, which arises as a consequence of insufficient lymph transport. The diagnosis of lymphatic vascular disease relies heavily upon the physical examination. If the diagnosis remains in question, the presence of lymphatic vascular insufficiency can be ascertained through imaging, including indirect radionuclide lymphoscintigraphy. Beyond lymphoscintigraphy, clinically-relevant imaging modalities include magnetic resonance imaging and computerized axial tomography. The state-of-the-art therapeutic approach to lymphatic edema relies upon physiotherapeutic techniques. Complex decongestive physiotherapy is an empirically-derived, effective, multicomponent technique designed to reduce limb volume and maintain the health of the skin and supporting structures. The application of pharmacological therapies has been notably absent from the management strategies for lymphatic vascular insufficiency states. In general, drug-based approaches have been controversial at best. Surgical approaches to improve lymphatic flow through vascular reanastomosis have been, in large part, unsuccessful, but controlled liposuction affords lasting benefit in selected patients. In the future, specifically engineered molecular therapeutics may be designed to facilitate the controlled regrowth of damaged, dysfunctional, or obliterated lymphatic vasculature in order to circumvent or mitigate the vascular insufficiency that leads to edema and tissue destruction.

View details for DOI 10.1016/j.jacc.2008.06.005

View details for Web of Science ID 000258720200001

View details for PubMedID 18755341
The clinical spectrum of lymphatic disease LYMPHATIC CONTINUUM REVISITED Radhakrisihnan, K., Rockson, S. G. 2008; 1131: 155-184
Abstract

Lymphatic disease is quite prevalent, and often not well clinically characterized. Beyond lymphedema, there is a broad array of human disease that directly or indirectly alters lymphatic structure and function. The symptomatic and objective presentation of these patients can be quite diverse. In this review, we have attempted to provide a systematic overview of the subjective and objective spectrum of lymphatic disease, with consideration of all of the categories of disease that primarily or secondarily impair the functional integrity of the lymphatic system. Lymphedema is discussed, along with chromosomal disorders, lymphangioma, infectious diseases, lymphangioleiomyomatosis, lipedema, heritable genetic disorders, complex vascular malformations, protein-losing enteropathy, and intestinal lymphangiectasia.

View details for DOI 10.1196/annals.1413.015

View details for Web of Science ID 000256902600016

View details for PubMedID 18519969
Gorham's disease - An osseous disease of lymphangiogenesis? LYMPHATIC CONTINUUM REVISITED Radhakrishnan, K., Rockson, S. G. 2008; 1131: 203-205
Abstract

Gorham's disease, also known as massive osteolysis, Gorham-Stout disease, vanishing bone disease, or, phantom bone disease is a rare disorder of the musculoskeletal system. The disease is characterized by osteolysis in bony segments, with localized proliferation of lymphatic channels. The presence of abundant, leaky systemic lymphatic vessels is often accompanied by chylous ascites. There is no standardized treatment available for Gorham's disease, and its molecular mechanisms remain unclear. Future strategies for understanding Gorham's disease should emphasize its apparent identity as a disease of disordered lymphangiogenesis. Breakthroughs in lymphatic research have identified several lymphangiogenic pathways that may play a relevant role in Gorham's disease.

View details for DOI 10.1196/annals.1413.022

View details for Web of Science ID 000256902600019

View details for PubMedID 18519972
Estimating the population burden of lymphedema LYMPHATIC CONTINUUM REVISITED Rockson, S. G., Rivera, K. K. 2008; 1131: 147-154
Abstract

Lymphedema is a complex, regional edematous state that ensues when lymph transport is insufficient to maintain tissue homeostasis. The disorder is remarkably prevalent, but the population implications of lymphatic dysfunction are not well-studied. Prevalence estimates for lymphedema are relatively high, yet its prevalence is likely underestimated. The ability to estimate the burden of disease poses profound implications for current and future lymphedema patients, but the challenge to correctly surmise the incidence and prevalence of lymphedema is complex and the relevant medical literature is scanty. In the absence of the highly desired, prospectively designed and rigorously performed relevant epidemiologic studies, it is instructive to look at the existing studies of lymphedema disease burden. In the current review, the extant literature is examined in the context of the disease setting in which tissue edema is encountered. Incidence or prevalence estimates are provided or inferred, and, where feasible, the size of the subject population is also identified. It is extremely attractive to contemplate that future approaches will entail formal, prospectively designed studies to objectively quantitate incidence and prevalence statistics for individual categories, as well as for the global lymphedema population.

View details for DOI 10.1196/annals.1413.014

View details for Web of Science ID 000256902600015

View details for PubMedID 18519968
Molecular targets for therapeutic lymphangiogenesis in lymphatic dysfunction and disease. Lymphatic research and biology Nakamura, K., Rockson, S. G. 2008; 6 (3-4): 181-189
Abstract

The convergence of multiple disciplines upon the study of the lymphatic vasculature has invigorated a renaissance of research, using powerful investigative tools and an exponential growth of interest in this historically underappreciated system. Fundamental discoveries in lymphatic development have yielded relevant animal models for vexing clinical diseases that suffer from nonexistent of minimally effective treatments. Inherited and acquired lymphedema represent the current crux of research efforts to identify potential molecular therapies born from these early discoveries. The importance of the lymphatic system is, however, not limited to lymphedema but encompasses a diverse spectrum of human disease including inflammation and cancer metastasis. As the lymphatic vasculature continues to benefit from fruits of biomedical investigation, translation of mechanistic insights into targeted, rationally-conceived therapeutics will be become a reality.

View details for DOI 10.1089/lrb.2008.63404

View details for PubMedID 19093791
Animal models for the molecular and mechanistic study of lymphatic biology and disease LYMPHATIC CONTINUUM REVISITED Shin, W. S., Rockson, S. G. 2008; 1131: 50-74
Abstract

The development of animal model systems for the study of the lymphatic system has resulted in an explosion of information regarding the mechanisms governing lymphatic development and the diseases associated with lymphatic dysfunction. Animal studies have led to a new molecular model of embryonic lymphatic vascular development, and have provided insight into the pathophysiology of both inherited and acquired lymphatic insufficiency. It has become apparent, however, that the importance of the lymphatic system to human disease extends, beyond its role in lymphedema, to many other diverse pathologic processes, including, very notably, inflammation and tumor lymphangiogenesis. Here, we have undertaken a systematic review of the models as they relate to molecular and functional characterization of the development, maturation, genetics, heritable and acquired diseases, and neoplastic implications of the lymphatic system. The translation of these advances into therapies for human diseases associated with lymphatic dysfunction will require the continued study of the lymphatic system through robust animal disease models that simulate their human counterparts.

View details for DOI 10.1196/annals.1413.005

View details for Web of Science ID 000256902600006

View details for PubMedID 18519959
The lymphatic continuum revisited - Preface LYMPHATIC CONTINUUM REVISITED Rockson, S. G. 2008; 1131: IX-X
View details for DOI 10.1196/annals.1413.000

View details for Web of Science ID 000256902600001

View details for PubMedID 18519954
Reinforcing a continuum of care: In-hospital initiation of long-term secondary prevention following acute coronary syndromes CARDIOVASCULAR DRUGS AND THERAPY Rockson, S. G., DeGoma, E. M., Fonarow, G. C. 2007; 21 (5): 375-388
Abstract

Patients with a history of acute coronary syndrome are particularly susceptible to further vascular or ischemic events. Effective secondary prevention following acute coronary syndrome requires multiple medications targeting the different mechanisms of atherothrombosis. The 2002 American College of Cardiology/American Heart Association guidelines for the management of unstable angina and non ST-segment myocardial infarction and the 2004 guidelines for ST-segment myocardial infarction assign priority to the long-term administration of four critical classes of drugs: antiplatelet agents, in particular aspirin and clopidogrel, beta-blockers, angiotensin-converting enzyme inhibitors, and statins.Despite clinical trial evidence demonstrating their ability to reduce cardiovascular morbidity and mortality, available preventive pharmacotherapies remain underutilized. Suboptimal compliance with current recommendations, as with other management guidelines, arises from a host of entrenched physician, patient, and system-related factors. Optimal management of acute coronary syndrome acknowledges a continuum of care in which acute stabilization represents a single important component. Early, in-hospital implementation of secondary preventive measures reinforces the continuum of care approach, promoting a successful transition from treatment to prevention, inpatient to outpatient management, and, when appropriate, subspecialist to generalist care.

View details for DOI 10.1007/s10557-007-6043-1

View details for Web of Science ID 000250205000008

View details for PubMedID 17701334
Rapid diagnosis of myocardial injury with troponin T and CK-MB relative index MOLECULAR DIAGNOSIS & THERAPY Engel, G., Rockson, S. G. 2007; 11 (2): 109-116
Abstract

Current hospital practice involves protracted observation of chest-pain patients to rule out myocardial infarction. Concurrent measurement of multiple biomarkers may increase sensitivity and make rapid diagnosis feasible.We sought to determine the optimal biomarker strategy for highly sensitive, early diagnosis of myocardial injury.A prospective evaluation of 171 acute coronary syndrome patients admitted to a single university medical center was performed. Blood tests for creatine kinase (CK), CK myocardial band isoenzyme (CK-MB), and troponin T were obtained at 0, 3, 6, 8, and 16 hours after presentation to the emergency department. Myocardial injury was defined as a troponin T level of >or=0.03 ng/mL.Troponin T had sensitivities of 79.7%, 95.7%, and 98.4% at the time of initial presentation, 3 and 6 hours after presentation, respectively. Using a combination of troponin T and CK-MB relative index, sensitivity on presentation was increased to 90.6%. The sensitivity was improved to 97.9% and 100% at 3 and 6 hours, respectively.This study demonstrates that the diagnosis of myocardial injury can be accurately excluded within 6 hours of admission with high sensitivity using troponin T. The combination of troponin T and CK-MB relative index provided the largest improvement in diagnostic sensitivity at patient arrival. These results support the feasibility of rapid, efficient triage for the emergent presentation of patients with chest pain.

View details for Web of Science ID 000246216600007

View details for PubMedID 17397247
Biomarkers of lymphatic function and disease: state of the art and future directions. Molecular diagnosis & therapy Nakamura, K., Rockson, S. G. 2007; 11 (4): 227-238
Abstract

Substantial advances have accrued over the last decade in the identification of the processes that contribute to lymphatic vascular development in health and disease. Identification of distinct regulatory milestones, from a variety of genetic models, has led to a stepwise chronology of lymphatic development. Several molecular species have been identified as important tissue biomarkers of lymphatic development and function. At present, vascular endothelial growth-factor receptor (VEGFR)-3/VEGF-C/VEGF-D signaling has proven useful in the identification of clinical lymphatic metastatic potential and the assessment of cancer prognosis. Similar biomarkers, to be utilized as surrogates for the assessment of inherited and acquired diseases of the lymphatic circulation, are actively sought, and will represent a signal advance in biomedical investigation.

View details for PubMedID 17705577
Inflammatory manifestations of experimental lymphatic insufficiency PLOS MEDICINE Tabibiazar, R., Cheung, L., Han, J., Swanson, J., Beilhack, A., An, A., Dadras, S. S., Rockson, N., Joshi, S., Wagner, R., Rockson, S. G. 2006; 3 (7): 1114-1139
Abstract

Sustained lymph stagnation engenders a pathological response that is complex and not well characterized. Tissue inflammation in lymphedema may reflect either an active or passive consequence of impaired immune traffic.We studied an experimental model of acute post-surgical lymphedema in the tails of female hairless, immunocompetent SKH-1 mice. We performed in vivo imaging of impaired immune traffic in experimental, murine acquired lymphatic insufficiency. We demonstrated impaired mobilization of immunocompetent cells from the lymphedematous region. These findings correlated with histopathological alterations and large-scale transcriptional profiling results. We found intense inflammatory changes in the dermis and the subdermis. The molecular pattern in the RNA extracted from the whole tissue was dominated by the upregulation of genes related to acute inflammation, immune response, complement activation, wound healing, fibrosis, and oxidative stress response.We have characterized a mouse model of acute, acquired lymphedema using in vivo functional imaging and histopathological correlation. The model closely simulates the volume response, histopathology, and lymphoscintigraphic characteristics of human acquired lymphedema, and the response is accompanied by an increase in the number and size of microlymphatic structures in the lymphedematous cutaneous tissues. Molecular characterization through clustering of genes with known functions provides insights into processes and signaling pathways that compose the acute tissue response to lymph stagnation. Further study of genes identified through this effort will continue to elucidate the molecular mechanisms and lead to potential therapeutic strategies for lymphatic vascular insufficiency.

View details for DOI 10.1371/journal.pmed.0030254

View details for Web of Science ID 000239493300030

View details for PubMedID 16834456
Lymphedema. Current treatment options in cardiovascular medicine Rockson, S. G. 2006; 8 (2): 129-136
Abstract

Aggressively applied decongestive measures (ie, manual lymphatic drainage, low-stretch bandaging, exercise, skin care, application of compressive elastic garments) are the mainstay of lymphatic therapy. Therapeutic regimens should differentiate between the sequential goals of acute volume reduction and maintenance of limb volume. Elastic garments should not be employed until maximal volume reduction has been attained through decongestive lymphatic techniques. It is my opinion that use of intermittent pneumatic compression devices can play an important adjunctive role to decongestive lymphatic therapy but should not be substituted for these techniques. At this time, I am not inclined to use pharmacologic therapy in these patients but anxiously await the results of studies that might demonstrate efficacy for molecular approaches. Surgical intervention is reserved for a small number of well-selected patients. Liposuction for volume reduction appears to be a very promising approach for specific patients.

View details for PubMedID 16533487
A pilot, prospective evaluation of a novel alternative for maintenance therapy of breast cancer-associated lymphedema [ISRCTN76522412] BMC CANCER Wilburn, O., Wilburn, P., Rockson, S. G. 2006; 6
Abstract

Prospective investigations of complete decongestive lymphatic physiotherapy (CDPT), including manual lymphatic drainage (MLD), have validated the efficacy of these interventions for the initial reduction of edema and long-term maintenance of limb volume in lymphedema. However, CDPT demands substantial time and effort from patients to maintain these benefits; the treatments are not always well-accepted, and patients may suffer from a deterioration in quality-of-life or a time-dependent loss of initial treatment benefits. A new device designed for home use by the patient, the Flexitouch, has been developed to mechanically simulate MLD. We have undertaken a prospective, randomized, crossover study of the efficacy of the Flexitouch, when compared to massage, in the self-administered maintenance therapy of lymphedema.A prospective, randomized, crossover study of maintenance therapy was performed in 10 patients with unilateral breast cancer-associated lymphedema of the arm. Each observation phase included self-administered treatment with the Flexitouch or massage, 1 hour daily for 14 days, respectively, followed by crossover to the alternate treatment phase. Each treatment phase was preceded by a 1 week treatment washout, with use of garment only. The sequence of treatment was randomly assigned. The potential impact of treatment modality on quality of life was assessed with serial administration of the SF-36.Statistical analysis disclosed that the order of treatment had no outcome influence, permitting 10 comparisons within each treatment group. Post-treatment arm volume reduced significantly after the Flexitouch, but not after self-administered massage. The patients' mean weight decreased significantly with Flexitouch use, but not with massage. The Flexitouch device was apparently well-tolerated and accepted by patients. Serial SF-36 administration showed no deterioration in physical or psychosocial scores compared to baseline measurements; there were no statistical differences in scores when the two treatment modalities were compared.This short-term prospective evaluation of the Flexitouch suggests that the device may provide better maintenance edema control than self-adiminstered massage in breast cancer-associated lymphedema. The apparent ease of use and reliability of response to the device suggest that further broad-scale testing is warranted.

View details for DOI 10.1186/1471-2407-6-84

View details for Web of Science ID 000236919700001

View details for PubMedID 16571129
Literature watch. Lymphatic research and biology Rockson, S. G. 2006; 4 (1): 57-61
View details for PubMedID 16569210
Addressing the unmet needs in lymphedema risk management. Lymphatic research and biology Rockson, S. G. 2006; 4 (1): 42-46
View details for PubMedID 16569207
The lymphatic continuum continues. Lymphatic research and biology Rockson, S. G. 2006; 4 (1): 1-2
View details for PubMedID 16569199
Validation of a new technique for the quantitation of edema in the experimental setting. Lymphatic research and biology Pan, D., Han, J., Wilburn, P., Rockson, S. G. 2006; 4 (3): 153-158
Abstract

An inherent limitation to the study of in vivo animal models of lymphedema is the potential inaccuracy or unreliability of existing methods for the quantification of edema volume as a surrogate functional measure of lymphatic transport capacity. Circumference-based techniques have been proposed and validated as a suitable alternative to volume displacement measurements in human clinical studies; accordingly, we have elaborated a new application of this approach that can be applied to small animal studies.Acute postsurgical lymphedema was created experimentally in the murine tail. Both normal and lymphedematous murine tails were examined. Tail volume was quantitated both by water displacement and by a digital photographic technique. In selected mice, after sacrificed on postsurgical day 7, a 6 cm segment was resected from the midportion of the tail and cauterized to create a closed space. Known incremental volumes of saline (20-100 microL) were injected for subsequent digital photographic volumetry.The coefficients of variation for volume assessment by water displacement and by digital imaging were 0.08+/-0.09 and 0.01+/-0.009, respectively. The two techniques were poorly correlated: while serial water displacement analysis yielded highly variable measurements within the same tail, concurrent digital imaging of the tail circumference was quite reproducible. Furthermore, after parenteral injection of known incremental volumes of saline, the correlation between the injectate volumes and the digitally measured increases in volume was high, both in the normal and the lymphedematous tail.In the murine tail, when compared to water displacement volumetry, digital photography yields highly reproducible data. We can conclude that the lack of correlation between the two methods, with the relatively flat slope of the linear regression relationship, reflects inherent inaccuracies of the water displacement method.

View details for PubMedID 17034295
An experimental model for the study of lymphedema and its response to therapeutic lymphangiogenesis BIODRUGS Cheung, L., Han, J., Beilhack, A., Joshi, S., Wilburn, P., Dua, A., An, A., Rockson, S. G. 2006; 20 (6): 363-370
Abstract

Evaluation of the efficacy of molecular treatment strategies for lymphatic vascular insufficiency requires a suitable preclinical animal model. Ideally, the model should closely replicate the untreated human disease in its pathogenesis and pathological expression.We have undertaken a study of the time course of the development and resolution of acquired, experimental lymphedema and of its responses to vascular endothelial growth factor (VEGF)-C lymphangiogenesis in the mouse tail model.We provoked post-surgical lymphedema in the mouse tail model and assessed the effects of exogenously administered human recombinant VEGF-C. Quantitative assessment of immune traffic function was performed through sequential in vivo bioluminescent imaging.In untreated lymphedema, tail edema was sustained until day 21. Exogenous administration of human recombinant VEGF-C produced a significant decrease in volume. Untreated lymphedema in the mouse tail model was characterized by the presence of dilated cutaneous lymphatics, marked acute inflammatory changes, and hypercellularity; VEGF-C produced a substantial reversion to the normal pattern, with notable regression in the size and number of cutaneous lymphatic vessels that express lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1). In vivo imaging confirmed the presence of an impairment of immune traffic in lymphedema that was ameliorated after VEGF-C administration.The post-surgical murine tail model of lymphedema closely simulates attributes of human lymphedema and provides the requisite sensitivity to detect therapeutically induced functional and structural alterations. It can, therefore, be used as an investigative platform to assess mechanisms of disease and its responses to candidate therapies, such as therapeutic lymphangiogenesis.

View details for Web of Science ID 000244131200006

View details for PubMedID 17176124
Indirect magnetic resonance lymphangiography to assess lymphatic function in experimental murine lymphedema. Lymphatic research and biology Pan, D., Suzuki, Y., Yang, P. C., Rockson, S. G. 2006; 4 (4): 211-216
Abstract

Recently, indirect magnetic resonance lymphangiography with gadolinium (Gd) has been demonstrated to offer the potential for safe, high-resolution visualization of the lymphatic vessels, in addition to the lymph nodes. In this study, the potential utility of indirect Gd contrast magnetic resonance imaging of lymphatic vascular function was investigated in the murine tail. Functional imaging of healthy mice is contrasted with the findings in experimentally-induced lymphatic vascular insufficiency.Postsurgical lymphedema was experimentally created in the murine tail. Normal and lymphedematous mouse tails were imaged following direct subcutaneous administration of Gadolinium-DTPA, 0.1 mmol/kg. Images were obtained in axial and coronal planes with a T1-weighted spin echo inversion-recovery sequence.In the normal tail, both of the bilateral major collecting lymphatics were clearly visualized as the Gd tracer was cleared from the interstitial compartment. In contrast, the Gd tracer accumulated at the prior surgical site in the lymphedematous tail. Quantitative assessment of Gd clearance demonstrates that accumulation of Gd correlates with the impedance to lymph flow proximal to the site of surgical lymphatic ablation.Magnetic resonance is a feasible and reliable method to be applied to quantitative functional imaging of the lymphatic vasculature in experimental models of lymphedema.

View details for PubMedID 17394404
Treprostinil for the treatment of severe digital necrosis in systemic sclerosis VASCULAR MEDICINE Engel, G., Rockson, S. G. 2005; 10 (1): 29-32
Abstract

We report a case of severe digital ulcerations associated with systemic sclerosis, successfully treated with treprostinil (Remodulin). There was improvement within days of the treatment initiation; complete healing was accomplished after 16 weeks of therapy. Patients with systemic sclerosis and peripheral small vessel disease have limited therapeutic options. Treprostinil is a prostacyclin analogue that can be delivered by subcutaneous infusion and is approved in the USA only for treatment of primary pulmonary hypertension. This report provides an impressive example of an alternative, complementary indication for the use of treprostinil.

View details for DOI 10.1191/1358863x05vm579cr

View details for Web of Science ID 000228828200005

View details for PubMedID 15920997
Therapeutics for lymphatic disease: the role of the pharmaceutical and biotechnology sector. Lymphatic research and biology Rockson, S. G. 2005; 3 (3): 103-104
View details for PubMedID 16190814
The lymphatic biology of Kaposi's sarcoma. Lymphatic research and biology Cheung, L., Rockson, S. G. 2005; 3 (1): 25-35
View details for PubMedID 15770083
Lymphedema therapy in the vascular anomaly patient: therapeutics for the forgotten circulation. Lymphatic research and biology Rockson, S. G. 2005; 3 (4): 253-255
View details for PubMedID 16379595
Literature watch. A genetic Xenopus laevis tadpole model to study lymphangiogenesis. Lymphatic research and biology Rockson, S. G. 2005; 3 (4): 263-267
View details for PubMedID 16379598
Benefits of resident work hours regulation ANNALS OF INTERNAL MEDICINE Skeff, K. M., Ezeji-Okoye, S., Pompei, P., Rockson, S. 2004; 140 (10): 816-817
View details for Web of Science ID 000221520900007

View details for PubMedID 15148069
Comparing the guidelines: Anticoagulation therapy to optimize stroke prevention in patients with atrial fibrillation JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Rockson, S. G., Albers, G. W. 2004; 43 (6): 929-935
Abstract

Atrial fibrillation (AF) is an important risk factor for stroke. According to a pooled analysis of controlled clinical trials with warfarin, anticoagulation therapy reduces stroke risk by 62%. However, clinicians must decide whether the benefit of long-term anticoagulation therapy with available agents outweighs the risk of bleeding for individual patients. Guidelines issued by the American College of Chest Physicians and by the joint American College of Cardiology, American Heart Association, and the European Society of Cardiology task force recommend antithrombotic therapy to protect AF patients from stroke based on risk-stratification algorithms. Risk factors for stroke AF patients include age > or =75 years; hypertension; thyrotoxicosis; diabetes; cardiovascular disease; congestive heart failure; and history of stroke, transient ischemic attack, or thromboembolism. Patients at high risk for stroke experience greater absolute benefit from anticoagulation therapy than patients at low risk. The guidelines are consistent in recommendations for high-risk patients (warfarin therapy, international normalized ratio 2.0 to 3.0) and low-risk patients (aspirin 325 mg), but differ for intermediate-risk patients with diabetes or heart disease. The guidelines continue to evolve, and future guidelines are likely to incorporate new clinical data, including the CHADS(2) algorithm for determining risk and the results of the Atrial Fibrillation Follow-up Investigation of Rhythm Management trial, the Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation study, and the Stroke Prevention Using an Oral Thrombin Inhibitor in Atrial Fibrillation II to V trials.

View details for DOI 10.1016/j.jacc.2003.11.028

View details for Web of Science ID 000220212400001

View details for PubMedID 15028346
Lymphatic biology and disease: is it being taught? Who is listening? Lymphatic research and biology Rockson, S. G., Granger, D. N., Skeff, K. M., Chaite, W. 2004; 2 (2): 86-95
View details for PubMedID 15615490
The elusive adipose connection. Lymphatic research and biology Rockson, S. G. 2004; 2 (3): 105-106
View details for PubMedID 15609810
Tumors, wounds, and lymph. Lymphatic research and biology Rockson, S. G. 2004; 2 (4): 153-154
View details for PubMedID 15650384
How can lymphatic research influence lymphatic education? Lymphatic research and biology Rockson, S. G. 2004; 2 (2): 67-68
View details for PubMedID 15615487
The potential for molecular treatment strategies in lymphatic disease. Lymphatic research and biology An, A., Rockson, S. G. 2004; 2 (4): 173-181
View details for PubMedID 15650387
Coronary restenosis: A review of mechanisms and management AMERICAN JOURNAL OF MEDICINE Rajagopal, V., Rockson, S. G. 2003; 115 (7): 547-553
Abstract

Percutaneous coronary interventions represent an attractive alternative to surgical revascularization; nevertheless, these techniques continue to be characterized by their propensity to elicit restenosis. Despite an exhaustive search for an effective pharmacotherapy to treat or prevent restenosis, hundreds of clinical trials have failed to identify an agent with proven therapeutic benefit. Recently, however, the Food and Drug Administration approved intracoronary radiation (brachytherapy) as a viable therapeutic option for in-stent stenosis. In addition, recent randomized trials have shown encouraging results for drug-eluting stents. This article reviews the pathophysiology of restenosis, along with current and future treatment options.

View details for DOI 10.1016/S0002-9343(03)00477-7

View details for Web of Science ID 000186411700006

View details for PubMedID 14599634
Endothelial cell diversity revealed by global expression profiling PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA Chi, J. T., Chang, H. Y., Haraldsen, G., Jahnsen, F. L., Troyanskaya, O. G., Chang, D. S., Wang, Z., Rockson, S. G., van de Rijn, M., Botstein, D., Brown, P. O. 2003; 100 (19): 10623-10628
Abstract

The vascular system is locally specialized to accommodate widely varying blood flow and pressure and the distinct needs of individual tissues. The endothelial cells (ECs) that line the lumens of blood and lymphatic vessels play an integral role in the regional specialization of vascular structure and physiology. However, our understanding of EC diversity is limited. To explore EC specialization on a global scale, we used DNA microarrays to determine the expression profile of 53 cultured ECs. We found that ECs from different blood vessels and microvascular ECs from different tissues have distinct and characteristic gene expression profiles. Pervasive differences in gene expression patterns distinguish the ECs of large vessels from microvascular ECs. We identified groups of genes characteristic of arterial and venous endothelium. Hey2, the human homologue of the zebrafish gene gridlock, was selectively expressed in arterial ECs and induced the expression of several arterial-specific genes. Several genes critical in the establishment of left/right asymmetry were expressed preferentially in venous ECs, suggesting coordination between vascular differentiation and body plan development. Tissue-specific expression patterns in different tissue microvascular ECs suggest they are distinct differentiated cell types that play roles in the local physiology of their respective organs and tissues.

View details for DOI 10.1073/pnas.1434429100

View details for Web of Science ID 000185415300012

View details for PubMedID 12963823
Endothelial dysfunction: Clinical strategies for treating oxidant stress AMERICAN HEART JOURNAL Fenster, B. E., Tsao, P. S., Rockson, S. G. 2003; 146 (2): 218-226
Abstract

A growing body of evidence has demonstrated that oxidants play a critical role in the pathogenesis of endothelial dysfunction. Pathologic processes fundamental to development and progression of endothelial dysfunction such as the oxidation of LDL, the loss of bioavailable nitric oxide, and the vascular inflammatory response are all modulated by oxidant stress. Therapeutic strategies to reverse endothelial dysfunction have begun to focus on agents with the ability to ameliorate oxidant stress.Preclinical and clinical studies evaluating the actions of antioxidants as well as traditional cardiovascular therapies in ameliorating oxidative stress and endothelial dysfunction were reviewed through the use of a MEDLINE search of English language articles published between the years of 1992 and 2002.Antioxidants appear to be an attractive candidate therapy, yet despite compelling preclinical evidence supporting their benefits, efforts to validate the use of vitamins C and E in a clinical setting have been conflicting. In contrast, conventional cardiovascular therapies such as ACE inhibitors, statins, insulin-sensitizing agents, and estrogens have been shown to alleviate endothelial dysfunction, often independent of their effects on systemic disease processes.These agents restore endothelial function through their salutary effects on pathologic vascular oxidative processes.

View details for DOI 10.1016/S0002-8703(03)00087-X

View details for Web of Science ID 000184708400011

View details for PubMedID 12891188
The third circulation: Radionuclide lymphoscintigraphy in the evaluation of lymphedema JOURNAL OF NUCLEAR MEDICINE Szuba, A., Shin, W. S., Strauss, H. W., Rockson, S. 2003; 44 (1): 43-57
Abstract

Lymphedema-edema that results from chronic lymphatic insufficiency-is a chronic debilitating disease that is frequently misdiagnosed, treated too late, or not treated at all. There are, however, effective therapies for lymphedema that can be implemented, particularly after the disorder is properly diagnosed and characterized with lymphoscintigraphy. On the basis of the lymphoscintigraphic image pattern, it is often possible to determine whether the limb swelling is due to lymphedema and, if so, whether compression garments, massage, or surgery is indicated. Effective use of lymphoscintigraphy to plan therapy requires an understanding of the pathophysiology of lymphedema and the influence of technical factors such as selection of the radiopharmaceutical, imaging times after injection, and patient activity after injection on the images. In addition to reviewing the anatomy and physiology of the lymphatic system, we review physiologic principles of lymphatic imaging with lymphoscintigraphy, discuss different qualitative and quantitative lymphoscintigraphic techniques and their clinical applications, and present clinical cases depicting typical lymphoscintigraphic findings.

View details for Web of Science ID 000180276500028

View details for PubMedID 12515876
Immune traffic: a functional overview. Lymphatic research and biology Beilhack, A., Rockson, S. G. 2003; 1 (3): 219-234
Abstract

The efficient function of the immune system necessitates the complex interaction of antigens, antigen-presenting cells, and cell populations that modulate, regulate and effectuate the immune response. In order to overcome the spatial limitations that are imposed by the constraints of the system, the immune system has evolved a dependence upon the lymphatic vasculature to serve the biological needs of immune trafficking. This review will focus upon useful ex vivo and intact animal models that possess the ability to provide valuable information about leukocyte trafficking.

View details for PubMedID 15624439
Animal models for the study of lymphatic insufficiency. Lymphatic research and biology Shin, W. S., Szuba, A., Rockson, S. G. 2003; 1 (2): 159-169
Abstract

Lymphedema is the term commonly employed to describe the spectrum of pathological states that arise as a consequence of functional lymphatic insufficiency. These human disease entities currently lack an effective cure. Satisfactory therapeutic strategies for both primary and secondary lymphedema will require additional insight into the complex cellular mechanisms and responses that comprise both normal lymphatic function and its regional derangement in states of pathologic dysfunction. Such insights must, initially, be derived from suitable animal models of the chronic human disease process. Historically, efforts to replicate the untreated disease of human lymphedema in animals, through surgery, irradiation, and toxicology, have been fraught with difficulty. The major impediments to the creation of satisfactory animal models have included an inability to reproduce the chronic disease in a stable, reproducible format. Recently, with the promise of potentially successful growth factor-mediated therapeutic lymphangiogenesis, and with the enhanced availability of investigative tools to assess therapeutic responses to molecular therapies, there has been a resurgence of interest in the development of viable animal models of lymphatic insufficiency. Current research has led to the development of genetic and postsurgical models of lymphedema that closely simulate the human conditions of primary and secondary lymphatic insufficiency, respectively. Such models will help to refine the assessment of various therapeutic approaches and their potential applicability to human disease interventions.

View details for PubMedID 15624423
Quantitative radionuclide lymphoscintigraphy predicts outcome of manual lymphatic therapy in breast cancer-related lymphedema of the upper extremity NUCLEAR MEDICINE COMMUNICATIONS Szuba, A., Strauss, W., Sirsikar, S. P., Rockson, S. G. 2002; 23 (12): 1171-1175
Abstract

Secondary lymphedema is a localized, acquired lymphatic microcirculatory disturbance that affects large numbers of patients after breast cancer therapy. There is a paucity of objective methods to quantitate lymphatic function and to anticipate the response to therapeutic interventions. We applied radionuclide lymphoscintigraphy to evaluate lymphatic transport and axillary lymph node visualization in women following breast cancer therapy to determine the utility of these data in these patients. Lymphoscintigraphy was performed after subcutaneous injection of 0.25 mCi of Tc-filtered sulfur colloid. Subcutaneous accumulation of radiotracer ('dermal backflow') and the visualization of axillary lymph nodes were graded using our own scoring system. The ratio of radioactivity within the affected to normal axillae (ARR) was also quantified. Nineteen patients with lymphedema after breast cancer therapy were evaluated. The disease severity was documented by serial measurements of the limb volume using the truncated cone formula. Responses to therapy were quantified after completion of the therapy. There was a correlation between the ARR and the percentage reduction in edema volume. The lymphoscintigraphic score correlated with the initial arm volume excess and with the durationof lymphedema. It can be concluded that quantitative and semi-quantitative assessment by radionuclide lymphoscintigraphy represents a potentially useful tool for the clinical assessment of upper extremity lymphedema.

View details for DOI 10.1097/01.mnm.0000046208.83338.da

View details for Web of Science ID 000180086600004

View details for PubMedID 12464781
Decongestive lymphatic therapy for patients with breast carcinoma-associated lymphedema - A randomized, prospective study of a role for adjunctive intermittent pneumatic compression CANCER Szuba, A., Achalu, R., Rockson, S. G. 2002; 95 (11): 2260-2267
Abstract

Disruption of the lymphatic circulation through breast carcinoma-associated axillary lymph node dissection, with or without radiation therapy, reportedly is the most common cause of lymphedema in developed countries. There is no cure for breast carcinoma-associated lymphedema. Although intermittent pneumatic compression (IPC) has been acknowledged as a potential component of the multidisciplinary therapeutic strategy in the treatment of patients with breast carcinoma-associated lymphedema, prospective study of its adjunctive safety and efficacy is required.IPC was assessed as a component of the initial therapeutic regimen for newly treated patients with breast carcinoma-associated lymphedema. Twenty-three patients who had not previously been treated for lymphedema were randomized to receive either decongestive lymphatic therapy (DLT) alone or DLT with daily adjunctive IPC. Patients with stable, treated, breast carcinoma-associated lymphedema also were assessed in the maintenance phase of therapy. Twenty-seven patients were randomized either to DLT alone or to DLT coupled with daily IPC. In both studies, objective assessment included serial measurement of volume by water displacement, tissue tonometry to assess elasticity of the skin, and goniometry to measure joint mobility.During initial treatment, the addition of IPC to standard DLT yielded an additional mean volume reduction (45.3% vs. 26%; P < 0.05). During maintenance DLT alone, there was a mean increase in volume (32.7 +/- 115.2 mL); with DLT and IPC, there was a mean volume reduction (89.5 +/- 195.5 mL; P < 0.05). In both studies, IPC was tolerated well without detectable adverse effects on skin elasticity or joint range of motion.When IPC is used adjunctively with other, established elements of DLT, it provides an enhancement of the therapeutic response. IPC is well tolerated and remarkably free of complications.

View details for DOI 10.1002/cncr.10976

View details for Web of Science ID 000179371400002

View details for PubMedID 12436430
Therapeutic lymphangiogenesis with human recombinant VEGF-C. FASEB journal Szuba, A., Skobe, M., Karkkainen, M. J., Shin, W. S., Beynet, D. P., Rockson, N. B., Dakhil, N., Spilman, S., Goris, M. L., Strauss, H. W., Quertermous, T., Alitalo, K., Rockson, S. G. 2002; 16 (14): 1985-1987
Abstract

Chronic regional impairments of the lymphatic circulation often lead to striking architectural abnormalities in the lymphedematous tissues. Lymphedema is a common, disabling disease that currently lacks a cure. Vascular endothelial growth factors C and D mediate lymphangiogenesis through the VEGFR-3 receptor on lymphatic endothelia. The purpose of this study was to investigate the therapeutic potential for lymphangiogenesis with VEGF-C. We developed a rabbit ear model to simulate human chronic postsurgical lymphatic insufficiency. Successful, sustained surgical ablation of the ear lymphatics was confirmed by water displacement volumetry. After complete healing, the experimental animals (n=8) received a single, s.c. 100 microg dose of VEGF-C in the operated ear; controls (n=8) received normal saline. Radionuclide lymphoscintigraphy was performed to quantitate lymphatic function. Immunohistochemistry (IHC) was performed 7-8 days following treatment. After VEGF-C, there was a quantifiable amelioration of lymphatic function. IHC confirmed a significant increase in lymphatic vascularity, along with reversal of the intense tissue hypercellularity of untreated lymphedema. This study confirms the capacity of a single dose of VEGF-C to induce therapeutic lymphangiogenesis in acquired lymphedema. In addition to improving lymphatic function and vascularity, VEGF-C can apparently reverse the abnormalities in tissue architecture that accompany chronic lymphatic insufficiency.

View details for PubMedID 12397087
Lymphedema-lymphangiectasia-mental retardation (Hennekam) syndrome: A review AMERICAN JOURNAL OF MEDICAL GENETICS Van Balkom, I. D., Alders, M., Allanson, J., Bellini, C., Frank, U., de Jong, G., Kolbe, I., Lacombe, D., Rockson, S., Rowe, P., Wijburg, F., Hennekam, R. C. 2002; 112 (4): 412-421
Abstract

The Hennekam syndrome is an infrequently reported heritable entity characterized by lymphedema, lymphangiectasia, and developmental delay. Here we add an additional 8 patients, and compare their findings to the 16 cases from the literature. The lymphedema is usually congenital, can be markedly asymmetrical, and, often, gradually progressive. Complications such as erysipelas are common. The lymphangiectasias are present in the intestines, but have also been found in the pleura, pericardium, thyroid gland, and kidney. Several patients have demonstrated congenital cardiac and blood vessel anomalies, pointing to a disturbance of angiogenesis in at least some of the patients. Facial features are variable, and are chiefly characterized, in a typical patient, by a flat face, flat and broad nasal bridge, and hypertelorism. Facial features are thought to mirror the extent of intrauterine facial lymphedema, or may be caused by lymphatic obstruction that affects the early migration of neural crest tissue. Other anomalies have included glaucoma, dental anomalies, hearing loss, and renal anomalies. The psychomotor development varies widely, even within a single family, from almost normal development to severe mental retardation. Convulsions are common. The existence of 10 familial cases, equal sex ratio, increased parental consanguinity rate (4/20 families), and absence of vertical transmission are consistent with an autosomal recessive pattern of inheritance. It seems likely that most (but not all) manifestations of the entity can be explained as sequences of impaired prenatal and postnatal lymphatic flow, suggesting that the causative gene(s) should have a major function in lymphangiogenesis.

View details for DOI 10.1002/ajmg.10707

View details for Web of Science ID 000178568700018

View details for PubMedID 12376947
Myocarditis in systemic lupus erythematosus AMERICAN JOURNAL OF MEDICINE Wijetunga, M., Rockson, S. 2002; 113 (5): 419-423
Abstract

Although clinical manifestations of myocarditis in systemic lupus erythematosus are uncommon, noninvasive cardiac testing may detect subclinical cases. The pathogenesis of myocarditis in systemic lupus erythematosus has been ascribed to many factors, including autoimmunity, medications, and coexisting diseases. Lupus myocarditis merits urgent clinical attention because of the likely progression to arrhythmias, conduction disturbances and heart block, dilated cardiomyopathy, and heart failure. Endomyocardial biopsy can be used to identify the underlying inflammatory histopathology. Usual therapy includes high-dose corticosteroids, in addition to standard cardiac medications.

View details for Web of Science ID 000178799400009

View details for PubMedID 12401537
Therapeutic lymphangiogenesis with human recombinant VEGF-C FASEB JOURNAL Szuba, A., Skobe, M., Karkkainen, M. J., Shin, W. S., Beynet, D. P., Rockson, N. B., Dakhil, N., Spilman, S., Goris, M. L., Strauss, H. W., Quertermous, T., Alitalo, K., Rockson, S. G. 2002; 16 (12): 1985-?
View details for DOI 10.1096/fj.02-0401fje

View details for Web of Science ID 000179167600007
Diagnosis and treatment of concomitant venous obstruction in patients with secondary lymphedema JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Szuba, A., Razavi, M., Rockson, S. G. 2002; 13 (8): 799-803
Abstract

It has been proposed that concomitant iatrogenic venous obstruction substantially contributes to the appearance and severity of the secondary lymphedema that follows cancer surgery, radiation, and other traumas. The purpose of this study was to investigate the frequency of venous obstruction in the clinical presentation of patients with secondary lymphedema and to analyze the efficacy of interventional therapy in this patient population.The experience of the university center for lymphatic and venous disorders with combined lymphaticovenous edema was retrospectively examined. The records and clinical course were reviewed for all patients referred to a university lymphedema center for evaluation between January 1996 and March 1999. During this interval, in 365 patients with lymphedema, 35 radiocontrast venograms were obtained to evaluate the suspected presence of mixed lymphaticovenous edema. Venographic evidence of venous stenosis (>50%) or occlusion was analyzed, as were the technical success of the intervention, determined by ability to cross the affected segment of the vein and perform venoplasty and place the stent, and the clinical success of the intervention assessed by relief of clinical symptoms (edema, pain) within 24 hours.The diagnosis of venous obstruction was confirmed in 17 patients (4.6% of all patients with lymphedema; 49% of patients studied with venography). Venography disclosed clinically relevant venous stenosis in five of seven patients with edema of the upper extremity and in six of 10 patients with leg lymphedema. Venous occlusion was found in two of seven patients with upper extremity edema and in four of 10 patients with leg lymphedema. Percutaneous endovascular venoplasty was attempted in all 17 patients and was successful in 16. Subsequent venous stent placement was performed in three patients with upper extremity edema and in all patients with lower extremity lymphedema. Clinical amelioration of edema was observed in 15 of these 17 patients. Amelioration was assessed by relief of symptoms, improvement in function, and reduction in limb girth.This study supports the clinical importance of concomitant venous obstruction in some patients with chronic secondary lymphedema. Edema can often be ameliorated through percutaneous catheter-based interventions.

View details for Web of Science ID 000177455700005

View details for PubMedID 12171983
Preclinical models of lymphatic disease - The potential for growth factor and gene therapy LYMPHATIC CONTINUUM: LYMPHATIC BIOLOGY AND DISEASE Rockson, S. G. 2002; 979: 64-75
Abstract

The human disease states that are characterized by functional lymphatic insufficiency currently lack a cure. Molecular approaches may ultimately provide a therapeutic window to reverse the stigmata of both primary and secondary lymphatic insufficiency. To harness the potential therapeutic power of lymphangiogenesis, testing the safety and efficacy of the treatment response will be necessary. This, in turn, necessitates the availability of suitable preclinical animal models of the disease processes in question, along with suitable research tools to permit an assessment of the response to applied therapies. An ideal model would reproducibly and inexpensively replicate the untreated disease of human lymphedema. It would closely simulate the biology, as we understand it, of the human disease, and would replicate both the pathogenesis of the disease, including its natural history and the temporal patterns of its clinical expression. In this way, one might aspire to make valid predictions about the human applicability of therapy by extrapolation from observations in animal models. In addition to the availability of suitable animal models, the required investigative tools must also be available. In the context of lymphangiogenesis, to assess the therapeutic response, one must certainly possess the ability to recognize newly developed lymphatic vasculature. Sophisticated immunohistochemical and imaging techniques make this increasingly feasible. Initial experimental observations indicate that growth factor and gene therapy with VEGF-C holds promise for the treatment of both primary and secondary forms of lymphedema.

View details for Web of Science ID 000180751900008

View details for PubMedID 12543717
The lymphatic continuum - The past, present, and exciting future of lymphatic research LYMPHATIC CONTINUUM: LYMPHATIC BIOLOGY AND DISEASE Rockson, S. G. 2002; 979: 1-4
View details for Web of Science ID 000180751900001

View details for PubMedID 12543710
The role of chemokines in human cardiovascular pathology: enhanced biological insights ATHEROSCLEROSIS Shin, W. S., Szuba, A., Rockson, S. G. 2002; 160 (1): 91-102
Abstract

A growing body of experimental evidence supports the pivotal role of chemokines in the pathogenesis of vascular disease. The endothelial expression of monocyte chemoattractant protein-1 (MCP-1) is apparently essential for the earliest cellular responses of atherogenesis. Many atherogenic and anti-atherogenic stimuli can be construed to exert their effects predominantly upon MCP-1 expression within the vascular wall. The atherogenic effects of interleukin-8 (IL-8) seem to be mediated through the down-regulation of the tissue inhibitor of metalloproteinase-1 (TIMP-1). Biological expression of these two important vascular chemokines is further modulated by NF-kappaB. The delineation of these molecular forces that drive atherogenesis increasingly underscores the pivotal role of various chemokines. It is anticipated that more precise delineation of these patterns of gene expression will help to identify molecular targets for the prevention and treatment of atherosclerosis.

View details for Web of Science ID 000173588500010

View details for PubMedID 11755926
Feasibility and reliability of rapid diagnosis of myocardial infarction AMERICAN JOURNAL OF THE MEDICAL SCIENCES Engel, G., Rockson, S. G. 2001; 322 (6): 339-344
Abstract

Prevailing hospital practice dictates a protracted phase of observation for patients with chest pain to establish or exclude the diagnosis of myocardial infarction. Early diagnosis of acute myocardial infarction may improve patient care and reduce both complications and hospital costs. A study was performed to investigate the feasibility of early diagnosis of myocardial infarction within the first 9 hours of the hospital stay.The records of all patients admitted with chest pain within one calendar year were analyzed. The timing of creatine kinase-MB (CK-MB) quantification was determined with reference to the initial phlebotomy (time 0). An enzymatic diagnosis of myocardial infarction was assigned if any determination of CK-MB exceeded the upper limit of normal, and the diagnosis of each patient at or before 9 hours (early diagnosis) was compared to the ultimate diagnosis at 14 to 24 hours (final diagnosis) beyond initial assessment.Of the 528 included patients, 523 patients (99.1%) had identical early and final diagnostic outcomes; 5 patients (0.9%) had conflicting results. An early diagnosis of myocardial infarction was assigned to 195 of the 528 patients (36.9%). Of these, 190 achieved the diagnosis within 9 hours (sensitivity 97.4%). The negative predictive value was 98.5%.Standard CK-MB mass measurements within 9 hours of arrival provided an accurate clinical assessment in > 99% of the cases. The high sensitivity and negative predictive values suggest that early diagnosis of myocardial infarction is feasible and reliable.

View details for Web of Science ID 000172724700006

View details for PubMedID 11780691
Photoangioplasty recount: Clear punch or dimpled chad? Response CIRCULATION Rockson, S. G., Razavi, M., Szuba, A., Filardo, S., Fitzgerald, P., Cooke, J. P., Yousuf, S., Kramer, P., DeVault, A. R., Renschler, M. F., Adelman, D. C. 2001; 104 (11): E55-E56
View details for Web of Science ID 000171000200004
Angiogenesis and the ischaemic heart EUROPEAN HEART JOURNAL Tabibiazar, R., Rockson, S. G. 2001; 22 (11): 903-918
View details for Web of Science ID 000169334600007

View details for PubMedID 11428814
Formulating clinical strategies for angiotensin antagonism: A review of preclinical and clinical studies AMERICAN JOURNAL OF MEDICINE Tabibiazar, R., Jamali, A. H., Rockson, S. G. 2001; 110 (6): 471-480
Abstract

Extensive animal studies and a growing number of human clinical trials have now definitively demonstrated the central role of the renin-angiotensin-aldosterone system in the expression and modulation of cardiovascular disease. In contrast to the original hypothesis, the benefits of angiotensin antagonism do not emanate from the antihypertensive effect alone. Subsequent extensive investigations of angiotensin blockade suggest that the benefits of this approach may also result from the pharmacologic alteration of endothelial cell function and the ensuing changes in the biology of the vasculature. The more recent availability of direct antagonists of the AT(1) angiotensin receptor has introduced an element of doubt into this realm of clinical decision making. The receptor antagonists and the more widely studied converting-enzyme inhibitors share many endpoint attributes. Nevertheless, the partially overlapping mechanisms of action for the two classes of angiotensin antagonists confer distinct pharmacologic properties, including side effect profiles, mechanisms of action, and theoretic salutary effects upon the expression of cardiovascular disease. The current review will attempt to contrast the biology of angiotensin converting-enzyme inhibition with angiotensin II receptor antagonism. A discussion of the differential effects of these drug classes on endothelial cell function and on the modulation of vascular disease will be utilized to provide a theoretic framework for clinical decision making and therapeutics.

View details for Web of Science ID 000168267700008

View details for PubMedID 11331059
Lymphedema AMERICAN JOURNAL OF MEDICINE Rockson, S. G. 2001; 110 (4): 288-295
Abstract

Lymphedema is a set of pathologic conditions that are characterized by the regional accumulation of excessive amounts of interstitial protein-rich fluid. These occur as a result of an imbalance between the demand for lymphatic flow and the capacity of the lymphatic circulation. Lymphedema can result from either primary or acquired (secondary) disorders. In this review, the pathophysiology, classification, natural history, differential diagnosis, and treatment of lymphedema are discussed.

View details for Web of Science ID 000167190300007

View details for PubMedID 11239847
Decongestive lymphatic therapy for patients with cancer-related or primary lymphedema AMERICAN JOURNAL OF MEDICINE Szuba, A., Cooke, J. P., Yousuf, S., Rockson, S. G. 2000; 109 (4): 296-300
Abstract

A prospective evaluation was undertaken to assess the efficacy of intensive, short-term decongestive lymphatic therapy coupled with focused patient instruction in long-term self-care for the management of lymphedema.The therapeutic responses of 79 patients with lymphedema were analyzed prospectively. Each patient received intensive, short-term decongestive lymphatic therapy, with quantification of the extent and durability of the clinical response. Decongestive lymphatic therapy was performed by therapists trained in these techniques. The mean (+/-SD) duration of therapy was 8+/-3 days. Instruction in self-management techniques was incorporated into the therapeutic regimen by day 3 of the patient's treatment. The mean period of follow-up was 38+/-52 days. Changes in the volume of the affected limb were assessed with a geometric approximation derived from serial measurements of circumference along the axis of the limb.The mean short-term reduction in limb volume was 44%+/-62% of the excess volume in the upper extremities and 42%+/-40% in the lower extremities. At follow-up, these results were adequately sustained: mean long-term excess volume reductions of 38%+/-56% (upper extremities) and 41%+/-27% (lower extremities) were observed.Decongestive lymphatic therapy, combined with long-term self-management, is efficacious in treating patients with lymphedema of the extremity.

View details for Web of Science ID 000089356600005

View details for PubMedID 10996580
Photoangioplasty - An emerging clinical cardiovascular role for photodynamic therapy CIRCULATION Rockson, S. G., Lorenz, D. P., Cheong, W. F., Woodburn, K. W. 2000; 102 (5): 591-596
Abstract

Photodynamic therapy (PDT) has been studied and applied to various disease processes. The potential of PDT for selective destruction of target tissues is especially appealing in cardiovascular disease, in which other existing interventional tools are somewhat nonselective and carry substantial risk of damage to the normal arterial wall. Enthusiasm for photoangioplasty (PDT of vascular de novo atherosclerotic and, potentially, restenotic lesions) is fueled by more effective second-generation photosensitizers and technological advances in endovascular light delivery. This excitement revolves around at least 4 significant attributes of light-activated therapy: the putative selectivity and safety of photoangioplasty, the potential for atraumatic and effective debulking of atheromatous plaque through a biological mechanism, the postulated capability to reduce or inhibit restenosis, and the potential to treat long segments of abnormal vessel by simply using fibers with longer light-emitting regions. The available nonclinical data, coupled with the observations of a new phase I trial in human peripheral atherosclerosis, suggest a promising future for photoangioplasty in the treatment of primary atherosclerosis and prevention of restenosis.

View details for Web of Science ID 000088486200020

View details for PubMedID 10920074
Benefits of lipid-lowering agents in stroke and coronary heart disease: pharmacoeconomics. Current atherosclerosis reports Rockson, S. G. 2000; 2 (2): 144-150
Abstract

Coronary heart disease remains the leading cause of death in the United States. Although coronary heart disease and stroke entail very expensive therapies and extensive hospital utilization, the cost of preventive measures is also quite expensive. In this review, the factors that determine the cost-effectiveness of statin therapy for the primary and secondary prevention of coronary heart disease are discussed. A risk-based strategy for the selection of patients seems to provide cost-effective utilization of this potent treatment strategy. Appropriate patient selection should be accompanied by aggressive measures to improve utilization and compliance through improved physician and patient education.

View details for PubMedID 11122738
Lymphedema. Current treatment options in cardiovascular medicine Rockson, S. G. 2000; 2 (3): 237-242
Abstract

Aggressively applied decongestive measures (eg, manual lymphatic drainage, low-stretch bandaging, exercise, skin care, application of compressive elastic garments) are the mainstay of lymphatic therapy. Therapeutic regimens should differentiate between the goals of acute volume reduction and the maintenance of limb volume. Elastic garments should not be employed until maximal volume reduction has been attained through decongestive lymphatic techniques. It is my opinion that use of intermittent pneumatic compression devices can play an important adjunctive role to decongestive lymphatic therapy but should not be substituted for these techniques. At this time, I am not inclined to use pharmacologic therapy in these patients but anxiously await the results of studies that might demonstrate efficacy for molecular approaches. Surgical intervention is reserved for a small number of well-selected patients. Liposuction for volume reduction appears to be a very promising approach for specific patients.

View details for PubMedID 11096529
Lymphoscintigraphic manifestations of Hennekam syndrome - A case report ANGIOLOGY Rockson, S. G., De Los Santos, M., Szuba, A. 1999; 50 (12): 1017-1020
Abstract

Hennekam syndrome is a rare, recently described genetic disorder in which facial anomalies and mental retardation accompany congenital lymphedema and intestinal lymphangiectasia. Several other somatic abnormalities have variously been described, as have milder degrees of lymphatic dysfunction. The authors herein describe a case of Hennekam syndrome in which the diagnostic difficulties were partially overcome by the judicious use of radionuclide scintigraphy to verify the lymphedematous component of the patient's presentation.

View details for Web of Science ID 000084362900007

View details for PubMedID 10609768
Complex lower extremity edema in a young woman VASCULAR MEDICINE Rockson, S. G., Szuba, A. 1999; 4 (4): 273-274
View details for Web of Science ID 000084256600011
Fibroblast growth factor as therapy for critical limb ischemia: a case report VASCULAR MEDICINE Cooke, J. P., Bhatnagar, R., Szuba, A., Rockson, S. G. 1999; 4 (2): 89-91
Abstract

In an attempt to avert impending, primary amputation, an 85-year-old woman with chronic critical leg ischemia was enrolled in an experimental protocol to induce therapeutic angiogenesis. Treatment consisted of six consecutive, weekly intravenous infusions of recombinant basic fibroblast growth factor (bFGF). Angiographic evaluation was performed before and after therapy. The patient's clinical response was monitored through serial measurements of the ankle/brachial index and by repetitive assessment of limb flow by mercury strain-gauge plethysmography. A beneficial clinical response was detectable by week 4 of therapy, which was characterized by an improved walking distance, relief of ischemic pain, a marked reduction in analgesic consumption, and healing of persistent, unresponsive, painful inflammation of the hallux. The clinical improvement was sustained throughout the remaining weeks of therapy and follow-up evaluation. Plethysmography documented improved blood flow; specifically, the augmentation of digital flow was sustained and correlated with the marked improvement in the patient's clinical status.

View details for Web of Science ID 000081421600006

View details for PubMedID 10406455
Lutetium Texaphyrin: A New Therapeutic Tool for Human Atherosclerosis. Current treatment options in cardiovascular medicine Rockson, S. G. 1999; 1 (3): 199-202
View details for PubMedID 11096484
Precipitating factors in lymphedema: Myths and realities CANCER Rockson, S. G. 1998; 83 (12): 2814-2816
Abstract

Lymphedema is an all too common occurrence following breast carcinoma therapy. Despite its prevalence, the predisposing factors to the development of this secondary form of lymphedema remain poorly understood.Several studies have addressed these questions and are reviewed here.Treatment factors that appear to predispose to the late, subjective appearance of lymphedema include the extent of axillary surgery and exposure to high dose axillary radiotherapy, particularly when combined with surgical clearance of the axilla. Other pertinent patient factors may include the presence of hypertension and exposure to airline travel. Clinical features unrelated to the risk of lymphedema development include patient age; drug therapy; time interval to presentation, surgery, or radiotherapy to the breast; total dose of radiation; and menopausal status. The potential importance of concomitant venous abnormalities in these patients is worthy of consideration.Breast carcinoma-related secondary lymphedema is an important subjective and functional problem for affected patients. Additional research into the predisposing factors to this common problem is likely to foster enhanced patient education and to produce more efficacious measures to control this disease.

View details for Web of Science ID 000077732500008

View details for PubMedID 9874403
Workgroup III - Diagnosis and management of lymphedema CANCER Rockson, S. G., Miller, L. T., Senie, R., Brennan, M. J., Casley-Smith, J. R., Foldi, E., Foldi, M., Gamble, G. L., Kasseroller, R. G., Leduc, A., Lerner, R., Mortimer, P. S., Norman, S. A., Plotkin, C. L., Rinehart-Ayres, M. E., Walder, A. L. 1998; 83 (12): 2882-?
View details for Web of Science ID 000077732500022
Myocardial ischemia and infarction due to multiple coronary-cameral fistulae: Two case reports and review of the literature CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Wolf, A., Rockson, S. G. 1998; 43 (2): 179-183
Abstract

The functional significance of coronary-cameral fistulae, and the effect of these arterial anomalies upon effective coronary blood flow, continue to be debated. Two cases of coronary cameral fistulae, each of which illustrates the likelihood of an ischemic substrate, are herein presented, along with a review of the relevant literature regarding this disorder.

View details for Web of Science ID 000071801100015

View details for PubMedID 9488552
Images in vascular medicine. Phlegmasia coerulea dolens--venous gangrene. Vascular medicine Szuba, A., Cooke, J. P., Rockson, S. G. 1998; 3 (1): 29-31
View details for PubMedID 9666529
Images in vascular medicine. Lymphoscintigraphy in congenital lymphedema. Vascular medicine De Los Santos, M., Szuba, A., Rockson, S. G. 1998; 3 (4): 327-328
View details for PubMedID 10102673
Lymphedema: classification, diagnosis and therapy. Vascular medicine Szuba, A., Rockson, S. G. 1998; 3 (2): 145-156
Abstract

This review presents the diagnostic features, the pathophysiology and the available therapies for lymphedema. This disease is often able to be diagnosed by its characteristic clinical presentation, yet, in some cases, ancillary tests might be necessary to establish the diagnosis, particularly in the early stages of the disease and in edemas of mixed etiology. These diagnostic modalities are also useful in clinical studies. Available modalities include isotopic lymphoscintigraphy, indirect and direct lymphography, magnetic resonance imaging, computed tomography and ultrasonography. Lymphedema may be primary or secondary to the presence of other disease and/or to the consequences of surgery. Primary lymphedema may occur at any phase of life but it most commonly appears at puberty. Secondary lymphedema is encountered more often. The most prevalent worldwide cause of lymphedema is filariasis, which is particularly common in south-east Asia. In the USA, postsurgical lymphedema of the extremity prevails. Complications of chronic limb lymphedema include recurrent cellulitis and lymphangiosarcoma. Most patients are treated conservatively, by means of various forms of compression therapy, including complex physical therapy, pneumatic pumps and compressive garments. Volume reducing surgery is performed rarely. Lymphatic microsurgery is still in an experimental stage, although a few centers consistently report favorable outcomes.

View details for PubMedID 9796078
Peripheral arterial insufficiency: mechanisms, natural history, and therapeutic options. Advances in internal medicine Rockson, S. G., Cooke, J. P. 1998; 43: 253-277
View details for PubMedID 9506185
Lymphedema: anatomy, physiology and pathogenesis. Vascular medicine Szuba, A., Rockson, S. G. 1997; 2 (4): 321-326
Abstract

The authors review the current understanding of lymphatic anatomy and physiology, and the pathophysiology of lymphedema. The skin lymphatic system consists of the initial lymphatics, which converge into lymphatic precollectors, collectors and lymphatic ducts; these in turn convey the lymph to the regional lymph nodes. Interstitial fluid and particles enter the initial lymphatics through interendothelial openings and by vesicular transport. Lymphatic uptake is enhanced by external compression. Lymphatic transport depends greatly on contraction of lymphangions, which generate the suction force that promotes absorption of interstitial fluid and expels lymph to collecting ducts. In lymphedema, various types of congenital and acquired abnormalities of lymphatic vessels and lymph nodes have been observed. These often lead to lymphatic hypertension, valvular insufficiency and lymphostasis. Accumulation of interstitial and lymphatic fluid within the skin and subcutaneous tissue stimulates fibroblasts, keratinocytes and adipocytes eventuating in the deposition of collagen and glycosaminoglycans within the skin and subcutaneous tissue together with skin hypertrophy and destruction of elastic fibers.

View details for PubMedID 9575606
Limitations of Quantitative Coronary Angiography Guidebook to Coronary Endovascular Diagnostic Techniques. Geschwind HJ, Kern MJ, Editors. Futura Publications, Mt. Kisko, NY, Rockson S. 1997
Lymphedema: A review of the relevant anatomy and physiology of the lymphatics. Vascular Medicine Rockson S., Szuba A. 1997: 321-6
A novel therapy for lymphedema complicated by lymphorrhea. Vascular medicine Szuba, A., Cooke, J. P., Rockson, S. G. 1996; 1 (4): 247-250
Abstract

Lymphorrhea is a rarely described complication of chronic lymphedema, in which the disrupted flow through diseased lymphatic channels gives rise to the external drainage of lymph, often heralded by the presence of an enlarging lymphocele. This report documents the applicability of the Reid sleeve, a novel, conservative form of therapy, in an unusually severe and protracted example of lymphorrhea.

View details for PubMedID 9552579
Pregnancy-associated group B streptococcal endocarditis: a report of two fatal cases. Obstetrics and gynecology Sexton, D. J., Rockson, S. G., Hempling, R. E., CATHEY, C. W. 1985; 66 (3): 44S-47S
Abstract

Group B streptococci commonly colonize parturient women, yet pregnancy-associated endocarditis due to this organism is rare. Most reports of group B streptococcal endocarditis are from the preantibiotic era and occurred in women with rheumatic mitral valve disease. Reported herein are two cases of fatal group B streptococcal endocarditis involving the aortic valve of women with no preexisting heart disease. One had undergone a second-trimester abortion and the other had a normal pregnancy and uncomplicated vaginal delivery.

View details for PubMedID 3895083
PREGNANCY-ASSOCIATED GROUP-B STREPTOCOCCAL ENDOCARDITIS - A REPORT OF 2 FATAL CASES OBSTETRICS AND GYNECOLOGY Sexton, D. J., Rockson, S. G., Hempling, R. E., CATHEY, C. W. 1985; 66 (3): S44-S47
View details for Web of Science ID A1985APU2400015
PURIFICATION AND CHARACTERIZATION OF THE MAMMALIAN BETA-2-ADRENERGIC RECEPTOR BIOCHEMISTRY Homcy, C. J., Rockson, S. G., COUNTAWAY, J., Egan, D. A. 1983; 22 (3): 660-668
View details for Web of Science ID A1983QA68000021

View details for PubMedID 6301525
AN ANTIIDIOTYPIC ANTIBODY THAT RECOGNIZES THE BETA-ADRENERGIC-RECEPTOR JOURNAL OF CLINICAL INVESTIGATION Homcy, C. J., Rockson, S. G., Haber, E. 1982; 69 (5): 1147-1154
Abstract

Antialprenolol rabbit antibodies were fractionated on an acebutolol affinity resin, followed by L-propranolol elution so as to separate a class of binding sites that mimic the beta-adrenergic receptor. Allotype-identicaL rabbits were immunized with this fraction. After 6 mo, antisera exhibited antiidiotypic activity inhibiting [3H]alprenolol binding to the original antibody and to rabbit antiacebutolol antibodies, which had a spectrum of ligand-binding properties identical to the original idiotype. Those antisera demonstrating the original idiotype. Those antisera demonstrating the most potent antiidiotypic activity also blocked [3H]alprenolol binding to the beta-adrenergic receptor of turkey membrane, canine pulmonary membrane, and rat reticulocyte. An idiotype affinity-purified fraction showed similar activity, inhibiting beta-receptor binding with a calculated dissociation constant (KD) of 53 nM. Isoproterenol-mediated adenylate cyclase activity was also inhibited in a competitive manner. The universality of recognition of these antiidiotypic antisera indicate that the three-dimensional structure of a receptor's binding site can be modeled by a subset of an elicited antibody population.

View details for Web of Science ID A1982NN58300010

View details for PubMedID 6279698
CELLULAR MECHANISMS OF IMPAIRED ADRENERGIC RESPONSIVENESS IN NEONATAL DOGS JOURNAL OF CLINICAL INVESTIGATION Rockson, S. G., Homcy, C. J., QUINN, P., MANDERS, W. T., Haber, E., Vatner, S. F. 1981; 67 (2): 319-327
Abstract

The myocardial responsiveness of conscious, instrumental dogs to exogenously administered isoproterenol and norepinephrine was investigated in neonatal, 6-wk-old, and adult animals. Comparable base-line values for peak left ventricular derivative of pressure with respect to time were observed in all age categories. However, when compared with adult responses, the sympathomimetic amine-induced increases in neonatal left ventricular dP/dt were significantly blunted at each concentration of adrenergic agonist examined, whereas the 6-wk-old puppies displayed an intermediate inotropic response. To investigate the cellular mechanisms of this blunted neonatal response, we correlated physiologic and biochemical measurements of the myocardial responses to catecholamines in each age category. When compared with adult myocardial membrane preparations, neonatal cardiac membranes were characterized in vitro by an increased density of beta-adrenergic binding sites, comparable affinity for adrenergic agonists and antagonists, and an enhanced coupling of adenylate cyclase activation to receptor occupancy. Simultaneous changes in either the serum catecholamine concentration or the membrane content of other intrinsic proteins failed to account for the observed neonatal increase in beta-adrenergic receptor density. These findings are most consistent with a compensatory mechanism of the cardiac cell membrane, whereby an inherent depression in the adrenergic responsiveness of the immature myocardium appears to induce the increase in receptor density and activation of adenylate cyclase.

View details for Web of Science ID A1981LA65700001

View details for PubMedID 6257759
ANTI-ALPRENOLOL ANTIBODIES IN THE RABBIT - A NEW PROBE FOR THE STUDY OF BETA-ADRENERGIC-RECEPTOR INTERACTION CIRCULATION RESEARCH Rockson, S. G., Homcy, C. J., Haber, E. 1980; 46 (6): 808-813
Abstract

We immunized rabbits with an antigen prepared by covalent linkage of alprenolol, a beta-adrenergic receptor antagonist, to bovine serum albumin. Competitive inhibition of [3H]dihydroalprenolol binding to antisera with a variety of unlabeled ligands revealed broad antibody specificity for beta-adrenergic antagonists and agonists. The antiserum was subjected to affintiy fractionation on hydroxybenzylpindolol-Sepharose 4B. Successive elution with 100 mM Tris HCl, 1M NaCl, 4 M LiBr, and 5 M guanidine yielded fractions with increasing affintiy for hydroxybenzylpindolol. The ligand-binding properties of these affinity-fractionated antibodies suggest that certain of these fractions recognize structural aspects of individual beta-adrenergic ligands which are irrelevant to their biological activity, whereas others can be used to distinguish shared functional properties, such as the ethanolamine side chain, within the structural heterogeneity of beta-adrenergic drugs. In particular, elution of hydroxybenzylpindolol-adsorbed antibody with (-)-propranolol allowed identification of an antibody fraction specific for the (-)-stereoisomer. Thus, affinity fractionation of antibodies raised against beta-adrenergic ligands can provide useful analogues for the further study of the recognition properties of the beta-adrenergic receptor.

View details for Web of Science ID A1980JW90400010

View details for PubMedID 6247081
PLASMA DOPAMINE-BETA-HYDROXYLASE IN DIAGNOSIS OF NEUROBLASTOMA CANCER Rockson, S. G., Stone, R. A., ODERE, F., GUNNELLS, J. C. 1976; 37 (1): 386-389
Abstract

An atypical case of neuroblastoma is described, in which the diagnosis was facilitated by the application of a new biochemical procedure, the assay of plasma dopamine-beta-hydroxylase activity. This laboratory tool is proposed as a useful adjunct to established techniques in the diagnosis of neural crest tumors.

View details for Web of Science ID A1976BF17600047

View details for PubMedID 1247966
PLASMA DOPAMINE-BETA-HYDROXYLASE ACTIVITY IN ORAL-CONTRACEPTIVE HYPERTENSION CIRCULATION Rockson, S. G., Stone, R. A., GUNNELLS, J. C., Schanberg, S. M., KIRSHNER, N., Robinson, R. R. 1975; 51 (5): 916-923
Abstract

A prospective study was undertaken to evaluate the relative contribution of changes in sympathetic nervous system activity, as reflected by changes in dopamine-beta-hydroxylase (DBH) activity, to the pathogenesis of oral contraceptive-induced hypertension. Precontraceptive and serial post contraceptive determinations of blood pressure, plasma renin activity (PRA), DBH activity, and changes in body weight were obtained in twelve control patients and forty-one oral contraceptive users. Forty-four percent of oral contraceptive users had increases in blood pressure but remained normotensive and 17% became frankly hypertensive. The precontraceptive and average post contraceptive levels of mean arterial pressure (MAP), PRA and DBH activity in each patient were compared using paired group analysis. Control patients (group I) exhibited no significant changes in these variables, while the patients with contraceptive-induced increases in MAP (groups III and IV) underwent significant, parallel increases in DBH activity. Finally, the linear regression of changes in MAP on the percent change in DBH activity was examined. The positive slopes in groups III and IV differed significantly from the negative slope of the controls (group I). The data have been interpreted to reflect an inappropriate oral contraceptive-induced stimulus to sympathetic nervous system activity, leading to increases in MAP in susceptible individuals.

View details for Web of Science ID A1975AA03800021

View details for PubMedID 1122595
LESCH-NYHAN SYNDROME - EVIDENCE FOR ABNORMAL ADRENERGIC FUNCTION SCIENCE Rockson, S., Stone, R., VANDERWE, M., Kelley, W. N. 1974; 186 (4167): 934-935
Abstract

Subjects with the Lesch-Nyhan syndrome (hypoxanthine-guanine phosphoribosyltransferase deficiency with self-mutilation) exhibit an apparently unique pattern of adrenergic dysfunction characterized by elevated plasma dopamine beta-hydroxylase activity and an absence of pressor response to acute sympathetic stimulation. Patients with a partial deficiency of hypoxanthine-guanine phosphoribosyltransferase without self-mutilation do not exhibit these abnormalities of adrenergic function.

View details for Web of Science ID A1974U773500024

View details for PubMedID 4469689
SOLITARY RENAL CYST WITH SEGMENTAL ISCHEMIA AND HYPERTENSION JOURNAL OF UROLOGY Rockson, S. G., Stone, R. A., GUNNELLS, J. C. 1974; 112 (5): 550-552
View details for Web of Science ID A1974U697800004

View details for PubMedID 4424446

Conference Proceedings

Causes and consequences of lymphatic disease Rockson, S. G. WILEY-BLACKWELL. 2010: E2-E6
Abstract

The visceral manifestations of lymphatic disorders (lymphangiomatosis and lymphangiectasia) are particularly severe. Any pathology of the lymphatic vasculature, whether superficial or internal, regional, or systemic, is predominated by the appearance of lymphedema, the characteristic form of tissue edema that occurs when lymphatic dysfunction supervenes. Disease manifestations may include dysregulation of body fluid homeostasis, immune traffic impairment, and disturbances of lipid and protein reabsorption from the gut lumen. The appearance of lymphatic edema invokes complex biological alterations. Many of these changes seem to relate uniquely to chronic lymphatic edema, including a profound stimulus to collagen and adipose deposition. Despite the recent advances in our understanding of these disorders, substantial knowledge gaps remain; these gaps inhibit our ability to accurately identify, categorize, treat, and prevent these diseases. Future diagnostic, therapeutic, and reproductive decisions for affected individuals require an accurate knowledge of the clinical and laboratory presentation, mode of inheritance, treatment response, outcomes, and prognosis.

View details for DOI 10.1111/j.1749-6632.2010.05804.x

View details for Web of Science ID 000288277700002

View details for PubMedID 20961302
Lymphatic research: past, present, and future. Rockson, S. G. 2009: 183-187
View details for DOI 10.1089/lrb.2009.7402

View details for PubMedID 20143916
Therapeutic lymphangiogenesis in a rabbit ear model of chronic post-surgical lymphatic insufficiency Szuba, A., Skobe, M., Shin, W., Beynet, D. P., Rockson, N. B., Dakhil, N., Goris, M. L., Strauss, H. W., Quertermous, T., Alitalo, K., Rockson, S. G. FEDERATION AMER SOC EXP BIOL. 2002: A516-A516
View details for Web of Science ID 000174533602861
A model for chronic, post-surgical lymphatic insufficiency Shin, W., Szuba, A., Skobe, M., Beynet, D. P., Rockson, N. B., Dakhil, N., Goris, M. L., Strauss, H. W., Quertermous, T., Alitalo, K., Rockson, S. G. FEDERATION AMER SOC EXP BIOL. 2002: A123-A124
View details for Web of Science ID 000174533600683
A model of acute, post-surgical lymphedema Beynet, D. P., Szuba, A., Skobe, M., Rockson, N. B., Dakhil, N., Shin, W., Goris, M. L., Strauss, H. W., Quertermous, T., Alitalo, K., Rockson, S. G. FEDERATION AMER SOC EXP BIOL. 2002: A124-A124
View details for Web of Science ID 000174533600684
Photoangioplasty for human peripheral atherosclerosis - Results of a phase I trial of photodynamic therapy with motexafin lutetium (Antrin) Rockson, S. G., Kramer, P., Razavi, M., Szuba, A., Filardo, S., Fitzgerald, P., Cooke, J. P., Yousuf, S., DeVault, A. R., Renschler, M. F., Adelman, D. C. LIPPINCOTT WILLIAMS & WILKINS. 2000: 2322-2324
Abstract

In photoangioplasty, light activation of a photosensitive drug offers the potential for treatment of long segments of vascular disease. This is a brief description of a study designed to evaluate the safety and tolerability of a new photosensitizer, Antrin (motexafin lutetium), in the endovascular treatment of atherosclerosis.An open-label, single-dose, escalating drug- and light-dose study was performed in patients with atherosclerotic peripheral arterial insufficiency. Clinical evaluation, serial quantitative angiography, and intravascular ultrasonography were performed. Therapy was well tolerated, and only minor side effects were observed. Treatment produced no deleterious vascular effects. Although this study was not designed to examine clinical efficacy, several secondary end points suggested a favorable therapeutic effect.This phase I study demonstrates that photoangioplasty with motexafin lutetium is well tolerated and safe. Preliminary efficacy data suggest a future role for the treatment of flow-limiting atherosclerosis.

View details for Web of Science ID 000165169200001

View details for PubMedID 11067782
American Cancer Society Lymphedema Workshop. Workgroup III: Diagnosis and management of lymphedema. Rockson, S. G., Miller, L. T., Senie, R., Brennan, M. J., Casley-Smith, J. R., Földi, E., Földi, M., Gamble, G. L., Kasseroller, R. G., Leduc, A., Lerner, R., Mortimer, P. S., Norman, S. A., Plotkin, C. L., Rinehart-Ayres, M. E., Walder, A. L. 1998: 2882-2885
View details for PubMedID 9874417

Allan and Tina Neill Professor of Lymphatic Research and Medicine

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