title: Extracorporeal shock wave therapy combined with vascular endothelial growth factor-C hydrogel for lymphangiogenesis.
abstract: OBJECTIVE
  Lymphedema is a clinically incurable disease that occurs commonly after lymph node dissection and/or irradiation. Several studies have recently demonstrated that extracorporeal shock wave therapy (ESWT) could promote lymphangiogenesis associated with expression of vascular endothelial growth factor (VEGF)-C. This research concerned primarily the synergistic effect of ESWT combined with VEGF-C incorporated hydrogel (VEGF-C hydrogel) combination therapy for promoting lymphangiogenesis and ultimately alleviating lymphedema.
  
  
  METHODS
  The VEGF-C hydrogel was applied to the injury site in a mouse model of lymphedema and then regularly underwent ESWT (0.05 mJ/mm(2), 500 shots) every 3 days for 4 weeks.
  
  
  RESULTS
  Four weeks after the treatment, mice treated with VEGF-C hydrogel and ESWT showed signs of the greatest decrease in edema/collagenous deposits when compared with the other experimental group. LYVE-1-positive vessels also revealed that the VEGF-C/ESWT group had significantly induced the growth of new lymphatic vessels compared to the other groups. Western blot analysis showed that expression of VEGF-C (1.24-fold) and VEGF receptor-3 (1.41-fold) was significantly increased in the VEGF-C/ESWT group compared to the normal group.
  
  
  CONCLUSIONS
  These results suggested that VEGF-C and ESWT had a synergistic effect and were very effective in alleviating the symptoms of lymphedema and promoting lymphangiogenesis.
authors.affiliation: Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: In Gul
authors.initials: IG
authors.lastname: Kim
authors.forename: Ji Youl
authors.initials: JY
authors.lastname: Lee
authors.forename: David S
authors.initials: DS
authors.lastname: Lee
authors.forename: Jeong Yi
authors.initials: JY
authors.lastname: Kwon
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Hwang
mesh_terms: D000818:Animals; D003131:Combined Modality Therapy; D004195:Disease Models, Animal; D004353:Drug Evaluation, Preclinical; D004343:Drug Implants; D005260:Female; D005780:Gelatin; D005786:Gene Expression Regulation / Q000187:drug effects; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006614:Hindlimb; D020100:Hydrogels; D042583:Lymphangiogenesis / Q000187:drug effects*; D042601:Lymphatic Vessels / Q000187:drug effects / Q000293:injuries / Q000502:physiology; D008209:Lymphedema / Q000188:drug therapy / Q000628:therapy*; D008262:Macrophage Activation / Q000187:drug effects; D051379:Mice; D008807:Mice, Inbred BALB C; D012038:Regeneration / Q000187:drug effects; D042582:Vascular Endothelial Growth Factor C / Q000008:administration & dosage / Q000096:biosynthesis / Q000235:genetics / Q000627:therapeutic use*; D040321:Vascular Endothelial Growth Factor Receptor-3 / Q000096:biosynthesis / Q000235:genetics; D014945:Wound Healing / Q000187:drug effects / Q000502:physiology
chemical_list: D004343:Drug Implants; D020100:Hydrogels; D042582:Vascular Endothelial Growth Factor C; C467483:vascular endothelial growth factor C, mouse; D005780:Gelatin; D040321:Vascular Endothelial Growth Factor Receptor-3