The role of the mononuclear system in lymphoedema is detailed. The occurrence of localized regions of bacterial and non-bacterial inflammation during the course of lymphoedema is discussed. Some analogies are drawn between the functioning of the blood-tissue-lymph system in thermal injury, in wounds and lymphoedema. The behavior of the cells of the mononuclear system (specifically the macrophage) is discussed in each of these and interrelated to explain the underlying histo-pathological changes which occur during the progression of lymphoedema. It seems that the majority of such changes can be ascribed to changes in macrophage function - particularly those of the fixed tissue population. For instance, the spread of fibrosis from focal accumulations to the whole limb in chronic lymphoedema of long duration seems to be the consequence of a failure of the members of the mononuclear phagocytic system to maintain the delicate balance between collagen lysis and deposition. The evidence relating to the activity of such cells can appear contradictory, the results being dependent on the model, the technique, and just what the research group is looking for. Some data have shown macrophage activity to be depressed. Others have shown that the macrophages like the conditions which stagnating fluids and low oxygen tension offer, and in fact deposit large quantities of collagen in these areas. Whether macrophage activation is only transient when the cells enter the affected area from the circulation or whether some remain activated throughout their stay in the tissues is not exactly known, and much needs to be done in this area. However, it certainly seems that the macrophage does play an important role in collagen metabolism in the lymphoedematous tissues. It seems also that this cell substantially contributes to the high degree of vascularization seen in lymphoedematous tissues. A further study of the macrophage and its immediate precursors is absolutely necessary - it may provide an answer to the question concerning the progressive histopathological changes which we know as lymphoedema. More importantly, however, it may lead us to ways to control these processes with the subsequent elimination of the oedema. Since at least one person in ten will suffer from lymphoedema of some type during their lives, this work is of extreme importance.
|Number of pages||8|
|Journal||Zeitschrift fur Lymphologie|
|Publication status||Published - 1 Dec 1980|