Effect of complex decongestive physiotherapy on gene expression for the inflammatory response in peripheral lymphedema

Complex decongestive physiotherapy (CDP), consisting of manual lymph draina ge, compression bandaging, remedial exercises and skin care, mobilizes accu mulated edema fluid and increases lymph flow. On the other hand, if also ha s a beneficial therapeutic effect on fibrosclerosis. Because little is know n of its possible mode of action on a molecular let el, this preliminary st udy evaluated CDP in patients with peripheral leg lymphedema as to the pote ntial role of gene expression in the inflammatory response. The quantitativ e expression of genes for CD14, interferon-gamma receptor (IFN gamma R), tu mor necrosis factor-alpha (TNF alpha), integrin alpha(4)beta(1) (VLA-4), tu mor necrosis factor receptor p55 (TNFR1) and CD44 (standard form) was exami ned in 9 patients with primary or secondary leg lymphedema before and after phase 1 of CDP. Overall, there was a decrease of expression of these pro-i nflammatory genes after CDP, suggesting that biologic mechanisms implicated in the inflammatory cascades in other disorders are also involved in the f ibrosclerotic reactivity in lymphedema. However, whereas each patient acted as his or her own control before and after CDP, gene expression in normal patients and normal limbs before and after CDP needs to be examined before the full meaning of these observations can be understood.