Complex decongestive physiotherapy (
CDP), consisting of
manual lymph drainage, compression bandaging,
remedial exercises and
skin care, mobilizes accumulated
edema fluid and increases lymph flow. On the other hand, it also has a beneficial
therapeutic effect on fibrosclerosis. Because little is known of its possible mode of action on a molecular level, this preliminary study evaluated
CDP in patients with peripheral leg
lymphedema as to the potential role of gene expression in the inflammatory response. The quantitative expression of genes for CD14,
interferon-gamma receptor (IFN gamma R),
tumor necrosis factor-alpha (
TNF alpha),
integrin alpha 4 beta 1 (VLA-4),
tumor necrosis factor receptor p55 (
TNFR1) and CD44 (standard form) was examined 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-inflammatory genes after
CDP, suggesting that
biologic mechanisms implicated in the inflammatory cascades in other disorders are also involved in the fibrosclerotic 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.