Lymphedema and Latest Research          Initiatives for Lymphedema                Eva M. Sevick-Muraca, Ph.D.             ...
Disclosures• Investigational human studies presented  herein were funded by the National Institutes  of Health• Investigat...
Acknowledgements                                           Memorial Herman Hospital/UT                                    ...
An IntroductionTHE LYMPHATICS                  http://www.tqnyc.org/NYC04071                  9/lymphatic_system.htm      ...
Initial and Collecting Lymphatics                                                           www.thodgeslmp.comValves      ...
10/26/2011   6
Lymphedema• 3-5 million Americans suffer from  lymphedema; 12 million are at risk• Occurs months to years after cancer  tr...
Current “State-of-the Art”HOW TO IMAGE THE LYMPHATICS?                               8
NIR Fluorescent Lymphatic Contrast Agent                                        lymphatic                                 ...
NIR Fluorescence Imaging DeviceMelissa Aldrich, (CMI)    10/26/2011                                     10
10/26/2011   11
Forearm                                                                             Axilla                                ...
NIRFLI versus lymphoscintigraphy10/26/2011                                      13
Some example results            Adams and Alitalo, 2007Rasmussen, et al., 2009, 2010DISEASED LYMPHATICS                   ...
10/26/2011   15
10/26/2011   16
Melissa Aldrich, (CMI)
Prox1 +/-                 Normal Mice (courtesy of G. Oliver)10/26/2011                               18
Images of 6 week old VEGFR3+/- (Chy) Mouse                    White Light                      Fluorescence               ...
Some example resultsSTAGING OF DISEASE                       20
Imaging progression of BCRLMelissa Aldrich, (CMI)   10/26/2011                                 21
Lymphatic architectural anomalies        observedb in BCRLc subjects.        a                        d            hyperpl...
Some example resultsAdams, et al., 2010, Tan et al., 2011STIMULATION OF LYMPHATICFUNCTION                                 ...
10/26/2011   Confidential   24
10/26/2011   25
10/26/2011   26
10/26/2011   27
10/26/2011   28
10/26/2011   29
Pneumatic Compression    Devices (PCDs)
Vessel recruitment
An Introduction   THE GENETICS OF RARE LYMPHATIC   DISORDERS10/26/2011                          33
The “Genotype”10/26/2011                    34
Adapted from Trusolino, et al., 201010/26/2011                                   35
Whole Exome Sequencing     • The Human Genome has 6 billion base pairs, but only       1-2 % of the Genome has Information...
10/26/2011             The “Phenotype”   37
Family Studies• Rare diseases      Common Diseases  provide insight  into more  common  diseases• Efficient  genetic studi...
10/26/2011   39
SO, WHAT TO DO? HOW TO DISCOVERY  CURES FOR LYMPHEDEMA10/26/2011                           40
Summary/Speculations• Lymphatic involvement plays a significant role  in the development of lymphedema.• NIR fluorescence ...
Lymphedema & Latest Research Initiatives, Dr. Eva Sevick - 7th Annual Breast Health Summit
Upcoming SlideShare
Loading in …5
×

Lymphedema & Latest Research Initiatives, Dr. Eva Sevick - 7th Annual Breast Health Summit

1,717 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,717
On SlideShare
0
From Embeds
0
Number of Embeds
8
Actions
Shares
0
Downloads
23
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Lymphedema & Latest Research Initiatives, Dr. Eva Sevick - 7th Annual Breast Health Summit

  1. 1. Lymphedema and Latest Research Initiatives for Lymphedema Eva M. Sevick-Muraca, Ph.D. October 21, 2011 Breast Health Summit, Houston, TX10/26/2011 1
  2. 2. Disclosures• Investigational human studies presented herein were funded by the National Institutes of Health• Investigational studies were approved by the FDA under several INDs and institutional IRBs.• Investigators could receive financial gain associated with imaging techniques developed in the course of these studies.10/26/2011 2
  3. 3. Acknowledgements Memorial Herman Hospital/UT Caroline E. Fife, M.D.; Erik A. Maus,Center for Molecular Imaging/IMM M.D.; Latisha Smith, M.D., LisaMilton Marshall, Ph.D. Kinder, B.S.Ali Azhdarina, Ph.D.; John C. M.D. Anderson Cancer Center Rasmussen, Ph.D.; Sunkuk Kwon, Janice Cormier, M.D., and Funda Ph.D.; Kristen Adams, Ph.D Meric Bernstam, M.D.Melissa Aldrich, Ph.D.; Sukhen Ghosh, Ph.D.; Pradeed Ghosh, Ph.D.; Yujie Next Generation Sequencing Lu, Ph.D.; I-Chih Tan, Ph.D.; Banghe Center/IMM Zhu, Ph.D. Manuel Gonzalez-Garay, Ph.D.; OtisChinmay Darne, Ph.D.; Lakshmi Hall; C. Thomas Caskey, M.D. Sampath, M.S.; Pier- Anne Lachance, B.S.; Cynthia Davies- The >250 volunteer subjects who Venn, B.S.; Germaine Agollah, M.S., generously gave their time and Nathaniel Wilganowski, B.S.; Holly bodies for research Robinson; Karen Gore
  4. 4. An IntroductionTHE LYMPHATICS http://www.tqnyc.org/NYC04071 9/lymphatic_system.htm 4
  5. 5. Initial and Collecting Lymphatics www.thodgeslmp.comValves Lymphangion www.thodgeslmp.com Alitalo, K., et.al., Nature, 2005. www.thodgeslmp.com
  6. 6. 10/26/2011 6
  7. 7. Lymphedema• 3-5 million Americans suffer from lymphedema; 12 million are at risk• Occurs months to years after cancer treatment, estimated to afflict between 9 – 40% of all breast cancer survivors• Increased risk with axillary lymph node dissection• Increased risk with radiation treatment• Also occurs rarely as a congenital disease10/26/2011 7
  8. 8. Current “State-of-the Art”HOW TO IMAGE THE LYMPHATICS? 8
  9. 9. NIR Fluorescent Lymphatic Contrast Agent lymphatic capillaries pre-collectors systemic circulation collectors lymph node10/26/2011 Melissa Aldrich, (CMI) 9
  10. 10. NIR Fluorescence Imaging DeviceMelissa Aldrich, (CMI) 10/26/2011 10
  11. 11. 10/26/2011 11
  12. 12. Forearm Axilla Shoulder ElbowMicrodosing: Sevick-Muraca, et al., Radiology, 2008 Upper arm Upper arm a b Thigh Groin Thigh Calf
  13. 13. NIRFLI versus lymphoscintigraphy10/26/2011 13
  14. 14. Some example results Adams and Alitalo, 2007Rasmussen, et al., 2009, 2010DISEASED LYMPHATICS 14
  15. 15. 10/26/2011 15
  16. 16. 10/26/2011 16
  17. 17. Melissa Aldrich, (CMI)
  18. 18. Prox1 +/- Normal Mice (courtesy of G. Oliver)10/26/2011 18
  19. 19. Images of 6 week old VEGFR3+/- (Chy) Mouse White Light Fluorescence Possible lymphatic vessel Swollen abdomenDavies-Venn 19/30
  20. 20. Some example resultsSTAGING OF DISEASE 20
  21. 21. Imaging progression of BCRLMelissa Aldrich, (CMI) 10/26/2011 21
  22. 22. Lymphatic architectural anomalies observedb in BCRLc subjects. a d hyperplasia of nonmobile mobile vessels/tortuous extravascular extravascular “starry night” lymphatic bundles ICG/hypoplasia ICG/hypoplasiaMelissa Aldrich, (CMI)
  23. 23. Some example resultsAdams, et al., 2010, Tan et al., 2011STIMULATION OF LYMPHATICFUNCTION 23
  24. 24. 10/26/2011 Confidential 24
  25. 25. 10/26/2011 25
  26. 26. 10/26/2011 26
  27. 27. 10/26/2011 27
  28. 28. 10/26/2011 28
  29. 29. 10/26/2011 29
  30. 30. Pneumatic Compression Devices (PCDs)
  31. 31. Vessel recruitment
  32. 32. An Introduction THE GENETICS OF RARE LYMPHATIC DISORDERS10/26/2011 33
  33. 33. The “Genotype”10/26/2011 34
  34. 34. Adapted from Trusolino, et al., 201010/26/2011 35
  35. 35. Whole Exome Sequencing • The Human Genome has 6 billion base pairs, but only 1-2 % of the Genome has Information necessary to generate proteins • (90 million base pairs) • Genes are blocks of Exons • Exome = all exons5 3 GENE1 Introns Exons, information necessary to generate proteins
  36. 36. 10/26/2011 The “Phenotype” 37
  37. 37. Family Studies• Rare diseases Common Diseases provide insight into more common diseases• Efficient genetic studies require entire family studies for gene discovery Rare Diseases 10/26/2011 38
  38. 38. 10/26/2011 39
  39. 39. SO, WHAT TO DO? HOW TO DISCOVERY CURES FOR LYMPHEDEMA10/26/2011 40
  40. 40. Summary/Speculations• Lymphatic involvement plays a significant role in the development of lymphedema.• NIR fluorescence lymphatic imaging could play a role in diagnosing, identifying treatment.• Family genetic studies of rare diseases could provide opportunities to understand breast cancer related lymphedema.10/26/2011 41

×