Lymphedema is a
chronic condition causes by a lymphatic dysfunction that leads to the accumulation of fluid and fat in the limb. Here, the inventors identified the
bioactive peptide apelin as good candidate to restore the lymphatic flow in
lymphedema. They found a significant decrease in
apelin expression in women lymphedematous arm compared to their normal arm. Using an
apelin-
knockout mouse model, they confirmed the crucial role of apelin as
lymphedema was maintained more than 4 weeks after
surgery and was associated with a lack of
dermis lymphangiogenesis and increased dermal
backflow. The inventors show that
intradermal injection of apelin-lentivector significantly reduced limb swelling. This was associated with a reduction of
dermis fibrosis and increase in lymphatic density. Importantly, apelin stimulates eNOS-mediated lymphatic pumping via Akt and eNOS
phosphorylation in lymphatic endothelial cells (LEC). This was associated with significant increase in E2F8-targeted
gene expression through the
direct binding of E2F8 on CCBE1
promoter in LEC. Taken together, the results show that apelin plays a key role in
lymphedema and thus represents a novel partner for VEGF-C to prevent limb swelling and
tissue fibrosis in lymphedema.