Abstract
Radiation therapy after lymph node dissection increases the risk of developing painful and incurable lymphedema in breast cancer patients. Lymphedema occurs when lymphatic vessels become unable to maintain proper fluid balance. The sensitivity of lymphatic endothelial cells (LECs) to ionizing radiation has not been reported to date. Here, the radiosensitivity of LECs in vitro has been determined using clonogenic survival assays. The ability of various growth factors to alter LEC radiosensitivity was also examined. Vascular endothelial growth factor (VEGF)-C enhanced radiosensitivity when LECs were treated prior to radiation. VEGF-C-treated LECs exhibited higher levels of entry into the cell cycle at the time of radiation, with a greater number of cells in the S and G2/M phases. These LECs showed higher levels of γH2A.X—an indicator of DNA damage—after radiation. VEGF-C did not increase cell death as a result of radiation. Instead, it increased the relative number of quiescent LECs. These data suggest that abundant VEGF-C or lymphangiogenesis may predispose patients to radiation-induced lymphedema by impairing lymphatic vessel repair through induction of LEC quiescence.
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Acknowledgments
This work was funded by NIH R00CA137167, NIH DP2OD008780 and NCI Federal Share/MGH Proton Beam Income on C06 CA059267. We would like to thank Dr. Rakesh Jain, Dr. Brian Seed, Dr. Dai Fukumura, Dr. Jay Loeffler, Nicole Magpayo and members of the Edwin L. Steele Laboratories for helpful discussions. We would also like to thank Dr. David Schoenfeld and Harvard Catalyst Biostatistical Consulting.
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Cristina T. Kesler and Angera H. Kuo have contributed equally to this work.
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Kesler, C.T., Kuo, A.H., Wong, HK. et al. Vascular endothelial growth factor-C enhances radiosensitivity of lymphatic endothelial cells. Angiogenesis 17, 419–427 (2014). https://doi.org/10.1007/s10456-013-9400-7
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DOI: https://doi.org/10.1007/s10456-013-9400-7