Food additives used in apple juice, yogurts and red wine could reverse lymphedema swelling, according to research published in the journal Nature.
Scientists at the National University of Singapore discovered that starch-derived compounds called cyclodextrins can reverse fluid retention and inflammation, offering potential hope to millions of patients.
The condition causes severe swelling in the arms and legs and currently affects up to 10 million people in the United States, many as a result of cancer treatment.
About one in five people develops lymphedema in the arm following breast cancer treatment, such as surgery to remove lymph nodes or radiotherapy to clear cancer cells.
Lymph nodes are bean-shaped structures located all around the body that filter waste from lymph fluid, which consists of liquid and waste produced by tissues before joining the bloodstream.
However, lymph nodes are also often the first location cancer cells migrate to when developing in nearby tissues in the breast, head or neck, before traveling to other vital organs such as the lungs.
Surgically removing nodes to prevent cancer spreading or treating them with radiotherapy can damage the lymph system and cause blockages, leading to a chronic build-up of fluid that makes simple tasks like getting dressed extremely difficult.
Current treatment options and high medical costs
Research suggests the impact of lymphedema on quality of life can be considerable, while existing medical treatment options remain limited.
Patients are initially advised to try compression sleeves or stockings on swollen limbs, but these must be worn daily, restrict movement, and can cause skin irritation and itching.
Another option is manual lymphatic drainage, a type of massage patients perform themselves, which requires regular application to deliver good results.
Surgery to replumb lymphatic vessels so fluid does not build up is available, but studies suggest it costs between $15,000 and $42,000 and still requires ongoing treatment.
Liposuction, where excess fluid and fat is broken up using lasers or high-frequency sound waves before being sucked out by a machine, can also be prohibitively expensive for many people.
How cyclodextrin targets cholesterol build-up
The study by scientists at the National University of Singapore suggests a cheaper and more practical solution focusing on cyclodextrin, a compound formed from starch.
Cyclodextrin has been used for years throughout the food and drink industry to improve the smell and taste of products by trapping unwanted odors that sour flavor.
The compound is also widely used to remove cholesterol from dairy products such as cheese and butter to create low-fat versions, encapsulating cholesterol crystals inside its hollow interior and attracting water to flush them away.
When the Singapore team analyzed skin tissue from women with lymphedema who were undergoing treatment for breast cancer, they found that reduced lymphatic flow was associated with large amounts of cholesterol accumulating in surrounding tissue.
Although lymphatic vessels normally transport cholesterol from tissues back to the bloodstream, the study showed that cholesterol build-up actively drives lymphedema by causing inflammation and scarring that blocks normal lymph flow.
Animal trial results and vessel regeneration
To test whether cyclodextrin could alleviate swelling, researchers treated mice with lymphedema by regularly injecting the compound into affected areas over eight weeks.
The results showed that cyclodextrin significantly reduced swelling and inflammation in the animals.
As a bonus, researchers found that cyclodextrin appeared to help regenerate damaged lymphatic vessels, leading to a gradual reversal of symptoms.
Babak Mehrara, chief of the plastic and reconstructive surgery service at Memorial Sloan Kettering Cancer Center in New York, who wrote a review of the study for Nature, explained the cycle of the disease.
"Lymphedema is a fluid retention problem but fluid accumulation causes inflammation, which inhibits the function of existing lymphatics," Mehrara said.
"That leads to more fluid accumulation and more inflammation. Fat deposits and cholesterol build-up then occurs as a result of the inflammatory changes."
Expert reaction and future clinical trials
Professor Kefah Mokbel, a consultant breast surgeon at the London Breast Institute, said the findings open a genuinely new therapeutic avenue.
"This is potentially groundbreaking because lymphedema remains a chronic condition with no cure," Mokbel said.
"The study identifies excessive cholesterol deposition in affected tissues as a potential target for treatments. But we need carefully designed human trials to establish safety and efficacy."
Mokbel added that cholesterol-lowering drugs such as statins would be unlikely to work because they target cholesterol in the bloodstream rather than specifically in the lymph nodes.
