Lipoedema news:
causes and pathophysiology
Lipedemais a chronic, progressive disease characterized by abnormal deposits of subcutaneous fat tissue and a significant increase in the volume of the lower limbs.
Although the lower limbs are more frequently affected, the disease can also develop to a lesser extent in the upper limbs.
Discover the causes and its pathophysiology.
Etiology of lipedema
It is a multifactorial disease, meaning that it depends on several different circumstances.
Genetics
There is some evidence of genetic predisposition. Family history is checked for 15 to 64% (recent studies suggest up to 89%) of affected patients.
The inheritance pattern is autosomal dominant with incomplete penetrance. (The disease can be passed down from generation to generation through a genetic mutation inherited from only one parent, but the presence of this mutation does not guarantee that the disease will develop in all individuals who carry the mutated gene.)
Genetic research has failed to identify significant contributors to the risk of developing lipedema. Increased expression of genes associated with cell proliferation leading to hyperplasia remains a subject of debate.
Female sex hormones
There are many indications that they are involved, the main one being their appearance at puberty. Very few men are affected (1-2%) and they generally present with a condition associated with an increase in female hormones, such as prostate or breast disease.
However, there are many other situations where changes in hormone levels can be triggers or aggravating factors, without necessarily being the underlying cause of the disease: birth control pills, pregnancy, and menopause in the range of female hormones, and others such as hypothyroidism and Cushing's syndrome.
Diet
There is very little medical literature specific to lipedema. It would not be considered a causal factor. It can cause enlargement, probably due to obesity and not lipedema.
Pathogenesis
Although the mechanisms involved in the development of lipoedema are not yet fully understood, we know that various factors inside and outside the adipocyte play a role.
In adipocytes:Hypertrophy and/or hyperplasia.
Outside the adipocyte:Many factors involved: macrophages, eosinophils, T lymphocytes, sodium, inflammatory mediators.
Theoretically, the production mechanism could be as follows:
Hypertrophy and hyperplasia cause a decrease in oxygen supply and remodeling of the extracellular matrix. The latter includes increased sodium concentration, collagen deposition, and alterations in the glycocalyx (including proteoglycans and glycosaminoglycans), leading to microangiopathy and fibrosis.
Endothelial permeability and paracellular leakage are increased due to the loosening of tight junctions between endothelial cells, causing further vascular deterioration and inflammation. In addition, the ability of lymphatic capillaries to absorb interstitial fluid is reduced, causing leakage and promoting lymphatic dysfunction and expansion of the interstitial space.
Finally, excess fluid around adipocytes acts as a source of nutrients, further contributing to the pathological expansion of fat cells and eventually causing remodeling of subcutaneous adipose tissue and cyclic lipedema.
Lipoedema news
Nutrition
Weight loss is possible but disproportionate. A reduction in size may occur due to slimming, but the possibility of reducing lipedema is very low.
However, it has been proven to be useful in reducing pain.
Conservative treatment
Manual lymphatic drainage and compression show benefits even in advanced stages. They reduce swelling and pain and increase function in the affected areas.
Some phase 1-2 pilot studies also suggest benefits and possible changes in molecular markers of inflammation.
Liposuction
We now know that liposuction reduces the need for conservative treatment, as well as pain at all stages of lipedema. There may be greater benefits if the procedure is performed at earlier stages or at a younger age.
On the other hand, we note that bariatric surgeries can promote weight loss, but are less likely to reduce the symptoms of lipedema.
Our sources:
- Lipedema: Insights into Morphology, Pathophysiology, and Challenges. Poojari et al. Biomedecines. 2022.
- Lipedema Research. Kartt et al. Lipedema Foundation. 2022.
- Liposuction for Lipedema: 2022 Update. Tran et al. Canadian Journal of Health Technologies. 2022.
- Current Mechanistic Understandings of Lipedema. Duhon et al. International Journal of Molecular Sciences. 2021.
- Lipedema: More than a "fat legs" problem. Update in Pathophysiology, Diagnosis, and Surgical Treatment. Pereira et al. Chilean Journal of Plastic Surgery. 2021.
- Lipedema – Pathogenesis, Diagnosis, and Treatment Options. Kruppa et al. Deutsches Ärzteblatt International. 2020.