Project: Utilizing Molecular Tissue Profiles and Lymphatic Clearance to Improve Clinical Discriminatory Capacity in Patients with Lipedema

The overall goal of this work is to apply novel and non-invasive (i.e., those that do not require injection of exogenous agents) magnetic resonance imaging (MRI) methods to improve our understanding of the physiological mechanisms underlying lipedema. A major limitation in lipedema treatment is that patients are frequently misdiagnosed owing to a lack of an objective and validated diagnostic tool. This issue is fundamental, as without such diagnostic criteria there remains an inability of clinicians to correctly triage patients for appropriate therapies, and even more generally, generate acceptance of lipedema as a distinct condition from obesity that requires alternative treatment plans.

Here, we will apply imaging methods developed in our laboratory, sensitive to whole-body fat and water content, sodium accumulation, lymphatic pumping, and perfusion to test fundamental hypotheses about how fat accumulates and is removed in patients with lipedema. The short-term goal is to provide an objective, internal understanding of how lipedema differs from other conditions such as obesity and lymphedema, which will serve as a necessary prerequisite for accepting lipedema as a unique disease that requires separate diagnosis and treatment. The long-term goal is to develop and validate a routine diagnostic test, founded in internal physiological biomarkers that can be measured using equipment available at most hospitals, that can be used to identify patients suffering from lipedema and ultimately triage these patients for disease-modifying therapies.

LF Funding History: 2017 Collaborative Award

Hypothesis: The overall hypotheses of this work are that lower extremity (i) sodium and (ii) fat-to-water ratios, as measured using non-invasive MRI, are uniquely elevated in patients with lipedema relative to body-mass-index matched healthy adults and adults with lymphedema; if confirmed, findings could provide information for a quantitative diagnostic test for distinguishing lipedema from other conditions with overlapping external presentation.

Current and Potential Collaborative Opportunities: Our lipedema research group at Vanderbilt comprises a multi-disciplinary team with expertise in imaging science and vascular physiology (Manus Donahue, PhD and Rachelle Crescenzi, PhD), physical therapy (Paula Donahue, DPT), vascular medicine (Joshua Beckman, MD), clinical radiology (Kate Hartley, MD), and molecular physiology and pharmacology (Jens Titze, MD).

We also collaborate with lipedema researchers at the University of Arizona (Karen Herbst, PhD, MD) and are in process of implementing many of these methods at Washington University, St Louis, and University Medical Center Utrecht, The Netherlands. We are interested in additional collaborations with Radiology Departments that may be interested in utilizing new imaging methods as screening tools in patients with lipedema and related fat disorders.