This work was supported by grant funding provided by the American Association of Plastic Surgeons Academic Scholarship and the Department of Defense W81XWH2110135&#160;to AHH. Aesthetic Surgery Education and Research Foundation grant to MS. NIH U01DK119099, R01NS042617 and R01DK125835 to CKS.

The protocol follows the guidelines of the institution&#39;s animal research ethics committee. All animal experiments were approved by the Indiana University School of Medicine Institutional Animal Care and Use Committee. Animals were housed under a 12-hour light-dark cycle with food and water ad libitum.
1. Surgical Disruption of Mouse Tail Lymphatics
<ol>
	<li>Use eight week-old C57BL/6 mice of equal gender distribution.</li>
	<li>Place a mouse under general anesthesia in an induction chamber with 3-4% isoflurane in 100% oxygen followed by maintenance sedation at 1-3% during the procedure.</li>
	<li>Administer 0.5 mg/kg sustained-release (SR) buprenorphine subcutaneously for pain control. 
	NOTE: Additional analgesic drugs administered post-op: Carprofen&#160;once every 24 h for at least 48 h and Bupivacaine once either after the incision was made or before closing the incision, applied by dripping onto skin edges (lasts up to 4 &#8211; 6 h).</li>
	<li>Position the mouse dorsally and prep the tail with 70% isopropyl alcohol.</li>
	<li>Measure the tail diameter prior to the procedure at 5 mm increments starting 20 mm from the base of the tail using a caliper. These measurements will be used to calculate volume using the truncated cone equation37.</li>
	<li>Mark a 3 mm circumferential excision on the tail 20 mm from the base.</li>
	<li>Perform a meticulous 3 mm full-thickness skin excision with a sterile surgical blade (size 15), leaving all the underlying vasculature intact under surgical microscopic magnification. Incise the superior circumferential mark (20 mm from tail base) first through the dermis followed by a circumferential full thickness incision 3 mm distlal to the first incision.
	<ol>
		<li>Make a perpendicular full thickness vertical incision to connect the two incisions. Use a toothed fine pickup to grasp a leading edge and use microscissors to carefully dissect deep within the avascular plane to the dermis and superficial to the vein adventitia.</li>
	</ol>
	</li>
	<li>Inject 0.1 mL of isosulfan blue (1%) subcutaneously proximal to tip of the tail.</li>
	<li>Identify the two lymphatic channels adjacent to the lateral tail veins under the surgical microscope. The lymphatics will appear blue because of isosulfan injection. Transect the lymphatics using straight microsurgical scissors. Use the scissors to carefully dissect a plane between the lateral vein and the lymphatic. Then pass the tip of one scissor blade between the lymphatic vessel and the lateral vein and close the blades to transect the lymphatic vessel.</li>
	<li>Dress the tail wound with a sterile&#160;adherent clear dressing.&#160;Check post-op incisions daily to ensure that they are not infected or bleeding and provide wound care for 2 weeks.&#160;</li>
	<li>House the animals singly to prevent any further injury to the tail and to prevent the animals from biting each other, which would lead to surgical complications.&#160;</li>
</ol>
2. Tail vascular assessment with laser speckle contrast imaging
<ol>
	<li>Anesthetize the mouse as in step 1.2.</li>
	<li>To use laser speckle contrast imaging to visualize tail vascularity, set the width to 0.8 cm, height to 1.8 cm, point density to high, frame rate to 44 images/second, time to 30 seconds, and color photo to 1 per 10 seconds.</li>
	<li>Evaluate the venous and arterial perfusion for patency. Qualitatively, continuity of flow should be visualized.</li>
</ol>
3. Functional lymphatic evaluation with near infrared laser angiography
<ol>
	<li>Anesthetize the animal as in step 1.2</li>
	<li>Reconstitute indocyanine green (ICG) (25 mg/10 mL) and administer 0.1 mL subcutaneously into the distal mouse tail near the tip.</li>
	<li>Dim the room lights. Place near-infrared laser angiography in buffering setting followed by live capture.</li>
</ol>
4. Focal delivery of nucleic acid cargo to mouse tail using TNT
<ol>
	<li>Anesthetize the animal as in step 1.2.</li>
	<li>Exfoliate the mouse tail using topical skin exfoliation cream.</li>
	<li>Immerse the mouse tail in collagenase solution (10 mg/mL) at 37 &#176;C for 5 minutes.</li>
	<li>Load DNA into the TNT2.0 chip reservoir35.</li>
	<li>Place the TNT2.0 silicone chip device over the desired focal site of delivery on the tail with nanoneedles in contact with the tail.</li>
	<li>Place a positive electrical probe in the reservoir. Attach the negative probe to a 30 G needle and insert the needle subcutaneously into the tail to the site of delivery.</li>
	<li>Apply square wave pulse electric stimulation (10 x 10 ms pulses, 250 V, 10 mA).</li>
</ol>

<ol>
	<li>Kataru, R. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fibrosis+and+secondary+lymphedema:+chicken+or+egg.">Fibrosis and secondary lymphedema: chicken or egg.</a> Translation Research. 209, 68-76 (2019).</li><li>Brayton, K. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphedema+prevalence+and+treatment+benefits+in+cancer:+impact+of+a+therapeutic+intervention+on+health+outcomes+and+costs.">Lymphedema prevalence and treatment benefits in cancer: impact of a therapeutic intervention on health outcomes and costs.</a> PLoS One. 9 (12), 114597 (2014).</li><li>Mendoza, N., Li, A., Gill, A., Tyring, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Filariasis:+diagnosis+and+treatment.">Filariasis: diagnosis and treatment.</a> Dermatology and Therapy. 22 (6), 475-490 (2009).</li><li>Rockson, S. G., Rivera, K. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Estimating+the+population+burden+of+lymphedema.">Estimating the population burden of lymphedema.</a> Annals of the New York Academy of Sciences. 1131, 147-154 (2008).</li><li>Soran, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Breast+cancer-related+lymphedema--what+are+the+significant+predictors+and+how+they+affect+the+severity+of+lymphedema.">Breast cancer-related lymphedema--what are the significant predictors and how they affect the severity of lymphedema.</a> Breast Journal. 12 (6), 536-543 (2006).</li><li>Hayes, S. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Upper-body+morbidity+after+breast+cancer:+incidence+and+evidence+for+evaluation,+prevention,+and+management+within+a+prospective+surveillance+model+of+care.">Upper-body morbidity after breast cancer: incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care.</a> Cancer. 118, 2237-2249 (2012).</li><li>Carl, H. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Systematic+Review+of+the+Surgical+Treatment+of+Extremity+Lymphedema.">Systematic Review of the Surgical Treatment of Extremity Lymphedema.</a> Journal of Reconstructive Microsurgery. 33 (6), 412-425 (2017).</li><li>Garza, R., Skoracki, R., Hock, K., Povoski, S. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comprehensive+overview+on+the+surgical+management+of+secondary+lymphedema+of+the+upper+and+lower+extremities+related+to+prior+oncologic+therapies.">A comprehensive overview on the surgical management of secondary lymphedema of the upper and lower extremities related to prior oncologic therapies.</a> BMC Cancer. 17 (1), 468 (2017).</li><li>Hassanein, A. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deep+Inferior+Epigastric+Artery+Vascularized+Lymph+Node+Transfer:+A+Simple+and+Safe+Option+for+Lymphedema.">Deep Inferior Epigastric Artery Vascularized Lymph Node Transfer: A Simple and Safe Option for Lymphedema.</a> Journal of Plastic, Reconstructive, Aesthetic Surgery. 73 (10), 1897-1916 (2020).</li><li>Hassanein, A. H., Sacks, J. M., Cooney, D. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optimizing+perioperative+lymphatic-venous+anastomosis+localization+using+transcutaneous+vein+illumination,+isosulfan+blue,+and+indocyanine+green+lymphangiography.">Optimizing perioperative lymphatic-venous anastomosis localization using transcutaneous vein illumination, isosulfan blue, and indocyanine green lymphangiography.</a> Microsurgery. 37 (8), 956-957 (2017).</li><li>Chang, D. W., Masia, J., Garza, R., Skoracki, R., Neligan, P. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphedema:+Surgical+and+Medical+Therapy.">Lymphedema: Surgical and Medical Therapy.</a> Plastic and Reconstructive Surgery. 138, 209-218 (2016).</li><li>Gould, D. J., Mehrara, B. J., Neligan, P., Cheng, M. H., Patel, K. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymph+node+transplantation+for+the+treatment+of+lymphedema.">Lymph node transplantation for the treatment of lymphedema.</a> Journal of Surgical Oncology. 118 (5), 736-742 (2018).</li><li>Cook, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immediate+Lymphatic+Reconstruction+after+Axillary+Lymphadenectomy:+A+Single-Institution+Early+Experience.">Immediate Lymphatic Reconstruction after Axillary Lymphadenectomy: A Single-Institution Early Experience.</a> Annals of Surgical Oncology. , (2020).</li><li>Cook, J. A., Hassanein, A. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ASO+Author+Reflections:+Immediate+Lymphatic+Reconstruction:+A+Proactive+Approach+to+Breast+Cancer-Related+Lymphedema.">ASO Author Reflections: Immediate Lymphatic Reconstruction: A Proactive Approach to Breast Cancer-Related Lymphedema.</a> Annals of Surgical Oncology. , (2020).</li><li>Johansson, K., Branje, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arm+lymphoedema+in+a+cohort+of+breast+cancer+survivors+10+years+after+diagnosis.">Arm lymphoedema in a cohort of breast cancer survivors 10 years after diagnosis.</a> Acta Oncologica. 49 (2), 166-173 (2010).</li><li>Johnson, A. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphedema+Incidence+After+Axillary+Lymph+Node+Dissection:+Quantifying+the+Impact+of+Radiation+and+the+Lymphatic+Microsurgical+Preventive+Healing+Approach.">Lymphedema Incidence After Axillary Lymph Node Dissection: Quantifying the Impact of Radiation and the Lymphatic Microsurgical Preventive Healing Approach.</a> Annals of Plastic Surgery. 82, 234-241 (2019).</li><li>Gartner, R., Mejdahl, M. K., Andersen, K. G., Ewertz, M., Kroman, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+in+self-reported+arm-lymphedema+in+Danish+women+treated+for+early-stage+breast+cancer+in+2005+and+2006--a+nationwide+follow-up+study.">Development in self-reported arm-lymphedema in Danish women treated for early-stage breast cancer in 2005 and 2006--a nationwide follow-up study.</a> Breast. 23 (4), 445-452 (2014).</li><li>Shin, W. S., Rockson, S. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Animal+models+for+the+molecular+and+mechanistic+study+of+lymphatic+biology+and+disease.">Animal models for the molecular and mechanistic study of lymphatic biology and disease.</a> Annals of the New York Academy of Sciences. 1131, 50-74 (2008).</li><li>Tobbia, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphedema+development+and+lymphatic+function+following+lymph+node+excision+in+sheep.">Lymphedema development and lymphatic function following lymph node excision in sheep.</a> Journal of Vascular Research. 46 (5), 426-434 (2009).</li><li>Olszewski, W., Machowski, Z., Sokolowski, J., Nielubowicz, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+lymphedema+in+dogs.">Experimental lymphedema in dogs.</a> Journal of Cardiovascular Surgery. 9 (2), 178-183 (1968).</li><li>Rutkowski, J. M., Moya, M., Johannes, J., Goldman, J., Swartz, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Secondary+lymphedema+in+the+mouse+tail:+Lymphatic+hyperplasia,+VEGF-C+upregulation,+and+the+protective+role+of+MMP-9.">Secondary lymphedema in the mouse tail: Lymphatic hyperplasia, VEGF-C upregulation, and the protective role of MMP-9.</a> Microvascular Research. 72 (3), 161-171 (2006).</li><li>Tabibiazar, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Inflammatory+manifestations+of+experimental+lymphatic+insufficiency.">Inflammatory manifestations of experimental lymphatic insufficiency.</a> PLoS Medicine. 3 (7), 254 (2006).</li><li>Slavin, S. A., Van den Abbeele, A. D., Losken, A., Swartz, M. A., Jain, R. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Return+of+lymphatic+function+after+flap+transfer+for+acute+lymphedema.">Return of lymphatic function after flap transfer for acute lymphedema.</a> Annals of Surgery. 229 (3), 421-427 (1999).</li><li>Zampell, J. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Toll-like+receptor+deficiency+worsens+inflammation+and+lymphedema+after+lymphatic+injury.">Toll-like receptor deficiency worsens inflammation and lymphedema after lymphatic injury.</a> American Journal of Physiology-Cell Physiology. 302 (4), 709-719 (2012).</li><li>Gardenier, J. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diphtheria+toxin-mediated+ablation+of+lymphatic+endothelial+cells+results+in+progressive+lymphedema.">Diphtheria toxin-mediated ablation of lymphatic endothelial cells results in progressive lymphedema.</a> JCI Insight. 1 (15), 84095 (2016).</li><li>Weiler, M. J., Cribb, M. T., Nepiyushchikh, Z., Nelson, T. S., Dixon, J. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+novel+mouse+tail+lymphedema+model+for+observing+lymphatic+pump+failure+during+lymphedema+development.">A novel mouse tail lymphedema model for observing lymphatic pump failure during lymphedema development.</a> Scientific Reports. 9 (1), 10405 (2019).</li><li>Avraham, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Th2+differentiation+is+necessary+for+soft+tissue+fibrosis+and+lymphatic+dysfunction+resulting+from+lymphedema.">Th2 differentiation is necessary for soft tissue fibrosis and lymphatic dysfunction resulting from lymphedema.</a> FASEB J. 27 (3), 1114-1126 (2013).</li><li>Zampell, J. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=CD4(+)+cells+regulate+fibrosis+and+lymphangiogenesis+in+response+to+lymphatic+fluid+stasis.">CD4(+) cells regulate fibrosis and lymphangiogenesis in response to lymphatic fluid stasis.</a> PLoS One. 7 (11), 49940 (2012).</li><li>Arruda, G., Ariga, S., de Lima, T. M., Souza, H. P., Andrade, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+modified+mouse-tail+lymphedema+model.">A modified mouse-tail lymphedema model.</a> Lymphology. 53 (1), 29-37 (2020).</li><li>Jun, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modified+Mouse+Models+of+Chronic+Secondary+Lymphedema:+Tail+and+Hind+Limb+Models.">Modified Mouse Models of Chronic Secondary Lymphedema: Tail and Hind Limb Models.</a> Annals of Vascular Surgery. 43, 288-295 (2017).</li><li>Karkkainen, M. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+model+for+gene+therapy+of+human+hereditary+lymphedema.">A model for gene therapy of human hereditary lymphedema.</a> Proceedings of the National Academy of Sciences of the United States of America. 98 (22), 12677-12682 (2001).</li><li>Yoon, Y. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=VEGF-C+gene+therapy+augments+postnatal+lymphangiogenesis+and+ameliorates+secondary+lymphedema.">VEGF-C gene therapy augments postnatal lymphangiogenesis and ameliorates secondary lymphedema.</a> Journal of Clinical Investigation. 111 (5), 717-725 (2003).</li><li>Gallego-Perez, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Topical+tissue+nano-transfection+mediates+non-viral+stroma+reprogramming+and+rescue.">Topical tissue nano-transfection mediates non-viral stroma reprogramming and rescue.</a> Nature Nanotechnology. 12 (10), 974-979 (2017).</li><li>Moore, J. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nanochannel-Based+Poration+Drives+Benign+and+Effective+Nonviral+Gene+Delivery+to+Peripheral+Nerve+Tissue.">Nanochannel-Based Poration Drives Benign and Effective Nonviral Gene Delivery to Peripheral Nerve Tissue.</a> Advanced Biosystems. , 2000157 (2020).</li><li>Zhou, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Exosome-Mediated+Crosstalk+between+Keratinocytes+and+Macrophages+in+Cutaneous+Wound+Healing.">Exosome-Mediated Crosstalk between Keratinocytes and Macrophages in Cutaneous Wound Healing.</a> ACS Nano. 14 (10), 12732-12748 (2020).</li><li>Roy, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neurogenic+tissue+nanotransfection+in+the+management+of+cutaneous+diabetic+polyneuropathy.">Neurogenic tissue nanotransfection in the management of cutaneous diabetic polyneuropathy.</a> Nanomedicine. 28, 102220 (2020).</li><li>Sitzia, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Volume+measurement+in+lymphoedema+treatment:+examination+of+formulae.">Volume measurement in lymphoedema treatment: examination of formulae.</a> European Journal of Cancer Care. 4 (1), 11-16 (1995).</li><li>Smeltzer, D. M., Stickler, G. B., Schirger, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Primary+lymphedema+in+children+and+adolescents:+a+follow-up+study+and+review.">Primary lymphedema in children and adolescents: a follow-up study and review.</a> Pediatrics. 76 (2), 206-218 (1985).</li><li>Maclellan, R. A., Greene, A. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphedema.">Lymphedema.</a> Seminars in Pediatric Surgery. 23 (4), 191-197 (2014).</li><li>Clavin, N. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=TGF-beta1+is+a+negative+regulator+of+lymphatic+regeneration+during+wound+repair.">TGF-beta1 is a negative regulator of lymphatic regeneration during wound repair.</a> American Journal of Physiology: Heart and Circulatory Physiology. 295 (5), 2113-2127 (2008).</li><li>Gnyawali, S. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Retooling+Laser+Speckle+Contrast+Analysis+Algorithm+to+Enhance+Non-Invasive+High+Resolution+Laser+Speckle+Functional+Imaging+of+Cutaneous+Microcirculation.">Retooling Laser Speckle Contrast Analysis Algorithm to Enhance Non-Invasive High Resolution Laser Speckle Functional Imaging of Cutaneous Microcirculation.</a> Scientific Reports. 7, 41048 (2017).</li></ol>

The authors have no competing conflicts of interest.

Lymphedema is categorized as a primary (congenital) or secondary (iatrogenic lymphatic) injury38,39. Secondary lymphedema comprises 99% of cases39. Secondary lymphedema is most commonly caused by infection (filariasis) or post-oncological treatment with lymphadenectomy or radiation4,39. A translational animal model is challenging for secondary lymphedema, as 70% of animals treated ...

Lymphedema is extremity swelling caused by lymphatic dysfunction. The affected limb enlarges because of the accumulation of fluid, adipose, and fibrosis1. Lymphedema affects 250 million people worldwide2,3,4. It is estimated that 20-40% of patients who undergo treatment for solid malignancies, such as breast cancer, melanoma, gynecological/urologic tumors, or sarcomas, develop lymphedema2,4,5. Morbidity from lymphedema includes recurrent infections, pain, and deformity6. There is no cure for this progressive, life-long disease. Current therapies are variaby effective7 and include compression, complete decongestive therapy by physical therapists, excisional procedures, and microsurgical operations, including vascularized lymph node transfer and lymphovenous bypass7,8,9,10,11,12,13,14. The ideal treatment for lymphedema has yet to be discovered.
Studying the mechanism and therapy of lymphedema has been limited. There is an average delayed onset of one year following the lymphatic injury15,16 and most individuals who experience iatrogenic insult with radiation and surgery do not develop lymphedema4,6,17. Although large animal models, including canine, sheep, and pig have been described18,19,20, the mouse tail model has been the most widely applied because of ease, cost, and reproducibilty. Mouse models for investigating lymphedema include a tail model, diptheria-toxin mediated lymphatic ablation, and axillary or popliteal lymph node dissection21,22,23,24,25,26. Most tail models use a focal, full thickness skin excision with lymphatic channel clipping that is performed near the base of the tail22, resulting in tail swelling and histological features similar to human lymphedema24,27,28,29. However, the standard murine tail model typically spontaneous resolves in as few as 20 days and is accompanied by periodic tail necrosis30. The lymphedema mouse tail model extends a sustained lymphedema beyond 15 weeks, demonstrates confirmed arterial and venous patency, and allows functional lymphatic dysfunction assessment.
An murine tail model of lymphedema allows for evaluation of novel therapeutics to treat lymphedema. Gene-based strategies have been used in the mouse model mediated by viral vectors31,32. We also use a novel tissue nanotransfection technology (TNT) for genetic cargo delivery to the lymphedematous mouse tail. TNT facilitates direct, transcutaneous gene delivery using a chip with nanochannels in a rapid focused electric field33,34,35,36. The model includes using TNT2.0 to allow for focal gene delivery of potential gene-based therapeutics to the lymphatic injury site of the mouse tail35.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Surgical Microscope</td>
			<td>Leica, Wetzlar, Germany</td>
			<td>MSV266</td>
			<td></td>
		</tr>
		<tr>
			<td>Adherent Dressing (Tegaderm)</td>
			<td>3M, St. Paul, Minn.</td>
			<td>1626W</td>
			<td></td>
		</tr>
		<tr>
			<td>Laser speckle (Pericam PSI System )</td>
			<td>Perimed AB, Stockholm, Sweden)</td>
			<td>PSIZ</td>
			<td></td>
		</tr>
		<tr>
			<td>Near-infrared laser (LUNA)</td>
			<td>Stryker (Formerly Novadaq Technologies, Toronto, Canada)</td>
			<td>LU3000</td>
			<td></td>
		</tr>
		<tr>
			<td>C57BL/6 mice</td>
			<td>Jackson Laboratories</td>
			<td>000664</td>
			<td></td>
		</tr>
		<tr>
			<td>Micro-Adson Forceps - 1x2 Teeth</td>
			<td>Fine Science Tools (USA) Inc.</td>
			<td>11019-12</td>
			<td></td>
		</tr>
		<tr>
			<td>V-Hook</td>
			<td>Fine Science Tools (USA) Inc.</td>
			<td>18052-12</td>
			<td></td>
		</tr>
		<tr>
			<td>Scalpel SS NO15</td>
			<td>Fischer Scientific</td>
			<td>29556</td>
			<td></td>
		</tr>
		<tr>
			<td>Disposable Needle 30GX1</td>
			<td>Fischer Scientific</td>
			<td>305128</td>
			<td></td>
		</tr>
		<tr>
			<td>Operating Scissors</td>
			<td>Fischer Scientific</td>
			<td>12-460-796</td>
			<td></td>
		</tr>
		<tr>
			<td>Surgi-Or Jeweler&#39;s Forceps, Sklar 4-1/2 in</td>
			<td>Fischer Scientific</td>
			<td>50-118-4255</td>
			<td></td>
		</tr>
		<tr>
			<td>Spring Scissors - Straight/Sharp-Sharp/8mm Cutting Edge</td>
			<td>Fine Science Tools (USA) Inc.</td>
			<td>15024-10</td>
			<td></td>
		</tr>
		<tr>
			<td>Cardiogreen</td>
			<td>Sigma</td>
			<td>I2633-25MG</td>
			<td></td>
		</tr>
		<tr>
			<td>IsosulfanBlue (Lymphazurin)&#160; 50 mg/5ml</td>
			<td>Mylan</td>
			<td>67457-220-05</td>
			<td></td>
		</tr>
	</tbody>
</table>

a murine tail lymphedema model

Lymphedema is extremity swelling caused by lymphatic dysfunction. The affected limb enlarges because of accumulation of fluid, adipose, and fibrosis. There is no cure for this disease. A mouse tail model that uses a focal full thickness skin excision near the base of the tail, resulting in tail swelling, has been used to study lymphedema. However, this model may result in vascular comprise and consequent tail necrosis and early tail swelling resolution, limiting its clinical translatability. The chronic murine tail lymphedema model induces sustained lymphedema over 15 weeks and a reliable perfusion to the tail. Enhancements of the traditional murine tail lymphedema model include 1) precise full thickness excision and lymphatic clipping using a surgical microscope, 2) confirmation of post-operative arterial and venous perfusion using high resolution laser speckle, and 3) functional assessment using indocyanine green near infrared laser lymphangiography. We also use tissue nanotransfection technology (TNT) for novel non-viral, transcutaneous, focal delivery of genetic cargo to the mouse tail vasculature.

The technique for the mouse tail model for sustained lymphedema is shown in Figure 1. The figure exhibits the relevant anatomy of the mouse tail model. Figure 2 demonstrates the progressive swelling and sustained persistant lymphedema in the mouse tail after lymphedema induction. The mouse tail volume, as calculated by the truncated cone equation, peaks at week 4 and plateaus to week 6 followed by gradual improvement that is sust...

Watch this Scientific Journal Video about A Murine Tail Lymphedema Model at JoVE.com

A Murine Tail Lymphedema Model

Lymphedema is extremity swelling caused by lymphatic dysfunction. We describe a chronic murine tail model of lymphedema and the novel use of tissue nanotransfection technology (TNT) for genetic cargo delivery to the tail.

Lymphedema is extremity swelling caused by lymphatic dysfunction. The affected limb enlarges because of accumulation of fluid, adipose, and fibrosis. ...

Research

JoVE Journal

Medicine

5.5K Views.  Indiana University School of Medicine. Lymphedema is extremity swelling caused by lymphatic dysfunction. We describe a chronic murine tail model of lymphedema and the novel use of tissue nanotransfection technology (TNT) for genetic cargo delivery to the tail.

Video: A Murine Tail Lymphedema Model

Murine Bioluminescent Hepatic Tumour Model

This video describes the establishment of liver metastases in a mouse model that can be subsequently analysed by bioluminescent imaging. Tumour cells are administered specifically to the liver to induce a localised liver tumour, via mobilisation of the spleen and splitting into two, leaving intact the vascular pedicle for each half of the spleen. Lewis lung carcinoma cells that constitutively express the firefly luciferase gene (luc1) are inoculated into one hemi-spleen which is then resected 10 minutes later. The other hemi-spleen is left intact and returned to the abdomen. Liver tumour growth can be monitored by bioluminescence imaging using the IVIS whole body imaging system. Quantitative imaging of tumour growth using IVIS provides precise quantitation of viable tumour cells. Tumour cell death and necrosis due to drug treatment is indicated early by a reduction in the bioluminescent signal. This mouse model allows for investigating the mechanisms underlying metastatic tumour-cell survival and growth and can be used for the evaluation of therapeutics of liver metastasis. 

This article describes a procedure for the induction of orthotopic bioluminescent liver tumours in mice, and subsequent analysis of tumour growth confined to the liver using live whole body luminescence imaging.

This video describes the establishment of liver metastases in a mouse model that can be subsequently analysed by bioluminescent imaging. Tumour cells are ...

A Murine Model of Muscle Training by Neuromuscular Electrical Stimulation

Neuromuscular electrical stimulation (NMES) is a common clinical modality that is widely used to restore1, maintain2 or enhance3-5 muscle functional capacity. Transcutaneous surface stimulation of skeletal muscle involves a current flow between a cathode and an anode, thereby inducing excitement of the motor unit and the surrounding muscle fibers. 
NMES is an attractive modality to evaluate skeletal muscle adaptive responses for several reasons. First, it provides a reproducible experimental model in which physiological adaptations, such as myofiber hypertophy and muscle strengthening6, angiogenesis7-9, growth factor secretion9-11, and muscle precursor cell activation12 are well documented. Such physiological responses may be carefully titrated using different parameters of stimulation (for Cochrane review, see 13). In addition, NMES recruits motor units non-selectively, and in a spatially fixed and temporally synchronous manner14, offering the advantage of exerting a treatment effect on all fibers, regardless of fiber type. Although there are specified contraindications to NMES in clinical populations, including peripheral venous disorders or malignancy, for example, NMES is safe and feasible, even for those who are ill and/or bedridden and for populations in which rigorous exercise may be challenging. 
Here, we demonstrate the protocol for adapting commercially available electrodes and performing a NMES protocol using a murine model. This animal model has the advantage of utilizing a clinically available device and providing instant feedback regarding positioning of the electrode to elicit the desired muscle contractile effect. For the purpose of this manuscript, we will describe the protocol for muscle stimulation of the anterior compartment muscles of a mouse hindlimb.

A murine model of neuromuscular electrical stimulation (NMES), a safe and inexpensive clinical modality, to the anterior compartment muscles is described. This model has the advantage of modifying a readily available clinical device for the purpose of eliciting targeted and specific muscle contractions in mice.

Neuromuscular electrical stimulation (NMES) is a common clinical modality that is widely used to restore1, maintain2 or enhance3-5 muscle functional ...

Murine Model of Wound Healing

Wound healing and repair are the most complex biological processes that occur in human life. After injury, multiple biological pathways become activated. Impaired wound healing, which occurs in diabetic patients for example, can lead to severe unfavorable outcomes such as amputation. There is, therefore, an increasing impetus to develop novel agents that promote wound repair. The testing of these has been limited to large animal models such as swine, which are often impractical. Mice represent the ideal preclinical model, as they are economical and amenable to genetic manipulation, which allows for mechanistic investigation. However, wound healing in a mouse is fundamentally different to that of humans as it primarily occurs via contraction. Our murine model overcomes this by incorporating a splint around the wound. By splinting the wound, the repair process is then dependent on epithelialization, cellular proliferation and angiogenesis, which closely mirror the biological processes of human wound healing. Whilst requiring consistency and care, this murine model does not involve complicated surgical techniques and allows for the robust testing of promising agents that may, for example, promote angiogenesis or inhibit inflammation. Furthermore, each mouse acts as its own control as two wounds are prepared, enabling the application of both the test compound and the vehicle control on the same animal. In conclusion, we demonstrate a practical, easy-to-learn, and robust model of wound healing, which is comparable to that of humans.

A murine model of cutaneous wound healing that can be used to assess therapeutic compounds in physiological and pathophysiological settings.

Wound healing and repair are the most complex biological processes that occur in human life. After injury, multiple biological pathways become activated. ...

A New Murine Model of Endovascular Aortic Aneurysm Repair

Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of Abdominal aortic aneurysm (AAA) pathophysiology. There is no abdominal aortic aneurysm endograft exclusion model cheap and reproducible, which would allow deep investigations of AAA before and after treatment. We hereby describe how to induce, and then to exclude with a covered coronary stentgraft an abdominal aortic aneurysm in a rat. The well known elastase induced AAA model was first reported in 19901 in a rat, then described in mice2. Elastin degradation leads to dilation of the aorta with inflammatory infiltration of the abdominal wall and intra luminal thrombus, matching with human AAA. Endovascular exclusion with small covered stentgraft is then performed, excluding any interactions between circulating blood and the aneurysm thrombus. Appropriate exclusion and stentgraft patency is confirmed before euthanasia by an angiography thought the left carotid artery. Partial control of elastase diffusion makes aneurysm shape different for each animal. It is difficult to create an aneurysm, which will allow an appropriate length of aorta below the aneurysm for an easy stentgraft introduction, and with adequate proximal and distal neck to prevent endoleaks. Lots of failure can result to stentgraft introduction which sometimes lead to aorta tear with pain and troubles to stitch it, and endothelial damage with post op aorta thrombosis. Giving aspirin to rats before stentgraft implantation decreases failure rate without major hemorrhage. Clamping time activates neutrophils, endothelium and platelets, and may interfere with biological analysis.

Histological and biochemical modifications after aneurysm endograft exclusion are still unclear. We describe a new model of endograft implantation on a murine aneurysm. Through thrombus analysis with and without persistant circulating blood stream interface, and new endovascular biomaterials evaluation, this model will help to better understand endovascular aneurysm exclusion pathobiology.

Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of ...

A Murine Model of Subarachnoid Hemorrhage

In this video publication a standardized mouse model of subarachnoid hemorrhage (SAH) is presented. Bleeding is induced by endovascular Circle of Willis perforation (CWp) and proven by intracranial pressure (ICP) monitoring. Thereby a homogenous blood distribution in subarachnoid spaces surrounding the arterial circulation and cerebellar fissures is achieved. Animal physiology is maintained by intubation, mechanical ventilation, and continuous on-line monitoring of various physiological and cardiovascular parameters: body temperature, systemic blood pressure, heart rate, and hemoglobin saturation. Thereby the cerebral perfusion pressure can be tightly monitored resulting in a less variable volume of extravasated blood. This allows a better standardization of endovascular filament perforation in mice and makes the whole model highly reproducible. Thus it is readily available for pharmacological and pathophysiological studies in wild type and genetically altered mice.

A standardized mouse model of subarachnoid hemorrhage by intraluminal Circle of Willis perforation is described. Vessel perforation and subarachnoid bleeding are monitored by intracranial pressure monitoring. In addition various vital parameters are recorded and controlled to maintain physiologic conditions.

In this video publication a standardized mouse model of subarachnoid  hemorrhage (SAH) is presented. Bleeding is induced by endovascular Circle of  Willis ...

A Preclinical Murine Model of Hepatic Metastases

Numerous murine models have been developed to study human cancers and advance the understanding of cancer treatment and development. Here, a preclinical, murine pancreatic tumor model of hepatic metastases via a hemispleen injection of syngeneic murine pancreatic tumor cells is described. This model mimics many of the clinical conditions in patients with metastatic disease to the liver. Mice consistently develop metastases in the liver allowing for investigation of the metastatic process, experimental therapy testing, and tumor immunology research.

A preclinical, murine model of hepatic metastases performed via a hemispleen injection technique.

Numerous murine models have been developed to study human cancers and advance the understanding of cancer treatment and development. Here, a preclinical, ...

A Murine Model of Irreversible and Reversible Unilateral Ureteric Obstruction

Obstruction of the kidney may affect native or transplanted kidneys and results in kidney injury and scarring. Presented here is a model of obstructive nephropathy induced by unilateral ureteric obstruction (UUO), which can either be irreversible (UUO) or reversible (R-UUO). In the irreversible UUO model, the ureter may be obstructed for variable periods of time in order to induce increasingly severe renal inflammation and interstitial fibrotic scarring. In the reversible R-UUO model the ureter is obstructed to induce hydronephrosis, tubular dilation and inflammation. After a suitable period of time the ureteric obstruction is then surgically reversed by anastomosis of the severed previously obstructed ureter to the bladder in order to allow complete decompression of the kidney and restoration of urinary flow to the bladder. The irreversible UUO model has been used to investigate various aspects of renal inflammation and scarring including the pathogenesis of disease and the testing of potential anti-inflammatory or anti-fibrotic therapies. The more challenging model of R-UUO has been used by some investigators and does offer significant research potential as it allows the study of inflammatory and immune processes and tissue remodeling in an injured and scarred kidney following the removal of the injurious stimulus. As a result, the R-UUO model offers investigators the opportunity to explore the resolution of kidney inflammation together with key aspects of tissue repair. These experimental models are of relevance to human disease as patients often present with obstruction of the renal tract that requires decompression and are commonly left with significant residual kidney impairment that has no current treatment options and may lead to eventual end stage kidney failure.

The murine model of irreversible unilateral ureteric obstruction (UUO) is presented together with the model of reversible UUO in which the ureteric obstruction is relieved by anastomosis of the severed ureter into the bladder. These models enable the study of renal inflammation and scarring as well as tissue remodeling.

Obstruction of the kidney may affect native or transplanted kidneys and results in kidney injury and scarring. Presented here is a model of obstructive ...

Pre-clinical Orthotopic Murine Model of Human Prostate Cancer

To study the multifaceted biology of prostate cancer, pre-clinical in vivo models offer a range of options to uncover critical biological information about this disease. The human orthotopic prostate cancer xenograft mouse model provides a useful alternative approach for understanding the specific interactions between genetically and molecularly altered tumor cells, their organ microenvironment, and for evaluation of efficacy of therapeutic regimens. This is a well characterized model designed to study the molecular events of primary tumor development and it recapitulates the early events in the metastatic cascade prior to embolism and entry of tumor cells into the circulation. Thus it allows elucidation of molecular mechanisms underlying the initial phase of metastatic disease. In addition, this model can annotate drug targets of clinical relevance and is a valuable tool to study prostate cancer progression. In this manuscript we describe a detailed procedure to establish a human orthotopic prostate cancer xenograft mouse model.

Prostate cancer is the second most common cause of cancer-related deaths in the United States. An orthotopic cancer model provides a useful approach to understand the biology of prostate cancer and to evaluate the efficacy of therapeutic regimens. This protocol describes detailed steps necessary to establish an orthotopic prostate cancer mouse model.

To study the multifaceted biology of prostate cancer, pre-clinical in vivo models offer a range of options to uncover critical biological information ...

Generating a Murine Orthotopic Metastatic Breast Cancer Model and Performing Murine Radical Mastectomy

In vivo mouse models to assess breast cancer progression are essential for cancer research, including preclinical drug developments. However, the majority of the practical and technical details are commonly omitted in published manuscripts which, therefore, makes it challenging to reproduce the models, particularly when it involves surgical techniques. Bioluminescence technology allows for the evaluation of small amounts of cancer cells even when a tumor is not palpable. Utilizing luciferase-expressing cancer cells, we establish a breast cancer orthotopic inoculation technique with a high tumorigenesis rate. Lung metastasis is assessed utilizing an ex vivo technique. We, then, establish a mastectomy model with a low local recurrence rate to assess the metastatic tumor burden. Herein, we describe, in detail, the surgical techniques of orthotopic implantation and mastectomy for breast cancer with a high tumorigenesis rate and low local recurrence rates, respectively, to improve breast cancer model efficiency.

We introduce a murine orthotopic breast cancer model and radical mastectomy model with bioluminescence technology to quantify the tumor burden to mimic human breast cancer progression.

In vivo mouse models to assess breast cancer progression are essential for cancer research, including preclinical drug developments. However, the majority ...

Isometric Contractility Measurement of the Mouse Mesenteric Artery Using Wire Myography

The wire myograph technique is used to assess the contractility of vascular smooth muscles in response to depolarization, GPCR agonists/inhibitors and drugs. It is widely used in many studies on the physiological functions of vascular smooth muscle, the pathogenesis of vascular diseases such as hypertension, and the development of smooth muscle relaxant drugs. The mouse is a widely used model animal with a large pool of disease models and genetically modified strains. We introduced this method to measure the isometric contraction of mouse mesenteric artery in detail. A 1.4-mm segment of mouse mesenteric resistance artery was isolated and mounted on a myograph chamber by passing two steel wires through its lumen. After equilibration and normalization steps, the vessel segment was potentiated by a high-K+ solution twice prior to the contraction assay. As an example of the application of this method in drug development, we measured the relaxant effect of a novel natural substance, neoliensinine, isolated from a Chinese herb, embryos of the lotus seed (Nelumbo nucifera Gaertn.) on mouse mesenteric arteries. The vessel segments mounted on the myograph chamber were stimulated with a high-K+ solution. When the force tension reached a stable sustained phase, cumulative doses of neoliensinine were added to the chamber. We found that neoliensinine had a dose-dependent relaxant effect on smooth muscle contraction, thus suggesting that it bears potential activity against hypertension. In addition, as the vessel segment can survive at least 4 hours after mounting and maintain contractility induced by the high-K+ solution for many times, we suggest that the wire myograph system may be used for the time-consuming process of drug screening.

The wire myograph technique is used to investigate vascular smooth muscle functions and screen new drugs. We report a detailed protocol for measuring the isometric contractility of the mouse mesenteric artery and for screening new relaxants of vascular smooth muscle.

The wire myograph technique is used to assess the contractility of vascular smooth muscles in response to depolarization, GPCR agonists/inhibitors and ...