Adipose Tissue

The TREAT program seeks to understand how the whole body is affected by SAT disorders initially focusing on the adipose tissue and vessels.

Adipose tissue is found all over the outside of our bodies under the skin but is also found in and around muscles, around the heart, intestines, as part of bone marrow and around nerves.  People with subcutaneous adipose tissue (SAT) disorders like lipedema and Dercum’s disease have SAT that grows under the skin independent of food intake or exercise. This SAT that is resistant to food restriction or over-exercise or even bariatric surgery acts differently than “normal” fat. Normal fat responds to environmental cues such as increasing carbohydrate and fat intake when food is eaten and releases fat when there is a high consumption of energy such as during exercise and fasting. Normal fat stores can dramatically decrease during fasting or high exercise regimens but lipedema fat is resistant and stays intact. 

The goal of the TREAT program is to figure out why the lipedema SAT is resistant SAT.

Adipose tissue is an endocrine organ secreting a whole list of hormones or messages called adipokines and sometimes cytokines. You can find a comprehensive list of adipose derived hormone and cytokines/adipokines here: http://themedicalbiochemistrypage.org/adipose-tissue.php

The TREAT program will be determining if the adipokines from lipedema SAT are different than normal SAT.

Normal Adipose Cells

Immune cells are very important in SAT. Macrophages which are like the pac man of the immune cells are prevalent in lipedema SAT and are therefore likely important in the physiology of lipedema SAT. When a fat cell dies, macrophages eat the debris and fat and become engorged with fat droplets themselves.  In the image fat cell image (left), the darker areas are blood vessels.

Panniculitis

When the fat becomes inflamed, this is known as panniculitis. The image (left) displays many immune cells in the fat tissue depected as the dark dots in the fat cells.  We do not see this often in either lipedema or Dercum’s disease.

Angiolipoma

If a large number of blood vessels grow in an area of fat it is called an angiolipoma.
Angiolipoma can be found commonly in people with a diagnosis of Dercum’s disease but can also be found in people with lipedema.
The TREAT program is very interested in the blood and lymphatic vessels in lipedema.

Nerve in Fat

Lipedema and Dercum’s disease are painful fat disorders.  It is not known why the nerves are painful.

It may be that the excess fat in lipedema and Dercum’s disease presses on the nerves causing pain or that the the cytokines and adipokines cause damage to the nerve cells.

Two nerves

It may be that the excess fat in lipedema and Dercum’s disease presses on the nerves causing pain or that the the cytokines and adipokines cause damage to the nerve cells.

The two nerves below are surrounded by fibrotic tissue.  Fibrotic tissue is like a scar and is found around blood vessels and nerves in both lipedema and Dercum’s disease.  Fibrosis is the end result of inflammation and therefore when you see fibrosis, you know that inflammation was present.  So it may be that inflammation damages nerves causing pain in lipedema and Dercum’s disease.

Photographs were taken by Dr. Karen Herbst from tissues generously offered from men and women with SAT disorders.