Exteriorization of thoracic duct lymph. Theoretical considerations and an experimental model.

Successful manipulation of the immune response will ultimately provide the answers for controlling homograft rejection, reversing autoimmune states, and quite possibly for curing carcinoma and other malignant neoplasms. During the past decade, many new drugs and techniques have been developed that alter the immune state. The theoretical basis for approaching the immune system via the thoracic duct is based on the fact that 90% to 95% of the cells in thoracic duct lymph are thymus-derived lymphocytes. Therefore, by tapping the thoracic duct, we could conceivably manipulate the T lymphocytes and control the cell-mediated arm of the immune system. This has in fact been done in renal transplantation and autoimmune diseases. An experimental canine model was developed that exteriorized lymph flow in a closed system. We describe our experiences with four dogs and we discuss proposed immunologic manipulation.