Cardiac lymphatics: state of the art

Abstract

Purpose of reviewThe beneficial role of cardiac lymphatics in health and disease has begun to be recognized, with both preclinical and clinical evidence demonstrating that lymphangiogenesis is activated in cardiovascular diseases. This review aims to summarize our current understanding of the regulation and impact of cardiac lymphatic remodeling during development and in adult life, highlighting emerging concepts regarding distinguishing traits of cardiac lymphatic endothelial cells (LEC).Recent findingsGenetic lineage-tracing and clonal analyses have revealed that a proportion of cardiac LECs originate from nonvenous sources. Further, these sources may vary between different regions of the heart, and could translate to differences in LEC sensitivity to molecular regulators. Several therapeutic approaches have been applied to investigate how lymphatics contribute to resolution of myocardial edema and inflammation in cardiovascular diseases. From these studies have emerged novel insights, notably concerning the cross-talk between lymphatics and cardiac interstitial cells, especially immune cells.SummaryRecent years have witnessed a significant expansion in our knowledge of the molecular characteristics and regulation of cardiac lymphatics. The current body of work is in support of critical contributions of cardiac lymphatics to maintain both fluid and immune homeostasis in the heart.

Single-Cell and Spatial Transcriptomic Analyses Reveals the Dynamic Transcript Profiles of Myocardial Lymphangiogenesis post Myocardial Infarction

“…The cardiac lymphatic vasculature was first described in the 17 th century(Tammela & Alitalo, 2010). To date, studies have demonstrated the role of the lymphatic system only in embryonic heart development and cardiac health in adults(Brakenhielm & Alitalo, 2019; Heron, Ratajska, & Brakenhielm, 2022; Klotz et al, 2015). Cardiac lymphatics can take up inter-tissue fluid and transport immune cells through highly branched, blunt, open-ended lymphatic capillaries, to the lymph nodes near the thoracic ducts and, finally, into the superior vena cava(Huang, Lavine, & Randolph, 2017).…”