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Abstract
The lymphatic vasculature, which accompanies the blood vasculature in most organs, is indispensable in the maintenance of tissue fluid homeostasis, immune cell trafficking, and nutritional lipid uptake and transport, as well as in reverse cholesterol transport. In this Review, we discuss the physiological role of the lymphatic system in the heart in the maintenance of cardiac health and describe alterations in lymphatic structure and function that occur in cardiovascular pathology, including atherosclerosis and myocardial infarction. We also briefly discuss the role that immune cells might have in the regulation of lymphatic growth (lymphangiogenesis) and function. Finally, we provide examples of how the cardiac lymphatics can be targeted therapeutically to restore lymphatic drainage in the heart to limit myocardial oedema and chronic inflammation.
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Affiliation(s)
- Ebba Brakenhielm
- Normandy University, UniRouen, INSERM (Institut National de la Santé et de la Recherche Médicale) UMR1096 (EnVI Laboratory), FHU REMOD-VHF, Rouen, France.
| | - Kari Alitalo
- Wihuri Research Institute and Translational Cancer Biology Program, University of Helsinki, Biomedicum Helsinki, Helsinki, Finland.
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Huang LH, Lavine KJ, Randolph GJ. Cardiac Lymphatic Vessels, Transport, and Healing of the Infarcted Heart. ACTA ACUST UNITED AC 2017; 2:477-483. [PMID: 28989985 PMCID: PMC5628514 DOI: 10.1016/j.jacbts.2017.02.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The lymphatic vasculature plays a key role in regulating tissue fluid homeostasis, lipid transport, and immune surveillance throughout the body. Although it has been appreciated that the heart relies on lymphatic vessels to maintain fluid balance and that such balance must be tightly maintained to allow for normal cardiac output, it has only recently come to light that the lymphatic vasculature may serve as a therapeutic target with which to promote optimal healing following myocardial ischemia and infarction. This article reviews the subject of cardiac lymphatic vessels and highlights studies that imply targeting of lymphatic vessel development or transport using vascular endothelial growth factor-C therapy may serve as a promising avenue for future clinical application in the context of ischemic injury.
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Affiliation(s)
- Li-Hao Huang
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
- Address for correspondence: Dr. Li-Hao Huang, Department of Pathology and Immunology, Washington University School of Medicine, 425 South Euclid Avenue, BJCIH 8307, St. Louis, Missouri 63110.
| | - Kory J. Lavine
- Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Gwendalyn J. Randolph
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
- Dr. Gwendalyn J. Randolph, Department of Pathology and Immunology, Washington University School of Medicine, 425 South Euclid Avenue, BJCIH 8307, St. Louis, Missouri 63110.
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Edwards LA, Nowocin AK, Jafari NV, Meader LL, Brown K, Sarde A, Lam C, Murray A, Wong W. Chronic Rejection of Cardiac Allografts Is Associated With Increased Lymphatic Flow and Cellular Trafficking. Circulation 2017; 137:488-503. [PMID: 28775077 DOI: 10.1161/circulationaha.117.028533] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 07/20/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cardiac transplantation is an excellent treatment for end-stage heart disease. However, rejection of the donor graft, in particular, by chronic rejection leading to cardiac allograft vasculopathy, remains a major cause of graft loss. The lymphatic system plays a crucial role in the alloimmune response, facilitating trafficking of antigen-presenting cells to draining lymph nodes. The encounter of antigen-presenting cells with T lymphocytes in secondary lymphoid organs is essential for the initiation of alloimmunity. Donor lymphatic vessels are not anastomosed to that of the recipient during transplantation. The pathophysiology of lymphatic disruption is unknown, and whether this disruption enhances or hinders the alloimmune responses is unclear. Although histological analysis of lymphatic vessels in donor grafts can yield information on the structure of the lymphatics, the function following cardiac transplantation is poorly understood. METHODS Using single-photon emission computed tomography/computed tomography lymphoscintigraphy, we quantified the lymphatic flow index following heterotrophic cardiac transplantation in a murine model of chronic rejection. RESULTS Ten weeks following transplantation of a minor antigen (HY) sex-mismatched heart graft, the lymphatic flow index was significantly increased in comparison with sex-matched controls. Furthermore, the enhanced lymphatic flow index correlated with an increase in donor cells in the mediastinal draining lymph nodes; increased lymphatic vessel area; and graft infiltration of CD4+, CD8+ T cells, and CD68+ macrophages. CONCLUSIONS Chronic rejection results in increased lymphatic flow from the donor graft to draining lymph nodes, which may be a factor in promoting cellular trafficking, alloimmunity, and cardiac allograft vasculopathy.
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Affiliation(s)
- Lindsey A Edwards
- MRC Centre for Transplantation, King's College London, Guy's Hospital, United Kingdom (L.A.E., A.K.N., N.V.J., L.L.M., K.B., A.S., C.L., A.M., W.W.)
| | - Anna K Nowocin
- MRC Centre for Transplantation, King's College London, Guy's Hospital, United Kingdom (L.A.E., A.K.N., N.V.J., L.L.M., K.B., A.S., C.L., A.M., W.W.)
| | - Nazila V Jafari
- MRC Centre for Transplantation, King's College London, Guy's Hospital, United Kingdom (L.A.E., A.K.N., N.V.J., L.L.M., K.B., A.S., C.L., A.M., W.W.)
| | - Lucy L Meader
- MRC Centre for Transplantation, King's College London, Guy's Hospital, United Kingdom (L.A.E., A.K.N., N.V.J., L.L.M., K.B., A.S., C.L., A.M., W.W.)
| | - Kathryn Brown
- MRC Centre for Transplantation, King's College London, Guy's Hospital, United Kingdom (L.A.E., A.K.N., N.V.J., L.L.M., K.B., A.S., C.L., A.M., W.W.)
| | - Aurélien Sarde
- MRC Centre for Transplantation, King's College London, Guy's Hospital, United Kingdom (L.A.E., A.K.N., N.V.J., L.L.M., K.B., A.S., C.L., A.M., W.W.)
| | - Carolyn Lam
- MRC Centre for Transplantation, King's College London, Guy's Hospital, United Kingdom (L.A.E., A.K.N., N.V.J., L.L.M., K.B., A.S., C.L., A.M., W.W.)
| | - Alex Murray
- MRC Centre for Transplantation, King's College London, Guy's Hospital, United Kingdom (L.A.E., A.K.N., N.V.J., L.L.M., K.B., A.S., C.L., A.M., W.W.)
| | - Wilson Wong
- MRC Centre for Transplantation, King's College London, Guy's Hospital, United Kingdom (L.A.E., A.K.N., N.V.J., L.L.M., K.B., A.S., C.L., A.M., W.W.)
- King's College London, School of Medicine at Guy's, King's and St. Thomas' Hospitals, United Kingdom (W.W.)
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Perin EC, Tian M, Marini FC, Silva GV, Zheng Y, Baimbridge F, Quan X, Fernandes MR, Gahremanpour A, Young D, Paolillo V, Mukhopadhyay U, Borne AT, Uthamanthil R, Brammer D, Jackson J, Decker WK, Najjar AM, Thomas MW, Volgin A, Rabinovich B, Soghomonyan S, Jeong HJ, Rios JM, Steiner D, Robinson S, Mawlawi O, Pan T, Stafford J, Kundra V, Li C, Alauddin MM, Willerson JT, Shpall E, Gelovani JG. Imaging long-term fate of intramyocardially implanted mesenchymal stem cells in a porcine myocardial infarction model. PLoS One 2011; 6:e22949. [PMID: 21912635 PMCID: PMC3164664 DOI: 10.1371/journal.pone.0022949] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 07/01/2011] [Indexed: 12/22/2022] Open
Abstract
The long-term fate of stem cells after intramyocardial delivery is unknown. We used noninvasive, repetitive PET/CT imaging with [(18)F]FEAU to monitor the long-term (up to 5 months) spatial-temporal dynamics of MSCs retrovirally transduced with the sr39HSV1-tk gene (sr39HSV1-tk-MSC) and implanted intramyocardially in pigs with induced acute myocardial infarction. Repetitive [(18)F]FEAU PET/CT revealed a biphasic pattern of sr39HSV1-tk-MSC dynamics; cell proliferation peaked at 33-35 days after injection, in periinfarct regions and the major cardiac lymphatic vessels and lymph nodes. The sr39HSV1-tk-MSC-associated [(18)F]FEAU signals gradually decreased thereafter. Cardiac lymphography studies using PG-Gd-NIRF813 contrast for MRI and near-infrared fluorescence imaging showed rapid clearance of the contrast from the site of intramyocardial injection through the subepicardial lymphatic network into the lymphatic vessels and periaortic lymph nodes. Immunohistochemical analysis of cardiac tissue obtained at 35 and 150 days demonstrated several types of sr39HSV1-tk expressing cells, including fibro-myoblasts, lymphovascular cells, and microvascular and arterial endothelium. In summary, this study demonstrated the feasibility and sensitivity of [(18)F]FEAU PET/CT imaging for long-term, in-vivo monitoring (up to 5 months) of the fate of intramyocardially injected sr39HSV1-tk-MSC cells. Intramyocardially transplanted MSCs appear to integrate into the lymphatic endothelium and may help improve myocardial lymphatic system function after MI.
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Affiliation(s)
- Emerson C Perin
- The Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, United States of America
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Nakamura K, Rockson SG. Molecular targets for therapeutic lymphangiogenesis in lymphatic dysfunction and disease. Lymphat Res Biol 2009; 6:181-9. [PMID: 19093791 DOI: 10.1089/lrb.2008.63404] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The convergence of multiple disciplines upon the study of the lymphatic vasculature has invigorated a renaissance of research, using powerful investigative tools and an exponential growth of interest in this historically underappreciated system. Fundamental discoveries in lymphatic development have yielded relevant animal models for vexing clinical diseases that suffer from nonexistent of minimally effective treatments. Inherited and acquired lymphedema represent the current crux of research efforts to identify potential molecular therapies born from these early discoveries. The importance of the lymphatic system is, however, not limited to lymphedema but encompasses a diverse spectrum of human disease including inflammation and cancer metastasis. As the lymphatic vasculature continues to benefit from fruits of biomedical investigation, translation of mechanistic insights into targeted, rationally-conceived therapeutics will be become a reality.
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Affiliation(s)
- Kenta Nakamura
- Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
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The role of the lymphatic circulation in the natural history and expression of cardiovascular disease. Int J Cardiol 2008; 129:309-17. [PMID: 18559287 DOI: 10.1016/j.ijcard.2008.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Revised: 11/19/2007] [Accepted: 02/09/2008] [Indexed: 11/23/2022]
Abstract
The lymphatic vasculature is essential to fluid, protein and cellular transport, and to immune responsiveness. The last decade has witnessed a virtual renaissance of investigation into the function of the lymphatic microvasculature, prompting re-consideration of its role in the genesis and progression of cardiovascular pathology. The lymphatic microvasculature of the heart and vascular wall likely participate in atherogenesis, myocardial infarction, congestive heart failure, and cardiac transplantation. Intensive exploration of lymphatic mechanisms of cardiovascular disease is likely to lead to enhanced insights and novel therapeutic approaches.
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