Profibrotic VEGFR3-Dependent Lymphatic Vessel Growth in Autoimmune Valvular Carditis

Rheumatic heart valve disease: navigating the challenges of an overlooked autoimmune disorder

Despite being a leading cause of morbidity and mortality among young people, affecting predominantly women, rheumatic heart disease (RHD) remains neglected and understudied. This autoimmune condition arises from a complex continuum that begins with repeated Group A Streptococcal (GAS) pharyngitis, leading to acute rheumatic fever (ARF) that eventually results in damage to the heart, mainly affecting the mitral valve. While RHD has been nearly eradicated in high-income countries, it continues to be a significant and active health issue in low- and middle-income countries. The resolution of this disease faces several challenges, including the difficulty of diagnosis and the lack of access to preventive measures in resource-poor communities. Addressing these issues will require a global health collaboration involving healthcare professionals, policymakers, and advocacy groups. However, over the past two decades, there has been a revival of scientific interest, fostering optimism for the future. Recent research has significantly advanced our understanding of RHD, shedding light on the immune-to-autoimmune transition, neoangiogenesis, and lymphangiogenesis processes. Additionally, perspectives of discoveries in biomarkers and the development of genetic, transcriptomic, and provide a solid foundation for further advancements in the field.

Disease-Specific Alteration of Cardiac Lymphatics: A Review from Animal Disease Models to Clinics

For many years, the significance of cardiac lymphatic vessels was largely overlooked in clinical practice, with little consideration given to their role in the pathophysiology or treatment of cardiac diseases. However, recent research has brought renewed attention to these vessels, progressively illuminating their function and importance within the realm of cardiovascular science. Experimental studies, particularly those utilizing animal models of cardiac disease, have demonstrated a clear relationship between cardiac lymphatic vessels and both the pathogenesis and progression of these conditions. These findings have prompted a growing interest in potential therapeutic applications that specifically target the cardiac lymphatic system. Conversely, while clinical investigations into cardiac lymphatics remain limited, recent studies have begun to explore their identification through specific surface markers, as well as the expression dynamics of lymphangiogenic factors. These studies have increasingly highlighted associations of lymphatic dysfunction with inflammation and fibrosis, both of which negatively impact cardiac function and remodeling across various pathological states. Despite these advances, comprehensive reviews of the current knowledge regarding the cardiac lymphatic vasculature, particularly within specific disease contexts, remain scarce. This review aims to address this gap by providing a detailed synthesis of existing reports, encompassing both animal model research and studies on human clinical specimens, with a special focus on the role of cardiac lymphatic vessels in different disease states.