Development and engineering of lymphatic endothelial cells: clinical implications

Studies on the lymphatic endothelium have been hampered by the difficulty to identify lymphatic endothelial cells (LECs) and to distinguish them from blood vascular endothelial cells (BECs). The situation was greatly improved by the identification of molecules with high specificity for LECs. A great deal of progress in the field of lymphangiogenesis research has been due to the detection of lymphangiogenic growth factors and their receptors, and there is growing evidence that these molecules are also involved in tumor-induced lymphangiogenesis and lymphatic dissemination of tumor cells. There is a considerable spectrum of congenital and acquired lymphedema-lymphangiodysplasia syndromes ranging from primary aplasia, hypoplasia and hyperplasia to secondary (acquired) obstructive, obliterative and surgical hindrance of lymph drainage. Consequently, there are a number of clinical applications for therapeutics that either inhibit or induce lymphangiogenesis. Although natural lymphatic regeneration is mostly very efficient, engineering of LECs may be useful in cases of lymphatic aplasia or hypoplasia. To achieve these goals, studies on the embryonic development and differentiation of LECs will reveal the key regulatory factors that need to be targeted.