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Abnormal mural cell recruitment in lymphatic capillaries: a common pathological feature in chronic lymphedematous
1Lymphology Centre of Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Abnormal mural cell coverage of lymphatic capillaries is common in chronic lymphedema (LE). This finding suggests mural cells play a role in the progression of lymphedema.
Area of Science:
- Vascular biology
- Dermatology
- Pathology
Background:
- Chronic lymphedema (LE) affects dermal lymphatic capillaries.
- Mural cells are key components of lymphatic vessels.
Purpose of the Study:
- To investigate the structural and functional characteristics of dermal lymphatic capillaries in patients with chronic LE.
- To focus on the role of mural cells in skin lymphatics.
Main Methods:
- Studied 44 LE patients and 8 controls.
- Performed genetic analysis of FOXC2 in primary LE patients.
- Used immunohistology for podoplanin and alpha-smooth muscle actin (α-SMA) staining.
- Assessed lymphatic vascular function using indocyanine green lymphography.
Main Results:
- Identified FOXC2 mutations in two primary LE patients.
- Observed increased α-SMA positive mural cell coverage in lymphatic capillaries of most LE patients.
- Found significantly higher α-SMA positive lymphatic vessel percentages in LE patients compared to controls.
- Detected dermal backflow in lymphedematous extremities, unlike healthy limbs.
Conclusions:
- Abnormal mural cell recruitment in dermal lymphatic capillaries is a common pathological feature of chronic LE.
- These cellular changes may contribute to the evolution and progression of lymphedema.
Objectives:
This study aimed to explore the structural and functional characteristics of dermal lymphatic capillaries in patients with chronic LE, specifically focused on the mural cells that are associated with skin lymphatics.
Methods:
Forty-four patients (30 primary LE and 14 secondary LE) and eight healthy controls were enrolled in this study. Genetic analysis of the FOXC2 was performed in 18 patients with primary LE. Full-thickness skin was excised and immunohistologically stained for podoplanin and α-SMA. The proportions of α-SMA+ Lv (α-SMA+ Lv%) were calculated. Lymphatic vascular function was assessed by indocyanine green lymphography.
Results:
Analysis of FOXC2 revealed two mutations in two patients with LDs. Histologically, thirty-nine patients exhibited increased α-SMA+ mural cell coverage of lymphatic capillaries. The α-SMA+ Lv% values in the superficial and deep dermis in patients with primary and secondary LE were significantly higher than in the control group. Compared with imaging findings in healthy limbs, in which the collecting lymphatics were clearly visualized, lymphedematous extremities all exhibited dermal backflow.
Conclusions:
Abnormal recruitment of mural cells in dermal lymphatic capillaries is a common pathological event in chronic LE, and may play a role in disease evolution.
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