Lymphatic circulation in astronauts: basic knowledge, challenges and perspectives

Space missions expose the astronauts' bodies to various stressors, including microgravity. While numerous studies have investigated the effects of this stressor, research on its impact on the lymphatic system remains confidential. This review highlights the importance of scientific research into the human lymphatic system exposed to long-duration space missions. The safety of astronauts is a major issue. Chronic slowing of lymphatic drainage disrupts the balance of fluid and macromolecule exchange within poorly drained anatomical areas. Their extracellular matrix gradually becomes the site of dispersed deposits of degraded proteins and increased local water content. The interaction between these two phenomena leads to mutual amplification, resulting in a slow, gradual increase in pressure within the impacted tissue, which undergoes an expansion known as edema. The speed at which these pathophysiological processes take hold includes the extent of the lymphatic insufficiency and any compensatory measures that may or may not be put in place. Lymphatics are present everywhere in the body where tissues receive blood. Organs such as the brain, heart, and intestines, among others, as well as local immune function, can be damaged over time when their lymphatic system becomes chronically insufficient. The human clinical experience of lymphatic insufficiency tells us that the onset of edema takes time and is an insidious but inevitable phenomenon if adequate compensation does not occur. The time required for the pathophysiological consequences of lymphatic insufficiency to become established does not coincide with the time allocated to bed rest experiments or current space missions. With the prospect of longer space missions, lymphatic insufficiency linked to microgravity could unexpectedly become a major obstacle to human life in space.