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Trivedi A, Reed HO. The lymphatic vasculature in lung function and respiratory disease. Front Med (Lausanne) 2023; 10:1118583. [PMID: 36999077 PMCID: PMC10043242 DOI: 10.3389/fmed.2023.1118583] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/23/2023] [Indexed: 03/18/2023] Open
Abstract
The lymphatic vasculature maintains tissue homeostasis via fluid drainage in the form of lymph and immune surveillance due to migration of leukocytes through the lymphatics to the draining lymph nodes. Lymphatic endothelial cells (LECs) form the lymphatic vessels and lymph node sinuses and are key players in shaping immune responses and tolerance. In the healthy lung, the vast majority of lymphatic vessels are found along the bronchovascular structures, in the interlobular septa, and in the subpleural space. Previous studies in both mice and humans have shown that the lymphatics are necessary for lung function from the neonatal period through adulthood. Furthermore, changes in the lymphatic vasculature are observed in nearly all respiratory diseases in which they have been analyzed. Recent work has pointed to a causative role for lymphatic dysfunction in the initiation and progression of lung disease, indicating that these vessels may be active players in pathologic processes in the lung. However, the mechanisms by which defects in lung lymphatic function are pathogenic are understudied, leaving many unanswered questions. A more comprehensive understanding of the mechanistic role of morphological, functional, and molecular changes in the lung lymphatic endothelium in respiratory diseases is a promising area of research that is likely to lead to novel therapeutic targets. In this review, we will discuss our current knowledge of the structure and function of the lung lymphatics and the role of these vessels in lung homeostasis and respiratory disease.
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Affiliation(s)
- Anjali Trivedi
- Weill Cornell Medical Center, New York, NY, United States
| | - Hasina Outtz Reed
- Weill Cornell Medical Center, New York, NY, United States
- Graduate School of Medical Sciences, Weill Cornell Medicine, New York, NY, United States
- *Correspondence: Hasina Outtz Reed,
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2
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Probst CK, Montesi SB, Medoff BD, Shea BS, Knipe RS. Vascular permeability in the fibrotic lung. Eur Respir J 2020; 56:13993003.00100-2019. [PMID: 32265308 PMCID: PMC9977144 DOI: 10.1183/13993003.00100-2019] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 03/26/2020] [Indexed: 12/26/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is thought to result from aberrant tissue repair processes in response to chronic or repetitive lung injury. The origin and nature of the injury, as well as its cellular and molecular targets, are likely heterogeneous, which complicates accurate pre-clinical modelling of the disease and makes therapeutic targeting a challenge. Efforts are underway to identify central pathways in fibrogenesis which may allow targeting of aberrant repair processes regardless of the initial injury stimulus. Dysregulated endothelial permeability and vascular leak have long been studied for their role in acute lung injury and repair. Evidence that these processes are of importance to the pathogenesis of fibrotic lung disease is growing. Endothelial permeability is increased in non-fibrosing lung diseases, but it resolves in a self-limited fashion in conditions such as bacterial pneumonia and acute respiratory distress syndrome. In progressive fibrosing diseases such as IPF, permeability appears to persist, however, and may also predict mortality. In this hypothesis-generating review, we summarise available data on the role of endothelial permeability in IPF and focus on the deleterious consequences of sustained endothelial hyperpermeability in response to and during pulmonary inflammation and fibrosis. We propose that persistent permeability and vascular leak in the lung have the potential to establish and amplify the pro-fibrotic environment. Therapeutic interventions aimed at recognising and "plugging" the leak may therefore be of significant benefit for preventing the transition from lung injury to fibrosis and should be areas for future research.
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Affiliation(s)
- Clemens K. Probst
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sydney B. Montesi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin D. Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Barry S. Shea
- Division of Pulmonary and Critical Care Medicine, Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Rachel S. Knipe
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
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3
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Kopf KW, Harral JW, Staker EA, Summers ME, Petrache I, Kheyfets V, Irwin DC, Majka SM. Optimization of combined measures of airway physiology and cardiovascular hemodynamics in mice. Pulm Circ 2020; 10:2045894020912937. [PMID: 32206308 PMCID: PMC7074541 DOI: 10.1177/2045894020912937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/11/2020] [Indexed: 12/11/2022] Open
Abstract
Pulmonary hypertension may arise as a complication of chronic lung disease typically associated with tissue hypoxia, as well as infectious agents or injury eliciting a type 2 immune response. The onset of pulmonary hypertension in this setting (classified as Group 3) often complicates treatment and worsens prognosis of chronic lung disease. Chronic lung diseases such as chronic obstructive lung disease (COPD), emphysema, and interstitial lung fibrosis impair airflow and alter lung elastance in addition to affecting pulmonary vascular hemodynamics that may culminate in right ventricle dysfunction. To date, functional endpoints in murine models of chronic lung disease have typically been limited to separately measuring airway and lung parenchyma physiology. These approaches may be lengthy and require a large number of animals per experiment. Here, we provide a detailed protocol for combined assessment of airway physiology with cardiovascular hemodynamics in mice. Ultimately, a comprehensive overview of pulmonary function in murine models of injury and disease will facilitate the integration of studies of the airway and vascular biology necessary to understand underlying pathophysiology of Group 3 pulmonary hypertension.
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Affiliation(s)
- Katrina W Kopf
- Biological Resource Center, National Jewish Health, Denver, USA
| | - Julie W Harral
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, National Jewish Health, Denver, USA
| | - Emily A Staker
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, National Jewish Health, Denver, USA
| | - Megan E Summers
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, National Jewish Health, Denver, USA
| | - Irina Petrache
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, National Jewish Health, Denver, USA
| | - Vitaly Kheyfets
- Department of Bioengineering, Anschutz Medical Campus University of Colorado, Aurora, USA
| | - David C Irwin
- Department of Medicine, Division of Cardiology, Anschutz Medical Campus University of Colorado, Aurora, USA
| | - Susan M Majka
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, National Jewish Health, Denver, USA.,Department of Biomedical Research, National Jewish Health, Denver, USA.,Gates Center for Regenerative Medicine and Stem Cell Biology and Cardiology University of Colorado Medical Center, Aurora, USA
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4
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Weber E, Sozio F, Borghini A, Sestini P, Renzoni E. Pulmonary lymphatic vessel morphology: a review. Ann Anat 2018; 218:110-117. [PMID: 29679722 DOI: 10.1016/j.aanat.2018.02.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/07/2018] [Accepted: 02/28/2018] [Indexed: 01/02/2023]
Abstract
Our understanding of lymphatic vessels has been advanced by the recent identification of relatively specific lymphatic endothelium markers, including Prox-1, VEGFR3, podoplanin and LYVE-1. The use of lymphatic markers has led to the observation that, contrary to previous assumptions, human lymphatic vessels extend deep inside the pulmonary lobule, either in association with bronchioles, intralobular arterioles or small pulmonary veins. Pulmonary lymphatic vessels may thus be classified into pleural, interlobular (in interlobular septa) and intralobular. Intralobular lymphatic vessels may be further subdivided in: bronchovascular (associated with a bronchovascular bundle), perivascular (associated with a blood vessel), peribronchiolar (associated with a bronchiole), and interalveolar (in interalveolar septa). Most of the intralobular lymphatic vessels are in close contact with a blood vessel, either alone or within a bronchovascular bundle. A minority is associated with a bronchiole, and small lymphatics are occasionally present even in interalveolar septa, seemingly independent of blood vessels or bronchioles. The lymphatics of the interlobular septa often contain valves, are usually associated with the pulmonary veins, and connect with the pleural lymphatics. The large lymphatics associated with bronchovascular bundles have similar characteristics to pleural and interlobular lymphatics and may be considered conducting vessels. The numerous small perivascular lymphatics and the few peribronchiolar ones that are found inside the lobule are probably the absorbing compartment of the lung responsible for maintaining the alveolar interstitium relatively dry in order to provide a minimal thickness of the air-blood barrier and thus optimize gas diffusion. These lymphatic populations could be differentially involved in the pathogenesis of diseases preferentially involving distinct lung compartments.
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Affiliation(s)
- E Weber
- Dept. of Molecular and Developmental Medicine, University of Siena, via A.Moro 2, 53100 Siena, Italy
| | - F Sozio
- Dept. of Molecular and Developmental Medicine, University of Siena, via A.Moro 2, 53100 Siena, Italy
| | - A Borghini
- Dept. of Molecular and Developmental Medicine, University of Siena, via A.Moro 2, 53100 Siena, Italy
| | - P Sestini
- Dept. of Medicine, Surgery and Neuroscience, University of Siena, viale Bracci 16, 53100 Siena, Italy
| | - E Renzoni
- ILD Unit Royal Brompton Hpospital,Sydney Street SW3 6LR, London, UK.
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5
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Distinct Profiles of CD163-Positive Macrophages in Idiopathic Interstitial Pneumonias. J Immunol Res 2018; 2018:1436236. [PMID: 29507864 PMCID: PMC5817286 DOI: 10.1155/2018/1436236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/14/2017] [Indexed: 12/27/2022] Open
Abstract
Background The types of cells most significantly linked to individual subtypes of idiopathic interstitial pneumonias (IIPs) remain unclear. Few studies have examined CD163+ macrophages in IIPs. Objective We retrospectively aimed to immunohistochemically characterize the CD163+ macrophages in IIPs. Methods Paraffin-embedded lung tissue samples were obtained from 47 patients with IIPs, including idiopathic pulmonary fibrosis (IPF), idiopathic nonspecific interstitial pneumonia (NSIP), and cryptogenic organizing pneumonia (COP), and 12 normal controls were immunohistochemically analyzed, using primary antibodies against CD68 and CD163 as indicators of pan and M2 macrophages, respectively. Results CD68+ macrophage density was significantly increased in the 3 subtypes of IIPs relative to that in the control group, although no difference was detected within the different IIPs. CD163+ macrophage density was significantly increased in NSIP and COP samples relative to that in IPF samples. The density ratio of CD163+ macrophages to CD68+ macrophages was significantly decreased in IPF/UIP samples relative to that in the others, while the densities in NSIP and COP were significantly higher than those in control cases. Conclusion CD163+ macrophages show distinct profiles among IIPs, and the standardized numerical density is decreased in IPF cases that have poor prognoses.
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Kropski JA, Richmond BW, Gaskill CF, Foronjy RF, Majka SM. Deregulated angiogenesis in chronic lung diseases: a possible role for lung mesenchymal progenitor cells (2017 Grover Conference Series). Pulm Circ 2017; 8:2045893217739807. [PMID: 29040010 PMCID: PMC5731726 DOI: 10.1177/2045893217739807] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Chronic lung disease (CLD), including pulmonary fibrosis (PF) and chronic obstructive pulmonary disease (COPD), is the fourth leading cause of mortality worldwide. Both are debilitating pathologies that impede overall tissue function. A common co-morbidity in CLD is vasculopathy, characterized by deregulated angiogenesis, remodeling, and loss of microvessels. This substantially worsens prognosis and limits survival, with most current therapeutic strategies being largely palliative. The relevance of angiogenesis, both capillary and lymph, to the pathophysiology of CLD has not been resolved as conflicting evidence depicts angiogenesis as both reparative or pathologic. Therefore, we must begin to understand and model the underlying pathobiology of pulmonary vascular deregulation, alone and in response to injury induced disease, to define cell interactions necessary to maintain normal function and promote repair. Capillary and lymphangiogenesis are deregulated in both PF and COPD, although the mechanisms by which they co-regulate and underlie early pathogenesis of disease are unknown. The cell-specific mechanisms that regulate lung vascular homeostasis, repair, and remodeling represent a significant gap in knowledge, which presents an opportunity to develop targeted therapies. We have shown that that ABCG2pos multipotent adult mesenchymal stem or progenitor cells (MPC) influence the function of the capillary microvasculature as well as lymphangiogenesis. A balance of both is required for normal tissue homeostasis and repair. Our current models suggest that when lymph and capillary angiogenesis are out of balance, the non-equivalence appears to support the progression of disease and tissue remodeling. The angiogenic regulatory mechanisms underlying CLD likely impact other interstitial lung diseases, tuberous sclerosis, and lymphangioleiomyomatosis.
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Affiliation(s)
- Jonathan A Kropski
- 1 12328 Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bradley W Richmond
- 1 12328 Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christa F Gaskill
- 1 12328 Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert F Foronjy
- 3 5718 Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Susan M Majka
- 1 12328 Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,2 74498 Department of Medicine, Division of Pulmonary and Critical Care Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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7
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Montero MA, Osadolor T, Khiroya R, Salcedo MT, Robertus JL, Rice A, Nicholson AG, Roman A, Monforte V. Restrictive allograft syndrome and idiopathic pleuroparenchymal fibroelastosis: do they really have the same histology? Histopathology 2017; 70:1107-1113. [DOI: 10.1111/his.13171] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/21/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Maria A Montero
- Histopathology Department; Royal Brompton and Harefield NHS Foundation Trust; London UK
- Biomedical Respiratory Unit; Imperial College London; London UK
| | - Tina Osadolor
- Biomedical Respiratory Unit; Imperial College London; London UK
| | - Reena Khiroya
- Histopathology Department; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | | | - Jan L Robertus
- Histopathology Department; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - Alexandra Rice
- Histopathology Department; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - Andrew G Nicholson
- Histopathology Department; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - Antonio Roman
- Respiratory Medicine; Vall d'Hebron University Hospitals; Barcelona Spain
| | - Victor Monforte
- Respiratory Medicine; Vall d'Hebron University Hospitals; Barcelona Spain
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8
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Yamashita M, Niisato M, Hanasaka T, Iwama N, Takahashi T, Sugai T, Ono M, Yamauchi K. Development of Lymphatic Capillary Network Along the Alveolar Walls of Autopsied Human Lungs with Pneumonia. Lymphat Res Biol 2016; 14:210-219. [PMID: 27617628 DOI: 10.1089/lrb.2015.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Limited information is available regarding the lymphatic vasculature during pneumonia. OBJECTIVE To characterize lymphatic vasculatures in autopsied cadavers with pneumonia. METHODS Paraffin-embedded lung tissues obtained from 20 autopsied cadavers with complicated pneumonia and 10 control cadavers without pneumonia were used for immunohistochemical analyses using primary antibodies against podoplanin, vascular endothelial growth factor receptor-3 (VEGFR-3), CD34, vascular endothelial growth factor (VEGF)-C, VEGF-D, CD73, and CD163. RESULTS There was no difference in the vascular density of podoplanin+ usual lymphatics between the individuals with and without pneumonia. In half of the cadavers with pneumonia, however, a network of podoplanin+ cells lying together in a side-by-side bead-like arrangement appeared along the alveolar septa; however, this was absent in the control cadavers. The podoplanin+ cells in the network were characterized by a weaker expression of podoplanin, relative to usual lymphatics, and the occasional presence of ductal structures. Although podoplanin+ cells were not coexpressed with VEGFR-3, a part of the network was connected to CD73+ afferent lymphatics. The network showed an intertwined relationship with CD34+ capillaries, suggesting that the network represents lymphatic capillaries. The number of CD163+ macrophages was significantly increased in individuals with the network than those without the network, while a significant decrease in neutrophils was observed. VEGF-C expressed in CD163+ macrophages and type II epithelial cells was observed in the cadavers with the network. CONCLUSION The development of lymphatic capillary networks along the alveolar septa rather than the usual lymphangiogenesis was noted in autopsied individuals with pneumonia.
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Affiliation(s)
- Masahiro Yamashita
- 1 Department of Pulmonary Medicine, Allergy and Rheumatology, Iwate Medical University School of Medicine , Morioka, Japan .,2 Department of Pathology, Tohoku University Graduate School of Medicine , Sendai, Japan
| | - Miyuki Niisato
- 1 Department of Pulmonary Medicine, Allergy and Rheumatology, Iwate Medical University School of Medicine , Morioka, Japan
| | - Tomohito Hanasaka
- 3 Technical Support Center for Life Science Research, Iwate Medical University , Iwate, Japan
| | - Noriyuki Iwama
- 4 Department of Pathology, Tohoku Rosai Hospital , Sendai, Japan
| | - Tohru Takahashi
- 5 Department of Pathology, Ishinomaki Red Cross Hospital , Ishinomaki, Japan
| | - Tamotsu Sugai
- 6 Department of Pathology, Iwate Medical University School of Medicine , Morioka, Japan
| | - Masao Ono
- 2 Department of Pathology, Tohoku University Graduate School of Medicine , Sendai, Japan
| | - Kohei Yamauchi
- 1 Department of Pulmonary Medicine, Allergy and Rheumatology, Iwate Medical University School of Medicine , Morioka, Japan
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9
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Yamashita M. Lymphangiogenesis and Lesion Heterogeneity in Interstitial Lung Diseases. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2016; 9:111-21. [PMID: 26823655 PMCID: PMC4725607 DOI: 10.4137/ccrpm.s33856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/03/2015] [Accepted: 11/23/2015] [Indexed: 01/26/2023]
Abstract
The lymphatic system has several physiological roles, including fluid homeostasis and the activation of adaptive immunity by fluid drainage and cell transport. Lymphangiogenesis occurs in adult tissues during various pathologic conditions. In addition, lymphangiogenesis is closely linked to capillary angiogenesis, and the balanced interrelationship between capillary angiogenesis and lymphangiogenesis is essential for maintaining homeostasis in tissues. Recently, an increasing body of information regarding the biology of lymphatic endothelial cells has allowed us to immunohistochemically characterize lymphangiogenesis in several lung diseases. Particular interest has been given to the interstitial lung diseases. Idiopathic interstitial pneumonias (IIPs) are characterized by heterogeneity in pathologic changes and lesions, as typified by idiopathic pulmonary fibrosis/usual interstitial pneumonia. In IIPs, lymphangiogenesis is likely to have different types of localized functions within each disorder, corresponding to the heterogeneity of lesions in terms of inflammation and fibrosis. These functions include inhibitory absorption of interstitial fluid and small molecules and maturation of fibrosis by excessive interstitial fluid drainage, caused by an unbalanced relationship between capillary angiogenesis and lymphangiogenesis and trafficking of antigen-presenting cells and induction of fibrogenesis via CCL21 and CCR7 signals. Better understanding for regional functions of lymphangiogenesis might provide new treatment strategies tailored to lesion heterogeneity in these complicated diseases.
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Affiliation(s)
- Masahiro Yamashita
- Department of Pulmonary Medicine, Allergy and Rheumatology, Iwate Medical University School of Medicine, Morioka, Japan
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10
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Isolation and Characterization of Human Lung Lymphatic Endothelial Cells. BIOMED RESEARCH INTERNATIONAL 2015; 2015:747864. [PMID: 26137493 PMCID: PMC4475539 DOI: 10.1155/2015/747864] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/24/2014] [Accepted: 01/12/2015] [Indexed: 12/21/2022]
Abstract
Characterization of lymphatic endothelial cells from the respiratory system may be crucial to investigate the role of the lymphatic system in the normal and diseased lung. We describe a simple and inexpensive method to harvest, isolate, and expand lymphatic endothelial cells from the human lung (HL-LECs). Fifty-five samples of healthy lung selected from patients undergoing lobectomy were studied. A two-step purification tool, based on paramagnetic sorting with monoclonal antibodies to CD31 and Podoplanin, was employed to select a pure population of HL-LECs. The purity of HL-LECs was assessed by morphologic criteria, immunocytochemistry, flow cytometry, and functional assays. Interestingly, these cells retain in vitro several receptor tyrosine kinases (RTKs) implicated in cell survival and proliferation. HL-LECs represent a clinically relevant cellular substrate to study lymphatic biology, lymphoangiogenesis, interaction with microbial agents, wound healing, and anticancer therapy.
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11
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Maniwa T, Kondo H, Mori K, Sato T, Teramukai S, Ebina M, Kishi K, Watanabe A, Sugiyama Y, Date H. Outcomes in surgically managed non-small-cell lung cancer patients with evidence of interstitial pneumonia identified on preoperative radiology or incidentally on postoperative histology. Interact Cardiovasc Thorac Surg 2015; 20:641-6. [DOI: 10.1093/icvts/ivv021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/14/2015] [Indexed: 12/30/2022] Open
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Baluk P, Adams A, Phillips K, Feng J, Hong YK, Brown MB, McDonald DM. Preferential lymphatic growth in bronchus-associated lymphoid tissue in sustained lung inflammation. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 184:1577-92. [PMID: 24631179 DOI: 10.1016/j.ajpath.2014.01.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 12/09/2013] [Accepted: 01/07/2014] [Indexed: 01/19/2023]
Abstract
Lymphatics proliferate, become enlarged, or regress in multiple inflammatory lung diseases in humans. Lymphatic growth and remodeling is known to occur in the mouse trachea in sustained inflammation, but whether intrapulmonary lymphatics exhibit similar plasticity is unknown. We examined the time course, distribution, and dependence on vascular endothelial growth factor receptor (VEGFR)-2/VEGFR-3 signaling of lung lymphatics in sustained inflammation. Lymphatics in mouse lungs were examined under baseline conditions and 3 to 28 days after Mycoplasma pulmonis infection, using prospero heomeobox 1-enhanced green fluorescence protein and VEGFR-3 as markers. Sprouting lymphangiogenesis was evident at 7 days. Lymphatic growth was restricted to regions of bronchus-associated lymphoid tissue (BALT), where VEGF-C-producing cells were scattered in T-cell zones. Expansion of lung lymphatics after infection was reduced 68% by blocking VEGFR-2, 83% by blocking VEGFR-3, and 99% by blocking both receptors. Inhibition of VEGFR-2/VEGFR-3 did not prevent the formation of BALT. Treatment of established infection with oxytetracycline caused BALT, but not the lymphatics, to regress. We conclude that robust lymphangiogenesis occurs in mouse lungs after M. pulmonis infection through a mechanism involving signaling of both VEGFR-2 and VEGFR-3. Expansion of the lymphatic network is restricted to regions of BALT, but lymphatics do not regress when BALT regresses after antibiotic treatment. The lung lymphatic network can thus expand in sustained inflammation, but the expansion is not as reversible as the accompanying inflammation.
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Affiliation(s)
- Peter Baluk
- Department of Anatomy, the Cardiovascular Research Institute, and the Comprehensive Cancer Center, University of California, San Francisco, California.
| | - Alicia Adams
- Department of Anatomy, the Cardiovascular Research Institute, and the Comprehensive Cancer Center, University of California, San Francisco, California
| | - Keeley Phillips
- Department of Anatomy, the Cardiovascular Research Institute, and the Comprehensive Cancer Center, University of California, San Francisco, California
| | - Jennifer Feng
- Department of Anatomy, the Cardiovascular Research Institute, and the Comprehensive Cancer Center, University of California, San Francisco, California
| | - Young-Kwon Hong
- Departments of Surgery, Biochemistry, and Molecular Biology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mary B Brown
- Department of Infectious Diseases and Pathology, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Donald M McDonald
- Department of Anatomy, the Cardiovascular Research Institute, and the Comprehensive Cancer Center, University of California, San Francisco, California
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13
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Yao LC, McDonald DM. Plasticity of airway lymphatics in development and disease. ADVANCES IN ANATOMY, EMBRYOLOGY, AND CELL BIOLOGY 2014; 214:41-54. [PMID: 24276885 DOI: 10.1007/978-3-7091-1646-3_4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The dynamic nature of lymphatic vessels is reflected by structural and functional modifications that coincide with changes in their environment. Lymphatics in the respiratory tract undergo rapid changes around birth, during adaptation to air breathing, when lymphatic endothelial cells develop button-like intercellular junctions specialized for efficient fluid uptake and transport. In inflammatory conditions, lymphatic vessels proliferate and undergo remodeling to accommodate greater plasma leakage and immune cell trafficking. However, the newly formed lymphatics are abnormal, and resolution of inflammation is not accompanied by complete reversal of the lymphatic vessel changes back to the baseline. As the understanding of lymphatic plasticity advances, approaches for eliminating the abnormal vessels and improving the functionality of those that remain move closer to reality. This chapter provides an overview of what is known about lymphatic vessel growth, remodeling, and other forms of plasticity that occur during development or inflammation, with an emphasis on the respiratory tract. Also addressed is the limited reversibility of changes in lymphatics during the resolution of inflammation.
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Affiliation(s)
- Li-Chin Yao
- Department of Anatomy, Comprehensive Cancer Center, Cardiovascular Research Institute, University of California-San Francisco, San Francisco, CA, 94143, USA
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14
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Parra ER, Ruppert ADP, Capelozzi VL. Angiotensin II type 1 and 2 receptors and lymphatic vessels modulate lung remodeling and fibrosis in systemic sclerosis and idiopathic pulmonary fibrosis. Clinics (Sao Paulo) 2014; 69:47-54. [PMID: 24473559 PMCID: PMC3870314 DOI: 10.6061/clinics/2014(01)07] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 07/18/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To validate the importance of the angiotensin II receptor isotypes and the lymphatic vessels in systemic sclerosis and idiopathic pulmonary fibrosis. METHODS We examined angiotensin II type 1 and 2 receptors and lymphatic vessels in the pulmonary tissues obtained from open lung biopsies of 30 patients with systemic sclerosis and 28 patients with idiopathic pulmonary fibrosis. Their histologic patterns included cellular and fibrotic non-specific interstitial pneumonia for systemic sclerosis and usual interstitial pneumonia for idiopathic pulmonary fibrosis. We used immunohistochemistry and histomorphometry to evaluate the number of cells in the alveolar septae and the vessels stained by these markers. Survival curves were also used. RESULTS We found a significantly increased percentage of septal and vessel cells immunostained for the angiotensin type 1 and 2 receptors in the systemic sclerosis and idiopathic pulmonary fibrosis patients compared with the controls. A similar percentage of angiotensin 2 receptor positive vessel cells was observed in fibrotic non-specific interstitial pneumonia and usual interstitial pneumonia. A significantly increased percentage of lymphatic vessels was present in the usual interstitial pneumonia group compared with the non-specific interstitial pneumonia and control groups. A Cox regression analysis showed a high risk of death for the patients with usual interstitial pneumonia and a high percentage of vessel cells immunostained for the angiotensin 2 receptor in the lymphatic vessels. CONCLUSION We concluded that angiotensin II receptor expression in the lung parenchyma can potentially control organ remodeling and fibrosis, which suggests that strategies aimed at preventing high angiotensin 2 receptor expression may be used as potential therapeutic target in patients with pulmonary systemic sclerosis and idiopathic pulmonary fibrosis.
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Affiliation(s)
- Edwin Roger Parra
- Laboratory of Histomorphometry and Pulmonary Genetics, Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Department of Pathology, Laboratory of Histomorphometry and Pulmonary Genetics, São Paulo/SP, Brazil
| | - Aline Domingos Pinto Ruppert
- Laboratory of Histomorphometry and Pulmonary Genetics, Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Department of Pathology, Laboratory of Histomorphometry and Pulmonary Genetics, São Paulo/SP, Brazil
| | - Vera Luiza Capelozzi
- Laboratory of Histomorphometry and Pulmonary Genetics, Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Department of Pathology, Laboratory of Histomorphometry and Pulmonary Genetics, São Paulo/SP, Brazil
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15
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Mori M, Andersson CK, Graham GJ, Löfdahl CG, Erjefält JS. Increased number and altered phenotype of lymphatic vessels in peripheral lung compartments of patients with COPD. Respir Res 2013; 14:65. [PMID: 23758732 PMCID: PMC3728038 DOI: 10.1186/1465-9921-14-65] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/05/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND De novo lymphatic vessel formation has recently been observed in lungs of patients with moderate chronic obstructive pulmonary disease (COPD). However, the distribution of lymphatic vessel changes among the anatomical compartments of diseased lungs is unknown. Furthermore, information regarding the nature of lymphatic vessel alterations across different stages of COPD is missing. This study performs a detailed morphometric characterization of lymphatic vessels in major peripheral lung compartments of patients with different severities of COPD and investigates the lymphatic expression of molecules involved in immune cell trafficking. METHODS Peripheral lung resection samples obtained from patients with mild (GOLD stage I), moderate-severe (GOLD stage II-III), and very severe (GOLD stage IV) COPD were investigated for podoplanin-immunopositive lymphatic vessels in distinct peripheral lung compartments: bronchioles, pulmonary blood vessels and alveolar walls. Control subjects with normal lung function were divided into never smokers and smokers. Lymphatics were analysed by multiple morphological parameters, as well as for their expression of CCL21 and the chemokine scavenger receptor D6. RESULTS The number of lymphatics increased by 133% in the alveolar parenchyma in patients with advanced COPD compared with never-smoking controls (p < 0.05). In patchy fibrotic lesions the number of alveolar lymphatics increased 20-fold from non-fibrotic parenchyma in the same COPD patients. The absolute number of lymphatics per bronchiole and artery was increased in advanced COPD, but numbers were not different after normalization to tissue area. Increased numbers of CCL21- and D6-positive lymphatics were observed in the alveolar parenchyma in advanced COPD compared with controls (p < 0.01). Lymphatic vessels also displayed increased mean levels of immunoreactivity for CCL21 in the wall of bronchioles (p < 0.01) and bronchiole-associated arteries (p < 0.05), as well as the alveolar parenchyma (p < 0.001) in patients with advanced COPD compared with never-smoking controls. A similar increase in lymphatic D6 immunoreactivity was observed in bronchioles (p < 0.05) and alveolar parenchyma (p < 0.01). CONCLUSIONS This study shows that severe stages of COPD is associated with increased numbers of alveolar lymphatic vessels and a change in lymphatic vessel phenotype in major peripheral lung compartments. This novel histopathological feature is suggested to have important implications for distal lung immune cell traffic in advanced COPD.
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Affiliation(s)
- Michiko Mori
- Unit of Airway Inflammation and Immunology, Department of Experimental Medical Sciences, Lund University, Lund, Sweden
| | - Cecilia K Andersson
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Gerard J Graham
- Institute of Infection, Immunity and Inflammation, Glasgow Biomedical Research Centre, University of Glasgow, Glasgow, UK
| | - Claes-Göran Löfdahl
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jonas S Erjefält
- Unit of Airway Inflammation and Immunology, Department of Experimental Medical Sciences, Lund University, Lund, Sweden
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
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16
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Kambouchner M, Bernaudin JF. [Lymphatics in non-tumoral pulmonary diseases. Review]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:170-174. [PMID: 23474099 DOI: 10.1016/j.pneumo.2012.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 12/25/2012] [Indexed: 06/01/2023]
Abstract
Whereas lymphatics in pulmonary non-tumoral diseases have been less studied than blood microcirculation, they clearly play a significant role. This review is a short update on lymphatics in various non-tumoral pulmonary diseases, from asthma to interstitial pneumonitis, excluding lymphangioleiomyomatosis. A lymphatic remodelling has been evidenced in asthma as well as in acute or chronic (UIP as NSIP) interstitial lung diseases. Such a remodelling can be explained as a side effect of local changes in fluidics but could also be an active player in the fibrosing process. Moreover the association of juxta-alveloar lymphatics and granulomas provides new insights in the emergence of these lesions in pulmonary sarcoidosis.
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Affiliation(s)
- M Kambouchner
- Service d'anatomie pathologique, hôpital Avicenne, 93009 Bobigny, France
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17
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Pardo J, Panizo A, Sola I, Queipo F, Martinez-Peñuela A, Carias R. Prognostic value of clinical, morphologic, and immunohistochemical factors in patients with bronchiolitis obliterans–organizing pneumonia. Hum Pathol 2013; 44:718-24. [DOI: 10.1016/j.humpath.2012.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/11/2012] [Accepted: 07/18/2012] [Indexed: 11/16/2022]
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18
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Lymphatic vessel memory stimulated by recurrent inflammation. THE AMERICAN JOURNAL OF PATHOLOGY 2013; 182:2418-28. [PMID: 23578386 DOI: 10.1016/j.ajpath.2013.02.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 02/18/2013] [Accepted: 02/25/2013] [Indexed: 01/13/2023]
Abstract
Inflammation stimulates new lymphatic vessel growth (inflammatory lymphangiogenesis). One key question is how recurrent inflammation, a common clinical condition, regulates lymphatic vessel remodeling. We show here that recurrent inflammation accelerated the development a functional lymphatic vessel network. This observation suggests a novel program of lymphangiogenesis and identifies a property of lymphatic vessel memory in response to recurrent inflammation. A brief episode of initial inflammation regressed lymphatic vessels, and a significant increase in CD11b(+) macrophages were associated with the development of lymphatic vessel memory. These vessels had major differences in the structure and the spatial distribution of specialized lymphatic vessel features. Surprisingly, we found that the lymphatic vessel memory response did not depend on the vascular endothelial growth factor C or A pathway, indicating that different molecular pathways regulate inflammatory lymphangiogenesis and lymphatic vessel memory. These findings uncover a priming mechanism to facilitate a rapid lymphatic vessel memory response: a potential important component of peripheral host defense.
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19
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Lara AR, Cosgrove GP, Janssen WJ, Huie TJ, Burnham EL, Heinz DE, Curran-Everett D, Sahin H, Schwarz MI, Cool CD, Groshong SD, Geraci MW, Tuder RM, Hyde DM, Henson PM. Increased lymphatic vessel length is associated with the fibroblast reticulum and disease severity in usual interstitial pneumonia and nonspecific interstitial pneumonia. Chest 2013; 142:1569-1576. [PMID: 22797508 DOI: 10.1378/chest.12-0029] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Lymphangiogenesis responds to tissue injury as a key component of normal wound healing. The development of fibrosis in the idiopathic interstitial pneumonias may result from abnormal wound healing in response to injury. We hypothesize that increased lymphatic vessel (LV) length, a marker of lymphangiogenesis, is associated with parenchymal components of the fibroblast reticulum (organizing collagen, fibrotic collagen, and fibroblast foci), and its extent correlates with disease severity. METHODS We assessed stereologically the parenchymal structure of fibrotic lungs and its associated lymphatic network, which was highlighted immunohistochemically in age-matched samples of usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP) with FVC < 80%, COPD with a Global Initiative for Obstructive Lung Disease stage 0, and normal control lungs. RESULTS LV length density, as opposed to vessel volume density, was found to be associated with organizing and fibrotic collagen density (P < .0001). Length density of LVs and the volume density of organizing and fibrotic collagen were significantly associated with severity of both % FVC (P < .001) and diffusing capacity of the lung for carbon monoxide (P < .001). CONCLUSIONS Severity of disease in UIP and NSIP is associated with increased LV length and is strongly associated with components of the fibroblast reticulum, namely organizing and fibrotic collagen, which supports a pathogenic role of LVs in these two diseases. Furthermore, the absence of definable differences between UIP and NSIP suggests that LVs are a unifying mechanism for the development of fibrosis in these fibrotic lung diseases.
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Affiliation(s)
- Abigail R Lara
- Division of Pulmonary Science and Critical Care Medicine, University of Colorado Denver, Aurora, CO.
| | - Gregory P Cosgrove
- Division of Pulmonary Science and Critical Care Medicine, University of Colorado Denver, Aurora, CO; Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO
| | - William J Janssen
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO
| | - Tristan J Huie
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO
| | - Ellen L Burnham
- Division of Pulmonary Science and Critical Care Medicine, University of Colorado Denver, Aurora, CO
| | - David E Heinz
- Division of Pulmonary Science and Critical Care Medicine, University of Colorado Denver, Aurora, CO
| | - Douglas Curran-Everett
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, CO; Department of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO
| | - Hakan Sahin
- Department of Radiology, University of Colorado Denver, Aurora, CO
| | - Marvin I Schwarz
- Division of Pulmonary Science and Critical Care Medicine, University of Colorado Denver, Aurora, CO
| | - Carlyne D Cool
- Department of Pathology, University of Colorado Denver, Aurora, CO
| | | | - Mark W Geraci
- Division of Pulmonary Science and Critical Care Medicine, University of Colorado Denver, Aurora, CO
| | - Rubin M Tuder
- Division of Pulmonary Science and Critical Care Medicine, University of Colorado Denver, Aurora, CO
| | - Dallas M Hyde
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Peter M Henson
- Division of Immunology, National Jewish Health, Denver, CO
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20
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Heterogeneous Characteristics of Lymphatic Microvasculatures Associated with Pulmonary Sarcoid Granulomas. Ann Am Thorac Soc 2013; 10:90-7. [DOI: 10.1513/annalsats.201209-078oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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21
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Glasgow CG, El-Chemaly S, Moss J. Lymphatics in lymphangioleiomyomatosis and idiopathic pulmonary fibrosis. Eur Respir Rev 2013; 21:196-206. [PMID: 22941884 DOI: 10.1183/09059180.00009311] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The primary function of the lymphatic system is absorbing and transporting macromolecules and immune cells to the general circulation, thereby regulating fluid, nutrient absorption and immune cell trafficking. Lymphangiogenesis plays an important role in tissue inflammation and tumour cell dissemination. Lymphatic involvement is seen in lymphangioleiomyomatosis (LAM) and idiopathic pulmonary fibrosis (IPF). LAM, a disease primarily affecting females, involves the lung (cystic destruction), kidney (angiomyolipoma) and axial lymphatics (adenopathy and lymphangioleiomyoma). LAM occurs sporadically or in association with tuberous sclerosis complex (TSC). Cystic lung destruction results from proliferation of LAM cells, which are abnormal smooth muscle-like cells with mutations in the TSC1 or TSC2 gene. Lymphatic abnormalities arise from infiltration of LAM cells into the lymphatic wall, leading to damage or obstruction of lymphatic vessels. Benign appearing LAM cells possess metastatic properties and are found in the blood and other body fluids. IPF is a progressive lung disease resulting from fibroblast proliferation and collagen deposition. Lymphangiogenesis is associated with pulmonary destruction and disease severity. A macrophage subset isolated from IPF bronchoalveolar lavage fluid (BALF) express lymphatic endothelial cell markers in vitro, in contrast to the same macrophage subset from normal BALF. Herein, we review lymphatic involvement in LAM and IPF.
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Affiliation(s)
- Connie G Glasgow
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1590, USA
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22
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Maniwa T, Isaka M, Nakagawa K, Ohde Y, Okumura T, Endo M, Kondo H. Chest-tube drainage is a sign of acute exacerbation of interstitial lung disease associated with lung cancer. Surg Today 2012. [PMID: 23180119 DOI: 10.1007/s00595-012-0428-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Interstitial lung disease (ILD) is associated with primary lung cancer and an increased risk of postoperative acute exacerbation (AE). Although the preoperative factors associated with AE of ILD are well described, there is little information about the postoperative factors. Thus, the present study focuses on the postoperative management of chest-tube drainage associated with AE of ILD. METHODS We conducted a retrospective chart study of 1,309 patients with lung cancer, who underwent pulmonary resection at Shizuoka Cancer Center between September 2002 and January 2011. ILD was diagnosed by chest computed tomography (CT) findings in 95 patients. After the exclusion of 6 patients with a history of pneumonectomy, the subjects of this study were 8 patients who suffered AE after surgery (AE group) and 81 patients (non-AE group) who did not. We investigated the clinicopathological findings and postoperative management of chest-tube drainage in the two groups. RESULTS The clinicopathological findings of the two groups did not differ significantly. The chest tubes could not be removed before postoperative day 5 because of pleural effusion in 5 patients (62.5 %) from the AE group and 12 patients (14.8 %) from the non-AE group (P = 0.0040). CONCLUSIONS The postoperative volume draining from the chest-tube is an important sign of AE of ILD.
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Affiliation(s)
- Tomohiro Maniwa
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan.
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23
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Parra ER, Araujo CAL, Lombardi JG, Ab'Saber AM, Carvalho CRR, Kairalla RA, Capelozzi VL. Lymphatic fluctuation in the parenchymal remodeling stage of acute interstitial pneumonia, organizing pneumonia, nonspecific interstitial pneumonia and idiopathic pulmonary fibrosis. ACTA ACUST UNITED AC 2012; 45:466-72. [PMID: 22488224 PMCID: PMC3854286 DOI: 10.1590/s0100-879x2012007500055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 03/21/2012] [Indexed: 11/24/2022]
Abstract
Because the superficial lymphatics in the lungs are distributed in the subpleural, interlobular and peribroncovascular interstitium, lymphatic impairment may occur in the lungs of patients with idiopathic interstitial pneumonias (IIPs) and increase their severity. We investigated the distribution of lymphatics in different remodeling stages of IIPs by immunohistochemistry using the D2-40 antibody. Pulmonary tissue was obtained from 69 patients with acute interstitial pneumonia/diffuse alveolar damage (AIP/DAD, N = 24), cryptogenic organizing pneumonia/organizing pneumonia (COP/OP, N = 6), nonspecific interstitial pneumonia (NSIP/NSIP, N = 20), and idiopathic pulmonary fibrosis/usual interstitial pneumonia (IPF/UIP, N = 19). D2-40+ lymphatic in the lesions was quantitatively determined and associated with remodeling stage score. We observed an increase in the D2-40+ percent from DAD (6.66 ± 1.11) to UIP (23.45 ± 5.24, P = 0.008) with the advanced process of remodeling stage of the lesions. Kaplan-Meier survival curves showed a better survival for patients with higher lymphatic D2-40+ expression than 9.3%. Lymphatic impairment occurs in the lungs of IIPs and its severity increases according to remodeling stage. The results suggest that disruption of the superficial lymphatics may impair alveolar clearance, delay organ repair and cause severe disease progress mainly in patients with AIP/DAD. Therefore, lymphatic distribution may serve as a surrogate marker for the identification of patients at greatest risk for death due to IIPs.
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Affiliation(s)
- E R Parra
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, Brasil.
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24
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Sozio F, Rossi A, Weber E, Abraham DJ, Nicholson AG, Wells AU, Renzoni EA, Sestini P. Morphometric analysis of intralobular, interlobular and pleural lymphatics in normal human lung. J Anat 2012; 220:396-404. [PMID: 22283705 DOI: 10.1111/j.1469-7580.2011.01473.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
In spite of their presumed relevance in maintaining interalveolar septal fluid homeostasis, the knowledge of the anatomy of human lung lymphatics is still incomplete. The recent discovery of reliable markers specific for lymphatic endothelium has led to the observation that, contrary to previous assumptions, human lymphatic vessels extend deep inside the pulmonary lobule in association with bronchioles, intralobular arterioles or small pulmonary veins. The aim of this study was to provide a morphometric characterization of lymphatic vessels in the periphery of the human lung. Human lung sections were immunolabelled with the lymphatic marker D2-40, followed by blood vessel staining with von Willebrand Factor. Lymphatic vessels were classified into: intralobular (including those associated with bronchovascular bundles, perivascular, peribronchiolar and interalveolar), pleural (in the connective tissue of the visceral pleura), and interlobular (in interlobular septa). The percentage area occupied by the lymphatic lumen was much greater in the interlobular septa and in the subpleural space than in the lobule. Most of the intralobular lymphatic vessels were in close contact with a blood vessel, either alone or within a bronchovascular bundle, whereas 7% were associated with a bronchiole and < 1% were not connected to blood vessels or bronchioles (interalveolar). Intralobular lymphatic size progressively decreased from bronchovascular through to peribronchiolar, perivascular and interalveolar lymphatics. Lymphatics associated with bronchovascular bundles had similar morphometric characteristics to pleural and interlobular lymphatics. Shape factors were similar across lymphatic populations, except that peribronchiolar lymphatics had a marginally increased roundness and circularity, suggesting a more regular shape due to increased filling, and interlobular lymphatics had greater elongation, due to a greater proportion of conducting lymphatics cut longitudinally. Unsupervised cluster analysis confirmed a marked heterogeneity of lymphatic vessels both within and between groups, with a cluster of smaller vessels specifically represented in perivascular and interalveolar lymphatics within the alveolar interstitium. Our data indicate that intralobular lymphatics are a heterogeneous population, including vessels surrounding the bronchovascular bundle analogous to the conducting vessels present in the pleural and interlobular septa, many small perivascular lymphatics responsible for maintaining fluid balance in the alveolar interstitium, and a minority of intermediate lymphatics draining the peripheral airways. These lymphatic populations could be differentially involved in the pathogenesis of diseases preferentially involving distinct lung compartments.
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Affiliation(s)
- Francesca Sozio
- Department of Neuroscience, Molecular Medicine Section, University of Siena, Siena, Italy
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25
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Hardavella G, Tzortzaki EG, Siozopoulou V, Galanis P, Vlachaki E, Avgousti M, Stefanou D, Siafakas NM. Lymphangiogenesis in COPD: another link in the pathogenesis of the disease. Respir Med 2011; 106:687-93. [PMID: 22154125 DOI: 10.1016/j.rmed.2011.11.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 11/13/2011] [Accepted: 11/14/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND New lymphatic vessels are associated with tissue injury and repair. Recent studies have shown increased lymphatic follicles formation in the lungs of COPD patients. We hypothesized that lymphatic vascular remodeling could be part of COPD pathogenesis. AIM To investigate the lymphangiogenetic process in COPD we measured the lymphatic microvessel density (LMVD), the lymphatic invasion (L.I), and their correlation with clinical and laboratory parameters. METHODS Lung tissue from 20 COPD patients and 20 non-COPD smokers was immunohistochemically stained for D2-40 (lymphatic endothelial cell marker), and LYVE-1 (lymphatic endothelial hyaluronan receptor 1). Both groups had similar age and smoking history. RESULTS D2-40 and LYVE-1 were expressed in all specimens. Lymphatic invasion was presented only in COPD specimens. Lymphatic microvessel density (LMVD) as revealed by D2-40 and LYVE-1 markers was statistically significantly higher in COPD patients when compared with non-COPD smokers. Both markers (D2-40, LYVE-1) were correlated with FEV1 (% pred) (R(2) = 0.415, R(2) = 0.605, respectively). CONCLUSIONS We report for the first time high lymphatic microvessel density and lymphatic invasion in COPD patients, related to the degree of airway obstruction. Our findings could provide novel insights in the pathogenesis of the disease.
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Affiliation(s)
- Georgia Hardavella
- Department of Respiratory Medicine, Medical School, University of Ioannina, Ioannina, Greece
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26
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Ebina M, Shibata N, Ohta H, Hisata S, Tamada T, Ono M, Okaya K, Kondo T, Nukiwa T. The disappearance of subpleural and interlobular lymphatics in idiopathic pulmonary fibrosis. Lymphat Res Biol 2011; 8:199-207. [PMID: 21190492 DOI: 10.1089/lrb.2010.0008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The lymphatics in the interlobular and subpleural parenchyma contribute to alveolar clearance in the lung, but the information on the remodeling of these lymphatics is quite limited in idiopathic pulmonary fibrosis lungs that contain severe fibrosis in these regions. We compared the alteration of these lymphatics and lymphangiogenesis among idiopathic pulmonary fibrosis and nonfibrotic interstitial pneumonias with a better prognosis. METHODS AND RESULTS The lung tissue specimens of eighteen patients with idiopathic pulmonary fibrosis (ten surgical biopsies and eight autopsies), six with organizing pneumonia, six with cellular nonspecific interstitial pneumonia, and five normal controls were examined by morphometric analysis of the lymphatics identified by immunohistochemistry. In addition, three-dimensional reconstruction of lymphatics, apoptosis of lymphatic endothelial cells and the cells producing growth factors for lymphangiogenesis were also evaluated. Both the subpleural and the interlobular lymphatics in idiopathic pulmonary fibrosis lungs were significantly decreased in the severe fibroconnective lesions, with rare lymphangiogenesis. The three-dimensional images of the subpleural lymphatics in idiopathic pulmonary fibrosis clearly revealed destruction by fibrosis; apoptosis was observed in these lymphatic endothelial cells. In contrast, organizing pneumonia and cellular nonspecific interstitial pneumonia preserved these lymphatics, and active lymphangiogenesis occurred in the alveolar lesions. CONCLUSIONS These results reveal severe damage of the subpleural and interlobular lymphatics in idiopathic pulmonary fibrosis lungs, and suggest impaired alveolar clearance as another pathogenesis of its refractoriness.
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Affiliation(s)
- Masahito Ebina
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan.
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27
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El-Chemaly S, Pacheco-Rodriguez G, Ikeda Y, Malide D, Moss J. Lymphatics in idiopathic pulmonary fibrosis: new insights into an old disease. Lymphat Res Biol 2010; 7:197-203. [PMID: 20143918 DOI: 10.1089/lrb.2009.0014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The lymphatic vasculature plays a key role in tissue homeostasis and immune surveillance. There is mounting evidence of a role for the lymphatic circulation and for newly formed lymphatic vessels in the pathogenesis of lung disease. Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, debilitating lung disease. In IPF, the lung parenchyma undergoes extensive remodeling. This review focuses on the current knowledge and understanding of the pathogenesis of IPF, and recent evidence of the involvement of lymphangiogenesis in lung injury and repair and the molecular and cellular pathways leading to the development of lymphatic vasculature.
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Affiliation(s)
- Souheil El-Chemaly
- Translational Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-1590, USA
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28
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Ji RC, Eshita Y, Xing L, Miura M. Multiple expressions of lymphatic markers and morphological evolution of newly formed lymphatics in lymphangioma and lymph node lymphangiogenesis. Microvasc Res 2010; 80:195-201. [PMID: 20382171 DOI: 10.1016/j.mvr.2010.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
Abstract
The rapid evolution of reliable technology combined with increasing number of specific markers for lymphatic endothelial cells (LECs) facilitates the investigation of lymphangiogenesis in developing and diseased tissues. Here, we injected incomplete Freund's adjuvant (IFA) peritoneally into BALB/c and nonobese diabetic (NOD) mice to induce lymphangioma and found atypical lymphatic accumulations with intervening fibrous tissue and lymphoid aggregates. Lymphatic markers, LYVE-1 and podoplanin, were used to specifically define the morphological features of the neoplastic lymphatics. The NOD mice (affected by an autoimmune disorder) had fewer and smaller lymphangiomas than the BALB/c mice. Injection of IFA in the footpad skin of the mice also disturbed draining regional lymph node lymphangiogenesis and caused enlargement of popliteal lymph nodes. Molecular analyses of the LECs indicated potential interventions for lymphangioma through vascular endothelial growth factor (VEGF)-A/-C/-D and their receptors, VEGF receptors-2/-3, and Prox-1 signaling pathways. These findings represent an important link between multiple factors and lymphatic disorders.
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Affiliation(s)
- Rui-Cheng Ji
- Department of Human Anatomy, Oita University Faculty of Medicine, Oita, Japan.
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29
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Yamashita M, Iwama N, Date F, Shibata N, Miki H, Yamauchi K, Sawai T, Sato S, Takahashi T, Ono M. Macrophages participate in lymphangiogenesis in idiopathic diffuse alveolar damage through CCL19-CCR7 signal. Hum Pathol 2009; 40:1553-63. [PMID: 19540558 DOI: 10.1016/j.humpath.2009.03.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 03/23/2009] [Accepted: 03/26/2009] [Indexed: 01/13/2023]
Affiliation(s)
- Masahiro Yamashita
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8575, Japan.
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30
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Yamashita M, Yamauchi K, Chiba R, Iwama N, Date F, Shibata N, Kumagai H, Risteli J, Sato S, Takahashi T, Ono M. The definition of fibrogenic processes in fibroblastic foci of idiopathic pulmonary fibrosis based on morphometric quantification of extracellular matrices. Hum Pathol 2009; 40:1278-87. [PMID: 19386353 DOI: 10.1016/j.humpath.2009.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 01/27/2009] [Accepted: 01/30/2009] [Indexed: 11/28/2022]
Abstract
There is limited information regarding the process of tissue remodeling in fibroblastic foci associated with idiopathic pulmonary fibrosis. The aim of this study was to identify the different pathologic stages of tissue remodeling in fibroblastic foci based on the histopathologic differences in the glycosaminoglycan distribution and collagen deposition. In addition, we also aimed at clarifying the stage-specific characteristics by taking into consideration the expression pattern of matrix metalloproteinase and angiogenesis. Lung biopsies of 16 patients with idiopathic pulmonary fibrosis were used. The presence of glycosaminoglycans was detected by Alcian blue staining, and type I collagen was detected by immunohistochemical analysis with a primary antibody specific to the cross-linked carboxyterminal telopeptide of type I collagen. The fibroblastic foci characterized by the expression intensity of Alcian blue and telopeptide of type I collagen were divided into 3 groups, namely, Alcian blue(+)telopeptide of type I collagen(weak), Alcian blue(+)telopeptide of type I collagen(+), and Alcian blue(weak)telopeptide of type I collagen(+); consequently, 3 new stages were defined--stages I, II, and III, respectively. A significant inverse correlation was observed between the area densities of Alcian blue(+) and telopeptide of type I collagen(+) in fibroblastic foci. Stage I was characterized by the expression of matrix metalloproteinase-2 and tissue inhibitor of matrix metalloprotease-2 in fibroblasts and the overlying epithelium of fibroblastic foci, and also the absence of capillary angiogenesis. In contrast, the expression of these proteins was attenuated in stage III, except for that of matrix metalloproteinase-2 in fibroblasts. In stages II and III, capillary angiogenesis was observed. Lymphangiogenesis was undetected in all the 3 stages. Thus, pathologic staging helps understand the roles of the factors involved in tissue remodeling in idiopathic pulmonary fibrosis.
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Affiliation(s)
- Masahiro Yamashita
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8575, Japan.
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