Neural Regeneration Research ›› 2023, Vol. 18 ›› Issue (6): 1249-1256.doi: 10.4103/1673-5374.355741

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The lymphatic system: a therapeutic target for central nervous system disorders

Jia-Qi Xu1, 2, 3, 4, Qian-Qi Liu1, 2, 3, 4, Sheng-Yuan Huang5, Chun-Yue Duan1, 2, 3, 4, Hong-Bin Lu2, 3, 4, 6, *, Yong Cao1, 2, 3, 4, *, Jian-Zhong Hu1, 2, 3, 4, *   

  1. 1Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China;  2Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, Hunan Province, China;  3Mobile Health Ministry of Education - China Mobile Joint Laboratory, Changsha, Hunan Province, China;  4National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China;  5Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China;  6Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
  • Online:2023-06-15 Published:2022-12-22
  • Contact: Yong Cao, XYcaoyong@csu.edu.cn or Caoyong1912@163.com; Hong-Bin Lu, hongbinlu@hotmail.com; Jian-Zhong Hu, jianzhonghu@hotmail.com.
  • Supported by:
    This work was supported by the Key Program of the National Natural Science Foundation of China, No. 82030071 and the Science and Technology Major Project of Changsha, No. kh2103008 (both to JZH).

Abstract: The lymphatic vasculature forms an organized network that covers the whole body and is involved in fluid homeostasis, metabolite clearance, and immune surveillance. The recent identification of functional lymphatic vessels in the meninges of the brain and the spinal cord has provided novel insights into neurophysiology. They emerge as major pathways for fluid exchange. The abundance of immune cells in lymphatic vessels and meninges also suggests that lymphatic vessels are actively involved in neuroimmunity. The lymphatic system, through its role in the clearance of neurotoxic proteins, autoimmune cell infiltration, and the transmission of pro-inflammatory signals, participates in the pathogenesis of a variety of neurological disorders, including neurodegenerative and neuroinflammatory diseases and traumatic injury. Vascular endothelial growth factor C is the master regulator of lymphangiogenesis, a process that is critical for the maintenance of central nervous system homeostasis. In this review, we summarize current knowledge and recent advances relating to the anatomical features and immunological functions of the lymphatic system of the central nervous system and highlight its potential as a therapeutic target for neurological disorders and central nervous system repair.

Key words: central nervous system, central nervous system injury, glymphatic system, lymphatic vessels, meninges, neurodegenerative disorders, neuroinflammatory diseases, vascular endothelial growth factor C