The lymphatics began receiving attention in the scientific community as early as 1622, when Gasparo Aselli noted the appearance of milky white vessels in the mesentery of a well-fed dog. Since this time, the lymphatic system has been historically regarded as the sewer of the vasculature, passively draining fluid and proteins from the interstitial spaces (along with lipid from the gut) into the blood. Recent reports, however, suggest that the lymphatic role in lipid transport is an active and intricate process and when lymphatic function is compromised, there are systemic consequences to lipid metabolism and transport. This review highlights these recent findings and suggests future directions for understanding the interplay between lymphatic and lipid biology in health and disease.
Lymphatic FunctionThe lymphatic system (Figure 1) is found in most tissues in the body and plays important roles in maintaining fluid balance [1], immune cell trafficking from the periphery to lymph nodes [2], and lipid transport from the intestine to the circulation [3]. The lymphatic vasculature is comprised of unique functional features that enable entry and transport of large proteins, immune cells, lipids, and fluid against a pressure gradient (Figure 2). Specifically, the entry point of the lymphatic system is regulated by initial lymphatics (blind ended microvessels lacking smooth muscle), which have specialized junctions that prevent backflow of fluid into the tissue after it has entered the vessel [4,5]. The initial lymphatics merge into larger collecting vessels composed of individually contracting units known as lymphangions. Each lymphangion is lined with a functionally unique form of smooth muscle that provides vessel tone and allows the vessel to contract down to as much as 20% of its resting diameter [6,7]. These contractions, when combined with the valve leaflets that separate each lymphangion [8], promote unidirectional propagation of flow [9]. In this review we specifically focus on the lymphatic vasculature's role in lipid metabolism and trafficking, highlighting recent work that suggests a connection between lymphatic dysfunction and lipid-related diseases such as obesity and hyperlipidemia.