“…These valve-forming cells reorient themselves with respect to the longitudinal axis of the vessel, extend into the vessel lumen, and form elongated valve leaflets composed of a bilayer of endothelial cells sandwiching an extracellular matrix core composed largely of Fibronectin-EIIIA (FN-EIIIA), laminin-α5, and EMILIN1 (19)(20)(21). Genes identified to be important for lymphatic vessel valve development include the transcription factors FOXC2 and NFATC1 (15,20,22), the transmembrane ligand ephrinB2 (23), integrin-α9 and its ligands FN-EIIIA (19) and Emilin1 (21), gap junction proteins connexin37 (CX37) and connexin43 (CX43) (16,24), NOTCH1 (25), SEMA3A together with receptor components NRP1 and PLEXINA1 (26,27), angiopoietin2 (28,29), TIE1 (30), and BMP-9 (31). Though the signals that initiate valve development are in large part enigmatic, the location of valves predominantly in regions of disturbed flow suggested that mechanical stimuli including shear stress might be important valve-initiating stimuli.…”