Afferent Lymphatic Transport and Peripheral Tissue Immunity

The lymphatic system is composed of a hierarchy of lymphatic vessels that transport lymph unidirectionally to lymph nodes (LNs) and the specialized lymphatic endothelial cells (LECs) that compose both these vessels and LN lymphatic networks. Blunt-ended lymphatic capillaries are composed of a single layer of LECs anchored to extracellular matrix fibers and extend into peripheral tissues to facilitate uptake of fluid, cells, and lipids. Collecting vessels, differentiated from capillaries by the investment of lymphatic muscle cells (LMCs), a continuous basement membrane, and valves, contract to generate intrinsic propulsive forces that transport lymph to LNs and prevent retrograde flow. The structure and function of lymphatic vessels as it varies across organ sites in health and disease was recently covered in two excellent reviews (1, 2). In this article, we focus on the role of afferent lymphatic transport in peripheral tissue immune responses.

Lymphatic transport and interstitial fluid dynamics regulate the physiological context of peripheral tissues at steady-state and in response to challenge (e.g., infection, wound healing, and tumor formation). Peripheral tissues receive necessary nutrients and oxygen from vascular transudate, which drives a net excess of fluid within tissue interstitium, generating directional interstitial fluid flows (0.1–1.0 μm/s) toward lymphatic capillaries (3). At steady-state, the sparse basement membrane and discontinuous intercellular junctions (termed button junctions) found in lymphatic capillaries allow passive, paracellular fluid transport to form lymph (4, 5). In addition to the directional movement of fluid, the distribution of signaling molecules, cytokines, and Abs is biased toward lymphatic transport dependent upon oncotic pressure gradients that limit vascular reabsorption. Large particulates, such as exosomes, chylomicrons, and protein complexes, must enter lymphatic vessels to access circulation (6). Lymph formation is further supported by active endocytic and transcellular LEC transport (7), and as a net result, lymph is composed of a unique repertoire of tissue-derived lipids, metabolites, soluble proteins, and Ags that reflects the immunological status of the tissue from which it originates (8). Upon arrival in LNs, lymph and its constituents orchestrate the rapid activation of adaptive immune responses in which both the functional heterogeneity of LN LECs (9) and fluid transport (10) directly impact Ag distribution, presentation, and leukocyte interactions.

In this article, we provide an overview of afferent lymphatic transport during peripheral tissue immune responses. We discuss our current understanding of how lymphatic vessels move fluid and leukocytes out of resting and inflamed tissue, how lymphatic transport is affected by inflammatory context, and how it contributes to immune surveillance, adaptive immune activation, and resolution in peripheral nonlymphoid tissue.

Through the constitutive transport of lymph, memory lymphocytes, and APCs, the afferent lymphatic vasculature provides the anatomic framework for immune surveillance in peripheral, nonlymphoid tissues (Fig. 1), defined in this article as the initial detection of pathogenic or inflammatory insult. The observation that afferent lymph harbors a significant population of migratory leukocytes distinct from those found in blood and efferent lymph was made decades ago following cannulation of ovine afferent lymphatic vessels (11, 12), and similar findings have been reported in mice (13, 14) and humans (15, 16). These early studies profiled afferent lymph across tissues and demonstrated a relatively constant proportion of mature lymphocytes (80–90%), myeloid cells (5–20%), and various granulocytes and plasma cells in sheep (11) and mice (17). Lymph-borne lymphocytes at steady-state are predominantly of a memory phenotype and mostly CD4⁺ [including regulatory T cells (T_REG) from skin (18)], although they also include B cells, CD8⁺, and γδ T cells (19). In contrast, naive T cells are largely excluded from nonlymphoid peripheral tissue-draining lymph, with the exception of the gut (19, 20), where Peyer patches likely provide a source of naive T cells that enter afferent lymph. Importantly, the recirculation of memory lymphocytes provides the opportunity for rapid response to secondary challenge, whereas migratory APCs amplify memory and activate de novo responses in LNs to drive protective adaptive immune responses.

In response to peripheral tissue challenge, proinflammatory mediators activate the vascular endothelium, increasing permeability and fluid influx that drives tissue swelling. Accumulation of interstitial fluid (termed edema) is itself a critical feature of host defense, as it directly promotes effector molecule (e.g., Igs and complement) accumulation and thereby facilitates local inflammation, pathogen control, and adaptive immunity (21). Multiple overlapping signals regulate vascular permeability (reviewed in Ref. 22). Mast cells, for example, produce histamine that activates the type 1 histamine (H₁) receptor, leading to Src-mediated tyrosine phosphorylation of the adherens junction molecules VE-cadherin and β-catenin (23). Disruption of tight and adherens junctions disrupts the size exclusion properties of postcapillary venules, allowing for the influx of larger macromolecules. The importance of vascular permeability is highlighted in mouse models of HSV-2 and vesicular stomatitis virus infection, in which production of IFN-γ by memory CD4⁺ T cells increases vascular permeability, which is necessary for Ab access to infected neuronal tissue and viral control (24). Although increased vascular permeability enhances tissue access, the extent to which fluid and effector molecules accumulate in the interstitial space also depends on local lymphatic transport.

In response to increased interstitial fluid load and inflammatory mediators, lymphatic vessels can adapt their intrinsic pumping activity to both increase and decrease transport, dependent on context. In lymphatic vessels of the guinea pig mesentery, histamine increases the frequency of collecting lymphatic constriction by activating LMC H₁ receptors (25). In contrast, histamine may also act through H₁ receptors expressed by LECs to cause NO-dependent relaxation (26, 27), and stimulation of LMC type 2 histamine receptors induces relaxation that may reduce fluid flows, at least in a subset of vessels of the mesentery (25). Imposed fluid flow through ex vivo mesenteric lymphatic vessel explants also induces NO production and subsequently reduces, rather than elevates, collecting lymphatic contraction and pumping (28). In vivo, lymph stasis, initiated by a surgical model of persistent mouse tail lymphedema, drives the accumulation of Th2 CD4⁺ T cells (29) that inhibit collecting lymphatic pumping through local activation of macrophage inducible NO synthase (30) and exacerbate local pathology. Although increased intrinsic pumping would presumably counteract vascular permeability and reduce edema, a decrease in pumping may limit transport to LNs. To this point, during oxazolone treatment of skin, a rapid, transient reduction in collecting lymphatic vessel contraction, dependent upon the overproduction of NO by CD11b⁺Gr1⁺ myeloid cells, transiently decreases Ag-loaded dendritic cell (DC) accumulation in LNs and impairs induction of experimental autoimmune encephalomyelitis (31). Therefore, it appears as though local inflammatory mediators act in coordination with lymphatic transport to affect tissue physiology and the kinetics of Ag presentation in LNs. How inflammatory context (e.g., infection versus allergy) may differentially affect collector contraction within various tissue sites remains an important question moving forward.

The contextual plasticity of collecting lymphatic vessels described above is progressively lost with age (32) and may be disrupted by infection. Cutaneous infection with methicillin-resistant Staphylococcus aureus results in an acute reduction in lymphatic vessel contractility and lymph flow that persists long after infection and inflammation are resolved because of a permanent loss of LMCs (33). In the gut, Yersinia pseudotuberculosis infection induces persistent local inflammation driven by lymphatic leakage in mesenteric adipose tissue and impaired DC migration to LNs (34). Consistent with these preclinical findings, patients with lymphedema exhibit increased risk for skin and soft tissue infections, and conversely, lymphedema can arise as a consequence of infection (35, 36), suggesting the possibility of regional changes in lymphatic transport that have long-lasting effects on local immune surveillance.

In addition to inflammation and flow-mediated changes to collecting lymphatic contraction, recent evidence indicates that lymphatic capillaries are responsive to inflammatory context and may remodel their interendothelial junctions to regulate paracellular transport. Lymphatic capillary junctions, normally discontinuous (buttons), become continuous (zippering) during Mycoplasma pulmonis infection of the trachea and lose the loose, interendothelial flaps presumed to facilitate passive fluid and cellular uptake (37). The intestinal lacteal, a specialized lymphatic capillary of the small intestine, exhibits a similar zippering phenotype following antibiotic depletion of commensal microbiota (38) or increased bioavailability of vascular endothelial growth factor (VEGF)–A (39), in both cases leading to impaired dietary lipid absorption. During cutaneous vaccinia virus infection, a rapid reduction in lymphatic transport is dependent upon type I IFN signaling and associated with elongation of lymphatic capillary blunt ends and viral retention within the skin (40). Peripheral lymphatic capillaries are therefore sensitive to changing context and may determine differential transport of fluid and soluble macromolecules that impact immune surveillance. How lymphatic capillary zippering is regulated across diverse peripheral tissues and its physiological relevance in vivo, however, remain to be carefully dissected in a cell-specific manner.

Although lymph flow can deliver soluble Ag to LNs in minutes (41–44), the data discussed above suggest the possibility that under certain inflammatory contexts lymphatic vessel-intrinsic mechanisms reduce fluid transport and thereby may impact the kinetics of Ag presentation in LNs. Interestingly, although fluid flow is reduced following vaccinia virus infection by scarification, DCs continue to migrate across inflamed lymphatic vessels and prime CD8⁺ T cells in draining LNs (40). Similarly, whereas s.c. injection of HSV-1 leads to rapid virion transport to LNs and Ag presentation by resident DCs, CD8⁺ T cell activation following vaginal administration depends specifically on migratory DCs (45). Therefore, how lymphatic vessels actively regulate the specific transport of DCs, in concert with fluid transport, likely determines the kinetic of adaptive immune priming in LNs.

The migration of mature DCs to LNs is regulated at each step by the lymphatic vasculature, which provides directional cues to increase the probability that Ag-loaded DCs reach their cognate T lymphocytes in LNs. Although interstitial fluid flows are slow (0.1–1μm/s) (46), they are sufficient to bias interstitial gradients (47, 48), influence matrix remodeling and orientation (49, 50), and activate adhesive properties and chemokine secretion in draining lymphatic vessels (51). Together, these mechanisms collaborate to facilitate directional DC migration toward draining lymphatic capillaries in peripheral, nonlymphoid tissue. Importantly, DC migration is largely, although not exclusively, dependent upon the homeostatic chemokine CCL21, which is expressed by LECs, required for CCR7-dependent homing (52), and elevated by inflammatory cytokines, such as TNF-α (53, 54), and inflammatory fluid flows (48, 50, 54). DCs increase CCL21 production by LECs during transmigration, thereby supporting subsequent waves of DC migration (55–57). Interestingly, the cytoplasmic tail of programmed death-ligand 1 (PD-L1) on type 1 and type 2 conventional DCs (cDC) reinforces G-coupled protein receptor signaling and enhances CCR7-directed LN migration via CCL21 gradients (58), suggesting there are multiple, intrinsic and extrinsic mechanisms that regulate the lymphatic migration of DCs. Importantly, CCR7-dependent DC migration is required for Ag presentation to naive CD8⁺ T cells from skin during HSV-1 infection and following DC adoptive transfer (45, 53, 59, 60) for presentation of intestinal epithelial cell–derived Ags from lamina propria in mesenteric LNs (61) and presentation of tumor Ag by cross-presenting cDC1s in tumor-draining LNs (62, 63).

Interestingly, however, during allergic sensitization, cDC2s can migrate to LNs in a CCR7-independent manner (64), suggesting that mechanisms of lymphatic homing and migration may be cell-type and tissue state-specific. Given that LECs activate specific secretion profiles in response to inflammatory cytokines (type 1, 2, 17, etc.) (65, 66) and TLR stimulation (67), it is possible that a dynamic LEC chemokine repertoire may preferentially support the tissue exit of specific DC subtypes in a context-dependent manner. To this point, dermal LECs secrete CXCL12 in response to cutaneous irritants, such as 2,4-dinitrofluorobenzene, which drives CXCR4⁺ DC exit, including langerin^+/−, CD11c⁺, and CD11b⁺ subsets (68), and CX3CL1 stimulated by oxazolone treatment recruits CX3CR1⁺CD11c⁺ dermal DCs (54). The signaling sphingolipid sphingosine-1-phosphate (S1P), is required for lymphocyte egress from lymphoid tissues (69) but may also play a role in mediating DC egress from peripheral tissues such as skin and lung (70, 71). Lymph S1P is maintained by LECs (72, 73), and migratory DCs show a tissue-specific requirement for the S1P receptors. Dermal DCs seem to rely only on S1P₁ to migrate to draining LNs following topical application of FITC in organic solvents, whereas both S1P₁ and S1P₃ are required for the accumulation of CD103⁺ DCs in mesenteric LNs draining LPS-inflamed gut (74).

In addition to producing chemotactic gradients, peripheral LECs express several atypical chemokine receptors (ACKRs), including ACKR2 and ACKR4, that scavenge inflammatory chemokines to shape interstitial gradients, and amplify directional cues. ACKR4, expressed by dermal LECs and keratinocytes, scavenges excess CCL19, another CCR7-binding chemokine, to improve CCL21-dependent homing of CCR7⁺ Langerhans cells to lymphatic vessels following cutaneous terephthalic acid application (75), and ACKR2 [also known as D6 and expressed by dermal LECs (76, 77)] scavenges CCL2 and may promote the migration of DCs by preventing the perilymphatic accumulation of CCR2⁺ inflammatory myeloid cells (78). Inflammatory chemokine scavenging by the afferent lymphatic endothelium may also prevent persistent LN activation. Indeed, mice lacking ACKR2 display exacerbated inflammatory responses following s.c. administration of CFA (79).

At steady-state, the permissive nature of lymphatic capillary interendothelial button junctions allows for integrin-independent DC transendothelial migration across the lymphatic endothelium (5, 80). However, the lymphatic capillary zippering observed in some infection and inflammatory contexts (37) may presumably remove these passive portals and thus increase the requirements for DC transmigration (5). To support DC transendothelial migration, inflammatory cytokines, including TNF-α and IL-1β (65, 81, 82), and transmural fluid flows (51) induce expression of cellular adhesion molecules, including ICAM-1, VCAM, and selectins. Although shear stresses are much lower in lymphatic capillaries as compared with blood, active binding through cell adhesion molecules and selectins is still required for DC entry into inflamed dermal lymphatic capillaries (51). Both Ab blockade and genetic ablation of ICAM-1, VCAM, or their respective integrin ligands (LFA-1 and CD11b) significantly reduce dermal DC migration to LNs in several models of skin inflammation (81, 83, 84) and inhibit adaptive immune responses (85). The hyaluronan-binding lymphatic vessel endothelial receptor 1 (LYVE-1), expressed by lymphatic capillaries, facilitates hyaluronan-dependent DC docking and transendothelial migration under inflammatory contexts, and LYVE-1–deficient animals exhibit reduced CD8⁺ T cell priming following vaccination (86). Owing to the low shear stresses in lymphatic capillaries, intraluminal DCs exhibit a slow, semidirectional, ICAM-1–dependent crawling behavior (87). This proceeds until DCs reach collecting vessels (57), where elevated shear stresses are hypothesized to downregulate adhesion molecules to permit flow-induced transport to LNs (88). Although the immunological consequences of intralymphatic crawling are unknown, it may suggest that the lumen of lymphatic capillaries is a specialized niche wherein prolonged interactions between DCs, lymphocytes (89), and LECs occur that may have functional consequences for immune responses (82).

The number of leukocytes present in afferent lymph increases during acute and chronic inflammation (13, 90, 91), indicating a dynamic process of tissue exit that may contribute to peripheral tissue inflammation. Like fluid transport, leukocyte egress is critical for the removal of proinflammatory signals that would otherwise exacerbate tissue inflammation and immunopathology. Multiple studies indicate that the induction of lymphangiogenesis by the lymphangiogenic growth factor VEGF-C in chronically inflamed tissues (e.g., dextran sulfate sodium–induced colitis, psoriasis-like cutaneous inflammation, and tumors) increases fluid and leukocyte transport out of tissue and thereby reduces ongoing inflammatory processes (92–94). Similarly, during cutaneous Leishmania major infection, VEGF-A–induced lymphangiogenesis restricts lesion formation without affecting parasite burden by reducing inflammatory lesion size (95).

Although it is clear that multiple cell types are capable of accessing afferent lymph, the mechanisms that direct the egress of diverse leukocyte subtypes have only been examined in a handful of tissue and inflammatory contexts. Still, these data indicate interesting cell-type and tissue state specificity. For example, neutrophils use CCR7 to egress acutely inflamed skin (CFA) (96) and cremaster muscle (97), but CXCR4 and CD11b to reach LNs following cutaneous S. aureus infection, where they boost T cell proliferation in draining LNs (98). ICAM-1 and its cognate ligands are required for neutrophil transendothelial migration in several contexts, including CFA-induced inflammation and Mycobacterium bovis infection of skin (99, 100). B cells also exhibit elevated rates of egress from chronically CFA-inflamed skin (14) via both CCR7-dependent and -independent mechanisms (13), and entrance of monocytes and macrophages into afferent lymph (101–104) is inhibited by integrin ɑ1β1 in Con A­–inflamed skin (105).

The abundance of T cells in afferent lymph and their critical role in immune surveillance and adaptive immunity have encouraged more studies examining mechanisms of T cell exit from inflamed tissues, particularly from skin. Although it appears that multiple mechanisms may regulate CD4⁺ and CD8⁺ T cell egress via lymphatic vessels (Fig. 2), as with DCs, the predominant pathway studied to date is CCL21–CCR7, which is required for egress at both steady-state (106) and during acute inflammation in lung (107, 108) and skin (100). CCR7-deficient CD4⁺ Th1 cells dramatically accumulate in skin and exacerbate pathology associated with delayed-type hypersensitivity responses (109), and transgenic expression of CCR7 in CD4⁺ T cells is sufficient to enhance egress from the lung following Ag challenge (107). Therefore, T cell egress through lymphatic vessels may provide an important control point to balance protective immunity with damaging immunopathology. The mechanisms that regulate T cell egress, however, seem to vary by context. CD4⁺ and CD8⁺ T cell exit from chronically inflamed skin and tumors appears to be CCR7-independent (13, 110); however, the signals that direct exit in this context remain unknown (111). T cells also use multiple adhesion molecules to facilitate transendothelial migration, including common lymphatic endothelial and vascular endothelial receptor-1 (112), ICAM-1 (83), and macrophage mannose receptor-1, which facilitates interactions with lymphocyte CD44 (113), although when, where, and for which subsets each of these are used remains incompletely understood. In addition to ɑβ T cells, γδ T cells are found in afferent lymph-draining resting (19, 114), inflamed (115), and malignant (110, 116) tissues. Important surveyors of peripheral nonlymphoid tissue, γδ T cells are presumed to exit tissue via CCR7-independent mechanisms owing to a lack of CCR7 surface expression in bovine (114) and ovine lymph (115). There, high expression of E-selectin and CCR6-dependent chemotaxis toward CCL20 may indicate alternative mechanisms of lymphatic homing (115). These mechanisms, however, have not been tested functionally in vivo.

In addition to chemokines, S1P may play an important role in T lymphocyte egress from tissue (117). Effector and memory CD4⁺ T cells respond to S1P gradients in vitro and require S1P₁ and S1P₄ for migration into lymphatic vessels following coinjection with LPS (118). Interestingly, S1P₁ and S1P₄ appear to exhibit nonredundant roles and coordinate with S1P₂ on lymphatic vessels to activate adhesive sites for transendothelial migration (118). This highlights the important fact that S1P also regulates endothelial cell homeostasis (119, 120), which should be considered when manipulating S1P signaling in vivo.

Consistent with the hypothesis that S1P regulates T cell exit from tissue, S1P receptors are transcriptionally repressed in tissue-resident memory T cells (121, 122), and enforced S1pr1 expression reduces resident memory formation by CD8⁺ T cells (122). S1P receptor stimulation and desensitization through application of the small molecule FTY720 is sufficient to reduce CD4⁺ T cell egress to LNs (117) and rescues CD69^−/− retention in the skin following HSV-2 infection (123). FTY720-treated CD4⁺ T cells notably arrest their migration at the basal surface of lymphatic monolayers in vitro and capillaries in vivo (117), perhaps suggesting that chemokine receptors (e.g., CCR7) generate directional gradients, whereas S1P signaling acts in coordination with cell adhesion molecules to facilitate transendothelial migration. Interestingly, Ag recognition in peripheral, nonlymphoid tissue boosts tissue retention (108, 109) and the formation of tissue-resident memory (124), in part through changes in trafficking potential. Consistent with this, influenza virus-specific T cells are largely CCR7-negative in the lung (107, 125), and TCR stimulation is sufficient to modulate surface expression of CCR7 (126). Taken together, the Ag-dependence of T cell egress might contribute to the focusing of the interstitial T cell repertoire through combined S1P- and CCR7-dependent signals to promote the recirculation of bystander T cells while limiting overt pathology. How local Ag, inflammatory context, and lymphatic-derived signals may over time regulate interstitial T cell repertoires and contraction to memory is an interesting area for continued study.

Interestingly, peripheral lymphatic vessels are responsive to cytokines derived from infiltrating and transmigrating T lymphocytes and subsequently adapt their surface expression and function. T_REG, which migrate from skin during steady-state, show increased migration during contact hypersensitivity reaction, and migratory T_REG exhibit more potent suppressive activity when compared with LN-resident T_REG (18). Similarly, in allograft models, T_REG egress suppresses alloimmune responses and improves graft survival (127). Interestingly, T_REG activate lymphotoxin β receptor (LTβR) signaling in LECs to specifically facilitate their VCAM-dependent egress from grafted tissue (128), and in so doing, also condition LECs to increase expression of CCL21 that supports subsequent effector CD4⁺ and CD8⁺ T cell migration (129). This resolves the allograft response by both removing excessive inflammatory cells (e.g., CD4⁺ and CD8⁺ T cells, neutrophils, and macrophages) and inhibiting activation in LN. Furthermore, IFN-γR signaling in lymphatic capillaries seems to limit effector T cell responses in both infected and malignant skin (130). IFN-γ drives expression of both MHC class II and PD-L1 on peripheral lymphatic capillaries (130), which may indicate the potential for direct signaling between T lymphocytes and inflamed capillaries, consistent with prior observations that peripheral lymphatic vessels can scavenge and cross-present tumor-derived Ags (92). How the cross-talk between accumulating lymphocytes and lymphatic vessels contributes to ongoing inflammatory processes remains to be systematically dissected across tissue sites, but these studies indicate that it may have significant implications for local pathology and disease control.

Importantly, the mechanisms discussed above may all be influenced by the progressive lymphatic vessel remodeling observed in inflamed tissues. Tissue-infiltrating macrophages secrete VEGF-C and drive local lymphangiogenesis in tumors (131, 132) and experimental inflammatory models in the gut and skin (93, 94, 133). Under chronic conditions, lymphatic vessels are often dilated and leaky (93, 134), which can ultimately lead to poor tissue clearance (33, 135) and thus exacerbate local pathology. Importantly, whether once expanded, lymphatic networks contract as inflammation resolves remains poorly understood. In LNs, LECs undergo extensive inflammatory lymphangiogenesis, in part driven by B cell–derived VEGF-A (136) and contract postinflammation in an IFN-dependent manner (137, 138). However, the extent to which lymphangiogenic vessels in nonlymphoid peripheral tissues contract postinflammation appears both tissue-specific and dependent on the inflammatory insult itself. Airway lymphatic networks remain expanded for several months after M. pulmonis clearance and are resistant to dexamethasone treatment (139), and transgenic VEGF-C expression leads to persistent durable lymphatic hyperplasia in skin (140). In contrast, lymphangiogenic corneal networks completely regress following sterile injury (141, 142) and surprisingly exhibit accelerated lymphangiogenic responses following repeated challenge (143), perhaps suggesting a type of inflammatory memory (144). How the immunological experience of a peripheral tissue may lay the groundwork for future regional immune responses through long-lasting changes in lymphatic morphology and transport, particularly in barrier tissues, will continue to be an exciting area of study.

As this field grows, it becomes increasingly clear that lymphatic vessels and their associated transport properties directly contribute to immune homeostasis and disease through multiple overlapping and context-dependent mechanisms. As the exquisite phenotypic heterogeneity of lymphatic vessels is revealed, both within and across tissues, we are in critical need of functional studies that dissect the relative contribution of distinct LEC subsets and pathways to immunity with anatomic resolution in vivo. These mechanisms will inform therapeutic strategies to leverage lymphatic biology for immune benefit in patients across disease type.

There is already growing interest in identifying strategies that boost immune surveillance or alter peripheral tissue inflammation through the manipulation of resident lymphatic vessels. This is particularly true in the context of cancer, in which it was first shown in melanoma (145) and subsequently in glioblastoma (146) that overexpression of VEGF-C improves tumor-immune surveillance and response to immunotherapy. Similar approaches in the context of the CNS have raised the exciting prospect that boosting lymphatic transport through VEGF-C delivery may improve neurodegeneration (147, 148) and traumatic brain injury (149). VEGF-C, however, has pleiotropic effects on lymphatic and blood vessels, as well as recruited myeloid cells, and it remains unclear what the relative contribution of each of these players may be to the therapeutic effects observed. Furthermore, at least in a vascularized tissue, rapid and potent immunity can be achieved in the absence of VEGF-C–driven lymphangiogenesis (40), and DC trafficking proceeds, even in the face of severe lymphatic hypoplasia (150). Therefore, therapeutic approaches to boost immune surveillance or reduce chronic inflammation may not need to necessarily focus on hyperproliferative vessel growth. Importantly, the data we discuss above paint a less binary picture of lymphatic transport, for which its plasticity and transient responsiveness to inflammatory context are required for both the activation and resolution of inflammatory insult. Given the vast array of mechanisms through which lymphatic vessels regulate the inflammatory state of the peripheral tissues that they drain, a nuanced approach to manipulating their function is likely warranted. Although there is clearly a therapeutic opportunity to target lymphatic vessels for immune benefit across disease states, there is also much to understand about normal and inflamed lymphatic vessel function and its multifaceted roles in immunity to inform these approaches.

The authors have no financial conflicts of interest.