Rossitto, G., Bertoldi, G., Rutkowski, J. M., Mitchell, B. M. and Delles, C. (2024) Sodium, interstitium, lymphatics, and hypertension - A tale of hydraulics: Salt series. Hypertension, (doi: 10.1161/HYPERTENSIONAHA.123.17942) (PMID:38385255) (Early Online Publication)
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Abstract
Blood pressure is regulated by vascular resistance and intravascular volume. However, exchanges of electrolytes and water between intra and extracellular spaces and filtration of fluid and solutes in the capillary beds blur the separation between intravascular and interstitial compartments. Contemporary paradigms of microvascular exchange posit filtration of fluids and solutes along the whole capillary bed and a prominent role of lymphatic vessels, rather than its venous end, for their reabsorption. In the last decade, these concepts have stimulated greater interest in and better understanding of the lymphatic system as one of the master regulators of interstitial volume homeostasis. Here, we describe the anatomy and function of the lymphatic system and focus on its plasticity in relation to the accumulation of interstitial sodium in hypertension. The pathophysiological relevance of the lymphatic system is exemplified in the kidneys, which are crucially involved in the control of blood pressure, but also hypertension-mediated cardiac damage. Preclinical modulation of the lymphatic reserve for tissue drainage has demonstrated promise and also generated conflicting results thus far. A better understanding of the hydraulic element of hypertension and the role of lymphatics in maintaining fluid balance can open new approaches to prevent and treat hypertension and its consequences, such as heart failure.
| Item Type: | Articles |
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| Additional Information: | GR and GB are supported by the NextGenerationEU-funded program STARS@UNIPD 2021 (Starting Grant to GR; project: POLYPHEMUS-CVD), from Fondazione Cassa di Risparmio di Padova e Rovigo (CARIPARO, grant PHD@UNIPD to GB; project: MERLIN-CRVD) and from the University of Padua. CD receives funding from the British Heart Foundation (BHF Centre of Research Excellence; RE/18/6/34217). BMM is supported in part by the National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (R01 DK120493). JMR is supported in part by the NIDDK (R01 DK119497) and also receives support from DK120493. |
| Keywords: | lymphatics, interstitium, volume homeostasis, fluid balance, capillaries, hypertension. |
| Status: | Early Online Publication |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Rossitto, Dr Giacomo and Delles, Professor Christian and Bertoldi, Dr Giovanni |
| Authors: | Rossitto, G., Bertoldi, G., Rutkowski, J. M., Mitchell, B. M., and Delles, C. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
| Journal Name: | Hypertension |
| Publisher: | American Heart Association |
| ISSN: | 0194-911X |
| ISSN (Online): | 1524-4563 |
| Published Online: | 22 February 2024 |
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