title: Abnormal mural cell recruitment in lymphatic capillaries: a common pathological feature in chronic lymphedematous skin?
abstract: This study aimed to explore the structural and functional characteristics of dermal lymphatic capillaries in patients with chronic LE, specifically focused on the mural cells that are associated with skin lymphatics.
  
  
  
  Forty-four patients (30 primary LE and 14 secondary LE) and eight healthy controls were enrolled in this study. Genetic analysis of the FOXC2 was performed in 18 patients with primary LE. Full-thickness skin was excised and immunohistologically stained for podoplanin and α-SMA. The proportions of α-SMA+Lv (α-SMA+Lv%) were calculated. Lymphatic vascular function was assessed by indocyanine green lymphography.
  
  
  
  Analysis of FOXC2 revealed two mutations in two patients with LDs. Histologically, thirty-nine patients exhibited increased α-SMA+mural cell coverage of lymphatic capillaries. The α-SMA+Lv% values in the superficial and deep dermis in patients with primary and secondary LE were significantly higher than in the control group. Compared with imaging findings in healthy limbs, in which the collecting lymphatics were clearly visualized, lymphedematous extremities all exhibited dermal backflow.
  
  
  
  Abnormal recruitment of mural cells in dermal lymphatic capillaries is a common pathological event in chronic LE, and may play a role in disease evolution.
authors.affiliation: Lymphology Centre of Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Zi-You
authors.initials: ZY
authors.lastname: Yu
authors.affiliation: Lymphology Centre of Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Di
authors.initials: D
authors.lastname: Sun
authors.affiliation: Lymphology Centre of Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Lymphology Centre of Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. liuningfei@126.com.
authors.forename: Ning-Fei
authors.initials: NF
authors.lastname: Liu
mesh_terms: D000199:Actins / Q000032:analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002465:Cell Movement; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D051858:Forkhead Transcription Factors / Q000235:genetics; D006801:Humans; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D008209:Lymphedema / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology*; D008220:Lymphography / Q000379:methods; D008297:Male; D008562:Membrane Glycoproteins / Q000032:analysis; D008875:Middle Aged; D009131:Muscle, Smooth, Vascular / Q000473:pathology*; D020286:Pericytes / Q000473:pathology*; D012867:Skin / Q000737:chemistry / Q000473:pathology; D055815:Young Adult; D000098853:Podoplanin
chemical_list: D000199:Actins; D051858:Forkhead Transcription Factors; D008562:Membrane Glycoproteins; C541116:ACTA2 protein, human; C117468:PDPN protein, human; D000098853:Podoplanin; C082078:mesenchyme fork head 1 protein
keywords: FOXC2; indocyanine green lymphography; lymphatic capillary; lymphedema; mural cells