Premium
Lymphatic Dysfunction, Not Aplasia, Underlies Milroy Disease
Author(s) -
Mellor Russell H.,
Hubert Charlotte E.,
Stanton Anthony W.B.,
Tate Naomi,
Akhras Victoria,
Smith Alberto,
Burnand Kevin G.,
Jeffery Steve,
Mäkinen Taija,
Levick J. Rodney,
Mortimer Peter S.
Publication year - 2010
Publication title -
microcirculation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.793
H-Index - 83
eISSN - 1549-8719
pISSN - 1073-9688
DOI - 10.1111/j.1549-8719.2010.00030.x
Subject(s) - lymphatic system , medicine , lymphedema , lymphatic vessel , pathology , aplasia , anatomy , hypoplasia , forearm , breast cancer , cancer , metastasis
Microcirculation (2010) 17 , 281–296. doi: 10.1111/j.1549‐8719.2010.00030.x Abstract Objective: Milroy disease is an inherited autosomal dominant lymphoedema caused by mutations in the gene for vascular endothelial growth factor receptor‐3 (VEGFR‐3, also known as FLT4). The phenotype has to date been ascribed to lymphatic aplasia. We further investigated the structural and functional defects underlying the phenotype in humans. Methods: The skin of the swollen foot and the non‐swollen forearm was examined by (i) fluorescence microlymphangiography, to quantify functional initial lymphatic density in vivo ; and (ii) podoplanin and LYVE‐1 immunohistochemistry of biopsies, to quantify structural lymphatic density. Leg vein function was assessed by colour Doppler duplex ultrasound. Results: Milroy patients exhibited profound (86–91%) functional failure of the initial lymphatics in the foot; the forearm was unimpaired. Dermal lymphatics were present in biopsies but density was reduced by 51–61% (foot) and 26–33% (forearm). Saphenous venous reflux was present in 9/10 individuals with VEGFR3 mutations, including two carriers. Conclusion: We propose that VEGFR3 mutations in humans cause lymphoedema through a failure of tissue protein and fluid absorption. This is due to a profound functional failure of initial lymphatics and is not explained by microlymphatic hypoplasia alone. The superficial venous valve reflux indicates the dual role of VEGFR‐3 in lymphatic and venous development.