Lymphatic function and responses in periodontal disease

Extravasated fluid, proteins and cells are returned into the circulation by lymphatic vessels that are also important in immune cell trafficking. Lymphatic vessels in gingiva are located in lamina propria, and traverse the external surface of the alveolar bone. Lack of gingival lymphatics has been shown to increase the interstitial fluid pressure and fluid volume, thus showing that lymphatics are important for fluid drainage also in this tissue. Gingival lymphatic vessels require continuous signaling by the growth factors VEGF-C and D via their receptor VEGFR-3 for their maintenance, factors that are expressed in the gingival epithelium and also in immune cells in lamina propria. VEGF-C seems to be of critical importance for lymphangiogeneses induced during periodontal disease development. Mice are protected against periodontitis by lymphatics clearing bacteria and bacterial products and promoting humoral immune responses. CCL21, a ligand important for dendritic cell migration, has been found to be downregulated in lymphatics from patients with periodontitis. Such patients may have impaired gingival lymphatic function due to high enzymatic activity and thus loss of structural components in the interstitium. At present there are few studies on the role of lymphatic vessels in periodontal disease making this a rather unexplored field.