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Lymphatic vessels clean up your arteries
Carlos Fernández-Hernando
Carlos Fernández-Hernando
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Commentary

Lymphatic vessels clean up your arteries

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Abstract

Reverse cholesterol transport (RCT) is the pathway by which cholesterol accumulated in peripheral tissues, including the artery wall, is transported to the liver for excretion. There is strong evidence suggesting that interventions that increase macrophage cholesterol efflux and RCT would be antiatherogenic. In this issue of the JCI, Martel et al. investigate the contribution of lymphatic vasculature to RCT. Their results support the concept that the lymphatic vessel route is critical for RCT from atherosclerotic plaques. Therefore, strategies to improve lymphatic transport might be useful for treating atherosclerotic vascular disease.

Authors

Carlos Fernández-Hernando

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Figure 1

Regulation of RCT by HDL.

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Regulation of RCT by HDL.
The macrophages that accumulate in atheroscler...
The macrophages that accumulate in atherosclerotic plaques efflux cholesterol to HDL particles via ABCA1 and ABCG1. Both transporters are regulated at the transcriptional level by LXRs and post-transcriptionally by miR-33. HDL particles exit the artery wall and return to the liver via the SR-BI receptor. In the liver, most cholesterol is transformed into bile acids and is secreted into the bile for excretion. Cholesterol esters (CE) from HDL can also be transferred to VLDL/LDL by the cholesterol ester transfer protein (CETP), and after that can be removed from the plasma through the hepatic LDL receptor (LDLr). In this issue of the JCI, Martel et al. suggest that lymphatic vessels play a key role in controlling HDL particle entry into and exit from atherosclerotic lesions, thereby regulating RCT. TG, triglycerides.

Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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