A recent study reports that adenosine A2A receptor-mediated lymphangiogenesis increases lymphatic clearance of excess Na+ from the skin and reduces blood pressure, whereas impairment of this process leads to salt-sensitive hypertension. These findings raise intriguing physiological questions regarding the relationships among sodium, water and blood pressure.
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References
Krebs, H. A. Excursion into the borderland of biochemistry and philosophy. Bull. Johns Hopkins Hosp. 95, 45–51 (1954).
Guyton, A. C. The surprising kidney-fluid mechanism for pressure control–its infinite gain! Hypertension 16, 725–730 (1990).
Brands, M. W. Unifying approach for interpreting the physiological effect of high salt intake. Hypertension 75, 620–622 (2020).
Zhuang, T. et al. A2AR-mediated lymphangiogenesis via VEGFR2 signaling prevents salt-sensitive hypertension. Eur. Heart J. 44, 2730–2742 (2023).
Wiig, H. et al. Immune cells control skin lymphatic electrolyte homeostasis and blood pressure. J. Clin. Invest. 123, 2803–2815 (2013).
Machnik, A. et al. Mononuclear phagocyte system depletion blocks interstitial tonicity-responsive enhancer binding protein/vascular endothelial growth factor C expression and induces salt-sensitive hypertension in rats. Hypertension 55, 755–761 (2010).
Machnik, A. et al. Macrophages regulate salt-dependent volume and blood pressure by a vascular endothelial growth factor-C-dependent buffering mechanism. Nat. Med. 15, 545–552 (2009).
Nikpey, E. et al. High-salt diet causes osmotic gradients and hyperosmolality in skin without affecting interstitial fluid and lymph. Hypertension 69, 660–668 (2017).
Nosalski, R. & Guzik, T. J. Skin sodium, lymphatics, and blood pressure: a non-canonical mechanism of salt-sensitive hypertension. Eur. Heart J. 44, 2743–2745 (2023).
Wiener, N. Cybernetics: Or Control and Communication in the Animal and the Machine, 2nd revised edn (Herman & Cie, The Technology Press, John Wiley & Sons, 1948).
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Titze, J.M. Lymph vessels, Na+ and the teleological science of hypertension. Nat Rev Nephrol 19, 692–693 (2023). https://doi.org/10.1038/s41581-023-00770-5
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DOI: https://doi.org/10.1038/s41581-023-00770-5