Blood and lymphatic vasculature in the ovary: development, function and disease.

BACKGROUND The remodelling of the blood vasculature has been the subject of much research while rapid progress in the understanding of the factors controlling lymphangiogenesis in the ovary has only been reported more recently. The ovary undergoes cyclic remodelling throughout each menstrual/estrous cycle. This process requires significant vascular remodelling to supply each new cohort of growing follicles. METHODS Literature searches were performed to review studies on the ovarian lymphatic vasculature that described spatial, temporal and functional data in human or animal species. The role of ovarian blood and lymphatic vasculature in the pathogenesis of ovarian disease and dysfunction was also explored. RESULTS Research in a number of species including zebrafish, rodents and primates has described the lymphatic vasculature within the remodelling ovary, while recent research in mouse has confirmed hormonal regulation of lymphangiogenic growth factors, their receptors and also a role for the protease, ADAMTS1 in the development of the lymphatic vasculature. With a critical role in the maintenence of fluid homeostasis, the ovarian lymphatic vasculature is important for normal ovarian function and has been linked to syndromes involving ovarian fluid imbalance, including ovarian hyperstimulation syndrome and massive ovarian edema. The lymphatic vasculature has also been heavily implicated in the metastatic cancer process. CONCLUSION The spatial and temporal regulation of the ovarian lymphatic vasculature has now been reported in a number of species and the data also implicate the ovarian lymphatic vasculature in ovarian pathologies, including cancer and those linked with use of artificial reproduction technologies.