|  Gaps in the Field of Lymphatic Research  |  2026–27 Update  |  4
5. Epidemiologic and Longitudinal Data
• Need for epidemiologic studies to realistically 
determine the incidence and prevalence of lymphatic 
diseases in the US (primary and secondary 
lymphedema, lipedema, vascular malformations  
and other rare lymphatic disorders). 
• We lack natural history studies for lymphatic diseases 
and require them for FDA clinical trials. 
• More comprehensive registries are needed with 
better collaboration across the lymphatic community 
to share and analyze the data. 
6. Access to Care and Global Health
• Rural and global health disparities in people living  
with lymphedema.
• Impact of climate change on chronic edema/
lymphedema.
• Remote education/telehealth interventions to  
support those living remotely and rural people  
living with lymphedema.
7. Standards for Outcomes Measures
• Development of validated patient reported outcomes 
in lymphatic disease. 
• Development of validated clinical outcomes  
(i.e., radiologic measures).
8. Patient Advocates Emphasized  
These Gaps
Data collected from the NIH 2022 Yet to Be Charted: 
Lymphatics in Health and Disease Research Workshop
• Improved awareness and specialized training  
for medical staff to recognize, diagnose, and treat  
lymphatic diseases. 
• Improved imaging of lymphatic diseases.
• Non-invasive diagnostics and emphasis placed on 
establishing lymphatic medicine as a discipline.
• Need for more Centers of Excellence and need  
for more specialists.
• Need for primary care givers to be more educated  
in lymphatic diseases. 
• Need for creative state-of-the-art surgical approaches. 
• Need for methods of “transition of care” from 
pediatric to adult vascular anomaly patients and 
specialty centers for pediatric and adult vascular 
anomaly patients.
• Need a method to include psychosocial counseling 
for patients with lymphatic diseases that have been 
historically neglected.
• Identify the barriers to the routine referral of  
at-risk people for lymphatic disease and/or 
lymphedema assessment, preventative exercises, 
self-management education, and treatment as 
needed across the lifespan. 
BASIC & TRANSLATIONAL 
SCIENCE GAPS
Basic research is often overlooked in terms of the 
impact and significance it can have in the development 
of novel therapies for diseases. Many of the 
advancements in the fields of cancer, cardiovascular 
disease, and neurology, for example, have been made 
due to the efforts of researchers who investigated the 
basic biology of those systems. Funding for this type 
of research for lymphatics is of the utmost importance 
to advance the knowledge and treatment of lymphatic 
diseases and lymphedema.
1. The Developmental Origin of  
the Lymphatic System
Including often neglected lymphatic muscle cells 
(where do lymphatic muscle cells originate in 
development?), contractile protein and ion channel 
expressions of lymphatics, and the regional 
differences.
2. Compendium of Lymphatic Biology  
and Physiology
Create a compendium of lymphatic biology and 
physiology to better understand the basic physiology 
of normal lymphatic tissue so that we can understand 
genetic and anatomic variations.
3. Quantification of Lymphatic Function
We lack an understanding of the pressures and flows  
in healthy and dysfunctional lymphatic networks. 
• Mechanisms that maintain vessel homeostasis and 
role in optimizing function.
•  Functional studies of human vessels, especially  
of healthy vessels. 
• Studies to better understand the extent to which 
lymphatic contractile and valve dysfunction result 
from, or contribute to, other pathologies.
• Because it is technically difficult to study human 
lymphatic smooth muscle cells, this has resulted in 
relying on the study of lymphatic endothelial cells 
(LECs). We have a paucity of research on the diversity 
and function of lymphatic smooth muscle cells.  
This includes the developmental origin of  
lymphatic muscle cells, contractile protein and  
ion channel expressions of lymphatics, and the  
regional differences.
• Further evaluation required to understand the 
consequences of having or not having a normal 
functioning thoracic duct. 
• Do primary lymphedema-causing genetic  
mutations affect lymphatic vessel contractility  
and permeability?

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