Nakanishi, N.; Nakamori, S.; Hara, S.; Nagaharu, K.; Matsuyama, R.; Fujita, S.; Okamoto, R.; Dohi, K.; Hiroe, M.; Imanaka-Yoshida, K.; Maruyama, K.

BACKGROUND: Acute myocarditis is an immune-mediated inflammatory disease characterized by myocardial inflammation and edema. Cardiac lymphatic vessels are essential for fluid clearance and immune regulation; however, their role in modulating inflammation in autoimmune myocarditis remains largely unclear. METHODS: We investigated the impact of cardiac lymphangiogenesis using a murine model of experimental autoimmune myocarditis induced by cardiac myosin peptide immunization. Human autopsy samples were analyzed for lymphatic expansion. Mice were treated with VEGF-C C156S, a VEGFR3-specific agonist, beginning one week after immunization. Cardiac lymphangiogenesis, myocardial edema, inflammatory infiltration, fibrosis, and cardiac function were evaluated by immunohistochemistry, echocardiography, gene expression analysis, and water content measurements. RESULTS: The VEGF-C treatment accelerated cardiac lymphangiogenesis, enhanced lymphatic drainage, reduced myocardial edema, and attenuated inflammatory cell infiltration and fibrosis. Echocardiography showed the preservation of left ventricular function. VEGF-C selectively decreased the accumulation of iNOS inflammatory macrophages without broadly suppressing T cells or reparative macrophages. Bulk RNA sequencing confirmed the down-regulation of inflammatory gene signatures associated with macrophage activation. CONCLUSIONS: The early stimulation of cardiac lymphangiogenesis by VEGF-C promotes the resolution of inflammation, reduces myocardial injury, and preserves cardiac function in autoimmune myocarditis. Targeting the cardiac lymphatic system may represent a promising therapeutic strategy for acute myocarditis.