Bidirectional roles of meningeal lymphatic vessels in brain metastases: friend and foe

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Meningeal lymphatic vessels (MLVs) are crucial for cerebrospinal fluid drainage, waste clearance, and immune cell trafficking in the brain.
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MLVs exhibit a dual role in brain metastases, promoting anti-tumor immunity initially but facilitating tumor spread as they undergo pathological remodeling.
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Excessive tumor-derived factors like VEGF-C can cause MLV dysfunction, leading to immunosuppressive environments that aid in immune evasion.
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Therapeutic strategies targeting MLVs may enhance immunotherapy effectiveness and limit metastatic spread by improving drainage and inhibiting lymphangiogenesis.
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The discovery of MLVs has transformed the understanding of CNS immunity and highlights their potential as therapeutic targets in brain metastasis treatment.

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