Regulation, maintenance, and remodeling of high endothelial venules in homeostasis, inflammation, and cancer

High endothelial venules (HEVs), high-walled cuboidal blood vessels, through their expression of adhesion molecules and chemokines, allow the entrance of lymphoid cells into primary, secondary, and tertiary lymphoid structures (TLSs) (aka tertiary lymphoid organs). HEV heterogeneity exists between various lymphoid organs in their expression of peripheral node addressin and mucosal vascular addressin adhesion molecule 1. Transcriptomic analyses reveal extensive heterogeneity, plasticity, and regulation of HEV gene expression in ontogeny, acute inflammation, and chronic inflammation within and between lymphoid organs. Rules regulating HEV development are flexible in inflammation. HEVs in tumor TLSs are diagnostic of favorable clinical outcome and response to immunotherapy, including immune checkpoint blockade. Immunotherapy induces HEVs and provides an entrance for naive, central memory, and effector cells and a niche for stem-like precursor cells. Understanding HEV regulation will permit their exploitation as routes for drug delivery to autoimmune lesions, rejecting organs, and tumors.