The central role of the endothelial microenvironment in orchestrating bone marrow (BM) homeostasis and hematopoietic support has been confirmed at various developmental stages and in adult life. The BM vasculature is crucial in mediating communication between BM parenchyma and circulating blood, displaying remarkable heterogeneity in structure and function. While vascular cell diversity in other tissues has long been recognized, the molecular basis of this phenomenon in BM is just now emerging. Over the past decade, single-cell approaches and microscopic observations have expanded our understanding of BM vasculature. While solely characterized for their paracrine properties in the past, recent advances have revolutionized our perception of endothelial function, revealing distinct anatomical locations associated with diverse endothelial cell states. The identification of phenotypic differences between normal and pathological conditions has therefore deepened our understanding of vascular dynamics and their impact on hematopoiesis in health and disease. In this review, we highlight key milestones and recent advances in understanding vascular heterogeneity within BM microenvironment during development, adulthood and aging. We also explore how leukemia affects this heterogeneity and how we can take this knowledge forward to improve clinical practices. By synthesizing existing literature, we aim to address unresolved questions and outline future research directions.

内皮微环境在协调骨髓 （BM） 稳态和造血支持中的核心作用已在各个发育阶段和成年生活中得到证实。BM 脉管系统在介导 BM 实质和循环血液之间的通讯中至关重要，在结构和功能上表现出显着的异质性。虽然其他组织中的维管细胞多样性早已得到认可，但 BM 中这种现象的分子基础现在才刚刚出现。在过去的十年中，单细胞方法和显微镜观察扩大了我们对 BM 脉管系统的理解。虽然过去仅以其旁分泌特性为特征，但最近的进展彻底改变了我们对内皮功能的看法，揭示了与不同内皮细胞状态相关的不同解剖位置。因此，对正常和病理状况之间表型差异的鉴定加深了我们对血管动力学及其对健康和疾病造血影响的理解。在这篇综述中，我们重点介绍了在发育、成年和衰老过程中理解 BM 微环境中血管异质性的关键里程碑和最新进展。我们还探讨了白血病如何影响这种异质性，以及我们如何利用这些知识来改进临床实践。通过综合现有文献，我们旨在解决未解决的问题并勾勒未来的研究方向。