Die neurogene Entzündung.
II. Pathophysiologie und klinische Implikationen

Zusammenfassung

Neurogene Entzündungen werden hervorgerufen durch Aktivierung unmyelinisierter sensorischer Nervenfasern und nachfolgender Freisetzung von Neuropeptiden, z. B. Substanz P und Calcitonin Gene-related Peptide (CGRP) aus den peripheren Nervenendigungen. Die lokale Entzündungsreaktion am Ort der Reizung besteht aus einer Hyperämie und einem Ödem, die unter Umständen mit Schmerzen einhergehen. Die Entzündungszeichen und die Hyperalgesie bei chronischen Schmerzsyndromen, z. B. der Migräne, Arthritiden und dem Komplexen Regionalen Schmerzsyndrom entsprechen den Charakteristika der neurogenen Entzündung. Aufgrund überzeugender Hinweise aus Tierversuchen, die überwiegend an Nagern durchgeführt wurden, wird auch beim Menschen angenommen, dass die neurogene Entzündung an vielen Erkrankungen der Atemwege, des Magendarmtraktes, des Urogenitaltraktes und der Haut beteiligt sind. In Anbetracht der eher enttäuschenden Ergebnisse neuer klinischer Studien zur Behandlung neurogener Entzündungen mit selektiven Substanz P- (NK₁)-Antagonisten werden in dieser Übersicht die Hypothesen einer Beteiligung neurogener Entzündungen an Erkrankungen beim Menschen kritisch hinterfragt. Außer dem inflammatorischen Charakter hat die neurogene Entzündung in ganz anderer Weise physiologisch eine besondere Bedeutung. Sie hat eine protektive und nozifensive, aber auch trophische Funktion und trägt mit zur Gewebeintegrität und -homöostase bei.

Abstract

Neurogenic inflammation is elicited by activation of unmyelinated sensory neurons through noxious stimuli and subsequent release of neuropeptides such as substance P and calcitonin gene-related peptide (CGRP) from peripheral nerve endings. The nerve-mediated inflammatory responses in the tissue consist of hyperaemia and oedema which under some circumstances may be accompanied by pain. Neurogenic inflammation has been implicated in the pathophysiology of various human diseases with uncertain etiology. Signs of inflammation and hyperalgesia associated with chronic pain syndromes such as migraine, arthritis and complex regional pain syndrome resemble the characteristics of neurogenic inflammation. By extrapolation of convincing evidence obtained in rodent models, neurogenic inflammation is assumed to contribute to diseases of the respiratory system, gastrointestinal tract, urogenital tract, and skin in humans. Since, however, highly selective substance P receptor antagonists, found to be effective against inflammation in rodents, failed to inhibit inflammatory processes in clinical trials, the hypothesis of an involvement of neurogenic inflammation in human diseases is discussed critically in this review. Beyond its primarily inflammatory character neurogenic inflammation can be regarded as a mechanism that activates protective responses, thus bringing about a first line of defence to maintain the integrity of the tissue and to contribute to tissue repair.

Neurogene Entzündung - Pathophysiologie - Migräne - Arthritis

Neurogenic inflammation - Pathophysiology - Migraine - Human diseases

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