The role of regulatory peptides in the pathogenesis of cutaneous necrotizing vasculitis.

Cutaneous necrotizing vasculitides (CNV) are a group of clinical disorders characterized by: 1) angiocentric segmental inflammation, 2) cellular infiltrate, 3) red cell extravasation, 4) fibrinoid necrosis of the blood vessels, and possibly 5) nuclear debris. There are many classifications of vasculitides based or on the diameter of the vessels or on the type of the cellular infiltrate. In this paper we outline the major key role played by the endothelium in this pathological process and the possible role of the regulatory peptides in the pathogenesis of CNV. Despite there are not direct yet clear evidences of the role of neuropeptides in the pathogenesis of cutaneous necrotizing vasculitis, we suggest a possible major role of them, on the basis of the activity of regulatory peptides on microvascular endothelium, on polymorphonuclear chemotaxys and on lymphocytic functions. Thus, neuropeptides and endothelins could act on the tone of the vessel, provoking vasodilation or vasoconstriction, determining a possible stimulus to inflammation and/or venular thrombosis. The release of neuropeptides at the sites of local inflammation could modulate the activity of nearby inflammatory cells and other tissue elements. Organs with neuropeptidergic fibers in high density, such as the skin, could be particularly susceptible to perturbations from inflammation-derived neuropeptides.