The concept of neurogenic inflammation

Abstract

Neurogenic inflammatory responses have recently been linked to both acute and chronic pathological conditions in the urinary tract. Neurogenic inflammation encompasses a series of vascular and non‐vascular inflammatory responses, triggered by the activation of primary sensory neurons and the subsequent release of inflammatory neuropeptides, including substance P and calcitonin gene‐related peptide. The reduction of neurogenic inflammatory responses may be key in the mode of action of the adrenergic α 1 ‐adrenoceptor antagonists used to treat lower urinary tract symptoms (LUTS). Indeed, the α 1 ‐adrenoceptor antagonist alfuzosin inhibits expression of the oncogene c‐ fos – a marker of nociceptive pathway activation – evoked by cyclophosphamide in rats. Capsaicin ameliorates urinary bladder symptoms through its stimulatory action on the transient receptor potential vanilloid 1 (TRPV1) calcium channel, resulting in desensitization of bladder sensory nerve terminals. Involvement of the TRP cation channel, subfamily A, member 1 (TRPA1) has also been reported in models of neurogenic inflammation and nociception promoted by the cyclophosphamide metabolite, acrolein. Blockade by alfuzosin demonstrates the beneficial effects of α 1 ‐adrenoceptor antagonists on neurogenic inflammation via the transient receptor potential family of ionic channels. Consequently, these drugs may have an important role in reducing LUTS.