Microenvironment of the peripheral nervous system under normal and pathological conditions.

The peripheral nervous system (PNS) is composed of neurons and their processes which are located in a special fluid microenvironment. As is well known, complex biological functions such as those going on in peripheral nerves are best carried out when there is homeostasis, i.e., in a constant internal milieu. This paper is concerned with the maintenance of the homeostasis in the PNS under normal and pathological conditions. Diffusion barriers located in the intrinsic vessels of the PNS and the perineurium have the capacity to regulate the environment around the nerve fibers and to keep it away from the blood and the extracellular fluid outside the PNS. Endoneurial vascular permeability has similarities to that in the central nervous system, but compared with the blood-brain barrier the blood-nerve barrier is less efficient. This implies that toxic and infectious agents as well as some drugs have easier access to the parenchyma in nerves than to the brain parenchyma. However, ganglionic vessels lack an efficient vascular barrier to many substances which is important in intoxications caused by, e.g., doxorubicin, lead, mercury, and cadmium. It has also a significance in herpes zoster infection and presumably in Guillain-Barré syndrome. The diffusion barriers may themselves be influenced by pathologic processes and can then respond with an increased permeability. This may lead to the formation of edema in the PNS, i.e., one of the cardinal features of many diseases in nerves of traumatic, toxic, and inflammatory nature. Such a response had negative as well as positive implications. Severe edema may disturb the normal microcirculation in the endoneurial vessels and stimulate collagen production and fibrosis. However, the presence of a protein-rich endoneurial edema may well be important in repair processes such as reduplication of Schwann cells and growth of axons.