Several clinical syndromes of vasculitis exist. The etiology of most inflammatory conditions of blood vessels are not known, but immune mechanisms appear to account for many forms of vasculitis. The reasons for suggesting that immune mechanisms are involved in these disorders are multiple. Inflammatory vascular lesions are common and reproducible in experimental models of acute serum sickness, chronic serum sickness, spontaneous models of autoimmune diseases, and certain chronic viral diseases in animals. Vasculitis is a common manifestation of human serum sickness, and vasculitis is part of known immunologically mediated diseases such as systemic lupus erythematosus and rheumatoid arthritis.Similar to other target organs, immunologically mediated inflammation of blood vessels may arise by involvement of only cellular immunity, by involvement of humoral immunity, or potentially a combination of both. The purpose of this article is to consider the involvement of immune complexes in the pathogenesis of vascular inflammation. Clinical aspects of vasculitides will be considered by P. A. Bacon in this volume and have been reviewed in a monography by Cupps and Fauci (1).In human diseases the size of blood vessels involved vanes among the categories of vasculitides. In small vessel vasculitis or leukocytoclastic vasculitis inflammation and immune deposits affect venules, capillaries and arterioles. In periarteritis nodosa the lesions and immune deposits involve in segmental fashion small and medium size arteries. In some patients with systemic, necrotizing vasculitis both large and small vessels are involved. It is not clear what leads to involvement of blood vessels with varying size. A single etiologic agent, for example hepatitis virus B, can cause immune complex-mediated vascular inflammation ranging from small vessel vasculitis to involvement of medium size vessels in periarteritis nodosa.
General considerations of immune complex-mediated vascular inflammationThe development of vasculitis in acute and chronic serum sickness in experimental animals was appreciated by many workers. How immune complexes localized in blood vessel walls, however, was not understood. The work of Cochrane and colleagues in the mid-nineteen sixties provided substantial new information on the mechanisms of localization of immune complexes in blood vessels of experimental animals, as reviewed by Cochrane and Koffler (2).A key feature was that circulating immune complexes localized in blood vessels only after an increase of permeability. In rabbits with serum sickness, this was caused by release of vasoactive amines from aggregated platelets, which was brought about by platelet activating factor that was released by interaction of antigen with IgE class of antibodies. For guinea pigs, in contrast, the vasoactive amines were released from basophils. Furthermore, the necessary increased permeability could be induced by administration of vasoactive amines while appropriate immune complexes were present in circulation. Immune complexes that posse...