Inflammation and coagulation.
In the pathogenesis of sepsis, inflammation and coagulation play a pivotal role. Increasing evidence points to an extensive cross-talk between these two systems, whereby inflammation leads to activation of coagulation, and coagulation also considerably affects inflammatory activity. Molecular pathways that contribute to inflammation-induced activation of coagulation have been precisely identified. Pro-inflammatory cytokines and other mediators are capable of activating the coagulation system and down-regulating important physiologic anticoagulant pathways. Activation of the coagulation system and ensuing thrombin generation is dependent on expression of tissue factor and the simultaneous down-regulation of endothelial-bound anticoagulant mechanisms and endogenous fibrinolysis. Conversely, activated coagulation proteases may affect specific cellular receptors on inflammatory cells and endothelial cells and thereby modulate the inflammatory response.
Levi
Marcel
M
Department of Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands. m.m.levi@amc.uva.nl
van der Poll
Tom
T
D000991:Antithrombins / Q000502:physiology; D001777:Blood Coagulation / Q000502:physiology*; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000276:immunology / Q000503:physiopathology; D001792:Blood Platelets / Q000502:physiology; D015536:Down-Regulation / Q000502:physiology; D005337:Fibrin / Q000502:physiology; D005341:Fibrinolysin / Q000502:physiology; D005342:Fibrinolysis / Q000502:physiology; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D008074:Lipoproteins / Q000502:physiology; D010958:Plasminogen / Q000502:physiology; D011486:Protein C / Q000502:physiology; D044462:Receptors, Proteinase-Activated / Q000502:physiology; D013917:Thrombin / Q000502:physiology
D000991:Antithrombins; D008074:Lipoproteins; D011486:Protein C; D044462:Receptors, Proteinase-Activated; C051928:lipoprotein-associated coagulation inhibitor; D005337:Fibrin; D010958:Plasminogen; D013917:Thrombin; D005341:Fibrinolysin