"Endothelium
in Sepsis and Multiple Organ Dysfunction Syndrome
Sepsis"
Sepsis,
defined as the systemic inflammatory response to
infection, is both common and deadly. The common
themes in sepsis pathophsyiology are the following:
1) it is the host response rather than the nature
of the pathogen that dictates patient outcome,
2) sepsis involves the activation of the coagulation
and inflammatory pathways, both of which contribute
to the high degree of morbidity and mortality associated
with this condition, 3) the monocyte initiates
the host response to infection, 4) the endothelium
plays an important role in perpetuating the host
response, 5) the monocyte and endothelial cell
function in concert to defend host against pathogen,
but in the process may inflict collateral damage
that results in organ dysfunction that is not diffuse
but rather remarkably focal in its distribution.
The sepsis field is plagued by a long history of
failed clinical trials. An understanding of the
innate immune response, particularly the importance
of the link between inflammation and
coagulation provides helpful insight into emerging
new therapies. In this lecture, we will emphasize
the potential value of the endothelium as a therapeutic
target in severe sepsis.