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The Role of the Contact System in the Pathogenesis of Septic Shock

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Sepsis

Abstract

The contact system traditionally has been considered to participate in the intrinsic pathway of coagulation. However, recent studies suggest that it rather may function as an auxillary fibrinolytic system. In addition, during activation of the system a number of biologically active proteases and peptides are generated that have potent inflammatory activities. Hence, the contact system likely plays a key role in regulating hemostatic and inflammatory responses. The contact system is activated during sepsis. Although bacteria or products derived therefrom may activate the system in vitro, it is not known whether these are the activators in vivo as well. Studies in animal models suggest that contact activation contributes to hypotension and to a number of inflammatory effects. Clinical studies support that contact activation may contribute to the hypotension in septic shock, but the relation to inflammatory reactions is less clear. Whether inhibition of contact activation constitutes a therapeutic option for patients with septic shock, remains to be established in future studies.

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  1. Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, Laboratory for Experimental and Clinical Immunology, University of Amsterdam, and Department of Internal Medicine of the Free University Hospital, Amsterdam, The Netherlands

    C. Erik Hack

  2. Sol Sherry Thrombosis Research Center, and Hematology Division of the Department of Medicine, Temple University School of Medicine, Philadelphia, PA

    Robert W. Colman

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Hack, C.E., Colman, R.W. The Role of the Contact System in the Pathogenesis of Septic Shock. Sepsis 3, 111–118 (1999). https://doi.org/10.1023/A:1009895315442

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