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Published in: Critical Care 5/2007

01-12-2007 | Review

Recombinant human activated protein C: current insights into its mechanism of action

Authors: Marcel Levi, Tom van der Poll

Published in: Critical Care | Special Issue 5/2007

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Abstract

Impairment of the protein C pathway plays a central role in the pathogenesis of sepsis. Administration of recombinant human activated protein C (rhAPC) may correct the dysregulated anticoagulant mechanism and prevent propagation of thrombin generation and formation of microvascular thrombosis. Furthermore, it may simultaneously modulate the inflammatory response. It is likely that the beneficial effect of rhAPC observed in experimental and clinical studies of severe sepsis results from a combination of mechanisms that modulate the entangled processes of coagulation and inflammation. This review presents an analysis of the various mechanisms of action of rhAPC in sepsis.
Literature
1.
go back to reference Levi M, ten Cate H: Disseminated intravascular coagulation. N Engl J Med. 1999, 341: 586-10.1056/NEJM199908193410807.CrossRefPubMed Levi M, ten Cate H: Disseminated intravascular coagulation. N Engl J Med. 1999, 341: 586-10.1056/NEJM199908193410807.CrossRefPubMed
2.
go back to reference Levi M, Marder VJ: Coagulation abnormalities in sepsis. Hemostasis and Thrombosis: Basic Principles and Clinical Practice. Edited by: Colman RW, Marder VJ, Clowes AW, George JN, Goldhaber SZ. 2006, Philadelphia, PA: Lippincott, Williams and Wilkins, 1601-1613. Levi M, Marder VJ: Coagulation abnormalities in sepsis. Hemostasis and Thrombosis: Basic Principles and Clinical Practice. Edited by: Colman RW, Marder VJ, Clowes AW, George JN, Goldhaber SZ. 2006, Philadelphia, PA: Lippincott, Williams and Wilkins, 1601-1613.
3.
go back to reference Wheeler AP, Bernard GR: Treating patients with severe sepsis. N Engl J Med. 1999, 340: 207-214. 10.1056/NEJM199901213400307.CrossRefPubMed Wheeler AP, Bernard GR: Treating patients with severe sepsis. N Engl J Med. 1999, 340: 207-214. 10.1056/NEJM199901213400307.CrossRefPubMed
4.
go back to reference Levi M, van der Poll T, Buller HR: Bidirectional relation between inflammation and coagulation. Circulation. 2004, 109: 2698-2704. 10.1161/01.CIR.0000131660.51520.9A.CrossRefPubMed Levi M, van der Poll T, Buller HR: Bidirectional relation between inflammation and coagulation. Circulation. 2004, 109: 2698-2704. 10.1161/01.CIR.0000131660.51520.9A.CrossRefPubMed
5.
go back to reference Esmon CT: Role of coagulation inhibitors in inflammation. Thromb Haemost. 2001, 86: 51-56.PubMed Esmon CT: Role of coagulation inhibitors in inflammation. Thromb Haemost. 2001, 86: 51-56.PubMed
6.
go back to reference Levi M, de Jonge E, van der Poll T: Rationale for restoration of physiological anticoagulant pathways in patients with sepsis and disseminated intravascular coagulation. Crit Care Med. 2001, 29 (Suppl): S90-S94. 10.1097/00003246-200107001-00028.CrossRefPubMed Levi M, de Jonge E, van der Poll T: Rationale for restoration of physiological anticoagulant pathways in patients with sepsis and disseminated intravascular coagulation. Crit Care Med. 2001, 29 (Suppl): S90-S94. 10.1097/00003246-200107001-00028.CrossRefPubMed
7.
go back to reference Esmon CT: The regulation of natural anticoagulant pathways. Science. 1987, 235: 1348-1352. 10.1126/science.3029867.CrossRefPubMed Esmon CT: The regulation of natural anticoagulant pathways. Science. 1987, 235: 1348-1352. 10.1126/science.3029867.CrossRefPubMed
8.
go back to reference Esmon CT: The endothelial cell protein C receptor. Thromb Haemost. 2000, 83: 639-643.PubMed Esmon CT: The endothelial cell protein C receptor. Thromb Haemost. 2000, 83: 639-643.PubMed
9.
go back to reference Perez-Casal M, Downey C, Fukudome K, Marx G, Toh CH: Activated protein C induces the release of microparticle-associated endothelial protein C receptor. Blood. 2005, 105: 1515-1522. 10.1182/blood-2004-05-1896.CrossRefPubMed Perez-Casal M, Downey C, Fukudome K, Marx G, Toh CH: Activated protein C induces the release of microparticle-associated endothelial protein C receptor. Blood. 2005, 105: 1515-1522. 10.1182/blood-2004-05-1896.CrossRefPubMed
10.
go back to reference Mesters RM, Helterbrand J, Utterback BG, Yan B, Chao YB, Fernandez JA, Griffin JH, Hartman DL: Prognostic value of protein C concentrations in neutropenic patients at high risk of severe septic complications. Crit Care Med. 2000, 28: 2209-2216. 10.1097/00003246-200007000-00005.CrossRefPubMed Mesters RM, Helterbrand J, Utterback BG, Yan B, Chao YB, Fernandez JA, Griffin JH, Hartman DL: Prognostic value of protein C concentrations in neutropenic patients at high risk of severe septic complications. Crit Care Med. 2000, 28: 2209-2216. 10.1097/00003246-200007000-00005.CrossRefPubMed
11.
go back to reference Vary TC, Kimball SR: Regulation of hepatic protein synthesis in chronic inflammation and sepsis. Am J Physiol. 1992, 262: C445-452.PubMed Vary TC, Kimball SR: Regulation of hepatic protein synthesis in chronic inflammation and sepsis. Am J Physiol. 1992, 262: C445-452.PubMed
12.
go back to reference Eckle I, Seitz R, Egbring R, Kolb G, Havemann K: Protein C degradation in vitro by neutrophil elastase. Biol Chem Hoppe Seyler. 1991, 372: 1007-1013.CrossRefPubMed Eckle I, Seitz R, Egbring R, Kolb G, Havemann K: Protein C degradation in vitro by neutrophil elastase. Biol Chem Hoppe Seyler. 1991, 372: 1007-1013.CrossRefPubMed
13.
go back to reference Nawroth PP, Stern DM: Modulation of endothelial cell hemostatic properties by tumor necrosis factor. J Exp Med. 1986, 163: 740-745. 10.1084/jem.163.3.740.CrossRefPubMed Nawroth PP, Stern DM: Modulation of endothelial cell hemostatic properties by tumor necrosis factor. J Exp Med. 1986, 163: 740-745. 10.1084/jem.163.3.740.CrossRefPubMed
14.
go back to reference Faust SN, Levin M, Harrison OB, Goldin RD, Lockhart MS, Kondaveeti S, Laszik Z, Esmon CT, Heyderman RS: Dysfunction of endothelial protein C activation in severe meningococcal sepsis. N Engl J Med. 2001, 345: 408-416. 10.1056/NEJM200108093450603.CrossRefPubMed Faust SN, Levin M, Harrison OB, Goldin RD, Lockhart MS, Kondaveeti S, Laszik Z, Esmon CT, Heyderman RS: Dysfunction of endothelial protein C activation in severe meningococcal sepsis. N Engl J Med. 2001, 345: 408-416. 10.1056/NEJM200108093450603.CrossRefPubMed
15.
go back to reference Garcia de Frutos P, Alim RI, Hardig Y, Zoller B, Dahlback B: Differential regulation of alpha and beta chains of C4b-binding protein during acute-phase response resulting in stable plasma levels of free anticoagulant protein S. Blood. 1994, 84: 815-822.PubMed Garcia de Frutos P, Alim RI, Hardig Y, Zoller B, Dahlback B: Differential regulation of alpha and beta chains of C4b-binding protein during acute-phase response resulting in stable plasma levels of free anticoagulant protein S. Blood. 1994, 84: 815-822.PubMed
16.
go back to reference Taylor FBJ, Dahlback B, Chang AC, Lockhart MS, Hatanaka K, Peer G, Esmon CT: Role of free protein S and C4b binding protein in regulating the coagulant response to Escherichia coli. Blood. 1995, 86: 2642-PubMed Taylor FBJ, Dahlback B, Chang AC, Lockhart MS, Hatanaka K, Peer G, Esmon CT: Role of free protein S and C4b binding protein in regulating the coagulant response to Escherichia coli. Blood. 1995, 86: 2642-PubMed
17.
go back to reference Taylor FBJ, Stearns-Kurosawa DJ, Kurosawa S, Ferrell G, Chang AC, Laszik Z, Kosanke S, Peer G, Esmon CT: The endothelial cell protein C receptor aids in host defense against Escherichia coli sepsis. Blood. 2000, 95: 1680-1686.PubMed Taylor FBJ, Stearns-Kurosawa DJ, Kurosawa S, Ferrell G, Chang AC, Laszik Z, Kosanke S, Peer G, Esmon CT: The endothelial cell protein C receptor aids in host defense against Escherichia coli sepsis. Blood. 2000, 95: 1680-1686.PubMed
18.
go back to reference De Pont AC, Bakhtiari K, Hutten BA, de Jonge E, Vlasuk GP, Rote WE, Levi M, Buller HR, Meijers JC: Endotoxaemia induces resistance to activated protein C in healthy humans. Br J Haematol. 2006, 134: 213-219. 10.1111/j.1365-2141.2006.06127.x.CrossRefPubMed De Pont AC, Bakhtiari K, Hutten BA, de Jonge E, Vlasuk GP, Rote WE, Levi M, Buller HR, Meijers JC: Endotoxaemia induces resistance to activated protein C in healthy humans. Br J Haematol. 2006, 134: 213-219. 10.1111/j.1365-2141.2006.06127.x.CrossRefPubMed
19.
go back to reference Taylor FBJ, Chang A, Esmon CT, D'Angelo A, Vigano-D'Angelo S, Blick KE: Protein C prevents the coagulopathic and lethal effects of Escherichia coli infusion in the baboon. J Clin Invest. 1987, 79: 918-925. 10.1172/JCI112902.PubMedCentralCrossRefPubMed Taylor FBJ, Chang A, Esmon CT, D'Angelo A, Vigano-D'Angelo S, Blick KE: Protein C prevents the coagulopathic and lethal effects of Escherichia coli infusion in the baboon. J Clin Invest. 1987, 79: 918-925. 10.1172/JCI112902.PubMedCentralCrossRefPubMed
20.
go back to reference Isobe H, Okajima K, Uchiba M, Mizutani A, Harada N, Nagasaki A, Okabe K: Activated protein C prevents endotoxin-induced hypotension in rats by inhibiting excessive production of nitric oxide. Circulation. 2001, 104: 1171-1175. 10.1161/hc3501.093799.CrossRefPubMed Isobe H, Okajima K, Uchiba M, Mizutani A, Harada N, Nagasaki A, Okabe K: Activated protein C prevents endotoxin-induced hypotension in rats by inhibiting excessive production of nitric oxide. Circulation. 2001, 104: 1171-1175. 10.1161/hc3501.093799.CrossRefPubMed
21.
go back to reference De Backer D, Verdant C, Chierego M, Koch M, Gullo A, Vincent JL: Effects of drotrecogin alfa activated on microcirculatory alterations in patients with severe sepsis. Crit Care Med. 2006, 34: 1918-1924. 10.1097/01.CCM.0000220498.48773.3C.CrossRefPubMed De Backer D, Verdant C, Chierego M, Koch M, Gullo A, Vincent JL: Effects of drotrecogin alfa activated on microcirculatory alterations in patients with severe sepsis. Crit Care Med. 2006, 34: 1918-1924. 10.1097/01.CCM.0000220498.48773.3C.CrossRefPubMed
22.
go back to reference Gruber A, Harker LA, Hanson SR, Kelly AB, Griffin JH: Antithrombotic effects of combining activated protein C and urokinase in nonhuman primates. Circulation. 1991, 84: 2454-2462.CrossRefPubMed Gruber A, Harker LA, Hanson SR, Kelly AB, Griffin JH: Antithrombotic effects of combining activated protein C and urokinase in nonhuman primates. Circulation. 1991, 84: 2454-2462.CrossRefPubMed
23.
go back to reference Gruber A, Marzec UM, Bush L, Di Cera E, Fernandez JA, Berny MA, Tucker EI, McCarty OJ, Griffin JH, Hanson SR: Relative antithrombotic and antihemostatic effects of protein C activator versus low molecular weight heparin in primates. Blood. 2007, 109: 3733-3740. 10.1182/blood-2006-07-035147.PubMedCentralCrossRefPubMed Gruber A, Marzec UM, Bush L, Di Cera E, Fernandez JA, Berny MA, Tucker EI, McCarty OJ, Griffin JH, Hanson SR: Relative antithrombotic and antihemostatic effects of protein C activator versus low molecular weight heparin in primates. Blood. 2007, 109: 3733-3740. 10.1182/blood-2006-07-035147.PubMedCentralCrossRefPubMed
24.
go back to reference Aoki Y, Ota M, Katsuura Y, Komoriya K, Nakagaki T: Effect of activated human protein C on disseminated intravascular coagulation induced by lipopolysaccharide in rats. Arzneimittelforschung. 2000, 50: 809-815.PubMed Aoki Y, Ota M, Katsuura Y, Komoriya K, Nakagaki T: Effect of activated human protein C on disseminated intravascular coagulation induced by lipopolysaccharide in rats. Arzneimittelforschung. 2000, 50: 809-815.PubMed
25.
go back to reference Bernard GR, Ely EW, Wright TJ, Fraiz J, Stasek JE, Russell JA, Mayers I, Rosenfeld BA, Morris PE, Yan SB, et al: Safety and dose relationship of recombinant human activated protein C for coagulopathy in severe sepsis. Crit Care Med. 2001, 29: 2051-2059. 10.1097/00003246-200111000-00003.CrossRefPubMed Bernard GR, Ely EW, Wright TJ, Fraiz J, Stasek JE, Russell JA, Mayers I, Rosenfeld BA, Morris PE, Yan SB, et al: Safety and dose relationship of recombinant human activated protein C for coagulopathy in severe sepsis. Crit Care Med. 2001, 29: 2051-2059. 10.1097/00003246-200111000-00003.CrossRefPubMed
26.
go back to reference Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, et al: Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001, 344: 699-709. 10.1056/NEJM200103083441001.CrossRefPubMed Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, et al: Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001, 344: 699-709. 10.1056/NEJM200103083441001.CrossRefPubMed
27.
go back to reference Vangerow B, Shorr AF, Wyncoll D, Janes J, Nelson DR, Reinhart K: The protein C pathway: implications for the design of the RESPOND study. Crit Care. 2007, 11 (Suppl 5): S4-10.1186/cc6155.PubMedCentralCrossRefPubMed Vangerow B, Shorr AF, Wyncoll D, Janes J, Nelson DR, Reinhart K: The protein C pathway: implications for the design of the RESPOND study. Crit Care. 2007, 11 (Suppl 5): S4-10.1186/cc6155.PubMedCentralCrossRefPubMed
30.
go back to reference De Pont AC, Bakhtiari K, Hutten BA, de Jonge E, Vroom MB, Meijers JC, Buller HR, Levi M: Recombinant human activated protein C resets thrombin generation in patients with severe sepsis: a case control study. Crit Care. 2005, 9: R490-497. 10.1186/cc3774.PubMedCentralCrossRefPubMed De Pont AC, Bakhtiari K, Hutten BA, de Jonge E, Vroom MB, Meijers JC, Buller HR, Levi M: Recombinant human activated protein C resets thrombin generation in patients with severe sepsis: a case control study. Crit Care. 2005, 9: R490-497. 10.1186/cc3774.PubMedCentralCrossRefPubMed
31.
go back to reference Dhainaut JF, Yan SB, Joyce DE, Pettila V, Basson BR, Brandt JT, Sundin D, Levi M: Treatment effects of drotrecogin alfa (activated) in patients with severe sepsis with or without overt disseminated intravascular coagulation. J Thromb Haemost. 2004, 2: 1924-1933. 10.1111/j.1538-7836.2004.00955.x.CrossRefPubMed Dhainaut JF, Yan SB, Joyce DE, Pettila V, Basson BR, Brandt JT, Sundin D, Levi M: Treatment effects of drotrecogin alfa (activated) in patients with severe sepsis with or without overt disseminated intravascular coagulation. J Thromb Haemost. 2004, 2: 1924-1933. 10.1111/j.1538-7836.2004.00955.x.CrossRefPubMed
32.
go back to reference Ely EW, Laterre PF, Angus DC, Helterbrand JD, Levy H, Dhainaut JF, Vincent JL, Macias WL, Bernard GR: Drotrecogin alfa (activated) administration across clinically important subgroups of patients with severe sepsis. Crit Care Med. 2003, 31: 12-19. 10.1097/00003246-200301000-00002.CrossRefPubMed Ely EW, Laterre PF, Angus DC, Helterbrand JD, Levy H, Dhainaut JF, Vincent JL, Macias WL, Bernard GR: Drotrecogin alfa (activated) administration across clinically important subgroups of patients with severe sepsis. Crit Care Med. 2003, 31: 12-19. 10.1097/00003246-200301000-00002.CrossRefPubMed
33.
go back to reference Dhainaut JF, Shorr AF, Macias WL, Kollef MJ, Levi M, Reinhart K, Nelson DR: Dynamic evolution of coagulopathy in the first day of severe sepsis: Relationship with mortality and organ failure. Crit Care Med. 2005, 33: 341-348. 10.1097/01.CCM.0000153520.31562.48.CrossRefPubMed Dhainaut JF, Shorr AF, Macias WL, Kollef MJ, Levi M, Reinhart K, Nelson DR: Dynamic evolution of coagulopathy in the first day of severe sepsis: Relationship with mortality and organ failure. Crit Care Med. 2005, 33: 341-348. 10.1097/01.CCM.0000153520.31562.48.CrossRefPubMed
34.
go back to reference Levi M, Levy M, Williams MD, Douglas I, Artigas A, Antonelli M, Wyncoll D, Janes J, Booth FV, Wang D, et al: Prophylactic heparin in patients with severe sepsis treated with drotrecogin alfa (activated). Am J Respir Crit Care Med. 2007, 176: 483-490. 10.1164/rccm.200612-1803OC.CrossRefPubMed Levi M, Levy M, Williams MD, Douglas I, Artigas A, Antonelli M, Wyncoll D, Janes J, Booth FV, Wang D, et al: Prophylactic heparin in patients with severe sepsis treated with drotrecogin alfa (activated). Am J Respir Crit Care Med. 2007, 176: 483-490. 10.1164/rccm.200612-1803OC.CrossRefPubMed
35.
go back to reference De Pont AC, Bouman CS, de Jonge E, Vroom MB, Buller HR, Levi M: Treatment with recombinant human activated protein C obviates additional anticoagulation during continuous venovenous hemofiltration in patients with severe sepsis. Intensive Care Med. 2003, 29: 1205-10.1007/s00134-003-1781-4.CrossRefPubMed De Pont AC, Bouman CS, de Jonge E, Vroom MB, Buller HR, Levi M: Treatment with recombinant human activated protein C obviates additional anticoagulation during continuous venovenous hemofiltration in patients with severe sepsis. Intensive Care Med. 2003, 29: 1205-10.1007/s00134-003-1781-4.CrossRefPubMed
36.
go back to reference van der Poll T, Levi M, Nick JA, Abraham E: Activated protein C inhibits local coagulation after intrapulmonary delivery of endotoxin in humans. Am J Respir Crit Care Med. 2005, 171: 1125-1128. 10.1164/rccm.200411-1483OC.PubMedCentralCrossRefPubMed van der Poll T, Levi M, Nick JA, Abraham E: Activated protein C inhibits local coagulation after intrapulmonary delivery of endotoxin in humans. Am J Respir Crit Care Med. 2005, 171: 1125-1128. 10.1164/rccm.200411-1483OC.PubMedCentralCrossRefPubMed
37.
go back to reference Wang L, Bastarache JA, Wickersham N, Fang X, Matthay MA, Ware LB: Novel role of the human alveolar epithelium in regulating intra-alveolar coagulation. Am J Respir Cell Mol Biol. 2007, 36: 497-503. 10.1165/rcmb.2005-0425OC.PubMedCentralCrossRefPubMed Wang L, Bastarache JA, Wickersham N, Fang X, Matthay MA, Ware LB: Novel role of the human alveolar epithelium in regulating intra-alveolar coagulation. Am J Respir Cell Mol Biol. 2007, 36: 497-503. 10.1165/rcmb.2005-0425OC.PubMedCentralCrossRefPubMed
38.
go back to reference Taylor FBJ, Chang A, Esmon CT, D'Angelo A, Vigano-D'Angelo S, Blick KE: Protein C prevents the coagulopathic and lethal effects of Escherichia coli infusion in the baboon. J Clin Invest. 1987, 79: 918-925. 10.1172/JCI112902.PubMedCentralCrossRefPubMed Taylor FBJ, Chang A, Esmon CT, D'Angelo A, Vigano-D'Angelo S, Blick KE: Protein C prevents the coagulopathic and lethal effects of Escherichia coli infusion in the baboon. J Clin Invest. 1987, 79: 918-925. 10.1172/JCI112902.PubMedCentralCrossRefPubMed
39.
go back to reference Murakami K, Okajima K, Uchiba M, Johno M, Nakagaki T, Okabe H, Takatsuki K: Activated protein C attenuates endotoxin-induced pulmonary vascular injury by inhibiting activated leukocytes in rats. Blood. 1996, 87: 642-647.PubMed Murakami K, Okajima K, Uchiba M, Johno M, Nakagaki T, Okabe H, Takatsuki K: Activated protein C attenuates endotoxin-induced pulmonary vascular injury by inhibiting activated leukocytes in rats. Blood. 1996, 87: 642-647.PubMed
40.
go back to reference Hancock WW, Tsuchida A, Hau H, Thomson NM, Salem HH: The anticoagulants protein C and protein S display potent antiin-flammatory and immunosuppressive effects relevant to transplant biology and therapy. Transplant Proc. 1992, 24: 2302-2303.PubMed Hancock WW, Tsuchida A, Hau H, Thomson NM, Salem HH: The anticoagulants protein C and protein S display potent antiin-flammatory and immunosuppressive effects relevant to transplant biology and therapy. Transplant Proc. 1992, 24: 2302-2303.PubMed
41.
go back to reference Hancock WW, Grey ST, Hau L, Akalin E, Orthner C, Sayegh MH, Salem HH: Binding of activated protein C to a specific receptor on human mononuclear phagocytes inhibits intracellular calcium signaling and monocyte-dependent proliferative responses. Transplantation. 1995, 60: 1525-1532.CrossRefPubMed Hancock WW, Grey ST, Hau L, Akalin E, Orthner C, Sayegh MH, Salem HH: Binding of activated protein C to a specific receptor on human mononuclear phagocytes inhibits intracellular calcium signaling and monocyte-dependent proliferative responses. Transplantation. 1995, 60: 1525-1532.CrossRefPubMed
42.
go back to reference White B, Schmidt M, Murphy C, Livingstone W, O'Toole D, Lawler M, O'Neill L, Kelleher D, Schwarz HP, Smith OP: Activated protein C inhibits lipopolysaccharide-induced nuclear translocation of nuclear factor kappaB (NF-kappaB) and tumour necrosis factor alpha (TNF-alpha) production in the THP-1 monocytic cell line. Br J Haematol. 2000, 110: 130-134. 10.1046/j.1365-2141.2000.02128.x.CrossRefPubMed White B, Schmidt M, Murphy C, Livingstone W, O'Toole D, Lawler M, O'Neill L, Kelleher D, Schwarz HP, Smith OP: Activated protein C inhibits lipopolysaccharide-induced nuclear translocation of nuclear factor kappaB (NF-kappaB) and tumour necrosis factor alpha (TNF-alpha) production in the THP-1 monocytic cell line. Br J Haematol. 2000, 110: 130-134. 10.1046/j.1365-2141.2000.02128.x.CrossRefPubMed
43.
go back to reference Levi M, Dorffler-Melly J, Reitsma PH, Buller HR, Florquin S, van der Poll T, Carmeliet P: Aggravation of endotoxin-induced disseminated intravascular coagulation and cytokine activation in heterozygous protein C deficient mice. Blood. 2003, 101: 4823-4827. 10.1182/blood-2002-10-3254.CrossRefPubMed Levi M, Dorffler-Melly J, Reitsma PH, Buller HR, Florquin S, van der Poll T, Carmeliet P: Aggravation of endotoxin-induced disseminated intravascular coagulation and cytokine activation in heterozygous protein C deficient mice. Blood. 2003, 101: 4823-4827. 10.1182/blood-2002-10-3254.CrossRefPubMed
44.
go back to reference Lay AJ, Donahue D, Tsai MJ, Castellino FJ: Acute inflammation is exacerbated in mice genetically predisposed to a severe protein C deficiency. Blood. 2007, 109: 1984-1991. 10.1182/blood-2006-07-037945.PubMedCentralCrossRefPubMed Lay AJ, Donahue D, Tsai MJ, Castellino FJ: Acute inflammation is exacerbated in mice genetically predisposed to a severe protein C deficiency. Blood. 2007, 109: 1984-1991. 10.1182/blood-2006-07-037945.PubMedCentralCrossRefPubMed
45.
go back to reference Esmon CT: New mechanisms for vascular control of inflammation mediated by natural anticoagulant proteins. J Exp Med. 2002, 196: 561-564. 10.1084/jem.20021088.PubMedCentralCrossRefPubMed Esmon CT: New mechanisms for vascular control of inflammation mediated by natural anticoagulant proteins. J Exp Med. 2002, 196: 561-564. 10.1084/jem.20021088.PubMedCentralCrossRefPubMed
46.
go back to reference Riewald M, Petrovan RJ, Donner A, Mueller BM, Ruf W: Activation of endothelial cell protease activated receptor 1 by the protein C pathway. Science. 2002, 296: 1880-1882. 10.1126/science.1071699.CrossRefPubMed Riewald M, Petrovan RJ, Donner A, Mueller BM, Ruf W: Activation of endothelial cell protease activated receptor 1 by the protein C pathway. Science. 2002, 296: 1880-1882. 10.1126/science.1071699.CrossRefPubMed
47.
go back to reference Ludeman MJ, Kataoka H, Srinivasan Y, Esmon NL, Esmon CT, Coughlin SR: PAR1 cleavage and signaling in response to activated protein C and thrombin. J Biol Chem. 2005, 280: 13122-13128. 10.1074/jbc.M410381200.CrossRefPubMed Ludeman MJ, Kataoka H, Srinivasan Y, Esmon NL, Esmon CT, Coughlin SR: PAR1 cleavage and signaling in response to activated protein C and thrombin. J Biol Chem. 2005, 280: 13122-13128. 10.1074/jbc.M410381200.CrossRefPubMed
48.
go back to reference Xu J, Qu D, Esmon NL, Esmon CT: Metalloproteolytic release of endothelial cell protein C receptor. J Biol Chem. 2000, 275: 6038-6044. 10.1074/jbc.275.8.6038.CrossRefPubMed Xu J, Qu D, Esmon NL, Esmon CT: Metalloproteolytic release of endothelial cell protein C receptor. J Biol Chem. 2000, 275: 6038-6044. 10.1074/jbc.275.8.6038.CrossRefPubMed
49.
go back to reference Kurosawa S, Esmon CT, Stearns-Kurosawa DJ: The soluble endothelial protein C receptor binds to activated neutrophils: involvement of proteinase-3 and CD11b/CD18. J Immunol. 2000, 165: 4697-4703.CrossRefPubMed Kurosawa S, Esmon CT, Stearns-Kurosawa DJ: The soluble endothelial protein C receptor binds to activated neutrophils: involvement of proteinase-3 and CD11b/CD18. J Immunol. 2000, 165: 4697-4703.CrossRefPubMed
50.
go back to reference Oganesyan V, Oganesyan N, Terzyan S, Qu D, Dauter Z, Esmon NL, Esmon CT: The crystal structure of the endothelial protein C receptor and a bound phospholipid. J Biol Chem. 2002, 277: 24851-24854. 10.1074/jbc.C200163200.CrossRefPubMed Oganesyan V, Oganesyan N, Terzyan S, Qu D, Dauter Z, Esmon NL, Esmon CT: The crystal structure of the endothelial protein C receptor and a bound phospholipid. J Biol Chem. 2002, 277: 24851-24854. 10.1074/jbc.C200163200.CrossRefPubMed
51.
go back to reference Feistritzer C, Sturn DH, Kaneider NC, Djanani A, Wiedermann CJ: Endothelial protein C receptor-dependent inhibition of human eosinophil chemotaxis by protein C. J Allergy Clin Immunol. 2003, 112: 375-381. 10.1067/mai.2003.1609.CrossRefPubMed Feistritzer C, Sturn DH, Kaneider NC, Djanani A, Wiedermann CJ: Endothelial protein C receptor-dependent inhibition of human eosinophil chemotaxis by protein C. J Allergy Clin Immunol. 2003, 112: 375-381. 10.1067/mai.2003.1609.CrossRefPubMed
52.
go back to reference Sturn DH, Kaneider NC, Feistritzer C, Djanani A, Fukudome K, Wiedermann CJ: Expression and function of the endothelial protein C receptor in human neutrophils. Blood. 2003, 102: 1499-1505. 10.1182/blood-2002-12-3880.CrossRefPubMed Sturn DH, Kaneider NC, Feistritzer C, Djanani A, Fukudome K, Wiedermann CJ: Expression and function of the endothelial protein C receptor in human neutrophils. Blood. 2003, 102: 1499-1505. 10.1182/blood-2002-12-3880.CrossRefPubMed
53.
go back to reference Hoffmann JN, Vollmar B, Laschke MW, Inthorn D, Fertmann J, Schildberg FW, Menger MD: Microhemodynamic and cellular mechanisms of activated protein C action during endotoxemia. Crit Care Med. 2004, 32: 1011-1017. 10.1097/01.CCM.0000120058.88975.42.CrossRefPubMed Hoffmann JN, Vollmar B, Laschke MW, Inthorn D, Fertmann J, Schildberg FW, Menger MD: Microhemodynamic and cellular mechanisms of activated protein C action during endotoxemia. Crit Care Med. 2004, 32: 1011-1017. 10.1097/01.CCM.0000120058.88975.42.CrossRefPubMed
54.
go back to reference Nick JA, Coldren CD, Geraci MW, Poch KR, Fouty BW, O'Brien J, Gruber M, Zarini S, Murphy RC, Kuhn K, et al: Recombinant human activated protein C reduces human endotoxin-induced pulmonary inflammation via inhibition of neutrophil chemotaxis. Blood. 2004, 104: 3878-3885. 10.1182/blood-2004-06-2140.CrossRefPubMed Nick JA, Coldren CD, Geraci MW, Poch KR, Fouty BW, O'Brien J, Gruber M, Zarini S, Murphy RC, Kuhn K, et al: Recombinant human activated protein C reduces human endotoxin-induced pulmonary inflammation via inhibition of neutrophil chemotaxis. Blood. 2004, 104: 3878-3885. 10.1182/blood-2004-06-2140.CrossRefPubMed
55.
go back to reference Shimizu S, Gabazza EC, Taguchi O, Yasui H, Taguchi Y, Hayashi T, Ido M, Shimizu T, Nakagaki T, Kobayashi H, et al: Activated protein C inhibits the expression of platelet-derived growth factor in the lung. Am J Respir Crit Care Med. 2003, 167: 1416-1426. 10.1164/rccm.200206-515OC.CrossRefPubMed Shimizu S, Gabazza EC, Taguchi O, Yasui H, Taguchi Y, Hayashi T, Ido M, Shimizu T, Nakagaki T, Kobayashi H, et al: Activated protein C inhibits the expression of platelet-derived growth factor in the lung. Am J Respir Crit Care Med. 2003, 167: 1416-1426. 10.1164/rccm.200206-515OC.CrossRefPubMed
56.
go back to reference Zeng W, Matter WF, Yan SB, Um SL, Vlahos CJ, Liu L: Effect of drotrecogin alfa (activated) on human endothelial cell permeability and Rho kinase signaling. Crit Care Med. 2004, 32: S302-308. 10.1097/01.CCM.0000128038.49201.8C.CrossRefPubMed Zeng W, Matter WF, Yan SB, Um SL, Vlahos CJ, Liu L: Effect of drotrecogin alfa (activated) on human endothelial cell permeability and Rho kinase signaling. Crit Care Med. 2004, 32: S302-308. 10.1097/01.CCM.0000128038.49201.8C.CrossRefPubMed
57.
go back to reference Feistritzer C, Riewald M: Endothelial barrier protection by activated protein C through PAR1-dependent sphingosine 1-phosphate receptor-1 crossactivation. Blood. 2005, 105: 3178-3184. 10.1182/blood-2004-10-3985.CrossRefPubMed Feistritzer C, Riewald M: Endothelial barrier protection by activated protein C through PAR1-dependent sphingosine 1-phosphate receptor-1 crossactivation. Blood. 2005, 105: 3178-3184. 10.1182/blood-2004-10-3985.CrossRefPubMed
58.
go back to reference Finigan JH, Dudek SM, Singleton PA, Chiang ET, Jacobson JR, Camp SM, Ye SQ, Garcia JG: Activated protein C mediates novel lung endothelial barrier enhancement: role of sphingosine 1-phosphate receptor transactivation. J Biol Chem. 2005, 280: 17286-17293. 10.1074/jbc.M412427200.CrossRefPubMed Finigan JH, Dudek SM, Singleton PA, Chiang ET, Jacobson JR, Camp SM, Ye SQ, Garcia JG: Activated protein C mediates novel lung endothelial barrier enhancement: role of sphingosine 1-phosphate receptor transactivation. J Biol Chem. 2005, 280: 17286-17293. 10.1074/jbc.M412427200.CrossRefPubMed
59.
go back to reference Cheng T, Liu D, Griffin JH, Fernandez JA, Castellino F, Rosen ED, Fukudome K, Zlokovic BV: Activated protein C blocks p53-mediated apoptosis in ischemic human brain endothelium and is neuroprotective. Nat Med. 2003, 9: 338-342. 10.1038/nm826.CrossRefPubMed Cheng T, Liu D, Griffin JH, Fernandez JA, Castellino F, Rosen ED, Fukudome K, Zlokovic BV: Activated protein C blocks p53-mediated apoptosis in ischemic human brain endothelium and is neuroprotective. Nat Med. 2003, 9: 338-342. 10.1038/nm826.CrossRefPubMed
60.
go back to reference Mosnier LO, Griffin JH: Inhibition of staurosporine-induced apoptosis of endothelial cells by activated protein C requires protease activated receptor-1 and endothelial cell protein C receptor. Biochem J. 2003, 373: 65-70. 10.1042/BJ20030341.PubMedCentralCrossRefPubMed Mosnier LO, Griffin JH: Inhibition of staurosporine-induced apoptosis of endothelial cells by activated protein C requires protease activated receptor-1 and endothelial cell protein C receptor. Biochem J. 2003, 373: 65-70. 10.1042/BJ20030341.PubMedCentralCrossRefPubMed
61.
go back to reference Mosnier LO, Zlokovic BV, Griffin JH: The cytoprotective protein C pathway. Blood. 2007, 109: 3161-3172. 10.1182/blood-2006-09-003004.CrossRefPubMed Mosnier LO, Zlokovic BV, Griffin JH: The cytoprotective protein C pathway. Blood. 2007, 109: 3161-3172. 10.1182/blood-2006-09-003004.CrossRefPubMed
Metadata
Title
Recombinant human activated protein C: current insights into its mechanism of action
Authors
Marcel Levi
Tom van der Poll
Publication date
01-12-2007
Publisher
BioMed Central
Published in
Critical Care / Issue Special Issue 5/2007
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc6154

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