Beyond sepsis: activated protein C and ischemia-reperfusion injury.

Abstract

To review potential clinical situations beyond sepsis in which activated protein C might be an effective treatment. Published articles between 1970 and 2003 on experimental and clinical studies of activation of both coagulation and inflammation in various disease states. The efficacy of activated protein C in sepsis might rely on the fact that it can modulate both coagulation and inflammation. Therefore, administration of activated protein C could be beneficial in disease states that are also characterized by the simultaneous activation of these systems. Ischemia-reperfusion injury of various organs may represent such a state. Indeed, the involvement of the protein C system has been demonstrated in various experimental studies of ischemia-reperfusion, including studies in renal ischemia-reperfusion syndromes, coronary atherosclerosis and acute coronary syndromes, and intestinal ischemia and reperfusion. In some of these models, activated protein C administration, or other interventions in the protein C system, was shown to be beneficial.