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Open Access Review

How tissue injury alarms the immune system and causes a systemic inflammatory response syndrome

Jérôme Pugin

Author Affiliations

Intensive Care - SIRS Unit, University Hospitals of Geneva, 1211, Geneva 14, Switzerland

Annals of Intensive Care 2012, 2:27  doi:10.1186/2110-5820-2-27

Published: 12 July 2012

Abstract

Systemic inflammation is very prevalent among critically ill patients, particularly those with extensive tissue injury. Although downstream mediators (cytokines) and effector cells (phagocytes) have been identified, proximal mediators originating from injured tissues remained elusive. Alarmins (“danger signals”) released by necrotic/injured cells have been identified recently and certainly play a role in triggering local and systemic inflammation in critically ill patients. The most promising alarmin candidates are of mitochondrial origin, i.e. mitochondrial DNA and the chemotactic factor fMet-Leu-Phe (fMLP). ATP also is released from necrotic tissues and stimulates the assembly of the inflammasome, leading to the production of proinflammatory cytokines, such as interleukin (IL)-1ß. The identification of novel alarmins opens new therapeutic avenues for the treatment of severe SIRS, and SIRS-dependent organ dysfunction.

Keywords:
SIRS; Inflammation; Alarmins; Danger signals; Mitochondria; Pro-inflammatory cytokines