Figure 2.

Endothelial theory. Similar to platelets invading pathogens bind either directly or indirectly to the vascular endothelium. Binding results in endothelial cell activation that results in apoptosis. Although the pathway to apoptosis has not yet been defined apoptosis leads to endothelial cell shrinkage and loss of barrier integrity leading to increased vascular permeability and shock. Separation of endothelial cells allows for pathogens to escape the bloodstream and infect major organs which eventually leads to multi organ failure. Endothelial cell activation also leads to granule secretion which deposits vonwillebrand factor on the surface of the endothelial cells. This encourages platelet rolling, activation and aggregate formation. In addition, bacteria also roll on the deposited vonwillebrand factor eventually coming to a halt and firmly adhering. Passing platelets bind to the immobilized bacteria on the endothelial cells which leads to inappropriate thrombus formation and exacerbation of the dysregulation.