Figure 1.

Simplified scheme of processes that will lead to vascular damage and multiorgan failure. An inflammatory trigger activates the immune system and initiates the production of several cytokines and the generation of secretory phospholipase A2 (sPLA2). Apoptotic processes activate phosphatidylserine (PS) exposure, a signal for cell removal. In hyperinflammation, overwhelming numbers of PS exposing cells that are not properly removed will imbalance the hemostatic system by unwanted activation of the prothrombinase complex. PS exposing cells are targets for sPLA2, leading to cell damage and generation of products including Fatty Acid (FA) and Lysophospholipid (LPL) that will damage additional cells. This can lead to a prothrombotic state and multiorgan failure. (A color version of this figure is available in the online journal.)