Potential for Endotoxin-Activated Kupffer's Cells to Induce Microvascular Thrombosis

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Abstract
• The potential contribution of Kupffer's cells, ie, hepatic macrophages (HMϕs) to the diffuse microvascular thrombosis seen during septicemia was evaluated by measuring the ability of a homogeneous population of explanted HMϕs to express procoagulant activity (PCA). Addition of as little as 100 ng/mL of endotoxin stimulated a 30-fold increase over control values of PCA within eight hours. This PCA was membrane associated and functioned externally to the macrophage. Sensitivity to heat (56 °C) and diisopropyl fluorophosphate differentiated this PCA from typical tissue thromboplastin activity. The increase in PCA was blocked by pretreatment with warfarin sodium (a phytonadione blocker) and could be restored by addition of phytonadione. These studies showed that endotoxin induces in HMϕs a significant increase in PCA, functioning like coagulation factor VII. These results support a role for Kupffer's cells in the initiation of microvascular thrombosis in endotoxemia. (Arch Surg 1984;119:62-67)