Lung liver interactions in sepsis and multiple organ failure syndrome

This article examines interactions between the lungs and the liver during microbial sepsis from four interrelated elements of host defense: (1) control of systemic endotoxemia, bacteremia, and vasoactive by-products of sepsis via hepatic mononuclear phagocytic (Kupffer's) cell clearance; (2) biosynthesis and export of cytokine and eicosanoid inflammatory mediators into hepatic venous blood; (3) metabolic inactivation and detoxification of these mediators by Kupffer's cell-hepatocyte interactions at the hepatic sinusoidal interface; and (4) cytokine-driven synthesis of acute phase proteins, including alpha(2)-macroglobulin, C-reactive protein, and lipopolysaccharide-binding protein, that are capable of modifying sepsis-related changes in metabolism and inflammation.