Search

Key points Inflammation in response to bacterial endotoxin challenge impacts physiological functions, including cardiovascular, thermal and pain dynamics, although the mechanisms are poorly understood. We develop an innovative mathematical model incorporating interaction pathways between inflammation and physiological processes observed in response to an endotoxin challenge. We calibrate the model to individual data from 20 subjects in an experimental study of the human inflammatory and physiological responses to endotoxin, and we validate the model against human data from an independent study. Using the model to simulate patient responses to different treatment modalities reveals that a multimodal treatment combining several therapeutic strategies gives the best recovery outcome. Abstract Uncontrolled, excessive production of pro-inflammatory mediators from immune cells and traumatized tissues can cause systemic inflammatory conditions such as sepsis, one of the ten leading causes of death in the USA, and one of the three leading causes of death in the intensive care unit. Understanding how inflammation affects physiological processes, including cardiovascular, thermal and pain dynamics, can improve a patient's chance of recovery after an inflammatory event caused by surgery or a severe infection. Although the effects of the autonomic response on the inflammatory system are well-known, knowledge about the reverse interaction is lacking. The present study develops a mathematical model analyzing the inflammatory system's interactions with thermal, pain and cardiovascular dynamics in response to a bacterial endotoxin challenge. We calibrate the model with individual data from an experimental study of the inflammatory and physiological responses to a one-time administration of endotoxin in 20 healthy young men and validate it against data from an independent endotoxin study. We use simulation to explore how various treatments help patients exposed to a sustained pathological input. The treatments explored include bacterial endotoxin adsorption, antipyretics and vasopressors, as well as combinations of these. Our findings suggest that the most favourable recovery outcome is achieved by a multimodal strategy, combining all three interventions to simultaneously remove endotoxin from the body and alleviate symptoms caused by the immune system as it fights the infection.

The objective of this study was to examine whether serum iron (Fe) concentration is useful as a prognostic biomarker for cows with acute coliform mastitis (ACM). Our study was composed of determining the reproducibility of serum Fe concentration as a prognostic criterion in cows with ACM (Study 1) and clarifying the sequential changes in serum Fe concentration in cattle that received endotoxin (Study 2). Seventy-seven cows with (n = 47) or without (n = 30) ACM were enrolled in Study 1. The proposed diagnostic cut-off value of serum Fe concentration indicating a poor prognosis of ACM based on the analysis of the receiver operating characteristic curves was < 31.5 µg/dL. Ten young cattle aged 176.8 ± 23.7 days were enrolled in Study 2. Five young cattle received endotoxin (LPS group) and the remaining five received physiological saline (control group). Blood collections were carried out before endotoxin challenge (pre), and 0.5, 1, 2, 4, 8, 12, 24, and 48 h after the challenge. As a result, a significant decrease in serum Fe concentration was not observed until 24 h after endotoxin challenge. Because in cows with clinical ACM it is difficult to know the time course after infection, the alteration in serum Fe concentrations alone may be an insufficient prognostic criterion.

There is limited information on the effects of stress and/or physiological manipulation on plasma concentrations of corticosterone (CORT) in turkeys. Under basal conditions, there was evidence for episodic release of CORT in turkeys. The present studies determine the effects of handling, herding, herding, the administration of Escherichia coli endotoxin, and challenge with turkey adrenocorticotropic hormone (ACTH) on plasma concentrations of CORT in market-weight male turkeys. Plasma concentrations of CORT were increased after challenge with turkey ACTH, handling together with saline injection or herding (moving birds from one pen to another). There were no effects on plasma concentrations of CORT of the following putative stressors: handling per se, endotoxin challenge, or of placing in an inverted position on simulated shackles.

The aim of the present study was to measure changes in the serum concentrations of some elements in endotoxin-challenged calves using a particle-induced X-ray emission analysis and to screen for elements useful as diagnostic markers. The results obtained revealed that serum Zn concentrations were more accurate diagnostic markers for detecting endotoxin shock in calves than other elements. Serum Zn level in endotoxin-challenged calve was significantly lower from 8 to 12 hr after the endotoxin challenge than pre-challenge values. In addition, serum Zn concentrations in calves from 4 to 24 hr after endotoxin challenges were significantly lower than those of control. Our results indicate that serum Zn concentration has potential as diagnostic markers for detecting inflammation in calves with endotoxin shock.

The objective of this study was to assess the influence of prenatal stress (PNS) on innate immune responses to an endotoxin challenge in weaned bull calves. Altered innate immune response to lipopolysaccharide (LPS), as characterized by changes in a range of variables was hypothesized in PNS bull calves. Brahman cows (n = 96; 48 stressed by transportation at five stages of gestation and 48 Controls) produced 85 calves, from which 16 uncastrated male (bull) calves from each PNS and Control treatment were selected for an LPS challenge period. Rectal temperature (RT), sickness behavior score (SBS), serum concentrations of cortisol, interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and complete blood count (CBC) variables were assessed in response to intravenous LPS (0.25 μg/kg body weight) administration. Each reported variable increased or decreased following LPS administration. Prior to LPS, PNS bull calves exhibited increased TNF-α, IL-6, and monocyte counts, but decreased IFN-γ, eosinophils, and basophils (p .05). Compared with Control, in response to LPS, PNS bull calves exhibited greater circulating concentrations of cortisol. PNS bull calves exhibited lower (p.05) eosinophil and basophil counts at time 0 (time of LPS administration) but similar counts to Control bull calves 2 h after LPS. PNS bull calves exhibited a greater change from baseline for IFN-γ and monocytes in response to LPS administration. No other variables were influenced by prenatal treatment (p .05). These findings suggest that PNS did not adversely affect basal or induced components of the innate immune response to an immunological challenge. Lay summary Our laboratory studied the influence of prenatal stress (i.e., transportation of pregnant cows) on immune function of bull calves at 8 months of age. This was accomplished by studying aspects of their innate immune response to an immunological challenge. Prenatal stress did not adversely affect basal or induced components of the innate immune response to an immunological challenge.

Multicolour flow cytometry (MFC) is used to measure multiple cellular markers at the single-cell level. Cellular markers may be coloured with different panels of fluorescently-labelled antibodies to enable cell identification or the detection of activated cells in pre-defined, gated’ specific cell subsets. The number of markers that can be used per measurement is technologically limited however, requiring every panel to be analysed in a separate aliquot measurement. The combined analyses of these dedicated panels may enhance the predictive ability of these measurements and could enrich the interpretation of the immunological information. Here we introduce a fusion method for MFC data, based on DAMACY (Discriminant Analysis of Multi-Aspect Cytometry data), which can combine information from complementary panels. This approach leads to both enhanced predictions and clearer interpretations in comparison with the analysis of separate measurements. We illustrate this method using two datasets: the response of neutrophils evoked by a systemic endotoxin challenge and the activated immune status of the innate cells, T cells and B cells in obese versus lean individuals. The data fusion approach was able to detect cells that do not individually show a difference between clinical phenotypes but do play a role in combination with other cells. This research received funding from the Netherlands Organization for Scientific Research (NWO) in the framework of the Technology Area COAST of the Fund New Chemical Innovations. Functions for Matlab are available at http://www.ru.nl/science/analyticalchemistry/research/software/.

Incorporation of precision livestock technology has the potential to provide swine producers with the means to rapidly and accurately identify immune-compromised pigs, allowing for accurate and timely interventions. The objective of this study was to utilize the NUtrack System (NUtrack) to identify changes in general (lying, standing and sitting) and spatial behaviors (at the feeder and meters/day) of newly weaned pigs exposed to a lipopolysaccharide (LPS) challenge. To achieve this objective, 12 nursery pens with 192 weaned pigs (16 pigs/pen) were randomly assigned to three treatments (4 pens/treatment): Control (saline injection), Mixed (8 pigs/pen received an LPS challenge and 8 pigs received saline injection) and 100% (all pigs received LPS). The LPS challenge consisted of a bolus subcutaneous injection at 300 µg/kg BW (E. coli O111:B4). Prior to placement, NUtrack was installed above the 12 nursery pens and initiated continuous data capture for the duration of the nursery phase (43 days). Ten days after placement in the nursery pens pigs received the assigned challenge (LPS or sham). Data were analyzed using the MIXED procedure of SAS specific for repeated measures (SAS Inst. Inc., Cary, NC). Regardless of treatment group, general special behaviors were similar (P = >0.28) prior to the LPS challenge (days 1–9). Following LPS challenge (day 10), spatial behaviors decreased (P =

Studies of inflammation in alcohol use disorder (AUD) are overwhelmingly preclinical, and translation to clinical samples is necessary. Endotoxin administration has been used successfully in humans to study mood disorders, offering a translational, reliable and safe model that may be validated in AUD research. We argue for the use of endotoxin challenge to elucidate the interplay between AUD and inflammation.

Summary The molecular mechanisms that restore microglial quiescence after acute stimulation remain largely unexplored, unlike those that drive microglial activation. In this issue of Immunity, Shemer et al. discover that the microglial IL-10 receptor counteracts the pro-inflammatory effects of TNF to allow restoration of microglial quiescence after peripheral endotoxin challenge.

ECV has a specification certificate of analysis (CoA) worth 9616 EU/mL where the limit of acceptability recovery is in the range of 50 – 200 percent (4808 EU/mL - 19232 EU/mL). The verification results of ECV concentration with kinetic turbidimetry method showed recovery outside the lower limit of the predetermined range less than 50 percent. This is due to endotoxin adsorbed onto the surface of the glass. To get a recovery that goes within the limits of acceptability then do the time variation of sonication (5; 10; 15; 20; 25; 30) minutes and variations of the dilution factor of 10−4; 10−5. The result showed that the optimum sonication time was 25 minutes with a 10−4 dilution factor. The average concentration of ECV obtained worth 7828,98 EU/mL with a recovery 81,4 percent. The validation test showed a significant correlation coefficient values (-0,9963); and the precision of data with CV < 2/3 CVH, control of graph showed that the data was homogenic; the value of LOD (1070,6823 EU/mL); LOQ (3568,9411 EU/mL) and percent recovery value was 81,0844 percent. Suggested for further research to optimize the use of buffer solution as a solvent, but it also can optimize the temperature and the frequency of the sonication process.

Relationships between avian physiology and bacterial assemblages in the cloaca are poorly understood. We used molecular techniques to analyze cloacal swabs from pigeons that were subjected to two immunological manipulations: lysozyme supplementation and endotoxin challenge. From the swabs, we derived ecological indices of evenness, richness, and diversity of bacterial assemblages. Challenge led to changes in evenness that depended on supplementation. When analyzing these changes, we neutralized the effects of a possible statistical artifact by including the starting values as a covariate. Repeatability calculations suggested that swabbing reliably captured the evenness but not the richness or diversity of bacterial assemblages in the cloaca.

Sudden infant death syndrome (SIDS) remains the leading cause of infant mortality beyond the neonatal period. An increase in body temperature as a result of high environmental temperature, overwrapping of infants, and (or) infection are associated with SIDS. Endotoxins such as lipopolysaccharide (LPS) and heat stress may perturb cardiorespiratory function and thermoregulation. Although LPS-mediated body temperature and cytokine responses are well documented in older animals, the capacity of LPS to induce fever and cytokine response in young rats remains unclear. Therefore, we sought to investigate the acute effects of LPS on body temperature and cytokine concentrations in rat pups. Postnatal day 7 rat pups were divided into 3 groups: Group 1, rats were administered LPS intraperitoneally (200 μg/kg); Group 2, rats received saline at volume equal to that administered in the LPS group; Group 3, rats received no treatment. Pups were placed in custom-made chambers maintained at ambient temperature of 33 °C. Body surface temperature was continuously monitored for 4 h. Thereafter, the rats were euthanized and serum was collected for cytokine analysis. We demonstrate that LPS treatment increased MIP-1α, IL-10, MCP-1, IP-10, fractalkine, and TNF-α with no concurrent rise in body surface temperature. Although neonatal rats produced an array of cytokines in response to LPS, there was no evidence of fever.

A total of 83 lactating dairy ewes (Manchega, n=48; Lacaune, n=35) were used in 2 consecutive experiments for assessing the ability of infrared thermography (IRT) to detect intramammary infections (IMI) by measuring udder skin temperatures (UST). In experiment 1, ewes were milked twice daily and IRT pictures of the udder were taken before and after milking at 46 and 56d in milk (DIM). Milk yield was 1.46 ± 0.04 L/d, on average. Detection of IMI was done using standard bacterial culture by udder half at 15, 34, and 64 DIM. Twenty-two ewes were classified as having IMI in at least one udder half, the others being healthy (142 healthy and 24 IMI halves, respectively). Four IMI halves had clinical mastitis. No UST differences were detected by IMI and udder side, being 32.94 ± 0.04°C on average. Nevertheless, differences in UST were detected for breed (Lacaune - Manchega=0.35 ± 0.08°C), milking process moment (after - before=0.13 ± 0.11°C), and milking schedule (p.m. - a.m.=0.79 ± 0.07°C). The UST increased linearly with ambient temperature (r=0.88). In experiment 2, the UST response to an Escherichia coli O55:B5 endotoxin challenge (5 μg/udder half) was studied in 9 healthy Lacaune ewes milked once daily in late lactation (0.58 ± 0.03 L/d; 155 ± 26 DIM). Ewes were allocated into 3 balanced groups of 3 ewes to which treatments were applied by udder half after milking. Treatments were (1) control (C00, both udder halves untreated), (2) half udder treated (T10 and C01, one udder half infused with endotoxin and the other untreated, respectively), and (3) treated udder halves (T11, both udder halves infused with endotoxin). Body (vaginal) temperature and UST, milk yield, and milk composition changes were monitored by udder half at different time intervals (2 to 72 h). First local and systemic signs of IMI were observed at 4 and 6h postchallenge, respectively. For all treatments, UST increased after the challenge, peaking at 6h in T 0055 (which differed from that in C00, C01, and T10), and decreased thereafter without differences by treatment. Vaginal temperature and milk somatic cell count increased by 6h postchallenge, whereas lactose content decreased, in the endotoxin-infused udder halves. Effects of endotoxin on lactose and somatic cell count values were detectable in the infused udder halves until 72 h. In conclusion, despite the accuracy of the camera (± 0.15°C) and the moderate standard errors of the mean obtained for UST measures (± 0.05 to 0.24°C), we were unable to discriminate between healthy and infected (subclinically or clinically) udder halves in dairy ewes.

Background: Lipopolysaccharide binding protein (LBP) is an acute-phase protein produced by the liver. It has been shown that LBP plays an important role in the inflammatory response to sepsis. LBP has also been shown to protect animals from endotoxin challenge by facilitating the removal of endotoxin from the blood circulation. Cirrhotic patients are susceptible to bacterial infection. It is unknown whether pre-existing liver dysfunction impacts the LBP levels and thus the prognosis in severe sepsis. Methods: We evaluated the serum LBP, inflammatory cytokines, and the relationship between LBP concentrations, functional liver reserve and outcomes in 58 critically ill cirrhotic patients with severe sepsis. Results: The serum LBP levels were significantly higher in 28-day survivors, while the interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were significantly higher in non-survivors. We analyzed the receiver operating characteristic (ROC) curve to determine the cut-off point for LBP to predict 28-day mortality. The cumulative rates at 28 days were 58.3% versus 16.7% for the high LBP group (>46 ng/mL) and low LBP group (

This study examined the effect of feeding yeast cell wall (YCW) products on the metabolic responses of newly-received feedlot cattle to an endotoxin challenge. Heifers were separated into treatment groups receiving either a Control diet, YCW-A or YCW-C, and were fed for 52 d. Heifers were weighed on d 0, 14, 36, 38 and 52. On d 37 heifers were challenged i.v. with LPS [0.5 µg/kg body weight (BW)] and blood samples were collected relative to LPS challenge. Heifer BW increased from d 0 to 36 and from d 38 to 52, but was not affected by treatment. Post-LPS, glucose concentrations increased and were less in YCW-A than Control and YCW-C heifers. Pre-LPS, insulin concentrations were greater in YCW-A and YCW-C than Control heifers. Post-LPS, insulin concentrations increased with YCW-C having greater insulin than Control heifers. Pre-LPS, NEFA concentrations tended to be less in YCW-C than Control heifers. Post-LPS non-esterified fatty acids (NEFA) concentrations were less in YCW-C than Control and YCW-A heifers. Post-LPS, blood urea nitrogen (BUN) concentrations were greater in YCW-A than Control and YCW-C. These data indicate, based on NEFA and BUN data, that certain YCW products can enhance energy metabolism during an immune challenge without causing lipolysis or muscle catabolism.

A study was conducted to determine the effect of feeding yeast cell wall (YCW) products on the physiological and acute phase responses of crossbred, newly-received feedlot heifers to an endotoxin challenge. Heifers ( n = 24; 219 ± 2.4 kg) were separated into treatment groups receiving either a control diet ( n = 8), YCW-A (2.5 g/heifer/d; n = 8) or YCW-C (2.5 g/heifer/d; n = 8) and were fed for 52 d. On d 37 heifers were challenged i.v. with LPS (0.5 µg/kg body mass) and blood samples were collected from −2 h to 8 h and again at 24 h relative to LPS challenge. There was an increase in vaginal temperature in all heifers post-LPS, with YCW-C maintaining a lower vaginal temperature post-LPS than control and YCW-A heifers. Sickness behavior scores increased post-LPS in all heifers, but were not affected by treatment. Cortisol concentrations were greatest in control heifers post-LPS compared with YCW-A or YCW-C heifers. Concentrations of IFN-γ and TNF-α increased post-LPS, but were not affected by treatment. Serum IL-6 concentrations increased post-LPS and were greater in control heifers than YCW-A and YCW-C heifers. These data indicate that YCW supplementation can decrease the physiological and acute phase responses of newly-received heifers following an endotoxin challenge.

Supplemented protein or specific amino acids (AA) are proposed to help animals combat infection and inflammation. The current study investigates whole-body and splanchnic tissue metabolism in response to a lipopolysaccharide (LPS) challenge with or without a supplement of six AA (cysteine, glutamine, methionine, proline, serine and threonine). Eight sheep were surgically prepared with vascular catheters across the gut and liver. On two occasions, four sheep were infused through the jugular vein for 20 h with either saline or LPS fromEscherichia coli(2 ng/kg body weight per min) in a random order, plus saline infused into the mesenteric vein; the other four sheep were treated with saline or LPS plus saline or six AA infused via the jugular vein into the mesenteric vein. Whole-body AA irreversible loss rate (ILR) and tissue protein metabolism were monitored by infusion of [ring-2H2]phenylalanine. LPS increased (PP=0·001), with no effect of AA infusion. Absorption of dietary AA was not reduced by LPS, except for glutamine. LPS increased the hepatic removal of leucine, lysine, glutamine and proline. Absolute hepatic extraction of supplemented AA increased, but, except for glutamine, this was less than the amount infused. This increased net appearance across the splanchnic bed restored arterial concentrations of five AA to, or above, values for the saline-infused period. Infusion of key AA does not appear to alter the acute period of endotoxaemic response, but it may have benefits for the chronic or recovery phases.

Objective—To evaluate the effects of endotoxin administered IV on glucose and insulin dynamics in horses. Animals—16 healthy adult mares. Procedures—Each week of a 2-week randomized crossover study, each horse received an IV injection (duration, 30 minutes) of Escherichia coli O55:B5 lipopolysaccharide (LPS) in 60 mL of sterile saline (0.9% NaCl) solution (20 ng/kg) or sterile saline solution alone (control treatment). Frequently sampled IV glucose tolerance test procedures were performed at 24 hours before (baseline) and 24 and 48 hours after injection; glucose and insulin dynamics were assessed via minimal model analysis. Results—13 of 16 horses had a clinical response to LPS, which was characterized by mild colic and leukopenia. Before treatment, mean ± SD insulin sensitivity was 2.9 ± 1.9 × 10−4 L·min−1·mU−1; this significantly decreased to 0.9 ± 0.9 × 10−4 L·min−1·mU−1 24 hours after treatment (69% reduction) and was 1.5 ± 0.9 × 10−4 L·min−1·mU−1 48 hours after treatment. At baseline, mean ± SD acute insulin response to glucose was 520 ± 196 mU·min·L−1; this significantly increased to 938 ± 620 mU·min·L−1 (80% increase) and 755 ± 400 mU·min·L−1 (45% increase) at 24 and 48 hours after LPS treatment, respectively. Conclusions and Clinical Relevance—Compared with baseline values, insulin sensitivity was decreased for 24 hours after IV injection of LPS, and affected horses had a compensatory pancreatic response. These disturbances in glucose and insulin dynamics may contribute to development of laminitis in horses.

To define gene expression profiles that occur during the initial activation of human innate immunity, we administered intravenous endotoxin ( n = 8) or saline ( n = 4) to healthy subjects and hybridized RNA from blood mononuclear cells (0, 0.5, 6, 24, 168 h) or whole blood (0, 3, 6, 24, 168 h) to oligonucleotide probe arrays. The greatest change in mononuclear cell gene expression occurred at 6 h (439 induced and 428 repressed genes, 1% false discovery rate, and 50% fold change) including increased expression of genes associated with pathogen recognition molecules and signaling cascades linked to receptors associated with cell mobility and activation. Induced defense response genes included cytokines, chemokines, and their respective receptors, acute-phase transcription factors, proteases, arachidonate metabolites, and oxidases. Repressed defense response genes included those associated with co-stimulatory molecules, T and cytotoxic lymphocytes, natural killer (NK) cells, and protein synthesis. Gene expression profiles of whole blood had similar biological themes. Over 100 genes not typically associated with acute inflammation were differentially regulated after endotoxin. By 24 h, gene expression had returned to baseline values. Thus the inflammatory response of circulating leukocytes to endotoxin in humans is characterized by a rapid amplification and subsidence of gene expression. These results indicate that a single intravascular exposure to endotoxin produces a large but temporally short perturbation of the blood transcriptome.

Clinical pharmacology is the investigation of drug effects in humans. This review discusses the basic tenets of clinical pharmacology research, including pharmacokinetic and pharmacodynamic analysis, therapeutic window, and clinical trial design, and the issues that may arise in the application of transcriptome analysis to clinical pharmacology studies. Examples of how transcriptome analysis can be applied to clinical pharmacology research are described, including a model system of endotoxin challenge (in vitro and in vivo), and an example of a cross-over drug study in normal volunteers. Various data display and analysis methods are also illustrated, including principal component analysis, hierarchical cluster analysis, and pathways analysis.

The influence of endotoxin on the disposition kinetics of oxytetracycline (OTC) (10 mg/kg) was investigated in five healthy ruminating male crossbred calves. The serum concentration-time data of OTC before and after endotoxin challenge were best described by a two-compartment open model. Repeated administration of Escherichia coli endotoxin (1 microg/kg, i.v.) at an interval of 12 h up to 48 h produced a clear rise in the body temperature and an increase in the pulse and respiration rates. Endotoxin caused a significant reduction in mean transit time in tissue compartment (MTTT) (P < or = 0.05), mean residence time in the peripheral tissue compartment (MRTT) (P < or = 0.05), mean residence time in the body (MRTB) (P < or = 0.05), elimination half-life (t1/2lambda2) (P < or = 0.05) and distribution space in tissues (VT) (P < or = 0.01) and at steady-state (Vd(ss)) (P < or = 0.01). Endotoxin had no effect on the distribution clearance (ClD), systemic clearance (Cl) and distribution half-life of OTC, while the values of first order rate constant of transfer of drug from tissue to central compartment (K21) and the zero time intercept at terminal phase (C2) were significantly high. The drug dosage regimens to maintain serum OTC concentrations of 0.5, 1, 2, 4, 6 and 8 microg/mL were also determined in febrile and clinically healthy animals.

The Sickness Questionnaire is a newly developed questionnaire for self-reported sickness behavior in humans. Here, we determined the time-course of sickness behavior and the association with changes in cytokine levels in an experimental study where 22 subjects received 2.0 ng/kg endotoxin or placebo in a crossover design, with a minimum of 20 days between injections. The Sickness questionnaire (from 0 to 30) and cytokines interleukin (IL)-6, IL-8 and tumor necrosis factor (TNF)-alpha were assessed at five time points: baseline, 1.5 h, 3 h, 5 h and 7 h post injection. Sickness behavior after endotoxin injection peaked at 1.5 and 3 h (Sickness Questionnaire score 18.9 and 19.8, respectively, vs baseline 5.8, p’s

Today the basic principles of septic conditions are understood. Nevertheless, sepsis research has reached a critical point. To integrate our knowledge towards a consistent theory of the disease process and to derive effective therapies, new perspectives for future research that fit the complexity of the problem have to be found. We conducted a review of the literature concerning systemic inflammatory response syndrome (SIRS) and sepsis with particular reference to liver pathophysiology. And compared our findings with characteristic features of complex systems. The complexity of sepsis is broadly recognized. A review of the different aspects of liver inflammation during SIRS and sepsis, i.e. endotoxin challenge, cytokine induced dysfunction, the mechanisms of leukocyte transmigration, and hormonal and neuroendocrine regulatory mechanisms is given. Key aspects of complex systems, including parallelism, locality, emergence, and cross-scale interactions are introduced. We conclude that sepsis research needs new perspectives that allow us to handle the complex interactions occurring during the disease process. We propose to focus research on the interactions between the constituents of the system rather than only describing isolated aspects of the disease process. We also conclude that the ideas and techniques of non-linear systems theory are suitable tools for the analysis of complex and dynamic diseases like SIRS and sepsis.