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Triggered by exposure to pathogens, microbial toxins, or endogenous danger signals, EC responses are polymorphous, heterogeneous, and multifaceted. During sepsis, ECs shift toward a proapoptotic, proinflammatory, proadhesive, and procoagulant phenotype. In addition, glycocalyx damage and vascular tone dysfunction impair microcirculatory blood flow, leading to organ injury and, potentially, life-threatening organ failure. This review aims to cover the current understanding of the EC adaptive or maladaptive response to acute inflammation or bacterial infection based on compelling recent basic research and therapeutic clinical trials targeting microvascular and endothelial alterations during septic shock.<\/jats:p>","DOI":"10.1164\/rccm.201910-1911tr","type":"journal-article","created":{"date-parts":[[2020,2,26]],"date-time":"2020-02-26T16:54:37Z","timestamp":1582736077000},"page":"361-370","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":666,"title":["Endothelial Responses in Sepsis"],"prefix":"10.1093","volume":"202","author":[{"given":"J\u00e9r\u00e9mie","family":"Joffre","sequence":"first","affiliation":[{"name":"Medical Intensive Care Unit, H\u00f4pital Saint-Antoine, Assistance Publique-H\u00f4pitaux de Paris, Sorbonne Universit\u00e9, Paris, France"},{"name":"Department of Anesthesia and Perioperative Care, University of California San Francisco School of Medicine, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Hellman","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Perioperative Care, University of California San Francisco School of Medicine, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can","family":"Ince","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafid","family":"Ait-Oufella","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, H\u00f4pital Saint-Antoine, Assistance Publique-H\u00f4pitaux de Paris, Sorbonne Universit\u00e9, Paris, France"},{"name":"INSERM U970, Cardiovascular Research Center, Universit\u00e9 de Paris, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,8,1]]},"reference":[{"key":"2026030321504446900_bib1","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"2026030321504446900_bib2","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1007\/s00134-010-1893-6","article-title":"The endothelium: physiological functions and role in microcirculatory failure during severe sepsis","volume":"36","author":"Ait-Oufella","year":"2010","journal-title":"Intensive Care Med"},{"key":"2026030321504446900_bib3","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.ccm.2016.01.009","article-title":"Endothelial and microcirculatory function and dysfunction in sepsis","volume":"37","author":"Colbert","year":"2016","journal-title":"Clin Chest Med"},{"key":"2026030321504446900_bib4","doi-asserted-by":"crossref","first-page":"a006429","DOI":"10.1101\/cshperspect.a006429","article-title":"Endothelial cell heterogeneity","volume":"2","author":"Aird","year":"2012","journal-title":"Cold Spring Harb Perspect Med"},{"key":"2026030321504446900_bib5","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1161\/01.RES.0000255690.03436.ae","article-title":"Phenotypic heterogeneity of the endothelium: II. 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