Activated protein C downregulates p38 mitogen-activated protein kinase and improves clinical parameters in an in-vivo model of septic shock

Marcel Nold, Claudia Nold-Petry, Doris Fischer, Bernd Richter, Roman Blaheta, Josef Pfeilschifter, Heiko Muhl, Dietmar Schranz, Alex Veldman

Research output: Contribution to journalArticleResearchpeer-review

17 Citations (Scopus)


Despite the success of the anti-coagulant protease protein C (PC) in treating septic shock in humans, the signaling pathways used are still unclear. To explore the effects of treatment with PC zymogen and its activated form aPC in a setting of sepsis, we employed a piglet model of endotoxic shock. In the aPC group, we observed a 65 -90 reduction in plasma TNF-alpha levels and a concomitant clinical improvement. Unexpectedly, administration of aPC also resulted in stabilization of the plasma pH above 7.2. Moreover, phosphorylated p38 mitogen-activated protein kinase (p38MAPK) was virtually absent in the livers of those piglets receiving aPC. In cultured human umbilical vein endothelial cells, we observed that nanomolar concentrations of PC and aPC inhibited the phosphorylation of p38MAPK. Furthermore, we showed that the regulation of the pro-apoptotic cell cycle regulator p53 by PC and aPC is dependent on the reduction of p38MAPK activation. The transduction of these effects involves all three receptors associated with protein C signaling, namely endothelial protein C receptor, protease-activated receptor 1, and sphingosine 1-phosphate receptor 1. Ultimately, this study elucidates novel signaling pathways regulated by protein C and emphasises the pivotal importance of its multiple modes of action beyond anticoagulation. APC s clinical success may, in part, be due to p38MAPK inhibition.
Original languageEnglish
Pages (from-to)1118 - 1126
Number of pages9
JournalThrombosis and Haemostasis
Issue number5
Publication statusPublished - 2007
Externally publishedYes

Cite this