C-Terminal Alpha-1 Antitrypsin Peptide: A New Sepsis Biomarker with Immunomodulatory Function

Figure 9

Hypothetical pathway illustrating CAAP47/48 generation by infection specific proteases. (1) In severe sepsis infection specific proteases are activated that lead to AAT cleavage and thus generation of CAAP47/48 (blue arrows). This proteolytic fragment activates PMN, which in turn leads to secretion of further proteases from PMN that will result in additional cleavage of ATT and accumulation of CAAP47/48 (2), that subsequently activates other PMN (red arrows). Due to the activation of further PMN and the induction of migration, cell death, and oxidative burst, this activation loop contributes to a strong enhancement of inflammation.