Pathogenesis of sepsis: modern concepts of molecular mechanisms

Polyakova E.A., Matselski N.A.

Belarusian Research Center for Pediatric Oncology and Hematology, Minsk, Belarus
Belarusian State Medical University, Minsk, Belarus

The modern concept of sepsis pathophysiology views the endothelium as a functionally active structure integrating immune, hemostatic, and metabolic processes, rather than simply an anatomical barrier lining the vascular bed. Endothelial dysfunction in sepsis arises from the combined effects of pathogen-associated and injury-associated molecular patterns, cytokine cascades, complement activation, hemostatic impairment, and mitochondrial and microvascular dysfunction. The result is loss of barrier function, pathological vasoplegia, microthrombosis, and heterogeneous tissue perfusion, which forms the basis for organ failure. This review discusses the key molecular axes linking systemic inflammation with microcirculatory dysfunction.