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Second, aCLs may activate endothelial cells and cause a diffuse small-vessel vasculopathy – a neuropathological finding that was reported as long ago as 1968 [ 3, 11, 37- 39].

These findings suggest that hypoxia stimulates EBs to produce VEGF, which, in turn, may activate endothelial differentiation in an autocrine and/or paracrine manner.

Severe systemic inflammatory reactions as a result of massive inflammatory mediator release and reperfusion injury may activate endothelial cells in remote organs which are not exposed to initial ischemic injury [ 11].

In the case of PEG-albumin, the mechanism related to viscosity remains unclear and it has been hypothesized that it may activate endothelial pathways by direct physical interaction of the PEG with the glycocalyx on the endothelium surface [ 37].

Finally, through interactions with adhesion molecules they may activate endothelial signal transduction, although this is less well understood Previous experiments have addressed the idea that neutrophils may modulate vascular function by examining vascular tone in isolated aortic rings in vitro.

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Generally, aPL may activate platelets, endothelial cells, and monocytes, leading to the inhibition of the fibrinolytic system, activation of the coagulation cascade, and possibly activation of the complement system [16].

We demonstrated that MVs from endothelial progenitor cells may activate in normal endothelial cells an angiogenic program by transfer of functional mRNAs [4].

It stimulates proliferation of lymphohaematopoetic cells and increases the phagocytic activity of macrophages which may enhance host eradication of S. aureus but it can also activate endothelial cells resulting in a severe sepsis phenotype [ 21, 22].

Tumor-derived EVs can activate endothelial cells to promote angiogenesis or vascular permeability.

However, NETs can also activate endothelial cells and induce collateral tissue damage in the lungs, heart, and liver [47, 48].

In contrast, the soluble GP does not activate endothelial cells or change the endothelial barrier function.

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