Proposed sequence of host responses
causing plasma leakage in DHF. DENV infection
predominantly targets monocytic cells; endothelial
cells may be infected, but represent a minor target.
Vascular endothelial cell dysfunction and increased
endothelial permeability are caused by waves of
circulating mediators. Cytokines are released as a
direct response to cellular infection. Additionally, cytokines
are released by antigen-specific T lymphocytes
that recognize virus-infected cells, particularly in
secondary DENV infections. “Proximal mediators” refer
to cytokines with direct effects to increase endothelial
permeability, such as TNF-α and VEGF. “Critical
inducers” refer to cytokines that initiate the cytokine
cascade through effects on monocytes, T lymphocytes,
and/or endothelial cells, but do not directly
cause plasma leakage.
Proposed sequence of host responses
causing plasma leakage in DHF. DENV infection
predominantly targets monocytic cells; endothelial
cells may be infected, but represent a minor target.
Vascular endothelial cell dysfunction and increased
endothelial permeability are caused by waves of
circulating mediators. Cytokines are released as a
direct response to cellular infection. Additionally, cytokines
are released by antigen-specific T lymphocytes
that recognize virus-infected cells, particularly in
secondary DENV infections. “Proximal mediators” refer
to cytokines with direct effects to increase endothelial
permeability, such as TNF-α and VEGF. “Critical
inducers” refer to cytokines that initiate the cytokine
cascade through effects on monocytes, T lymphocytes,
and/or endothelial cells, but do not directly
cause plasma leakage.
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