In addition, another widely accepted theory holds that these endogenous mediators
activate receptors on endothelial cells and stimulate the release of adhesion molecules
(intracellular adhesion molecule [ICAM1 or endothelial leukocyte adhesion molecule
[ELAM]; Figure 1) [24]. These molecules, once they attach to endothelial cells, in turn
attract neutrophils, platelets, and macrophages to attach to the endothelium, become activated,
and release a variety of immunomodulator, vasoactive, and cytotoxic compounds
(Table 3). While considerable evidence suggests that such a series of events does, indeed,
occur, a single precipitating factor probably does not underlie the many diverse sequelae
that become apparent with the development of MODS.