Damage-associated molecular patterns in critical illness and multi-organ failure

In the mid-90s, Polly Matzinger introduced the Danger model to explain how our immune system responds to harmful insults. According to this theory, the immune system may care less about identifying self versus non-self, but instead discriminate and respond based upon potential threat to host survival (1). Whether the nidus of critical illness is a sterile insult or septic process, alarm signals, such as damage-associated molecular patterns (DAMPs), from stressed and damaged cells have the potential to trigger the same downstream immune effectors as canonical pathogen-associated molecular patterns (PAMPs) expressed on bacteria and viruses (2). Thus, DAMPs remain an area of heightened clinical interest and deserve to be the focus of further targeted research.