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HMGB1 and LPS interactions provide potential therapeutic targets for inflammation and coagulation in sepsisNew research identifies how specific proteins drive sepsis inflammation

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Key Takeaway
Note that HMGB1 and LPS interactions provide potential but currently untranslated therapeutic targets for sepsis.

This narrative review examines the molecular mechanisms of Lipopolysaccharide (LPS) and High Mobility Group Box 1 (HMGB1) in the context of sepsis. The authors synthesize how LPS acts as a pro-inflammatory toxin that initiates inflammatory and coagulation cascades via TLR4 and cytosolic inflammatory caspases, specifically caspase-11 in mice and caspases-4 and -5 in humans.

A critical finding highlighted is the interaction between these two molecules; in extracellular environments, LPS binds to HMGB1 to form a complex. This complex is internalized through RAGE-mediated endocytosis and trafficked to the lysosome, where HM1 permeabilizes the membrane to allow LPS to activate caspase-11. Additionally, the review notes that HMGB1 can be actively released by peripheral sensory neurons following tissue injury.

The authors acknowledge a significant gap in clinical application, noting that no HMGB1-targeted strategies have been translated into clinical practice yet. While these mechanisms provide potential therapeutic targets for sepsis, they are currently only established in preclinical models. Clinical utility is limited by the current lack of translational data.

How this fits prior evidence

This review addresses a gap in understanding the specific molecular drivers of inflammation and coagulation in sepsis. It builds upon prior evidence that characterizes sepsis as an inflammation-driven immune reprogramming disorder. While previous findings identified specific clinical interventions, such as hyperoxygenation to reduce 28-day mortality, this review focuses on the underlying biochemical pathways involving HMGB1 and LPS as potential future targets.

Sepsis is a life-threatening reaction to infection that can cause the body to attack its own organs. Researchers are looking closer at how this happens, specifically focusing on a toxin called LPS and a protein called HMGB1. They found that these two work together like a team to trigger a massive inflammatory response.

In the body, the protein HMGB1 can be released by nerves after an injury. Once outside the cells, it binds with the LPS toxin. This complex then enters cells where it breaks down membranes and activates specific enzymes called caspases. These enzymes are what drive the dangerous inflammation and blood clotting issues seen in sepsis patients.

While these findings help scientists understand the mechanics of how sepsis damages the body, it is important to note that this research is currently in the early stages. No treatments targeting HMGB1 have been used in actual clinical practice yet. These results are based on preclinical models, meaning they are not yet ready for use in human patients.

What this means for you:
The interaction between HMGB1 and LPS drives the severe inflammation seen in sepsis cases.

Common questions

What is the role of HMGB1 in sepsis?

HMGB1 is a protein that can be released by nerves after tissue injury. In the body, it binds with a toxin called LPS to form a complex. This complex then moves into cells where it breaks down membranes and activates enzymes that cause inflammation and blood clotting issues during sepsis.

How does the body react to the LPS toxin?

LPS acts as a pro-inflammatory toxin. It starts a chain reaction of inflammation and blood clotting by interacting with specific receptors and enzymes called caspases. This process is a key part of how sepsis leads to multi-organ failure.

Are there new treatments available for these proteins?

While the interaction between HMGB1 and LPS provides potential targets for future medicine, no strategies targeting HMGB1 have been translated into clinical practice yet. These findings are currently in preclinical models and are not yet used to treat patients.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
Sepsis is a life-threatening clinical syndrome characterized by high morbidity and mortality. In the pathogenesis of Gram-negative bacterial infection, lipopolysaccharide (LPS) functions as a critical pro-inflammatory toxin that initiates inflammatory and coagulation cascades through two principal receptor systems: Toll-like receptor 4 (TLR4), expressed on the cell surface and within endosomes, and the cytosolic inflammatory caspases — caspase-11 in mice and caspases-4 and -5 in humans. In the extracellular environment, LPS binds to high mobility group box 1 protein (HMGB1) to form an HMGB1–LPS complex, which is internalized through receptor for advanced glycation end-products (RAGE)–mediated endocytosis and trafficked to the lysosome. Within the acidic lysosomal compartment, HMGB1 permeabilizes the limiting membrane, enabling LPS to access and activate caspase-11. This cascade drives further HMGB1 release, amplifies inflammation and coagulopathy, and ultimately contributes to multi-organ failure. The observation that LPS-driven fulminant inflammation depends critically on HMGB1 cooperation has opened new therapeutic avenues directed at HMGB1 and has yielded encouraging results in preclinical models. However, no such strategy has yet been translated into clinical practice. In addition, HMGB1 can be actively released by peripheral sensory neurons following tissue injury, a mechanism now recognized as integral to the initiation and propagation of inflammation. The present review synthesizes current understanding of the reciprocal interactions between LPS and HMGB1 and considers emerging therapeutic opportunities in sepsis.
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