One of the central cellular players in this system is the endothelial cell (EC). Once thought to serve as an inert vascular lining, ECs are highly heterogeneous and constitute an active disseminated organ throughout the circulatory system. ECs form the border between every organ and the bloodstream and thus with the rest of the body. The EC receives and gives signals, stores active substances of multiple systems, and regulates the passage of fluids, electrolytes, proteins and cells. The EC has a time and place dependent phenotype that is dynamically controlled, and its reactions to stimuli are specific to organ and vascular bed [10] [11] [12] [13] . The EC merits robust investigation in critical illness, as in vascular medicine [14] . genesis and organogenesis in normal physiology and in wound repair, but it is considered pathologic in tumour growth and diabetes [15] . Second, in the adult organism, ECs help to maintain homeostasis, including fluid, electrolyte and protein transport, and cell migration into and out of the vessel, and to regulate blood flow. Third, ECs react and respond to disturbances of homeostasis (for example, in inflammation, coagulation and hypoxia/reperfusion).