Activated platelets are known to release large amounts of TGF-β,56 potentially acting in an anti-inflammatory fashion and characteristic for systemic inflammatory response syndrome.57 Indeed, many characteristic TGF-β induced proteins derived from macrophages [eg, TNC, AIF1] and epithelial cells [eg, SERPINB5, GREM1, MUC12] were found significantly upregulated. This evidence concerns the gene GREM1 and systemic inflammatory response syndrome.