The molecular diversity of receptors in human blood vessels remains largely unexplored. We developed a selection method in which peptides that home to specific vascular beds are identified after administration of a peptide library. Here we report the first in vivo screening of a peptide library in a patient. We surveyed 47,160 motifs that localized to different organs. This large-scale screening indicates that the tissue distribution of circulating peptides is nonrandom. High-throughput analysis of the motifs revealed similarities to ligands for differentially expressed cell-surface proteins, and a candidate ligand-receptor pair was validated. These data represent a step toward the construction of a molecular map of human vasculature and may have broad implications for the development of targeted therapies.

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Objective To determine whether automated identification with physician notification of the systemic inflammatory response syndrome in medical intensive care unit (MICU) patients expedites early administration of new antibiotics or improvement of other patient outcomes in patients with sepsis. Design A prospective, randomized, controlled, single-center study. Setting MICU of an academic, tertiary-care medical center. Patients 442 consecutive patients admitted over a 4 month period who met modified SIRS criteria in a MICU. Intervention Patients were randomized to monitoring by an electronic “Listening Application” to detect modified (SIRS) criteria vs. usual care. The Listening Application notified physicians in real-time when modified SIRS criteria were detected, but did not provide management recommendations. Measurements and Main Results The median time to new antibiotics was similar between the intervention and usual care groups whether comparing among all patients (6.0h vs 6.1h, p=0.95), patients with sepsis (5.3h vs. 5.1h; p=0.90), patients on antibiotics at enrollment (5.2h vs. 7.0h, p= 0.27), or patients not on antibiotics at enrollment (5.2h vs. 5.1h, p= 0.85). The amount of fluid administered following detection of modified SIRS criteria was similar between groups whether comparing all patients or only patients hypotensive at enrollment. Other clinical outcomes including ICU length of stay, hospital length of stay, and mortality were not shown to be different between patients in the intervention and control groups. Conclusions Real-time alerts of modified SIRS criteria to physicians in one tertiary care MICU were feasible and safe but did not influence measured therapeutic interventions for sepsis or significantly alter clinical outcomes.