Apoptotic hepatocytes have been demonstrated to represent an important signal for transmigration of leukocytes sequestered in sinusoids during endotoxemia in vivo. Beside leukocytes, platelets and their adhesion to endothelial cells and leukocytes have been implicated in inflammatory liver injury. Using in vivo multifluorescence microscopy, we examined the possibility that hepatocellular apoptosis causes both leukocytes and platelets to colocalize within the sinusoidal microvasculature of endotoxemic livers. We further addressed the issue whether cellular colocalization with apoptotic hepatocytes is cause or consequence of apoptosis. Intraperitoneal exposure of rats with lipopolysaccharide (5mg/kg) induced liver injury after 6 and 16h, as given by nutritive perfusion failure (20±2% and 21±2%), intrahepatic leukocyte (60±10 and 121±48cells/mm²) and platelet (12±4 and 34±4cells/mm²) accumulation as well as parenchymal cell apoptosis (4±1 and 11±2cells/mm²) and caspase cleavage (4.7±2.4 and 7.0±3.0-fold increase) (p<0.05 vs saline-exposed controls). Higher dose of lipopolysaccharide (10mg/kg ip) further increased intrahepatic leukocyte and platelet accumulation, but not the extent of parenchymal apoptosis. Detailed spatial analysis revealed colocalization of leukocytes (range 12-24%), but barely of platelets (<6%) with apoptotic hepatocytes in all endotoxemic groups studied. Of interest, however, platelets were found at increasing rates in colocalization with leukocytes at 6h and 16h after LPS exposure (5mg/kg LPS: 7±3% and 25±6%; 10mg/kg LPS: 11±4% and 14±1%). Platelet-leukocyte events significantly correlated with the extent of caspase cleavage as an indicator of tissue apoptosis (p<0.05; r=0.82). Blockade of apoptosis by a pan-caspase inhibitor caused a significant reduction of leukocyte adherence and platelet-leukocyte colocalization upon LPS exposure. On the other hand, leukocytopenic animals revealed reduced hepatocyte apoptosis, although values still exceeded those of controls, and in leuko- and thrombocytopenic animals hepatocyte apoptosis was found reduced to control values. Taken together, LPS-associated hepatocyte apoptosis seems to be initiated by circulating blood cells which become adherent within the liver, but might also contribute to further sustain the inflammatory cell-cell response.