THBD (thrombomodulin) is an endothelial cell receptor that plays critical roles in regulating hemostasis, coagulation, fibrinolysis, inflammation, and angiogenesis 1. As a cofactor on vascular endothelial surfaces, THBD facilitates thrombin activation of protein C, initiating the activated protein C anticoagulant pathway 2. Additionally, THBD accelerates activation of plasma carboxypeptidase B2, promoting fibrinolysis and removal of pro-inflammatory kinins and anaphylatoxins. Beyond anticoagulation, THBD suppresses inflammation by sequestering HMGB1, preventing engagement with inflammatory receptors. THBD is expressed on islet-specific and sinusoidal endothelial cells, where it contributes to organ-specific vascular function and coagulation factor production 34. Clinically, THBD dysfunction is associated with thrombotic complications: rare loss-of-function variants increase venous thromboembolism risk (hazard ratio 3.0) 5, while THBD gene variants are implicated in atypical hemolytic uremic syndrome and thrombophilia 6. In sepsis-induced disseminated intravascular coagulation, recombinant thrombomodulin represents a potential adjunct therapeutic to attenuate pathological coagulation and inflammation 2. THBD also serves as a cellular receptor for human cytomegalovirus entry 1.