Thrombin activatable fibrinolysis inhibitor (TAFI), when activated, forms a basic carboxypeptidase that can inhibit fibrinolysis. Potential physiologic activators include both thrombin and plasmin. In vitro, thrombomodulin and glycosaminoglycans increase the catalytic efficiency of TAFI activation by thrombin and plasmin, respectively. The most relevant (patho-) physiologic activator of TAFI has not been disclosed. Our purpose was to identify the physiologic activator of TAFI in vivo. Activation of protein C (a thrombinthrombomodulin-dependent reaction), prothrombin, and plasminogen occurs during sepsis. Thus, a baboon model of Escherichia coli-induced sepsis, where multiple potential activators of TAFI are elaborated, was used to study TAFI activation. A monoclonal antibody (mAbTAFI/ TM#16) specifically inhibiting thrombinthrombomodulin-dependent activation of TAFI was used to assess the contribution of thrombin-thrombomodulin in TAFI activation in vivo. Coinfusion of mAbTAFI/TM#16 with a lethal dose of E coli prevented the complete consumption of TAFI observed without mAbTAFI/TM#16. The rate of fibrin degradation products formation is enhanced in septic baboons treated with the mAbTAFI/TM#16; therefore, TAFI activation appears to play a key role in the extent of fibrin(ogen) consumption during E coli challenge, and thrombinthrombomodulin, in a baboon model of E coli-induced sepsis, appears to be the predominant activator of TAFI.
IntroductionFibrinolysis is achieved primarily through the proteolytic action of plasmin on fibrin polymers that reinforce and maintain the integrity of a thrombus. In the hemostatic response, fibrin is a critical component preventing blood loss due to injury. However, in certain circumstances inappropriate fibrin-rich thrombus formation occludes vessels required to maintain the viability of a tissue area. Degradation of fibrin by plasmin exposes basic C-terminal residues (lysines and arginines) as the fibrin strands continually truncate. 1 Generation of C-terminal basic amino acids provides positive feedback enhancing plasminogen activation. [1][2][3][4] Fibrin is a key component of the fibrinolytic cascade, not only as a substrate but as a cofactor and modulator, and is also the end product of the coagulation cascade. Therefore, fibrinolysis is regulated by all of the regulatory elements attributed to control of coagulation. Recently, another connection between coagulation and fibrinolysis has been identified and is mediated through thrombin activatable fibrinolysis inhibitor (TAFI, also known as procarboxypeptidase U and procarboxypeptidase R). 5 Activation of TAFI to TAFIa generates a carboxypeptidase capable of catalyzing the removal of C-terminal basic amino acids. [5][6][7][8][9] Therefore, by modulating the steady-state concentration of these C-terminal basic amino acids, TAFIa modulates the steady-state concentrations of various forms of bound and free plasminogen and plasmin: activated, inhibited, and inhibitable. 5,6,[10][11][12][13] TAFI, secreted by the liver, circulates...