title: Thrombin-thrombomodulin connects coagulation and fibrinolysis: more than an in vitro phenomenon.
abstract: 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 thrombin-thrombomodulin-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 thrombin-thrombomodulin-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 thrombin-thrombomodulin, in a baboon model of E coli-induced sepsis, appears to be the predominant activator of TAFI.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Tanya M
authors.initials: TM
authors.lastname: Binette
authors.forename: Fletcher B
authors.initials: FB
authors.lastname: Taylor
authors.forename: Glenn
authors.initials: G
authors.lastname: Peer
authors.forename: Laszlo
authors.initials: L
authors.lastname: Bajzar
mesh_terms: D000818:Animals; D000911:Antibodies, Monoclonal / Q000494:pharmacology; D001777:Blood Coagulation / Q000502:physiology*; D025901:Carboxypeptidase B2 / Q000037:antagonists & inhibitors / Q000097:blood / Q000276:immunology / Q000378:metabolism*; D004927:Escherichia coli Infections / Q000097:blood / Q000473:pathology; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005340:Fibrinogen / Q000378:metabolism; D005342:Fibrinolysis / Q000502:physiology*; D006207:Half-Life; D006801:Humans; D008826:Microbial Sensitivity Tests; D048548:Papio cynocephalus; D018805:Sepsis / Q000097:blood / Q000473:pathology; D013917:Thrombin / Q000502:physiology*; D018180:Thrombomodulin / Q000502:physiology*
chemical_list: D000911:Antibodies, Monoclonal; D005338:Fibrin Fibrinogen Degradation Products; D018180:Thrombomodulin; D005340:Fibrinogen; D025901:Carboxypeptidase B2; D013917:Thrombin