Modulation of fibrinolysis by the combined action of phospholipids and immunoglobulins.

Because both immunoglobulin G (IgG) and phospholipids interfere with fibrinolysis, their combined modulating effects were investigated in experimental models of three consecutive steps of the fibrinolytic process [diffusion of tissue-type plasminogen activator (tPA) into the clot, plasminogen activation on fibrin surface and fibrin dissolution by plasmin] using IgGs isolated from healthy subjects and from patients with antiphospholipid syndrome in combination with mixtures of synthetic dipalmitoylphosphatidylcholine and dipalmitoylphosphatidylserine. In fibrin clots containing phospholipids the normal IgG enhanced the barrier function of the phospholipids with respect to the diffusion of tPA and plasminogen activation, but did not modify the lysis by plasmin. One of the examined antiphospholipid syndrome-IgGs also restricted the diffusion of tPA, but it accelerated the plasminogen activation on the fibrin surface and slowed down the lysis of fibrin by plasmin. Another antiphospholipid syndrome IgG, which did not affect significantly the tPA penetration into the fibrin gel, did not modify the plasminogen activation on its own, but it partially opposed the inhibiting effect of phospholipids on plasmin formation and accelerated the end-stage lysis of fibrin containing phospholipids. The IgGs from the two examined antiphospholipid syndrome patients did not show consistent deviation from the pattern of normal IgG effects on fibrinolysis in phospholipid environment. Thus, a high degree of heterogeneity with respect to the profibrinolytic or antifibrinolytic effects of the pathological IgGs can be expected in the antiphospholipid syndrome patient population, which may contribute to the variable thrombotic symptoms in this clinical syndrome.