The activated protein C-mediated enhancement of tissue-type plasminogen activator-induced fibrinolysis in a cell-free system.

The effect of human activated protein C (APC) on fibrinolysis was studied in a cell-free system by continuously monitoring the thrombin-induced formation and subsequent tissue-type plasminogen activator-induced degradation of fibrin. In systems comprising dialyzed human plasma, APC shortens the time for lysis to occur in a concentration-dependent, saturable manner. Half-maximal activity occurs at an APC concentration of 10 nM. The effect is mediated by enhanced plasminogen activation and is dependent upon ionized calcium. The effect is lost when plasma adsorbed with barium citrate is utilized in place of unadsorbed plasma. The effect can be reconstituted, however, from components recovered from the barium citrate precipitate. Fractionation of the barium citrate adsorbable proteins with polyethylene glycol (PEG) provides two fractions, one of which is obtained by precipitation at 5% PEG, and the other of which is obtained from the 5% PEG supernatant by further precipitation at 40% PEG. The latter fraction contains Factor X and presumably the other vitamin K-dependent clotting factors. Both of these fractions together, but neither of them alone, fully reconstitute barium-adsorbed plasma, such that APC-enhanced fibrinolysis occurs as in non-adsorbed plasma. These fractions also are sufficient to provide for an APC effect in a system in which purified plasminogen and fibrinogen are used in place of barium citrate-adsorbed plasma. Thus, an effect of APC on tissue-type plasminogen activator-induced fibrinolysis exists which is Ca2(+)-dependent and requires two or more, as yet unidentified, components that can be precipitated from human plasma by barium citrate.