Mutation of 79 highly exposed amino acids that comprise approximately 62% of the solvent accessible surface of thrombin identified residues that modulate the inhibition of thrombin by antithrombin III, the principal physiological inhibitor of thrombin. Mutations that decreased the susceptibility of thrombin to inhibition by antithrombin III in the presence and absence of heparin (W50A, E229A, and R233A) also decreased hydrolysis of a small tripeptidyl substrate. These residues were clustered around the active site cleft of thrombin and were predicted to interact directly with the "substrate loop" of antithrombin III. Despite the large size of antithrombin III (58 kDa), no residues outside of the active cleft were identified that interact directly with antithrombin III. Mutations that decreased the susceptibility of thrombin to inhibition by antithrombin III in the presence but not in the absence of heparin (R89A/R93A/ E94A, R98A, R245A, K248A, K252A/D255A/Q256A) in general did not also affect hydrolysis of the tripeptidyl substrate. These residues were clustered among a patch of basic residues on a surface of thrombin perpendicular to the face containing the active site cleft and were predicted to interact directly with heparin. Three mutations (E25A, R178A/R180A/D183A, and E202A) caused a slight enhancement of inhibition by antithrombin III.Vascular injury or inflammation results in the activation of thrombin (1, 2). Thrombin cleaves and activates multiple substrates to mediate hemostasis through fibrin clot formation and platelet aggregation (3-7) and also regulates blood coagulation by activating the anticoagulant protein C pathway (8). The predominant mechanism for the clearance of thrombin is through inhibition by antithrombin III (ATIII), 1 a member of the family of serine protease inhibitors known as serpins (1, 9 -11). The physiological importance of this process is illustrated by the observation that individuals possessing inherited ATIII deficiency or insufficiency are subject to recurrent thrombosis (12).ATIII is a 58-kDa glycoprotein that inhibits thrombin in two kinetically distinct steps: the formation of a weak initial complex followed by rapid conversion to a stable complex (13). Based on the crystal structures of ATIII (14) and other serpins in cleaved (15, 16) and uncleaved (17) forms, inhibition has been proposed to proceed through the recognition of the Arg 393 -Ser 394 bond in an exposed loop of ATIII as a substrate. However, upon cleavage, a conformational change in the inhibitor has been proposed to result in the trapping of the enzyme either as a tetrahedral intermediate or as an acyl-enzyme. Unlike the intermediate typically formed with substrates, the intermediate formed between thrombin and ATIII is stable and resistant to hydrolysis perhaps due to the conformational change which may exclude water from the active site (9).The rate-limiting step in the inhibition of thrombin by ATIII is the formation of the initial complex (ϳ2 ϫ 10 5 M Ϫ1 min Ϫ1 ) which can be accelerated by 3 orders of...